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; |
| 3 |
The person finds it difficult to control the worry; |
| 3 |
The worry is associated with at least 3 of the
following symptoms |
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Restlessness or feeling on edge; |
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Being easily fatigued; |
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Difficulty concentrating or mind going blank; |
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Irritability; |
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Muscle Tension; |
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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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