You haven't slept well in weeks. Everything feels heavier. You're short with the people you love, you can't focus, and you've stopped doing the things that used to help. Then night comes, and you're lying awake again.
It's hard to tell which problem came first. Honestly, it often doesn't matter as much as you'd think. What matters is that depression and insomnia tend to keep each other going.
When I interviewed Jill Hasso, LPC, on October 2, 2026, I asked how often she sees depression and sleep problems show up together. She didn't hesitate. "Oh, all the time."
The research backs her up. Researchers estimate that up to 80% of people with depression have sleep complaints that look like insomnia. And people with insomnia who aren't depressed have about twice the risk of developing depression compared to people who sleep well.
How does the cycle work?
It runs in both directions.
Poor sleep makes depression worse
When you're exhausted, everything costs more energy. Your mood is lower, your patience is thinner, and it's harder to do the things that might help, like seeing friends, moving your body, or getting out of the house.
Depression makes sleep worse
When you're depressed, it's common to pull back from activities and spend more time in bed or on the couch. Days lose their structure. You might nap, sleep in, or stay in bed scrolling because there's not much pulling you out of it. All of that can throw off your sleep at night.
And then there's a third piece, which Jill described in a way that really stuck with me.
Why does everything come up at night?
"During the day, you have all these other responsibilities and other things that you have to do," Jill said. "Think about it. Sleep is, like, one of the only times where it's just yours."
That quiet is exactly when the hard stuff shows up. "If you're not dealing with it in the middle of the day," she said, "it's gonna come up at some point. Right?"
Maybe you're anxious about something. Maybe there's trauma you haven't had space to work through. Maybe it's just the worries you pushed aside all day so you could function. When your head hits the pillow, there's finally nothing to distract you from them.
Over time, your brain starts to connect your bed with being awake and stuck in your thoughts instead of with sleep. Jill explained that when you're in bed scrolling or lying there anxious, "your brain essentially doesn't know how to determine, like, am I sleeping, or am I gonna be up anxious all night?"
So the depression feeds the late-night rumination, the rumination keeps you awake, and the lost sleep feeds the depression.
Should I rest more or less?
This is where depression and insomnia can feel like they're pulling you in opposite directions.
When you're depressed and exhausted, everything in you says rest more. Go to bed early. Sleep in. Lie down in the afternoon. That makes sense. You're tired.
But with insomnia, more time in bed often makes things worse. It gives your brain more practice lying awake, and it weakens the natural sleep drive that builds up over the day.
The good news is that the two treatments that help most, behavioral activation for depression and CBT-I for insomnia, actually point in the same direction.
Behavioral activation adds structure to your day
In behavioral activation, Jill schedules small, meaningful activities with clients during the session, with a real day and time. That might be fifteen minutes with a cup of coffee, a walk, or a call with a friend. Over time, those activities give your days a shape again. Days with more shape tend to lead to nights with more sleep. You can see what that looks like in what behavioral activation actually looks like in a therapy session.
CBT-I gives your nights structure
CBT-I works on the other end. You track your sleep, set a consistent wake-up time, and match your time in bed to how much you're actually sleeping. Jill gave a common example: "Let's say, like, you're getting into bed at ten o'clock at night every night, but you're not actually asleep until midnight. Well, why don't we go to bed at midnight then?"
When I've used CBT-I with clients, that piece has been the hardest for them to accept. But I've also noticed it's especially helpful when someone is depressed, because it cuts down on the time spent lying in bed ruminating. When I mentioned this, Jill agreed, and added that CBT-I also works directly on the thoughts that keep people up. We go deeper on this in why sleep hygiene isn't enough and what CBT-I does differently.
Both make room for what's weighing on you
Remember Jill's point that if you don't deal with things during the day, they come up at night. Part of the work is giving those thoughts somewhere else to go.
"If we start working through those thoughts and have structured time during the day to be able to work through those things," she said, "you're gonna wake up a lot less middle of the night with anxious thoughts." That might be a short journaling window, a worksheet from therapy, or Cognitive Processing Therapy if trauma is part of the picture.
Which one do you treat first?
It depends on what's most stuck right now. Often, it's both at once.
If your nights are so broken that you can barely function during the day, starting with sleep can make everything else more possible. If your days have lost all their shape and you've pulled away from almost everything, starting with behavioral activation might come first. A lot of the time, a therapist trained in both will weave them together, since they support each other.
That's one reason it helps to work with someone who can see the whole picture. Depression rarely shows up alone. Sleep, anxiety, and past trauma can all be part of what's keeping you stuck, and the plan should fit what's actually going on for you.
What should I expect?
A few honest things.
The start of CBT-I can feel harder. "It gets worse before it gets better," Jill said. You may feel more tired for a week or two while your sleep consolidates. That usually passes.
Small steps count. In behavioral activation, you start with activities that feel doable, not the hardest thing on your list. We explain why in when you're depressed, start smaller than you think.
Some sleep problems need a doctor first. If you snore loudly, gasp in your sleep, have restless legs, or have bipolar disorder or a seizure disorder, talk with your doctor before starting CBT-I. And if you take sleep or mood medication, don't change it without talking to your prescriber.
When I asked Jill what she'd want someone to know if they were depressed and hadn't slept well in months, she said, "I think change is possible when it comes to that. And, like, there is help and support out there for people that are struggling."
Begin Counseling for Depression and Insomnia in Missouri
At Aspire Counseling, we believe in doing what works. We don't just ask you how your week was every week for a year with no big changes. You can do that with your friend. What you're paying for when you come to counseling is our expertise, our knowledge, and therapy that moves the needle to really help you get out of this funk.
Different therapists in our practice use different treatment modalities to treat depression. Jill sticks really closely to Behavioral Activation, and she's also trained in CBT-I, so she can work on your sleep and your mood at the same time. Jordan uses more Acceptance and Commitment Therapy. Samantha uses Dialectical Behavior Therapy principles. But all of them have this element of how to help you stop just pushing through and get you re-engaging in life in a meaningful way. Any of our therapists who routinely treat depression will help you figure out how to use the very limited energy you have left in a way that will help you start to feel more like yourself again.
Start by calling our office at (816) 287-1116 (Lee's Summit) or 573-328-2288 (Columbia), scheduling a time to chat with our intake team, or emailing us through our contact page. We have offices in Lee's Summit and Columbia, or we can meet with you online from anywhere in Missouri.
About the Author
This blog post is one of a series that grew out of an interview on October 2, 2026, with Jill Hasso, LPC, one of our Missouri depression therapists who is especially passionate about Behavioral Activation and also provides CBT-I for insomnia. Jessica Oliver, MSW, LCSW, our clinic founder and director, who also has 15+ years of experience treating depression and has used CBT-I with her own clients, led the interview and wrote this blog post. So it's a true joint effort, representing the expertise of two experienced Missouri therapists who are passionate about helping people get unstuck and make meaningful change when they've been depressed.
