Everyone has experienced sadness at some point as it is a fundamental human emotion, particularly during difficult times. However, persistent sadness, distorted self-image, anxiety, hopelessness, and disinterest in once enjoyable activities are symptoms of depression, a psychiatric disorder affecting approximately 20 million Americans. Clinical depression will not go away on its own and cannot be ignored. In fact, it is a serious problem which affects all aspects of life; from the way a person feels, thinks, eats and even sleeps. Fortunately, depression can be effectively treated.
Sleep is important because it is restorative for the body. When sleep is disrupted or inadequate, you can become tense, irritable or depressed. Poor sleep can also cause fatigue, making you less active, and becoming a vicious cycle of inactivity and sleep deprivation. This progression can cause both physical and mood-related problems.
Sleep and depression have a complex relationship. Depression may cause problems with sleep or, on the other hand, it may be the sleep problems that cause or contribute to depression. In some cases, a person will have symptoms of depression before experiencing problems with sleep. Others may have sleep problems before they show any concrete symptoms of depression. Some of the same treatment strategies may be used for both depressive illnesses and sleep problems as the two conditions share risk factors and biological features.
Grief and Sleep
After a loss, such as the death of a loved one or a divorce in the family, a person can feel more stress than any other time of their life. A person may even feel “survivor’s guilt,” if they think the incident could have been prevented. Other people may have more than just transient grief and become clinically depressed. All of these problems may result in sleepless nights where you can’t sleep as your memories or mournful thoughts keep you awake.
Depression and Insomnia
Insomnia is a common problem amongst depressed people. Research has shown that people with insomnia have ten times the risk of developing depressions in comparison to people who sleep well. A range of insomnia symptoms may develop for depressed individuals, such as difficulty falling asleep, difficulty staying asleep, waking up feeling unrefreshed and experiencing excessive daytime sleepiness. The risk of developing depression is highest among those who have sleep onset and sleep maintenance insomnia (difficulty falling asleep and difficulty staying asleep, respectively).
Depression and Sleep Apnea
Another sleep disorder associated with depression is obstructive sleep apnea (OSA). A study conducted at Stanford found that people with depressive illnesses are five times more likely to suffer from a sleep-disordered breathing condition (OSA is the most common sleep-disordered breathing condition). Fortunately, OSA may be effectively treated with continuous positive airway pressure (CPAP) which also may improve symptoms of depression. A 2007 study found that OSA patients who used CPAP for one year had significant and long-lasting improvements in their depression, as well as the associated symptoms.
Depression, Sleep Disorders and Diagnosis
Symptoms of depression may overlap with symptoms of other sleep disorders, so there is a chance of misdiagnosis. For instance, depression symptoms are common for people with insomnia, OSA, or narcolepsy. Another condition associated with both depression and sleep problems is the neurological disorder, restless leg syndrome (RLS), which causes discomfort in the legs and is only temporarily alleviated by movement.
Children or adolescents with depression are likely to suffer from insomnia or hypersomnia (excessive sleeping) or both. Recent research suggests that children who suffer from insomnia and hypersomnia are more likely to have more serious and longer lasting depressive illnesses. Other symptoms they may experience are weight loss, impaired movement and anhedonia, the inability to feel pleasure. The National Sleep Foundation’s 2006 Sleep in America Poll found a strong association between negative mood and sleep problems for children aged 11 to 17. 73 percent of the adolescents who reported being unhappy were not sleeping enough at night.
Certain people are more prone to develop depression than others, even though anyone can be affected by it. Older adults are one group highly affected by depression, which may be explained by life changes or higher rates of physical illness. Women are also more likely to develop depression than men due to motherhood and hormonal fluctuations that come with menstruation, pregnancy and menopause. Women and older adults are also more likely to suffer from insomnia.
Seasonal Affective Disorder
Another type of depression, sometimes called “winter depression,” is Seasonal Affective Disorder (SAD). Influenced by the increased darkness during the approach of winter, SAD can develop when circadian rhythms (the body’s internal clock) are desynchronized. Usually depressive symptoms experienced by those with SAD are resolved in the springtime with the increasing hours of daylight. For those who are affected by SAD and sleepy poorly, bright light therapy has been shown to be an effective treatment. Also known as phototherapy or heliotherapy, bright light therapy exposes an individual to high-intensity light for approximately 30-60 minutes at a time in order to advance or delay sleep.
The following is a list of the most common symptoms of depression:
- Feeling hopeless, helpless or persistently sad
- Low self esteem
- Thoughts of death of suicide
- Difficulty concentrating
- Loss of libido
- Loss of interest in formerly enjoyable activities
- Weight loss or weight gain
- Loss of energy
- Excessive daytime sleepiness
- Insomnia or hypersomnia
Depression may also present with physical symptoms such as headaches, stomach aches or back pain. Sleep problems are among the most draining features of depression as they hinder your productivity and mood.
There are many different forms of depression, such as major depressive disorder, dysthymia, or bipolar disorder. Other psychiatric disorders may also cause depression, as well.
Treatment for Depression and Sleep Disorders
The most successful treatment for depression involves both psychotherapy or psychiatric medication. Psychotherapy is useful in improving coping skills and changing negative attitudes and beliefs which stem from depression, while medication eases the feelings of sadness and hopelessness. These treatment strategies may be used to treat depression and insomnia, as sleep problems are often present in people with depression.
In some cases, treatment for depression is complicated by an existing sleep disorder, causing treatment to be individualized. This is especially true for people who have a sleep disorder such as OSA, which can be worsened by sedating antidepressant medication as it can suppress breathing. Make sure to thoroughly disclose all of your symptoms with your sleep specialist about your sleep problems. Sometimes treating the sleep problem is sufficient to alleviate your symptoms of depression.
Before visiting a health professional for your depression, it is useful to keep track of your mood and write a sleep diary for two weeks. By sharing this information, your sleep specialist, therapist, or physician will be able to evaluate your condition, make the correct diagnosis and guide treatment.
Be aware that it takes time to treat clinical depression. Antidepressant medications take up to one month to have any effect and it is not uncommon for an individual to try multiple medications before finding one that works best. Remember that you should not stop taking your medication if your symptoms start to improve, as this may lead to a relapse or other ill effects from possible withdrawal. Always consult with your physician prior to making any changes to your treatment and medication regimen.
Treating your sleep problems is critical in recovering from depression. Make sure to keep track of your sleep problems that persist as your mood improves. This may be a sign that you have an underlying sleep disorder.
Coping with Depression and Sleep Disorders
If you lie in bed awake at night, try the following:
- About two hours before you go to bed, write down problems which have kept you awake. Write down possible solutions to these problems.
- If you start thinking about your problems while awake in bed, remind yourself that such thoughts are unproductive and that you can work on your problems the following day.
- If you cannot manage to fall asleep, or if you wake up in the middle of the night and can’t get back to sleep, don’t just toss and turn. Get up and do something else such as listening to relaxing music, reading a book, or having a warm bath. Go back to bed when you feel sleepy again.
If you are interested in finding out more about depression and its affect on sleep, call The Los Angeles Sleep Study Institute at 1-855-690-0563 and one of our representatives will be happy to answer any of your questions.