Evidence Suggesting Sleep Disorders Such As Insomnia Cause Depression
In the Henry Ford Health Sciences Center study, young adults were brought in for an initial interview that included questions on sleep and mental health issues and returned again three years later to follow up.
The research showed that individuals who in the initial interview reported episodes of insomnia but no signs of major depression were four times as likely to develop major depression by their second interview three years later.
A more recent study, also done by the Henry Ford Health Sciences Center, employed a very similar experimental design and presented similar results. The team discovered that those expressing insomnia or insomnia-like sleep issues were again at a significantly greater risk of developing a major depressive disorder than those without sleep issues. This study specifically controlled for stressor events, age, and gender, making it extremely strong evidence for sleep disorders as a cause for depression.
Lets throw some more evidence into the pile. Researchers in a long-term study on twins discovered that while sleep problems at age eight were a statistically significant predictor of depression by age ten, the opposite relationship was not true.
Can Sleep Disorders Cause Mental Illness
Can Sleep Disorders Cause Mental Illness?
Which causes the other, a sleep disorder or a mental illness?
Both sleep disorders and mental illnesses are well-understood phenomena with mechanisms that have been thoroughly mapped and set into law years ago. There is very little stigma to discussing either openly. Right?
Kidding. Theres obviously lots to talk about here. But first
A bit of background on sleep and mental illnessWhile historically our theory on the interplay between mental illness and sleep disorders was simply that mental illness can cause sleep disorders. Recent research has made the link between the two stronger and more complicated.
As opposed to mental illness being the cause of sleep disorders, new evidence suggests that sleep disorders can cause and/or exacerbate mental illness. The relationship between the two groups of ailments varies based on the specific disorders involved and can change on a case-by-case basis.
One mental illness may develop in part due to a specific sleep disorder, but it can also be a symptom of the same mental illness creating a positive feedback loop. Some mental issues may show no causal relationships with sleep at all. And some sleep disorders have no relationship with mental disorders whatsoever.
Just now were beginning to understand the complex synergy between mental and sleep health, and were still only on the cusp of reaching a basic understanding of these interactions.
Lets focus on this in particular.
Major Depressive Disorder With Seasonal Pattern
Commonly called seasonal affective disorder or seasonal depression, this condition involves symptoms of depression that flare up during certain times of the year. Seasonal depression usually occurs in the winter due to less sunlight, but it also impacts some people during the lighter months instead.
Because seasonal depression impacts the circadian rhythm during certain times of year when theres more or less sunlight, it can cause changes in sleep.
If you live with seasonal depression, you might sleep more in the winter or have trouble sleeping in the summer due to changes in the amount of sunlight youre exposed to.
Living with depression can alter or negatively impact your sleep patterns, but there are ways to combat this.
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The Relationship Between Sleep And Mental Health
Its no secret that sleep plays an important role in good physical and mental health. Sleep deprivation can leave you feeling irritable and exhausted in the short-term, but it can also have serious long-term health consequences as well. Lack of sleep is linked to a number of unfavorable health consequences including heart disease, type 2 diabetes, and depression.
Some psychiatric conditions can cause sleep problems, and sleep disturbances can also exacerbate the symptoms of many mental conditions including depression, anxiety, and bipolar disorder.
Research suggests that the relationship between sleep and mental health is complex. While sleep has long been known to be a consequence of many psychiatric conditions, more recent views suggest that sleep can also play a causal role in both the development and maintenance of different mental health problems.
In other words, sleep problems can lead to changes in mental health, but mental health conditions can also worsen problems with sleep. Lack of sleep may trigger the onset of certain psychological conditions, although researchers are not completely certain of the underlying reasons for this. Because of this circular relationship between your sleep patterns and your mental state, it is important to talk to your doctor if you are having problems falling or staying asleep.
How Major Depressive Disorder Might Affect Your Sleep
Sleep problems may be one of the first symptoms of major depressive disorder — a serious, but treatable mental health problem, more commonly known as depression.
Not only a symptom of depression, some sleep problems, like insomnia, may also help cause depression. Up to 20% of people who have trouble falling or staying asleep — that’s insomnia — eventually develop depression. In one major study, people with insomnia were five times more likely to get depression than others.
This link between insomnia and depression can lead to a painful cycle in which depression leads to sleep problems, which in turn worsen your depression.
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Mistimed Rem Sleep Is Linked To Depression
A more helpful way to understand the sleep disturbances that people with depression experience is to think of their sleep cycle as being somewhat âshiftedâ.
As a result of this âshiftâ REM sleep appears to be experienced earlier in the night and consequently, the sleeper gets less restorative slow-wave sleep during their time in bed.
The disruption to the timing of REM sleep appears to lead to mood disturbances like depression because it reduces their opportunity to get that restorative slow-wave sleep.
Now that weâve explained a little about how sleep and depression are linked, letâs consider what options there are for someone living with depression to improve their sleep.
How Do We Determine That Sleep Disorders Can Cause Or Exacerbate Mental Illness
There are a few ways to try and figure this out.
One approach is to identify people presenting sleep disorders with no evidence of mental health issues as determined by testing and follow them over time. While a robust approach, it does leave to question whether the same genetic, lifestyle or psychological factors that could cause sleep issues may also play a role in depression that tends to manifest itself at a later date than the sleep disorder .
This study from the Henry Ford Health Sciences Center makes use of this type of experimental design and serves as much of the basis for what we know about sleep disorders potentially leading to mental health issues.
Additionally, to see if sleep disorders can worsen mental illnesses, we need to see if treating a sleep disorder helps to improve the psychiatric issue. This may hint that sleep disorders can be a cause of mental illness. However, due to the structure, we can only say with certainty that the presence or severity of sleep disorders can affect the severity of mental health issues.
A study from Oxford has provided some of the most compelling research on the intersection between mental health and sleep using a form of the above methodology.
These studies are difficult to get right, and there are some things we should keep in mind when discussing them.
Inherent difficulties in establishing causal relationships between sleep disorders and mental health
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Sleep Disturbances In Major Depressive Disorder
A large and occasionally contradictory body of literature describes sleep findings associated with major depressive disorder. The most common subjective sleep complaints elicited from patients with major depressive disorder are insomnia and hypersomnia .15 Insomnia, in particular terminal insomnia, is classically associated with major depressive disorder. The relationship between insomnia and mood symptoms is bidirectional in that poor sleep can precede an episode of major depressive disorder, and depressed mood can disrupt normal sleep patterns.7 Furthermore, it is 3 times more likely that major depressive disorder will develop in individuals with insomnia than those without.16 In addition, hypersomnia, fatigue, and sleepiness are closely correlated with depressive symptomology.15 Complaints of nonrestorative sleep and excessive daytime sleepiness can be elicited from many subjects however, these findings are not universal.7 In addition, many patients with major depressive disorder have poor insight into their sleep quality, often misestimating their sleep latency, sleep time, and sleep duration.17
Background On Sleep And Mental Illness
While historically our theory on the interplay between mental illness and sleep disorders was simply that mental illness can cause sleep disorders, recent research has made the link between the two stronger and more complicated.
As opposed to mental illness being the cause of sleep disorders, new evidence suggests that sleep disorders can cause and/or exacerbate mental illness. The relationship between the two groups of ailments varies based on the specific disorders involved and can change on a case-by-case basis.
One mental illness may develop in part due to a specific sleep disorder, but it can also be a symptom of the same mental illness creating a positive feedback loop. Some mental issues may show no causal relationships with sleep at all. And some sleep disorders have no relationship with mental disorders whatsoever.
Mental illness and sleep disorders are still fairly misunderstood compared to other pathologies, in no small part because of their origin in the wild, unexplored frontier of the human brain. Only about fifty years ago did we end the barbaric and widespread use of lobotomies and electroshock therapy used to cure a whole host of mental disorders in the mid 20th century including depression, anxiety, or even the perceived sickness of homosexuality.
Just now were beginning to understand the complex synergy between mental and sleep health, and were still only on the cusp of reaching a basic understanding of these interactions.
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Sleep Deprivation And Major Depressive Disorder
Several studies found positive effects of sleep deprivation on depression symptoms. Multiple studies have shown that a single night of total sleep deprivation produces positive results in up to 50% of subjects.31 This response rate is comparable to what can be achieved with antidepressant medications. Furthermore, TSD responders show benefits comparable with those observed with pharmacotherapy.31 Patients with melancholic depression, characterized by terminal insomnia and diurnal variation of symptoms, are more likely to respond to TSD than patients with atypical or seasonal depression.7 Imaging studies suggest that TSD responders have increased metabolism in the amygdala, orbital prefrontal gyrus, and inferior temporal and anterior cingulate cortices, which normalizes after sleep deprivation.31 Intriguingly, the degree of hypermetabolism in these regions is correlated to the response to TSD. However, response to TSD is unpredictable in that prior positive responses do not predict future responses.32 Furthermore, even in patients for whom it is effective, TSD is not a practical therapeutic intervention because the benefits dissipate after recovery sleep.32 This has led researchers to study more sustainable ways of scheduling sleep to improve depression.
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 citalopram , escitalopram , fluoxetine , paroxetine , and sertraline 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 vilazodone and vortioxetine .
- SNRIs such as desvenlafaxine , desvenlafaxine succinate , duloxetine , levomilnacipran , or venlafaxine
- Sedating antidepressants such as mirtazapine . The antidepressant trazodone is not widely used to treat depression but because it can cause drowsiness it is often paired as a sleep aid.
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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.
Other conditions that interrupt your sleep, including sleep apnea and sleep movement disorders, can also contribute to depression.
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.
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Coping With Sleep Disturbances During Depression
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.
The Rem Theory Of Sleep And Why Its Not Quite Right
Sleep consists of a number of stages, one of which is termed REM sleep. The REM stage of sleep is linked to dreaming and during this stage our brain activity levels are similar to what they are when weâre awake.
There are also non-REM sleep stages, with the the most important of these being NREM slow-wave sleep. Thatâs the type of sleep we need to feel refreshed in the morning.
During sleep, we alternate between REM and NREM stages and itâs been found that people living with depression spend a greater amount of their sleep time in the REM stages.567
This has led to the suggestion that increased REM sleep leads to depression. This is something you may have read online or in earlier scientific literature relating to sleep science and depression but it isnât strictly true.
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What Is Major Depressive Disorder
Depression, which doctors may call major depressive disorder, is a treatable mental illness. You feel sad more often than usual, and you may lose interest in activities you once enjoyed. It can lead to problems in your work and home life as well as other emotional and even physical problems. Other symptoms may include:
- Pacing, handwringing, and other restless activities
- Slowed speech and movements that others notice
- Trouble focusing on tasks or making decisions
- Low energy and tiredness
- Weight loss or gain unrelated to dieting
- Feelings of guilt or worthlessness
- Thoughts of death or suicide
If you notice symptoms that last more than 2 weeks, it may be time to talk to your health care provider.
Mechanisms Of Sleep Regulation And Disturbances In Depression
Research over the past 25 years has revealed that the sleep-wake cycle is regulated by two separate but interacting processes, the circadian process and the homeostatic , or recovery process.
The C process is that which regulates the daily rhythms of the body and brain. Circadian patterns of activity arc found in many organs and cells, and the main circadian pacemaker is found in a group of cells in the suprachiasmatic nucleus of the hypothalamus. These cells provide an oscillatory pattern of activity which drives rhythms such as sleep-wake activity, hormone release, liver function, etc. This drive from the SCN is innate, self-sustaining, and independent of tiredness or amount of sleep. It is affected markedly by light and to some extent by temperature. Bright light in the evening will delay the clock, and bright light in the morning is necessary to synchronize the clock to a 24-hour rhythm in constant light or darkness the cycle length is about 24.3 h. All animals have such a clock, and the period and timing appear to be dependent on particular genes, which are similar in fruit flies and mammals.
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Does Depression Affect Sleep
According to the NSF, because symptoms of sleep disorders and depression overlap, misdiagnosis is possible.
Many sleep disorders may contribute to a person experiencing depression. However, depression can result in a person feeling excessively tired. This condition is known as excessive daytime sleepiness .
According to a study in females that was a 10-year follow-up from baseline research, depression is an important factor in causing EDS.
EDS may have adverse effects on peoples cognitive and behavioral functions. These knock-on effects can interfere with a persons quality of life.
Poor sleep can affect a persons ability to think clearly and cause an individual to have greater difficulty controlling their emotions. All these things can contribute to depression.
Is Oversleeping A Symptom Of Depression
While there are many potential symptoms of depression, oversleeping can be one of them. If you’re noticing that you’re sleeping significantly more than normal, or if you find it difficult to get out of bed in the morning, it might be time to talk to your doctor about whether or not depression could be the cause. There’s no definitive answer as to why people with depression might oversleep it could be because they’re trying to avoid the world, because their brains are telling them they need more sleep than usual, or simply because they’re depressed and have lost interest in activities that used to keep them busy. Whatever the reason, if you’re frequently oversleeping and you think it might be related to your mental health, please don’t hesitate to seek help. Depression is a very common condition, and there are many effective treatments available.
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