Managing depression and insomnia

Depression and insomnia – advice, information and treatment from The Priory: Depression and insomnia are often interlinked but the connection between them can be complex. It is far from a simple cause-and-effect relationship:

• Depression can result in a person experiencing insomnia, as sleep problems are a common symptom of the mental health condition
• Insomnia can appear first, and then trigger and perpetuate depression as the lack of sleep impacts a person’s mood and anxiety levels
• epression and insomnia can also be experienced as two simultaneous yet unrelated disorders

Within this blog, we will look at the steps that you can take if you are currently experiencing both depression and insomnia.

Addressing your depression and insomnia

When dealing with both depression and insomnia, it is recommended that you seek professional support so that a specialist can review your symptoms and advise on the best steps forward.

As a first port of call, you may want to visit your GP. They will either be able to provide you with treatment or refer to a specialist service such as Priory Group for further assessments and specialist treatment.

You can also come directly to one of Priory Group’s hospitals or wellbeing centres to discuss your depression and insomnia with a consultant psychiatrist. They will be able to carry out a thorough assessment to determine the best form of treatment for you, which may include therapy and pharmacological treatment.

CBT for depression and sleep disorders

Cognitive behavioural therapy (CBT) is a practical, hands-on form of therapy that can be particularly useful for people suffering with depression and insomnia.

CBT techniques for sleep disorders

Cognitive behavioural therapy for insomnia (CBT-I) teaches you ways to change any thoughts and behaviours that are impacting your sleep. Sessions typically focus on the following areas:

• Stimulus control – re-associating your bedroom with sleep and sex. As part of this, you will be encouraged to move away from your bedroom if you can’t sleep at night and only return when you are sleepy again
• Sleep restriction – setting and sticking to rigid sleep and wake times, helping your body to fall back into a natural rhythm so that you have a better sleep pattern
• Cognitive restructuring – addressing thoughts and beliefs that are destructive to your sleep. For example, if you go to bed thinking “I will never go to sleep”, you are encouraged to replace this with “it’s normal to take some time to get to sleep”. CBT-I also teaches you how to relax and quieten your mind before bed to stop your thoughts from going into overdrive as soon as your head hits the pillow
• Sleep hygiene education – assessing aspects of your lifestyle and environment to see if improvements can be made to help you sleep better. This will include evaluating such things as your caffeine and alcohol intake, your bedtime routine as well as your sleep environment.

CBT techniques for depression

When dealing with depression, you will often experience negative thoughts and beliefs about yourself, other people and the world around you. This can cause you to feel extremely sad, hopeless, ashamed and guilty.

CBT sessions can help you to address and move past these destructive thoughts and beliefs in the following ways:

• You work to identify any destructive self-talk and automatic thoughts that you hold onto, which may include things like “I’m worthless”, “no one likes me” or “there’s no point”
• You learn how these thoughts and beliefs have been affecting how you feel and behave, and how they could impact you going forward

You practise replacing these destructive thoughts and beliefs with ones that are more positive and productive, which could include “I have family and friends who care about my worth”, “I won’t give up” or “I have accomplished a lot”
By learning how to identify, stop and swap destructive thoughts and beliefs through CBT, you can stop them from having such a negative influence on your mood as you go forward.

Ways to help you manage your depression and insomnia

We understand that living with depression and insomnia can be exhausting. When accessing professional support, there are also strategies that you can start to include in your day-to-day life to help you manage how you are feeling. These include:

• Keeping to a regular sleep/wake routine – when we stick to a sleep schedule, the routine helps our body to fall into a natural rhythm, where it comes to recognise times when we should be asleep and times when we should be up and about
• Exercising outdoors once a day – exercise can be a mood-lifter and also a good distraction from our thoughts and feelings. It can also be a good way to exert energy, so that you feel more tired in the evenings. Just make sure that you don’t exercise in the four hours before your bedtime as this can actually make it more difficult to sleep
• Avoiding afternoon naps – these can stop you from sleeping well in the night. If you feel like you need to take a nap, avoid sleeping for longer than 20 to 30 minutes
• Limiting the amount of caffeine and alcohol you consume – avoid alcohol and caffeine in the six hours before you go to bed, as it can impact on the quality of your sleep. Caffeine and alcohol can also cause spikes and dips in your mood and energy levels, so monitor the amount your consume
• Making the most of your support system – when you are dealing with depression and insomnia, reach out and talk to people who you trust and who care about you. You don’t have go through this alone. If you don’t feel comfortable speaking to close friends and family about it, you can also speak to a therapist or counsellor, or seek support from The Samaritans, who will always be there to listen when you are going through a difficult time.

Blog reviewed by Dr Ian Nnatu (MB BS, PG DIP (CBT), MSc, FRCPsych, MRCPsych) Consultant Adult Psychiatrist at Priory Hospital North London