Having sad days is normal but having persistent feelings of hopelessness, sadness, anxiety or disinterest in usual activities could be a symptom of depression, an illness that affects close to 20 million Americans. Depression is not something that will go away or that can be cured by a good night’s sleep; it is a serious disorder that affects all aspects of a person’s life – including sleep.
The connection between sleep and depressive illnesses is a complex one; depression may cause sleep problems and sleep problems may cause or contribute to depressive disorders. Symptoms of depression occur before the onset of sleep problems for some people, but in others sleep problems appear first.
While insomnia is common among depressed patients, evidence shows people with insomnia run a risk ten times stronger for developing depression compared with those who sleep well. Depressed individuals may suffer from a range of insomnia symptoms, including difficulty falling asleep, difficulty staying asleep, unrefreshing sleep, and daytime sleepiness. However, research suggests that the risk of developing depression is highest among people who experience trouble falling asleep and staying asleep.
Obstructive sleep apnea (OSA) is also linked with depression. OSA is the most common form of sleep disordered breathing. The good news is that treating OSA with continuous positive airway pressure (CPAP) may improve depression; a 2007 study of OSA patients who used CPAP for one year showed that improvements in symptoms of depression were significant and lasting.
Because symptoms of depression overlap with symptoms of sleep disorders, there is a risk of misdiagnosis. For example, depressed mood can be a sign of insomnia, OSA or narcolepsy. Restless legs syndrome (RLS), a neurological condition that causes discomfort in the legs and sleep problems, is also associated with depression. According to the Restless Legs Syndrome Foundation, approximately 40% of people with RLS complain of symptoms that would indicate depression if assessed without consideration of a sleep disorder.
Many children and adolescents with depression suffer from sleep problems such as insomnia or hypersomnia (excessive sleepiness) or both. According to recent research, children with depression who suffer from both insomnia and hypersomnia are more likely to have severe and longer-lasting depression. They are also more likely to suffer from weight loss, impaired movement, and anhedonia (an inability to feel pleasure).
Depression affects all types of people from all over the world, but certain people are more likely than others to develop depression, including women and older adults. Among older adults, higher rates of depression and sleep problems may be explained in part by higher rates of physical illness. Among women, motherhood and hormonal changes throughout the life cycle (menstruation, menopause) may contribute to higher rates of depression. Among women and older adults, higher rates of depression may also be explained by higher rates of insomnia in these groups.
Treatment for depression may be complicated by sleep disorders. For example, patients with both OSA and depression should avoid sedating antidepressant medications due to their potential to suppress breathing and worsen OSA. Before beginning therapy for depression, talk to your physician about any sleep symptoms you are experiencing. In some cases, effectively treating the sleep problem may be enough to alleviate the symptoms of depression.
Some individuals show significant improvements in depression symptoms following a night of partial or complete sleep deprivation, leading physicians to consider using sleep deprivation as an intervention. However, such improvements are unreliable and are reversed after a night of normal sleep, making sleep deprivation an impractical therapeutic choice for depression. Moreover, sleep deprivation carries the potential for serious side effects such as extreme sleepiness, cognitive impairment and an increased risk of injury or traffic accidents.
In preparation for a visit to a health professional for depression evaluation and treatment, it is helpful to keep track of your mood and to use a sleep diary for a period of two weeks. Sharing this information with your therapist will help guide treatment and the correct diagnosis.
Addressing sleep symptoms are of critical importance to recovery from depression. Be sure to discuss any sleep problems that persist as mood improves. Such problems may signal the presence of an underlying sleep disorder.
Depression can be stressful and exhausting. It can also make you feel helpless and hopeless. In addition to treatment with a medical or mental health professional, here are some tips for helping you cope with depression on a daily basis:
- Keep a regular sleep/wake schedule
- Get into bright light soon after waking in the morning
- Get some form of exercise every day
- Avoid afternoon naps if you have nighttime insomnia
- Limit caffeine and alcohol
As with any medical condition, you should consult with either your medical doctor or a sleep professional.
For more information on sleep disorders and help with apnea and other issues, contact http://www.valleysleepcenter.com or call Lauri Leadley at (480) 830-3900.
Information courtesy of the National Sleep Foundation.