Comorbid sleep and wake problems in treatment-resistant psychiatric conditions

Sleep and wake problems are comorbid in several psychiatric illnesses and are often important factors in treatment resistance. They are often experienced in clinical situations. For example, it is common to continue pharmacotherapy due to sleep problems, such as insomnia, after initial antidepressant treatment in depression. In chronic psychiatric disorders, sleep and related problems, such as insomnia, sleep apnea, restless legs syndrome, sleepiness, irregular circadian sleep-wake cycle, and prolonged and inappropriate hypnotic use, are commonly comorbid and often contribute to a treatment-resistant condition if not properly managed. Psychotropic medications frequently lead to sleep and wake problems in mental disorders. This review addresses the sleep and wake problems that are often comorbid in treatment-resistant psychiatric conditions and their cause and management.