It’s normal to feel blue every now and again; it’s a part of the human experience. However, if you’re constantly feeling out of sorts, upset, stressed, anxious, or whatever, these are not normal feelings and must be addressed. If you no longer enjoy the things you used to, you could be suffering from depression – a disease that affects approximately 20 million Americans every year.
Try as you might, you can’t just ignore depression. It’s a very serious condition that will affect how you live – your eating, sleeping, thinking, and feeling. There are no known causes for it, but with treatment the symptoms can be controlled.
The link between depression and sleep disorders is complicated. After all, depression can lead to sleep problems, and sleep problems can lead to depression. Some people suffer from symptoms of depression before sleeping issues, while others may notice sleeping issues before the depression begins.
The two may also have similar biological and risk factors, and they may even respond to the same treatment methods.
A closer look at depression
According to the Center for Disease Control and Prevention there are over 7% of Americans who suffer from moderate to severe depression. While the symptoms and severity of the disease can vary from one person to another, there are common clues:
- changes in appetite
- excessive daytime sleepiness
- loss of interest in previously fun activities
- weight loss or gain
- decrease in self-esteem
- low sex drive
- low energy levels
- difficulty concentrating
- frequent thoughts about death and/or suicide
- feelings of sadness, despair, etc.
Any sleep problems can be a symptom of depression. Both sleep disorders and depression can raise the risk of an array of health problems – heart disease, strokes, and heart attacks. They can lead to other mental health problems and suicide. Depression can cause headaches, back pain, and stomach issues.
People who suffer from depression are unable to be fully productive at work and school, and this can hinder them professionally and socially. Due to their sleeping problems they often seek help to get to the bottom of their issues.
Those most at risk of suffering from depression are under constant stress, have suffered a recent illness or loss, or have a family history of depression. While it affects both men and women, women and middle-aged individuals are at a higher risk. Coincidentally, these two groups are also high sufferers of insomnia.
The types of depression
There are several types of depression that can be the result of sleeping problems.
Seasonal Affective Disorder (SAD)
This condition, which is also called winter depression, occurs due to changing levels of sunlight, usually with the onset of winter. The body’s internal clock gets its regulation from the circadian rhythm. When autumn approaches, the days become shorter. This causes the circadian rhythm to come out of sync and can lead to depression.
While the condition can happen 10 percent of the time in the summer, it’s usually seen in the winter with symptoms such as worsened mood, insomnia, and hypersomnia. For the majority of people SAD usually resolves itself in the spring when there is an increase in sunlight and the days get longer.
People who have bipolar disorder tend to experience extreme highs and lows. When they are in a high, they may not be able to sleep or are extremely energetic. When they are in a low, they may sleep all the time.
This disorder is a bit milder than major depressive disorders, but can cause a person to suffer from hypersomnia and fragmented sleep. While they often don’t have as any many symptoms from the list above, people tend to suffer from them for much longer.
Major Depressive Disorder (MDD)
This disorder causes a person to feel extremely sad, hopeless, or suicidal regardless of what they do. Any moments of happiness are often fleeting. MDD often leads to excessive daytime sleepiness and insomnia.
Treatments for depression
Treatments are usually a combination of behavioral therapy and drugs. Therapies are often used in conjunction with each other and for both depression and sleeping problems such as insomnia.
However, sleep disorders can complicate some depression treatments. For instance, a person who has both depression and obstructive sleep apnea needs to avoid taking any sedative antidepressant medications because they can worsen breathing and the OSA disorder.
Before you can start any depression treatment you need to discuss your sleep-related problems with a doctor. It can be that your sleeping problems are causing the depression and treating the sleeping problems may alleviate the depression.
When you seek help for depression from a doctor, you need to keep a record of your moods and sleeping patterns for several weeks. Give the doctor this information to get the right diagnosis and treatment.
Treatment of clinical depression won’t happen overnight. Depression medications can take weeks before they kick in, and you may need to use an array of drugs before you find one that works for you.
Never quit taking a depression medication when you notice an improvement in your symptoms. Doing so may lead to a reoccurrence of the symptoms. Talk to your doctor before you make changes to your therapy and medication.
It’s imperative that you address your sleep symptoms to recover from depression. Therefore talk to your doctor about the sleeping problems you are having as you experience mood improvements. It could be that your depression symptoms are the result of an undiagnosed sleep disorder.
There is minor evidence that people who have depression can benefit from getting little to no sleep (sleep deprivation), which is why some doctors will recommend it. The problem with the method is that there is no real evidence for it, and a night of normal sleep can reverse any sustained benefits. Using sleep deprivation is not considered a practical treatment method for depression.
Sleep deprivation treatment also comes with serious risks such as cognitive impairment, extreme tiredness, and an increased chance of injuries or accidents.
People diagnosed with seasonal affective disorder (SAD) can benefit from light therapy, which involves natural light or lightbox treatment. While light therapy is deemed safe, there is no evidence that supports its effectiveness of treating SAD or other forms of depression.
Always talk to a doctor before you use any light therapy to treat your depression and sleep problems. Exposure to the sun and bright light can have negative effects.
When it comes to medications for insomnia and depression, you and your doctor will need to find the one that works for you. However, the more common drug methods used for depression include:
- Mood stabilizers and lithium – used to treat people who have bipolar disorder
- Tricyclic antidepressants – work as a sedative, but can have major side effects such as high blood pressure.
- Selective serotonin reuptake inhibitors (SSRIs) – can help improve mood, but can worsen insomnia.
Cognitive behavioral therapy (CBT)
One very popular approach to treating depression is cognitive behavioral therapy due to its effectiveness and no side effects. CBT uses the cognitive restructuring technique, which focuses on the thoughts that can cause depressive feelings. Another technique used in CBT is behavioral activation, which focuses on the behaviors that can lead to depression. The great thing about CBT is that it’s useful for both depression and insomnia.
Children and adolescents with depression and sleep disorders
The 2006 Sleep in America poll by the NSF discovered a strong link between sleep problems and bad mood. 73% of adolescents reported that they were unhappy and not sleeping well enough at night.
It’s not uncommon for children and teenagers to have depression and sleeping issues such as hypersomnia and insomnia – maybe even both. And according to recent research adolescents who have both hypersomnia and insomnia often suffer from prolonged depression as well. They may also have weight loss, anhedonia (an inability to feel pleasure), and impaired movement.
Depression can affect anybody in the world, but there are people who are far more likely to develop it than others – women and older adults, for example. Older adults suffer from a high rate of depression and have sleep problems that are somewhat explainable by the high number of physical health problems. Depression in women may be caused by hormonal changes (menstruation and menopause) and motherhood. High depression rates could explain the high insomnia rates in both groups.
It can be hard to live with depression, as it affects how you think and feel. And research has shown that it can lead to major health problems such as heart disease. If you have symptoms of depression, get treatment right away.
And there have been cases where depression symptoms correlated with sleep disorder symptoms. For that reason it’s not uncommon for doctors to treat the wrong disease or disorder. For instance, a person who is depressed may actually be narcoleptic, have OSA, or insomnia.
What are some sleep disorders that depressed patients tend to have?
Restless leg syndrome (RLS)
If you have ever felt pain and discomfort in your legs and have sleep problems because of it, you may have the restless leg syndrome (RLS). It’s a neurological condition that can also be tied to depression. Patients with the restless legs syndrome complain of symptoms that would indicate depression if assessed without consideration of a sleep disorder.
Obstructive sleep apnea (OSA)
Obstructive sleep apnea has also been tied to depression. Stanford researcher Dr. Maurice Ohayon conducted a study of nearly 19,000 people and found that those who have depression were five times more likely to suffer from OSA. Thankfully there have been many treatments in the last few decades to help with this condition.
One such treatment is the CPAP machine. The CPAP machine provides constant air to the body, which can help improve depression. OSA patients who used CPAP for a year In a 2007 study were found to have improved depression symptoms that lasted.
Insomnia is one of the most common complaints among depressed patients. According to various research people who have insomnia are at a higher risk of developing depression than people who sleep well. Symptoms of insomnia that depressed patients often complain about include:
- sleep that doesn’t refresh
- daytime lethargy
- problems falling asleep
- problems staying asleep.
And evidence shows that depression risk increases for people who have sleep onset and sleep maintenance insomnia.
Tips for getting better sleep with depression
Besides using the mentioned therapies to treat depression there are other things you can do to get better sleep while being treated for depression and other sleep disorders.
1. Stay calm when you wake up
Unfortunately retraining your body to sleep well isn’t easy and won’t happen overnight. Accept the fact that you’ll need to be patient and might still have problems falling and staying asleep during this process. When waking up, do some deep breathing and muscle relaxation. Meditate or visualize something that makes you feel happy or calm. When going to sleep, turn a soft lamp on and read something soothing (no TV). Sleep will eventually come.
2. Eat healthily, avoid consuming stimulating products
Do not consume sugary or fatty foods that can hinder you from getting good sleep and lead to a bad mood. Eat foods that are healthy and improve both your sleep and energy levels. Don’t consume caffeine, nicotine, or alcohol a few hours before bed.
3. Get out in the sun
Natural sunlight helps in creating a healthy sleep/wake cycle. Get as much sunshine as you can – exercise outdoors in the morning or early part of the day. While you’re at school or work, sit by the windows to increase exposure to natural light. This will provide you with an energy boost to get through the day and feel more energetic. When it starts getting dark, the brain will realize that it’s time for you to fall asleep.
4. Develop a relaxing bedtime routine
If you feel anxious or depressed, you may be unable to sleep. With a calming bedtime routine you can alleviate worries and ease your mind. Enjoy a nice warm bath, light some candles, meditate, and do relaxation exercises.
If your mind continues racing, write the thoughts in a journal. This will lessen their hold on you and alleviate anxiety so that you can fall asleep easily. You can worry about what you have to do tomorrow instead of while you’re trying to go to sleep.
5. Create a regular sleep schedule
The key to a good night’s rest is to go to bed at a regular time and wake up at the same time each day – at weekends too. Give yourself a minimum of seven hours of sleep, but you shouldn’t worry about spending all that time asleep. The only goal is to stick to your schedule, which lets the brain catch up and get the sleep it needs. By doing this you’ll go to bed and wake up more naturally.
You should avoid naps, but if you are really tired, limit them to short power naps of 30 minutes or less.
6. Create A welcoming sleeping environment
The bedroom should only be used for sleep and intimacy. Avoid watching television, working, or socializing in it. You want your mind to see your bedroom as a place where you sleep, not stress, worry, or socialize.
Make the room as dark as possible and cool. Keep electronics out and hang blackout curtains if necessary. Buy a supportive mattress so that you can easily fall asleep.
7. Keep a sleep diary
Sleep diaries are useful for learning if you are depressed or have a sleep disorder (or even both). Keep one for two weeks to share with your doctor. Include information such as:
- when you go to bed
- how long it takes you to fall asleep
- when you get up
- how long you slept for
- how many times you woke up at night
- what is your energy level during the day
- changes in your sex drive, mood, and thoughts.
How long a nap should you take if any?
While you should avoid taking daytime naps at all costs because of how difficult they can make going to sleep at night, sometimes it’s not possible. In this case take a nap before 3p.m. and no more than 15-20 minutes long (think of it as a power nap).
Can antidepressants worsen sleep conditions?
There are a class of antidepressants, known as SSRIs, that have been known to worsen insomnia in some patients. SSRIs are useful in improving moods and don’t affect everyone’s sleep the same way. The best thing you can do is talk to your doctor about each drug. Sometimes changing the time of day of taking the medication is enough to help you sleep at night.
Can light therapy help with winter depression?
Bright light therapy can help you get control over sleep problems by readjusting your internal clock. It’s also useful for depression, which can be caused by lack of bright light. SAD (seasonal affective disorder) occurs more in the winter when there is less sunlight in the day. However, anybody who lives in a part of the world where sunlight is scarce is susceptible to it.
Light therapy involves artificial bright light. Talk to a doctor about how much artificial light is necessary to stem off the symptoms. The best thing you can do is to increase the amount of outdoor light you get (especially morning time) to combat sleep problems and depression.
What can you do if depression and insomnia happen simultaneously?
If you have insomnia, your doctor may consider cognitive behavioral therapy (CBT). A sleep psychologist may consider how your behaviors, thoughts, and feelings affect your sleep and its quality. CBT involves no drugs, but requires numerous sessions over weeks or months. You are taught various strategies to get better sleep.
The great thing about CBT is that it can also be useful for depression. And it’s not uncommon for some psychologists to suggest a regimen of antidepressants.
Should you avoid consuming alcohol and caffeine?
Alcohol and caffeine are not good for you anyway, and are certainly not conducive to sleep. In small amounts they can be fine, but avoid them for at least four hours before bedtime. While it’s easy to avoid alcohol, caffeine is a bit trickier. For some people caffeine in the afternoon can still affect their sleep. There’s caffeine not just in soda, but also in tea, coffee, and chocolate. Learn what foods and drinks have caffeine to avoid overconsumption of it.
When I have slept well, I don’t feel depressed. What does this mean?
It may be that your moods are tied to sleep and the amount of it that you get. Lack of sleep and depression are not the same things, but it is easy to confuse the two. And it’s not easy to know which problem came first. If you sleep well and the depression goes away, it could be that you don’t actually have depression. Get help to improve your sleeping habits.
How can you know if you’re depressed?
If you’re constantly feeling helpless and upset, you could be suffering from clinical depression. If you’re low on motivation and energy and nothing makes you happy, consider seeing a doctor for treatment. If you’re noticing changes in how you eat and sleep, it could be a sign of depression too. It’s not uncommon for some depressed people to feel guilty or have low self-esteem.
What is clinical depression? It’s not just about feeling blue or sad every now and then; it’s a serious condition. If you don’t know whether the feelings you have are the result of clinical depression, discuss your concerns with a doctor.