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I disturbi del sonno nelle patologie psichiatriche

I sleep disorders are often signs of other psychiatric disorders or organic that need further study. In this case they are defined as secondary sleep disorders.

Sleep and depression

According to the form it takes, depression may be associated with both an increased desire for sleep and excessive sleep (hypersomnia), and a decrease quality and quantity of sleep (insomnia). Insomnia affects approximately 90% of depressed subjects .

parameters:

• sleep latency becomes longer: the depressed take about an hour to fall asleep
• decreases the amount of slow-wave sleep ( restful and restorative sleep) about 1 / 3 compared with normal subjects.
• the depressed subjects tend to maintain sleep for a few hours and wake up very early in the morning. That 's what the most critical moment, in which patients feel more distressed: the peak of suicide in depressed subjects is around at 6 am.
• the person wakes up many times during the night.
• the Sleep efficacy, ie the amount of time spent asleep compared to the total time we spend in bed decreases by about 40%.
• the depressed person spends more time in REM sleep rather than sleep.

According to a study Riemann 2001, the relationship between depression and insomnia is not a one-way and insomnia is not just a typical symptom of depression but, conversely, can be an independent risk factor for its occurrence: sleep a little short, making it more depressed . Sleep seems so closely related to depression for some patients, total sleep deprivation (the person is prevented from sleeping for a few days), or a selective REM (the patient is awakened every time you enter into REM sleep) seem have antidepressant effects, although limited in time.

Sleep and bipolar disorder

The various forms of mania (excessive elevation of mood) are typical of bipolar disorder has a constantly reducing the time to sleep. These patients wake up refreshed after 2 or 3 hours of sleep and seem to have an actual reduction in their need for sleep during the course of the episode manic or hypomanic.

parameters:

• The sleep latency was increased
• the continuity of sleep is interrupted
• the total sleep time is significantly reduced.

is important to note that the spectrum of sleep disorders in manic patients are not related by lack of sleep, impaired functioning or subjective discomfort.

The reduction of sleep time is accompanied by motor hyperactivity,
incongruous behavior, irritability and aggressive manifestations both in the daytime than in nighttime.
Insomnia in mania often precedes the onset of specific symptoms and may persist even after the episode its resolution. In many cases it may be aggravated by the abuse of coffee or taking psychostimulants.
The reduction in the time of sleep is a nearly constant prodromal symptoms of manic episode and may occur before the onset of other signs of excitement. Consequently
has a special importance in view of a diagnosis, early treatment and prevention, especially in later episodes. It is known as the acceptance of each type of therapy when the manic episode has been blown
is very low given the lack of awareness of the disease. However, you can
that the patient accepts the treatment is specific for the incipient manic episode that symptomatic sleep disturbance in this prodromal phase is carried out if an early diagnosis.

Sleep and schizophrenia

Schizophrenic patients tend to sleep and abnormally low: about 50% it seems not even have restorative sleep (slow-wave sleep). In schizophrenia because the amount of dopamine (a neurotransmitter involved in the processes of supervision), increases considerably, as in people who slept little.

Parameters:

• increased sleep latency
• reduction of total sleep time
• latency reduction REM.

The data reported in literature are relatively weak, poorly correlated with the conditions and time course and was especially influenced by antipsychotic treatment, even if temporarily suspended.
Recent work has assessed polysomnographic abnormalities in a group of schizophrenic patients treated at their first episode ever. The data indicate a difficulty in initiating but not maintaining sleep in this group of patients.

At the clinical level, we can distinguish the two conditions in schizophrenia, which require different therapeutic approaches.

1. The first condition is represented by psychotic episodes characterized by delusions, hallucinations and cognitive and behavioral disorganization. These episodes, unique or recurrent activation are accompanied by behavioral and emotional experiences particularly intense. Fear-fear, anger, hostility, hyperactivity, mental and motor may be present in these episodes and influence on timing and methods of sleep. Sometimes, hallucinatory experiences particularly intense in the evening may be an additional factor of disturbance. During acute psychotic episodes, sleep latency was increased, sleep is discontinuous, its total time is reduced. The determining factor is the iperarousal emotional, sometimes aggravated by persecutory fear of possible violence that may be perpetuated in the unconsciousness of sleep.
2. The second condition is characterized by stages of schizophrenic illness where apathy, listlessness, adynamia, loss of ability to plan and alogia symptoms are dominant. In this condition, where the iperarousal is generally low or absent, a common sleep disturbance is the total or partial reversal of the sleep-wake rhythms (patients sleep during the day and lie awake at night). In this stage of the disease on the total sleep time is not reduced, rather it is often increased (up to 10-12 hours), also depending on the intake of antipsychotic drugs, but the time dell’addormentamento e quello del risveglio sono spostati di fase.

Giocano un ruolo importante nella schizofrenia anche fattori come un disturbato rapporto con l’ambiente, l’abuso di sostanze lecite (caffè,
nicotina) o, in alcuni casi, illecite (doppia diagnosi) e alterazioni proprie della psicopatologia schizofrenica.

Sonno e disturbi d’ansia

L’ansia può essere un sintomo o rappresentare un disturbo categoriale indipendente. Come sintomo is present in various degrees throughout the psychiatric disorders, such as disorder is classified in several syndromic entities that are part of the spectrum of anxiety disorders.

• In Generalised Anxiety Disorder (GAD) insomnia is an extremely common symptom. It is present in 80-90% of cases, is represented mainly by difficulties and delays in falling, but it can be presente anche come insonnia centrale e terminale. Quasi costantemente viene riferita una cattiva qualità del sonno. Per queste ragioni è nel GAD che si riscontra la maggiore incidenza di abuso o di uso improprio di ipnoinducenti, in genere benzodiazepinici.
• Nel Disturbo di Panico (DP) i disturbi del sonno sono un sintomo poco frequente, soprattutto quando il DP non si associa ad un quadro di ansia generalizzata. Il DP può essere associato a risvegli parossistici in cui sono These cognitive and emotional symptoms of panic attack, as well as tachycardia and tachypnea.
• In Post-Traumatic Stress Disorder (PTSD), sleep disorders are present with high frequency, difficulties in falling, early morning awakening, poor quality of sleep often associated with REM parasomnias (terrifying dreams).
  • in Obsessive Compulsive Disorder (OCD), recent work has shown an incidence of 58.2% of insomnia in a sample of patients with severe obsessive. Insomnia is prevalent initial (often due to continued execution of rituals).
  polysomnographic data in anxiety disorders, taken together, showed a reduction in the total time (TST) and sleep efficiency and increased sleep latency in accordance with the clinical findings. (Bench, 1992).

  When sleep disturbances are the consequence of another disease, their treatment is not related to sleep properly, but the care of the problem in question, which is reflected indirectly on the quantity and quality of sleep.

  
  
  Lucia Emperor
  courtesy of www.psicozoo.it