May 2009


Sleep and depression

Theory and practice

Volume 38, No.5, May 2009 Pages 302-304

Michael Berk


Sleep disorders are particularly common in the primary care setting, and are intimately interlinked with depression.


This article aims to review the relationship between sleep and depression, with an emphasis on the foundation and clinical salience of this relationship.


Depression is the most common cause of insomnia, and insomnia is highly prevalent in depression. This association has a well characterised physiological foundation. Sleep disorder in depression has prognostic and therapeutic implications. Residual insomnia after remission of depression is predictive of relapse, and prominent insomnia predicts a poorer treatment outcome in depression. Evidence based management involves integrating both pharmacological and behavioural strategies; the latter includes sleep hygiene and regulating diurnal rhythms.

Insomnia is one of the most common presenting symptoms in the primary care setting, and depression is one of the most common causes of insomnia. Insomnia is a symptom not a diagnosis, and has a wide differential diagnosis that includes psychiatric disorders such as depression and anxiety, and pain, medical conditions and psychological causes. Conditioned, or psychophysiological insomnia, is a common form of insomnia, and occurs when anxiety that centres on not sleeping well generates arousal at bed time.1 This anxiety about sleep sustains a cycle that perpetuates the insomnia. The aetiological foundations of insomnia, both psychological and biological, need to be the focus of management, rather than the symptom itself.

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