Sleep is important for maintaining health and preventing various diseases. The millions of Americans who suffer from undiagnosed sleep disorders, such as obstructive sleep apnea, are also at risk for adverse health effects. Sleep problems and disorders can cause or exacerbate psychiatric and medical problems. As sleep physicians, we can radically change patients’ lives through the evaluation and treatment of sleep disorders, which can lead to dramatic improvements in patients’ health and well-being. Because sleep disorders affect the whole body, sleep physicians collaborate across numerous fields of study. As a result, becoming a sleep physician is an attractive option for anyone who is considering a career in medicine.
Role of sleep in prevention of psychiatric disorders
Sleep can promote emotional well-being. Sleep problems can be a symptom of psychiatric disorders. They can also cause or worsen various psychiatric disorders. Insufficient sleep can result in impaired attention, alertness, concentration, reasoning and problem solving. Lack of sleep can impede productivity and efficiency. Sleep is also important for learning and memory consolidation.1
Insomnia can be a symptom of depression, and people with chronic insomnia are at a higher risk for subsequent development of depression. Persistent insomnia can lead to relapse of depressive disorder, substance use abuse, bipolar disorder and psychotic disorders. Insomnia is also a risk factor for suicide, and treatment of insomnia decreases that risk.2, 3
Sleep problems and disorders are common in patients with various anxiety disorders. Patients with obstructive sleep apnea can have panic disorder and nocturnal panic symptoms. Treatment of insomnia and sleep disorders improves the outcome of anxiety disorders.4
Patients with attention deficit/hyperactivity disorder (ADHD) are more susceptible to sleep disruption resulting from poor sleep habits and other disorders, and adequate sleep helps patients with ADHD.5, 6
Sleep problems and disorders could mimic a presentation of a psychiatric disorder. Sleep apnea can lead to symptoms of fatigue and poor energy, resembling symptoms of untreated depressive disorder.
Insomnia can be a symptom, cause or associated disorder in patients with depression and anxiety disorders. Untreated sleep disorders like insomnia or obstructive sleep apnea could also lead to incomplete resolution of depressive symptoms and possibly treatment resistance.7
Poor sleep can also lead to decreased quality of life, impaired physical functioning and increased memory impairments in older adults. Sleep problems like insomnia and sleep apnea increase the risk of stroke and dementia. Treatment of sleep apnea seems to slow the memory decline and improve functioning in patients with dementia.8
Role of sleep in prevention of medical disorders
Untreated sleep disorders and chronic sleep deprivation also can increase the risk of various medical disorders like cardiovascular disease, hypertension, stroke, diabetes and obesity, and the treatment of sleep disorders can help prevent these medical problems.8
Hypertension, coronary artery disease, arrhythmias and heart failure are often co-morbid with obstructive sleep apnea. There is also a high prevalence of obstructive sleep apnea in patients with atrial fibrillation. Those who have both atrial fibrillation and obstructive sleep apnea are more likely to stay in normal sinus rhythm after cardioversion if their sleep apnea is treated.9 Use of continuous positive airway pressure (CPAP) therapy has been shown to improve systolic function, reduce left ventricular end-systolic diameter, and improve quality of life in heart failure patients.
Sleep apnea leads to insulin resistance and type 2 diabetes. Treatment of sleep apnea seems to have beneficial effects in improving glycemic control in patients with type 2 diabetes.10
Sleep problems, like insomnia, could lead to weight gain. Sleep disorders and sleep problems can also exacerbate other medical problems like gastroesophageal regurgitation disorder (GERD) and asthma. Sleep problems can exacerbate pain symptoms in various pain disorders, and improving sleep and treating sleep disorders can decrease pain symptoms in these patients.
Sleep problems can also lead to work absenteeism and reduced quality of life. Evaluation and treatment of sleep problems and sleep disorders can have a beneficial effect, and a preventive role, in promoting the overall health of patients with various medical problems. As sleep medicine physicians, promoting optimal sleep and healthy sleep habits, along with screening for and treatment of sleep disorders, can have an important role in the emotional and physical well-being of our patients, who after treatment can feel like a new person. Making this kind of impact in a patient’s life is one of the many reasons why a career in sleep medicine is great.
To learn more about sleep medicine as a specialty, visit aasm.org/choosesleep.
Khurshid A. Khurshid, MD, FAASM
Chief of Neuromodulation and Sleep Disorders Program
Department of Psychiatry
University of Florida
- Khurshid KA. Bi-directional relationship between sleep problems and psychiatric disorders. Guest Editorial, Psychiatric Annals 2016; vol 46(7):385-87
- Ağargün MY, Kara H, Solmaz M. Sleep disturbances and suicidal behavior in patients with major depression. J Clin Psychiatry. 1997;58(6):249- 251.
- Rumble ME, White KH, Benca RM. Sleep disturbances in mood disorders. Psychiatr Clin North Am. 2015;38:743-759
- Su VY, Chen YT, Lin WC, et al. Sleep apnea and risk of panic disorder. Ann Fam Med. 2015; 13(4):325-330.
- Cortese S, Brown TE, Corkum P, et al. Assessment and management of sleep problems in youths with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2013; 52(8):784-796.
- Hiscock H, Sciberras E, Mensah F, et al. Impact of a behavioral sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomized controlled trial. BMJ. 2015; 350:h68.
- Ong JC, Gress JL, San Pedro-Salcedo MG, Manber R. Frequency and predictors of obstructive sleep apnea among individuals with major depressive disorder and insomnia. J Psychosom Res. 2009; 67(2):135-141.
- Pandey A, Demede M, Zizi F, et al. Sleep apnea and diabetes: insights into the emerging epidemic. Curr Diab Rep. 2011;11(1):35-40
- Saeidifard F, Kolla BP, Foroughi M, Mansukhani MP. Immediate impact of positive airway pressure on atrial fibrillation. Sleep Med 2017 Nov; 39: 84-86
- Peng CS, Cao YA, Tian YH, Zhang WL, Xia J, Yang L. Features of continuous glycemic profile and glycemic variability in patients with obstructive sleep apnea syndrome. Diabetes Res Clin Pract. 2017 Aug 20; 134:106-112