For years, the thinking on the subject was that depression gave rise to sleep problems. Being depressed causes changes in REM sleep (when we dream), and decreases in deep sleep (associated with feelings of rest and restoration). Insomnia was but a symptom of depression, so the story went. Treat the depression, and the sleep problems would go away.
A New Perspective
The story is different now. It looks more and more like chronic insomnia is a way station to depression (and perhaps to other mental disorders as well). Insomnia often precedes the first episode of depression, researchers note today. And even when depression is successfully treated, the insomnia may persist.
Consider these interesting facts, taken from an article by Chiara Baglioni and Dieter Riemann summarizing some very large studies:
- People with insomnia are twice as likely to develop depression as people without insomnia.
- While the incidence of depression in the general population is 9.9 percent, the incidence is 13.1 percent in people with insomnia and 4 percent in people without sleep problems. Not only are insomniacs more vulnerable to depression, but the absence of sleep problems is very protective in this regard.
Why Is This Important?
Chronic insomnia is now understood to be a causal factor in major depression and a risk factor for suicide. It also increases our vulnerability to heart disease, hypertension, obesity, diabetes, and a host of other medical problems.
Even so, it is still regarded by many—including some primary care physicians—as a trivial matter without serious consequences. Over the years I was interviewing insomniacs for my book, time and time again, I heard comments like these:
- “Insomnia just wasn’t something my primary care doctor seemed to really have any concept of. He just said something to the effect of, ‘Well, maybe you just don’t need that much sleep.’ But I kept trying to tell him I felt much better when I got a little bit more sleep. So I really just got nowhere.”
- “You mention it to doctors and they just kind of shrug their shoulders. I haven’t gotten a very in-depth response at all.”
- “Year after year of going to the doctor, I would tell him my biggest problem is that I’m unable to fall asleep at night. And he’d say, ‘Well, you know, that’s how it is. A lot of women tell me that and I just don’t know what to say. Have you tried warm milk?’”
The research documenting persistent insomnia’s effects on long-term health is out there for the taking. Yet somehow it’s not trickling down to the places where we need it to be.
Have you discussed your sleep problem with your doctor? If so, what was his or her response?