Depression | Insomnia: present in the majority of patients with major depression Generalized sleep disturbance: | |
Increased time to sleep onset Increased nighttime awakenings Early morning awakenings | ||
Sleep architecture findings: | ||
Decreased slow-wave sleep Decreased rapid eye movement (REM) latency | ||
Medication effects: | ||
Selective serotonin reuptake inhibitors (SSRIs) may cause insomnia—increased REM latency, decreased REM duration, sleep fragmentation, increased awakenings, increased dreaming/nightmares/sexual dreams/obsessions (with fluoxetine) Trazodone—increased sleep onset, improved sleep quality, increased REM latency, decreased REM duration, increased slow-wave sleep Bupropion—decreased REM latency, increased REM sleep, decreased sleep continuity and slow-wave sleep, vivid dreams/nightmares | ||
Mania and hypomania | Increased time to sleep onset Reduced slow-wave sleep | |
Schizophrenia | Decreased sleep continuity Increased time to sleep onset Sleep fragmentation with multiple arousals Decreased slow-wave sleep | |
Anxiety | Decreased sleep continuity Increased time to sleep onset Increased sleep fragmentation No change in REM latency or percentage of REM sleep | |
Substance-related (alcohol) | Decreased REM sleep the first half of the night Rebound increase of REM sleep in the second half of the night with increased arousals | |
Primary sleep disorders | Primary insomnia Narcolepsy Obstructive sleep apnea Circadian rhythm, sleep disorder Periodic limb movement disorder | |
Brief, stereotypic, nonepileptiform movement of the limbs, which increases with age Can occur in association with folate deficiency, renal disease, anemia, and the use of antidepressants | ||
Nocturnal myoclonus | ||
Repetitive, brief leg jerks that are associated with transient awakenings leading to sleep fragmentation Associated with sleep apnea, narcolepsy, uremia, diabetes, and central nervous system disorders | ||
Restless leg syndrome | ||
Characterized by the irresistible urge to move the legs/crawling feelings at rest or while trying to fall asleep Associated with anemia, pregnancy, nocturnal myoclonus and with uremia | ||
Parasomnias (e.g., night terrors, sleepwalking) | ||
Psychiatric | Anxiety disorders Affective disorders Psychosis Substance or alcohol abuse Eating disorders Dementia Psychological stress Bedtime worrying Poor sleep hygiene/conditioning (associating the bed with wakefulness) | |
Medical | Pain from any source or cause (e.g., arthritis, back pain) Dyspnea from any cause (e.g., asthma, chronic obstructive pulmonary disease, congestive heart failure) Gastrointestinal disease (e.g., gastroesophageal reflux disease) Neurologic disease (Parkinson, Alzheimer) Nocturia (e.g., uncontrolled diabetes, benign prostatic hypertrophy) Menopause Drug or alcohol intoxication or withdrawal | |
Medication-induced | Serotonin reuptake inhibitors Monoamine oxidase inhibitors Buproprion Stimulants (e.g., Ritalin) Short-acting hypnotics Beta-blockers Bronchodilators Corticosteroids Theophylline Thyroid hormones Caffeine Nicotine | |
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
