Can staying awake beat depression? | Hacker News Reader

Can staying awake beat depression?

bbc.com

175 pointsIndrekR73 comments

As a "healthy" person, if I'm feeling overwhelmed or (situationally) depressed I find that I almost always feel better in the morning after a long sleep. It may recur as the day wears on, but sleep is extremely helpful. That makes sense if people with depression experience the opposite effect.

What I wonder is if those sleep-deprived individuals are experiencing a semi-manic state. I once had severe insomnia for a period of two weeks, and during that time I slept maybe 0-3 hours per night (typically zero). Early on I experienced manic effects. Toward the end, I felt like I was going completely nuts.

Sleep deprivation doesn’t make you feel like you’re going nuts, it makes you go nuts. Hallucinations, paranoia, agitation, transient hypnogogic states, memory loss, and eventually psychosis.

I’m glad that you pulled through.

Can you source? Specifically the "eventual psychosis" part?

I can, but it’s not just one source with one clear answer.

https://www.uni-bonn.de/Press-releases/sleep-deprivation-lea...

http://www.jneurosci.org/content/34/27/9134.short

Lighter reading:

https://www.scientificamerican.com/article/can-a-lack-of-sle...

https://www.theatlantic.com/health/archive/2013/12/how-sleep...

I should admit that there is still some debate around this issue, with key points being:

1. Do people who experience a psychotic break or symptoms during sleep deprivation represent a vulnerable group?

2. Sleep deprivation is often seen in the context of stimulants, from caffeine to methamphetamine, and they are known to potentially lead to psychosis when abused.

Personally I’m in the camp who believes that sleep deprivation is more than capable of leading to transient psychosis without preexisting risk factors. The problem is that long term sleep deprivstion studies can’t be done for ethical reasons, so it’s hard to know for sure. Ultimately it comes down to a combination of studying more limited sleep deprivation, and evidence gathered in the field over time. It is all highly suggestive though.

As a "not healthy" person, suffering from bouts of depression and heavy demotivation (especially during winter months), missing out on a night of sleep can put me in quite a positive mood.

But it's mostly a rather "hyped up" feeling, so it feels like the opposite extreme of the depressive phase.

When I was younger I'd regularly miss out on a night of sleep for exactly that reason, but as I get older I notice side-effect of this "treatment" of the physical kind. My teeth, which are already damaged by years of nightly gnashing, will start to hurt easily, with a higher chance of gum infections after I missed out on a night of sleep.

That's sadly something not mentioned at all in the BBC article, while my mind feels like it could be awake for days on end, my body doesn't really like that strain, especially as I get older.

Sounds like hypomania. Do you find yourself also chatty and more likely to take risks (spend money, do new things, etc.)?

See: https://en.wikipedia.org/wiki/Bipolar_II_disorder#Hypomanic_...

In my good moods, I'm very chatty, annoyingly chatty to some people, I like risks of the physical kind (bungee jumping/skydiving) but "social risks" are my bane, I've become very careful about being too open when meeting new people, needing time to open up until I open up "too much" for some.

As a kid, I was pretty much constantly very social, lively and chatty, without any of these apathetic down phases. I kinda trained myself into these due to negative social feedback to my "liveliness". By now I feel somewhat guilty/out of character when I'm "too happy", as I fear I might annoy my social surroundings.

I like doing new things, up to a point where I dread any routine, but at the same time, I notice how not having routine makes me anxious. It feels like a trade-off between "stable but uncreative routine" and "creative/volatile let's try everything".

As you might notice: I'm a bit all over the place, which doesn't make a diagnosis very easy, especially once it starts factoring in my, rather unconventional, upbringing in two different languages across three different countries.

That is exactly how I feel and I don't know how I FEEL about THAT. Welp...

If your still grinding your teeth a lot look into increasing your Magnesium intake (either through food or supliments). It completely eliminated my nightly grinding

Oh wow, I never thought about that! I tend to only take Magnesium supplements when I suffer from leg cramps, after working out too much.

I don't know how it would stop the grinding, but it, sure enough, sounds like it would help with the tension headaches I get when my neck muscles tense up/cramp up from all the grinding.

Thank you very much for suggesting this, if this actually stops the grinding too then you've just given me some serious increase in quality of life!

No problem and hope it helps! And yeah, the grinding, in my experience, is very closely related to muscle tension in general. From my research Mg and Zn tend to help by improving nerve function. Another helpful compound I've found is L-Theanine, especially if you drink coffee as I do. It's found in tea and seems to mitigate some of the stress/tension effects of Caffeine.

> My teeth, which are already damaged by years of nightly gnashing

My dentist made me a slimfit mouthguard for teeth grinding. It cost $500 but it's the best dental investment I ever made as it prevents further expensive damage to my teeth.

The first few nights I kept dreaming I had a piece of steak in my mouth though.

Yeah, I've gotten one of those as well for my upper jaw, sleeping way better since I got it.

It was also the dentist who unriddled particular nasty tension headaches I suffer from sometimes. All the nightly gnawing makes my neck muscles sometimes tense up, which leads to pains in the back of the neck radiating up to the back of the head.

Sadly that's not something the mouthguard helps with, so I will probably have to look for a solution to actually end the gnawing itself.

edit: This commenter [0] suggests Magnesium might help with the nightly teeth gnawing. A quick Google search, sure enough, seems to confirm the relation [1], awesome!

[0] https://news.ycombinator.com/item?id=16219942

[1] https://sleeptrack.io/2016/03/10/magnesium-rhodiola-bruxism/

It is still possible to get jaw problems with such a mouthguard though. As you still exert force on the mandibular joint, it may start to wear. The result is not very pleasant, to say the least.

https://en.wikipedia.org/wiki/Temporomandibular_joint_dysfun...

I suffer from depression pretty frequently. It gives me insomnia and unfortunately the lack of sleep never really helps me feel better.

I've seen a lot of people swear by a mixture of 2 tbsp. apple cider vinegar + 1 tbsp. honey mixed in a glass of hot water, drink before going to bed.

ASMR videos often help me calm down and fall asleep. Many different kinds out there, from soft whispers with positive reinforcement to simple stuff like rain. Just make sure to listen to the audio only, the blue light of most tablet/smartphone screens are really bad for trying to sleep (just like most monitors) because it's a light frequency that keeps the brain awake.

A good workout, like running, can lift the spirits and if you power your body out it often helps to calm down and fall asleep easier. Once you get into regular running it's also a great way to "declutter" your brain from whatever thoughts you might have collected during the day.

You could also try Indica Cannabis, which is usually a good sedative. Tho it can make depressions worse due to the sedative effect, so try with some caution.

Just as perspective. Any sport gets me to a high that ends with a crash. Just like with coffiene for example. Personally it makes things worse for me.

Also i usually recommend sativa and to stay away from indica. Sativa turns my depression into productivity, indica into a careless couch potato (which may is what you want tho)

Agreed on sativa for getting out of a low, but depending on strain they can make me too active and keep me awake till late in the night, but that's just me.

That's why I'm not sure they are that good of a choice for dealing with insomnia, a hybrid might be a good middle ground between light couchlock and lifting mood.

I've been running lately and I think it does make a bit of a difference. I'll have to try the apple cider vinegar + honey thing. Thanks for the advice.

> What I wonder is if those sleep-deprived individuals are experiencing a semi-manic state.

Yes, of course–in a certain way. It's not even much of a secret. While mania is itself a serious condition and should be avoided, it is fundamentally the same dimension as depression, only opposite. That's why you cannot be manic and depressed at the same time (Manic Depression, or Bipolar Disorder, is alternating between these states).

So it is really that simple: Depression + "semi-mania" = something approaching normalcy, for a limited time, with some cognitive impairment and just a bit too much nervousness.

I'm not sure there is much evidence that mania is in "the same dimension as depression, only opposite." And, in fact, mixed episodes can occur in those with bipolar disorder.

https://en.wikipedia.org/wiki/Mixed_affective_state

In someone with bipolar (I or II) sleep deprivation can indeed trigger a manic or hypomanic state. It will definitely raise your energy level but it may or may not make you happier. Additionally, there are tons of risks involved with going into those states intentionally. Mania ("full-blown bipolar") is particularly troublesome. Hypomanic states are much less extreme and are not necessarily a "problematic" part of ordinary life, if properly managed. However, both come along with things like increased risk taking and hypersexuality that can do things like screw up your finances and budgeting, destroy your relationships, or put you at greater risk of STDs or unintended pregnancies. On top of that there's a risk of developing a psychotic break, especially in conjunction with stress, which will typically result in hospitalization and being placed on psychiatric hold (if you're lucky).

And, as you note, periods of hypomania aren't long-term sustainable. Ultimately you need to learn how to cope with all of your moods and states.

I used to work with a brilliant women who really struggled with her manic episodes. She ended up going off her meds and on a weeklong manic state, ending with her walking straight through a plate glass window. She was window shopping and saw a coat she really liked, and she felt so powerful and was so nearly psychotic that she just walked straight through the window.

Cuts all over, dozens of stitches, yet amazingly no permanent injuries. She had to spend a couple of months in inpatient care to stabilize.

You make mania sound like "student holiday".

That's the thing, they can easily fit into the normal range of human behavior, even in bipolar I. Popculture puts out this image that bipolar people are bonkers crazy and that manic/hypomanic episodes are extremely noticeable, dramatic, and also obviously destructive. The reality is that, especially with bipolar II, things can be much more nuanced and subtle. Hypomania can manifest as being really interested in something, working on projects, and just being generally productive, maybe while staying up late a few nights in a row, or even just one. It can be as simple as progressing through a challenging but fun video game. And the risk taking and impulsiveness aspects might seem perfectly normal as well. It might just mean that you buy that thing on amazon that you've been putting off for a few months because you didn't really need it. That can make it hard for people to see their behavior as in any way "abnormal".

However, it's still incredibly important to understand whether or not you have these behavioral changes because they can often have a negative impact on your life if you don't understand them and develop coping skills for them. Your behavioral controls might be calibrated to who you are day to day rather than who you are when you're hypomanic. And that can lead to a lot of problems, spending too much money, taking irrational risks, etc. Being able to step back and realize that your feelings and impressions are being filtered by basically a mood altering state (just as you'd realize that you act differently when drunk and need to compensate for that) will help you navigate those behaviors better and be able to retain your ability to act rationally and in your own future best interests.

From personal experience I can confirm that it does feel manic sometimes. And occasionally that 'mania' kind of bootstrapped me back into feeling better, sometimes after months of 'not leaving the house and constant bombardment of negative self-directed thoughts' depression.

I've also personally experienced how a friend of mine was depressed for years, unemployed but still functional 'enough' to carry on, and what helped him 'snap out of it' was dragging him along on a trip/adventure. Whether it was the change in scenery, the change in behavior as a result, or perhaps just suddenly being too busy to dwell on things in the 'comfort' of home, or something else, I'm convinced this trip was the primary cause of his eventual (but still of course gradual) improvement.

While I think depression is so broad that any advice should not be taken as applicable to every depressed person, I do wish it was an option for more people with depression to try solutions like this. I completely understand that a therapist might not always have the luxury of suggesting this, but I wish we'd experiment a bit more with such approaches.

It also reminds me a bit of the whole rehab/relapse cycle that many people get stuck in. Sometimes I wonder if perhaps we should spend more energy thinking of ways to make the 'rehab' experience more permanent or at least long-term, and more integrated with or at least much less disconnected from 'real life'.

Of course maybe all these things are happening and I'm just not aware of it :). I really hope so.

I often don't go to a bed for a few more hours because I don't want to lose the optimistic productivity I can get. In the morning I generally feel like shit the first X hours. So I try to have fewer but longer sleeping sessions.

Which I realize only works because I am self employed.

As the article says, sleep deprivation has been used to treat depression for years. It has been used in inpatient care because it often has immediate short term effects and provides relief before the medication kicks in. The attempt to use chronotherapy as a long term treatment seems to be a new development.

The problem with depression is that it easily becomes "trashbin diagnosis" trough diagnosis of exclusion. Depression symptoms are common with many physical and mental problems. After other options are excluded, what is left is depression diagnosis.

It's possible that there are people suffering from depression where the root cause is malfunctioning circadian system. This research direction might end up with real cure for them. For others suffering from clinical depression chronotherapy might ease the symptoms and help with other treatments.

"once you go to sleep and catch up on those missed hours of sleep, you’ll have a 95% chance of relapse."

Unless you plan on spending the rest of your life severely sleep deprived, this doesn't seem like a great solution.

There's a danger in tabbing back to the comments page after the third paragraph. A few paragraphs lower, you would have seen this:

>So he and his colleagues turned to the scientific literature for ideas. A handful of American studies had suggested that lithium might prolong the effect of sleep deprivation, so they investigated that. They found that 65% of patients taking lithium showed a sustained response to sleep deprivation when assessed after three months, compared to just 10% of those not taking the drug.

wow that's so much better

Sustained sleep deprivation by lithium doesn’t sound any better than sleep deprivation by literal lack of sleep.

too bad lithium is such a hard drug to administer (it's psychoactive at doses very close to harmful doses, so usually there needs to be monitoring of the levels of lithium in the blood)

Long term use of lithium may also lead to kidney problems[1][2]. Monitoring of kidney function is also needed over a long time[3].

[1]https://www.ncbi.nlm.nih.gov/m/pubmed/25735990/

[2]https://www.sciencedirect.com/science/article/pii/S008525381...

[3]https://www.nhs.uk/conditions/bipolar-disorder/treatment/#li...

My mother has bipolar and takes lithium, it's scary stuff, the effective dose is so close to the toxicity dose that she has has to get her bloods checked every couple of weeks.

The stuff works for her though, well enough that she sometimes feels she doesn't need it because she's OK, historically things have gone bad when that happens.

Scary disease especially as they still unsure of the cause, we took part in a medical study 20ish years ago as they wanted siblings with a parent with bipolar so they could look for genetic causes/pre-dispositions.

Sounds like:

- induce mania by sleep deprivation

- take lithium to counteract the mania

5% not relapsing is actually more than I would have expected, and an astonishingly high success rate for an intervention as easy as sleep deprivation.

There's also the hope of a sort of "learning effect": Chronically depressed people sometimes don't even know/remember the experience of normal or positive mood. Even short-lived fixes could allow them to find a way to better cope with the disease.

staying awake for extended periods leads to a manic state. sure, it beats depression, but it's not necessarily a good way to persist either.

indeed, a blurb in the article mentions this, only once...

> Particularly for anyone who has bipolar disorder, there’s a risk of it triggering a switch into mania – although in his experience, the risk is smaller than that posed by taking antidepressants.

i don't think that's necessarily true only for those with bipolar disorder though, anyone sleep deprived long enough will end up in a manic state. perhaps some are more susceptible to it than others, or others may be more adept at navigating that headspace, than many.

i find some of my most productive hours are late at night, after i've been awake for a while... for one there are less distractions from everyone else, but primarily, it's much easier to get into that "zone" when the brain is tired. or maybe it's just a honing of focus over time, and sleep resets that ability and all the short-term memory that has been built up during the day. shrug

Interesting. For me being sleep deprived is the number one way to get depression. Especially if it goes on for a few days.

2-4am used to be pure hell for me.

Yep. After being on various prescribed drugs over the years i've settled on one. 25mg of Quetiapine at night when needed to knock myself out. Not being able to get to sleep - when i'm actually tired - and my brain spinning and running loops is not good for me.

Out of curiosity (not judging), is your doc okay with that and did they prescribe it that way? I've never heard of quetiapine being prescribed on an as-needed basis.

Yeah the prescription is PRN which means as needed i think. As well as helping me sleep it helps a bit taking the edge off some other issues. I've got a good relationship with my doc and he trusts my input. I've got good drug 'insight' apparently.

This seems like really bad advice on several fronts. For one, sleep deprivation has severe negative side-effects and is implicated in long term decline of overall health. For another, this is a big risk for people with bipolar, many of whom are unaware of that fact and may think they only have depression. Aggressive sleep deprivation can trigger a psychotic break in people who are susceptible, which is a shockingly high percentage of the population, especially along with other factors like stress and certain kinds of (very common) drug use. That's something you generally want to avoid at all costs.

> For another, this is a big risk for people with bipolar, many of whom are unaware of that fact and may think they only have depression.

Imho this is the biggest issue with this whole complex of psychology. I've struggled with mental issues for pretty much my whole life, in my teens, it was considered "clinical depression", a couple of years later it was supposedly something along the lines of ADHS or maybe I'm somewhere on the spectrum, another couple of years later it's either borderline or bipolar, depending what doctor you ask.

It's just a frustrating situation to be in because it feels like the diagnoses wholly depend on what doctor you ask, what mood they are in, how well you vibe with them on a personal level, or what literature they've read recently. In the end, it all feels like "professionals" who are mostly just wild-guessing around and on the basis of said wild-guess start suggesting some pretty drastic medication.

At this point, I've pretty much given up on getting a "solid diagnosis", it all just feels way too arbitrary which is not at all helpful to my self-perception and my trust in medical institutions.

Yep. When you start digging into mental health you realize that we're at a very primitive level of understanding of it, in almost every aspect. For one there's this sort of broken model of untainted perfect neurotypicality that is the gold standard and any deviation from that is a disease or a disorder. For another there's a very poor understanding of what different classes of symptoms actually represent in underlying physiology and how they are related. Many times things are described as being "comorbid" when in reality they are just different expressions of the same underlying biology or psychology. Also there's a huge role that culture, education, and so forth play into these things. In general I'd say the best tactic is to learn as much as you can yourself (while remembering to be honest with yourself) and pursue general purpose coping strategies across the board (for example, mindfulness based cognitive therapy).

> In general I'd say the best tactic is to learn as much as you can yourself (while remembering to be honest with yourself) and pursue general purpose coping strategies across the board (for example, mindfulness based cognitive therapy).

Yup, that's exactly what I've been doing for years now. I've read through quite a bit of stuff ranging from Freud, Jung, B.F. Skinner to Edward de Bono and countless others in addition to lots of Wikipedia surfing and study reading.

A rather common theme among a lot of them: Many of them went into studying psychology as an attempt to diagnose their own issues and often it feels more like reading philosophy rather than actual medical science.

I wonder if we will ever be able to articulate something like a "Grand Unified Theory of the mind"? Considering how much of this is subjective to the individual and atop of that the individual's brain physiology, it seems like an impossible task.

But then I see stuff like talks by Joscha Bach on C3 [0] [1] [2] and it's quite inspirational as it gives me hope that creating strong AI might actually help us understand what's going on under our own hoods a little bit better.

[0] https://www.youtube.com/watch?v=lKQ0yaEJjok

[1] https://www.youtube.com/watch?v=WRdJCFEqFTU

[2] https://www.youtube.com/watch?v=K5nJ5l6dl2s

I've felt that semi-manic state you're referencing when I haven't been sleeping. Several nights lately I've been in bed awake until 5:00 or so when I doze off (only to get up at 6 for work). In these situations, I've felt great considering my lack of sleep. In the long run, lack of sleep (for me) results in depression.

I'm probably not normal. I take three antidepressants and an anxiolytic.

Not depression, but I notice that I have less social anxiety when sleep deprived.

I notice this but with inhibition. I find I do different kinds of coding, more creative and less rigid, when I have less inhibition. Good sleep is good for rigid code, bad sleep is good for creative problem solving and inhibition. I tend to be better on the phone on <6 hours of sleep as well. I think getting a full night's sleep leads to my prefrontax cortex functioning properly, which I find makes me rigid and anxious with all the threads I follow and things I predict. Without a good sleep, that is significantly inhibited, making it easier to go with the flow, on a call or writing code.

What about people who have depression and get insomnia because of it?

It's all about circadian rhythm disruption, a key feature of many types of depression. This can result in both hypersomnia and hyposomnia.

Maybe this is natural defense mechanism? Body tries to alleviate symptoms of depression by sleep deprivation :)

Strange, I've always found that sleep deprivation decreases my ability to handle stress, increasing the effect of depression. Even now that I'm stable, it sends me into a blue funk the next day or the day after.

IME, not going to sleep causes depression.

This is my experience too (jet lag, staying up way too late, etc), but I would hesitate to call it "depression" out of respect for those who suffer from the real thing.

At least when I'm feeling this way I have the comfort of knowing that I'll feel much better after a good night's sleep.

Hmm what could people do while trying to stay awake? I know how about some light exercise dancing to some music you enjoy or even don't enjoy but rather go out just to learn about it.

Maybe there are other anti-depression techniques out there as well?

https://www.cnbc.com/2017/09/14/how-a-party-drug-could-becom...

I've often wonder what the world record for a human is. Are their competitions? Like can you be the best at staying awake for > 2 weeks?

The official record is only a bit over 11 days: https://en.wikipedia.org/wiki/Randy_Gardner_(record_holder)

> Randy Gardner (born August 7, 1949) is the holder of the scientifically documented record for the longest a human has intentionally gone without sleep not using stimulants of any kind. In 1964, Gardner, a high school student in San Diego, California, stayed awake for 264.4 hours (11 days 25 minutes).

https://en.wikipedia.org/wiki/Randy_Gardner_(record_holder)

The article mentions longer records but they aren't so well documented.

I wonder if there are longer records using drugs like modafinil; I know that the USAF used modafinil to offset losses to mental acuity for wakefulness on the order of 48 hours.

Randy Gardner was on the Hidden Brain podcast last November. It's a good listen with plenty of reasons to always try to get enough sleep.

https://www.npr.org/2017/11/06/562305141/eleven-days-without...

Sleep deprivation can have long-term cumulative effects. If you're not doing it for a good medical reason, it's probably a bad idea for your health.

It's not ideal. I can't speak from personal experience, but have a relevant anecdote.

My brother was in SIGOPS in the Canadian military, and they had to run combat and stealth field exercises during periods of sleep-deprivation over the period of days(++). He said by a few days in (I can't recall exactly) they were experiencing vivid, realistic audio-visual-tactile hallucinations that they regularly succumbed to believing.

Until he said he started seeing white rabbits bouncing all over an open field between him and passing enemy actors.

Beside any other negative health effects, I just don't think it would be sustainable. The world is weird enough.

Guinness doesn’t accept new record attempts because it’s too dangerous.

Also, anyone who does this under anything but lab conditions can’t be trusted. They’ll ignore/be unaware of many periods of microsleep which would invalidate any record attempt.

I seriously doubt any person with intact sleep regulation could go anywhere near eleven days without microsleep. Wikipedia is wrong in suggesting that was the case with Randy Garnder (Wikipedia is in general not a reliable source on sleep issues). There were at least strong signs of microsleeps before the fifth day (noted in the study[0]) and my guess is that occasional microsleeps would have happened earlier. They did not closely monitor for microsleep.

[0] Gulevich et al. Psychiatric and EEG Observations on a Case of Prolonged (264 Hours) Wakefulness http://dabamirror.sci-hub.mn/f1cafe0b11ce25fef6875f3c55c6652...

The true record for sleep deprevation may be held by someone with fatal familial insomnia, although it sounds like stage 1 sleep is at least sometimes possible with that condition so it might depend how you count that. Morvan's Syndrome is another one that can cause an extended lack of sleep.

https://en.wikipedia.org/wiki/Fatal_familial_insomnia

https://en.wikipedia.org/wiki/Morvan's_syndrome

A few people claim to have stayed awake for most of their life:

https://en.wikipedia.org/wiki/Th%C3%A1i_Ng%E1%BB%8Dc

https://en.wikipedia.org/wiki/Al_Herpin

I think they're lying, but it's worth mentioning!

I don't thing you'll find that many people willing to participate in this.

I personally went through 40 hours of sleep deprivation once(we were on a trip and our host "forgot" that we were booked - apparently he expected a bribe) and it was hell, especially since we were a group, because in these circumstances minor misunderstandings turn into major conflicts easily.

Yeah, except the effect only lasts past the next good night's sleep for 5% of patients.

And I can't speak for about anyone else, but having experienced moderate depression, I'd rather be depressed than chronically sleep deprived.

Not sleeping induces a state of mania - temporary frenzied relation. So if you're depressed, you'll temporarily feel better the next day, but the relapse comes soon after.

https://en.wikipedia.org/wiki/Wake_therapy

it works but not when it becomes routine IMO. pulling 1 or 2 all nighters in a row, gives kind of a once in a while snap-out of it effect. I have no proof other than this worked for me in practice only in the decade and half that I suffered from it.

Sleep deprivation increases serotonin and dopamine directly. Of course it helps with depression.

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