How Do Maladaptive Sleep-Related Thought Processes Influence Depression and Hypersomnolence?

depressed woman in bed
Portrait of depressed woman in bed
Depression contributed to elevated ratings in patients with MDD on items related to perceived inability to cope with the negative consequences of disturbed sleep and reported tendency to cancel social plans after poor sleep.

Maladaptive thought processes related to sleep may play an important role in overlapping major depressive disorder (MDD) and hypersomnolence, according to a study published in Behavioral Sleep Medicine. Cognitive therapies tend to target negative thinking patterns more broadly, and flawed sleep expectations and worries over sleep trouble could be a specific area to tackle in treatment.

Jesse David Cook, MS, of the Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, and colleagues explored dysfunctional sleep-related cognitions (SRCs) in 22 unmedicated patients with MDD and hypersomnolence, as well as matched controls with MDD alone and healthy controls. Participants completed the 16-item Dysfunctional Beliefs and Attitudes About Sleep (DBAS-16) and underwent overnight polysomnography.

In both MDD groups, DBAS-16 global scores were similarly elevated relative to healthy controls (P <.0001). Patients with comorbid MDD and hypersomnolence had a uniquely high rating relative to both control groups for 3 items: 1) When I don’t get the proper amount of sleep on a given night, I need to catch up on the next day by napping or on the next night by sleeping longer; 2) After a poor night’s sleep, I know that it will interfere with my daily activities on the next day; and 3) Without an adequate night’s sleep, I can hardly function the next day.

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Depression contributed to elevated ratings in both MDD groups on items related to perceived inability to cope with the negative consequences of disturbed sleep and reported tendency to cancel social plans after poor sleep. After adjusting for depression severity, however, global DBAS-16 scores for patients with comorbid MDD and hypersomnolence no longer differed significantly from those of healthy controls, although there was a significant main group effect.

The study was limited by the unequal sex distribution in the sample (81.6% women), which may restrict generalizability of results to men, and the overall small sample size. The findings pointed to the importance of beliefs about the impact of quantity and quality of sleep on functioning, which may reflect genuine challenges related to hypersomnolence rather than SRCs. In addition, the researchers concluded that the field of sleep research could benefit from a new measure for SRCs, particularly inventory items that assess feelings of hopelessness related to improvement of hypersomnolence

The researchers stated, “While these findings suggest there may be potentially maladaptive SRCs in persons with hypersomnolence, translating these results into treatment strategies that impact the care of persons with hypersomnolence will require several levels of clarification and further investigation.”

Disclosures: Multiple study authors reported industry ties. Please see the original study for a full list of disclosures.


Cook JD, Rumble ME, Tran KM, Plante DT. Potential maladaptive sleep-related cognitions in depression with comorbid hypersomnolence: an exploratory investigation. Behav Sleep Med. 2020. doi: 10.1080/15402002.2020.1732390.