The Evaluation and Management of the Anxious Insomniac

Karl Doghramji, MD


March 02, 2004

In This Article

Interrelationships Between Insomnia and Anxiety

Insomnia and anxiety disorders often coexist. As described above, the process of insomnia formation involves -- at least in the case of primary insomnia -- mental or physical activation and anxiety at bedtime or after falling asleep. It is not surprising, therefore, that 24% of community insomnia sufferers have a diagnosable anxiety disorder. Even in insomniacs who do not have a current psychiatric disorder, the persistence of insomnia confers an increased risk for the development of future anxiety disorders.[7] In turn, patients who have anxiety disorders have a high risk for disturbed sleep. The sleep of generalized anxiety patients is characterized by an increased time to fall asleep and increased awakenings and arousals after falling asleep, as well as a decrease in the percentage of time slept in deeper stages (3 and 4) of sleep.[8,9] Patients with PTSD frequently awaken with startle symptoms and physiologic arousal following trauma-related nightmares, typically during REM sleep.[10,11]


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