You’ve been feeling listless and low, can’t concentrate, and don’t enjoy doing anything that used to give you pleasure. You can barely keep your eyes open during the day, yet the minute your head hits the pillow at night, you are wide awake.
Insomnia and Depression
Depression can stem from any sleep disorder that causes chronic fatigue and mood problems. But insomnia, the inability to fall asleep or stay asleep, is the sleep disorder most often linked to depression.
“If you were to follow people with insomnia and no history of depression, they would be four times more likely to develop depression than individuals with no history of insomnia,” says R. Robert Auger, MD, a sleep specialist at the Mayo Center for Sleep Medicine in Rochester, Minn. This increased risk persists even decades later.
Which Comes First, Sleep Loss or Depression?
“In people who have bad insomnia and bad depression, it is often very difficult to tell which came first,” says Mark Mahowald, MD, director of the Minnesota Regional Sleep Disorders Center in Hennepin County. “Sleep deprivation can impair mood, and impaired mood can result in impaired quality and quantity of sleep.”
According to Auger, the relationship between sleep and depression is not entirely understood. “But there is a well-established connection between lack of sleep and mental and physical health,” Auger says. “Sleep is as important an aspect of health as exercise and nutrition. Sleep is non-negotiable.”
How Treating Insomnia Can Improve Depression
The first step to better sleep is to diagnose and treat the sleep disorder and/or the underlying depression. “If you treat the insomnia in someone with depression, you will improve their chances of achieving remission from the depression,” Auger says.
Your primary care doctor may be able to educate you about sleep habits that will help your insomnia. In some cases, your doctor may treat insomnia with prescription sleeping aids. Some individuals will respond to them. Others may not if they have another underlying sleep disorder such as sleep apnea that is also robbing them of quality sleep.
Your primary care doctor may also refer you to a sleep specialist.
Seeing a Sleep Specialist
A sleep specialist will conduct a thorough evaluation and sleep study, in which you are monitored while sleeping, and then develop a treatment plan.
Your better sleep treatment plan may include medication as well as good sleep hygiene techniques – ways to prepare your body for sleep. Avoiding caffeine after lunch, not consuming alcohol within six hours of bedtime, and not smoking or using any type of nicotine product before bedtime are some sleep hygiene techniques. Experts may also teach you relaxation techniques and cognitive therapy, in which you learn to replace sleep worries with positive thoughts.
“We also use a very powerful technology called ‘stimulus control,’” says Auger. Essentially, stimulus control is a behavioral technique that limits the time you spend in bed.
"It teaches people to use the bedroom for sleep and sex, and to leave the bedroom after about 20 minutes if they can’t fall asleep and engage in a relaxing activity,” he says. “It can be as powerful as medications and possibly more powerful in the long term.”
Treating Depression to Improve Insomnia
“Insomnia can precede a bout of depression or increase risk of a relapse in someone with a history of depression, but treating the insomnia can improve the outcomes of depression,” agrees Jason Ong, PhD, director of the behavioral sleep medicine program Rush University Medical Center in Chicago.
But Ong says it’s also important to address the depression that may exist independently of the sleep issues. If you think you are depressed, be sure to discuss this with your doctor, who can help you decide on whether treatment for it should be part of your sleep therapy.
Some antidepressants may also cause sleeplessness. In that case, your doctor or sleep specialist can investigate other options. ”Try to find an antidepressant with sedating properties,” Ong says. “Or if the most effective antidepressant for you causes insomnia, you may be able to take it in the morning instead of night.”
Susan Zafarlotfi, PhD, clinical director of the Institute for Sleep and Wake Disorders at Hackensack University Medical Center in New Jersey, uses insomnia as a clue to other issues when evaluating a new patient.
“Insomnia is one of the ways to identify depression, and I make sure all of my patients get depression and anxiety screening,” Zafarlotfi says. “We need to address both the sleep problem and the depression. It doesn’t matter which came first.”