Old Age Crisis: Risk of Depression Increases with Insomnia

The study, directed by Michael Irwin, MD, is the first to investigate the mechanisms behind the relationship between sleeplessness and depression in seniors. The study discovered that older persons who are chronically sleep deprived are not only more vulnerable, but also have worse and longer-lasting symptoms.

Sleep disorders are very common in older adults, resulting in many getting less sleep than they need. On average, younger adults may awaken briefly five times every night. However, some persons over the age of 60 may wake up 150 times while sleeping.

Dr. Irwin, the Norman Cousins Distinguished Professor of Psychiatry and Biobehavioral Science at UCLA’s David Geffen School of Medicine, stated that older persons who suffer from insomnia are at a significantly higher risk of developing depression. The author further stated that the data are simply astonishing and there is a several-fold increase in the incidence of depression. Longer the sleeplessness lasts, the more likely it is that depression may develop, even if depression was not present before.

Connection Between Depression, Inflammation, and Sleeplessness.

Inflammation can also contribute to depression, and Dr. Irwin and his colleagues discovered that a “inflammatory challenge,” such as an infection, can trigger depressed symptoms.

In an ongoing study, researchers will inject an endotoxin – inactive bacteria – into up to 160 elderly people, some of whom have sleeplessness and some do not.

Previous research has found that this inflammatory challenge, when compared to a placebo, causes a depressive reaction. The depressive feelings fade as the inflammation lessens. For seniors who did not have sleeplessness, this resolution took roughly six hours. However, for half of the participants with sleep issues, it lasted up to nine hours.

Dr. Irwin highlighted that sleep loss affects the immune system, therefore these older persons already had high levels of inflammation.

Early studies indicate that sleeplessness at the time of injection or in the weeks preceding it worsens and prolongs depressed symptoms.

Depression symptoms were both self-reported and seen by a professional. Notably, no trial participants reported suicide ideation when depression was induced.

According to the author, “When you meet people before the study, you’re just having a friendly chat,”. After receiving the endotoxin, they are frequently withdrawn, sad, and depressed.” They make poor eye contact and describe people as unpleasant, leaving them feeling socially isolated. These are the early symptoms, before individuals report feeling depressed. Fortunately, as the inflammation subsides in a few hours, the depression fades and they return to their normal selves.

Clinicians can better monitor older persons who are at higher risk by knowing the connection between depression, inflammation, and sleeplessness.

Dr. Irwin stated that an older adult with insomnia who has a UTI, for instance, needs to have their depression appropriately evaluated. Similarly, a vaccination might be sufficient to set off depression in someone who suffers from sleeplessness.

Who is more vulnerable?

More research is necessary on one element of the findings. While the inflammatory reactions of the study participants were similar, differences were seen in the depressive responses.

The changes in depressed mood have to do with sensitivity, how the brain is actually perceiving or receiving that signal from the inflammatory challenge. And we have really scratched our heads as to why some people are more likely to be sensitive. We don’t really know what’s contributing to this differential risk.

Dr. Irwin, Director of the Cousins Center for Psychoneuroimmunology and the Mindful Awareness Research Center at the Semel Institute for Neuroscience & Human Behavior

For instance, women experience depression at a higher rate than men. However, the effect of sex hormones was not able to account for the variations in reactions when the researchers took that into account.

Dr. Irwin and his colleagues are employing a genome-wide approach to find out which genes are affected by the injection of endotoxin and whether insomniacs may have a different genetic profile in order to better understand the mechanics of the reactions. Further investigation of gene expression reveals molecular alterations that could eventually be targets for therapy. Identifying risk profiles will be essential in preventing depression entirely in addition to future treatment.

He stated, “People who are ill feel sick and depressed a lot of the time.” Additionally, most medical professionals simply tell patients, “Oh, that’s part of your sickness.” However, we don’t really know how to prevent depression from happening or if it can be treated early enough.

“The objective is to identify the biological and behavioral factors that are associated with risk and can actually be modified in order to improve upon current depression prevention methods.”

What is Sleep disorder in older adults

Any disturbed sleep pattern is considered a sleep disorder in older persons. This can involve irregular sleep-related behaviors, issues getting to sleep or remaining asleep, or too much sleep.

Causes

Older adults frequently experience sleep issues. The amount of sleep required in adulthood does not change. Adults should aim for 7 to 8 hours of sleep every night, according to doctors. Compared to younger people, elderly peoples’ sleep is less deep.

Older individuals’ sleep difficulties could be caused by any of the following:

• Alzheimer’s disease
• Alcohol
• Alterations in the body’s circadian rhythm, which lead to individuals dozing off sooner in the evening
• Long-term (chronic) illnesses, like heart failure
• Specific medications
• Depression
• Conditions affecting the brain and nervous system
• Inactivity
• Pain brought on by illnesses like arthritis
• Stimulants (nicotine and caffeine)

Symptoms

• Frequent urinating at night
• Having trouble falling asleep
• Inability to distinguish between day and night
• Waking up early in the morning
• Frequently awakening during the night (maybe as a result of nocturia)

Treatment

For some people, sleep can be improved by managing medical issues including frequent urination and relieving chronic pain. Sleep quality can typically improved by treating depression.

Having a soothing night-time routine and sleeping in a quiet, comfortable room may assist with symptoms. These ideas for a healthy lifestyle are among the several strategies to encourage sleep:

• Adhere to a regular sleep and wake-up schedule each day.
• Avoid taking naps.
• The bedroom is not the place to watch television or use a computer, phone, or tablet.
• Keep tobacco items away, especially right before bed.
• Only sleep or engage in sexual activities on the bed.
• After twenty minutes if you still can’t sleep, get out of bed and engage in a calm activity like reading or listening to music.
• Steer clear of heavy meals right before bed. A small snack before bed might be beneficial. Warm milk is known to induce drowsiness in many due to the presence of a naturally occurring amino acid that has sedative properties.
• Avoid using stimulants.
• Engage in physical activity on a daily schedule, but avoid doing so three hours before bed.

Before you start taking sleep aids, your doctor should evaluate your risks of falls, mental (cognitive) adverse effects, and daytime sleepiness.

Disclaimer: The information provided is for general informational purposes only and is not intended to replace professional medical advice. Always seek the guidance of your doctor or other qualified health professionals with any questions you may have regarding your health or a medical condition.