Ambien and Insomnia

Fiona Macdonald-Smith
March 5, 2009
http://www.smh.com.au/lifestyle/wellbeing/insomnia-may-fuel-more-than-anxiety-20090403-9mmf.html 

"The first thing I knew about it was from the woman downstairs, who was banging on the door of our flat and asking about the water pouring through her ceiling. I went into the bathroom and saw that the bath was overflowing. I'd forgotten to turn it off and, even worse, had no recollection of ever having run it," says Louise, a copywriter and mother of two, who has been an insomniac since the age of seven.

Louise's behaviour might usually be put down to extreme forgetfulness due to lack of sleep rather than a sign of a serious problem. But an article in New Scientist raises the possibility that insomnia could cause mental illness.

Insomnia has long been linked to mental health problems but they were always considered a side-effect. Now studies by US scientists suggest otherwise. "It was just so easy to say about a patient, well, he's depressed or schizophrenic, of course he's not sleeping well - and never to ask whether there could be a causal relationship the other way," said Robert Stickgold, a sleep researcher at Harvard University. Psychiatric problems including post-traumatic stress, depression and attention deficit disorder could be caused by sleep problems, the research suggests.

Louise, from north London, is convinced there is a connection. "I'm sure the insomnia was the cause of my mental state, not a side-effect," she says.

Louise had become used to coping on four hours' sleep a night and watched old films on a loop to try to make herself ready for sleep.

But recently her insomnia has spiralled into something more sinister. "I don't mind missing the odd night here and there but sometimes it's night after night after night, and then it becomes relentless," she says. "I can feel my sense of sanity slipping away, I see things that aren't there, I become preoccupied with things that don't matter, like checking my Facebook account constantly during the night, just to get communication from the outside world." She has been prescribed anti-depressants for anxiety.

A US study of patients suffering sleep apnoea - a condition in which the upper airway intermittently and repeatedly collapses or closes, leading to interrupted sleep - found the condition doubled the chances of depression. Another study, by Matt Walker of the University of California, Berkeley, involved showing increasingly disturbing images to people who had slept normally, and others who had been deprived of sleep for 35 hours. "We found that the emotional centre of the brain, the amygdala, was about 60 per cent more active in people who had been sleep deprived."

The connection between the amygdala and the frontal lobe had also been disrupted: "As the frontal lobe puts the brakes on the brain's emotional centre, it shows that when you're sleep deprived you're all accelerator and no brakes. You don't have control over your emotions."

Jim Horne, director of the Sleep Research Centre at Loughborough University, in Britain, is less convinced. He says that in most "people who have psychological problems, a common finding is disturbed sleep, because in order to have a good night's sleep you need an untroubled mind. Simply treating the insomnia will not cure the psychiatric disorder … Mental illness is down to psychological factors, genetic factors. Insomnia is a symptom."

Horne believes much of the evidence cited could be interpreted differently: "People with sleep apnoea may be more likely to be depressed but that doesn't mean the apnoea caused it. A lot of these people are also likely to be obese and that is associated with depression."

He advises insomniacs not to worry about whether they're going mad but concentrate on overcoming the problem. "Insomnia is not really a sleep disorder but a disorder of wakefulness intruding into sleep. Sufferers need a professional to help them deal with their waking problems - most people know in their heart what those are … you won't become mentally ill through lack of sleep," he says.