INTRODUCTION
Depression and sleep disorders are often intertwined, creating a harmful cycle for emotional, physical, and mental health. In a stressful city like New York, where stress levels are high and sleep is sacrificed, the relationship becomes even more significant.
Understanding how depression can hamper sleep and how lack of sleep can exacerbate depression will help you take the steps toward healing. In this blog, mental health practitioners in NYC share their views on overcoming unhelpful cycles and navigating the path to productive nights of rest.
Understanding Depression
Depression is a very common yet serious mental health disorder that greatly affects how a person feels, thinks, and acts. It is mainly characterized by ongoing feelings of sadness, a significant loss of interest or pleasure in activities that were once enjoyed, and hopelessness or worthlessness.
- People suffering from depression may also have fatigue, changes in concentration, or can have recurrent thoughts of death or suicide.
- The World Health Organization says that 280 million people globally have Major Depressive Disorder (MDD), while depression is one of the most prevalent mental illnesses affecting quality of life on a global scale.
- One of the most common and disruptive symptoms of depression is sleep disturbance.
- Sleeping too much (hypersomnia) or not sleeping enough (insomnia) is not just a side effect of depression, but is the core of the diagnosis of depression and symptoms related to sleep are even included in the diagnostic criteria of the disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).
- Other physical and emotional symptoms can be related to depression like changes in appetite, little energy, and constant feelings of guilt or low self-worth that complicate the daily living experience for those with depression.
Types of Sleep Disorders Linked with Depression
Multiple Sleep Disorders can be closely connected with depression, sometimes intensifying symptoms and complicating a person’s recovery.
- The sleep disorder that is most likely associated with depression is insomnia, in which an individual can have difficulties falling asleep, staying asleep, or waking up too early and failing to feel well-rested.
- Insomnia is commonly a part of the cause of depression, and insomnia might sometimes manifest in depression as depression is developing.
- Hypersomnia, or excessive daytime sleepiness, or sleeping longer at nighttime, is also relevant in relation to depression. About 15% of people with depression and hypersomnia are younger or have atypical depression.
- Obstructive Sleep Apnea (OSA) is another sleep disorder that is well-documented in its relation with depressive symptoms, in which people experience repeated interruptions in their breathing during sleep.
- OSA is strongly associated with depressive symptoms, and studies have shown that treatment of OSA with CPAP (Continuous Positive Airway Pressure) is effective in improving relations of mood and improving overall mental health.
- Restless leg syndrome (RLS) is a movement-related sleep disorder bearing mention, in that RLS symptoms manifest as an irresistible urge to move one’s legs due to uncomfortable sensations, with sleep disruption being common in RLS.
- Chronic sleep loss and discomfort from RLS results in risk for depression. Identifying sleep disorders and addressing those sleep disorders can improve mental health.
Bidirectional Relationship Between Sleep and Depression
Sleep and depression coexist in a bidirectional relationship—one can impact, severity, and influence the other.
How Depression Affects Sleep
- Depression frequently impacts sleep due to disturbances in neurochemistry, which are tied to the neurotransmitters serotonin, norepinephrine, and dopamine, which motivate mood regulation and sleep.
- Further, depression is also associated with overactivity of the hypothalamic-pituitary-adrenal (HPA) axis, such that the overall level of stress hormones (e.g., cortisol) are elevated, this leads to disturbances of sleep cycles and interferes with sleep, contributing to insomnia and/or restless sleep.
- In addition, people struggling with depression often engage in persistent negative thought patterns, and ruminate (think persistently) about the past or worry about the future.
Thought patterns can interfere with the ability to fall asleep after nightmares, return to sleep after awakening, or both, which creates a cycle to reinvigorate or contribute to the impacts of both sleep problems and continuing depressive symptoms.
How Sleep Disorder Worsen Depression
Sleep disorders complicate depression, as it has been shown that insufficient sleep diminishes the brain’s ability to regulate emotions, including sadness, irritability, and emotional instability.
- When individuals experience less than adequate sleep, they become less psychologically resilient, and they have a much harder time adapting, problem-solving, and managing the stress of daily living, which are all necessary skills when dealing with depression.
- Further, failing to obtain restorative sleep can impede neuroplasticity, which is the brain’s ability to heal itself, and form new neural connections within the brain.
- In summary, poor sleep results in poor emotional recovery, and may increase the duration or intensity of depressive episodes.
Poor sleep is thus a contributing factor not only to depressed mood, but also to obstacles to effective treatment, and durable recovery.
Biological Mechanism of Sleep Pattern
The biological processes involved in sleep disorders and depression are complex and intertwined.
- A primary consideration is circadian rhythm disruption or misalignment. The human body’s circadian rhythm refers to the internal clock that regulates the 24-hour cycle of sleep and awake periods, as well as many other processes in the body.
- Individuals who are depressed have impaired circadian rhythm, which often leads to underwent sleep disruption, such as delayed sleep phase disorder. This misalignment may take the shape of healthily devoted sleep, but also has the potential to induce or maintain a depressive episode.
- Another biological process at play in sleep and depression is sleep abnormalities in rapid eye movement (REM) sleep. Depressed people enter REM more quickly and exhibit greater density in REM sleep than healthy, well-functioning individuals.
- Since REM sleep is associated with effective emotional processing, impairment of REM sleep will therefore impede the ability to regulate emotional distress over prolonged emotional and cognitive misalignments, such as depressed episodes.
- Serotonin dysregulation is also an important contributor. Serotonin is a neurotransmitter involved in mood regulation and the capacity to attain sleep.
- In depressed individuals, low serotonin not only creates mood disruptions but also inhibits the capacity to enter deep or good quality sleep which produces a cyclical pattern of poor sleep, depression and then more poor sleep.
These unique biological processes reflect the importance that sleep has on mental health.
NYC Therapists Share Evidence-Based Treatment Insights
- Cognitive behavioral therapy for insomnia (CBT-I) is considered the first-line treatment for insomnia whether it exists with depression or not.
- CBT-I addresses negative thoughts and behaviors about sleep using stimulus control therapy, sleep restriction, relaxation training, and sleep hygiene.
- Research has shown that CBT-I not only improves sleep quality but also reliably reduces depressive symptoms.
- Even when pharmacological treatment is used, certain antidepressants, such as Trazodone, Mirtazapine, and Doxepin, are used because of their sedative side effects and the ability to help stabilize mood and improve sleep.
- Some SSRIs and SNRIs can cause worsening insomnia, so it is important to obtain the right psychiatric consultation on the individual.
- Chronotherapy involves waking up and sleeping earlier in the morning and introducing bright therapy light (especially in the morning) in order to realign circadian rhythms, especially for seasonal affective disorder (SAD).
- For those with both obstructive sleep apnea (OSA) and depression, CPAP therapy can provide substantial improvements in mood and sleep quality.
- In addition, facilitating other healthy lifestyle strategies (e.g., regular exercise, taking caffeine and alcohol out of the diet, developing consistent sleep schedules/routines, and limiting screen time in the evening all can promote healthier sleep and improve emotional well-being).
When to Seek Help in NYC
If you’re battling persistent sleep problems along with feelings of sadness, hopelessness, or persistent fatigue, you shouldn’t ignore them.
- Seeking assistance from a licensed professional as soon as possible can have a positive impact on your healing process.
- Mental health professionals can provide individualized treatment through diagnostic assessments and therapy and prescribe medication when necessary.
- In cities like New York City, there are a wide network of mental health professionals who specialize in providing both therapeutic and pharmacological methods for both depression and sleep disorder in a single treatment plan, so you are able to restore the important balance in mental health sleep difficulties can affect.
Final Thought
Depression and sleep disorders often cycle back on one another, which can have far-reaching implications for mental, emotional, and physical health and wellness.
- If you know about the connection between sleep and mental health and you seek the right, evidence-based treatment in a timely manner, there is a good chance you can affect real change.
- Whether it’s cognitive behavioral therapy or chronotherapy, CPAP or medication, depression therapists in New York offer a wide range of methods and approaches for individualized treatment.
- Remember that whether you are experiencing insomnia, hypersomnia, or mood instability, you don’t have to tackle these issues on your own.
Depression therapists in NYC can help you break the cycle and start gaining control over your sleep and emotional health, through the right support and expert care.
Reference
- Depression. (2025, June 2). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9290-depression
- World Health Organization: WHO & World Health Organization: WHO. (2023, March 31). Depressive disorder (depression). https://www.who.int/news-room/fact-sheets/detail/depression
- Nutt, D., Wilson, S., & Paterson, L. (2008). Sleep disorders as core symptoms of depression. Dialogues in Clinical Neuroscience, 10(3), 329. https://doi.org/10.31887/DCNS.2008.10.3/dnutt
- Karamanlı, H., Kayhan, F., & Akgedik, R. (2016). Depressive Symptoms in Patients with Obstructive Sleep Apnea. Turkish Thoracic Journal, 17(3), 109. https://doi.org/10.5578/ttj.30506
- Restless legs Syndrome. (2025, June 2). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9497-restless-legs-syndrome
- How major depressive disorder might affect your sleep. (n.d.). WebMD. https://www.webmd.com/depression/major-depressive-disorder-affects-sleep
- Walker, J., Muench, A., Perlis, M. L., & Vargas, I. (2022). Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer. Klinicheskaia i Spetsial’naia Psikhologiia = Clinical Psychology and Special Education, 11(2), 123. https://doi.org/10.17759/cpse.2022110208
- Sun, Y., & Chen, H. (2022). Treatment of Circadian Rhythm Sleep–Wake Disorders. Current Neuropharmacology, 20(6), 1022. https://doi.org/10.2174/1570159X19666210907122933
