Sleep and Mood Disorders
Sleep and mood form a two-way circuit: disrupted nights amplify negative affect and impulsivity; depression, bipolar states, and anxiety in turn fragment sleep architecture and circadian timing. Sleep and Mood Disorders unpacks this loop so teams can diagnose precisely and intervene where it counts. We start with sleep physiology—homeostatic pressure and circadian rhythm gates—and how they shift across adolescence, pregnancy, and late life. Assessment goes beyond “how many hours”: ask about timing, regularity, chronotype, naps, caffeine, alcohol, nicotine, stimulants, pain, and screen exposure; screen for insomnia, hypersomnia, parasomnias, RLS/PLMD, OSA, delayed sleep–wake phase, and social jetlag. Psychiatric mapping matters: major depression often shortens REM latency and increases early-morning awakening; bipolar patterns can begin with reduced need for sleep; PTSD brings nightmares and hyperarousal spikes; ADHD frequently includes delayed sleep phase and inconsistent routines. We review first-line behavioral treatments—stimulus control, sleep restriction, circadian anchoring, light timing, exercise, and digital CBT-I—and pair them with pharmacologic options staged to diagnosis and risk. Antidepressants and mood stabilizers are chosen for night effects (sedation, activation, REM influence, weight, RLS) and for interactions with OSA or movement disorders. For OSA, we emphasize motivational onboarding to PAP, mask fit, desensitization, and weight or mandibular options; for nightmares, we cover imagery rehearsal and α-adrenergic strategies. Shift work, caregiving, and travel demand tailored plans: anchor wake time, pre-shift naps, light management, melatonin timing, and safety protocols. Measurement-based care keeps it practical: 2–3 minute scales, sleep diaries, wearable summaries, and weekly “energy–function” checks. Equity threads run through access to DCBT-I, PAP supplies, and language-matched coaching. When teams align sleep timing, light, and medications, Sleep and Mood Disorders, the discoverability of a sleep psychiatry conference, and core science like circadian rhythm become everyday tools to lift mood, cognition, and safety.
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Shared sleep map
- List sensitivities (light, caffeine, late screens) and typical triggers for relapse.
- Translate goals into wake-time anchors, wind-down cues, and bedroom rules.
Primary therapeutic lane
- Choose digital or therapist-guided CBT-I as first line.
- Blend brief ACT/DBT skills for rumination and arousal spikes at bedtime.
Night safety and relapse guardrails
- Define steps for severe insomnia, nightmares, or hypomania warning signs.
- Create after-hours escalation, next-day check-ins, and medication hold rules.
Circadian alignment plan
- Set fixed wake time, morning light dose, and meal/exercise timing.
- Use timed melatonin or light avoidance to shift delayed phase.
Medication stewardship
- Select agents by night profiles; avoid activation near bedtime.
- Schedule dose moves with sleep diary review and side-effect checks.
Practice Gains You Can Deliver This Quarter
Normalize sleep timing
Anchor wake time and reduce weekend drift to steady mood.
Cut sleep latency
Stimulus control and sleep restriction shorten time-to-sleep.
Reduce nightmares
Imagery rehearsal plus α-adrenergic options lower reactivity.
Improve daytime energy
Morning light and activity scheduling boost activation safely.
Stabilize bipolar sleep
Early warning rules for reduced need for sleep prevent escalation.
Raise PAP adherence
Fit coaching and habit loops increase nightly hours.
Track what matters
Weekly function/safety checks show gains beyond hours slept.
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