Nonorganic Insomnia in Generalized Anxiety Disorder

Abstract

Objective and subjective sleep and awakening quality as well as daytime vigilance of insomniac patients with generalized anxiety disorder (GAD) were investigated, as compared with normal controls. Forty-four outpatients (25 females, 19 males), aged 24–65 (mean 43) years, diagnosed with non-organic insomnia (ICD-10: F 51.0), related to mild GAD (F 41.1), with a Hamilton anxiety (HAMA) score of 22 ± 6 and a Zung self-rating anxiety (SAS) score of 37 ± 6 were included. After 1 adaptation night, sleep induction, maintainance and architecture were measured objectively by polysomnography, subjective sleep and awakening quality were assessed by self-rating scales and visual analog scales, objective awakening quality was measured by a psychometric test battery, and diurnal tiredness was measured by a 3-min vigilance-controlled EEG (V-EEG) and a 4-min resting EEG mapping. In polysomnography patients demonstrated – as compared with normals – significantly increased wake time during the total sleep period and more early-morning awakening, decreased total sleep and sleep efficiency. Subjective sleep quality was deteriorated as well, as were well-being, drive, mood, and wakefulness in the morning. In noopsychic performance, GAD patients did rather well in attention, concentration, attention variability, and numerical memory, while fine-motor activity and reaction time were deteriorated. In psychophysiology, critical flicker frequency was decreased in the morning, while muscle strength, blood pressure and pulse rate showed no differences. EEG mapping during the late morning hours (10.00–12.00 h) demonstrated hypervigilance in the V-EEG, while in the resting recording an increased sleep pressure was detected. The latter was correlated significantly to the SAS score, but less so to the observer-rated Hamilton anxiety score. Our findings suggest that CNS hypervigilance and hyperarousal, as actual symptoms of GAD, lead to nocturnal insomnia, which in turn may cause – as a consequence of sleep pressure not slept off -diurnal tiredness.

Predicting Symptoms of Depression and Anxiety Using Smartphone and Wearable Data

“…One explanation for this may be the lack of motivation and fatigue exhibited by individuals suffering from depression. The additional finding that longer periods of wakefulness after falling asleep significantly predicted symptoms of anxiety may be explained by the hypervigilance or hyperarousal characteristic of anxiety disorders causing individuals to wake up more frequently during their sleep (70). Similar findings to these have been reported in previous studies using polysomnography in a laboratory setting (32), however this is the first study to use validated consumer wearable devices to provide sleep data in real-life settings.…”

Maternal stress induces adult reduced REM sleep and melatonin level

“…Despite the fact that melatonin levels are significantly higher during the dark phase, the underlying reason for selection of this time point was the fact that this model has been proposed to be a model of insomnia and human insomniacs have symptoms of difficulty in falling asleep and highest blood hormones of ACTH and cortisol during evening or early night (Drake et al , 2004; Saletu-Zyhlarz et al , 1997; Stepanski et al , 1988; Vgontzas et al , 2001), a period corresponding to rat’s early light period. Thus, a reduction of sleep in the light period could indicate a reduction in melatonin levels due to melatonin having a promoting effect on sleep (Bendz & Scates, 2010; Holmes & Sugden, 1982; Mendelson, 2002; Mendelson et al , 1980) or an increase of brain CRH or orexin A because CRH and orexin A are increased in this model (Feng et al, 2007).…”

Pregabalin for the treatment of generalised anxiety disorder

“…GAD is frequently associated with insomnia (typically, difficulties in sleep maintenance) and reductions in total sleep time and sleep efficiency, as well as a reduction in the amount of restorative, slow-wave sleep [58][59][60]. Treatment with benzodiazepines, whilst effective in improving total sleep time and sleep efficiency, result in significant further reduction in slow-wave sleep [61,62].…”