KIRA STEIN, MD, APC

ADULT PSYCHIATRY - BOARD CERTIFIED ABPN


Insomnia: A Sleeping Disorder Commonly Seen With Depression

Insomnia: A Sleeping Disorder Commonly Seen With Depression


6 October, 2011

If you suffer from insomnia, you are not alone.

What is insomnia? http://www.dreamstime.com/-image20468258

It is a sleeping disorder that affects about 30% of the general population.  While 25% of insomnia is not associated with a medical or psychiatric condition (primary insomnia), 75% of insomnia is secondary to other illnesses, most commonly major depressive disorder, anxiety, drugs or alcohol, and chronic pain.  Insomnia sleeping disorder can also be caused by medical conditions such as obstructive sleep apnea, restless legs, congestive heart failure and emphysema. Even medications can cause a sleeping disorder like insomnia.

In some instances, insomnia may be a minor sleeping disorder as a result of temporary external factors or an inconsistent sleep routine. For example, someone that goes to sleep and awakens at different times each day, exercises or watches television late into the evening, or is ingesting a lot of caffeine is more likely to trigger a sleeping disorder.  Sometimes sleeping disorder, or insomnia, is due to mild work or personal stress that is passing.  Basic lifestyle changes, called “Healthy Sleep Hygiene” may be all that is needed to reverse such sleeping disorder.  However, with more serious insomnia, more comprehensive support and treatments may be required, such as cognitive behavioral therapy for insomnia and/or sleep medications.

Untreated, persistent insomnia is a major risk factor for clinical depression, the occurrence of motor vehicle or work-related accidents, work absenteeism, and interpersonal and occupational dysfunction.

Populations at Risk for Insomnia-related Sleeping Disorder

Insomnia is more common in women, the elderly, people who are unemployed, widowed or divorced.  Lower socioeconomic status is also associated with insomnia.  Further, patients suffering from psychiatric illnesses are much more likely to experience insomnia.

Solutions to Insomnia-related Sleeping Disorder

If you suffer from disruptive or chronic form of insomnia, consider seeking a qualified physician, such as a primary care doctor, psychiatrist or a sleep specialist, who can distinguish between primary and secondary forms of insomnia and direct you towards the appropriate treatment.

PRIMARY INSOMNIA

Often, improving sleep hygiene and the sleep environment can treat primary insomnia.  This includes addressing this sleeping disorder as follows:

(1) Waking up and going to bed at the same time daily

(2) Exercising regularly during the first half of the day, not after 5:00PM

(3) Avoiding caffeine and cigarettes any time after 3:00pm

(4) Avoiding naps during the daytime

(5) Drinking alcohol in moderation; and avoiding alcohol for 4-5 hours prior to bedtime

(6) When having trouble falling asleep, do not lay awake and watch the clock.  Get out of the bedroom and do a quiet activity until you are tired (the bedroom needs to be associated with sleep, not anxiety).

(7) Keeping the bedroom cool, dark, and quiet.

(8) Avoiding eating, reading or watching TV in bed; bed should only be associated with sex and sleep;

Primary insomnia can also be effectively treated with cognitive behavioral therapy and biofeedback, and can also be addressed with hypnotic medications, such as Ambien or Ativan, or sedating antidepressants, such as trazodone, doxepin, or mirtazapine.

SECONDARY INSOMNIA AND HYPERSOMNIA SLEEPING DISORDER

If the insomnia is a symptom of another medical condition, it is important to seek medical care to fully identify and treat the illness causing the sleeping disorder.  The best place to start your insomnia work-up is with your general physician, who can get the appropriate laboratory tests and conduct a full medical history and physical to narrow down the possible causes of insomnia.  Sometimes medical conditions, such as cardiac illness, sleep apnea, and peri-menopausal hot flushes are suspected causes of insomnia. Alcohol or drug dependence may also be a factor contributing to insomnia; if so, your doctor will provide you with the appropriate recommendations.

Psychiatric Causes of Insomnia-related Sleeping Disorder

35% of patients suffering from insomnia have been found to also experience psychiatric problems, such as anxiety and depression.  Post-traumatic Disorder can cause recurrent nightmares and anxiety that trigger insomnia.  Generalized anxiety, panic disorders, and OCD are also associated with insomnia. Clinical depression is the most common psychiatric condition linked to insomnia, and patients suffering from insomnia secondary to depression are often referred for psychotherapy and/or psychiatric care.

Depression and Sleeping Disorder

People with pre-existing insomnia alone are more likely to experience a depressive episode over the ensuing year.  Alternatively, Insomnia is also a symptom of clinical depression; sleeping disorder occurs in about 40% to 60% of depressed patients.  Often simply treating the depression to remission causes the sleeping disorder of insomnia to completely resolve.  However, many depressed patients only partially respond to antidepressant medication, with insomnia as one of the residual symptoms of depression.  Research shows that lingering insomnia is a predictor of depressive relapse, and should be addressed as soon as possible to prevent worsening of symptoms.  Ironically, however, while antidepressant medications can treat insomnia both directly and indirectly, it is not uncommon for antidepressant drugs to actually cause insomnia, resulting in patients requiring an additional medication.

Sometimes the sleeping disorder associated with depression is hypersomnia, or excessive sleeping.  Paradoxically, hypersomnia is a sleeping disorder that can actually co-occur with insomnia.  For example, a depressed person may take hours to fall asleep (“early insomnia”) and once asleep, sleeps for more than 10 hours daily (hypersomnia).


To maximize your chances of effectively addressing insomnia, it is important to make sure your insomnia is diagnosed correctly as either a primary or a secondary condition; then, the appropriate treatment can be pursued for the sleeping disorder.

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