Why am I so tired?

 The link between depression and sleep

**Approximate reading time: 3.7 minutes**

New year, new you?

The beginning of a new year can seem a bit of a slog for lots of reasons. All the build-up to Christmas, coupled with overspending, overeating, drinking too much, family stress - not a recipe for a calm mind and rested body.

And then suddenly it's January 1, and the advertisers are berating you for all that cheese you ate, and expecting you to snap back into discipline like lean, teenage greyhounds. New year, new you! everyone shouts. It's a bit much.

Add in disturbed sleep, and you really have the perfect recipe for fatigue, low mood, underperformance at work, irritability and more.

Why sleep?

Sleep is the most amazing thing. For the 7-9 hours we rest (yes, you really need that much) your brain and body go through a whole range of restorative, renewal processes. Without sleep, we die. There's a reason sleep deprivation is used as a method of torture.

When is it the sign of a larger problem?

For many, it isn't lack of sleep which is the issue. It's lack of *refreshing* sleep, and the root of this can be psychological rather than physical.

“I’m exhausted.”

“I can’t seem to catch up on my sleep.”

“I can’t get out of bed in the morning.”

“I’m tired of being tired.”

These are often things people living with depression will say. Long-term disturbed sleep is often one of the first signs that all is not right with your mental wellbeing. Fatigue goes hand-in-hand with depression, and can affect you emotionally, cognitively and physically.

At its most extreme, it can be impossible to get out of bed in the morning, despite having clocked up the recommended hours of sleep. Everything seems exhausting. Even interactions with other people - texting or talking - can seem like too much to bear.

How fatigue is defined in depression

Dr Maurizio Fava explains that fatigue is one of the identified symptoms of major depressive disorder (MDD) as listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. It is defined as physical fatigue or loss of energy.

“However, in my opinion, fatigue is much more than that. We see apathy and considerable emotional disturbance occurring as a consequence of fatigue. We have also seen     high rates of diminished focus, word finding difficulties, and recall problems in fatigued patients with MDD."

Three categories of fatigue commonly occur in patients with MDD; these include physical, cognitive and emotional symptoms.

 “The physical symptoms of fatigue include reduced activity, low energy, tiredness, decreased physical endurance, increased effort to do physical tasks, general weakness,  heaviness, slowness or sluggishness, non-restorative sleep, and sleepiness. The cognitive symptoms include decreased concentration, decreased attention, decreased mental  endurance, and slowed thinking. The emotional (affective) symptoms of fatigue include decreased motivation or initiative (apathy), decreased interest, feeling overwhelmed, feeling bored, aversion to effort, and feeling low. Given the broad range of related, comorbid symptoms, it can be difficult to differentiate between independent symptoms of fatigue from symptoms directly related to MDD.”

 So why does depression make you tired?

It's about quality of sleep. Depressed people may well be clocking up the requisite number of hours, but when researchers scanned their brains, they found the following:

• It takes depressed people much longer to fall asleep, so this equates to less sleep overall
• There is little to no deep sleep, and REM occurs much earlier in the night
• Depressed people may wake up frequently throughout the night, which disrupts their sleep cycles.
• They may wake up earlier in the morning and struggle to fall asleep again, even though they are exhausted.

The other issue is that your body is constantly battling against itself. It’s fighting to stabilise your moods, it’s pushing you to do things that should come easily (getting out of bed, eating, relaxing) but often become a chore when you're depressed, so you're working far harder to achieve everyday things.

Energy is not just for physical activities. When thinking, our brain requires a great deal of energy too, like a computer that keeps processing memory. The difference is, when you're in a normal state of mind, it works efficiently. When you are depressed, it starts to process thoughts in an unhealthy way. It can keep looping around depressive topics, and on the flipside, it's also working hard to solve the issue. We obsess and overthink, and that's exhausting.

 On a personal note

I wrote this because I woke up this morning and truly struggled to get out of bed. I had no physical energy, and the thought of dealing with my commute was just too much.

It's the second morning in a row where I've been exhausted, gone to bed early and then been unrefreshed when I woke up. This is a huge red flag for my mental health, so I thought I'd look further into why it happens and then share it with you.

Fortunately (sort of) I know what has triggered this particular episode. I've experienced a specific situation which I knew would be difficult, so I can do things to support my mental wellbeing whilst I get through it. But plenty of times this happens for no obvious reason, so we don't always think about depression as a cause.

What now?

If you're reading this and are tired all the time, but don't know why - it might be worth having a chat with someone. Whether that's via your GP, a work-based Mental Health First Aider, or grabbing a cup of tea with someone who's a good listener. Sleep is too important to ignore, and this could be your first step to feeling a whole lot better.