Sleep disturbances are a common symptom of mental disorders. Somnologists associate sleep disturbances with mental disorders such as dementia, schizophrenia, depression, anxiety-phobic disorders, post-traumatic stress disorder, neuroses, and also as a side effect of pharmacotherapy. Each disorder has certain characteristics of sleep disturbance as a symptom or a consequence of the disease. Depending on the etiology of sleep disorders, individual therapy for patients is recommended.

Sleep disturbances in depression

Depressive conditions are often accompanied by sleep disturbances in more than 50% of cases. Polysomnographic findings in depression are very specific and can be both a symptom of depression and an indicator of the chronic course of a mental disorder.

Sleep disorders in depression include:

• decreased sleep duration;
• increased time to fall asleep, more than 30 minutes;
• lack of slow-wave sleep;
• increasing the duration of the first sleep period;
• increase in the number of rapid eye movements.

In addition to sleep disturbances, patients with depression are characterized by concomitant mental disorders, such as fear of nightfall and recurrent episodes of insomnia.

Why does insomnia occur with depression?

It sounds paradoxical, but depression is accompanied by excessive activation of the nervous system. In addition to changes in higher nervous activity and the appearance of anxiety and obsessive thoughts, an imbalance also occurs in endocrine regulation - the amount of stress hormones in the blood increases during depression. Developing changes lead to desynchronosis - a disruption of human circadian rhythms, which ensure the normal functioning of all organs and systems in a 24-hour mode.

Under such conditions, it is quite difficult, and sometimes even impossible, for the nervous system to move from a state of wakefulness to sleep. It becomes difficult for a person to fall asleep not only in the evening but also after night awakenings, which appear more and more often against the background of depression.

The source of sleep disturbance in neuroses is stress and psycho-emotional stress, hysterical character traits, and in the overwhelming majority, people with an evening chronotype suffer from this. Sleep disturbances in neuroses are often accompanied by daytime sleepiness, lack of a feeling of rest after sleep, and difficulty waking up in the morning.

Sleep disturbances with neuroses are observed in 95% of patients. Experts note that sleep problems arise at any stage of treatment for a mental disorder. The most common problem is falling asleep or sudden awakenings, which are accompanied by such disorders as excitement, anxiety, fear of insomnia, nightmares and fear of them and other obsessive states.

Treatment of sleep disorders in mental disorders

If the patient’s history contains complaints of sleep disturbances, this requires close attention from the doctor when drawing up a treatment plan for the patient. With pharmacotherapy, sleep disturbance becomes a serious problem, which persists even against the background of remission of mental disorders.

Psychotropic medications, such as Ativan (Lorazepam), can either improve sleep or disrupt it. New-generation drugs have fewer side effects. However, they all make changes to the architecture of sleep, increasing or shortening its duration and affecting the ratio of fast and slow sleep. This effect of drugs should be taken into account when treating mental disorders and sleep problems associated with them. During therapy, it is necessary, if possible, to monitor changes in sleep structure and make adjustments to treatment in accordance with the patient's response.

Treatment of sleep disorders in depression is varied and depends on the severity of the disorder. Primary therapy includes the prescription of antidepressants from the group of selective serotonin reuptake inhibitors. These drugs have minimal side effects and are safer than tricyclic antidepressants and monoamine oxidase inhibitors.

Treatment of sleep disorders in anxiety-phobic disorder involves stopping panic attacks during sleep and while awake after awakening. Therapeutic treatment includes the administration of tricyclic antidepressants and monoamine oxidase inhibitors. Ativan, as well as selective and dual serotonin reuptake inhibitors, have proven themselves in use.

Cognitive behavioral psychotherapy has been successfully used to treat sleep disturbances in this disorder. Most often, treatment is more effective when combining therapy methods.