Depression and sleep are deeply interconnected, with one often exacerbating the other in a frustrating cycle. When someone is struggling with depression, their brain chemistry and stress levels can disrupt normal sleep patterns, making it difficult to fall asleep, stay asleep, or achieve restorative rest. Insomnia is common, with racing thoughts and feelings of hopelessness keeping individuals awake at night, while others may experience excessive sleep, using it as an escape from emotional pain. These disturbances not only worsen fatigue but also intensify depressive symptoms, creating a cycle that can be difficult to break. Understanding this relationship is crucial for finding effective ways to improve both mental health and sleep quality.
Which Depression Symptoms Interfere With Sleep the Most?
One of the main symptoms of depression does include sleep disturbance. This can be too much sleep in a 24-hour period or boughts of insomnia. With too much sleep, sometimes those with depression may find themselves sleeping in the day and this can potentially make it hard to sleep at night. Some patients over the course of 24 hours get too little sleep. Depression can manifest in a very vegetative, apathetic, way that is reminiscent of hibernation. Whereas in others it can manifest in a way that looks agitated, anxious, and with insomnia. Another symptom of depression that can interfere with sleep is rumination. People can find themselves overthinking things, often relatively insignificant things. They may even be matters of the distant past that have no impact on the present. The excessive thinking makes it difficult to let one’s guard down and fall into a slumber.
Is There A Bidirectional Nature of Depression and Poor Sleep?
When it comes to the bidirectional nature of depress and sleep, it depends on the nature of each individual person’s depression. Some have a strongly biochemical nature where the depression is propelling the preponderance of the symptoms. In these cases, other more notable symptoms can manifest. This includes depression with psychosis. So in other words, auditory and visual hallucinations and/or delusions. If there is a stronger psychological piece over a neurochemical piece, that tends to be more amenable to non-pharmacologic interventions that promote sleep. Poor sleep can entrench depression and vice versa. In a person who has a more psychological nature to their depression, evidence based psychotherapy and CBTi (therapy specifically for insomnia) can be very helpful. Other forms of depression such as bipolar depression and psychotic depression would benefit also from therapy but may need some further help from other interventions such as pharmacotherapy or even possibly FDA approved neuromodulation interventions.
How Can Someone With Depression Get Better Sleep?
Fortunately, bipolar depression and psychotic depression are not very common. Most cases of poor sleep that come with depression respond very well to non-pharmacologic approaches, and any indicated medications in most patients I have treated are rather straightforward regimens with little if any medical risk. There are a number of non-pharmacologic tips a person can use to help with sleep when they are dealing with depression. For more in depth discussions about how to deal with depression-related sleep issues with the help of medication it is always best to book an appointment with a professional mental health provider near you.
Always remember, sleep functions on a deficit model. When we stay awake and exert energy (e.g. exercise or even a walk around the block), metabolites are generated and as they accumulate, they start to generate a signal for sleeping at night. The more metabolites there are, the stronger the biological urge to fall asleep and stay asleep. This is why when in the first half of the day when we have a routine of aerobic exercise, we sleep more soundly at night. So regular exercise that is not scheduled too late in the day is a great option that also has evidence for improving depression.
Also, waking up at a consistent time each morning and staying awake for consistent block of time each day will help with sleep consistency. Napping during the day has potential to clear out some of those metabolites so the drive to sleep is weaker in the evening.
Last but not least, do not worry too much about sleep. Remember, it is normal to wake up in the night. It is normal to have a bad night or two of sleep. The human circadian rhythm has day to day variability. It is more about the pattern of sleep over the course of a couple of weeks (e.g. over 10 days is the average amount of sleep about __ hours a day and is it mostly consolidated in the night). I have worked with patients who worry that if they have a night of a lot less sleep or frequent awakenings, they can get very determined to make sure every night is almost identical and there are little to no awakenings. As a matter of fact, this is not what normal sleep looks like–and it is a great recipe for generating anxiety and rumination over sleep which can oddly, psychologically keep us up at night. The trick is to not sweat it. Your body knows what to do. Along that same territory, do not watch the clock. At night, you want to try to think as little about sleep as possible and just be present. The less you think, the easier it will be to fall asleep.
Contact a Mental Health Professional for Problems with Depression and Sleep
Our patients and many others (including myself) have found sleep trackers to be helpful objective measures of sleep. They can be on Fitbits for example and someone can wear it and not have to worry about keeping a journal. If there is objective evidence of very very little sleep over a course of time that seems to be persistent, that can be a matter to bring up to a professional. Also, if there are accompanying concerning psychiatric symptoms, it is worth discussing. These can be thoughts of death, dying, suicidal feelings. If other symptoms seem to be escalating like depressed mood, hopelessness, utter lack of quality of life — it could be an indication of a need for more assertive treatment approaches.
If you think you or struggling with depression and sleep, an experienced therapist near you can help. We invite you to reach out to our clinic to book an appointment today. Request an Appointment online.
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“I’m very grateful to have found Dr. Yin. She spent a great deal of time with me in the first session to get my information/insights to add to the info in my medical records, which she had read prior to the visit. She listens and offers very helpful insight. She doesn’t believe in simply throwing more medications at psychiatric symptoms. I was on 6 meds prior to seeing her and I’m now on 2. She’s kind, respectful, and incredibly knowledgeable. I couldn’t be happier with her and strongly recommend her!”