Which of the following is most characteristic of sleep in a 45-year-old woman with major depressive disorder?
**Core Concept**
Non-rapid eye movement (NREM) sleep is typically characterized by a decrease in body temperature, heart rate, and blood pressure. In contrast, rapid eye movement (REM) sleep is associated with increased brain activity and a higher risk of sleep disruptions. Major depressive disorder (MDD) often leads to disturbances in sleep architecture, including altered REM sleep patterns.
**Why the Correct Answer is Right**
In patients with MDD, there is often an increase in the duration of REM sleep and a decrease in the latency to REM sleep. This is thought to be due to the abnormal regulation of the neurotransmitters serotonin and norepinephrine, which play a crucial role in modulating the sleep-wake cycle. The increased REM sleep in MDD may be a reflection of the hyperarousal state that is common in these patients. Additionally, the decreased REM sleep latency may indicate an increased drive for REM sleep, which can disrupt the normal sleep-wake cycle.
**Why Each Wrong Option is Incorrect**
**Option B:** This option is incorrect because it does not accurately describe the sleep disturbances in MDD. While sleep disturbances are common in MDD, they are not typically characterized by an increase in stage 2 NREM sleep.
**Option C:** This option is incorrect because it is not a characteristic feature of sleep in MDD. While some patients with MDD may experience insomnia, it is not a universal feature of the disorder.
**Option D:** This option is incorrect because it does not accurately describe the sleep disturbances in MDD. While some patients with MDD may experience daytime fatigue, it is not a characteristic feature of their sleep patterns.
**Clinical Pearl / High-Yield Fact**
The use of selective serotonin reuptake inhibitors (SSRIs) can alter sleep architecture in patients with MDD, often leading to an increase in REM sleep and a decrease in REM sleep latency. This is an important consideration when prescribing SSRIs to patients with MDD.
**Correct Answer: C. Increased REM sleep and decreased REM sleep latency.**