The core practices
Consistent sleep and wake times, including weekends. Wind-down routine in the hour before bed. No screens for 30 to 60 minutes before sleep. Cool, dark, quiet bedroom. Bed for sleep only (not for reading, working, or scrolling). Get out of bed if you cannot sleep after 20 minutes. Morning light exposure to anchor circadian rhythm.
What matters more when starting an antidepressant
Sleep is often disrupted in the first weeks — vivid dreams, earlier waking, harder to fall asleep. Consistency becomes more important than usual because the body is already adjusting. Caffeine sensitivity is often elevated — reduce coffee and cut off earlier in the day. Alcohol worsens sleep architecture and interacts unpredictably; avoid close to bedtime particularly.
When to consider more
If sleep problems persist past week four, discuss with your prescriber. Options include shifting the dose timing (morning versus evening), CBT-I (cognitive behavioural therapy for insomnia — the strongest non-medication treatment for chronic insomnia), or short-term sleep medication in specific circumstances. The Sleep Health Foundation website has practical resources on all of these.
What to flag to your prescriber
Raise these at any review
- Persistent insomnia past week four.
- Sleep disruption severely affecting daily function.
- Increased daytime sleepiness that affects safety.
- Any new sleep-related breathing symptoms (snoring, gasping).
Frequently asked questions
Why is my sleep worse on a new antidepressant?
Sleep disruption is common in the first weeks. Most patients see meaningful improvement by week three.
Should I take a sleeping tablet if I cannot sleep?
Discuss with your prescriber. Non-medication approaches are typically first-line.
When should I worry about sleep problems?
Persistent disruption past week four, or problems severely affecting daily function, warrant discussion.
Evidence and sources referenced
- NICE Guideline NG222 — Depression in adults: treatment and management (United Kingdom).
- Royal Australian and New Zealand College of Psychiatrists (RANZCP) — Clinical Practice Guidelines for Mood Disorders.
- NPS MedicineWise — prescriber and patient resources on antidepressant treatment (Australia).
- Royal College of Psychiatrists — patient information on antidepressants.
- TGA and FDA — product information for SSRI and SNRI medication classes.
- Maudsley Prescribing Guidelines in Psychiatry — prescribing patterns and side-effect timelines.
Related reading
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