Insomnia[Poor Sleep] in Depression: 7 tips on How to get rid of Sleeplessness If you've Depression

Jun 26, 202412 min
Author's Profile picture
Manasvi Dodiya
Scientific Writer | Microbiologist
young woman sitting on bed - poor sleep due to depression

The symptoms of depression appear soon after the nest is grown. The first effect is commonly observed with sleep. In most people, depression leads to sleeplessness. This sleeplessness poses a big problem for many people.    

Sleep is like fuel for the body. It prepares our minds, boosts our memory, improves heart health, and makes our immune system strong.  It prepares our minds for carrying out tasks the next day. However, sometimes, you might encounter problems while falling asleep.

There can be multiple factors that deprive you of good sleep. If you are experiencing sleep problems, you can ask yourself these questions:

  • Are you stuck with staying awake for long hours at night?
  • Do you have problems getting a good night’s sleep? Are you easily awakened by sound or light?
  • Do you think you faced some event that triggered the onset of sleeplessness?
  • Is the sleep difficulty occurring at least 3 nights per week?
  • Are you waking up early in the morning even after having fragmented sleep?

If the answer to any of these questions is a yes, there is a possibility that you have insomnia.  Insomnia can be a symptom of many disorders like thyroid, chronic pain, sleep apnea, pulmonary diseases, heart diseases, etc.  It is to be noted that depression is one of the most common causes of insomnia. 

Insomnia caused by depression can have serious implications on your life if not treated correctly. In this article, we’ll understand the nitty-gritty of insomnia in depression. 

What Is Insomnia? 

Insomnia is a common sleep disorder that makes it hard to fall asleep, stay asleep, or have a good quality of sleep. It happens even if you have had the right environment and time to fall asleep. The inability to sleep can affect your routine life and make you groggy and tired during the day. 

Insomnia can be short-term (acute), lasting a few days or weeks, often due to stress or life changes, or long-term (chronic), lasting a month or longer, and may require medical attention and lifestyle changes to manage. 

What Is Depression?

Depression is a mood disorder that causes a feeling of sadness, hopelessness, and loss of interest in activities that were previously enjoyable. It is a common but serious mood disorder. It causes severe symptoms that affect how a person feels, thinks, and handles daily activities, such as sleeping, eating, or working.

For example, Maria lost her mother 6 months back. Since her demise, Maria has been experiencing feelings of profound sadness and hopelessness. She finds herself crying multiple times, sometimes even by a single thought of her mother. Even activities that she used to enjoy, like gardening or reading, no longer bring her any pleasure.

Depression takes a toll on a person as well as affects the relationships he/she shares. When there are unresolved issues related to depression, feelings of hopelessness, sadness, and anxiety are meant to accompany them.

To be diagnosed with depression, the symptoms must be present for at least 2 weeks. There are different types of depression, some of which develop due to specific circumstances. One of them is Dysthymia, a form of depression where the depressive symptoms persist for at least two years. 

Is Insomnia a symptom of Depression? 

Yes, insomnia is a common symptom in people suffering from depression. About three-quarters of depressed patients have insomnia symptoms. For many, the depressive symptoms do not improve until sleep disturbances are resolved. (1

Are Insomnia and Depression Two Different Mental Health Disorders?

While depression is a mental disorder, insomnia is a sleep disorder. Insomnia manifests as a symptom of other mental or physiological disorders. Moreover, in most of the patients suffering from depression, insomnia presents itself as a residual symptom. They are two different disorders but they co-occur often. 

How are Depression and Insomnia linked?

Insomnia and depression are closely related. Poor sleep increases the risk of developing depression while depression can lead you to stay awake for long periods. 75% of depressed patients experience difficulty falling or staying asleep, as well as early morning awakenings. 40% of people suffering from insomnia develop depression. (2)  It can be said that depression and insomnia have a bidirectional relationship. This complex relationship can make it challenging to know which came first, sleep issues or depression. However, in cases of depression, insomnia can be considered an early warning sign.  

The common link between the two is hormones. Regulation of serotonin, cortisol, and melatonin are responsible for sleep as well as dealing with depression. Studies have shown that hypercortisolism (chronically elevated level of cortisol), a state-dependent correlate of severe depression also leads to poor sleep efficiency. (3)

Why Does Depression Make You Sleepless?

1.Heredity:

Twin studies have shown that insomnia and depression are not only clinically related but also genetically related. Genetic overlap between insomnia and MDD was reported in several studies. The genetic factors that lead to depression in people are also known to contribute to insomnia. One of these is a gene called TCF4. TCF4 has a mutual influence on depression and insomnia. (10) Genome-wide association studies found another 719 genes that share a linkage for depression and insomnia.  (11)

2.Medical conditions:

Heart conditions, diabetes, cancer, and multiple sclerosis are examples of some medical conditions that may lead to depression. Depression due to these conditions can also trigger insomnia in patients. The depressive symptoms might worsen if a person does not receive a proper amount of sleep. 

3.Change in routine:

Depression may result in changes in routine. For example, Ricky used to eat healthy and exercise daily. Since the time he started experiencing depressive symptoms, he lost his motivation to work out and often indulged in eating junk food. This caused him to gain weight and become obese which resulted in disturbed and reduced sleep. 

4.Sleepy hygiene practices:

As mentioned earlier, depression and insomnia have a bidirectional relationship. Maintaining proper sleep hygiene like creating a bedtime routine or not using electronic devices before sleeping is crucial to get appropriate rest. If you have depression, there is a high chance that your sleeping schedule is affected. This is because depression lowers the motivation to follow sleep hygiene practices and thus impacts our sleep. 

5.Substance abuse during the depression:

Resorting to drugs or alcohol may be a coping mechanism for individuals dealing with depression. People sometimes use them to numb their feelings or to avoid facing the issues directly.

Alcohol and substance use may provide momentary relief but in the long run, they affect your brain chemistry and aggravate depression. Moreover, the use of drugs has been known to affect the sleep cycle of individuals. A study revealed that people with a persistent drinking problem for 3 years developed abnormal sleep patterns with elevated REM (rapid eye movement) percentages.  

6.Poor diet:

A diet lacking the essential macro and micronutrients affects the normal functioning of the brain. A balanced diet is essential for ensuring that the brain functions normally.

For example, carbohydrates have been known to affect individuals with their energy levels. Carbohydrates are broken down in our body to generate more energy. With a carbohydrate imbalance in our body, It can affect our mood and behaviour. Low carbohydrate level tends to increase tryptophan levels in the body which in turn affects the neurotransmitters (chemical messengers of our brain)

A lot of neurotransmitters are made up of proteins. A diet lacking protein might also affect the neurotransmitters and this might eventually affect mood or aggravate depression. (6)

7.Physiological changes in the brain:

Sleep occurs in five stages. Wake, N1, N2, N3 and REM. out of these, N1 to N3 are non-rapid eye movements (NREM). N3, also known as slow-wave sleep, is the deepest stage of sleep.  Slow wave activity is extremely important for determining the quality of sleep. The higher the activity, the better the sleep. During the depression, there is decreased regional cerebral blood flow in the orbitofrontal and anterior cingulate cortex parts of the brain during slow-wave sleep (SWS). Reduction in SWS leads to fragmented sleep and hence people experience insomnia as a result of depression. (7)

How to tell you Have Depression if you are experiencing Insomnia:

Since insomnia can be an early sign of depression, it is advisable to watch out for the obvious signs. The most common signs - early awakening or difficulty falling asleep and maintaining deep sleep are to be kept in check. 

You must also look out for mood changes. For example, getting easily irritable, less alertness and attention, and inability to perform tasks that require logical reasoning. Another common sign is sleeplessness accompanied by persistent low/ sad mood and lack of energy. 

Note that a definite diagnosis of depression can only be done by a mental health professional. If you suspect that you are experiencing some symptoms or you think somebody is going through the same, you can always take the help of a mental health professional

7 Tips to Overcome Insomnia if You Have Depression:

1.Antidepressant Medications:

Administration of antidepressants can be useful for treating insomnia that is caused by depression. Initially, the medications might keep you awake but once the depressive symptoms improve, the effects of insomnia also improve.

A psychiatrist can  Prescribe an SSRI (selective serotonin reuptake inhibitor) or other antidepressant along with a sedating antidepressant or with a hypnotic medication can treat insomnia. Consuming these medications under the supervision of medical professionals is necessary. They will guide you with the dosage and duration of the medications that are medically appropriate for each patient, 

2.Cognitive Behavior Therapy (CBT):

Cognitive behavioural therapy is one of the most effective treatments used to treat insomnia. Generally, it is the first treatment that is recommended. It helps you trace the problems that cause you to stay awake at night. CBT teaches you to look for and challenge beliefs that affect your ability to sleep. This type of therapy can help you control or get rid of negative thoughts and worries and solve the problem from the root. Studies have shown that 70-80% of insomnia symptoms are improved with the help of CBT. 

3.Practice relaxation and breathing exercises:

Practising mindfulness and meditation can help reduce the level of cortisol in the body. If you do not have a specific routine, you can try the following:

  • Sit or lie down in a quiet place comfortably
  • Close your eyes and take gentle breaths
  • Slowly focus on your breathing
  • With each exhalation, try to release tension from your body. 
  • Start with the muscles in your head, neck, and face. Move down to your shoulders, hands and arms, back, stomach, buttocks, thighs, calves and feet.

You can also take the help of guided meditations to help reduce stress and have a good night’s sleep. 

4.Exercise:

Exercising helps improve depressive symptoms to a great extent. People with physically active routines also have lower complaints of insomnia. This is because exercise pumps up the body's “feel good” neurotransmitters called endorphins. A study performed in Greece suggested a link between the level of exercise and the presence of insomnia in individuals with depression. The results showed that individuals with a moderate-to-high level of physical activity were 56% less likely to have insomnia. (4)  

5.Avoid screen time before sleeping:

Exposure to screen time in the hours leading to sleep contributes to insomnia. Screen time delays the release of melatonin - a hormone that is produced in response to darkness and helps with circadian rhythms and sleep. Using smartphones, tablets or laptops makes the body more alert and deceives it into thinking that it is still functioning in the daytime. Reducing screen time or avoiding it completely before sleeping can help you resolve insomnia issues. 

6.Avoid caffeine in the evening:

Caffeine blocks the production of adenosine, a sleep-inducing chemical. The more adenosine builds up in our body, the sleepier we become. Caffeine reduces sleepiness by blocking adenosine. While consuming caffeine can be good in the morning, it can make it harder to sleep if consumed in the evening. It reduces the amount of slow-wave sleep, which is the most crucial part of getting quality sleep. 

7.Yoga:

Yoga is a relaxing and helpful activity that helps the body enter a state of calm. A study showed that long-term practice of yoga improved sleep disturbances, shorter sleep latency, and decreased use of sleep medications in the elderly. (5) Yoga is now also being used as an adjunctive treatment to treat the symptoms of depression. Yoga encourages an individual to improve their posture and maintain balance, giving them a sense of control over their body. Yoga may also have an anti-depressant and anxiolytic effect. (9)

Treating Insomnia in Depression:

An extensive line of treatments is present to treat insomnia in depression. Cognitive Behavioral Therapy is the common approach for many individuals. If the symptoms of insomnia are affecting an individual’s health, antidepressants or sleeping pills may also be prescribed. Antidepressants help relieve both, depression and insomnia. 

SSRIs, SNRIs, TCA amitriptyline, trimipramine, and doxepin are known to improve total sleep efficiency in adults. Sedating antidepressants are more favourable if insomnia is too grave. 

Deep brain stimulation is steadily gaining popularity amongst doctors as well as patients. Multiple studies provide evidence that the use of deep brain stimulation, especially Non-invasive brain stimulation (NIBS) to treat depression is highly effective. Several NIBS techniques like Transcranial Magnetic Stimulation (TMS), Transcranial Direct Current Stimulation (tDCS), and Transcranial Alternate Current Stimulation (tACS) are used.  These techniques take the aid of magnetic fields or electric currents to excite certain parts of the brain to enhance its functioning.  A study found significant improvement in insomnia as well as depressive symptoms after the use of tDCS. The sleep duration increased and so did the quality of sleep. (8)

Online therapy options:

We understand that taking steps to reach out to somebody for your mental health concerns might feel overwhelming. If you feel that visiting a mental health professional in personal is too demanding, you can opt for online consultations. With professional help, you can take small steps every day to improve your mental health. If you feel too overwhelmed, do not worry, Mave Health’s got you! 

Mave Health has a team of experienced psychologists who can help you navigate through your problems. You can start your journey online by booking a consultation call.

 

When to Consult your Mental Health professional

If insomnia is disrupting your routine life by causing sleeplessness, fatigue, and irritability, you must consider consulting a primary care physician or a mental health professional. There might be chances that the cause of your insomnia is deeply rooted in some unaddressed psychological issues. If you have feelings of low mood, hopelessness, loneliness, or suicidal thoughts alongside insomnia, it is advisable to consult a mental health professional immediately. 

Although insomnia is an independent disorder, studies have shown that it can be the initial sign of depression. If you find no physiological reason hindering your sleep, consulting a mental health professional would be wise. 


Conclusion:

Depression and insomnia are closely related conditions that can cause an endless loop that may significantly impact your quality of life.  Both depression and insomnia can be managed and treated using an array of interventions, including cognitive behavioral therapy, medication, lifestyle modifications, and online counseling.

Remember that you are not alone in this. Getting expert assistance is a brave move and a necessary first step on the road to taking back control of your sleep and general health. It is possible to manage depression and sleeplessness. There is hope, and you can take the first step towards better sleep and improved mental health today.

FAQs of Insomnia[Poor Sleep] in Depression

Is sleeping too much a sign of depression? 

Sleeping too much or Hypersomnia is a highly prevalent symptom of depression. Depression can affect your energy, mood, outlook toward the future, and desire to do things. You might feel drained and lethargic and sleep can help you escape reality. However, a lot of other players might be at play to cause sleepiness. If you are experiencing excessive daytime sleepiness, you must consider consulting a mental health professional. 

Is Insomnia[staying asleep] a side effect of depression? 

Yes, insomnia is a side effect of depression. Depression causes one to have ruminative thoughts and they tend to overthink quite often. These ruminative thoughts and certain physiological changes in the body can lead to Insomnia. About three-quarters of individuals with depression also have symptoms of insomnia. 

Citation


  1. Sleep disturbances: core symptoms of major depressive disorder rather than associated or comorbid disorders Julien Mendlewicz 1 
  2. Exploring the relationship between insomnia and depression: a cross-sectional prospective study Ahmed Mishaal Mohammed Salih, MSc,a Zeyad Tariq Madallah, PhD,a Radhwan H Ibrahim, PhD,corresponding authorb Mahfoodh Suliaman Hasan Alseadn, FIMS,c and Osama Ismael Almushhadany, FIBMSd 
  3. Electroencephalographic sleep profiles before and after cognitive behavior therapy of depression M E Thase 1, A L Fasiczka, S R Berman, A D Simons, C F Reynolds 3rd 
  4. Is exercise an alternative treatment for chronic insomnia? Giselle Soares Passos,I,,II Dalva Lucia Rollemberg Poyares,I Marcos Gonçalves Santana,I,,II Sergio Tufik,I and Marco Túlio de MelloI 
  5. Impact of long term Yoga practice on sleep quality and quality of life in the elderly Mangesh A. Bankar, Sarika K. Chaudhari,1 and Kiran D. Chaudhari2.
  6. Understanding nutrition, depression and mental illnesses T. S. Sathyanarayana Rao, M. R. Asha,1 B. N. Ramesh,2 and K. S. Jagannatha Rao2
  7. Sleep disorders as core symptoms of depression David Nutt, DM, FRCP, FRCPsych, FMedSci,* Sue Wilson, PhD, and Louise Paterson, PhD 
  8. The effects of repeated transcranial direct current stimulation on sleep quality and depression symptoms in patients with major depression and insomnia Qi Zhou 1, Chang Yu 1, Haihang Yu 1, Yuanyuan Zhang 1, Zhiwang Liu 1, Zhenyu Hu 1, Ti-Fei Yuan 2, Dongsheng Zhou 3 
  9. How Might Yoga Help Depression? A Neurobiological Perspective Patricia Anne Kinser, PhDc, WHNP-BC, MS, RN,1,2,* Lisa Goehler, PhD,1 and Ann Gill Taylor, EdD, RN, FAAN1
  10. Causal links between major depressive disorder and insomnia: A Mendelian randomisation study Lei Cai 1, Yiran Bao 1, Xiaoqian Fu 2, Hongbao Cao 3, Ancha Baranova 4, Xiangrong Zhang 5, Jing Sun 6, Fuquan Zhang 7 
  11. GWAS Meta-Analysis Reveals Shared Genes and Biological Pathways between Major Depressive Disorder and Insomnia by Yi-Sian Lin 1ORCID,Chia-Chun Wang 1 andCho-Yi Chen 1,2, 
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Manasvi Dodiya
Scientific Writer | Microbiologist
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