How Are Depression And Insomnia Related?

With over 300 million people managing depression, the leading cause of disability in the world today can be attributed to this mood disorder. This number is alarming, especially when considering the symptoms that accompany this disorder that complicates daily living and effects a person’s general well-being. One of these symptoms is difficulty sleeping, or insomnia. Disturbed sleep can grow more distressing with time and have a large impact on a person’s quality of life. 

In the United States, scientists estimate that 40% of Americans will struggle with insomnia at one point in their life, while an estimated 17.3 million U.S. adults will deal with the symptoms of a major depression episode at least once per year. Depression and insomnia are often linked as interrelated disorders due to the high percentage of people who have insomnia and depressive episodes concurrently. In fact, some research suggests that medical practitioners should be wary of diagnosing depression without evidence of sleep complaints by the individual. This interrelationship of insomnia and depressive disorders is further explained in this article with an emphasis on identifying symptoms and reaching out for professional help to manage both. 

The Cycle Of Insomnia And Depression

Approximately 75% of individuals with depression will experience sleep disturbances from insomnia, suggesting that the two disorders often appear in tandem with each other. A further 40% of depressed patients also have hypersomnia—a disorder that is characterized by excess sleep. The relation between the two is influenced by a variety of factors, but are commonly categorized into two groups: 

1. Insomnia and sleep disorders as subsequent symptoms of depressive episodes 

2. Insomnia and sleep disorders as antecedent symptoms or precursors to depressive episodes 

Many researchers theorize that the combination of the two  creates a cycle of sleeping difficulties and depressive symptoms that is difficult to break.

Insomnia As A Subsequent Symptom

According to Harvard Health, 69% of people with insomnia also struggled with depression following a cycle of disturbed sleeping patterns. In another study, 21% of individuals reported that they experienced a combination of hypersomnia and insomnia. These two studies suggest that depressive episodes may cause insomnia or hypersomnia. Some individuals get depressed at night hindering them from experiencing healthy sleep. Issues with sleep due to depression can happen in a variety of ways, including changes to sleep regulation processes or side effects of prescription medication. This, in turn, may exacerbate symptoms of depression, but experts in a U.K. study notethat depressive disorders without insomnia or other sleep disorders are increasingly rare.

Disturbances In Sleep Regulation

Over the past 35 years, research has determined the existence of two sleep regulation mechanisms: the circadian process and the homeostatic process, also known as the recovery process. Both work together to maintain sleep regularity and need for sleep after wakeful periods. The circadian process is the mechanism that drives individuals to sleep on a regular basis during nighttime hours. In individuals without sleep disorders, the circadian process begins at around 11 p.m. and peaks at 4 a.m. It subsequently fades around waking hours. The recovery process is another mechanism that drives sleep, but it is directly dependent on the amount of time that has passed since an individual has last slept. 

The difference between the two is that the circadian process controls sleep at relatively set times each night, while the recovery process may drive an individual to sleep at an irregular time if they have spent too much time without sleep. This mechanism is what drives the body’s need for a midday nap after an individual stays awake for the entire night.

In individuals without depression or insomnia, these two mechanisms interact for a regular sleeping schedule of about seven to eight hours each night, from about 11 p.m. to 6 a.m. The brain activity that controls these processes is called slow-wave activity and shows up most prevalently at the onset of sleep. In individuals who do not have sleep disorders, slow-wave brain activity helps an individual to fall asleep quickly and easily. It also aids them in staying asleep for the entire night. However, those who struggle with depression and sleep disorders are also found to have disrupted circadian and homeostatic processes. In these individuals, slow-wave activity is much lower. 

Therefore, the drive to sleep is much less powerful for individuals with depression and insomnia, as the person struggles to sleep within a regular rhythm. This disruption in sleep processes is why insomnia is much more common than hypersomnia in individuals with depressive disorders. Depression is shown to disrupt sleep mechanisms and make it much harder for an individual to fall or stay asleep on a regular basis.

Effects From Prescription Medications

Many people with depression take anti-depressant prescription medication to help them control their symptoms. While medication can be helpful in aiding depressed patients to combat mood shifts, lethargy, and other symptoms of depression, it may also induce or increase sleep disorders, especially insomnia. 

There are two main types of medication geared towards those with depression—medication with “activating” properties and medication with “sedative” properties. Medication with activating effects is geared towards improving energy levels and raising the moods of those with depression. Sedative medications are mainly used to control the moods of those with bipolar disorder and relieve anxiety. While many of these medications work wonders to relieve these symptoms, they can negatively affect a depressed patient’s sleep as well.

Activating medication can use fluoxetine or venlafaxine, which are agents that can make an individual feel more alert and reduces the urges to sleep at a regular interval. Sedative medication may have the opposite effects—medication using doxepin and mirtazapine can cause an increased need to sleep, much like prescription or over the counter sleep medication. While good for short-term use, it can cause many problems in long-term sleep regulation and make it even harder for the individual to sleep at normal intervals and for regular lengths.

Insomnia As An Antecedent Symptom

In the UK study described earlier, while 68% of individuals with depression described their insomnia symptoms as appearing at or after their depressive disorder began, 16% reported that their sleep problems began long before they experienced changes or shifts in mood. While this is a minority category, it seems to suggest that those with insomnia can develop depression as a result. This is backed up by the mood changes that come with depression as well as the studies that describe situations in which people who have insomnia will have an  risk for developing symptoms of depressive disorders.

Insomnia And Risk Of Developing Depression

While some may categorize insomnia and other sleep disorders as symptoms of a depressive disorder, research has revealed that they may be antecedents to depressive episode. This suggests that depression could be categorized as a symptom of insomnia. For younger adults along with middle-aged individuals, insomnia was found to lead to a two to four-fold increased risk for having a relapsed depressive episode later in life.

In addition, researchers have posited that complaints of episodes of insomnia almost every night for two weeks or more could be a useful indicator to predict a major depression episode for those who have a history of depressive disorders. The link is not only reserved for those with a history, however. In fact, research studies show that 14% of individuals who had insomnia at one date developed new major depression one year later. This research suggests that for some individuals, insomnia can lead to new depressive episodes and not simply exacerbate a relapse.

Sleep Disorders And Mood Changes

Besides disturbed sleep patterns, mood changes and an overall feeling of lethargy are  primary . Concomitantly, people with sleep problems may experience mood shifts and emotional dysregulation. The mood changes caused by insomnia may explain why individuals who have a sleep disorder may develop depressive thoughts or habits. 

In general, insomnia is linked to a reduced quality of life by enhancing anxiety, frustration, hopelessness, exhaustion, and issues with concentration. Certain studieshave researched how different age groups are affected by insomnia and other sleep disorders, discovering that many symptoms of insomnia coincide with symptoms of depression. These findings suggest that those struggling with insomnia begin to take on symptoms of depression as well and can eventually develop a depressive disorder.

In the same study, there were some concerning findings revolving children and adolescents with insomnia. In adolescents, poor sleep quality has been linked to decreased performance in school as well as an increased risk of self-harm and suicidal ideation. These are two symptoms of depression that may be brought about in the first place by an adolescent’s lack of sleep. In adults, insomnia has been shown to cause a decreased health-related quality of life, mortality, inflammation, and a greater risk for other chronic diseases, such as chronic depression.

Sleep disorders do not just cause nighttime impairments with falling and staying asleep, but daytime impairments as well. These impairments can severely lower an individual’s ability to concentrate, self-motivated, perform to peak abilities in school or work environments, initiate projects, or solve problems. The daytime impairments that individuals struggling with insomnia face may lead to low self-esteem and a decreased quality of life. These two factors can quickly lead to anxiety depression, and further exacerbate the symptoms of sleep disorders.

Professional Support For Insomnia And Depression

Sleep disorders and their link to depressive disorders are varied and complex. Scientists and psychologists have determined that while there is an undeniable link between depression and insomnia, there is very little way to determine if sleep disorders present as a precursor to depression or if they are caused by depression. While research studies have shown that most depressed patients develop symptoms of insomnia after they develop depression, individuals who experience the opposite cannot be overlooked. Most likely, the two go hand in hand.

If you are managing depressive symptoms along with insomnia, talk to your healthcare provider to make sure you do not have an underlying health disorder that is contributing to these symptoms. Your doctor may be able to not only diagnose the root cause, but refer you to a mental health professional who can help you manage symptoms and even work towards healing and recovery. 

Sometimes, the stress of finding a therapist and making appointments along with traveling to and from appointments may keep some people from reaching out for help. If you can relate, consider online therapy. With virtual therapy, you can set up a time that is convenient for you and in a comfortable space of your choosing. Research has also shown that online therapy is a highly effective method to receive mental health care as compared to-in person therapy. For example, a recent study published in Sleep Medicine Clinics looked at the efficacy of internet-based cognitive behavioral therapy (iCBT) in the treatment of insomnia. Researchers found that in tailoring CBT sessions specific for people with chronic insomnia, people had significant improvement in symptoms along with a reduced need for pharmacological interventions. 

With appropriate mental health interventions, you may find relief in symptoms that are interrupting your quality of not only sleep, but life in general. Our therapists at BetterHelp are experts in their field and are dedicated to helping people manage symptoms related to depression and improve the quality of life.  If you or someone you know is depressed and needs help, contact us today to speak to a licensed professional

Takeaway

Depression can inhibit slow-wave activity that disrupts circadian and homeostatic rhythms which controls sleep, but the resulting insomnia can exacerbate other symptoms of depression such as anxiety, lethargy, and irritability. Luckily, due to the prevalence of these two disorders, there are many options available for individuals struggling with both depression and insomnia. Medical professionals have developed many treatments to simultaneously treat depression and insomnia and help individuals get back to the peak of health. If you are managing depression, consider scheduling meetings with a counselor. A licensed counselor, such as one from BetterHelp, can assist you in managing your major depression symptoms, which may be linked to better sleep quality.