Sleep & Depression

Do you have trouble sleeping at night? Or do you sleep too much during the day? While these problems may be caused by external factors (e.g., noise, light) or temporary stresses (e.g., new baby, starting a new job), it is important to understand that these problems may also be connected to our moods. In some cases, these sleep problems may be related to a condition called depression.

What is Depression?

Increasingly, depression is being recognized as a brain disease that involves how we feel about ourselves and how our body functions. Disturbed sleep is just one of the many symptoms of depression. Other symptoms include:

  • Down or low moods, feeling sad most of the day, nearly every day
  • Loss of interest or inability to experience pleasure in things that generally had been pleasurable before
  • Sharp changes in weight, either significant weight loss or weight gain
  • Loss of energy
  • Difficulty concentrating or making decisions
  • Thoughts that life isn't worth living, even to the point of actively considering ending one's life

If I Don't Sleep at Night, Does that Mean I'm Depressed?

No, not necessarily. Depression is only one cause of difficulty sleeping and there are others. For example, some people have trouble breathing during sleep, a condition referred to as obstructive sleep apnea syndrome (OSAS). This problem can awaken them often during sleep. If you are male, seriously overweight, middle-aged or older, or a frequent snorer, you may want to find out if OSAS is causing your sleep problems and overall tiredness. Another condition that could cause your sleep problems is periodic limb movement disorder (PLMD). With PLMD, a person's muscles twitch during sleep, usually in the legs, making it difficult for the person to get a sound night's sleep.

Of course, it is possible that your sleep problems are not related to these disorders. If difficulty sleeping, or insomnia, is your main symptom, it is worth ta1k- ing to your healthcare professional or to a sleep medicine specialist, who can help you to understand what is responsible for your sleep problems. Sometimes, spending a night in a sleep laboratory can provide useful information on your condition.

For instance, a sleep study is the best way to look for OSAS or PLMD. Also, people with depression show abnormal sleep patterns for both deep sleep and dream sleep. These signs can help a sleep specialist and/or healthcare professional make the right diagnosis, and suggest the best approach to treatment. If you experience both depression symptoms and insomnia, a sleep study may also help paint a clearer picture of the problems for both your healthcare professional and you.

In most cases, a complete history provides the best information. Most patients can complete a short (two-week) sleep diary to record their sleep problems and habits. Identifying the pattern of the sleep problem may actually help diagnosis a specific type of depression. When a relatively young person (under age 30 or 40) complains of difficulty falling asleep, for example, this may fit with a diagnosis of depression. In an older person (over 40) who falls asleep easily but doesn't sleep soundly or awakens often, a diagnosis of depression is more likely because of the age group.

If your healthcare professional and sleep medicine specialist determine that your sleep problems are the result of a sleep disorder, they can put you on the road to recovery by recommending the appropriate treatment for the disorder. If, however, they determine that depression is the most likely cause, they can begin initial treatment and refer you to other physicians as necessary.

If Depression is Causing My Sleep Problems, What Can I Do?

If your sleep problems are related to depression, the key to improving your sleep is treating the depression first. Many excellent treatments for depression are widely available. These include talk therapy, or psychotherapy, as well as medication therapy using antidepressant medications. Milder, less chronic forms of depression may recover well with psychotherapy alone. For persons who have had several episodes of depression that tend to be more severe, the recommended treatment would be a combination of an antidepressant medication and psychotherapy. Your healthcare professional or sleep medicine specialist may initiate these treatments themselves, or refer you to a psychiatrist who specializes in these forms of treatment.

Good Sleep Hygiene

Regardless of whether your sleep problems are related to depression, sleep can often be improved by following the practices of good sleep hygiene. Sleep hygiene is a recipe of simple habits and behaviors that help keep you "on schedule" to sleep better.

Choosing and maintaining regular bed and wake-up times seven days a week is one example of sound sleep hygiene. Try not to spend more time in bed than you think you are actually sleeping, as this tends to lighten sleep.

Another helpful technique is to use your bed and bedroom primarily for sleeping. Spending too much time in bed lying awake and trying to sleep can be counterproductive. Try leaving the bed and bed- room until you feel sleepy again. At that time you can return to bed to let yourself fall asleep. See the How to Sleep Well section in this brochure for more sleep hygiene tips.


If you have difficulty sleeping, or find that you sleep too much in the daytime, consider whether or not you are showing any depression symptoms, as out- lined above. If you experience a significant number of these symptoms, mention this to your healthcare professional. He or she can then explore your symptoms with you in more detail, work with a sleep medicine specialist, and recommend appropriate treatments. If you are diagnosed with depression, treatment of the depression is the first step toward solving your sleep problems, and to helping you achieve a greater feeling of well-being.

How to Sleep Well

These guidelines can be used for a variety of sleep disorders. They will help most people sleep better. For more specific guidelines for your particular sleep disorder, consult your healthcare professional.

  • Maintain a regular wake time, even on days off work and on weekends.
  • Try to go to bed only when you are drowsy.
  • If you are not drowsy and are unable to fall asleep for about 20 minutes, leave your bedroom and engage in a quiet activity elsewhere. Do not permit yourself to fall asleep outside the bedroom. Return to bed when, and only when, you are sleepy. Repeat this process as often as necessary throughout the night.
  • Use your bedroom only for sleep, sex and times of illness.
  • Avoid napping during the daytime. If you nap, try to do so at the same time every day and for no more than one hour. Mid-afternoon (no later than 3:00pm) is best for most people.
  • Establish relaxing pre-sleep rituals such as a warm bath, light bedtime snack, or ten minutes of reading.
  • Exercise regularly. Confine vigorous exercise to early hours, at least six hours before bedtime, and do mild exercise at least four hours prior to bedtime.
  • Keep a regular schedule. Regular times for meals, medications, chores, and other activities help keep the inner clock running smoothly.
  • While a light snack before bedtime can help pro- mote sound sleep, avoid large meals.
  • Avoid ingestion of caffeine within six hours of bedtime.
  • Don't drink alcohol when sleepy. Even a small dose of alcohol can have a potent effect when combined with tiredness.
  • Avoid the use of nicotine close to bedtime or during the night.
  • Sleeping pills should be used only conservatively. Most doctors avoid prescribing sleeping pills for periods longer than three weeks.
  • Do not drink alcohol while taking sleeping pills or other medications.