Experts say that simply increasing daily activity levels can help people with depression and anxiety regulate their sleep cycles and sleep more soundly.
By Sasha Kildare
“I wouldn’t be able to sleep. It was horrible. I would sleep three to four hours, tops, and not be able to go back to sleep,” say Angie G., recalling her tortured nights. When Angie committed to regular exercise four years ago, getting a good night’s sleep became a reality for her.
When you battle depression or anxiety, or both, the quality of your sleep can determine the intensity of the fight. Sleeping too much can pose just as much of a problem as sleeping too little.
Most individuals diagnosed with depression either have hypersomnia or insomnia, and a small percentage alternate between the two, says Madhukar Trivedi, MD, director of the Center for Depression Research and Clinical Care at University of Texas Southwestern Medical Center at Dallas.
Exercise can help with both.
“Exercise can be effective to help treat or prevent depression, as well as improve the quality of your sleep,” says Ruth Benca, MD, PhD, professor and chair of the Department of Psychiatry and Human Behavior at University of California, Irvine.
“It increases the continuity of your sleep. You wake up less and have deeper sleep. The quality of sleep counts. Less fragmented sleep is more restorative,” she adds.
“Insomnia is probably one of the biggest risk factors for depression. Insomnia is often the first symptom to appear and the last to go. It is both a risk factor and a predictor,” says Benca, who is also director of the UC Irvine sleep Medicine Center, which is opening in August.
Mike Kneuer, wellness director at the Fourmula in Boca Raton, Florida, works with mental health professionals in an intensive outpatient setting that pairs traditional therapy with clinically driven exercise and nutrition programs to rehabilitate dual-diagnosis clients.
Kneuer says that his clients tell him that they have trouble sleeping, because their brains seem to be going a mile a minute. Their challenge is to learn how to relax their thoughts enough so that they are able to sleep.
For Angie, who was formally diagnosed with depression, anxiety, and PTSD 10 years ago and works in community relations in Los Angeles, the encouragement she received from her psychiatrist convinced her to give exercise a chance. “It took me a while to make time to exercise,” she says. “Once I started exercising even three times a week, I started noticing results after one week.”
“The quality of sleep counts. Less fragmented sleep is more restorative.”
“I started going to the gym, and it helped me to relax. It helped my anxiety a ton, and it helped me sleep throughout the night,” she says.
Scheduling her exercise sessions provided unexpected benefits to Angie, too. “It helped me organize myself. It helped me think about other things I needed to do and create a game plan for the next day,” she says.
“For the past couple of years, anxiety would keep me up at times, and then I would want to sleep all day and have a bad day,” says Maria L. from Toronto, Canada.
Though Maria believes she has a chemical imbalance, it takes more than medication for her to manage her symptoms. “Medication takes the edge off. I still have bad days, though,” she says.
“You still need to work on yourself and take care of yourself. Regular exercise does help me feel much better and more energetic; and it also helps me sleep better at night,” Maria adds.
Whereas insomniacs have trouble sleeping, hypersomniacs sleep excessively, crave even more sleep, and do not wake up feeling refreshed.
Those experiencing hypersomnia might be influenced by more than depression. “They might have another sleep disorder, sleep apnea, snoring, or weight management challenges,” says Benca.
“How I know I am still fighting depression is that if there’s a day in which I have nothing to do, I want to sleep all day,” says Al A., from Greater Los Angeles, who was diagnosed with anxiety and depression while in high school more than a decade ago.
“I had a mental breakdown my second semester of my freshman year of college,” Al recalls. “My parents told me that they had my back no matter what. That was a turning point for me. I knew I had to do more to fight the depression,” he says.
Al now walks at least every other day, usually in the late afternoon or early evening. “Walking gives me the space to breathe. I get home and even though I am feeling tired, I am not defeated.”
Sleep, inflammation, and depression
Research indicates that lack of sleep, inflammation, and depression interact in a negative loop that can progressively worsen.
“We don’t know the exact cause of the inflammation. The current hypothesis is that it is a stress response — hyperstress leading to an inflammation process in the body and the brain,” explains Trivedi, one of the authors of the 2006 Treatment with Exercise Augmentation for Depression (TREAD) study, which evaluated the effects of aerobic exercise on more than 100 participants with depression.
Thirty to 40 percent of the TREAD participants had significant reduction in depression symptoms. “Those patients who have some inflammation did better, suggesting that exercise may be causing an anti-inflammatory effect,” says Trivedi, who is also chief of the Mood Disorders Division of Psychiatry at UT Southwestern.
Exercise helps set your body clock
Our body clocks operate in a 24-hour cycle; our activities during the day, including exercise, determine how smoothly that cycle runs. To help set up your body clock for sound sleep, Benca says, “your day includes bright light and outdoor sunshine. Bedrooms should be dark at night.”
“Bright artificial lighting during the night will mess up your internal clock, your circadian rhythm. That can lead to difficulty being awake and alert during the day or sleeping at night,” adds Benca.
As clients progress through treatment and become fit, Kneuer has observed that the improved fitness helps regulate their internal clocks.
Kneuer points out that exercise can make you more tired, which tends to help his clients who have trouble sleeping get to sleep.
Get up and move
The very word exercise intimidates some; it’s simply about moving more. “You can start off small with 10 minutes here and there, on your break for example, and build it up from there,” Benca says. “Increase your activity level. For example, take the stairs, not the elevator. We become overweight and depressed sitting at desks all day.”
“Set reasonable, small goals to start out with,” says Kneuer. “Don’t try for five days a week if you never exercised ever. Start off with two days. You can start off with a 30-minute walk and then accomplish more and more,” says Kneuer. He adds, “The initial movement is tough. An object at rest wants to stay at rest.”
“Schedule your workout as if it’s an appointment,” says Kneuer. He points out that this appointment will pay off in sounder sleep, as well as improved self-esteem, a sense of accomplishment, and more of a willingness to take on everyday challenges.
Morning movement is best
Many health and fitness professionals, including Kneuer, recommend exercising first thing in the morning, if possible, for several reasons:
- Not many things can come up first thing in the morning that can interfere with your workout.
- Later in the day, many things can derail your workout.
- You don’t have to dread fitting in a workout all day.
- Waking up from a decent night’s sleep makes you inclined to work out
- You start off the day with a sense of accomplishment.
- Exercise releases endorphins, which put you in a good mood and full of energy to begin your day.
If you don’t have time to make it to the gym in the morning, Kneuer recommends a 15- to 30-minute body weight workout in your living room.
Early morning workouts don’t work for Maria. “I’m not a morning person, and I struggle with a mid-afternoon slump. That’s when I head to the gym. The boost of energy from a good workout can help me get through the rest of the day.”
Maria, who writes the amotherworld.com blog and is the author of Oh Baby! A Mom’s Self-Care Survival Guide for the First Year, times her workouts to boost her energy.
Currently, her workouts include lifting weights at the gym and Moksha yoga, or hot yoga, twice a week. “The poses are quite quick and use your own body weight as resistance. The meditative part is great for anxiety.”
But exercising much later in the day is not recommended. Evening exercise can interfere with sleep if it’s too close to bedtime and paired with caffeine.
As to how often exercise is needed to achieve a therapeutic effect, all three experts refer to what research recommends—four to five days a week for at least 30 minutes.
“The quality of your sleep reflects the quality of your waking activity during the day,” says Benca.
“The larger issue is optimizing your sleeping and waking existences. You should be active during the day and stimulated. To maintain your circadian rhythms, you should aim for a regular bedtime and wake time, regular timing of meals,” Benca says.
As far as increasing your activity during the day through exercise, Kneuer says, “anything is better than nothing. Everybody’s different. No two people have the same experience.”
He adds, “Find stuff you enjoy doing—kayaking, jogging through the woods, playing basketball or tennis, anything. Movement. Movement is key.”
Finding stuff to enjoy has become a way of life for Angie, who looks forward to her Zumba class every week. “One of my exercises every other Sunday morning is hiking. I also love how quiet it can be,” she says.
Read More: 7 Facts About Exercise & Sleep
Printed as “Sweat More, Sleep Better”, Summer 2018
via Esperanza – Hope To Cope
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