21.01.2014
Clinicians have long recognized and have been taught in clinical training that sleep and mood are closely related. Research has also demonstrated that changes in sleep architecture are predictive in the diagnosis of depression, of probable response to treatment, and of risk of relapse in the future.
It is reasonable to question whether the presence of insomnia prior to the onset of depression increases the likelihood that depression will develop.
Dryman and Eaton13 used data from the Epidemiologic Catchment Area Program to examine relationships between insomnia symptoms and the onset of major depression. Sleep apnea patients frequently present with complaints of fatigue which they may attribute to insomnia.
These patients, with complaints of several awakenings during the night and of nonrestorative sleep or fatigue, should be evaluated with polysomnography (laboratory sleep studies). OSA is associated with an increased risk of cognitive abnormalities and of affective disorders such as depression.20 Cognitive impairment associated with apnea may be misdiagnosed as dementia, with capacity for substantial improvement in cognition associated with effective treatment. Nasal continuous positive airway pressure (CPAP) administered via a nasal mask or interface is the treatment of choice for moderate to severe obstructive sleep apnea. Outcomes included sleep items, HRQOL, chronic medical comorbidity, depression, and anxiety. It is reasonable to assume that insomniacs, who report sleeping less at night, should feel sleepy in the daytime on the basis of sleep deprivation. Dew and colleagues29 reviewed polysomnographic data collected from 184 community-dwelling individuals between 55 and 80 years of age who had participated in polysomnographic sleep research studies at the University of Pittsburgh. Erman is clinical professor in the Department of Psychiatry at the University of California, San Diego School of Medicine, is a staff scientist for the Scripps Research Institute Department of Neuropharmacology, and is the president of Pacific Sleep Medicine Services. When conditions such as depression, chronic pain, and even sleep apnea are present, they must be recognized and addressed as a component of the overall treatment plan. When sleep is disrupted in association with conditions such as nocturnal pain, restless legs, or depression, the comorbid disorder must be treated to maximize the probability of a successful treatment response. Individuals with healthy, normal sleep should be free of symptomatic complaints about their sleep (ie, insomnia complaints), and should be able to remain alert throughout the daytime, avoiding unwanted naps or bouts of sleep suggestive of a hypersomnia (excessive sleepiness) disorder.
The DSM-IV1 includes symptoms of disturbed sleep as one of the primary diagnostic criteria for major depression and for mania.
Overall, the results indicated a strong positive association between initial insomnia symptoms and the development of depressive symptoms over the following year.
Data gathered on sleep habits during medical school assessed the risk for subsequent clinical depression.


Obstructive sleep apnea (OSA) is the most common form of sleep apnea and is a state-dependant disorder of breathing.
These patients will typically report no problems with sleep initiation, but will report awakening several times over the course of the night. Although portable monitoring devices to evaluate suspected OSA are available, these devices as effective diagnostic instruments provide limited data of uncertain validity and reliability.18 Since they provide no formal EEG data, sleep cannot be differentiated from wake, and REM sleep from non-REM sleep. Similarly, untreated apnea may exacerbate depression severity or limit response to therapy, with substantial improvement in mood seen after treatment is initiated.21 OSA is associated with a wide variety of health-related consequences, quality of life is demonstrably impaired in patients with OSA, including complaints of fatigue, memory impairment, reduced concentration, depressed mood, and irritability. Katz and McHormey22 examined the association between insomnia and Health-Related Quality of Life (HRQOL) in patients with chronic illness, attempting to exclude effects of depression, anxiety, and medical comorbidities.There were 3,445 patients recruited from practitioners of family medicine, internal medicine, endocrinology, cardiology, and psychiatry.
Indeed, formal sleep deprivation (sleep restriction) is used in several behavioral therapies utilized to treat insomnia.
These conditions are associated with documented changes in sleep architecture, as well as subjective complaints of disturbed, poor quality sleep. For all patients, consideration of sleep habits and education about sleep hygiene should be incorporated into treatment regimens, whether or not hypnotic medication is used as well. Normal sleep occurring at inappropriate or undesirable hours may be a component of sleep disorders such as delayed sleep phase syndrome and advanced sleep phase syndrome. A large portion of research performed over the past 40 years has validated this relationship, and has also demonstrated that specific abnormalities of sleep are seen in association with depressive disorders. Thase and colleagues11 have shown that severely depressed patients with more disturbed polysomnographic sleep profiles were less likely to benefit from cognitive-behavioral therapy. Perlis and colleagues14 have also shown that new episodes of major depression are often preceded by periods of insomnia. The relative risk for new onset of major depression during the 3.5 year follow-up period in those with insomnia at baseline was 4. OSA occurs because of obstruction in the upper airway, developing due to the reduced muscle tone during sleep and the negative upper airway pressure associated with inspiratory effort. Other medical treatment options include efforts at weight loss, avoidance of alcohol, avoiding all sedating medications at night (unless CPAP is used), and avoiding the supine position in sleep.
However, when daytime testing is performed on insomnia patients, excessive daytime sleepiness, is typically not seen.24,25 This absence of daytime sleepiness, despite reduced amounts of sleep at night, is presumed to be a consequence of increased levels of physiologic, cognitive, and cortical arousal experienced by insomniacs. Affect intensity and phasic REM sleep in depressed men before and after treatment with cognitive-behavioral therapy .J Consult Clin Psychol. Abnormal electroencephalographic sleep profiles in major depression: association with response to cognitive behavior therapy.


Affective symptoms associated with the onset of major depression in the community: findings from the US National Institute of Mental Health Epidemiologic Catchment Area Program.
Clinical features and evaluation of obstructive sleep apnea-hypopneas syndrome and upper airway resistance syndrome. Evaluation of the accuracy of SNAP technology sleep sonography in detecting obstructive sleep apnea in adults compared to standard polysomnography. Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults. Healthy older adults’ sleep predicts all-cause mortality at 4 to 19 years of follow-up.
There were 7,954 respondents questioned at baseline and again 1 year later about sleep complaints and psychiatric symptoms.
Apnea is usually worse in REM sleep, due to reductions in muscle tone and activity associated with the REM state and changes in breathing dynamics associated with REM. Since these studies usually are performed without a sleep technician present, no observations can be made about body position, movement, or the sleep environment.
Although such agents do not alter the frequency of leg movement activity and may lead to residual sedation, patients may experience a sense of relief, presumably on the basis of sleep consolidation. Patients with insomnia demonstrated significant reductions in HRQOL; insomnia was independently associated with worsened HRQOL to almost the same extent as chronic conditions such as congestive heart failure and clinical depression. Far higher rates of psychiatric disorder were seen in those with insomnia (40%) compared with of those with no sleep complaints (16.4%). The most common clinical signs of OSA are loud snoring, interrupted or absent breathing in sleep, breathing pauses observed by a bed-partner or family member, and excessive daytime sleepiness.
Although this could be interpreted as a sign of the concurrent comorbidity of these disorders, this hypothesis was refuted by data reflecting the presence of depression at the 1-year follow-up interview. Some patients report awareness of awakening from sleep with a sensation of choking, at times associated with dreams of drowning or suffocating. Those who had insomnia at both interviews had almost 40 times the risk of developing new major depression compared with subjects who never reported insomnia (odds ratio=39.8). For subjects whose initial insomnia had resolved by the time of the second interview, there was only a slight increased risk of depression compared to those who had never experienced insomnia (OR=1.6).



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Comments Sleep abnormalities depression

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  2. karizmati4ka1
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