A Vicious Cycle: Insomnia Anxiety And Depression
Heed this condition it could lead to early detection of mental disorders and other illnesses.
Chronic insomnia can increase a persons chances for developing anxiety disorders and depression, according to a study conducted by Dag Neckelmann, MD, PhD, of the Department of Psychiatry at Haukeland University Hospital in Bergen, Norway.
The study, published in the July 1, 2007, issue of the journal SLEEP, was based on data collected from 25,130 adults from two general health surveys conducted over a 10-year period. Neckelmann found significant associations between the long-term course of chronic insomnia and the development of anxiety disorders and depression.
Compared to the group of participants without chronic insomnia in both surveys, the group with chronic insomnia had increased associations with anxiety disorders and depression. Those subjects who reported that they had insomnia during the initial survey had a higher risk of developing an anxiety disorder during the second phase of the study conducted 10 years later.
The findings were upheld even when factors such as the patients age, gender, and educational level were taken into consideration.
How Are Depression And Sleep Related
Depression and sleep are closely connected. Almost all people with depression experience sleep issues. In fact, doctors may hesitate to diagnose depression in the absence of complaints about sleep.
Depression and sleep issues have a bidirectional relationship. This means that poor sleep can contribute to the development of depression and that having depression makes a person more likely to develop sleep issues. This complex relationship can make it challenging to know which came first, sleep issues or depression.
Sleep issues associated with depression include , hypersomnia, and obstructive sleep apnea. Insomnia is the most common and is estimated to occur in about 75% of adult patients with depression. It is believed that about 20% of people with depression have obstructive sleep apnea and about 15% have hypersomnia. Many people with depression may go back and forth between insomnia and hypersomnia during a single period of depression.
Sleep issues may contribute to the development of depression through changes in the function of the neurotransmitter serotonin. Sleep disruptions can affect the bodys stress system, disrupting circadian rhythms and increasing vulnerability for depression.
Fortunately, people who are treated for major depression often report improved quality of their sleep.
What Is The Treatment For Depression
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Talk therapy or psychotherapy .
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Lifestyle changes .
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Complementary therapies .
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One or more prescription medicines.
It is not uncommon to use more than one type of treatment. For example, a person may establish a regular exercise routine, start seeing a therapist, and begin taking antidepressant medicine.
Changes In Appetite And Weight
We all tend to overeat or feel loss of appetite from time to time. However, if it’s coupled with other symptoms, such as feeling depressed or losing interest and pleasure in usual or favorite activities for two weeks or more, it could be a sign of a depressive episode, according to Simon Rego, PsyD, director of psychology training at Montefiore Medical Center in the Bronx, N.Y. A weight gain of at least 5 percent of a person’s total body weight in a short period of time that causes significant distress may be considered part of depression, Dr. Rego says.
Which Types Of Antidepressants Can Help With Sleep
Your doctor may prescribe one of the following antidepressants that can also help you sleep:
- An SSRI such as , ,  ,  , and  can be effective for treating depression but may take several weeks or longer to become effective. At the beginning, they may also cause or worsen insomnia, for which your doctor may prescribe a separate sleeping medication on a short-term basis. Other antidepressant medicines that affect serotonin through multiple serotonin receptors include  and  .
- SNRIs such as  , desvenlafaxine succinate ,  ,  , or Â
- Sedating antidepressants such as  . The antidepressant  is not widely used to treat depression but because it can cause drowsiness it is often paired as a sleep aid.
Insomnia As A Transdiagnostic Symptom/ Syndrome For Psychopathology
A further boost for the field came from DSM-5 with the establishment of the category of insomnia disorder, thus ascribing independent value to this symptom complex instead of considering it mainly a symptom of any kind of mental disorder. Still, in DSM-5, separation of condition by categories is current practise but clinical research inspired by RDoC is supporting a dimensional approach using constructs and domains to understand pathophysiology. RDoC has suggested a major domain named arousal and regulatory systems with the constructs arousal, circadian rhythms and sleep-wakefulness with a detailed listing of areas of interest for research from the level of molecules to circuits, behavior and paradigms. Two recently published meta-analysis on PSG derived sleep variables in insomnia and all different types of mental disorders support this concept and stress a transdiagnostic approach of sleep continuity disturbances/ insomnia towards mental illness. Instead of adhering to an approach, which sought to identify disease-relevant mechanisms through identifying biological markers for specific mental disorders, we postulate that sleep and circadian rhythm disturbances occur independently of and predict/coincide with affective disorders, clinical psychopathological syndromes do not necessarily reflect homogenous pathophysiological origin, neuropsychiatric syndromes like depression and sleep/circadian disturbances are linked through common mechanistic origins .
The Health Risks Associated With Depression And Sleep Disturbances
Depression and sleep disturbances can take a toll on your physical health if left untreated. One 2010 study found that lack of sleep was associated with a higher risk of early death. Lack of sleep increases the risk of heart disease and failure, heart attacks, high blood pressure, stroke, diabetes, and obesity.
Depression can constrict blood vessels, which may increase your risk of heart disease. People with depression may experience a weakened immune system, aches and pains, and fatigue.
Get Up Around The Same Time Each Morning
This helps your circadian rhythm establish wakefulness in the morning and sleep drive at night.
O’Neill says that if it’s hard for someone with depression to get up in the morning, they may consider scheduling commitments early in the day that encourage them to get up and out.
Consistent wake-up times also help individuals feel in the morning, combatting the lethargy typically associated with depression.
Health Risks Related To Insomnia And Depression
Sleep disturbances and depression can adversely affect your physical health if you leave them untreated for a long time.
This 2010 study established that lack of adequate sleep was linked to a higher risk of death. Some of the health issues that can come as a result of lack of sleep include:
- Obesity
- Heart attacks
- Heart attack and disease
Depression constricts blood vessels that might, in turn, raise your risk of heart disease/attack. Fatigue, pains, aches and a weak immune system are also characteristics of those with depression.
Distress And Quality Of Life
Disturbed sleep is a very distressing symptom which has huge impact on quality of life in depressed patients. We surveyed the views of patients with depression about their symptoms and associated sleep difficulties. In this study, 2800 members of Depression Alliance, a UK-based charity for people with depression, were sent a postal questionnaire. Respondents were asked if, when they are depressed, they suffer from sleep difficulties .
: Difficulty Experiencing Joy Or Connection
When were depressed, it can take all of the enjoyment out of the things we love and make it more difficult for us to connect to those closest to us. We may begin to lose interest in hobbies, friendships, schoolwork, social activities, sex or life in general. When this happens, we may find ourselves isolating from friends, family members or others who care about us.
Can Depression Cause Insomnia Understanding The Connection Between Depression And Sleep
April Sutphen
August 23, 2021
Depression is the most common mental disorder in the world, affecting over 264 million people. Characterized by sadness, hopelessness, social isolation, and mood swings, depression can impact numerous aspects of your life including your sleep.
Theres a close connection between depression and sleep patterns. For example, individuals suffering from insomnia are at a higher risk of developing depression and 75% of depression sufferers report having trouble falling or staying asleep.
To avoid this vicious cycle its important to understand the close relationship between these two conditions to help ease symptoms and live a healthy, fulfilling life.
The Importance Of Managing Insomnia For Successful Depression Treatment
The complex relationship between depression and insomnia creates treatment challenges. However, treatment of the depression will depend in great part on the successful management of the symptomatic insomnia. If the ongoing insomnia is not addressed, treatment will be undermined, and depression relapse would be likely. Living with the effects of insomnia is distressing, with daily life being negatively impacted and potentially triggering the depression again.
Adequately managing the insomnia necessitates a comprehensive view of the problem. Many times, individuals with insomnia will develop poor sleep habits that only exacerbate the problem. These might include such things as not sticking to a routine sleep schedule, or going to bed while continuing to use a smartphone or laptop that emits blue light as well as keeping the mind in an active or agitated state. Other habits that undermine quality sleep include drinking alcohol, consuming too much caffeine, engaging in exercise later in the evening, or eating a heavy meal late at night.
If you or someone you know experiences mental health issues, it is important to seek help from a qualified professional. Our Resource Specialist can help you find expert mental health resources to recover in your community. Contact us now for more information on this free service to our users.
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Which One Is It
Mild emotional symptoms and difficulty concentrating when you know you are dealing with sleep debt can likely be attributed to sleep deprivation. While sleep debt can be dangerous , it can be remedied with proper sleep hygiene and stress reduction techniques.
Major depressive disorder, on the other hand, can significantly impair functioning and requires further treatment than proper sleep and stress reduction. A depressed mood that lasts two weeks or longer is a red flag to seek help from a licensed mental health practitioner. If you or a loved one experiences suicidal thoughts, dial 911 or go the nearest emergency room for an evaluation.
Treating Depression And Insomnia: A Dual Approach
Because depression and sleep disorders are so closely linked, treatment is often closely related, similar, or is used together to ease overlapping symptoms.
Lets start by discussing common ways to treat depression.
Depression Treatment
As with any mental disorder, medical and mental professionals work together to create a customized treatment plan for your specific needs. Specialists take into account the type of symptoms you have and their severity. Here are some of the most common forms of therapy used to treat depression.
Therapy and Counseling
Several types of counseling are used to help treat depression, with the most popular being cognitive-behavioral therapy and interpersonal therapy . CBT-I is a unique type of behavioral therapy that focuses on treating chronic insomnia.
Brain Stimulation Therapy
Another form of therapy but slightly more intense than CBT is brian stimulation. The most common form is ECT or electroconvulsive therapy. Through VNS and rTMS , magnetic pulses are used to target certain sections of the brain that control feelings of sadness. Not everyone is open to this treatment method. If you are, it must be done under the guidance of a medical professional.
Medication
The most effective depression treatment plans often include a combination of medication and therapy.
Insomnia Treatment
Therapy
Maintain a Healthy Lifestyle and Schedule
Avoid Certain Stimuli
Get Help For Both Depression And Sleep
If you have insomnia and depression, dont assume that medical treatment for one will automatically cure the other. Treatments for depression, such as selective serotonin reuptake inhibitors and other medications, may improve your mood and outlook, but they may not be enough to improve your sleep.
Theres some evidence that lingering sleep problems in people undergoing depression treatment increase the risk of a slide back into depression. The good news: Theres also some early evidence that CBT-I , along with depression treatment, improves sleep in people with depression and may increase the chances of a remission of depression.
Poor Quality Sleep Reduces Resilience
In a recent Johns Hopkins study, healthy women and men whose sleep wasinterrupted throughout the night had a 31 percent reduction in positivemoods the next day. Sleep interruptions interfere with deep, restorativeslow-wave sleep, explains lead researcher Patrick Finan, Ph.D. Ongoing insomnia could increase a persons risk of depression, he says, byweakening their emotional resiliencethe buffer of positive emotions thathelps people deal with stress and challenges of life.
A Closer Look At The Connection Between Depression And Sleep
Depression may cause insomnia and chronic insomnia or poor sleep quality can cause depression. Its this back-and-forth exchange that makes the connection between these two conditions so complex and difficult to treat. Both doctors and patients struggle to determine which issue to address first and which is the root cause of their symptoms.
Most people diagnosed with depression cite sleep problems including the inability to sleep, lack of quality sleep, or excessive sleepiness. Although most people with depression have insomnia, sleep apnea and hypersomnia are also common. The opposite of insomnia, hypersomnia causes excessive sleepiness.
The inability to sleep can trigger depression symptoms due to changes in how the brains neurotransmitter serotonin functions. Recurring sleep disturbances can cause extreme stress, interfering with your bodys natural circadian rhythms and putting you at a higher risk of developing depression.
The Link Between Sleep Disturbances And Depression
Approximately 80% of people with depression experience sleep disturbances. While some have trouble falling asleep, others have difficulty staying asleep. And some find themselves sleeping too much.
Both depression and insomnia involve chemicals in the brain. Changes in neurotransmitters and hormonal imbalances may affect both sleep and mood.
For many years, researchers studied which came first: depression or insomnia. It was clear that the two issues often go hand-in-hand and exacerbate one another.
Studies show that sleep disturbances often occur before depression begins. Experiencing insomnia prior to feeling depressed may increase the severity of depression.
The American Academy of Sleep Medicine now encourages treatment providers to pay close attention to whether insomnia needs to be identified as a separate condition as opposed to viewing it as a symptom of depression only.
Coping With Sleep Disturbances During Depression
editorial processMedical Review Board
Dealing with sleep disturbances when youre feeling depressed can seem like a vicious circle. The more depressed you feel, the harder it is to sleep. And the more exhausted you feel, the harder it is to fight depression.
It can feel like theres no way to break the cycle. And its frustrating to feel tired yet be unable to fall or stay asleep. Here’s what you should know about the relationship between sleep disturbances and depression.
Do You Feel Sleep Deprived
Take our 2-minute Sleep Deprivation and Depression quizzes to see if you simply aren’t getting enough sleep or if you may benefit from further diagnosis and treatment.
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Sleep deprivation weakens the prefrontal cortexs ability to control the amygdala , making it difficult to process and cope with emotions. When the brain is deprived of adequate sleep, it also struggles to concentrate and regulate growth and appetite.
Sleep deprivation can have a profound effect on both the emotional and cognitive functioning of the brain. This results in bad moods, negative thinking, decreased empathy, and poor impulse control.
The good news is that sleep deprivation can be treated, and getting on a regular sleep cycle can alleviate the above symptoms.
Insomnia And Depression Are Two Disorders Says Study
The common belief that insomnia is a secondary symptom of depression when they co-occur is not supported by scientific evidence, and doctors should direct targeted diagnostic and treatment attention to both disorders, according to a narrative review published by the Medical Journal of Australia.
Up to 90% of patients with mood disorders also report difficulties initiating and/or maintaining sleep, and about 20%-50% of patients with insomnia disorder report symptoms of depression, wrote the authors of the review, led by Dr Alexander Sweetman, Adelaide Institute for Sleep Health Research Associate and Flinders University College of Medicine and Public Health colleagues.
The co-occurrence of depression and insomnia is associated with reduced quality of life, greater overall morbidity, and increased health care use, compared with either depression or insomnia alone, they say.
Therefore, it is critical to consider diagnostic and management approaches for patients with co-occurring depression and insomnia to improve patient outcomes and reduce health care costs.
Depression is commonly conceptualised as the primary disorder, and the insomnia as a secondary symptom. This is evidenced by clinicians prioritising the management of depression over insomnia, and an expectation that insomnia symptoms will abate when depression is successfully managed.
Journal About Your Worries
If your worries or repetitive negative thoughts arent going away with relaxation strategies, find a notebook and write down the troubling thoughts. This contains the thoughts that might keep you awake as your brain goes over them again and again.
You might even designate a bit of time before bedtime as your designated worry time, so you can really clear your mind.
Physiological Findings In Depression
As well as the distressing symptoms of sleep disturbance experienced by patients, changes in objective sleep architecture arc well-documented in depression. Compared with normal controls, sleep continuity of depressed subjects is often impaired, with increased wakefulness , and reduced sleep efficiency. Sleep onset latency is significantly increased and total sleep time reduced. Rapid eye movement latency is often shortened, and the duration of the first REM period is increased . The number of eye movements in REM is also increased.
Hypnograms from a normal subject and a depressed patient . The depressed patient has a shortened REM sleep latency, very little slow-wave sleep, particularly in the first sleep cycle, more awakening, and a long period of waking at about 0430.
Another anomaly seen in depressed patients is that the normal pattern of SWA decreasing from the first to the last NREM episode is disrupted, with less of a decrease in SWA occurring from the first to the second episode in depressed patients, . This is sometimes expressed as a lower delta sleep ratio that is the quotient of SWA in the first to the second non-RRM period of sleep.
Evolution of slow-wave activity over the night in a normal subject and a depressed patient . In the normal subject the amount of slow-wave activity is high in the first nonREM period, then diminishes over the night. In the depressed patient, the highest activity is in the second non-REM period.
How Is Depression Diagnosed
Depression can only be diagnosed by a medical professional, so people experiencing symptoms of depression should talk with their doctor, counselor, or psychiatrist. They may ask about the severity of the symptoms and how long theyve persisted. They may also suggest tests that can help them to better understand your situation and monitor changes or improvements over time.
A provider may also refer patients to a specialist in sleep disorders to help determine if there is an underlying sleep disorder, such as sleep apnea or restless leg syndrome, that may be causing depression or contributing to symptoms.
Relationship Between Depression And Insomnia
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Depressive symptoms: Goodpath’s internal data shows that 79% of our sleep assessment respondents also have symptoms of depression and/or anxiety.
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Diagnosis of depression: Trouble sleeping is also a common symptom when someone is diagnosed with clinical depression.
If youre able to sleep better, it may help with depression and other mental disorders. Likewise, treatment for mental disorders, including depression, may lessen or even resolve your sleep problems.
Talk To Your Physician
Difficulty sleeping may stem from an underlying medical condition, such as obstructive sleep apnea. Restless leg syndrome and bruxism can also interfere with sleep. These medical issues may cause sleep problems that worsen or cause depression.
Its important to talk to your physician about any sleep problems or depressive symptoms youre experiencing. Your physician can assess whether you have underlying health issues contributing to your conditions.
Depression-Like Symptoms That Aren’t Depression
Rem Sleep And Depressionearly Hopes
The discovery of phases of REM during sleep in 1953 and the ensuing interest in sleep research led to the establishment of psychiatric sleep research utilizing polysomnography . Kupfer et al. from Pittsburgh were among the first to suggest that changes of REM sleep, i.e., shortened REM sleep latency , increased total REM sleep duration and increased REM density , are typical sleep characteristics of patients with primary vs. secondary depression . Furthermore, polysomnographically measured sleep continuity was disturbed and Slow Wave Sleep reduced. These findings were met with enthusiasm at the time and promoted the idea, later known as biomarkers , to identify functional subtypes within and across diagnostic categories by which treatment could be stratified and response predicted for each patient in order to achieve remission.
Fig. 1
Comparison of the polysomnographic profile of a good sleeper and a patient hospitalized for severe depression according to DSM-IV criteria . Both subjects have been free from intake of any psychotropic drug for at least 14 days. The y-axis lists arousal , wake and sleep stages and eye movements). The x-axis is the time axis. Sleep in depression is characterized by alterations of sleep continuity , a decrement of SWS and a disinhibition of REM sleep: this encompasses shortening of REM latency, prolongation of the first REM period and increase of REM density. Original data from Freiburg sleep lab, hitherto unpublished
What Other Sleep Disorders Are Linked To Depression
Narcolepsy is another sleep disorder that has been linked to depression. Narcolepsy causes disturbances in your sleep-wake cycle. You tend to get very sleepy at times during the day and frequently wake up at night.
People with narcolepsy often also have depression, research shows. And sometimes, narcolepsy is misdiagnosed as depression. Lack of sleep can lead to symptoms, like lack of energy or motivation, that mimic those of depression.Â
Other conditions that interrupt your sleep, including sleep apnea and sleep movement disorders, can also contribute to depression.
Getting Back On Track
If oversleeping is a symptom of depression, its most important to see a healthcare provider for treatment of that depression. And even if someone is being treated for depression, the sleep difficulties can be residual. Sleep can remain a struggle because its developed a life of its own and become very habitual, she says.
Dr. Drerup does have a few suggestions on how you can avoid falling into bad sleep habits that could exacerbate the sleep situation. These techniques can make a huge difference for people when they implement behavioral changes like this because the mood symptoms arent impairing them.
If people can get out of bed and get a more consistent start to their day, it can make their day better, Dr. Drerup says. They feel like they can be more productive and get more accomplished. And it can help improve their mood and allow them to make other changes over time that helps increase more pleasurable activities and engaging with people instead of the oversleeping and avoidance of interactions.
Hands off the snooze button
This may not be a popular idea given how much its a ritual for so many of us. But Dr. Drerup points out that repeatedly hitting the snooze button doesnt really help you. When you hit the snooze button and you doze for those short seven or eight minute increments, youre getting brief, fragmented sleep periods. You may think youre gradually becoming more alert but really youre developing sleep inertia and your body wants to stay asleep.
Difficulty Concentrating Remembering And Making Decisions
Depression can interfere with a persons cognitive abilities. They may have trouble focusing or concentrating on personal or professional matters. They may also struggle to make decisions, including small, everyday choices.
People with depression may also find that they cannot remember things as well as they did previously. They may forget appointments or commitments and might not recall things that they said or did recently.