Sleep patterns of nursing home residents are extremely fragmented. This is manifested not only as disrupted night-time sleep, but also by frequent daytime sleeping. Poor sleep represents more than a mild annoyance for nursing home residents. Nursing home residents often suffer from multiple medical and psychiatric co-morbidities and are often in poor physical health. Circadian rhythm changes contribute to sleep problems in nursing home residents. Real change will require administrators and other staff to recognize that sleep is important and encouraging better sleep would benefit both residents and staff over the long term. Sleep disturbance is associated with negative outcomes among nursing home residents. While data to support the use of pharmacotherapy for sleep in the nursing home are limited, there is some suggestion that disturbed sleep improves with non-pharmacological treatments; however, these treatments have not been adapted for implementation into routine care.

This chapter reviews the existing literature on the relationship between sleep and mood disorders, in particular, treatment-resistant disorders. It also reviews the subjective and objective changes in sleep that occur in depressive and manic episodes, and describes how these sleep findings may be predictive of treatment-resistant states. Normal sleep consists of alternating rapid eye movement (REM) and non-REM epochs. Deliberate sleep deprivation produces an antidepressant effect in major depressive episodes (MDE) patients. While acute sleep deprivation can be beneficial for symptoms of depression, like any effective therapy, there are side effects. For some depressed individuals, sleep deprivation simply induces fatigue. The application of sleep deprivation to treat treatment-resistant depressions and sleep induction to treat treatment-resistant manic states holds promise. The relative contribution of primary sleep disorders to treatment-resistant mood states is virtually unknown and warrants investigation.