The relationship between sleep and depression is typical of many personal relationships: it’s complicated. Poor mood can interfere with sleep quality, and in turn, a rough night can make it more difficult to cope with the demands of the day. Which condition predates the other is unclear, and potentially changeable. The bidirectional nature of sleep and mood makes it difficult to tease out cause and effect, so targeting both areas is key to maximizing improvement.

Sleep and Emotional Regulation

Getting proper rest helps us regulate our emotions. Poor sleep leads to a shorter emotional fuse and more intense reactions to negative situations. We default to automatic behaviors, those that require less cognitive reasoning, which also tend to be more selfish and biased. Sleep negatively impacts attention and concentration, so we are more impulsive and less likely to pick up on social cues when underslept. We have a harder time accurately reading faces, experience more conflict and have less empathy for those around us. When we do not get adequate sleep, our emotional intelligence takes a deep dive and impairs our ability to get along well with others.

Sleep, Loneliness and Social Isolation

Loneliness and social isolation increase mortality, and as such are important markers of health. A person who does not sleep well is less likely to engage with others. There is a natural reflex to withdraw, and that distance then makes the person less attractive to others – so that often others fail to reach out to them. Loneliness creates stress and anxiety that contribute to further disruptions in sleep. This sets up a cycle that reinforces itself. In the 2019 State of America’s Sleep survey, poor sleepers were 1.77 times as likely to have difficulty in social situations as those who were rated excellent sleepers.

Talking to Your Healthcare Team about Your Mood

The CDC estimates depression may affect up to 16 million adults in the United States each year, and 1 out of every 6 people will experience symptoms of depression over the course of their lifetime. A good indicator that it’s time to talk about your mood with your healthcare team is if you have been feeling down, blue or hopeless for longer than two weeks and have lost interest in activities that you used to enjoy. Your clinician will take a thorough history of your mood disturbance, including how it has impacted your energy, sleep, appetite, feelings of worth, concentration and activity level. If you have thoughts of hurting yourself or others, please seek help immediately.

Talking to Your Healthcare Team about Your Sleep

Troubled sleep (both not enough or too much) is a sign of depression. If you are dissatisfied with your sleep, bring it up with your provider. Keep a sleep diary leading up to your visit so you have some data to share. Sleep disorders put you at greater risk for mood alterations and can have a major impact on your well-being. Find a sleep specialist who can help evaluate, diagnose and manage these conditions.

• Obstructive sleep apnea (OSA) is a condition where a blocked airway causes you to have trouble breathing. Those with OSA are five times more likely to develop depression.  Common symptoms of sleep apnea are snoring, waking gasping or choking, dry mouth, daytime sleepiness, changes in mood or cognition, morning headaches, and restless sleep or insomnia.
• Narcolepsy is a chronic neurological condition characterized by sleep-wake instability and excessive daytime sleepiness. Persons with narcolepsy are at greater risk for mood disruptions.
• Restless leg syndrome fragments and disrupts sleep, and depression rates increase with severity.
• Insomnia can increase chances of developing depression tenfold. Often patients experiencing difficulty falling asleep or staying asleep seek treatment with prescription medications, alcohol or some other “quick fix.” There is no medication that produces healthy sleep. “Sleeping pills” have serious side effects, particularly in regards to cognition and mental health. Cognitive behavioral therapy (CBT) can help with depression, and a specialized version of CBT for insomnia is the treatment of choice for ongoing insomnia concerns.

Double Whammy: Knockout Punches for Both Depression and Sleep Problems

Treatments for depression are more successful when sleep quality and duration are sound. Seek professional help for both issues, but to boost your chances of success, work on these four habits that have been shown to improve both sleep and mood:

• Exercise regularly
• Get lots of outdoor light, particularly in the morning
• Keep to a routine
• Practice meditation

Poor sleep negatively impacts relationships, social life and connectedness, and often coexists with symptoms of depression. Sleep and mood are reciprocal and should be treated together for the best outcomes.

About Ellen Wermter

Ellen Wermter is a board-certified family nurse practitioner through the American Nurses Credentialing Center and a member of Sigma Theta Tau National Honor Society. She earned her Bachelor of Science in Nursing at the University of Virginia and her Master of Science at Virginia Commonwealth University and is a member of the Virginia Council of Nurse Practitioners (VCNP). Ellen is a dedicated sleep professional certified in cognitive behavioral therapy for insomnia who actively treats patients full time. In addition to her clinical work, she is a regular contributor to media about the science of sleep and healthy rest. Her expertise has been featured in publications such as Reader’s Digest, Elite Daily, Offspring and Women’s Running.

Sources:

• https://www.sleepfoundation.org/articles/depression-and-sleep
• https://www.cdc.gov/tobacco/campaign/tips/diseases/depression-anxiety.html

This blog provides general information about sleep and sleep products. The words and other content provided in this blog, and in any linked materials, are not intended to replace a one-on-one relationship with a qualified heath care professional. This blog should not be construed as medical advice or used to diagnose, treat, prevent or cure any disease or condition. If the reader or any other person has a medical concern, he or she should consult with an appropriately-licensed physician or other health care professional. This blog is not a substitute for professional medical advice, diagnosis or treatment, and should not be relied upon to make decisions about your health or the health of others. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog or elsewhere on bettersleep.org. If you think you may have a medical emergency, immediately call your doctor or dial 911

Methodology

2,000 surveys were fielded between April 10-18, 2019, among a representative sample of U.S. adults (age 18+), using a questionnaire lasting approximately 15 minutes. Sample size provides a confidence interval of ±2.19% at 95%. The sample was provided by Dynata, one of the largest online sample providers in the country.

Respondent Profile

Sleep Index

Analysis was conducted to establish a Sleep Index (SI) that can be used to track America’s sleep quality over time. The SI is calculated using the following questions:

Q2. On average, how would you describe your sleep within the past two weeks?

Q7.  Within the past two weeks, how often have you felt the following when you wake up in the morning?

The multiplicative index was scaled so the average score is 100. The index was used to create three groups, as depicted below, for analysis purposes.

There is a Strong Relationship Between Quality of Sleep and Quality of Interpersonal Relationships and Loneliness

People Who Feel Isolated or Have Difficult Interpersonal Relationships Tend to be Worst Sleepers:

• Adults who agree (completely or somewhat) that they wish they had more friends represent 46% of poor sleepers / 36% of excellent sleepers (Index 90)
• Adults who agree (completely or somewhat) that they have a difficult time in social situations represent 39% of poor sleepers / 22% of excellent sleepers (Index 74)
• Poor sleepers are 1.77 times as likely to have difficulty in social situations
• Adults who agree (completely or somewhat) that they would love to go out, but have no one to go out with represent 36% of poor sleepers / 24% of excellent sleepers (Index 82)
• Poor sleepers are 1.5 times as likely to want to go out and not have anyone to go out with
• Adults who agree (completely or somewhat) to having a difficult relationship with their spouse/partner represent 16% of poor sleepers / 9% of excellent sleepers (Index 81)

Conversely, People Who Do Not Feel Isolated or Have Strong Interpersonal Relationships are More Likely to be Excellent Sleepers:

• Adults who agree (somewhat or completely) that they have a great relationship with their spouse/partner make up 77% of poor sleepers / 88% of excellent sleepers (Index 110)
• Adults who agree (somewhat or completely) that they have deep, meaningful friendships with people outside of their family make up 54% of poor sleepers / 61% of excellent sleepers (Index 107). While the Index is not quite 110, it is very different than the Index among adults who disagree (somewhat or completely) (Index 83).
• Adults who agree (somewhat or completely) that they enjoy spending time with extended family make up 59% or poor sleepers / 67% of excellent sleepers (Index 105). While the Index is not quite 110, it is different than the Index among adults who disagree (somewhat or completely) (Index 81) and the difference in percentage between poor and excellent sleepers is statistically significant.
• Adults who agree (somewhat or completely) that they enjoy meeting new people make up 45% of poor sleepers / 55% of excellent sleepers (Index 109)

Other Studies Discovered That Lack Of Sleep Causes Loneliness

Lack of sleep has been identified as a cause of poor socialization, isolation and loneliness in other research as well. A recent study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791747/)  suggests that when people sleep poorly, they are less accurate at judging other people’s expressions, quicker to rely on stereotypes, and are more susceptible to social stressors such as rejection and relationship conflict.

Another study (http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.888.3314&rep=rep1&type=pdf) found that increased relationship conflict and decreased conflict resolution can occur due to poor sleep. This study suggested that people are less empathically accurate after a poor night of sleep, affecting socialization and relationships.

Who Is More Socially Isolated In America?

Methodology

Two items were used to identify those who were feeling isolated (based on review of the data/ correlations/dimension analysis):

I wish I had more friends.

I would love to go out, but I don’t have anyone to go out with.

Those who gave a top 2 box response on either item were identified as isolated.

• Those who are isolated are more likely to be female (55%) compared to those who are not isolated (47%)
• Younger generations
  • Those who are isolated are more likely to be age 18 to 34 (39%) compared to those who are not isolated (27%)
  • Those who are isolated are more likely to be Gen Zs, 18 through 22 (11%) compared to those who are not isolated (6%)
  • Those who are isolated are more likely to be Millennials (35%) compared to those who are not isolated (28%)
• Single (never married). Those who are isolated are more likely to be Single (never married) (37%) compared to those not isolated (27%)
• Heavy users of social media, particularly at bedtime:
  • Those who are isolated are more likely to check social media before bed (39%) compared to those who are not isolated (31%)
• Struggle with finances:
  • Those who are isolated agree (somewhat or completely) that for the most part they live paycheck to paycheck (55%) compared to those who are not isolated (44%)
  • Those who are isolated agree (somewhat or completely) that they generally have enough money to pay only for necessities (54%) compared to those not isolated (42%)
• Sleep poorer:
  • Those who are isolated are more likely to indicate they often or frequently have trouble getting back to sleep when they’ve woken up at night (32%) compared to those who are not isolated (26%)
  • Those who are isolated are more likely to indicate waking up tired often or frequently (58%) compared to those who are not isolated (44%)
  • Those who are isolated are less likely to indicate rarely or never waking up refreshed (45%) compared to those who are not isolated (39%)

Who Is Less Socially Isolated In America?

• Those who are not isolated are more likely to be male (53%) compared to those who are isolated (45%)
• Older generations
  • Those who are not isolated are more likely to be aged 55+ (39%) compared to those who are isolated (26%)
  • Those who are not isolated are more likely to be Boomers (33%) compared to those who are isolated (22%)
• Those who are not isolated are more likely to be married (48%) compared to those who are isolated (38%)
• Those who are not isolated are more likely to be retired (26%) compared to those who are isolated (15%)

Sleep Better:

• Those who are not isolated are more likely to indicate they never or rarely have trouble getting back to sleep when they’ve woken up at night (38%) compared to those who are isolated (29%)
• Those who are not isolated are more likely to indicate never or rarely waking up tired (30%) compare to those who are isolated (18%)
• Those who are not isolated are more likely to indicate often or frequently waking up refreshed (34%) compared to those who are isolated (28%)

Survey Details: Better Sleep Council November 2019