Last updated on April 12, 2021
In this article: Everything you need to know and what you can do to sleep better.
Depression and Insomnia
Feeling blue every once in a while is a normal part of the human experience, especially after trying or difficult times. In contrast, ongoing feelings of sadness, disinterest, hopelessness, and anxiety are all symptoms of depression.
Depression is a medical illness that affects nearly 20 million Americans. Major depressive disorder is not something that will just go away or that you can ignore. Instead, it is a serious problem that affects the way a person thinks, feels, sleeps, and eats.
Depression and sleep problems often go hand-in-hand. Sleep problems as they relate to depression range from sleeping too much, which affects about 15% of those with depression and insomnia that features difficulties falling asleep or staying asleep, which affects 80% of those with depression.
Moreover, those who experience chronic and persistent insomnia are more vulnerable to developing depression, in fact three times more than those who have no sleep issues.
If you have been diagnosed with depression, you may be having difficulty staying asleep or getting to sleep, and so it is very important to see a doctor as soon as possible.
What Is Insomnia?
Insomnia is a problem maintaining a normal sleep or in initiating sleep. Insomnia is often an indication or symptomatic of various mental health problems, including depression.
Insomnia can present as not being able to fall asleep, or not sleeping enough, or even waking too early or several times a night and not being able to fall back asleep. It can result in a sleep that is nonrestorative and can affect the way you function during the daytime hours.
With untreated depression, you may have problems with feelings of guilt, worthlessness, hopelessness, or sadness. These difficulties can interrupt your sleep, leading to depression related insomnia.
Your mind may be in overdrive, ruminating situations over which you have no control. With rumination comes anxiety, a tendency to misperceive sleep, low daytime levels, anxiety, and fears around sleep.
Sleep Problems May Include
- Waking up early in the morning time
- Waking up tired
- Difficulty staying asleep
- Difficulty falling asleep
Why Is Sleep So Vital?
Experts report that adults need 7-9 hours of sleep per night but even without depression, the average American only gets about seven hours of sleep a night.
- Normal sleep is restorative; however, when the sleep is so inadequate or disrupted, it can lead to irritability, vigilance, and increased tension
- Emotional or physical trauma or other medical trauma can trigger sleep problems.
- Poor sleep can lead to fatigue which prevents you from exercising
- Work performance may suffer
- Cognitive abilities suffer, including loss of focus, concentration and memory
- Good sleep supports general wellness and quality of life
- Good sleep supports health immunity and physical health
- Lack of sleep may make depression worse
Statistics On Depression Related Insomnia
According to the National Sleep Foundation’s 2005 “Sleep in America” poll, almost 10% of adults between the ages of 18-64 have been diagnosed with depression related insomnia.
The poll also showed that people who had been depressed or have any other medical condition were more likely to have depression related insomnia.
In addition, the poll showed that teens between the ages of 11-17, who were unhappy, had an increased likelihood of not being able to sleep at night.
The Relationship Between Depression And Sleep Problems
If you have been diagnosed with depression, you may be having difficulty getting to sleep or staying asleep or possibly you have been suffering from insomnia and this caused a depressive condition.
Two Types Of Insomnia
Those who have insomnia fall generally into two groups.
- Short-term insomnia – The first group has short-term insomnia, lasting only one to six months. This is often precipitated by a change in lifestyle or a major illness. Other changes might contribute to disrupting the sleep pattern. Once the triggering event is over with, the insomnia usually goes away.
- Chronic insomnia – People who have insomnia for longer than 1-6 months may have it chronically.
The relationship between good sleep and depression is complex. Sleep difficulties can cause depression or occur as a result of depression.
- In some cases, depression comes first and features sleep difficulties in the form of insomnia or sleeping too much.
- In other cases, insomnia or lack of good sleep on a consistent basis causes one to become depressed.
Insomnia is extremely common among those who have depression, and research has shown that those who suffer from insomnia have ten times the risk developing depression versus those who have no sleep problems.
- Sometimes, insomnia and sleep disturbances can be the start of a major depressive disorder, as one of the symptoms used in diagnosis is insomnia.
- People who are depressed may have a variety of symptoms, such as daytime sleepiness, unrefreshing sleep, difficulty staying asleep (sleep maintenance insomnia), or difficulty falling asleep (sleep onset insomnia).
- The issue of cause and effect in relation to depression related insomnia is of significant importance to those who work in the area of sleep medicine. It is known that people with depression related insomnia have a psychiatric disorder but it isn’t known exactly what causes it. The regulation of mood and the regulation of sleep seem to be closely related. Additionally, recent brain imaging studies indicate that there is a relationship between depression related insomnia and problems with brain activity.
- The most recent scientific research, which was shown at the “Associated Profession Sleep Societies,” found that people with insomnia who get less than 6 hours of sleep per night suffer from greater degrees of depression related insomnia than those who get more sleep each night. What they don’t known is what comes first, difficulty sleeping or a trouble with their mind.
- Both insomnia and depression might share the same pathways in the brain and may be related to a disruption of the rhythms of the body. Research tells us that, when the sleep-wake cycle is disrupted, depression and insomnia may be the result.
- There isn’t any doubt that insomnia and depression are related. In fact, there have been many scientific reports that show that there is a connection between sleeplessness and depression and that insomnia is a typical symptom of depression. Research, suggests that the risk of getting depressive symptoms is greatest among those who have both sleep maintenance insomnia and sleep onset insomnia.
- Sleep problems and depression share some of the same biological factors and risk factors and both may be treated with the same therapy strategies.
- Obstructive sleep apnea is also connected to depression. In a research study of nearly 20,000 people in Europe conducted by Stanford researchers, the participants who were depressed had a 5x more likelihood of suffering from sleep-disordered breathing problems. In obstructive sleep apnea with continuous positive airway pressure overlap with symptoms of sleep problems, there is a risk of misdiagnosing the disorder.
- Those with a depressed mood can have narcolepsy, obstructive sleep apnea, or insomnia.
- Restless legs syndrome is a neurological problem that causes sleep problems and discomfort in the legs. It is also linked with depression. According to the Restless Legs Sleep Foundation, about 40% of those with restless legs syndrome complain of symptoms that seem like depression if taken without consideration of a sleep problem.
- In addition, the National Sleep Foundation’s 2006 Sleep Poll showed that kids aged 11-17 found that there was a strong association between sleep problems and negative mood. Among teens who reported being unhappy nearly 755 reported not sleeping well at night.
- Depression affects all types of individuals from all over the world, but certain individuals are more likely than other people to develop sleep problems as a symptom of depression, including older adults and women. Among the elderly, there are higher rates of sleep problems and depression that may be explained in part by increased rates of physical fitness.
- Among women, hormonal changes and motherhood throughout the life cycle (menopause and menstruation) might cause higher rates of depression. Among older adults and women, higher incidences of depression may also be explained by increased rates of insomnia in this group of women.
- Seasonal affective disorder (SAD), also known as “depression in the wintertime” is one type of depression. Seasonal affective disorder is believed to be caused by the changing of the weather. Circadian rhythms are controlled by exposure to sunshine and by the body’s internal clock. For most of the people with seasonal affective disorder, depressive symptoms resolve in springtime, when the days are lengthened out.
What The Science Shows
Here are some findings from the research on depression and insomnia:
- Insomnia is worse when it presents in conjunction with depression
- Insomnia may actually cause changes in the brain to trigger depression
- A person with insomnia has a ten times risk of being depressed when compared to someone who sleeps normally
- Insomnia is often not only the first symptom of depression but is also the first to show up if there is a relapse of depression after successful recovery
- Insomnia may be worse when it is associated with depression
The Link Between Depression And Insomnia
These are a few theories about how depression and insomnia react with one another:
- Insomnia may be a warning sign that depression related insomnia is about to start.
- Insomnia may change the way the neurochemicals of the brain react with one another.
- Lying awake at night might make the depression worse and may trigger depression related insomnia.
- Insomnia may decrease the person’s quality of life and may cause depression related insomnia.
According to Dr. Michael Perlis, associate professor of psychiatry and director of the Behavioral Sleep Medicine Program at the University of Pennsylvania states that new research has shown that insomnia is not simply a symptom of depression, but depression and insomnia may just be two distinct disorders that either overlap or occur at the same time.
The mindset now is that doctors need to treat both conditions in order to help patients sleep better; improve mood and general wellness and quality of life.
Scientists believe that there is a combination of factors that cause depression related insomnia, although the exact cause isn’t known.
One thing that might predispose you is a hereditary factor. Some kinds of depression related insomnia tend to run in families.
If you have a family member who has some kind of depression, such as bipolar depression or major depression, you have an increased likelihood of developing sleep-related depression as well. It can also occur without a family history of depression. The cause of the depression related insomnia can be hereditary or non-hereditary.
Depression related insomnia could come in any age group. Even kids can have it. What do the symptoms look like in the different age groups? In kids, it can show itself indirectly. Changes in eating and sleeping habits, as well as their temperament can be seen.
Parents report kids to have an increase in nightmares and clinginess, along with fears of being alone, and more whininess. Some kids will have an increase in headaches and stomachaches. Kids may also show a fear or avoidance of going to school.
In teens, depression-related insomnia may show itself as substance abuse, a decrease in activities or friends, lethargy, a change in attitude, or overall negativity.
In certain cases, insomnia can make depressive symptoms worse. Therefore, whether we think of insomnia as the start of depression, a side effect of depression, or a symptom of depression, the effectiveness of treatment methods may depend on getting rid of the insomnia.
The treatment for depression related sleep disorders usually involves psychotherapy and medication.
Antidepressant medication block the reuptake of serotonin in the brain helping to improve mood and reduce sadness, and psychotherapy addresses negative attitudes and beliefs, which are caused by depression related insomnia. Talk therapy also helps to ease some of the depression symptoms that prevent good sleep.
Treating Insomnia Helps Depression
Scientific research has shown that treating sleep problems helps depressive symptoms and can potentially prevent any recurrence of them once the sufferer has gone into remission.
WebMD reports on one study that included 56 subjects who had both depression and insomnia and who participated in psychotherapy, which addressed only their insomnia. The results showed that depression symptoms were reduced in more than 50% of the subjects, even considering the fact that the treatment plans did not address depression directly.
Another study of 545 subjects with depression related insomnia found that those who received both antidepressants and sleep medication fared better than those who only took antidepressants. Those subjects who took both antidepressants and sleep medicine had improved their depression symptoms and also enjoyed better sleep.
CBT-I For Insomnia
CBT-I is a form of cognitive behavioral therapy specifically designed for insomnia. This type of treatment approach has been shown effective, as it encourages patients towards healthier behaviors, a more positive attitude towards sleep and teaches bedtime rituals that support a better nighttime experience.
Medications For Depression Related Anxiety
Your physician may treat your depression related anxiety with an antidepressant, such as a serotonin reuptake inhibitor (SSRI). He or she may also prescribe a medication that is sedating or a hypnotic medication, such as a sleeping pill.
The doctor may prescribe one of the following medications that might help your depression related sleep disorder:
- A sedating antidepressant, such as Remeron.
- The antidepressant trazodone is widely used to treat depression related insomnia because it is sedating and is often used along with a sleep medication that can be used with other antidepressants.
- SNRIs or serotonin/norepinephrine reuptake inhibitors such as Cymbalta, Fetzima, Khedezla, Pristiq, and Effexor.
- Tricyclic antidepressants, such as Elavil and Pamelor.
- A selective serotonin reuptake inhibitor (SSRI), such as Paxil, Lexapro, Celexa, Prozac, and Zoloft. These are medications that can both help the depressive symptoms and the sleep problems.
Commonly Prescribed Sleeping Pills
Your doctor may prescribe one of the following sleeping pills or hypnotics to help improve your symptoms:
CPAP may help depression, as a 2007 study of obstructive sleep apnea patients illustrated that those who used CPAP for a year had significant and lasting improvements in depression.
The Best Approach For Treating Depression And Insomnia
It is difficult to pinpoint whether medication or therapy will work best, as each has their pros and cons. While sleep medications can help people fall asleep and jump-start recovery, their underlying issues remain unaddressed and so once they stop taking those medications the sleep problems return.
Conversely, while CBT-I takes more effort and more time, usually about 12 weeks, the effects and improvements are more durable and longer lasting as patients will learn skill sets that can last a lifetime. While it may require work on the part of the patient, the payoffs are long term helping to permanently improve sleep, and also there is no risk of dependence on sleeping pills.
A study conducted in 2004, and published in the Archives of Internal Medicine found that CBT-I was particularly helpful for young and middle-aged patients who were able to fall asleep faster and sleep throughout the night by participating in regular CBT-I sessions.
The best treatment for you is best determined by you and your doctor, as different variables can play a role in your treatment needs.
What You Can Do
Just lying awake at night when you are suffering from depression related insomnia can make the problem worse and might also be a part of a cycle that can worsen the depression.
Learning self-help methods of dealing with depression at night is an important part of your recovery. In addition to therapy with a mental or medical health professional, here are some ways you can help yourself to feel better and improve you sleep.
- Keep as close to a regular sleep schedule as you can—try to go to sleep and wake up at the same time of the day.
- Have a sleep routine—use good sleep hygiene habits so that you can fall asleep easier.
- Get help from family—let them know that you need to get sleep in order to be less depressed.
- Have a quiet and comfortable sleep environment—use your bed only for sleeping and sex and don’t watch TV, text, or use the phone in your bedroom.
- Try not to nap in the afternoon—this only makes the sleep problems at night a lot worse.
- Avoid caffeine and alcohol—these can worsen your sleep patterns.
- Get out in the sun every day if you can—it helps you reset your circadian rhythm.
- Get some exercise every day—exercise helps decrease depression related insomnia and can make you tired enough to fall asleep at night. It can be difficult to exercise when you are depressed, but a 10-minute walk daily is all you need.
- Get out of bed if you can’t sleep – don’t just lie there staring at the walls. Get up and do something if you can’t get any sleep. It will help make you tired and will help you fall back to sleep again.
- Have a loved one help you – You don’t have to nor should you deal with this alone.
- Decrease your alcohol and caffeine intake
- Avoid naps in the afternoon, especially if you have insomnia at night
- Get some type of exercise every day
- Get into some bright sun right after getting up in the morning
Depression is treatable, and so is insomnia. Speak with your doctor as soon as possible, so you can start your road to recovery.
Before starting therapy for depression related insomnia, speak to your doctor about any problems you are having with sleeping. Sometimes, they can treat sleep problems, which at the same time alleviates the depression.
Treatment for depression related insomnia might be complicated. As an example, for patients with both obstructive sleep apnea and depression, they should not take any sedative medications or antidepressants as this can worsen their breathing and can worsen the sleep apnea.
Treating depression related insomnia might take a while. Antidepressants often take several weeks to take effect and some people may need to try several different medications before finding one that is best for them. Bear in mind that you shouldn’t stop taking the antidepressant because your symptoms are better as this can cause a recurrence of the symptoms or other problems. Always talk to your doctor about your treatment plan or any other changes in your medications or therapy.
Sleepless nights can have a detrimental effect on your quality of life, and your emotional and mental state, and untreated depression can lead to many serious complications for the mind, body, and spirit.
You don’t have to suffer, and you don’t have to deal with these issues on your own. Both insomnia and depression, no matter their cause or hos they present are serious medical conditions that require treatment.
The most important thing you can do to improve your quality of life and begin the healing process is to talk with your doctor.
Get well and take care!