16 These autonomic changes vary in amplitude depending on the

intensity of the arousal, but they may occur in response to minor stimuli producing no visible cortical effect, and they are resistant to habituation.17,18 Kupfer et al19 showed that depressed patients had significantly lower EEG power than control subjects in the delta band (0.5 to 2 Hz) and in a 4- to 10-Hz band (including theta and part of alpha activities) during the first 100 min of the sleep period. Over the whole night, a significantly lower EEG power was found in the depressed patient group compared with the Inhibitors,research,lifescience,medical control group, but only in the delta activity. Previously, Borbely et al20 suggested that it was intermittent wakefulness and microarousals in depressed patients that resulted in decreased delta amplitude. Increased phasic activity during rapid eye movement (REM) sleep, such as microarousals and body movements, has been also found in posttraumatic Inhibitors,research,lifescience,medical stress disorder.21,22 Awakenings Among arousals, a specific place should be reserved for those large arousals that lead to awakenings. While awakenings in Trametinib molecular weight normal subjects Inhibitors,research,lifescience,medical are relatively rare during the first sleep cycle, they appear to be more frequent in patients suffering from mental disorders.23 However, in contrast to healthy subjects and patients suffering from chronic schizophrenia,

episodes of wakefulness in the first sleep cycle do not increase the REM sleep latency in patients with major depression.24 Arousals constitute the basis for sleep fragmentation leading to Inhibitors,research,lifescience,medical daytime impairment.25 Sleep continuity problems are also quite a common complaint among patients with psychiatric disorders.26-29 Objective laboratory findings indicate that sleep is shortened and fragmented (due

to increased awakenings/arousals) in patients with mania,27 generalized anxiety disorder,28,30 panic disorder,26 obsessive-compulsive Inhibitors,research,lifescience,medical disorder,31 schizophrenia,29,31 posttraumatic stress disorder,31 and borderline personality disorders.31 Many studies have reported increased number of awakenings to be characteristic of posttraumatic stress disorder. However, experimental studies have found reduced thresholds for awakening, and particularly arousal thresholds using neutral tones from stages 3 and 4.32 Nightmares (stereotyped anxiety dreams) are generally associated with psychopathology33 and they are common isothipendyl in patients suffering from posttraumatic stress disorder.34,35 These anxious awakenings are related to REM sleep,21 but they can also be found in non-REM (NREM) sleep.36 The sleep of schizophrenic patients is profoundly disturbed in the acute phase of the illness, and nightmares often precede this phase.37 Depressed patients show prevalent sleep continuity disturbances (eg, frequent and prolonged awakenings together with longer sleep latency and diminished total sleep time), although not specific to affective disorders.