Sleep Issues and Depression: What’s the Connection?

It can be hard to tell which comes first, but it’s important to have serious sleep woes checked out by a professional.

teenager on phone at night

Medically reviewed in May 2021

Updated on March 2, 2022

We often skimp on sleep in favor of answering emails, binging on TV, or even waking up early for a workout. But sleep is not a luxury—it’s a necessity, a basic cornerstone of health. In fact, research finds that people who clock less than seven hours of sleep a night are at a higher risk of conditions like heart disease, asthma, and diabetes. Troublingly, less sleep is linked to a higher risk of depression, too.

Depression is a common mental illness that influences the way a person thinks, feels, and acts. It can show up as persistent sadness and loss of interest in things you once enjoyed.

If you have depression, getting enough sleep is often challenging. Insomnia is, in fact, one of the hallmark symptoms. But the reverse is also true. A sleep disorder—such as obstructive 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 can be a vicious and unpleasant cycle.

Here’s how difficulty sleeping and depression feed on each other, and how to know when it’s time to check in with a healthcare provider (HCP).

Sleep disorders and depression are deeply entwined
If you have both depression and difficulty sleeping, it can be hard to untangle which came first. Either is possible.

Take insomnia, for starters. “Depression and insomnia tend to have substantial overlap,” says Alex Dimitriu, MD, of Menlo Park Psychiatry & Sleep Medicine in California. Insomnia can be a stand-alone condition, but it is also a symptom of depression. In particular, people with depression often wake too early and are not able to get back to sleep, says Dr. Dimitriu.

Insomnia isn’t the only sleep disorder with a strong link to depression.

Obstructive sleep apnea and restless legs syndrome are two common sleep disorders that can cause insomnia, and thus may also exacerbate depression,” says Nate Watson, MD, co-director of the UW Medicine Sleep Center in Seattle, Washington.

A 2012 study published in the 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. A 2022 study published in Movement Disorders found more depressive symptoms and suicidal thoughts 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 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,” Dimitriu says. So while poor sleep quality won’t necessarily lead to depression, if it happens on a regular basis it will at least diminish your quality of life.

You spend about a third of your life sleeping, says Dimitriu, so disruptions to those hours of shut-eye are worth investigating and taking seriously.

Four signs you should seek professional help
Everyone experiences insomnia or a poor night’s rest occasionally, says Dr. Watson. But if insomnia drags on for months, you’ve tried changing your sleeping habits, and insomnia is making it hard to cope with daily life, you should see an HCP. Another rule of thumb for when it’s time to get medical care is if the problem happens at least once a week for multiple weeks in a row. Here are more red flags that merit an HCP visit:

You experience the characteristic gasps and snorts of sleep apnea. Obstructive sleep apnea causes you to snore or gasp while sleeping, as well as to actually stop breathing for multiple brief periods during the night. It typically happens because your airway becomes physically blocked and is often related to conditions like obesity or large tonsils. There's also a less common form of sleep apnea 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 sound sleep, and daytime sleepiness is the result. Those who have an overbite or a large neck or tongue may have an increased risk of sleep apnea. Smokers, people who are overweight, and people age 40 or older are also at heightened risk.

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

You have difficulty falling asleep and staying asleep. Insomnia is common during times of stress and upheaval, but it can arise for a variety of other reasons. In addition, it can crop up on its own or it can be part of other conditions.

Common risk factors and contributors to insomnia include:

  • Stress, anxiety, and worries
  • Poor sleep habits, such as eating late or looking at a smartphone before bed
  • An irregular schedule or frequent travel
  • Mental illnesses, including depression, anxiety, or post-traumatic stress disorder
  • Stimulants, such as the caffeine in coffee, nicotine, or the stimulants in certain cold medications
  • Alcohol, which can cause you to wake up in the night
  • Inactivity
  • Napping
  • Chronic pain
  • Medical conditions that lead you to get up to urinate during the night
  • Older age
  • Female sex
  • A previous history of insomnia and family history of insomnia

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.

But insomnia is treatable. Changing certain sleep habits like your regular bedtime, screen time, and caffeine and alcohol intake may improve the situation. Exercise, relaxation techniques, and cognitive behavioral therapy can also be helpful.

You spend your days feeling sleepy. Are you consistently fatigued? Do drowsiness or low energy levels interfere with your everyday activities? Do you have a hard time concentrating on tasks? Are you tired despite a full night’s sleep? These could all be symptoms of a sleep disorder. But fatigue is also a symptom of depression. Whatever its cause, daytime sleepiness is 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,” Dimitriu says.

Contact an HCP if you’re consistently tired, having a hard time working productively, or making frequent mistakes.

You feel sad and have other signs of depression. There are several other depression-related symptoms besides sleep problems. 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 an HCP. In its most serious form, depression can cause suicidal thoughts. If that's the case with you, call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255; or call, text, or chat 988.

Use a sleep diary to help diagnose the root cause
Many factors can disrupt sleep, with sleep loss potentially leading to depression. Or depression may be the root of your sleep difficulties. To get started untangling 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 track your sleep with the free Sharecare app, available for iOS and Android. This information will help an HCP determine what's at the root of your sleep troubles.

Article sources open article sources

Centers for Disease Control and Prevention. How Does Sleep Affect Your Heart Health? January 4, 2021.
Rob Newsom. Depression and Sleep. Sleep Foundation. Updated May 19, 2021.
Danielle Pacheco. How to Talk to Your Doctor about Your Sleep. Sleep Foundation. Updated June 23, 2021.
Mayo Clinic. Depression (major depressive disorder). February 3, 2018.
Johns Hopkins Medicine. Depression and Sleep: Understanding the Connection. Accessed February 21, 2022.
Jehan S, Auguste E, Pandi-Perumal SR, et al. Depression, Obstructive Sleep Apnea and Psychosocial Health. Sleep Med Disord. 2017;1(3):00012.
Zhang MM, Ma Y, Du LT, et al. Sleep disorders and non-sleep circadian disorders predict depression: A systematic review and meta-analysis of longitudinal studies. Neurosci Biobehav Rev. 2022;134:104532.
National Heart, Lung, and Blood Institute. Sleep Apnea. Accessed February 22, 2022.
Wheaton AG, Perry GS, Chapman DP, Croft JB. Sleep disordered breathing and depression among U.S. adults: National Health and Nutrition Examination Survey, 2005-2008. Sleep. 2012;35(4):461-467. Published 2012 Apr 1
Chenini S, Barateau L, Guiraud L, et al. Depressive Symptoms and Suicidal Thoughts in Restless Legs Syndrome [published online ahead of print, 2022 Jan 5]. Mov Disord. 2022.

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