By John M. Grohol, Psy.D. 

Clinical depression goes by many names -- depression, "the blues," biological depression, major depression. But it all refers to the same thing: feeling sad and depressed for weeks or months on end (not just a passing blue mood). This feeling is most often accompanied by feelings of hopelessness, a lack of energy (or feeling "weighed down"), and taking little or no pleasure in things that gave you joy in the past. A person who's depressed just "can't get moving" and feels completely unmotivated to do just about anything. Even simple things -- like getting dressed in the morning or eating -- become large obstacles in daily life.

We've compiled a library of depression resources for you to explore. We encourage you to take your time with these resources, print out things you'd like to read more carefully, and bring anything you have additional questions about to your family doctor or a mental health professional.

Depression is readily treated nowadays with modern antidepressant medications and short-term, goal-oriented psychotherapy. Don't be put off by the number of things written about depression -- because it's so common, a lot has been written about it! Read what you need, and leave the rest for another day. Continue reading this introduction to depression...

By AMY BELLOWS, PH.D.

It’s a horrible feeling to be captain of the ship when the ship goes down. That’s how Antonina Radzikowski, 55, says she felt after falling asleep while driving down a Maryland highway one afternoon in 1994.

Radzikowski and her husband, Phillip, were heading home after dropping their teen-age son off at a gifted and talented summer program. Roughly 60 miles away from home on I-70 near Hagerstown, Md., the car Radzikowski was driving smashed into the guardrail, flew over it, and fell 30 feet before landing on railroad tracks on the opposite side of the highway. Radzikowski’s husband died and she was left with severe brain injuries that shortened her attention span and led to her retirement from teaching.

“I sometimes felt drowsy before, but I never knew why until after the accident,” Radzikowski says. A sleep study revealed that she suffers from obstructive sleep apnea, a condition in which her breathing stops for about 10 seconds to as long as a minute while she’s sleeping. Her effort to breathe wakes her up, and this stop-and-start cycle of waking to breathe can repeat hundreds of times a night. A person with sleep apnea isn’t aware of the frequent awakenings, but is likely to feel overwhelming sleepiness during the day.

There are many reasons for sleep deprivation. Each year, there are about 40 million people in the United States who suffer from sleeping disorders. An additional 20 million have occasional sleeping problems, according to the National Institute of Neurological Disorders and Stroke.

People who work nights, for example, probably never completely adapt because our bodies want to be awake during the day and asleep at night. We are governed by the circadian rhythm, an internal clock that regulates sleep and wake cycles. Sleep deprivation can also result when people choose to skimp on sleep in favor of work, parties or late-night television.

Whatever the reason for sleep loss, research has shown that it takes a toll on us both mentally and physically. While we sleep, our bodies secrete hormones that affect our mood, energy, memory, and concentration. Testing has shown that with a driving simulator or a hand-eye coordination task, sleep-deprived people may perform just as badly as intoxicated people.

Sleep deprivation and fatigue have long been issues for professions that have traditionally held long work hours. Pilots have federal regulations that limit their work hours to eight hours of flying time within a 24-hour period. Truck drivers can’t drive more than 10 hours without a mandatory eight-hour break. Physician advocacy groups are pushing for the passage of the Patient and Physician Safety Protection Act, currently under consideration in Congress, that would set limits nationwide on the number of hours worked by medical residents.

New research suggests sleep disturbancessleep disturbance are associated with clinically meaningful reductions in health-related quality of life.

The study also finds that the magnitude of this effect varies by race and sleep disorder.

The research is found in theJournal of Clinical Sleep Medicine.

Results indicate that physical health-related quality of life in African-Americans who snored frequently, had insomnia symptoms or reported excessive daytime sleepiness was significantly worse than in Caucasians.

African-Americans with insomnia also had significantly more physical limitations than Hispanics.

However, when mental health-related quality of life was evaluated, it was Hispanics with frequent snoring, insomnia symptoms or excessive daytime sleepiness who had significantly greater mental distress than Caucasians.

African-Americans with insomnia also had significantly worse mental health than Caucasians.

“The study highlights the increased disparities among African- and Latino-Americans compared with Caucasians even in the sleep and health-related quality of life domain,” said lead author Carol M. Baldwin, PhD, RN, FAAN.

The study involved a secondary analysis of data from the Sleep Heart Health Study, a multi-center study that recruited participants from seven regions of the U.S. Eighty-six percent of the 5,237 people in the current study were Caucasian, nine percent were African-American and five percent were Hispanic.

The Hispanic participants were predominantly of Mexican heritage residing in Arizona, with a smaller number of Puerto-Rican participants from the New York cohort. All participants were 40 years of age or older, and their mean age was 63.5 years.

The presence of obstructive sleep apnea was detected by overnight, in-home polysomnography. Snoring and insomnia – defined as trouble falling asleep, staying asleep or waking too early – were assessed using the Sleep Habits Questionnaire. The Epworth Sleepiness Scale was used to evaluate daytime sleepiness.

Health-related quality of life was assessed with the physical and mental composite scales of the Medical Outcomes Study 36-item short form survey.

According to the authors, low scores on the physical scale suggest limitations in self-care and physical activities, severe bodily pain and frequent tiredness. A low score on the mental scale indicates frequent psychological distress, as well as social and role disability due to emotional problems.

The study found that sleep disturbances were common, with 46 percent of people having at least mild sleep apnea, 34 percent reporting frequent snoring, 30 percent having insomnia symptoms and 25 percent reporting excessive daytime sleepiness.

Frequent snoring was significantly more common among Hispanics (41 percent), and excessive daytime sleepiness was significantly more common among African-Americans (32 percent). There were no statistically significant differences in the distribution of obstructive sleep apnea or insomnia symptoms by race.

According to Baldwin, the study could help reduce health disparities and improve outcomes by advancing “tailored care” in sleep medicine.

“These findings support the need for sleep clinicians to use culturally-responsive sleep education, assessment and intervention approaches, as well as depression, anxiety and other relevant mood and socioeconomic-status measures,” she said.

The authors cautioned that the correlational nature of the study did not allow for an analysis of causality. Baldwin added that the causes of differences in health-related quality of life can be complex and may include such factors as lifestyle and activity patterns, diet, sleep architecture and access to health care.

However, the study suggests that the impact of sleep disorders on daily living and general well-being may be similar to that of other chronic conditions. The mean score profiles for health-related quality of life in people with sleep apnea and other sleep symptoms were similar to those that have been previously reported for patients with hypertension and type 2 diabetes.

Source: American Academy of Sleep Medicine

                                                                                             By LYNN PONTON, MD

It’s especially important to get enough sleep during stressful times. You may feel pulled in many directions by relationships, errands and work to be done. However, if you sacrifice sleep when you’re stressed, you’ll create a vicious cycle where you’re tired all the time — and you may end up getting sick as a result.

1. Work Out
Exercise relaxes muscles and relieves tension. Just make sure you don’t exercise too late in the day: Since working out is an adrenaline-booster, you may find yourself too wired to sleep. A good rule to follow: Don’t exercise for at least two hours before you go to bed.

2. Relax and Unwind
Relaxation techniques calm you and let you forget your stresses for awhile. Yoga or meditation often does the trick, as does massage or even a nice, warm bubble bath. Aaaah. Lovemaking is also a natural relaxant that can be quite effective before bedtime!

3. Set Your Internal Clock
It’s important to establish a consistent time for going to bed and waking up. Your body becomes used to hitting the sack at a regular time, and this helps you fall asleep more easily.

4. Divert Yourself
Once you get into bed, if you toss and turn and can’t sleep a wink, go into another room and pick up a book for a while, or listen to some music. When you start feeling drowsy, head back to bed.

5. Factor Food In
While you don’t want to go to bed hungry, be careful of what you eat close to bedtime. Spicy, greasy, or heavy foods may not digest well, and can cause you to wake up during the night with an unhappy stomach. Also avoid caffeine within six hours of hitting the sack. Better choices for before-bed snacks include foods high in carbohydrates, such as bagels or crackers, which digest more easily. And don’t forget the old standby, a glass of warm milk — it really may help soothe you to sleep.

If you focus on something as simple as your own breath, you can help eliminate the tossing and turning that often precedes a restless night’s sleep. Deep breathing helps your body unwind, relax and prepare for rest.

The following two techniques — breathing and relaxing yourself to sleep — are modified from traditional yoga postures. Besides being a great form of physical exercise, yoga can also be a holistic sleeping aid. The controlled breathing that you’ll learn in these two exercises promotes deep relaxation, and can ease the mental strains that often block sound sleep.