Insomnia that lasts for an extended period is the symptom of another, more serious problem, and in many cases, problems getting to sleep, staying asleep, or sleeping long enough are related to psychological problems. It is often difficult for people who are suffering from insomnia, or who have a loved one going through it, to remember that insomnia is less a condition in and of itself than a symptom of another problem. In the case of depression, insomnia is such a pervasive symptom that it is actually rare to make a diagnosis without sleeplessness being present. In fact, about half of all patients who have a sleep problem serious enough to send them to a sleep lab have an underlying, often undiagnosed depression.
Depression is a psychological problem that can cover a wide range of emotions. For some, depression is experienced as a mild sense of sadness or hopelessness that is characterized by a diminished level of happiness or enjoyment in every day activities. For others it can be a much more overwhelming experience in which everything in life is tinged by melancholy and a sense of hopelessness.
Depression’s impact on sleep varies from patient to patient, but in most cases it makes sufferers wake up two to three hours earlier than normal and unable to go back to sleep. Others find that they are unable to fall asleep in the first place, while still others wake up repeatedly throughout the course of the night. In ten to fifteen percent of depression patients the problem is sleeping too much. Depressed patients are in a constant state of drowsiness, unable to rouse themselves and spending too much time in bed. Sleep studies done on patients suffering from depression have detected a pattern in which they go into the Rapid Eye Movement phase of sleep far earlier than is normal and experience too little of the deep and restful sleep that is needed in order to wake up feeling refreshed each morning. This explains why they so frequently wake up in the middle of the night and why their sleep is shortened.
There is an obvious “chicken and the egg” aspect to depression, sleep, and why those suffering from this condition experience such a disruption in satisfaction with their lives. Does the depression cause sadness that then prevents sleep, or does the depression cause lack of sleep, which then causes a sense of unhappiness. We certainly know that lack of sleep colors our experience of the world. Patients who are experiencing depression often remove themselves from other enjoyable aspects of life, including eating and interacting with others.
Successfully treating a patient’s depression generally eliminates their sleep problems as well, but interestingly it is often the insomnia that leads to the diagnosis of depression that leads to a cure. Depression, like other psychological diagnoses, has so many negative associations attached to it that sufferers are hesitant about seeking treatment and being labeled as having a mental illness. In many cases, seeking treatment for insomnia is what allows depressed people to restore their life to normalcy.