Insomnia and depression– it often seems that the two go together. In fact, science has shown a strong association between the two conditions. Healthier Sleep spoke with Tarun Amalnerkar, Master of Physiotherapy, about the relationship between insomnia and depression.
Insomnia and Depression
Insomnia and depression can be bidirectional, meaning if you have insomnia, you are more likely to develop depression. Likewise, if you have depression you are inclined towards insomnia. Whether it is due to worrying over things out of our control, or the pressures of work and stress, insomnia is a common problem. So common, that people may neglect to recognize that they are experiencing a sleep disorder. If insomnia continues for too long, it can become chronic and lead to other health problems such as depression. Not everyone will develop depression, but there is a strong predisposition for those with insomnia to develop depression. If you have depression sleep issue are common.
How Depression Affects Sleep
There are four stages of sleep, non-rapid eye movement NREM (stage one, two, and three) and rapid eye movement (REM) that occur during sleep. These repeat four to six times nightly. The duration of rapid eye movement increases with each cycle. Normally, it takes some time to transition through stages one through three to reach stage four, REM sleep.
It has been shown that people with depression often have reduced NREM and short REM latency resulting in sleep that is not restorative. They may wake up in the middle of the night during the second or third cycle and have difficulty getting back to sleep.
Is it Insomnia?
Most people will experience insomnia in one form or another at some time. Acute insomnia may keep you awake for hours with worry, anxiety, or stress due to life events. This type of insomnia may be intense but short lived meaning you may lose a night or two of sleep but soon are back to your regular sleep habits when the problem or stress is resolved. In contrast, chronic insomnia continues over months with sleepless nights multiple times a week. You may not even be able to pinpoint the cause of sleeplessness.
The inability to sleep may be due to insomnia, but it could also be a circadian disorder. While you may not realize it, using cell phones or watching screens late at night can push your circadian rhythm out of its normal cycle. It is easy to fall into the trap of checking one more email or watching one more video late at night. The light from the screens sends the message of wakefulness to your body. When this happens, fatigue may catch up with you the next day, so you may take a long nap. This then delays the onset of sleep in the evening or causes you to wake up in the middle of the night. You end up sleeping at odd times, unable attain restorative healthy sleep.
Treatments
Because insomnia and depression are often linked, treating one may help alleviate the symptoms of the other. Insomnia can be the result of behaviors. If insomnia is your primary concern, try making changes in your behaviors to sleep better such as:
- Restructure thinking: The first line of treatment is usually cognitive behavior therapy for insomnia (CBT-I). A sleep specialist can guide you through retraining your brain to sleep. There is a strong association between negative thinking and insomnia. Changing a negative outlook can be difficult, but it can bring positive rewards.
- Sleep restriction therapy: The bed is reserved for sleeping only. Do not “hang out” on your bed.
- Winding down: As evening approaches and you are preparing for sleep, begin by dimming the lights an hour or two ahead of bedtime.
- Clearing your mind: This may be done by writing in a journal or reading non-stimulating material.
- Only go to bed when you feel sleepy: Even if you don’t sleep one night because you didn’t feel sleepy, carry on through your normal day, and you should feel sleepy the next night. Think of it as a reset for sleep.
Keep in mind that some behaviors we learn from our parents. Consider the message you are sending to your children about sleep. Do you prioritize sufficient sleep? Does your family prepare for sleep? Your example and approach to sleep can give your family the gift of health throughout their lives.
Depression is amplified with insomnia. If depression is your primary concern, Mr. Amalnerkar suggests:
- Accept things as they are. Sometimes we ask why, and that question never ends. Accept what you have and where you are and build upon that.
- Spend time with people. Put down the phone.
- Spend time in nature. Get some sunlight, particularly in the morning.
- Make time to do some things you enjoy.
- Consult a medical professional
While there is no magic wand to cure insomnia or depression, making improvements in one of these areas can help alleviate both conditions.
Tarun Amalnerkar holds a Master of Physiotherapy with Neurology emphasis, and is on the M Kandiah Faculty of Medicine & Health Sciences at Universiti Tunku Abdul Rahman.