Sleep Issues and Depression
Can Depression Interfere with Sleep?
Millions of US adults struggle with getting enough sleep. In some cases though, trouble falling asleep or staying asleep can either indicate a depressive episode or precipitate the onset of major clinical depression. The connection between sleep and depression is complex, and in many cases, it can be difficult to determine if poor sleep led to an episode of major depression, or if a depressive episode is the cause of someone’s sleep issues. The following article will explore the complex relationship between sleep and depression, and how someone can treat both conditions.
What are the most common types of clinical sleep issues?
Insomnia is the most common type of sleep disorder and is characterized by excessive daytime sleepiness and unrefreshing sleep. There are two types of subsets of insomnia:
- Trouble falling asleep called sleep onset insomnia.
- Problems staying asleep called sleep maintenance insomnia.
Obstructive sleep apnea is another common sleep disorder that can lead to depression. In this type of disorder, the airway becomes blocked. Men with obstructive sleep apnea are the most at-risk of experiencing a depressive episode.
Restless leg syndrome (RLS) is another sleep disorder linked to depression. In RLS, people have a feeling of pins and needles in their lower extremities, and an urge to move their legs at night, which prevents them from getting enough sleep. Up to 40% of restless leg syndrome patients have symptoms of depression.
How often are sleep issues linked to depression?
Problems with sleeping are one of the signs of depression. Hypersomnia, the act of sleeping too much, is a common symptom of depression. Teenagers and young adults are more likely to exhibit hypersomnia when depressed than older adults. It is possible for a depressed person to suffer from both hypersomnia and insomnia. Those who have both conditions report more severe and long-lasting depression. Up to 60% of adults with depression will list sleep disturbances as a symptom of their depression. In teenagers, it’s 90%.
People with insomnia are also ten times more likely to develop severe depression than people who don’t suffer from this type of sleep disorder. Studies indicate that people who experience both clinical subsets of insomnia are most at-risk for experiencing a major depressive episode.
Recent findings also show that experiencing a sleep disorder, even if a person has never had a psychiatric episode before, is a considerable risk factor in the onset of clinical depression. The strongest risk factor for depression is having insomnia that lasts for at least two weeks.
However, people who experience depression without a precipitating sleep disturbance are likely to encounter issues with their sleep when in the midst of a depressive episode. Sleep issues, whether they occur before or after the onset of clinical depression, are a reliable risk factor for depression and also a significant indicator of it.
A study from the late 1980s found that adults with a history of insomnia were four times as likely to go on to develop major depression within three years after the sleep disturbance. In teenagers, studies also found that sleep problems happened before the survey participants’ first episode of clinical depression.
Who is most at risk of suffering from sleep issues and depression?
Although many US adults complain of sleep deprivation, people suffering from psychiatric disorders are more likely to suffer from sleep issues than the general population. In inpatient settings, between 50% and 80% of mental health patients suffer from poor sleep, compared to about 18% of the general adult US population. The patients most likely to suffer from sleep issues are those with anxiety, depression, bipolar disorder, and ADHD.
Before studies indicated otherwise, most clinicians believed that sleep issues in psychiatric patients were symptoms of depression. But sleep problems increase the risk of depression and can also cause it. Treating the sleep disorder can alleviate the symptoms of co-occurring depression. Recent findings show that when sleep apnea patients are given CPAP machines, their depression symptoms are greatly reduced. Patients who used a CPAP for at least one year had the most significant and long-lasting relief from depression symptoms.
Why do sleep issues cause or worsen depression?
Neuroimaging and neurochemistry studies indicate that good sleep can cultivate mental and emotional resilience to stress. Long-term sleep disturbances can also feed into negative thinking patterns and emotional vulnerability to stressors.
What are the treatment methods for sleep issues that can stop depression from developing?
Patients who get treatment for depression, but continue to experience insomnia, are unable to respond to treatment adequately. Patients who do not have sleep issues are more likely to respond favorably to treatment. Also, at-risk patients with untreated sleep conditions are more likely to experience a recurrence of depressive symptoms if their sleep disturbance isn’t treated along with the depression. Patients with depression and untreated sleep disturbances are at higher risk of suicide, too. It’s crucial that depressed patients who suffer from a co-occurring sleep issue have their sleep disturbances fully addressed and treated.
Treatment for sleep problems varies depending on the specifics of the disorder. For people with obstructive sleep apnea, CPAP machines are highly effective at alleviating the sleep disturbance and also relieving depressive symptoms. Short-term sleep aids are usually the first line of defense against insomnia. Different medications can ease either sleep onset insomnia or sleep maintenance insomnia. For restless leg syndrome, nerve pain blockers and dopamine promoters can treat the condition.
In the case of hypersomnia, it’s usually a symptom of depression and not a risk factor for the onset of depression. SSRIs, SNRIs, and TMS are effective, first-response medications and therapies for alleviating the symptoms of depression, including hypersomnia. CBT, DBT, and talk therapy in combination with medication and TMS are the most effective methods of treating clinical depression.
Deep brain stimulation techniques are useful in treating clinical depression and severe insomnia. Transcranial magnetic stimulation, or TMS, is a known treatment method for stubborn depression and insomnia.
Patients who experience sleep disturbances and clinical depression must have the sleep disturbances adequately treated along with the depression. Failure to address sleep issues can worsen depression symptoms, and increase the risk of recurrence and suicide. Fortunately, a combination of therapy, medications, and deep brain stimulation techniques can treat depression and insomnia.