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People have different reasons for not getting enough sleep – stress with school, family problems, or work-related issues. Other times, lack of sleep is caused by a sleep disorder, which breaks and disrupts sleep in many ways. And it has significant negative effects on one’s quality of life and health. Sleep deprivation can also put one at risk for serious medical problems. Identifying the causes of sleeplessness and subsequently implementing lifestyle changes will help protect you from daytime exhaustion and health problems.

A lot of times people experience the after effects of sleep loss such as exhaustion, lack of concentration, forgetfulness, clumsiness, and irritability. A person’s overall functioning and feeling during the day reflect how well a person slept the night before. In the same light, some remedies for sleep problems result from one’s daily lifestyle choices and they can make a huge difference in the quality of sleep.

Sleep Hygiene Practices

The following sleep habits, also named sleep hygiene can help optimize one’s nightly rest in order to be productive, focused, refreshed, emotionally stable, and physically energetic throughout the next day:

• No napping during the day as this disturbs the normal sleep pattern (possibly except up to 1 hour siesta after lunch).
• No stimulants (caffeine, nicotine, etc.), or alcohol. These should not be taken close to sleeping time.
• No heavy meals before bedtime.
• Not sleep with an empty stomach.
• No heavy exercising before bedtime. Usual energetic exercises should be completed at least 4-6 hours before bedtime.
• Remove anything that adds to light and noise in the bedroom at night. Keeping the room dim, quiet, with comfortable room temperature and with relaxing music can set the right mood for sleeping.
• Practice relaxation exercises like yoga, meditation, deep breathing, light stretching or a winding down routine before going to sleep.
• Avoid stressful activities and conversations before going to bed. The subconscious might pick up on these thoughts and cause sleep disruption.
• Keeping a regular bedtime and wake up time every day including weekends and holidays.
• Use the bed ONLY for sex and sleep and not for other activities like watching TV, reading, surfing internet, listening to the radio, texting, etc.

Keeping a Sleep Diary

Some sleep specialists also recommend keeping a sleep diary where all sleep habits and patterns will be recorded. The diary should contain the following information:

• What time you go to bed?
• What time you wake up?
• What time you wake up during the night, how many times, how long does it take to fall back asleep?
• How much alcohol, caffeine, and cigarette were consumed and at what times?
• What time you had your meal, what food you ate and beverages you drank?
• Any emotion or stress experienced during the day, and what time?
• Any drugs or medicine taken and what time they were taken?

The sleep diary may contain more than the information listed above. Any information that might be associated with having sleep problems should be included. This will help the doctor or the sleep specialist to identify the possible triggers to the sleep problem.

Sleep Hygiene for Travelers

A common problem of frequent travelers is jet lag. The change in time zones causes disruption in the body’s biological clock and the difficulties in adjusting to the new time zone results to sleep disturbance. There are ways to minimize the effects of jet lag on one’s sleeping pattern:

• Condition the mind and body to the change in time zone when you make the trip by adjusting your sleeping and waking up schedule according to the time zone of your destination a week or so before the scheduled travel date.
• Adjusting your watch to destination time as soon as you board the plane.
• If possible, select a flight that arrives in the destination early evening.
• Do not take alcohol or caffeine for 3 – 4 hours before bedtime at your destination.
• No heavy exercising before bedtime.
• Use earplugs and blindfolds to mask outside noise and lighting while sleeping.
• Don’t stay indoors most of the time as this worsens the jet lag.
• Make arrangements with the hotel for voice mail services and let them handle all your calls.
• Request wake-up calls from the hotel staff.
• Some people find use of melatonin to induce sleep helpful.

A change in the environment, i.e., time zone, requires the body and mind some time to adjust. By allowing the mind and body to prepare early for such anticipated change, the adjustments will be less when you are actually in the new time zone area.

Sleep Hygiene for Older Adults

As people age, there are normal changes in the sleeping patterns – sleeping and waking up earlier, and feeling rested even with less deep sleep. However, if less sleep becomes disturbing and disruptive to daily functions, it is not any more a normal part of aging. And just as good sleep is important to younger people, so it is as equally important to senior people as it helps maintain good concentration and memory function, refreshes the immune system, and allows the body to recover from the effects of cell damage that happened during the day. The following sleep hygiene tips can help alleviate age-related sleep problems to have better sleep at night:

• Limit caffeine intake late in the day. Avoid caffeinated drinks such as coffee, tea, soft drinks and chocolate.
• Don’t take alcoholic beverages before sleeping because alcohol disrupts sleep.
• Keep stomach satisfied before sleeping. Light snacks like crackers, cereal, and warm milk may help having a good night sleep.
• Do not eat big meals or spicy foods before bedtime. Spicy food can cause indigestion and stomach discomfort. The best is eating dinner at least three hours before sleeping.
• Reduce intake of liquid before sleeping to minimize middle of night bathroom visits. Drinking liquid should be limited an hour and a half before sleeping.

If the depressed mood is caused by drugs, alcohol, or medications, or if caused by a general medical condition, then MDD diagnosis cannot be used. Major depressive disorder diagnosis cannot be given to persons with a history of manic or hypomanic episodes, bipolar or schizoaffective disorders. Typically, a person grieving over the loss of an important loved one may not be diagnosed of major depressive disorder. Pathological bereavement is a term used for grieving or bereavement beyond cultural norms.

Symptoms

Although feeling sad, down, or depressed sometimes during life can be accepted as normal, clinical depression is characterized by depressed mood lasting most of the day, and with the presence of other symptoms such as loss of interest in regular activities, hobbies, and relationships, sleep and appetite problems, feelings of guilt, worthlessness, helplessness, etc.

Depression symptoms in Children and Teens

Children and teens with depression may have different symptoms from the symptoms of depressed adults. Irritability, sadness, hopelessness, and constant worrying are commonly seen in younger children, while adolescents and teens may exhibit symptoms of anxiety, avoidance of social interaction, and anger more frequently. Adults and adolescents may also have sleep and thinking changes.

Depression in children and teens may commonly co-occur along with mental health conditions and other behaviour problems like anxiety or attention deficit hyperactivity disorder or ADHD. Children’s school performance and work may significantly be affected because of depression.

Depression Symptoms in Older Adults

Depression may go undiagnosed in older adults because the symptoms that manifest might be mixed up with the symptoms of aging and other illnesses – loss of appetite, fatigue, loss of sexual desire, and sleep problems. Depression in older adults manifest itself with less obvious symptoms – they are dissatisfied with life in general, they feel helpless or worthless, they want to stay at home isolated rather than to go out and socialize.  If older adults entertain suicidal thoughts, it may be a sign of extreme depression and suicidal ideation or plans should be asked and addressed in all depressed patients.

Diagnosis

Doctors and licensed mental health care providers evaluate the person suspected of having major depressive disorder and ask questions about their moods, feelings, and thoughts to establish the diagnosis. Some questionnaires may be used to check for depression symptoms or measure the severity of depressive symptoms

The person may need to undergo medical and psychological tests in order to rule out other problems, medical or otherwise and to help clearly pinpoint a diagnosis and check for any related complications. The doctors and mental health professionals may ask the person to get the following exams and tests:

• Physical exam. This is a comprehensive physical assessment which includes height and weight measurements, vital signs checking – heart rate, temperature and blood pressure; heart and lung sounds and checking of abdomen.
• Laboratory tests. Complete blood count (CBC), thyroid hormone, complete metabolic panel are minimally needed tests to rule out physical.
• Mental Status Evaluation. The doctor or licensed mental health provider assesses the person’s thoughts and feelings or behavioural patterns. Medical history will be checked for previous similar episodes. They should also check for any suicidal ideation or tendencies.

The American Psychiatric Association has set criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) which is used for the diagnosis of mental conditions. DSM 5 will be published in 2013 which will revise some of the criteria in DSM-IV.

In order for the diagnosis to qualify, a person suspected of major depressive disorder must have at least five of the following symptoms over a two-week period. At least one of the symptoms must be either depressed mood or loss of interest or pleasure (anhedonia).

• Every day feeling loss of energy and fatigue
• Almost every day feeling worthless or guilty
• Loss of concentration, indecisiveness.
• Insomnia or hypersomnia
• Significant diminished interest or pleasure in everyday activities
• Being restless and feeling slowed down
• Suicidal thoughts
• Marked loss or gain of weight or appetite

It is important to note that the symptoms are determined not to be caused by a mixed episode — simultaneous mania and depressive symptoms that can occur in bipolar disorder; must be severe enough to interrupt day-to-day activities, such as work, school, social activities, or relationships; drug abuse, taking other medications for other medical conditions and grieving or temporary sadness after a loss of a loved one are not causing the symptoms.

Treatment

Major depressive disorder like most mental conditions usually is treated with medication and/or therapy.

• Medications. There are a number of antidepressants available for treatment of major depressive disorder. They are classified according to the effects on the chemicals in the brain associated with mood changes. Some of the most commonly recommended medications include:

1. Selective serotonin reuptake inhibitors (SSRIs). This is the primary group of medications prescribed by the doctor due to its fewer side effects. Decreased sexual desire and delayed orgasm are two of the most common side effects of SSRIs. Other side effects can include digestive problems, jitteriness, restlessness, headache, and insomnia.
2. Serotonin and norepinephrine reuptake inhibitors (SNRIs).  These drugs are as effective as, if not more than the SSRIs and may exhibit side effects similar to those caused by SSRIs including excessive sweating, dry mouth, fast heart rate, and constipation.
3. Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) is one of the few antidepressants which do not have common sexual side effects. However if given on high doses, bupropion may increase the risk of having seizures.

• Psychotherapy. This is another treatment option for major depressive disorder where a psychotherapist would talk to the person about the condition and its causes in order to understand the condition better. Identifying negative thought and behaviour patterns which are causing the depression can be learned during the therapy. Psychotherapy can help the person regain happiness and ease other depression symptoms such as hopelessness and anger. Effective and healthy coping mechanisms can also be learned during psychotherapy.