Depression and Sleep
Nearly all depressed people experience sleeping problems. Depression is the persistent feeling of sadness, hopelessness and disinterest in things that were previously enjoyed. Affecting around 20 million Americans generally, and many millions more recently because of the times in which we live, depression is a serious disorder that affects the way a person eats, thinks, feels and sleeps.
Depression and insomnia, an inability to fall asleep or stay asleep, are intricately linked and comorbid conditions related to one another.
For some people, symptoms of depression occur before the onset of sleep problems. For others, insomnia appears first, and for some people with cyclical depression, insomnia may predictably predate the start of a bout of depression by around two weeks.
Treatment for depression typically involves a combination of psychotherapy (including cognitive behavioral therapy) and pharmacological (drug) treatment. Each of these therapies may be used to treat both depression and insomnia. Said another way, treatment for sleep problems is often an integral part of standard depression therapy.
Cognitive behavioral therapy (CBT) is a behavioral approach to treating depression that is increasingly popular due to its effectiveness and lack of side effects. The essential features of CBT for depression include cognitive restructuring of the thoughts that lead to depressive feelings, and redirected behavioral actions that stop the perpetuation of depression. Many insomniacs get into ruts of wrongful actions that promote insomnia, so CBT may be used to treat insomnia and depression at the same time.
Sleep problems and depression may also share risk factors and biological features that respond to some of the same treatment strategies. For example, obstructive sleep apnea (OSA) is linked with depression. In a European study of nearly 20,000 people, those with depression were found to be five times more likely to suffer from OSA, and treatment of the sleep disorder for one year caused significant and lasting improvement in the depression. Patients with both OSA and depression should be aware that sedating antidepressant medications as well as medication for insomnia may suppress breathing and worsen OSA, which can be taken into account when prescribing treatment for OSA.
Successful treatment of insomnia almost always leads to improved mood in a depressed person, and treatment of depression usually alleviates a person’s insomnia. Thus, addressing sleep symptoms are of critical importance to recovery from depression.