According to an article reported in General Hospital Psychiatry(March-April 2005), patients with insomnia may be dealing with morethan lost sleep. Chronic insomnia may in fact be a marker for a psychiatricdisorder, particularly depression or anxiety. At least 40% ofpatients with chronic insomnia also have an underlying psychiatric disorder.Comorbid insomnia in patients with major depressive episodesoften is manifested by difficulty in maintaining sleep. With generalizedanxiety disorder, a patient's sleep is often shortened and fragmented.Unfortunately, the medications used to treat depression or anxietyactually may exacerbate the patient's inability to sleep soundly.
When insomnia and a psychiatric disorder coexist, it often is difficultto know which came first. Whereas a psychiatric disorder may causeinsomnia, insomnia may be a factor in developing a psychiatric disorder.A history of insomnia is associated with a 4-fold increase in therisk of developing a new depressive disorder and a 2-fold increase inthe risk of developing a new anxiety disorder. In fact, emerging datasuggest that resolution of insomnia may improve psychiatric outcomes—underscoring the importance of a vigorous approach to treatinginsomnia. Because of the impact on insomnia of many medicationsfor psychiatric conditions, an ideal approach would be a monotherapythat treats both insomnia and the psychiatric disorder.