That depressed people sleep too little or too much is well known. Sleeping too little, a cardinal sign of depression, often is characterized by multiple awakenings, especially in the early hours of the morning, rather than by difficulty falling asleep. Almost all depressed people report low energy or fatigue and some difficulty involving sleep. Although sleeping too little (insomnia) is much more common (prevalence rates of 2/3rds to 4/5ths in most clinical samples), sleeping too much (hypersomnia) is not uncommon, particularly earlier in life. Young depressed patients, especially those with bipolar tendencies, often sleep too much and have difficulty getting up in the morning (Sadock, et al., 2017). An estimated 40 percent or more of adults under 30 with depression experience hypersomnia (Breus, 2019).
Thirty-five percent of patients seen in sleep disorders centers with sleeping too little as their chief complaint had a mental disorder, and half of these patients had a mood disorder. Ninety percent of patients with major depression sleep too little. Insomnia is a risk factor (or marker) for depression on 3-year follow-up. Insomnia is also an independent risk factor for suicide in patients with depression. It has also been suggested that treating insomnia may help prevent mental disorders, especially depression (Sadock, et al., 2017).
People with depression may experience symptoms of both insomnia and hypersomnia. A 2014 study investigated how often insomnia and hypersomnia occur together in adults with depression in the US. Scientists found that more than 27 percent have what’s known as “co-occurring” insomnia and hypersomnia (Breus, 2019).
Diagnosing Depression (Jordan, n.d.)
So how do you know if you have depression? The main symptoms of depression are:
- Increased anxiety
- Less inclination to socialize
- A loss of interest in things that you once enjoyed
- Reduced self-image – feeling hopelessness and worthlessness
- A long period of sadness
- Problems sleeping
Many people suffer from one or more of these symptoms over the course of their lifetime, but unlike a bad day or a bad week, people with depression suffer from these symptoms over a prolonged period of time when they are unable to do even daily activities of living properly.
What is Sleeping Too Little or Too Much (Breus, 2019)
How much sleep is too little or too much?
Throughout our adulthood, most of us need somewhere around 6-9 hours of sleep a night. Very few of us can function and feel at our best on 5 hours of nightly sleep or less. But if you’re regularly sleeping more than 9 hours and still feeling tired and fatigued, that’s an indication that you’re oversleeping.
However, there is no single right amount of sleep applicable to everyone. Sleep needs vary from person to person. The factors determining that are:
- Both circadian rhythms and internal sleep drive, the two primary biological sleep systems, are influenced by genes.
- In the 20s you may need 7 or more hours of sleep, but in the 50s or 60s you may need only around 6 hours of sleep.
- Activity level.The body needs sleep to recover from exertion. The more active you are, the more sleep you may need.
- Both short-term illnesses, like colds and flu, as well as long-term or chronic conditions—everything from arthritis to cancer—increase the need for additional rest and sleep.
- Life circumstances.Stress and periods of change can temporarily increase the need for sleep. They can also make it difficult to sleep. Chronic stress can create a chronic sleep debt. Also, even big positive life changes can increase the demand for more sleep.
Diagnosis of Too Little or Too Much Sleep
To diagnose insomnia, one or more of the following must be present:
- Difficulty initiating sleep
- Difficulty maintaining sleep
- Early morning awakening with inability to resume sleep.
The influences on subsequent wakefulness in DSM-5 include “significant distress or impairment of social, occupational, educational, academic, behavioral, or other important areas of functioning.” (Sadock, et al., 2017)
Hypersomnia has several core symptoms (Breus, 2019):
- Sleeping for extended hours at night (typically well beyond the seven-to-nine-hour norm).
- Difficulty waking up in the morning (including sleeping through an alarm).
- Trouble rising from bed and starting the day.
- Grogginess on and off or consistently throughout the day.
- Trouble concentrating.
Cause-Effect Relationship between Depression and Sleeping Too Little or Too Much
Does depression cause sleep problems or do sleep problems cause depression? In some, depression leads to sleep problems, so the solution is to treat the depression. But for others, sleep problems led to their depression, so their solution would be to treat the sleep problem and as they sleep better, the depression will naturally lift. Hence, it’s very helpful to know what came first, the sleep problem or the depression. That way you know which area needs your attention and which will resolve naturally (Jordan, n.d.).
In the past, it was argued that if insomnia was related to depression, treating the insomnia would mask the depression and thereby interfere with antidepressant treatment regimens. This does not appear to happen (Sadock, et al., 2017).
Treating Depression and Sleep Disorder
Depression is treated with (WebMD, 2017):
- Medications, such as antidepressants, to treat the symptoms
- Psychotherapy, such as cognitive-behavioral therapy, interpersonal therapy, counseling, especially to learn coping strategies to prevent the onset of future depressive symptoms
- Or, often a combination of both of the above
Sleep disorders like insomnia, are treated with the following methods (Sadock, et al., 2017):
- Medications, such as benzodiazepines, benzodiazepine receptor agonists (BzRAs), ramelteon, melatonin.
- Cognitive-Behavioral Therapy for Insomnia (CBTi). This treatment modality combines behavioral and cognitive techniques to overcome dysfunctional sleep behaviors and misperceptions, distorted, disruptive thoughts about sleep. Cognitive and behavioral techniques include universal sleep hygiene, stimulus control therapy, sleep restriction therapy, relaxation therapies and biofeedback, cognitive therapy, and occasionally, paradoxical intention.
Breus, M. J., 2019. The Surprising Risks of Sleeping Too Much. [Online]
Available at: https://www.psychologytoday.com/intl/blog/sleep-newzzz/201901/the-surprising-risks-sleeping-too-much
[Accessed 13 Sep 2019].
Jordan, P., n.d. How Depression Causes Sleep Problems. [Online]
Available at: https://sleephabits.net/depression-and-sleep
[Accessed 13 Sep 2019].
Sadock, B. J., Sadock, V. A. & Ruiz, P., 2017. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 10th ed. Philadelphia: Wolters Kluwer.
WebMD, 2017. Sleep and Depression. [Online]
Available at: https://www.webmd.com/depression/sleep-depression#1
[Accessed 13 Sep 2019].