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The Relationship Between Sleep and Depression

Posted by Lauren Juarez on

The Relationship Between Sleep and Depression

(For citing references, click on the links)

Unfortunately, feeling melancholy on occasion is a normal and an integral part of being human. However, if you’re regularly experiencing feelings of anxiety, sadness, or hopelessness, this could be an indication of clinical depression. Depression is an illness that affects at least 20 million Americans and is not easily ignored. Rather, it’s a dangerous disorder that affects how a person eats, sleeps, feels and thinks. The cause of depression is not known, but several factors have been linked to it, including:

What you may not know is that sleep and depression are interconnected and the relationship between the two is convoluted, at best. As I’ve mentioned in a few other blogs, one of these can lead to the other, and vice versa, complicating things even further. For example: depression can lead to difficulty sleeping, and difficulty sleeping can lead to depression, which can quickly become a vicious cycle. For some, signs of depression occur before the onset of sleep issues. Yet for others, difficulty sleeping may appear prior to experiencing symptoms of depression. The two also share risk factors and biological characteristics and the conditions may respond similarly to one another in regard to treatment. Sleep issues have been known to be associated with more severe depressive illnesses, such as Major Depressive Disorder, or MDD.

An inability to sleep, or insomnia, can be one sign of depression (approximately 15% of depressed people oversleep or sleep too much). And while lack of sleep alone can’t cause depression, it certainly plays a role. Lack of sleep caused by another medical illness, or by things like personal issues, can worsen depression.

Insomnia is a common happening for those who are depressed. Evidencesuggests that people with insomnia are more susceptible to developing depression compared to those who sleep well. These individuals may suffer from a range of symptoms, including:

  • Difficulty falling asleep (sleep onset insomnia)
  • Difficulty staying asleep (sleep maintenance insomnia)
  • Enervating (unrefreshing) sleep
  • Daytime lethargy

However, research also suggests that the risk of developing depression is highest among people with both sleep onset and sleep maintenance insomnia.

Obstruction Sleep Apnea (OSA) has also been linked to depression. In a survey of 18,980 participants conducted by a Stanford researcher, Maurice Ohayon, PhD, in Europe, people with depression were found to be five times more likely to suffer from sleep-disordered breathing, of which OSA is the most common form. The good news? Treating OSA with continuous positive airway pressure (CPAP) may aid in relieving the symptoms of depression; an OSA study done in 2007 found that patients who used CPAP for one year showed significant improvements.

However, because the symptoms of depression are so similar to the symptoms of other sleep disorders, there is a risk of misdiagnosis. Depression can be a sign of insomnia, OSA, or even narcolepsy. Restless Legs Syndrome (RLS) is a neurological condition which causes discomfort in the legs, leading to sleep issues, and is also associated with depression. According to the Restless Legs Syndrome Foundation, approximately 40% of people who suffer from RLS experience symptoms what would normally indicate depression if accessed without considering the possibility of additional sleep disorders.

Children who suffer from depression may also encounter sleep issues such as insomnia or hypersomnia (excessive sleepiness), or both. Children with depression who suffer from both are more susceptible to experience an unrelenting and extreme depression. Those with depression are also more likely to suffer from impaired movement, weight loss, or anhedonia (an inability to feel pleasure). A sleep poll conducted by the National Sleep Foundation in 2006, showed that children from the ages of 11-17 found a substantial association between sleep issues and negative emotions. Among the children who reported feelings of unhappiness, 73% reported insufficient sleep.

While depression affects people all over the world, certain people are more likely to develop depression, including women and older adults. Among elders, the rates of depression and sleep issues were higher, and may be due, in part, to higher rates of physical issues overall. Concerning women, hormonal changes over the course of their lives (menstruation and menopause) and motherhood may lend to higher rates of depression. And among both women and elders, the rates of depression may also lend to the higher rates of insomnia or other sleep issues.

Seasonal Affective Disorder (SAD), another type of depression, is defined as “a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer. Depressive episodes linked to the summer can occur, but are much less common than winter episodes of SAD”. SAD is believed to be influenced by the patterns of light and darkness that occur with the approach of winter. Circadian rhythms, or sleep-wake cycles, are governed by the body’s internal clock and its exposure to sunlight. As the days shorten in autumn, circadian rhythms become confused and can trigger depression. For a number of SAD people, depressive symptoms elucidate come springtime with the increase in daylight hours.

A diagnosis of depression can only come from your doctor who will take your medical history and inquire about the presence of depression or other health-related issues in your family history. They may ask you to detail your mood, appetite and energy levels, stress management practices, and if you’ve ever experienced thoughts of suicide. He or she may also perform a physical examination to determine if your depression symptoms are caused by other underlying illnesses.

The symptoms of depression vary from person to person. Some common symptoms are as follows:

  • Thoughts of death or suicide
  • Loss of interest in things that once brought joy
  • Feelings of hopelessness, sadness and helplessness
  • Trouble remembering things
  • Difficulty with concentration
  • Daytime sleepiness
  • Lack of sexual interest
  • Lethargy
  • Insomnia
  • Weight fluctuations

Depression may also be combined with anxiety, low self-esteem, and even physical symptoms such as headaches and gastrointestinal problems; insomnia and daytime sleepiness are some of the more debilitating symptoms of depression.

This illness may take varyious forms, including illnesses like Major Depressive Disorder (MDD), bipolar disorder, and dysthymia.MDD is defined as “a mental disorder characterized by at least two weeks of low mood that is present across most situations. It is often accompanied by low self-esteem, loss of interest in normally enjoyable activities, low energy, and pain without a clear cause”. Dysthymia is defined as “persistent mild depression”. Another type of depressive illness is bipolar disorder (manic depressive illness), and is characterized by extreme highs and lows in mood, energy, activity levels, and the ability to carry out day-to-day tasks; during the lows, they may experience symptoms of depression.

The treatment for depression is usually a combination of things, including psychotherapy(such as cognitive-behavioral therapy) and/or pharmacological (drug) treatment. Both therapies are commonly used to treat depression and insomnia both, and treatment for sleep issues are also usually a large part of depression therapy.

Keep in mind that treatment of depression may be complicated by sleep disorders. In other words, those who possess OSA and depression should avoid antidepressant medications with sedating side-effects due to their likelihood of suppressing breathing and worsening the symptoms of OSA. Prior to beginning therapy, especially pharmacological therapy, speak with your physician about any/all sleep issues you may be experiencing. In some cases, treating the sleep issues effectively may be sufficient in relieving the feelings of depression.

Cognitive Behavioral Therapy (CBT) is defined as “a type of psychotherapy that treats issues and boosts happiness by modifying dysfunctional emotions, behaviors, and thoughts. Unlike traditional Freudian psychoanalysis, which probes childhood wounds to get at the root causes of conflict, CBT focuses on solutions, encouraging patients to challenge distorted cognitions and change destructive patterns of behavior”. CBT is a behavioral approach to treating depression and has become increasingly popular due to the lack of harmful side effects and its overall success rate. Its fundamentals include cognitive restructuring (this technique targets the thoughts that may lead to feelings of depression), and behavioral activation (this technique targets behaviors that may perpetuate depression. CBT may be used to both depression and insomnia simultaneously.

There are several different medications and treatments used to lessen the symptoms of insomnia, and your doctor will assist you in determining which is best for you. Some of the most prevalent treatments for depression are:

  • Selective Serotonin Reuptake Inhibitors (SSRIs) – SSRIs are effective in improving moods in many patients, but may also cause or worsen the symptoms of insomnia.
  • Mood stabilizing anticonvulsants and lithium – these drugs are prevalent in the treatment of bipolar disorder.
  • Tricyclic antidepressants – tricyclic antidepressants are commonly sedative, but they may also possess formidable risks, such as high blood pressure.

In additional to the treatments listed above, patients who suffer from SAD may improve with bright light therapy (phototherapy). Light therapy is a way to treat SAD and other conditions by exposing the patient to artificial light; during this therapy, you sit of stand near a device known as a “light therapy box”; this box emits a bright light that mimics natural outdoor light. Bright light therapy is thought to affect brain chemicals linked to mood and sleep, easing the symptoms of SAD. Bight light therapy may also help with other classes of depression, sleep disorders, and other conditions. Consult with your physician prior to beginning bright light therapy, as exposure to the sun or bright light may evoke negative effects.

Some individuals may show an increase in symptoms following a night of partial or complete sleep deprivation, which may lead physicians to consider using sleep deprivation as a form of mediation. These improvements, however, are unreliable and can easily be reversed after a night of complete, or normal, sleep, proving sleep deprivation a quixotic choice for depression. Also, sleep deprivation possesses the potential for serious side effects, such as:

  • Cognitive impairment
  • Greater risk of injury or accidents
  • Acute sleepiness

To prepare for a visit with a health professional for evaluation of depression and treatment, it is advantageous to detail your moods and maintain a sleep diary for a two-week period. Providing this information to your doctor will help guide treatments and allow for a more accurate diagnosis.

The treatment(s) of clinical depression will take time. Antidepressant medications usually take weeks to build up in your system and some patients may need to try a variety of medications and combinations before finding what is best for their situation. Do not cease taking your medication(s) as directed by your doctor even after you’ve improved, as this may lead to your symptoms incurring or other ill effects. Always consult with your physician before making any changes to your medication regimen or depression therapy. Addressing any sleep issues and accompanying symptoms are critical to recovery.

Depression is aggravating and debilitating, leading to feelings of despondency and powerlessness. In addition to treatment with your physician, below are some tips to help you cope with depression and its symptoms:

  • Tracking your sleep/wake cycles
  • Limiting caffeine and alcohol
  • Reaching out to friends/family for support – You should not face depression alone
  • Getting regular exercise every day
  • Opening the blinds first thing in the morning, or stepping outside for a bit
  • Avoiding naps in the afternoon, especially if you suffer from insomnia

According to the National Sleep Foundation’s census, Sleep in America, conducted in 2005, 18% of adults from the ages of 18-64 have been diagnoses at one time or another with some form of depression. The study also showed that of those people who had been diagnosed with depression or another medical condition, were more inclined to report symptoms of a sleep disorder. Additionally, NSF’s study of adolescents aged 11-17 conducted the same year, revealed that among those who reported feelings of unhappiness, 73% proclaimed insufficient sleep.

"Understanding is the first step to acceptance, and only with acceptance can there be recovery" - J.K. Rowling

Thanks for reading!

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