Depression and Sleep

Depression is marked by persistent bouts of sadness, disappointment, and hopelessness, as well as other emotional, mental, and physical changes that lead to difficulties with daily activities. When difficult emotions remain present for more than two weeks, are felt nearly every day, and remain present for most of the day, they may be related to a group of mood disorders called depressive disorders.

Depression is often accompanied by sleep troubles. People with depression may find it difficult to fall asleep and stay asleep during the night or experience periods of excessive daytime sleepiness.

Sleep problems can exacerbate depression, leading to a negative cycle between depression and sleep that can be challenging to break. Poor sleep may even provoke depression in some people. Understanding the complex relationship between sleep and depression can be an important step in improving sleep quality and better managing depression.

How Are Depression and Sleep Related?

Depression and sleep are closely connected. A majority of people with depression experience sleep issues. In fact, doctors may hesitate to diagnose depression in the absence of complaints about sleep Trusted Source Elsevier Elsevier is a publishing company that aims to help researchers and health care professionals advance science and improve health outcomes for the benefit of society. View Source . 

Depression and sleep issues have a bidirectional relationship Trusted Source National Center for Biotechnology Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . This means that poor sleep can contribute to the development of depression and having depression makes a person more likely to experience sleep troubles. This complex relationship can make it challenging to know which came first, sleep issues or depression.

Sleep Problems Associated With Depression

Sleep issues commonly associated with depression include insomnia, hypersomnia, and obstructive sleep apnea. It is believed that about 20% of people with depression have obstructive sleep apnea and about 15% have hypersomnia. Sleep issues may influence the function of the neurotransmitter serotonin, which can contribute to the development of depression. Sleep disruptions can affect the body’s stress system, disrupting circadian rhythms Trusted Source Elsevier Elsevier is a publishing company that aims to help researchers and health care professionals advance science and improve health outcomes for the benefit of society. View Source and increasing vulnerability for depression Trusted Source Elsevier Elsevier is a publishing company that aims to help researchers and health care professionals advance science and improve health outcomes for the benefit of society. View Source .

Depression and Insomnia

Approximately 40% of people with insomnia have clinical depression, and up to 80% of patients with depression experience bouts of insomnia Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source . Early wakening is closely associated with depression, as well as difficulty falling asleep at night. Those with depression may switch back and forth between insomnia and hypersomnia during a single period of depression.

Symptoms of Depression

In addition to troubling moods and thoughts, depression can also manifest in physical changes that interfere with daily activities. Symptoms may include Trusted Source Anxiety and Depression Association of America (ADAA) ADAA's mission focuses on improving quality of life for those with anxiety, depression, OCD, PTSD, and co-occurring disorders through education, practice, and research. View Source :

• Persistent sad, low, or irritable mood
• Feelings of hopelessness, worthlessness, or guilt
• Loss of interest or pleasure in activities
• Decreased energy and fatigue
• Difficulty concentrating
• Insomnia, waking up too early, or oversleeping
• Low appetite or overeating
• Thoughts of death or suicide

Depression is more common in women, and there may be differences in the symptoms of depression based on sex and age. Men often experience symptoms such as anger, whereas women more frequently experience sadness and guilt. Adolescents with depression may be irritable and have trouble in school, and younger children may pretend to be sick or worry that a parent may die.

When to Speak With Your Doctor

If your sleep quality or general quality of life is routinely affected by troubling feelings or low mood, it is important to share these concerns with a health care provider. Typically, symptoms must remain present for at least two weeks to be formally diagnosed as clinical depression. A medical professional can determine whether your symptoms are caused by depression or another health condition. 

Treatments for Depression

Fortunately, people who undergo treatment for major depression often report improved sleep quality. After working with a doctor or mental health provider to understand the type and severity of depression, a treatment plan will be created accordingly. 

• Counseling: Depression can be treated effectively with several types of counseling, including cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Cognitive behavioral therapy for insomnia (CBT-I) is a type of CBT that focuses on managing chronic insomnia.
• Medications: Antidepressants are an effective treatment for depression. These prescription medications usually take time before they begin to improve symptoms and people may need to try several antidepressants at various doses before finding the right fit. A doctor or psychiatrist can discuss the appropriateness of these medications and recommend a specific type.
• Brain stimulation therapies: When medications and other approaches are not effective, some people with depression consider electroconvulsive therapy (ECT) or emerging methods of brain stimulation like repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). These treatments can be effective but are only conducted under the guidance of a trained professional.

These approaches are often used in tandem to develop an effective treatment protocol. A combination of medication and psychotherapy has shown higher rates of improvement than one approach alone.

Tips for Sleeping Better With Depression

Sleep problems can increase the risk of initially developing depression, and persistent sleep issues can also increase the risk of relapse in people who have successfully been treated for depression. As a result, implementing these healthy habits can both help you sleep better, boost your mood, and help decrease some of the challenging symptoms of depression.

Talk to a Therapist 

There are several different kinds of therapy to help you cope with depression and change your thought patterns around sleep. Therapeutic models such as CBT, interpersonal psychotherapy, and psychodynamic therapy can help you process some of the underlying feelings and challenges that contribute to depression. Mental health professionals can also suggest concrete behavioral changes to mitigate some of the symptoms of depression and provide coping mechanisms to manage restless, sleepless nights.

Keep a Consistent Sleep Schedule 

Suffering from depression can make it difficult to stick to a routine. Waking up and going to sleep at the same time each day gives your body an opportunity to get at least seven hours Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source of sleep per night. Additionally, establishing a nightly routine provides a cue for the body to wind down and prime itself for sleep.

Nap Carefully 

Restless or inconsistent sleep at night can make it tempting to nap during the day, but it is important to keep naps relatively brief. Research has found the ideal nap length is between 10 and 20 minutes, what is usually called a “power nap.” Power naps can help regulate emotions, reduce sleepiness, and lead to an overall uptick in performance. Naps that last longer than 20 minutes could interfere with your ability to fall asleep, while naps shorter than 10 minutes are not long enough to gain the benefits from napping.

Avoid Alcohol

It can be tempting to have a drink or two to promote relaxation and sleepiness, but alcohol has a harmful effect on sleep. While studies have shown that binge-drinking before bed leads to difficulty falling asleep and staying asleep, even moderate drinking is enough to disrupt the sleep cycle and shorten REM sleep.

Get Outside 

Spending time outdoors is one of the simplest ways to aid your sleep if you suffer from depression. Exposure to sunlight aligns the body’s internal clock and circadian rhythms, giving cues for when to be alert and when to sleep. For instance, getting regular sunlight is a signal to the body to be alert and active. As the sun sets, the body then produces melatonin to induce sleepiness and promote sleep. Time outside can be a simple and effective way to trigger the natural chemicals in the brain that promote high-quality sleep.

Exercise Regularly 

Research indicates those who engage in light, moderate, or vigorous exercise reported very good or fairly good sleep quality. Additionally, regular exercise has shown to significantly decrease symptoms of depression, making it an excellent choice to promote sleep health and mental health. If you decide to implement an exercise regimen, consider doing your workout during the first half of the day, as exercising in the evening could interfere with your ability to fall asleep.

Frequently Asked Questions About Depression and Sleep