Sleeping All Day: Could It Be Depression?

Sleep and depression are closely linked, and it is not uncommon for people with depression to experience sleep issues. While insomnia is more commonly associated with depression, oversleeping can also be a symptom. In fact, around 15% of people with depression experience hypersomnia, with a higher prevalence among younger adults. Depression can make individuals feel fatigued, both physically and mentally, and sleeping can become a way to pass the time or escape negative feelings. However, it is important to note that oversleeping does not cause depression, but it can worsen its symptoms and create a cycle that reinforces the condition.

Depression and insomnia

Overview

The link between sleep and depression is a complex one, with a bidirectional relationship. Sleep issues can contribute to the onset of depression, and depression can also lead to sleep difficulties. This connection is so fundamental that researchers have suggested caution when diagnosing depression in the absence of sleep-related complaints.

Sleep Issues and Depression

People with insomnia have a tenfold higher risk of developing depression compared to those who get a good night's sleep. Sleep problems can create difficulties in regulating emotions, leaving individuals more vulnerable to depression in the future. Poor sleep can also weaken emotional resilience, reducing positive moods and making it harder to deal with stress and challenges.

Depression and Sleep Issues

On the other hand, depression itself is associated with sleep difficulties. About 75% of people with depression have trouble falling asleep or staying asleep. They may experience periods of excessive daytime sleepiness, with persistent fatigue and low energy.

Treatment

Treating sleep problems can help alleviate depressive symptoms. Cognitive behavioural therapy for insomnia (CBT-I) has been found to improve sleep in people with depression and may increase the chances of remission. Additionally, treatments for depression, such as selective serotonin reuptake inhibitors and other medications, can improve mood and outlook, but they may not be sufficient to address sleep issues.

Breaking the Cycle

To break the cycle of depression and insomnia, it is crucial to take sleep problems seriously and seek help. Talking to a doctor or a mental health professional is an important first step. They can help determine whether sleep issues are a separate condition or a symptom of depression and provide guidance on the best course of treatment.

Depression and hypersomnia

Hypersomnia, or excessive daytime sleepiness, is a symptom in 15% of people with depression, and it is more prevalent in younger people, with about 40% of depressed patients under 30 and 10% of those in their 50s experiencing it. It is also more common in women. Hypersomnia tends to be a feature of atypical depression, in which a person's mood can improve in response to a positive event, although this improvement is only temporary.

People with depression may find it difficult to fall asleep and stay asleep during the night, or they may experience periods of excessive daytime sleepiness. This can create a cycle where anxious thoughts keep them up or disrupt their sleep, which can then lead to more anxious thoughts. Depression can make people feel fatigued, both physically and mentally, to the point where even small tasks can feel exhausting or difficult.

The physical and mental exhaustion that comes with depression can also affect sleep, leading to sleeping throughout the day, using sleep to pass the time, or choosing sleep over other daily activities. This can be due to a person's desire to escape their negative feelings: they may think, "I don't have anything to look forward to, so why do I even start the day?"

In addition to treating depression, it is important to address sleep problems, as they can increase the risk of developing or relapsing into depression. Cognitive behavioural therapy for insomnia (CBT-I) has been shown to improve sleep in people with depression and may increase the chances of remission.

Tips for Managing Sleep Problems:

• Keep a consistent sleep schedule by waking up and going to bed at the same time each day.
• Avoid hitting the snooze button, as this can lead to fragmented sleep and sleep inertia.
• Avoid sleeping in on the weekends to maintain a consistent sleep schedule.
• Get plenty of light in the morning and avoid it before bedtime to help regulate your body's internal clock.
• Spend time outdoors, as exposure to sunlight can aid in aligning your body's internal clock and improving sleep quality.

Depression and sleep apnea

Oversleeping can be a symptom of atypical depression, which is characterised by a temporary improvement in mood in response to positive events. Sleep psychologist Michelle Drerup notes that oversleeping is a symptom in 15% of people with depression and is often related to atypical depression.

Atypical depression can cause people to feel like they are missing out on the day, falling behind, and unable to accomplish their goals. This can, in turn, worsen depression symptoms. Drerup also notes that people with depression may sleep as a form of escape, thinking, "I don't have anything to look forward to, so why do I even start the day?"

A study by the Centers for Disease Control and Prevention found a link between obstructive sleep apnea and other symptoms of OSA with probable major depression, regardless of factors like weight, age, sex, or race. The study's lead author, Anne G. Wheaton, PhD, suggested that screening for these disorders in the presence of the other could help address the high prevalence and underdiagnosis of sleep apnea and depression.

The most common symptoms of OSA and depression are fatigue and sleep disturbances. However, it is important for clinicians to treat the symptoms of a specific disease and determine the underlying cause. Obstructive sleep apnea can be treated with continuous positive airway pressure (CPAP) therapy, which has been shown to improve depressive symptoms and quality of life.

Atypical depression

Oversleeping can be a symptom of atypical depression. Atypical depression is a specific type of depression where a person's mood can improve in response to a positive event. However, this improvement is temporary, and the underlying depression remains.

To be diagnosed with atypical depression, a person must experience mood reactivity (a temporary improvement in mood in response to positive events) and at least two of the following symptoms:

• Significant weight gain or an increased appetite
• Hypersomnia (sleeping too much)
• A heavy sensation in the limbs
• Interpersonal rejection sensitivity that results in significant social or occupational impairment

It is important to note that criteria for melancholic or catatonic features of depression must not be met during the same episode for a diagnosis of atypical depression.

Treatments for atypical depression include psychotherapy (talk therapy) and medication. Antidepressants such as SSRIs, SNRIs, NRIs, and mirtazapine are typically recommended due to their efficacy and fewer side effects compared to previous treatments.

Circadian rhythm disruption

Circadian rhythm is the body's internal clock, which is controlled by molecular clockworks within the brain. It is reset daily to precisely 24 hours by exposure to the light-dark cycle. Circadian rhythm disruption can be caused by jet lag, night-shift work, or exposure to artificial light at night. Circadian rhythm disruption has been linked to mood disorders, including depression, anxiety, bipolar disorder, and seasonal affective disorder.

Treatments for depression, such as bright light therapy, wake therapy, and social rhythm therapy, can help to improve circadian rhythm. Additionally, maintaining a consistent sleep schedule and exposing oneself to morning light and avoiding light before bedtime can help to keep a consistent sleep pattern.

Frequently asked questions