What to Know About Sleeping and Depression

One of the most common emotional disorders that impact Americans is depression. The disorder can manifest itself with symptoms that you may not immediately recognize as being part of depression—especially when it comes to sleep issues. Here's what you should know about the connection between sleeping and depression.

The Centers for Disease Control and Prevention (CDC) tells us that depression is the most common emotional disorder in the United States. Approximately 1 in 5 American adults has a disorder that affects thoughts, behaviors, emotions, or a combination of the three, according to the National Institute of Mental Health (NIMH).

In general, depression can be tough to identify, said Michelle B. Riba, MD, associate director of the University of Michigan Comprehensive Depression Center, because physical symptoms can arise before psychological ones. "Many people will come to their doctor complaining about sleep problems or headaches, not realizing that it's a mood disorder because they don't have low mood," said Dr. Riba. "Not all symptoms of depression always occur at once."

In other words, the disorder can also manifest itself with symptoms that you may not immediately recognize as being part of depression—especially when it comes to sleep issues. Here's what you should know about the connection between sleeping and depression.

The Relationship Between Sleep and Depression

People experiencing depression may have sleep difficulties—from not sleeping enough to sleeping excessively—says the NIMH. They can also wake up much earlier than they intended to—known as early morning awakening. These issues are linked to depression through hormones and the nervous system.

According to a March 2015 study published in the International Journal of Endocrinology, there are several hormones that play a role in being asleep and awake. Those hormones include:

• Growth hormones
• Melatonin
• Thyroid-stimulating hormone (TSH)
• Cortisol
• Ghrelin and leptin

Melatonin and cortisol help regulate your circadian rhythm—your sleep-wake cycle—as they work opposite of one another. If they are out of balance, sleep issues can occur. Additionally, increased TSH or ghrelin levels and decreased growth hormone or leptin levels can all lead to sleeplessness and vice versa.

The nervous system contains neurotransmitters, which are chemical messengers that send signals between neurons (nerve cells). Certain neurotransmitters (e.g., acetylcholine and gamma-aminobutyric acid, or GABA) are responsible for regulating periods of wakefulness and sleep, according to a January 2022 study published in Frontiers in Psychiatry. The researchers found that neurotransmitter system abnormalities can result in both sleep-wake rhythm disorders and the development of depression.

Furthermore, a February 2019 study published in the Journal of Cellular and Molecular Medicine suggested that people with sleep issues may be susceptible to depression. This supports the idea that sleep and depression affect one another in a bidirectional way. Essentially, the link between the two may constitute a cycle of having sleep issues because of depression and having depression because of sleep issues.

When You Don't Sleep Enough

If you have depression and are having trouble falling asleep or staying asleep, you may likely be dealing with insomnia. Symptoms may entail being awake for long periods of time before you can fall asleep or being awake for the majority of the night, sleeping in short bursts, waking up long before you plan to do so, and feeling as if you actually didn't get sleep, according to MedlinePlus.

Insomnia can be a risk factor for depression, according to a March 2020 study published in The American Journal of Managed Care. "(I)nsomnia strongly predicts the occurrence of depression. About 90% of patients with major depressive disorder (MDD) report difficulty sleeping," the study reported. Further, if you don't get adequate sleep, you may have problems with concentration and memory or other serious issues.

When You Sleep Too Much

Excessive sleepiness is a common symptom of atypical depression. This subtype of the mood disorder can be tough to identify because it doesn't involve some of the classic symptoms, said Gail Saltz, MD, clinical associate professor of psychiatry at the New York Presbyterian Hospital, Weill-Cornell Medical College and a psychoanalyst with the New York Psychoanalytic Institute. "Instead of trouble sleeping and loss of appetite, you sleep too much and eat too much," Dr. Saltz told Health.

What's more, when you have atypical depression, you don't always feel low: Your mood may lift temporarily when positive events happen or you hear good news. This makes it easier to brush off other signs that something's amiss, like using the snooze button more often and having a lack of motivation to start the day.

Treatment for Sleep Affected by Depression

Dr. Riba recommended talking with your healthcare provider, who can give you the Patient Health Questionnaire (PHQ) diagnostic tool.

"Your doctor will probably ask you about when the symptom or symptoms started and if any big event or change happened in your life at that time," said Dr. Riba. Be prepared to talk about your and your family's mental health history and any other symptoms of depression, such as trouble concentrating, aches and pains, or wanting to use sleep as an escape.

Depression can usually be treated with medication and talk therapy. (If you have chronic insomnia, cognitive behavioral therapy for insomnia—or CBT-I—may be helpful.) If your sleep issues are minimal, you can try sleep hygiene practices recommended by the CDC, such as limiting access to electronic devices in your bedroom or avoiding eating too much before bed.

Of course, having a hard time going to bed at night or getting up in the morning doesn't necessarily mean you have a mood disorder. It can also be a sign of many other issues, including anemia and a thyroid condition. Your healthcare provider should ask about these possibilities too, said Dr. Riba, to get a full picture of your health and what's going on in your life.