Is Insomnia Caused By Depression

Can Depression Cause Insomnia Understanding The Connection Between Depression And Sleep

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.

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Dont Let Depression or Insomnia Rule Your Life

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.

Present Management Of Sleep/ Circadian Disorders In Depression

Subjectively reported sleep disturbances typically manifest in various forms, such as difficulties falling asleep and maintaining sleep, waking up too early and feeling worn, fatigued and sleepy during the day. Although these symptoms are described by DSM-5 as insomnia disorder, they are rarely investigated properly by general practitioners or mental health professionalsunfortunately at present it is far more probable that both insomnia and symptoms of circadian dysfunction are still more or less viewed as symptoms of an underlying mental disorder, which will, at best, remit when the primary disorder is properly treated or, at worst, treated with the wrong drugs. A main reason for this is that there is a serious lack in the knowledge about basic sleep and chronomedicine across fields in the medical professions, maybe because these disturbances are transdiagnostic. Insofar, there still is a strong need for further education of health professionals, in particular in psychiatry , in the domain of sleep and chronomedicine to enable them to recognize, properly diagnose and treat individuals with sleep problems . Specific evidence-based treatment strategies incorporating chronomedicine for these disorders are available and might offer not only to improve the underlying sleep/circadian disorder but concomitantly ameliorate the outcome and course of mental disorders compared to standard psychiatric treatment.

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Insomnia As A Predictor Of Depression And Suicidality

The renowned interest into the relationships between sleep and circadian rhythms and depression is mainly due to studies that have shown that insomnia/insomniac symptoms are independent predictors for depressive disorders and suicidal ideation/ suicide and suicide attempts . These epidemiologically based data have led to great interest in sleep continuity changes in the context of depression and other mental disorders. Thus, the quest for specific biological markers was given up in lieu of focussing on transdiagnostic overarching markers/mechanisms, which can be elucidated by subjective self-report, rendering research and clinical applicability easier and economic.

Link Between Depression And Insomnia

There is a strong link between sleep problems and depression, and its common for a person who reports experiencing a frequent low mood to also report getting inadequate sleep. As many as three-fourths of depressed people have insomnia. If you are depressed, you may have difficulty falling asleep, wake up frequently during the night and have trouble going back to sleep once youre awake. The next day you wake up feeling unrested, sluggish and probably more depressed. Untreated depression can cause physical symptoms such as headaches and backaches, and physical pain can affect the quality of your sleep.

The inability to sleep can have a huge impact on your quality of life. For many people with major depression, sleep disturbances are the first symptom that led them to seek professional help. When you are sleep deprived, its pretty hard to regulate your emotions. Your energy level is low, and it can be difficult to feel motivated to participate in activities that used to bring you pleasure. Continual difficulty sleeping can be so hard to live with that it can trigger suicidal tendencies.

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Impact Of Insomnia Symptoms On The Clinical Presentation Of Depressive Symptoms: A Cross

• 1Department of Neurology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
• 2Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea
• 3Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
• 4Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
• 5Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

Objective: Insomnia and depression are prevalent disorders that often co-occur. This study aimed to investigate the impact of clinically significant insomnia symptoms on the prevalence and clinical presentation of clinically significant depressive symptoms and vice versa.

Methods: This study used data from the Korean Headache-Sleep Study , a nationwide cross-sectional population-based survey regarding headache and sleep. Clinically significant insomnia symptoms were defined as Insomnia Severity Index scores 10 and clinically significant depressive symptoms were defined as Patient Health Questionnaire-9 scores 10, respectively. We referred clinically significant insomnia symptoms and clinically significant depressive symptoms as insomnia symptoms and depressive symptoms, respectively.

The Link Between Melatonin And Depression

Much of an individuals sleep cycle is regulated by the hormone melatonin, found in the pineal gland of the brain. During normal waking hours, melatonin levels are low. However, as it gets dark, optic nerves in the eyes send information to the pineal gland to begin producing melatonin and to promote sleepiness. Those who do not produce sufficient melatonin struggle to sleep at night and some may develop insomnia.

Sleep should occupy about a third of our day, or about seven hours per night according to the Center for Disease Control. Sleeping less than seven hours on a continual basis may lead to complications with mental and physical health, such as depression, anxiety, and obesity. According to the Sleep Foundation, those who struggle with insomnia are 10 times as likely to have clinical depression, as well as 17 times more likely to have clinical anxiety. As experience with insomnia increases in quantity and severity, the chances increase. Those with acute and chronic insomnia are much more likely to develop depressive symptoms than those who do not experience sleep deprivation.

Acute vs. Chronic Insomnia

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Impact Of Depressive Symptoms On The Prevalence Of Insomnia Symptoms

Among 116 participants with depressive symptoms, 75 were also classified as having insomnia symptoms. In addition, 215 of the 2,579 participants without depressive symptoms were classified as having insomnia symptoms . The prevalence of insomnia symptoms among participants with depressive symptoms was significantly higher than that among participants without depressive symptoms . The age- and sex-adjusted OR for the prevalence of insomnia symptoms with respect to the presence or absence of depressive symptoms was 21.5 .

Figure 3. Prevalence of insomnia symptoms in participants with depressive symptoms and those without depressive symptoms.

Insomnia And Depression Are Closely Related

Together, depression and insomnia create a vicious cycle, as both conditions further worsen symptoms for each other.

While depression can cause trouble sleeping, that lack of sleep can exacerbate irritability, low mood, and decreased energy levels or motivation.

To break this cycle, it’s important to address the root cause of your sleep troubles. If you feel that you have depression, you should talk with a therapist.

This can include a psychiatrist, psychologist, or mental health counselor and there are many online therapy services you can use to schedule a virtual consultation.

The three most common therapies to treat depression include:

• Cognitive behavioral therapy helps patients change negative thought patterns and behaviors that are associated with depression. One study found that 58% of depressed individuals who underwent CBT reduced their depressive symptoms.
• Psychodynamic therapy helps patients resolve psychological harm or conflicts typically rooted in childhood that could contribute to depression. A 2017 study found that psychodynamic therapy can be just as effective as CBT for treating depression.
• Interpersonal therapy focuses on how personal relationships can cause or exacerbate depression. Overall, research has found that there’s not much of a difference between the three therapies for treating depression, and aspects of each approach are all incorporated to mitigate depressive symptoms.

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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 energized in the morning, combatting the lethargy typically associated with 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.

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

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Increased Risk Of Depression In Insomnia

The National Institute of Mental Health Epidemiologic Catchment Area study 20 years ago interviewed 7954 adults on two occasions a year apart, and this study first highlighted the strong association between sleep disturbance and subsequent depression. They found that 14% of those who had insomnia at the first interview had developed new major depression a year later.35 This data has been augmented by several more recent reports of increased risk. Brcslau ct al,5 in a survey of 1200 young adults in Michigan, found that the odds ratio of new depression in was 4 times increased in those subjects who had insomnia 3 years earlier, and in a questionnaire survey of adults over 18 in the UK there was a 3-fold increased risk of new depression if subjects had reported one sleep problem occurring on most nights a year earlier.36 Doctors in a prospective study who had complained of insomnia during medical school in the 1950s and 1960s were twice as likely to have developed depression at follow-up in 1990s.37

It is apparent that sleep problems often appear before other depression symptoms,38 and that subjective sleep quality worsens before onset of an episode in recurrent depression.39

Coronasomnia And Increased Media Consumption

People across the globe have significantly increased their media consumption to keep up with the latest COVID-19 information. They rely on many news sources, leading to higher mental distress levels. The behaviors of checking the news frequently and spending more time consuming the news media have both been associated with higher anxiety levels.

Even worse, elevated media consumption often happens at night, close to bedtime, with the light of the bright screens of tech devices leading to issues with our circadian rhythms, causing phase disorders.

More time on screens means higher blue light exposure, which increases your cortisol levels while suppressing melatonin. It makes you feel more stressed and alert instead of relaxed and ready for sleep.

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How Could Mental Health Problems Affect My Sleep

If you live with a mental health problem, this could affect your sleep in lots of ways. For example:

• Anxiety can cause racing or repetitive thoughts, and worries that keep you awake. You may also have panic attacks while you’re trying to sleep.
• Depression and seasonal affective disorder can make you sleep more, including staying in bed for longer or sleeping more often. Depression can also cause insomnia.
• If you’ve gone through trauma, this can cause flashbacks, nightmares or night terrors that disturb your sleep. You might feel unsafe or uncomfortable in bed or in the dark.
• Paranoia and psychosis may make it difficult to sleep. You may hear voices, or see things you find frightening or disturbing.
• Mania often causes feelings of energy and elation, so you might not feel tired or want to sleep. Racing thoughts can also keep you awake and cause insomnia.
• Psychiatric medication can cause side effects including insomnia, disturbed sleep, nightmares and oversleeping. Stopping psychiatric drugs can also cause sleep problems.

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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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,21 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.

Rem Sleep And Depressiondisappointed Expectations

The question of the differential-diagnostic value of REM sleep abnormalities puzzled psychiatric sleep research for almost two decades . It was thought that REM sleep abnormalities might be more typical for the primary/melancholic/endogenous subtype compared to the secondary/neurotic/non-melancholic subtype. With increasing research efforts, however, it turned out that especially age, and to a certain extent sex, has a very strong effect on REM sleep latency, whereby REM sleep latency decreases with age. Revisiting the primary/secondary dichotomy and REM latency, carefully controlling for age and severity of depression, Thase et al. concluded that initial positive findings may have represented epiphenomena of sample differences with respect to age or severity of depression. Additional research into other mental disorders revealed that patients with these diagnostic entities also display some degree of REM sleep alterations , further weakening the assumptions of a high specificity of REM sleep abnormalities for depression.

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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.11 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 patients14,15 . 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.