Sleep problems and depression are closely interconnected and have a bidirectional relationship. Depression can make sleep problems worse and troubled sleep can worsen depression symptoms. In the October issue of The American Journal of Psychiatry, authors David T. Plante, M.D., Ph.D., with the University of Wisconsin School of Medicine and Public Health, suggests that there is important “opportunity to prevent depressive episodes using evidence-based treatments for insomnia.” Plante highlights several factors contributing to the potential for broad public health impact.

Insomnia is common

Insomnia, the most common sleep disorder, involves problems getting to sleep or staying asleep. About one-third of adults report some insomnia symptoms, 10-15% report problems with functioning during the daytime, and 6-10% have symptoms severe enough to meet criteria for insomnia disorder. An estimated 40-50% of individuals with insomnia also have another mental disorder. Insomnia is the most common type of sleep problem in people with depression—occurring in about 80 to 90% of people with depression. It is rare for a person with major depression not to experience some form of sleep problems, the authors note.

Insomnia significantly increases the risk of depression

Insomnia is a well-understood risk factor for depression. Research has found that having insomnia increases a person’s chance of developing depression twofold. This risk is similar to the risk associated with having a close relative with major depressive disorder.

Emerging technologies make sleep tracking more accessible

Plante suggests that emerging wearable technologies to track sleep and sleep problems at home, “offer great potential to advance clinical care and research.” They could be used to help personalize therapies early in treatment. However, he cautions that these newer technologies need further testing and validation, especially among people with depression, for use in sleep assessment and treatment.

Effective treatments for insomnia are available

Insomnia is typically treated with either psychotherapy or medication.  In particular, cognitive-behavioral therapy for insomnia (CBT-I), is a highly effective non-medication treatment for insomnia that and “is generally considered a first line therapeutic strategy,” Plante notes. In recent years, internet-based or digital CBT-I have also generally shown benefits for insomnia and depression symptoms in large-scale studies.

Lifestyle and complimentary approaches can also be helpful in addressing insomnia, such as relaxation techniques used before bedtime, sticking to a sleep schedule, meditation, yoga, melatonin supplements, and daily exercise. Herbs and dietary supplements have not been shown to be effective for insomnia. (If you are taking any alternative medicines or supplements, let your health care provider know about them.)

Advances in understanding and treating sleep issues hold promise for helping in treatment and prevention of depression and Plante specifically suggests: “from a public health perspective, it is possible that a more critical and fruitful time to target insomnia in the treatment of depression may be prior to the onset of a depressive episode.” The development of effective internet-based CBT-I therapies make this increasingly possible. In addition, because sleep is closely tied to many mental health disorders, these advances may potentially be used to help treat other mental health conditions.