Too Much Sleep, Not Enough Rest: The Link Between Hypersomnia and Depression

Constant fatigue is one of the hallmark signs of depression. If you’re going through a particularly bad episode, just finding the energy to get out of bed can feel impossible. It seems logical that the problem may stem from not getting enough sleep. However, in some cases of depression, the issue is in fact too much sleep, not too little.

What is hypersomnia?

Hypersomnia is the medical term for excessive daytime sleepiness that isn’t resolved by a normal amount of sleep. While people can develop hypersomnia as a standalone condition, it is also a side effect of many mental health issues, including depression.

Depression-related hypersomnia can cause a myriad of symptoms. You may feel groggy and disoriented, even after a full night's sleep. You might also have a hard time staying awake or feel the need to sleep for 10 or more hours per day.

Some people may feel as if their limbs are stiff and heavy. Symptoms can vary widely from person to person, or even within the same person over time. It is also common to oscillate between episodes of hypersomnia and insomnia.

Since hypersomnia can manifest in so many ways, it can be difficult to accurately identify. The condition is often made worse by other depressive symptoms, like automatic negative thoughts and loss of interest.

Feeling mentally and physically tired all the time makes it tough to exercise, get outside, or do other activities that would actually improve your sleep. Feeling well-rested is the foundation for improved mental health. A good night’s sleep makes it easier to follow a structured routine, socialize, and exercise — all of which are essential for managing depression.

How does hypersomnia feel?

Hypersomnia can feel like living in a negative loop. Being depressed throughout the day is exhausting and anxiety-inducing. Sleeping at night doesn’t provide relief. Instead, all the negativity of the day shows up as bad dreams and feelings of dread.

Sleep is not restful, so feelings of low energy and fatigue persist. Yet, life is so tiring that sleep can feel like an escape. Nearly a third of people with depression find themselves caught in this draining cycle.

Thankfully, hypersomnia is manageable with lifestyle changes and at-home treatments. We’ll get into those in a bit. Even better, treating daytime sleepiness can also reduce other depressive symptoms. To understand why, we should explore the link between depression and hypersomnia.

What is the link between depression and hypersomnia?

Researchers still don’t understand why depression affects sleep quality, but poor sleep and low mood tend to go hand-in-hand. A prevailing theory is that high-stress levels can disrupt the sleep cycle and make the rapid eye movement (REM) stage last longer. More time in REM means less time in deeper, more restorative sleep stages.

Other studies have found that hypersomnia is more common in some types of depression than others. For example, hypersomnia is a diagnostic criterion for atypical depression, which has different symptoms than traditional major depressive disorder.

Atypical symptoms include a mood-boosting reaction to positive experiences, increases in appetite, and sensitivity toward real or perceived rejection. Oversleeping and chronic fatigue are also common features of bipolar depression.

Probably the most interesting theory is that hypersomnia from depression is not an actual condition, but a distorted perception.

While the majority of people with depression report feeling tired enough to sleep during the day, few actually can. Researcher David T. Plante and his team at the University of Wisconsin School of Medicine and Public Health designed a study to assess if depression-related hypersomnia met the diagnostic criteria for idiopathic hypersomnia, or when the condition occurs without a clear cause.

The study recruited people with mood disorders and hypersomnia symptoms. The standard Multiple Sleep Latency Test (MSLT) was used to measure daytime sleepiness. During the test, the subjects took a nap 4 or 5 times throughout the day. The MSLT measures how long it took for each subject to fall asleep and enter REM.

Falling asleep in under 8 minutes indicates a sleep disorder. However, the study found that 75% of the subjects had normal results, despite experiencing hypersomnia symptoms.

This data suggests that true hypersomnia may be the result of a third comorbidity, like sleep apnea. Depression-related hypersomnia might stem from other factors, such as impaired brain function, systemic inflammation, or abnormal sleep cycles.

How to manage hypersomnia

Treating depression-related sleep problems is complex and can be a bit of a chicken or egg situation. While sleep disturbances and depression have a bidirectional relationship, there is some evidence that treating sleep problems first can relieve depression symptoms.

You can reduce your hypersomnia by updating your wake-up and bedtime routines. For example:

• Wake up at the same time every day, even on weekends. Sleeping in can throw off your circadian rhythm, which regulates the body’s sleep-wake cycles.
• Start the day with stretches you can do in bed, like the yoga positions child’s pose or happy baby.
• Do a sitting-up meditation with both feet planted on the floor.
• Prepare a nutritious breakfast.
• Make a playlist of your favorite songs to get you going in the morning.
• Schedule an early morning phone call with a friend early in the day to encourage you to get up.

At night, it's important to practice good sleep hygiene to calm the mind and body.

• Stop drinking coffee or other caffeinated beverages after lunch.
• No alcoholic beverages after dinner.
• Avoid bright light sources after sunset.
• Start your bedtime routine at least 90 minutes before you want to fall asleep.
• Shut off screens at least an hour before bedtime.
• Drink warm, caffeine-free tea.
• Take a hot bath. The heat from the water will lower your body temperature, which signals your brain to produce melatonin. Higher melatonin levels help you fall asleep faster.

In some cases, sleep deprivation can eliminate hypersomnia. Wake therapy is an intervention that combines sleep deprivation with light box therapy. Staying up for 24 to 36 hours at a time “resets'' the body’s sleep-wake cycles and temporarily eliminates hypersomnia symptoms. While the treatment is effective, it is best done under medical supervision. Contact a mental health professional before trying wake therapy.

If you are still tired during the day despite following a healthy morning and bedtime routine, it may be time to talk to your doctor and get screened for other possible causes, such as sleep apnea or a vitamin deficiency.

In addition to following a healthy sleep routine, using the Flow tDCS treatment for 30 minutes a day can improve sleep quality in as little as four weeks. The Flow app delivers helpful tips for maintaining sleep hygiene.