The Relationship between Insomnia and Depression

"What is depression and how do I know if I'm depressed?"

You've probably heard someone say, "I'm down in the dumps." Depression may also be described as feeling sad, miserable, unhappy or "blue." Depression can also appear as anger, rather than feelings of sadness. It is normal for us to experience these feelings at certain points in our lives for short periods. Life events that can trigger depression are major life transitions, which may include; loss, death, relationship conflict, divorce, job loss, substance abuse and social isolation. The following may also play a role in the onset and support of depression: medical conditions, such as, cancer, long-term pain, underactive thyroid, and hypoglycemia. Use of steroids and alcohol and substance abuse can also cause a physiologically-based depression.

Researchers believe that a combination of these factors may cause depression, although the exact cause is not known. One other predisposing condition may be related to gene inheritance. Some types of depression run in families. If you have a family member who struggles with major depression, or bipolar illness, you are more vulnerable to having depression at some point in your lifetime. But depression can occur even if you have no family history. The etiology of depression is best understood through a wide-angle lens.

Depression cuts across all age groups. Even children can have depression. What do the symptoms of depression look like in different age groups? In children, depression may manifest indirectly. Changes in sleep and eating patterns, as well as temperament can often be observed. Parents report whininess, an increase in clingy behavior, pervasive fears of being alone, and an increase in nightmares. Some children have chronic stomachaches and headaches. Children may develop an avoidance or fear of going to school. In adolescence, depression may manifest as overall negativity, change in attitude, lethargy, loss of interest in friends or activities, substance abuse.

Adolescents and adults report the following symptoms of depression:

• Agitation, restlessness and irritability
• Dramatic change in appetite, often with weight gain or loss
• Very difficult to concentrate
• Fatigue and lack of energy
• Feelings of hopelessness and helplessness
• Feelings of worthlessness, self-hate and guilt
• Becoming withdrawn or isolated
• Loss of interest or pleasure in activities that were once enjoyed
• Thoughts of death or suicide
• Trouble sleeping or excessive sleeping
• Compulsive spending/shopping

"What is the Relationship between Depression and Insomnia?"

Those who experience insomnia generally fall into two groups. The first group has insomnia that is transient, less than 1-6 months. Often, a precipitating life event such as major illness or other change may contribute to disruption in a patient's sleep pattern. Once the triggering event is resolved, the insomnia should resolve. Patients who continue to experience insomnia for greater than 1-6 months may be at risk for developing a chronic condition.

From a psychological perspective, patients often use compensatory strategies to address their sleepiness related to insomnia. These might include: regular napping during the day, changing the time that you go to bed, and sleeping later in the morning. Each one of these is a way of coping with sleep loss and deprivation. These behavioral factors create a catch-22 for the patient. This kind of sleep dysregulation can perpetuate insomnia.

"What happens to you psychologically when you have chronic insomnia?"

The possible relationship between sleep difficulties and depression are numerous. Sometimes, insomnia can be the precursor to the onset of major depressive disorder. Sleep disturbances may act as risk factors for or predictors of depression. A prominent symptom of all types of depression includes insomnia. Why is it so important to address and resolve insomnia? In some cases, insomnia can worsen already existing depressive symptoms. So, whether we think of insomnia as a precursor to depression, a symptom of depression, or a side effect of depression or its treatment, the efficacy of treatment methods depends upon remission of insomnia.

In an article in the Journal of Clinical Psychiatry, Dr. Fava states that the "remission of depression cannot be fully achieved until the associated insomnia or daytime sleepiness are resolved" (pp. 27-32). The question of cause and effect in relation to mood disorders and insomnia is of major importance to those of us working in the field of sleep medicine. We know that patients who have a psychiatric disorder, such as depression, often report changes in their sleep pattern. Conversely, those who have insomnia report feelings of depression. The regulation of sleep and the regulation of mood appear to be closely related. In addition, recent brain imaging sleep studies support the relationship between depression and abnormal sleep related brain activity.

Thank you for your interest in topics related to your sleep health. If you would like more information, please feel free to contact me at or call 847.674.3600.

Best regards,

Miranda Altman, PsyD, LCSW, MSW
Psychologist, Cognitive Specialist

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