Original articleSleep disturbances in patients treated for panic disorder
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.
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