The Connection Between Sleep and Depression

The connection between depression and sleep

Sleep difficulties and depression symptoms are closely tied. They have a bidirectional relationship, which means one can impact the other. Depression can have a negative effect on sleep quality, and poor sleep quality can increase your risk of depression.

If you frequently experience insomnia, your lack of sleep can make it harder for you to cope with stress and manage your emotions. If you struggle with depression, the feelings of hopelessness and sadness can keep you from enjoying restful sleep. Together, sleep problems and depression can trap you in a downward cycle that can weigh you down and seem hard to escape.

Plenty of scientific research has highlighted the connection between these issues. For example, studies have found that sleep problems are often an early warning sign of major depression.

It’s also possible that, in many cases, depression and sleep problems stem from the same source. Traumatic life events, such as the death of a loved one or sudden job loss, might keep you awake at night while also triggering depression symptoms. Certain personality traits, such as perfectionism, may put you at risk for both insomnia and depression as well.

If you’re struggling with sleep issues and depression, know that there is hope and multiple paths forward. Addressing your sleep problems can help ease your depressive symptoms, and managing your depression can help you achieve better sleep. It all starts with understanding how sleep and mental health overlap.

Common sleep issues associated with depression

Some of the following sleep disorders or problems may cause or contribute to depression. It’s also possible that some of them have the same underlying neurological or genetic causes as depression and other mood disorders.

Insomnia

Insomnia is an inability to fall asleep or stay asleep. Some studies show that somewhere between 80 to 90 percent of people with depression also deal with co-occurring insomnia. Experiencing insomnia also raises your risk of developing depression.

Hypersomnia

Hypersomnia is characterized by excessive sleepiness. With this condition, you have a hard time staying alert during the day, even if you’re getting plenty of sleep at night. You might even sleep for longer than you would normally. People with this disorder often report having depressive symptoms, and people with depression commonly struggle with excessive daytime sleepiness.

Circadian rhythm disorders

Circadian rhythm disorders (or sleep-wake cycle disorders) are characterized by problems with your internal clock, which lead to disrupted sleep patterns. Some of these disorders have links to depression. For example, roughly half of people with delayed sleep phase syndrome (DSPS)— a condition that disrupts your ability to fall asleep on time—report having either moderate or severe depressive symptoms.

Sleep apnea

Sleep apnea is a sleep disorder that involves pauses in breathing or shallow breathing. People with sleep apnea are also more likely to experience depression. However, the conditions have some similar symptoms—such as fatigue and poor concentration—which can lead to a misdiagnosis. The more severe your sleep apnea, the more likely you are to experience depression symptoms as well.

Restless leg syndrome (RLS)

Restless legs syndrome (RLS) is a neurological disorder that involves a strong urge to move your legs due to uncomfortable sensations, such as tingling or aching in your limbs. Unsurprisingly, this can affect your sleep quality as well as mood. Research indicates that somewhere around 30 percent of people with RLS may also experience depression.

The brain’s role in sleep and depression

Your sleep cycle and emotional states are influenced by your brain’s various functions and chemicals. Here are some of the many ways in which brain activity influences sleep and depression.

Serotonin and melatonin imbalances

Serotonin and melatonin are two neurotransmitters that affect both your sleep cycle and your mood.

Melatonin is sometimes called the “sleep hormone” because it helps regulate your sleep-wake cycle. Melatonin supplements are often touted as a sleep aid, although your body naturally produces it when you’re exposed to darkness.

Serotonin is involved in promoting feelings of relaxation and well-being. Your body also uses serotonin to create melatonin.

When levels of either of these hormones are low or out of balance, you might experience depressed mood as well as worse sleep quality.

Cortisol levels and sleep disruption

Cortisol is a hormone that’s usually associated with increased stress levels and the activation of your body’s stress response. Cortisol is the product of the hypothalamic-pituitary-adrenal (HPA) axis, a system that manages your body’s stress response.

When the HPA axis is overactive (perhaps due to chronic stress), your body releases excessive cortisol, and you’re more likely to experience sleep disruptions.

This can create a vicious cycle. When you don’t get enough sleep at night, your body will release more of the stress hormone the next day. Then, you return to bed the following night with high stress and once again struggle to sleep.

REM sleep in emotion regulation

During rapid-eye movement (REM) sleep—the stage of sleep during which dreaming occurs—your brain is engaged in emotional processing. One theory suggests that dreams provide your mind with the opportunity to safely experience and process emotions. For example, if you’re anxious about an upcoming work deadline, you might have an emotionally intense dream about it. Then, you show up to work the next day better prepared to handle the actual situation.

When REM sleep is unstable or fragmented, you might have more difficulty regulating your emotions.

On the other hand, research also shows that increased REM sleep duration is linked to a higher risk of depression. In fact, some antidepressant medications suppress REM sleep. This is known as REM deprivation, and the consequences and usefulness of it are still being investigated by researchers.

Tips for treating sleep issues to alleviate depression

When you’re dealing with both a sleep disorder and depression, tackling the specific sleep issue may help to manage your depression symptoms and improve your mood. For instance, you might turn to continuous positive airflow pressure (CPAP) therapy to address sleep apnea, which may then both improve your sleep and ease your depressive symptoms.

However, there are also some general strategies you can adopt on your own to improve both sleep and mood. These strategies involve making lifestyle adjustments, such as changing your pre-bedtime habits, exercising, eating well, and managing stress.

Tip 1: Improve sleep hygiene

Sleep hygiene encompasses all the little actions you take to improve the odds of a good night’s sleep. These steps may not guarantee that you fall asleep fast every night, but they may make it easier to achieve quality sleep.

Seek silence. When it’s time for bed, turn off your television and other sources of noise. Some sources, such as neighbors and traffic, will be completely out of your control. Consider using earplugs or a sound machine to block out those noises.

Keep your room dark. Everything from lamps to light coming in through your window blinds can reduce the quality of your sleep. Try out items like blackout curtains or an eye mask if darkening your bedroom is a challenge.

Reassess your mattress and bedding. Finding the right mattress for you can put a stop to tossing and turning at night. The same is true for your pillows. You should also reconsider whether your sheets and bedding are comfortable and keep you warm or cool enough at night.

Adjust your room temperature. The ideal sleep temperature for most people is somewhere between 60 to 68 degrees Fahrenheit. However, the number can vary, sometimes stretching well into the 70s.

Journal before bed. Set aside a few minutes in the evening to jot down your thoughts or a to-do list for tomorrow. Journaling can help you empty your mind and avoid ruminating in bed.

Eat dinner more than three hours before bedtime. In addition to watching what you eat, it’s also important to consider when you eat. Several surveys have found that eating a meal too close to bedtime (especially heavy or spicy foods) increased the odds of waking up in the middle of the night.

Tip 2: Set a regular sleep schedule

Maintaining a consistent sleep schedule is a crucial step in sleep hygiene. When you prep for bed at the same time every night, your body begins to recognize the pattern, and then falling asleep becomes easier. The same is true for your wake time.

Set a target bedtime. Consider factors like your work schedule and the times at which you naturally feel tired and when you wake up. Keep in mind that adults typically need seven to nine hours of sleep, and teenagers and children need more than that. Whatever time you decide on, try to stick with it as closely as possible, even on weekends.

Establish a relaxing routine before bedtime. Starting an hour before bed, have some go-to activities to help you wind down and quiet your mind. Some possibilities:

• Put away your phone and other screens.
• Enjoy a hot shower or bath.
• Read a book by a soft light or listen to an audiobook.
• Do a creative writing exercise or journaling practice.
• Enjoy a short yoga session or breathing exercise.

Be strategic about taking naps. Naps can offer an energy boost if you feel fatigued during the day, but you’ll want to be careful about how you time them. Avoid napping too close to your bedtime, and try to limit the nap to less than 20 minutes. Longer naps might result in grogginess.

[Read: How to Sleep Better]

Tip 3: Plan to get active

Research shows that people who exercise regularly often fall asleep faster and benefit from better sleep quality. Exercise can also be effective when managing depressive symptoms. In the short term, physical activity releases endorphins—your body’s natural feel-good chemicals. However, a long-term commitment to exercise can stimulate growth in the part of the brain that regulates your mood.

When you’re feeling physically tired and emotionally drained, though, it can be hard to find motivation to exercise. Here are some tips to get started:

Pick activities that you genuinely enjoy. Exercise doesn’t need to feel like a chore. If you enjoy biking or swimming, include those activities as core pieces of your workout routine.

Start with small goals. You don’t need to run a marathon or head straight to the gym every day after work. Instead, keep things simple and easy. Tell yourself that you’ll go for a brisk, 15-minute walk each morning or do 20 minutes of light yoga at home in the evenings. Gradually set higher goals over time.

Make it as easy as possible. Keep a yoga mat or dumbbell next to your bed so you’re ready to go when you wake up. Lay out some clean jogging clothes each night. The fewer barriers to exercise, the easier it’ll be to slip right into a session.

Have a workout buddy. Exercise may feel less daunting if you have a partner who’ll join you. You can motivate each other to show up, and socializing might even take your mind off the fact that you’re exercising.

Tip 4: Focus on dietary choices

What you eat can affect both your mood and your sleep quality. For example, a high intake of junk food, fast food, and sugary beverages can lead to inflammation, which can then contribute to a depressed mood and anxiety. In addition, eating a lot of foods that are high in saturated fats and refined carbs might lead to poorer sleep quality.

Try the Mediterranean diet. Research shows that the Mediterranean diet might lead to better sleep quality. Some studies also associate the diet with a reduced risk of depression. These potential benefits could be due to the diet’s emphasis on high-fiber foods, nutritious fruits and vegetables, and fish that are rich in omega-3 fatty acids. These are all elements that may come together to improve mood and sleep.

Make smaller dietary adjustments. If you don’t want to fully commit to the Mediterranean diet, simply adopt a few habits from it:

• Incorporate more veggies into your diet. For example, try adding mushrooms and peppers to your pizza or pasta dishes.
• Look for whole-grain alternatives to refined grains, such as substituting white rice with brown rice.
• Swap out high-sugar desserts for alternatives with real fruit.

Consume more foods that are high in tryptophan, such as eggs, oatmeal, nuts, and seeds. The body uses tryptophan to produce serotonin and melatonin—neurotransmitters that are important in regulating your sleep cycles.

Meal prep. Whenever you’re feeling well-rested and energetic, cook and store meals for later in the week. That way, if you experience bad sleep or feel depressed the next day, you’ll have quick and easy access to healthy food.

Avoid using alcohol and caffeine before bed. It’s true that alcohol might make you feel relaxed and drowsy, but it can also lead to more sleep disruptions throughout the night. Dietitians recommend you avoid caffeine for at least six hours before bedtime.

Tip 5: Manage stress

If you’ve ever sat awake in bed, ruminating late into the night, you know that anxiety can contribute to both sleep deprivation and depression. Maybe you can’t seem to quiet your thoughts and get stuck in a loop of catastrophizing and assuming the worst-case scenarios. Try out the following tips to manage your stress.

Familiarize yourself with relaxation techniques. Deep breathing, progressive muscle relaxation, self-massage, and visualization are all relaxation techniques that can help soothe you and melt away tension throughout the day. You can also use them to wind down before bed.

Meditate. People who meditate regularly seem to benefit from improved melatonin and serotonin levels. Guided meditations offer an easy introduction to practices that help calm your mind and improve emotional well-being.

Recognize your limits. Sometimes, poor boundaries can be an overlooked source of stress. Maybe you’re constantly taking on more assignments at work or handling more responsibilities at home. Learning to set boundaries, delegate some of your workload, or say “no” when your plate is full can help you avoid unnecessary stress.

Tip 6: Know when to seek professional help for sleep and depression

Some sleep and mood issues require more than just lifestyle adjustments. A mental health expert might be able to offer treatment options. If you’re not sure if professional treatment is necessary, consider the following questions:

How consistent or severe is the problem? Everyone experiences gloomy days and restless nights from time to time. However, if the issues seem to be enduring, it’s best to talk with a mental health expert. You might consider using a mood tracker or sleep journal to keep an eye on symptoms and identify patterns.

Is it affecting other areas of your life? Poor sleep may make it hard to concentrate at work, or maybe you find yourself lashing out at others because you generally feel irritable. Depression may sap your interest in hobbies or lead you to withdraw from friends and family members.

Do you feel stuck? Maybe you’ve tried plenty of self-help strategies and still feel frustrated or trapped. Acknowledge that everyone needs help sometimes and seeking professional treatment is a wise step. You don’t have to be alone in your journey.

Psychotherapy treatment options

Certain psychotherapy treatments can help you manage co-occurring sleep and mood disorders.

Cognitive behavioral therapy (CBT) is a common approach for managing sleep issues as well as depression. This type of therapy teaches you to recognize negative thought patterns and unhelpful behaviors, and then turn them into something healthier. It also equips you with other practical strategies to achieve better sleep and improved mood.

CBT is a flexible approach, so it can be adapted to meet your needs. For example, an expert might recommend you try cognitive behavioral therapy for insomnia (CBT-I), a type of sleep therapy that may involve:

• Completing and reviewing a sleep diary.
• Identifying specific barriers to sleep and coming up with strategies to overcome them.
• Adjusting your strategies to prevent relapse.

There’s evidence that CBT-I is as effective or even more effective than medication for treating long-term insomnia.

Medication

Aside from therapy, medication can also play a role. Some people rely on a combination of antidepressants and sleep aids to manage co-occurring problems.

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed to treat mental health conditions, including depression.

Sleeping pills and sleep aids are medications that help you achieve restful sleep. They can be over-the-counter, such as Nytol (diphenhydramine) and Unisom (doxylamine), or prescription, such as ProSom (estazolam) and Ambien (zolpidem).

Certain drugs, like trazodone, are used to treat depression as well as sleep conditions like insomnia.

It’s important to talk to your physician to understand how medications may interact when used together. For example, even mixing an over-the-counter sleep aid like melatonin with certain SSRIs may cause side effects because they both affect related neurotransmitters in the brain.

The importance of addressing both depression and sleep

Sleep and depression are closely interconnected, influencing each other in ways that can disrupt your well-being. When you’re depressed, your body’s sleep patterns become disrupted. And when your sleep patterns are disrupted, it’s harder to regulate your emotions.

Although this cycle can feel difficult to escape, it is possible. By understanding how depression affects sleep and vice versa, you’re already on your way to regaining a sense of balance and control.

Last updated or reviewed on November 25, 2024