For years, doctors have known that depression and sleep disorders are linked. Up to 80 percent of people with depression also struggle with insomnia, the inability to fall asleep or stay asleep. About 15 percent of people with depression suffer from hypersomnia, or chronic oversleeping.
Doctors don’t yet fully understand the link between sleep disorders and depression, but they do know that depression fundamentally affects the sleep cycle. Insomnia and depression are so intrinsically linked that it’s one of the first symptoms to appear in people who are succumbing to a depressive episode. Some researchers even believe that insomnia may cause depression, and not the other way around. If you’re suffering from depression-related insomnia, antidepressants may help improve your sleep quality. You may also benefit from cognitive behavior therapy for insomnia, or CBT-I.
How Depression Affects Sleep
From sleep studies, researchers have learned that depression affects more than just mood — it also fundamentally alters the sleep cycle and, by doing so, can have a profound effect on all of the body’s systems. People with depression can stop going into the deep sleep part of the sleep cycle entirely, and that’s bad. Your body needs to go into deep sleep in order to rejuvenate itself, repair and restore tissues, and strengthen immunity. Your brain produces growth hormone during deep sleep, and it’s from this part of the sleep cycle that you get the energy you need to function physically and mentally throughout the day to come.
People who are depressed also experience much more fragmented sleep than those who don’t suffer from depression. That means they wake often during the night and tend to reach a state of heightened physical alertness when they do wake up, as opposed to rolling over and going right back to sleep. Depression also changes rapid eye movement or REM sleep, the part of the sleep cycle during which dreams occur. Like deep sleep, REM sleep is essential; it helps the brain process information gleaned from the previous day, but it’s more than that. It’s also a time during which the brain forms new neural connections and produces neurotransmitters, including those responsible for maintaining a normal mood, like dopamine and serotonin.
While most people who suffer from depression have a hard time getting enough sleep, some have the opposite problem — they sleep too much, and when they’re not asleep, they’re still tired. Even though some people with depression may sleep for up to 16 hours a day, they’re still not getting enough deep sleep or REM sleep. Doctors think it’s the lack of quality sleep that explains excessive sleepiness and hypersomnia in some depressed patients.
Could Insomnia Cause Depression?
For some time, mental health professionals have believed that depression causes insomnia. But recent research indicates that it may be the other way around. Insomnia may in fact cause depression.
In one major study, researchers from Norway’s Haukeland University Hospital examined the health information of 25,130 adults. The researchers found a strong relationship between chronic insomnia and mood disorders like depression and anxiety. Those participants who suffered from chronic insomnia were much more likely to develop depression. Other studies have shown that when depression is treated but insomnia remains unresolved, people are much more likely to suffer a depression relapse. Researchers are still not sure whether insomnia is the causal factor in these patients’ depression, or whether it is simply a very early symptom of mental illness.
Treating Depression and Insomnia
As research into the link between depression and insomnia progresses, many doctors are beginning to think that insomnia is not a symptom of depression, but a distinct disorder that often occurs in conjunction with depression. Many say it’s becoming increasingly clear that treatment needs to address both conditions directly in order to be effective.
Treating your depression may be enough to improve the quality of your sleep. Psychotherapy for depression can help you change the negative beliefs and perspectives that contribute to your depressed mood, but antidepressants also have an important role to play. Selective serotonin reuptake inhibitors, or SSRIs, like Prozac, Paxil, and Zoloft, can improve both sleep and mood, as can serotonin/norepinephrine reuptake inhibitors (SNRIs) like Pristiq, Cymbalta, Effexor, or Fetzima. Tricyclic antidepressants and antidepressants that have a sedative effect, like trazodone or mirtazepine, may also be prescribed to people who are suffering from both depression and insomnia.
Doctors may prescribe multiple medications to someone with depression and insomnia to treat both conditions. Drugs like Abilify can improve the effectiveness of many antidepressants. Hypnotics, or sleeping pills, like Lunesta or Ambien, can also help depressed people fall asleep and sleep more soundly – although it’s worth noting that sleep medications alone often don’t work well for people who are suffering from depression. You will need to take an antidepressant too. Canadian pharmacies can help you find room in your budget for the expense of multiple prescriptions.
CBT-I, a special kind cognitive behavioral therapy that is designed to teach sleep hygiene and skills to help insomniacs cope with the anxiety they often feel about sleep, may also be effective for treating insomnia long-term. A small study performed on 66 depressed insomnia patients at Toronto’s Ryerson University found that 87 percent of those who experienced insomnia relief through CBT-I also experienced depression remission — after just four sessions of therapy. Studies also show that the results of CBT-I last for life, because the therapy teaches you skills that you can continue to use.
Depression and insomnia often go hand in hand, but researchers are beginning to think that treating insomnia can go a long way toward treating depression. If you’re experiencing depression-related insomnia, take your sleeplessness seriously and get treatment for it. You might be surprised how much better it makes you feel.