Sleep Disorders

Sleep and mental disorders: A meta-analysis of polysomnographic research. Baglioni C, Nanovska S, Regen W, Spiegelhalder K, Feige B, Nissen C, Reynolds CF, Riemann D. Psychol Bull. 2016 Sep;142(9):969-990. Epub 2016 Jul 14.

Controlled PSG studies evaluating sleep in affective, anxiety, eating, pervasive developmental, borderline and antisocial personality disorders, attention-deficit-hyperactivity disorder (ADHD), and schizophrenia were included. Sleep alterations were evidenced in all disorders, with the exception of ADHD and seasonal affective disorders. Sleep continuity problems were observed in most mental disorders. Sleep depth and REM pressure alterations were associated with affective, anxiety, autism and schizophrenia disorders. Comorbidity was associated with enhanced REM sleep pressure and more inhibition of sleep depth. No sleep parameter was exclusively altered in 1 condition; however, no 2 conditions shared the same PSG profile. Sleep continuity disturbances imply a transdiagnostic imbalance in the arousal system likely representing a basic dimension of mental health. Sleep depth and REM variables might play a key role in psychiatric comorbidity processes. Constellations of sleep alterations may define distinct disorders better than alterations in 1 single variable.

Relative Treatment Rates for Sleep Disorders and Sleep Disturbances Following Abortion and Childbirth: A Prospective Record-Based Study. Reardon, D.C. and Coleman, P.K. (2006) Sleep, 29, 105-106.

Sleep disorders are linked with mood disorders and other psychiatric illnesses. Many women attribute sleep difficulties to abortion, but this self-diagnosis has not been tested using record-based evidence. Examination of records for 56,824 women with no known history of sleep disorders or sleep disturbances revealed that women were more likely to be treated for sleep disorders or disturbances following an induced abortion compared to a birth. The difference was most pronounced in the first 180 days after pregnancy resolution and was not significant after the third year.

Resolution of unwanted pregnancy during adolescence through abortion versus childbirth: Individual and family predictors and psychological consequences. Coleman P. J Youth Adolesc. 2006.

Adolescents with a history of abortion were approximately four times more likely to report frequent problems sleeping compared to those who carried to term.

The psychosocial outcome of induced abortion. Ashton JR. Br J Obstet Gynaecol. 1980;87(12):1115-1122.

Eight weeks post-abortion (52% participation), 36% had sleeping difficulties and 44% had trouble with their nerves. Both sleep disorders and nervous trouble were associated with higher neuroticism scores.

"Emotional Distress Patterns Among Women Having First or Repeat Abortions," E. Freeman, K. Rickels, G.R. Huggins, C. Garcia and J. Polin, Obstetrics and Gynecology 55(5): 630, May 1980

Some 413 women between the ages of 14-40 who underwent first trimester abortions at the University of Pennsylvania in 1977-78 were rated on emotional symptoms on pre- abortion and post-abortion tests. Some 35% of the women were repeating abortions. Seventy percent of the women undergoing a first abortion were black and 93% of the women undergoing a repeat abortion were black. Post-abortion scores of emotional distress of repeat abortion patients compared with women who had a first-time abortion were significantly higher on interpersonal sensitivity, paranoid ideation, phobic anxiety and sleep disturbance.

The Long-Term Psycho-social Effects of Abortion, Catherine A. Barnard (Portsmouth, N.H.: Institute For Pregnancy Loss, 1990).

Some 18.8% of women who had undergone induced abortion 3-5 years previously reported all Post Traumatic Stress Syndrome criteria (DSM-III R). Some 39-45% of women still had sleep disorders, hyper-vigilance and flashbacks of the abortion experience. Some 16.9% had high intrusion scores and 23.4% had high avoidance scores on the Impact of Events Scale. Women showed elevated scores on the MCMI test in areas of histrionic, anti-social narcissism, paranoid personality disorder and elevated anxiety compared with the sample on which the test had been normal.

Associations of Pregnancy Loss and Psychological State. Serapinas D. Health Sciences 25(2):4-8, 2015. doi:10.5200/sm-hs.2015.021

Summary: Miscarriage and induced abortion are life events that can potentially cause mental distress. The objective of this study was literature review and to perform case study to determine whether there are any differences in the patterns of psychological symptoms after these two events and to point the importance of informed consent. In our study 20 women who experienced miscarriages and 20 women who underwent induced abortions were interviewed in Vilnius out patients clinics. We found that women who had pregnancy termination had more mental distress than women who experienced a miscarriage (guilty, anxiety, anger, episodes of crying etc). In abortion group 16 women mentioned that after event their sleep become more disturbed (insomnia, nightmires), while in control group 12 had such problems (p>0.05)."

Association of Poor Subjective Sleep Quality With Risk for Death by Suicide During a 10-Year Period: A Longitudinal, Population-Based Study of Late Life. Bernert RA, Turvey CL, Conwell Y, Joiner TE, Jr. JAMA Psychiatry. Published online August 13, 2014. doi:10.1001/jamapsychiatry.2014.1126.

Importance Older adults have high rates of sleep disturbance, die by suicide at disproportionately higher rates compared with other age groups, and tend to visit their physician in the weeks preceding suicide death. To our knowledge, to date, no study has examined disturbed sleep as an independent risk factor for late-life suicide.

Objective To examine the relative independent risk for suicide associated with poor subjective sleep quality in a population-based study of older adults during a 10-year observation period.

Design, Setting, and Participants A longitudinal case-control cohort study of late-life suicide among a multisite, population-based community sample of older adults participating in the Established :Populations for Epidemiologic Studies of the Elderly. Of 14 456 community older adults sampled, 400 control subjects were matched (on age, sex, and study site) to 20 suicide decedents. Main Outcomes and Measures Primary measures included the Sleep Quality Index, the Center for Epidemiologic Studies–Depression Scale, and vital statistics.

Results Hierarchical logistic regressions revealed that poor sleep quality at baseline was significantly associated with increased risk for suicide (odds ratio [OR], 1.39; 95% CI, 1.14-1.69; P < .001) by 10 follow-up years. In addition, 2 sleep items were individually associated with elevated risk for suicide at 10-year follow-up: difficulty falling asleep (OR, 2.24; 95% CI, 1.27-3.93; P < .01) and nonrestorative sleep (OR, 2.17; 95% CI, 1.28-3.67; P < .01). Controlling for depressive symptoms, baseline self-reported sleep quality was associated with increased risk for death by suicide (OR, 1.30; 95% CI, 1.04-1.63; P < .05)

Conclusions and Relevance Our results indicate that poor subjective sleep quality is associated with increased risk for death by suicide 10 years later, even after adjustment for depressive symptoms. Disturbed sleep appears to confer considerable risk, independent of depressed mood, for the most severe suicidal behaviors and may warrant inclusion in suicide risk assessment frameworks to enhance detection of risk and intervention opportunity in late life.

"Induced Elective Abortion and Perinatal Grief," Gail B. Williams, Dissertation Abstracts Int'l. 53(3): 1296B, Sept. 1992.

A study of 83 white women with one first trimester abortion, no documented psychiatric history and no self-reported prenatal losses in the last 5 years an average of 11 years postabortion. The Grief Experience Inventory was used as a test instrument and found a range of scores from 27-82. 50 represents at least minimal grief on 12 bereavement/research scales. Various scales measured included anger/hostility, social isolation, loss of control, death anxiety, loss of vigor, physical symptoms, dependency, somatization, sleep disturbance, loss of appetite, optimism/despair, denial. It was concluded that some women experienced persistence of various aspects of grief for long periods of time following induced abortion.

"Repeat Abortion: Is It A Problem?," C. Berger, D. Gold, D. Andres, P. Gillett and R. Kinch, Family Planning Perspectives, 16(2):70-75, March/April 1984,

Medical and counseling personnel are troubled by women who come back to their facilities for a repeat abortion. Counseling deficiencies, possible negative media coverage, unclear long-term effects on future child bearing are some of the reasons for concern. This study of Canadian women found that repeaters were more tolerant of abortion than women having a first abortion; they also had intercourse more frequently than first-time abortion patients [average 11 times per month versus 8 times per month]. Women having repeat abortions were slightly more likely to have been using contraceptives at the time they became pregnant. Repeaters described their relationships as being less satisfactory than first-time patients. More repeaters than first-time patients said they had made the decision by themselves [45 percent vs. 33 percent]. Repeaters reported fewer physical complaints but had more difficulty sleeping.

"Emotional Distress Patterns Among Women Having First or Repeat Abortions," Ellen Freeman, Obstetrics and Gynecology 55(5):630-636, May 1980

Repeat abortion patients showed significantly higher distress scores on interpersonal sensitivity, paranoid ideation, phobic anxiety and sleep disturbance, compared with controls. Repeaters also showed a trend in higher scores in somatization, hostility and psychoticism.

"Repeat Abortions-Why More?," Christopher Tietze, Family Planning Perspectives, 10(5):286-288, September/October 1978,

Repeaters tended to have more frequent intercourseless satisfying relationships, and more difficulty sleeping. They were less likely to live with their partners. (Women with prior abortion were almost 4 times more likely to have repeat abortion compared to women having an abortion for the first time.