IME,Inc.
211 Beaumont
Traverse City,
Michigan MI 49684
Tel: (800)
968-4637
(800) 968-4637 |
Independent Medical Evaluations, Inc.
A National Company Providing |
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Interrelationships
of Depression and Anxiety to Insomnia
Author: Roger J. Cadieux, MD IntroductionInsomnia is generally thought to be a symptom secondary to a coexisting condition (ie, secondary insomnia), and less so a primary disorder (ie, primary insomnia). Either primary or secondary insomnia can be transient (lasting days or weeks) or chronic (lasting months or years). Furthermore, patients exhibit different patterns and severity of sleep disturbance. All of these factors must be considered in the recognition, diagnosis, and treatment of insomnia. The need to increase recognition of insomnia is highlighted by its prevalence. Data from large community and primary care medicine surveys on insomnia in the United States reveal that approximately 10% of adults experience insomnia lasting more than 6 months.[1-5] Along with the physical and mental distress that this has for the individual sufferers, insomnia also profoundly affects society and is a public health issue. Direct monetary costs alone attributed to the treatment of insomnia in 1995 were estimated at $13.9 billion, which doesn't account for the indirect costs associated with increased morbidity and reduced daily functioning (eg, reduced job productivity, absenteeism).[6,7] Primary care physicians are in a key position to help ease the burden of insomnia, both on individuals and society. As the gatekeepers of healthcare delivery, they are in a position to either directly diagnose and treat a patient presenting with insomnia or refer patients to specialists. Because of the complex nature of insomnia, accurate diagnosis is critical for optimal care. With data showing that only 5% of all adults with insomnia in the United States are properly diagnosed,[6] there is a great need to improve awareness of the breadth and depth of this problem. This Clinical Update focuses on the interrelatedness of insomnia to anxiety and depression. Data show a high prevalence of coexisting insomnia and mood disorders; secondary insomnia is most often associated with psychiatric disorders, especially mood disorders.[1,8] Studies of patients with major depressive disorder indicate insomnia in 65% of outpatients and 90% of inpatients.[8-10] Similarly, studies of insomnia report that up to 46% of those with chronic insomnia presenting to sleep-disorder centers are diagnosed with a psychiatric disorder.[8,11] Evidence also suggests that chronic insomnia may be a significant risk factor for the development of depression or anxiety,[2] with one study finding a 4-fold increase in the relative risk of developing major depression in people with a history of insomnia.[12] Differentiating whether depression or anxiety precedes or follows insomnia may have important ramifications for diagnosis and treatment.
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Independent Medical Evaluations (IME), Inc. Company Services Legal Disclosure:
Independent Medical Evaluations - IME , Inc. provides expertise in many legal and medical situations including the following: Independent Medical Evaluation, Independent Medical Exam, Independent Medical Examinations, Impartial Evaluations, Physician Panel, Permanent Partial disability Examination, Medical Fraud Investigation, Medical Discovery, Expert Witness, Expert Witnesses, Medical-Legal Experts, Legal Nurse Consultant, Depositions, Live Testimony, Legal Nurse Consulting, Tort State, Personnel Injury, Defense Exams, Legal Nurse Consultants, Plaintiff Exams, Criminal Medical, Civil Medical, No Fault / Liability, Medical Claim, Medical Consultant, Insurance Medical Claim, Workers Compensation, Impairment Evaluations, Unbiased Medical Opinion, Disability, Medical-Legal Professionals, Certified Independent Medical Examiners, American Board of Independent Medical Examiners, SEAK, American Academy of Disability Evaluating Physicians (AADEP), Work Injuries, Auto Injuries, Car Accident Claims, Family Medical Leave (FMLA), Auto No Fault, Independent Medical Opinion (IMO), Medical Review, File Review, Medical Chart Review, Peer Review, Standards of Care, Malpractice, Medical Case Discovery, Medical Investigation, Long Term / Short Term Disability, Sickness and Accident, Early Assessments, Medical Illustrations, Auto Tort, Panel IMES, DNA Testing, Biomechanical Evaluations, Fitness for Duty, Physician Panel, Discovery, IME, Medical Malpractice, Compensibility, Management, Return To Work Issues, End Point, Maximum Medical Improvement, Orthopedics, Orthopedic Surgeon, Neurologist, Neurology, Physical Medicine, PMR, Psychiatry, Psychiatric, TMJ Specialist, Chiropractic, Chiropractor, Neurosurgeon, Neuropsychologist, Neuropsychology Testing, Plastic Surgeon, Oral Surgeon, ABIME, Disability Consultants, Psychologist, Psychology, MMPI, Nationwide Medical, Employer Health, Drug Testing, NIDA Labs and more.
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