SLEEP DISORDERS IN PSYCHIATRY
What are the sleep disorders associated with psychiatric conditions?
Sleep problems are common in individuals with psychiatric conditions, including depression, anxiety (post-traumatic stress disorder, generalized anxiety disorder, and panic disorder), bipolar disorder, schizophrenia, dementia, and substance abuse. Insomnia is the most common reported sleep problem related to psychiatric disorders. In mania, and possibly in depression, insomnia can worsen the condition, and early intervention to improve sleep may help to abort a relapse. Also, insomnia can signal an imminent relapse. In addition to increased insomnia, there can also be an increased incidence of parasomnia, circadian rhythm disorders, and hypersomnia. For these reasons, I always inquire about sleep as a routine part of patient assessment.
Insomnia is the most common symptom in depressed individuals, and is often the reason why they seek help. 75% of depressed individuals have insomnia (difficulty falling asleep, fragmented sleep, early-morning awakening, decreased amount of sleep, etc…). Insomnia tends to improve as mood lifts, and such relief of sleep disturbance may encourage individuals to adhere to antidepressant treatment. 5-10% of depressed individuals have hypersomnia, which is commonly associated with atypical depression.
Sleep problems are highly common in Post-traumatic stress disorder (PTSD). Around 70-90% of individuals with PTSD have difficulty falling asleep or staying asleep, and nightmares are reported by 20-70%. Parasomnias such as sleep walking and night terrors are more common than in the general population. More recently, a high incidence of sleep-disordered breathing and sleep movement disorders has also been reported.
In Generalized anxiety disorder (GAD), sleep onset insomnia is experienced by 20-30% of individuals, and sometimes sleep is the main focus of anxiety. They may also have increased night-time awakenings and report poor sleep quality. Individuals may spend hours ruminating before sleep onset, and the negative consequences of having too little of it.