Depression can have many symptoms and take many forms. But one of the more common symptoms may not feel like a mental health symptom at all. Depression affects sleep, often in complex, biological ways.
Some people with depression struggle to fall asleep or wake up multiple times during the night. But for others, the problem is the opposite — they sleep constantly. Twelve hours, fourteen hours, sometimes more. They wake up exhausted, go through the day in a fog, and collapse back into bed as soon as possible.
If you’re sleeping excessively and still feeling drained, it may be a symptom of depression. Depression can fundamentally change how your body regulates sleep, and while some parts of it are directly related to thoughts and feelings, others are related to the way that depression rewires and affects hormones in the brain.
How Depression Affects Sleep Regulation
Depression doesn’t just make you feel sad or hopeless. It disrupts the biological systems that control sleep, energy, and alertness.
Your brain relies on neurotransmitters like serotonin, dopamine, and norepinephrine to regulate mood, motivation, and wakefulness. Depression typically involves imbalances in these chemicals, which means the systems that keep you alert and energized during the day aren’t functioning properly. When these neurotransmitters are depleted or dysregulated, your brain struggles to maintain normal wakefulness, and sleep becomes the default state.
Depression also affects your circadian rhythm — the internal clock that tells your body when to sleep and when to wake up. When this rhythm is disrupted, you can feel tired all the time regardless of how much you sleep. Your body loses the ability to distinguish between rest time and active time, so exhaustion becomes constant.
The result is hypersomnia, which is the clinical term for excessive sleeping. People with hypersomnia sleep far more than the typical seven to nine hours but wake up feeling just as tired as when they went to bed. The sleep isn’t restorative because the underlying brain chemistry issues remain unresolved.
Depression and Fatigue
Depression causes profound physical and mental fatigue that goes beyond ordinary tiredness. Everything feels harder — getting out of bed, making decisions, holding conversations, even basic tasks like showering or eating. This overwhelming exhaustion makes sleep feel like the only relief available.
Part of this fatigue comes from the mental and emotional work depression creates. Your brain is constantly processing negative thoughts, managing feelings of worthlessness or hopelessness, and fighting against the weight of despair. That takes enormous energy, even if you’re not consciously aware of it. By the end of the day — or even by mid-morning — your brain is depleted, and sleep becomes the easiest escape.
Depression also reduces motivation and interest in activities that would normally energize you. When nothing feels rewarding or enjoyable, there’s no reason to stay awake. Sleep becomes preferable to facing another day where everything feels pointless.
For some people, excessive sleep also functions as avoidance. When you’re asleep, you’re not dealing with the pain, the negative thoughts, or the overwhelming sense that nothing will get better. Sleep offers a temporary reprieve from the emotional burden of depression, which makes it incredibly appealing even when you’ve already slept for hours.
Why Some People Sleep More While Others Sleep Less
Not everyone with depression experiences hypersomnia. Some people develop insomnia instead, lying awake for hours unable to shut off their racing thoughts or falling asleep only to wake up repeatedly throughout the night.
The type of depression you have can influence which sleep pattern emerges. People with atypical depression — a subtype characterized by mood reactivity, increased appetite, and sensitivity to rejection — are more likely to experience hypersomnia. Those with melancholic depression, which involves a persistent inability to feel pleasure and early morning waking, tend toward insomnia instead.
Your brain chemistry, stress levels, and individual physiology also play a role. Some people’s bodies respond to depression by shutting down and conserving energy, leading to excessive sleep. Others experience heightened anxiety or rumination that keeps them awake despite their exhaustion.
Treatment Options for Depression-Related Hypersomnia
If depression is causing you to sleep excessively, treatment needs to address both the depression and the sleep disturbance.
Therapy — particularly Cognitive Behavioral Therapy (CBT) — helps identify and challenge the negative thought patterns that fuel depression and the behaviors that reinforce excessive sleep. CBT for insomnia can be adapted to address hypersomnia by focusing on sleep restriction, activity scheduling, and gradual reintroduction of structure and routine.
Light therapy can help reset your circadian rhythm, especially if you’re sleeping through daylight hours. Regular exposure to bright light in the morning signals your brain that it’s time to be awake and alert, which can gradually restore a more normal sleep-wake cycle.
Establishing a consistent sleep schedule — even when you don’t feel like it — helps retrain your body’s internal clock. Going to bed and waking up at the same time every day, limiting naps, and creating boundaries around sleep can gradually reduce hypersomnia.
Another option is exercise. Physical activity, though difficult when depression saps your energy, can improve both mood and sleep quality. Even short walks or gentle movement can help regulate your sleep cycle and boost the neurotransmitters that depression depletes.
Getting Help for Depression and Sleep Problems
If you’re sleeping excessively and feeling trapped in a cycle of exhaustion and depression, reaching out for professional support can help you break that pattern. Depression-related hypersomnia responds well to treatment, but it requires addressing the underlying depression rather than just trying to force yourself to sleep less.
Flourish Psychology’s therapists in Brooklyn specialize in treating depression and understand how sleep disturbances complicate recovery. We use evidence-based approaches like CBT and other modalities to help you regain control over your sleep, your energy, and your life.
You can reach Flourish Psychology at 917-737-9475 to schedule a consultation, or connect through the website to learn more about services and availability.
Do You Mentally Prepare for Conversations That Haven’t Happened?
You’re lying in bed at 11 PM, trying to fall asleep, when your brain decides it’s the perfect time to rehearse tomorrow’s conversation with your boss. You run through what you’ll say, how they’ll respond, what you’ll say back. You plan for every possible objection, every dismissive comment, every worst-case scenario.
Or maybe you’re in the shower, mentally replaying a text message you sent three hours ago, crafting better versions of what you should have said. You imagine the other person’s reaction, prepare your defense, plan your follow-up.
This mental rehearsal – this constant preparation for conversations, confrontations, and scenarios that may never happen – is one of the most common patterns therapists see in people struggling with anxiety, and while it feels productive, like you’re getting ready for something important, it’s actually keeping you stuck in a cycle of worry and stress.
What Is Mental Rehearsal?
Mental rehearsal is when you repeatedly imagine future conversations, events, or confrontations in your mind. You script out what you’ll say, anticipate how others will respond, and plan your reactions to their responses. Sometimes you’re rehearsing something that’s actually scheduled to happen. Other times, you’re preparing for conflicts or conversations that exist only in your imagination.
This pattern shows up in different ways for different people. Some people mentally rehearse difficult conversations with partners, preparing for fights that haven’t started. Others rehearse work presentations over and over, imagining every question that could be asked. Some people rehearse explanations or defenses for situations that haven’t even occurred yet.
The problem is that mental rehearsal rarely stops at one run-through. You rehearse the conversation, then you revise it. You think of a better response, so you run through it again. You imagine a new objection, so you prepare for that too. Before you know it, you’ve spent 30 minutes or an hour mentally preparing for a conversation that might take five minutes – or might not happen at all.
Why Your Brain Does This
Mental rehearsal isn’t random. Your brain has a reason for doing this, even if it’s not helping you.
It Feels Like Control — When you’re anxious about something, your brain looks for ways to manage that anxiety. Mental rehearsal creates the illusion of control. If you can anticipate every possible response, plan every counterargument, you feel more prepared. The problem is that real conversations don’t follow scripts, and the more you rehearse, the more anxious you become about deviating from your mental plan.
It’s Avoidance In Disguise — Mental rehearsal can be a way to avoid actually dealing with uncomfortable situations. As long as you’re “preparing,” you don’t have to take action. You can tell yourself you’re being productive when you’re actually procrastinating or avoiding the real issue.
Every time you mentally rehearse a difficult conversation, you’re reinforcing the idea that the conversation is something to fear. Your brain doesn’t distinguish between imagined threats and real ones, so rehearsing a confrontation triggers the same stress response as actually having it. The more you rehearse, the more anxious you become about the real thing.
When you’re constantly running through future scenarios in your mind, you’re not fully engaged in what’s happening right now. You miss conversations happening in front of you because you’re too busy preparing for ones that haven’t happened yet.
How CBT Addresses Mental Rehearsal
Cognitive Behavioral Therapy offers specific, practical tools to interrupt this pattern and help you respond differently when your brain wants to start rehearsing.
Identifying The Pattern — The first step in CBT is recognizing when you’re doing this. Many people rehearse conversations so automatically that they don’t even realize it’s happening. CBT helps you become aware of the pattern – noticing when your mind shifts from the present moment to mentally preparing for future scenarios.
Examining The Thoughts — Once you recognize the pattern, CBT helps you look at the thoughts driving it. What are you afraid will happen if you don’t rehearse? What do you think you’re accomplishing by going through the conversation in your mind? Often, you’ll find that the mental rehearsal is based on assumptions that aren’t accurate.
Challenging Cognitive Distortions — Mental rehearsal is often fueled by cognitive distortions – thinking errors that make situations seem worse than they are. Common distortions include catastrophizing (assuming the worst possible outcome), mind reading (assuming you know what the other person will say or think), and fortune telling (predicting negative outcomes with certainty). CBT helps you identify these distortions and challenge them with more balanced, realistic thoughts.
Testing Your Predictions — One of the most effective CBT techniques is behavioral experiments – testing whether your predictions actually come true. If you’re mentally rehearsing a conversation because you’re convinced it will go badly, CBT encourages you to have the conversation without all the preparation and see what actually happens. Often, you’ll find that your predictions were wrong, and the conversation went differently than you imagined.
Developing Tolerance For Uncertainty — Mental rehearsal is often driven by a need for certainty and control. CBT helps you build tolerance for not knowing exactly how a conversation will go, for being unprepared in the moment, for trusting yourself to respond appropriately without a script. This is uncomfortable at first, but it’s useful for breaking the rehearsal pattern.
These CBT techniques give you tools to interrupt the mental rehearsal loop and redirect your attention to the present moment. Over time, you learn to trust yourself in real conversations without needing to prepare for every possible outcome.
What This Looks Like in Practice
In CBT sessions, addressing mental rehearsal might look like this:
You come to therapy reporting that you spent two hours last night mentally preparing for a conversation with your partner about household responsibilities. Your therapist helps you identify the thoughts driving the rehearsal – maybe you’re afraid your partner will get defensive, or you’re worried you won’t be able to articulate your needs clearly.
Together, you examine whether those fears are based in reality or distorted thinking. Your therapist might ask whether past conversations have actually gone the way you predicted, or whether your partner has shown the ability to hear your concerns without becoming defensive.
Then you work on an alternative approach. Instead of rehearsing the conversation, you might practice grounding techniques to stay present. You might identify the core point you want to make and trust yourself to communicate it without a script. You might even intentionally have the conversation without any preparation and observe what happens.
This process doesn’t happen all at once. Breaking the mental rehearsal habit takes time and repeated practice. But with consistent work, you start to notice the pattern earlier, challenge it more effectively, and trust yourself more in real-time conversations.
When to Seek Support
Mental rehearsal becomes a problem when it’s taking up significant time, interfering with your sleep or daily activities, increasing your anxiety rather than reducing it, or preventing you from being present in your actual relationships and interactions.
If you find yourself spending hours mentally preparing for conversations, replaying interactions over and over in your mind, or feeling more anxious despite all your preparation, it might be time to work with a therapist who specializes in CBT.
At Flourish Psychology, our therapists use evidence-based CBT techniques to help clients break free from patterns like mental rehearsal and develop healthier ways of managing anxiety and uncertainty. If you’re ready to stop spending so much mental energy preparing for conversations that haven’t happened and start being more present in your actual life, we can help.
Call (917) 737-9475 or fill out our from to schedule an appointment with one of our NYC therapists who specializes in Cognitive Behavioral Therapy.
There are so many joys a person can experience in life, but many of those same joys also come with stresses. For example, you may be happy to see your kids’ smiling faces when you pick them up from school (joy) but to get them, you have to rush and wait in a long line to pick them up (stresses).
Many people have a level of stress (arousal) that they can tolerate where it won’t interfere with their functioning. They can handle stresses, difficulties, noises/sounds, and more while still being mentally present, feeling all their emotions, and otherwise able to stay emotionally regulated.
One term for this is the “Window of Tolerance” – the amount of space someone has that allows for psychological comfort and flexibility. It’s not necessarily about happiness, but it is about being able to function despite what’s going on around them.
Those with mental health challenges, however, typically have a much smaller window of tolerance. Stresses and difficulties end up putting them above or below the window:
Above the Window – This is called the “hyperarousal” zone. It is more common for people with anxiety. It is where their bodies react with excess energy, like nervousness and agitation, when the stresses do not fit into their window of tolerance.
Below the Window – This is known as the “hypoarousal” zone. It is more common in those with depression. It is where a person’s response to issues not fitting in their window is to shut down, become numb, and give up.
Note: Admittedly, one of the limitations of the “Window of Tolerance” analogy is that it doesn’t explain why some people go “above the window” and some people go “below” other than an individual’s mental health. But the window of tolerance itself does help beneficially describe what a person can handle, and why it differs from one person to the next.
The Shrinking Window of Tolerance with Depression
When a person has depression, they have a smaller window of tolerance. That means that there are fewer things that they can handle before their window becomes full and overwhelmed. For example, a light criticism from a coworker becomes a head on collision, because their window is full and nothing else can fit through before it spills out below the window.
But why does this window shrink?
Low Battery – Depression is exhausting, so a person with depression often has a low battery that is less capable of handling multiple tasks before being depleted.
High Threat Systems – Those with both depression and anxiety have a higher than active threat detector, which misinterprets neutral or only mild threats as more significant threats.
Minimal Backup – When your mental health is functioning, you have mechanisms in place to keep you “in your window.” Not so with chronic stress and depression, where the systems that usually calm us, like neurotransmitters, are not able to do their job.
The smaller the window, the less a person feels like they can handle. So our role as therapists is to try to get the window bigger.
How Do We Increase the Size of the Window of Tolerance?
Improving the size of the Window of Tolerance is something we do indirectly in therapy, by teaching coping tools and stress reduction mechanisms that allow us to stay grounded, present, and reduce negative critical thoughts.
If you feel like you may be struggling with a smaller window of tolerance and want help addressing your depression, please reach out to Flourish Psychology, today.
We often talk about social anxiety by referring to its effects on relationships. Yet, what make social anxiety so challenging and so problematic is that it affects us even when we are not engaging in social activities. Like other forms of anxiety, social anxiety is ongoing and constant, and it is in our best interests to make sure that we are addressing this anxiety so that we can improve not only our social life, but the rest of our decision making as well.
The Ways Social Anxiety Shapes Decision Making
Remember, social anxiety is always there. It does not just appear when you’re in a party or a meeting. It, like most forms of anxiety, touches everything that you do.
That means that it can also guide choices that you make throughout the day. It affects decisions you make about work, school, dating, marriage, and much more.
Many people living with social anxiety make decisions based on fear of judgment rather than personal preference or practical benefit. This can influence everything from small routines to major life paths.
Avoiding Opportunities – A person with social anxiety may decline a job interview, pass on a promotion, or avoid signing up for a class because they anticipate embarrassment or fear not meeting expectations. These choices limit personal growth.
Over-Preparation and Perfectionism – Decisions can become slowed by the need to prepare excessively. Writing an email, submitting work, or even posting online may require multiple drafts because of concern about how others might perceive mistakes.
Choosing Convenience Over Preference – Something as simple as deciding where to shop or which restaurant to order from may be shaped by which option feels less likely to involve social stress, even if it is not the person’s preferred choice.
Difficulty Saying “No” – Fear of disappointing others or being seen negatively can lead to agreeing to commitments that do not align with personal goals or comfort.
Withdrawing from Conflict – When facing disagreements, the decision may be to avoid confrontation entirely, even at the expense of personal needs or fairness.
Trouble Analyzing Others – Negative self talk may cause people to misunderstand social media posts, texts, and more, as they assume that other people do not see the world the way they do, leading to worse decisions.
Any decision that is fueled by anxiety is one that may not be right for the person experiencing it. Instead of going through life in such a way that they’re able to make decisions that benefit them, they may be choosing things not just based on the anxiety itself, but on the way it shapes their opinions.
The Ongoing Effects of Social Phobia
Another factor to consider is the way that social anxiety reinforces its own behaviors. When you make small decisions in the moment based on your social anxiety, you create patterns that reinforce avoidance behaviors and problematic thinking.
This both:
Causes you to have more social anxiety and allow it to control you further.
Leads to situations where you’re in a job, relationship, or something else you do not want, leading to more unhappiness and, ultimately, more anxiety about life.
This is one reason why social anxiety is never limited to social experiences. When you have social anxiety, it quietly influences everyday decisions, leaving less space for spontaneity, growth, or authenticity.
Moving Toward Healthier Decision Making
Addressing social anxiety means more than reducing fear in social events. It involves building awareness of how anxiety guides decisions and working to shift the decision-making process back toward personal goals rather than avoidance.
Even if you feel like your social anxiety is manageable – maybe you have a few close friends, or you’re in a good relationship, or you’ve accepted this anxiety as a part of yourself – it’s always touching the decisions you make and the behaviors you do.
Treat social anxiety instead. You’ll find that you’re happier and more fulfilled when your anxiety is in your control.
Society’s attitudes towards mental health have changed considerably from where they were even a few decades ago. Seeking therapy, especially in places like New York City, is considered normal and encouraged.
Still, many people have trouble asking for help. Not just with mental health, but with anything. They don’t like asking their friends to help them move. They have trouble asking their family for advice or emotional support. They feel uncomfortable asking coworkers to take on parts of their projects.
They believe that they NEED to handle things on their own. It’s a part of their upbringing, almost like an identity.
It’s hard to seek help from a therapist when you have this mindset. Yet, it’s important to also take a moment to show you seeking a therapist is NOT asking for help. At least not the way you’re thinking about it.
In fact, seeing a therapist is exactly the behavior that you expect from someone that is handling things on their own.
Let’s talk about what we mean.
Are You Asking for Help When You See a Doctor?
Imagine your leg got a cut with a painful infection. What would you do?
You would call the doctor. Obviously.
Is that “asking for help?” No. It’s actually handling things on your own. You had a problem, a doctor can solve it, so you called the doctor. You didn’t need help from anyone to do that. Calling a doctor was the way to handle it on your own.
What would happen if your car broke down?
You would call a mechanic, or a towing company. You would not be “asking others to help” you do that. You would be the one “handling it” by calling the towing company and getting your car repaired.
You get the idea here.
So what happens when you have trouble with your mental health?
You’re not “asking for help” by reaching out to a therapist. You are doing the logical step – GETTING help from the person that is most qualified to provide that help. You’re then paying that person to do their job by helping you improve your mental health.
All of this IS handling things yourself, because you are the one, all on your own, seeking the solution to your challenges.
The Psychological Effects Behind Asking for Help
In addition, depending on what you feel you are struggling with, the difficulty asking for help may be a symptom – or even a cause – of the condition.
For example, there are those that struggle with what’s known as “functional anxiety.” This is a term that refers to individuals that tend to overachieve. Anxiety almost becomes fuel that pushes them to accept more projects, work harder, work extra, and be perfectionists in everything they do. These individuals struggle with asking for help because their anxiety pushes them to accept everything that comes their way.
There are also those that take on too much because they feel it’s their responsibility to care for others. These individuals tend to have considerable problems “asking for help” because they were raised to be the caregivers of the family, or the person responsible for keeping things together. This can cause a person to feel overwhelmed, burnt out, and anxious. In this case, the person’s tendency to feel responsible for others is a possible cause of their anxiety, and thus something that needs to be addressed.
Find a Therapist for Your Mental Health
As you can see, the challenges people have asking for help can cause (or be caused by) a person’s mental health, and – if you think deeply about it – contacting a therapist is doing things on your own anyway. It is not a sign of weakness, it is not leaning on others, it is not inconveniencing anyone. It is seeking a problem (“I need help”) and solving it.
See what therapy can do for you. If you’re in New York, reach out to Flourish Psychology and let’s begin the process of getting you the support that your mental health needs.
We’re not getting enough sleep. Most of us are sleep deprived, and rarely, if ever, get a full night’s sleep more than one day in a row.
There are many issues that lead to these difficulties, and addressing them can take time as we determine why they’re occurring and work individually with how to solve them. Yet some of the potential causes of sleep difficulties, including racing thoughts, metal to due lists, and emotional residue from the day can interfere with the onset and quality of sleep.
Sleep hygiene practices are, at least theoretically, designed to address this. By giving yourself a habit/routine to help you fall asleep, you should be able to calm your mind and ease off easier than if you simply go straight to bed with your phone in your hands.
But, of course, sleep is more complicated than that, and there are plenty of times when our brains stay highly active and we have too much on our minds to relax.
Why the Brain Struggles to Transition to Sleep
Before examining journaling, it’s important to understand why sleep onset is disrupted. One of the most well-documented factors is heightened cognitive arousal – essentially, excessive mental activity in the pre-sleep period. This can include:
Persistent planning or problem-solving thoughts
Unresolved emotional tension from daytime experiences
Anticipatory anxiety about the following day
New ideas you want to remember or to-dos that you would like to prioritize
Research shows that these thought patterns correlate with activity in the default mode network (DMN), a neural system associated with self-referential thinking. High DMN activity at bedtime is associated with longer sleep onset latency and lighter sleep cycles.
Because journaling externalizes internal dialogue, it has the potential to reduce DMN activity and shift the brain toward a state more conducive to sleep.
The Power of Sleep Journaling
In these situations, you may want to consider keeping a sleep journal next to your bed.
Sleep journals are, essentially, journals where you can write down anything and everything that is on your mind when you are trying to go to sleep at night. It doesn’t necessarily matter what you write down, and you never need to force yourself to write down anything if you’re feeling tired (it differs from a gratitude journal in this way, as those types of journals are designed to be completed daily).
Rather, it’s a place for you to put your thoughts on paper in order to get them out of your head.
Journaling at night can reduce mental overactivity and create psychological closure that supports sleep onset. This practice is not simply about venting thoughts onto paper. The type of journaling, the structure, and even the timing all contribute to how journaling interacts with the brain’s sleep-regulating systems.
What Happens When You Journal Before Bed
Journaling operates at the intersection of cognitive restructuring and emotional regulation. Several peer-reviewed studies have found that the right form of journaling can measurably affect key variables tied to sleep, including sleep latency (how long it takes to fall asleep) and overall sleep quality. For example:
A 2018 study published in Journal of Experimental Psychology found that individuals who wrote out specific tasks they needed to complete the next day fell asleep significantly faster than those who journaled about completed tasks.
Another study published in Behavioral Sleep Medicine showed that expressive writing – where individuals write about their thoughts and feelings – reduced symptoms of sleep-onset insomnia in people with anxiety.
Keep in mind these are examples of *different* benefits. The first study looked at something called “cognitive offloading” where moving thoughts out of your mind (your working memory) and onto paper basically tells your brain “don’t worry, you can’t forget, it’s written down on paper” which frees up additional resources and helps the brain disengage from active processing.
The second study showed that writing out our emotions and feelings is a form of processing. Anxieties and stresses often occur when emotions feel unresolved, or when they’re bouncing around in mind without being fully processed. Writing out these emotions help us process them, allowing us to have some closure and, eventually, sleep.
Remember, these thoughts may not all be stressful. Imagine you’re someone that loves writing, and – when you’re supposed to go to sleep – you have this great idea for a story. Your mind can’t relax if you’re worried that you may forget the idea. If you write it down, your brain knows you can’t forget it, and you can hopefully relax better and ease yourself into sleep.
Addressing Sleep for Mental Health
Sleep may not be directly responsible for the entirety of our mental health, but it becomes extraordinarily difficult to cope with stress and address our psychological challenges if we’re not also prioritizing sleep. Journaling may not solve all your issues, but if an active mind is keeping you awake, consider taking out a journal and testing out those benefits.
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