Depression is a serious mental health condition that can impact every part of your life. It can also seriously affect your sleep; it can take longer to fall asleep, you might wake much earlier or later than you’d like, and the overall quality of your sleep often suffers.
Paradoxically, it can also make you just want to curl up in bed and shut the world out. You might feel drained by the challenge of getting through each day, so you prioritize getting more sleep over activities like socializing or exercising.
Your bedroom feels like a safe space, and sleep can feel like a release from the negative thoughts and emotions that are caused by depression.
However, whether it’s too much time spent alone or spent sleeping, the growing sense of isolation can make depression worse.
A complex link
The link between depression and sleep is complex. Does depression cause insomnia, insomnia cause depression, or is not so straightforward? The reality is that the link may well be different for different people.
In this article I’ll be looking at some interesting theories about the connection between sleep and depression. I’ll first discuss some research looking at how the stages of sleep are affected by depression.
And then I’ll look at the common problem of managing the feelings of tiredness that often accompany depression, and finally some practical advice that can help with both depression and insomnia.
Can the REM sleep stage worsen depression?
Scientists have recently found evidence that suggests that, when you’re depressed, certain phases of sleep can have a negative impact on your mood the next day.
Sleep consists of 5 different stages, which you cycle through during the night. A typical sleep cycle is between 90 and 110 minutes long, with time spent in stages 1-4 and then the final stage, known as the REM stage.
During REM sleep, your sleeping brain’s activity is most similar to your waking brain’s activity. And this brain activity is thought to be responsible for your dreams.
Scientists investigating why we dream have found that a lot of the people, places and emotions that are present in your dreams are based on your recent experiences and feelings from your waking life.
In her recent book, Dr Penny Lewis talks about how this REM repetition of the day’s events could exacerbate depression for people with too much REM sleep. Someone who’s struggling with low mood and depressive thoughts could have their negative emotions and experiences replayed to them when they sleep.
Researchers have had some success in reducing the symptoms of depression by waking people up during REM sleep. The theory being that waking them during REM sleep can reduce how much the brain processes negative thoughts and emotions.
Anti-depressant medications also show some promise as a secondary effect; they can have the effect of temporarily reducing the amount of REM sleep experienced. So this could in fact be one of the ways these drugs help to combat depression.
Depression can change how you sleep
According to sleep researcher Rosalind D. Cartwright, depressed people have irregular REM stages, punctuated by more periods of wakefulness during the night.
The diagram below shows the difference between depressed and non-depressed peoples’ sleep. You can see that non-depressed sleepers have regular cycles of REM and Non-REM sleep.
Furthermore, normal sleepers will experience REM stages lasting between 10-15 minutes, whereas people suffering from depression can experience REM stages that last much longer.
And REM sleep can begin earlier for depressed people, leading to more overall REM sleep during the night. In severe cases of depression, people can get their first REM stage 45 minutes after falling asleep. This is about half as long as it takes in a typical sleep cycle.
This early REM sleep appears to squeeze out the other Non-REM sleep stages. Non-REM sleep serves an essential function, for example including the deepest stages of sleep where your body releases hormones to heal physical damage. As a result, when you’re depressed, you can wake up without feeling ‘rested.’
Tiredness and depression feed off one another
Depression can make it difficult to be around other people, so the level of social interaction can steadily decline. People might worry that they aren’t interesting or fun enough, or fear they’ll embarrass themselves or others, for example.
The unfortunate thing about this is that social support can play a key role in recovering from depression. Being with people that care about you reduces the sense of isolation, helps you keep things in perspective and maintain life goals, and talking can lessen the grip that negative thoughts have on your mind.
On the other hand, shutting yourself away can allow your negative thoughts to magnify and grow. It lets feelings of low self-esteem, hopelessness and shame become stronger.
So, someone suffering from a mental health condition like depression is doubly affected by insomnia. First, you can end up feeling tired and drained after many nights of bad sleep.
Second, these feelings of tiredness feed into your isolation; feeling tired becomes another reason to shut yourself off from family, friends, neighbors and the world.
Managing tiredness and activity levels with CBT
Finding ways to tackle your energy levels is important for recovery. And one way to do this is with Cognitive Behavioral Therapy (CBT).
CBT can be particularly useful for people who suffer from both depression and insomnia as it’s commonly used to help both, and can work for both at the same time.
A trained practitioner would work through different exercises and scenarios with you to help you recognize and manage your energy levels and negative thoughts.
The therapist might explain that avoiding social activity because you’re tired can be the start of a vicious cycle. You might worry that you won’t be good company when you’re tired, so you avoid social commitments.
On the other hand, if you’re having days when you aren’t feeling quite as tired and drained, you may push yourself too hard to be sociable or do other activities.
Doing too much in one day, or putting additional pressure on yourself, can lead to even more tiredness the next day – something known as boom and bust behavior.
CBT is useful for understanding how these kind of cause and effect situations and vicious cycles arise, and then managing your daily life better when you recognize the patterns.
Pacing: learning to break the link between tiredness and depression.
Working with a CBT councilor, one way to manage your energy levels and subsequent feelings is through what’s known as pacing.
Pacing is most often talked about for managing long-term pain and fatigue. But it’s also relevant for helping people to manage the tiredness and insomnia caused by depression.
Pacing involves trying to keep a consistent level of activity, regardless of how tired you’re feeling. This can mean doing a little more than you’d like on days you’re feeling tired, and a little less than you think you might be able to on days when you’re feeling better.
Here are three benefits of pacing:
- By pacing your activity, you haven’t pushed yourself too hard on days you’re feeling better, leading to exhaustion.
- In time, tiredness will have less and less control over your behavior. You’ll start to have more of a say over what you do, and when.
- By doing more activities when you’re feeling tired, you’ll get more experience of managing and overcoming your feelings of tiredness.
This is just one of the ways a CBT councilor might help you to overcome and manage negative thoughts around tiredness.
Practical tips for managing depression and insomnia
Whilst finding a way to deal with any REM sleep stage issues isn’t very practical for most people, there are some steps that can be taken to manage the combination of depression, insomnia and tiredness:
- Try to maintain a regular sleep pattern.
- Try to do some exercise every day, even if it’s just walking outside. But more physical exercise is preferable.
- Limit how much alcohol and caffeine you consume.
- Don’t nap if you suffer from insomnia.
- Get help from family or friends. Don’t allow yourself to become isolated.
- Try not to do too much in one day, then too little in the next. A little and often is better than nothing and then everything.
Recent discoveries about the relationships between sleep, depression and tiredness may seem a little complicated. If sleep doesn’t help with depression, what does?
I think findings about the way depression affects REM sleep shows the extent to which mental health conditions can affect every part of your life. It also shows the importance of getting professional help and guidance to put you on the road to recovery.
The discoveries about REM sleep will help researchers to understand depression better. This is good news as it could help them devise more effective treatment. In the meantime, CBT councilors can help you understand and manage some of the key symptoms of depression.
As much as possible, remember the practical tips for managing day to day. And remember to keep in touch with family and friends and ask for their support in difficult times.