Sleep disorders in psychiatric practice

WPA Section on Psychiatry and Sleep Wakefulness Disorders.
World psychiatry: official journal of the World Psychiatric Association (WPA) (Impact Factor: 12.85). 11/2005; 4(3):186-90.
Source: PubMed

ABSTRACT Over the last years, a large body of evidence has accumulated showing that complaints of disordered sleep are quite prevalent in the community. Insomnia is by far the most common disturbance and is often associated with concurrent psychiatric illness, in particular anxiety and mood disorders. On the other hand, sleep complaints are frequently present among psychiatric patients and have been incorporated in the official diagnostic criteria for many mental disorders, such as major depression, post-traumatic stress disorder, generalized anxiety disorder and substance-related disorders. Estimates of the prevalence of sleep disorders diverge widely, because these disorders have been variously conceptualized. Currently, however, three different classifications for sleep disorders establish reliable diagnostic criteria and allow for more consistency in clinical research. In particular, the ICD-10 diagnostic criteria for insomnia helped to establish a consensus among sleep specialists by defining accurately this clinical condition, i.e. by conceptualizing it as the subjective complaint of insufficient or non-restorative sleep, which is the important feature, not the actual amount of time spent asleep. Alongside the evolution of taxonomic systems, the development of specific diagnostic tools, such as rating scales for measuring clinical manifestations of sleep disorders, has contributed significantly to the growth in the field. For instance, the risk factors responsible for the development of chronic insomnia, its consequences, and the complex relationship between insomnia and psychopathology, have been considerably clarified. In terms of the polysomnographic aberrations observed in various mental disorders, these, although proven not to be pathognomonic for any of them, have been considerably refined over the last decade, and certain general sleep patterns for some specific disorders have emerged. Finally, substantial advances have been made in the elucidation of the neuropsychobiological substrate of disturbed sleep. Thus, hyperarousal has been identified as the cardinal feature of chronic insomnia, which is associated with an around-the-clock activation of both major components of the stress system, the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system.

Download full-text


Available from: Waldemar Szelenberger, Dec 29, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose. To examine the effects of acupuncture on sleep quality and on emotional measures among patients with schizophrenia. Methods. Twenty patients with schizophrenia participated in the study. The study comprised a seven-day running-in no-treatment period, followed by an eight-week experimental period. During the experimental period, participants were treated with acupuncture twice a week. During the first week (no-treatment period) and the last week of the experimental period, participants filled out a broad spectrum of questionnaires and their sleep was continuously monitored by wrist actigraph. Results. A paired-sample t-test was conducted comparing objective and subjective sleep parameters manifested by participants before and after sequential acupuncture treatment. A significant effect of acupuncture treatment was observed for seven objective sleep variables: sleep onset latency, sleep percentage, mean activity level, wake time after sleep onset, mean number of wake episodes, mean wake episode and longest wake episode. However, no significant effects of acupuncture treatment were found for subjective sleep measures. Likewise, the results indicate that acupuncture treatment improved psychopathology levels and emotional measures, that is, depression level and anxiety level. Conclusions. Overall, the findings of this pilot study suggest that acupuncture has beneficial effects as a treatment for insomnia and psychopathology symptoms among patients with schizophrenia.
    12/2013; 2013:327820. DOI:10.1155/2013/327820
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Disturbed sleep is a common subjective complaint among individuals diagnosed with anxiety disorders. In rodents, sleep is often recorded after exposure to various foot-shock paradigms designed to induce an anxiety state. Although differences in sleep-wake architecture are noted, the relationship to specific level of anxiety is often assumed or absent. Utilizing the elevated plus-maze (EPM) after exposure to escapable shock (ES), inescapable shock (IS) or fear conditioning (FC), resulting differences in sleep architecture were compared to an objective measure of anxiety. Male Wistar rats were implanted with EEG, EMG and hippocampal theta electrodes to record sleep-wake behavior. After recovery and recording of baseline sleep, rats were exposed to one of five manipulations: ES, IS, FC or control (CES or CIS; utilizing either chamber with no shock exposure). Shortly after experimental manipulation, the EPM was employed to quantify traditional and ethological measures of anxiety and polygraphic signs of sleep-wake behavior were recorded continuously for 6 h. Although no significance was observed in EPM measurements across groups, profound differences in sleep architecture were present. Individual correlation analysis revealed no differences in anxiety level and total percentage of time spent in sleep-wake states. These results indicate that differences in sleep architecture after foot-shock exposure may not be simply due to increased anxiety. Rather, individual anxiety may be exacerbated by disrupted sleep. To fully understand the relationship between anxiety and sleep-wake behavior, a more objective analysis of anxiety after stressor exposure is mandated.
    Brain Research 09/2007; 1164:72-80. DOI:10.1016/j.brainres.2007.06.034 · 2.83 Impact Factor
  • Source