Summary: Utilizing polysomnography (PSG) and psychometry, objective and subjective sleep and awakening quality was investigated in 11 patients with nonorganic insomnia (F51.0) related to a depressive episode (F32) or recurrent depressive disorder (F33) and 11 patients with nonorganic insomnia related to dysthymia (F34.1), as compared with 2 age- and sex-matched normal control groups. Both affective disorders demonstrated decreased sleep efficiency as well as prolonged sleep latency and an increased number of nocturnal awakenings. Moreover, in depression total sleep time was reduced and early morning awakening increased; in dysthymia there was an increase in wakefulness during the total sleep period (TSP). Concerning sleep architecture both patient groups showed an increase in S1, a decrease in S2 and a nonsignificant decrease in S3+S4, while SREM was significantly increased only in dysthymics. Also snoring was only increased in the latter, while the PLM index showed an increase in both groups. Subjective sleep and awakening quality as well as subjective well-being and mood were deteriorated in both groups. Drive was reduced only in depressed patients, affectivity and morning wakefulness only in dysthymics. Morning psychomotor activity was deteriorated in both groups, memory and reaction time variability only in dysthymic patients. Concerning psychophysiological variables, only depressed patients showed a significant increase in morning and evening systolic and diastolic blood pressure. In an acute, placebo-controlled cross-over design study, the acute effects of 100 mg trazodone, a serotonin reuptake inhibitor with sedative action due to 5-HT2 and
1 receptor blockade, were investigated in both patient groups. As compared with placebo, trazodone induced an increase in sleep efficiency, total sleep time (TST) and TSP as well as a decrease in wakefulness during the TSP and early morning awakening in depressed patients. Similar findings occurred in dysthymics, though the level of statistical significance was not reached. Concerning sleep architecture, a significant increase in slow-wave sleep (S3+S4) was seen in both groups. In depression S2 was significantly increased, in dysthymia SREM significantly decreased and REM latency significantly prolonged. The snoring index showed no significant changes, the apnea-hypopnea index was reduced in depression, the PLM index in dysthymia. Subjective sleep quality improved significantly in depression. There were no significant changes in the morning thymopsyche or noopsyche, except for an improvement of numerical memory in depression. Dysthymics exhibited a significant decrease in systolic blood pressure, while in depressives diastolic values were significantly decreased. In conclusion, both affective disorder groups showed significant changes in objective and subjective sleep and awakening quality as compared with normal controls, which were counteracted by trazodone 100 mg. This suggests a key-lock principle in regard to diagnosis and treatment of nonorganic insomnia due to affective disorder with this drug.

        Key words: nonorganic insomnia, depression, dysthymia, controls, polysomnography, subjective sleep quality, awakening quality, psychometry, trazodone.