Depression and Sleep: Getting the Right Amount

Lack of sleep can upset your biologic clock and make your depression worse. At the same time, depression can influence your sleeping habits.

By Chris Iliades, MD

Medically reviewed by Pat F. Bass III, MD, MPH

A change in your sleep habits is one of the most common effects ofdepression. Lack of sleep can start before depression, be a symptom of depression, and make depression worse.

"Depression and sleep are closely related. Depression is a brain illness, and it affects many types of brain functions, including the sleep-wake cycle. Once this biologic clock has been disturbed, it can make sleep even more irregular and that adds to the depression. It can become a vicious cycle for many people," says Prashant Gajwani, MD, associate professor and vice chairman of clinical affairs in the department of psychiatry and behavioral sciences at the University of Texas Medical School in Houston.

Effects of Depression on Sleep

People with depression commonly experience disturbed sleep patterns, but the way depression affects sleep varies widely.

"Difficulty getting enough sleep is a major symptom for most people with depression, but for about 10 to 20 percent of people, the effects of depression result in sleeping too much," says Dr. Gajwani. Depression commonly causes:

• Difficulty falling asleep
• Difficulty staying asleep
• Waking up early in the morning
• Oversleeping
• Sleeping during the day
• Poor quality of sleep
• Waking up feeling tired

Effects of Sleep on Depression

The amount of restful sleep you are getting can affect your emotional health. "Lack of sleep for a long enough time can cause depression," says Gajwani. Although it is unlikely that lack of sleep alone is responsible for most cases of depression, it may contribute to depression in some people. The fact that many people who have sleep problems develop depression may indicate that sleep disorders and depression have similar causes or risk factors. Links between depression and sleep have been found in many studies, for example:

• Research shows that people with insomnia have a 10-fold higher risk of developing depression.
• Other types of sleep-related disorders, like obstructive sleep apnea and restless leg syndrome, are associated with high rates of depression. For people with obstructive sleep apnea, depression often improves with apnea treatment.
• Research shows that children with depression who experience a lack of sleep or who sleep too much are more likely to have longer and more severe episodes of depression.
• Experts suspect that chronic lack of sleep caused by physical illness is one reason older people have higher rates of depression.

Tips for a Good Night's Sleep

If you’re having a hard time sleeping at night or are sleeping away too much of the day, setting a bedtime schedule may help. "It is very important for people with a history of depression to keep regular hours of sleep,” says Gajwani. “You should go to bed about the same time and get up about the same time, and use your bedroom only for sleep or sex." Here are some other tips to sleep by:

• Exercise. "Make sure to get regular exercise and spend some time outdoors in the sunlight every day. This is a good way to set your biologic clock, and it helps maintain a regular sleep-wake cycle," says Gajwani.
• Skip the nap. Avoid afternoon naps, which can lead to nighttime insomnia.
• Limit caffeine and alcohol, especially later in the day.Caffeine is a stimulant and can keep you wide awake, while alcohol can disrupt sleep quality. "Alcohol before bedtime will interfere with sleep,” warns Gajwani. “It may help you fall asleep, but you are less likely to sleep through the night."
• Get up if you can’t sleep. "Don't waste time lying in bed looking at your clock," says Gajwani. If you find yourself lying awake, the best thing is to get up and do something relaxing until you feel tired.
• Shut off the TV. "Avoid watching television late at night. Most shows in the evening are too stimulating and do not promote good sleep,” says Gajwani. “Better to read a book or do some relaxing activity in the hours before bed."
• Practice good sleep hygiene. This includes using your bedroom primarily for sleeping. Avoid distractions in your bedroom, like phones, computers, too much light, and too much noise. Make sure your bed is comfortable and that the room temperature is comfortable for sleeping.

Changes in sleep patterns can be an effect of depression or an early warning sign of it. Let your doctor know if you are not able to sleep or if you are sleeping too much. "Over-the-counter sleep aids are not a good solution for people with depression and sleep problems,” says Gajwani. “Practice good sleep hygiene, get regular exercise, and work with your doctor or therapist to get your depression under control." Taking care of yourself, including getting the right amount of restful sleep, can help you manage your depression.