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One of the common symptoms of clinical depression is insomnia, disrupted sleep or oversleeping. If someone is diagnosed with depression, he or she won’t necessarily have sleep issues, but most of the patients do. In order to evaluate depression, physicians often ask patients about their sleep habits and sleep patterns. Insomnia and depression are comorbid, and that is a big problem because while depression causes sleep issues, sleep problems further worsen mood, creating a vicious cycle. In this article, you will learn what is depression, how it affects insomnia, treatment options and how to sleep better when having depression.
What is Depression?
According to research done by the CDC, over 7% of US citizens suffer from moderate or severe depression. The symptoms of this mental illness vary, but most patients experience the following:
- Feelings of sadness and despair
- Suicidal thoughts
- Difficulty concentrating
- Lack of energy
- Lower libido
- Low self-esteem
- Weight loss or weight gain
- Daytime sleepiness
- Loss of interest in activities the affected person previously enjoyed
Symptoms of depression are persistent and may change every aspect of one’s life, starting from work and friendship to satisfying your basic needs such as eating and sleeping. People with depression often have trouble being productive at work or in school, and their social and romantic relationship may also be compromised. Sleep issues are one of the most common reasons depressed people seek professional help.
Types of Depression
Major Depressive Disorder – As the name might suggest, this mental illness is characterized by extreme depression. The affected person feels very sad, hopeless and has suicidal thoughts. The patient rarely feels happy or satisfied. When it comes to sleep problems, these patients experience insomnia and excessive daytime sleepiness.
Dysthymia – This is a milder form of depression. All the symptoms remain the same, but they are just less intense. Apart from disrupted and fragmented sleep, these patients also struggle with hypersomnia.
Bipolar Disorder – People struggling with bipolar disorder experience mood swings that oscillate between extreme highs and lows. The person may be either highly motivated, energetic, and excited or extremely sad, tired and hopeless. When their mood is positive, the excitement often prevents them from falling asleep at night. When they are feeling sad and tired, they typically oversleep.
Seasonal Affective Disorder (SAD) – As the name suggests, SAD is a type of seasonal depression. This mental disorder often occurs in winter months. Rarely, it can occur during warmer months and in summer. Common symptoms are insomnia, daytime sleepiness, and worsened mood. It’s very interesting to mention that this disorder is most likely caused by the changing levels of sunlight, which affect the circadian rhythms of the patients, messing both with their emotions and sleep. The disorder is effectively treated with light therapy.
Who Is at Risk for Depression?
One of the most significant factors for depression is stress, genetics, emotional trauma or loss. Depression can affect some people more than others, and according to certain studies, women and adults in middle age are more prone to this condition. These two groups are also more common to experience insomnia.
The Vicious Cycle of Depression and Sleep Deprivation
As mentioned in the beginning, depression and insomnia are comorbid. Depression and negative thoughts make it harder to fall asleep at night, while sleep deprivation only further worsens mood, and makes the affected person even more emotionally sensitive than before. It’s already hard to regulate the emotional volatility with depression, and sleep deprivation only makes things even worse.
Due to lack of sleep, depressed individuals don’t have enough and will to stay motivated, engage with others, go to work or even satisfy their basic needs such as eating. People who are depressed often self-isolate, which can lead to more sleep issues, because loneliness is associated with fragmented sleep.
Lastly, even if you are not depressed, lack of sleep and sleep deprivation over time increase the risk of depression. A study published in the Journal Sleep confirmed that children with both insomnia and hypersomnia are more likely to be depressed for longer periods of time. There is also a strong correlation between insomnia and major depressive disorder, especially in young adults. Lastly, research shows that teens who don’t get enough sleep are more prone to depression and suicide.
Now let’s take a look at how depression affects sleep and causes various sleep disorders.
Changes in REM sleep
Electroencephalogram tests of patients with depression show they have a longer sleep latency, spend significantly less time in deep sleep, shift REM sleep to earlier in the night, and often experience sleep maintenance insomnia, meaning they are prone to waking up during the night.
Electrical activity the brain exhibits during REM sleep is very similar to that in people with depression. Also, patients with depression have their first REM sleep much earlier during sleep than healthy people. If the depression gets worse, REM sleep further shifts and occurs earlier than normal. In severe cases, the sequence of sleep stages is completely disturbed, and first REM sleep occurs before the first deep sleep period.
Scientists still don’t know why rapid eye movement activity is increased in patients with depression. So far, researchers have noticed that patients with major depressive disorder have high activity in the ventromedial prefrontal cortex and low activity in dorsolateral prefrontal cortex section of the brain. When we take a look at the sleep architecture of a healthy individual, and one with depression, we can conclude that depressed people sleep shorter, experience decreased REM latency, and struggle with sleep maintenance insomnia.
Insomnia and Depression
Insomnia is characterized by a difficulty to fall or stay asleep. This sleep disorder is pretty common, and according to statistics, every third person struggled with insomnia at least once. As mentioned in the beginning, people with insomnia are 10 times more likely to develop depression. Some people with sleep issues don’t suffer from clinical depression but show some of its signs. This is understandable, as being unable to sleep frustrates the affected person. Most chronic insomniacs believe they will never sleep normally again. Also struggling with excessive daytime sleepiness the following day easily affect almost every aspect of your life and reduces its general quality.
Researchers still don’t know how exactly depression and sleep disorders are linked. However, they have found neurochemical links between the two – corticotropin-releasing factor. This neuropeptide is elevated both in people who suffer from depression and those who struggle with insomnia.
Other Sleep Disorders and Depression
Hypersomnia – as you may logically conclude it is the opposite of insomnia, and characterized by oversleeping. It occurs in 40% of young adults with depression.
Sleep apnea – this condition is characterized by short breathing interruptions during sleep. The affected person literally stops breathing for a few seconds. This condition interrupts the sleep cycle and may lead to sleep deprivation, even if you don’t wake up at night because of it. Sleep apnea and depression are also comorbid. The association is particularly strong among adult men.
Restless legs syndrome – this is another sleep disorder that occurs with depression. RLS is characterized by feeling intense and unpleasant sensations in the lower limbs when you lie down. The feeling is often described as being pierced by pins and needles. The only way the affected individuals find relief is by jerking their legs. As you might guess, this makes falling asleep very hard, and it contributes to the development of insomnia and sleep deprivation.
Treatment for Depression-Related Sleep Disorders
If you are struggling with depression or depression-related sleep disorders, getting a good night’s rest can help you alleviate the symptoms. Standard treatment for depression combines psychotherapy and medications.
When it comes to psychotherapy, the most popular choice is CBT or cognitive-behavioral therapy. This type of treatment is focused on helping the patient recognize the negative or destructive thought patterns and replace them with more positive thoughts and behaviors. The patient is trained to respond differently to a negative situation or thought, and to develop new ways of thinking and behavior. A sub-type of cognitive-behavioral therapy, called CBT-I is specifically designed to help people with insomnia.
When it comes to medications, there are different drugs for insomnia and depression. However, it’s interesting to mention that both conditions can be treated with antidepressants especially selective serotonin reuptake inhibitors (SSRIs). People suffering from insomnia also find relief when taking these drugs. In case, a patient is struggling with idiopathic hypersomnia, he or she needs a stimulant – something completely opposite of sleeping pills. Due to this, it’s very important for doctors to accurately diagnose the condition and evaluate whether people with sleep disorders may also have depression and whether they are a good candidate for anti-depressant medications.
Apart from psychotherapy and medications, light therapy and CPAP therapy may also be useful to alleviate some symptoms of depression.
Light therapy psychotherapy and medications, depression and depression-related sleep disorders can also be treated with light therapy or even CPAP therapy. Light therapy is a very effective form of treatment for SAD or seasonal affective disorder. It can also be used to treat insomnia or hypersomnia.
Light therapy is very simple. The patient needs to sit in front of a special light box that produces 10,000 lux of bright light similar to the sun. The special light box is typically used in the morning or at night to help the patient wake up or stay up (in case they struggle with excessive daytime sleepiness). Light therapy devices can also come in the form of wake-up lights, sunrise dawn simulating alarm clocks, and wearable visors.
CPAP therapy is used in case the patient suffers from sleep apnea. Continuous positive airway pressure devices are very effective for treating obstructive sleep apnea, and may also alleviate some symptoms of depression in individuals with co-morbid depression. Patients with OSA and depression should be very careful about taking sedative medications because these can worsen the symptoms of sleep apnea.
Tips for Getting Better Sleep with Depression
By improving your sleep hygiene and developing healthy sleep habits, you can significantly alleviate the symptoms of depression and depression-related sleep problems. Let’s take a closer look at some essential sleep tips and advice you should follow.
Keep a sleep diary – if you believe you suffer from depression or a comorbid sleep disorder, keep a mood and sleep diary for two weeks and take it to your doctor. It’s important to note when you go to bed, how long it takes to fall asleep when you wake up, did you wake up at night, and how much time you spent asleep. Note your level of sleepiness and fatigue through the day, as well as your mood changes. Changes in your diet, libido and thought patterns (for example, being very negative or constantly anxious) may be signs of depression.
Turn your bedroom into a sleep sanctuary – As we mentioned numerous times before in our articles, the bedroom should be used only for sleep and sex. Everything else, from watching TV to working should take place elsewhere. By ensuring you use your bedroom only for the things you should, your mind will start associating the environment with rest and peace, and won’t perceive it as a place of worry, stress, anxiety or social activity. Ideally, your sleep environment should be quiet, dark and reasonably cool. Make sure you remove all the unnecessary electronics out of there, and if there if the room is too bright in the morning (or in the evening due to street light), use blackout curtains. Lastly, invest in quality and comfortable mattress.
Stick to a regular sleep schedule – a regular bedtime is not only good for kids but also or adults. Try to go to bed and wake up every day at approximately the same time, even when you have a day off. You may struggle a bit in the beginning, but don’t worry if you can’t immediately fall asleep. Your goal is to stick to the schedule and eventually your brain, and circadian rhythm will catch up. Basically, as you once did with your kids (if you have them), you are training yourself to sleep and wake up in the morning more naturally.
Avoid napping – naps are allowed only if you are very tired during the day. However, it’s best to limit them to 20 or 30 minutes. Napping longer than that can be problematic because you risk transitioning into deep sleep.
Create a bedtime routine – depression can produce worrying thoughts that enable you to fall asleep peacefully at night. To ease your mind of worries and relax, create a simple bedtime routine that includes relaxation techniques, meditation or deep breathing exercises. Taking a warm bath or reading a good book will also help. If you still have troubles to unwind, write your thoughts down in a worry journal, and release them out of your head. If you are anxious, write a to-do list for tomorrow to organize your day in advance.
Enjoy the sunshine – natural sunlight is very healthy for your sleep-wake cycle, and it’s also great for improving your mood. Enjoy the sun by exercising outdoor or just by taking a walk with your friends. Sunlight will give you energy, and make you feel better and less tired during the day.
Eat healthier –food high in sugar or fats can easily mess up with your sleep, as well as stimulating substances such as caffeine, and alcohol. By eating healthier and drinking plenty of water, you will also sleep better.
Stay calm – training your body to sleep is not easy, and takes some time. Therefore, it’s important to stay calm if things don’t work out immediately. Every person is different, and what works for someone else, may not work for you. It’s important to keep trying until you find what suits you. Over time, sleep will naturally come.