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Sleep Disturbances in Our Patient Population
Fall 2002
Serious mental illnesses -- including major depression, bipolar disorder, schizophrenia, substance abuse, and dementia -- are nearly always associated with disturbances in sleep. As a result, providers of mental health services commonly include an assessment of the sleep cycle as an essential part of the evaluation of these disorders. The relationships are complex. For example, depression can be associated with either increased or decreased sleep. Insomnia can be an early sign of relapse in schizophrenia and excessive sleep can be associated with negative symptoms. The assessment is further complicated by medications which are used to treat these illnesses. Some antidepressants -- including fluoxetine -- can cause insomnia as a side effect whereas other agents can be sedating. This is also true for schizophrenia where agents such as clozapine can cause excessive sleeping at night and during the day. Poor sleep can lead to daytime drowsiness or irritability which -- in turn -- can interfere with attempts at returning patients to community life.
This issue of MindView focuses on sleep disturbances as an important target for assessing patients with serious mental illnesses and as a target for treatments. As noted in the article on Sleep and Schizophrenia, the routine evaluation of patients with schizophrenia should include the monitoring of sleep problems and the methods patients use to cope with these problems. In many cases, patients are unaware of the easy, but important steps that they can take to manage sleep disturbances. Caffeinated beverages -- particularly beverages taken late in the day -- can have serious effects on sleep as can excessive napping during the day. The article on Sleep and Insomnia provides advice that can be used by anyone -- including patients with serious mental illnesses -- to improve the quality of their sleep.
Understanding the disturbances in sleep that occur in mental illness may also provide a means for understanding the neurobiology of these disorders. MIRECC studies are focusing on the relations of sleep patterns to the course of serious mental disorders. Researchers within the MIRECC have examined the prevalence of more serious sleep disorders, such as sleep disordered breathing (where patients stop breathing for short time periods during sleep) or periodic limb movements in sleep (where patients kick their legs every 20-40 seconds throughout the night) to better understand some of the consequences in psychosis. They have also compared subjective reports of sleep complaints with objective recordings of sleep to better understand how to interpret complaints of sleep obtained in interviews. By recording sleep with special recording devices, these researchers are able to learn not only about sleep at night, but about napping behavior during the day and how these behaviors are effected by medications. In the future, the results of these types of studies will help in the development of improved treatment approaches for patients with schizophrenia.
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