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What is the Relationship Between Disrupted Sleep and Psychiatric Illness?

Association between persistent childhood sleep problems and development of adult anxiety disorders 1 Insomnia preceded mood disorders in 40% of cases 2 Suicidal thoughts are linked to short, nonrestorative sleep 3

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What is the Relationship Between Disrupted Sleep and Psychiatric Illness?

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  1. Association between persistent childhood sleep problems and development of adult anxiety disorders1 • Insomnia preceded mood disorders in 40% of cases2 • Suicidal thoughts are linked to short, nonrestorative sleep3 • Chronically disturbed sleep increases the risk of psychiatric illness and hinders recovery2,4,5 What is the Relationship Between Disrupted Sleep and Psychiatric Illness? 1.Gregory AM et al. J Abnorm Child Psychol. 2005;33(2):157-163. 2. Ohayon MM, Roth T. J Psychiatr Res. 2003;37(1): 9-15. 3. Park JH et al. Psychiatry ClinNeurosci. 2013;67(1):28-34. 4. Ford DE, Kamerow DB. JAMA. 1989;262(11):1479-1484. 5. JuYE et al. JAMA Neurol. 2013;70(5):587-593.

  2. Respiratory sleep disorder Obesity Interrelationship Between Disturbed Sleep and Dysfunction Disrupted or nonrestorative sleep Medication side effects Suicidality Psychiatric disorders Dysfunction, impaired quality of life Substance use Morbidity Mortality

  3. The Consensus Sleep Diary1 • The Pittsburgh Sleep Quality Index (PSQI)2 • The Patient Health Questionnaire (PHQ)-93 • The Generalized Anxiety Disorder 7-item (GAD-7) Scale4 • Primary Care Post-traumatic Stress Disorder (PTSD) screen5 • All tools are in the public domain. Useful Screening Tools for Assessing Sleep and Psychiatric Conditions Morin CM. Insomnia Rounds. 2012;1(1):1-6. Sleep Quality Index (PSQI). Available at: http://www.sleep.pitt.edu/content.asp?id=1484&subid=2316. Patient Health Questionnaire (PHQ)-9. Available at: http://www.phqscreeners.com. Generalized Anxiety Disorder 7-item (GAD-7) Scale. Available at: http://www.phqscreeners.com. The primary care PTSD screen (PCPTSD). Available at: http://www.ptsd.va.gov/professional/pages/assessments/pc-ptsd.asp.

  4. Sleep Changes in Mood Disorders PSG = polysomnography; REM = rapid eye movement

  5. MDD and bipolar I/II disorders • Pharmacotherapy • Nonpharmacological: CBT, interpersonal and social rhythm strategies, sleep hygiene • Most antidepressants benefit sleep • Many SSRIs/SNRIs contribute to / worsen insomnia • Hypnotic agents • Short-acting BDZ • Non-BDZ receptor agonists: zopiclone, zolpidem Treatment of Insomnia Associated with a Mood Disorder MDD = major depressive disorder; CBT = cognitive behavioural therapy; SSRI = selective serotonin reuptake inhibitor; SNRI = serotonin norepinephrine reuptake inhibitor

  6. Sleep complaints after trauma predict PTSD1 • >65% of PTSD patients report significant sleep difficulties2 • Main symptoms: insomnia and dreams/nightmares about trauma • Poor sleep affects severity of PTSD symptoms and perceived mental health2 • Treatment for traumatic nightmares3 • Prazosin • Imagery rehearsal therapy; exposure, relaxation, and rescriptingtherapy; and lucid dreaming therapy Anxiety Disorders Associatedwith Insomnia: PTSD Klein E et al. J Sleep Res. 2003;12(1):35-41. Belleville G et al. J NervMent Dis. 2009;197(2):126-132. Escamilla M et al. CurrPsychiatry Rep. 2012;14(5):529-535.

  7. Anxiety Disorders Associatedwith Insomnia: GAD • GAD is characterized by excessive anxiety and intrusive worrying, restlessness, fatigability, muscle tension, irritability, and difficulty concentrating • Anxiety ratings correlate with number of awakenings, latency to stage 1 sleep, and percentage of stage 2 sleep1 • Commonly treated with SSRIs (may worsen insomnia) • A hypnotic agent can improve sleep and daytime performance2 • Nonpharmacological therapies3 • CBT, mindfulness, relaxation exercises Rosa RR et al. BiolPsychol. 1983;16(1-2):119-126. Pollack M et al. ArchGen Psychiatry. 2008;65(5):551-562. Davidson JR. InsomniaRounds2012;1(3):1-6.

  8. Anxiety Disorders Associatedwith Insomnia: Panic Disorder • Insomnia is a common complaint in panic disorder • Prolonged sleep initiation and frequent awakenings1,2 • Panic attacks often occur during sleep1 • Reported by 33%–71% of patients with panic disorder; up to 1/3 have more episodes during sleep than awake • Frequent nocturnal panic attacks may lead to secondary insomnia • Pharmacological and nonpharmacological treatments3 • SSRIs/SNRIs are first-line and may require an SHA4 Abad VC, Guilleminault C. Dialogues ClinNeurosci. 2005;7(4):291-303. Mellman TA. Sleep Med Clin. 2008;3(2):261-268. American Psychiatric Association. Practice Guidelines for the Treatment of Patients With Panic Disorder, 2nd ed. Cervena K et al. Sleep Med. 2005;6(2):149-153.

  9. Insomnia and Schizophrenia • Severe insomnia is a prodromal sign of impending exacerbation or worsening after antipsychotic discontinuation1 • Sleep-related complications with schizophrenia2 • Inconsistent associations between PSG sleep indices and schizophrenia symptoms (positive and negative)2 • Antipsychotics have sedative effect • Maximize benefit through good sleep hygiene3,4 Benson KL. Sleep Med Clin. 2008;3(2):251-260. Krystal AD. NeurolClin. 2012;30(4):1389-1413. Davidson JR. Insomnia Rounds 2012;1(3):1-6. MacFarlane J. Insomnia Rounds. 2012;1(2):1-6.

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