Updated: December 31, 2019
By: Mary Sweeney RN, BSN, CEN, ONN-CG
Anxiety and depression are a common affliction in today’s world – according to the National Institution of Mental Health, 16 million American adults (6%) have at least one episode of major depression per year. In addition, 10-15% of women in the United States develop postpartum depression. Depression can have major effects on your health, including decreased energy levels, decreased appetite, and little to no interest in doing things that you usually enjoy doing.
Types Of Depression
There are a few different types of depression (source):
Major depressive disorder: According to Harvard University, major depressive disorder is characterized by profound sadness, loss of interest in doing things that used to be pleasurable, or an overwhelming sense of despair. Symptoms may last two weeks or longer, and significantly affect day-to-day activities.
Persistent depressive disorder: Persistent depressive disorder is when you have recurring episodes of lower-level depression. With this, you may feel consistent, ongoing feelings of sadness along with lower energy levels. This happens to 1.5% of adults in the United States per year (source).
Bipolar disorder: Bipolar disorder, also known as manic depressive disorder, is when a person may develop a manic (or hyperactive) mood that can be followed by episodes of severe depression. This affects just under 3% of the adult population in America.
Seasonal depression: If you’ve ever felt sad or down as the seasons change, you may suffer from seasonal depression (also known as seasonal affective disorder). Up to 5% of the U.S. population suffers from this type of depression, commonly brought on by the start of fall and lasting throughout the winter months.
Postpartum depression: A significant percentage of new mothers report experiencing the “baby blues,” or postpartum depression, following the birth of a child. Contributing factors to this type of depression include lack of sleep, stress, and fluctuating hormones after pregnancy.
Psychotic depression: Psychotic depression is when major depressive episodes are followed or accompanied by hallucinations or paranoid thoughts. Among people admitted to a hospital for depression-related issues, 25% are suffering from psychotic depression (source).
Symptoms of Depression
While symptoms of depression can vary widely from person to person, here are some of the most common symptoms:
- Lack of interest in things you used to enjoy doing
- Decreased appetite
- Lower energy levels
- Thoughts of self-harm or suicide
- Loss of focus or mental clarity
- Trouble sleeping
This is not an all-inclusive list, there are many more ways depression can manifest itself. If you or someone you love is suffering from any of the above symptoms, contact a doctor or healthcare professional right away and get help.
How Depression Affects Sleep
It is common to have occasional feelings of sadness, especially when you have a lot going on in your life. However, if you find that you are having persistent feelings of hopelessness, despair, or overwhelming sadness that are interfering with your ability to live your life day-to-day, you may be suffering from depression.
The relationship between depression and sleep is a two-way street – depression can cause sleep problems and sleep problems can cause or worsen depression. In a study done in Japan in 2006, participants that got less than six hours or more than eight hours of sleep per night were more likely to report symptoms of depression. In the same group, those who were chronically sleep deprived were more likely to remain chronically depressed (source). Sleep problems can hinder the quality and amount of sleep that you get each night – here are some common sleep problems and how they may be related to depression:
Obstructive sleep apnea: Obstructive sleep apnea (OSA) is a condition in which a person may go for a period of several seconds without breathing while sleeping. When this happens, the brain sends a message to the body to wake up and breathe, which causes many interruptions in sleep throughout the course of a night. Side effects of this type of sleep apnea include headache, fatigue, and trouble concentrating. Over 70% of people that are diagnosed with obstructive sleep apnea are overweight and have other chronic diseases like high blood pressure, diabetes, heart disease, and history of stroke. In a recent study, participants who suffered from obstructive sleep apnea were five times more likely to be diagnosed with depression. Obesity has been linked to depression, as people who are overweight are more likely to experience higher amounts of emotional stress. Those who are overweight are more likely to suffer from OSA, and those that suffer from OSA are likely to have poorer sleep quality and are therefore more likely to gain weight. If you’re not getting good sleep because you have sleep apnea, you are more likely to be less physically active during the day. In addition, you may have an increased appetite – this in turn causes weight gain, which in turn can cause or exacerbate depression symptoms.
Restless leg syndrome: Restless leg syndrome is a condition in which you experience uncomfortable sensations in your legs that is relieved by moving them periodically. The sensations often pop up at night and can make it difficult to fall asleep. Restless leg syndrome can significantly affect the quality and amount of sleep that you get, and research has shown that RLS can be a cause of depression. According to the Restless Legs Syndrome Foundation, 40% of people suffering from RLS report having depressive symptoms.
Insomnia: Insomnia, or the inability to fall and stay asleep even when the conditions are optimal, is extremely common among people suffering from depression. People with depression may experience daytime sleepiness, inability to fall asleep, or frequent night wakings – all of these things may make symptoms of depression worse and may contribute to the development of other chronic issues. People suffering from insomnia have been shown to be ten times as likely to suffer from depression.
The relationship between sleep and depression can be complicated, because lack of quality sleep can cause mood swings and emotional changes. If you have underlying anxiety or depression, those symptoms can be worsened without an appropriate amount of sleep. Not getting quality amounts of sleep can cause symptoms that can mimic depression, or can cause a person to develop it. This is why it’s always best to consult with your doctor if you are experiencing these issues.
What Can I Do?
If you are experiencing symptoms of depression or are suffering from a sleep disorder, the first step is to talk to your healthcare team. By working with your doctor, you can determine the underlying causes of any sleep disturbances you are having, and can find the appropriate treatments for them. It can be hard to differentiate between symptoms of sleep disorders and depression, so it’s always best to talk to your doctor before trying to treat these issues on your own.
Based on your visit with your doctor, they may recommend a number of different treatment methods. These can include:
Psychotherapy: This type of therapy can include cognitive behavioral therapy (CBT). CBT is a form of psychotherapy that is used to treat sleep issues in both children and adults, and involves talking through fears or feelings that may be causing sleep issues and forming alternative views on those fears, also known as restructuring. This technique targets the thoughts that cause the depressive symptoms and “restructures” the way you view them. CBT is helpful for treatment of depression as well as insomnia.
Medications: If you and your doctor decide that medications are right for treatment of your depression, there are a number of different options. Selective serotonin reuptake inhibitors (SSRIs) are helpful for improvement of mood, but there’s a chance that they can worsen your insomnia (source). Other options include tricyclic antidepressants, which may make you feel sleepy and may cause elevation in blood pressure. Finally anti-seizure medications and lithium may be used for bipolar depression. These may carry a risk of kidney damage when used long-term, which is something your doctor will watch carefully.
Light therapy: Bright light therapy is used to stimulate the production of the hormones serotonin and melatonin. By exposing you to natural light or light machines that simulate natural light early in the day, your brain is stimulated to make the hormone serotonin, making you feel more awake and stabilizing your mood. By gradually reducing the natural light exposure towards the end of the day, the brain is stimulated to produce melatonin, which alerts the body that it’s time to go to sleep. Regulating these hormones may help with the common sleep issues discussed above and may help with depressive symptoms.
Remember, it is extremely important to talk to your doctor about the symptoms you are having. Keep a sleep and symptom diary for a couple of weeks before your appointment so your doctor can identify any triggers or patterns that may be causing your sleep disturbances or depression.
For more information, see the below resources.