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there's not a reason you cannot exercise, but you should start at a level that is safe for you. In my experience, patients who have depression are not held back by a physical issue but rather by a psychological one—motivation. We will talk more about that in chapter 6 .
SLEEP
    Regular, quality sleep is of paramount importance to your good health. Although some patients with depression sleep too much,the vast majority I have worked with do not sleep enough. Sleep problems are considered a symptom of an underlying depression, and in many cases, sleep problems come before the onset or recurrence of depression. In fact, a survey of office-based physicians revealed that about 30 percent of patients diagnosed with insomnia were also diagnosed with depression. Interrupted or deficient sleep negatively affects your body's biorhythms (also known as circadian rhythm). Imbalanced biorhythms can cause suboptimal immune function and can release extra stress hormones like cortisol.
Why Am I Not Sleeping Well?
    About 20 percent of patients with depression suffer from sleep apnea, a disturbed sleep condition characterized by decreases (hypopneas) or pauses (apneas) when breathing. With this condition, affected patients have problems with daytime fatigue, traffic accidents, and blood pressure problems. An obstructive apnea is defined as at least ten seconds interruption of airflow and is associated with a decrease in the oxygen level in your blood, where the primitive part of your brain that monitors oxygen level makes you temporarily wake up, looking for air. Sometimes I ask my patient to ask a partner, “Do I snore, or start and stop breathing when I sleep?” If the answer is yes, I may refer these patients to a pulmonologist (lung doctor) or sleep specialist to explore the issue further.
    Naturopathic treatment for sleep apnea may include weight loss, support for the respiratory system, or food sensitivity/allergy work (see chapter 4 ). Helpful conventional medical treatments include using a continuous positive airway pressure (CPAP) machine at night if the naturopathic treatments are not enough. Some studies have seen clear improvement in depression symptoms using the CPAP machines alone, while others didn't observe improvement. In my experience, although this machine may take getting used to, when patients use it consistently and move past the initial discomfort of the apparatus, they tend to experience improved energy and mood. These benefits far outweigh the initial discomfort felt when first going to sleep with the machine.
Are You a Night Owl?
    Bright light exposure can cause a condition called delayed sleep phase syndrome (DSPS), a common but little-reported cause of severe insomnia and depression. A hormone called melatonin is normally released when our eyes sense darkness. This master hormone helps us prepare for sleep and is also a powerful antioxidant known to help the body detoxify, especially when it comes to cancer.
    Melatonin's properly timed release plays a key role in keeping optimal mood. Otherwise, people can experience circadian rhythm problems, including symptoms like sleep-onset insomnia (can't fall asleep at night) and waking up too early in the morning. Generally people with DSPS feel more alert at night than in the morning—they are the self-proclaimed night owls. Does this sound like you? Many suffer from the inability to wake up early enough to start their day—these people want to keep sleeping, and once they are up, they experience immeasurable fatigue during the day. The prevalence of depression and personality disorders in DSPS sufferers is very high.
    We will talk about how to readjust this cycle later in this chapter.

    Figure 1: Bright Light Makes Melatonin Get Released Too Late
Your Eight-Step Plan to a Good Night's Sleep
    In my practice, focusing on sleep quality is key for many issues: low immunity, muscle repair, mood problems, digestion . . . the list goes on and on. Try these steps if you need a