![]() They include shortened REM sleep latency, increased REM sleep time (especially in the first sleep cycle that is usually very short in healthy subjects), and increased REM sleep density. ![]() Alterations of REM sleep are the most prominent feature of sleep architecture in depressed subjects. It is expressed in sleep parameters as a reduced delta ratio (ratio between delta wave activity in the first and second sleep cycle). In healthy subjects, the highest delta wave activity in EEG can be observed in the first sleep cycle, whereas in depressed patients there is a frequent shift of delta activity from the first to the second sleep cycle. Furthermore, the distribution of deep sleep scored in PSG as sleep stage N3, also called delta or slow wave sleep (SWS), is altered in depressed patients. Sleep depth is substantially reduced in depressed patients. Early morning, awakening together with altered distribution of REM sleep is considered a biological marker of circadian rhythm disturbances in depression and is a characteristic biological marker of depression with melancholic features. Disrupted sleep continuity manifests as prolongation of sleep latency, increased number, and duration of awakenings from sleep expressed as increased wake after sleep onset (WASO) time, decreased sleep efficiency, and early morning awakenings. Patients with depression show abnormalities of sleep parameters across all three groups. Y-axis represents sleep stages: W- wake, R- REM sleep, N1 – stage 1 NREM sleep, N2 – stage 2 NREM sleep, N3 -stage 3 NREM sleep (slow wave sleep, deep sleep), and X-axis represents time and pages of sleep recording Sleep in depression is characterized by disturbances of sleep continuity (prolonged sleep latency, increased number and duration of awakenings from sleep, early morning awakening), reduction of deep (slow wave sleep), and disinhibition of REM sleep, with shortening of REM latency and prolongation of the first REM period. Graph (hypnogram) representing changes of sleep stages in the course of night in a depressed patient. The ratio of the intensity of rapid eye movements phasic activity (number and duration of rapid eye movements) to duration of REM sleep, e.g., can be expressed as number of rapid eye movements per minute of REM sleep. Total duration in minutes and as percentage relative to total sleep time of sleep stage REM. Reduced values are typically below 65 min in young and 50 min. The number of minutes from the onset of sleep to the onset of the first REM sleep period. The ratio of slow wave sleep in the first and second sleep cycle. The amount of stage N3 decreases with older age, normal values are around 10% for elderly and 20–25% for young subjects. Total duration in minutes and as percentage relative to total sleep time of sleep stage N3. The total time scored as awake occurring after the sleep onset. Normal values are typically above 90% in young and above 85% in elderly patients. The ratio of total sleep time to time in bed expressed as a percentage of time spent asleep during the recording period. In insomnia research as shortened sleep time are considered usually values below 6.5 h in young and below 6 h in elderly patients (these values are not applicable to short sleepers) ![]() This is equal to the time in bed less the awake time. The total time spent asleep during the sleep episode. Normal values are typically below 30 min in young and below 45 min in elderly patients. Time from start of the recording (“lights out”) to the onset of sleep. We also summarize recent data which has shaped our personal view on the use of antidepressants in treating insomnia in depressed and non-depressed subjects. The aim of this review article is to summarize the literature published in recent years on how antidepressants affect sleep, as an addition to our and previous reviews on this topic. Among the most common side effects of antidepressants and residual symptoms leading to incomplete remission from depression are those related to sleep. The most neglected pharmacological needs in the treatment of depression are the lack of early-onset response to the treatment, the moderate response and low remission rate to the first antidepressant trial, and side effects which frequently cause treatment non-compliance. Despite its frequent occurrence, high likelihood of a chronic course, negative impact on quality of life and ability to work, and strong association with an increased suicide risk, the available treatment options for depression are still not satisfactory for many patients. ![]() Depression is a severe and common mental disorder with 12-month prevalence as high as 3.2% in subjects without comorbid physical disease and 9.3 to 23.0% in subjects with chronic medical conditions. ![]()
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