The Overlap in Sleep Problems and Psychiatric Disorders

Key Takeaways

• Sleep disturbances exacerbate psychiatric symptoms and are common in psychiatric disorders, complicating treatment and increasing the risk of depression and suicidal behaviors.

• Insomnia is predictive of psychiatric disorders and can be effectively managed with cognitive behavioral therapy, improving psychiatric outcomes.

• Comorbid primary sleep disorders, such as obstructive sleep apnea and circadian rhythm disorders, overlap with psychiatric symptoms and require careful management.

• Sleep issues are often under-evaluated in psychiatric patients, necessitating improved identification and treatment strategies to enhance psychiatric care.

SPECIAL REPORT: SLEEP DISORDERS

Sleep and rhythm disturbances are prevalent in individuals with psychiatric disorders, and sleep complaints are part of the diagnostic criteria or related features in most disorders. Not only are sleep problems worsened by psychiatric illnesses, but sleep disturbances also exacerbate psychiatric symptomatology. This Special Report highlights these important interactions and the need to better identify and treat sleep disturbances and disorders in psychiatric patients.

Insomnia is frequently reported, and objective sleep recordings in groups of individuals with acute episodes of most major psychiatric illnesses tend to show reductions in total sleep amount and sleep efficiency, as well as increased latency to sleep onset. Not only does insomnia frequently occur in psychiatric disorders, but it is also predictive of new onset or exacerbation of psychiatric disorders, particularly depression. Both insomnia and reduced sleep time are also predictive of increased risk of suicidal behaviors. Treatment of insomnia with cognitive behavioral therapy for insomnia has been shown to reduce depressive symptoms or hasten the antidepressant response in individuals with depression.

Individuals with psychiatric disorders may also have sleep complaints related to comorbid primary sleep disorders. Obstructive sleep apnea (OSA), which is characterized by episodes of upper airway obstruction, commonly occurs in patients with psychiatric disorders. Furthermore, symptoms of OSA overlap with symptoms of many psychiatric disorders, including depressed mood, irritability, sleep disturbance, cognitive impairment, and lack of motivation.9 Psychiatric medications that lead to muscle relaxation, decreased upper airway muscle tone, or increase arousal threshold, can worsen OSA; these include benzodiazepines, nonbenzodiazepine hypnotics, and barbiturates. Circadian rhythm disorders—particularly delayed sleep-wake phase disorder, in which individuals fall asleep and wake up much later than desired—are also seen in individuals with psychiatric disorders, particularly bipolar disorder, and are associated with increased risk of developing bipolar disorder. Parasomnias, or abnormal behaviors arising from sleep, are also more frequent in individuals with psychiatric disorders. Restless legs syndrome (RLS), in which individuals feel an urge to move their legs in the evening or at rest, is also more commonly seen in individuals with psychiatric disorders in comparison with the general population, and both parasomnias and RLS may be triggered by some psychopharmacologic agents.

The articles in this Special Report review topics related to sleep in psychiatry that are relevant for the practicing clinician. “Beyond the Night: Unraveling the Psychiatric Impact of Sleep Disorders” points out the strong associations between various primary sleep disorders and psychiatric disorders. The importance of addressing insomnia in people with psychiatric disorders and an overview of its management are covered in “Promoting Insomnia Management in the Context of Psychiatric Symptoms” and “Cognitive Behavior Therapy for Insomnia and Hypnotic Deprescribing.”

Sleep problems are common in individuals with T, but unfortunately, patients are not routinely evaluated for sleep or rhythm disorders. Given the overlap in symptoms between the 2 groups of disorders, a treatment-resistant psychiatric disorder may be a treatment-responsive sleep disorder, and treating sleep problems often leads to improvement in psychiatric symptoms and quality of life.

Note: This article originally appeared on Psychiatric Times.