Depression and Insomnia

By Dr. Gregg D. Jacobs

Everyone feels sad or blue at times. However, about 10-20% of Americans experience clinical depression at some point in their lives and the numbers are growing. Insomnia is a hallmark symptom of depression; some depressed individuals may instead exhibit excessive sleep, called hypersomnia. Insomniacs also exhibit higher levels of depression than normal sleepers, although they generally do not have higher levels of depression than patients with other health problems such as pain, infertility, or heart diseases.

Furthermore, the majority of patients who visit their doctor with a primary complaint of insomnia do not have a diagnosable depressive disorder. And for those patients who do, research has shown that, for some of these individuals, depression can be the consequence of insomnia, not the cause.

Depressed people exhibit a number of other sleep disturbances in addition to insomnia, including reduced deep sleep, increased light sleep, and excessive dream sleep. They enter dream sleep earlier in the night and spend a greater percentage of time in dream sleep than nondepressed individuals. Research also suggests that the dream content of depressed people is more depressing than that of nondepressed people.

Another physiological abnormality associated with depression is a flattened body temperature rhythm; that is, a depressed person's body temperature does not rise and fall as much during the day as that of a nondepressed person. Interestingly, insomniacs exhibit the same problem with their body temperature rhythm. This irregular rhythm in depressed people, which may be the result of the increased fatigue and reduced physical activity that accompanies depression, may ultimately exacerbate insomnia and depressed mood.

To help you determine whether you have major depression, think about whether you have experienced either a relatively prominent, persistent depressed mood nearly every day for a two week period in the past few months or loss of interest or pleasure in almost all usual activities or pastimes. If you have experienced either of these two symptoms, you may have clinical depression and should consider seeking professional evaluation.

Although insomnia can be an important symptom of depression, it is not equivalent to depression. There has been a consistent tendency for both insomniacs and health professionals to conceptualize insomnia as a psychiatric problem, which is erroneous and leads to ineffective treatment. The majority of cases of chronic insomnia are caused by cognitive and behavioral factors, not psychiatric factors, and must therefore be treated with cognitive-behavioral therapy, not psychotherapy or antidepressant medication. . Regarding insomnia as a psychiatric disorder just reinforces the stigma associated with insomnia and diminished self-esteem.