Counseling For Depression

SLEEP

Control of our body is regulated by biological rhythms, called circadian rhythm, in relation to environment and 24 hours day night cycles. The brain co-ordinates the rhythm with sleep wake cycle. Any disturbance in the sleep cycle disturbs body and mind functioning. Sleep is what restores and rejuvenates the body and mind. Sleep disturbances disrupt all body and mind functions leading to all mental disorders. Your mood, attention, cognition, memory, learning becomes poor. Mood is linked to sleep quality and duration.

Recommended hours of sleep – 7-9 hours. Not getting enough sleep, sleep deprivation is a health risk factor. The problems become more with more sleep debt.

Sleep is an action consisting of 5 stages designed to restore and regenerate the body and mind. Broadly the stages are grouped into 4 NREM stages and 1 REM stage.

NREM Stage 1: Body falling asleep. Eye movements, breathing and heart rate slow down. Lightest stage. Few minutes.

NREM Stage 2: Lasting 15-20 minutes, it is light sleep. Eyes movements stopped. Go unconscious.

NREM Stage 3& 4: Deep sleep. Breathing, heart beat , temperature slow down. Hard to wake up. Restorative stage and feel refreshed when you wake up. NREM sleep restores body.

REM Sleep: REM sleep restores mind. Begins 90 minutes after falling asleep. REM sleep plays a role in storing memories, neuroplasticity, learning, mood and handling stress. The brain is awake, resembling brain activity while awake, to the extent that you remember a dream if you wake up in the middle of REM sleep.

Each REM sleep stage lasts 15 minutes and cycles every 90minutes with NREM3&4 stages. In a sleep duration of 7-8 hours, an individual enters REM sleep 4-5 times. During REM sleep stage, eye moves fast as if watching a moving object or dreams. Arms and legs become temporarily paralysed so that you don’t act out on your dreams. Your fight or flight response becomes activated so that you are responsive to external temperature which is protective and a survival mechanism. You respond to psychologically important stimuli like new born baby’s mother’s response to baby cry or when called by name.

RECEIPE FOR GOOD SLEEP

• 1. Create a sleep routine: Regularity and consistency are important
• 2. Light: dark rooms without any light source including night lamps chosen. Computers and mobile usage before bedtime affects melatonin secretion, the hormone for sleep and restoration.
• 3. Room temperature and sound
• 4. Don’ts: stare at the clock, focus on work next day
• 5. Dinner time and what you eat. Avoid coffee or stimulants
• 6. Meditation, yoga, exercise, breathing practices

SLEEP DISORDERS

A good sleep is both Non REM deep sleep and REM sleep.

NARCOLEPSY: Brain’s inability to control sleep wake cycle. Sleep without warning. It is condition of excessive daytime sleepiness. When narcolepsy is associated with sleep paralysis or muscle weakness it is called cataplexy.

SLEEP APNEA: Pauses in breathing during sleep commonly caused by blocked airway leading to snoring. Loud snoring, day time sleepiness, non restorative sleep are some of the symptoms of sleep apnea. Obese people are prone to apnea.

INSOMNIA: Insomnia is difficulty in falling sleep, maintaining sleep or early awakening. It causes distress in life and mood is the first victim of insomnia. 10-20 % of the population are estimated to suffer from insomnia. Insomnia often leads to anxiety and depression and vice versa. Insomnia may be

• 1. Sleep onset – takes more than 30 minutes to get sleep.
• 2. Sleep maintenance: stay awake for more than 30 minutes after waking up in the middle
• 3. Terminal: Early morning awakening: you wake up earlier and cannot go back to sleep
• 4. Interrupted sleep : waking multiple times during the night. They return to sleep quickly and don’t remember that they woke up. They don’t get the benefit of psychologically restorative benefit of full REM cycle.
• 5. Non restorative sleep (cannot wake up rested). They are heavy sleepers but don’t get into REM cycle. They awaken multiple times and remember that they woke up.
• 6. Restless sleep : Moving around in sleep, muscle tension.
• 7. Combination of all three- a sleepless night

QEEG show relevant EEG changes in the brain’s activity patterns in various sleep disorders..

DREAMS AND SLEEP: Dreams tell how well you slept. Most of our dreams occur during latter part, before waking hours and rarely, if at all, during the early hours. Dreams tell how restorative, restful the sleep was.

When the dreams are clear and vivid, you were waking up, the brain is getting activated. If you remember your dreams, you woke up to remember it naturally or by external disturbance. If you never dream, you may be sleep deprived. Dreaming is part of REM sleep. The brain prioritise Non REM sleep when the sleeping hours are shortened. If you have nightmares, may be you are psychologically stressed

ORTHOSOMNIA is a drive for perfect sleep using sleep and fitness trackers. They can lead to anxiety states and an impossible, unrealistic task of perfect sleep. Trackers don’t relieve the sleep problems; they measure and make individual hypervigilant about his poor performance.

SIGNS OF SLEEP PROBLEMS:

Sleep disturbances can trigger or exaggerate existing mental health problems like depression, anxiety, bipolar disorder, PTSD. The signs are:

• 1. You feel you need less and less sleep. You are prone to stress and unable to handle stress.
• 2. You feel your mind is racing or wide awake when it is time to sleep while at bed, spend 2-3 hours trying to fall asleep, if you wake up in the middle of the night and can’t go back.
• 3. Frequent, uncontrolled naps in the daytime and falling asleep without warning
• 4. Hypersomnia: Excessive sleep- compulsion to sleep and inability to get up