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The relationship of insomnia to anxiety disorders is also influenced by comorbid major depression. The severity of insomnia is increased when an anxiety disorder is comorbid with a major depressive disorder (MDD).1 This is highly relevant because 58% of MDD patients have a lifetime anxiety disorder.2
Just a heads up, I had to reload every page of this 5 page article.
Summary
Anxiety disorders with comorbid insomnia are highly prevalent with potential negative consequences. Therefore, assess for insomnia with self-rating scales and careful clinical interviews. When appropriate, refer patients for polysomnography.
Insomnia should be treated aggressively with pharmacotherapy, nonpharmacotherapy (particularly CBT-I), or a combination. Some of the hypnotic treatments actually appear to facilitate successful therapy for the anxiety disorder.
Benzodiazepines and nonbenzodiazepines have a number of adverse effects and can lead to abuse and dependence. Patients with an anxiety disorder may be particularly vulnerable, especially those with a history of alcohol(Drug information on alcohol) and drug abuse. Treatment with benzodiazepine and nonbenzodiazepine hypnotics needs to be reassessed monthly. Alternatively, ramelteon, low-dose sinequan, and CBT-I should be considered because they have minimal adverse effects and no risk of abuse.
Successful treatment of insomnia is an important goal in patients with anxiety disorders. Both pharmacological and nonpharmacological interventions have response rates of approximately 60%
#1 - Fri Jan 6, 2012 8:48 AM ESTI have about the worst insomnia known to man (though I've had that as long as I can remember - well before my panic attacks and anxiety kicked into full gear), and I've found that good sleep hygiene is critical if you want to sleep without taking medication (which I still need on occasion if I've been up for days). Some things that help me:
- Avoid over-the-counter sleeping medications like Tylenol PM and the like. The diphenhydramine can have paradoxical effects on a lot of people (it does on me), and it can actually keep you awake. I get the urge to constantly move around when I take that - not something conducive to sleep.
- Darkness. If, like me, you live in one room and have lots of electronics, those little lights can be surprisingly bright at night and can keep you awake. I also need the tv on in order to sleep (I need the noise). To counteract this, I use a black fabric headband (you can find these at any drugstore for about four bucks) to keep over my eyes to keep the light out.
- If possible, take medications that don't make you sleepy early in the day. They may keep you awake at night, and if they take a long time to get through your system, the effects can last for hours.
- Take a hot shower right before bed. Showers make me really sleepy - I've never quite understood the, "I need a shower to wake up!" crowd.
- If you have a lot on your mind, meditation and yoga will help clear it out. If that's not your thing, write down everything that's on your mind in a journal before bed. I've found that no matter how angry or upset I may be, as soon as I write it down, I feel better and much calmer.
That's what I can think of off the top of my head. I'll post more if I think of them.
#2 - Fri Jan 6, 2012 11:19 AM ESTI agree with cried! Great points!
- Avoid over-the-counter sleeping medications like Tylenol PM and the like. The diphenhydramine can have paradoxical effects on a lot of people (it does on me), and it can actually keep you awake. I get the urge to constantly move around when I take that - not something conducive to sleep.
Now I know why I have to get up and back on the computer. I hate that feeling of wanting to jump out of my skin!
From one insomniac to another, hang in there. :-)
Caffeine --avoid like the plague a few hrs. before sleep (or trying to).
Maybe that, Darrah, or maybe just the normal first half night sleep.
Definitely avoid the caffeine!
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