When Depression and Insomnia Collide

By Greg Moellmer
Greg Moellmer is a fourth-year medical student at the University of Utah. He is pursuing a career in diagnostic radiology.

Depression and insomnia are two conditions that often go hand in hand. Although some depressed individuals will sleep too much, up to 85 percent of those who suffer from depression report not being able to sleep enough. Those who suffer from persistent insomnia also have a higher likelihood of developing clinically significant depression. Also, insomnia is often the first symptom to appear at the beginning of a depressive relapse, and the last to go away.

Although the two conditions commonly occur together, it is difficult to say which one causes the other. Depression — and its partner-in-crime, anxiety — can keep the mind racing, preventing sleep. However, it is also likely that chronic loss of sleep worsens depression symptoms.

Mental health professionals agree that treating both conditions simultaneously can provide the greatest benefit. Just as depression can be treated with both therapy and medications, insomnia can also be treated through various tactics.

If you have talked with a healthcare professional before about insomnia, he or she has probably given you the following recommendations known as “sleep hygiene.” They are worth hearing again, as they offer effective help without a co-pay or side effects.

• Make your bedroom a place only for sleep and sex. No watching television, reading or updating your Facebook status.
• Keep your room dark, quiet and cool.
• Go to sleep and wake up at the same time every day. Keep this schedule even on the weekends.
• No caffeine after noon. Coffee should be consumed only for breakfast.
• Nightcaps are a no-no. Alcohol may help you fall sleep initially, but it decreases the quality of sleep.
• Exercise everyday. I know, another doctor telling you to exercise. But it works.
• Don’t nap.
• Don’t force sleep. If you can’t fall asleep, instead of staring at the ceiling, get up and do something quiet until you start to feel tired. Sleep specialists discourage television or computer use right before bedtime, as the lights from these devices stimulate your brain.

If these tricks don’t help, you may consider discussing the use of medications with your healthcare provider. Medicines for sleep are best used as a method to help you return to a normal sleep pattern, not as a permanent solution. Medication also may help to alleviate the fear that many insomniacs have of not being able to fall asleep.

Although there are some over-the-counter sleep medications, most of these rely on antihistamines to sedate. As such, they are typically only effective for short periods of time, as many individuals will become tolerant to the sedating effects.

You may also experience unwanted side effects such as dry mouth, and a “hung-over” feeling the next morning. If your insomnia appears only sporadically, these OTC options make be a good choice. However, the persistent insomnia that frequently accompanies depression may require use of prescription medications. These medications have the potential to interact with other medicines, and most also carry the potential for dependence and abuse. As such, be sure to carefully discuss this decision with your healthcare provider.