Depression is one of the most common psychiatric conditions in the world, characterized by bouts of disappointments, sadness, hopelessness, and other physical, mental, and emotional challenges. Many people who struggle with depression often develop sleep troubles, particularly finding it difficult to fall asleep and experiencing daytime sleepiness.
Depression and sleep problems share a close connection and often occur in a negative cycle that can be challenging to break. Poor sleep is even responsible for triggering depression in some people. Understanding how both conditions are connected and how they affect an individual is imperative to learn how to overcome them together.
Exploring the Connection between Depression and Sleep
Research has found many links between depression and oversleeping, and most evidence suggests it to be a symptom of depression rather than a cause. Sleep problems are fairly common in major depression, with studies suggesting that the majority of the people living with this condition experience some form of sleep difficulty. The figures are estimated to be around 92 percent, with insomnia being the most prevalent condition among all others.
Hypersomnia, a condition where a person experiences excessive daytime sleepiness despite having adequate sleep at night, is more commonly seen in those with atypical depression. For such people, positive life changes can significantly brighten the mood, something that does not happen in people with major depression. Oversleeping depression is also more prevalent in certain groups, such as women under the age of 30.
A lot of discussions have been going on, trying to investigate whether sleep problems lead to depression or vice versa. While it is possible to develop sleep issues long before acquiring depression, experts are not sure how these difficulties may contribute to the risk of developing the latter. Many also believe the relationship is bidirectional, with any leading to the other. [1] Hypersomnia, a common sleep difficulty, is also known to worsen the symptoms of depression. Studies suggest that people who sleep for more than eight hours per day experience more intense depression symptoms than those who sleep for fewer hours.
In simpler words, the situation must be considered a cycle where depression affects one’s energy, mood, and outlook for the future. It may make a person feel lethargic, drained, and less interested in daily activities. In such circumstances, sleeping seems like a solution, as people with depression believe that excessive sleeping will help them relieve fatigue or escape their symptoms. Hence, they may start spending hours in bed, feeling like it is the best way to spend time. However, they may start feeling guilty about spending so much time in bed, worsening their underlying depression.
Depression Sleep Symptoms
In addition to troubling thoughts and mood, depression and sleep issues may manifest in the form of physical changes that interfere with everyday activities. Some symptoms may include the following:
- Persistently low, sad, or irritable mood
- Loss of pleasure or interest in activities
- Feelings of hopelessness, guilt, or worthlessness in life
- Decreased energy and fatigue
- Going to sleep late at night or waking up too early
- Oversleeping
- Low appetite or overeating
- Difficulty concentrating
- Thoughts of death or suicide
Depression is more prevalent in women, and the way it presents along with sleep difficulties may be different for everyone based on their age and sex. Men usually experience depression symptoms in the form of anger, whereas women are more inclined towards feeling guilty and sad.
Depression and Sleep: What Issues to Expect?
Sleep depression problems often include the following three types of issues:
- Insomnia, a condition that causes issues with falling or staying asleep at night
- Hypersomnia, a condition characterized by excessive daytime sleepiness
- Obstructive sleep apnea, a condition which causes momentary gaps in breathing during sleep
Studies estimate that up to 15 percent of adults with depressive symptoms suffer from hypersomnia, 20 percent with obstructive sleep apnea, and a whopping 75 percent with insomnia. It is also estimated that many people with depression often keep fluctuating between insomnia and hypersomnia. Regardless of the nature of the sleep issue, they experience chronically poor sleep that contributes to circadian rhythm interruptions and imbalances in neurotransmitters, such as serotonin. Both of these issues can not only trigger depression but may also exacerbate it.
Hypersomnia
According to experts, hypersomnia includes excessive daytime sleepiness or prolonged sleep that feels uncomfortable. Sleep depression due to hypersomnia is not life-threatening but can lead to prolonged lethargy and poor concentration. In extreme cases, sleep deprivation can put a person in the middle of a life-threatening act, such as falling asleep while driving or operating heavy machinery.
Insomnia
This blanket term describes a condition where a person feels difficulty falling asleep, maintaining it, or getting good quality sleep. Insomnia may occur in people who sleep in the best environments, causing them to stay awake for hours every night. Moreover, such people also need help staying awake the following day or performing well. Insomnia is also noted to affect concentration and memory severely, in addition to causing severe health consequences. Chronic insomnia may also lead to many medical issues, such as cancer, coronary heart disease, diabetes, or high blood pressure.
Sleep Apnea
Also known as obstructive sleep apnea, this condition involves repeated pauses in breathing during sleep. This medical condition can be serious as it causes throat muscles to relax and collapse, which, in turn, blocks the airway when a person sleeps. OSA is prevalent in obese individuals with or without depression. Scientists also believe it to be associated with other health issues, such as type 2 diabetes, stroke, hypertension, and heart diseases.
Depression and Sleep Issues: How to Sleep Better
While sleep-related issues can greatly increase the risk of developing depression, experiencing persistent sleep issues can also lead to a relapse of this psychiatric illness in people who have it under control. Consequently, it is imperative to adopt healthy habits to regulate sleep and sleep better in addition to boosting mood and controlling depression symptoms.
Consider talking to a therapist.
Different types of therapy are available to help a person cope with depression while changing their sleep habits and thought patterns. Therapeutic models, such as psychodynamic therapy, cognitive behavioral therapy, and interpersonal psychotherapy, can help a person process their underlying challenges and feelings contributing to depression. Mental health experts can also suggest other concrete behavioral changes to reduce some depressive symptoms while providing patients with depression to manage sleep at night.
Maintain a consistent sleep schedule.
Suffering from depression can make it harder for someone to follow a routine. For such people, sleeping and waking up at the same time daily can give them adequate sleep every night. Additionally, establishing a nightly routine can provide cues for the body to relax and prime itself for sleep.
Nap more carefully.
Inconsistent or restless sleep due to depression can make it tempting to nap during the day, which may get longer. However, it is imperative to keep them short, ideally between 10 to 20 minutes. Such naps are power naps and can help people freshen up without disrupting their nighttime sleep. Naps at most 20 minutes can make it easier to fall asleep in time at night. Sometimes, people may be suffering from oversleeping depression, which may cause them to sleep frequently during the day and cause disruptions at night.
Avoid using alcohol.
Getting a drink or two to promote sleepiness and relaxation can be a tempting idea for someone who suffers from depression hypersomnia. However, studies have shown that binge drinking close to bedtime can make it difficult to fall asleep and maintain it. Even moderate drinking can disrupt sleep by shortening the REM sleep cycle; hence, avoiding drinking close to bedtime is the best tip.
Explore outdoors.
Spending more time outdoors is one of the simplest ways to aid sleep for people suffering from depression and sleep issues. Doing so can provide exposure to sunlight, which regulates the circadian rhythms and the internal clock, making it easier for the body to respond to cues regarding when to fall asleep and wake up. With regulated circadian rhythms, the body can start producing melatonin as soon as the sun sets, giving the brain a cue to feel sleepy and sleep more easily.
Get regular exercise.
Research highlights that people who engage in light to vigorous exercise report experiencing a good quality of sleep. Regular exercise has also been known to significantly manage the symptoms of depression, making it a good choice to promote both mental health and sleep health. For people considering exercise to boost sleep and control depression symptoms, the best time to engage in physical activity is during the first half, as exercising later in the day can interrupt their ability to fall asleep.
FAQs
Why do depressed people sleep a lot?
Depression can often lead to fragmented sleep, which may consequently cause fatigue and sleepiness during the daytime. Those facing active depressive symptoms may, therefore, feel the need to sleep more than usual. However, such people should also aim for seven hours per day of sleep like others.
Can depression cause sleep disorders?
Depression has been known to cause multiple sleep disorders, such as obstructive sleep apnea and insomnia. Since both conditions are closely intertwined, it may be difficult to determine which of them happened first and led to the other.
Is sleeping a lot a sign of depression?
Excessive sleep and depression have been closely connected in many instances. However, remember that while sleeping a lot can be a possible sign of depression, it should never be the first diagnosis. A medical professional ideally rules out other causes of oversleeping, including possible medical reasons, before labeling it a sign of depression.
References
1 Franzen PL, Buysse DJ. Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues in clinical neuroscience. 2008 Dec 31;10(4):473-81.
2 Léger D, Beck F, Richard JB, Sauvet F, Faraut B. The risks of sleeping “too much”. Survey of a national representative sample of 24671 adults (INPES health barometer). PloS one. 2014 Sep 16;9(9):e106950.
3 Daut RA, Fonken LK. Circadian regulation of depression: A role for serotonin. Frontiers in neuroendocrinology. 2019 Jul 1;54:100746.