When depression and burnout don’t let us sleep

01. February 2022

Almost everyone has had to deal with sleep problems. Usually, these are temporary and therefore no cause for concern. But at the latest, when one sleepless night follows the other over weeks and we are hardly able to perform during the day, the search for the cause begins. Not infrequently, this lies in our mental health.

To be even more precise: mental illnesses and sleep disorders are mutually dependent. Sleep disorders can occur as a result of mental problems, but they can also intensify or trigger them. Especially when burnout or depression is diagnosed, sleep has lost its regenerative effect in 90% of cases.

What distinguishes depression from burnout

Depression is a mental illness listed in the diagnostic classification system with clearly defined criteria. Burnout, on the other hand, is not listed as an independent illness and rather describes the subjective state of being “burned out.” Although the majority of people who feel burned out do not meet the criteria for depression, a considerable overlap of symptoms can be found in patients with both disorders.

DEPRESSION has many faces

Depressive symptoms can be observed at the following levels:

Emotional: dejection, guilt, feelings of worthlessness, etc

Cognitive: concentration problems, fear of the future, reduced attention, etc

Physical: listlessness, sleep disturbances, decreased appetite , etc

Behavioral: Slowed speech and motor skills, etc

Most people experience a selection of the listed depressive symptoms at times during their lives. However, we only speak of a depressive disorder when at least five symptoms occur repeatedly over a period of at least two weeks and with an intensity that requires treatment. If the course of the disease is particularly severe, thoughts of suicide may increase over time. The course of depression is very individual and phasic; phases of illness as well as symptom-free periods can alternate.

The main symptoms of the BURNOUT syndrome

Burnout results from a prolonged episode of stress – chronic stress. However, this can only develop when the stress phases are perceived by those affected as a persistent burden for which too few resources are available for coping. Chronic stress and an associated imbalance between tension and recovery are expressed in three dimensions of discomfort:

Emotional and physical exhaustion: e.g., feelings of anxiety , sleep problems, chronic fatigue

Reduced performance: e.g., more effort required in everyday life, longer regeneration times

Alienation: e.g. distanced, indifferent attitude towards work and other people

Many people affected by burnout develop depression in the course of their illness, which is another reason why there is a high degree of correspondence between many symptoms.

At what point do we speak of disturbed sleep?

In many cases, a sleep disorder is a symptom of another mental or physical illness. In general, a distinction is made between insomnia and sleep addiction. Insomnia includes insufficient duration and quality of sleep, as well as difficulty falling asleep, difficulty sleeping through the night, and early morning awakenings. Insomnia, on the other hand, is defined either as a state of excessive sleepiness during the day despite sufficient sleep at night or by prolonged transition periods from waking to wakefulness.

In addition, disruption of the sleep-wake rhythm, sleepwalking, nightmares, and nocturnal episodes of extreme fear and panic may be present in sleep disordered breathing. The decisive factor here is that the aforementioned symptomatology must exist over a longer period of time of about four weeks at least three times a week and severely restrict the performance as well as the state of mind during the day.

Sleep disorders: physical symptoms of depression and burnout

Disturbed sleep behavior is one of the first symptoms of depression and burnout. Researchers have identified several factors that explain this connection.

It is striking that especially in patients with depression or burnout, the levels of the stress hormone cortisol are elevated, both during the day and at night, compared to people who do not suffer from the disease. This could be a contributory cause of persistent wakefulness. Basically, cortisol ramps up body functions due to increased stress, and blood pressure as well as pulse rate skyrocket. Another observation is that in depressed individuals, less growth hormones are released during the initial sleep phase. These hormones ensure restful deep sleep, which is shorter in affected individuals.

Furthermore, it is assumed that the first REM sleep phase occurs earlier due to the shortened first deep sleep phase. REM stands for “rapid eye movement” – in this phase, the eyes move back and forth frantically with the eyelids closed. Depressed individuals exhibit more rapid eye movements than healthy individuals. Research is ongoing to determine the extent of impairment when REM sleep occurs at the wrong time. In summary, however, it can be stated that in depressed people the intervals between sleep phases are irregular, deep sleep is reduced and REM sleep is advanced.

EXCERPT: Sleep, however, can play an important role not only in the diagnosis of depression and burnout, but also in therapy. It is known that short-term sleep deprivation has a mood-enhancing effect, especially in the second half of the night. During an all-nighter, the body produces more mood-boosting substances such as serotonin and tryptophan than during sleep. Sleep disorders are therefore a double-edged sword: on the one hand, they are a risk factor for both depression and burnout; on the other hand, sleep deprivation can also have an antidepressant effect.

Preventing and treating sleep disorders

One thing is clear: Especially when sleep disorders occur in conjunction with burnout and depression, a calming evening routine alone will not replace psychotherapeutic treatment. However, regular bedtimes (including weekends), sleep rituals and relaxation procedures can be supportive and help the body find its way back into a good sleep rhythm.

The most common tips for good sleep hygiene in depression and burnout also include:

  • Regular physical activity
  • No coffee after noon, avoid alcohol and sleeping pills as much as possible
  • Avoid heavy meals in the evening
  • Use the bed only for sleeping and not, for example, for reading or watching television
  • Ensure a cool room temperature (18 to 22 degrees), quiet and darkness
  • Do not go to sleep until you are tired
  • Write down all stressful thoughts before going to sleep

Important: If insomnia persists, getting up and engaging in a quiet activity often helps better than staying in bed and tossing and turning!

Sleep disorders, whether they occur alone or in connection with a mental illness, should be treated professionally if they severely impair performance and well-being over a longer period of time. Those affected often find it difficult to accept this problem. They should be aware that they do not have to face the challenge alone and can receive expert help from psychotherapists and doctors.

References

Bruggisser, Hans Peter: Depression and burnout. Journal of Holistic Medicine (2010), Volume 22, Issue 5

Dilling, Horst et al: ICD-10: International Classification of Mental Disorders. Göttingen, 2015

Hapke, Ulfert (2012): Stress, Sleep Disorders, Depression and Burnout: Wie belastet sind wir?, Study on the Health of Adults in Germany, Berlin: Robert Koch Institute

Matura, Silke ; Oertel, Viola: Bewegung und Sport gegen Burnout, Depressionen und Ängste. Berlin, Heidelberg, 2017

Müller-Rörich, Thomas et al: Schattendasein – Das unverstandene Leiden Depression. Heidelberg, 2007

Voderholzer, Ulrich; Hillert, Andreas; Hiller, Gabriele: Burnout & Depression. Stuttgart, 2018.

Verena Klein
Autor:in Verena Klein
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