How Depression Affects Sleep
Depression is a serious mood disorder that can interfere with everyday life (1). Unlike normal fluctuations in mood, clinical depression is characterized by persistent symptoms that interfere with a person’s thoughts, feelings, and ability to function. Depression can occur at any age, but most often begins during adulthood (2).
One of the most common mood disorders in the United States (3), depression is also a leading cause of disability worldwide (4). Almost 21% of adults will develop major depressive disorder during their lifetime (5). Since sleep issues are often the symptom that causes people with depression to seek medical help, it’s more important than ever to understand the relationship between depression and sleep.
Links Between Depression and Sleep
Research suggests that sleep and depression have a two-way relationship (6). People with sleep disorders are more likely to develop depression, and poor sleep is often the chief complaint of people diagnosed with depression. In the past, sleep issues were seen as secondary to depression and were rarely a target of treatment. Today, researchers believe that sleep issues often begin before depressive symptoms, and treating sleep issues may be an important part of the overall treatment of depression.
Although researchers are still learning about the two-way relationship between sleep and depression, several potential links have been suggested. Depression and sleep disorders may be affected by similar processes within the body, such as:
- Inflammation: Sleep loss can activate the sympathetic nervous system and contribute to systemic inflammation. Also, people diagnosed with depression tend to have more markers of inflammation, suggesting a potential link.
- Biochemistry: One common hypothesis of depression suggests that this mood disorder is caused by changes in amounts of the hormones serotonin, norepinephrine, and dopamine in the body. Changes in serotonin, norepinephrine, and dopamine may also be linked to the altered sleep architecture often seen in people diagnosed with depression.
- Genetics: While depression typically doesn’t have a single cause and results from a variety of factors (7), both insomnia and depression may run in families. Some studies have suggested an overlap in the genes linked to depression and insomnia (8), suggesting that both of these conditions are influenced by similar genetic components.
- Circadian Rhythm: Circadian rhythm describes the 24-hour cycles linked to the body’s internal clock. The body’s circadian rhythm is affected by the environment, especially light, which is why these rhythms are usually synced to the pattern of day and night. Circadian rhythm disruptions (9) are linked to both depression and sleep disorders.
Sleep Complaints in Depression
In people diagnosed with depression, sleep complaints are common. In fact, it’s estimated that 90% of patients with depression experience sleep issues (10), including insomnia and hypersomnia. Depression is the most common cause of chronic insomnia. People with depression and insomnia may experience a variety of symptoms (11), including trouble falling asleep, staying asleep, and waking up too early.
Oversleeping, also called hypersomnia, occurs in about 15% of people with depression. Although there is some disagreement in how much sleep is considered too much, hypersomnia is usually defined as sleeping more than nine, 10, or 11 hours per night (12). Unfortunately, rather than leaving a person feeling more rested the next day, oversleeping often leads to feeling even more tired.
Depression and Sleep Disorders
Insomnia isn’t the only sleep disorder linked to depression. Patients diagnosed with sleep disorders have higher rates of depression then the general population. Sleep disorders with significant links to depression include sleep apnea, narcolepsy, and restless leg syndrome.
- Sleep Apnea: Sleep apnea is a condition in which a person’s breathing pauses during sleep (13). Sleep apnea can cause a variety of sleep issues and around 24% to 50% of people diagnosed with obstructive sleep also meet the diagnostic criteria for depression.
- Narcolepsy: Narcolepsy is a disorder of the nervous system (14) that results in extreme tiredness and sudden periods of daytime sleep. Almost 57% of people diagnosed with narcolepsy (15) have some level of depression.
- Restless Leg Syndrome and Periodic Limb Movement Disorder: Restless leg syndrome is a disorder in which a person experiences an irresistible urge to move their legs or walk. Similarly, people may be diagnosed with another condition called periodic limb movement disorder when they make involuntary movements during sleep. As many as 53% of people diagnosed with restless leg syndrome and periodic limb movement disorder also have symptoms of depression.
Treatment for clinical depression usually involves medication, psychotherapy, or a combination of these two approaches (16). A health professional trained in treating depression, such as a psychiatrist or psychologist, can help people decide on the most appropriate treatment. In addition to working with a health professional, there are several lifestyle tips that may help with depression (17):
- Eat Nutrient-Dense Foods: Diet may impact the development of depression. While research is ongoing, it appears that certain dietary patterns and nutritional deficiencies (18) are associated with depressed mood and anxiety. Early research suggests that a diet rich in nutrient-dense food can improve thoughts and mood.
- Get Adequate Exercise: Both sedentary behavior and screen time may increase the risk of depression (19). Fortunately, evidence suggests that adequate physical activity can significantly reduce the symptoms of depression (20).
- Try Mindfulness: Practicing meditation, yoga, or another mindfulness activity may improve your mood. Mindfulness involves intentionally focusing one’s attention non-judgmentally on the present moment.
- Reduce Alcohol and Tobacco: Both alcohol and tobacco use are associated with an increased risk of depression. Fortunately, abstaining from alcohol even for a short time has been shown to reduce symptoms of depression.
Tips for Better Sleep
Many lifestyle tips for coping with depression can also improve sleep. Tips for targeting sleep issues often focus on improving sleep hygiene (21), which are behaviors that have been shown to benefit sleep health:
- Exercise More: Getting sufficient exercise improves sleep quality (22), makes it easier to fall asleep, and reduces daytime sleepiness.
- Maintain a Consistent Sleep Schedule: Going to sleep and getting up at the same time every day may help sync your drive to sleep and your circadian rhythm. Since irregular sleep schedules are associated with daytime sleepiness and lower sleep quality, it’s important to maintain a consistent sleep schedule — even on the weekends.
- Reserve the Bed For Sleep and Sex: People who use their bed for activities other than sleeping may begin to associate their bedroom with these unhelpful habits. One behavioral approach to treating insomnia is to restrict the bed to only two activities (23): sleep and sex.
- Create a Nighttime Routine: Before bed, give yourself some time to wind down and relax. Turn off the TV, silence your cell phone, and find activities that help you ease into bed. Some people find reading, journaling, or taking a warm bath before bed to be helpful.
- Revamp Your Bedroom: Making sure that your bedroom is optimized for sleep can make a big difference. Reduce noise and light that may keep you awake, make sure the bedroom temperature is comfortable, and consider bedroom scents to help you relax.
Although depression and poor sleep go hand-in-hand, with the help of medical professionals and proper treatment, both of these problems can improve with time. Starting slowly and finding professional support can help you start to prioritize your sleep. Remember, even small changes to your sleep hygiene can make a big difference.
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