Yet another restless night. And then the alarm goes off. Maybe you woke up throughout the night. Maybe you woke too soon.
But listen closely. Your insomnia may be sounding the alarm that something might be wrong. You could have depression.
"We think 25 percent or more who have depression also have insomnia, which is a very common complaint," says Phyllis Zee, M.D., Ph.D., director of Northwestern Memorial Hospital's sleep disorders center in Chicago. "One of the symptoms of depression is insomnia."
People who are depressed may have trouble falling asleep, wake often throughout the night or simply wake too early. Mostly, people with depression have problems staying asleep and waking up too early, Zee says.
"They wake up at three and can't go back to sleep," Zee says.
Higher risk of depression
Not only could insomnia be a symptom for depression but insomnia could be a risk factor for depression, according to the National Sleep Foundation (NSF).
People start to feel lousy about their life and start obsessing about their insomnia. They might feel like they're not in control. It's a downward spiral into negative thinking, which can be enough to trigger depression.
Insomnia can affect your quality of life, productivity and safety. People with insomnia tend to miss more time from work or receive fewer promotions. To top it off, people usually miss work more often because of depression as well.
"People may be predisposed to insomnia just like depression," Zee says. "It's a trait, something you may be born with. And how you react to stressful events could be a marker for insomnia later in life."
Finding the cause of the insomnia is not as simple as saying it's depression.
"Insomnia is often associated with changes in mood," Zee says. Short-term insomnia that may persist for a week or two does not mean you have a chronic problem with either insomnia or depression. It could be you are stressed about work or just lost a loved one. Depression can persist for months or years.
Also, insomnia could be caused by physical problems such as sleep apnea and restless legs. In older people, having to go to the bathroom at night and prostate problems are common causes of sleep disruption.
Symptom or trigger?
"It can be hard to tell which comes first - insomnia or the depression - and what is the real problem," says Joyce Walsleben, Ph.D., R.N., research associate professor of medicine at New York University's School of Medicine and diplomate of the American Academy of Sleep Medicine. "Both sleep and mood use the same brain chemical. When this chemical is out of balance, sleep symptoms or depression can develop."
The brain has a chemical called serotonin, which is a neurotransmitter that controls mood and sleep. Serotonin modulates deep, consistent sleep. If you have low amounts of serotonin in the brain, sleep can be fragmented. When levels of serotonin are brought up to normal, sleep falls into place.
Because depression and insomnia are so closely linked, a bout of insomnia could signal the return of depression, she says.
"You would like to catch it earlier than later. If you have ever been depressed, take that hint and go to the doctor," Walsleben says.
Keep a journal of your sleep and mood to show your doctor.
Sleep tips from NSF:
- Keep a regular sleep schedule. Do this even on weekends.
- Avoid caffeine. Caffeine is a stimulant, which means it can produce an alerting effect. Don't drink caffeine within six to eight hours of going to bed.
- Avoid nicotine. Nicotine is a stimulant. Smokers also have withdrawal symptoms.
- Avoid alcohol. Alcohol actually disrupts sleep.
- Don't eat or drink too much close to bedtime. Eating or drinking too much may make you less comfortable when settling down and it can also cause heartburn.
- Exercise at the right time promotes sleep. Exercising regularly makes it easier to fall asleep and contributes to sounder sleep. However, exercising before going to bed makes falling asleep difficult by making you more alert. Finish your exercise at least three hours before bed.
- Use relaxing bedtime rituals. A relaxing, routine activity right before bedtime signals your body that it's time to go to sleep. Soak in a hot tub, read, listen to music or get a massage.
- Create the right environment. Make sure your room is cool, quiet, dark and comfortable. Use blackout curtains, eyeshades, earplugs, "white noise" machines and humidifiers.
- Associate your bed with sleep and sex only. Use your bed only for sleep and sex, and don't work in bed or watch television.
- Keep a "worry" book. In the afternoon, jot down notes in a "worry" or "to do" book. That's to keep the worry away from bedtime.