Sherri Winans
Whatcom Community College
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Sarah Wilson
English 201
Essay 3
December 2003

I’m Sad Because I Can’t Sleep!
The Link between Depression and Insomnia

Two years ago, I was suffering from insomnia. You know, where you lie awake night after night, wondering if sleep is ever going to come, praying for it to come. You glance at the clock every two minutes. You stare at the ceiling. You plump your pillow. You toss and turn. You twist around to the other end of the bed, the covers everywhere. You can’t get comfortable. You worry about things that happened that day. Then you start to think about the day ahead. You don’t have time for this; you’ve got stuff to do tomorrow. How are you going to make it with no sleep?

I was so tired all the time that my mom finally decided to take me to the doctor—hoping to get some serious medication. That was all we wanted. Just some sleeping pills.

But I was surprised by the kind of questions the doctor was asking me. How were things at home? Had I been feeling sad for a long time? Had any major changes or events happened to me recently? Dude, I just wanted some meds to help me sleep. But I told her that my older brother had been married a year and a half before (we had been very close), and that my dad had started to take classes online. I also told her that I had begun college that fall. Despite the funny questions, it did make sense that all these changes combined could have brought on my insomnia.

The doctor told me to go home and try some different things: write in a journal before bed, do relaxing activities before bed, and do some muscle relaxation exercises, with the addition of a strong sleeping pill. So, I went home, and did just what the doctor prescribed. For a month, I wrote in my journal, did relaxing activities before bed and did muscle relaxation exercises, and took my sleeping pill. Nothing. I went back to the doctor the day after Christmas, and told her I was still not sleeping. She told me I was depressed. My options were counseling or anti-depressants. Going to see a counselor and spilling all my problems to someone I didn’t know or trust did not appeal to me. I chose the pills. I came home and cried. Me, depressed? I felt horrible, like some deranged fool who couldn’t keep her emotions under control. Depression didn’t make any sense: I came from a happy, well-adjusted, homeschooling, middle-class family, where we went to church on Sundays and rarely watched anything over PG.

It became a secret, something to share only with my closest friends. I didn’t want people to treat me differently, just because I was on anti-depressants. I continued to feel like a freak for having to be on medication. So, I have a question about insomnia and depression—are they connected in any way? Was my doctor right in linking the two for me?

According to Henry Olders and Anthony D. Del Genio in their article, "What Causes Insomnia?", "people lose sleep for a variety of reasons, including medications, alcohol, caffeine, stress and pain" (Olders and Del Genio). Insomnia thus can be brought on by any number of external factors. It also can occur because of internal struggles, too: "stress and pain" rob people of sleep. But Hara Estroff Marano says, "The biggest sleep robber of all, however, is work—the puritan work ethic gone haywire in an ear of global markets" (Marano). People give up so much for work and jobs, not the least of which is sleep. I had started college after being homeschooled my whole life—could this be stressing me to the max, robbing me of sleep? Could I be suffering from "the biggest sleep robber of all"? Marano also says "to some degree, we can sacrifice sleep to oblige other demands on our time, but we pay a high price for the privilege. The need for sleep, anchored in part to the most ancient rhythms of the planet, is etched deeply in our brains".

In our fast-paced world, where speed and productivity reign, it is easy to see how sleep can take a back seat. But is it really worth it: "In any given year, about 15% of American adults have sleep problems that cause serious distress or impair their alertness, concentration, or memory - - inability to fall asleep, waking up repeatedly, waking up too early, restlessness, and unrefreshing sleep, falling asleep at the wrong time, daytime drowsiness", says an article that appeared in the Harvard Mental Health Letter. These effects are obviously taking a toll, causing dangerous effects that can not only have an impact on the insomniacs themselves, but can be harmful to those around them.

There are two different kinds of insomnia according to the same Harvard Mental Health Letter:

Many people are troubled by sleeplessness for a week or two because of illness, emotional stress, or a changing environment. For about 5%, this temporary disruption is prolonged and becomes learned or conditioned insomnia - - also sometimes called ‘primary’ insomnia. Their familiar bedrooms and nightly routines become triggers for sleeplessness. They may come to anticipate bedtime with dread, and eventually, in another turn of the screw, they are kept awake by worry about their inability to sleep. It is a kind of performance anxiety; every sleepless night is a personal failure that makes the next one more likely.

So, the first is called "primary insomnia". After reading the above, I wondered if perhaps my own experiences with sleeplessness were due to primary insomnia. Could it be because of Matt marrying, Dad studying all the time, me going to school, that I could not sleep? Not because I was "depressed? Or, if I was depressed, could it be because of those very things, not the other way around, as the doctor seemed to think? In other words, she seemed to think that I was depressed and not sleeping because of those things, whereas I believed and still believed that I was "blue" because I was tired and sleepy all the time.

The second kind of insomnia is "the result of a medical or psychiatric disorder" (A Hard Day’s Night). This kind of sleeplessness is not learned, as with primary insomnia. The same article says, "Almost everyone who suffers from serious anxiety has a sleep problem" (A Hard Day’s Night). But the main problem that walks hand in hand with this second type is depression (A Hard Day’s Night). It is called a psychiatric disorder because "mood is regulated by the same neurotransmitters that govern the sleep cycle: norepinephrine, serotonin, and acetylcholine" (A Hard Day’s Night). Dr. Joel C. Robertson with Tom Monte agrees when he says in his book, Peak—Performance Living, "Neurotransmitters create a wide spectrum of feelings, moods, and thoughts—everything from depression, mania, anxiety, compulsivity, and addiction to feelings of self-confidence, self-esteem, clarity of thought, enhanced memory, healthy aggression, and deep sleep" (4). He also discusses the affect of brain chemistry on our moods: "when serotonin levels are low, depression is common; so is poor sleep and an inability to concentrate" (Robertson 4). According to Robertson, everything we do has an effect on these brain chemistries, which control how we feel, and how we think. He believes that the reason so many people suffer from depression and other mood disorders is because the "standard Western diet, our sedentary lifestyles, the pressures of time, and the continual bombardment of arousing stimuli (such as violent and sexual media images) all combine to create stresses on our neurochemistry that deform and distort our behavior" (Robertson 7).

Maybe my insomnia/depression was due in part to not enough exercise (I’ve never been athletic—yuck, I’d far rather stay inside and read a book), not enough fruits and vegetables (I mean, who wants a carrot stick when you can have an old-fashioned glazed donut? With a glass of cold milk?), too much stress, and too much media. Maybe I wasn’t a freak after all—maybe I was just reacting in a normal way to the intense changes in my life at that point. Maybe I was just living the normal American life of fast-paced, busy-ness.

Does this normal American life include depression? According to a pamphlet put out by the Washington Advocates for the Mentally Ill, "more than 17 million Americans suffer each year from clinical depression". If so many people are depressed, what is it exactly? The same pamphlet gives a list of the symptoms:

Sad, anxious or ‘empty’ mood, sleeping too much or too little, changes in weight or appetite, loss of pleasure or interest in activities, feeling restless or irritable, trouble concentrating, remembering or making decisions, fatigue or loss of energy, feeling guilty, hopeless or worthless, physical symptoms that don’t respond to treatment, thoughts of death or suicide.

I could relate to the empty mood, the sleeping too little, and loss of energy, certainly. After my "diagnosis", my appetite changed too. I lost weight, enough that my parents noticed how baggy my jeans were getting. My mood was still down. I relied on my sleeping pills to get to sleep.

Kay Redfield Jamison relates some of the feelings that go along with depression: "depression, instead, is flat, hollow, and unendurable. It is also tiresome…you’re irritable and paranoid and humorless and lifeless and critical and demanding and no reassurance is ever enough" (215). Depression, then, sucks life out—in extreme cases like Jamison’s, it takes up your every thought, influences every thing you do, colors how you see the world. It takes out joy and emotion—it takes away meaning and significance. Jamison also says, "depression is awful beyond words or sounds or images…it bleeds relationships through suspicion, lack of confidence and self-respect, the inability to enjoy life, to walk or talk or think normally, the exhaustion, the night terrors, the day terrors"(214).

So, is there a link between these two: depression and insomnia? Was my doctor justified in pronouncing me depressed? According to the Harvard Mental Health Letter, "70 percent of depressed patients sleep too little". This is an amazingly high percentage of depressed insomniacs. Also, insomnia may invite depression. "17 % of people who said they were insomniac developed a psychiatric disorder within the next year" (A Hard Day’s Night). That means that out of that group, nearly one out of five developed some sort of depression. It appears that my doctor was justified in guessing that I was depressed, or at the very least, getting there. Marano says that insomnia "seems to be the true mother of depression…insomnia is not just a symptom: It’s the best single predictor of depression…two or more weeks of sleeplessness increase the risk of a first episode of depression by 400 percent—even for someone who has never been depressed". 400 percent? This overwhelmingly supports the link between insomnia and depression.

So, what goes on during the night for a depressed insomniac? Basically, sleep is disturbed by the brain. As we sleep, we are supposed to get the deep rest we need by hitting the REM (Rapid Eye Movement) stage (Marano). "But the depressed are on a fast track to dreamland. They dive too quickly into REM sleep, which lasts nearly twice as long…it’s also a souped up version of the REM phase" (Marano) Brain activity does not slow down, but adds to fatigue, even as the depressed sleep: "the central nervous system stays aroused. Mental hyperactivity…leads to an increase in negative thoughts. The depressed become overly biased to remember bad things" (Marano). This makes sense because sleep is the only time when we get deep rest, and when sleep is disturbed by internal means (too much brain activity) or even external (noisy neighbors), we lose the chance to recharge our bodies and minds.

My doctor was clearly not pushing pills, especially after I considered the following statement made by Marano: "the evidence suggests that treating insomnia may forestall a first episode of depression, or a recurrence, and at least keep insomnia from becoming chronic". It seems that because the two are so closely tied together, treating one would help the other to decrease. The proof exists for the duet that insomnia and depression often play. My doctor was right to link the two together, even if I did not understand at the time.

Today, almost two years after going to the doctor for just sleeping pills, I am still on medication. I am happy to report that I don’t have to take pills to get to sleep anymore. I only have insomnia when I don’t get some kind of exercise during the day. I feel "blue" when I get stressed out and feel like I have too much on my plate. So, some days are better than others. Now I know being depressed doesn’t mean I’m a freak of nature—it happens to nearly everyone. It can happen for any reason—change in schedule or routine, diet changes, relationship problems or issues, family issues, changed in responsibility, or even the loss of a pet. Being on medication is no shame; life is too short to settle for insomnia and depression.

  

Works Cited

"A Hard Day’s Night: Sleep and Mood". Harvard Mental Health Letter. 17 (2001): 5. Health Source: Nursing/Academic Edition.. EBSCO-Host. Whatcom Community College. 5 Nov. 2003.

Jamison, Kay Redfield. An Unquiet Mind. New York: Knopf. 1995

Marano, Hara Estroff. "Night Life". Psychology Today. 36 (2003): 42. Academic Search Elite. EBSCO-Host. Whatcom Community College. 10 Nov. 2003.

Olders, Henry, and Del Genio, Anthony D. "What causes Insomnia?". Scientific American. 289 (2003): 103. Academic Search Elite. EBSCO-Host. Whatcom Community College. 10 Nov. 2003.

Robertson, Dr. Joel C., and Tom Monte. Peak—Performance Living. San Francisco: Harper. 1997.

 

Copyright 2003
Sarah Wilson

 

Funded through the U.S. Dept. of Education, Title III Grant PO31A980143
Sherri Winans, Whatcom Community College, Bellingham, WA
1999-2015