SLEEP disturbance is a significant feature of most clinical descriptions of depression. Indeed, some authors attribute diagnostic or therapeutic implications to the nature of the sleep disturbance. Thus, for example, Mayer-Gross1 regarded early morning wakening as a feature of "endogenous depression," and onset sleep difficulty as a feature of "reactive depression." Noyes and Kolb2 reported that patients with severe depression (manic depressive psychosis) have characteristically little difficulty in falling asleep, but wake much earlier than when they are well. Kalinowsky3 reported that "sleeplessness" is an important diagnostic sign of "true depression" and an indication for electroconvulsive therapy (ECT). However, there are few systematic studies of the actual nature of sleep disturbance in depression.
Detre4 found sleep disturbance to be a feature in 70% of 295 newly admitted psychiatric patients. He claimed that early morning wakening correlated with the diag
Mendels J, Hawkins DR. Sleep and Depression: A Controlled EEG Study. Arch Gen Psychiatry. 1967;16(3):344–354. doi:10.1001/archpsyc.1967.01730210084013
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