COMMENTARY

The Evaluation and Management of the Anxious Insomniac

Karl Doghramji, MD

Disclosures

March 02, 2004

In This Article

The Clinical Presentations and Differential Diagnoses of Insomnia and Anxiety

Insomnia is the complaint of a difficulty in falling or staying asleep or unrefreshing sleep. Insomnia can represent a condition in and of itself, in which case it is referred to as primary insomnia. Most often, an acute emotional stressor, such as a job loss or hospitalization, triggers it and it remits shortly following the abatement of the stressor. However, in other cases, a short-term insomnia may escalate into a chronic problem, despite the resolution of the stressor, necessitating formal intervention. Insomnia can also be the symptom of other, underlying conditions, such as inadequate sleep hygiene, psychiatric and medical disorders such as major depression, circadian rhythm sleep disorders (eg, shift-work sleep disorder, jet lag, etc.), drug use and abuse (eg, stimulants and withdrawal from sedatives), and disorders of the sleep process itself, such as sleep apnea syndrome and periodic limb movement disorder/restless legs syndrome.[5]

Anxiety is a sense of worry (apprehensive expectation). In generalized anxiety disorder, anxiety is associated with various psychological and somatic symptoms, such as restlessness, fatigability, impaired concentration, irritability, muscle tension, and sleep disturbance. Other major anxiety disorders include panic disorder with or without agoraphobia, specific phobia, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder (PTSD), and acute stress disorder. Anxiety can also be due to a medical condition or substance, and can be a feature of other psychiatric disorders, such as major depression and schizophrenia.[6]

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