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Review: psychiatric and medical consequences of disordered sleep

Published online by Cambridge University Press:  14 October 2014

G. Stores*
Department of Psychiatry, University of Wallingford, Wallingford, UK
*Address for correspondence: G. Stores, Department of Psychiatry, University of Oxford, c/o North Gate House, 55 High Street, Dorchester on Thames, Wallingford, OX10 7HN, UK. (Email:



The aim of this article is to draw attention to the clinical importance of disordered sleep in psychiatry and to demonstrate the growing awareness of medical illness as a complication of disordered sleep. As background to these main objectives, some general points are made to illustrate present-day approaches to the common and often serious problem of sleep disturbance.


The review is based on a literature search from which key publications were selected to illustrate, in turn, main connections between disordered sleep and psychiatric and medical conditions.


Many such connections are described. Throughout psychiatry, regarding patients whatever their age, these connections have implications for clinical assessment and management. Emphasis is placed on the risk of misdiagnosis of sleep disorders as psychiatric or medical conditions. Examples of this are provided. The growing evidence that disordered sleep can predispose to medical illness is discussed.


As the subject of sleep and its disorders is particular relevant in psychiatry, a working knowledge of modern sleep medicine is important in all branches of psychiatric and other medical practice as well as in clinical research.

Review Articles
© College of Psychiatrists of Ireland 2014 

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Abad, VC, Guilleminault, C (2005). Sleep and psychiatry. Dialogues in Clinical Neurosciences 7, 291303.Google Scholar
American Academy of Sleep Medicine (2014). The International Classification of Sleep Disorders: Diagnostic and Coding Manual, 3rd edn.American Academy of Sleep Medicine: Westchester, IL.Google Scholar
Baglioni, C, Battaggliese, G, Feige, B, Spiegelhalder, K, Nissen, C, Voderholzer, U, Lombardo, C, Riemann, D (2011). Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders 135, 1020.Google Scholar
Bollinger, T, Bollinger, A, Oster, H, Solbach, W (2010). Sleep immunity, and circadian clocks: a mechanistic model. Gerontology 56, 574580.Google Scholar
Bonuck, K, Parikh, S, Bassila, M (2006). Growth failure and sleep disordered breathing: a review of the literature. International Journal of Pediatric Otorhinolaryngology 70, 769778.Google Scholar
Brown, RE, Basheer, R, McKenna, JT, Strecker, RE, McCarley, RW (2012). Control of sleep and wakefulness. Physiological Reviews 12, 10871187.Google Scholar
Cappuccio, FP, Miller, M, Lockley, SW (editors) (2010). Sleep, Health, and Society from Aetiology to Public Health. Oxford University Press: Oxford.Google Scholar
Colten, HR, Altevogt, BM (editors) (2006). Sleep Disorders and Sleep Deprivation. An Unmet Public Health Problem. National Academies Press: Washington, DC.Google Scholar
Dement, WC, Mitler, MM (1993). It’s time to wake up to the importance of sleep disorders. Journal of the American Medical Association 269, 15481550.Google Scholar
Depner, CM, Stothard, ER, Wright, KP Jr (2014). Metabolic consequences of sleep and circadian disorders. Current Diabetes Reports 14, 507.Google Scholar
Doghramji, K, Choufani, D (2010). Taking a sleep history. In Foundations of Psychiatric Sleep Medicine (ed. Winkelman JW and Plante DT), pp. 95109. Cambridge University Press: New York.Google Scholar
Eaton, HD (1923). The genesis and treatment of insomnia. California State Journal of Medicine 21, 175177.Google Scholar
Foster, RG, Kreitzman, L (2014). The rhythms of life: what your body clock means to you!. Experimental Physiology 99, 599606.Google Scholar
Graber, MA, Berner, ES (2008). Diagnostic error: is overconfidence the problem? American Journal of Medicine 121 (Suppl. 5): S2S23.Google Scholar
Grandner, MA (2012). Sleep duration across the lifespan: implications for health. Sleep Medicines Reviews 16, 199201.CrossRefGoogle ScholarPubMed
Grandner, MA, Jackson, NJ, Pak, VM, Gehrman, PR (2012). Sleep disturbance is associated with cardiovascular and metabolic disorders. Journal of Sleep Research 21, 427433.Google Scholar
Gregory, AM, Sadeh, A (2012). Sleep, emotional and behavioral difficulties in children and adolescents. Sleep Medicine Reviews 16, 129136.Google Scholar
Haus, EL, Smolensky, MH (2013). Shift work and cancer risk: potential mechanistic roles of circadian disruption, light at night, and sleep deprivation. Sleep Medicine Reviews 17, 273284.Google Scholar
Horne, J, Reyner, L (1999). Vehicle accidents related to sleep: a review. Occupational and Environmental Medicine 56, 289294.Google Scholar
Kaplan, KA, Harvey, AG (2009). Hypersomnia across mood disorders: a review and synthesis. Sleep Medicine Reviews 13, 275285.Google Scholar
Kim, R, Kapur, VK (2014). Emerging from the shadows: a possible link between sleep apnea and cancer. Journal of Clinical Sleep Medicine 10, 363364.Google Scholar
Knutsson, AM (2003). Health disorders of shift workers. Occupational Medicine 53, 103108.Google Scholar
Kothare, SV, Kotagal, S (editors) (2011). Sleep in Childhood Neurological Disorders. Demos Medical: New York.Google Scholar
Krachman, SL, Criner, GJ, D’Alonzo, GE (1995). Sleep in the intensive care unit. Chest 107, 17131720.Google Scholar
Kryger, MH, Roth, T, Dement, WC (editors) (2011). Principles and Practice of Sleep Medicine, 5th edn. Elsevier Saunders: St Louis Missouri.Google Scholar
Kryger, MH, Walld, R, Manfreda, J (2002). Diagnoses received by narcolepsy patients in the year prior to diagnosis by a sleep specialist. Sleep 25, 3641.Google Scholar
Mansukhani, MP, Kolla, BP, Surani, S, Varon, J, Ramar, K (2012). Sleep deprivation in resident physicians, work hour limitations, and related outcomes: a systematic review of the literature. Postgraduate Medicine 124, 241249.Google Scholar
Mezick, EJ, Hall, M, Matthews, KA (2011). Are sleep and depression independent or overlapping risk factors for cardiometabolic disease? Sleep Medicine Reviews 15, 5163.CrossRefGoogle ScholarPubMed
Mindell, JA, Owens, JA (2010). A Clinical Guide to Pediatric Sleep, Diagnosis and Management of Sleep Problems, 2nd edn. Lippincott Williams and Wilkins: Philadelphia, PA.Google Scholar
Morrison, I, Rumbold, JMM, Riha, R (2014). Medicolegal aspects of complex behaviours arising from the sleep period: a review and guide for the practicing sleep physician. Sleep Medicine Reviews 18, 249260.Google Scholar
National Sleep Foundation (2014). Sleep hygiene ( Accessed 17 April 2014.Google Scholar
Overeem, S, Reading, P (editors) (2010). Sleep Disorders in Neurology. A Practical Approach. Wiley-Blackwell: Oxford.Google Scholar
Pandi-Perumal, SR, Kramer, M (editors) (2010). Sleep and Mental Illness. Cambridge University Press: New York.Google Scholar
Peile, E (2010). A commentary on sleep education. In Sleep, Health, and Society from Aetiology to Public Health (ed. Cappucio FP, Miller M and Lockley SW), pp. 412416. Oxford University Press: Oxford.Google Scholar
Phaire, T ([1545] 1995). The Boke of Chyldren (Translated by A. V. Neale and H. R. E. Wallis) Livingstone: Edinburgh.Google Scholar
Pike, M, Stores, G (1994). Kleine-Levin syndrome: a cause of diagnostic confusion. Archives of Disease in Childhood 71, 355357.Google Scholar
Postuma, RB, Gagnon, JF, Vendette, M, Montplaisir, JY (2009). Idiopathic REM sleep behavior disorder in the transition to degenerative disease. Movement Disorders 24, 22252232.Google Scholar
Punjabi, NM (2008). The epidemiology of adult obstructive sleep apnea. Proceedings of the American Thoracic Society 5, 136143.Google Scholar
Putnins, SI, Griffin, ML, Fitzmaurice, GM, Dodd, DR, Weiss, RD (2012). Poor sleep at baseline predicts worse mood outcomes in patients with co-occurring bipolar disorder and substance dependence. Journal of Clinical Psychiatry 73, 703708.Google Scholar
Quera Salva, MA, Hartley, S, Barbot, F, Alvarez, JC, Lofaso, F, Guilleminault, C (2011). Circadian rhythms, melatonin and depression. Current Pharmaceutical Design 17, 14591470.Google Scholar
Schenck, CH, Arnulf, I, Mahowald, MW (2007). Sleep and sex: what can go wrong? A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences. Sleep 30, 683702.Google Scholar
Schweitzer, PK (2011). Drugs that disturb sleep and wakefulness. In Principles and Practice of Sleep Medicine, 5th edn. (ed. Kryger MH, Roth T, Dement WC), pp. 542560. Elsevier Saunders: St Louis, Missouri.Google Scholar
Sigurdardottir, LG, Valdimarsdottir, UA, Fall, K, Rider, JR, Lockley, SW, Schernhammer, E, Mucci, LA (2012). Circadian disruption, sleep loss, and prostate cancer risk: a systematic review of epidemiological studies. Cancer Epidemiology, Biomarkers & Prevention 21, 10021011.Google Scholar
Sigurdson, K, Ayas, NT (2007). The public health and safety consequences of sleep disorders. Canadian Journal of Physiology and Pharmacology 85, 179183.Google Scholar
Sivertsen, B, Lallukka, T, Salo, P, Pallesen, S, Hysing, M, Krokstad, S, Øverland, S (2014). Insomnia is a risk factor for ill health: results from a large population-based prospective HUNT Study in Norway. Journal of Sleep Research 23, 124132.Google Scholar
Smith, R, Ronald, J, Delaive, K, Walld, R, Manfreda, J, Kryger, MH (2002). What are obstructive sleep apnea patients being treated for prior to this diagnosis? Chest 121, 164172.Google Scholar
Stores, G (1998). Sleep paralysis and hallucinosis. Behavioural Neurology 11, 109112.Google Scholar
Stores, G (2009). Clinical sleep disorders associated with neurological and other medical illness. In New Oxford Textbook of Psychiatry, 2nd edn., Vol. 1, (ed. Gelder MG, Andreasen NC, López-Ibor JR and Geddes JR), pp. 931933. Oxford University Press: Oxford.Google Scholar
Stores, G (2010 a). Misdiagnosis of sleep disorders in adults and children: implications for clinical practice and epidemiology. In Sleep, Health, and Society from Aetiology to Public Health (ed. Cappucio FP, Miller M and Lockley SW), pp. 300324. Oxford University Press: Oxford.Google Scholar
Stores, G (2010 b). Dramatic parasomnias: recognition and treatment. British Journal of Hospital Medicine 71, 505510.Google Scholar
Stores, G (2014 a). Sleep and its Disorders in Children and Adolescents with a Neurodevelopmental Disorder. A Review and Clinical Guide. Cambridge University Press: Cambridge.Google Scholar
Stores, G (2014 b). Psychological disturbance associated with recurrent abnormal nocturnal events. British Journal of Hospital Medicine 75, 696700.Google Scholar
Thorpy, MJ (2000). Historical perspective on sleep and man. In Sleep Disorders and Neurological Disease (ed. Culebras A), pp. 136. Marcel Dekker: New York.Google Scholar
Turjanski, N, Lloyd, GG (2005). Psychiatric side-effects of medications: recent developments. Advances in Psychiatric Treatment 11, 5870.CrossRefGoogle Scholar
Williams, AN (2003). Thomas Willis’s practice of paediatric neurology and neurodisability. Journal of the History of the Neurosciences 12, 350367.Google Scholar
Wilson, S, Argyropoulos, S (2005). Antidepressants and sleep: a qualitative review of the literature. Drugs 65, 927947.CrossRefGoogle ScholarPubMed
Winkelman, JW, Johnson, EA, Richards, LM (2011). Sleep-related eating disorder. Handbook of Clinical Neurology 98, 577585.Google Scholar
Winkelman, JW, Plante, DT (editors) (2010). Foundations of Psychiatric Sleep Medicine. Cambridge University Press: New York.Google Scholar