Vol 7 No.4 - Sleep Disorders, Neuropsychiatry, and Psychotropics
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s much as one third of the adult population reports difficulty sleeping1-3 and the widespread use of prescribed hypnotic medication, as well as nonprescrip- tion remedies, is an indirect reflection of this high fre- quency of sleep complaints.2,4 Sleep disturbance is con- sidered as the second most common symptom of mental distress.5 Individuals reporting disturbed sleep are more likely to report emotional distress and recurrent health problems.1 In fact, disturbed sleep is a common finding in psychiatric illnesses. Some patients will even attribute their daytime psychiatric symptoms to abnormal sleep and believe that improved sleep will solve their prob- lems. In some cases, the psychological symptoms associ- ated with a primary sleep disorder could indeed improve with adequate therapy, for instance, the altered states of consciousness   or   depression   encountered   in   some patients with sleep apnea could indeed improve with nasal continuous positive airway pressure treatment. In primary psychiatric disorders, the sleep complaint usu- ally  parallels  the  state  of  the  disorder,  and  sleep improves when the psychiatric symptoms improve. Another point is that alterations of sleep by psychiatric conditions are likely to have underlying brain neuro- transmitter dysfunction directly involved in the patho- physiological  process  of  the  disease.  Indeed,  neuro- transmission disturbances, such as those encountered in mental disorders, are reflected in spontaneous alteration of sleep continuity and architecture.The corrective effect 3 2 3 P h a r m a c o l o g i c a l   a s p e c t s Copyright © 2005 LLS SAS.  All rights reserved www.dialogues-cns.org Sleep disturbances, psychiatric disorders, and psychotropic drugs Luc Staner, MD A Keywords:   sleep   disturbance;   polysomnography;   psychiatric   disorder;    sleep-wake mechanism; psychotropic drug; rapid eye movement sleep; non–rapid eye movement sleep; neurotransmitter Author   affiliations:   Sleep   Laboratory,   Forenap,   Centre   Hospitalier   de Rouffach, Rouffach, France   Address for correspondence:  Sleep Laboratory, Forenap, Centre Hospitalier de Rouffach, 27 rue du 4ème RSM, 68250 Rouffach, France (e-mail: luc.staner@forenap.asso.fr) Brain  neurotransmitter  dysfunctions  involved  in  the pathophysiological processes of psychiatric disorders are likely to be reflected by concomitant alterations in sleep continuity and architecture. Since the corrective effects of psychotropic drugs on dysfunctional neurotransmission systems  can  be  evidenced  through  polysomnographic recordings, one may consider sleep as a kind of “window” on the neurobiology of psychiatric disorders. During the last 10 years, major breakthroughs in our understanding of sleep-wake mechanisms have provided some indica- tions  on  how  psychotropic  drugs  could  influence  the sleep-wake cycle. In this review, recent inroads into the understanding of sleep regulatory neural mechanisms are introduced and discussed in terms of the effects of psy- chotropic drugs. The relationship between the patho- physiological process of a disease, its consequence on sleep, and the corrective effect of a psychotropic drug are exemplified by two psychopathological states: substance withdrawal and major depression. One may conclude that polysomnographic recordings are a unique noninvasive tool to analyze brain functioning, and are particularly well suited to evaluating the objective effects of new psy- chotropic drugs.    © 2005, LLS SAS Dialogues Clin Neurosci. 2005;7:323-334.