Depression and Sleeping Too Little or Too Much

Depression and Sleep Disturbances

It is well-known that people with depression sleep too little or too much. Sleeping too little, a cardinal sign of depression often is characterized by multiple awakenings, especially in the early morning, rather than by difficulty falling asleep. Almost all people suffering from depression report low energy (or fatigue) and some sleep problems.

Although sleeping too little (insomnia) is much more common (prevalence rates of 2/3rds to 4/5ths in most clinical samples), sleeping too much (hypersomnia) is not uncommon, particularly earlier in life. Young depressed patients, especially those with bipolar tendencies, often sleep too much and have difficulty getting up in the morning. About 40 percent or more of adults under 30 with depression are estimated to experience hypersomnia.

35 percent of patients seen in sleep disorders center with sleeping too little as their chief complaint had a mental disorder, and half of these patients had a mood disorder. Ninety percent of patients with major depression sleep too little. Insomnia is a risk factor (or marker) for depression on a 3-year follow-up. Insomnia is also an independent risk factor for suicide in patients with depression. It has also been suggested that treating insomnia may help prevent mental disorders, especially depression.

People with depression may experience symptoms of both insomnia and hypersomnia. Researches reveal that more than 27 percent have what’s known as ‘co-occurring’ insomnia and hypersomnia.

Diagnosing Depression

So how do you know if you have depression? The main symptoms of depression are:

• Increased anxiety
• Less inclination to socialize
• A loss of interest in things that you once enjoyed
• Reduced self-image – feeling hopelessness and worthlessness
• A long period of sadness
• Problems sleeping

Many people suffer from one or more of these symptoms throughout their lifetime, but unlike a bad day or a bad week, people with depression suffer from these symptoms over a prolonged period when they are unable to do even daily activities of living properly.

Read also: 5 Surprising Ways Depression Impacts Mental Health

What is Sleeping Too Little or Too Much

How much sleep is too little or too much?

Throughout our adulthood, most of us need somewhere around 6-9 hours of sleep a night. Not many of us can function and feel at our best on 5 hours of nightly sleep or less. But if you’re regularly sleeping more than 9 hours and still feeling tired, that may be an indication that you’re oversleeping.

Read also: Why Depression Makes You Tired and How to Deal With Fatigue

However, there is no single right amount of sleep applicable to everyone. Sleep needs vary from person to person. The factors determining that are:

• Both circadian rhythms and internal sleep drive, the two primary biological sleep systems, are influenced by genes.
• In the 20s you may need 7 or more hours of sleep, but in the 50s or 60s, you may need only around 6 hours of sleep.
• Activity level. The body needs sleep to recover from exertion. The more physically active you are, the more sleep you would need.
• Both short-term illnesses, like colds and flu, as well as long-term or chronic conditions – everything from arthritis to cancer – increase the need for additional rest and sleep.
• Life circumstances. Stress and periods of change can temporarily increase the need for sleep. They can also make it difficult to sleep. Chronic stress can create a chronic sleep debt. Also, even big positive life changes can increase the demand for more sleep.

Diagnosis of Too Little or Too Much Sleep

To diagnose insomnia, one or more of the following must be present:

• Difficulty initiating sleep
• Difficulty maintaining sleep
• Awakening in the early hours of the morning with an inability to resume sleep.

The influences on subsequent wakefulness in DSM-5 include –

significant distress or impairment of social, occupational, educational, academic, behavioral, or other important areas of functioning.

Hypersomnia has several core symptoms:

• Sleeping for extended hours at night (typically well beyond the seven-to-nine-hour norm).
• Difficulty waking up in the morning.
• Trouble rising from bed and starting the day.
• Grogginess on and off or consistently throughout the day.
• Trouble concentrating.

Cause-Effect Relationship between Depression and Sleeping Too Little or Too Much

Does depression cause sleep problems or do sleep problems cause depression? In some, depression leads to sleep problems, so the solution will be to treat the depression. But for others, sleep problems led to their depression, so their solution would be to treat the sleep problem, and as their sleep improves, the depression will naturally lift.

Hence, it’s important to know what came first, the sleep problem or the depression. That way you can determine which area needs your attention and which will resolve automatically.

In the earlier days, it was said that if insomnia was related to depression, treating insomnia would mask the depression and hence, interfere with antidepressant treatment regimens. This does not appear to happen.

Treating Depression and Sleep Disorder

Depression is treated with:

• Medications, such as antidepressants, to treat the symptoms
• Psychotherapy, such as cognitive-behavioral therapy, interpersonal therapy, and counseling, especially to learn coping strategies to prevent the onset of future depressive symptoms
• Or, often a combination of both of the above

  Read more: How To Deal with Depression

Sleep disorders like insomnia, are treated with the following methods:

• Medications, such as benzodiazepines, benzodiazepine receptor agonists (BzRAs), ramelteon, melatonin.
• Cognitive-Behavioral Therapy for Insomnia (CBTi). CBTi combines behavioral and cognitive techniques to overcome dysfunctional sleep behaviors and misperceptions, and distorted, disruptive thoughts about sleep. Cognitive and behavioral techniques include universal sleep hygiene, stimulus control therapy, sleep restriction therapy, relaxation therapies and biofeedback, cognitive therapy, and occasionally, paradoxical intention.

  Read also: How to Sleep Better with Insomnia