Sleep disturbances commonly seen in mood and anxiety disorders, and how are they addressed?

• A. Sleep disturbances always require benzodiazepines.
• B. Insomnia or hypersomnia; managed with sleep hygiene, CBT-I, and pharmacologic options when indicated, while treating the underlying mood/anxiety disorder and evaluating comorbid sleep disorders.
• C. Sleep disturbances are unrelated to mood disorders.
• D. All sleep problems are due to primary insomnia; treat only with CBT-I.

Answer: (B)

Sleep disturbances in mood and anxiety disorders reflect a two-sided problem: sleep symptoms often accompany the emotional disorder, and improving sleep can help mood and anxiety, while treating the underlying condition can alleviate sleep issues. The best approach acknowledges both aspects and looks for other sleep problems that may be present.

Insomnia or hypersomnia are common presentations. Start with nonpharmacologic foundations like good sleep hygiene and, for insomnia, cognitive-behavioral therapy for insomnia (CBT-I) as the first-line treatment. Medication can be added when needed and should be used judiciously, with consideration of side effects, dependence risk, and interactions with treatments for the mood or anxiety disorder. Importantly, you’re also treating the mood/anxiety disorder itself, which can reduce sleep symptoms, and you’re screening for comorbid sleep disorders (such as obstructive sleep apnea or restless legs) that may require specific interventions.

This framework is preferable to approaches that rely on a single drug for all sleep problems, ignore the mood disorder, or assume all sleep issues are primary insomnia.