We can say that the relationship between insomnia and depression is bidirectional, but at the same time complex and multifactorial. That is, people who have insomnia can develop depressive conditions, and people with depression can have sleep problems, and the causes for this can be different. We can say that insomnia is the sleep disorder that is most associated with psychiatric disorders, as well as having a more evident relationship with mental health [1] . Other sleep disorders such as sleep apnea, restless legs syndrome and narcolepsy are also associated with depression, but evidence suggests that people with insomnia tend to be more likely to develop depression. According to an epidemiological study on sleep in the general population of São Paulo [2], people who had chronic insomnia were four times more likely to have symptoms of depression compared to people who had no complaints or sleep problems.
If we think of insomnia as a antecedent to depressive episodes, it can be said that people with these conditions will have more symptoms such as fatigue, irritability, mood changes, more health problems such as hypertension and diabetes, as well as memory and concentration difficulties. In addition, cognitive characteristics of insomnia, such as hypervigilance, rigid and ruminative thoughts, can also lead to depressive episodes (see blog on sleep and mental health). Depression can often come as a consequence of insomnia, which can worsen or even maintain the sleep disorder. Research suggests that the risk of developing depression is higher among people with insomnia at onset and during sleep maintenance [3].
Depression is a psychiatric disorder that presents signs and symptoms such as: feelings of sadness, helplessness, lack of hope, loss of interest in things, memory changes, thoughts of death, loss of energy, fatigue and insomnia, often requiring treatment with experts. Depression can also be accompanied by low self-esteem, anxiety, and physical symptoms such as headaches, body aches, weight loss or gain, and gastrointestinal problems.
Such symptoms can vary from person to person, but insomnia can often be present in many cases, which can worsen the depressive condition. About 80% of patients diagnosed with depression have altered sleep patterns [4]. Depressed individuals can suffer from a variety of symptoms of insomnia, including difficulty falling asleep, difficulty maintaining sleep, non-restorative sleep, and increased daytime sleepiness. Thus, people with depression may have inadequate sleep and routine habits, such as: they stay in bed for a long time, sleep a lot during the day, do little or no daytime activity, stay in social isolation or confined, and these behaviors can lead to worsening of insomnia and, consequently, worsening of depressive symptoms. However, the temporal relationship between depressive symptoms and insomnia and whether or not the incidence of insomnia precedes the incidence of depressive symptoms is still controversial [5].
A large European telephone survey [6], which interviewed 14,915 individuals, found that 71% of depressed patients reported that symptoms of insomnia occurred before or during the first episode of mood disorder. Other studies have shown the persistence of chronic insomnia in depressed patients despite the successful resolution of symptoms of depression [7].
Depression is a mood disorder that has affected countless people around the world. However, some people are more vulnerable to developing depression than others, both genetically and biologically, as well as social and environmental. Women and the elderly are among them. This population has a higher risk factor for both depression and insomnia. Among the elderly, factors such as widowhood, chronic illness, loss of loved ones, loneliness may be among the most common causes of depression. Among women, on the other hand, multiple daily tasks related to their social role (maternity, professional life) and hormonal changes can contribute to worsening mood and sleep conditions (see blog about women's sleep).
Treatment
Treatment for both insomnia and depression depends on the severity of symptoms. Often it will be necessary to use medication and medical monitoring, but always associated with a non-pharmacological measure, in this case Cognitive Behavioral Therapy (CBT). CBT has been the most indicated line of treatment as an intervention in both cases (depression and insomnia), as it is believed that both patients with depression and patients with insomnia have dysfunctional cognitions (thoughts, perceptions and beliefs) about the process in which they are living. In other words, patients with depression have negative perceptions and thoughts about themselves, others and the future, thus leading to the development of bad feelings and, consequently, dysfunctional and inappropriate behaviors, which can lead to suffering.
Individuals with insomnia often have excessive worries, ruminative thoughts at bedtime contributing to increased cognitive alertness, increased anxiety and agitation, leading to difficulties in initiating sleep. Insomnia patients also have cognitive distortions, false expectations about sleep and its habits, which can often lead to a fear of sleep, thus making it difficult to start and maintain sleep. Thus, CBT will work to restructure negative beliefs both in depression and insomnia, thus leading to an improvement in emotions and, consequently, an improvement in the behavioral pattern.
Here are some tips to help you deal with insomnia and depression:
1. Have regular sleep times, especially when waking up. This can improve sleep onset at night.
2. Expose yourself to sunlight in the morning, but if you can't, look for sunnier places. The sun is a great ally for both insomnia and depression.
3. Even if you are tired, avoid staying in your room during the day, get up, make your bed, open the windows and make the room airy and light.
4. Do not do activities in bed such as: eating, reading, studying. Your brain needs to associate your bedroom with a sleep habit and not stress.
5. Avoid daytime naps. This can make sleep worse at night.
6. Decrease the use of caffeine or stimulant drinks around bedtime.
7. Do activities that give you pleasure, even if you don't feel like it. Program yourself, the first step must be taken.
8. Write down your thoughts before bed and try to be more flexible with them, giving more realistic and positive meanings.
9. Ask for help, don't face your challenges alone, always count on a friend or loved one. If necessary, seek help from an expert in the field of mental health.
SleepUp can help you with that! see our website more to know more: en.sleepup.com.br
[1] Pigeon, Wilfred R., Todd M. Bishop, and Kelsey M. Krueger. "Insomnia as a precipitating factor in new onset mental illness: a systematic review of recent findings." Current psychiatry reports 19.8 (2017): 44.
[2] Castro LS, Poyares D, Leger D, Bittencourt L, Tufik S. Objective prevalence of insomnia in the São Paulo, Brazil epidemiologic sleep study. Ann Neurol 2013; 74(4): 537-46
[3]National Sleep Foundation [4] Chellappa, S.L.; Araújo, J.F. / Rev. Psiq. Clín 34 (6); 285-289, 2007
[5] L. Staner / Sleep Medicine Reviews 14 (2010) 35–46
[6] Ohayon MM, Roth T. Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiatr Res 2003;37:9–15.
[7] Mouchabac S, Ferreri M, Cabanac F, Bitton M. Residual symptoms after a treated major depressive disorder: a survey among private psychiatrists. Encephale 2003;29:306–12.
