Sleep therapeutics and neuropsychiatric illness (original) (raw)
Related papers
Behavioural and Cognitive Psychotherapy, 2001
This book provides a general overview of the prominent features of several common sleep disorders and offers some limited information regarding treatment. Concise definitions and detailed characteristics of four specific sleep disturbances are carefully evaluated but the section reviewing therapeutic interventions for these disorders is restricted by its fundamentally pharmacological approach. Chapter One contains a brief introduction to sleep and its disorders, reviewing prevalence and outlining general facts about sleep. I feel that this chapter would strongly benefit from a more in-depth discussion about sleep stages and circadian rhythms as these underlying factors are essential to understanding sleep patterns. Subsequent chapters discuss assessment and diagnosis of specific disorders including insomnia, restless legs syndrome, narcolepsy and obstructive sleep apnea. These chapters are comprehensive and detailed, and contain useful information about various symptoms, signs and features common to each disorder. Several case studies are included, which help to give the reader a clear picture of the clinical impact of these problems. An interesting chapter focusing on sleep disorders among children is also included. The remainder of the book is essentially a review of relevant pharmacological interventions, although a short chapter about light therapy has also been incorporated. The strengths of this book lie in its organized format and its provision of clear definitions and criteria for the assessment and diagnosis of a handful of particular sleep problems. In addition, the chapter on pharmacological treatments presents a long list of effective medications along with information about their respective contraindications and side-effects. This information is likely to be useful to any clinician treating patients with sleep disorders. The book, however, is limited by its restricted approach to treatment. It is disheartening that despite the abundance of research concerning behavioural and cognitive treatments for sleep disorders, this text still maintains such a strong pharmacological perspective. While the chapter on insomnia contains a brief review of two behavioural treatments (stimulus control and sleep hygiene), the effectiveness of some of these treatments has been criticized in the literature (Harvey, 2000). Furthermore, descriptions of cognitive therapies, recently found to provide an effective means of treating insomnia (Espie, 1991; Morin, 1993) are conspicuously missing. Finally, a less significant yet frustrating oversight was the omission of several references to research studies discussed in the text. Although providing a detailed clinical description of a few common sleep disorders, this book is limited by its pharmacological approach to treatment. Little information about established cognitive and behavioural treatments for these disorders is provided. Use of this text among clinicians in the mental health community is likely to be
Metabolism, 2006
Sleep is an active state that is critical for our physical, mental, and emotional well-being. Sleep is also important for optimal cognitive functioning, and sleep disruption results in functional impairment. Insomnia is the most common sleep disorder in psychiatry. At any given time, 50% of adults are affected with 1 or more sleep problems such as difficulty in falling or staying asleep, in staying awake, or in adhering to a consistent sleep/wake schedule. Narcolepsy affects as many individuals as does multiple sclerosis or Parkinson disease. Sleep problems are especially prevalent in schizophrenia, depression, and other mental illnesses, and every year, sleep disorders, sleep deprivation, and sleepiness add billions to the national health care bill in industrialized countries. Although psychiatrists often treat patients with insomnia secondary to depression, most patients discuss their insomnia with general care physicians, making it important to provide this group with clear guidelines for the diagnosis and management of insomnia. Once the specific medical, behavioral, or psychiatric causes of the sleep problem have been identified, appropriate treatment can be undertaken. Chronic insomnia has multiple causes arising from medical disorders, psychiatric disorders, primary sleep disorders, circadian rhythm disorders, social or therapeutic use of drugs, or maladaptive behaviors. The emerging concepts of sleep neurophysiology are consistent with the cholinergic-aminergic imbalance hypothesis of mood disorders, which proposes that depression is associated with an increased ratio of central cholinergic to aminergic neurotransmission. The characteristic sleep abnormalities of depression may reflect a relative predominance of cholinergic activity. Antidepressant medications presumably reduce rapid eye movement (REM) sleep either by their anticholinergic properties or by enhancing aminergic neurotransmission. Intense and prolonged dreams often accompany abrupt withdrawal from antidepressant drugs, a reflection of an REM rebound after drug-induced REM deprivation. The postulated link between sleep and psychiatric disorders has been reinforced by the findings of modern neurobiology.
Sleep is a complex neurological state, with its primary function of providing rest and restoring the body's energy levels. The importance of sleep could be seen from the fact that people spend about one-third of their lifespan in sleep. Normal human sleep is divided into non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, and the alteration between NREM and REM occurs about 4-5 times during a night of normal sleep. Human NREM sleep could be classified into four stages, namely, stage I, II, III and IV, representing successively deeper stages of sleep. Sleep is an active rhythmic neural process produced by several brain areas, of which the preoptic and other basal forebrain areas play a major role in the generation of NREM sleep. Interaction of the pedenculo-pontine and lateral dorsal tegmental areas with the dorsal raphae nucleus and locus coeruleus, is important for REM sleep generation. Suprachiasmatic nucleus of the hypothalamus and the pineal gland ensure that sleep and wakefulness follow a circadian periodicity of nearly 24 hours. Alterations in the quality, quantity and pattern of sleep result in sleep disorders. Persistent and repeated interruption of sleep affects the health of an individual. Undiagnosed and untreated wake/sleep complaints cause not only misery to the sufferer, but it also has socioeconomic consequences. Sleep disorders cover a wide spectrum of diseases. Though there are more than 100 identified sleep/wake disorders, most sleep complaints can be categorised into five, namely, hypersomnia, insomnia, circadian rhythm disorders, parasomnias, and sleep disorders associated with mental, neurological, and other medical disorders. Researches during the last 50 years, and the advances made in clinical sleep medicine, have lead to more effective treatments for the myriad human sleep disorders. It is not possible to assign a specific reason for many of the sleep disorders, but some aspects of sleep and wakefulness are genetically influenced. But, most commonly, sleepiness during waking hours, results from volitional or forced sleep deprivation during previous nights, due to social, economic and environmental reasons. So, public awareness about sleep disorders should be an essential part of any programme aimed at global management of sleep disorders.
Psychiatric Disorders and Sleep
Neurologic Clinics, 2012
Psychiatric disorders and sleep are related in important ways. In contrast to the longstanding view of this relationship which viewed sleep problems as symptoms of psychiatric disorders, there is growing experimental evidence that the relationship between psychiatric disorders and sleep is complex and includes bi-directional causation. In this article we provide the evidence that supports this point of view, reviewing the data on the sleep disturbances seen in patients with psychiatric disorders but also reviewing the data on the impact of sleep disturbances on psychiatric conditions. Although much has been learned about the psychiatric disorders-sleep relationship, additional research is needed to better understand these relationships. This work promises to improve our ability to understand both of these phenomena and to allow us to better treat the many patients with sleep disorders and with psychiatric disorders.
Dialogues in clinical neuroscience, 2005
Psychiatric disorders constitute 15.4% of the disease burden in established market economies. Many psychiatric disorders are associated with sleep disturbances, and the relationship is often bidirectional. This paper reviews the prevalence of various psychiatric disorders, their clinical presentation, and their association with sleep disorders. Among the psychiatric disorders reviewed are affective disorders, psychosis, anxiety disorders (including posttraumatic stress disorder), substance abuse disorders, eating disorders, and attention deficit/hyperactivity disorders. The spectrum of associated sleep disorders includes insomnia, hypersomnia, nocturnal panic, sleep paralysis, hypnagogic hallucinations, restless legs/periodic limb movements of sleep, obstructive sleep apnea, and parasomnias. The effects on sleep of various psychotropic medications utilized to treat the above psychiatric disorders are summarized.
Neuropathology of Sleep Disorders
Journal of Neuropathology and Experimental Neurology, 2011
Sleep disorders are important manifestations of neurodegenerative diseases and sometimes are clinically evident well before the onset of other neurological manifestations. This review addresses the neuroanatomical basis and the mechanisms of sleep regulation in humans in relation to the neuropathology of entities associated with sleep disturbances in selected diseases, including Alzheimer disease, progressive supranuclear palsy, Lewy body disorders, multiple-system atrophy, and fatal familial insomnia. This includes abnormalities of circadian rhythm, insomnia, narcolepsy, rapid eye movements sleep behavior disorders, and excessive daytime sleepiness.