Depression and Sleep

Most people who have experienced depression know that it is often accompanied by sleeping problems. People with depression may find it difficult to fall asleep and stay asleep during the night. They can also have excessive daytime sleepiness or even sleep too much.

At the same time, 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.

What Is Depression?

Feelings of sadness, disappointment, or hopelessness can be a healthy reaction to life’s challenges. Normally, these feelings come in waves, are tied to thoughts or reminders of challenging situations, only last for a short period of time, and don’t interfere with  school, work, or relationships.

In depression, these feelings follow a different pattern. When they persist for more than two weeks, are felt nearly every day, and remain for most of the day, they may be related to a group of mood disorders called depressive disorders. Also called clinical depression, depressive disorders include feelings of sadness, disappointment and hopelessness, as well as other emotional, mental, and physical changes that lead to difficulties with daily activities.

Depression is the leading cause of disability globally, affecting about 4.4% of the world’s population. After anxiety, depression is the second-most-common mental health issue in the United States. As many people with depression know, it can dramatically affect a person’s sleep and overall quality of life.

What Causes Depression?

While researchers don’t know the exact cause of depression, there are a number of factors that can increase the risk of developing this condition. These include having a personal or family history of depression, experiencing major stressors or traumas, taking certain medications, and having specific illnesses.

Family history is a factor in about half of people with depression. A person’s genetics may affect the function of neurotransmitters (substances that help nerve cells communicate) that are linked to depression, such as serotonin, dopamine, and norepinephrine.

Symptoms of Depression

The symptoms of depression can include physical changes as well as changes in moods and thoughts that interfere with normal daily activities. Symptoms may include:

• 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 irritability and 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.

How Is Depression Diagnosed?

Depression can only be diagnosed by a medical professional, so people experiencing symptoms of depression should talk with their doctor, counselor, or psychiatrist. They may ask about the severity of the symptoms and how long they’ve persisted. They may also suggest tests that can help them to better understand your situation and monitor changes or improvements over time.

A provider may also refer patients to a specialist in sleep disorders to help determine if there is an underlying sleep disorder, such as sleep apnea or restless leg syndrome, that may be causing depression or contributing to symptoms.

Types of Depressive Disorders

Significant feelings of sadness or a loss of interest in their normal daily activities are common in all depressive disorders. Specific forms of depression vary based on the severity of symptoms and the situation in which they develop.

The most well-known type is major depressive disorder, and it is marked by symptoms that affect a person virtually every day for an extended period of time. It commonly involves sleep disruptions.

Persistent depressive disorder, also called dysthymia or chronic depression, may involve fewer symptoms than major depression, but symptoms last for at least two years (one year in children and adolescents) and any symptom-free period lasts no longer than two months.

Other types of depression, such as premenstrual dysphoric disorder and seasonal affective disorder tend to come and go over shorter periods but can also involve significant sleeping problems.

How Are Depression and Sleep Related?

Depression and sleep are closely connected. Almost all people with depression experience sleep issues. In fact, doctors may hesitate to diagnose depression in the absence of complaints about sleep.

Depression and sleep issues have a bidirectional relationship. This means that poor sleep can contribute to the development of depression and that having depression makes a person more likely to develop sleep issues. This complex relationship can make it challenging to know which came first, sleep issues or depression.

Sleep issues associated with depression include insomnia, hypersomnia, and obstructive sleep apnea. Insomnia is the most common and is estimated to occur in about 75% of adult patients with depression. It is believed that about 20% of people with depression have obstructive sleep apnea and about 15% have hypersomnia. Many people with depression may go back and forth between insomnia and hypersomnia during a single period of depression.

Sleep issues may contribute to the development of depression through changes in the function of the neurotransmitter serotonin. Sleep disruptions can affect the body’s stress system, disrupting circadian rhythms and increasing vulnerability for depression.

Fortunately, people who are treated for major depression often report improved quality of their sleep.

Treatments for Depression

While depression can have dramatic effects on a person’s sleep and overall quality of life, it can be treated. After working with a doctor or mental health provider to understand the type and severity of depression, treatment may include:

• Counseling: Depression can be treated effectively with several types of counseling, including cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). CBT 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 patients may need to try several antidepressants 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 other, more recent types of brain stimulation like repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). These treatments can be effective but are only provided under the guidance of a trained professional.

Treatment often isn’t limited to just one of these approaches; in fact, combining medication and psychotherapy has shown higher rates of improvement than one approach alone.

Tips for Sleeping Better

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, taking some of the following steps can both help you sleep better, boost your mood, and help decrease some of the problematic symptoms of depression.

• Talk to a therapist: There are several different kinds of therapy to help you cope with depression and change your thinking about 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 give you coping mechanisms to manage restless, sleepless nights.
• Keep a regular sleep/wake time: Suffering from depression can make it difficult to stick to a routine. Keeping a consistent bedtime and wake time sets aside the requisite 7-9 hours of sleep, and gives your body the opportunity for a full night of sleep. Additionally, establishing a nightly routine provides a cue for your body to begin winding down and prime itself for sleep.
• Nap carefully: Restless or inconsistent sleep at night can make it tempting to nap during the day. Research has found the ideal nap length is between 10 and 20 minutes, what is usually called a “power nap.” These power naps can help regulate our emotions, reduce sleepiness, and lead to an overall uptick in performance. It’s important to keep your napping relatively brief, however. Naps that last longer than 20 minutes could interfere with your ability to fall asleep, while naps shorter than 10 minutes just aren’t 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 deleterious effect on our 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 your sleep cycle and shorten REM sleep.
• Get outside: One of the simplest ways to aid your sleep if you suffer from depression is to spend time outside. Exposure to sunlight aligns our body’s internal clock — our circadian rhythms — and gives us cues when to be alert and when to sleep. For instance, when we get regular sunlight, it is a signal to our body to be alert and active. As the sun sets, our bodies then produce melatonin to induce sleepiness and promote sleep. Time outside can be a simple and effective way to trigger the natural chemicals in our brain that promote high-quality sleep.
• Exercise regularly: A great way to spend time outside is exercising. Not only do you gain the benefits of exposure to sunlight, but it improves sleep quality. In fact, 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 begin an exercise regimen, consider doing your workout during the first half of the day; exercising in the evening could interfere with your ability to fall asleep.

Tips for Coping With Depression

In addition to talking to a provider about treatments for depression, there are several steps you can take on your own:

• Exercise: Low-intensity exercise, even walking 10 minutes a day, can lead to improvements in mood and physical health. For some people with mild to moderate depression, exercise can work as effectively as an antidepressant.
• Support: Experiencing depression can feel isolating and hopeless, so remember that you’re not alone. Spend time with others, talk about what you’re experiencing, and try not to isolate yourself.
• Be realistic: Even with effective treatment, symptoms of depression may improve gradually.

Having depression can increase thoughts of suicide. If you or someone you know is in crisis, the National Suicide Prevention Lifeline provides 24/7, free and confidential support.

National Suicide Prevention Lifeline

1-800-273-8255