Psychiatric News June 17, 2005
Volume 40 Number 12
© 2005 American Psychiatric Association
p. 21
Insomnia Shows Strong Link To Psychiatric Disorders
Lynne Lamberg
Chronic sleep disorders affect an estimated 40 million Americans. They
cause or worsen health problems, reduce quality of life, and contribute to
premature death. They also exact a large economic toll.
Clinical treatment of sleep disorders has burgeoned in the past three
decades, fueled by the needs of a large patient population. Only five sleep
disorders centers existed in the United States in 1975; today, there are more
than 2,000.
But basic research in sleep medicine lags behind, asserted a committee
convened this spring by the Washington, D.C.–based Institute of Medicine
(IOM). The number of trained scientists falls far short of the demand, the IOM
said.
The IOM committee, whose full name is the Committee on Sleep Medicine and
Research, will assess the public health significance of sleep health, sleep
loss, and sleep disorders across the lifespan. It will hold fact-finding
workshops, some open to the public, over the next year. It then will develop a
plan to improve treatment and foster research, education, and training in this
multidisciplinary field. The IOM expects to publish its report in 2006.
Support for the $810,000 project comes from the American Academy of Sleep
Medicine, National Institutes of Health, National Sleep Foundation, and Sleep
Research Society.
Committee members include experts in sleep and public health, academic and
medical administration, and health sciences research. Harvey Colten, M.D.,
vice president and senior associate dean for translational research at
Columbia University College of Physicians and Surgeons, chairs the panel.
At the committee's first workshop in Washington, D.C., in April, Thomas
Roth, Ph.D., discussed psychiatric issues in insomnia, the most common sleep
disorder. Roth is director of research and chief of sleep medicine at Henry
Ford Health System in Detroit and a clinical professor of psychiatry at the
University of Michigan College of Medicine.
About 10 percent to 12 percent of adults across cultures have chronic
insomnia, Roth said; of this group, 40 percent have a psychiatric diagnosis.
Among the general population, 16 percent have a psychiatric diagnosis.
Insomnia is widely neglected in adolescents, Roth said. His research group
found that 32 percent of a large group of adolescents reported having
experienced insomnia, 14 percent of them in the preceding month. About 17
percent of adolescents met DSM-IV criteria for insomnia; 12 percent
had comorbid psychiatric disorders. A report on these findings is in press at
the journal Pediatrics.
People with any medical condition have a higher prevalence of chronic
insomnia than those who are well. About 1 in 4 shift and night workers reports
insomnia. Why some people develop insomnia while others with the same illness
or occupational risk do not remains unclear, Roth said. Insomnia affects about
25 percent of patients seen in primary care, 70 percent of geriatric patients,
and 90 percent of patients seen in psychiatric practices.
People with chronic insomnia use more medical and psychiatric services than
the general population; experience more social disability, role impairment,
and days of limited activity; and report poorer quality of life.
Some 82 percent of people with depression have insomnia. "This high
comorbidity is unique," Roth said. "The association suggests a
common pathophysiology." Every disorder with a high risk of insomnia, he
added, also carries a high risk of depression.
Eight published studies show that insomnia is a risk factor for psychiatric
disorders, he said. People with insomnia have a fivefold or higher risk of
developing depression over time. Whether insomnia is a risk factor for
depression or simply a prodromal symptom is not yet known.
A longitudinal study of 1,014 male medical students at Johns Hopkins
Medical School found that those who reported having insomnia as students had a
significantly higher likelihood of having depression 20 and 40 years after
their graduation.
Insomnia also is a possible predictor of mood disorder and relapse;
depression rarely precedes insomnia, Roth said. By contrast, in people with
generalized anxiety disorder, anxiety shows up before insomnia appears.
The fundamental response to sleep loss in healthy people is sleepiness,
Roth noted. In insomniacs, however, it is hyperarousal. Brain imaging, along
with elevations in cortisol and changes in circadian rhythms of cortisol
secretion, also show evidence of hyperarousal. The pathology in chronic
insomnia, he suggested, may be that people with the disorder become more
vigilant, even though they are sleeping less.
The IOM committee will hold its next public meeting July 29 and 30 in
Washington, D.C.
More information about the IOM sleep initiative is posted online at
<www.iom.edu/sleep>.
Related Article:
-
NIH Sleep Center Promotes Psychiatric Research
Psychiatr News 2005 40: 22.
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