Depression and Troubled Sleep

Colette Dowling, LCSW

Author of the following article on couples counseling and real love, NYC psychotherapist Colette Dowling, LCSW, has also written The Cinderella Complex: Women's Hidden Fear of Independence, a best seller in twenty-three languages, and other books on relationhip issues.

                                                What To Do for Troubled Sleep

People suffering from depression and troubled sleep 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, it reached a point where I was worrying about my writing studio tumbling into the stream next to it. It wasn’t a rational worry, I knew, but I felt helpless to control what my mind was doing. Depression was producing troubled sleep.

Anyone who’s been depressed knows how it goes. A relentlessly disturbing train of thought can begin with just the tiniest kernel of reality. For example, the bank along the stream next to my writing studio was etched away in places, damaged by heavy spring rains. this erosion escalated in my mind as depression began to take hold. First, I worried about losing my studio. Then I worried about losing my house, which was on the same piece of land. Depression and troubled sleep. There it was! But I didn't know it, at the time. All I was consumed with were my feverish, night-time thoughts. Maybe I should sell the property 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 and so on.

Lying in bed at night provides prime time for obsessonal thinking. Lucky were the mornings when sanity returned and I could tell myself, as the sun began peeping through the blinds, "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 for the anemia, 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 house and studio vanished. My daytime thoughts became positive, and my nighttime thoughts returned to dreamland, where they belonged.

Trouble falling asleep is usually associated with anxiety. On the other hand, regularly waking at four o’clock in the morning 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 a night. 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. Depression and troubled sleep appears in the elderly with as much frequency as it does in younger folks.

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 then waking from these dreams abruptly, sometimes in sobs. Of course the sleep people lose when they're depressed produces fatigue during the day and this can wreak havoc on the job.

Improved sleep, on the other hand, can be the first sign that a depression is lifting. This is especially noticeable in the patient who's been treated with antidepressants. Long before her mood improves she'll fall asleep more easily and find herself able to sleep through the night. Appetite–-whether minimal or excessive--will begin to normalize. Weight loss-–or gain-–will stop. Before long, things start looking positive again.

When episodes of depression are severe, psychotherapy plus medication is usually the most effective course of action. Serotonin reuptake inhibitors (SSRIs) such as Zoloft, Effexor, and Prozac often begin showing effectiveness within a couple of weeks. That the antidepressant has begun working will first be noted in improved quality of sleep.

Mindfulness skills are also helpful in improving depression and troubled sleep.  In my practice I teach different types of breathing. I also use audio equipment in a technique that helps people slow down their thought processes so that they can integrate things that have happened to them in the past with new thoughts, allowing relief from anxiety or trauma.   


About the Author

NY psychotherapist Colette Dowling, LCSW, received her masters degree from The Smith College School for Social Work and has done advanced training in psychotherapy and psychoanalysis at The Institute for Contemporary Psychotherapy, in New York. She has a private practice in Manhattan. 

For more information, or to arrange a consultation, call 718-594-0201, or e-mail

To hear Colette speaking about what it's like starting therapy with someone new, click the audio button.

For colette's article on menopausal depression, click here.

For Colette's article on postpartum depression click here.

For Colette's article on depression and premenstrual disorder click here.

Colette's website: www.womens-wellbeing-and-menta-health

Visit Colette Dowling's therapist profile at Psychology Today.

Copyright Colette Dowling, 2006-2010