Anxiety and Sleep

Insomnia, nightmares, or nocturnal panic attacks are prominent features of sleep disturbance that spans across many anxiery disorders. In a meta-analysis of 177 studies, Benca and colleagues (1992) reported that individuals with an anxiery disorder take longer ro get to sleep at the beginning of the night, experience more awakenings during rhe night, obtain less sleep overall, and exhibit poorer sleep efficienry, relative to nonpatients. More recently, a review of dre literature by Papadimitriou and Linkowski 2005) suggesrs rhat the major findings reported bv Benca et al. have held over the ensuing decade. \,foreover, Papadimitriou and Linkowski (2005) tbund an especially strong association beween sleep disturbance and several anxiety disorders, including panic disorder, generalized anxiery disorder (GAD), obsessive-compulsive disorder, and posttraumatic stress disorder (PTSD). Afthough -ort of the evidence to date is based on samples of aduhs in their rriddle years, there is also evidence ofan association )erween sleep disturbance and anxiety disorders in ;hildren and adolescence (Forbes et al., 2006), as well as among older adults (Spira, Friedman, Flint, & Sheikh,2005). The first aim of this chapter is to highlight the potential importance of sleep problems in individuals with anxiery disorders. W'e argue that disturbed sleep not only impairs the qualiry of a patientt life but may also contribute to rhe maintenance of the anxiety disorder. Our second aim is to review the evidence base for rrearing parienrs who sufFer from comorbid sleep disturbance and anxiery disorder. As will become evident throughout the chapter, there is a dearth of evidence that specifically delineates the relationship berween sleep disturbance and anxiery disorder and thus several ofour proposals are based on evidence from healthy nonpatients or patienrs with other clinical disorders. 'We raise this caveat at the outset as an importanr limitarion to rhe conclusions that we draw. 'We rurn now to begin this chapter by offering an overview of concepts that are basic to understanding human sleep; this knowledge is important for clinicians rreating individuals who sufFer from sleep disturbance. Sleep disturbances in the form of insomnia, nightmares, or nocrurnal panic attack are prominenr features across the anxiety disorders.The first aim ofthis chapter is to highlight rhe potential importance of sleep in individuals with anxiety disorders. lt is argued ttrat steep is important not only because disturbed sleep impairs the quality of a patient's life, but also because it likely contributes to the maintenance of the anxiety disorder. The second aim is to review the evidence base for treating Patients who suffer from comorbid insomnia and an anxiety disorder. Research attention and clinical intervention for sleep disturbance among individuals with anxiety disorders is a critical domain for future research.