Depression Treatment - Sleep

The relationship between sleep and depression is complicated—on the one hand, changes in sleep are a symptom of depression itself; on the other hand, sleep problems can cause depression-like symptoms that go away if the sleep problem is adequately treated. Thus, for a person with significant sleep and depressive symptoms, evaluation by a medical or mental health professional is important.
However, what is generally true is that sleep problems can make people vulnerable to developing depression (Baglioni et al., 2011) and that improving sleep in people who are depressed can reduce overall depression symptoms. Most studies looking at the effect of treating sleep in depression have focused on people who have both insomnia (persistent difficulty falling and staying asleep) and depression. Among those with insomnia and depression, treatment with sleep-focused psychotherapy (Manber et al., 2008) or sleep medication can improve depression in addition to insomnia symptoms. 
 
What Does Healthy Sleep Look Like?
 
There are three major factors that are important to consider when thinking about establishing healthy sleep:
1. Regular sleep schedule.  Does a person go to bed and wake up at roughly the same time each day? In general, more regular sleep schedules promote better mood and highly irregular sleep schedules can trigger depressive symptoms, especially in people with Bipolar Disorder.   
2. Amount of sleep a person gets in a 24-hour period. The “8-hour” rule is a widely believed recommendation that people need 8 hours of sleep per night to stay well-rested and healthy. Eight hours is a good guideline but the amount of sleep required for individual people to feel their best is widely variable. Although relatively rare, some people function well with as little as 6 hours of sleep per night. Other people feel at their best with 9 hours of sleep. 
3. Sleep quality. Even if a person sleeps 8 or 9 hours, if the sleep is perceived as frequently interrupted or restless, a person may be left feeling poorly rested and vulnerable to depression. Sometimes sleep quality can be improved using behavioral strategies described in the next section. In other cases, disrupted sleep may be related to another health condition such as Restless Legs Syndrome or Sleep Apnea, which can be evaluated and treated by a sleep specialist or other medical professional.
 
What does Sleep Treatment for Depression Look Like in Action?
 
There are several different treatment methods for addressing sleep problems in depression. A common approach is to focus on general strategies for promoting healthy sleep, sometimes called “sleep hygiene.” Sleep hygiene may include:
 
• Creating a bedtime routine to settle down and prepare the mind and body to sleep
• Avoiding caffeine, especially in the 6-8 hours prior to bedtime
• Making the environment comfortable for sleep (e.g. adjusting temperature, minimizing noise)
• Avoiding exposure to bright light or bright device screens prior to bedtime because certain types of light can disrupt the bodies natural drive to become sleepy
 
Another treatment strategy is Cognitive-Behavioral Therapy for Insomnia (CBT-I), a form of Cognitive Behavioral Therapy that is specifically designed for difficulty falling or staying asleep. Although CBT-I is designed as a stand-alone treatment for Insomnia, it has also been used as a treatment for depression that occurs along with insomnia and shown to be effective in reducing depressive symptoms (Manber et al., 2008). In CBT-I, the focus is on changing a person’s behaviors in a way that helps the body more strongly associate being in bed with being sleepy. People may also learn techniques for managing difficult thoughts and emotions that can occur when they are lying awake in bed and to adopt more realistic ideas about sleep.    
 
Medications are a common method for treating sleep problems, including those that occur with depression. There are several over the counter medications for sleep. In addition, prescription medications such as Ambien or Sonata may be used. Certain antidepressants, such as Tricyclics , can be helpful for sleep problems in addition to deceasing other depressive symptoms (Thase, 1999). 
 
Medication and behavioral strategies have different plusses and minuses. Medications may be more fast-acting than sleep hygiene or CBT-I techniques. However, most people find if they stop taking sleep medications, their sleep troubles return. Because behavioral strategies are new skills that a person carries with them for life, improvements in sleep quality are often more enduring for treatments like CBT-I than for medication.
 
Sources

  • Baglioni, C., Battagliese, G., Feige, B., Spiegelhalder, K., Nissen, C., Voderholzer, U., . . . Riemann, D. (2011). Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord, 135(1-3), 10-19. doi:10.1016/j.jad.2011.01.011
  • Manber, R., Edinger, J. D., Gress, J. L., San Pedro-Salcedo, M. G., Kuo, T. F., & Kalista, T. (2008). Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep, 31(4), 489-495. 
  • Thase, M. E. (1999). Antidepressant treatment of the depressed patient with insomnia. J Clin Psychiatry, 60 Suppl 17, 28-31; discussion 46-28.