Riemann Dieter, Voderholzer Ulrich, Berger Mathias
Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Germany.
Neuropsychobiology. 2002;45 Suppl 1:7-12. doi: 10.1159/000049255.
In the last 30 years, it has been convincingly demonstrated that sleep in major depression is characterized by disturbances of sleep continuity, a reduction of slow wave sleep, a disinhibition of REM sleep including a shortening of REM latency (i.e. the time between sleep onset and the occurrence of the first REM period) and an increase in REM density. Furthermore, manipulations of the sleep-wake cycle like total or partial sleep deprivation or phase advance of the sleep period have been proven to be effective therapeutic strategies for patients with unipolar depression. The database concerning sleep and sleep-wake manipulations in bipolar disorder in comparison is not yet as extensive. Studies investigating sleep in bipolar depression suggest that during the depressed phase sleep shows the same stigmata as in unipolar depression. During the hypomanic or manic phase, sleep is even more curtailed, though subjectively not experienced as disturbing by the patients. REM sleep disinhibition is present as well. An important issue is the question, whether sleep-wake manipulations can also be applied in patients with bipolar depression. Work by others and our own studies indicate that sleep deprivation and a phase advance of the sleep period can be used to treat bipolar patients during the depressed phase. The risk of a switch into hypomania or mania does not seem to be more pronounced than the risk with typical pharmacological antidepressant treatment. For patients with mania, sleep deprivation is not an adequate treatment--in contrast, treatment strategies aiming at stabilizing a regular sleep-wake schedule are indicated.
在过去30年中，已有确凿证据表明，重度抑郁症患者的睡眠具有以下特征：睡眠连续性紊乱、慢波睡眠减少、快速眼动（REM）睡眠脱抑制，包括REM潜伏期缩短（即从入睡到首次出现REM期的时间）以及REM密度增加。此外，对睡眠-觉醒周期的调控，如完全或部分睡眠剥夺或睡眠时间提前，已被证明是治疗单相抑郁症患者的有效治疗策略。相比之下，关于双相情感障碍患者睡眠及睡眠-觉醒调控的数据库尚不丰富。对双相抑郁症患者睡眠的研究表明，在抑郁发作期，睡眠表现出与单相抑郁症相同的特征。在轻躁狂或躁狂发作期，睡眠时间甚至更短，尽管患者主观上并未感到困扰。REM睡眠脱抑制也同样存在。一个重要问题是，睡眠-觉醒调控是否也适用于双相抑郁症患者。他人的研究以及我们自己的研究表明，睡眠剥夺和睡眠时间提前可用于治疗双相情感障碍患者的抑郁发作期。与典型的药理学抗抑郁治疗相比，转为轻躁狂或躁狂发作的风险似乎并没有更显著。对于躁狂发作的患者，睡眠剥夺并非合适的治疗方法——相反，应采用旨在稳定规律睡眠-觉醒时间表的治疗策略。
