The Relationship Between Depression and Sleep

    Sleep disturbances and depression have a complex, bidirectional relationship – not only can depression cause sleep problems, but chronic sleep issues can also lead to depression. Understanding this relationship is crucial as it helps us to establish effective strategies for managing both conditions. 

    There were several months a few years ago when I was in the hospital for weeks on end being treated for leukemia. And approaching that time, and during my hospital stay, I began sleeping more and more which was due to low hemoglobin. But there are other things that interrupt sleep patterns as well. In the hospital, I slept upwards of 20 hours per day if I could. They constantly wake you up though.

    Part of the reason I slept so much in the hospital was because they were giving me pain medication instead of treating my worsening sciatica. So there's something to be said for speaking up and making sure that doctors treat symptoms that you deem important to yourself. Otherwise, they will simply ignore it. They only gave me pain medication to fix my leg pain and never really looked into why I had leg pain when I was being treated for cancer.

    My leg pain ended up being sciatica from stenosis, spondylosis, and bulging discs. It presented as pain in my groin, glutes, lower back, knees, and all sides of my quadriceps, and at worst it reached my feet and ankles. But while I was being treated for cancer, they had me trying to walk laps around the unit. And that's normal. However, it wasn't helping my leg pains.

    After I was done with most of my cancer treatments, I badgered my general doctor to help me figure out why I had so much pain. I had even gone through 2 1/2 years of physical therapy, and the pain still was not diagnosed and was not getting better. In the end, I was prescribed Gabapentin which let me sleep more. My sleep has dwindled to sometimes 0 or 30 minutes per day. But with the gabapentin letting me pay too much attention to the pain, I was able to sleep upwards of 12 or more hours per day.

    As of now, I sleep 12 or more hours a day a few days a week. And then it declines for several days down to maybe two hours a day. And then it climbs back up and ends up being 12 hours again or 14. Another medication that helps my sciatica(I finally did get a diagnosis after an MRI and badgering my general doctor) is Tzanadine, a muscle relaxer. Outside of Gabapentin and Tizanidine, I'm doing much better. Along with about 12 to 18 hours per day of laying down. 

Here's a deeper dive into the topic of better sleep to solve depression:

1. Depression Leading to Sleep Problems: People suffering from depression often have difficulty falling asleep, staying asleep, or feeling refreshed after sleep. This is because depression can disrupt the sleep-wake cycle, causing insomnia (difficulty falling or staying asleep) or hypersomnia (excessive sleeping). In fact, insomnia is one of the most common symptoms of depression, experienced by about 75% of depressed patients.

    I have also found that pain interrupts and increases depression because of less sleep. So it's more of a vicious cycle. You almost have to solve both pain and depression at the same time if they are found together.

To help me understand my sleeping patterns I use a ring that is produced by Oura ( you would like a discount, please let me know, I have 5 referral links that will give you $40 off for an order for the rings, first come first serve. I do not get anything in return, you just get a discount. The Oura ring also lets me know what my blood oxygen levels are when I sleep, and lets me know how much deep sleep, light sleep, and REM I get as well. 

2. Sleep Problems Contributing to Depression: On the flip side, chronic sleep problems can also contribute to depression. Persistent lack of sleep affects the brain’s neurotransmitters that regulate mood, including serotonin, potentially triggering depressive symptoms.

    Part of my depression was solved with Gabapentin because it interrupted the neurotransmitters that let me fall asleep. When I was in the hospital every once in a while to go in for the pain, they would give me either Norco or ketamine, and either one of those would let me sleep or fall asleep, but ultimately I could take gabapentin at home, and achieve the same thing. I did not do this alone; I'm not a doctor, but these have been my experiences. You should check with your doctor if this is occurring for you.

3. Insomnia and Depression: Insomnia is often a hallmark of depression. While everyone experiences occasional restless nights, people with depression often struggle with prolonged periods of insomnia. This can exacerbate feelings of sadness, irritability, and fatigue, and it can make other symptoms of depression feel more intense.

    I don't know that I have insomnia, but I do have many nights where I only get a few hours of sleep. It does make you sad and irritability, fatigue, all of that leads to not being able to concentrate on tasks, or studying for school.

4. Hypersomnia and Depression: While insomnia is common in depression, so too is hypersomnia. Some people with depression find it hard to get out of bed and can sleep for long periods during the day, which can disrupt everyday routines and exacerbate feelings of isolation.

    It is hard for me to stay positive when I get little sleep, but I'm sure that I don't have hypersomnia, my doctors have never mentioned it. 

5. REM Sleep and Depression: Rapid Eye Movement (REM) sleep, the stage of sleep where dreaming occurs, has been found to be different in people with depression. They often enter REM sleep quicker and have less deep, restorative sleep, which can lead to feeling groggy and unrefreshed in the morning.

    I feel much better when I have dreamt during sleep. I also like that the Oura ring seems to corroborate the instances of when I sleep. 

6. Sleep Apnea and Depression: Sleep apnea, a disorder characterized by repeated pauses in breathing during sleep, has been linked to depression. The chronic sleep disruption caused by sleep apnea often results in excessive daytime sleepiness, fatigue, and feelings of depression.

    Many years ago, I was diagnosed with apnea with an index of 16.4. Being told that my oxygen levels were low during apnea bouts and that low oxygen was a culprit in my arterial disease, which led to a widow maker heart attack for me. The year that happened I changed a lot about my diet.

    One of the things that seems to happen to people when they have either heart attacks or cancer or anything like that, is that either your spouse or your family seems to shrink away and not spend as much time with you afterward. It is as if you don't exist as much as you did. And it's kind of depressing. This could be all in my head, however, but that was my perception. After taking meds for depression and getting better sleep, that notion went away mostly.

    Understanding this interplay between sleep and depression can help highlight the importance of seeking professional help if you're experiencing persistent sleep issues or depressive symptoms. Strategies such as maintaining good sleep hygiene, cognitive-behavioral therapy, and, in some cases, medication can be beneficial in addressing these issues.

    Remember, this information is intended to increase awareness and is not a substitute for professional advice or treatment. If you're struggling with depression or sleep problems, it's important to reach out to a healthcare provider for assistance.


Paul Norg said…
Here is an update. My leg pain has been further diagnosed. I have necrotic femoral heads on each of my thigh bones. And this December, 2023 I will be undergoing bilateral hip joint replacement. This should alleviate most of the pain after I get done recovering. I'm very anxious at this time.

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