Elsevier

Sleep Medicine

Volume 6, Issue 2, March 2005, Pages 149-153
Sleep Medicine

Original article
Sleep disturbances in patients treated for panic disorder

https://doi.org/10.1016/j.sleep.2004.08.008Get rights and content

Abstract

Background and purpose

Disturbed night sleep is a common complaint of patients with panic disorder. The aim of the present study was to demonstrate whether the sleep disturbances can be successively influenced by the standard therapy for treating panic disorder.

Patients and methods

Psychiatric examinations of 20 outpatients with panic disorder were supplemented with a study of sleep quality using standardised interviews, sleep logs and polysomnographic recordings.

Results

A statistical comparison of data showed that reduced anxiety after successful treatment of panic disorder was not necessarily followed by improved sleep parameters.

Conclusion

The results suggest that the conventional therapy applied to these patients is not sufficient to treat the co-existing insomnia. Consequently, it seems to be of importance to supplement the treatment of panic disorders with specific treatment of the sleep disturbance.

Introduction

Panic disorder (PD) is characterised by panic attacks which are episodes of fear that are accompanied by a number of physiological symptoms (tachycardia, hyperventilation and sweating). Patients with panic disorder often also complain of insomnia [1]. Mellman and Uhde [2] suggest that 67% of PD patients report insomnia as a regular and pervasive problem. In the literature, there is disagreement among various authors regarding the severity of sleep disturbances in patients with panic disorder. Most of the reports are based on subjective statements of the patients and unfortunately, the results of polysomnographic studies in PD patients are inconsistent. Thus, Uhde [3] reports that these patients have remarkably normal sleep. Ferini-Strambi et al. [4] found no difference between controls and PD patients for sleep induction and maintenance parameters, but the percentage of non-REM sleep stage 1 was increased in PD patients when compared with controls. Further, polysomnographic studies demonstrated a decrease of sleep efficiency, total sleep time and amount of non-REM sleep stage 4 in PD patients versus healthy controls [5], [6], [7], [8].

The aim of the present study was to objectify the patients' complaints of disturbed sleep in panic disorder and to elucidate the extent to which therapy, directed to the panic disorder, can also improve the concurrent sleep disturbance.

Section snippets

Patients

The study was based on 20 successive outpatients (14 females and 6 males) aged 19–50 years (mean 32.9; SD 10.0) with panic disorder according to DSM IV. The mean duration of the disorder was 4.3 years (SD 3.6). Agoraphobia was diagnosed in 11 cases. In 16 of the cases, the panic disorder was accompanied by chronic insomnia, documented by the patients' statements before the treatment period. No patient reported nocturnal panic attacks. Patients with dementia, alcohol-related disorders, substance

Psychopathology: pre-treatment and post-treatment data

The scores obtained before and after the 8-week treatment period are displayed in Table 1. After the therapy, the scores significantly decreased in the Beck Depression Inventory, Beck Anxiety Inventory and Hamilton Anxiety Scale. The efficacy of the therapy was also demonstrated by the CGI score, which initially averaged 4.2 (SD 0.9) and decreased to 2.41 (SD 0.9) following the therapy.

Subjective sleep items: pre-treatment and post-treatment data

Table 2 shows the results from the sleep logs before and after the 8-week treatment period. The subjective

Discussion

In the study, possible sleep disturbances were examined before and after treatment of panic disorder. A statistical comparison of the pre- and post-treatment data indicated a significant improvement of the panic disorder after CBT and, in some cases, combined with SSRI and benzodiazepines. The aim of the study was not to investigate the effect of different therapeutical interventions, but the relationship between improvement of panic disorder and changes of sleep variables. Thus, the main

Acknowledgements

The study was supported by the Ministry of Health of Czech Republic, grant IGA NF-7586-3.

References (21)

There are more references available in the full text version of this article.

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