Sleep and psychopathology

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Abstract

This article examines the relationship between sleep disturbance and psychopathology. Epidemiological, cross-sectional, and longitudinal data suggest a high rate of comorbidity between sleep disturbance and psychopathology, particularly between insomnia, anxiety, and depression. Between 50% and 80% of psychiatric patients complain of sleep disturbances during the acute phase of their illness. Conversely, among treatment-seeking individuals with a primary complaint of insomnia and randomly selected community samples, approximately one third display a concurrent psychopathology, one third exhibit psychological symptoms that do not necessarily exceed the threshold for a psychiatric disorder, and another third present insomnia as a functionally autonomous disorder. There is a positive relationship between severity of sleep disturbances and concurrent psychopathology, but unequivocal evidence of a cause-and-effect relationship is still lacking. However, longitudinal data suggest that anxiety and stressful life events often precede acute sleep difficulties, whereas persistent insomnia may be a risk factor for subsequent development of depression. Implications for the prevention and treatment of coexisting sleep disturbance and psychopathology are discussed.

References (91)

  • SteinM.B. et al.

    Sleep in nondepressed patients with panic disorder: II. Polysomnographic assessment of sleep architecture and sleep continuity

    Journal of Affective Disorders

    (1993)
  • StepanskiE.J. et al.

    Characteristics of individuals who do or do not seek treatment for chronic insomnia

    Psychosomatics

    (1989)
  • ThaseM.E. et al.

    Cognitive behavior therapy of endogenous depression: An outpatient clinical replication series

    Behavior Therapy

    (1991)
  • Van MoffaertM.P.

    Sleep disorders and depression: The “Chicken and Egg” situation

    Journal of Psychosomatic Research

    (1994)
  • ZarconeV.P. et al.

    Increased REM eye movement density in self-rated depression

    Psychiatry Research

    (1983)
  • American Psychiatric Association
  • American Sleep Disorders Association (ASDA)
  • AskenasyJ.J.M. et al.

    The impact of missile warfare on self-reported sleep quality

    Sleep

    (1996)
  • BencaR.M. et al.

    Sleep and psychiatric disorders: A meta-analysis

    Archives of General Psychiatry

    (1992)
  • BensonK.L. et al.

    Rapid-eye-movement sleep in schizophrenia and depression

    Archives of General Psychiatry

    (1993)
  • BerlinR.M. et al.

    Sleep disorders on a psychiatric consultation service

    American Journal of Psychiatry

    (1984)
  • BeutlerL.E. et al.

    Differentiating psychological characteristics of patients with sleep apnea and narcolepsy

    Sleep

    (1981)
  • BillardM. et al.

    Sleep and psychiatric disorders

    Journal of Psychosomatic Research

    (1994)
  • BliwiseD.L.

    Sleep in normal aging and dementia

    Sleep

    (1993)
  • BliwiseD.L.

    What is sundowning?

    Journal of the American Geriatric Society

    (1994)
  • BliwiseD.L. et al.

    Depression as a confounding variable in the estimation of habitual sleep time

    Journal of Clinical Psychology

    (1993)
  • BliwiseN.G. et al.

    Age and psychopathology in insomnia

    Clinical Gerontologist

    (1985)
  • BuysseD.J. et al.

    Electroencephalographic sleep in depressive pseudodementia

    Archives of General Psychiatry

    (1988)
  • BuysseD.J. et al.

    Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories: A report from the APA/NIMH DSM-IV field trial

    Sleep

    (1994)
  • CartwrightR.D.

    REM sleep characteristics during and after mood-disturbing events

    Archives of General Psychiatry

    (1983)
  • CartwrightR.D. et al.

    REM latency and the recovery from depression: Getting over divorce

    American Journal of Psychiatry

    (1991)
  • CartwrightR.D. et al.

    Broken dreams: A study of the effects of divorce and depression on dream content

    Psychiatry

    (1984)
  • ColemanR.M. et al.

    Sleep-wake disorders based on a polysomnographic diagnosis. A national cooperative study

    Journal of the American Medical Association

    (1982)
  • EdingerJ.D. et al.

    Cluster analysis of insomniacs' MMPI profiles: Relation of subtypes to sleep history and treatment outcome

    Psychosomatic Medicine

    (1988)
  • FerberR.

    Solve your child's sleep problems

    (1985)
  • FordD.E. et al.

    Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?

    Journal of the American Medical Association

    (1989)
  • FreedmanR.R. et al.

    Physiological and psychological factors in sleep-onset insomnia

    Journal of Abnormal Psychology

    (1982)
  • FunchD.P. et al.

    Factors associated with nocturnal bruxism and its treatment

    Journal of Behavioral Medicine

    (1980)
  • Gallup Organization

    Sleep in America

    (1991)
  • GilesD.E. et al.

    Reduced rapid eye movement latency: A predictor of recurrence in depression

    Neuropsychopharmacology

    (1987)
  • GillinJ.C. et al.

    Successful separation of depressed, normal, and insomniac subjects by EEG sleep data

    Archives of General Psychiatry

    (1979)
  • GoodenoughD.R. et al.

    The effects of stress films on dream affect and on respiration and eye-movement activity during rapid-eye-movement sleep

    Psychophysiology

    (1975)
  • HauriP.J. et al.

    Sleep of depressed patients in remission

    Archives of General Psychiatry

    (1974)
  • HauriP.J. et al.

    Persistent psychophysiologic (learned) insomnia

    Sleep

    (1986)
  • HauriP.J. et al.

    Sleep in patients with spontaneous panic attacks

    Sleep

    (1989)
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