Depression and sleep

Jennifer is a young healthy woman who used to enjoy her work, hanging out with her friends and loved horse- back riding. Over the past 2 years, she began to withdraw from her friends and her work became a unfulfilling. She also stopped horse-back riding. She started to have trouble sleeping and felt tired during the day. A psychiatrist diagnosed her with depression. He treated her depression with medications and he also addressed the insomnia so she can sleep and feel better; luckily for her, her psychiatrist recognized that focusing on her sleep issues is part of treating her depression. She also started counseling (talk therapy and learning ways to cope with stress) and overall she began to feel much better about her life.

Depression symptoms overlap with many symptoms sleep disorders such as insomnia, restless legs and sleep apnea. Depression can cause either insomnia or hypersomnia (sleeping too much). Unfortunately, it is often the case that sleep problems are diagnosed late or not at all in depressed individuals. Treating the sleep problems might be sufficient to improve or even abolish the symptoms of depression. Not getting enough sleep leads to sleep deprivation which then causes people to have daytime tensions, fatigue and mood problems- not much different from symptoms of depression. Next time you go to bed at 2 am and wake up at 6 am, think about how un-wonderful you feel the next day.

Insomnia is a major sign of depression. In fact, people with insomnia have a 10-fold risk of developing depression and anxiety than those who sleep well; also women are more affected than men (reference: Sleep 2005 November issue). When doctors treated the insomnia in patients who were depressed, the depression improved (reference: Journal of Clinical Sleep Medicine 2010 August). Therefore, an individual who is both depressed and has insomnia needs to have both (depression and insomnia) disorders treated. One should not assume that treating the depression alone is enough.

Sleep apnea can cause symptoms similar to clinical depression ! What is most important is that depressive symptoms can response fairly well when sleep apnea is treated.

Both groups share these common symptoms:

  • Low motivation
  • Fatigue, low energy
  • Lack of interest in things that were fun
  • Poor concentration and memory
  • Decreased libido

An interesting study from Florida found that for individuals with sleep apnea, treating them with CPAP significantly decreased their depression one month later and the benefit persisted when they were evaluated one year later. This study was published in the 2007 October issue of Journal of Clinical Sleep Medicine.

Restless legs syndrome (RLS) is a condition that causes discomfort in the legs (or arms) during rest and relieved with movements. Restless Legs Syndrome Foundation reports that 40% of people with RLS have symptoms that meet the criteria for depression.

Depression affects all types of people from all over the world, but women and older adults are more likely to develop depression. In the elderly, the higher rates of depression and sleep problems could be due to physical illness and medications. Among women, motherhood and hormonal changes (menstruation, menopause) may contribute to higher rates of depression. Among women and older adults, the higher rates of depression may also be explained by their higher rates of insomnia.

Tips on improving your depression through better sleep

  • Maintain a regular bed and wake hours. Try to get 8 hours of sleep. Avoid napping. Try to consolidate your sleep for the night.
  • Get sunshine after you wake up and throughout the day. Open your curtains in the house or office. Go for a walk outside. Go on long hikes on weekend. Some individuals with depression have SAD (seasonal affective disorder) and may benefit from bright light. Besides the preferred natural sunlight, treatment though the light box is possible. Discuss this with your psychiatrists before you use the light box.
  • Exercise daily. Avoid it too close to bedtime. Exercise improves your mood, keeps your food craving down and regulates your weight. Exercise has a direct benefit on your sleep quality; in fact getting gentle exercise in the evening (walking, yoga, stretching) might help you relax if you tend to get anxious or stressed at bedtime.
  • Limit your intake of caffeine. Avoid alcohol. Stop smoking (nicotine is a stimulant; it can also cause cancer, heart attacks and strokes)
  • Take a warm shower or bath in the evening to help your muscles relieve the tension.
  • Use earplugs or white noise and eyeshades at night if noise and lights are bothersome.
  • Turn electronics off 1 hour before bedtime and try to listen to ambient music and perhaps read something pleasant.
  • Make a habit of writing down activities you need to accomplish or worries for the next day.
  • Cognitive behavioral therapy (CBT) is an effective approach to the treatment of depression. It has no side effects. This is a restructuring technique that targets the negative or depressive thoughts and changes them into positive ones.
  • Meditation can reduce stress and improve depression
  • Support groups is important. Don’t stay isolated. Talk to people and seek support from family or through a local support group.
  • If you suspect sleep apnea, talk to your doctor to get a sleep study. Snoring, pauses in breathing at night, restless sleep, morning headaches and unrefreshed sleep are signs of sleep apnea. Treatment can make a difference in your mood. Unfortunately, many psychiatrists, psychologists and primary care physicians are unaware of the relationship and potential benefit from diagnosing and treating sleep apnea in a depressed individual. But you can bring up this issue with your doctor and they will be open to exploring it.
  • If you suspect restless legs, talk to your doctor. You might need medications. Avoid caffeine and alcohol since they make restless legs worse.
  • If you suffer from insomnia, you might need to talk to a sleep specialist to weed out the causes. Of course depression is a big cause, but treatment of insomnia needs to be addressed in a separate but complementary fashion to the treatment of depression.
  • Have your thyroid checked. For men, check your testosterone. Talk to your doctor about them.
  • In combination to antidepressants, you can use the above tips to help you overcome depression and insomnia.
  • Depression and anxiety are associated with racing thoughts, rumination and negative thinking patterns. Meditation, exercise, yoga, family and friend’s support, cognitive-behavioral therapy and relaxation techniques, hobbies are all helpful in reducing worries and perhaps having a more optimistic view of life.