Insomnia Insomnia

Insomnia in Psychiatric Disorders 137
Table 5
Sleep Abnormalities in Psychiatric Disorders
Disorder Symptoms Objective findings
Major depression Insomnia, vivid dreams, ↓total sleep ↑sleep latency
nightmares, and fatigue ↓sleep efficiency ↑wake
time ↑REM
Seasonal affective disorder/
bipolar depression
Hypersomnia ↑total sleep time
Mania Insomnia ↓total sleep ↑sleep latency
↓sleep efficiency ↑wake
time ↑REM
Anxiety disorders Insomnia ↓ sleep continuity
Posttraumatic stress
disorder
Insomnia, flashback dreams Normal or ↑REM
Schizophrenia Insomnia, reversal of sleep ↓ sleep continuity, normal or
wake cycles ↓SWS, normal or ↓REM
sleep
Eating disorders Insomnia, sleep-related Normal or ↓ sleep continuity,
eating spells normal or ↓REM sleep
Alcoholism Insomnia ↓ sleep continuity, ↓SWS,
normal or ↓REM sleep,
normal or ↑REM %
Dementia Alzheimer’s Insomnia, reversal of sleep– ↓total sleep ↑sleep latency
type wake cycles ↑wake time, ↓SWS.
Adapted from ref. 15.
REM, rapid eye movement; SWS, slow-wave sleep
Insomnia and Substance Abuse
Alcoholism
Special attention needs to be given to alcoholism, as it is often associated with
anxiety disorders, depression, and insomnia. Acute alcohol use reduces the amount
of wakefulness for the first 3 to 4 hours of sleep. The amount of wakefulness increases
during the second half of the night and sometimes the number of dreams,
particularly anxiety dreams, increase.
Chronic, excessive alcohol use eventually results in fragmented and restless
sleep (5).
Sleep problems due to alcohol abuse could be confused with insomnia due to
psychiatric disorders or primary insomnia if the problem with alcoholism is overlooked
or not addressed.
It is advisable to avoid prescribing benzodiazepines if alcohol use is a problem.
Benzodiazepine-prescribing decisions vary widely among physicians. Although
some agreed with prescribing for patients with high probability of alcohol abuse,