Medical Correlates

Written by Maurice M. Ohayon, MD, DSc, PhD


Smoking was found to be positively related to difficulties in initiating sleep and estimated sleep
latency in an epidemiological study of 2,202 European subjects aged 20-45 years (14).

Assessing the sleep and health of 869 individuals aged 14 to 84 years, Philips and Danner (65) found that cigarette smokers were significantly more likely than nonsmokers to report problems falling sleep, problems staying asleep, daytime sleepiness, minor accidents, depression and high daily caffeine intake.

Similarly, Wetter and Young (66) found in a sample of 3,516 adults that smoking was associated with difficulty initiating sleep and difficulty waking up. Excessive daytime sleepiness was related to smoking only for females, while nightmares and disturbing dreams were related to smoking only
among males.

Another study reported that smokers were more likely to sleep fewer than six hours per night than nonsmokers (67).
Although often reported in clinical studies, the association between the use of antihypertensive drugs and insomnia was seldom reported in epidemiological studies.
In an epidemiological study of 8,000 Swedish subjects, Bardage & Isacson (68) reported that nearly 20% of the users of antihypertensive drugs reported side-effects; insomnia being one of those that had the strongest negative impact on health utility.
Another epidemiological study with 3,201 Swedish men reported different results. Men with hypertension had more frequently a complaint of insomnia, but those treated with beta-blockers had lower rates of insomnia (23).

Alcohol is a central nervous system depressant known for its important effects on sleep and wakefulness.

On sleep patterns, alcohol at bedtime accelerates the sleep onset, increases the amount of slow-wave sleep, decreases the amount of REM sleep and causes sleep disruption in the second half of the sleep period (69).
However, prolonged use of alcohol at bedtime loses its effects on sleep onset but sleep disruption remains. Still, alcohol is often used as a sleeping aid in the general population (16,70). An epidemiological study reported that about four out of 10 insomnia subjects medicated themselves with
over-the-counter medications or alcohol (16), such as serotonergic reuptake inhibitors (SSRIs), some neuroleptics, some antiparkinsonians and amphetamines, may all provoke insomnia among
patients using these kinds of medications.
Hypnotics and anxiolytics may cause insomnia in several situations: a tolerance can be developed over time, causing the resurgence of insomnia; a rebound of insomnia upon discontinuation of the treatment and upon abrupt withdrawal. Tolerance to hypnotics and anxiolytics has often been studied in the general population. The results are the same: chronic users of hypnotics and anxiolytics show little or no
difference when compared with non-treated insomnia subjects (71-73)

More Information

 

Medical & Psychiatric Correlates
Smoking is positively related to difficulties in initiating sleep and estimated sleep latency.

Although often reported in clinical studies, the association between the use of antihypertensive drugs and insomnia was seldom reported in epidemiological studies.
On sleep patterns, alcohol at bedtime accelerates the sleep onset, increases the amount of slow-wave sleep, decreases the amount of REM sleep and causes sleep disruption in the second half of the sleep period.
About four out of 10 insomnia subjects medicate themselves with over-the-counter medications or alcohol.
Other medications, such as serotonergic reuptake inhibitors (SSRIs), some neuroleptics, some antiparkinsonians and amphetamines may all provoke insomnia among patients using these kinds of medications. Hypnotics and anxiolytics may cause insomnia

 

Morning Headaches

Waking up with a headache is traditionally associated with sleep disorders

 

Hypertension

Obstructive Sleep Apnea Syndrome is an independent risk factor (odds ratio: 9.7) for hypertension. Snoring and breathing pauses during sleep appeared to be non-significant predictive factors.

 

Chronic Pain

 

Depression, Pain and Sleep
Surprisingly, few studies have attempted to determine if a comorbid medical condition in individuals with chronic painful physical disease increased the likelihood of having a major depressive disorder

Depression with Psychotic Features

There are little data regarding the prevalence of associated psychotic features in subjects with major depressive disorders in the general population

 

Sleep Apnea and Depression
Some clinical studies have attempted to determine whether depression limits the recognition and treatment of breathing-related sleep disorders, or if breathing-related sleep disorders play a role in the etiology or course of depressive disorder