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.

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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.
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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

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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

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