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Medical and Psychiatric Sleep Disorders
A significant body of knowledge is accumulating on the role
of sleep and its disruption in the causes and prognosis
of a variety of Medical and Psychiatric Disorders. It is
now well established that poor sleep can contribute to dysfunction
of the immune system and that in some psychiatric disorders
where sleep disruption is prominent, adequate treatment
of the sleep disorder may improve prognosis.
Anxiety Disorders
Individuals with chronic Anxiety are recognised by friends,
family and colleagues as being 'nervous', 'tense', 'uptight'
and 'always been a worrier'. Between 50% and 70% of people
with Generalised anxiety Disorder report trouble sleeping
and often report difficulty falling asleep because they
cannot stop thinking about things at bedtime. There is ample
scientific evidence from Polysomnography (PSG) testing to
indicate that Anxiety Disorders result in problems of falling
asleep and problems staying asleep. There is also evidence
that adequate treatment of the sleep problems in these patients
results in improvement of the anxiety symptoms and general
functioning.
The American Psychiatric Association's Diagnostic and statistical
Manual of Mental Disorders (DSM IV) lists the following
core criteria for the diagnosis of Generalised Anxiety Disorder:
1. Excessive Anxiety and worry on most days for at least
the past 6 months;
2. The person finds it difficult to control the worry;
3. The worry is associated with at least 3 of the following
symptoms
- Restlessness or feeling on edge;
- Being easily fatigued;
- Difficulty concentrating or mind going blank;
- Irritability;
- Muscle Tension;
- Sleep Disturbances including difficulty falling asleep
or staying asleep or restless unsatisfying sleep.
For more information on these problems please contact
us.
Panic Disorder
The characteristic feature of panic disorder is the recurrent,
unexpected occurrence of Panic Attacks that can occur in
almost any environment or time of day. These are episodes
when a person experiences a high degree of anxiety which
is associated with symptoms such as heart palpitations,
difficulty breathing, a sense of choking, chest pain, dizziness,
feelings of unreality and gastrointestinal disturbances.
Patients with Panic disorder frequently report being woken
from sleep by a panic attack feeling a sensation of choking
and rushing to the nearest window to get some air. These
Sleep Panic Attacks occur in up to 70% of people
with Panic Disorder.
People with Panic Disorder experience these panic attacks
on a frequent basis and as result may become afraid of going
to places or situations that they associate with previous
panic attacks. At its worst, these people may become totally
housebound and unable to work or live according their previous
norms. Panic Disorder is three times more common in Women
as opposed to men and the average age at which it begins
is 22 years.
Sleep complaints by patients with panic disorder include
Insomnia, restless, broken sleep, and the more disabling
Sleep Panic Attacks or Nocturnal Panic.
The combination of Medical Treatment with Cognitive therapy
is highly effective in returning the patient to a normal
life.
For more information on these problems please contact
us.
Depression
Depression or depressive disorders refer to a constellation
of symptoms in which mood related symptoms are the predominant
feature.
The core features of Depression are summarised below:
1. Depressed Mood most of the day, nearly everyday, for
at least two weeks;
2. Decreased interest or pleasure in almost all daily activities;
3. Insomnia or excessive sleepiness;
4. Significant loss of weight and appetite;
5. Psychomotor Agitation or Retardation;
6. Fatigue and Loss of energy;
7. Feelings of worthlessness or excessive or inappropriate
guilt;
8. Decreased ability to concentrate;
9. Preoccupation with Morbid thoughts such as death and
dying
More than 80% of patients with depression complain of Insomnia
with remainder complaining of excessive sleepiness.
Many patients with Depression report an improvement in
their Depressive symptoms after their sleep pattern has
returned to normal.
The Sleep Problems in patients with Depression is the most
studied of all the psychiatric disorders.
The Sleep Disturbances in Depression are summarised
below
| 1 |
Problems with the Continuity of Sleep - patients with
depression characteristically have a prolonged sleep
onset and increased wakefulness during sleep. Early
morning waking is also considered a characteristic symptom; |
| 2 |
Slow-Wave Sleep Deficits - Patients with depression
have a decreased amount of Slow-Wave sleep (or deep
sleep) especially during the first half of the night; |
| 3 |
Rapid Eye Movement (REM) sleep abnormalities - The
time from falling asleep to the onset of REM sleep is
reduced in patients with depression - this decrease
in REM onset latency is one of the most robust findings
in depression. Other abnormalities of REM sleep include
a longer duration of the first REM period, an increased
number of rapid eye movements (REM Density) and an overall
increase in the percentage of REM sleep |
For more information on these problems please contact
us.
Dementia
The term Dementia refers to a group of illnesses that
have as their essential feature loss of memory associated
with degeneration of the brain. The most frequent type of
Dementia is Alzheimer's Disease. Other causes of
Dementia are Parkinson's Disease, Huntington's Disease,
Fatal Familial Insomnia and vascular or Multi-Infarct Dementia.
The following Sleep Disorders occur frequently in patients
with Dementia:
1. Sleep Apnoea
2. Sundowning - a state similar to delirium that occurs
in the early evening
3. Sleep Disruption at night
4. REM Sleep Dyscontrol
5. Forced Awakenings from Sleep
6. Disturbances of the Circadian/Biological Clock
For more information on these problems please contact
us.
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