Sarah SteventonPsychotherapist & Anxiety Specialist
Warwick, Warwickshire, Harley Street, London w1

Depression and Insomnia. Elaine


Meeting Sarah changed my life !
Yes, it was as dramatic as that. Having suffered with stress induced insomnia for 10 years I was desperate. Prescribed sleeping tablets no longer worked and all " how to sleep " tips had been tried and failed.
After only one 90 minute session she succeeded in releasing me from what had literally been torture. I am forever indebted to Sarah and would wholeheartedly recommend anyone who like me simply wanted to sleep !
Along with sleep problems I suffered with Claustrophobia and a phobia of worms. Sarah has worked with me to a point where I'm feeling confident that I can deal with my fears in the future and am feeling generally calmer than ever before.Life is feeling good....

Insomnia and sleep problems

Insomnia can be triggered by a number of possible factors, including worry and stress, underlying health conditions, Stress and anxiety.

Some people develop insomnia after a stressful event, such as a bereavement, problems at work or financial difficulties.

The problem can continue long after the event has passed because they start to associate going to bed with being awake. This develops into an anxiety about sleep itself.

Having more general worries, for example about work, family or health, are also likely to keep you awake at night. These can cause your mind to start racing while you lie in bed, which can be made worse by also worrying about not being able to sleep.

You may struggle to get a good night’s sleep if you go to bed at inconsistent times, nap during the day, or don’t ‘wind down’ before going to bed.
A poor sleeping environment can also contribute to insomnia, for instance an uncomfortable bed, or a bedroom that’s too bright, noisy, hot or cold.

Lifestyle factors
Drinking alcohol before going to bed, and taking certain recreational drugs can affect your sleep, as can stimulants such as nicotine (found in cigarettes) and caffeine (found in tea, coffee and energy drinks). These should be avoided in the evenings.

Changes to your sleeping patterns can also contribute to insomnia, for example because of shift work or changing time zone after a long-haul flight (jet lag).

Mental health conditions
Underlying mental health problems can often affect a person’s sleeping patterns, including:
– mood disorders –such as depression or bipolar disorder
– anxiety disorders –such as generalised anxiety, panic disorder or post-traumatic stress disorder
– psychotic disorders –such as schizophrenia

Physical health conditions
Insomnia can also be caused by underlying physical conditions, including

– heart conditions – such as angina or heart failure
– respiratory conditions –such as chronic obstructive pulmonary disease (COPD) or asthma
– neurological conditions –such as Alzheimer’s disease or Parkinson’s disease
– hormonal problems – such as an overactive thyroid
– joint or muscle problems – such as arthritis
– problems with the genital or urinary organs –such as urinary incontinence or an enlarged prostate
– sleep disorders – such as such as snoring and sleep apnoea, restless legs syndrome, narcolepsy, night terrors and sleepwalking
– long-term pain


Some prescriptions or over-the-counter medications can cause insomnia as a side effect. These include:
– certain antidepressants
– epilepsy medicines
– medicines for high blood pressure, such as beta-blockers
– steroid medication
– non-steroidal anti-inflammatory drugs (NSAIDs)
– some medicines used to treat asthma, such as salbutamol, salmeterol and theophylline

Check the leaflet that comes with any medication you’re taking to see if insomnia or sleeping difficulties are listed as a possible side effect.
For medical advice visit:

Help for insomnia
Once any medical cause has been eliminated by your doctor, there are a number of therapies available to help dissolve your symptoms and restore restful sleep.

If you are looking for help for insomnia, please contact Sarah for an appointment.


People sink into a depressed mood when their innate physical or emotional needs are not being met and, instead of dealing with this situation, they begin to worry about it — in effect, misusing their imagination.

All depressed people worry.

This increases the amount of dreaming they do, upsetting the balance between slow-wave, recuperative sleep and dream sleep. Consequently they start to develop an imbalance between energy burning dream sleep and refreshing slow-wave sleep. Soon they start to wake up feeling tired and unmotivated.

Depressed and anxious people dream far more intensely than non-depressed people. This makes them worry even more as they feel that, "something is wrong with me".

Depression is a human vulnerability. Suppose we have a setback or suffer some traumatic event that interferes with getting our innate needs met. This arouses negative expectations in the autonomic nervous system — feelings of frustration, being 'stressed', anxious, angry, guilty etc. — but, instead of taking action to bring the arousal down, which is what the autonomic nervous system is designed to help us do, we start to worry even more, going over and over what's troubling us: 'Why did I lose that job?'…"Why do they treat me like this?"… 'What is going to happen to me?'… 'How am I going to pay my bills?' — on and on creating a mountain of negative expectations. This over-stimulates the autonomic arousal system which is why depression is such a strong emotion.

The resources which are available to help us as human beings, to operate in life, such as the ability to build rapport, empathise and connect with others. Along with Imagination, which is a resource: that can allow us to focus our attention away from our emotions in order to solve problems more objectively.

We have a conscious, rational mind that can question, analyse and develop the ability to 'know' — understand the world unconsciously through metaphorical pattern matching.

Central to all these abilities and functions, and in many ways perhaps paramount, is the dreaming brain which preserves the integrity of our genetic inheritance every night.

The role of dreaming is key to a full understanding of depression.

All strong emotions focus and lock attention and, with depression, attention stays focused on all the bad things that seem to be happening to us, whether real or illusory. Every little thing we worry about and do not resolve in the day is translated into a bad dream the next night.

All these worries have to be worked through in extended and intense periods of dream activity in REM sleep as the brain attempts to rebalance your arousal levels. - this upsets the relationship between slow wave sleep and REM sleep.

Extended dreaming is exhausting, not just because it deprives us of restful and restorative slow-wave sleep (that should make up three-quarters of our sleep time), but also because it stimulates the orientation response. This is a vital pathway in the brain that alerts us to interesting things in the day, generating motivation to act, but it can't do this so well if it has been over-used in dream-sleep the previous night.

So, the next morning we awake feeling terrible because we haven't really slept, and we find it much harder to get motivated to get up and do anything because the brain mechanism that generates that interest in life is exhausted as well. Exhaustion on waking and lack of motivation are features common to all depressed people. Because our normal sense that life is meaningful comes from the actions we take, when our motivation levels are low, life quickly comes to seem meaningless. The natural delight we take in being alive and doing things drains away.

Depression, of course, is a very powerful emotion, and incessant worrying about things that the person believes can't immediately be solved generates a huge number of unfulfilled negative expectations, every one of which gets added to the list and has to be deactivated in order to complete the autonomic nervous system's arousal/dearousal circuit.

This puts enormous pressure on the brain's dreaming process as it furiously fires off the orientation response, causing excessive autonomic arousal discharge in REM sleep, burning up energy and reducing the amount of recuperative slow wave sleep, leading, in turn, to physical exhaustion, loss of motivation to do things and subsequent depression.

So waking unrefreshed, and with no motivation, occurs because one's sleep pattern is unbalanced, which is physically exhausting due to the decreased amount of restorative slow-wave sleep, and mentally draining due to the increased firing of the orientation response (which normally fuels our daytime motivation and attention capacities, which is why depressed people find concentration so difficult) during dreaming. Motivation drains away, as if the brain's battery is flat when our orientation response is overused.

This also explains other symptoms, and why so many depressed people have nightmares! Not being able to fall asleep, for example, is the worry circuit — catastrophic thoughts going round and round in their heads, preventing them from doing the hemispherical switch that normally precedes falling asleep.

And waking up early is a sort of survival mechanism for the brain, a response to energy depletion in the glial cells, which are not getting enough sugar to compensate for the energy being used up by the excessive dreaming. When we lose motivational energy and cease to engage, meaning quickly drains away. Naturally enough, the additional distress this causes compounds the worrying, which further depresses mood.

Someone can become depressed following a traumatic experiences, we are able to dissolve the trauma, and these individuals usually recover quickly after that.

When you are locked into a cycle of negative thinking, this is exhausting. Using the latest therapy techniques to firstly deal with the negative loops, then helping you to re-programme your brain to stop the worrying and the depression will lift.

If you are feeling depressed, please get in touch and

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