Elsevier

Journal of Affective Disorders

Volume 167, 1 October 2014, Pages 93-97
Journal of Affective Disorders

Brief report
Prevalence and clinical correlates of co-occurring insomnia and hypersomnia symptoms in depression

https://doi.org/10.1016/j.jad.2014.05.060Get rights and content

Abstract

Background

The aim was to examine the prevalence and consequences of co-occurring insomnia and hypersomnia symptoms in depressed adults drawn from a representative sample of the U.S. population.

Method

Data from 687 National Comorbidity Survey Replication (NCS-R) respondents meeting criteria for a major depressive episode (MDE) in the past year were included. Respondents completed clinical interviews that assessed 12-month DSM-IV disorders, impairment, mental health treatment, and depressive symptom severity. Outcomes were compared between respondents who experienced insomnia symptoms-only (N=404), hypersomnia symptoms-only (N=44), both insomnia and hypersomnia symptoms (N=184) and no sleep problems (N=55) during an MDE.

Results

Insomnia and hypersomnia symptoms co-occurred in 27.7% of respondents with past-year MDEs, most frequently in bipolar spectrum disorders and major depressive disorder with dysthymia. Similar to the insomnia-only group, respondents with co-occurring sleep disturbances had more severe depression, and higher rates of past-year impulse control disorders and suicide planning. Similar to the hypersomnia-only group, respondents with co-occurring sleep disturbances had higher rates of past-year drug use disorders and suicide attempts. Compared to the insomnia-only and no sleep problem groups, respondents with both sleep disturbances were more frequently in mental health treatment, seeing a general practitioner, and taking antidepressants.

Limitations

The NCS-R is cross-sectional and did not evaluate sleep disorder diagnoses.

Conclusions

Co-occurring insomnia and hypersomnia symptoms were associated with a more severe MDE. Further research is warranted to more fully understand the joint presentation of insomnia and hypersomnia in depression.

Introduction

Sleep disturbances are present in up to 90% of depressed patients, and can profoundly impact course of illness (Tsuno et al., 2005, Kaplan and Harvey, 2009). A broad spectrum of sleep disturbances occur in depression, including symptoms of insomnia (difficulty falling asleep, difficulty staying asleep, early morning awakening) and hypersomnia (Tsuno et al., 2005, Benca, 1996, Armitage, 2007). Research on insomnia and hypersomnia in depression has predominantly focused on these sleep problems as distinct entities (Sunderajan et al., 2010, Ford and Kamerow, 1989). However, growing evidence indicates that insomnia and hypersomnia can co-occur. Psychometric work on sleep complaints in psychiatric disorders found that insomnia and hypersomnia/lassitude factors exhibited a substantial positive correlation (Koffel and Watson, 2009). In general population studies, 6% of adults (Ohayon, 2012) and 8% of young adults (Breslau et al., 1996) experienced comorbid insomnia and hypersomnia. Furthermore, these sleep problems co-occurred in 10% of children with major depressive disorder (MDD; Liu et al., 2007) and 11% of older adults in a depressive episode (Roberts et al., 2000).

Initial studies suggest a detrimental impact of co-occurring insomnia and hypersomnia. Their joint presentation was associated with a longer history of depression, recurrent episodes and greater depression severity in children diagnosed with MDD (Liu et al., 2007), new depression onset in older adults (Roberts et al., 2000), and a greater number of lifetime psychiatric disorders in a general population sample (Breslau et al., 1996). Women were also more likely to experience both sleep disturbances (Breslau et al., 1996). However, definitions of insomnia and hypersomnia were not consistent across studies, and differences between mood disorders, functional impairment outcomes, and treatment utilization remain unexplored.

Drawing from National Comorbidity Survey-Replication (NCS-R) respondents, the overarching aim of the present investigation was to examine the prevalence and consequences of co-occurring insomnia and hypersomnia symptoms in depressed adults, using empirically-derived quantitative definitions for both hypersomnia (Kaplan et al., 2011) and insomnia symptoms (Lichstein et al., 2003). Our first aim was to examine the prevalence of four presentations of sleep disturbance (co-occurring insomnia and hypersomnia symptoms, insomnia symptoms-only, hypersomnia symptoms-only, and no sleep problems) during depressive episodes in NCS-R respondents meeting criteria for MDD, MDD with dysthymia, and bipolar spectrum disorders. The second aim was to evaluate whether co-occurring insomnia and hypersomnia symptoms were associated with specific sociodemographic characteristics, more severe clinical features and functional impairment, and mental health treatment utilization.

Section snippets

Sample

Participants were identified from the National Comorbidity Survey-Replication (NCS-R), a nationally representative community household survey of mental illness conducted in the United States between February 2001 and April 2003 (Kessler et al., 2004). Study procedures have been described elsewhere (Soehner and Harvey, 2012). The 2-part survey included 9282 respondents and had an overall response rate of 70.9% (Kessler et al., 2004). The analyses reported are based on NCS-R respondents meeting

Prevalence of sleep problems

Among respondents with an MDE in the past year (N=687), 7.2% had NSP, 59.1% had INS-only, 5.9% had HYP-only, and 27.7% had INS–HYP. Within the MDD-only group (N=455), 8% had NSP, 58.8% had INS-only, 7.5% had HYP-only, and 25.6% had INS–HYP. Similarly, in respondents with MDD and dysthymia (N=109), 6.5% had NSP, 57.4% had INS-only, 3.8% had HYP-only and 32.3% had INS–HYP. Finally, in bipolar spectrum disorders (N=123), 4.9% had NSP, 62.0% had INS-only, 2.0% had HYP-only, and 31.1% had INS–HYP.

Features associated with sleep problems

Discussion

The goal was to examine the prevalence of co-occurring insomnia and hypersomnia symptoms during depressive episodes, and to evaluate whether the presence of both sleep disturbances is associated with a more severe clinical profile (Breslau et al., 1996, Liu et al., 2007). Hypersomnia and insomnia symptoms co-occurred in over a quarter (27.7%) of respondents with depression. These sleep disturbances jointly presented more frequently in bipolar spectrum disorders (31.1%) and MDD with dysthymia

Role of funding source

This project was supported by National Institute of Mental Health NRSA Institutional Training Grant T32MH089919-01A1 awarded to Adriane Soehner and National Institute of Mental Health Grant R34MH080958 awarded to Allison G. Harvey. The NIMH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

All authors report no conflicts of interest.

Acknowledgments

This research was supported by the National Institute of Mental Health Grant R34 MH080958 awarded to Allison G. Harvey and National Institute of Mental Health Training Grant T32MH089919 awarded to Adriane M. Soehner.

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