51 Moreover, nocturnal panic could be differentiated from nocturnal seizures by the fact that, no LEG abnormality was demonstrated during nocturnal panic attacks and from sleep apnea because sleep apnea occurs mostly during stages 1 and 2, as well as during REM sleep, and is more repetitive than nocturnal panic.40 There are limited indications that subjects with frequent sleep panic attacks have

a severe form of panic disorder.37,38,52 More recent studies suggest that there are only few differences on measures of psychopathology and on sleep EEG between panic-disordered patients with and without sleep-related panic attacks.40,53 However, differences Inhibitors,research,lifescience,medical may be more subtle and evidenced by techniques such as measurement, of the autonomic nervous system (ANS) activity. For instance, Sloan et al54 used a. lactate infusion panicogenic challenge and heart, rate variability as a measurement, of ANS activity to demonstrate that ANS dysregulation during sleep is more pronounced in nocturnal panic patients than in daytime Inhibitors,research,lifescience,medical panic patients. This suggests a. more increased arousal level in nocturnal panic. On the basis of several observations,38,40,51 it, has been proposed that nocturnal panic is characterized by heightened distress to situations that involve loss of Inhibitors,research,lifescience,medical vigilance, such as sleep and relaxation, and that it. may represent. one particular version of panic disorder that, responds

just, as well as other forms of panic disorder to usual antipanic treatment.40 In this regard, the adjunction of cognitive-behavioral Inhibitors,research,lifescience,medical therapy to pharmacological agents will be particularly beneficial in patients with nocturnal panic, since

some patients can develop a conditioned fear or even an avoidance of sleep, which may cause further sleep deprivation and thus aggravate Inhibitors,research,lifescience,medical the condition. Generalized anxiety disorder A persistent state of anxiety, ie, lasting for at least 6 months, characterizes GAD. Anxiety and apprehensive expectation (“worry”) need to relate to a certain number of events and to be accompanied by additional symptoms belonging to a motor tension cluster (muscle tension; restlessness; and easy fatigability) or to a vigilance and scanning cluster (difficulty falling or staying NVP-BGJ398 purchase asleep; restless, unsatisfying Metalloexopeptidase sleep; difficulty concentrating; and irritability). According to DSM-IV,34 the diagnosis is not. made if the symptoms exclusively relate to another Axis I disorder. As sleep disturbances arc part, of the diagnosis requirement, a high prevalence of these symptoms is expected in GAD. For instance, in mental health epidemiological surveys, Ohayon et al55 found that, among subjects complaining of insomnia and having a primary diagnosis of mental disorder, GAD was the most prevalent, diagnosis. It. has been estimated that about. 60% to 70% of patients with GAD have insomnia complaint, whose severity parallels that, of the anxiety disorder,56,57 suggesting that insomnia could represent, one of the core symptoms of GAD.