Sleep and neuropsychiatric illness

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2024-07-02 07:00:04

Neuropsychopharmacology volume 45, pages 1–2 (2020 )Cite this article

Sleep and neuropsychiatric illness are entwined. Disturbances of sleep are DSM-5 diagnostic features for major depressive disorder, generalized anxiety disorder, post-traumatic stress disorder, and bipolar disorder, and are consistent features of psychoses and most neurodegenerative disorders. Pharmacologic or psychological treatment of these disorders often improves the sleep impairment, and medications used to treat neuropsychiatric disorders may also be used as primary treatments for sleep disorders.

The most promising aspect of this relationship was explicitly postulated 30 years ago for mood disorders: not only is sleep disturbance a phenotypic feature of many neuropsychiatric illnesses, but it may in fact predispose, contribute to, and dare we say it, cause them [1, 2]. The Epidemiologic Catchment Area study was the first high-profile data demonstrating that insomnia was a strong predictor of incident mood disorders, suggesting that sleeplessness was thus “an opportunity for prevention”. This type of “bidirectional” relationship with insomnia has been demonstrated (although not equivocally) over the last 30 years for a number of neuropsychiatric disorders, including bipolar disorder [3], anxiety disorders [4], PTSD [5], substance use disorders [6], and Alzheimer’s disease [7]. Sleep disturbance has also been established as a risk for transdiagnostic symptoms such as suicidality and pain [8, 9]. Further, circadian rhythm dysregulation (independent of sleep disturbance) may be a risk for neuropsychiatric illness, including bipolar disorder, neurodegenerative disorders, and schizophrenia [10, 11]. Many of the papers in the current issue of Neuropsychopharmacology Reviews discuss the bidirectional relationship of sleep disturbance/circadian rhythms and neuropsychiatric illness, and their potential underlying neurobiological mechanisms.

As recognition of the complex role that sleep disturbance plays in psychiatric illness, DSM-5 mitigated the nearly impossible task for clinicians of determining whether insomnia was caused by psychiatric illness or vice-versa. This continued the evolution of previous DSM editions in eliminating distinctions between primary vs secondary, and subsequently primary vs comorbid, insomnia; instead insomnia diagnosis in DSM-5 is primarily based on symptom features, frequency, and duration. As a result, it encourages independent treatment of insomnia, as well as facilitating further research into the role of sleep disturbance in the etiology and natural history of psychiatric illness.