Do Depressed People Need More Sleep? How To Do Wake Therapy

– Do depressed people need to sleep more? That’s what I’m gonna
be talking about today. I’m Dr. Tracey Marks, a
psychiatrist, and this channel is about mental health
education and self improvement. If you don’t wanna miss an episode, click subscribe and the notification bell. Today’s topic is based on a
viewer question from Judith, and she says, Hi Dr. Marks! How much extra rest does
someone with depression need to get better compared to
someone who’s completely healthy? Is any extra rest actually
needed to get better? If so, how do we know how much
is too much and vice versa? Thanks for your question Judith. In actuality people who are depressed do not need extra rest. Depression can make you
feel more tired and sleepy, giving you the feeling
that you need more sleep because you’re not well, but
sleeping 10 hours or more is considered hypersomnia
or too much sleep. And it doesn’t help you get any better. It’s actually a symptom
of your depression. In fact, sleep deprivation is
a treatment for depression, and it’s called wake therapy. We’ve known for decades that
if you keep a depressed person awake for 24 hours,
their symptoms resolve. But the problem is, the
improvement doesn’t last very long. It may last a day or two, or the symptoms can return as soon as you get sleep. So the next level of research looked at how to get
the improvement to last. And here’s what they came up with. Researchers found that you
can prolong the antidepressant effect of sleep deprivation
to last weeks or even months by combining the staying awake part with bright light therapy. Why does this happen? Your circadian rhythm is responsible for controlling certain body processes like your body temperature,
your sleep wake cycle, your hormone secretion, and
even neurotransmitter secretion. The neurotransmitter serotonin
affects your emotional state. The suprachiasmatic nucleus
is what controls this rhythm, and you can think of it as the
pacemaker of your body clock. This nucleus also has high concentrations of serotonin and melatonin receptors. So, when your rhythm is off, not only does it affect your sleep, but is also affects your body systems, including your neurotransmitter secretion. So wake therapy, which is
a form of chronotherapy, we call it, serves to
reset your body clock, similar to doing a hard
reboot on your computer when it starts acting up. Here’s how wake therapy
works, and this is based on a protocol used in a 2014 study
by Benedetti and colleagues. And I’ll have a guide for you
to download on how to do this. Wake therapy is administered
in one week blocks. And you have alternating periods of staying awake for 36 hours at a time. So for example, let’s
say Monday is day one. On Monday morning at 7:00am, you use bright light
therapy for thirty minutes. Then you’ll stay awake
all day and all night. On Tuesday you use bright light therapy at 3:00am in the morning
for another thirty minutes. This will give you some energy to stay awake for the rest of the day. And then you’ll remain awake
all day Tuesday until 7:00pm. You start preparing for bed
around between 7:00 and 8:00pm. Set your alarm so that you don’t sleep past 7:00am on Wednesday, and
that’s one complete cycle. You’ll complete this cycle two more times. Then on the the seventh day, you wake up at your desired time, but it should be in the morning
and not in the afternoon, and you go to bed at your desired bedtime. For the second week, you continue to use the bright light therapy in the mornings within 30 minutes of waking up. Did you get all that? No worries, see the
link in the description to download the guide on how to do this. How can you stay up? You start by doing things
that keep you active, like walking about, talking to people, if you know people up this time of night, or even cooking a meal. You can take wake promoting agents, like caffeine or Provigil,
which requires a prescription. If you’re on antidepressant medication, you would continue your medication. If you start to drift or feel very draggy, try splashing cold water on your face and hands for a refresher. The peak time for you to get sleepy is between around 3:00 and 4:00am, and that’s why the protocol suggests that you do the light
therapy at this time. But you can also plan
to be actively engaged at something between 3:00 and 4:00am. That wouldn’t be the time to plan to watch a movie or read a book. This therapy has been used for both unipolar and bipolar depression. Although with bipolar depression, the studies used lithium therapy along with the sleep
deprivation and light therapy. But if at anytime during the therapy you start showing signs of mania, like racing thoughts,
impulsivity, or irritability, you should stop the therapy
and call your doctor. The early manic symptoms may resolve as soon as you stop doing the therapy, or you may need to get an
adjustment on your mood stabilizer to get the mania to settle down. Although there’s been
quite a bit of research on chronotherapy and depression
and bipolar disorder, it’s still not widely used. As you can see, it takes a
lot of effort and discipline, and it probably works best for someone with mild to moderate symptoms. The person who’s severely depressed and barely able to get out of bed may not be able to carry this
out without a lot of help. Also, sometimes when people get depressed, and they sleep 10 to 12 hours a day, and they feel extremely
tired when they’re awake, and some people can even feel
like their limbs are heavy. If this is you, I would
imagine this kind of therapy would be a huge undertaking. But it’s still a good treatment, but there are some practical barriers that you have to get
past to make this work. Another obstacle is the
need to allow for 30 minutes in front of the light in the mornings. That would be in that second week. If you tend to get up just in
enough time to get to work, this will take some adjusting to factor in an extra 30 minutes to sit
idle in front of a light. So that’s wake therapy. I have links to some light
boxes in the description. Share this video with someone
who you think could benefit. And leave me a comment too,
I like hearing from you. See you next time. (upbeat music) ♪ I am what I am today ♪ ♪ ‘Cause I did it my way ♪ ♪ Nothin ya’ll could say ♪ ♪ In this life or the next one ♪

90 comments

  1. This a helpful video. Being a depressed person can make you feel very very very fatigued. You sleep better during the day than at night… well as for me I did. Depressed individuals DO NOT need more sleep , in fact sleeping more makes you feel more depressed and tired. The body needs energetic foods to start with to kick into gear the sluggish behavior. To make you feel like doing things. There's always a way to cope with depression. But sleeping too much actually makes it worse.

  2. Wow Dr. Tracey. This video help me to understand why I have the sleep this sleep cycle. I work two jobs and one I get off at 215 sometimes at 3 am. The morning job start time is 8:30 am. I purchased a light that slowly give bright light as if the sun was riding. I put this over my bed. I felt different and I also alternate my days to go home and sleep and I felt energized. When I stop using the light I was more tired. I had no idea there could be a connection between the both. I also take seroquil for sleep. I have gained 40 pounds since being on the meds. I asked my doctor if it will be ok that I did not take it everyday. Without giving too much info. There is a medicine adjustment. And I do feel better. But I feel better when working the two jobs alternating the night time job off every other night. To clarify. One of my jobs require I be there everyday. Which I am a special education assistant. And the night job I am a Longshorewoman women. I know two extreme. I did just recently let the school job go full time. So wow I know this was a lot. Your video really put some thing in perspective. But I am working with all my tools as things come up. And listening to my body. Without being obsessed but being mindful at their moment one day at a time.

  3. Very interesting! I've noticed that when I've had bad periods, just staying up all night and create things have had that reset effect.

    It's so cool to see your videos get better over time as you relax in front of the camera and put more personality into it. They are always informative, but this one had an extra nice flow I think.

  4. woah this was very interesting. i have a question about antidepressants. i’ve been doing research about them bc i’m considering starting one again. and i’ve heard that psychiatrists don’t truly know how antidepressants work and there is a debate as to whether depression is a chemical imbalance. what are your thoughts?

  5. Please suggest IDEA to get good ,sound sleep … also I always have dreams which makes me feel drowsy next morning …kindly suggest something to avoid dreams

  6. Love that you shared this and the video! These types of videos bring awareness that is needed so much and they make a difference! Found inspiration here for my channel and vids! All the support!

  7. I was really eager to try this after I read about it in the AJP and AMAJ last summer when I was going through a very tough bout of severe depression but my psychiatrist wasn't too psyched about me trying it out. She said it was against the best practice principles of achieving a healthy sleep schedule and balanced lifestyle. I was already quite insomniac and would stay up for 36-48h at least twice a week at the time (and walking A LOT at night) so maybe that's why she didn't think it would help. What do you think?

  8. For those looking for a good light. Here are two that I use. I still plan to do a video reviewing these for more details.
    Delonix Light box https://amzn.to/2H3Esjb
    Carex Daylight https://amzn.to/2Sy6zcg
    I like the Delonix better, but it's smaller. These are amazon affiliate links. Any proceeds I receive go to support producing these videos Thanks.

  9. Although I love the video.. it’s not what sticks out to me at the moment as much as the Hypochondriasis video.. I waited all week to see what would be next and I guess I was hoping for more on that topic ! I watch that video repeatedly to see what I could have missed that will help me to just be normal again! I wake up without even trying to… doing body checks (temp, blood sugar, feeling for masses , bp etc.!! I’m so drained it’s unreal! I cry in panic and fear! I’m so afraid it will lead to depression for me because this won’t stop! One minute and a very quick one… I tell myself I’m ok.. then I instantly get a body sensation and I’m back at it!! WHATS HAPPENED TO ME

  10. That's very interresting.

    I stopped taking clonazepam for a month, and i had severe withdrawal symptoms. One of them was that i couldn't sleep for a month. Not at night and not during the day. Nothing. When i tried to sleep i had so many bad and weird sensations. All kind of shakes and seeing and hearing things.

    Anyway, even though i felt really bad physicaly and trying to sleep was a nightmare- i actually felt much more awake, had much more energy, felt much less depressed. I started doing lots of things… but in the end i almost collapsed a few times, the symptoms were hell, and my doctor felt like i'm starting to get mania (which ive never had before). And so i got back to taking the drug…

  11. Do you have any comments on what alpha-intrusions are? I think they occur during non-REM sleep, but I don't recall much about what they mean. My sleep study was a couple years ago so my memory is a bit fuzzy on the matter. I remember they are associated with major depression and possibly fibromyalgia.

  12. Hey! I wanted to say thanks so much for your videos👏👏 they are so helpful!😊 thanks so much you are amazing!😘

  13. Thanks so much for addressing this. My sleep has been a struggle for me since I started anti depressant medication. I’m not sure I’m up to doing this therapy lol, but at least I know now that there’s brain chemistry involved and it’s not a failure of mine. Will definitely try the light therapy in the morning, though

  14. but ma'am what if someone exhibits insomniac and hypersomniac symptoms during intervals, as in unipolar depression?

  15. Can u guide me regarding hypochondriasis and it's treatment? My best friend is suffering from it and I m completely clueless… Kindly guide

  16. When I've had this and slept 10 hrs. And I was on a Trazodone antidepressant for 17yrs for sleep and anxiety, now I'm not on any medication and I'm sleeping 8hrs. And up at 8am. Great!

  17. I've tried staying awake for 24 hours straight. It actually helped my depression, though only temporarily. It was pretty bad again the next day.

  18. For 25yrs I slept 12hrs a day & awake for 12hrs now in 1996 I was diagnosed with bipolar disorder 1997 it changed to bipolar type 2 but social security has it down as bipolar disorder then last year some doctor at Sheppard Pratt in Baltimore said I had bipolar type 3 I don't believe that not one bit now doctor can you explain to me what unbipolar is? Is this in the DSM-5?

  19. This is interesting. I suffer from a continual mild depression and this must be why I always feel better when I have insomnia for a day or two. Although if I go to many nights with little sleep I become extremely anxious.

  20. This is very interesting. I have Bi Polar 2 and my try this, but will try when my brain is less foggy and I can understand better. Thankyou

  21. Thank you so much for taking the time to record this video! I just discovered you and can’t wait to explore more of your videos re mental health. 💜

  22. Hi Dr Marks! Love u videos as you know and how you cover so many different things for us all! This wouldn't work for me as I have depression, anxiety and insomnia and take meds for all 3 but I like the idea. I know for my self I have to stay busy at all times if not my anxiety takes over! I m exhausted all the time but I have to stay busy to survive.. thank you as always for being so helpful!!

  23. Wow, perfect timing! Thank you! I've been sleeping too much lately and I'm getting more and more tired by the day.

  24. Hey Dr. Marks, could you talk about the difference between suicidality and suicidal ideation. I've found it hard to explain to others that my ideation is a normal reaction for the brain when one is depressed, and that just because you think about it, doesn't mean you're prone to do it.

  25. ♀Hello ~ Tracey ~ 😏 Very astute and enlightening as expected from one such as yourself.When you share your doctoral expertise I am teleported to another realm of existence♂🌺.

  26. I’m so glad to see someone i can identify with covering mental issues I face daily. The way you explain everything is so accurate ❤️

  27. My sister has chronic depression and she has a horrible sleep cycle. Passing along this info. She can be awake for like two days then she will sleep during the day and is up at night .

  28. Dr Marks
    We like hearing from you too. I’ve never heard of this before and I don’t know why anybody would want to do this type of schedule I may try it someday if I become really bored but with the kids I think I’ll stick to my regular sleep schedule 11:30 PM to 9 AM . I’ll tell you one thing if I didn’t take all the drugs that I’m on my medications legal drugs for you YouTube or’s I would not sleep at all I need to be sedated I’m not sure why?. 🙂 these full spectrum lights that you’re talking about are very expensive have you ever check that out? I was looking into them years ago but he ended up with a 7 foot professional tanning bed from a tanning salon I like it but we haven’t used it in a while just too cold on the first floor. Have you done a video on seasonal affective disorder ?
    General repair

  29. I'm really glad I stumbled upon this channel; very interesting and helpful. I'd like to ask about your opinion on using EMDR therapy for treating anxiety and depression.

  30. Hi, doctor … I am taking paraxetin 25 mg for depression . What time of the day I should take it ?? Also I have problem of overthinking early in the morning even after getting good night sleep ,what should I take to or do to control it ?? I took pregabalin 25 mg for this & it helps … should I continue it & what dose ??

  31. What do you think of triple tharaphy. Wake theraphy, light theraphy and sleep phase advance pheraphy. The protocal you gave me does not mention about sleep phase advance theraphy. And what do you think about lithium. Do you think it really affect circadian rhythm? And what about lamictal as well?

  32. Wow i just found your videos.
    I want to be mentally strong and stable.
    Thank you for your videos
    The more aware i can be and understand the easier it is for me

  33. I find sleeping makes me feel better when I wake up. Say if I go to sleep at 1:15 p.m and wake up at 3:58 p.m.

  34. Hi Doctor Tracy Marks,
    I appreciate the info i get from your videos and from my personal experience have found it to be reliable.
    I would like to know from you if Bipolar people who are on medication such as Sodium Valproate and Risperdal/Risperidone give birth to healthy babies, i know that Sodium Valproate is not good for babies, is there any alternative treatment a person with bipolar 1 can go on if they are happily married and would like to fall pregnant? Or would you rather advise that they avoid falling pregnant for the safety of themselves and their babies, in other words would you consider it a high risk to fall pregnant if you are bipolar 1 and are highly dependent on medication?
    Anticipating your well informed response 🙂

  35. I’ve just been diagnosed with severe depression and starting to take medication for it. I’ve been undiagnosed for a few years, before I used to sleep 10-15 hours a day some days (still feeling sluggish when waking up). when my anxiety was introduced and got worse I would have 5 hours sleep and yet again feel terrible throughout the day but my mind was racing 24/7 which stopped me from sleeping. But, since being on anti depressants I’ve been sleeping 12+ hours again and I’m finding it harder and harder to stay awake (I also get dizzy and my appetite has gone completely)

    Is this normal?

    These videos are really informative and so helpful, thank you Dr.

  36. Hi Dr. Marks how are you..
    My girlfriend was diagnosed in October 2018 with depression by her doctor and was put on antidepressants. Before being diagnosed at the end of two weeks she would become irritable and snap, then her irritability would occur after every week, we saw an improvement immediately after she started taking the medication but after these 5 months she has started becoming irritable and snapping again every week. She had seen her doctor and increased the dose of the medication.
    Do you think she should be seen an assessed by a psychiatrist and can you shed some light on why this pattern of irritability is happening?

  37. FASCINATING. I've never heard of this application of light therapy. I've heard of light therapy for seasonal depression disorder, but nothing else. I even have a lightbox with full spectrum bulb, but I use it in late December, January and February when the daylight is short and nights are long (also for 20-30 minutes upon waking).

    Thank you so much! I think I'm starting to nerd-out on your videos. lol I get a little giddy when I learn something really new to me. {SUBSCRIBED}

  38. I have read this should be done in controlled conditions and with support. I will try doing this thought, as I am desperate for any kind of improvement. I usually sleep 16 hours per day and am severly depressed.

  39. This sleep remedy “Fαnvοkα Fawam” (Google it) has not just stopped me from purchasing numerous medicinal drugs but also helped me gain a superb night rest right after Few months of nightly insomnia episode. Prior to all these, I could simply obtain 3 or 4 hours of excellent rest. Yet soon after using the program, I was able to get Seven straight excellent resting hours. A year had passed, I could tell you that in many years these latest good sleep are the best I have. .

  40. Holy guacamole! If you stay up 24 hours that can help your depression?
    It's funny because I already kind of knew that, but I didn't realize that I knew it.
    Does that make any sense?I've already been doing wake therapy(obviously my own version of it) now and then for years but I didn't realize why I was doing it? I have to be very careful with it, I can easily fall into hypomania. Wow this is blowing me away right now. I've been staying awake all day and night now and again for years to purposely help my depression and make me feel more awake, I never knew why I did it until just now.
    I'm really starting to like this channel.
    I'm going to talk to my psychologist about this tomorrow, but I already know that she's going to tell me not to do it. My antidepressant mood stabilizers and anti-anxiety medications are working pretty good right now.

  41. Is it bad if you do this often? I reset my sleep cycle this way frequently, as sometimes I just can't sleep until it's daytime, then sleep through my important stuff 🙁 . I was afraid that staying up all night until next bedtime could trigger bipolar disorder (it runs in my family) but I do normally manage to sleep on the second night, just sometimes have to take a sleeping pill to relax.

  42. I might add, I do walk around like a zombie all day on the day I skip a night of sleep to reset :/ so hoping this means I'm not bipolar since I don't have more energy.

  43. I suffer with hyposomnia.i can sleep 12 to 14,even all day only waking to eat,drink and go toilet.evrn when I'm.not depressed I shut of from thinking and go to sleep so I dont have to worry. I love sleeping…I know it's not great to do it so much.

  44. Thats weird I've suffered from deppression for years and insomnia one time i almost went without sleep for a week from overthinking and over worrying for me sleep helps though

  45. For the past couple of weeks I’m finding myself suffering from hypersomnia, but only at home. I am fine at work, but crash immediate after getting home and on the weekends. I’m sleeping 10-12 hours a night and I have that feeling of my limbs being heavy. This is definitely something that is too much of an undertaking right now. Is there anything I can do to get from where I am now to being able to try this. I can’t seem to stay awake for more than a couple of hours without needing a nap on my days off.

  46. I doubt I could force myself to stay awake for any extended period. Is it still useful to try forcing wakefulness for a normal amount? As in, sleeping 7/8hrs then using light therapy?
    I have overslept for 20ish years. I know I need to commit to this, but really don't know if I could do it.

  47. Very interesting 👌. I'd love to hear you do something on depression and addiction/self medication Dr. Marks. Maybe a series? For the individual and their loved ones?

  48. Dr. Marks I like the way you explain stuff so thoroughly and you try to come up with plans to help people without it always big 5 more pills

  49. I have tried this in the past, but I only did it for 2 days. Very, very hard, but worth the day without depression. Glad to hear this can extend the benefits. My horrible depression peaks at between 11am and 2 pm. Crying hard sometimes helps I think because of the endorphins that are released when that happens thank goodness. I've given myself the Hamilton rating scale during the hardest part of the day and then at night. It's unbelievable how I can feel normal at night and horrific during the middle of the day. I've read a ton of articles about circadian rhythm core body temperature Etc. To get that one day with no depression after sleep deprivation is like heaven on Earth. I'm going to try it and I sure hope it works. I believe I knocked my circadian rhythm out of alignment from being prescribed benzodiazepines long-term as well as entering menopause.

  50. Hi Dr. Tracey, I'm curious about doing wake therapy when having to drive to work or anywhere during those 36 hours. I've read studies that indicate that going without sleep is like driving over the limit. What are your thoughts on that ?

  51. I failed to consider my sleep problems significantly before mainly because it only happens occasionally. Not until Five years later in which it has become the worst dilemma. It is already a good sleep for me if I am able to sleep at night for 3 hours. Usually, I couldn’t make myself to sleep all night long. I applied “Fαnvοkα Fawam” (Google it). On the spot, only just on that moment only, I experienced great results. After having a few days of pursuing the guidebook, I managed to get 4-7 hours of excellent sleep. My sleep gets even better day after day.. .

  52. I'm amazed to hear people with depression complaining about sleeping too much! With my depression Im considered extremely lucky if I get 5 hours of sleep (and that's with Xanax too)

  53. That sounds scary. I'm surprised you are mentioning this because isn't it dangerous if not done correctly?

  54. I get easily tired and sleepy but I'm not sure if is because I have depression or from my insomnia the weird thing is I can sleep easily In the afternoon but at night is impossible for me to sleep until is 3 or 4am even when I don't take a nap in the afternoon.

    This has been happening since I was in my late teens and im now 28 years old.

    Is this due to depression or the meds I take?

  55. What if you work at night? Im bipolar 1 and ive been extremely depressed, longer than ive ever been. Im going absolutely crazy and i want to try this but my schedule messes with this, and working for the VA, i don't have an option to switch shifts, also… Can sunlight be used for the light therapy aspect?

  56. My problem is barely enough sleep, a snoring spouse and physical disabilities. I don't suffer depression but barely a few hrs. of sleep a night is making me fell so severely sick and now it's depressing for me. I'm so alone.

  57. Dr Marks I went to click on the link and it took me to the web page I put in my first name and email address and it wanted me to subscribe to them I don't want to subscribe I just want to download program that you said wr could download to do that , I don't have to subscribe to all their stuff I don't want that!

  58. So all of my sleep problems were because of my depression? I still sleep for 14-17 hours a day, it’s not really a good thing I know but I just don’t know why I wouldn’t bother waking up. Thank you.

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