Connection and Treatments for Sleep Disorders and Depression

How are sleep and depression related?

Sleeping too much (hypersomnia) or not sleeping at all (insomnia) can be a sign of depression. These sleep problems alone are not the same as depression, but they can be one of its important symptoms.

Depression is a mood disorder characterized by sadness or feeling blue, along with a series of physical symptoms such as lack of energy, disturbed sleep and changes in appetite. Almost everyone experiences normal sadness or feels down from time to time. Sometimes, however, feelings of sadness become intense, last for long periods of time, and involve other physical symptoms that prevent a person from leading a normal life. These feelings often lead to a medical diagnosis of clinical depression.

Lack of sleep caused by another illness or personal problems can also lead to daytime fatigue and worsen diagnosed depression.

An inability to sleep that lasts for a long period of time is also an important clue that a person may be depressed.

Treatments for depression-related insomnia

Usually, once the depression has been successfully treated, the symptoms of insomnia improve.

Treatment choices for depression depend on the severity of the condition. The most effective treatment for depression for most people is often a combination of psychotherapy (counseling or talk therapy) and medication.

Medications tend to work faster to relieve symptoms, while psychotherapy helps people learn strategies to prevent future symptoms of depression from developing. Psychotherapy can also address coping skills to improve a person’s ability to fall asleep.

Medications

Doctors can sometimes treat depression and insomnia by prescribing an SSRI (selective serotonin reuptake inhibitor) or other antidepressant along with a sedating antidepressant or hypnotic medication. These medicines help you sleep.

Antidepressants include:

SSRIs. These medications can do double duty by helping you sleep and improving your mood. But for some people, SSRIs can cause insomnia. Your doctor may therefore ask you to take them in the morning, sometimes with additional medicine for a short time to help people sleep at night.

Examples are:

SNRIs (serotonin and norepinephrine reuptake inhibitors). These drugs affect two brain chemicals believed to be involved in depression: serotonin and norepinephrine. You might be prescribed them when an SSRI hasn’t worked. You can also suffer from it when your depression is accompanied by other problems such as pain disorders or certain forms of anxiety.

Examples are:

Other antidepressants you may be prescribed include:

Sedative antidepressants that can help you sleep include:

Hypnotics include:

Melatonin, an over-the-counter hormone, is also sometimes used to treat insomnia or disturbed sleep due to depression. A prescription drug called ramelteon (Rozerem) works similarly to melatonin and is also used to treat insomnia.

The drugs daridorexant (Quviviq) and suvorexant (Belsomra) are unique in that they are orexin receptor antagonists. They work by blocking a neurotransmitter called orexin which sends signals to your body to wake you up.

What else can help sleep?

In addition to trying medication, here are some tips for improving sleep:

  • Learn and practice relaxation and deep breathing techniques.
  • Clear your mind by writing a list of activities to do the next day and tell yourself that you will think about it tomorrow.
  • Avoid long and late naps.
  • Exercise regularly, but do so no later than a few hours before bedtime.
  • Don’t spend time watching television or staring at computer screens before bed, as light emission from display screens can interfere with the release of melatonin, a brain chemical, which signals sleep centers in the brain that it’s time to go to bed.
  • Do not use caffeine, alcohol or nicotine at night.
  • Don’t lie in bed tossing and turning. When you can’t sleep, go to another room and do something relaxing. When you begin to feel able to sleep, get back into bed.
  • Use the bed only for sleep and sexual activity. Do not lie in bed to watch TV or read. This way, your bed becomes a cue to sleep, not to stay awake.

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