Sleep disorders are often related to mood disorders, especially anxiety and depression. Some drugs such as psychotropic agents effect sleep. Alcohol and drugs also have a very negative effect on sleep. There are also some disorders which are revealed only during sleep. This is the case of sleep apnoea or restless leg syndrome. These diseases make fatigue and sometimes depression worse. We therefore pay close attention to our patients’ sleep in our clinic.
The most common symptom is insomnia, which affects 20 to 30% of the population, with 15 to 20% suffering from moderate insomnia and 9 to 10% from severe insomnia. Almost 10% of the population regularly takes a tranquillizer or hypnotic drug. Women are twice as affected as men by insomnia.
Anxiety in all its forms is a major cause of insomnia. Generalised anxiety, or anxiety brought about by OCD (obsessive-compulsive disorder) or phobias, most often leads to difficulties going to sleep due to repetitive thoughts, ruminating and obsessive preoccupations. Insomnia, which often comes on at around 3 or 4 in the morning or late at night, is more commonly concomitant during periods of poorly tolerated stress, with the risk of progression to depression if a solution is not found.
Depression is another frequent cause of insomnia. Together with anxiety, it accounts for 50% of cases of insomnia. The insomnia often comes on in the second part of the night, with the sensation of early waking or restless and highly fragmented sleep late night. This may be the first sign of depression, even before the depressive syndrome becomes obvious. Knowing your sleep well when you are depressed is important as sleep is a good mood indicator. Treating insomnia at the same time as depression allows for the best and longest-lasting improvement.
Insomnia may reveal sleep apnoea syndrome, but more often than not, the most unpleasant symptom is fatigue, with excessive drowsiness, noticed by the person’s family and by the person themselves. The syndrome usually comes with snoring. Sometimes, the person’s partner may notice worrying pauses in breathing, followed by loud snoring when breathing resumes. This causes impaired concentration and memory in the daytime, sometimes causing sufferers to fall asleep when it is not convenient, which can be highly problematic when driving.
Sleep apnoea syndrome has considerable consequences on health, especially the cardiovascular system. 50% of sleep apnoea subjects have high blood pressure and often have coronary heart disease. The risk of death from cardiac or vascular causes in untreated subjects with severe apnoea, is increase three-fold compared to healthy controls. It is therefore important to effectively screen for these diseases and to treat them.
Some sleep disorders cause sleep to become intrusive, whether after a long night’s sleep and non-restorative sleep as seen in idiopathic hypersomnia, or the repeated need to sleep in the daytime as seen in narcolepsy. Early onset narcolepsy is a disease of early onset, seen by the need to sleep in the day, associated with other symptoms, the most characteristic of which is cataplexy (sudden drop in muscle tone set off by emotions). However, in psychiatry, daytime drowsiness is most often related to mood disorders, without associated hypersomnia.
All of these diseases need to be looked out for, assessed and treated where necessary. In the clinic, we run workshops for discussing sleep, in order to better understand its mechanisms, the effects of drugs and diseases involved. Hospitalised patients and their families can take part in them. Sleep can be recorded if need be.