Depression And Sleep: Navigating The Cycle

Sleep and depression are closely linked, and a good night's sleep is an essential part of physical and mental health. However, the direction of the two isn't always clear. While insomnia is more commonly associated with depression, oversleeping can also be a symptom. In fact, research suggests that most people with major depression experience some form of sleep difficulty, with insomnia being the most common problem, followed by hypersomnia.

Depression can make individuals feel fatigued, both physically and mentally, and even small tasks can feel exhausting. It can also affect sleep, leading to excessive daytime sleepiness or insomnia.

It's important to note that oversleeping doesn't cause depression, but it can worsen symptoms. If you're concerned about your sleep patterns or think you may be experiencing symptoms of depression, it's crucial to seek professional help.

Depression and insomnia

A study by Dag Neckelmann, MD, PhD, of the Department of Psychiatry at Haukeland University Hospital in Bergen, Norway, found significant associations between the long-term course of chronic insomnia and the development of anxiety disorders and depression. Compared to those without chronic insomnia, the group with chronic insomnia had increased associations with anxiety disorders and depression.

Insomnia can manifest as difficulty falling asleep, staying asleep, or waking up too early, and is the most commonly reported of all sleep disorders. About 30% of adults experience insomnia, but less than 10% are likely to have chronic insomnia. It is more common among older adults and women.

A bidirectional relationship exists between depression and insomnia. Poor sleep may create difficulties regulating emotions, leaving you more vulnerable to depression in the future. Depression is also associated with sleep difficulties, such as shortening the amount of restorative slow-wave sleep a person gets each night. Daily stresses can lead to more nighttime wake-ups and trouble falling back asleep for those with depression.

People with insomnia may have a tenfold higher risk of developing depression than those who sleep well. Among people with depression, 75% have trouble falling or staying asleep. Approximately 40% of people with insomnia have clinical depression, and up to 80% of depressed patients experience insomnia.

Treating sleep problems can help alleviate depressive symptoms. Treatments for insomnia, such as cognitive behavioural therapy and continuous positive airway pressure (CPAP) devices for sleep apnea, can restore good sleep and help prevent related conditions like depression. There is also some early evidence that CBT-I (cognitive behavioural therapy for insomnia), along with depression treatment, improves sleep in people with depression and may increase the chances of remission.

Sleep as a form of escape

It is not uncommon for people with depression to use sleep as a form of escape. They may find themselves thinking, "I don't have anything to look forward to, so why even start the day?". This mindset can lead to a cycle of sleeping too much, feeling like they've missed out on the day, and then feeling even more depressed as a result.

Depression is often associated with insomnia, but oversleeping can also be a symptom. In fact, according to sleep psychologist Michelle Drerup, it is a symptom in 15% of people with depression and is more often related to atypical depression. Atypical depression is a specific type of depression in which a person's mood can improve temporarily in response to a positive event, but the underlying depression remains. People with this type of depression may not even realize they are depressed, as their mood can brighten temporarily. Other symptoms of atypical depression include increased appetite and interpersonal sensitivity, such as feeling rejected.

In addition to being a symptom of depression, oversleeping can also be caused by underlying sleep disorders, such as sleep apnea, which is commonly comorbid with depression. People with sleep apnea experience fragmented and disrupted sleep, often not getting into the deeper stages of sleep or getting enough REM sleep, which results in them feeling exhausted even after sleeping for an adequate number of hours.

It's important to note that while oversleeping can be a symptom of depression, it doesn't cause it. However, it can exacerbate and worsen depression symptoms. If someone is oversleeping, they may wake up feeling like they've missed out on the day, falling behind, and unable to accomplish the things they wanted to do. This can contribute to feelings of hopelessness and loneliness, which are common symptoms of depression.

If you or someone you know is struggling with depression and oversleeping, it's important to seek professional help. A healthcare provider can help treat the underlying depression and address any residual sleep difficulties.

Circadian rhythm disruption

Oversleeping can be a symptom of depression, but it is important to note that it does not cause depression. It can, however, worsen the symptoms of depression. According to sleep psychologist Michelle Drerup, PsyD, DBSM, oversleeping is a symptom in 15% of people with depression and is more often related to atypical depression.

Atypical depression is a specific type of depression in which a person's mood can improve temporarily in response to a positive event. However, even though their mood may brighten, the underlying depression remains. People experiencing this type of depression might not realise they are depressed. Besides oversleeping, other symptoms of atypical depression include increased appetite and interpersonal sensitivity, such as feeling rejected.

Drerup notes that when someone is depressed, they may sleep as a form of escape: "They may be thinking, 'I don't have anything to look forward to, so why do I even start the day?'". This can lead to a delayed sleep phase, where people are unable to fall asleep early and sleep into the morning or early afternoon hours.

An interruption to a person's circadian rhythm, or their body's internal clock, can also cause oversleeping. This can result in people feeling like they have missed out on the day and are unable to accomplish their daily tasks.

Additionally, underlying sleep disorders, such as sleep apnea, can contribute to oversleeping in people with depression. Sleep apnea is commonly comorbid with depression, and people with this condition often experience non-restorative sleep, feeling exhausted even after sleeping for eight hours or more.

Sleep disorders

While insomnia is more commonly associated with depression, sleeping too much can also be a symptom of something more serious. Sleep psychologist Michelle Drerup notes that oversleeping is a symptom in 15% of people with depression and is more often related to atypical depression. Atypical depression is a specific type of depression in which a person's mood can improve in response to a positive event, but this is only temporary and the root depression remains.

Drerup adds 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?" Oversleeping can also be a result of an underlying sleep disorder, such as sleep apnea, which is commonly comorbid with depression. In this case, a person often experiences non-restorative sleep at night and feels exhausted even after sleeping for eight hours or more.

Another factor that could cause oversleeping in a depressed individual is an interruption to their circadian rhythm, or an internal clock disruption. Drerup notes that sometimes it's not so much that a person is oversleeping, but rather they are sleeping on a delayed sleep phase. They can't wake up in the morning or sleep past their alarm because their circadian rhythm is delayed.

Treatments for Sleep Disorders and Depression

If oversleeping is a symptom of depression, it's important to seek treatment for that depression. Even if someone is being treated for depression, sleep difficulties can persist. Drerup suggests the following techniques to avoid falling into bad sleep habits:

• Get out of bed and get a more consistent start to your day.
• Avoid hitting the snooze button.
• Try not to sleep in on the weekends.
• Get plenty of light in the morning and avoid it before bedtime.

When to Seek Help

If you notice you're oversleeping on a consistent basis, it may be time to talk to a healthcare professional, especially if:

• Symptoms of depression persist for longer than one to two weeks.
• You don't feel rested after any amount of sleep.
• You can't stay awake during the day.
• Your regular activities no longer interest you.
• Changes in mood begin to affect your daily life or relationships.

Treatments for depression and insomnia

Depression and insomnia are closely linked, and treating one condition may help resolve the other. The approach to treatment depends on the individual. Doctors usually first treat what a patient identifies as the primary problem.

Non-medication and natural treatment options

• Cognitive Behavioural Therapy (CBT): Led by a mental health professional, CBT helps patients identify and change thoughts and behaviours linked to insomnia or depression. It may be combined with other techniques such as sleep hygiene and relaxation techniques. There are also CBT techniques designed specifically for insomnia (CBT-I).
• Relaxation techniques: Practices such as deep breathing, visualization, progressive muscle relaxation, and biofeedback are often recommended to address insomnia.
• Exercise: Regular exercise has been found to improve self-reported sleep quality, insomnia severity, and daytime sleepiness. It is also effective at treating depression, especially in combination with medication.
• Mind-body practices: A 2019 systematic review suggests that practices such as yoga, tai chi, qigong, and meditation can improve symptoms of insomnia and, therefore, overall health.
• Natural supplements: Some natural supplements may enhance both mood and sleep. These include valerian root, magnesium, passionflower, lavender, and tryptophan. However, supplements should always be approved by a physician.

Medication used to treat both insomnia and depression

• Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs can help with sleep and improve mood. However, for some people, SSRIs can cause insomnia, so they are sometimes prescribed in the morning or with an additional medicine to aid sleep.
• Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): These medicines affect two brain chemicals thought to be involved in depression: serotonin and norepinephrine. They may be prescribed when SSRIs do not work or when depression comes with other problems such as pain disorders or certain forms of anxiety.
• Other antidepressants: Examples include amitriptyline, trazodone, and mirtazapine.
• Sedating antidepressants: These can help with sleep and include mirtazapine, eszopiclone, temazepam, and zolpidem.
• Over-the-counter sleep aids: The hormone melatonin is sometimes used to treat insomnia or sleep disrupted by depression. A prescription drug called ramelteon works similarly to melatonin.
• Orexin receptor antagonists: Daridorexant and suvorexant work by blocking a neurotransmitter called orexin that sends signals to the body to wake up.

Frequently asked questions