By Deborah Jeanne Post
People with chronic depression can sleep too little or too much or experience disrupted sleep. But insufficient sleep can worsen existing depression.
“The relationship between sleep and depression is complex and can go in both directions,” said Alice Hoagland, Ph.D., director of the Insomnia Clinic at Rochester Regional Health. “People who are depressed or anxious commonly experience difficulty falling asleep or staying asleep. At the same time, chronic insomnia can contribute to worsening mood and emotional wellbeing.”
Studies by Johns Hopkins show that 75% of people who have depression also have sleep problems and inversely, insomnia can increase the risk of developing depression by up to tenfold. It seems like a chicken-and-egg scenario. Which do you solve first? Depression or insomnia?
Hoagland said that she encourages her patients to not look at their predicament as an either—or situation.
“If someone is struggling with both their mood and their sleep, we should address both together,” she said. “Treating the underlying mood concerns and the insomnia at the same time can be an important part of helping someone feel better overall.”
Some people find that obtaining in-person mental healthcare is difficult because of where they live or their schedule constraints. People caring for children or elders often struggle to find the time to seek their own mental healthcare. Telehealth via video conferencing or phone calls can help bridge the gap. These sessions are typically covered by health insurers just like in-person visits.
Between sessions, it can also help to journal, develop a gratitude list, do regular physical activity, get outdoors daily, talk with trusted friends and engage in enjoyable hobbies. These are all ways to lift the mood. During the wintertime, using bright lights, especially light therapy boxes first thing in the morning, can help relieve the “wintertime blues” and better regulate the wake—sleep cycle. A provider can help evaluate for seasonal affective disorder (SAD), but using a light therapy box won’t hurt with or without a diagnosis of SAD.
As for a visit with sleep specialist, some health insurance plans permit patients to self-refer and others require a referral from a primary care provider. A sleep specialist may help patients address and resolve their issue or refer patients to a sleep study for further investigation.
In the meantime, addressing sleep hygiene can help improve sleep quality, such as keeping the bedroom cool, dark, quiet and reserved only for sleep and intimacy. For people who sleep too much — and sometimes cannot sleep at night — it’s especially helpful to wake with an alarm and go to bed at the same time every evening, along with restricting naps to no longer than 30 minutes. This strategy taps into the body’s natural circadian rhythm to promote better rest.