Vol 5 n° 3 - Anxiety II
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2 4 9 nxiety is an experience of everyday life. It typ- ically functions as an internal alarm bell that warns of potential danger and, in mild degrees, anxiety is service- able to the individual. In anxiety disorders, however, the individual  is  submitted  to  false  alarms  that  may  be intense, frequent, or even continuous.These false alarms may lead to a state of dysfunctional arousal that often leads to persistent sleep–wake difficulties. Indeed, popu- lation surveys indicate that the prevalence of anxiety dis- order is about 24% to 36% in subjects with insomnia complaints and about 27% to 42% for those with hyper- somnia.1,2 Another point further underpinning the rela- tionship between anxiety and sleep is that sleep distur- bance is a diagnostic symptom for some anxiety disorders, such as generalized anxiety disorder (GAD) and post- traumatic stress disorder (PTSD). Anxiety states may be focused upon some particular sit- uation or may be generalized. Usually, there is a combi- nation and most people suffering from severe phobic dis- order  will  have  some  degree  of  generalized  anxiety. Likewise, patients with generalized anxiety often experi- C l i n i c a l   r e s e a r c h Sleep and anxiety disorders Luc Staner, MD Keywords:   sleep;  insomnia;  anxiety  disorder;  sleep–wake  regulation;  panic disorder; generalized anxiety disorder; obsessive-compulsive disorder; posttraumatic stress disorder Author affiliations: Sleep Laboratory, FORENAP, Rouffach, France Address   for   correspondence:   Sleep   Laboratory,   FORENAP,   Institute   for Research in Neuroscience and Neuropsychiatry, BP29, 68250 Rouffach, France (e-mail: luc.staner@forenap.asso.fr) A Sleep disturbances—particularly insomnia—are highly prevalent in anxiety disorders and complaints such as insomnia or nightmares have even been incorporated in some anxiety disorder definitions, such as generalized anxiety disorder and posttraumatic stress disorder. In the first part of this review, the relationship between sleep and anxiety is discussed in terms of adaptive response to stress. Recent studies suggested that the corticotropin-releasing hormone system and the locus ceruleus–autonomic nervous system may play major roles in the arousal response to stress. It has been sug- gested that these systems may be particularly vulnerable to prolonged or repeated stress, further leading to a dys- functional arousal state and pathological anxiety states. Polysomnographic studies documented limited alteration of sleep in anxiety disorders. There is some indication for alteration in sleep maintenance in generalized anxiety disorder and for both sleep initiation and maintenance in panic disorder; no clear picture emerges for obsessive-compulsive dis- order or posttraumatic stress disorder. Finally, an unequivocal sleep architecture profile that could specifically relate to a particular anxiety disorder could not be evidenced; in contrast, conflicting results are often found for the same disorder. Discrepancies between studies could have been related to illness severity, diagnostic comorbidity, and duration of illness. A brief treatment approach for each anxiety disorder is also suggested with a special focus on sleep. © 2003, LLS SAS Dialogues Clin Neurosci. 2003;5:249-258. Copyright © 2003 LLS SAS.  All rights reserved www.dialogues-cns.org