Sleep and mental health are closely linked. Sleep problems may exacerbate or cause mental health issues; mood disorders may worsen sleep disorders. Depression is a frequent symptom for people with insomnia, obstructive sleep apnea, and narcolepsy.

Neurological studies suggest a good night's sleep helps foster both mental and emotional resilience. Chronic sleep deprivation does the opposite. It makes you vulnerable to negative thinking and emotional instability. More research is needed to fully understand the exact relationship between sleep and mental health.

About Narcolepsy

Narcolepsy is considered both a neurological disorder and a sleep disorder. Narcolepsy is a rare condition that affects around 1 in 2,000 to 3,000 people. It can take between eight and 10 years for people to receive an accurate diagnosis of narcolepsy. This diagnostic delay may exist because doctors sometimes initially suspect symptoms of narcolepsy to be those of a psychiatric disorder. Narcolepsy and several mental health conditions share many symptoms.

Narcolepsy’s primary symptoms include excessive daytime sleepiness (EDS), hypnagogic hallucinations (hallucinations while falling asleep), and sleep paralysis. Type 1 narcolepsy is characterized by the presence of cataplexy. Cataplexy is a condition that causes sudden loss of muscle tone, often triggered by strong emotions — both positive and negative. Cataplexy is thought to be another manifestation of irregular sleep-wake cycles experienced by people with narcolepsy.

Learn more about narcolepsy and what causes narcolepsy.

About Depression

Depression is one of the most common mood disorders in America. In 2017, approximately 17.3 million people in the U.S. — more than 7 percent of the population — experienced at least one depressive episode.

Everyone gets sad sometimes. Depression, however, is more than feeling down in the dumps. Symptoms of a depressive disorder last longer than two weeks and can have a disruptive impact on a person’s work, social, and personal life. Depression symptoms include:

• Losing interest or pleasure in things you used to enjoy
• Changing appetite
• Feeling low energy or lethargic
• Experiencing excessive daytime sleepiness
• Difficulty concentrating or focusing
• Feelings of low self-worth or self-esteem

Sleep and Mental Health

The relationship between sleep and mental health is complex and not fully understood. Disordered sleep, clinical depression, anxiety, and other psychiatric conditions are closely linked. People with sleep disorders are more likely to have depression, and other mental health diagnoses. Sleep disorders can also cause emotional changes. Mood disorders can also disrupt sleep, causing insomnia or hypersomnia (sleeping too much).

The Centers for Disease Control and Prevention recommend at least seven hours of nighttime sleep for adults. Teens should get eight to 10 hours of sleep each night. A recent study found that teenagers were less likely to experience depression and suicidal thoughts when they went to sleep earlier. Teens who got fewer than five hours of sleep per night were 71 percent more likely to experience depression.

The Complex Relationship Between Narcolepsy and Depression

People with narcolepsy are at an increased risk of being diagnosed with depression. Some studies indicate as many as 57 percent of people with narcolepsy have depression.

Sleep deprivation is closely linked to depression. One study found that disordered sleep in teenagers preceded depression 69 percent of the time. People with narcolepsy have low levels of a hormone called hypocretin (or orexin) in the fluid around the brain. This contributes to being chronically under-rested and experiencing severe excessive daytime sleepiness, and it may also contribute to feelings of depression.

People with type 1 narcolepsy also report more vivid dreams. These dreams can prevent fully restful nighttime sleep.

Depression and narcolepsy also share several of the same symptoms. For example, about 40 percent of young adults and 10 percent of older people with depression experience hypersomnia, which also includes excessive daytime sleepiness. This overlap of symptoms may contribute to misdiagnosis and the diagnostic delays frequently experienced by people with narcolepsy.

Brain Chemistry

Narcolepsy and depression are closely linked. This may be because the brain chemistry involved in narcolepsy might also be connected to a person’s mood and mental health. Frequent sleep disruption can wreak havoc on vital neurological processes.

Scientists believe when sleep is repeatedly disrupted, brain activity and neurochemicals may be affected. These neurological impacts can alter a person’s mood and cognitive abilities. This can disrupt:

• Neurotransmitters
• Stress hormones
• Cognition and memory
• Emotional regulation

Narcolepsy may be caused by a deficiency in hypocretin, also called orexin, a chemical in the brain that helps regulate sleep and wake patterns. The same areas of the brain that produce hypocretin are also responsible for producing neurochemicals that play a key role in emotion and mood regulation: dopamine, serotonin, and norepinephrine.

This is likely why antidepressants that act on neurotransmitters, such as certain selective serotonin reuptake inhibitors (SSRIs), may be prescribed to manage narcolepsy as well as mood and behavioral disorders.

Co-occurring Sleep Disorders

People with narcolepsy can have other sleep disorders that cause frequent interruptions to their nighttime sleep, including insomnia and obstructive sleep apnea.

Insomnia

People with insomnia experience higher rates of depression than those who regularly get ample, uninterrupted sleep. People with insomnia are 10 times more likely to have clinical depression. Insomnia is also a frequent symptom of people diagnosed with depression. Approximately 75 percent of people with depression have difficulty falling asleep or staying asleep.

Sleep Apnea

In a study of 18,980 people in Europe, those with depression suffered from sleep-disordered breathing five times more than those without. Obstructive sleep apnea is the most common type of sleep-disordered breathing, and it can be greatly improved — sometimes fully treated — with a continuous positive airway pressure (CPAP) machine. Another study of people with obstructive sleep apnea who used a CPAP machine for a year saw symptoms of both their sleep apnea and depression improve significantly.

Quality of Life

People with narcolepsy may experience depression at greater rates because of the impact narcolepsy has on their quality of life. Narcolepsy’s symptoms can impact a person’s ability to work and be productive. They can also affect personal relationships, leading to feelings of isolation and loneliness.

People with narcolepsy experience mental health or psychiatric conditions at a higher rate than the general population. The fact that narcolepsy is a chronic condition with no known cure can, in itself, be stressful. This stress may be a factor in the psychiatric diagnoses among people with narcolepsy.

Other Mood Disorders

Disrupted sleep is characteristic of several mood disorders, not just depression. Sleep problems also occur at higher rates in people with anxiety and bipolar disorder.

Anxiety Disorder

Sleep problems may be a risk factor for developing an anxiety disorder. As many as 53 percent of people with narcolepsy have anxiety disorders. People with insomnia are 17 times more likely to also have clinical anxiety. Chronic sleep deprivation can also exacerbate anxiety symptoms and worsen treatment outcomes.

In a study of teenagers, sleep problems occurred before their anxiety disorders in 27 percent of cases. Another study found that children and teens with an anxiety disorder took longer to fall asleep and slept less deeply than those without an anxiety disorder.

Bipolar Disorder

The Burden of Narcolepsy Disease (BOND) study found that people with narcolepsy had a 6.2 percent higher likelihood of having bipolar disorder than people without narcolepsy. Certain medications used in the treatment of narcolepsy, especially stimulants like Provigil (Modafinil), have been known to trigger manic episodes.

Sleep deprivation, a common effect of narcolepsy, is known to trigger mania in people with bipolar disorder. Several studies suggest that between 69 percent and 99 percent of people with bipolar disorder experience insomnia. Sleeping too much can be as unhealthy and problematic as sleeping too little. Studies show that 23 percent to 78 percent of people with bipolar depression experience hypersomnia.

If you’re regularly sleeping too little or too much, it’s important to raise your concerns with your doctor. Irregular sleep may be a sign of underlying or worsening mental health issues. An assessment of your full health — mental and physical — is likely in order. You may also want to discuss the benefits of a referral to a sleep medicine specialist or a mental health specialist.

Have you experienced other sleep disorders or mood disorders in addition to narcolepsy? Do you have suggestions for staying balanced, mentally and physically? Comment below or start a conversation on MyNarcolepsyTeam. You never know who might benefit from hearing your story.