Depression and Sleep
by Katie Harris
Disclaimer – Nothing on this website is intended to be a substitute for professional medical advice, diagnosis, or treatment… Read More Here.
Depression is one of the most common mental illnesses. If you’re struggling with depression, you know very well how difficult a depressive episode can make your life, not to mention your sleep. When you’re depressed, you sleep more poorly, and when you sleep more poorly, it can compound your depression. This cycle seems unfair and hard to get out of, especially when you’re feeling so low.
That’s why in this guide on depression and sleep we will give you the key information about the ties between depression and sleep. From there, we’ll discuss some available treatment options, as well as tips for sleeping better with depression.
Depression Defined
Depression affects an estimated 21 million adults in the U.S.[1] alone.Even though depression is one of the most common mental disorders, it can also be one of the most misunderstood. 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. MDD is characterized by symptoms that last for at least two weeks and have an overall impact on your ability to live your normal life[1].
Symptoms of Depression
Not everyone will experience the same symptoms[2] of depression; some people might experience many of the symptoms listed below, whereas others might only experience a few. Symptoms can also vary in severity and length.
– Persistent sad, anxious, or empty mood
– Hopelessness
– Irritability or restlessness
– Guilt, worthlessness, helplessness
– Loss of interest or pleasure in your usual activities
– Fatigue
– Difficulty concentrating
– Difficulty sleeping
– Changes in appetite
– Thoughts of death or suicide attempts
– Physical pains– headaches, stomach cramps, digestive problems
Studies show that in some cases, adjusting sleeping patterns has been successful in helping manage depression. That’s why we researched depression and sleep and learned how to unlock their complex relationship.
The Connection Between Depression and Sleep
A study[3] 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 sleep.
This is hardly a surprise as countless research studies[4] have produced evidence of the complex relationship between depression and sleep, 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 to work.
According to a study [5]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[6] 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.
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 Depression Affects Sleep
While it’s no surprise that there is a strong relationship between depression and sleep, movies and television 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[3]. Both effects are characteristic of the disease.
While insomnia may be more common than hypersomnia, research cited by Scientific American suggests that the two go hand-in-hand[6], and 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.
Even if you are someone who doesn’t normally deal with depression but struggles to get enough sleep each night, you could end up in a depressive cycle. For example, if you consistently pull all-nighters to get your work done, you’ll go to work exhausted, not feeling present or joyful, and you’ll probably have difficulty getting work done that day. Once again, you’ll need to pull an all-nighter to make up for it, creating a problematic cycle. Even if you don’t have depression, consistently not sleeping could cause it and certainly worsen it for those who already have depression.
To further complicate matters, according to the American Psychological Association[7], 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. Their research says people 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.
Get More Info: 10 Surprising Insomnia Statistics
How Sleep Deprivation Impacts Depression
In most cases, sleep deprivation can make things worse. Referencing a study[8] 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[9] conducted on adolescents at the University of Texas Health Science Center at Houston. However, the results can depend on the current issues a person is experiencing.
For example, in cases where depressed people 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. Sleep experts recommend 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[10] 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.
This could be because the brain processes our emotions while we sleep, according to a study[11] 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[12], REM sleep, or the periods when we dream, contributes 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.
Treatment Options for Depression
Fortunately, we have come a long way from the days of understanding and treating “melancholia” or other types of “quiet insanity[13].” There are now a variety of options for treating depression, and we recommend talking to a therapist, psychiatrist, or doctor to determine what will work best for you.
Cognitive behavioral therapy (CBT)
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[14] 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.
Talk therapy
This common method of treating depression is also in the realm of talk therapy, or counseling, 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.
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[15].
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[16] 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[17] 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 Cognitive Behavioral Therapy, 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[18].
Tips for Sleeping Better With Depression
1. Avoid caffeine and other stimulants
Caffeine is one of the most common legal stimulants out there, and if you drink it daily, you’re among about 80 percent[19] of the U.S. population. 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.
Caffeine has a half-life of 5 to 6 hours for most people, meaning if you want to start getting sleepy by 10:00 p.m., your last cup should be before 4, at the latest.
Research[20] shows that some people will have a different response to caffeine and could be kept awake for up to 8 to 10 hours after their last sip. To stabilize your sleep schedule, it may be a good idea to limit your caffeine intake to the morning or avoid it altogether.
Another of the more common legal stimulants is nicotine. Research[21] shows that those who smoke are more likely to experience insomnia, shorter sleep duration, and overall poorer sleep quality–especially if you smoke at night.
2. Avoid alcohol
Avoiding alcohol is not just a tip for improving your sleep but improving your depression as well.
While heavy drinking and alcoholism have a major impact[22] on the quality of our sleep, science is now revealing that even light or moderate drinking can worsen our sleep. One recent study[23] shows that as little as one drink can negatively impact sleep. Other studies[24] confirm this: at all dosages, alcohol has an impact on sleep quality, particularly when it comes to REM sleep.
As we now know, getting poor sleep is a major factor contributing to depression, but even if alcohol was not impacting your sleep, it alone worsens depression. Research[25] shows that alcohol has a direct impact on your serotonin levels, one of the major chemicals in our bodies responsible for mood.
Due to alcohol’s direct impact on depression, experts[26]recommend that those living with depression stop drinking altogether. If you are a regular or heavy drinker, this might make sleep harder at first, but in the long-term, quitting or significantly reducing drinking should improve both depression[27] and sleep quality[23].
3. Create 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 high-stress activities such as checking social media or answering emails until you are fully awake the next day.
4. Be cautious 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.
5. Join an exercise class with a friend
Exercise is an important part of sleep hygiene as it can help you fall asleep more quickly and rest for longer according to Johns Hopkins Medicine[28]. 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[29]. As long as you don’t exercise right before going to bed, this could be an important lifestyle change that makes a big difference.
6. Reserve your bedroom for sleep only
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.
7. Get exposure to the 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[30] 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[31] 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.
8. Try guided meditation with an app
Harvard Medical School[32]suggests meditation 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.
Questions for Your Doctor
Though it is estimated that around 21 million Americans have depression1, according to a study[33] 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.
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 for 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.
Is my depression making 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 sleep?
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[34] 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 to overcome jet lag or 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.
See Our Full Guide: Best Rated Melatonin Supplements
Would it help if I tracked my sleep?
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.
Last Word of Advice
The relationship between depression and sleep is a cyclical one: if you are depressed, it impacts your sleep; if your sleep is impacted, it can make you depressed. The good news is that it’s a cycle that can be broken.
Tackling the symptoms of depression with treatments like CBT, talk therapy, medication, and other options should ultimately help improve your sleep. On the other hand, tackling sleep issues with methods like light therapy, creating a consistent bedtime routine, and getting your circadian rhythm back on track should ultimately help improve your depression.
For best results, you can start working on both, and remind yourself it’s okay to start small. Perhaps that looks like starting talk therapy and getting 30 minutes of exercise; maybe it’s trying light therapy and improving your sleep routine. Whatever works for you, know that feeling better is possible and achievable through small, dedicated steps. If you’re struggling with sleep, depression, or both, we recommend you contact a professional: a therapist, psychiatrist, or doctor, who can help guide you to feeling better sooner.
References
- “Major Depression”. National Institute of Mental Health. Last modified January 2022.
- “Depression”. National Institute of Mental Health. Last modified September 2022.
- Nutt, David., Wilson, Sue., Paterson, Louise. “Sleep disorders as core symptoms of depression”. National Library of Medicine. 2008.
- Costandi, Moheb. “The Link Between Depression, Sleep, and Stress”. Dana Foundation. 2014.
- Sun, Xiaoyan., Zheng, Bang., et al. “Sleep behavior and depression: Findings from the China Kadoorie Biobank of 0.5 million Chinese adults”. Journal of Affective Disorders. 2018.
- “Fighting Depression by Staying Awake”. Scientific American. 2016.
- “Getting a good night’s sleep: How psychologists help with insomnia”. American Psychological Association. 2014.
- “Studies find new links between sleep duration and depression”. American Academy of Sleep Medicine. 2014.
- Roberts PhD, Robert E., Duong MD, Hao T. “The prospective association between sleep deprivation and depression among adolescents”. Sleep. 2014.
- McGlinchey, Eleanor., Reyes-Portillo, Jazmin., Turner, J. Blake., Mufson, Laura. “Innovations in Practice: The relationship between sleep disturbances, depression, and interpersonal functioning in treatment for adolescent depression”. The Association for Child and Adolescent Mental Health. 2016.
- van der Helm, Els., Walker, Matthew P. “Overnight therapy? The role of sleep in emotional brain processing”. Psychological Bulletin. 2009.
- “Sleep and Mental Health”. Harvard Health Publishing. 2021.
- Paykel MD, Eugene S., “Basic concepts of depression”. Dialogues in Clinical Neuroscience. 2008.
- Lopez PhD, Molly A., Basco PhD, Monica A. “Effectiveness of cognitive behavioral therapy in public mental health: comparison to treatment as usual for treatment-resistant depression”. Administration and Policy in Mental Health. 2015.
- “Antidepressants: Selecting one that's right for you”. Mayo Clinic. Last modified September 23, 2022.
- Sawchuk PhD, Craig N. “Depression and anxiety: Can I have both?”. Mayo Clinic. Last modified June 2, 2017.
- Wilson, Sue., Argyropoulos, Spilios. “Antidepressants and sleep: a qualitative review of the literature”. National Library of Medicine. 2005.
- “Seasonal affective disorder treatment: Choosing a light box”. Mayo Clinic. Last modified March 30, 2022.
- “Caffeine & Long Work Hours”. Centers for Disease Control & Prevention. Last modified April 1, 2020.
- Yang, Amy., Palmer, Abraham A., de Wit, Harriet. “Genetics of caffeine consumption and responses to caffeine”. National Library of Medicine. 2010.
- Nuñez PhD, Alicia., Unbin Rheeet, Joshua., et. al. “Smoke at night and sleep worse? The associations between cigarette smoking with insomnia severity and sleep duration”. National Library of Medicine. 2021.
- Koob, George F., Colrain, Ian M. “Alcohol use disorder and sleep disturbances: a feed-forward allostatic framework”. National Library of Medicine. 2020.
- Pietilä, Julia., Helander, Elina., et. al. “Acute Effect of Alcohol Intake on Cardiovascular Autonomic Regulation During the First Hours of Sleep in a Large Real-World Sample of Finnish Employees: Observational Study”. JMIR Publications. 2018.
- Ebrahim, Irshaad O., Shapiro, Colin M., Williams, Adrian J., Fenwick, Peter B. “Alcohol and sleep I: effects on normal sleep”. National Library of Medicine. 2013.
- Lovinger, D.M. “Serotonin's role in alcohol's effects on the brain”. National Library of Medicine. 1997.
- “Alcohol and depression”. Royal College of Psychiatrists. 2021.
- Yao, Xiaoxin I., Ni, Michael Y., et. al. “Change in moderate alcohol consumption and quality of life: evidence from 2 population-based cohorts”. Canadian Medical Association Journal. 2019.
- “Exercising for Better Sleep”. Johns Hopkins Medicine. Webpage accessed January 17, 2022.
- Dimeo, F., Bauer, M., Varahram, I., et. al. “Benefits from aerobic exercise in patients with major depression: a pilot study”. BMJ Journals. 2001.
- Penckofer Phd, Sue., Kouba Phd, Joanne., et. al. “Vitamin D and depression: where is all the sunshine?” Issues in Mental Health Nursing. 2010.
- Kent, Shia T., McClure, Leslie A., et. al. “Effect of sunlight exposure on cognitive function among depressed and non-depressed participants: a REGARDS cross-sectional study”. Environmental Health. 2009.
- Corliss, Julie. “Mindfulness meditation helps fight insomnia, improves sleep”. Harvard Health Publishing. 2020.
- Williams, Sharifa Z., Chung, Grace S., Muennig, Peter A. “Undiagnosed depression: A community diagnosis”. SSM – Population Health. 2017.
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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.
