Depression...I can't sleep

you should ask your doctor for something to help you sleep. i have an odd sleep pattern where i wake up in the middle of the night several times. i can usually get back to sleep but i understand what your going through. you probably just have so much on your plate right now that your worry is keeping you awake. i would definantly let your doctor know what is going on. good luck.

I DO HAVE ALOT ON MY PLATE RIGHT NOW BUT NO MEDS IS GOING TO HELP ME. I HAVE NO HEALTH INSURANCE AND IT IS ALL ANXIETY. I SLEEP ON AND OFF. BEEN LIKE THAT FOR YEARS. BUT I WILL SURVIVE I HOPE. THANKS FOR THE ENCOURGEMENT. I APPRECIATE IT.

This is a website address for the National Sleep Foundation.

http://www.sleepfoundation.org/site/c.huIXKjM0IxF/b.2417141/k.27D9/Home_of_the_Sleep_in_America_Poll.htm

Here is an article from this website about RLS (Restless Leg Syndrome):

Sleep and Restless Legs Syndrome

Restless Legs Syndrome (RLS) is a neurologic sensorimotor disorder that is characterized by an overwhelming urge to move the legs when they are at rest. The urge to move the legs is usually, but not always, accompanied by unpleasant sensations. It is less common but possible to have RLS symptoms in the arms, face, torso, and genital region. RLS symptoms occur during inactivity and they are temporarily relieved by movement or pressure. Symptoms of RLS are most severe in the evening and nighttime hours and can profoundly disrupt a patient’s sleep and daily life.

According to the National Center on Sleep Disorders Research, “restless legs syndrome is a common, under diagnosed and treatable condition.” Recent research suggests it affects about 10% of adults in North America and Europe with rates increasing with age. Lower prevalence has been found in India, Japan and Singapore, indicating that racial, ethnic or genetic factors are associated with RLS. Researchers believe that RLS is commonly unrecognized or misdiagnosed as insomnia or other neurological, muscular, or orthopedic condition. RLS may also be confused with depression. According to the Restless Legs Syndrome Foundation, approximately 40% of people with RLS complain of symptoms of that would indicate depression if assessed without knowledge or consideration of a sleep disorder. RLS may also have a genetic component, with a family history of the disorder being present in about 50% of patients.

RLS affects both men and women and can start at any age. It may be confused with growing pains or restlessness when experienced by children. In addition, the severity of the disorder appears to increase with age. Older patients experience symptoms more frequently and for longer periods of time.

The exact cause of RLS is unknown but it has a primary form, not related to other disorders, and a secondary form related to an underlying condition such as kidney failure, pregnancy, or iron deficiency anemia. It may also be caused or made worse by certain medications. This is considered secondary RLS. When no other cause is found for RLS symptoms, it is considered a primary disorder. Primary RLS accounts for 40-60% of RLS diagnoses.

Recently, several research teams have taken a closer look at what might cause primary RLS. In particular, recent studies at Johns Hopkins and Pennsylvania State Colleges have found evidence for brain iron deficiency as a cause for primary RLS. This was first demonstrated in cerebrospinal fluid studies and more recently by the first-ever autopsy analysis of the brains of people with RLS. The autopsy studies reported that cells from the portion of the brain called the substantia nigra showed a deficit in one of the proteins that regulates iron status. However, this evidence suggests that the iron insufficiency in the brain of RLS patients comes directly from a failure of normal iron regulation. In terms of finding a cure, this is good news. The results of this study show that there is no brain damage in people with RLS and that drugs that target the problem of iron uptake may be one way to approach future developments of a treatment.

More than 80 percent of people with RLS also suffer from a condition know as periodic limb movement disorder (PLMD). Characteristics of PLMD include involuntary leg twitching or jerking movements during sleep that occur repeatedly throughout the night and result in disrupted sleep.

In addition to poor quality and short sleep at night, research has shown that people with RLS generally experience a reduced quality of life in the absence of treatment. There is also evidence of a connection between RLS and attention-deficit hyperactivity disorder (ADHD).

Reviewed by Richard P. Allen, Ph.D.and Merrill M. Mitler, Ph.D.

Cyndi,
Your comment about having frequent awakenings during the night bothered me. As I’ve said before I used to work in a sleep lab and have performed hundreds and hundreds of sleep studies. It sounds like you might have OSA (Obstructive Sleep Apnea). One of the symptoms this article mentions is daytime sleepiness. I want to add that with MOST of my patients they told me that they aren’t sleepy during the day and don’t have some of the symptoms that are described in this article I’m going to include in this post. They were only there because their partners told them that they either snore or have observed pauses in their breathing while they were asleep. If anyone suspects that they might have this condition, a sleep study is very important to get. You can get a referral from your family doctor for this. Also in the meantime you can do some things to help with this while you are waiting for the test to be done. You can sleep with your head elevated at least 30 degrees. Sleeping on your side DOES NOT help. I’ve had some patients that actually slept in their recliners because it was the only place they could get some decent sleep. If anyone has any questions, please feel free to ask them to me either here or in a pm. Hope this and the previous article helps.

BASICS:
Obstructive sleep apnea is a disorder in which breathing is briefly and repeatedly interrupted during sleep. The “apnea” in sleep apnea refers to a breathing pause that lasts at least ten seconds. Obstructive sleep apnea occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe. Another form of sleep apnea is central sleep apnea, in which the brain fails to properly control breathing during sleep. Obstructive sleep apnea is far more common than central sleep apnea.
Obstructive sleep apnea, or simply sleep apnea, can cause fragmented sleep and low blood oxygen levels. For people with sleep apnea, the combination of disturbed sleep and oxygen starvation may lead to hypertension, heart disease and mood and memory problems. Sleep apnea also increases the risk of automobile crashes. Sleep apnea can be life-threatening and you should consult your doctor immediately if you feel you may suffer from it.
More than 18 million American adults have sleep apnea. It is very difficult at present to estimate the prevalence of childhood OSA because of widely varying monitoring techniques, but a minimum prevalence of 2 to 3% is likely, with prevalence as high as 10 to 20% in habitually snoring children. OSA occurs in all age groups and both sexes, but there are a number of factors that increase risk, including having a small upper airway (or large tongue, tonsils or uvula), being overweight, having a recessed chin, small jaw or a large overbite, a large neck size (17 inches or greater in a man, or 16 inches or greater in a woman), smoking and alcohol use, being age 40 or older, and ethnicity (African-Americans, Pacific-Islanders and Hispanics). Also, OSA seems to run in some families, suggesting a possible genetic basis.

SYMPTOMS:
Chronic snoring is a strong indicator of sleep apnea and should be evaluated by a health professional. Since people with sleep apnea tend to be sleep deprived, they may suffer from sleeplessness and a wide range of other symptoms such as difficulty concentrating, depression, irritability, sexual dysfunction, learning and memory difficulties, and falling asleep while at work, on the phone, or driving. Left untreated, symptoms of sleep apnea can include disturbed sleep, excessive sleepiness during the day, high blood pressure, heart attack, congestive heart failure, cardiac arrhythmia, stroke or depression.

TREATMENT:
If you suspect you may have sleep apnea, the first thing to do is see your doctor. Bring with you a record of your sleep, fatigue levels throughout the day, and any other symptoms you might be having. Ask your bed partner if he or she notices that you snore heavily, choke, gasp, or stop breathing during sleep. Be sure to take an updated list of medications, including over the counter medications, with you any time you visit a doctor for the first time. You may want to call your medical insurance provider to find out if a referral is needed for a visit to a sleep center.
One of the most common methods used to diagnose sleep apnea is a sleep study, which may require an overnight stay at a sleep center. The sleep study monitors a variety of functions during sleep including sleep state, eye movement, muscle activity, heart rate, respiratory effort, airflow, and blood oxygen levels. This test is used both to diagnose sleep apnea and to determine its severity. Sometimes, treatment can be started during the first night in the sleep center.
The treatment of choice for obstructive sleep apnea is continuous positive airway pressure device (CPAP). CPAP is a mask that fits over the nose and/or mouth, and gently blows air into the airway to help keep it open during sleep. This method of treatment is highly effective. Using the CPAP as recommended by your doctor is very important.
Second-line methods of treating sleep apnea include dental appliances, which reposition the lower jaw and tongue, and upper airway surgery to remove tissue in the airway. In general, these approaches are most helpful for mild disease or heavy snoring.
Lifestyle changes are effective ways of mitigating symptoms of sleep apnea. Here are some tips that may help reduce apnea severity:
* Lose weight. If you are overweight, this is the most important action you can take to cure your sleep apnea (CPAP only treats it; weight loss can cure it in the overweight person).
* Avoid alcohol; it causes frequent nighttime awakenings, and makes the upper airway breathing muscles relax.
* Quit smoking. Cigarette smoking worsens swelling in the upper airway, making apnea (and snoring) worse.
* Some patients with mild sleep apnea or heavy snoring have fewer breathing problems when they are lying on their sides instead of their backs.

COPING:
The most important part of treatment for people with OSA is using the CPAP whenever they sleep. The health benefits of this therapy can be enormous, but only if used correctly. If you are having problems adjusting your CPAP or you’re experiencing side effects of wearing the appliance, talk to the doctor who prescribed it and ask for assistance.
Getting adequate sleep is essential to maintaining health in OSA patients. If you have symptoms of insomnia such as difficulty falling asleep, staying asleep, or waking up unrefreshed, talk to your doctor about treatment options. Keep in mind that certain store-purchased and prescription sleep aids may impair breathing in OSA patients. One exception is ramelteon, which was studied in mild and moderate OSA patients and found to not harm their breathing.

POLL DATA:
In the 2005 Sleep in America poll, 8% of respondents experienced or had been observed having pauses in their breathing during sleep at least three nights per week. Adults in the poll were also given the Berlin questionnaire, a standardized test assessing risk for sleep apnea. Based on the questionnaire, 26% of all poll respondents were at risk. Of those at risk, 70% said that they snored, slept on average 6.4 hours/weeknight (compared to overall mean of 6.8 hours); 66% were experiencing daytime sleepiness at least 3 days per week and over half (58%) were obese. Of adults in this population who had been diagnosed with high blood pressure or depression, almost half were also at risk for sleep apnea. 33% of those who drink 4 or more caffeinated beverages daily are designated at risk for sleep apnea.

Thank you for the information you sent us on RLS, but now I’m not sure if I don’t have Sleep Apena, and ADHD instead of just the Bipolar 1.
Now I’ve been up since 5:00 PM and had only slept for 2 hours before I started getting the restless legs. Then this morning after I got off work at 3:00 AM I took my meds, Visteril and Respirdal, I slept for two hours after I went to sleep at 5:00; awake at 7:00, now it is 12:09 and am afraid to try to sleep now for fear I won’t go to sleep and I’ll get restless legs again. I get the RLS all over my body, arms, legs, shoulders, hands and arms, so I’m forcing myself to stay up now. I’ll probably go down pretty soon to try to sleep.
Any way my sleep is so messed up; it could be my job too, and my own body signals. I’ve always had trouble with sleeping at night, my Mom would stay up with me because I couldn’t sleep. Sometimes it would be 2-5 AM before I could sleep. But I think my Mom had problems too, like the Bipolar; I do know she had RLS because she bought CALMS to help her sleep, but they didn’t work for me.
Neurontin seems to work the best.
Any way thank you for the information. Here lately I’m beginning to feel like the "living Dead."
Thank you,
ike/bip

The best thing you can do is talk to your family doctor and request that they send you to a sleep specialist. They will most likely recommend a sleep study and that will give you the answers of why your not getting the rest you need. They will also be able to treat the condition.
The great thing about it is, the treatment for OSA is simple and doesn’t require more medication. It’s just a machine called a CPAP machine. It’s a machine that puts pressurized air through a mask into your respiratory tract to keep your airways open. About the only side effect with this is maybe some depression lines on your face when you wake up!
If you want more information, just send me a pm and i’ll do my best to answer them.
hugs and hopes for sleep at night for all,
dream

Hi Dream,
I know that there isn’t any medication involved with sleep apena, but it does involve that machine, and money that I don’t have. I don’t insurance and the clinic I go to won’t provide one. Neither would they do a sleep study on me, not in this lousy town. If I was in Portland, maybe. I don’t qualify for state assisted insurance, and can’t afford to buy my own. So I am stuck without a paddle! So even if I do have sleep apena, I can’t get the machine I need. Not that I’m trying to sound like a hard nose or “pity pot” stuff, that’s just the way it is.
But thank you any way for the advice. I’ve thought this myself quite often, but knew I didn’t have the money to get it done.
Thank you,
ike/bip