Depression and Sleep Disorders: Strategies for Improving Sleep Quality

Depression and sleep disorders are closely linked, with those suffering from insomnia having a higher likelihood of depression symptoms and those with depression having a 75% likelihood of changes to their sleep. Women are more likely to be impacted by both depression and sleep disorders, and symptoms can cause massive distress and negatively impact the quality of life. It can be difficult to feel your best mentally and emotionally when you aren’t sleeping well; conversely, chronically poor sleep can lead to neurochemistry changes that affect how you feel on a daily basis. Because these two conditions often overlap, it’s essential to address the underlying causes of depression as well as getting quality sleep to improve overall health and well-being.

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What is the Link Between Depression and Sleep Disorders?

Common sleep disorders that are associated with depression include insomnia, hypersomnia, and obstructive sleep apnea. Up to 20% of patients with diagnosed depression may have obstructive sleep apnea, and vice versa. The statistics don’t stop there: 40% of patients with insomnia have clinically diagnosed depression, and nearly 80% of patients with depression experience insomnia.  

Poor sleep can impact levels of neurotransmitters such as serotonin, which has long been studied for its role in depressive disorders. Chronic lack of sleep may change activities in certain parts of the brain, leading to trouble with decision-making, regulation of emotions, and coping with change. Additionally, disruptions in sleep can negatively impact the body’s circadian rhythm, which makes individuals more vulnerable to developing depression and other mental health disorders.  

Recognizing Sleep Disorder Symptoms in Depression 

There are several symptoms to pay attention to when identifying if sleep disorders are contributing to a patient’s depression.  Symptoms may include:

• Difficult falling asleep, or it regularly takes longer than 30 minutes to fall asleep
• Waking up often throughout the night
• Snoring, gasping, or choking during sleep
• Daytime sleepiness
• Feeling like you need to move when you try to relax
• Irritability or trouble regulating emotions
• Trouble concentrating or paying attention

Ultimately, if it feels like it’s challenging for a patient to get a good night’s rest or if they have difficulty during the day getting through basic activities of daily living, it’s important to evaluate sleep quality. Those who are dealing with depression may feel like they need to sleep longer than most, and this is often due to fragmented sleep that adds up over time.

Early recognition of sleep disorders is essential when addressing mental health, as sleep disorders are also known to have a negative impact on recovery from mental disorders and increase the risk of recurring symptoms. For sleep apnea in particular, the earlier the symptoms are recognized, the more likely it is that patients can restore their sleep quality and minimize the risks of cardiovascular morbidity that accompany sleep apnea diagnoses. The sooner sleep can be optimized, the more likely patients experiencing depression are to start to feel better and find some relief. 

Lifestyle Changes for Improved Sleep 

When it comes to improving sleep, creating a consistent sleep-wake cycle and an evening routine are both critical. The regularity of one’s sleep schedule (meaning going to bed and waking up at the same time) has recently been found to have more of an impact on health and longevity than the total sleep duration, so consistency is key. Creating a routine that helps unwind from the day and get ready for sleep is also important; this may look like powering down technology (as blue light exposure at night can negatively impact sleep) and doing some deep breathing or meditation to help relax. Additionally, making sure the bedroom is dark, cool, and quiet is helpful to improve sleep consistency and quality if televisions and other devices can be removed from the bedroom, even better.

Dietary Considerations for Sleep

There are several aspects of nutrition to be considered when it comes to sleep quality. Meal timing is one important component of getting quality sleep, with evidence showing that eating the last meal 2-3 hours before bed leads to better sleep than eating late at night right before bed. 

Additionally, carbohydrate intake has been linked to changes in sleep. Higher carbohydrate intake has been linked to higher REM sleep and less deep sleep, while low-carb diets have been found to have the opposite effect on sleep. Another study found that higher intakes of seafood alongside fruits and vegetables, such as a Mediterranean-type diet, can support better sleep quality likely by keeping blood sugar in check. 

Some things, such as caffeine, excess sugar, and alcohol, are known to negatively impact sleep and can lead to poor sleep quality and quantity, especially when consumed frequently. However, there’s also evidence that including some specific foods can help support healthy sleep quality. Foods high in zinc, such as meat, poultry, and seafood, have been shown to improve the ability to fall asleep. Additionally, preliminary research suggests that kiwi, tart cherries or tart cherry juice, fatty fish, and milk may all be beneficial for sleep due to their impact on melatonin production.

Physical Activity's Role

Exercise is a helpful tool for improving sleep quality in individuals with depression. While exercise has been shown in many studies to have a beneficial impact on sleep, it should be noted that ongoing poor sleep is correlated with lower physical activity levels, likely due to feelings of fatigue and lethargy. It’s been well-documented that at least 30 minutes of physical activity per day is ideal to support healthy sleep, though in individuals dealing with depression and poor sleep, starting with aiming for 20 minutes of exercise at least three days a week may be an ideal recommendation considering individual patient history. Exercise plans can then build on consistency and increase the frequency and duration of exercise once it becomes a habit. 

Additionally, regular exercise is perhaps the most important intervention for those dealing with depression or other mental health symptoms. It’s been found to improve symptoms through mechanisms including endorphin release, stress relief, and even taking one’s mind off other worries during the moment.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Cognitive behavioral therapy is another first-line treatment for insomnia. CBT-I explores the connection between thoughts and feelings about sleep and actual behaviors. This can help address the worries and anxiety about sleep that many who deal with insomnia often have, and it has been shown to be effective for insomnia in depression. 

CBT-I has five key components, including:

• Sleep consolidation (limiting the number of hours an individual spends in bed)
• Stimulus control (no tech in the bedroom; the bedroom is only for sleeping)
• Sleep hygiene (same sleep/wake time, dark room, and proper sleep environment)
• Cognitive restructuring (changing negative or fearful thoughts about sleep into constructive affirmations)
• Relaxation techniques, such as mindfulness meditation

While CBT-I has been shown to be effective, it’s often underutilized in treating insomnia, as medications tend to be more commonly recommended. Additionally, there is a shortage of CBT-I-trained professionals.

Medications and Supplements

Medication and supplements are commonly used to treat sleep disorders that can occur with depression. In fact, many prescription medications used in managing depression have drowsiness as a side effect and are often recommended for those who are dealing with both depression and sleep troubles. However, prescription medications can come with additional side effects and are recommended on an individual basis. These side effects include gastrointestinal symptoms, daytime drowsiness, trouble with attention, headaches, and dizziness, amongst others - it’s important to know side effects so you can contact your doctor should you begin to experience them while taking a drug to help with your sleep.

Another option to support sleep is to take natural supplements to help support sleep. Similar to medications, supplements can help with managing stress, encouraging relaxation, and balancing neurotransmitters that can be non-optimal in depression. The most common supplements recommended to improve sleep include melatonin, theanine, magnesium, tryptophan, 5-hydroxytryptophan, chamomile, and cannabidiol. Supplements, however, can also have side effects, and some may interfere with various prescription medications, so it’s important to talk to your doctor when making decisions about which sleep support supplements to incorporate into your routine.  

Mindfulness and Relaxation Techniques

Mindfulness and relaxation practices can also be beneficial for those with sleep disorders that overlap with depression. Such practices can help ease physical tension, reduce mental chatter, and help with having an easier time falling asleep.

Several types of mindfulness and relaxation practices have been studied with regard to improving sleep, including meditation, deep breathing, and progressive muscle relaxation. Deep breathing is one of the most commonly used techniques and can help reduce stress and worrisome emotions that may interfere with sleep. Meditations may be guided, meaning an individual can listen to someone taking them through the meditation, or may encompass breathing practices or a body scan to help with relaxation.

Ultimately, mindfulness practices are available for anyone to try and can be a beneficial part of an evening routine to help wind down and prepare for sleep.

Testing for Sleep Disorders

There are several tests that can assess for sleep disorders, including home sleep apnea tests, clinical sleep studies (polysomnography), and actigraphy. At-home sleep apnea testing is a cost-effective, simple test to help identify if breathing difficulties are contributing to poor sleep quality since sleep apnea is one of the more common causes of poor sleep in depressed individuals.  

Polysomnography is typically done at a sleep center and involves recording brain waves, oxygen levels, heart rate, breathing, and eye/leg movements during sleep to help diagnose sleep disorders. Based on the data gathered, an individual is able to get a more personalized treatment plan to help them sleep better and often leaves with a diagnosis related to their poor sleep.

Actigraphy involves a wearable piece of technology that gives feedback about sleep-wake cycles and other sleep parameters and is more reliable than self-reported sleep journals for those suffering from sleep problems with depression. The user wears something similar to a wristwatch, collecting data to help with clinical correlations of sleep disturbances.

Functional medicine testing can also help provide a bigger picture of what’s contributing to poor sleep as well. The DUTCH Plus by Precision Analytical (which looks at cortisol levels as related to insomnia), can help identify if neurotransmitter imbalances or abnormal cortisol levels are contributing to poor sleep quality.  

Altogether, results from sleep testing can help identify why a depressed individual may not be sleeping well and tailor a treatment plan to promote better sleep patterns.

Seeking Professional Help

Suffering from chronically poor sleep doesn’t have to be accepted as the “norm.” It’s essential to seek professional help if you’re sleeping poorly, whether it's having trouble staying asleep or falling asleep. Sleep specialists, CBT-I-trained professionals, psychiatrists, and therapists may all be able to play a role in supporting sleep for depressed individuals, depending on the root cause of sleep issues. Additionally, functional medicine practitioners can help identify and outline nutrition and lifestyle recommendations, in addition to functional lab testing, that can help promote healthy sleep patterns.

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Depression and Sleep Disorders: Key Takeaways

Supporting optimal sleep quality is an essential component of any treatment plan for depression, particularly in cases where sleep is being chronically affected. Utilizing lifestyle changes such as exercise prescription, mindfulness and relaxation techniques, nutrition, supplements, and therapy, alongside guidance from a sleep-trained professional, can help improve sleep and positively impact the management of depression.