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: 14.23). 11/2005; 4(3):186-90.
Source: PubMed


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.

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Available from: Waldemar Szelenberger, Dec 29, 2014
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    • "Yet standard treatments, especially biological treatments, are only partially effective and have possible serious side effects. Insomnia is the most common sleep disorder in psychiatry [15] [16]. Polysomnographic studies have shown that patients with schizophrenia exhibit increased sleep latency manifested by difficulties initiating or maintaining sleep, reduced sleep efficiency and total sleep time, reduced REM latency and REM density, and disturbed non-REM sleep architecture, specifically a decrease in SWS, especially in stage 4 [12, 17–21]. "
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    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.
    Full-text · Article · Dec 2013
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    • "The relationship between chronic psychological stress and reduced health is well established [1], with psychological stress having been shown to increase susceptibility to a wide range of diseases including anxiety, depression, diabetes, and obesity [2-4]. Even the “stress” of short-term sleep loss has significant implications for long-term health and well-being due to adverse systemic health effects including suppressed immune function, abdominal obesity, insomnia, depression, and generalized fatigue [5,6]. "
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    ABSTRACT: Magnolia (Magnolia officinalis) and Phellodendron (Phellodendron amurense) barks are medicinal plants commonly used as traditional remedies for reducing stress and anxiety. Modern dietary supplements are intended to induce relaxation and reduce stress as well as stress-related eating. Previous studies have shown the combination of Magnolia/Phellodendron (MP) to reduce both cortisol exposure and the perception of stress/anxiety, while improving weight loss in subjects with stress-related eating. Competitive athletes are "stressed" by their intense exercise regimens in addition to their normal activities of daily living and thus may benefit from a natural therapy intended to modulate baseline perceptions of stress and stress hormone exposure. We assessed salivary cortisol exposure and psychological mood state in 56 subjects (35 men and 21 women) screened for moderate stress and supplemented with a standardized/patented MP combination (Relora(R), Next Pharmaceuticals) or Placebo for 4 weeks. After 4 weeks of supplementation, salivary cortisol exposure was significantly (p<0.05) lower (-18%) in the Relora group compared to Placebo. Compared to Placebo, the Relora group had significantly better (p<0.05) mood state parameters, including lower indices of Overall Stress (-11%), Tension (-13%), Depression (-20%), Anger (-42%), Fatigue (-31%), and Confusion (-27%), and higher indices of Global Mood State (+11%) and Vigor (+18%). These results indicate that daily supplementation with a combination of Magnolia bark extract and Phellodendron bark extract (Relora(R)) reduces cortisol exposure and perceived daily stress, while improving a variety of mood state parameters, including lower fatigue and higher vigor. These results suggest an effective natural approach to modulating the detrimental health effects of chronic stress in moderately stressed adults. Future studies should examine the possible performance and recovery benefits of Relora supplementation in athletes overstressed by the physical and psychological demands of training and competition.
    Full-text · Article · Aug 2013 · Journal of the International Society of Sports Nutrition
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    • "Additionally, among people who identified themselves as "stress eaters," weight gain tended to increase over time [3]. It is also known that stress worsens insomnia, and insomnia has been linked to overweight and obesity [4,5]. Among 6,115 people, ages 32–59, comparisons were made between the weights of those who slept for a normal period of time (7–9 hours) and those who slept for shorter or longer periods of time. "
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    ABSTRACT: Recent research has established correlations between stress, anxiety, insomnia and excess body weight and these correlations have significant implications for health. This study measured the effects of a proprietary blend of extracts of Magnolia officinalis and Phellodendron amurense (Relora) on anxiety, stress and sleep in healthy premenopausal women. This randomized, parallel, placebo controlled clinical study was conducted with healthy, overweight (BMI 25 to 34.9), premenopausal female adults, between the ages of 20 and 50 years, who typically eat more in response to stressful situations and scores above the national mean for women on self-reporting anxiety. The intervention was Relora (250 mg capsules) or identical placebo 3 times daily for 6 weeks. Anxiety as measured by the Spielberger STATE-TRAIT questionnaires, salivary amylase and cortisol levels, Likert Scales/Visual Analog Scores for sleep quality and latency, appetite, and clinical markers of safety. The study was conducted by Miami Research Associates, a clinical research organization in Miami, FL. The intent-to-treat population consisted of 40 subjects with 26 participants completing the study. There were no significant adverse events. Relora was effective, in comparison to placebo, in reducing temporary, transitory anxiety as measured by the Spielberger STATE anxiety questionnaire. It was not effective in reducing long-standing feelings of anxiety or depression as measured using the Spielberger TRAIT questionnaire. Other assessments conducted in this study including salivary cortisol and amylase levels, appetite, body morphology and sleep quality/latency were not significantly changed by Relora in comparison to placebo. This pilot study indicates that Relora may offer some relief for premenopausal women experiencing mild transitory anxiety. There were no safety concerns or significant adverse events observed in this study.
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