Sleep and Depression –
How To Unlock Their Complex Relationship

Depressed Woman Trying To Fall Asleep Animation

Picture this. 

It has been a long day, you are feeling both emotionally and mentally exhausted, and when you get to your bedroom you expect to fall asleep quickly. Instead, what you end up with is a crushing feeling of despair, apathy, or sadness.

Your heart feels heavier than your eyelids and though you know you need sleep, you just can’t seem to will it into existence. Instead, you feel too sad to sleep, and your thoughts dwell on everything that isn’t right with the world, or worse, you just can’t seem to care about anything.

Is this just another thing wrong with you? Is there something you did to self-sabotage your sleep efforts? Before you run away with your thoughts, there is a scientific explanation, and it boils down to the fact that it’s not your fault, and there is something you can do about it.


Section 1

What is Depression?


Section 2

Strong-Tie between Sleep and Depression


Section 3

How Does Depression Affect Sleep?


Section 4

Can Sleep Deprivation Make Things Worse?


Section 5

Possible Treatments


Section 6

Questions for Your Doctor


Section 7

Tips for Managing Your Sleep While Depressed


Section 8

Conclusion

What is Depression?

Depression is one of the most common mental illnesses with sometimes the least common correct understanding. Depression goes deeper than just feeling “super sad,” it usually refers to Major Depressive Disorder (MDD), which affects the way you think, feel, and behave. The mental illness is often characterized by a loss of interest in things once enjoyed, sleep problems, change in appetite, and increased fatigue.

Illustration of a Sad Woman Traveling to Work

Studies show that in some cases, adjusting sleeping patterns has been successful in helping manage depression. That’s why we researched sleep and depression and learned how to unlock their complex relationship.

Strong-Tie between Sleep and Depression

A study at the University of Bristol suggests that up to three-quarters of depressed patients experience insomnia and 40 percent of depressed young adults (predominantly females) experience hypersomnia, or too much rest.

 

This is hardly a surprise as countless research studies have produced evidence of the complex relationship between sleep and depression, however, the relationship is more like a cycle than a cause-effect chain. Though rest generally tends to be a mood stabilizer, it also needs to occur for a precise amount of time in order to work.

Man Laying in Bed Wide Awake Illustration

According to a study conducted by the China Kadoorie Biobank, abnormal sleep duration, meaning sleeping for more or less than 7 to 9 hours, often results in symptoms like apathy, fatigue, and feeling low, especially when your sleep is frequently disturbed or interrupted. The study even suggests that while depression can make it hard to sleep through the night, the lack of sleep can also put otherwise healthy people at a risk for the disease.

This means that no matter where you start – whether as a depressed person or a sleep-deprived person – the cycle will likely continue unless there is some form of intervention.

An article by Scientific American offers one explanation for the biological link. Depression increases fatigue in a variety of ways, whether due to a lack of appetite, increased stress, or sometimes side effects from antidepressants. Some try to compensate by taking naps during the day or by getting up late because it took them longer to fall asleep.

A Woman in Bed Sleeping while a Rooster Crows Illustration

After doing this for long enough, the irregular schedule can begin to seriously mess with your circadian rhythm, which is the internal clock that tells you when it’s time to rest and when it’s time to be awake. This can cause some to rest for much longer or shorter than necessary, or to sleep at odd hours.

How Does Depression Affect Sleep?

While it’s no surprise that there is a strong relationship between sleep and depression, movies and TV shows often only depict the illness manifesting itself as hypersomnia, or excessive rest when in reality the opposite occurs more frequently. Many people with depression suffer from chronic insomnia and feel that their symptoms get in the way of falling or staying asleep. Both effects are characteristic of the disease.

Illustration of A Man Sitting on the Edge of His Bed With a To-Do List Looming Over

While insomnia may be more common than hypersomnia, research cited by Scientific American suggests that the two go hand in hand, here’s why: disturbed sleep is incredibly distressing. While this is probably a pretty unsurprising statement, let’s look closer at how this all fits together.

For someone with depression, missing a few hours of sleep can feel like a major defeat, especially when you are doing everything you can to fix the problem.

If a woman (let’s name her Sarah) is experiencing a major depressive episode, around the time most people go to bed, she may be in a dark room, at the ideal room temperature with the best mattress in the world, but she would probably  still be awake thinking about all the things she needs to do the next day.

 

Trapped between apathy and feelings of defeat, everything from registering her car to attending a performance review at work feels so unrewarding to her. Sarah may ask herself why it matters, why anything at all matters, and feel helpless to change her situation.

 

As she eventually wears herself out mentally from her distressing thoughts, she falls into a wakeful sleep close to six o’clock in the morning and snoozes her alarms. Because she is so exhausted, she will probably either sleep through the day or be late to work and drift through without feeling present, making life feel even less rewarding. She may perceive that she is a failure because of her inability to be productive, when the reality is she just needs some sleep.

 

Let’s be clear. Sarah could be anyone, from any walk of life. Sarah could be you or someone you love. The biggest danger is assuming that this condition is caused by external factors or because you’re “broken” somehow.

Illustration of A Woman Laying in Bed Curled into a Ball Looking Stressed

If you are someone who doesn’t normally deal with depression but struggles to get enough sleep each night, you could end up in the exact same place. If you constantly pull all-nighters to get your work done, but still keep falling behind, the longer you go without adequate rest, the more distressed and exhausted you will feel and the less ability you will have to regulate your mood or get ahead. The result is the same, worsened sleep and depression.

To further complicate matters, those who experience conditions such as narcolepsy, sleep apnea, restless leg syndrome, or other disorders associated with rest are at a higher risk for MDD. According to the National Sleep Foundation, those with insomnia are ten times as likely to have MDD, those with sleep apnea are five times as likely to experience it, and about 40 percent of those with restless leg syndrome indicated the presence of symptoms resembling depression.

Can Sleep Deprivation Make Things Worse?

In most cases, the answer is yes. Referencing a study on the effects of sleep deprivation on adult twins, Dr. Safwan Badr, the President of the American Academy of Sleep Medicine, clearly states the importance of adequate rest.

Healthy sleep is a necessity for physical, mental and emotional well-being,” he says. “This new research emphasizes that we can make an investment in our health by prioritizing sleep.” — Dr. Safwan Badr.

Sleep deprivation can put one at risk for if not cause depression, according to a study conducted on adolescents at the University of Texas in Houston. However, the results can depend on the current issues a patient is experiencing.

 

For example, in cases where depressed patients are experiencing hypersomnia, sleep deprivation could mean leveling out an irregular schedule, and for those who are already depressed with insomnia, sleep deprivation is the norm.

In terms of alleviating depressive symptoms, the key is to rest for a normal amount of time, which isn’t always easy. The National Sleep Foundation recommends resting at least 7 to 9 hours per night.

For those with depression who consistently get less than 7 hours, studies show that symptoms are generally worsened. According to a study conducted by The Association for Child and Adolescent Mental Health, ongoing rest disturbances were associated with worsened MDD symptoms and function of interpersonal relationships. In fact, for all participants in the study, disturbed sleep was an indicator for future depressive episodes.

A Woman Dreaming of Herself Crying

This could be because the brain processes our emotions while we sleep, according to a study conducted at the University of California, Berkeley. When we can’t get enough rest, or we sleep too much, our emotional processing gets disrupted, and we might not be able to properly respond to emotional experiences the next day or accurately remember events from the day before. This kind of distorted thinking can seriously affect depression.

 

The limbic system is the part of the brain where powerful emotions, arousal, and memory are triggered. It is also responsible for classifying experiences as either negative or positive.  When this function cannot properly respond to experiences, you may find yourself looking at your life and experiences through a distorted negative lens.

 

Additionally, according to Harvard Medical School, REM sleep, or the periods when we dream, contribute to improved emotional health. When we consistently shorten the time we can dream or process emotions, our brain struggles to regulate the production of happy hormones like dopamine, meaning we often end up feeling more stressed or upset…

Possible Treatments

As a society, we have come a long way from recommending a “can-do” attitude and counting our blessings to reduce depression, but the best form of treatment varies based on the situation. We have researched a variety of treatments ranging from traditional to experimental options, but we recommend talking to your doctor before trying anything drastic.

Sleep Deprivation

Some scientists and doctors have been investigating sleep deprivation as a new form of treating depression. Yes, you read that correctly. Though it may seem counter-intuitive, Researchers at the University of Pennsylvania discovered up to 50 percent of those treated with the new therapy saw remarkable improvements in depression symptoms in less than 24 hours.

 

Many studies have backed up these claims, showing that depriving oneself of rest for up to 36 hours can result in dramatically improved mood among depressed patients. However, there are some consequences. The treatment has only been shown to work around half the time, and among those it does help, the improvements are usually short-lived, and depression symptoms tend to return after a normal rest cycle, according to Mosaic Science.

A Man Stands at a Concession Stand Ready to Order Illustration

A Tufts University study postulates that the antidepressant effect is due to an adenosine buildup in the brain. Adenosine is a chemical that the body produces throughout the day, and as the concentration increases, the pressure to rest intensifies. However, for those experiencing MDD, delaying rest also creates an antidepressant effect. This treatment can be a useful substitute for antidepressants in some patients as they wait for their medications to take effect.

 

Though it may seem like a quick fix, patients are usually closely monitored by doctors during this treatment and it is often supplemented by light therapy or other circadian rhythm manipulators to minimize the effects of a sudden emotional low after the antidepressant effect wears off.


Cognitive Behavioral Therapy

CBT is a form of psychotherapy that focuses on rehabilitating destructive patterns of thought in order to better shape future behavioral patterns. It’s essentially a long way of saying talk therapy that focuses on retraining the brain. This method is one of the most acclaimed versions of talk-therapy as its results speak for themselves.

 

A study conducted by the Journal of Consulting and Clinical Psychology suggests that those who make rapid improvements early in CBT tend to be less depressed at the end of treatment and maintain their results for longer.


Counseling

This common method of treating depression is also in the realm of talk-therapy and focuses on helping patients identify coping mechanisms. It also is useful in creating a safe space for patients to discuss their problems and find healthy ways to manage them. Talk therapy does not always center on finding a solution or getting rid of a problem, but rather on increasing one’s arsenal of abilities that can be used to help them get through a difficult time or situation.

Illustration of A Woman Sitting on a Couch Talking to a Therapist

For those who are wary of taking medications such as antidepressants, counseling can be a healthy alternative with long-lasting effects, though it usually takes a series of sessions to make a difference.


Medications

For those who have consistently tried counseling or other forms of talk therapy with little improvement, antidepressants are often prescribed to counter the effects of feeling low, decreased appetite, and disinterest in hobbies or activities. These medications come in a variety of forms, the most common among them being serotonin reuptake inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), according to the Mayo Clinic.

Illustration of A Prescription Bottle of Sleep Pills

These drugs work by balancing neurotransmitters in the brain that directly affect mood, allowing patients to experience relief from both anxiety and depression in some situations. Some studies suggest the two illnesses occur hand in hand and can often be treated in similar ways, however, some of these medications can cause some issues.

 

According to a study at the University of Bristol, antidepressants often reduce REM, the time during sleep responsible for processing memories and emotional events. The good news is that the study suggests that this effect should taper off after a few months of using most medications.


Light Therapy

This form of treatment is based on the functionality of the circadian rhythm and is most effective in those who need their rhythm recalibrated. Often used in conjunction with other forms of therapy such as sleep deprivation, light therapy works to balance the production of neurotransmitters by taking advantage of their biological response to light, aiming to trigger timely periods of wakefulness and sleepiness.

 

Light therapy can also be an effective form of treatment for those with Seasonal Affective Disorder, or SAD, as the simulation could mimic outdoor lighting when used regularly throughout the day, alleviating the symptoms of SAD, according to the Mayo Clinic.

Questions for Your Doctor

Though it is estimated that around 17 million Americans have depression, according to a study conducted by Columbia University, two-thirds of those with depression go undiagnosed. The good news is that it doesn’t have to be that way.

 

Many are unaware that most general practitioners or family doctors can screen for depression and prescribe treatment in what should be a relatively painless process. If you are uncomfortable with seeing a psychologist or unable to get an appointment, there should be accessible options for you.

 

When you decide to meet with your doctor to discuss your depression, we’ve prepared a few questions you may want to ask.

A Doctor Listening to a Patient Illustration

Is it possible that I’m depressed?

To begin treatment and get on the road toward recovery, a diagnosis is a good place to start. After discussing your symptoms, and maybe after a depression screening survey, your doctor should be able to determine if you have major depressive disorder.

Will sleeping more help me feel better?

While your doctor will ultimately be able to answer this question in regards to your personal case, the general answer is yes if you experience insomnia. For those who are on the other side of the spectrum, the answer is still yes, in a way. More sleep at the correct time will likely contribute to helping you feel better. However, in order to improve depression symptoms, there are usually a few preceding steps in treatment. Your doctor may even recommend you reduce your sleeping time, or restrict it to only specific times to test how your body responds.

A Survey Attached with the Question "Do You Struggle to Do the Things You Once Loved?"

Can my depression make me tired?

It could be helpful to discern where your fatigue is stemming from. While your afternoon grogginess could be the result of depression, a side effect of your medication, or even the result of excess stress, it could also be due to your diet or other external factors. Your doctor should be able to help you move in the right direction.

What are my best treatment options?

Every doctor has different ideas of what the best treatment options are, often varying by the situation. After reading our list of potential treatments, it may be a good idea to ask your doctor if a particular strategy is right for your case.

Can my meds be affecting my rest?

Your doctor should be able to discern if any of your current medications are affecting your sleep and could be worsening your depression. Common culprits are stimulants and antidepressants, and it could be useful to know this before you shake up your medication habits. Your doctor should be able to give you some new medication options or let you know if there are other factors to consider.

Should I take a sleeping pill?

Many sleep aids are available over the counter, but you should probably consult your doctor before beginning their use. Many of these pills are not widely regulated and it may be a good idea to determine if they have the potential to help you before experimenting.

 

While melatonin is a widely used way to facilitate drowsiness, research shows it isn't always as effective as it seems, and there are some consequences for its abuse. Johns Hopkins warns that the supplement could have consequences for those with underlying health concerns like diabetes or autoimmune disorders, and extended use is probably not the best idea even for those who are otherwise healthy.

 

The research suggests that the best use for melatonin is for overcoming jet lag or to temporarily treat insomnia. However, it's important to note that the supplement is unlikely to work unless combined with other factors, such as reduced light, phone time, and decreased activity before bed.

Would it help if I tracked my sleep and showed you my patterns?

Some doctors can get a better idea of your sleeping problems by seeing a log indicating how long you rest each night. It can be difficult to recall a few nights prior and by keeping a log, patterns that are affecting your depression may become more obvious.

Tips for Managing Your Sleep While Depressed

Managing Sleep and Depresison Illustration

We’re just going to say it like it is: sleep and depression have a notoriously bad relationship and there is no option for a breakup in sight. Sleep and depression are married in Catholic Tudor England and Henry VIII isn’t around yet. Long story short: you have to make it work. 

 

However, before you get too depressed to treat your depression, can we interest you in marriage counseling? There are a few proven ways to improve your relationship with rest and these suggestions are similar to therapy in that they can provide solutions, but you have to put in the work.

Avoid Caffeine or other Stimulants

While it may be tempting to solve your mid-afternoon slump with a cup of coffee or sugary energy drink, these will ultimately make it more difficult for you to fall asleep later. Caffeine works by binding to adenosine receptors, making it nearly impossible for you to feel tired until it wears off and the adenosine can take over, creating almost irresistible pressure to rest. Time it poorly, and you could end up awake all night and then drooling on your keyboard the next day at work. 

 

Caffeine has a half-life of 5 to 6 hours, meaning a hit around 4 pm will still be partially active in your system at 10 pm. In order to stabilize your sleep schedule, it may be a good idea to limit their use to the morning, or avoid them altogether.

A Woman Looking at Her Watch Illustration

Make a Sleep Routine

Though it may sound simple, creating a bedtime routine is a powerful tool that may help train your body to prepare for rest at the same time every day. Creating a schedule and sticking to it is not always easy, especially when your schedule is dependent on a partner or roommate, but performing the same tasks nightly can help signal your brain that you are preparing for bed. 

 

You may start by brushing your teeth, washing your face, reading a physical book, or listening to music. It’s probably a good idea to avoid higher stress activities such as checking social media or answering emails until you are fully awake the next day.

Be Careful with Naps

While in many cases naps can be beneficial for making up for lost sleep, with depression, experts often recommend skipping them and waiting for bedtime. Staying awake during the day may make it easier to fall asleep at the correct time to combat insomnia and reduce hypersomnia according to a study conducted at the University of Freiburg Medical Center.

Join an Exercise Class with a Friend

Exercise is an important part of sleep hygiene as it can both help you fall asleep more quickly and rest for longer according to Johns Hopkins Medicine. For those with depression, a little cardio exercise can also help boost mood and reduce depressive symptoms by releasing endorphins, according to a German study.  As long as you don’t exercise right before going to bed, this could be an important lifestyle change that makes a big difference.

Illustration of a Couple Running

Only Go into Your Bedroom when Ready to Sleep

The National Sleep Foundation reports that using the bedroom for sleep alone can help train your body to associate your bed with rest, rather than with worrying or completing important tasks. If you need a productive space at home, we suggest investing in a desk and a comfortable chair for the living room.

Get Some Sun

Just as light therapy is an effective way to treat depression in some cases, getting outside during the day may also have some benefits. According to a study from Loyola University, both eating foods and participating in experiences that increase Vitamin D could help improve mental health and reduce the symptoms of depression.

 

Researchers at NASA also found that increasing exposure to sunlight can naturally help improve cognitive function among those with depression. We know it’s not always easy to take the steps to get outside amid a depressive episode, but this simple practice may help improve your outlook, even if it doesn’t immediately remove all of your obstacles.

A Woman Shielding her Face from the Sun Illustration

Meditate with an App

The National Sleep Foundation suggests mediation as an inexpensive supplemental treatment for insomnia. Slowing down your breathing and your heart rate even has additional benefits including reduced anxiety and lowered blood pressure.

With a variety of self-care apps available, it shouldn’t be hard to find guided meditations to help you prepare for rest. Some will even feature narrators with soothing voices telling bedtime stories.

Conclusion


Sleep and depression may have a difficult relationship, but it's not time to call it quits just yet. There are a variety of practices and treatments that can contribute to improved rest and improved depression symptoms, most of which can be implemented with a doctor for a better chance at improvement. 

 

While this article should give you the information you need to take the first few steps, there are many other resources available for those who struggle with depression. If you are struggling, we implore you not to give up, but to pursue your options and know that sleep is just one of the many factors that could be improved to relieve depression. 

 

Try not to get discouraged. While sleep can worsen depression and vice versa, when one improves, it’s likely the other will as well.

<span style="border-left: 6px solid #f4772c; padding-left:10px;">Katie</span> Harris
Katie Harris

Katie is a content writer and serial hobby collector who enjoys naps almost as much as her pets do. When she isn't writing, she likes to ride her motorcycle, catch Pokemon with her hubby, and practice yoga with her dog.

The Sleep Advisor