sleepiness (hypersomnia), and parasomnia. Sleep disturbances are so commonly seen as symptoms of certain psychiatric disorders that they are listed as diagnostic criteria under DSM-IV (APA, 1994). For example, insomnia is a symptom used with others to diagnose major depression. The comorbidity, or coexistence, of a full-blown sleep disorder (particularly insomnia and hypersomnia) with a psychiatric disorder is also common. Forty percent of those diagnosed with insomnia, in a population-based study, also have a psychiatric disorder (Ford and Kamerow, 1989). Among those diagnosed with hypersomnia, the prevalence of a psychiatric disorder is somewhat higher—46.5 percent.

The reasons behind the comorbidity of sleep and psychiatric disorders are not well understood. Comorbidity might be due to one disorder being a risk factor or cause of the other; they might both be manifestations of the same or overlapping physiological disturbance; one might be a consequence of the other. In some cases, the sleep disturbance can be both cause and consequence. In generalized anxiety disorder, for example, the symptoms of fatigue and irritability used to diagnose it are often the result of a sleep disturbance, which itself is also a diagnostic symptom.

Adolescents with major depressive disorders report higher rates of sleep problems and, conversely, those with sleep difficulties report increased negative mood or mood regulation (Ryan et al., 1987). In addition, sleep-onset abnormalities during adolescence have been associated with an increased risk of depression in later life (Rao et al., 1996).

The best studied and most prevalent comorbidity is insomnia with major depression. Insomnia as a symptom of depression is highly common. On the basis of longitudinal studies, insomnia is now established as a risk factor for major depression. Not all people with insomnia have a depression diagnosis; however, studies have found that 15 to 20 percent of people diagnosed with insomnia have major depression (Ford and Kamerow, 1989; Breslau et al., 1996).

Depressed individuals have certain abnormalities detected by polysomnography. One is shorter rapid eye movement (REM) latency (a shorter period of time elapsing from onset of sleep to onset of REM sleep), an effect that persists even after treatment for depression. Other abnormalities include shortened initial REM period, increased REM density, and slow-wave deficits (Benca, 2005a). Shorter REM latency and slow-wave sleep (SWS) deficits tend to run in families; these abnormalities are also found in first-degree relatives of people with major depression, but who are unaffected by depression (Giles et al., 1998). A variety of polysomnographic abnormalities have been found with other psychiatric disorders (Benca, 2005a).



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