German Journal of Psychiatry    ISSN 1455-1033

2000, Vol. 3, Supplement 1, S9

Nonorganic Insomnia in Panic Disorder: Comparative Sleep Laboratory Studies with Normal Controls and Placebo-Controlled Trials with Alprazolam

Gerda M. Saletu-Zyhlarz, Peter Anderer, Peter Berger, Georg Gruber, Stefan Oberndorfer, Bernd Saletu

Department of Psychiatry, School of Medicine, University of Vienna, Austria


70% of the patients of our outpatient clinic for sleep disorders were found to be suffering from nonorganic, 30% from organic sleep disorders (Saletu et al., 1997a). Within mental disorders related to sleep disorders, neurotic, stress-related and somatoform disorders were leading (41%), followed by affective disorders (31%) and mental and behavioral disorders due to psychoactive substance use (15%). Within the first group, anxiety disorders (F 41) amounted to 29.2%.

In this context we investigated objective and subjective sleep and awakening quality in 11 drug-free patients (4 females, 7 males) aged 30-55 years with nonorganic insomnia (F 51.0) related to panic disorder (F 41.0) as compared with 11 age- and sex-matched normal controls utilizing polysomnography (PSG) and psychometry. PSG demonstrated decreased sleep efficiency, total sleep time (TST) and S2 as well as increased middle and late insomnia, S1 and S3+S4. There were no intergroup differences in REM variables. Subjective sleep quality was deteriorated, as were drive and fine motor activity in the morning, while concentration was increased. These differences as compared with normals were distinct from those observed in other sleep disorders.

As compared with placebo, alprazolam induced changes that were opposite to the differences between patients and controls, thus normalizing sleep and awakening. As observed in insomnia related to GAD and subsequent benzodiazepine therapy, the present study also points to a key-lock principle in the treatment of insomnia due to anxiety disorders.