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Insomnia in Psychiatric Disorders 139 The older sedative hypnotics like barbiturates are less frequently used due to the higher risk of dependence and the more severe withdrawal symptoms like withdrawal seizures. The benzodiazepines polysomnographic changes include increased TST, decreased WASO, decreased REM sleep, and increased sleep spindles in stage 2. Most benzodiazepines decrease the SL and decrease delta sleep (22). The sedative hypnotics abuse occurs predominantly in the context of polysubstance abuse (16). Benzodiazepines with rapid onset of action (e.g., Alprazolam and Diazepam) are more likely to be abused than the longer onset of action type of benzodiazepine (Oxazepam or Chlordiazepoxide). Withdrawal from sedative hypnotics can result in a rebound insomnia or emergence of insomnia as a new symptom (in prolonged high-dose use). Anxiety is a common withdrawal symptom, which independently can initiate or worsen insomnia. In evaluating the risks vs benefits of the sedative hypnotic therapy in patients including those who have insomnia, it is helpful to distinguish between “drug-seeking behavior” from “therapy-seeking behavior” (16). REFERENCES 1. Harvey, A. G. (2001) Insomnia: symptom or diagnosis? Clin. Psychol. Rev. 21(7), 1037–1059. 2. Ohayon, M. M., Caulet, M., and Lemoine, P. (1998) Comorbidity of mental and insomnia disorders in the general population. Compr. Psychiatry 39 (4), 185–197. 3. Bonnet, M. H. and Arand, D. L. (1999) Diagnosis and treatment of insomnia. Respir. Care Clin. North Am. 5(3), 333–348. 4. American Psychiatric Association. (1994) Diagnostic and statistical manual of mental disorders (4th ed.). American Psychiatric Association, Washington, DC. 5. American Sleep Disorders Association, Diagnostic Classification Steering Committee. (1997) The international classification of sleep disorders, revised: diagnostic and coding manual. American Sleep Disorders Association, Rochester, MN. 6. Benca, R. M. (2001) Consequences of insomnia and its therapies. J. Clin. Psychiatry 62(10), 33–38. 7. Hales, S. C., Yudofsky, R. E., and Talbott, J. A., eds (1999) The American Psychiatric Press Textbook of Psychiatry (3rd ed.). American Psychiatric Press, Inc., Washington, DC. 8. McCall, W.V. (2001) A psychiatric perspective on insomnia. J. Clin. Psychiatry 62(10), 27–32. 9. Naylan, T. C., Metzler, T. J., Schoenfeld, F. B., et al. (2001) Fluvoxamine and sleep disturbances in posttraumatic stress disorders. J. Traum. Stress 14(3), 461–467. 10. Sadock, B. J. and Sadock V. A. eds. (1999) Kaplan and Sadock’s comprehensive textbook of psychiatry (7th ed.). Lippincott Williams & Wilkins, Philadelphia, PA, pp. 1380–1384, pp. 1490–1503. 11. Simon, G. E., Heiligenstein, J. H., Grothaus, L., Katon, W., and Revicki, D. (1998) Should anxiety and insomnia influence antidepressant selection: a randomized comparison of fluoxetine and imipramine. J. Clin. Psychiatry 59(2), 49–55. 12. Kupfer, D. G. (1999) Pathophysiology and management of insomnia during depression. Ann. Clin. Psychiatry 11(4), 267–276. 13. Bourdet, C. and Goldenberg, F. (1994) Insomnia and anxiety: Sleep EEG changes. J. Psychosom. Res. 38(Suppl 1), 93–104. 14. Soldatos, C. R. (1994) Insomnia in relation to depression and anxiety: epidemiologic considerations. J. Psychosom. Res. 38(Suppl 1) 3–8. 15. Martinez-Gonzalez, D., Obermeyer, W. H., and Benca, R. M. (2002) Comorbidity of insomnia with medical and psychiatric disorders. Prim. Psychiatry 9(8), 37–49. 16. Kryger, M. H., Roth, T., and Dement, W. C., eds. (2000) Principles and practice of sleep medicine (3rd ed.), WB Saunders, Philadelphia, PA, pp. 642, 1128, 1134–1135.
140 Karaz 17. Attarian, H. P. (2000) Helping patients who say they cannot sleep. Postgrad. Med. 107(3), 127–142. 18. Lepola, U., Koponen, H., and Leinonen, E. (1994) Sleep in panic disorders. J. Psychosom. Res. 38(1), 105–111. 19. Warner, M. D., Dorn, M. R., and Peabody, C. A. (2001) Survey on the usefulness of Trazodone in patients with PTSD with insomnia or nightmares. Pharmacopsychiatry 34 (4), 128–131. 20. Krakow, B., Johnston, L., Melendrez, D., et al. (2001) An open trial of evidence-based cognitive behavior therapy for nightmares and insomnia in crime victims with PTSD. Am. J. Psychiatry 158(12), 2043–2047. 21. Brown, R. L., Brown, R. L., Saunders, L. A., Castelaz, C. A., and Papasouliotis, O. (1997) Physicians Decision to Prescribe Benzodiazepines for Nervousness and Insomnia. J. Gen. Intern. Med. 12, 44–52. 22. Chokroverty, S. ed. (1999) Sleep disorders medicine (2nd ed.). Butterworth-Heinemann Medical, St Louis, 342–343.
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Clinical Handbook of Insomnia Edite
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C URRENT CLINICAL NEUROLOGY Daniel
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© 2004 Humana Press Inc. 999 River
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Series Editor’s Introduction The
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x Foreword nervous system hypersomn
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Contents Series Editor’s Introduc
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Contributors HRAYR P. ATTARIAN, MD
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2 Attarian et al.
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4 Attarian et al. until the 1970s t
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6 Attarian et al. Table 2 Diagnosti
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8 Attarian et al. Duration of Illne
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10 Attarian et al. REFERENCES 1. Ma
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12 Attarian Another study in Austri
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14 Attarian even less well studied.
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16 Attarian communities. A structur
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18 Attarian 5. Sutton, D. A., Moldo
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20 Attarian 53. Kageyama, T., Kabut
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22 Attarian
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24 Bonnet and Arand Table 1 Reporte
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26 Bonnet and Arand On the day spen
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28 Bonnet and Arand SUMMARY These m
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30 Bonnet and Arand chronic caffein
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32 Bonnet and Arand response that a
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34 Bonnet and Arand The Development
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36 Bonnet and Arand ACKNOWLEDGMENT
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38 Bonnet and Arand 45. Bonnet, M.
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40 Attarian Table 1 Types of Insomn
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42 Attarian 15 to 40 seconds. PLMs
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44 Fig. 1. Example of a 1-week slee
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46 Fig. 3. One-week printout of an
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48 Attarian Fig. 4. Algorithm. (Use
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50 Attarian 27. Polo-Kantola, P., E
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52 Garcia
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54 Garcia association is known as s
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56 Fig. 1. A sleep log used in chil
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58 Garcia the reality that the tend
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60 Fig. 2. Actigraph recording in a
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62 Garcia neurodevelopmental disabi
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64 Garcia 35. Czeisler, C., kronaue
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66 Garcia
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68 Attarian showed similar degrees
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70 Attarian agitation and hence the
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72 Attarian Affective disorder is s
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74 Attarian and Drug Administration
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76 Fig. 2. Sleep log after treatmen
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78 Attarian 18. Bonnet, M. H. and A
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80 Attarian 65. Perlis, M., Aloia,
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82 Attarian was confirmed by resear
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84 Attarian times worrying about th
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86 Attarian insomnia or for other s
Page 105 and 106: 88 Attarian
Page 107 and 108: 90 Duntley tion systems found that
Page 109 and 110: 92 Duntley Case 1 A 36-year-old fem
Page 111 and 112: 94 Fig. 2. The objective amount of
Page 113 and 114: 96 Duntley PROGNOSIS AND COMPLICATI
Page 115 and 116: 98 Duntley
Page 117 and 118: 100 Attarian EPIDEMIOLOGY There are
Page 119 and 120: 102 Attarian CLINICAL MANIFESTATION
Page 121 and 122: 104 Attarian DIAGNOSTIC WORKUP The
Page 123 and 124: 106 Attarian 13. Hauri, P. J. (1998
Page 125 and 126: 108 Plotkin
Page 127 and 128: 110 Plotkin quality of sleep. Ultim
Page 129 and 130: 112 Plotkin of the therapeutic effi
Page 131 and 132: 114 Plotkin months or years. The ef
Page 133 and 134: 116 Plotkin associated somatic disc
Page 135 and 136: 118 Plotkin Table 1 Causes of Secon
Page 137 and 138: 120 Plotkin Table 1 (continued) Lew
Page 139 and 140: 122 Plotkin REFERENCES 1. Foley, D.
Page 141 and 142: 124 Plotkin 48. Marchetti, F., Rome
Page 143 and 144: 126 Plotkin
Page 145 and 146: 128 Karaz Table 1 DSM-IV Diagnoses
Page 147 and 148: 130 Karaz poor. Focusing only on th
Page 149 and 150: 132 Karaz He felt hopeless that his
Page 151 and 152: 134 Karaz Table 4 Diagnostic Criter
Page 153 and 154: 136 Karaz complained of feeling anx
Page 155: 138 Karaz other physicians avoided
Page 159 and 160: 142 Duntley disorders has been conf
Page 161 and 162: 144 Duntley itance. A recent study
Page 163 and 164: 146 Duntley The patient’s primary
Page 165 and 166: 148 Duntley return to sleep. He tos
Page 167 and 168: 150 Duntley Treatment of RLS should
Page 169 and 170: 152 Duntley 34. Cartwright, R. (197
Page 171 and 172: 154 Perlis et al.
Page 173 and 174: 156 Perlis et al. Fig. 1. A schemat
Page 175 and 176: 158 Perlis et al. ditioned arousal
Page 177 and 178: 160 Perlis et al. subjected to empi
Page 179 and 180: 162 Perlis et al. effect), (3) may
Page 181 and 182: 164 Perlis et al. Cognitive Therapy
Page 183 and 184: 166 Perlis et al. Table 2 Cognitive
Page 185 and 186: 168 Perlis et al. Perhaps more impo
Page 187 and 188: 170 Perlis et al. 28. Carskadon, M.
Page 189 and 190: 172 Perlis et al.
Page 191 and 192: 174 Attarian Secondary Insomnias Re
Page 193 and 194: 176 Attarian 50 years of age who sl
Page 195 and 196: 178 Attarian Antidepressants Becaus
Page 197 and 198: 180 Attarian The use of benzodiazep
Page 199 and 200: 182 Attarian to placebo. Zaleplon a
Page 201 and 202: 184 Attarian 3. Wyatt, R. J., Engel
Page 203 and 204: 186 Attarian residual sedation foll
Page 205 and 206: 188 Index Clonidine, 183 CNS arousa
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190 Index Proton pump inhibitors, 1
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Current Clinical Neurology CLINICAL
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