Depression is night's claws. When public fades to private, and I uncloak the many masks of the day, my mind is often flooded with thoughts steeped in hopelessness, worthlessness, and suicidal ideation.
Since being diagnosed with major depressive disorder in December 2012, time has taught me to disguise my nocturnal turmoil. I learned to cut the lights off and keep a blue hand towel by my pillow that was stained by crispy, dry mucus from many crying nights before. No matter how quietly I wept, I couldn't silence the disappointments of the day from ricocheting in my mind. My sobbing triggered headaches that felt like an aneurysm.
Bouts with depression have caused me to sleep too much, but my sense of impending danger comes when I sleep too little. Insomnia means negative thoughts unfiltered by friends, family, and daytime tasks.
I want to figure out the relationship between insomnia and depression in hopes of finding solutions to them both. To better understand why depression and insomnia have been my nightly conspirators, I spoke with Dr. Julio Fernandez-Mendoza of Penn State's Hershey Sleep Research & Treatment Center. His recent study found that severe insomniacs with less than six hours of sleep per night have twofold odds of experiencing depression. He discovered that insomnia and depression have a bidirectional relationship where each condition can lead to the other.
"You should not just treat depression, you should treat both things at the same time"
"Being awake at the beginning of the night or the middle of the night is the best moment to think about life and ruminate, to suffer, to really be very distressed," said Dr. Fernandez-Mendoza. "It's the perfect circumstances to become depressed."
Insomnia and depression are both influenced by high stress levels and are linked by having a racing mind. Just like a car and a motorbike, both entities are different but run on the same fuel. "It's the presence of high cortisol levels in insomniacs with short sleep that would explain why they become depressed in the future," Dr. Fernandez-Mendoza said. "We know that depression is also associated with high cortisol levels and high inflammation."
Hyperarousal can be triggered by stressful life events, even positive ones like getting married, having a child, or moving. But hospitalization is an insomnia trigger that can cause entrenched problems, and I know these issues intimately.
This past summer, after several nights of fighting suicidal thoughts, my passive suicidal ideation became active. Swallowing pills led to an emergency room stay where I had to wait until 1 AM to be medically cleared. Sleep was impossible when the bed to my right had an adorable elderly Jamaican woman who tried to wander past the emergency room divider. Her repeated request, "Follow mi go," sparked a tussle with a hospital security guard. In the bed across from me, a middle aged woman moaned about her leg while hospital staff ignored her rapidly beeping heart monitor.
After 1 AM, I was transferred to the psychiatry unit. I gave drowsy intake answers to a friendly and understanding nurse. Shortly after, I was placed in a fishbowl observation room full of blue recliners and sleeping strangers. Around 5, a nurse tapped my shoulder and led me to a private room.
Later that day, I was told about an amazing mental health facility that would ensure my full recovery. I walked the elegant hallways that had large windows, plush carpet, and antique wooden furniture. My best friend and I joked that we were entering a resort and not a mental hospital. Once inside a locked floor with none of those amenities, I realized I would be surrounded by patients much sicker than I was.
On my first night, my non-verbal roommate slammed her book against the wall every few minutes. While I tried to sleep, I could hear a male patient in front of my door yell, "I hate this place! I hate the fucking food. I want to go home!" I silently cheered him on as he listed my same complaints. Shortly after, there were hurried commands to handcuff him.
Unlinking stress from sleep has been a constant struggle since leaving the hospital, even after cognitive behavioral therapy (CBT) to reframe my nighttime thoughts.
But Dr. Fernandez-Mendoza says another method would have been better. "You should not just treat depression, you should treat both things at the same time," he said. Sleep psychologists teach their clients two key methods of sleep therapy: stimulus control—eschewing reading and technology before bed, and disconnecting from the sleep environment when they can't fall asleep—and sleep restriction—increasing their sleep time in increments above a baseline of six hours only as they see signs of improvement.
Dr. Fernandez-Mendoza also does cognitive therapy to modify the thought patterns that fuel harmful sleep habits. "CBT for insomnia is a very structured treatment. It's beautiful because what we know about sleep biology and sleep behavior, we use behavioral things to manipulate how the brain is reacting to insomnia."
After talking to Dr. Fernandez-Mendoza, I gained hope that I could disarm the night. I'm judging myself less for insomnia and learning to leave the bed and enjoy other things until I can fall asleep. Even when nocturnal thoughts question the point of my life, I'm learning to see them as cognitive distortions that bend and shape what truly appear.
This is Dr. Fernandez-Mendoza's mission, that today's adolescents never hit my rock bottom. "I work with insomnia predicting depression because I see it as a modifying factor, something that we can intervene early on on... and protect people from severe outcomes."
You'll Sleep When You're Dead is Motherboard's exploration of the future of sleep. Read more stories.