Insomnia may also be associated with increased risk of suicidal ideation, inflammation, heart disease, breathing problems, hypertension, and chronic pain.
Sleep difficulties can both cause and result from psychiatric disorders, and clinicians must be sure to treat the conditions simultaneously, Psych Congress co-chair Charles L. Raison, MD, said at the Psych Congress Regionals meetings.
Insomnia is underrecognized because people often believe its symptoms are normal, and many suffer through it without seeking treatment, said Dr. Raison, the Mary Sue and Mike Shannon Chair for Healthy Minds, Children & Families and Professor of Human Development and Family Studies and Psychiatry at the University of Wisconsin-Madison.
Untreated insomnia can have a detrimental impact on quality of life, inducing such conditions as fatigue, difficulty paying attention, bad mood, memory and visual disorders, and aggressiveness.
“Sleep is the king of both psychological well-being and psychological dismay. It is at the back of so many things,” Dr. Raison told the audience of about 150 mental health clinicians.
Anxiety disorders are the most common comorbid psychiatric condition with insomnia, followed by mood disorders and substance abuse disorders. In general, Dr. Raison said, insomnia precedes or is concurrent with the onset of depression, whereas anxiety more commonly precedes insomnia.
Dr. Raison explained there is a yin and yang in the body between systems which promote sleep and systems which promote wakefulness. In most people, insomnia results from hyperactivity in the wakefulness systems and the inability to appropriately modulate when and how to turn them off, he said.
Behavioral interventions should be at the core of treating insomnia, Dr. Raison said.
They can include stimulus control, sleep restriction, and adjunctive sleep hygiene education. Cognitive behavioral therapy can also have robust effects on sleep quality, though Dr. Raison said the improvements can fade and periodic reinforcement may be needed.
