Managing Your Depression (3 page)

Why does sleep matter to your mental health? Sound sleep optimizes brain function and has a positive effect on your mood disorder. A change in the amount or quality of sleep will affect your illness. For example, periods of insufficient or poor-quality sleep can worsen your depression or bring on your bipolar illness. A consistent period of good night’s sleep can help improve your mood.

Changes in your sleep may or may not be fully under your control. They may be related to a physical condition or stress. Sleep difficulties may be Warning Signs or Symptoms of your mood disorder, which you and your treatment team can recognize and address. Sleep disruption may also be related to environmental conditions, such as noise level, excess light, or extremes in room temperature. The good news is that you can control some things to help yourself achieve a good night’s sleep. This is called Sleep Hygiene.

Sleep Hygiene

Sleep Hygiene refers to the personal habits and environmental (home) conditions that affect your sleep. Good sleep habits can help improve your sleep, which in turn will help improve your mood. So it is important to maintain good sleep habits and a consistent sleeping and waking pattern in a bedroom environment that favors sound sleep. Sleep Hygiene recommendations, adapted from the American Academy of Sleep Medicine, are listed below. One of the essential steps in managing your mood disorder is to follow these recommendations as best as you can. Speak with your doctor if you are still having sleep problems after following these suggestions.

Sleep Hygiene

Recommendations to improve your sleep include:

• Keep the same bedtime and wake-up time every day, including weekends. Set an alarm clock if necessary. Get up and out of bed at the same time even if you’ve had a bad night’s sleep.

• Avoid napping during the day.

• Develop a relaxing sleep ritual before bedtime. Create downtime in the last 2 hours before going to bed, and avoid overstimulation, such as family arguments, excess noise, vigorous activity, or violent TV shows or video games.

• Try going to bed only when you are sleepy.

• Avoid watching the clock. Turn the clock away from you.

• Avoid lying in bed unable to fall asleep and feeling frustrated. If you are not asleep after 20 to 30 minutes, get out of bed. Relax and distract your mind with a quiet activity in another room (music, reading), then return to bed when you are sleepy.

• Relaxation exercises before bedtime may be helpful. Examples include progressive muscle relaxation, deep breathing, guided imagery, yoga, or meditation.

• Designate a specific “worry time” earlier in the day or evening to sort out problems you may have. Writing down reminders for the next day is a good way to clear your mind before bed.

• Use your bed and bedroom only for sleep, sex, or occasional illness. Eliminate nonsleep activities in bed, using another room for reading, watching TV, working, and eating.

• Limit how much caffeine you have during the day, and avoid its use after 12:00 noon. Note that coffee, tea, colas, cocoa, chocolate, and some medications contain caffeine.

• Avoid or limit the use of nicotine (tobacco) and alcohol during the day and avoid their use within 4 to 6 hours of bedtime.

• Avoid large meals before bedtime, but do not go to bed hungry. If needed, have a light snack.

• Exercise regularly. Avoid strenuous exercise within 4 to 6 hours of bedtime.

• Create a bedroom environment that favors sound sleep. A comfortable bed in a dark, quiet room is recommended. Minimize light, noise, and extremes in room temperature (hot or cold) in the bedroom. Room-darkening shades, curtains, earplugs, or a sound machine may be helpful.

• Speak with your physician if you are having continued difficulty with sleep, including falling asleep, staying asleep, and early or frequent awakenings.

Source:
Adapted in part from the American Academy of Sleep Medicine, “Sleep Hygiene: The Healthy Habits of Good Sleep” (AASM, 2010),
www.yoursleep.aasmnet.org/hygiene.aspx
, accessed April 2012.

What is enough sleep? The amount of sleep required by a person depends in part on age. It varies from infancy, through childhood, to older age. The average amount of sleep required by healthy adults is 7 to 8 hours per night. “Enough sleep” is the amount that makes you feel physically and mentally rested, sharp, not irritable,
and able to concentrate, focus, and correctly do small motor tasks.

How do you know how much sleep you are really getting, and what your sleep patterns are? Most people tend to underestimate the amount of sleep they had. One way to know is to keep track of your sleep for several weeks with a Sleep Diary (
pages 12
–13). A Sleep Diary is a chart where you record

• your bedtime

• how long it took to get to sleep

• the number of times you woke up during the night

• how long you stayed awake (duration of awakening)

• the time you are finally awake and out of bed in the morning

Fill it out first thing in the morning for several weeks and then share it with your doctor(s). Keeping a Sleep Diary helps you and your treatment team understand your sleep patterns. It is used to track your progress and response to therapy, and it provides valuable information used in making treatment decisions. It also helps you to stick with good Sleep Hygiene habits.

Diet and Nutrition

You have probably heard that it is important to eat a nutritious and varied diet to keep your body and vital organs working properly. Did you know that this is also true for your brain? Food is the fuel that keeps your body and your brain functioning optimally. Eating well-balanced healthy meals is one way of taking care of yourself that you have control over. It can make a positive difference in your mental health. When you stray from a healthy, regular diet you become vulnerable to mood changes. You may become irritable and fatigued, and your brain may not function very well.

Several research studies have shown an association between particular eating patterns and mental health. For example, a “western diet” high in saturated fats and processed, fried, and sugary foods was found to be associated with a high rate of depression.
In contrast, a diet high in fruits, vegetables, nuts, legumes, fish, whole grains, and olive oil, also known as the Mediterranean diet, was associated with a lower rate of depression. It is not known whether a poor-quality diet is a result of the appetite changes and inertia that accompany depression or whether it causes those symptoms—perhaps both are true. Other studies have shown the significance of the supplements folate, vitamin B12, and omega-3 fatty acids in the diet, but this is a complex discussion that I will not go into here. Talk with your doctor about whether you need to take any of these as dietary supplements for your depression.

A healthy eating pattern is valuable for additional reasons. Improving your brain’s nutritional status may increase the effectiveness of antidepressant medications. Depression, lack of activity, sleep problems, and many medications prescribed for mood disorders have the potential to increase body weight. Symptoms of depression include loss of appetite and weight loss in some people, while others may have increased appetite, carbohydrate cravings, and weight gain. Weight gain following antidepressant therapy may be an indication of recovery in those who had weight loss as a symptom, or it may be related to taking the medication. Weight gain is a relatively common problem during acute or long-term treatment with antidepressants and is a significant reason people stop taking their medications. Be mindful of this possibility, particularly if you are on medication for the long term.

Significant weight gain related to taking antidepressant medications can affect your overall health and cause physical and emotional discomfort and distress. Many people feel worse about themselves, having low self-esteem and low confidence, when they gain substantial weight. Healthy eating may prevent or reduce the likelihood of becoming overweight or obese while on these medications. Those already overweight will have to control their total caloric intake to manage their body weight. This is only part of the picture. Controlling your weight also means increasing physical activity (exercise) and decreasing the amount of time spent sitting around. This is not easy to do, but you can take steps to make it less difficult, as I discuss in the Physical Exercise section of this chapter. Remember that different antidepressant medications all have different effects on your metabolism, so you should remain open to trying more than one drug (if necessary) until you find one that you tolerate well.

Since you have control over what you eat, it is in your best interest to nourish your brain in the most beneficial way. To help you improve your eating habits and reach the goal of a healthy, balanced diet, I have included basic nutritional information in the sections that follow.

What Is a Balanced, Nutritious Diet?

A comprehensive and easy-to-use resource is the USDA
Dietary Guidelines for Americans 2010
. These are evidence-based nutritional guidelines designed to promote health, reduce the risk of chronic diseases, and reduce overweight and obesity through improved nutrition and physical activity. The guidelines are not specific to depression but address general health and well-being. They can be found online at
www.health.gov/DietaryGuidelines/
(click on the link to the “policy document”).

The
Dietary Guidelines 2010
describe a healthy diet as one that:

• emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products;

• includes lean meats, poultry, fish, beans, eggs, and nuts; and

• is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.

You may have seen these recommendations drawn as a food pyramid in the past. The guidelines now display healthy food as portions divided on a dinner plate, with fruits, vegetables, grains, lean protein (such as chicken or fish), and a small amount of dairy. There is an easy-to-use interactive Web site to help you understand the food portions at
www.choosemyplate.gov
. Visit this Web site for many helpful tips on healthy eating, including menu choices
and specific calorie goals for your age and gender. Optimal caloric intake depends on your gender, age, your current weight, and your goals for maintaining, losing or gaining weight. I will not go into that here.

The
Dietary Guidelines 2010
recommend that you make half your plate fruits and vegetables, or that you eat five ½ cup servings of colorful fruits and vegetables per day. The protein portion for adults is 5 to 6 ounces total per day, or approximately one-quarter of your plate at each meal. Grains should be two 3-ounce servings per day for active adults, or approximately one-quarter of your plate. Dairy should be low fat and used in moderation.

Eating for energy and balanced mental health means that you have 3 small to medium meals per day plus two healthy snacks as you choose. Do not skip meals. A snack might be a piece of fruit, or string cheese and a few walnuts or almonds, but no chips, fries, candy, soda, or junk food. You should stay well hydrated by drinking 6 to 8 glasses of water per day. Avoid sugary drinks and diet soda. Avoid alcohol, as it is a depressant and not good for your general physical and mental health. Avoid tobacco and street drugs. If necessary, take one multivitamin supplement per day, but do this with the advice of your doctor. Remember, a balanced, healthy diet leaves you satisfied and not hungry for more.

Pay attention to portion sizes at home and when you eat out, because they have inappropriately increased in size over the years at restaurants and in the home. For example, a healthy serving of protein such as meat or fish is actually 3 ounces, about the size of a deck of cards. A serving (½ cup) of fresh fruit is about the size of half a baseball. One cup of cereal (a serving) is the size of your fist. One serving of rice, pasta, or potato is ½ cup, about the size of half a baseball. (See the NHLBI “Serving Size Card” at
http://hp2010.nhlbihin.net/portion/servingcard7.pdf
.)

USDA 2010 Dietary Guidelines for Americans

This list summarizes the key points in maintaining a healthy body and weight.

• Increase whole grains, vegetables, and fruits in your diet.

• Eat a variety of vegetables, especially beans, peas, and dark green, red, and orange vegetables.

• Eat at least half of all grains as whole grains. Increase whole-grain intake by replacing refined grains with whole grains.