A Sleeper Hit: Depression and Hypersomnia

Major depressive disorder, commonly known as depression, is defined by a number of different symptoms. While its central features are a consistently low mood and the being unable to feel joy, it can also include hypersomnia—the inability to stay awake during the day, despite sleeping well during the night. Read on to learn more about the link between hypersomnia and depression.

Hypersomnia depression

Uncomfortably Numb: Depression and an Emotional Disconnect

Depression has been described by Freud and his successors not just as prolonged sadness, but as the inability to acknowledge the emotional pain caused by a significant loss. This disconnect from one’s own feelings that is thought to leave them feeling empty, hopeless, alone, and also deeply sad.

Tying into Freudian theory, empirical studies have shown that individuals experiencing depression often describe it as a sense of loss, without being able to identify what it is that is no longer in their life. For this reason, depression is perceived as closely resembling grief, though without being able to fully process one’s loss. As a result of this inability to come to terms with what had been lost to them, many patients with depression speak about going through their day without being able to enjoy themselves, having difficulty engaging with others, and returning home to a solitary evening.

Roughly one in 15 adults (or 6.7%) struggle with depression. In the US alone, 17.3 million adults (or 7.1%) have reported to have experienced one or more depressive episodes across their lifetime. 350 million individuals are believed to be facing this condition internationally.

Depression is one of the most common mental health disorders in the world, as well as one of the most debilitating: the World Health Organization (WHO) cites it as the number one cause of years lost from disability, meaning that it shortens the lives of those afflicted by it more than any other disability.

Hypersomnia and depression

Waking Up is Hard to Do: Hypersomnia and the Struggle Not to Sleep

The exact definition of hypersomnia is still being debated. The general consensus regarding hypersomnia is that it is defined by a general sleeping during waking hours, with a possible, irresistible tendency to fall asleep.

While the World Health Organization (WHO) refers to this definition as hypersomnia, the APA refers to it as hypersomnolence, while alluding to the fact that hypersomnia should also include narcolepsy.

Described more plainly, narcolepsy appears to be short, uncontrollable daytime bouts of “true sleep” that mimics many of the characteristics of nighttime sleep. Hypersomnia/hypersomnolence, on the other hand, are defined more through unrelenting daytime sleepiness, with possible bouts of sleep that do not offer the individual the refreshing feeling of a good night’s sleep.

In any case, both the WHO and the APA agree that narcolepsy is different from hypersomnia/hypersomnolence, since narcolepsy is usually accompanied by:

  • “Sleep attacks” that bring on uncontrollable bouts of sleep.
  • More disturbed nighttime sleep.
  • A more refreshed feeling after a daytime nap.
  • Dreaming during daytime sleeping.

Hypersomnia/hypersomnolence, on the other hand, tends to cause:

  • A persistent and prolonged sense of sleepiness when awake.
  • Longer bouts of undisrupted sleep at night.
  • No dreams during daytime sleep.

For the sake of simplicity, and since many studies in the field of sleep research use hypersomnia and hypersomnolence interchangeably, the remainder of this article will also refer to the two as synonyms.

About 1% of the general population is believed to face hypersomnia. Extreme cases can include up to 20 hours of sleep. While it is generally easier for those facing hypersomnia to reduce day sleep time on weekdays, it is much harder for them to accomplish on weekends and holidays.

Several risk factors have been shown to be in relation to hypersomnia. Among them are:

  • Psychological stress.
  • Alcohol use.
  • Viral infections.
  • Genetic predisposition.
  • Following head trauma.

Daysleeper: On Hypersomnia and Depression

Hypersomnia is a common feature in several types of mood disorders, including major depression. And so, while it sometimes appears as its own, distinct condition, it can also be emblematic of a broader mental health disorder. Under major depression, hypersomnia—or insomnia—may be present each and every day. On a related note, persistent lack of energy, as well as being easily tired out, may also appear, as additional symptoms of depression.

How is it, though, that an individual struggling with depression can experience a lack of sleep—clinically referred to as insomnia—or oversleep, via hypersomnia? The answer is derived from the way mental health disorders are described and defined. The APA, for instance, refers to “sleep disturbance” as a possible feature of depression, with patients battling depression citing bouts of either insomnia or hypersomnia.

When it comes to battling depression, an existing comorbidity with hypersomnia and depression tends to signal less favorable outcomes: more specifically, patients diagnosed with depression who were also found to suffer from hypersomnia were more likely to display treatment resistance, relapse into future depressive episodes, increased risk of suicide, and functional impairment.

Insomnia, and not hypersomnia, is often the initial, presenting complaint from patients battling depression. And yet, the propensity to retreat from external reality, brought on by hypersomnia, can be seen as reflecting the essential nature of major depression.

Indeed, studies have shown that patients reporting hypersomnia are at a greater risk of experiencing more severe depression, developing comorbidities with other adverse conditions, and struggling with greater impairment of their daily functioning.

Finally, hypersomnia can also act as a marker for atypical depression. As such, it could also signal the existence of other, more latent atypical depression symptoms, including increased sensitivity to social rejection.

The appearance of hypersomnia in comorbidity with depression may indicate that a certain case is both not a typical manifestation of depression, and that its symptom severity needs to be taken very seriously, as it might significantly hinder the individual’s well-being. Noticing such lesser-discussed symptoms can help facilitate a more accurate diagnosis, and a shorter, more efficient road to true relief.