The implications of sleep disturbance epidemiology

Article Abstract:

The author reviews an article by Daniel Ford and Douglas Kamerow, "Epidemiologic study of sleep disturbances and psychiatric disorders", in the Sep 15, 1989 issues of The Journal of the American Medical Assoc. and finds it to be an exceptionally well-designed and meaningful project. The high rate of psychiatric illness discovered in patients with hypersomnia (excessive daytime sleepiness) is surprising. This is the first evidence that psychiatric illnesses such as depression occurs in many unusually sleepy patients. The finding that many insomniacs (those who have difficulty sleeping) had psychiatric disorders confirms previous results but also adds useful data on the course of these problems over time. Most fascinating is the suggestion that early diagnosis and management of sleep disorders could prevent psychiatric illness. This concept is compatible with the theory that changes in sleep patterns may occur before psychiatric problems such as depression develop. The reviewer proposes strategies for early clinical intervention to treat sleep disorders. Patients should wake up at the same time every day and avoid using stimulants or depressants. Modest restriction of time spent in bed to 6 or 7 hours may help some patients with insomnia sleep more deeply and steadily. Mental illness is not the only cause of insomnia, however. Social changes such as unemployment or death of a family member, or physical pain and disability also frequently affect sleep.

Psychological aspects, Demographic aspects, editorial

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Epidemiologic study of sleep disturbances and psychiatric disorders: an opportunity for prevention?

Article Abstract:

Difficulty with sleeping, including insomnia and hypersomnia (sleeping too much) is a common health complaint. Sleep disturbances have been linked to psychiatric illness, sleep apnea (arrested breathing while sleeping), emotional stress, cardiovascular disease, and even increased mortality. This study focused on the relationship between sleep disturbances and psychiatric disorders, because it was hypothesized that difficulty sleeping may be an early symptom of or conversely a cause of certain psychiatric illnesses. This investigation was part of the National Institute of Mental Health Epidemiologic Catchment Area study and it surveyed 7,954 people between 1981 and 1985. The respondents, adults from three US cities, were interviewed initially and then again after one year. Insomnia was found in 10.2 percent of the respondents and hypersomnia in 3.2 percent at the first interview. Of the people with either insomnia or hypersomnia, 40-47 percent had a psychiatric illness as well while only 16.4 percent of people with no sleep complaints had a psychiatric problem. Specifically, the chance of developing a new major depression was much greater for insomniacs than respondents without insomnia. If sleep problems had resolved by the second interview, new psychiatric illness was less likely to develop. The authors suggest that physicians could possibly prevent new or recurrent psychiatric disorders by diagnosing and addressing sleep complaints promptly.

Research, Case studies, Causes of, Depression, Mental, Depression (Mood disorder), United States. National Institute of Mental Health

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Evidence-based medicine meets cost-effectiveness analysis

Article Abstract:

A 1996 study found that screening all adults 35 and older for asymptomatic hypothyroidism was cost-effective. However, this contradicts a report by the US Preventive Services Task Force, which does not recommend screening asymptomatic adults. This illustrates the difficulty physicians can have with contradictory statements from studies that use different approaches to analyze cost-effectiveness. If physicians follow different recommendations, the wide variations in medical practice will remain.

Editorial, Evaluation, Medical care, Quality management, Medical care quality, Cost benefit analysis, Evidence-based medicine

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