Dark nights, heavy thoughts: Dealing with depression after dark

When you think of depression, what comes to mind? Perhaps you picture someone who’s sad, isolates themselves, or has angry outbursts. But what about someone who struggles to sleep at night or falls asleep but then wakes up in the middle of the night and can’t get back to bed? These aren’t uncommon situations. In fact, 75% of people with depression have sleep issues. 

While common, sleep difficulties are less talked about when it comes to depression. If you relate, don’t worry. Understanding that sleep issues can be a sign of depression can be the first step to getting the support you deserve.

Signs your nighttime feelings may indicate depression

Insomnia can be your body’s way of telling you that you’re depressed. That’s because depression may interfere with biological processes that help you fall asleep. This can lead to a vicious cycle: An inability to fall asleep or stay asleep can also make your depression worse. In fact, people who experience insomnia are twice as likely to get depression. 

Insomnia can also trigger anxious thoughts as you lie in bed ruminating, or constantly returning to the same thoughts over and over again, intensifying your depression. It’s also worth noting that if you have depression, you’re more likely to develop an anxiety disorder.  

Depression can look different for everyone. For example, depressed middle-aged adults are more likely to experience insomnia in the middle of the night, and teens might excessively sleep. 

Why do you get depressed late at night?

But why can depression get worse at night? When you can’t sleep, you may turn toward rumination. Rumination involves an endless cycle of negative thoughts that are difficult to turn off. You might continually think about a fight with a friend, a work meeting that didn’t go well, or you might worry about something bad happening to a loved one.  

Rumination doesn’t help depression. In fact, it can make you feel worse. That’s because you’re repeatedly thinking about real or imagined bad scenarios. Genetics can play a role here too. Research suggests that some people may be more vulnerable to rumination because of their genes. And those who’ve experienced a major depressive episode are more likely to ruminate.

You might also be consciously or subconsciously holding off your depression all day. If you’re around people all day, it isn’t always emotionally safe to feel your depression. You may also have to “mask” or hide your symptoms at work so you can get your job done.  When nighttime rolls around, that’s when those feelings can kick in. They might be worse than usual if you’re feeling them for the first time that day.  

Many people with depression battle with feelings of worthlessness or guilt. Depression can make it hard to muster the motivation to get things done. At night, you may feel that guilt as you go over the tasks you might not have completed from your to-do list. 

Biology also has an influence too. When you’re deep asleep, your brain is experiencing what’s called slow-wave activity. People with depression usually have less slow-wave activity. This can make them sleep even more poorly, which can just worsen depression. 

Tips for falling asleep despite depressive thoughts

There are many strategies you can try to avoid nighttime depression and get better sleep.

• Try replacing negative thoughts with positive ones. This can take some practice, but if you notice yourself ruminating while awake at night, try to switch your thoughts toward more helpful ones. For example, while your work meeting may not have ended well, remind yourself of the times you’ve done well in your job. Write down these positive affirmations or accomplishments, and read them if your nighttime depression hits. 
• Avoid alcohol, caffeine, and other substances close to bedtime. These substances will only make it even harder for you to fall asleep. You could opt for a hot tea instead and focus on the relaxing sensation of the mug against your hands.
• Go to another room. If you spend hours tossing and turning, it can help to go to another room. If your brain starts to associate your bedroom with little or zero sleep, it can make sleeping even harder.  
• Set boundaries around screen time. Did you know that the blue light from screens can make it harder to sleep? Explore settings on your phone that can limit your time on apps or make a promise to yourself to not look at your phone after a certain time. Some people benefit from keeping their phone in a different room at nighttime. 
• Incorporate relaxation exercises before bed. Deep breathing techniques are one of the easiest ways to calm your nervous system. Studies also show mindfulness meditation can improve sleep quality. 

Professional support for nighttime depression 

If lifestyle changes and coping skills aren’t enough, and your sleep issues at night don’t improve or get worse, it might be time to get professional support. A number of treatments may help you with nighttime depression, including:

• Cognitive behavioral therapy (CBT): CBT is one of the most common therapy types for treating depression and anxiety. This approach focuses on your thoughts, feelings, and behaviors. It can help you challenge negative patterns, like ruminating at night time, and make positive changes.
• Cognitive behavioral therapy for insomnia (CBT-I): This approach to therapy can help tackle the sleeplessness that can accompany depression. CBT-I involves identifying thoughts, behaviors, and feelings that feed insomnia. It also includes experimenting with different behaviors to see what does and doesn’t help you sleep.

Antidepressants can also help. Typically, it can take four to eight weeks to know if they’re working. Everyone is different, so it’s important to work with your provider to determine if medication is the right option for your life and circumstances.

If your depression doesn’t respond to therapy or medication, you may want to discuss brain stimulation therapy with your doctor. This type of therapy involves activating or slowing down the brain with electricity or magnetic waves. You’d also probably continue therapy and medication if you’re taking them already. 

Find care with Rula

An inability to fall or stay asleep isn’t always an obvious sign of depression. But if you suspect that your symptoms are related to depression, there’s help available. 

With Rula’s easy-to-use therapist matching tool, you can select a therapist who’s compatible with you and takes your insurance. Whether your treatment options for your depression include talk therapy, medication or both, you can book an appointment as soon as tomorrow.

Find a therapist with Rula