How Depression May Cause Sleep Problems

Depression can manifest itself with symptoms you may not immediately recognize as being part of it, especially when it comes to sleep issues. Sleeping too much or sleeping too little can be signs of depression.

Sleep problems can also contribute to depression risk. Insomnia, or trouble falling and staying asleep, can affect brain chemicals and hormones. Some evidence suggests that depression and sleep problems worsen if these substances are out of balance.

Depression is one of the most common mental health disorders that impact Americans. Nearly 80% of people with depression report trouble sleeping. Read on to learn about the link between depression and sleep problems.

What Is Major Depressive Disorder?

Major depressive disorder, or clinical depression, causes persistent feelings of hopelessness, guilt, sadness, or worthlessness. This type of depression is different from feeling down or unhappy, which happens to most people from time to time.

Other major depressive disorder symptoms include:

• Agitation, anger, or irritability
• Appetite or weight changes
• Difficulty focusing
• Fatigue  
• Isolating or withdrawing yourself from others
• Loss of interest in things you previously enjoyed
• Restlessness
• Sleeping too much or too little
• Suicidal ideation, or thoughts of death or self-harm

The Relationship Between Sleep and Depression

Depression can cause sleep difficulties, from not sleeping enough to sleeping excessively. These issues are linked to depression through hormones and the nervous system.

There are several hormones that play a role in being asleep and awake, such as:

• Cortisol
• Ghrelin and leptin (hormones that help regulate appetite)
• Growth hormones
• Melatonin
• Thyroid-stimulating hormone (TSH)

Melatonin and cortisol help regulate your circadian rhythm, or your sleep-wake cycle, as they work opposite of one another. Sleep issues can occur if they're out of balance. Increased TSH or ghrelin levels and decreased growth hormone or leptin levels can all lead to sleeplessness and vice versa.

People with sleep issues may also be susceptible to depression. This supports the idea that sleep and depression affect one another in a bidirectional way. The link between the two may constitute a cycle of having sleep issues because of depression and having depression because of sleep issues.

Insomnia

You may likely be dealing with insomnia if you have depression and are having trouble falling asleep or staying asleep. Symptoms may include:

• Being awake for long periods before you can fall asleep
• Being awake for the majority of the night
• Feeling as if you actually didn't get sleep
• Sleeping in short bursts
• Waking up long before you plan to do so

Insomnia can be a risk factor for depression. About 90% of people with depression have experienced insomnia symptoms. You may also have problems with concentration and memory if you don't get adequate sleep.

Hypersomnia

Hypersomnia, or excessive sleepiness, is a common sign of atypical depression. This subtype of the mood disorder can be hard to identify. It doesn't typically involve some of the classic symptoms. You might sleep too much and eat too much instead of having trouble sleeping and a loss of appetite.

You don't always feel low when you have atypical depression. Your mood may lift temporarily when positive events happen, or you hear good news. This makes it easier to brush off other signs that something's amiss, like using the snooze button more often.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a sleep disorder in which blocked or narrowed airways cause stops in breathing while you sleep. OSA symptoms are similar to those of depression, including fatigue and tiredness.

Research has shown that OSA affects oxygen levels, which can impair brain function and cause mood changes. OSA has also been linked to inflammation, which might increase depression risk. More research is needed to understand the link between OSA and depression.

How To Treat Depression and Sleep Problems

Talk with a healthcare provider if you have depression symptoms, including sleep problems. They'll probably ask you when the symptoms started and if any big event or change happened in your life at that time. Be prepared to talk about your health history and any other depression symptoms.

Depression can usually be treated with medication and talk therapy. Cognitive behavioral therapy for insomnia (CBT-I) may be helpful. CBT-I is a type of talk therapy that helps change your behaviors and thoughts surrounding sleep. A mental health specialist may teach you relaxation techniques to improve sleep quality.

You can also try sleep hygiene practices, such as:

• Avoiding caffeinated beverages in the late afternoon and evening
• Going to bed and waking up at the same time each day
• Making sure it's cool, quiet, and relaxing in your sleeping environment
• Not eating large meals or drinking alcohol too close to bedtime
• Putting electronic devices away 30 minutes before bedtime
• Staying physically active and eating a healthy diet

Having a hard time going to bed at night or getting up in the morning doesn't necessarily mean you have a mood disorder. It can also be a sign of many other issues, including anemia and a thyroid condition. A healthcare provider can ask about these possibilities to get a full picture of your health.

A Quick Review

Sleeping too much or sleeping too little are signs of depression. Sleep problems, including insomnia, can also increase the risk of depression. Not sleeping enough may affect the brain chemicals and hormones that regulate mood, which can cause or worsen depression.

It's important to reach out to a healthcare provider if you have depression symptoms or sleep problems. They may advise medication, talk therapy, or a mix of both to help you sleep better.