One of the things that makes depression so hard to live with is the sleep and fatigue thing. For instance, if you tussle with depression, how difficult is it to get out of bed and get your day going? And how’s your overall fatigue factor? That’s what I thought. Let’s talk about sleep inertia…
Dr. Aiken starts by acknowledging how difficult it is for someone with depression to feel fully awake. He then mentions fatigue and submits that sleep inertia is one of its causes.
This go-round I used my shovel. And, go figure, I came across a term – sleep inertia – that was new to me. Best part is, it’s hugely relevant for anyone trying to manage depression – especially one who has major problems with sleep and fatigue.
Let’s see what we can see…
Sleep Inertia: What Is It?
Before we get knee-deep, let’s make sure we understand what “inertia” is. Here’s a simple definition: resistance of an object to any change in its speed.
Okay, sleep inertia (SI), a normal phenomenon, is the grogginess most of us feel upon awakening. It can last from a minute to several hours, though 15-30 minutes is average. During this time we’re at a reduced level of capacity, as even simple tasks can become troublesome. Fact is, in some cases the impairment can become dangerous. Consider driving, for example.
How SI looks in any of us depends upon a number of factors. Duration of prior sleep certainly impacts SI severity; however, more critical is the sleep stage prior to awakening. Awakening following deep sleep generates more SI than waking-up after stage 1 or 2. Awakening after REM sleep seems to be in the middle of the SI duration scale.
SI can be a factor to deal with even after a short nap. And if we’re sleep-deprived, SI can be brutal – even if we’ve slept for eight hours. Finally, core body temperature plays a role in SI’s presentation.
So what’s the brain anatomy and physiology of SI? Very simply, cerebral blood flow returns to waking levels in the brainstem and works its way up to the thalamus first. In time, normal daytime blood flow is established in the regions of the brain that manage executive functioning. The time it takes to do this is, indeed, SI duration. Makes sense, right?
Sleep Inertia & Depression
So now that we have a handle on what SI is, let’s bring in the depression piece. I’m using some great information from a Psychiatric Times article written by psychiatrist Chris Aiken, MD. Link below. Oh, and it’s important to keep in mind he’s writing for other psychiatrists and mental health professionals.
Dr. Aiken starts by acknowledging how difficult it is for someone with depression to feel fully awake. He then mentions fatigue and submits that SI is one of its causes. He goes on to say that studies indicate troubling SI is reported by 42% of bipolarity patients. To be sure, SI is a major player in unipolar depression as well.
Earlier we learned that SI can last for several hours. Aiken confirms it can “drag on” for four hours for depression sufferers. Think about that. It equates to being in an impaired state for a quarter of one’s day. I’m thinking many of you get it.
Hugely important: Aiken states that SI perpetuates depression by causing many to stay in bed too long. And that screws-up circadian rhythms and fuels inactivity. Another bell-ringer?
Sleep Inertia: Two Behavioral Interventions
We can discuss what SI is, and its negative impact, until the cows come home. But what’s the point if we don’t take a look at what to do about it? Dr. Aiken highlights two behavioral interventions…
Brisk awakening is a technique that asks the patient to do the very opposite of what the brain is telling her/him to do upon awakening. Specifically, one is to quickly get their butt out of bed and engage in energizing activity for the first hour of the day. Yikes! Though physical activity is best, outdoor movement, conversation, upbeat music, sunlight, and a cold shower are helpful.
Aiken shares that a small controlled trial indicated brisk awakening cut SI duration in half.
A dawn simulator is a device that creates a virtual sunrise by gradually turning on a light over 30-60 minutes. The steady increase in light transitions the brain from deep to light sleep, to full awakening. Earlier I mentioned that awakening from deep sleep causes more SI. That’s what a dawn simulator addresses. Aiken finds them to be highly effective.
According to Dr. Aiken, getting out of bed in the morning is one of the most important steps in treating depression. And it’s key in benefiting from psychotherapies such as social rhythm therapy, CBT-insomnia, and behavioral activation.
In bipolarity those therapies emphasize getting out of bed at the same time, give or take 15 minutes. Doing so stabilizes circadian rhythms. I think it’s a great practice for any form of depression.
That’ll Do It
I say it time and again: even though it isn’t direct treatment, identifying and understanding the cause of symptoms provide a ton of relief. I learned that truth 40 years ago.
And so it is with the misery of getting a day started and cruel fatigue for the rest of that day. Consider sleep inertia, okay? More than that, learn all you can about it and talk with your docs and therapist. Most of all, devise a plan to minimize it.
Healthline created a guide to help those living with bipolar disorder who are unable to get enough sleep to feel fully rested. If you fit the criteria, spend some time with it.
Two Ways to Treat Fatigue in Bipolar and Depression by psychiatrist Chris Aiken, MD, from Psychiatric Times, got the ball rolling on this piece.
Plenty more Chipur mood and anxiety disorder-related articles where this baby came from. Peruse hundreds of titles.