Depression and Sleep

Table of Contents

More than 19 million people in the United States have depression, a mental health condition that involves persistent feelings of sadness, hopelessness, and guilt. Depression is a serious disorder that can make it difficult for people to get through the day. If left untreated, depression can significantly interfere with a person’s work, relationships, and even their sleep.

Sleep is a critical element of overall health and well-being. People with depression may struggle to fall asleep, while others may sleep too much. Sleep problems often begin prior to other symptoms, which has led some experts to suggest that sleeping difficulties may contribute to the development of depression.

We’ll discuss the connection between depression and sleep, including the basics of depression and sleep disorders associated with this condition. We’ll also cover information about the treatment of depression, tips for coping with symptoms, and resources for people living with this common condition.

Everyone has periods of feeling sad or unhappy. Typically these feelings resolve after a short time. When feelings of emptiness, irritability, anger, or frustration last for more than a few weeks and make daily life a challenge, they may be due to depression.

Depression is a treatable mental health condition with symptoms that can substantially affect an individual’s daily life and make it difficult to work, socialize, and enjoy activities. Around 10% of people have experienced an episode of major depression in the past year and 21% of people will experience an episode at some point in their lifetime.

Types of Depression

The term depression can describe one of several depressive disorders, classified based on their cause and symptoms.

• Major Depressive Disorder: Major depressive disorder is the second most common cause of disability in the United States. Also called major depression or unipolar depression, this condition involves having at least one episode in which a person experiences symptoms that interfere with daily life and last for at least two weeks.
• Persistent Depressive Disorder: Previously called dysthymia, this condition is similar to major depressive disorder, but symptoms last for at least two years and the effects on a person’s ability to function can be more severe. Studies indicate that about 3% of people experience persistent depressive disorder during their lifetime.
• Postpartum Depression: Although it is normal for a parent to experience “baby blues” for a few weeks after giving birth, postpartum depression may be diagnosed when symptoms are severe and last longer than two weeks. Pregnant people may also be diagnosed with depression during pregnancy, a condition called prenatal depression.
• Seasonal Affective Disorder: This type of depression is associated with the changing of seasons. Individuals with seasonal depression usually develop symptoms in fall or winter and find that their symptoms subside in the spring or summer.

Causes of Depression

While the exact cause of depression is unknown, depressive disorders are likely caused by a combination of genetic and environmental factors. About 50% of the factors that cause depression are believed to be genetic.

In fact, people who have a first-degree relative with depression, like a parent, sibling, or child, are at a two to three times greater risk of developing the condition themselves. Experts believe that genetics impact a person’s susceptibility to depression in several ways, including by affecting the function of certain chemicals in the brain, like serotonin, dopamine, and norepinephrine.

Studies have found a variety of other factors that can increase a person’s chances of developing depression, including:

• A personal history of depression
• Being female
• Stress or trauma
• Social isolation
• Medical conditions such as thyroid disease and chronic pain
• A history of a substance use disorder or addiction
• Certain medications

Symptoms of Depression

Depression can cause a wide variety of symptoms and may look completely different from one person to the next. Symptoms also vary in severity and how much they interfere with a person’s day-to-day functioning. Symptoms of depression include:

• Persistent feelings of sadness or irritability
• Loss of interest in pleasurable activities
• Difficulty concentrating and making decisions
• Feelings of guilt, worthlessness, or hopelessness
• Tiredness and fatigue
• Physical aches and pains
• Sleeping too little or too much
• Changes in appetite and eating
• Feeling agitated or restless

Symptoms also affect people differently based on their age. For example, symptoms may appear in children as anxiety or feigning sickness, along with refusing to go to school or participate in social activities. Teenagers and older children may experience low self-esteem, restlessness, or acting out in school.

The symptoms of depression overlap with natural feelings of sadness and grief. While people may describe themselves as depressed after a significant loss, disappointment, or challenging experience, these reactions are often expected and reasonable.

To determine whether symptoms meet the criteria for a depressive disorder, people can consult with a health professional. Doctors and mental health professionals consider the severity and duration of symptoms, as well as how much symptoms interfere with a person’s daily life. In general, people with depression have multiple symptoms that interfere with their ability to function at work, school, or in relationships. Symptoms generally last most of the day for at least two weeks.

The majority of people with depression have trouble sleeping. Some researchers estimate that as many as 90% of people living with depression have sleep issues, including trouble falling asleep, waking up repeatedly during the night, or sleeping more than needed.

While sleep issues were historically viewed as a side effect of mental illness, research now suggests a bidirectional relationship between sleep and mental health. Sleep issues may play a role in the development of depression, and as many as 40% of people diagnosed with depression report insomnia that develops before other symptoms.

While researchers are still learning about the connections between depression and sleep, studies suggest that both sleep and mood may be affected by similar processes within the body. For example, both depression and sleep issues are also associated with changes in certain hormones, like serotonin, dopamine, and cortisol.

Depression also appears to follow a circadian rhythm, with more severe symptoms often occurring in the morning hours. Studies show that the severity of major depressive disorder may be correlated with the degree to which a person’s circadian rhythms are disrupted.

Depression is associated with several sleep disorders, including insomnia, hypersomnia, and sleep apnea.

Insomnia

Insomnia is a sleep disorder in which individuals have difficulty sleeping despite adequate opportunities for rest. People with insomnia often have trouble falling asleep and staying asleep through the night, resulting in poor sleep quality and symptoms like daytime sleepiness, irritability, and symptoms of depression.

Research suggests that insomnia is the most common sleep issue reported by people with depression. Insomnia is present in around 80% of people with depression and often begins prior to a depressive episode. Conversely, depression is found in nearly 40% of people with insomnia.

Hypersomnia

People with hypersomnia sleep excessively, experience daytime sleepiness, or nap too much during the day. Unfortunately, long sleep and regular naps typically do not alleviate the sleepiness associated with hypersomnia.

Hypersomnia may be related to a medical condition, medication or other substance, or a mental health condition like depression. In some cases, the cause of hypersomnia is not known. As many as 50% of people with major depressive disorder experience hypersomnia.

Sleep Apnea

Sleep apnea is a common condition in which a person’s breathing becomes shallow or stops during sleep. Most people with sleep apnea have obstructive sleep apnea, a type of sleep apnea in which a person attempts to breathe, but is unable because the airway is narrow or blocked.

Frequent pauses in breathing during sleep can reduce sleep quality and lead to sleepiness during the day, medical problems like headaches and heart disease, and an increased risk of accidents at work or while driving a car. Sleep apnea can also cause symptoms similar to depression, including mood changes, difficulty concentrating, and excessive fatigue.

Research suggests that around 18% of people with major depressive disorder have sleep apnea or another sleep-related breathing disorder. Depression appears to increase the risk of obstructive sleep apnea and, conversely, sleep apnea may increase the risk of depression. Sleep apnea can also exacerbate the symptoms of depression and make depression more resistant to treatment.

Depression is treated with counseling therapy, medications, or both. According to the CDC, about 19% of adults reported receiving mental health treatment in the past year, with 9.5% engaging in counseling with a mental health professional and 16% taking prescription medication.

Treating depression can reduce symptoms, improve a person’s quality of life, and reduce their risk of additional health issues. Fortunately, 80% to 90% of people with depression respond to treatment and see improvements in their symptoms. People experiencing symptoms of depression should talk to their doctor or a mental health professional for accurate information and diagnosis.

Professional Counseling

Professional counseling is a common treatment for depression where an individual talks with a psychiatrist, psychologist, counselor, or other mental health professional about their symptoms. Counseling helps by providing emotional support as well as practical strategies for improving mental health.

People interested in counseling can begin by speaking with their doctor or a mental health professional. Individuals typically begin to see improvements within a few weeks of starting counseling, though it may take up to 10 weeks to see significant progress.

There are many approaches to counseling that are effective in treating depression, including psychodynamic psychotherapy, interpersonal psychotherapy, and cognitive-behavioral therapy (CBT). Many mental health professionals combine techniques of several types of counseling in order to customize treatment for an individual’s needs.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is one type of counseling used to treat depression. In CBT, a counselor helps people recognize, understand, and shift thoughts, feelings, and behaviors. A counselor using CBT may help a person with depression identify and stop negative thoughts, practice positive thinking, and develop habits that support a healthy body and mind.

People with insomnia may benefit from a specific type of CBT called cognitive behavioral therapy for insomnia (CBT-I). This form of CBT focuses on identifying and changing thoughts, feelings, and behaviors that contribute to chronic sleep loss.

Antidepressants

Antidepressants are a type of medication commonly prescribed to treat depression. There are several types of antidepressants used to treat depression, each affecting the body in a different way to help people with depression feel better.

• Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are the most prescribed type of antidepressant, often suggested first due to their safety and effectiveness. Used to treat a variety of mental health conditions, SSRIs increase the level of a hormone called serotonin in the body by limiting its reabsorption.
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): SNRIs are another type of medicine prescribed to treat depression. These medications are similar to SSRIs, but also block the reabsorption of another hormone called norepinephrine.

Other types of antidepressants include atypical antidepressants, serotonin modulators, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs). A doctor will select the right antidepressant based on several factors such as a person’s symptoms, any co-occurring mental or physical health issues, and a person’s past response to antidepressants.

Most people can find relief from depression by working with their doctor to find an accurate diagnosis and treatment. There are also coping strategies that people living with depression can try to reduce their symptoms and improve their quality of life.

• Stay Active: Spend time doing enjoyable activities and continue engaging in activities that used to bring pleasure. While depression can make it difficult for people to do things that they used to enjoy, continuing those activities despite feeling depressed may help to reduce symptoms of depression.
• Exercise: Regular exercise can improve mood, increase positive feelings, and reduce the symptoms of depression. Start with 30 minutes to boost mood, then work up to exercising three to five times each week, with each session lasting 45 to 60 minutes.
• Avoid Drugs and Alcohol: People with depression may turn to drugs and alcohol to cope with their symptoms. Be careful of these substances, as they can make depression work and interfere with antidepressants.
• Find Support: It is important to know when to ask for help. If the symptoms of depression begin to interfere with daily life, work, and relationships, contact a doctor or mental health professional for support.

Sleep is an important step to maintain mental and physical health, and is particularly important for people living with depression. Taking steps to improve sleep hygiene may help people with depression to feel better.

• Stick to a Schedule: Go to sleep and wake up at the same time each day. On weekends and holidays, stick to the same schedule and limit changes in sleep time to an hour or less.
• Time Light Exposure: Getting sunlight during the day can help people feel more alert and may relieve seasonal symptoms of depression. Around an hour before bed, shut off bright lights and stay away from cell phones, tablets, and televisions that may cue the brain to stay awake.
• Nap Carefully: A short afternoon nap may improve mood, but can also interfere with nighttime sleep. Try limiting naps to no more than 20 minutes and avoid naps after 3 p.m.

• National Suicide Prevention Lifeline: The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States.
• What Is Professional Counseling: The American Counseling Association offers information about the benefits of professional counseling as well as resources to find a professional counselor.
• Support Groups: The Anxiety & Depression Association of America provides information and resources on anxiety and depression, along with a searchable database of virtual and in-person support groups.
• Find Treatment: The Substance Abuse and Mental Health Services Administration offers several resources for finding treatment for different mental health conditions. Individuals struggling with opioid abuse and veterans can use specific search tools to find support.
• Mental Health Myths and Facts: MentalHealth.gov provides information about the most common mental health myths, as well as resources for individuals experiencing mental health conditions, including a distress hotline and clinical trials.

About The Author

Dr. Michael Breus

Clinical Psychologist, Sleep Medicine Expert

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Michael Breus, Ph.D is a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine and one of only 168 psychologists to pass the Sleep Medical Specialty Board without going to medical school. He holds a BA in Psychology from Skidmore College, and PhD in Clinical Psychology from The University of Georgia. Dr. Breus has been in private practice as a sleep doctor for nearly 25 years. Dr. Breus is a sought after lecturer and his knowledge is shared daily in major national media worldwide including Today, Dr. Oz, Oprah, and for fourteen years as the sleep expert on WebMD. Dr. Breus is also the bestselling author of The Power of When, The Sleep Doctor’s Diet Plan, Good Night!, and Energize!

• POSITION: Combination Sleeper
• TEMPERATURE: Hot Sleeper
• CHRONOTYPE: Wolf

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