The Effects of Stress Disorders on Sleep

DEPRESSION – Sleep disorders are both a risk factor for and a symptom of depressive disorders. A study of 373 adults showed that 60% of people being treated for depression also had insomnia. Depression causes delayed sleep onset and awakenings, especially early morning awakenings. REM occurs earlier and is more intense. Dreams are usually negative.
Stage 4 sleep is usually decreased the most by depression. This can inhibit the body’s ability to promote growth hormones and boost the immune system. Early morning awakenings, possibly caused by cortisol are common. Cortisol (stress hormone) is higher than normal during serious depression. Cortisol releasing hormone causes a decrease in stage 4 and increase in REM sleep.

BIPOLAR-MANIA – Mania usually creates a feeling of high energy and reduced need for sleep. Severe insomnia can result. Sleep is essential for the bipolar individual. It helps reduce the risk of a manic episode.

ANXIETY – Most anxiety disorders have related insomnia. Anxiety causes vigilance and an inability to “turn off the mind.” This results in problems going to sleep and also produces shallow sleep.

PANIC ATTACKS – Sleep related panic attacks can be found in up to 30% of those with the disorder. Night time panic attacks occur three hours after going to sleep. This is during stage 4 deep sleep when breathing becomes shallow and CO2 levels peak. Individuals with panic disorder are extremely sensitive to CO2.

MEDICATIONS AND INSOMNIA

Most of the antidepressants which are used to treat depression can initially cause insomnia (especially if taken at night). This is due to the stimulating or activating effect they have on the system. Antidepressants include the SSRI’s-Zoloft, Paxil, Prozac, Celexa, Lexapro and also Wellbutrin XL, Effexor XR, most Tricyclics, and MAOI’s.
Antidepressants that increase stage 4 sleep include Remeron, Serzone, Trazodone, and Elavil. They decrease REM. Most antidepressants should be started in the morning and switched to bedtime later, (dinner time with Effexor XR) if sluggishness begins to occur.
The Benzodiazepines (Xanax, Klonopin, Ativan) improve sleep continuity by promoting quick sleep onset and reducing night awakenings. However, they don’t give normal sleep because they decrease stage four sleep.