Sleep and Anxiety Disorders

      Sleep disturbances frequently are associated with and can comprise core features of anxiety disorders. Two anxiety disorders feature sleep disturbances among their diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) [

      American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edition. Washington, DC: American Psychiatric Press; 1994.

      ]. Posttraumatic stress disorder (PTSD) criteria include nightmares with trauma-related content and difficulty initiating and maintaining sleep, which is a common definition of insomnia. Insomnia also is a symptom criterion for generalized anxiety disorder (GAD). Panic disorder, with and without agoraphobia, also is associated with complaints of difficulty initiating and maintaining sleep in many studies. There also is interest in the phenomenon of panic attacks that arise from sleep, which are not an uncommon occurrence with panic disorder. Sleep disturbances can occur with, but seem to be less salient features of, obsessive-compulsive disorder (OCD) and specific and social phobic disorders. In addition to comprising prominent features, insomnia, as with depression, is a risk factor for the subsequent onset of anxiety disorders There is overlap between interventions that target insomnia and other sleep disturbances and those that are used in treating anxiety disorders. Overlapping approaches include medications and cognitive behavioral strategies that target worry, tension, and maladaptive cognitions. Optimal sequencing or integration of treatments targeting anxiety and sleep disturbance is not well investigated, however.
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