Are Sleep Issues and Depression Connected? Two Experts Weigh In

Are Sleep Issues and Depression Connected? Two Experts Weigh In

Oftentimes, it’s difficult to tell which one comes first.

Sleep is far more than a luxury, even if we treat it that way, skipping shuteye in favor of answering work emails, binging TV shows, or even waking up early for a workout session. Those nightly hours of rest and recharge are essential for good health. In fact, research finds that people who clock less than seven hours of sleep are at a higher risk of conditions like heart disease, asthma and diabetes. And troublingly, less sleep is linked to a higher risk of depression, too.

Depression is a common mental health condition that influences the way a person thinks, feels and acts. Persistent sadness and loss of interest in things you once enjoyed are very characteristic of the condition.

If you have depression, though, getting sufficient sleep is often challenging—insomnia is one of the hallmark symptoms of the condition. The reverse is also true: a sleep disorder—such as sleep apnea or restless legs syndrome—that causes interrupted or reduced sleep can also lead to depression. Sleeping more than usual can also be a symptom of depression. It's a truly vicious and unpleasant cycle.

Here’s how difficulty sleeping and depression feed into each other, and when it’s time to check in with your doctor.

Sleep disorders and depression are deeply entwined
What’s difficult to untangle is which happens first: difficulty sleeping or depression. In fact, either option is possible.

Take insomnia. “Depression and insomnia tend to have substantial overlap,” says Alex Dimitriu, MD, with Menlo Park Psychiatry & Sleep Medicine in California. Insomnia is both a symptom of depression and other sleep disorders, as well as a condition itself. In particular, people who are experiencing depression often wake up too early and are not able to go back to sleep, says Dr. Dimitriu.

Insomnia isn’t the only sleep disorder deeply connected to depression.

Obstructive sleep apnea and restless legs syndrome are two common sleep disorders that can cause insomnia, and thus may also exacerbate depression,” notes Nate Watson, MD, SleepScore Labs advisory board member from Seattle, Washington. A study in the Sleep Research Society's journal SLEEP found that people diagnosed with sleep apnea, a condition in which a person’s breathing stops and starts during sleep due to blocked airways, were more likely to experience depression. Another study in the Journal of Neurology, Neurosurgery and Psychiatry found that more anxiety and depression symptoms were observed among patients with restless legs syndrome, which is characterized by a strong need to move your legs when lying down.

Without a good night’s rest, it’s that much harder to get through the day.

“Lack of sleep can also result in fatigue, decreased energy, impaired memory and concentration, and overall diminished life satisfaction,” says Dimitriu. So while poor sleep quality won’t necessarily lead to depression, on a regular basis, it will diminish your quality of life.

Four signs you should visit your doctor
Of course, everyone experiences insomnia or a poor night’s rest occasionally, says Dr. Watson. It's only when you have chronic insomnia, defined as three sleepless nights a week over a three-month period, that a visit to the doctor is necessary, he says. Here are more red flags that merit a visit to the doctor:

The characteristic gasps and snorts of sleep apnea: Obstructive sleep apnea causes an interruption to breathing that can last 10 seconds or more, five or more times an hour, according to the National Institutes of Health. There's also a less common form that occurs because a person's brain fails to send the correct signals to the muscles that control your breathing.

For people with sleep apnea—especially obstructive sleep apnea—breathing typically restarts with a snore, a snort or a gasp. The frequent disturbances throughout the night make it difficult for a person to obtain quality sleep. Those who have an overbite, or a large neck or tongue, may have an increased risk of sleep apnea, as well as smokers, those who are overweight and people who are age 40 or older.

If you or your partner spot signs of sleep apnea, it’s time to pay your doctor a visit.

Difficulty falling asleep and staying asleep: Insomnia is more common in women—particularly older women—than men. Some of the risk factors for insomnia include:

  • Age
  • A previous history of insomnia and family history of insomnia
  • Anxiety
  • Substance abuse
  • Post-traumatic stress disorder
  • Hypertension
  • Diabetes
  • Cancer

This sleep disorder can be a primary condition and can exist without the presence of depression, but it can also be connected. The quality of your sleep matters as much as the duration, points out Dimitriu. Anxiety can lead to what he terms “battlefield” sleep, which is characterized by a struggle to both get—and stay—asleep, with many periods of wakefulness.

However, insomnia is treatable. Changing certain lifestyle habits like your regular bedtime, screentime limits and your caffeine and alcohol intake may improve symptoms. Exercise, relaxation techniques and cognitive behavioral therapy (counseling) are also successful treatment methods.

Daytime sleepiness: Are you consistently fatigued during the day? Does drowsiness or low energy levels interfere with your regular, everyday activities? Or do you have a hard time concentrating on tasks? These could all be symptoms of a sleep disorder. It’s also one of the many symptoms of depression. Whatever the cause, it’s not something to take lightly. “Excessive daytime sleepiness and sluggishness, or sleepiness while driving, in meetings, or any time during the day should be brought up with your doctor,” says Dimitriu.

Take note and see your doctor if you’re consistently tired, you’re having a hard time working productively or you make frequent mistakes. Those with excessive sleepiness may feel tired despite getting a good night’s sleep, too.

Improving sleep habits and your sleeping environment can often help daytime exhaustion.

Feeling sad and other signs of depression: There's a whole cluster of symptoms associated with depression beyond those related to sleep disorders. If you're feeling sad and hopeless, have lost interest in hobbies or passions you once enjoyed or are struggling to concentrate, then it’s time to see a doctor. In its most serious form, depression can cause suicidal feelings—and if that's the case, you should immediately call 911 or the National Suicide Prevention Lifeline for help.

Use a sleep diary to help diagnose the root cause
There are many factors that can disrupt sleep, potentially leading to depression. Or, depression may be the root of your sleep difficulties. To untangle this, keep a sleep diary.

“If something is wrong with your sleep, track your sleep times for about a week or two, and bring it in to your doctor,” says Dimitriu. You can jot down notes each morning, or use the free Sharecare app, available for iOS and Android, to easily track how many hours you spend asleep.

Armed with this information, a sleep specialist or psychiatrist can help determine what's at the root of your sleep troubles and treat the issues accordingly. You spend about a third of your life sleeping, says Dimitriu, so disruptions to those hours of shuteye are worth investigating and taking seriously.

Medically reviewed in October 2018.

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