Why do I feel worse after getting enough sleep?
February 14, 2011 9:02 AM   Subscribe

Why do I feel worse after getting enough sleep? As the physical symptoms of exhaustion recede, my emotional state goes to pieces.

Like most folks living in the industrialized Western world, I generally operate on a sleep deficit. I have to drag myself awake in the mornings, and I’m tired quite a bit. Some of the general feeling of fatigue is probably related to my clinical depression, but some of it is certainly related to insufficient sleep. Every now and then I try to correct my sleep patterns according to all the articles on how to sleep better. I pick a reasonable bedtime and stick to it, reduce distractions, and so forth. And after a few days, physically, I feel better. I have an easier time getting up in the morning, I ache less, and I have more energy.

And then the ruminations start. I have this deep nonspecific feeling that there’s just something wrong with me. I start running through everything wrong or awkward I may have said in the last ten years over and over. Incidents just pop into my head and intrude on whatever I’m doing. I can’t read contentious threads because I obsess over everything upsetting, and if I’ve posted I fuss over whether I’ve expressed myself badly, or wasn’t nice enough, or should have just shut up in the first place. I have to put more and more effort into pushing aside the hurtful thoughts, or I stop being able to function. I can’t focus on my work, and I withdraw from my friends. Eventually, I decide that I prefer the dragging exhaustion to the stress of holding myself together and go back to the mild sleep deficit.

Shouldn’t getting enough sleep make me less stressed? Why would being rested make me less resilient? Does anyone else get this?
posted by Karmakaze to Health & Fitness (16 answers total) 11 users marked this as a favorite
More rest => more spare brain capacity over and above than required to function on a day to day basis. Combine with depression & there's a recipe for that brain power to be put to work in negative ways.

Intrusive thoughts are really, *really* common. Are you getting any therapy? Talk to your therapist about CBT methods for dealing with them perhaps?
posted by pharm at 9:07 AM on February 14, 2011

Sleep deficit and the accompanying zombie state always gave me an excuse to not deal with unpleasant thoughts for now.
Um...maybe find a different excuse? Ok, that was flippant. But find a new way to deal with it.
posted by Omnomnom at 9:18 AM on February 14, 2011

Best answer: This particular article discusses sleep deprivation as a treatment for postpartum depression specifically, but alludes to its use as a treatment for depression in general.

Here's the abstract from the main journal article it cites:

This paper reviews the functional brain imaging studies in depressed patients treated with sleep deprivation. Sleep deprivation is an excellent experimental model of antidepressant treatments which offer new opportunities to understand the basic neural mechanisms. Its antidepressant effects are efficacious and rapid; sleep deprivation is easy to administer, inexpensive, and relatively safe; it can be studied in patients, normal controls, and animals; and it may lead to new treatments and new paradigms for antidepressant therapies. Seven published papers, coming from five different research centers, using either positron emission tomography (PET) with 18fluorodeoxyglucose (FDG) or single photon emission computerized tomography (SPECT) with Technetium-99-hexamethyl propyleneamine oxime (HMPAO) have relatively consistent findings. First, before sleep deprivation, responders have significantly elevated metabolism compared with non-responders, and usually the normal controls, in the orbital medial prefrontal cortex, and especially in the ventral portions of the anterior cingulate cortex. Secondly, after sleep deprivation, these hyperactive areas normalize in the responders. The magnitude of the clinical improvement was significantly correlated with decreased local glucose metabolic rate or cerebral blood flow in three studies. The results are consistent with some but not all functional brain imaging studies of antidepressant medications in depressed patients. Finally, a SPECT study using a radioactively labeled D2 receptor antagonist suggests that the antidepressant benefits of sleep deprivation are correlated with endogenous release of dopamine. Depression and Anxiety 14:37–49, 2001. © 2001 Wiley-Liss, Inc.

So, is it possible that you might actually be clinically depressed? If so, treatment (therapy and / or meds) might help more than sleepless nights.
posted by charmcityblues at 9:30 AM on February 14, 2011 [2 favorites]

Response by poster: I've been diagnosed with clinical depression (atypical). I'm medicated, but not in therapy. This question more or less explains why I'm not in therapy, though I left out the complication that just the attempt to cold call therapists tends to trigger crying jags. Last fall, my prescription ran out and I got ahold of a doctor who does medication maintenance and I figured that was better than nothing. Finding a therapist is still beyond me, though.
posted by Karmakaze at 9:46 AM on February 14, 2011

Work on your negative thought processes, don't worry about the sleep for now. Get your 7-8 hours in per night. Make a routine, and stick to it. That is not negotiable.

Back to the ruminations. Be aware of when you are ruminating or dwelling on something in the past, or something negative. You'll have to become accustomed to recognizing when you are doing it. It's a habit, and you'll slip into it without realizing it - at first.

Make a mental image of yourself stopping those kinds of thoughts when you recognize them. Some people visualize negative thoughts coalescing into a ball of energy and leaving their heads. When you recognize negative thoughts, stop them, and visualize them going away.

Then, when your mind is clear, bring up positive thoughts. Focus on the positive steps you have made and will be making. Think about all the good things that will be happening to you. Make it a habit to visualize progress, think about feeling good, think about what you are doing to feel good. If you sarcastically say to yourself "oh yeah, right....pffft!" That's a negative thought. Stop it. Don't undermine yourself. Your brain will try to do that - because it's a habit. It's reflexive. You have to unlearn that reflex.

It takes practice. It takes time. But it works - I have done this exact thing. You developed the habit of thinking negative thoughts, you can develop a habit of thinking positive ones.
posted by Xoebe at 10:00 AM on February 14, 2011

Can you ask a friend to help you find a therapist? It really sounds like you need to be talking to someone.

Feel free to msg me if you think it would help to talk to me about my experience of CBT / group therapy.
posted by pharm at 10:20 AM on February 14, 2011

If you are sleeping and waking up not feeling refreshed, it might be sleep apnea. Do you snore at night? If so, go for a sleep study. I did so, got diagnosed with sleep apnea, got treatment and now I feel 100% better.
posted by dudeman at 10:42 AM on February 14, 2011

Sleep deficit and the accompanying zombie state always gave me an excuse to not deal with unpleasant thoughts for now.

This. I set aside some time in my daily routine to "feel feelings" and mentally work through why I don't like someone / whether I'm being a jerk, whatever.

Meditation might also be something to try, as it gives you practice in directing your thoughts and also provides some quiet space to let your emotions work themselves out.

But I also think that getting someone else on board to help you is a good idea. Can your medication management doc recommend a therapist / psychiatrist?
posted by momus_window at 10:48 AM on February 14, 2011

Shouldn’t getting enough sleep make me less stressed? Why would being rested make me less resilient? Does anyone else get this?

This is how I think about it (some may think it's hokum, but it works for me): When the body has adequate, even abudant levels of energy -- meaning that you have adequate rest, food, health and so on -- you start to feel emotional discomfort and turbulence if that energy encounters emotional/psychological/physical blocks.

Think of your body like a pipe or a river... if there are no obstructions, then energy (that one gets from something as simple as regularly getting enough sleep ) flows smoothly and easily. But if you have rocks and obstructions in there, like emotional, mental, or physical baggage, then the water becomes turbulent, pressurized, unpleasant. You feel like the pipe will burst or you will overflow.

So, one strategy to avoid those uncomfortable feelings is certainly to keep your energy levels low enough that you can operate without that turbulence, such as by being sleep deprived. But that type of strategy is only temporary, since eventually your energy levels will rise again.

A better long term strategy is probably to clear up your blocks. How you do that is up to you -- you could do therapy, yoga, massage, or something like that, anything that helps you process your blocks.
posted by Theloupgarou at 10:50 AM on February 14, 2011

Best answer: Not to discount the thoughtful responses posted above, but sleep deprivation is a well known treatment for depression. Its all about the serotonin.
posted by jindc at 12:50 PM on February 14, 2011 [2 favorites]

or, what charmcityblues said...
posted by jindc at 12:50 PM on February 14, 2011

I'm not a doctor, but couldn't this be an addiction of sorts? Your mind is used to being stressed due to physical ailments. Remove physical ailments, but the stress hormones are still being produced probably due to depression. What will the mind stress about? _______ (fill in blank with whatever it can remember).
You need to figure out a way of breaking that cycle. Do something out of the ordinary. A day trip to somewhere different or a completely different activity that lasts a few hours, anything that can get your mind off of the usual stress. Do you exercise? Endorphins are a very good thing to calm stress. Maybe eat more foods with triptophan?

Best of luck and power to you for getting adequate amounts of sleep!
posted by Neekee at 2:17 PM on February 14, 2011 [1 favorite]

I tend to get particularly intrusive thoughts if I'm trying to go to sleep and I'm at the wrong temperature - if I'm too hot, I'll be thinking of every embarrassing incident in the last ten years, and about what an idiot those incidents prove I am. If I'm too cold it's more about failures and mistakes and how I therefore deserve to be alone forever. The less-crazy, better temperature-controlled parts of my brain know that these thoughts are inaccurate and unhelpful, but isn't always terribly good at getting rid of them. Turning myself into a square-eyed zombie does seem to lead to a briefer period of consciousness while trying to go to sleep, but being at the right temperature (ideally a warm duvet in a cool room) helps me more.
posted by Lebannen at 3:47 PM on February 14, 2011

Best answer: Yeah, nthing that sleep deprivation is actually a legit treatment for depression (NYT article). Maybe you want to see someone with the appropriate qualifications about tweaking your medication regimen? Best of luck!
posted by en forme de poire at 3:25 PM on February 15, 2011

I had this when I was depressed. Ie sleep deprivation really seemed to help - but, the next day only.

However, I'm doing much, much better now, on a vaguely reasonable sleep schedule, and I realise it was only ever working as a short term solution, and appears to have been very counterproductive overall. I read those studies at the time, and you'll note that people were immediately depressed on a non-sleep deprived day.
I'm getting sufficient sleep now, and yes, the transition period was a bit sucky, but I'm happier and healthier now.

What I try to do:
Sleep between 7.5 and 9.5 hours. Not too much, or too little. Either immediately screws me over the next day.
Hot shower before bed - this makes me fall asleep faster, and sleep deeper.
Fresh air while sleeping.
Eyemask, and every light in the room off - even little speaker lights etc. I try and get it as dark as possible while I sleep, but this is traded off against - open curtains. As much sunlight as possible first thing in the morning.
I had a consistent wakeup time - got up same time in the morning and had breakfast. Could go to sleep again later, but had to have breakfast first.

This in conjuction with - gtd style writing everything I have to do down, so I stop cycling them on mental washing cycle (including worries - write them down, and stop thinking about it), a lot more social contact, stopped watching the news on tv or in newspapers - if I want to know about a major event I am only allowed to look at the wikipedia page (just the facts, no excess traumatising) and I had had some counseling a few months before outside events forced me to normalise my sleep schedule, so maybe I was better about not thinking stupid stuff.
posted by Elysum at 1:58 AM on March 14, 2011

Response by poster: I've talked to my doctor and he's added a small dose of a SSRI to boost my existing medication. With any luck that'll mimic the sleep-deprivation effect enough that I can try a better sleep schedule.
posted by Karmakaze at 12:25 PM on March 16, 2011

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