The Fog of Depression

In the early stages of dealing with depression, one of the more difficult aspects was trouble sleeping. At its worst, I would wake up at 3:30 every night and drive to an all-night coffee shop.  I would sit there like a block of cement and let the steam of the coffee wash over my face.  Looking out the large windows, the empty streets mirrored my own profound loneliness.  I didn’t know or understand why this had happened to me.  What had I done to deserve such misery?

Eventually, the sun came up. All I could think of was how I was going to do my job while feeling so bone weary and depressed.  Those days were tough.  They didn’t last forever, though.  What turned the tide was that I discovered that I had sleep apnea, a serious sleep disorder in which your brain wakes up during the night thus preventing a restorative night’s rest.  People with apnea are sometimes misdiagnosed with depression.  It’s important if you are having problems with fatigue and sleep to be evaluated by a sleep disorder specialist.   Watch this video of a man who suffered from sleep apnea and how he got help.

There are many people, like me, who have both sleep apnea and a sleep disorder caused by depression.  This is so because the causes of sleep apnea are not the same as the causes of a sleep problem associated with depression.  Thus, treatment and resolution of an apnea problem will not fix your sleep problems if you are also suffering from clinical depression.  Apnea is usually found in individuals with low muscle tone and soft tissue around the airway (e.g. due to obesity), and structural features that give rise to a narrowed airway. The cause of sleep disturbance because of depression is more complicated.

Our sleep patterns are dictated by the circadian rhythms in our bodies.  There is a body clock located in our hypothalamus of our brains which controls how we sleep and feel.  The center creates daily signals or rhythms that govern when our hormones and neurotransmitters are released – two critical elements in depression.  Antidepressants target neurotransmitters and hormones.

Due to problems with our circadian rhythms during depression, our sleep cycle does not function properly and we feel sleepiness in the daytime and will be awake at night.  My own experience is that the type of antidepressant you are on may be helping or hurting your ability to sleep.  You may need to change antidepressants (or the dosage). Alternatively, you may need to supplement your antidepressant with another medication that will help you to sleep.  I know many who are doing this and it helps them to sleep well.

Finally, there are a number of prompts or small behaviors that you can employ to let your body and mind know that it’s time to sleep.  This can be important because sleep disturbance is just not about biology, but also psychology.  Depressives ruminate and they do it at the worst of times:  when trying to fall asleep.  There are several things you can do to get ready for sleep.  Just don’t leave it to chance that you might sleep well.  Be pro-active and recognize the critical importance of a good night’s sleep in helping you to recover from depression.