Contents
Sleep Disorders
Sleep disorders nosology is rather complex, but it is important to be aware of major categories.
- Insomnia
- primary insomnia
- insomnia due to mental condition, medical condition or substances
- behavioral insomnia of childhood
- Sleep-related Breathing Disorders
- central sleep apnea
- obstructive sleep apnea
- sleep-related hypoventilation/hypoxemic syndrome
- Hypersomnia of Central Origin
- narcolepsy
- Kleine–Levin syndrome
- menstrual-related hypersomnia
- Circadian Rhythm Sleep Disorders
- jet lag, shift work disorders
- Parasomnias
- Disorders of arousal from NREM: sleepwalking, sleep terrors
- REM: REM sleep behavior disorder, recurrent isolated sleep paralysis, nightmares
- other: enuresis, sleep-related eating disorder
- Sleep-related Movement Disoders
- restless leg syndrome
- bruxism
- periodic limb movement disorder
Sleep and Depression
Depression causes a number of sleep disturbances: increased sleep latency, increased nocturnal and early-morning awakenings, shortened latency to REM sleep, increased REM density, decreased slow-wave sleep in first NREM cycle.
REM sleep deprivation alleviates depression; also most antidepressants suppress REM sleep (exceptions: bupropion, nefazodone (Serzone)) (K&S, p.2154)
Activating antidepressants
These are believed to have activating effect and offer require co-prescribed sleeping aid [2]:
- imipramine, desipramine (TCAs),
- fluoxetine,
- paroxetine,
- venlafaxine,
- reboxetine (not effective for MDD in adults according to meta-analysis) [3]
- bupropion
Sedating antidepresants
These are believed to promote sleep through resynchronization of the circadian rhythm (not through sedating action)
- doxepin, trimipramine (TCAs),
- mirtazapine,
- trazodone,
- agomelatine (Valdoxan, Melitor) (great for improving sleep AND severe depression!) [4]
[2] Wichniak A., Sleep and Antidepressant Treatment. Curr Pharm Des. 2012
[3] Cipriani A., Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis, Lancet, 2009
[4] Montgomery, SA., Severe depression and antidepressants: focus on a pooled analysis of placebo-controlled studies on agomelatine.". Int Clin Psychopharmacol. 22 (5): 283–91.