Management of Decreased Sensation with Depression and/or Sleep Deprivation

Understanding the Connection

The British Journal of Sports Medicine suggests that sleep disturbances and depression have a bidirectional relationship, where poor sleep exacerbates depression and negative mood, while depression and stress worsen sleep quality and quantity 2
Decreased sensation can be a symptom of both depression and sleep deprivation, with sleep deprivation potentially causing increases in proinflammatory cytokines that affect nervous system function 1
Treating insomnia improves depression symptoms, and treating depression improves insomnia, as reported by the British Journal of Sports Medicine 2

A comprehensive sleep history should include current sleep schedule, sleep quality, napping patterns, medication and substance use, and mental health status, according to the British Journal of Sports Medicine 3
The American Academy of Sleep Medicine recommends assessing for overwhelming anxiety, difficulty functioning, and suicidal ideation in patients with depression 2

The American Academy of Sleep Medicine recommends Cognitive Behavioral Therapy for Insomnia (CBT-I) as a standard of care for chronic insomnia, which includes identifying maladaptive behaviors and cognitions, restructuring cognitive distortions, and utilizing behavioral approaches to associate bed with relaxation and sleep 4
The Journal of the American Geriatrics Society suggests stimulus control and sleep hygiene techniques, such as going to bed only when sleepy, using the bedroom only for sleep and sex, and maintaining stable bedtimes and rising times 5

The American Academy of Sleep Medicine recommends first-line pharmacological interventions for sleep disturbance, including benzodiazepine receptor agonists (BzRAs) for short-term use, such as eszopiclone, zolpidem, and zaleplon 6
The American Academy of Sleep Medicine also recommends melatonin receptor agonists as a second-line treatment for sleep disturbance 4

The Journal of the American Geriatrics Society recommends using lower doses of medications and emphasizing non-pharmacological approaches in older adults 5
The Journal of the American Geriatrics Society also suggests increasing exposure to bright light during daytime, implementing structured physical and social activities, and reducing nighttime light and noise for patients with irregular sleep-wake patterns 7

The American Academy of Sleep Medicine recommends monitoring primary goals of treatment, including improvement in sleep quality and/or time, improvement of daytime impairments, reduction in depression symptoms, and improvement in decreased sensation 4
The American Academy of Sleep Medicine also recommends monitoring secondary goals, including sleep onset latency, wake after sleep onset, total sleep time, and sleep efficiency 4