Sleep deprivation produces a number of negative outcomes, including cognitive impairments, weight gain, a weakened immune system, a greater risk of cancer and heart disease, and a lowered sex drive. However, there is one surprising area where sleep deprivation is actually beneficial.
Nearly 200 years ago, a German psychiatrist named Johann Heinroth noticed the beneficial effect that sleep deprivation had on people suffering from depression. This scientific insight was largely lost over the years, but a resurgence of interest in the past two decades has provided empirical evidence to back up Heinroth’s claim. This work on what experts now call “wake therapy” suggests that if done properly, sleep deprivation can be an effective treatment for depression.
The Science of Wake Therapy
Here is what wake therapy looks like: Someone suffering from depression arrives at a hospital or facility, usually as part of a small group of four to five others. Under the supervision of a therapist, these patients remain awake a total of 36 hours. During this time, their depressive symptoms are assessed and then they are released.
As you can see, the procedure for wake therapy is fairly straightforward. Even better, science appears to back up the claim that this therapy can be used to effectively treat depression.
In a recent study published in the Journal of Clinical Psychiatry, researchers conducted a meta-analysis that reviewed 66 wake therapy studies conducted on nearly 1,600 patients who were suffering from depression. Overall, 50 percent of patients who experienced sleep deprivation showed a significant improvement in depression symptoms. This benefit also appeared to be quite robust—improvement occurred regardless of the patient’s gender, age, type of depression (unipolar vs. bipolar), or whether they were on anti-depressant medication. This meta-analysis also found that partial sleep deprivation (sleeping 3 hours and then staying awake 20 hours) may be just as effective as skipping a full night’s sleep, although more studies utilizing partial deprivation arre needed to fully make this conclusion.
Now a 50 percent improvement rate may not sound particularly impressive, but keep in mind that anti-depressant medications have an improvement rate that is much lower, around 20 percent. So starving yourself of a night of sleep seems to be twice as effective as using standard medications in treating depression. Plus, anti-depressants take a month or longer to kick in, whereas the benefit of sleep deprivation is instantaneous.
That’s the good news, but here is the bad. The benefits of sleep deprivation are very short-lived. Although depression symptoms significantly improve after a night spent awake, eventually everyone has to sleep. And once that occurs, the effects of wake therapy quickly wear off. One review found that 83 percent of non-medicated patients and 59 percent of medicated patients experienced an immediate relapse of depressive symptoms after one night of sleep.
Exactly How Does Sleep Deprivation Alleviate Depression?
The work on wake therapy clearly shows its benefits. But what it doesn’t show us is why sleep deprivation is an effective, albeit temporary, treatment for depression.
In truth, there is no easy answer. Scientists are still trying to fully understand the nature of depression, the function of sleep, and the exact brain areas responsible for both. However, recent research does offer some insights.
The most likely explanation has to do with our brain’s inner clock. Everyone has a metaphoric clock inside their brain, called a circadian rhythm, that tells their brain when to feel drowsy and when to feel alert. Your circadian rhythm also coordinates with various bodily process that turn on or off (depending on their function) to prepare you for sleep, then reverse when it’s time to wake up. Although in most cases our circadian rhythm runs fairly smoothly behind the scenes without our awareness, like a real clock, sometimes its timing can get off.
This is especially true for people suffering from depression. Depressed people often exhibit sleep patterns that differ greatly from healthy people. Rather than showing great spikes and dips throughout the 24-hour cycle, depressed people’s circadian rhythms tends to be flat. They often fail to show the decrease in cortisol (a chemical that facilitates alertness) that occurs as night approaches, nor the typical increase in melatonin (a chemical that facilitates sleep). One belief is that this imbalance in circadian rhythm is a cause, not a consequence, of depression. If that’s the case, then depression should be alleviated by treatments designed to reignite people’s circadian rhythms.
This is exactly what wake therapy is thought to do. Depriving a depressed person of a full night’s sleep essentially acts as a “hard reset” for their inner clock.
When you starve your body of sleep, it increases a chemical called adenosine that drives your brain’s urge to sleep (what experts call “sleep pressure”). When adenosine receptors in our brains are blocked—which is what caffeine does—we feel alert. When those same receptors are stimulated—which is what sleep deprivation does—we get sleepy. Thus, one possibility is that wake therapy triggers the release of adenosine, which in turn resets the circadian clock, and as a result depression is alleviated.
In support of this assertion, scientists from Tufts University found that when they gave mice with depression-like symptoms a chemical that triggered their adenosine receptors, the mice acted less depressed (if you’re curious, a “depressed mouse” is one that fails to escape when they are put in a negative situation, like being held by their tail). The reduction in depressive-like symptoms after that one dose lasted a full 48 hours. These results are promising because they suggest that in the future, the antidepressant benefits of sleep deprivation may be achieved with a pill that could sidestep all the other negative outcomes associated with sleep loss.
A Bright Idea for Treating Depression
Because of its short-term effect, sleep deprivation may work best when used in combination with longer-ranging therapies that target circadian rhythms. One promising option is light therapy.
Sunlight is the primary calibrator of your circadian rhythm: early morning light cues your brain to become alert and waning evening light cues your brain to wind down. Given this, some scientists believe a combination of wake therapy and sleep therapy might be the key to providing a more enduring remedy for depression.
To test this idea, researchers at the University of Vienna identified a group depressed people who responded positively to a night of partial sleep deprivation (i.e., showed a 40 percent or greater reduction in depressive symptoms). They then randomly assigned these patients to receive either bright light exposure (3000 lux) or dim light exposure (100 lux) every day for the week following sleep deprivation. The results indicated that compared to the dim light group, the bright light group showed significantly less relapse of depressive symptoms.
This suggests that although sleep deprivation alleviates depression by kick-starting a person’s sluggish circadian rhythm, light therapy helps maintain these benefits over the long haul.
Don’t Try This at Home
Before you try attempting this approach at home, a word of caution. Wake therapy is a tricky business. Sleep deprivation may soothe depression but it can also lead to cognitive impairments, health risks, and even increases in suicidal thoughts. Wake therapy should not be attempted at home or without the supervision of a trained therapist. However, if you or someone you love is suffering from depression, wake therapy should be discussed with the treatment team as an effective supplement to anti-depressants.
And here is another alternative. Instead of taking the extreme step of sleep deprivation, consider adopting a less severe approach to reset your inner clock. Circadian-reinforcement therapy involves following a regular daily schedule in order to gently nudge your circadian rhythm back on track. For example, here is an example of what that schedule might look like:
- wake up every day at 6 a.m. (even on weekends)
- immediately eat breakfast, even if you’re not hungry
- get early light exposure, either by going on a morning walk or using a light therapy lamp
- avoid naps during the day
- avoid caffeine after lunch
- eat dinner by 6 p.m. (preferably no heavy or spicy foods) and no snacking afterwards
- go to bed by 10 p.m.
Adopting a schedule like this that encourages good sleep hygiene has the potential to alleviate depression. But it also will result in the many other benefits associated with a healthy inner clock, including more alertness, better sleep, weight loss, and even a stronger immune system.
Author: Melissa Burkley, PhD
Melissa Burkley received her Ph.D. in psychology from the University of North Carolina at Chapel Hill. Her scientific research has been featured in The New York Times, Cosmopolitan and Men's Health and she has made appearances on Oprah Radio and Martha Stewart Radio. Her freelance work has appeared in Poets & Writers Magazine and Hinnom Magazine. Her personal blog, entitled “The Writer's Laboratory,” teaches authors how to boost their creativity and improve their writing by incorporating psychological principles into their work. She also writes blog for Psychology Today called “The Social Thinker.”
Visit her website at www.melissaburkley.com