Generalized anxiety disorder is a common anxiety disorder whose symptoms include both psychogenic and somatic anxiety. The disorder is characterized by anxiety symptoms and avoidance behaviors as the basic features of the mental disorder. Sleep disorders that accompany anxiety disorders are characterized by sleep onset insomnia or maintenance insomnia, due to excessive anxiety and apprehensive expectations about one or more life events. Waking with or without anxious dreamscapes occurs frequently. Contemplative meditative thoughts or acute anxiety attacks during the waking period in bed, not only at the beginning of sleep but also at waking. Very poor sleep occurs every night, and severe anxious depression may be present during the day.
Clinical manifestations of chronic anxiety are accompanied by shaking, muscle tension, restlessness, easy fatigue, shortness of breath, palpitations, tremors, sweating, dry mouth, dizziness, extreme nervousness, easy startling, and difficulty concentrating thoughts. Specific fears or personality traits that do not contribute to personal satisfaction and coping with stressful events in their lives may be added. It is less severe and longer-lasting when accompanied by major depression. It can also be accompanied by apprehension-related conditioned features due to poor sleep in a particular sleep environment or focused on the inability to sleep, but neither is its basic manifestation.
Generalized anxiety disorder sleep problem manifestations: insomnia occurs in 50-70% of patients with generalized anxiety. The main problems are difficulty falling asleep, difficulty maintaining sleep, and non-restful sleep. Compared to controls, generalized anxiety disorder presents with reduced sleep quality, increased sleep latency, reduced sleep duration, sad dreams, and morning mind disturbance. Reduced quality of life, decreased motivation, and poor mood in the morning and evening were reported for generalized anxiety disorder. Patients show psychomotor deficits, but attention, concentration and memory are relatively unaffected, suggesting that patients can compensate for sleep deficits
There are pharmacological treatments and adjunctive psychotherapy:
I. Pharmacological treatment
1, benzodiazepine anxiolytics, according to its half-life decision drugs. Since the improvement of sleep can significantly improve the symptoms of anxiety, so you can take low doses of medium-acting benzodiazepines before bedtime to improve sleep.
The main ones are: Clonidine, Lola, etc.
Drugs need to start in small doses and gradually increase the dosage. There is no consensus on the course of anxiolytic treatment for sleep disorders caused by generalized anxiety disorder.
2.β-blockers
Patients with anxiety have obvious somatic symptoms, such as palpitations, tachycardia, tremor and sweating, which are the result of sympathetic over-activity. beta-blockers such as TCA can slow down the heart rate, reduce the symptoms of sympathetic excitation and alleviate the somatic symptoms of anxiety, especially for those patients with prominent somatic symptoms.
3.Butrocyclone
It is a non-benzodiazepine anxiolytic drug, which has no hypnotic effect and therefore does not produce tolerance, somatic dependence and withdrawal symptoms. It can significantly relieve somatic anxiety symptoms, mainly effective for generalized anxiety, and has no significant effect on panic disorder and terror symptoms.
4.Antidepressant treatment
Generalized anxiety is often combined with other anxiety disorders, also combined with depression or in the chronic course of the disease, the chance of depression is also higher.
The relationship between generalized anxiety and depression can be co-morbid, or it is believed that they are different stages of development of depression, or generalized anxiety is a precursor symptom of depression.
Some new antidepressants have both anxiety and depression effects, and antidepressants are chosen for more severe anxiety. The advantage of using antidepressants for generalized anxiety is to reduce the patient’s dependence on benzodiazepines.
II. Psychotherapy
1.Supportive psychotherapy is helpful for patients with mild anxiety under the condition of good therapeutic relationship, sympathetic listening, and necessary explanation to ensure the relief of symptoms. This treatment helps to interrupt the vicious circle brought about by self-reinforcement of symptoms.
2.Relaxation therapy self-relaxation training, especially progressive muscle relaxation training and mental relaxation training, can help to relieve the mental and physical symptoms of anxiety.
3.Cognitive therapy self-monitoring of anxiety-inducing concepts, recording, observing cognitive styles, somatic reactions and emotional changes that accompany anxiety and learning to block and switch to rational cognitive styles.