Is It Depression or Insomnia, or Both?
Sleep difficulties are very common in people with depression, and both issues can wreak havoc on your ability to perform at your best—whether it’s on the field, in the boardroom, or in the classroom. Did you know that about 75% of depressed people also struggle with symptoms of insomnia? Many aspects of sleep are linked to depression. How many of the following sleep issues do you have?
7 Sleep Issues Related to Depression
1. Going to bed early and getting out of bed late
Many people who are depressed want to sleep more, as it is considered an escape from their suffering. Many find it difficult to get out of bed in the morning due to reduced motivation and lack of energy, resulting in more time spent in bed trying to sleep. This worsens insomnia because the bed becomes associated with wakefulness and negative thoughts.
2. Waking up earlier than desired
Although early morning awakenings are more common in depressed people, they may also be due to simply being an “early bird” or “lark.” To know the difference, think about whether you were an early riser prior to the depression setting in.
3. Challenges faced by depressed people with strong “eveningness” tendencies
People who have a delayed sleep schedule (“eveningness” tendencies), in which they go to bed later at night, are more likely to have a lower mood in the morning and a better mood in the evening. So, they tend to delay their bedtime because they finally feel better in the evening, and they tend to postpone getting out of bed because they have a lower mood in the morning.
4. More negative thinking (dysfunctional beliefs)
This often means higher alertness in bed, which can lead to an increased effort to go to sleep, which leads to more wakefulness of the mind, which perpetuates the cycle of insomnia.
5. Obstructive sleep apnea (OSA)
Sleep apnea—which is characterized by snorting, gasping, or temporarily stopping breathing while sleeping—may be more prevalent among patients with insomnia and depression. One possibility for the connection may be because of depression-associated inactivity and weight gain, as excess weight and obesity are the most common causes of sleep apnea.
6. Problems quieting the mind at night
When repeated thoughts (ruminations) occur in bed at night, they will interfere with your sleep.
7. Failure to get out of bed when unable to sleep
When you can’t sleep, it’s a good idea to get up so you don’t associate the bed with sleeplessness. However, depressed people often fail to do this because they may have low energy and less motivation, and they already use the bed for negative thinking and as an escape from “the depressing real world” (the wish for sleep to provide an escape from emotional suffering).
When Depression Treatment Doesn’t Help Your Sleep
Surprisingly, many of these sleep problems do not resolve with psychotherapy or antidepressant medication. In fact, several antidepressants are known to contribute to sleep disruptions. Medications like bupropion and venlafaxine can be activating and keep you up at night. Common side effects of most antidepressants include a number of digestive problems, which could also affect sleep. Medications such as mirtazapine can cause weight gain and potentially worsen conditions like sleep apnea. Most antidepressants worsen or contribute to Restless Leg Syndrome, a condition that causes your legs to move involuntarily, making it difficult to get restful sleep. And most antidepressants that work on the neurotransmitter serotonin can worsen or contribute to dream enactment (REM sleep behavior disorder), thereby disrupting sleep.
In addition, when stimulants are used off-label for motivation and energy in depressed patients, they can cause insomnia. When bipolar depression is treated with medications, such as olanzapine and quetiapine, they can cause weight gain and worsen sleep apnea, which in turn causes sleep disruption.
Treat the Depression AND the Insomnia
In general, individuals with co-occurring depression and insomnia tend to have a more serious disability, greater severity of depression, and poorer depression outcomes than those without insomnia. Depressed people with disturbed sleep are also at increased risk for suicide and are more vulnerable to a recurrence of depression. This is why it’s so important to address both issues. If you’re struggling with both depression and sleep deprivation, be sure to have your insomnia diagnosed and treated in addition to treating the depression.
You can find many more common sleep saboteurs that compromise performance, in addition to solutions to optimize sleep, in Dr. Shane Creado’s book, Peak Sleep Performance for Athletes: The Cutting-edge Sleep Science That Will Guarantee a Competitive Advantage.
In “Peak Sleep Performance for Athletes: The Cutting-edge Sleep Science That Will Guarantee a Competitive Advantage” author Dr. Shane Creado, who is board-certified in both psychiatry and sleep medicine and is on the Board of Directors for the International Society for Sports Psychiatry, shares his unique sleep optimization program for athletes that he uses with his patients at Amen Clinics. Order your copy here.
If you or a loved one is looking for that competitive edge or is struggling with sleep problems or depression, Amen Clinics can help. Speak to a specialist today at 888-288-9834 or schedule a visit online.