Just got this mass email. The ad next to it is for zolpidem – just the kind of stuff that might NOT benefit post-traumatic states. What’s the message here?
OCTOBER 2012
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Editor’s note
Approximately 50% of chronic insomnia patients have a comorbid psychiatric disorder.1 Historically, the focus has been on depression, but in this issue we focus on insomnia’s relationship with other psychiatric disorders and symptoms.
Although posttraumatic stress disorder (PTSD) has been associated with insomnia, Krakow et al suggest the mediator of the insomnia-PTSD link is time monitoring (“clock-watching”). Nadorff et al describe a relationship between insomnia and suicidal ideation in older adults and that the mediator of this association is depressive symptoms.
Most insomnia patients don’t abuse hypnotics,2 but Ruiter et al document a 3-way relationship among personality disorders, insomnia, and hypnotic dependence. Finally, Haario et al found unhealthy behaviors—smoking, binge drinking, and inactivity—are a consequence of as well as risk factor for insomnia.
Together, these studies support the clinical wisdom of treating both conditions when patients present with insomnia and a comorbid disorder.—Thomas Roth, PhD, Director of Research and Chief of Sleep Medicine, Henry Ford Hospital, Detroit, MI
References
1. Insomnia: assessment and management in primary care. Washington, DC: National Institutes of Health; 1998.
2. Mendelson WB, Roth T, Cassella J, et al. The treatment of chronic insomnia: drug indications, chronic use and abuse liability. Summary of a 2001 New Clinical Drug Evaluation Unit meeting symposium. Sleep Med Rev. 2004;8(1):7-17.
“Clock-watching” and insomnia are linked
to posttraumatic stress symptoms
Krakow B, et al. J Nerv Ment Dis. 2012;200(9):821-825.
Researchers reviewed the medical charts of 1,078 patients who had poor sleep quality (51%), sleep-disordered breathing (26%), or insomnia (24%). Almost one-third reported moderate to severe posttraumatic stress symptoms (PSSs). Insomnia and time monitoring (“clock-watching”) severity were greater in patients with PSSs (n = 350) than in patients with minimal or no PSSs.
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In older adults, insomnia is related
to suicidal ideation
Nadorff MR, et al. J Gerontol B Psychol Sci Soc Sci. Epub August 28, 2012.
Researchers surveyed 81 patients age ≥65 about their sleep habits, depressive symptoms, and suicidal ideation. Insomnia symptoms were related to suicidal ideation independent of nightmares, and depression mediated the relationship between insomnia symptoms and suicidal ideation.
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