Typically, when we talk about depression, we discuss the feelings of being “low.” We talk about the hopelessness, and the ideations, and possibly the sadness and emptiness that are hallmarks of the condition. But depression is much more than that, and it is often important for individuals struggling with depression – and their loved ones – to recognize not only what these other symptoms are, but also why they’re occurring.
One such example is hypersomnia.
What is Hypersomnia?
Hypersomnia, or excessive sleepiness, is a common symptom of depression that can be challenging to manage. Unlike insomnia, which involves difficulty falling or staying asleep, hypersomnia causes a person to feel overly tired despite sleeping for long periods.
When someone experiences hypersomnia, they can sleep for well over 8+ hours and still be tired enough to fall asleep when they’re woken up. Depression doesn’t always cause hypersomnia, but when it does, many of those individuals have periods of 12+ hours of sleep or more on a regular basis, missing out on much of the day.
Hypersomnia can be partially behavioral (when you’re feeling down/empty, you may not want to get up), but it also has to do with the way depression affects the brain. Several interconnected biological factors can contribute to hypersomnia in depression, including:
- Imbalances in Neurotransmitters – Depression is often associated with changes in the levels of neurotransmitters like serotonin, dopamine, and norepinephrine. These chemicals regulate mood and energy. A reduction in their availability can disrupt normal sleep-wake cycles, leading to prolonged feelings of tiredness.
- Dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) Axis – The HPA axis is involved in the body’s stress response and also influences sleep. Chronic stress or depression can dysregulate this system, causing abnormal cortisol levels that impact the quality of sleep and result in persistent fatigue.
- Inflammation and Immune System Activity – Emerging research suggests that depression may be linked to increased levels of inflammatory markers in the body. Inflammation can influence the brain’s sleep centers, causing excessive sleepiness and fatigue.
- Melatonin and Circadian Rhythm Disruption – Depression often disrupts the circadian rhythm, which regulates the sleep-wake cycle. Abnormal melatonin secretion, which controls sleep timing, may cause individuals to feel sleepy at unusual times or sleep excessively.
- Thalamus and Prefrontal Cortex Dysregulation – Depression can reduce activity in these regions, which are crucial for maintaining alertness and concentration. This diminished activity may explain why individuals with depression struggle to stay awake and alert during the day.
- Reduced Orexin Levels – Orexins are neuropeptides that promote wakefulness. Studies suggest that people with depression and hypersomnia may have lower orexin levels, further contributing to excessive sleepiness.
It may be one factor or many. Some people also go through periods of insomnia, which can be followed by excessive sleepiness as a person tries to “make up” for lost sleep. The exact cause may never be known, but all of these are evidence that any excessive sleepiness is something a person may not be able to control on their own.
Why Hypersomnia Matters in Depression Management
Hypersomnia isn’t just inconvenient. It can make depression management more difficult. Hypersomnia can create a cycle of reduced energy, lower productivity, and greater feelings of hopelessness, compounding depressive symptoms. Addressing hypersomnia isn’t just about improving sleep – it’s an important part of treating the underlying depression.
Managing hypersomnia in depression requires addressing both the underlying depressive symptoms and the biological mechanisms that cause excessive sleepiness. If you’re experiencing these symptoms, reach out to Flourish Psychology today for more information about our depression treatment options.