|
Sleep Disorders
Dyssomnias
(Insomnia)
- difficulty initiating or maintaining sleep
- distress
- impairment in normal functioning
- non-restorative sleep
- condition persists for at least one month
- not due to any other physical condition or substance use
Hypersomnia
- excessive, prolonged sleeping episodes
- daytime sleeping
- distress
- impairment in normal functioning
- condition persists for at least one month
- not due to any other physical condition or substance use
Narcolepsy
- daily irresistible attacks of refreshing sleep
- condition persists for three months
- cataplexy (episodes of sudden loss of bilateral muscle
tone, often in association to intense emotion)
- not due to any other physical condition or substance use
Breathing-related Sleep Disorder
- sleep disruption
- sleep-related breathing condition (sleep
apnea,
sleep-related hyperventilation)
- not due to any other physical condition or substance use
Circadian Rhythm Sleep Disorder
- persistent and recurrent sleep disruption
- insomnia or hypersomnia
- disruption in sleep-wake pattern
- distress
- impairment in normal functioning
- not due to any other physical condition
Somnambulism (Sleepwalking
Disorder)
- Repeated episodes of rising from bed and walking about.
- Blank, staring expression.
- Unresponsive to other's efforts to awaken or communicate
with them
- Amnesia about episode on awakening
Adapted
from:
Diagnostic and Statistical Manual of Mental Disorders. Vol. IV
American Psychiatric
Association. 1994
Sleep is a part of our everyday life. Most
of the time we take it for granted. If we do find that we can't sleep, it
can be quite upsetting. At some point in our lives, most of us will find
it hard to sleep. It's often just for a short time and may be due to worry
or excitement. After a few days things settle down and we find we are able
to sleep well again. If we carry on sleeping badly, we may need some extra
help to get our sleep back to normal. Poor sleep, or insomnia, is a common
and distressing symptom. It often leads people to consult their doctor.
Usually we sleep badly because of ordinary, everyday reasons, but
sometimes it can be caused by a more serious problem.
While we sleep, we are not aware that
anything is happening to us. However, a lot of important things happen to
our body while we sleep. Sleep keeps us healthy.
We sleep in different ways at different
times of the night. One of the most important types of sleep is called
Rapid Eye Movement (REM) sleep. It comes and goes throughout the night and
takes up around one fifth of our sleep time. During REM sleep, our brain
is very active, our eyes move quickly from side to side and we dream. The
rest of the time, during non-REM sleep, the brain is quiet, but hormones
are released into the bloodstream and our body repairs itself after the
wear and tear of the day.
This depends mainly on our age and how much
exercise we get. Babies sleep for about 17 hours each day but older
children only need 9 or 10 hours a night. In adult life, most of us need
between 7 and 8 hours sleep each night, but we need less as we get older.
There is a lot of difference between different people of the same age, and
some people can manage on only three hours a night. Most of us can't do
this. If we go without the sleep we need for any length of time, we become
drowsy and can't concentrate on things. As we get older, we do need less
sleep. If we take naps during the daytime, we are more likely to wake at
night.
It's very natural to worry when you can't
sleep. You may feel dreadful, but the occasional night without sleep has
very little effect on our physical or mental health. However, after
several sleepless nights, you start to feel tired and may find yourself
dropping off to sleep during the day. You will find it more difficult to
make decisions and may start to feel depressed. This can be extremely
dangerous if you are driving or operating heavy machinery. People falling
asleep at the wheel while driving cause many deaths each year.
Insomnia
People often complain that they are not getting enough sleep or that,
although they sleep, their sleep is not satisfying. Quite often, people
actually sleep much more than they imagine. This is because the short
periods of wakefulness feel much longer than they really are.
There are many common things in everyday
life that can make it difficult to sleep. Your bedroom may be too noisy,
the bed may be uncomfortable or too hot or too cold. You may not have a
regular routine or you may not be getting enough exercise. If you eat too
much you may find it difficult to get off to sleep, if you are hungry you
may find yourself waking too early. Cigarettes, alcohol and drinks
containing caffeine, such as tea and coffee, will also disturb your sleep.
We often sleep badly if we are in pain or running a high temperature.
However, if you carry on sleeping badly, it
may be caused by more serious problems. These can be emotional problems,
difficulties at work or sometimes more serious psychological problems. For
instance, if you are very anxious, you will probably find it difficult to
get off to sleep. If you become depressed, you may find yourself waking
very early in the morning, and may not be able to get back to sleep again.
Can drugs help?
People have used sleeping tablets for many years, but we now know that
they don't work for very long. They tend to make you tired and irritable
the next day. They lose their effect quite quickly, so you have to take
more and more to get the same effect, which is one reason why some people
become addicted to them. The longer someone takes sleeping tablets for,
the more likely they are to become dependent on them. Sleeping tablets
should only be used for short periods, for instance when someone is so
distressed that they cannot sleep at all.
Substances to avoid
Alcohol affects us like sleeping tablets and tranquilizers - you
should avoid using it if possible. Slimming tablets make it hard to sleep,
as do street drugs like Ecstasy, cocaine and amphetamines.
If you have trouble sleeping, here are some
simple tips that will help you get a good night's rest.
- Don't go without sleep for a long time -
keep to a regular pattern of going to bed and getting up at the same
time every day, whether you are tired or not.
- Make sure that your bed and bedroom are
comfortable - not too hot, not too cold, not too noisy.
- Make sure that your bed is properly
supportive. It should not be so firm that your hips and shoulders are
under pressure or so soft that your body sags. Generally, you should
replace your bed roughly every 10 years to maintain optimum support
and comfort.
- Get some exercise. Don't overdo it but
try some regular swimming or walking.
- Cut down or stop drinking tea or coffee
in the evening. Try a milk drink instead.
- Don't drink a lot of alcohol. It may
help you fall asleep, but you will almost certainly wake up during the
night.
- Don't eat or drink a lot late at night.
Try to have your evening meal early rather than late.
- If you've had a bad night, resist the
temptation to sleep the next day - it will make it harder to get off
to sleep the following night.
- Take some time to relax properly before
going to bed.
- If something is troubling you and there
is nothing you can do about it right away, try writing it down before
going to bed and then tell yourself to deal with it tomorrow.
- If you can't sleep, don't lie there
worrying about it. Get up and do something you find relaxing. Read,
watch television or listen to quiet music. After a while you should
feel tired enough to go to bed again.
- If you still aren't sleeping after
trying all these tips, go and see your doctor. You can talk over any
problems that may be stopping you from sleeping. Your doctor can make
sure that your sleeplessness is not being caused by a physical
illness, prescribed medicine, or emotional problems.
Sleeping at the wrong time?
Sometimes we just have to stay awake when
we would normally be asleep. If we only have to do this from time to time,
we adjust quite easily. It is much more difficult when we have to do this
a lot. Shift workers, doctors working all night or nursing mothers may all
find this difficult. People in these situations often find themselves
sleeping at times when they ought to be awake. This is similar to jet lag,
where rapid travel between time zones means that you find yourself awake
when everybody else is asleep.
A good way to get back to normal is to make
sure that you wake, quite early, at the same time every morning. It
doesn't matter how late you fell asleep the night before. Use an alarm
clock to help you. Make sure that you don't go to bed again before about
10 o'clock that night. If you do this for a few nights, you should soon
start to fall asleep naturally at the right time.
Sleeping too much?
You may find that you often fall asleep
during the day, although you want to stay awake. The commonest reason is
lack of sleep at night. People sometimes fall asleep as a way of escaping
from the pressures of everyday life. However, if this goes on for more
than a few days, it may be caused by a physical illness of some sort. This
could be diabetes, a viral infection, or a thyroid problem.
There are also two unusual conditions that
make people sleep too much.
Narcolepsy
A person with narcolepsy will suffer sudden and uncontrollable attacks of
sleepiness in the daytime, sometimes in public. They may feel as though
they can't move their body and may see or hear strange things as they are
falling asleep. They may also have the alarming experience of suddenly
collapsing when they are angry, laughing or excited.
Sleep Apnea
The main symptom is loud snoring. Of course, this may seem to be more of a
problem for the person sharing the bed than the person snoring! However,
Sleep Apnea can be a serious condition. The sufferer not only snores
loudly, but also stops breathing for short periods of time during the
night. Every time this happens, they wake for a short time before falling
off to sleep again. Understandably, they feel tired the next day. It is
more common in older people and in those who are overweight.
Sleepwalking and Night Terrors
At some point in their life, about 1 in 20 adults experience night
terrors and 1 in 100 report that they sleepwalk. Both these conditions are
more common in children.
Someone who sleepwalks will appear to wake
from the deepest stage of sleep. They then get up and may do some quite
complicated things, like walking around or going up and down stairs. This
may land them in embarrassing (and occasionally dangerous) situations.
Unless someone else wakes them, they will remember nothing about it the
next day. Sometimes a person may sleepwalk after experiencing a night
terror (see below).
A sleepwalker should be guided gently back
to bed and should not be woken up. It may be necessary to take precautions
to protect a sleepwalker or others from injury. You may need to lock doors
and windows, or lock away sharp objects, like knives and tools.
Night terrors can occur on their own,
without leading to sleepwalking. Like a sleepwalker, a person with night
terrors will appear to wake suddenly from a deep sleep. They look only
half-awake, are obviously very frightened, but will often settle down to
sleep again without waking up completely. People with night terrors don't
seem to remember anything about it when they wake up in the morning, so
they are not just having vivid dreams, or nightmares.
Nightmares
Most of us have had frightening dreams or nightmares. They usually
happen during the later part of the night, when we have our most vivid and
memorable dreams. They do not normally cause problems unless they happen
regularly. This is usually due to emotional difficulties. Nightmares often
follow a distressing or life-threatening event such as bereavement, a
disaster or a violent attack. Counseling may help.
back to psychdisorders |
