The three highest odds ratios were those for obsessive-compulsive disorder (OCD) and for panic disorder associated with both insomnia and hypersomnia, and that for GAD associated with insomnia, alone. Table I. Odds ratios for specific anxiety disorders associated

with lifetime sleep disturbances (adapted from Breslau et al2). GAD, generalized anxiety disorder; OCD, obsessive-compulsive Inhibitors,research,lifescience,medical disorder. These findings were replicated for chronic insomnia in a recent study,33 which further showed that, insomnia appeared before the anxiety disorder in 18% of cases, anxiety and insomnia appeared about, in the same time in 38.6% of cases, and anxiety appeared before insomnia in 43.5% of cases. These authors concluded that, psychiatric history, including anxiety disorder, is closely related to the severity and chronicity of current, insomnia. Panic disorder and agoraphobia The essential features of panic disorder are recurrent. attacks of severe anxiety (panic attacks), which are not, restricted Inhibitors,research,lifescience,medical to any particular situation or set of circumstances and are therefore unpredictable.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) 34 criteria of panic disorder, unexpected panic attacks have to be followed by at. least 1 month of persistent concern about, having another panic attack. The dominant, symptoms of a panic attack vary from Inhibitors,research,lifescience,medical individual to individual. Typically, it includes autonomic symptoms with marked psychic anxiety. The most, prominent autonomic symptoms Inhibitors,research,lifescience,medical are palpitations, sweating, trembling, shortness of breath, dizziness, chest, pain, nausea, and paresthesias. There is almost always a secondary fear of dying, losing control, or going mad. Most individual attacks last only for a. few minutes, but. a. common complication is the development, of anticipator}’ fear of helplessness or loss of Inhibitors,research,lifescience,medical control during a panic attack, so that, the individual may progressively

develop avoidant, behavior leading to agoraphobia or specific phobias. In this respect, most, if not all, patients with agoraphobia also have a BIBW2992 current diagnosis (or history) of panic disorder.34 Accordingly, sleep disturbances of panic disorder and agoraphobia are discussed in the same section. Subjective sleep Sleep disturbances, predominantly insomnia, are extremely common in panic disorder. Sheehan et al35 reported a prevalence of 68% for difficulties in falling asleep and of 77% for restless and disturbed OSI-906 sleep. In a self-report sleep survey, Mellman and Uhde36 found that, compared with healthy subjects, patients with panic disorder reported more complaints of middle night, insomnia (67% versus 23%) and late night, insomnia (67% versus 31 %); the two groups did not. differ with regard to early night, insomnia. Many patients with panic disorder experience occasional sleep panic attacks, but only about 20% to 45% of patients with panic disorder have repeated nocturnal panic attacks.