Health: How’s your rhythm?

If your circadian rhythm is disturbed, you will suffer from sleep disorders which can lead to depression

SLEEP sets in like a dance. The biological rhythm called circadian must first come into play and this is best when the light is dim. The rhythm produces a hormone called melatonin which slowly and surely, leads a person in a dance into the sleep wonderland.

The trigger point of the circadian rhythm is above the optic nerves, which relays information from the eye to the brain. However, for some people, the rhythm is impaired because of stress, anxiety, bad sleep hygiene, irregular working hours or depression, resulting in insomnia.

The inability to initiate sleep is usually due to a disrupted circadian rhythm, said the past president of the Asean Federation for Psychiatry and Mental Health, Prof Dr Mohamad Hussain Habil, one of the three doctors who spoke at the Servier Malaysia workshop on Circadian Rhythm And Depression in conjunction with the Mental Health Month, last month.

The inability to sleep can lead to depression though it can also be the other way around, said the doctor who added that depression is the fourth most serious ailment in the country, affecting some 10 per cent of the population, most of them over the age of 40. Among women, it is the most prevalent health problem. However, only 10 per cent of those depressed undergo treatment because of the stigma attached, he added.

“Most depressed persons are seen by primary care doctors rather than psychiatrists, and a majority are not diagnosed.”

Eighty two per cent of the depressed, he said, are never properly treated. The rest are merely given standard antidepressant medications, some of which do not help their condition. There are indications that many more young people are also affected.

The circadian rhythm is a biological clock that controls the physical, mental and behavioural patterns in a 24-hour cycle. When the rhythm does not work properly, brain waves, hormone production, cell regeneration and other biological activities are weakened and, over a period of time, can cause health problems especially depression, said Dr. Mohamad Hussain.

Between 10 and 35 per cent of the population suffer from some form of sleep disorder but few seek treatment, said Dr Ting Joe Hang, a consultant psychiatrist. Apart from insomnia, sleep disorders include sleep apnea, restless leg syndrome and narcolepsy, a disorder that causes severe daytime sleepiness.
Dr Ting said circadian rhythm sleep disorders are not always related to depression and are often misdiagnosed as insomnia or a psychiatric condition.

Regular transmeridian travel, working a shift job for prolonged period and delayed sleep phase syndrome can alter circadian rhythm and lead to depression.

Dr Ting said: “Most depressed patients have sleep problems but not everyone with a sleep problem is depressed.” The majority of those who suffer from depression are singles and divorced people, members of the lower income group, women and older people above the age of 60, he added.

Professor Dr Azhar Mohd Zain, consultant psychiatrist at the Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, said the symptoms of circadian rhythm disturbance include waking up early, feeling low in the morning, changes in sleep patterns, changes in temperature and hormonal activity.

Sleep is important as it has a restorative effect on both the physical and the mental processes and is an essential component of good mental and physical health as well as for optimal cognitive functioning.

Azhar said that in modern life, stress is a major contributor to depression and insomnia. It can be caused by a wide range of events ranging from traumatic life events like personal bereavement, marital conflict, major illnesses and financial failure.

Source: JOHN TIONG
chunghoo@nst.com.my