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Sleep and Depression: What you should know!

Author: Yap Xin Yi, Intern @ ARKCC

Date: 5 Dec 2021

What is Depression?

Depression is a common mental condition when the feeling of sadness, disappointment and hopelessness affect a person negatively on how one feel, act and way of thinking (Torres, 2020). Depression produces unhappiness and/or a loss of interest in previously appreciated activities. It can cause a slew of mental and physical issues, as well as a reduction in your capacity to operate at work and at home. The research found that women have twice likely to experience depression starting from age 12 than men because of the hormonal difference and the socialization difference where women are more sensitive than men (Schimelpfening, 2020).

Depression is a complicated illness, no one exact cause of it. However, several factors are associated with depression which can increase the risk of depression including family history, serious medical conditions, personal problems, life transitions such as the death of a loved one (Bruce, 2021). Anyone can be affected by depression, even those who are living in relatively ideal circumstances.

According to the Diagnostic and Statistical Manual of Mental Disorders- 5th edition (DSM-5), the symptoms of depression include the following:

  • Depressed mood most of the day, nearly every day.

  • Insomnia or hypersomnia nearly every day.

  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

  • Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

  • A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).

  • Fatigue or loss of energy nearly every day.

  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

  • Diminished ability to think or concentrate, or indecisiveness, nearly every day.

  • Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

  • Symptoms recurrent for at least 2 weeks

Sleep and Depression

As the symptoms mentioned above, it is common that people with depression are having sleep disturbances such as insomnia or hypersomnia. Depression and sleep issues are closely connected and the relationship is bidirectional (Franzen & Buysse, 2008). This means that depression may lead to sleep issues and poor sleep might contribute to the development of depression. It is difficult to determine which comes first and lead to another. Among the sleep issues, insomnia is the most common which contribute to 75% of depressed individual while 15% of depressed individuals experience oversleep or hypersomnia (Nutt, Wilson, & Paterson, 2008). Many people suffering from depression may alternate between sleeplessness and hypersomnia. Also, other sleep disturbances such as restless legs syndrome, obstructive sleep apnea syndrome and narcolepsy may also be associated with depression (Provini, 2021).

On the other hand, as suicidal ideation/ attempt/ behaviour is also one of the symptoms of depression, the relationship between sleep disturbances and suicide is investigated. There is a strong relationship between suicide and sleep. Although depression is the factor that is most associated with suicide, depressed individuals with sleep disturbances increased the suicidal possibility by 34% (Bernert & Joiner, 2007). Without taking the condition of depression, sleep disturbances can be an independent risk for suicide. Suicide also happened in persons without mental health illnesses. Research indicated that sleep disturbances especially insomnia and nightmares are highly associated with suicidal thoughts and actions while ruling out the depression conditions (Breus, 2018). The relationship between suicide and sleep disturbances can be explained because of the negative effects of poor sleep quality on human’s cognitive functioning (McCall, 2015). Also, sleeping poorly can make people more inclined towards negative emotions about self and others, more vulnerable to stress and less physically and mentally resilient (McCall, 2015). In short, sleep plays an important role in a human's life.

Treatment for Depression and Sleep

Normally, the treatment for depression and sleep problems are psychotherapy, medications or a combination of both (Casserella, 2020). Psychotherapy such as cognitive-behavioural therapy (CBT) or talk therapy with a licensed counsellor is commonly used to help individuals to change their thinking patterns that are related to depression. On the other hand, medications are used to decrease the symptoms quickly, for example, selective serotonin reuptake inhibitors (SSRIs) that can help individuals sleep and elevate their mood. However, the effects of the medications act differently on different people. Thus, it is important to closely work with health professionals to seek better treatment for the condition.

Ways to have better sleep

Above mentioned may be effective for a short-term period on the sleep problems as it depends on the medications, thus, changing the lifestyle may be more applicable for a long-term effect to have a better sleep. These might be also helpful to work with the treatment mentioned earlier. Here are some tips to have better sleep (Breus, 2018; Newsom, 2021).

  • Keep the bedroom at a comfortable temperature

  • Wear a sleep mask and earplugs if there is light or noise that bother your sleep

  • Use the bed only for sleeping purposes, this is because lying in bed can be a cue for sleep if it is only for sleeping purposes. Do not do other things on your bed.

  • Do not use alcohol, caffeine, nicotine in the evening/ hours before getting to bed.

  • Avoid looking at electronic devices (laptop, TV, smartphones) before bedtime because the hormone that signals the human’s brain to sleep can be affected by the light emitted from the electronic devices.

  • Get regular exercise no later than a few hours before bedtime. Daily exercise, such as stretching and conditioning activities, can aid sleep and alleviate the worry that many people experience when it comes to sleeping.

  • Relaxation techniques like breathing exercises and yoga may be useful in initiating sleep as racing thoughts and worries might cause high arousal and delay sleep onset.

  • Keep a regular sleep routine with a sleep duration of 7 to 9 hours

  • Be aware of the nap duration, although it might be tempting to take a nap if inconsistent sleep at night occurred, the ideal nap length is between 10 to 20 minutes.

Sleep is essential and important for humans!

Start prioritising sleep in your schedule, this entails planning ahead of time for the hours you'll need so that work or social activities don't affect your sleep. Good sleep is important and necessary for physical and mental well-being.

Reference & Resources

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

  2. Bernert, R. A., & Joiner, T. E. (2007). Sleep disturbances and suicide risk: A review of the literature. Neuropsychiatric disease and treatment, 3(6), 735–743.

  3. Bruce, D. F. (2021). Causes of Depression. WebMD.

  4. Casserella, J. (2020). Sleep and depression. WebMD.

  5. Franzen, P. L., & Buysse, D. J. (2008). Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues in clinical neuroscience, 10(4), 473–481.

  6. McCall, W. V. (2015). The Correlation Between Sleep Disturbance and Suicide. Psychiatric Times, 32(9).

  7. Newsom, R. (2021). Depression and Sleep. Sleep Foundation.

  8. Nutt, D., Wilson, S., & Paterson, L. (2008). Sleep disorders as core symptoms of depression. Dialogues in clinical neuroscience, 10(3), 329–336.

  9. Provini, F. (2021). Sleep and Depression. Med Link Neurology.

  10. Schimelpfening, N. (2020). Why Depression Is More Common in Women Than in Men. Very Well Mind.

  11. Torres, F. (2020, October). What is Depression? American Psychiatric Association (APA).

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