How we see the world shapes who we choose to be — and sharing compelling experiences can frame the way we treat each other, for the better. This is a powerful perspective.
We all know how just one night of bad sleep can put us in a total funk. When you struggle getting restorative rest night after night, the effects can be devastating.
I’ve spent much of my life lying awake in bed until the early morning, praying for sleep. With the help of a sleep specialist, I was finally able to connect my symptoms with a diagnosis: delayed sleep phase syndrome, a disorder in which your preferred sleep time is at least two hours later than conventional bedtimes.
In a perfect world, I’d fall asleep in the early morning hours and stay in bed until noon. But since this isn’t a perfect world, I have many sleep-deprived days.
That’s a significant connection, as roughly 50 to 70 million U.S. adults have some type of sleep issue, from insomnia to obstructive sleep apnea to chronic sleep deprivation.
Sleep deprivation is so potent that it can easily launch us into a downward spiral that, for many, can lead to depression or chronic pain.
It’s the classic chicken-and-egg scenario: Does disordered sleep cause depression and chronic pain or do depression and chronic pain cause disordered sleep?
“That can be hard to determine,” says Michelle Drerup, PsyD, director of behavioral sleep medicine at Cleveland Clinic. Drerup specializes in the psychological and behavioral treatment of sleep disorders.
There’s some evidence to suggest that sleep chronotype, or preferred sleep-wake times, can influence depression risk in particular. A large-scale study found that early risers had a 12 to 27 percent lower risk for developing depression and late risers had a 6 percent higher risk, compared with intermediate risers.
The cycle of sleep and depression
As a late riser, I’ve certainly dealt with my share of depression. When the rest of the world goes to bed and you’re the only one still awake, you feel isolated. And when you struggle to sleep according to society’s standards, you inevitably miss out on things because you’re too sleep-deprived to take part. It’s hardly surprising then, that many late risers — myself included — develop depression.
But no matter which comes first, the depression and chronic pain or the disordered sleep, both issues need to be resolved somehow.
You might assume that sleep improves once depression or chronic pain is resolved, but according to Drerup, this often isn’t the case.
“Out of all the symptoms of depression, insomnia or other sleep issues are the most residual despite improvement in mood or other symptoms of depression,” Drerup says.
I’ve used antidepressants for years and have noticed that I can be in a decent mood yet still struggle to sleep at night.
Similarly, people with chronic pain don’t necessarily see improvements in sleep once their pain is resolved. In fact, the pain often only continues to worsen until sleep is addressed. This may be related to the fact that some people with chronic pain may battle anxiety which in turn may cause stress chemicals such as adrenaline and cortisol to flood their systems. Over time, anxiety creates an overstimulation of the nervous system, which makes it difficult to sleep.
Because adrenaline increases the sensitivity of the nervous system, people with chronic pain will actually feel pain they wouldn’t ordinarily feel, says spinal surgeon and chronic pain expert Dr. David Hanscom.
“Eventually, the combination of sustained anxiety and lack of sleep will cause depression,” Hanscom adds.
The most effective way to resolve both chronic pain and depression is to calm the nervous system, and inducing sleep is an important first step.
Charley’s story of chronic pain and sleep problems
In 2006, Charley hit a rough patch in his personal and professional life. As a result, he became sleep-deprived, depressed, and experienced multiple panic attacks along with chronic back pain.
After seeing a variety of doctors and specialists — and making four visits to the ER in a month — Charley finally sought Hanscom’s help. “Instead of scheduling me for an MRI right away and talking about surgery options, [Hanscom] said, ‘I want to talk to you about your life,’” Charley recalls.
Hanscom has noticed that stress often creates or worsens chronic pain. By first recognizing the stressful life events contributing to his pain, Charley was better able to identify solutions.
First, Charley began by taking moderate amounts of anti-anxiety medication to help calm his system. For six months, he monitored his dosage carefully and then slowly weaned off the medication completely. He notes that the pills helped him transition back into a regular sleep pattern within a few months.
Charley also followed a consistent bedtime routine so his body could develop a regular sleep rhythm. The cornerstones of his routine included going to bed every night at 11, cutting down on TV, eating his last meal three hours before bed, and eating a clean diet. He now limits sugar and alcohol after learning that they could trigger an anxiety attack.
“All those things combined contributed to developing sleep habits that’ve been a lot healthier for me,” Charley says.
Once his sleep improved, the chronic pain resolved itself over the course of several months.
After finally getting a full night’s sleep, Charley recalls, “I was aware of the fact that I had a good night's sleep and that gave me a little bit of confidence that things would get better.”
3 tips for breaking the sleep-depression-pain cycle
In order to break the cycle of depression-sleep or chronic pain-sleep, you need to start by getting your sleep habits under control.
Some of the methods you can use to help sleep, such as cognitive behavioral therapy (CBT), may also be used to address symptoms of depression or chronic pain.
1. Sleep hygiene
According to Drerup, one reason why many people may not see improvements in sleep once their depression is resolved may be due to bad sleep habits they’ve developed. For example, people with depression may stay in bed too long because they lack the energy and motivation to engage with others. As a result, they may struggle with falling asleep at a normal time.
Sleep hygiene tips
- Keep daytime naps to 30 minutes.
- Avoid caffeine, alcohol, and nicotine close to bedtime.
- Establish a relaxing bedtime routine. Think: a hot bath or a nightly reading ritual.
- Avoid screens — including your smartphone —30 minutes before bedtime.
- Make your bedroom a sleeping-only zone. That means no laptops, TV, or eating.
2. Expressive writing
Grab a piece of paper and pen and simply write down your thoughts — whether positive or negative — for a few minutes. Then immediately destroy them by tearing up the paper.
This technique has been shown to induce sleep by breaking up racing thoughts, which ultimately calms the nervous system.
This exercise also gives your brain the opportunity to create new neurological pathways that’ll process pain or depression in a healthier way. “What you’re doing is actually stimulating your brain to change structure,” Hanscom says.
3. Cognitive behavioral therapy
If you’re dealing with depression or chronic pain in addition to sleep issues, regular visits to a therapist may be in order.
Using CBT, a therapist can help you identify and replace problematic thoughts and behaviors affecting your well-being with healthy habits.
For example, your thoughts about sleep itself could be causing you anxiety, making it hard to fall asleep, thereby worsening your anxiety, Drerup says. CBT can be used to address sleep disorders, depression, or chronic pain.
To find a cognitive behavioral therapist in your area, check out the National Association of Cognitive-Behavioral Therapists.
Working with a sleep therapist or medical professional might be your best bet to get back on the path to a solid night’s sleep, as they may prescribe anti-anxiety medications or therapy and provide other solutions.
Lauren Bedosky is a freelance fitness and health writer. She writes for a variety of national publications, including Men’s Health, Runner’s World, Shape, and Women’s Running. She lives in Brooklyn Park, Minnesota, with her husband and their three dogs. Read more at her website or on Twitter.