![]() ![]() What is already known about insomnia in patients with anxiety disorder? Anxiety disorders frequently coexist with insomnia. ![]() If at all possible, monitoring for up to 2 weeks is highly recommended because it allows for sleep abnormalities that might show marked day-to-day variability and would more likely be detected by extensive monitoring. 8,9 The log is filled out by the patient shortly after awakening in the morning (see Morin 9(p38) for an example of a sleep log). The use of a sleep log allows for an analysis of day-to-day sleep patterns, such as the time that the patient went to bed, sleep latency, and nighttime awakenings. 11īesides self-rating questionnaires that depend on memory of sleep disturbances, a sleep log or diary can confirm questionable sleep disturbances prospectively. The LSEQ consists of 10 self-rating questions that cover sleep and aberrant sleep behaviors. 10 Another widely used questionnaire is the Leeds Sleep Evaluation Questionnaire (LSEQ). The questions cover sleep quality, sleep problems, sleep medications, and so on, within the past month. The most widely used and validated questionnaire is the 19-question Pittsburg Sleep Quality Index. A number of well-validated sleep questionnaires have been widely used. Self-rating sleep questionnaires and direct clinical interviews are used to obtain a history of potential sleep disorders (eg, insomnia). 3,8,9 Thus, a carefully taken history is an important first step in the assessment of insomnia. Adding to the problem of detecting insomnia is the finding that doctors rarely inquire about insomnia in their patients. Patients rarely report their symptoms of insomnia spontaneously to their doctor. ![]() Insomnia is an underrecognized and undertreated problem. It is important to carefully assess for insomnia early in the evaluation of patients with anxiety disorders and to aggressively treat this complicating comorbidity. 4-6 In addition, insomnia as an early symptom in traumatized patients increases the risk of the development of PTSD 1 year later. For example, in patients with PTSD, insomnia is associated with an increased likelihood of suicidal behavior, depression, and substance abuse as well as nonresponsiveness to treatment. 3 Also, there is clear evidence that the presence of insomnia in anxiety disorders is associated with increased morbidity. The presence of insomnia has a deleterious effect on daytime functioning and negative effects on quality of life, including social and work relationships. 1 This is highly relevant because 58% of MDD patients have a lifetime anxiety disorder. The severity of insomnia is increased when an anxiety disorder is comorbid with a major depressive disorder (MDD). The relationship of insomnia to anxiety disorders is also influenced by comorbid major depression. For example, difficulty in falling or staying asleep is a criterion for PTSD, acute stress disorder, and generalized anxiety disorder (GAD). Just how specifically insomnia relates to and possibly affects anxiety disorders is highlighted by the fact that insomnia is one of the defining criteria in a number of the DSM-IV-TR anxiety disorders. The prevalence of comorbid insomnia in anxiety disorders is addressed and the clinical implications associated with insomnia are discussed as well as when and how to treat this important comorbidity. This review focuses on insomnia in the context of anxiety disorders. Insomnia is highly prevalent in psychiatric disorders, and it has significant implications. ![]()
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