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SLEEP MEDICINE CLINICS Sleep Med Clin 3 (2008) xiii–xiv
Foreword
Teofilo Lee-Chiong, Jr., MD Section of Sleep Medicine National Jewish Medical and Research Center University of Colorado Health Sciences Center 1400 Jackson Street Room J232 Denver, CO 80206, USA
Teofilo Lee-Chiong, Jr., MD Consulting Editor
A bidirectional relationship exists between the sciences of psychiatry and sleep medicine. Indeed, symptoms of psychiatric disorders are modified by and, more importantly, can lead to sleep disruption. The association of insomnia and the risk of a new psychiatric disorder, specifically major depression, developing is well described. Furthermore, psychiatric disorders can give rise to complaints of insomnia (eg, bipolar disorder, depression, generalized anxiety disorder, obsessive–compulsive disorder, panic disorder, personality disorders, posttraumatic stress disorder, and schizophrenia) or excessive daytime sleepiness (eg, atypical depression and seasonal affective disorder). Certain parasomnias, such as nightmares and sleep terrors, may be more prevalent in patients with psychiatric illnesses. Finally, the medications used to manage psychiatric disorders, including many antidepressant and antipsychotic agents, can affect sleep quality, duration, and architecture. The clinical course of schizophrenia may be complicated by sleep disturbance, sleep-initiation and sleep-maintenance, insomnia, reversal of day– night sleep patterns, or alternating phases of sleeplessness and sleepiness. Since some antipsychotic
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agents can cause sedation, insomnia may also develop following discontinuation of these medications. During exacerbations of psychotic symptoms, prolonged periods of waking may be maintained and terminated only by exhaustion. Conversely, rebound sleepiness can occur during the waning phase of schizophrenia or during residual schizophrenia. Insomnia is common among persons suffering from mood disorders, and there is generally a correlation between the severity of both conditions. Sleep disturbances and changes in sleep architecture (ie, increase in sleep onset latency or reductions in sleep efficiency, N3 sleep, and REM sleep latency) may both precede or persist after remission of major depressive episodes. Insomnia can be especially severe during a manic episode. Excessive daytime sleepiness, along with an increase in the requirement for sleep, may be seen during the depressive phase of a bipolar disorder, seasonal affective disorder, or atypical depression. In seasonal affective disorder, major depressive episodes occur during the fall and winter, when patients may complain of daytime sleepiness, fatigue, and decreased energy levels; during spring and summer,
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doi:10.1016/j.jsmc.2008.04.012
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Foreword
some patients’ moods improve, but they may experience hypomanic symp