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Behavioral Health

Troubled Sleep

Adequate sleep is essential to good health and well-being. Lack of sleep can have a powerful impact on your memory, ability to learn, think clearly, or feel and express emotions. It's not unusual to have changes in sleep patterns or trouble sleeping from time to time, but prolonged sleep trouble can be a sign of a more serious health condition or a need for a lifestyle change or medical intervention.

The National Sleep Foundation reports that chronic sleeping problems afflict as many as 70 million Americans, costing the nation billions in medical expenses, accidents and lost productivity each year. More than one in 10 Americans suffer from chronic insomnia, according to the study released by the Institute of Medicine, an arm of the National Academy of Sciences. There are some 80 different sleep disorders and while sleep research and care has expanded over the past several years, there is still much we do not know to adequately diagnose and treat all who suffer from these problems. If you or a loved one is experiencing troubled sleep, the self-help resources available here may provide some tips and resources. If sleep issues continue for longer than a month, it may be time to find out more about professional help options.

Identifying Sleep Disorders

If you have troubled sleep it does not necessarily mean that you have a Sleep Disorder. It is not uncommon to experience low-level or occasional sleeping difficulties during stressful periods of time without meeting criteria for a specific disorder.

Many people have troubled sleep including:

  • Problems falling and staying asleep
  • Problems staying awake
  • Problems with adhering to a regular sleep schedule
  • Sleep-disruptive behaviors (e.g., nightmares)1

According to the Diagnostic and Statistical Manual of Mental Disorders, Edition 4, which is the handbook used most often in diagnosing mental disorders, Primary Sleep Disorders are diagnosed when sleep problems cannot be attributed to another mental disorder, a general medical condition, or use of a substance. Secondary Sleep Disorders are sleep problems that are associated with medical, neurological, or substance misuse disorders.1 There are two categories of Primary Sleep Disorders: Dyssomnias and Parasomnias.

Types of Dyssomnias

These disorders involve difficulty initiating sleep (falling asleep), maintaining sleep (staying asleep), or sleeping too much. These disorders cause disruptions in the amount, quality or timing of sleep.

Primary Insomnia: The essential feature of Primary Insomnia is difficulty falling or staying asleep, or nonrestorative sleep (sleep was light, restless, or of poor quality). People with Insomnia often become distressed about their difficulties, which in turn impacts their ability to sleep. In order to meet diagnostic criteria for Primary Insomnia these symptoms must be present for at least one month, and must cause significant distress or impairment in functioning. Physical illness, depression, anxiety or stress, poor sleep environment (physical discomfort, too much light), alcohol or other drugs (especially caffeine), certain medications, heavy smoking, and counterproductive sleep habits (e.g., daytime napping, early bedtimes, excessive time spent awake in bed) can impact insomnia.1

Primary Hypersomnia: The essential feature of Primary Hypersomnia is excessive sleepiness. People with Primary Hypersomnia often take long naps (an hour or more) that do not lead to improved alertness or feeling refreshed. Also, people can inadvertently fall asleep during low-stimulation and low-activity situations, such as attending a lecture, reading, watching television, or taking a long drive. In order to meet diagnostic criteria for Primary Hypersomnia these symptoms must be present for at least one month, and must cause significant distress or impairment in functioning. More

Narcolepsy: The essential features of Narcolepsy are repeated irresistible attacks of refreshing sleep. Sleepiness usually decreases after the attack, but returns several hours later. In order to meet DSM-IV criteria for Narcolepsy, these symptoms must occur daily over at least a three month period. Also, one or more of the following must be present:

  • Attacks of cataplexy, which are episodes of muscular weakness. Signs of cataplexy may include a barely perceptible slackening of the facial muscles to the dropping of the jaw or head, weakness at the knees, or total collapse on the floor. More
  • Recurrent intrusions of elements of rapid eye movement (REM) sleep into the transition between sleep and wakefulness as evidenced by hallucinations or paralysis at the beginning or end of sleep episodes.

Breathing-Related Sleep Disorder: The essential feature of Breathing-Related Disorder is sleep disruption caused by breathing abnormalities that lead to excessive sleepiness or insomnia. Sleep apnea and central alveolar hypoventilation syndrome are examples of this disorder. Sleep apnea is most common in obese young adult males, but it may affect anyone with a short neck or a small jaw, regardless of weight.1

Circadian Rhythm Sleep Disorder: The essential feature of Circadian Rhythm Sleep Disorder is a persistent or recurrent pattern of sleep disruption that leads to insomnia or excessive sleepiness that is caused by a mismatch between the sleep-wake schedule required by a person's environment and his or her circadian sleep-wake pattern. For instance, some "night owls" have a difficult time falling asleep at socially acceptable times, and therefore have difficulty awakening on time for work or school. More.

Types of Parasomnias:

Parasomnias are sleep disorders involving abnormal behavioral or physiological events associated with sleep, specific sleep stages, or sleep-wake transitions. Specifically, the autonomic nervous system (system that controls involuntary actions of internal organs), motor system, or cognitive processes are activated at inappropriate times during the sleep-wake cycle. People with these disorders usually complain of unusual behavior during sleep rather than insomnia or sleepiness during the day.

Nightmare Disorder: The essential feature of Nightmare Disorder is repeated nightmares that lead to awakenings from sleep. People are able to recall their dreams in detail. The content of dreams usually involves threats to survival, security, or self-esteem. Unlike Sleep Terror Disorder, individuals with Nightmare Disorder quickly become oriented and alert when they awaken. Since nightmares are common, dream experiences or sleep disturbances caused by awakening must cause significant distress or impairment in functioning in order to meet criteria for Nightmare Disorder.

Sleep Terror Disorder: The essential feature of sleep terror disorder is the repeated occurrences of abrupt awakenings from sleep usually beginning with a panicky scream or cry. Sleep terrors are sometimes mistaken for nightmares, however they occur during deeper stages of sleep and are not manifestations of a dream.2 These episodes last usually one to ten minutes and are accompanied by:

  • Intense fear and signs of autonomic arousal, such as rapid heart beat and breathing, and sweating during each episode.
  • Relative unresponsiveness to efforts of others to comfort the person during the episode.
  • No detailed dream is recalled and there is amnesia (no memory) of the episode.
  • Additionally, episodes must cause significant impairment in functioning or distress.

Sleepwalking Disorder: The essential feature of Sleepwalking Disorder is repeated episodes of rising from bed and walking about, which is initiated during sleep. Other symptoms:

  • While sleepwalking the person has a blank, staring face and is relatively unresponsive to the efforts of others to communicate with him or her. Awakening the individual is very difficult.
  • When the individual awakens he or she has amnesia for the episode (i.e., does not remember it).
  • Within several minutes after awakening from the sleepwalking episode there is no impairment of mental activity or behavior, although the person might initially be confused or disoriented.
  • Sleepwalking must cause significant distress or impairment in functioning.

Sleeping difficulties are sometimes symptoms of other disorders. For example, people who suffer from depression may have trouble falling or staying asleep (insomnia), or may sleep too much (hypersomnia). People experiencing Posttraumatic Stress Disorder may have nightmares.

If you think you might be suffering from a Sleep Disorder, take this Sleep Self Assessment Quiz.

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