Depression and Sleep Disorders

Troubled sleep, insomnia, and oversleeping are classic symptoms of clinical depression. While not all depressed people have sleep disorders, many do. When evaluating patients for depression, doctors typically ask about sleep patterns as part of the diagnosis.
Problematically, sleep problems worsen mood and can cause depression themselves, creating a vicious cycle.
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What is depression?

The CDC estimates that just over 7% of Americans have moderate or severe depression. The severity and symptoms of depression vary, but the most common include:

• Feelings of despair, hopelessness, sadness
• Frequent or occasional thoughts of death or suicide
• Difficulty concentrating
• Lower energy
• Lower libido
• Reduced self-esteem
• Weight gain or loss
• Loss of interest in activities the person formerly enjoyed
• Excessive daytime sleepiness
• Insomnia

As you can see, sleep problems are core symptoms of depression. Both depression and severe sleep problems are major risk factors for suicide and health problems like heart disease, other mental disorders, and smoking. People with depression have trouble being productive in work or school, which can impact their career and social life. The sleep issues are often one of the reasons depressed people seek out professional help.
The symptoms of depression are persistent and pervade all aspects of an individual’s’ life, from work and play to basic needs like eating and sleeping. Within the larger category of depression, there are several different types of depression which come with their own sleep problems:

• Major Depressive Disorder: This is extreme depression where the individual feels sad, hopeless, or suicidal through much of the day, regardless of what they are doing. Feelings of pleasure and happiness are hard to come by. Major depression is associated with insomnia and excessive daytime sleepiness.
• Dysthymia: This is a milder form of major depression, also associated with fragmented sleep and hypersomnia. People with dysthymia experience fewer symptoms from the list above and in a less intense way, but symptoms typically persist for much longer.
• Bipolar Disorder: People with bipolar disorder swing between extreme highs and lows. When they’re high, they’re overly energetic and unable to sleep, even if they’re tired. When they’re low, they oversleep.
• Seasonal Affective Disorder (SAD): SAD is a type of seasonal depression. The vast majority of affected individuals experience it during the winter months, with symptoms like hypersomnia, insomnia, and worsened mood – although about 10% experience it during the summer. SAD is likely brought on by the changing levels of sunlight, which affect the circadian rhythms of affected individuals, messing with their sleep and emotions.

Who’s at risk for depression? Stress, a recent loss or illness diagnosis, and family history are all risk factors for depression.
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Anyone can become depressed, but it affects some people more than others, particularly women and adults in middle age. Coincidentally, these two groups are also more likely to have insomnia. The chart below from the CDC reveals the correlation between age and depression as well as the disproportionate prevalence between the genders:

The cyclical relationship between depression and sleep

The sleep problems brought on by depression – or the ones that caused it in the first place – make it much more difficult to get better. Sleep deprived people have stronger emotional reactions in general, so it’s tougher to regulate the emotional volatility associated with depression.

Abnormal sleep interferes with mood and energy levels during the day, so it’s difficult to stay motivated to engage with others, exercise, and even go to work. To cope, people who are depressed may self-isolate, which can lead to more sleep problems: loneliness itself is associated with fragmented sleep.

The cause-and-effect runs both ways.  Even if you’re not depressed, lack of sleep increases your chances of depression and other mental illnesses. Depression causes insomnia and hypersomnia.   

An article in the Journal Sleep reported that children with both insomnia and hypersomnia are more likely to be depressed, to be depressed for longer periods of time, and to experience additional problems such as weight loss.

Particularly for young adults, there is a strong correlationbetween insomnia and major depressive disorder. Genes involved in the molecular clock and circadian cycle are known to be involved with bipolar disorder, although nobody exactly knows how. When scientists examine mice with mutations in the so-called CLOCK gene (important in the circadian cycle), they find the mice act like humans with mania. When the mice are given lithium (a treatment for bipolar disorder), their behavior reverts to normal. So it appears that this important part of the sleep control cycle is tied up with mood and mood disorders.
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Teens who don’t get enough sleep are at a significantly greater risk for depression and suicide.
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Treatment for depression-related sleep disorders

The good news is that treating either depression or related sleep problems tends to improve the symptoms of the other. Getting good sleep is essential for overcoming depression.

You may have seen stories of sleep deprivation as the new cure to depression, but be wary of these. Researchers have indeed found that a night of sleep deprivation reduces symptoms of depression the following day. However, they can experience a rebound effect (known as “residual insomnia”) the following day. Moreover, sleep deprivation on a long-term basis is simply impractical – and also dangerous, given the serious side effects for your mental, physical, and emotional health.
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Rather, the recommended treatment for depression typically combines psychotherapy and/or pharmacology.
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Psychotherapy
One popular form of psychotherapy is cognitive-behavioral therapy (CBT). CBT focuses on helping the individual recognize the negative or destructive thoughts (the cognitive aspect) that make them feel depressed, and the behaviors they’ve become accustomed to responding with. Once they learn to recognize these thoughts and behaviors, they develop new ways of thinking or responding. A sub-type of CBT is CBT-I, which applies the same techniques to curing insomnia.

Pharmacology
Although both depression and insomnia can be treated without drugs, there are pharmacological interventions for both, and not coincidentally, both can be addressed with antidepressants.  The most common antidepressant medications today are selective serotonin reuptake inhibitors (SSRIs). Those with insomnia who start taking one of those drugs often find relief for their sleeping problems.
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The pharmacological treatment for idiopathic hypersomnia is usually a stimulant – something that works opposite of sleeping pills.  That’s why it is important for doctors to evaluate whether long-sleeping patients might have depression and be a better candidate for anti-depressant medication.
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Tips for getting better sleep with depression

In addition to the therapies suggested above, the following advice can help you get better sleep while you’re getting treated for depression and related sleep problems.

1. Keep a sleep diary. If you believe you are suffering from depression and/or a comorbid sleep disorder, keep a sleep/mood diary for 2 weeks to share with your doctor.
Note when you go to bed, how long it takes you to fall asleep, when you wake up, and how much time you spent asleep. Also note your level of fatigue or energy throughout the day, as well as any changes in mood, diet, libido, or thought patterns.
2. Turn your bedroom into a sleep haven. Use your bedroom exclusively for sleep and sex. Everything else, from watching television to working to socializing, should take place elsewhere. You want your mind to see your bedroom as a place of rest, not of worry, stress, or social activity. Keep your bedroom as cool and as dark as possible by removing electronics and using blackout curtains if necessary. Invest in a comfortable, supportive mattress that makes sleep come easier.
3. Stick to a regular sleep schedule. Go to bed and wake up at the same time every day, even weekends. Ensure you leave enough room for you to conceivably get at least 7 hours of sleep, but don’t worry about whether you spend all of that time asleep. Your only goal is to stick to the schedule; eventually your brain will catch up and train itself to sleep and wake at those times more naturally. Avoid napping if you can. If you’re absolutely exhausted, limit them to short power naps of 30 minutes or less.
4. Create a calming bedtime routine.Depression and anxiety-producing thoughts are a recipe for insomnia. Help ease your mind of worries with a calming bedtime routine. Try relaxation techniques, deep breathing exercises, or meditation. Take a warm bath or light some candles.
If your mind continues to race at night, take time to write your thoughts down in a worry journal – getting them out of your head and onto the page will diminish their power. Relieve anxieties by listing out any remaining to-do items you can take care of tomorrow.
5. Get plenty of sunshine. Natural sunlight facilitates a healthy sleep-wake cycle. Aim to get plenty of sunshine, ideally by exercising outdoors in the morning or early part of the day. This will give you an energy boost that makes it easier to feel better and less fatigued during the day time. Then, as it gets dark, your brain will recognize it’s time to wind down and fall asleep.
While you’re at work or school, sit by the windows to increase your amount of sunlight.
6. Eat well and avoid stimulating substances. Foods that are high in sugar or fats mess with your sleep, your health, and your mood. Instead, fill your diet with foods that promote healthy energy levels and sleep. Also take care to avoid any stimulating substances in the afternoon or evening that interfere with sleep, such as caffeine, alcohol, or nicotine.
7. Stay calm when you wake up. Unfortunately, retraining your body to sleep well is not an overnight process. Expect – and accept – that you’ll continue having disturbed sleep during this process.
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When you do wake up, practice your deep breathing or progressive muscle relaxation exercises. Meditate or visualize something that makes you feel happy or calm. Turn on a soft lamp and read a book. Stay calm and sleep will come.

This article was shared with Compass Point from Tuck. 

Compass Point is located in Cincinnati, Ohio and has quite a few therapists who specialize in Depression in both adults and children. If you are interested in scheduling an appointment please call the front office at 513-939-0300.