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Marc Ettensohn, MD, is a Senior Resident. Yarelis Soto, MD, is a second-year Resident. Bruce Bassi, MD, is a second-year Resident. Khurshid A. Khurshid, MD, FAASM, is an Associate Professor. All contributors are affiliated with the Department of Psychiatry, University of Florida.
Disclosure: The authors have no relevant financial relationships to disclose.
Major depressive disorder (MDD) is a significant public health problem that affects about 10% of the population. 1 Patients with MDD present with various sleep problems and disorders. Patients frequently have difficulty in initiating sleep, frequent awakenings during the night, early morning awakening, daytime sleepiness, fatigue, and nonrestorative sleep. 2
Various studies have shown that depressive disorders increase the risk of cardiovascular disease and other medical comorbidities. Depression increases the onset of cardiovascular disease over and above other determinants in older primary care patients. 1
It has also been shown that improvement in comorbid medical disorders and physical symptoms improves depression and quality of life. Insomnia is one such symptom/disorder that if not treated increases the risk of depression. Persistent insomnia increases the risk of relapse in patients treated for depression. 3,4
Insomnia is seen in about two-thirds of patients diagnosed with MDD, and up to one-third of depressed patients have hypersomnia. About one-third of patients presenting with insomnia have depression. Insomnia is also a risk factor for suicide and substance abuse. Treatment of insomnia improves outcome in patients treated for depression. Prevalence of the most common sleep disorders such as obstructive sleep apnea (OSA) and restless legs syndrome (RLS) is higher in patients with depression compared with the general population. The evaluation and treatment of sleep problems and sleep disorders may play an important role in alleviating symptoms of depression and also lead to prevention of mortality and morbidity in these patients. 5
In this article, we review sleep problems and disorders in patients with depression and stress the importance of evaluating for comorbid sleep disturbances in patients with depression.
Subjective and Objective Sleep Problems in Depression
Studies have attempted to make reports of sleep disturbances more objective, as subjective sleep disturbances often times do not correlate with objective polysomnogram (PSG) recordings in depressed patients. Peterson and Benca 6 found both underestimation and overestimation of sleep latency, awakenings, sleep depth, and sleep...