Is there a connection between depression and insomnia?

Q:  I have been diagnosed with depression.  What I don’t understand is if insomnia is only a symptom of depression and not a disease by itself, how did I get insomnia in the first place?

A:  You are right that insomnia is invariably only a symptom of something else going on deeper that is causing the sleep problems.  You are also right that insomnia is often correlated with depression, although the direction of causality is often not clear.

Are we depressed because we can’t sleep?  Or is it we can’t sleep because we’re depressed?  Maybe a little of both?

Medical surveys show up to 80% of patients with depression have insomnia, and those with chronic insomnia are up to three times more likely to develop depression.  The conditions seem to be two distinct but overlapping phenomena.

In treating insomnia some doctors prescribe pills to unnaturally force sleep, but many healthcare professionals take the position that in some cases sleeping pills may do more harm than good.  That’s because sleeping pills by themselves are only treating the symptom (sleep), not the true underlying cause for the insomnia, and tend to reinforce the idea that the solution to insomnia is external and resides out of one’s self-control.

On the other hand, depression is a legitimate psychiatric condition that is treatable with drugs as well as cognitive therapy, and by successfully treating depression sleep may well improve.  Interestingly, studies have also shown nondrug cognitive therapy can actually work better and faster than drugs to both lift depression and improve sleep, and the results can be sustained long term.

One compelling reason why cognitive therapy is so effective on both insomnia and depression is because both conditions are often characterized by underlying patterns of recurring negative thought distortions.

Distortions of rational thought are often at the root of many psychiatric disorders like depression and generalized anxiety disorder, both of which are correlated with insomnia.  Similarly, negative and often inaccurate thoughts specifically about sleep also tend to fuel and perpetuate insomnia.

One of the best self-help resources on cognitive therapy for depression is the book “Feeling good:  New mood therapy” by psychiatrist David Burns.  In his book Dr. Burns cites his own research as well as the findings of other medical researchers showing sometimes nearly immediate and lasting improvement of depression symptoms as the patient comes to understand how his or her underlying concepts and attitudes are unrealistic, distorted, and overly pessimistic.

The same holds true with sleep.  The nondrug methods in a good cognitive behavioral therapy-based sleep training program combine cognitive therapy with powerful behavioral tools like stimulus control and sleep hygiene.  Together, the two are an exceptionally effective way to improve sleep.

So your question somewhat defies a direct answer.  But you should be reassured that both your depression and insomnia are treatable as you come to grips with their true root causes.

Explore posts in the same categories: Depression, Insomnia, sleep

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