WHILE the link between unemployment and increased risk of depression is long-established, lack of sleep and erratic sleep patterns, the medical community warn, are detrimental to remaining healthy, both mentally and physically.
Being unemployed or doing shift work can commonly lead to sleep disruption, and doctors are seeing a significant increase in the number of these patients complaining of sleep issues.
The latest figures from the Central Statistics Office (CSO) show there are about 300,000 unemployed, with a seasonally adjusted unemployment rate of 14 per cent at the end of July.
HSE data shows more than 596,000 medical card and Drug Payment Scheme prescriptions were written for the insomnia drug Zopiclone in 2009, an increase of more than 100,000 prescriptions since 2004, while there were more than 559,000 prescriptions for anti-anxiety drug diazepam, which is often prescribed to those who have anxiety-related sleep issues.
Dr Ronan Boland, Irish Medical Organisation president and a GP in Cork city, says he has definitely noticed a significant increase in patients coming to him with stress and recession-related sleep issues in the past 2½ years.
“Sleep is often the first thing to go,” he says of newly unemployed or very stressed working patients, and he says confidence is a major part of the equation – as in, “if you don’t believe you will sleep, you won’t”.
“I encourage good sleep hygiene, avoiding alcohol and coffee late at night and going to bed at a reasonable time,” while he also prescribes “hypnotics” (sleep medication) for suitable patients on a short-term basis to try to help restore a normal sleeping pattern.
Prof Walter McNicholas, of the increasingly busy sleep clinic in St Vincent’s University Hospital, Dublin, agrees that stress and anxiety are well recognised features causing sleep disturbance.
“We do find that the patients coming to us with sleep apnoea are increasingly likely to report considerable sleep disturbance probably to a greater extent than in the past and it’s likely stress and anxiety are factors in that increase.”
Prof McNicholas maintains the HSE needs to provide more resources for sleep-disorder services and he has made numerous representations to the health authorities to encourage this.
“It is a very common problem, and it is not confined to those who can come along and pay for private healthcare. We do struggle to deal with the large number of patients who present to us, though we make determined efforts to treat all comers.”
The medical implications of stress-related sleep loss are becoming increasingly apparent to psychiatrists too.
Prof Patricia Casey, a psychiatrist with the Mater hospital, Dublin, says it is certainly her experience that people are talking more about being unemployed and not having a timetable to their day and staying up late, and running into difficulties with sleep.
“Certainly, people who are unemployed are sleeping less well because they are worried, and in some people who are vulnerable that can lead to depression.
“Sleep deprivation can actually trigger depression in someone who has that vulnerability and who may have had a prior episode of depression or who has a family history of depression.”
However, Prof Casey points out that most unemployed people who are “sad and gloomy” and say they are depressed don’t actually have a depressive illness but are “understandably and appropriately worried and concerned about their future”.
She points out that patients are saying how they are staying up later, and watching TV during the night, which also upsets the sleep cycle and is a depression risk factor.
Addiction to the internet and to online chat rooms has also been strongly linked to depression and sleep issues, while conflicting sleep schedules can place a significant strain on romantic relationships.
So what can be done to improve sleeping habits if you are unemployed or stressed about the recession?
Casey, like Dr Boland, believes that having a good routine and “sleep hygiene” is vital to getting a good night’s sleep.
“Being in a routine is extremely important and people who don’t have routine, perhaps because they are unemployed, unless they’re highly motivated, run the danger of doing unproductive things like staying in bed, doing nothing and sitting in front of the television rather than filling their time by going for walks, doing exercise, some housework, cooking or taking up a hobby,” she says.
“Having a sense of purpose for the day is very important in people getting through recent unemployment and coping in a positive way with worries about the recession.”
Case study: “Every day is the same. It’s horrible.”
Gavin (40), from Dublin, became unemployed in December 2008 and developed sleeping problems within six weeks.
“When you’re unemployed you don’t have a routine any more, and you can stay up until 4 or 5 in the morning as you’ve nothing to get up for, and the knock-on effect is it affects your family life terribly.
“I’ve got to the stage now where I mostly sleep about three hours a night, regardless of what I do. I feel like I’m going mental.”
Gavin says he has tried to keep busy and has been to his doctor and tried sleeping tablets, “which didn’t work”, and he was also referred to a sleep clinic but “to no avail”.
“An awful lot of people I know have the same issues and try to keep a set routine, but you talk to them a few months later and they still have problems.
Case study: 'How are the bills going to be paid?'
Pat (53) lives in rural west Clare and had a career as a guidance councillor until work dried up.
He describes his sleep problems as being a direct consequence of the current economic climate, leading to a “lethargy, a downturn in positive mental health. It’s been quite dramatic.
“Sleep is constantly broken throughout the night because you’re worrying. Where does my next job come from? What’s going to happen? How are the bills going to be paid? So it’s constantly on your mind.
“You go to sleep and it’s there in your subconscious. Even though you go to sleep it’s never a good sleep as the subconscious is working in a negative manner.”
Pat avoids watching TV late at night and tries listening to music and reading, while his doctor has suggested sleeping pills, but he is not prepared to go down that route yet despite being “drained” from his ongoing sleep problems.
“We are living in very unusual times . . . there doesn’t seem to be light at the end of the tunnel.”
Case study: ‘I just want to work’
Caroline (61) is from the US originally but has been in Ireland for a number of years. Having worked all her life in different jobs since the age of 13, she was made redundant last year from her job in a petrol station in west Cork having just taken on a mortgage.
“Work identifies you, particularly where I come from in the States, where you work two or three jobs. When you lose your work, you lose your identity.
“I know a lot of people don’t have a lot of hope right now, I’m not the only one, but I think when you reach a certain age a lot of the normal pathways are closed as far as emigration and so on are concerned.
“When you wake in the middle of the night and you’re feeling completely hopeless and you can’t see a way of changing your own situation you just don’t sleep . . . I just want to work.”
