Insomnia is a common symptom of depression, but the relationship between the two is complex. For some, insomnia only occurs when they are experiencing a depressive episode. For others, insomnia may be a pre-existing problem that contributes to, or overlaps with, depression.
It is difficult to say if depression directly causes insomnia, and if so, how. Many factors influence sleep, such as brain chemistry, behavior, stress, and more. Any of these could play a role in depression-related insomnia.
However, depression and insomnia are treatable. Some may find treatment for their depression improves their sleep. If not, a doctor may suggest combining strategies to improve sleep with mental health treatment.
Read on to learn more about whether depression causes insomnia, and what may help.
Yes, insomnia is a
- difficulty getting to sleep
- difficulty staying asleep
- waking up too early
Some may also have a mixture of insomnia and excessive sleep, which is also a symptom of depression.
Both primary and secondary insomnia have links to depression. Primary insomnia occurs with no obvious underlying cause, while secondary insomnia does have an underlying cause.
Secondary insomnia
Depression-related insomnia can also be acute or chronic. Acute insomnia causes symptoms for
There are many ways in which depression could impact sleep. Insomnia may occur as a result of:
- Behavior changes: Depression can result in behavior changes that then affect sleep. For example, a person may begin using screens more often in the evening, drink more caffeinated or alcoholic drinks, or sleep in late, making them less tired at bedtime.
- Psychological changes: Stress is a
risk factor for depression and may cause a person to ruminate on problems and negative thoughts. If a person often does this at bedtime, it may be difficult to sleep. This may make bedtime stressful in itself, creating a vicious cycle of stress and sleeplessness. - Physiological changes: Depression impacts a person’s brain chemistry, brain activity, and hormones, which may be another mechanism behind depression-related sleep problems.
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The researchers found that people with major depression and primary insomnia displayed several similarities. They:
- woke up more frequently after falling asleep
- had shorter periods of slow-wave/rapid eye movement (REM) sleep
- exhibited changes in the first and last third of sleep, including deficits in REM sleep and excessive wakefulness
These similarities in people with each condition suggest that the mechanisms behind both are similar. This could explain why depression and insomnia often occur together, or why one may trigger the other.
Yes, antidepressants can sometimes cause insomnia. A person may experience new or worsened insomnia, particularly when they first begin taking antidepressants. This can get better with time, but it depends on the individual.
Certain antidepressants can also have sedative effects. How well these work as an insomnia treatment remains unclear.
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People who experience insomnia and depression should mention this to their doctor, especially if they are considering trying an antidepressant.
If a person believes a drug they are already taking could be contributing to insomnia, they should discuss options with a medical professional.
Doctors use the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to diagnose mental health conditions, including depression. It lists nine symptoms, each of which can manifest in different ways. They
- sleep changes
- a reduction in the ability to feel pleasure
- feelings of guilt or worthlessness
- fatigue or loss of energy
- a depressed mood
- thoughts of suicide
- unintentional changes in weight or appetite
- feeling physically agitated (e.g., pacing)
- difficulty concentrating, or brain fog
A person needs five of these symptoms to meet the criteria for a depression diagnosis. Symptoms may also change over time.
If a person’s insomnia occurs secondary to depression, then treating the depression may improve sleep. There are also self-care strategies people can use to aid sleep alongside their mental health treatment.
- Sleep hygiene: This refers to practices that promote a regular sleep-wake schedule, such as waking up at the same time each day, eating meals at regular times, reserving the bedroom only for sleep or sex, and avoiding evening activities that disrupt sleep, such as drinking alcohol or using electronic devices.
- Sleep restriction therapy: This involves limiting the length of time a person sleeps to increase tiredness, resulting in better or longer sleep. This approach may help a person resume a typical sleep-wake schedule again.
- Relaxation therapy: This can help calm stress and anxiety. People may find it helpful to try gentle forms of yoga, tai chi, meditation, or other techniques every evening.
- Cognitive behavioral therapy for insomnia (CBTi): This is a specialized form of cognitive behavioral therapy to treat insomnia. It encourages a person to reframe their thoughts, with the aim of changing behavior and improving their sleep.
On nights when a person cannot sleep, it is best to leave the sleep area and do something calming. This may help to reduce stress and prevent a person from forming negative associations with sleep.
Only try sleep medications when other interventions do not work. Some of these medications can cause addiction and are only safe to use short-term.
A person should speak with a doctor if they have a low mood, difficulty sleeping, or both. They should also contact their doctor if:
- self-management has not improved symptoms of insomnia
- depression treatment could be making insomnia worse
- their symptoms have become severe
Anyone with thoughts of self-harm or suicide should seek support as soon as possible.
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Insomnia and depression commonly occur together. One may cause or contribute to the other, and
Managing both depression and insomnia may feel overwhelming, but both are treatable. This may involve behavior changes to promote sleep, as well as treatments that address depression itself, such as therapy. In some cases, people may need a dedicated intervention for insomnia, such as CBTi.