Depression and Insomnia
The Link Between Depression and Insomnia
Medications for depression and/or anxiety may not mix well with medications for insomnia. If you are taking medications for depression and/or anxiety (like an SSRI), and you have trouble sleeping, please talk to your doctor about trying non-medicinal SleepPhones as a safer option to help improve de-stressing and sleep.
Learn to Boost Your Mood With Better Sleep
The relationship between depression and sleep is complex, tenacious, and at times, debilitating. In many ways, poor sleep and mood disorders have a kind of cyclic, chicken-or-the-egg relationship, wherein it's difficult to see where one begins and the other ends.
According to a study by Dialogues in Clinical Neuroscience, about three quarters of those affected by depression also suffer from symptoms of insomnia. In contrast, 40% of depressed young adults suffer from hypersomnia, a condition in which a person has severe difficulty staying awake during the day.
Insomnia Increases Risk of Depression
Even a few consecutive restless nights can put a serious damper on one's mood. Correspondingly, a study published by National Center for Biotechnology Information suggested that people with insomnia are nearly ten times more likely to develop depression and are over 17 times more likely to develop clinical anxiety when compared to their well-rested counterparts. For these reasons, it's imperative that one strives to get quality, ample sleep.
Sleep Symptoms in Mood Disorders
The National Sleep Foundation found that nearly 20 million people suffer from depression comorbid with insomnia. Interestingly, hypersomnia, or excessive daytime sleepiness (EDS), is also associated with insufficient rest— sometimes even despite getting a full seven or eight hours of sleep a night. Individuals with EDS have difficulty waking from sleep and frequently experience distress and disorientation during the day that can impair functioning.
According to UCLA Health, one's age plays a significant role in insomnia. People suffering from depression in their 30s generally have a harder time falling asleep, while those in their 40s and beyond are more likely to wake up in the middle of the night.
Depression and Sleep Apnea
Unfortunately, the side effects of chronic sadness don't stop at insomnia. Obstructive sleep apnea, a breathing-related sleep condition that interrupts deep sleep, is also linked to depression.
According to a study by The Journal of Clinical Psychiatry, people with depression are over 500% more likely to suffer from obstructive sleep apnea and other sleep-disordered breathing problems than those without a depressive mood disorder.
An Array of Mood Disorders
Major depressive disorder is an umbrella term commonly used for long term depression, which is characterized by unwavering sadness as well as an inability to carry out acts of daily living. However, several forms of this disorder exist, each with their own sleepless symptoms.
Seasonal affective disorder (SAD) is one subgroup of depression that, like its name suggests, is triggered by the changing of seasons when the patterns of daytime light shift and cause the body's "internal clock" to adjust, or as it were, fail to adjust. Because our circadian rhythms are regulated by sunshine, the short autumn and winter days cause desynchronized sleep schedules and trigger depression.
Bipolar disorder is a manic-depressive illness defined by severe mood changes, in which one cycles between periods of highs (mania), lows (depression), and moments of stability in between. As opposed to depression, mania is characterized by abnormal periods of elation and a decreased need for sleep. Often, an individual in the midst of a manic phase will report feeling well-rested after only three hours of sleep. During depressive episodes, many or all symptoms of depression are evident, including loss of energy and interest.
More Than One Kind of Insomnia
- Acute Insomnia is generally caused by a life event, such as a marriage, divorce, retirement, or any other significant life change. Symptoms for these brief episodes of sleeplessness can usually be cured relatively quickly with appropriate non-medical treatment. Acute insomnia is often grouped with onset insomnia (trouble falling asleep at the beginning of the night) and maintenance insomnia (the inability to stay asleep).
- Chronic insomnia can be caused mood disorders, medical conditions, unhealthy sleep habits, substance abuse, and many other factors. This long-term pattern of restlessness is usually classified by three or more months of sleeping problems.
- Comorbid insomnia occurs with another condition such as mood disorders like anxiety or depression or physical conditions like arthritis or severe back pain.
Treatment and Coping
Whether the root cause of depression is insomnia or vice versa, current research indicates that depression is often misdiagnosed. In fact, a study by John Hopkins Bloomberg School of Public Health suggests up to 86% of patients being treated for depression do not actually meet the specific criteria for the mood disorder. For this reason, it can be beneficial to explore non-medical solutions to your insomnia first, before jumping into sleep aids.
- Use SleepPhones for better night's sleep. You can listen to relaxing music, soothing meditations, and/or soundscapes without the hassle of bulky headphones or irritating earbuds. AcousticSheep uses clinically-proven sound technology to ensure a better night's sleep.
- Although it may be the last thing you want to do, try to get some exercise throughout the day. Physical activity can do wonders for counteracting symptoms of depression and insomnia. If music is a must during your workouts, try RunPhones for higher sound quality and added comfort.
- Limit caffeine and alcohol intake. Remember, a healthy body inspires a healthy life. Stick to a 2:00 pm to 3:00 pm cut off for caffeine and a one drink limit as a nightcap.
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Posted On October 30, 2017 By Shae, On Shades Of Shamrock Blog
Hi everybody! Today I wanted to talk about insomnia and depression. Both of these issues have such a strong impact on everyday life. One thing that I've noticed with my depression is that sometimes it is so incredibly hard to sleep. I've been told quite a few times that depression makes people want to sleep MORE, so I have always been so confused about why I can't sleep when I want and need to.
As a result of not being able to sleep very well (or at all), my depression seems to take hold of me even more than it used to. I've been so surprised to find that it's not just me that has this problem. So many people are out there suffering from the same issue. So how in the world do I not just curl in a corner and give up entirely? Well, thanks to the fact that I am always trying to write about my mental health and how to improve different issues I have, I have come across some things that actually help me sleep again.
Yes, I've already written a post about different things people can do when their anxiety keeps them awake (see the post here), but it seems like my insomnia caused by depression is an entirely different animal. When I can't sleep because of my anxiety, all the things that I am worried about get me wound up in a pretty tight knot and I can't sleep. When I can't sleep because of my depression, I lay in bed feeling utterly hopeless. It's like my inner demons are beating up on me and no matter how hard I try, they won't let me slip into peaceful sleep.
How in the world do I manage to fall asleep then? Well, for a long time I had been using a fan to help me sleep because the white noise was comforting and something I could focus on until I finally slept. I had tried sleeping with music but earphones are absolutely uncomfortable. There was also that incident where I dreamt that I had been kidnapped and tied up, only to find when I woke up that my earphones had tangled themselves around me at some point in the night... After that I pretty much gave up on listening to music while I sleep. That is until I discovered my new favorite thing in the whole world.
A few weeks ago I discovered this amazing company that makes headphones specifically for sleeping. I was skeptical at first because I have that whole issue where I toss and turn in the night, but I was willing to give them a try. I decided to check out their site before I made my final decision to give them a try and they looked really cool. The company is called AcousticSheep (which is adorable. They even had a picture on their site of a whole bunch of super cute stuffed sheep (which I secretly totally wanted)).
I couldn't believe that I'd never heard of them before. I was absolutely 100% on board (probably after seeing the stuffed animal sheep). When my SleepPhones came in the mail I have to admit I was pretty excited! Of course the first thing I had to do when I got them was mess around with them and try them out. They were absolutely the most comfortable headphones I had ever tried! No surprise though because the company's slogan is "Pajamas for your ears" (totally genius).
The first night
I downloaded a nature sounds app on my phone, connected my SleepPhones to my phone and drifted off to sleep listening to a thunderstorm track. When I woke up in the morning, I couldn't believe how good I felt. I had even woken up a half hour before my alarm was supposed to go off and I felt wide awake. One crazy thing I realized after I got out of bed was I was sleeping so well that I didn't even need to get up to go to the bathroom once (which is unheard of for me). My usual mornings consist of me waking up groggily, going through the internal struggle of whether to sleep in and sacrifice breakfast or get up right then and be like the undead until around noon. I had an amazing day too. It is crazy how much better my day can be with a good night's sleep.
The second night
I got home from work and I went to sleep because I wasn't feeling well at all. Naturally, I had my SleepPhones on while I slept. I woke up around midnight with the worst sore throat I could ever remember having. I took some nighttime severe cold and flu medicine and went back to sleep. When I woke up in the morning my throat seemed a million times worse, but I felt like I was okay on sleep thanks to my SleepPhones.
The third night
I was even more sick than I had been the night before. I had really started to feel the fatigue and the general yuckiness earlier that day and I had napped on and off. If I didn't have my SleepPhones I don't think I would have been able to sleep. Things would have been even more miserable. I took more nighttime cold medicine and all but passed out the minute I got in bed and put my SleepPhones on.
The fourth night
Most of my day was spent napping on and off. All I wanted to do was be curled up in bed listening to music or audiobooks. To say that I was loving my new SleepPhones would be a massive understatement. I felt like they were the reason I was still sane. I felt bad for my husband though, because he was going through the same thing I was but he was just using regular earphones because he didn't have a pair of SleepPhones yet. He was even more miserable than I was because he had to deal with uncomfortability along with the horribleness of being sick.
It is unfortunate that while trying out my awesome new SleepPhones I got sick, but I suppose if they helped me through that, they could more than help me through anything else. Having insomnia because of depression is bad, but when being sick gets thrown into the mix it turns into an absolute disaster. I am so grateful that the SleepPhones helped me through. They were such a comfort. Nothing helps make me feel better like music. Now the next thing on my to-do list is getting my poor husband a pair!
If you would like to read more about Shae's Story, Click Here for a link to her blog!Read more about Sleeping Through Insomnia and Depression
Free Insomnia Solution for the Insomniac - Explained by a Family Physician
People with chronic or severe insomnia often say that they dread bedtime. They hate trying to go to sleep. They know it will be one more night of staring at the clock, thinking about how they have to be upright and working again in 5 hours, 4 hours, 3 hours... It's a huge struggle trying to concentrate and not yawn through the next day. And yet, they are so tired and irritated! It’s just that when they lay down to sleep, the brain begins to wake up and the body is wracked with anxiety and exhaustion at the same time. It's an extremely frustrating experience for anyone who has gone through it. Thankfully, there is a wide variety of insomnia solutions, some more natural than others.
If the insomniac comes in to see me, then they've tried Tylenol PM, Unisom, Simply Sleep, and other over the counter sleeping pills. Hint: Generic Benedryl is probably the cheapest option— they are all made from the same active ingredient, diphenhydramine. Benedryl is known to cause hangover effects and a dry mouth. It often dulls a person the next day, so it is not ideal. Plus, some people have a paradoxical reaction to Benedryl, making them more hyper and unable to sleep. Those people can sometimes have a similar reaction to alcohol. Instead of being slightly sedated like most people who drink alcohol, they become more agitated and excitable. If it works well though, it's a fine option, and relatively safe, even when used frequently. It says to not use it long-term on the package because sometimes insomnia is caused by or related to other medical problems, so you should see the doctor if you have chronic insomnia.
Some insomniacs have tried the more "natural" melatonin, valerian root, chamomile tea, or warm milk. The problem with herbals is that it is not controlled by the FDA, so there is no guarantee that you are getting what you are buying. The dosage may vary greatly from one pill to the next so the results are inconsistent. Certainly herbal tea and milk can be calming, so it's worth a try. However, if you are allergic to ragweed, you should avoid chamomile, which is a relative of ragweed. I recommend trying melatonin products to travelers with frequent jet-lag. But for the severe insomniac, melatonin usually doesn't work well enough.
Other Problems Caused by Insomnia
Insomnia is dangerous when it makes someone so tired they start falling asleep at the wheel. It also makes people gain weight because the hormones produced during sleep suppress appetite. Plus, the body makes more steroid hormones during the day to keep a tired body awake, and that increases appetite. The steroid hormones can cause metabolic syndrome, making insulin and blood sugars chronically high, leading to diabetes. It is extremely important to get enough sleep for many reasons, but for insomniacs, sleep just seems impossible.
Hope for Insomniacs
When I see a patient suffering from insomnia, I have a few tricks up my sleeves. First, there is the ever-powerful placebo effect. No, I'm not kidding. I tell them that there is hope and that there are many treatments out there that can help. There is one treatment that is bound to work. So there's no reason to give up hope. Most insomnia treatments are quite safe, non-addictive, and effective. Some treatments can be used in combination with each other. Once the insomnia is treated and sleep is finally stabilized, we can wean off any pills. Confidence in being able to fall asleep again is critical for stopping insomnia. The insomniac views the bedroom as a bad place, wrought with frustrations. Just thinking about sleep is anxiety-provoking. Once the bedroom is a friendly inviting place for rest again, insomnia can be cured.
The sleep hygiene rules are a set of completely natural tips that help with mild sleeping problems. The most important thing is to maintain a regular sleep schedule. Do not eat a dinner that causes heartburn. Avoid exercising or caffeine after dinner. Keep the bedroom cool, dark, and quiet, which means no TV. Avoid long naps during the day. These are great guidelines to help people sleep well in general. However, the tired insomniac may not be able to fight insomnia with those tips alone.
Help! - Detailed Guide to Treating Severe Insomnia
I recommend the following:
- Decide on a time to wake up in the morning. Let's say 7am for this example.
- Count back 10 hours. That would be 9pm.
- At 9pm, one should not exercise anymore. Do not eat any meals beyond this point. Do not do anything exciting. Taking a relaxing stroll, a candlelight bath, or reading a book would be good activities for this time.
- At 10pm, one should prepare for going to bed. So changing into sleeping clothes, brushing, flossing, defrosting the next days dinner, preparing the next day's lunch, or packing one's bags for the next day are good activities. Making a to do list or a shopping list is okay too, but not if it's too anxiety-provoking.
- At 11pm, settle down to sleep. Set the alarm clock, put on SleepPhones, and listen to your favorite sleep track. If you just want nature sounds, we offer those on our CD, and on free download. Take 10 deep breaths, counting 4 seconds each for the inhale, the exhale, and the time between breaths. If you prefer to be guided into sleep, I recommend self-hypnosis tracks, such as those offered by Dr. Steven Gurgevich.
Wake up at the time that you should wake up and open the curtains or turn on the lights to get some morning light. Having exposure to some light upon awakening is helpful to train your brain. Whether or not you drink any caffeine in the morning is up to you. I do not recommend any more than 1-2 small cups of coffee a day. 3-4 cups of a light tea is fine. Red Bull, Monster, and other such "energy" drinks are strongly discouraged. They contain excessive caffeine and sugar.
- Stay active during the day, taking the stairs instead of the elevator. Take a short walk during lunch hour. Try to walk 10,000 steps a day. If you do that, there is no need to spend money on a gym membership.
- Eat at least 3 times a day. Healthy snacks between healthy meals is fine. Eat slowly, savoring each bite, and relax.
- One alcoholic drink a day is fine, but no more than that. Studies show that drinking more than two drinks a day causes more sleep disruptions.
Around 9pm, begin to relax again.
After trying the above method for 3 days, if it is starting to work, then continue. If it has not helped at all, then start a prescription sleeping pill and change the sleep track. Take the prescription sleeping pill about 15 minutes before going to bed. Continue to use the SleepPhones. That way, weaning off of the sleeping pills will be easier if you are already in the habit of falling asleep with your favorite SleepPhones sleep track. If you travel a lot, be sure to bring your SleepPhones along! SleepPhones can be like a security blanket sometimes because it's soft and relaxing.
Prescription Sleeping Medicines
As for prescription sleeping pills, there is a wide variety of them. The main ones are in these categories.
- Sedative-hypotics (the Z-drugs) – Ambien, Sonata, Lunesta
- Anxiolytics (benzodiazepines) – Xanax, Valium, Klonopin, Ativan
- Antidepressants – Trazadone, Elavil
- Synthetic melatonin – Rozerem
The anxiolytics are the classic sleeping pills, with the bad reputation of being addictive. They work well, but I prefer to start with the Z-drugs. These are the newer sleeping pills with the main effect of bringing on sleep. They are not physically addictive, so the dosing would never need to be increased. Stopping them abruptly would not cause physical withdrawl problems. Ambien is the oldest of the group and is well known for its effectiveness. These Z-drugs work for most people, but sometimes, one works better than another, so it is worth trying another Z-drug if the first one didn't work. The biggest side effect I watch for is sleep walking. I never prescribe it to a sleep walker, since it makes the problem worse. Only one person has ever complained of eating more in the middle of the night to me, and it was not exactly sleep eating. None of my patients have had sleep driving. A sleep walker is at increased risk for sleep eating (binging on random things, including inedible objects like paper plates smothered in ketschup) or sleep driving, which is obviously very bad. Other that that, the Z-drugs are quite effective and safe for insomnia. The biggest drawback for most people is the cost. Since they do not cure the root cause of insomnia, it something that might be taken long term. They are at least a few dollar a pill, so a month of pills cost far more than SleepPhones.
The anxiolytics are good medications for calming people down. They are addictive though, especially when used inappropriately. Short-term use or steady long-term use are possibilities as long as the dosing does not need to be continually increased. Because they are scheduled substances, the drug enforcement administration watches the doctors writing these prescriptions with severe penalties for over-prescribing, so some doctors are very reluctant to prescribe these. The people who benefit most from these medication are those with underlying anxiety. But people with a tendency to abuse alcohol must avoid these medications.
The antidepressants Trazadone and Elavil are probably more effective for sleep than they are for depression. They are very old medications and therefore very cheap. The main drawback is a dry mouth, potential for hangovers, and drug interactions. They are generally safe for long-term use and are not addictive. But one should taper off of them rather than stopping abruptly. I think they are not great insomnia solutions because of the annoying side effects frequently reported.
Rozerem is another insomnia treatment in a pill form, but this one is completely not addictive. It is a synthetic melatonin that is supposed to work only on the brain's melatonin receptors controlling sleep. It is still a relatively new drug, with unknown long-term effects and very expensive. It works for some people and not for others. The effectiveness is not as consistent as with the Z-drugs in my experience. Like melatonin, it would probably work better for jet-lagged people rather than the chronic insomniac. I would like to see a few more years of experience with this medication before prescribing it more regularly.
A Holistic Approach
There are many things that can impact sleep. Sometimes it is work or school stressors. Going through a divorce is one of the most stressful events in a person's life. Even marriage, moving, or starting a new job can be extremely stressful. Recognizing the stress that started the insomnia can be helpful. Sometimes the fear of a bad night or anxiety associated with trying to sleep can perpetuate the insomnia beyond the stressor. For example, staying up late studying for a big exam then worrying about the results afterward can start an episode of insomnia. But then the lack of sleep and messy sleep schedule spiral out of control, leading to prolonged insomnia, long after the exam is over. Looking within and figuring out what started the insomnia and what's causing it to perpetuate helps one understand the disease. Sometimes one can prioritize a fix to the stressor if one recognizes its full impact. Psychotherapy is a great natural insomnia treatment, if one can afford it.
Some medical diseases can cause or worsen insomnia. These problems are often intertwined. Mental illnesses such as depression and anxiety frequently disturb sleep. Even diabetes, allergies, arthritis, heart disease, or high blood pressure can affect sleep. In fact, most medical problems affect sleep, which is why older people tend to sleep poorly due to accumulating medical conditions. If allergies are causing lots of snoring or coughing at night, then treating it may be more beneficial than not. If pain from arthritis is preventing sleep, then taking some plain Tylenol at night might help. Getting a good night sleep is so important to feeling good the next day and preventing other illnesses that it may be worth treating an otherwise minor problem.
Seeing the Doctor
This article is to help you understand more about sleep from my perspective. It is not intended to diagnose, treat, or advise you about your own medical situation. Please consult your doctor for your insomnia.
There are many treatment options for insomnia. Some will work better than others, and natural lifestyle changes can always be used in conjunction with medications orSleepPhones. You should ask your doctor if you are on any medications or have any other medical problems that could be impacting your sleep. Sometimes a cure is as easy as stopping another pill! It may take some time, but you can stop insomnia with the help of your doctor!