A brief treatment approach for each anxiety disorder is also suggested with a special focus on sleep. Discrepancies between studies could have been related to illness severity, diagnostic comorbidity, and duration of illness. Finally, an unequivocal sleep architecture profile that could specifically relate to a particular anxiety disorder could not be evidenced in contrast, conflicting results are often found for the same disorder. There is some indication for alteration in sleep maintenance in generalized anxiety disorder and for both sleep initiation and maintenance in panic disorder no clear picture emerges for obsessive-compulsive disorder or posttraumatic stress disorder. It has been suggested that these systems may be particularly vulnerable to prolonged or repeated stress, further leading to a dysfunctional arousal state and pathological anxiety states, Polysomnographic studies documented limited alteration of sleep in anxiety disorders. Recent studies suggested that the corticotropin-releasing hormone system and the locus ceruleus-autonomic nervous system may play major roles in the arousal response to stress.

In the first part of this review, the relationship between sleep and anxiety is discussed in terms of adaptive response to stress. Sleep disturbances-particularly insomnia - are highly prevalent in anxiety disorders and complaints such as insomnia or nightmares have even been incorporated in some anxiety disorder definitions, such as generalized anxiety disorder and posttraumatic stress disorder.

Nocturnal panic attacks nhs