Depression and sleep: Expert interview with Prof. Dr. Richter

27.01.2025

Prof. (TH Nuremberg) Dr. med. Kneginja Richter, MHBA, is an experienced specialist in psychiatry, psychotherapy and sleep medicine and heads the CuraMed Day Clinic Nuremberg. With her many years of experience and specialization in psychiatry, psychotherapy, sleep medicine and neurostimulation, she attaches particular importance to the holistic and innovative treatment of her patients. A central component of her work is the combination of proven psychotherapeutic methods with modern procedures such as repetitive transcranial magnetic stimulation (rTMS), which is particularly effective in treating depression and other mental illnesses.

With her additional Master of Health Business Administration (MHBA) degree, Prof. Dr. Kneginja Richter has expanded her medical expertise with business management skills, which makes her particularly qualified for managerial positions in the healthcare sector. At the day clinic, Prof. Dr. Richter and her interdisciplinary team offer a wide range of treatments tailored to the specific needs of patients. In addition to depression and anxiety disorders, this also includes the treatment of sleep disorders, tinnitus, panic disorders, obsessive-compulsive disorders, trauma-related disorders, chronic pain disorders and integrative treatment for burnout, chronic fatigue and chronic somatic illnesses with psychosomatic effects.

The day clinic offers the advantage of structured day treatment with a high density of psychotherapy with three individual sessions lasting 50 minutes per week, while patients can return to their familiar home environment in the evening. This concept promotes the transfer of the therapeutic approaches learned into everyday life and supports a sustainable, everyday recovery. Thanks to the modern equipment at the HighTech Center Nuremberg and the comprehensive diagnostic and therapeutic options, Prof. Richter can offer excellent care and personalized and individually tailored treatment planning.

The interdisciplinary and integrative approach of the CuraMed Day Clinic combines psychodynamic and behavioral medicine approaches with body-oriented therapies and equipment-based procedures to promote the well-being of patients holistically and open up long-term perspectives for their health. Prof. Richter and her team are committed to providing their patients with the best possible support in their recovery process and helping them to lead a stronger and more fulfilling life.

Many patients who suffer from sleep disorders in connection with depressive illnesses also come to the CuraMed day clinic. The editors of the Leading Medicine Guide were able to find out more about this in an interview with Prof. Dr. Richter.

Prof. (TH Nürnberg) Priv.-Doz. Dr. med. MHBA Kneginja Richter

Depression and sleep disorders are closely related health problems that often occur together and can reinforce each other. While depression is often accompanied by a deep psychological burden and feelings of hopelessness, listlessness and inner emptiness, sleep disorders impair recovery and lead to exhaustion and concentration problems. This connection poses a major challenge, as disturbed sleep quality can exacerbate depressive symptoms and, conversely, depressive moods can impair sleep.

Depression and sleep disorders are in a complex interaction that can mutually reinforce both disorders and worsen the course of the disease.

In depression, the sleep-wake rhythm is often disturbed, which manifests itself in various forms of sleep disorders: Problems falling asleep and staying asleep, early morning awakening or generally non-restorative sleep are among the typical symptoms. In many cases, the sleep architecture is altered, which means that the phases of deep sleep or the REM phase - in which most dreams take place and which is important for emotional processing - are shortened or interrupted. Such disturbed sleep, in turn, can intensify depressive symptoms and impair recovery, as it weakens the body's own mechanisms for regulating emotions.

"About 80% of people who suffer from depression have trouble falling asleep and staying asleep and suffer from chronic insomnia. This is characterized by the fact that those affected take a long time to fall asleep, wake up frequently after falling asleep and are very tired the next day. About 20% of people with depression, on the other hand, suffer from excessive sleep - women and younger people are more often affected by this", states Prof. Dr. Richter at the beginning of our conversation and describes the treatment options that are available after a detailed and individual anamnesis:

"We treat depression with high-frequency psychotherapy, which takes place in an individual setting three times a week and additionally in a group setting over a period of three to six weeks, and supplement this with antidepressants if necessary. If the treatment falls in the autumn and winter time, we additionally combine it with light therapy and support the process with neurostimulation, the so-called RTMS procedure. Repetitive Transcranial Magnetic Stimulation is a non-invasive neurological treatment method that uses magnetic pulses to stimulate certain areas of the brain. The goal is to improve the drive and mood of the patients. Patients who have developed a sleep disorder due to depression first receive a comprehensive sleep diagnosis. This is done with the help of a Smartwatch-like device that patients wear on their wrist for a week - a kind of 'to go' sleep lab. The patient can sleep in his own bed and then brings the device back for evaluation, so that the results can be communicated directly". In addition, mobile diagnostics is performed at home in the usual sleeping environment to diagnose sleep apnea, restless legs syndrome and other sleep disorders. The evaluation and discussion of the findings usually follow the very next day.

Serotonin plays a central role in the regulation of mood and sleep, with many depressed patients having reduced serotonin levels. These deviations can promote both depressive symptoms and sleep disorders, as serotonin has a direct influence on sleep architecture, especially the REM phase. Norepinephrine is also important for mood control, and dysregulation of this neurotransmitter can lead to listlessness, which negatively affects sleep. Dopamine, the neurotransmitter associated with reward mechanisms, can also affect sleep regulation, with reduced dopamine activity often observed in depression. In addition, cortisol, the stress hormone, plays a crucial role. Chronically elevated cortisol levels are common in depressed patients, and these stress reactions can significantly impair sleep quality, resulting in a vicious cycle of sleeplessness and increased depressive symptoms. The sleep architecture itself is altered in many depressed patients, which can manifest itself in earlier onset and more intense REM sleep as well as shortened deep sleep. These changes impair the ability to regulate emotions and negatively affect the quality of life.

"There are also patients who suffer from a chronic sleep disorder. We can treat these in the CuraMed Day Clinic Nuremberg without medication: The patient comes to us for consultation 4-6 times within the framework of a day clinic sleep program for two weeks and can keep a sleep diary. Based on the recorded data - when the patient went to bed, what he did during the day and how long he slept - we have all the necessary information for an individual sleep plan as well as for a cognitive therapy of insomnia. This therapy, which is also anchored in the guidelines, helps about 70% of patients. In addition, we offer patients a sleep school. If the therapy does not help sufficiently, a low-dose medication without risk of dependence can also be prescribed", explains Prof. Dr. Richter the success of the therapy option.

Sleep disorders are common harbingers of depression and can act as an early warning sign by often being among the first symptoms that occur in those affected.

The reciprocal relationship between sleep disorders and depression is based on various neurobiological mechanisms that regulate both mood and sleep. A central mechanism that explains the link between sleep and depression is the dysregulation of neurotransmitters such as serotonin, norepinephrine and dopamine. These neurotransmitters are critical for regulating mood and sleep-wake rhythm. People with depression often have an imbalance of these neurotransmitters, which negatively affects both sleep architecture and mood. The serotonin balance, in particular, plays an important role, as it regulates not only mood but also sleep. A lack of serotonin can lead to problems falling asleep and reduced sleep quality, which in turn can increase the risk of a depressive episode. These interactions are exacerbated by changes in the circadian rhythm, the biological 24-hour cycle that is regulated by light and darkness. Depressed patients may experience disruptions in this rhythm, leading to sleep problems and thus an exacerbation of depressive symptoms. Early detection of sleep disorders as an indicator of the risk of a depressive episode is crucial in order to be able to take preventive measures in time.

"Sleep disorders are often a harbinger of mental disorders and also of burnout. You can do a lot to prevent this. For patients who, for example, think too much before falling asleep, there are special techniques. When falling asleep, you should have beautiful, pleasant feelings and images in your head - then you usually fall asleep within 20 minutes. Improving sleep hygiene, which includes a regular sleep routine, creating an optimal sleeping environment, and avoiding stimulants such as caffeine and nicotine before bed, is essential. Consistent sleep hygiene can help shorten the time it takes to fall asleep and improve sleep quality. You shouldn't stay in bed too long if you can't sleep. A television in the bedroom is also rather counterproductive and is often used by traumatized people as a sleep aid because they then have the feeling of not being alone. In addition, the blue light of the TV suppresses the release of melatonin. Many people also watch TV while lying down, which falsely signals to the body that it is time to sleep. If you like to watch TV, you should therefore do it better while sitting. Alcohol should ideally be avoided altogether or at least two hours before bedtime, as it otherwise makes the body restless", advises Prof. Dr. Richter.

In addition, promoting stress management mechanisms plays a crucial role. Techniques such as mindfulness meditation, yoga or progressive muscle relaxation can not only help improve sleep quality, but also increase overall emotional well-being. Regular physical activity is another key factor that not only promotes sleep but also reduces stress and lifts mood. Moderate exercise, such as walking or swimming, can help improve sleep quality and reduce depressive symptoms.

Hypersomnia is a sleep disorder characterized by excessive daytime sleepiness and a persistent need for sleep.

"The causes can be varied and range from primary sleep disorders such as idiopathic hypersomnia - a sleep disorder with no apparent cause - to secondary causes such as sleep apnea, depression, neurological diseases or side effects of certain medications. Therefore, hypersomnia must be organically clarified before going to the psychologist. With the help of a Smartwatch observation measurement, it must first be determined whether the patient actually sleeps longer than nine hours and is still tired. In this case, an MRI of the skull is recommended to rule out certain inflammations in the brain. Thyroid function should also be checked, as an underactive thyroid can lead to increased fatigue. Iron stores in the body should also be examined, as iron deficiency also causes extreme fatigue. A large blood count and an allergy test are also among the necessary examinations to rule out physical causes for hypersomnia. If these examinations show no abnormalities, the only remaining cause is usually the psychogenic component", describes Prof. Dr. Richter and adds:

"At this stage, the patient should be examined for depression, which can then be treated accordingly. However, there is also the clinical picture of fatigue, which is very common. In this case, the patient is in a state of persistent fatigue. Fatigue can be caused by cancer, neurological diseases or as a result of Long-Covid. If the cause is psychogenic, one works with psychotherapy and wake-up measures such as daily light therapy, increasing physical activity as well as relaxation exercises. People with hypersomnia often have a disturbed function of the sympathetic nervous system and are very stressed internally. Therefore, therapeutic measures such as yoga or meditation help to create an inner balance. It is important to find out together with the patient where all the energy is going".

The effects of hypersomnia on the quality of life of those affected can be significant. People who suffer from hypersomnia often report difficulties in their daily routine, such as at work, school or social life. They often have problems with concentration and memory, which leads to decreased performance. This constant fatigue can also contribute to emotional problems such as anxiety or depression, which further worsen the symptoms.

In today’s world, sensory overload also plays a major role when it comes to states of exhaustion. Media consumption - especially through social media and working on the screen - is very high and overstimulates our brain, causing energy to be lost. You must not forget how exhausting it is for the brain to perceive 20 different pieces of information on a screen at the same time. This is different from when you leaf through or read a newspaper. People with dogs, for example, have a natural protection against depression, as they are outdoors in daylight every day, which releases happy hormones. In addition, nature stimulates the nerve cells in the brain,” explains Prof. Dr. Richter.

Targeted pharmacological treatment can be useful if sleep disorders persist over a longer period of time and treatment for depression is not sufficient. 

In such cases, antidepressants are often used that also have a sleep-promoting effect, such as certain tricyclic antidepressants or the most modern drugs that do not cause dependency. “The use of medication should always be discussed with a doctor. The general fear of medication is exaggerated. For example, if sleeping pills help people to process a trauma, then that's fine for a certain period of time as long as they help the person. That's what medication is for - to help people. Conversely, many patients' complaints here at the clinic improve without medication. However, if necessary, we also give psychotropic drugs. We are very careful with this and the decision is always made on an individual basis. Moreover, most psychotropic drugs are not addictive. In the case of moderate depression, however, psychotherapy should be used first and foremost. Psychotherapy is very effective and efficient, especially in combination with neurostimulation,” explains Prof. Dr. Richter. We conclude our conversation with these words.

Thank you very much, Professor Dr. Richter, for the insight into your work at the CuraMed Day Clinic in Nuremberg.

Is your mind tired, and your body too? How the psyche and a good night's sleep are connected

Our sleep at night is in a bad state. But sleep expert Prof. Dr. Kneginja Richter promises that we can do something about sleep disorders if we approach them holistically. She answers 99 questions about the secrets of sleep and provides profound insights into the interplay between sleep, psyche and body. She shows us how to get to the bottom of poor sleep and how to create optimal conditions for good sleep even in stressful times. Aspects such as the clarification of psychosomatic causes, the usefulness of sleep therapy and sleep aids and much more on the topics are highlighted:

  • What promotes healthy sleep - and what doesn't
    Sleep and illness - how the two are connected
    Sleep aids - effective or not?

With numerous valuable tips on how to get to the bottom of sleep problems and spend relaxed nights again and live a happier life.

Ausgeschlafen und mental stark

Prof. (TH Nürnberg) Priv.-Doz. Dr. med. Kneginja Richter

Publisher / Editor: Kösel

ISBN-13: 9783466348244

Info: Paperback, 256 pages

Packaging weight: 335 grams

Packaging dimensions (LxWxH): 21.5 13.5 2 cm

20,00 €

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