Insomnia in Psychiatric Disorders
Insomnia is a common feature of mental illness and data have emerged indicating that sleep disturbance can be a risk factor for developing a psychiatric disorder and for worsening of pre-existing mental illness. Management of insomnia without accounting f
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Insomnia in Psychiatric Disorders Zachary L. Cohen and Katherine M. Sharkey
Abstract Insomnia is a common feature of mental illness and data have emerged indicating that sleep disturbance can be a risk factor for developing a psychiatric disorder and for worsening of pre-existing mental illness. Management of insomnia without accounting for underlying psychiatric disorders can be expected to result in suboptimal outcomes. Although associations between insomnia and mental illness are likely bidirectional, evidence suggests that treating comorbid insomnia can improve sleep and psychiatric outcomes. This chapter reviews the prevalence and features of insomnia in patients with frequently encountered psychiatric disorders, including mood disorders, anxiety disorders, substance-use disorders, and psychotic disorders, as well as specific treatment strategies where applicable. Further study of the subtleties of sleep disturbance among patients with different mental disorders may elucidate the genetic, neurochemical, and neurophysiological mechanisms underlying overlapping syndromes of insomnia and psychiatric illness. Keywords Major depressive disorder • Bipolar disorder • Generalized anxiety disorder • Panic disorder • Post-traumatic stress disorder • Substance-use disorders • Schizophrenia
Z.L. Cohen, B.A. The Warren Alpert Medical School of Brown University, Providence, RI, USA K.M. Sharkey, M.D., Ph.D. (*) Sleep for Science Research Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine, Rhode Island Hospital, Brown University, 300 Duncan Drive, Providence, RI 02906, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 H.P. Attarian (ed.), Clinical Handbook of Insomnia, Current Clinical Neurology, DOI 10.1007/978-3-319-41400-3_14
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Z.L. Cohen and K.M. Sharkey
Introduction Over 18 % of US adults experience mental illness annually, with an estimated 4.2 %, or ~10 million, diagnosed with serious mental illness that results in substantial functional impairment [1]. The costs of mental illness are staggering, not only in terms of human suffering, but also in societal burden, including costs of care, lost income, and economic impact of disability. Disturbed sleep can contribute to the onset, persistence, and severity of psychiatric disorders, including increased risk of suicide attempts and death by suicide [2]. In addition to insomnia, other common sleep disorders may contribute to sleep disturbance in patients with mental illness. For instance, many psychiatric medications increase weight gain and thus obstructive sleep apnea should be considered as a source of disturbed sleep in overweight patients taking psychoactive medications that cause weight gain. Similarly, several psychiatric medications (e.g., selective serotonin reuptake inhibitors [SSRIs], lithium, tricyclic antidepressants) have been implicated in restless leg syndrome and periodic limb movement disorder and thus iatrogenic causes of sleep disturbance should not be overlooked in patients taking
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