Depression and Insomnia
According to the Family Doctor Association, a recent survey has revealed, “the number of patients displaying symptoms of stress or depression over the last 18 months has increased according to GPs, with more than three-quarters (78%) of those surveyed reporting a rise. Just under half (49%) of patients feeling the pressure were suffering from sleep disorders.”
According to a recent paper in Australian Family Physician, depression is the most common cause of insomnia, and insomnia is highly prevalent in depression.
“This association has a well-characterised physiological foundation. Sleep disorder in depression has prognostic and therapeutic implications. Residual insomnia after remission of depression is predictive of relapse, and prominent insomnia predicts a poorer treatment outcome in depression. Evidence based management involves integrating both pharmacological and behavioural strategies; the latter includes sleep hygiene and regulating diurnal rhythms.”
When novel hypnotic drugs to treat insomnia are developed, the focus tends to be on the marginal and statistically significant increase in minutes slept during the night instead of the effects on the quality of wakefulness. Recent research on the mechanisms underlying sleep and the control of the sleep-wake cycle has the potential to aid the development of novel hypnotic drugs; however, this potential has not yet been realized.
Non-pharmacological strategies may be superior to hypnotic medication for insomnia because tolerance develops to the hypnotic effects. There are also potential problems of dependence and rebound withdrawal.
Sleep disorders remain poorly understood, under-diagnosed and under-treated.