It’s pitch black outside, and I’m standing in the shower trying to find the energy to face the day.

I’d come off a weekend call, and between the sound of the water hitting the tiles and the thought of 6am rounds, I found myself sobbing.

It was the kind of crying that sneaks up on you without warning. All I wanted was to crawl back into bed and hide.
That was my Internal Medicine intern year in Detroit, Michigan.

My mom had called at some point during those months to check in.

“How are you doing?” she asked.

“I hate this,” I told her.

As a normally quite positive person, it was unlike me, but honest.
The chronic sleep deprivation wasn’t just making me tired, it was rearranging things in my brain.

I was ruminating, emotional, negative, exhausted, and a little lost inside my own head. I didn’t have language for it at the time. I just thought something was wrong with me because it seemed like everyone else was thriving.
Then vacation came, and I slept. Like long and deep sleeps. And the fog lifted so quickly, that I remember thinking, “I feel like myself again.”

I see this in my patients frequently as well, with a combination of disrupted sleep and low mood.

One feeds the other and it can be hard to know which came first.
I sat down with Amit Chopra MD — psychiatrist and sleep specialist at Massachusetts General Hospital, Assistant Professor at Harvard Medical School, and co-author of Management of Sleep Disorders in Psychiatry published by Oxford University Press, to dig into exactly that relationship.

• What looks like treatment-resistant depression may actually be undiagnosed sleep apnea. Dr. Chopra explains the presentation most physicians miss — particularly in women.
• Insomnia is an independent risk factor for suicidality, even when you control for depression severity. We get into the specific features that should raise your concern.
• CBT-I isn’t just for sleep. It has measurable antidepressant effects and can even prevent depression onset in vulnerable patients. Dr. Chopra explains why it belongs in your treatment toolkit.
• The sleep-depression relationship is bidirectional, and the direction matters clinically. We break down what that means for your treatment plans.
• Untreated insomnia increases depression recurrence risk by 3-6x. Treating the mood disorder without addressing the sleep may be setting your patients up to relapse.

Watch the interview here and claim your CME credit using the Learner+ link below.

Did you learn something today? Click here to find out how Learner+ can help you meet your evolving educational goals.