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There is a strong connection between depression and sleep.  Seventy-five percent of people diagnosed with depression have insomnia (chronically sleep-deprived).  Hypersomnia (sleeping too much) affects 40% of young adults with depression, and 10% of mature adults, most patients with hypersomnia are female.  Sleep dysregulation caused by depression substantially impacts patients’ quality of life and significantly raises their risk for suicide.   Often these sleep disturbances do not resolve with treatment.

“Studies have had also shown that patients with insomnia were at a greater risk of developing depression when they had not previously had it.  Therefore, it is essential to find better treatments to manage sleep dysregulation for patients with depression to improve their quality of life and reduce their chances of relapse of their depression.”- Dr. Tomkinson

The connection between depression and sleep is so strong that some doctors and clinicians have said that sleep dysregulation should be one of the diagnostic criteria for depression.  They have even gone so far as to say that a depression diagnosis given to someone without sleep dysregulation should be heavily scrutinized.

“Mental pain is less dramatic than physical pain, but it is more common and also more hard harder to bear. The frequent attempt to conceal mental pain increases the burden: it is easier to say “My tooth is aching” than to say “My heart is broken.”― C.S. Lewis

If a patient’s other symptoms are resolved but continue to have sleep disturbances, their chances of relapse of their depression and suicide are very high.  A healthy sleep cycle is therefore critically important to patients diagnosed with depression.

One of the reasons that the link between depression and sleep is so strong is that they both are affected by chemicals in the brain called neurotransmitters.  A few of these neurotransmitters are serotonin, dopamine, and norepinephrine.   When these neurotransmitters change, hormonal imbalances occur, which affect both sleep and depression.

Depression and sleep are very much a “which came first, the chicken or the egg” scenario.  Researchers believe that either condition can trigger the other.   Statistically, sleep dysregulation before the start of depression increases the severity of the depression.

When a patient’s neurotransmitters change, and hormones become imbalanced, their circadian rhythm becomes disrupted.  The circadian rhythm is the process that the body uses to manage our sleep/ wake cycle.  Studies show that patients suffering from depression have a significantly higher chance of a dysregulated circadian rhythm. As a result, their sleep cycle seems to have moved and is disrupted.

Patients with depression often have intrusive thoughts that can also cause their sleep dysregulation.  Repetitive thoughts ( also known as ruminations) can hinder the patient from falling asleep as they become stuck in a loop of thoughts of regret, fears, and anxiety.  These thought loops can be a challenging trap for the patient to escape.  Often their anxiety then becomes compounded because they can’t fall asleep.

All of this can feel rather hopeless and overwhelming.  But there are some simple changes that you can make to help to improve your sleep.

“It is our job as doctors to provide hope as much as healing.  Suffering damages hope as surely as it damages the body.” Dr. Tomkinson 

Tips for Sleeping With Depression

You can do many things to help yourself have a better night’s sleep, but before trying these tips, be sure to see a doctor to get your depression and sleep dysregulation treated.  Depression is a medical issue.  There is no shame in seeing your doctor for the treatment of diabetes.  Depression is no different than diabetes in that it is an illness that affects your body internally.  Even though you can’t see it with your eyes by looking at someone doesn’t mean that diabetes isn’t an actual disease or that they are weak for seeking help in regulating their body’s insulin.  Diabetes, if left untreated, can be deadly.  Depression is the same.  It is an illness that is on the inside of your body.  If left untreated, it can have fatal results.  So if you haven’t already done it, make an appointment today.

“Every man has his secret sorrows which the world knows not, and often times we call a man cold when he is only sad.”

― Henry Wadsworth Longfellow

Now it’s time to explore tips for helping you sleep with depression.

• Set a sleeping schedule.  Go to bed and wake up at the same time every day (yes, even on the weekends).  Good sleep hygiene is dependent on a consistent schedule.
• Sunshine is essential for producing vitamin D, lifting your mood, and regulating your sleep cycle.  Get at least forty minutes of sunshine a day.
• Do not drink caffeine within five hours of going to bed.  Caffeine has a half-life of around five hours.  Avoid drinking things with high levels of caffeine like tea, coffee, soda, and energy drinks.  If you have high anxiety levels, avoid caffeine entirely because it heightens anxiety levels.
• Only take short naps of less than sixty minutes. Don’t nap at all after 2 pm.
• Avoid drinking alcohol for two hours before bedtime because it disrupts your sleep. In addition, alcohol should be avoided altogether when you are depressed.
• Do not eat a heavy meal before going to bed.  Heavy meals increase your likelihood of heartburn and indigestion, which will disrupt your sleep.
• Get at least thirty minutes of exercise a day.  However, it would help if you did not exercise around bedtime.
• Quit smoking; not only is it bad for your health, but it is also bad for your sleep cycle.
• Do relaxing activities for at least thirty minutes before going to bed.  Meditation, reading, listening to relaxing music, or a hot bubble bath are all good options.
• Talk to your doctor about the medications that you are taking.  If you are taking any medications that are known stimulants, ask if it is possible to switch to a non-stimulant medication.  These types of drugs often keep people awake at night.
• Turn your bedroom into a relaxing retreat. Try not to use it as a place to work because your body will recognize it as a workplace instead of as a place to unwind, relax, and sleep.
• Keep your bedroom dark, quiet, and lower the temperature.  Your body sleeps better in this environment.
• Buy comfortable bedding.  Uncomfortable sheets and fabrics that don’t breathe make it hard to fall asleep.
• If your mattress is old, worn-out, or uncomfortable, replace it.  Managing your sleep is the most important thing you can do for your health.  A comfortable bed is essential for a good night’s sleep.
• If you go to bed and can’t fall asleep after thirty minutes, get up and do something relaxing until you are tired.  Then try to go to bed again.
• Do not use any technology with a screen for at least an hour before bed.  Blue light has been proven to affect your cortisol levels, which can dysregulate your sleep.  So turn off your computer, television, tablet,  and phone.
• Try cognitive-behavioral therapy with a certified therapist.  This type of therapy can give you the tools for long-term success in creating healthy sleep hygiene habits.
• Try taking melatonin an hour before bed.  This is a natural supplement that helps to relax you before bed gently.  Research the supplement before you buy it. Not every supplement brand is created equal.  Buy a reputable brand.

These are tips for helping to increase your chances of getting a good night’s sleep. In addition, some patients may need to use a prescribed sleep medicine in conjunction with healthy sleep hygiene to sleep. Finally, talk to your doctor if you have sleep dysregulation issues, especially if you are also depressed.  Both of these conditions are serious and can exacerbate each other.

“Depression and sleep dysregulation seem to go hand-in-hand. To treat one effectively, you must treat the other.” Dr. Tomkinson

Conclusion

Sleep and depression share a link that researchers and doctors are just beginning to understand. Unfortunately, that connection can worsen individual disorders.  However, if both conditions are treated, the patient is more likely to recover their quality of life and health.

Doctors need to take a whole-person approach when treating depression and sleep dysregulation.  Therapies such as cognitive-behavioral therapy, animal therapy, psychotherapy, art therapy, and music therapy can all be beneficial forms of treatment.  Some patients have also found great solace and relief in their religious beliefs.  Patients with depression need a thriving support system to turn to when the feelings and thoughts begin to overwhelm them.  Online support groups are valuable when qualified individuals moderate them.  Patients can find a list of support groups at their local doctor’s office or on the NAMI (National Alliance of Mental Illness) website.

“As doctors, we often see the patient as only the symptoms we are treating.  But patients are whole beings, and those symptoms usually are a part of a much larger whole.  We must look at these symptoms in the context of the patient as a whole to truly alleviate their suffering.” Dr. Tomkinson

The information in this article is not meant for diagnostic purposes, and we are not doctors. Please consult your doctor before making any decisions concerning your healthcare.

Resources

Amy Morin, L. C. S. W. (n.d.). Why It May Be Hard to Sleep If You’re Depressed. Verywell Mind. https://www.verywellmind.com/coping-with-sleep-disturbances-during-depression-4161015.

Depression and Sleep: Understanding the Connection. Johns Hopkins Medicine. (n.d.). https://www.hopkinsmedicine.org/health/wellness-and-prevention/depression-and-sleep-understanding-the-connection.

Goodreads. (n.d.). Depression Quotes (4354 quotes). Goodreads. https://www.goodreads.com/quotes/tag/depression.

Nutt, D., Wilson, S., & Paterson, L. (2008). Sleep disorders as core symptoms of depression. Dialogues in clinical neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181883/.

Tips for beating anxiety to get a better night’s sleep. Harvard Health. (2020, October 13). https://www.health.harvard.edu/mind-and-mood/tips-for-beating-anxiety-to-get-a-better-nights-sleep.