The link between anxiety and depression and quality of sleep

in Sleep Research and Insights

THE LINK BETWEEN ANXIETY AND DEPRESSION AND QUALITY OF SLEEP

Fellow research review of: “The Effect of Anxiety and Depression on Sleep Quality of Individuals With High Risk for Insomnia” a research conducted by  Chang-Myung Oh1 , Ha Yan Kim , Han Kyu Na , Kyoo Ho Cho, and Min Kyung Chu.

HIGHLIGHTS:

  • A face-face interview with structured questions was used to collect data from the population sample in Korea. The data collection took about three months, running from November to January 2012. The aim of the study was to explore the relationship between common mood disorders and sleep quality. 3114 individuals responded and provided all the information required for the study. The participants were between the ages of 16 and 69 years. The insomnia severity index was used to determine those who had insomnia. The Goldberg anxiety scale was used to determine if a participant has anxiety. In addition, patient health questionnaire-9 was the assessment tool used to differentiate participants who had depression.   

  • Several myths surround the concept of mental health. Until recently, people were not eager to seek medical assistance for mental conditions, especially those with little impact on their functioning in society. Mental illness can span across mood disorders, behavioral disorders, and cognitive impairment. In this article, we shall focus on the common mood disorders- anxiety and depression. Individuals with anxiety and depression may experience a significant alteration in sleep patterns. Mood disorders can result from sleep deprivation which creates an imbalance in circulating hormones. In most cases, anxiety and depression are caused by other factors such as excessive serotonin uptake, which may lead to depression. Mood disorders like anxiety and depression are quite illnesses. If structured questions are not asked, you may not be able to pinpoint them. 

  • Insomnia is a common disorder that is underdiagnosed, maybe because people do not see a need to report it. Several individuals, irrespective of age, marital status, or residential area, suffer from either mild or severe insomnia. Millions of people around the world have insomnia. Insomnia can be defined as a persistent inability to fall asleep or stay asleep. It has been linked to mood disorders like anxiety and depression. Certain medication, pain, stress, or illness may also contribute to insomnia. An average person needs about 8 hours of sleep per night for maximum daytime functioning. Failure to get this required sleep may lead to daytime drowsiness, uneasiness and ultimately affect mood. Several factors predispose a person to insomnia. Individuals with anxiety and depression are at high risk for insomnia. This study is important to explore the relationship between these high-risk individuals and sleep quality. A person experiencing depression and anxiety is prone to poor sleep quality. They may experience sleep disturbances like interrupted sleep patterns. There is a tendency that they may spend a long time in light sleep. 

RESULTS

The participants were divided into different categories. One category had insomnia without anxiety and depression. Some had insomnia with anxiety; others had insomnia with depression. The individuals with anxiety and depression had poorer sleep quality than other groups. From the study, we can conclude that insomnia and poor sleep quality is directly influenced by anxiety and depression. The PSQI score for those with both anxiety and depression was poorer. This category of respondents also had impaired daytime alertness, found it difficult to fall asleep, and stay asleep.

INTRODUCTION TO THE RESEARCH

The ultimate goal of myAir app is to promote wellness. An individual cannot be on the wellness continuum of health without getting adequate sleep. The study helps us to understand the effects of mood disorders on sleep patterns properly. This disruption of sleep patterns may eventually lead to insomnia. Sleep is an important part of regeneration. Thus a lack of adequate sleep can expose the individual to many conditions. Nevertheless, some psychological conditions can interfere with the ability to sleep.  

Insomnia is an umbrella term that describes the inability to fall asleep and stay asleep. This condition is not dependent on age. The risk for developing insomnia increases with the presence of mood disorders like anxiety and depression. These two conditions are the most common form of mental illness in the population sample. A good number of individuals with anxiety or depression reported an inability to stay asleep for a long period. An intricate relationship exists between anxiety, depression, and sleep quality. Insomnia can also put an individual at risk of developing anxiety and depression. 

myAir focuses on promoting health and helping the individual make healthier choices. Having an extensive knowledge pool of the relationship between anxiety, depression, and insomnia helps us serve you better. This data, combined with data from the app, allows us to create the perfect chocolate bar formulation to reduce anxiety, thus reducing the risk for insomnia. For individuals who have not developed full insomnia, the goal is to promote healthy sleeping patterns. Insomnia is a condition without a cure, so preventing it is the best way possible. 

In the treatment of depression, insomnia is a critical sign that health professionals must observe. Most times, the onset of insomnia heralds a relapse in a recovering client. Generally, individuals with anxiety and depression have more symptoms of insomnia. The mechanism of anxiety and insomnia is similar because they both stimulate alertness. In more cases, anxiety exists simultaneously with insomnia. The individual is not relaxed; hence it is impossible to stay asleep for a long time. All this information gathered from the research helps myAir provide better services to clients diagnosed with anxiety, depression and requires a safe approach to improving sleep quality.

RELATIONSHIP BETWEEN ANXIETY AND INSOMNIA

It is normal to be anxious on the first day of school when you have an exam or a job interview. However, a persistent feeling of worry or fear that interferes with functioning and is present for at least six months is diagnosed as anxiety. For some individuals, their anxiety manifests as obsession or irrational fear about something. Several people in the world suffer from one form of anxiety or the other. When there is a significant change in mood, behavior, and thinking because of excessive worrying, then anxiety becomes pathogenic. It can progress to affect the sleeping pattern, which predisposes such an individual to various health hazards. The general symptoms of anxiety may include restlessness, fear, difficulty concentrating, uncontrollable worry, and sleep problems.

Insomnia is a technical term that describes individuals who have difficulty sleeping. It may include difficulty falling asleep, difficulty staying asleep, waking up at short intervals, and feeling unrested. Studies globally have shown that individuals with anxiety suffer from sleep problems. The controversy arises in determining which factor causes the other. However, they are both related, and the onset of one, say, anxiety, may herald the other, which is insomnia. In some clients, the reverse is the case. 

Adequate sleep is instrumental in the regression of anxiety and other mood disorders. Sleep is essential to build physical, mental, and emotional health. Lack of sleep can trigger anxiety disorders in a person. Inadequate sleep quality can prompt negative ideas and emotional sensibility. An uncontrolled lack of sleep can cause anxiety symptoms to degenerate. For swift recovery from anxiety, the client must adhere to a relaxing bedtime pattern. On the other hand, anxiety can interfere with a person’s ability to fall asleep and stay asleep. 

For myAir app users who experience sleeping difficulty, we try to determine if they felt any form of anxiety the previous day. Thanks to research, we can conclude that anxiety may reduce sleep duration. Others may have difficulty falling asleep, and they keep tossing and turning until it is almost time to wake. We usually suggest relaxation techniques to help deal with the anxiousness to promote a sense of relief. Taking a warm bath, reading a book, or listening to music are relaxation techniques to tackle anxiety. They promote the ability to fall asleep so that the body can recharge.

HOW DEPRESSION AFFECTS QUALITY OF SLEEP

Depression is an intense feeling of sadness or hopelessness. The feeling of sadness is normal when a situation does not make you happy. Sadness is usually linked to an event and lasts for a short amount. For example, the death of a loved one may cause a person to be depressed if the grief is intense. However, this is a normal phase of life that will definitely pass. Some individuals experience hopelessness and intense sadness without any apparent reason. The clinical suggestion is a decline in the number of happy hormones like serotonin and dopamine in the brain. Depressive disorders are diagnosed when a person exhibits an intense feeling of sadness for more than 14 days, such that it affects the level of functioning. The common symptoms of depression include persistent sad mood, the feeling of hopelessness, and loss of interest in activities, self-isolation, fatigue, poor appetite /increased appetite, and suicidal thoughts. 

Depression and alterations in sleep patterns are strongly related. It is rare to diagnose a depressive disorder without the sleep factor. However, the argument is still ongoing for which triggers the other. The current study shows that depression and sleep problems affect each other irrespective of which condition develops first. Depressive disorders may come with insomnia or hypersomnia. However, insomnia is more common in individuals with depression. Inadequate sleep patterns can disrupt the circadian rhythms and cause the brain's excessive uptake of happy hormones (serotonin, dopamine, etc.). The cumulative effects manifest as depression. People with depression sleep better as their condition improves. 

myAir app may ask if the client was using their phone before falling asleep. Science has shown that excessive exposure to blue light from phones and laptops may increase difficulty falling asleep. One of the sleep rules we offer is to ensure the sleeping environment is dark, calm, and quiet. As a sleep therapy, turning off the TV is important in staying asleep. Waking up frequently interrupts the slow-wave sleep, which is necessary for the body to build itself so that you can go through the day without breaking down. 

CONCLUSIONTHE LINK BETWEEN ANXIETY AND DEPRESSION AND QUALITY OF SLEEP

We can say that anxiety, depression, and quality of sleep are interrelated. One may signal the presence of the other. There are tools for assessing anxiety, depression, and their relationship with quality of sleep. The DSM-5 also gives criteria for diagnosing anxiety and depression. The feeling of worry and sadness, i.e., anxiety and depression, is a normal human response to situations. However, they become classified as a disorder when a person’s personality becomes maladaptive and significantly impairs how they function in society. Depression is a major mood disorder that takes a toll on a person’s physical, mental, psychological health, and interpersonal relationships. 

Insomnia is one of the oldest ways of recognizing anxiety in a person. They have trouble falling asleep. Most times, they wake up shortly after and find it difficult to go back to sleep. Their mind is running a thousand miles with a thousand worries that keep them preoccupied such that sleeping becomes challenging. Individuals with anxiety when facing a stressor exhibit high sleep reactivity. They are more likely to sleep even less than before or develop sleep apnea. People with anxiety experience sleep fragmentation which significantly reduces the quality of sleep. Sometimes they are preoccupied with thoughts of sleeplessness that they cannot fall asleep. This leads to more anxiety, which increases sleep problems, and the cycle is endless. Inadequate sleep can worsen anxiety as such individuals become easily irritable.

Depression is a mood disorder that is unique to each person. The feeling of intense grief, sadness, hopelessness, and worthlessness is usually common among those with depression. Some individuals with depression may manifest binge eat, under eat, oversleep, or under sleep. Some alternate between extremes of the manifestations. There is a concrete relationship between depression and sleep quality. When you do not get enough sleep, the body cannot build resilience, which can be a beacon that pushes you off the edge of hopelessness.

Furthermore, depression may stimulate wakefulness causing insomnia. Lack of sleep makes one wake with less energy, and this worsens depression. Insomnia increases the risk of developing depression. We can say depression and insomnia fuel each other to maintain a disruption in the physical, mental, and emotional balance. Untreated insomnia makes treating depression impossible. Lack of sleep causes an imbalance in hormones, and this can further precipitate depression. 

In conclusion, insomnia, daytime dysfunction, and poor sleep quality are consistent among individuals with anxiety and depression. In planning treatment for these clients, sleep therapy is as important as eliminating sources of anxiety. At myAir organization, our elite team creates formulation that promotes relaxation and helps to regulate mood. We also strictly monitor sleep patterns to ensure the client returns to a state of wellness.

Reference and Footnotes:

Original publication: The Effect of Anxiety and Depression on Sleep Quality of Individuals With High Risk for Insomnia

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6700255/pdf/fneur-10-00849.pdf

By Chang-Myung Oh1 , Ha Yan Kim , Han Kyu Na , Kyoo Ho Cho, and Min Kyung Chu.

Published in 2005 in Korea by Frontiers in Neurology

Footnote: No potential conflict of interest relevant to this article was reported.

References:

  1. Belleville G, Cousineau H, Levrier K, St-Pierre-Delorme ME. Meta-analytic review of the impact of cognitive-behavior therapy for insomnia on concomitant anxiety. Clin Psychol Rev. (2011) 31:638–52. doi: 10.1016/j.cpr.2011.02.004 [Google Scholar]

  2. Breslau N, Roth T, Rosenthal L, Andreski P. Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young [Pubmed].

  3. Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. (1989) 28:193–213. doi: 10.1016/0165-1781(89)90047-4 [Pubmed]

  4. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. (1986) 51:1173–82. doi: 10.1037//0022-3514.51.6.1173 [Pubmed]

  5. Babson KA, Feldner MT. Temporal relations between sleep problems and both traumatic event exposure and PTSD: a critical review of the empirical literature. J Anxiety Dis. (2010) 24:1–15. doi: 10.1016/j.janxdis.2009.08.002 [Pubmed]

  6. Cho MJ, Lee JY. Epidemiology of depressive disorders in Korea. Psychiatry Investig. (2005) 2:22–7. [Google Scholar]

  7. Cho MJ, Seong SJ, Park JE, Chung IW, Lee YM, Bae A, et al. Prevalence and Correlates of DSM-IV Mental Disorders in South Korean Adults: the Korean Epidemiologic Catchment Area Study 2011. Psychiatry Investig. (2015) 12:164–70. doi: 10.4306/pi.2015.12.2.164 [Google Scholar]

  8. Clark LA, Watson D. Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnormal Psychol. (1991) 100:316–36. doi: 10.1037/0021-843X.100.3.316 [Google Scholar]

  9. Choi HS, Choi JH, Park KH, Joo KJ, Ga H, Ko HJ, et al. Standardization of the Korean version of patient health questionnaire-9 as a screening instrument for major depressive disorder. Korean J Fam Med. (2007) 28:114–9. Available online at: https://koreamed.org/article/1001KJFM/2007.28.2.114  [Google Scholar]

  10. Cho YW, Shin WC, Yun CH, Hong SB, Kim J, Earley CJ. Epidemiology of insomnia in korean adults: prevalence and associated factors. J Clin Neurol. (2009) 5:20–3. doi: 10.3988/jcn.2009.5.1.20 [Pubmed]

  11. Crawley SA, Caporino NE, Birmaher B, Ginsburg G, Piacentini J, Albano AM, et al. Somatic complaints in anxious youth. Child Psychiatry Hum Develop. (2014) 45:398–407. doi: 10.1007/s10578-013-0410-x [Google Scholar]

  12. Cox RC, Olatunji BO. A systematic review of sleep disturbance in anxiety and related disorders. J Anxiety Dis. (2016) 37:104– 29. doi: 10.1016/j.janxdis.2015.12.001[Pubmed]

  13. Dryman A, Eaton WW. Affective symptoms associated with the onset of major depression in the community: findings from the US National Institute of Mental Health Epidemiologic Catchment Area Program. Acta Psychiatr Scandinav. (1991) 84:1–5. doi: 10.1111/j.1600-0447.1991.tb01410.x [Pubmed]

  14. Eun KS, Seung-eun C. Sleep duration and suicidal impulse of Korean adolescents: weekday/weekend sleep duration effects and gender difference. J Korean Offic Stat. (2010) 15:82–103. Available online at: http://www.koreascience.or.kr/article/JAKO201502152089319.page [Google Scholar]

  15. Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA. (1989) 262:1479–84. doi: 10.1001/jama.262.11.1479 [Pubmed]

  16. Geoffroy PA, Hoertel N, Etain B, Bellivier F, Delorme R, Limosin F, et al. Insomnia and hypersomnia in major depressive episode:prevalence, sociodemographic characteristics and psychiatric comorbidity in a population-based study. J Affect Dis. (2018) 226:132–41. doi: 10.1016/j.jad.2017.09.032 [Pubmed]

  17. Gehrman PR, Meltzer LJ, Moore M, Pack AI, Perlis ML, Eaves LJ, et al. Heritability of insomnia symptoms in youth and their relationship to depression and anxiety. Sleep. (2011) 34:1641–6. doi: 10.5665/sleep.1424 [Google Scholar]

  18. Khan MS, Aouad R. The effects of insomnia and sleep loss on cardiovascular disease. Sleep Med Clin. (2017) 12:167–77. doi: 10.1016/j.jsmc.2017.01.005 [Pubmed]

  19. Kapfhammer HP. Somatic symptoms in depression. Dialog Clin Neurosci. (2006) 8:227–39. [Google Scholar]

  20. Kawada T, Yosiaki S, Yasuo K, Suzuki S. Population study on the prevalence of insomnia and insomnia-related factors among Japanese women. Sleep Med. (2003) 4:563–7. doi: 10.1016/S1389-9457(03)00109-6 [Pubmed]

  21. Lim JY, Lee SH, Cha YS, Park HS, Sunwoo S. Reliability and validity of anxiety screening scale. J Korean Acad Fam Med. (2011) 22:1224–32. Available online at: https://koreamed.org/article/1001KJFM/2001.22.8.1224 [Google Scholar]

  22. Morin CM, Belleville G, Bélanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. (2011) 34:601–8. doi: 10.1093/sleep/34.5.601 [Pubmed]

  23. Mason EC, Harvey AG. Insomnia before and after treatment for anxiety and depression. J Affect Dis. (2014) 168:415–21. doi: 10.1016/j.jad.2014.07.020[pubmed]

  24. Mellinger GD, Balter MB, Uhlenhuth EH. Insomnia and its treatment. Prevalence and correlates. Archiv Gen Psychiatry. (1985) 42:225–32. doi: 10.1001/archpsyc.1985.01790260019002 [Pubmed]

  25. Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev. (2016) 25:52–73. doi: 10.1016/j.smrv.2015.01.009 [Pubmed]

  26. Ohayon MM. Prevalence of DSM-IV diagnostic criteria of insomnia: distinguishing insomnia related to mental disorders from sleep disorders. J Psychiatr Re. (1997) 31:333–46. doi: 10.1016/S0022-3956(97)00002-2 [Pubmed]

  27. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. (2002) 6:97–111. doi: 10.1053/smrv.2002.0186 [Pubmed]

  28. Ohayon MM. Observation of the natural evolution of insomnia in the american general population cohort. Sleep Med Clin. (2009) 4:87–92. doi:10.1016/j.jsmc.2008.12.002 [Pubmed]

  29. Oh K, Cho SJ, Chung YK, Kim JM, Chu MK. Combination of anxiety and depression is associated with an increased headache frequency in migraineurs: a population-based study. BMC Neurol. (2014) 14:238. doi: 10.1186/s12883-014-0238-4 [Pubmed]

  30. Ohayon MM, Hong SC. Prevalence of insomnia and associated factors in South Korea. J Psychosomat Res. (2002) 53:593–600. doi: 10.1016/S0022-3999(02)00449-X [Pubmed]

  31. Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans CT, Mulrow CD, et al. Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Int Med. (2002) 136:765–76. doi: 10.7326/0003-4819-136-10-200205210-00013 [Google Scholar]

  32. Ramsawh HJ, Stein MB, Belik SL, Jacobi F, Sareen J. Relationship of anxiety disorders, sleep quality, and functional impairment in a community sample. J Psychiatr Res. (2009) 43:926–33. doi: 10.1016/j.jpsychires.2009.01.009 [Pubmed]

  33. Roth T, Jaeger S, Jin R, Kalsekar A, Stang PE, Kessler RC. Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication. Biol Psychiatry. (2006) 60:1364–71. doi: 10.1016/j.biopsych.2006.05.039 [Pubmed]

  34. Roberts RE, Shema SJ, Kaplan GA, Strawbridge WJ. Sleep complaints and depression in an aging cohort: a prospective perspective. Am J Psychiatry. (2000) 157:81–8. doi: 10.1176/ajp.157.1.81[Google Scholar]

  35. Stoller MK. Economic effects of insomnia. Clin Therapeut. (1994) 16:873–97; discussion: 54. [Pubmed]

  36. Sateia MJ. International classification of sleep disorders. Chest. (2014) 146:1387–94. doi: 10.1378/chest.14-0970 Frontiers in Neurology | www.frontiersin.org 7 August 2019 | Volume 10 | Article 849 Oh et al. Insomnia and Psychiatric Morbidities [Google Scholar]

  37. Soehner AM, Harvey AG. Prevalence and functional consequences of severe insomnia symptoms in mood and anxiety disorders: results from a nationally representative sample. Sleep. (2012) 35:1367–75. doi: 10.5665/sleep.2116 [Google Scholar]

  38. Sateia MJ, Doghramji K, Hauri PJ, Morin CM. Evaluation of chronic insomnia. An American Academy of Sleep Medicine review. Sleep. (2000) 23:243–308. doi: 10.1093/sleep/23.2.1l [Pubmed

  39. Taylor DJ, Lichstein KL, Durrence HH, Reidel BW, Bush AJ. Epidemiology of insomnia, depression, and anxiety. Sleep. (2005) 28:1457–64. doi: 10.1093/sleep/28.11.1457 [Pubmed]

  40. Taylor DJ, Lichstein KL, Durrence HH. Insomnia as a health risk factor. Behav Sleep Med. (2003) 1:227–47. doi: 10.1207/S15402010BSM0104_5 [Pubmed]

  41. Thorpy MJ. Classification of sleep disorders. Neurotherapeutics. (2012) 9:687–701. doi: 10.1007/s13311-012-0145-6 [Pubmed]

  42. Tsuno N, Besset A, Ritchie K. Sleep and depression. J Clin Psychiatry. (2005) 66:1254–69. doi: 10.4088/JCP.v66n1008 [Pubmed]

  43. Tranter R, O’Donovan C, Chandarana P, Kennedy S. Prevalence and outcome of partial remission in depression. J Psychiatry Neurosci. (2002) 27:241–7.[Pubmed]

  44. Walsh JK, Engelhardt CL. The direct economic costs of insomnia in the United States for 1995. Sleep. (1999) 22(Suppl. 2):S386–93. [Pubmed]

  45. Wong ML, Lau KNT, Espie CA, Luik AI, Kyle SD, Lau EYY. Psychometric properties of the Sleep Condition Indicator and Insomnia Severity Index in the evaluation of insomnia disorder. Sleep Med. (2017) 33:76–81. doi: 10.1016/j.sleep.2016.05.019 [Pubmed]

  46. Wilsmore BR, Grunstein RR, Fransen M, Woodward M, Norton R, Ameratunga S. Sleep habits, insomnia, and daytime sleepiness in a large and healthy community-based sample of New Zealanders. J Clin Sleep Med. (2013) 9:559–66. doi: 10.5664/jcsm.2750 [Pubmed]

  47. Van Londen L, Molenaar RP, Goekoop JG, Zwinderman AH, Rooijmans HG. Three- to 5-year prospective follow-up of outcome in major depression. Psychol Med. (1998) 28:731–5. doi: 10.1017/S0033291797006466 [Pubmed]