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By Colette Dowling, LMSW 
Four out of five people who become depressed approach bedtime with varying degrees of dread. They toss and turn, restlessly occupied with negative thoughts, obsessing over something dumb they did, or think they did, at the party that night. Money, taxes, their teeth falling out of their gums, you name it they have fantasies about it. When I became depressed after a long bout of anemia (many chronic illnesses produce depression), I found myself worrying about my studio tumbling into the stream that lay next to it. I knew it wasn’t rational but I felt helpless to control what my mind was doing.
Anyone who’s been depressed knows how it goes. A relentlessly disturbing train of thought can begin with just the tiniest kernel of reality. The bank along the stream next to my studio was etched away in places, damaged by heavy spring rains. As my brain cells altered with the depression, the erosion escalated in my mind–first to the loss of my studio; ultimately to the loss of my home, on the same piece of land. Perhaps I should sell before my entire nest egg was swept away by the ravages of nature; on the other hand, the real estate market was so bad, maybe there would be no nest egg, and so on. Obsessional thoughts like these go hand in hand with depression and lying in bed awaiting sleep provides prime time. Lucky were the mornings when sanity returned and I told myself, "This house has been sitting here since 1775; I don’t think it’s going anywhere soon."
The biological underpinnings of these anxious thoughts became strikingly clear when, after taking iron for a month or so, my blood count returned to normal and so did my mood. Suddenly–really, from one week to the next–concerns about the imminent demise of my farmhouse vanished. My daytime thoughts became positive, and my nighttime thoughts returned to dreamland, where they belonged.
Trouble falling asleep is usually associated with anxiety. Waking at four o’clock in the morning, anxious and disturbed, is considered a sign of depression. In milder cases only an hour or so of sleep may be lost. When depression is more serious, the loss can add up to several hours or more. Some people say they don’t get any sleep at all, or they fall asleep shortly before they’re supposed to get up. Those in their sixties, seventies and eighties who have trouble sleeping should be evaluated for depression, if no organic reason for sleep loss can be found. Some physicians think poor sleep is inevitable in older patients. It isn’t, and it should be taken seriously.
Lack of rest is not the only sleep disturbance associated with depression. Someone who’s going to bed at midnight and getting up at one the next afternoon also has a sleep problem. Hypersomnia, it’s called–the need for more sleep than normal.
No matter which kind of sleep disturbance, it will become more severe as the depressive episode gathers force. There may be terrible, depressive dreams and abrupt waking in sobs.
Of course lack of sleep produces daytime fatigue, which can become so severe it dominates the clinical picture. Doctors and other health practitioners may come rushing in with any diagnosis other than a mood problem. There are verbal tests that go a long way toward helping doctors and therapists make an accurate diagnosis, for those whom depression is a possibility.
Sleep improvement, on the other hand, can be the first sign that a depression is lifting. Long before her mood changes the depressed person falls asleep more easily and sleeps through the night. The appetite–whether minimal or excessive--normalizes. Weight loss–or gain–stops. And before long, things start looking positive again. About the Author...
Colette Dowling, LMSW, is a therapist with a private practice in Manhattan. She specializes in treating women, and is especially interested in their conflicts between ambition and intimacy. Ms. Dowling has written many books, including The Cinderella Complex: Women's Hidden Fear of Independence, You Mean I Don't Have to Feel this Way?; New Help for Depression, Anxiety and Addiction, and Red Hot Mamas: Coming into Our Own at Fifty. For cutting edge information on aspects of mental health unique to women, see Dowlng's webite: http://www.womens-wellbeing-and-mental-health.com. For excerpts from her books see http://www.colettedowling.com Last Update: 6/30/2007
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