Ketamine Therapy as a Promising Treatment for Insomnia and Sleep Disorders

A New Clinical Study Investigating the Effects of Ketamine on Sleep

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Objective:
The purpose of this study was to explore the impact of intravenous (IV) ketamine on sleep quality and circadian rhythm in depressed patients with treatment-resistant depression.
 
Method:
This observational study included twenty nine participants aged 19-64, with treatment-resistant depression, defined as a failure to respond to at least two prior antidepressant treatments. Participants underwent eight ketamine treatments involving infusions of 0.5mg-1.0mg/kg over 40 minutes for four weeks. Exclusion criteria included active psychotic symptoms, poorly controlled hypertension, and substance use disorders.
 
Results:

1. Improvements were observed in sleep quality, duration, and daytime dysfunction.
2. Positive changes were noted in circadian rhythm.
3. Reduction in depressive symptoms.‍

Conclusion:
This study is among the first to assess sleep outcomes in patients with treatment-resistant depression treated with IV ketamine. Overall, ketamine treatments demonstrated positive effects on sleep quality, circadian rhythm, and symptoms of depression.

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Further Research on Ketamine's Effectiveness for Sleep Disturbance Treatment

This systematic review included five studies on ketamine's effects on sleep disturbances in treatment-resistant depression, focusing on improvements in insomnia, nighttime restlessness, and early-morning waking. Findings indicate that ketamine not only enhances sleep quality but also contributes to reduced depression severity and increased chances of treatment response or remission. EEG brain wave analyses show that ketamine improves total sleep time, slow wave sleep, and REM sleep, with these changes potentially driving its rapid antidepressant effects.

Ketamine's benefits are linked to its action on the glutamatergic system, modulation of circadian rhythms, and neuroprotective effects. It blocks NMDA receptors on GABAergic interneurons, leading to a cascade that improves sleep quality and has potential implications for neurodegenerative diseases like Alzheimer's. Ketamine's impact on sleep in depressive disorders involves complex interactions with brain systems and circadian rhythms, offering promising therapeutic insights. However, further research is needed to clarify its mechanisms and optimize its clinical use.

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Tips for Getting Better sleep:

View sunlight

Exposure to sunlight, specifically in the morning and evening, helps to regulate the body's internal clock, synchronize it with the natural day-night cycle, and promote healthy sleep patterns.  Morning sunlight exposure aids in regulating hormone release, including cortisol, which boosts alertness and energy levels throughout the day. Additionally, early sunlight exposure postpones the start of melatonin production, preserving it for the evening when it promotes sleep.

Limit caffeine:

Enjoy your coffee, tea, or other sources of caffeine earlier in the day rather than later. Remember that caffeine has a half-life of approximately five hours, meaning that if you drink a standard cup of coffee with 100mg of caffeine at 5pm, about 50mg will still be in your system at 10pm!

Stick to a sleep schedule:

Try to go to bed and wake up at the same time every day, including weekends. Importantly, get out of bed at the same time regardless of how much or how little sleep you may have had. Although sometimes challenging, this helps regulate your body's internal clock and is likely to improve your sleep quality.

Create a wind down routine:

Develop a calming routine before bed to signal to your body that it's time to wind down. This could include activities like stretching, meditating, chatting with your partner, or taking a warm bath. Set aside work and other tasks for a period before your bedtime.

Make your bedroom comfortable:

Ensure that your bedroom is conducive to sleep by keeping it cool, dark, and quiet. Invest in a comfortable mattress, pillows, blackout curtains, and/or an eye mask. Consider using soft earplugs, especially if you or your partner snores at night.

Use the bedroom for sleep:

Using the bedroom solely for sleep helps reinforce the association between the space and rest, making it easier to fall asleep. Engaging in other activities like eating or watching TV in the bedroom can disrupt this association and interfere with your natural sleep-wake cycle.

Limit exposure to screens:

Avoid screens (phones, tablets, computers, TVs) at least an hour before bedtime, as the blue light emitted can disrupt your sleep-wake cycle. Spend the last hour before bed in candlelight or low-light red lights.

Watch what you eat and drink:

Avoid heavy meals close to bedtime and limit liquids to reduce nighttime trips to the bathroom. Both alcohol and cannabis have been shown to decrease the quality of sleep.

Exercise regularly:

Engage in regular physical activity, but try to avoid vigorous exercise close to bedtime as it can be stimulating. Aim for exercise earlier in the day to promote better sleep.

Manage Stress:

Practice relaxation techniques such as deep breathing, meditation, or progressive muscle relaxation (e.g., Yoga Nidra) to help alleviate stress and promote relaxation before bed.

If you can't sleep, move:

Allow yourself 30-45 minutes of tossing and turning. If you are still unable to fall asleep, consider moving locations such as another bedroom or couch. Oftentimes, you will find it easier to fall asleep once you make a change in the environment.

Limit naps:

While short naps can be beneficial, avoid long naps during the day, especially in the late afternoon or evening, as they can interfere with nighttime sleep.

While pharmacological agents, such as ketamine, may offer benefits in improving sleep and reducing episodes of insomnia, it's advisable to first prioritize non-drug approaches, starting with improvements in sleep hygiene. Recent research has highlighted the potential advantages of ketamine therapy in enhancing sleep quality and regulating circadian rhythm. Certainly, more studies are necessary to deepen our understanding of the relationship between sleep and the rapid improvement of depression with ketamine. Nonetheless, it is reassuring to observe that these findings align with our clinical experiences in treating patients with depressive disorders and anxiety, many of whom also struggle with sleep disturbances.