Sleep disorders related to another mental disorder

Table 89-3 Sleep disorders related to another mental disorder
Disorder	Subjective sleep complaints	Objective sleep findings	Treatment options
Major depression	Insomnia (sleep-onset difficulty, increased awakenings, early-morning awakening) Hypersomnia (prolonged nighttime sleep, daytime fatigue/sleepiness) Nightmares	Long sleep latency, increased wakefulness, early-morning awakening Decreased Stage 3/4 sleep Decreased REM sleep latency Altered temporal distribution of slow-wave activity and REM sleep Increased phasic REM activity	Medication: antidepressants; benzodiazepines, trazodone, or sedating tricyclic as adjunct for insomnia Behavioral: cognitive-behavioral therapy; periodic or partial sleep deprivation Other: phototherapy
Dysthymia	Insomnia (sleep-onset difficulty, increased awakenings, early-morning awakening) Hypersomnia (prolonged nighttime sleep, daytime fatigue/sleepiness) Nightmares	Increased wakefulness Decreased REM latency (slight) Abnormal sleep findings attenuated relative to major depression	Medication: antidepressants; benzodiazepines, trazodone, or sedating tricyclic as adjunct for insomnia Behavioral: cognitive-behavioral therapy
Mania	Short sleep Disorganized sleep-wake schedule Sleep disruption may not be seen as problem by patient	Long sleep latency, increased wakefulness, decreased sleep time Decreased Stage 3/4 sleep Decreased REM sleep latency	Medication: lithium, valproic acid, carbamazepine, or other mood-stabilizing drugs; antipsychotic drugs; benzodiazepines as adjunct for severe insomnia Behavioral: reinforce regular sleep schedule
Schizophrenia	Insomnia (sleep-onset difficulty, increased awakenings) Disorganized sleep-wake schedule Delayed sleep schedule	Long sleep latency, increased wakefulness, decreased sleep time Decreased Stage 3/4 sleep Decreased REM sleep latency Decreased REM sleep (during exacerbation)	Medication: antipsychotic drugs; benzodiazepines as adjunct for insomnia Behavioral: reinforce regular sleep schedule
Generalized anxiety disorder	Insomnia (sleep-onset difficulty, increased awakenings) Nightmares	Long sleep latency, increased number of awakenings Decreased Stage 3/4 sleep Decreased REM sleep	Medication: antidepressants; benzodiazepines, trazodone, or tricyclic antidepressants at bedtime Behavioral: sleep restriction, stimulus control, cognitive-behavioral therapy
Panic disorder	Insomnia (increased awakenings, restless sleep) Abrupt awakenings with panic	Long sleep latency Abrupt awakenings from early Stage 3/4 sleep with tachycardia, tachypnea, cognitive/emotional symptoms of panic Increased body movement	Medication: antidepressants; benzodiazepines at bedtime Behavioral: sleep hygiene (avoid caffeine, sleep deprivation, exercise before sleep), relaxation
Posttraumatic stress disorder	Insomnia (sleep-onset difficulty, increased awakenings) Nightmares Sleep terror	Long sleep latency, increased awakenings from REM and NREM sleep REM latency reported as increased or decreased REM sleep reported as increased or decreased	Medication: antidepressants; benzodiazepines if no substance abuse history Behavioral: desensitization, rehearsal, relaxation
Note. REM = rapid eye movement; NREM = non-rapid eye movement.