ABCs of SLEEP || F is for Fragmentation

Fragmentation is what occurs during sleep when you struggle to maintain one long stretch of uninterrupted sleep. Instead, you awaken frequently, and can't get good blocks of deep sleep, as a result. It is a marker of sleep-maintenance insomnia, the kind of insomnia in which you have no trouble falling asleep, but you arouse easily and often and, therefore, cannot maintain sleep.

What makes fragmentation particularly difficult is that if you have multiple periods of awakening, you become conscious that you aren't sleeping, but that you should be sleeping. Rumination and hypervigilance about sleep loss tend to perpetuate anxiety, which then only adds to your inability to fall asleep again. If you have ever watched the clock all night long, after falling asleep easily but waking up frequently after you've fallen asleep, then you are experiencing fragmented sleep.

The worry that comes with not getting good sleep isn't without good reason. Fragmented sleep can be a nighttime devil for many.

When your sleep is fragmented, you are less likely to cycle through the slow-wave sleep that helps your body heal and you are more likely to wake up unrefreshed in the morning (because you've been awake, on and off, all night).

Sleep fragmentation also threatens certain brain processing functions like memory consolidation and can even interfere with the brains ability to keep consciousness and memory separate.

As we age, our sleep is more likely to fragment, though it's not well understood as to why. It could be a normal byproduct of aging or the result of medication use or the presence of other illnesses.

People with depression and anxiety, who also have fragmented sleep, may see their mental illness worsen. Also, people with Parkinson's Disease, dementia and other neurological troubles may report broken sleep patterns as a symptom of their condition.

Other sleep disorders, like narcolepsy, periodic leg movement disorder, restless legs, UARS and sleep apnea, may also lead to sleep fragmentation.

Treating sleep fragmentation requires identifying its root cause first and treating it. Easier said than done...  If there are no physical or mental illnesses or medications that could explain the sleep fragmentation, then doctors have little else to go on except for the presence of sleep-maintenance insomnia. Patients with this sleep disorder may benefit greatly from cognitive behavior therapy.

INSOMNIA || Why is it linked to depression?

Image courtesy TMS NeuroHealth Centers

This could be a chicken/egg question, truly... which came first, insomnia or depression?

One can definitely lead to the other. Let's think about this for minute.

Depression can be its own illness, categorized in severity based on a wide range of physical and emotional symptoms and linked to physical illness, hormonal imbalance, stress and aging. When people experience the psychic symptoms of depression (feeling emotionally drained, agitated, anxious, worried, or suicidal, for instance), it makes sense that it could become either difficult for them to sleep or difficult for them to get out of bed feeling rested.

When it comes to insomnia, not being able to sleep due to physiological triggers (other underlying sleep disorders, transient illness, chronic illness, pain, stress, hormonal imbalance, aging) can lead to disorders of mood, thanks to shifting brain and body chemistry and processes that come from not getting adequate sleep. Sleep helps your body to heal itself at the cellular level as well as maintain the proper body and brain chemistry necessary for normal, balanced function. It makes sense that, lacking sleep, a person is more likely to become ill, either physically or mentally, or even suffer from both.

According to a study published in SLEEP in 2005, people with insomnia are 10 times more likely to develop depression than those who sleep well. This is a serious problem, as insomnia is the most common sleep disorder in the United States. Problems with insomnia range from having trouble falling asleep, staying asleep, fragmented sleep and day-after fatigue or excessive daytime sleepiness.

Major depressive disorder, according to the National Institute on Mental Health, is no small problem, either. As one of the most common mental health disorders in the United States, nearly 7 percent of our entire population suffers from it.

It seems there are endless ways in which insomnia and depression can pair up. Drug addiction or withdrawal, for instance, or even the side effects of some maintenance drugs people must take for chronic illness. Major life stressors, such as divorce or the death of a child or a lost job, will cause one or the other--or both--if not addressed. Poor diet or lack of exercise may lead to insomnia or depression. Another common and very specific relationship between sleep and mood--Seasonal Affective Disorder--has also been researched at length (see what SHC published on this topic in 2014).

Treatments for insomnia often mirror treatments for depression, which may simplify the process for many. They usually involve either a pharmacological therapy, cognitive behavioral therapy, or ideally, a combination of both. A medical doctor will review history, symptoms and ask for a thorough physical exam to help establish any biological causes for either sleep insufficiency or depression, to help determine a therapeutic course that serves to treat both.

The main takeaway is this: never think that ongoing symptoms of either insomnia or depression are best ignored. The presence of ongoing bouts with either--and especially both at once--is a major cause for concern and should not be overlooked.

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There is no badge of courage attached to going without sleep; the longer you go without it, the worse your brain and body will suffer. The human body can go for up to 11 days without sleep, and then it will die. Sleep is not optional.

Likewise, there is no shame in admitting to feelings of despair or chronic low mood; in fact, these could by symptoms of a physical condition you could easily treat. Often, the challenges of our lives also require outside help; even the strongest individuals will struggle to power through dark times.

If you are struggling with either condition, you are best advised to seek help regarding either via the healthcare professional you are most comfortable approaching, whether it's your primary care physician, a behavioral therapist you are already seeing, a naturopath, or a specialist who oversees any other chronic health conditions you might have.

(And please avoid going to online forums or private groups as these communities; even when they strive to provide support, they can often be the source of some of the worst, most dangerous misinformation out there. Members and moderators of these groups are generally not medical professionals.)

Ultimately, hope lies in the reality that both insomnia and depression, together and separately, are eminently treatable.