4/14/2020 Understanding the Link Between Depression, Insomnia, and Sleep Problems

Mattresses Bedding Sleep Products How Sleep Works Sleep

Resources

Tuck Sleep > Sleep Resources > Depression and Sleep Disorders

Depression and Sleep

Disorders
Last updated March 31, 2020

Troubled sleep, insomnia, and oversleeping are classic symptoms of clinical depression. While
not all depressed people have sleep disorders, many do. When evaluating patients for
depression, doctors typically ask about sleep patterns as part of the diagnosis.

Problematically, sleep problems worsen mood and can cause depression themselves, creating
a vicious cycle.

What is Depression?
The CDC estimates that just over 7 percent of Americans have moderate or severe depression.
The severity and symptoms of depression vary, but the most common include:

Feelings of despair, hopelessness, sadness

Frequent or occasional thoughts of death or suicide

Dif culty concentrating

Lower energy

Lower libido

Reduced self-esteem

Weight gain or loss

Loss of interest in activities the person formerly enjoyed

Excessive daytime sleepiness

https://www.tuck.com/depression-and-sleep/ 1/12
4/14/2020 Understanding the Link Between Depression, Insomnia, and Sleep Problems

Insomnia

Sleep problems are core symptoms of depression. Both depression and severe sleep problems
are major risk factors for suicide and health problems like heart disease, other mental
disorders, and smoking. People with depression have trouble being productive in work or
school, which can impact their career and social life. The sleep issues are often one of the
reasons depressed people seek out professional help.

The symptoms of depression are persistent and pervade all aspects of an individual’s’ life, from
work and play to basic needs like eating and sleeping. Within the larger category of
depression, there are several different types of depression which come with their own sleep
problems:

Major Depressive Disorder: This is extreme depression where the individual

feels sad, hopeless, or suicidal through much of the day, regardless of what
they are doing. Feelings of pleasure and happiness are hard to come by. Major
depression is associated with insomnia and excessive daytime sleepiness.

Dysthymia: This is a milder form of major depression, also associated with

fragmented sleep and hypersomnia. People with dysthymia experience fewer
symptoms from the list above and in a less intense way, but symptoms
typically persist for much longer.

Bipolar Disorder: People with bipolar disorder swing between extreme highs
and lows. When they’re high, they’re overly energetic and unable to sleep, even
if they’re tired. When they’re low, they oversleep.

Seasonal Affective Disorder (SAD): SAD is a type of seasonal depression. The

vast majority of affected individuals experience it during the winter months,
with symptoms like hypersomnia, insomnia, and worsened mood – although
about 10 percent experience it during the summer. SAD is likely brought on by
the changing levels of sunlight, which affect the circadian rhythms of affected
individuals, messing with their sleep and emotions.

Who’s at risk for depression? Stress, a recent loss or illness diagnosis, and family history are all
risk factors for depression.

Anyone can become depressed, but it affects some people more than others, particularly
women and adults in middle age. Coincidentally, these two groups are also more likely to have

https://www.tuck.com/depression-and-sleep/ 2/12
4/14/2020 Understanding the Link Between Depression, Insomnia, and Sleep Problems

insomnia. The chart below from the CDC reveals the correlation between age and depression
as well as the disproportionate prevalence between the genders:

The Cyclical Relationship Between

Depression and Sleep
The sleep problems brought on by depression – or the ones that caused it in the rst place –
make it much more dif cult to get better. Sleep deprived people have stronger emotional
reactions in general, so it’s tougher to regulate the emotional volatility associated with
depression.

Abnormal sleep interferes with mood and energy levels during the day, so it’s dif cult to stay
motivated to engage with others, exercise, and even go to work. To cope, people who are
depressed may self-isolate, which can lead to more sleep problems: loneliness itself is
associated with fragmented sleep.

The cause-and-effect runs both ways.  Even if you’re not depressed, lack of sleep increases
your chances of depression and other mental illnesses. Depression causes insomnia and
hypersomnia.   

An article in the Journal Sleep reported that children with both insomnia and hypersomnia are
more likely to be depressed, to be depressed for longer periods of time, and to experience
additional problems such as weight loss.

Particularly for young adults, there is a strong correlation between insomnia and major
depressive disorder. Genes involved in the molecular clock and circadian cycle are known to be
involved with bipolar disorder, although nobody exactly knows how. When scientists examine
mice with mutations in the so-called CLOCK gene (important in the circadian cycle), they nd
the mice act like humans with mania. When the mice are given lithium (a treatment for bipolar

https://www.tuck.com/depression-and-sleep/ 3/12
4/14/2020 Understanding the Link Between Depression, Insomnia, and Sleep Problems

disorder), their behavior reverts to normal. So it appears that this important part of the sleep
control cycle is tied up with mood and mood disorders.

Teens who don’t get enough sleep are at a signi cantly greater risk for depression and suicide.

Depression makes achieving quality sleep dif cult, and it leads to serious sleep issues and
even disorders. We’ll review each of these below.

Changes in REM Sleep

The impact of depression on sleep is not accidental. EEG tests of depressed patients show they
have a longer sleep latency, spend less time in slow-wave sleep, shift REM sleep to earlier in
the night, and experience sleep maintenance insomnia (they wake up during the night).

The effects on REM sleep are especially intriguing to researchers. REM (rapid eye movement)
sleep abnormalities result in brain activity patterns similar to those seen in depression.  Indeed,
during REM parts of the brain exhibit similar electrical activity to that in depressed people.  And
depressed people have their rst REM session earlier in the night than non-depressed people.
The worse the depression, the earlier the REM, and in bad cases the sequence of sleep stages
is upset and the rst REM period happens before the rst deep sleep period. Given the
importance of this rst deep sleep period to growth hormone and the body’s maintenance, this
pattern is particularly detrimental.

Scientists have found that patients with major depressive disorder have high activity in the
ventromedial prefrontal cortex (vmPFC) coupled with low activity in dorsolateral prefrontal
cortex section of the brain. Scientists are working out the details, but this may provide a clue to
why REM activity increases in depressed patients.

The image below compares the sleep architecture of a healthy individual (top) vs. one with
depression (bottom). It shows the overall shorter sleep time, reduced REM latency, and more
disturbed sleep.

https://www.tuck.com/depression-and-sleep/ 4/12
4/14/2020 Understanding the Link Between Depression, Insomnia, and Sleep Problems

Insomnia
Insomnia describes a dif culty falling or staying asleep. It’s pretty common – one in three
people in the US experience insomnia at some point in their lives.

Unfortunately, people with insomnia are ten times more likely to develop depression than
people without, and 83 percent of depressed individuals display insomnia symptoms.

It is easy to think of reasons why insomnia might lead to depression: it is extremely frustrating
and causes a person to lie awake at night and ruminate on unpleasant thoughts. Then, the
excessive daytime sleepiness the following day reduces their general quality of life.

Even though scientists still don’t fully understand what causes depression or sleep disorders,
they have found neurochemical links between the two. Corticotropin-releasing factor (CRF) is a
neuropeptide and is found in elevated levels in people with depression and anxiety disorders. It
also is found in high levels in many insomniacs. The hypothalamic-pituitary-adrenal (HPA) axis
is stimulated perhaps excessively in both depressed people and insomniacs.

Hypersomnia
Hypersomnia is basically the opposite of insomnia. It’s characterized by extreme oversleeping,
and not feeling refreshed in spite of that.
https://www.tuck.com/depression-and-sleep/ 5/12
4/14/2020 Understanding the Link Between Depression, Insomnia, and Sleep Problems

Hypersomnia occurs in 40 percent of young adults with depression, and is more common in
women. It’s much more prevalent in younger individuals than older (40 percent vs 10 percent).

Sleep Apnea
Sleep apnea describes a condition where the individual literally stops breathing momentarily
while sleep. When the brain kicks in to start breathing again, it interrupts the sleep cycle, so
even if the person does not wake up, it can still lead to sleep deprivation.

People with apnea are more likely to suffer from depression, and even people without true
apnea, but who snore, are more likely to be depressed.  This relationship is particularly strong
in men.

A large scale study of nearly 19,000 people found that those with depression were over 5
times more likely to have obstructive sleep apnea or another form of sleep-disordered
breathing.

Restless Leg Syndrome

Restless leg syndrome (RLS) is another common comorbid sleep disorder with depression.

Individuals with RLS feel an intense “pins and needles” sensation in their lower limbs when
they lie down (as one does when they fall asleep). The only way they can nd relief is by
jerking the limb, which understandably makes sleep hard to come by and can contribute to
insomnia along with depression.

Treatment for Depression-Related

Sleep Disorders
The good news is that treating either depression or related sleep problems tends to improve
the symptoms of the other. Getting good sleep is essential for overcoming depression.

You may have seen stories of sleep deprivation as the new cure to depression, but be wary of
these. Researchers have indeed found that a night of sleep deprivation reduces symptoms of
depression the following day. However, they can experience a rebound effect (known as
“residual insomnia”) the following day. Moreover, sleep deprivation on a long-term basis is
simply impractical – and also dangerous, given the serious side effects for your mental,
physical, and emotional health.

https://www.tuck.com/depression-and-sleep/ 6/12
4/14/2020 Understanding the Link Between Depression, Insomnia, and Sleep Problems

Rather, the recommended treatment for depression typically combines psychotherapy and/or
pharmacology.

Psychotherapy
One popular form of psychotherapy is cognitive-behavioral therapy (CBT). CBT focuses on
helping the individual recognize the negative or destructive thoughts (the cognitive aspect)
that make them feel depressed, and the behaviors they’ve become accustomed to responding
with. Once they learn to recognize these thoughts and behaviors, they develop new ways of
thinking or responding. A sub-type of CBT is CBT-I, which applies the same techniques to
curing insomnia.

CBT-I
A sub-type of CBT is CBT-I, which applies the same techniques used in CBT but speci cally to
treat insomnia. Researchers nd depression and insomnia are often co-morbid meaning they
exist at the same time and often perpetuate one another. Depression can be made worse with
insomnia and insomnia can make dealing with depression more dif cult. CBT-I aims to treat
insomnia without medication but through conditioning sleep techniques. Many CBT-I
techniques are simple, such as using the bed and bedroom for sleeping only, getting up if not
tired or not able to fall asleep. Many physicians use CBT-I at the rst option to treat insomnia.

The rst step CBT-I increases sleep quality and then moves to focus on quantity of time spent
asleep. This technique also includes learning effective sleep hygiene. These are bedtime rituals
and nightly habits that help achieve quality sleep. Going to bed at the same time every night,
limiting screen time before bed, avoiding caffeine and alcohol, and sleeping in ideal conditions
– quiet, dark and not too cold or hot. Further steps in CBT-I involve eliminating or managing
thoughts that interfere with sleep. Instead the emphasis is placed on calming an active mind
and allowing sleep to happen rather than trying hard to sleep.

CBT-I may take longer to treat insomnia than pharmaceuticals but the results are longer
lasting. Drugs that alleviate insomnia provide moderate improvements but only when the drug
is administered. CBT-I techniques can assist sleep quality inde nitely.

Pharmacology
Although both depression and insomnia can be treated without drugs, there are
pharmacological interventions for both, and not coincidentally, both can be addressed with
https://www.tuck.com/depression-and-sleep/ 7/12
4/14/2020 Understanding the Link Between Depression, Insomnia, and Sleep Problems

antidepressants.  The most common antidepressant medications today are selective serotonin
reuptake inhibitors (SSRIs). Those with insomnia who start taking one of those drugs often nd
relief for their sleeping problems.

The pharmacological treatment for idiopathic hypersomnia is usually a stimulant – something

that works opposite of sleeping pills.  That’s why it is important for doctors to evaluate
whether long-sleeping patients might have depression and be a better candidate for anti-
depressant medication.

Light therapy
Light therapy is especially effective for seasonal
affective disorder, and it can be applied to
instances of insomnia or hypersomnia
independent of SAD.

Light therapy involves sitting in front of a special

light box that delivers 10,000 lux of bright light
similar to the sun. The individual uses it in the
morning or at night to help them wake up or stay
up, depending on how the extent of their daytime sleepiness. Besides light boxes and lamps,
light therapy devices come in wearable visors, dawn simulating alarm clocks, and more.

CPAP therapy
Individuals with obstructive sleep apnea can get tted for a continuous positive airway
pressure (CPAP) device. These are extremely effective for treating OSA and related insomnia –
and apparently depression, too. Individuals with co-morbid depression showed signi cant
improvement a year after using their device.

Individual with OSA and depression should be careful about taking tricyclic antidepressants,
since sedatives can worsen symptoms of OSA. Check with your doctor rst and be sure to let
them know about your OSA.

Exercise
In most healthy individuals, exercise is known to help with sleep by reducing sleep latency
times and increasing the amount of time spent in deep sleep. Starting an exercise program is

https://www.tuck.com/depression-and-sleep/ 8/12
4/14/2020 Understanding the Link Between Depression, Insomnia, and Sleep Problems

one recommendation given to those looking to cure insomnia without medication. Exercise has
also been proven to help with depression. The link between exercise and depression is
biochemical when the body release endorphins, or “feel-good” chemicals during moderate to
intense exercise. Researchers have also found the hippocampus in the brain which helps
regulate mood, is smaller in depressed patients. Exercise encourages nerve cell growth in the
hippocampus which helps relieve depression.

CBD Oil
CBD oil is a naturally occurring cannabinoids found in the hemp plant. Although derived from
the same plant, CBD oil doesn’t contain THC, the element of marijuana that produces the
“high.” CBD oil has been shown to have a calming effect showing positive results for helping
anxiety, insomnia, depression, and chronic pain. CBD oil may help with both falling asleep and
staying asleep. Although not extensively studied, CBD oil shows no results of becoming habit
forming, making it an option for those looking to seek relief from depression and insomnia.

Tips for getting better sleep with

depression
In addition to the therapies suggested above, the following advice can help you get better
sleep while you’re getting treated for depression and related sleep problems.

1. Keep a sleep diary.

If you believe you are suffering from depression and/or a comorbid sleep disorder, keep a
sleep/mood diary for 2 weeks to share with your doctor.

Note when you go to bed, how long it takes you to fall asleep, when you wake up, and how
much time you spent asleep. Also note your level of fatigue or energy throughout the day, as
well as any changes in mood, diet, libido, or thought patterns.

2. Turn your bedroom into a sleep haven.

Use your bedroom exclusively for sleep and sex. Everything else, from watching television to
working to socializing, should take place elsewhere. You want your mind to see your bedroom

https://www.tuck.com/depression-and-sleep/ 9/12
4/14/2020 Understanding the Link Between Depression, Insomnia, and Sleep Problems

as a place of rest, not of worry, stress, or social activity.

Keep your bedroom as cool and as dark as possible by removing electronics and using
blackout curtains if necessary. Invest in a comfortable, supportive mattress that makes sleep
come easier.

3. Stick to a regular sleep schedule.

Go to bed and wake up at the same time every day, even weekends. Ensure you leave enough
room for you to conceivably get at least 7 hours of sleep, but don’t worry about whether you
spend all of that time asleep. Your only goal is to stick to the schedule; eventually your brain
will catch up and train itself to sleep and wake at those times more naturally.

Avoid napping if you can. If you’re absolutely exhausted, limit them to short power naps of 30
minutes or less.

4. Create a calming bedtime routine.

Depression and anxiety-producing thoughts are a recipe for insomnia. Help ease your mind of
worries with a calming bedtime routine. Try relaxation techniques, deep breathing exercises, or
meditation. Take a warm bath or light some candles.

If your mind continues to race at night, take time to write your thoughts down in a worry
journal – getting them out of your head and onto the page will diminish their power. Relieve
anxieties by listing out any remaining to-do items you can take care of tomorrow.

5. Get plenty of sunshine.

Natural sunlight facilitates a healthy sleep-wake cycle. Aim to get plenty of sunshine, ideally by
exercising outdoors in the morning or early part of the day. This will give you an energy boost
that makes it easier to feel better and less fatigued during the day time. Then, as it gets dark,
your brain will recognize it’s time to wind down and fall asleep.

While you’re at work or school, sit by the windows to increase your amount of sunlight.

https://www.tuck.com/depression-and-sleep/ 10/12
4/14/2020 Understanding the Link Between Depression, Insomnia, and Sleep Problems

6. Eat well and avoid stimulating

substances.
Foods that are high in sugar or fats mess with your sleep, your health, and your mood. Instead,
ll your diet with foods that promote healthy energy levels and sleep.

Also take care to avoid any stimulating substances in the afternoon or evening that interfere
with sleep, such as caffeine, alcohol, or nicotine.

7. Stay calm when you wake up.

Unfortunately, retraining your body to sleep well is not an overnight process. Expect – and
accept – that you’ll continue having disturbed sleep during this process.

When you do wake up, practice your deep breathing or progressive muscle relaxation
exercises. Meditate or visualize something that makes you feel happy or calm. Turn on a soft
lamp and read a book. Stay calm and sleep will come.

Additional resources
Guides from Tuck about mental health and
sleep:
Stress and Sleep Problems: Stress is a trigger for insomnia and a host of sleep
issues. Learn more about reducing stress so you can sleep better at night.

Seasonal Affective Disorder and Sleep: 4 to 6 percent of people experience

SAD, a form of seasonal depression. Learn about the unique sleep issues
associated with SAD and recommended treatment options.

Mental Illness and Sleep: Sleep disorders are a hallmark of mental illness. Learn
how people living with schizophrenia and psychiatric disorders experience
disrupted sleep.

Women and Insomnia: Women are more prone to insomnia and depression.
Learn how hormones, pregnancy, and menopause affect women’s sleep.

https://www.tuck.com/depression-and-sleep/ 11/12
4/14/2020 Understanding the Link Between Depression, Insomnia, and Sleep Problems

Anxiety and Sleep: People with mood and anxiety disorders, including phobias,
OCD, PTSD, and social anxiety also suffer from poor sleep. Learn about the
relationship between anxiety and sleep.

Support and resources for depression:

If you are in crisis, please call the National Suicide Prevention Lifeline
immediately. You are not alone and people are here to help you. The hotline is
available 24/7 and is completely free and con dential. Reach them anytime,
toll-free at 1-800-273-8255 or via live chat on their website.

Lean on others for emotional support and share advice on online forums such
as the Depression and Insomnia subreddits, the Depression support group on
The Tribe, Depression forums on PsychCentral, and Depression Forums.

The CDC offers an overview of depression and publishes the latest

demographic research regarding individuals most at risk in America.

The Anxiety and Depression Association of America provides fact sheets and
information for professionals, caregivers, and individuals dealing with
depression, as well as online support groups for multiple mood and anxiety
disorders.

Contact Press tuck.com logo

About Us Research Process
Blog

© COPYRIGHT 2020 TUCK.COM LLC ALL RIGHTS RESERVED SITEMAP | PRIVACY | ADVERTISING DISCLOSURE

https://www.tuck.com/depression-and-sleep/ 12/12