Depression is often accompanied by a variety of physical symptoms. One of the most powerful physical changes accompanying depression is impaired sleep. Usually this involves an inability to get enough sleep because the person has difficulty falling asleep, repeatedly wakes during the night, or awakens much too early. Sometimes the person sleeps too much or experiences fatigue so pervasive that they can never seem to get enough sleep. When the person does not awake feeling refreshed and rested, it becomes harder to face the day. Depressed people may lack energy and feel exhausted by everyday activities. They may have trouble focusing on tasks and staying alert. This is a particular problem for those who work long hours or alternating shifts.