Sleepless Through the Night: When Sleep Problems Burden Your Mood

Sleeplessness can manifest in very different ways. You might lie awake for hours at night despite feeling tired. Perhaps you fall asleep easily at first, but wake up in the middle of the night and cannot get back to sleep. Or you might wake up much earlier in the morning than planned.

The daytime impact can also vary. Some people primarily feel exhausted and unable to concentrate. Others feel more irritable, less resilient, or like they are constantly fighting against fatigue.

Not every sleepless night is automatically a sign of a sleep disorder or depression. Sleep is not a static state. It changes over the course of our lives and reacts sensitively to what affects us day and night, external circumstances as well as internal thoughts and feelings.

However, if you experience sleeplessness over a prolonged period and the lack of rest impairs your daily life, you should take the situation seriously.

The reasons for becoming sleepless can be varied, and multiple factors often interact.

1. Stress and Racing Thoughts

• A stressful workday, family worries, life-altering events, important appointments, or other psychological strains can keep your mind active well into the evening. You might feel physically tired, but internally remain on high alert. Scientifically, this can be explained in part by the body's stress response: stress can increase the activity of the sympathetic nervous system, promoting physical and mental tension that makes falling asleep difficult.
• This can create a vicious cycle: you sleep poorly, feel exhausted the next day, and by evening, you are already worrying about whether you will be sleepless again. This pressure can make falling asleep even harder.

2. Sleep Environment and Habits

• Conditions surrounding your sleeping space also play a role. Noise, light, uncomfortable room temperatures, or an unsupportive bed can disrupt your night's rest.

Similarly, certain habits can interfere with sleep:

• High caffeine intake in the late afternoon or evening
• Alcohol consumption before bedtime
• Irregular sleeping schedules
• Long daytime naps
• Intense physical exercise immediately before bed
• Extended screen time right before sleeping

3. Physical Symptoms and Medications

• Physical complaints can also lead to sleeplessness, including pain, heartburn, or nighttime breathing issues. In sleep apnea, repeated pauses in breathing can interrupt sleep without you being consciously aware of them.
• Restless Legs Syndrome (RLS) can also impair sleep. Characterized by uncomfortable sensations and a strong urge to move the legs when at rest, it can make falling asleep or staying asleep difficult. Other conditions that can be accompanied by sleep problems include thyroid disorders, asthma, chronic lung diseases, cardiovascular conditions, or neurological disorders.
• Certain medications can influence sleep as well, such as some antidepressants, corticosteroids, asthma medications, certain blood pressure medications, or stimulant medications used to treat ADHD. Some over-the-counter medications may also affect sleep. If you suspect such a connection, you should not stop taking your medication or alter the dosage on your own and consult your doctor instead.

When you feel worn-out, depressed, and sleepless, it can be difficult to recognize which actually came first.

Perhaps the sleep problems began during a stressful or burdensome phase of life. After several bad nights, you feel increasingly exhausted and have less energy for your daily routine. However, it can also work in reverse: a depressive mood, rumination, or a lack of drive alters your sleep. You lie awake at night thinking about your situation and find it hard to settle down. This can create a vicous cycle.

Poor sleep can leave you feeling exhausted and less energized during the day. As a result, it may become harder to stay active and engage in things that usually do you good. Fewer physical activities, social contacts, and positive experiences can in turn foster depressive thoughts or a low mood. This mood can intensify rumination, making it even more difficult to unwind and fall asleep at night. In this way, sleep problems and depressive thoughts can reinforce each other and form a burdensome cycle.

This does not automatically mean that depression is the sole cause of your symptoms. However, it can be a reason to pay closer attention to other depressive symptoms. Therefore, when dealing with persistent sleep issues, it is worthwhile not to focus solely on sleep duration, but also to ask yourself: How am I feeling overall?

In this context, insomnia can be linked to additional depressive symptoms:

• Depressed or low mood
• Loss of interest and pleasure
• Lack of drive or initiative
• Concentration and decision-making difficulties
• Sleep disturbances
• Reduced self-esteem
• Feelings of guilt
• Social withdrawal
• Pessimistic thoughts about the future

Small, consistent steps can be a great place to start when taking action against insomnia. You don't need to completely overhaul your entire evening routine right away.

1. Keep Your Sleep-Wake Rhythm as Consistent as Possible

• Try to go to bed and wake up at roughly the same time every day. Your morning wake-up time in particular can serve as a helpful anchor. Avoid shifting your sleep schedule dramatically on weekends on a regular basis.

2. Only Go to Bed When You Are Actually Tired

• Your bed should primarily be associated with sleep. If you are still wide awake in the evening, it can be helpful to engage in a calming activity rather than getting into bed while feeling pressured to fall asleep.

3. Don't Stay Awake in Bed for Hours

• If you notice that you have been lying awake for a long time and are becoming increasingly tense, get up for a bit. Move to another room or do something quiet and relaxing.
• You don't need to check the clock. Repeatedly checking the time often creates additional pressure. Only return to bed when you feel sleepy again.

4. Create a Peaceful Sleep Environment

• Your bedroom should be as dark, quiet, and comfortably cool as possible. A room temperature of around 18°C is frequently recommended as a general guideline, though the key is that the temperature feels comfortable to you.
• Asking yourself these questions can also help:
• Is the room dark enough?
• Are there disturbing noises?
• Is your mattress or pillow uncomfortable?
• Is your smartphone lying right next to your pillow?
• Do you associate your bed mainly with sleep, or often with work, watching TV, and ruminating?

5. Make Use of Physical Activity and Daylight

• Regular physical activity can support healthy sleep. Daylight, especially in the morning and during the day, helps stabilize your internal sleep-wake rhythm. Avoid scheduling intense workouts right before bedtime if you notice that they tend to energize you.

6. Be Mindful of Caffeine and Alcohol

• Coffee, energy drinks, cola, and other caffeinated beverages can affect your sleep hours after consumption. If you experience insomnia, it can be worth reducing caffeine in the afternoon and evening.
• While alcohol may initially make you feel sleepy, it can disrupt your sleep architecture later in the night, leading to more frequent awakenings.

7. Develop a Relaxing Evening Routine

• A consistent sequence of events before bedtime signals to your body that it is time to unwind. Dim the lights in the evening and set aside time for quiet activities, such as reading, listening to music, or taking a warm shower. Relaxation techniques or breathing exercises can also help you settle down.

8. Reserve the Bed for Sleep As Much As Possible

• Try to avoid working, studying, watching TV, or scrolling on your smartphone while in bed. This helps maintain a strong psychological association between your bed and restful sleep. If you regularly lie awake in bed feeling annoyed or ruminating, this positive association can break down.

9. Reduce Screen Time in the Evening

• Try to limit your use of smartphones, tablets, computers, and televisions during the last hour before going to bed. Screen light, and particularly the content itself, can keep your mind active and make winding down more difficult. If you don't want to avoid screens entirely, reducing screen brightness and consuming calm, low-stimulation content can help.

If it turns out that your insomnia is linked to depression, treatment should not focus solely on fighting the sleep issues themselves. Instead, it can be helpful to address the underlying factors that maintain the depression. These may include unhelpful thought patterns, social withdrawal, lack of activity, or a loss of daily structure.

Which treatment is appropriate depends, among other factors, on the severity of the depression and your individual situation. For a first mild depressive episode, low-barrier interventions such as supportive counseling or online therapy programs may be used initially. For more severe forms of depression, psychotherapy and/or medication may be considered, depending on the specific case.

When your sleep problems are part of a depression, deprexis can support you in dealing with depressive thoughts, emotions, and behavioral patterns.

This digital program is based on methods of cognitive behavioral therapy (CBT). It is not about forcing you to perform despite your exhaustion. Rather, it allows you to step-by-step understand the connections between your thoughts, your behavior, and your mood, while trying out new coping strategies.

deprexis is available free of charge on prescription, as the costs are fully covered by your health insurance. This means your doctor or therapist can prescribe deprexis, providing you with an activation code for the program. As soon as you receive your code, you can easily redeem it on our website and start your digital therapy right away.