Skip to main content
SpringerLink
Log in

Is Chronic Insomnia a Precursor to Major Depression? Epidemiological and Biological Findings

  • Sleep Disorders (MJ Sateia, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Insomnia has been found to be a clinical predictor of subsequent depression. Nevertheless the biological processes underlying this causal relationship are yet not fully understood. Both conditions share a common imbalance of the arousal system. Patients with insomnia present fragmented REM sleep, which probably interferes with basal processes of emotion regulation. The interaction between the arousal and the affective system with the persistence of the disorder could slowly alter also the cognitive system and lead to depression. Although preliminary results seem to support this hypothesis, data are still too few to make valid conclusions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. AASM (American Academy of Sleep Medicine). International classification of sleep disorders. 2nd ed. Westchester: AASM; 2005.

    Google Scholar 

  2. Ohayon M. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6:97–111.

    Article  PubMed  Google Scholar 

  3. Zhang B, Wing YK. Sex differences in insomnia: a meta-analysis. Sleep. 2006;29:85–93.

    PubMed  Google Scholar 

  4. Morin CM, Bélanger L, LeBlanc M, Ivers H, Savard J, Espie CA, et al. The natural history of insomnia: a population-based 3-year longitudinal study. Arch Intern Med. 2009;169:447–53.

    Article  PubMed  Google Scholar 

  5. Kessler RC, Berglund PA, Coulouvrat C, Hajak G, Roth T, Shahly V, et al. Insomnia and the performance of US workers: results from the American Insomnia Survey. Sleep. 2011;34:1161–71.

    PubMed  Google Scholar 

  6. Roszkowska J, Geraci SA. Management of insomnia in the geriatric patient. Am J Med. 2010;123:1087–90.

    Article  PubMed  Google Scholar 

  7. Smith MT, Huang MI, Manber R. Cognitive behavior therapy for chronic insomnia, occurring within the context of medical and psychiatric disorders. Clin Psychol Rev. 2005;25:559–92.

    Article  PubMed  Google Scholar 

  8. Riemann D, Voderholzer U. Primary insomnia: a risk factor to develop depression? J Affect Disord. 2003;76:255–9.

    Article  PubMed  Google Scholar 

  9. Sunderajan P, Gaynes BN, Wisniewski SR, Miyahara S, Fava M, Akingbala F, et al. Insomnia in patients with depression: a STAR*D report. CNS Spectr. 2010;15:394–404.

    PubMed  Google Scholar 

  10. Riemann D, Berger M, Voderholzer U. Sleep in depression: results from psychobiological studies. Biol Psychol. 2001;57:67–103.

    Article  PubMed  CAS  Google Scholar 

  11. Kraepelin E. Psychiatrie. Leipzig: JA Barth; 1909.

    Google Scholar 

  12. •• Manber R, Chambers AS. Insomnia and depression: a multifaceted interplay. Curr Psychiatr Rep. 2009;11:437–42. This review summarizes research demonstrating the multifaceted interplay between insomnia and depression and evidencing that insomnia may merit focused attention as part of the overall management of depression.

    Article  Google Scholar 

  13. • Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011;135:10–9. This meta-analysis have summarized the results of 21 longitudinal studies evaluating the predicting role of insomnia for depression and found that people with insomnia have a twofold risk to develop depression compared with people with no sleeping difficulties.

    Article  PubMed  Google Scholar 

  14. Baglioni C, Spiegelhalder K, Nissen C, Riemann D. Clinical implications of the causal relationship between insomnia and depression: how individually tailored treatment of sleeping difficulties could prevent the onset of depression. EPMA J. 2011;2:287–93.

    Article  Google Scholar 

  15. Murphy JM, Nierenberg AA, Laird NM, Monson RR, Sobol AM, Leighton AH. Incidence of major depression: prediction from subthreshold categories in the Stirling County Study. J Affect Disord. 2002;68:251–9.

    Article  PubMed  Google Scholar 

  16. Yokoyama E, Kaneita Y, Saito Y, Uchiyama M, Matsuzaki Y, Tamaki T, et al. Association between depression and insomnia subtypes: a longitudinal study on the elderly in Japan. Sleep. 2010;33:1693–702.

    PubMed  Google Scholar 

  17. Salo P, Siversten B, Oksansen T, Sjösten N, Pentti J, Virtanen M, et al. Insomnia symptoms as a predictor of incident treatment for depression: prospective cohort study of 40,791 men and women. Sleep Med. 2012;13:278–84.

    Article  PubMed  Google Scholar 

  18. Jansson-Fröjmark M, Lindblom K. A bidirectional relationship between anxiety and depression, and insomnia? a prospective study in the general population. J Psychosom Res. 2008;64:443–9.

    Article  PubMed  Google Scholar 

  19. McCall WV, Blocker JN, D’Agostino Jr R, Kimball J, Boggs N, Lasater B, et al. Insomnia severity is an indicator of suicidal ideation during a depression clinical trial. Sleep Med. 2010;11:822–7.

    Article  PubMed  Google Scholar 

  20. Bjørngaard JH, Bjerkeset O, Romundstad P, Gunnell D. Sleeping problems and suicide in 75,000 Norwegian adults: a 20-year follow-up of the HUNT I study. Sleep. 2011;34:1155–9.

    PubMed  Google Scholar 

  21. McCall WV. Insomnia is a risk factor for suicide—what are the next steps? Sleep. 2011;34:1149–50.

    PubMed  Google Scholar 

  22. •• Riemann D, Spiegelhalder K, Feige B, Voderholzer U, Berger M, Perlis M, et al. The hyperarousal model of insomnia: a review of the concept and its evidence. Sleep Med Rev. 2010;14:19–31. This review provides substantial support for the concept that hyperarousal processes from the molecular to the higher system level play a key role in the pathophysiology of primary insomnia.

    Article  PubMed  Google Scholar 

  23. Saper CB, Cano G, Scammell TE. Homeostatic, circadian, and emotional regulation of sleep. J Comp Neurol. 2005;493:92–8.

    Article  PubMed  CAS  Google Scholar 

  24. Nofzinger EA, Price JC, Meltzer CC, Buysse DJ, Villemagne VL, Miewald JM, et al. Towards a neurobiology of dysfunctional arousal in depression: the relationship between beta EEG power and regional cerebral glucose metabolism during NREM sleep. Psychiatry Res. 2000;98:71–91.

    Article  PubMed  CAS  Google Scholar 

  25. LeDoux J. The amygdala. Curr Biol. 2007;17:868–74.

    Article  Google Scholar 

  26. Sakurai T, Mieda M. Connectomics of orexin-producing neurons: interface of systems of emotion, energy homeostasis and arousal. Trends Pharmacol Sci. 2011;32:451–62.

    Article  PubMed  CAS  Google Scholar 

  27. Pallesen S, Johnsen BH, Hansen A, Eid J, Thayer JF, Olsen T, et al. Sleep deprivation and hemispheric asymmetry for facial recognition reaction time and accuracy. Percept Mot Skills. 2004;98:1305–14.

    PubMed  Google Scholar 

  28. van der Helm E, Gujar N, Walker MP. Sleep deprivation impairs the accurate recognition of human emotions. Sleep. 2010;33:335–42.

    PubMed  Google Scholar 

  29. McGlinchey EL, Talbot LS, Chang KH, Kaplan KA, Dahl RE, Harvey AG. The effect of sleep deprivation on vocal expression of emotion in adolescents and adults. Sleep. 2011;34:1233–41.

    PubMed  Google Scholar 

  30. Berger RH, Miller AL, Seifer R, Cares SR, LeBourgeois MK. Acute sleep restriction effects on emotion responses in 30- to 36-month-old children. J Sleep Res. 2011;21:235–46.

    Google Scholar 

  31. Yoo SS, Gujar N, Hu P, Jolesz FA, Walker MP. The human emotional brain without sleep—a prefrontal amygdala disconnect. Curr Biol. 2007;17:R877–8.

    Article  PubMed  CAS  Google Scholar 

  32. Franzen PL, Siegle GJ, Buysse DJ. Relationships between affect, vigilance, and sleepiness following sleep deprivation. J Sleep Res. 2008;17:34–41.

    Article  PubMed  Google Scholar 

  33. Franzen PL, Buysse DJ, Dahl RE, Thompson W, Siegle GJ. Sleep deprivation alters pupillary reactivity to emotional stimuli in healthy young adults. Biol Psychol. 2009;80:300–5.

    Article  PubMed  Google Scholar 

  34. Harvey AG. A cognitive model of insomnia. Behav Res Ther. 2002;40:869–93.

    Article  PubMed  CAS  Google Scholar 

  35. Espie CA. Insomnia: conceputal issues in the development, persistence, and treatment of sleep disorders in adults. Annu Rev Psychol. 2002;53:215–43.

    Article  PubMed  Google Scholar 

  36. Buysse DJ, Thompson W, Scott J, Franzen PL, Germain A, Hall M, et al. Daytime symptoms in primary insomnia: a prospective analysis using ecological momentary assessment. Sleep Med. 2007;8:198–208.

    Article  PubMed  Google Scholar 

  37. McCrae CS, McNamara JP, Rowe MA, Dzierzewski JM, Dirk J, Marsiske M, et al. Sleep and affect in older adults: using multilevel modelling to examine daily associations. J Sleep Res. 2008;17:42–53.

    Article  PubMed  Google Scholar 

  38. • Baglioni C, Spiegelhalder K, Lombardo C, Riemann D. Sleep and emotions: a focus on insomnia. Sleep Med Rev. 2010;14:227–38. This review summarizes research on sleep, and especially insomnia, and emotionality/emotion regulation.

    Article  PubMed  Google Scholar 

  39. Baglioni C, Lombardo C, Bux E, Hansen S, Salveta C, Biello S, et al. Psychophysiological reactivity to sleep-related emotional stimuli in primary insomnia. Behav Res Ther. 2010;48:467–75.

    Article  PubMed  Google Scholar 

  40. Baglioni C, Spiegelhalder K, Lombardo C, Feige B, Violani C, Riemann D. Neurobiological correlates of emotional processes in primary insomnia. [Abstract O177]. Presented at the 20th Congress of the European Sleep Research Society. Lisbon, Portugal; September 14–18, 2010c.

  41. Feige B, Al-Shajlawi A, Nissen C, Voderholzer U, Hornyak M, Spiegelhalder K, et al. Does REM sleep contribute to subjective wake time in primary insomnia? a comparison of polysomnographic and subjective sleep in 100 patients. J Sleep Res. 2008;17:180–90.

    Article  PubMed  Google Scholar 

  42. • Riemann D, Spiegelhalder K, Nissen C, Hirscher V, Baglioni C, Feige B. REM sleep instability—a new pathway for insomnia? Pharmacopsychiatry. 2012;45:167–76. This review proposes that REM sleep instability could play a key-role in primary insomnia and explain the causal link between insomnia and depression.

  43. Mäkela KA, Wigren HK, Zant JC, Sakurai T, Alhonen L, Kostin A, et al. Characterization of sleep-wake patterns in a novel transgenic mouse line overexpressing human prepro-orexin/hypocretin. Acta Physiol. 2010;198:237–49.

    Article  Google Scholar 

  44. •• Fortier-Brochu E, Beaulieu-Bonneau S, Ivers H, Morin CM. Insomnia and daytime cognitive performance: a meta-analysis. Sleep Med Rev. 2012;16:83–94. This meta-analysis summarizes the results of studies evaluating cognitive performance in people with primary insomnia compared with good sleepers on neuropsychological measures. Results show impairments of small to moderate magnitude in primary insomnia.

    Article  PubMed  Google Scholar 

  45. •• Borsboom D, Cramer AOJ, Schmittmann VD, Epskamp S, Waldorp LJ. The small world of psychopathology. PLoS One. 2011;6:e27407. This article proposes a new network model for psychiatric disorders. Comorbidity would arise through the effect of symptoms shared by multiple disorders, called “bridge symptoms”.

    Article  PubMed  CAS  Google Scholar 

  46. Harvey AG. Insomnia, psychiatric disorders, and the transdiagnostic perspective. Curr Dir Psychol Sci. 2008;17:299–303.

    Article  Google Scholar 

  47. Benca RM, Obermeyer WH, Thisted RA, Gillin JC. Sleep and psychiatric disorders. A meta-analysis. Arch Gen Psychiatry. 1992;49:651–68.

    Article  PubMed  CAS  Google Scholar 

  48. •• Harvey AG, Murray G, Chandler RA, Soehner A. Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms. Clin Psychol Rev. 2011;31:225–35. In this review, the authors summarize a novel approach to insomnia. Sleep disturbances would represent a mechanistically transdiagnostic process in the context of psychiatric disorders by contributing to their development and maintenance.

    Article  PubMed  Google Scholar 

  49. Siversten B, Overland S, Bjorvatn B, Maeland JG, Mykletun A. Does insomnia predict sick leave? the Hordaland Health Study. J Psychosom Res. 2009;66:67–74.

    Article  Google Scholar 

  50. Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep. 2006;29:1398–414.

    PubMed  Google Scholar 

  51. Taylor DJ, Lichstein KL, Weinstock J, Sanford S, Temple JR. A pilot study of cognitive-behavioral therapy of insomnia in people with mild depression. Behav Ther. 2007;38:49–57.

    Article  PubMed  Google Scholar 

  52. Manber R, Edinger JD, Gress JL, San Pedro-Salcedo MG, Kuo TF, Kalista T. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep. 2008;31:489–95.

    PubMed  Google Scholar 

  53. Manber R, Bernert RA, Suh S, Nowakowski S, Siebern AT, Ong JC. CBT for insomnia in patients with high and low depressive symptom severity: adherence and clinical outcomes. J Clin Sleep Med. 2011;7:645–52.

    PubMed  Google Scholar 

  54. Watanabe N, Furukawa TA, Shimodera S, Morokuma I, Katsuki F, Fujita H, et al. Brief behavioral therapy for refractory insomnia in residual depression: an assessor-blind, randomized controlled trial. J Clin Psychiatry. 2011;72:1651–8.

    Article  PubMed  Google Scholar 

  55. ••Edinger JD, Olsen MK, Stechuchak KM, Means MK, Lineberger MD, Kirby A, et al. Cognitive behavioral therapy for patients with primary insomnia or insomnia associated predominantly with mixed psychiatric disorders: a randomized clinical trial. Sleep. 2009;32:499–510. This randomized controlled trial showed that cognitive-behavioral treatment for insomnia is equally efficacious for primary insomnia and insomnia comorbid with mixed psychiatric disorders.

    PubMed  Google Scholar 

  56. Espie CA, MacMahon KMA, Kelly HL, Broomfield NM, Douglas NJ, Engleman HM, et al. Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice. Sleep. 2007;30:574–84.

    PubMed  Google Scholar 

  57. Ritterband LM, Thorndike FP, Gonder-Frederick LA, Magee JC, Bailey ET, Saylor DK, et al. Efficacy of an internet-based behavioral intervention for adults with insomnia. Arch Gen Psychiatry. 2009;66:692–8.

    Article  PubMed  Google Scholar 

  58. Belleville G, Cousineau H, Levrier K, St-Pierre-Delorme MÈ. Meta-analytic review of the impact of cognitive-behavior therapy for insomnia on concomitant anxiety. Clin Psychol Rev. 2011;31:638–52.

    Article  PubMed  Google Scholar 

  59. Myers E, Startup H, Freeman D. Cognitive behavioral treatment of insomnia in individuals with persistent persecutory delusions: a pilot trial. J Behav Ther Exp Psychiatry. 2011;42:330–6.

    Article  PubMed  Google Scholar 

  60. Arnedt JT, Conroy D, Rutt J, Aloia MS, Brower KJ, Armitage R. An open trial of cognitive-behavioral treatment for insomnia comorbid with alcohol dependence. Sleep Med. 2007;8:176–80.

    Article  PubMed  Google Scholar 

  61. Nissen C, Nofzinger E. Sleep and depression: a functional neuroimaging perspective. In: Pandi-Perumal SR, Ruoti RR, Kramer M, editors. Sleep in psychosomatic medicine. Boca Raton: Taylor and Francis; 2006. p. 51–65.

    Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Hauptstraße 5, 79104, Freiburg, Germany

    Chiara Baglioni & Dieter Riemann

Authors
  1. Chiara Baglioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dieter Riemann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chiara Baglioni.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baglioni, C., Riemann, D. Is Chronic Insomnia a Precursor to Major Depression? Epidemiological and Biological Findings. Curr Psychiatry Rep 14, 511–518 (2012). https://doi.org/10.1007/s11920-012-0308-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-012-0308-5

Keywords

Search

Navigation