Napping during major depressive episodes identifies a distinct hypersomnolence phenotype

Prior studies have linked depression with napping, though findings remain inconsistent. Given that major depressive episodes (MDE) commonly involve sleep-wake and circadian disturbances, we hypothesized that daytime Napping during MDE reflects more pronounced sleep/circadian disruptions and a distinct clinical profile.

We compared MDE patients with and without napping (MDE-NAP vs MDE), as well as unipolar and bipolar subgroups, using subjective and objective biomarkers, including actigraphy.

The MDE-NAP group had more frequently hypersomnia (30.6% vs 8.2% p < .001), daytime sleepiness (73.1% vs 41.8%, p < .001), daytime fatigue (97.1% vs 88.5%, p = .042), family history of depression (68.2% vs 52.2%, p = .044), weight gain (42.2% vs 21.6%, p = .006), and feelings of guilt (75.0% vs 57.8%, p = .027). The unipolar napping group had greater weight gain (48.8% vs 21.4%, p = .004) and more hypersomnia (26.1% vs 3.4%, p < .001). The bipolar napping group were more frequently women (76.9% vs 52%, p = .046), with more suicidal ideation (65.4% vs 37.8%, p = .031), sad mood (73.1% vs 43.1%, p = .019), hypersomnia (38.5% vs 15.8%, p = .04), and guilt (61.9 vs 35.1, p = .049). Regarding sleep scales, MDE-NAP had more hypersomnolence symptoms (HSI total score, p < .001), with higher frequencies of sleep inertia, daytime sleep, sleepiness, daytime dysfunction, and sleep attacks; and showed longer sleep duration (PSQI sleep duration, p = .025), and higher sleep efficiency (PSQI sleep efficiency, p = .015). Actigraphy did not reveal significant between-group differences in the subsample with usable recordings (N = 90).

Daytime napping during MDE appears to identify a distinct hypersomnolence phenotype with sleep-vegetative burden, supporting the systematic assessment of napping to guide personalized sleep- and circadian-based therapeutic strategies. This paper is part of the Sleep and Circadian Mechanisms in Mental Health Collection.