Nightmares and insomnia can make depression worse

This article discusses the link between nightmares and insomnia, and how they can make depression worse.

Nightmares can cause difficulty both to sleep and to our waking lives. Intense and distressing dreams often lead to waking at night and can create anxiety about returning to sleep. Nightmares also can have an impact on our moods the next morning, bringing anxiety and difficult emotions into the waking day. New research suggests that nightmares also have an aggravating effect on symptoms of depression, and in combination with insomnia may significantly exacerbate the severity of the mood disorder.

Researchers at Japan's Tokyo Medical University investigated the influence of nightmares on depression, both independently and in conjunction with insomnia. They found the presence of nightmares associated with aggravating effects on depression. They also learned that the joint presence of insomnia with nightmares had a significant effect on the severity of depression.

The study included 2,822 adults, all of whom were residents of a rural community in Japan. The average age of participants was 57. All participants responded to questionnaires regarding their sleep habits and sleep quality, as well as the presence of nightmares and their frequency. Participants also answered questions to evaluate the presence and severity of depression. Researchers' findings indicate that while both insomnia and nightmares influence depression, when they exist together their influence is particularly strong:

• Among the 2,822 adults in the study, 25.5 percent had insomnia. 
• Of the total participants, 4.6 percent experienced nightmares one or more times per week. 
• Nightmares were present much more often in people with insomnia than without. Among participants with insomnia, 70.7 percent also had nightmares, compared to 29.3 percent of participants without insomnia. 
• Both insomnia and nightmares were linked individually to higher scores for depression, indicating more severe versions of the disorder. 
• When insomnia and nightmares were both present, depression severity was rated even higher, indicating a compounding effect of the two sleep problems.

Interestingly, researchers found that the severity of depression was no worse among people who experienced nightmares three or more times in a week, compared to people who reported having nightmares one or two times weekly. This suggests that it is the presence of nightmares at an even modest degree, as opposed to the frequency of the nightmares, which may exacerbate depression.

Nightmares remain a relatively little understood phenomenon of sleep. But we have seen recent research that explores the neurological activity that takes place during disturbed dreaming, as well as investigations of the possible neurocognitive functions behind nightmares and bad dreams.

A recent study explored the often provocative and frightening content of disturbed dreams, as a way to further understand the purpose and the impact that these dreams have on our sleep and our waking lives. There is also a body of research that links the presence of nightmares to more severe depression and anxiety as well as to increased risk of suicide among people with depression:

• Among patients with major depression, nightmares may increase the likelihood of suicide attempts, according to research. In a group of people diagnosed with major depression, those who had attempted suicide one or more times had significantly higher rates of both nightmares and insomnia.

• Another study examining the link between major depression and nightmares found that patients with major depression who reported frequent nightmares were more likely to be identified as suicidal than people who suffered major depression not accompanied by nightmares. Women with major depression and nightmares were found to be at particular risk for suicidal tendencies.

• Other research also indicates women may be especially vulnerable to the influence of nightmares on depression. Scientists in Estonia studied anxiety and depression in relation to sleep problems among a group of medical students. They found among female students an association between the presence of nightmares and both anxiety and depression. No similar link between nightmares, anxiety, and depression was found in male students.

We have a great deal more to learn about nightmares and other forms of disturbed dreaming, and how they may complicate and heighten the risk of mood disorders such as depression. We've seen some important recent breakthroughs in treatment for depression that highlight how important a role sleep play in the course of depressive illness, and in its treatment:

• Recent research indicates that a drug used to treat the sleep disorder narcolepsy may have benefits for depression when used in combination with other medication. Modafinil, a drug used to treat narcolepsy, has shown promise in easing the severity of depression when used in conjunction with anti-depressant medication. This treatment combination also raised rates of remission from depression.

• A federal study on sleep and depression -- the first of several to be released on the topic -- found that treating insomnia in people with depression may as much as double the likelihood of recovery from the mood disorder.

Achieving a deeper understanding of sleep and its impact on mental health may soon be changing the way we treat depression and other mood disorders. Just as sleep is now recognized not only as a symptom of depression but also a contributor to the illness, we may also find that nightmares exist as both a consequence of depression and a factor in its development.

Recognizing the specific risks that the presence of nightmares may pose -- on their own and in combination with other symptoms of disrupted sleep -- can help better identify people who are at higher risk for more aggravated and more dangerous forms of depression. And that could bring us one important step closer to getting people the help they need.

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Sleep disorder could be a sign of Parkinson's and Alzheimer's

Research shows that a brain disorder that causes people to act out their dreams may be a sign of Parkinson's or Alzheimer's.

A sleep disorder that causes people to act out their dreams is a predictor of brain diseases like Alzheimer's and Parkinson's, a new research has found. 

"Rapid-eye-movement sleep behaviour disorder (RBD) is not just a precursor but also a critical warning sign of neurodegeneration that can lead to brain disease," said associate professor and lead author Dr John Peever from the University of Toronto in Canada. 

"In fact, as many as 80 to 90 per cent of people with RBD will develop a brain disease," said Peever. 

The disturbance occurs during the rapid-eye-movement (REM) stage of sleep and causes people to act out their dreams, often resulting in injury to themselves and/or bed partner, researchers said. 

In healthy brains, muscles are temporarily paralysed during sleep to prevent this from happening. 

"It's important for clinicians to recognise RBD as a potential indication of brain disease in order to diagnose patients at an earlier stage," said Peever. 

"This is important because drugs that reduce neurodegeneration could be used in RBD patients to prevent (or protect) them from developing more severe degenerative disorders," Peever said. 

His research examines the idea that neurodegeneration might first affect areas of the brain that control sleep before attacking brain areas that cause more common brain diseases like Alzheimer's. 

Peever said he hopes the results of his study lead to earlier and more effective treatment of neurodegenerative diseases. 

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Scientists Measure Dream Content for the First Time: Dreams Activate the Brain in a Similar Way to Real Actions

The ability to dream is a fascinating aspect of the human mind. However, how the images and emotions that we experience so intensively when we dream form in our heads remains a mystery. Up to now it has not been possible to measure dream content. Max Planck scientists working with colleagues from the Charité hospital in Berlin have now succeeded, for the first time, in analysing the activity of the brain during dreaming.

They were able to do this with the help of lucid dreamers, i.e. people who become aware of their dreaming state and are able to alter the content of their dreams. The scientists measured that the brain activity during the dreamed motion matched the one observed during a real executed movement in a state of wakefulness.

Methods like functional magnetic resonance imaging have enabled scientists to visualise and identify the precise spatial location of brain activity during sleep. However, up to now, researchers have not been able to analyse specific brain activity associated with dream content, as measured brain activity can only be traced back to a specific dream if the precise temporal coincidence of the dream content and measurement is known. Whether a person is dreaming is something that could only be reported by the individual himself.

Scientists from the Max Planck Institute of Psychiatry in Munich, the Charité hospital in Berlin and the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig availed of the ability of lucid dreamers to dream consciously for their research. Lucid dreamers were asked to become aware of their dream while sleeping in a magnetic resonance scanner and to report this "lucid" state to the researchers by means of eye movements. They were then asked to voluntarily "dream" that they were repeatedly clenching first their right fist and then their left one for ten seconds.

This enabled the scientists to measure the entry into REM sleep -- a phase in which dreams are perceived particularly intensively -- with the help of the subject's electroencephalogram (EEG) and to detect the beginning of a lucid phase. The brain activity measured from this time onwards corresponded with the arranged "dream" involving the fist clenching. A region in the sensorimotor cortex of the brain, which is responsible for the execution of movements, was actually activated during the dream. This is directly comparable with the brain activity that arises when the hand is moved while the person is awake. Even if the lucid dreamer just imagines the hand movement while awake, the sensorimotor cortex reacts in a similar way.

Read more: http://www.sciencedaily.com/releases/2011/10/111028113626