Sleep & Depression

Do You Have Trouble Sleeping At Night?

Or do you sleep too much during the day? While these problems may be caused by external factors (e.g., noise, light) or temporary stresses (e.g., new baby, starting a new job), it is important to understand that these troubles may also be connected to your moods. In some cases, these sleep problems may be related to a condition called depression.

What Is Depression?

Increasingly, depression is being recognized as a condition that involves how our body functions, how we feel about ourselves and also how we respond to events in our lives. Trouble falling asleep and/or staying asleep are important features of depression. Other symptoms may include: Down or low moods, feeling sad most of the day, nearly every day, loss of interest or inability to experience pleasure in things that generally had been measurable before, sharp changes in weight, either significant weight loss or weight gain loss of energy, difficulty concentrating or making decisions, thoughts that life isn’t worth living, even to the point of actively considering ending one’s life, anger outbursts, irritability, and nervousness. Some people with depression experience only a few of these symptoms. If you have trouble sleeping and also have two or more of these symptoms, inform your healthcare professional.

If I Don’t Sleep, Does That Mean I’m Depressed?

No, not necessarily. Depression is certainly one cause of sleep difficulties, but there are many others. For example, some people stop breathing over and over again du ring sleep, a condition referred to as obstructive sleep apnea syndrome (OSAS). This problem can arouse them often while sleeping, promoting daytime sleepiness. if you are tired, fatigued or sleepy during the day and snore frequently you may want to find out if OSAS is causing your sleep problems. Another condition, periodic limb movement disorder (PLMD) occurs when a person’s leg muscles twitch during sleep, causing him or her to sleep poorly. Sometimes, other parts of the body twitch as well. Lastly, it’s important that you realize that trouble sleeping (for any reason) can promote feelings of depression.

Well, Does That Mean I’m Depressed?

Depending on your age, depression may also affect your sleep differently. For example, a relatively younger person (under 40 years of age) may experience trouble falling asleep, while people over 40 may have trouble remaining asleep. Both can be features of depression.

Of course, it is possible that your sleep problems are not related to snoring, OSAS or PLMD. if sleep problems are your main symptom, it is well worth talking to your healthcare professional, who may help you understand what is causing your sleep difficulties. Sometimes, referral to a sleep disorders center for consultation can provide useful information about your condition.

What Happens When I Am Referred To The Sleep Disorders Center?

In many cases, the sleep disorders specialist will complete an interview with you. This serves to provide a complete history of your sleep and related problems. Most patients also complete a short (two-week) sleep diary to record their sleep habits and difficulties. In addition, some specialists also provide questionnaires for you to complete. Together, these procedures can significantly help diagnose specific sleep and/ or depression problems.

if the sleep specialist determines that your sleep troubles are the likely result of snoring, OSAS, PLMD or another disorder, a sleep laboratory evaluation can provide very useful information about your condition. If depression seems to be causing the sleep problems, testing in the sleep laboratory may also be helpful, because people with depression or other ”mood disorders” tend to show abnormal deep sleep and dream sleep patterns. For example, people with depression may enter dreaming sleep quickly after falling asleep and show deep sleep later on. The opposite tends to happen with people who are not depressed.

If Depression Is Causing My Sleep Problems, What Can I Do?

If your sleep problems are related to depression, the key to improving your sleep is treating the depression and using good sleep hygiene measures first. Many excellent treatments for depression are widely available. These include talk therapy (i.e., counseling, psychotherapy) and medication therapy.

Some people recover from depression with psychotherapy alone, but many require both counseling and medication therapy. If medication therapy is recommended, several excellent antidepressants are currently available. Your healthcare professional or sleep medicine specialist may initiate these treatments, or refer to you to a psychologist or psychiatrist who specializes in these forms of treatment.

Good Sleep Hygiene

Regardless of whether your sleep problems are related to depression, sleep can often be improved by following the practices of good sleep hygiene. Sleep hygiene is a recipe of simple habits and behaviors that help keep you “on schedule” to sleep better.

Choosing and maintaining regular bed and wake-up times seven days a week is one example of sound sleep hygiene.

Try not to spend more time in bed than you think you are actually sleeping, as this tends to lighten sleep.

Another helpful technique is to use your bed and bedroom primarily for sleeping. Spending too much time in bed lying awake and trying to sleep can be frustrating and counterproductive. Try leaving the bed and bedroom until you feel sleepy again. At that time you can return to bed to let yourself fall asleep. See the ”How to Sleep Well” section in this brochure for more sleep hygiene tips.

Summary

If you have difficulties falling asleep, staying asleep or awakening too early, consider whether or not you are showing depression symptoms, as described earlier. Again, if you experience two or more of these symptoms, mention this to your healthcare professional. He or she may explore your symptoms with you in more detail, perhaps work with a sleep specialist, and also recommend appropriate tests or treatments. If diagnosed with depression, treating the condition and using good sleep hygiene will help you take the first steps to achieve a greater feeling of well-being.

How to Sleep Well

These guidelines can help most people sleep better, as well as many individuals with different types of sleep disorders. For more specific guidelines about your own sleep problem, consult your healthcare professional.

  • Maintain a regular wake time, even on days off work and on weekends.
  • Try to go to bed only when you are drowsy.
  • If you get in bed and are not drowsy, and unable to fall asleep for about 20 minutes, leave your bedroom and engage in a quiet activity elsewhere. Do not permit yourself to fall asleep outside the bedroom. Return to bed when, and only when, you are sleepy. Repeat this process as often as necessary throughout the night.
  • Use your bedroom only for sleep, sex and times of illness.
    If you have trouble sleeping at night, don’t nap during the daytime. If you do nap, try to do so at the same time every day and for no more than one hour. Mid-afternoon (no later than 3:00pm) is best for most people.
  • Establish relaxing pre-sleep rituals such as a warm bath, light bedtime snack, or ten minutes of reading.
  • Exercise regularly. Confine vigorous exercise to early in the day, at least six hours before bedtime, and do mild exercise at least four hours before bedtime.
  • Keep a regular schedule. Regular times for meals, medications, chores, and other activities help keep the brain’s inner clock running smoothly allowing you to sleep more easily and soundly.
  • While a light snack before bedtime can help promote sound sleep, avoid large meals.
  • Avoid caffeine (coffee, tea, soda pop with caffeine, cocoa or chocolate) within six hours of bedtime
  • Don’t drink alcohol when sleepy. When you are sleepy, even a small dose of alcohol can affect activities like driving. Do not drink alcohol while taking sleeping pills or certain other medications (consult your healthcare professional). Don’t use alcohol to help you sleep at night. ‘While alcohol may help you to fall asleep more quickly, it severely sects the quality of sleep later in the night and may even keep you from sleeping through the night.
  • Avoid tobacco close to bedtime or during the night.
  • Sleeping pills should be used only conservatively. Most healthcare professionals avoid prescribing sleeping pills for periods longer than two or three weeds. Remember to tell your healthcare professional about any symptoms of breathing problems during sleep (snoring, stop-breathing episodes, waking up short of breath, waking up with a headache or nausea) when being prescribed sleeping pills.
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