The importance of sleep when recovering from depression

What is the relationship between sleep and depression?

The question is, can lack of sleep cause depression? There is a clear link between depression and insomnia, but it isn’t a one-way causality.^[1] Meaning, some people experience symptoms of insomnia or other sleep difficulties first, which can lead to depression. Others exhibit depression symptoms first, which can lead to trouble sleeping.

In either case, a lack of sleep lowers your ability to cope with daily stressors. As stress mounts, so does worry. As you continue to struggle with everyday tasks, that stress and worry can lead to feelings of worthlessness and low self-esteem, which are hallmarks of depression.^[2]

While it might not be known which condition occurs first, what is certain is that the link between insomnia and depression is strong. Research shows that about 75 percent of people with depression experience insomnia. About 40% of young adults with depression have hypersomnia or periods of excessive sleep.^[3] Furthermore, insomnia increases one’s risk of depression.^[1] 

Sleeping disorders linked to depression

Insomnia and depression aren’t the only combinations of sleeping disorders and depressive disorders (though depression and insomnia are the most common combination).^[3] Other connections between sleep issues and depression include:

• Hypersomnia - As noted above, hypersomnia occurs in about 40% of young adults with depression. It also occurs in about 10% of older adults with depression. Hypersomnia disproportionately affects women.^[3] 
• Narcolepsy - Narcolepsy is characterized by disturbed sleep, excessive daytime sleepiness, and sleep paralysis, among other symptoms. Depressed mood is the most common psychiatric symptom of narcolepsy, with more than half of people with this sleep disorder reporting that they are depressed.^[4] 
• Sleep apnea - Sleep apnea involves a host of symptoms, including loud snoring, gasping for air while asleep, and breathing in fits and starts while asleep. Studies show that these symptoms are associated with virtually all symptoms of depression, particularly feelings of hopelessness. This association cuts across many factors, including race, age, sex, and weight.^[5]
• Restless legssyndrome (RLS) - RLS is characterized by uncomfortable or painful sensations in one or both legs, which often worsen at night. This disorder impairs one’s ability to sleep and can result in depressive symptoms. In fact, one study revealed that nearly one-third of participants with depression also had RLS.^[6] Moreover, people with RLS are at a greater risk of self-harm and suicide.^[7]

Additionally, some parasomnias, such as nightmares (the most common parasomnia during depression) ^[8], occur with more frequency in people that are depressed.

Apart from sleeping disorders, other sleep situations are associated with depression. For example, sleep deprivation and depression have strong associations. Studies of medical students - who work long hours with little sleep - show an increased incidence of depressive symptoms in students over the course of a year-long residency.^[9]

But the level of sleep deprivation needn’t be severe or long-term. In fact, one’s subjective assessment of mood diminishes after just one night of deprived sleep.^[10] Researchers speculate that an accumulated effect of this type of sleep deprivation might result in clinical depression.^[10]  

How to get a better night's sleep

Though it can feel utterly hopeless when you can’t sleep, there are many strategies you might use to help make a better night’s sleep more likely. The self-help tips below are an excellent place to start:^[11]

• Create a quality sleep environment - Your bedroom should be quiet, dark, and cool. Consider investing in items that help facilitate these qualities, like a white noise machine, light-blocking drapes or an eye mask, and a fan.
• Practice good sleep habits - Avoid looking at device screens an hour or two before bedtime, as the blue light they emit can trick your brain into thinking it’s time to be awake. Avoid watching TV in bed, drinking alcohol or smoking before bed, and taking stimulants like caffeine.
• Utilize relaxation techniques - Yoga, meditation, and mindfulness exercises can help relax you and induce sleep. Even listening to music or ambient sounds can help bring about sleep faster.
• Exercise regularly - Daily exercise helps release feelings of anxiety while boosting positive self-feelings. The physical output also tires you out and prepares you for better sleep. If possible, exercise outdoors. Our circadian rhythm is controlled by daylight, and exposure to daylight helps maintain appropriate patterns of wakefulness and sleepiness.
• Go to bed at the same time each night - The more consistent you are with your bedtime and awake time, the easier it will be to fall asleep and stay asleep.

Above all, if you’re in bed and cannot sleep, don’t just lay there. Instead, researchers suggest you leave the bed and occupy your mind and body with another activity. You might clean the kitchen, organize the pantry, or fold the laundry - it’s up to you. The important part is to distract yourself from stressing about how you’re not asleep.

When to seek professional help

If you’ve implemented the self-help sleep strategies outlined above but are still struggling with sleep, you may need to see a medical or mental health professional for help. Sleep disturbances and depression are both highly treatable conditions with therapy, medication, or a combination of the two.

One of the most popular and effective therapies for depression and sleep disorders is cognitive-behavioral therapy (CBT). As a treatment for depression, CBT helps you relearn negative thought patterns that contribute to your symptoms. By breaking these negative patterns, you begin to feel better about yourself.^[12] There is also a specialized form of cognitive therapy for insomnia patients (CBT-I) that teaches you how to fall asleep faster and stay asleep longer.^[13]

Both depression and sleep disorders can be treated with medications as well. Depression is commonly treated with antidepressants like fluoxetine, venlafaxine, and bupropion. Common sleep disorder medications include trazodone to help you sleep, stimulants (if you have hypersomnia), or anti-seizure medications to help minimize your movements during sleep.