If you’re struggling with unipolar depression or bipolar disorder, sleep is probably an issue. For instance, do you have a hard time getting out of bed and getting your day going? 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.
A few weeks ago, I came upon a term – sleep inertia – that grabbed my attention. I did some digging and knew it was a great fit for what we do here.
So sleep inertia, let’s see what we can see…
What is sleep inertia?
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.
What does sleep inertia look like?
How SI looks depends upon a number of factors. Duration of prior sleep certainly impacts SI severity; however, more critical is the sleep stage prior to awakening.
Waking up following deep sleep generates more SI than getting up after stage 1 or 2. Awakening after REM sleep seems to be in the middle of the SI duration spectrum.
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.
Brain anatomy and physiology
Blood flow upon awakening is bottom-up: brain stem (bottom center) to thalamus (oval at center) to prefrontal cortex (front of brain)
So what’s the brain anatomy and physiology of SI?
Very simply, blood flow in the brain returns to waking levels in the brain stem and works its way up.
The thalamus is next and in time, normal daytime blood flow is established in the prefrontal cortex, which is responsible for executive functioning. That’s when the lights go on, if you will.
The time it takes to do this is SI duration. Makes sense, right?
Sleep inertia and depression
So now that we have a handle on what SI is and what it looks like, let’s bring in the depression piece.
In doing so, we’ll reference a great article from Psychiatric Times, Two Ways to Treat Fatigue in Bipolar and Depression, written by psychiatrist Chris Aiken, MD.
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 studies indicate troubling SI is reported by 42% of bipolar disorder patients.
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.
Hugely important: Aiken states that SI perpetuates depression by causing many to stay in bed too long. And that gums up circadian rhythms and fuels inactivity.
Sleep inertia: Two behavioral interventions
We can discuss what SI is, and its negative impact, ‘til 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
“I need to get my head together. I’ll try anything.”
Brisk awakening is a technique that asks the patient to do the very opposite of what the brain is telling them 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.
Dawn Simulator
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 bipolar disorder, 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 mood situation.
Learn all you can
I say it time and again. Though it isn’t direct treatment, identifying and understanding the cause of symptoms provides a lot of relief. I learned that 40 years ago.
And so it is with the misery of getting a day started and fatigue for the rest of it. Learn all you can about it and talk with your docs and therapist.
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, is a worthy read.
Plenty more Chipur mood and anxiety info and inspiration articles where this baby came from. Peruse the titles.
