Sleep disorders

Although sleep is crucial to human functioning, some individuals find that they have a sleep disorder, which means that their normal sleeping patterns are interrupted, with some disorders even being severe enough to warrant inclusion in the Diagnostic and Statistical Manual for Mental Illnesses (DSM), such is the impact that they have on the person’s life.

Sleep disorders are classed as primary and secondary. Primary sleep disorders are not related to any other problem but are classed as a problem themselves, for example anything related to going to sleep, staying asleep or waking up. Secondary sleep disorders are those which are related to another issue, such as jet lag or chronic pain, both of which can interrupt a normal sleep pattern either short or long term.

The sleep disorders, which you might be asked about in the exam, are:

• Insomnia
• Narcolepsy

Insomnia

Insomnia is the most common of all sleep disorders, thought to affect almost everyone at some point in their life. Insomnia means that an individual has problems going to sleep and/or staying asleep. It is classed as a disorder when its effects mean that the lack of sleep that it causes is having a significant impact on an individual’s ability to go about their daily activities.

According to the NHS, an individual is thought to be experiencing insomnia when they experience any of the following symptoms:

• Finding it difficult to fall asleep
• Lying awake for long periods at night
• Waking up several times during the night
• Waking up early in the morning and not being able to get back to sleep
• Not feel refreshed when you get up
• Finding it hard to nap during the day, despite feeling tired
• Feeling tired and irritable during the day and have difficulty concentrating

Individuals may experience these symptoms for a short period of time, such as a few days, or they may go on for much longer, and in this instance the individual is much more likely to be classed as having a sleep disorder.

Explanations for the causes of insomnia cannot determine that it is caused by a single factor but the following are thought to contribute to this specific sleep disorder:

• Stress and anxiety
• A poor sleeping environment, such as too warm, too light or too noisy
• Lifestyle factors, such as working shifts, having jet lag or having too much caffeine late in the evening
• Mental health conditions such as depression
• Physical health conditions, especially those which cause pain
• Certain types of medication, such as antidepressants or steroids

Insomnia can be difficult to treat but individuals are encouraged to make positive changes to their lifestyle and to try and relax before going to bed. In some cases, individuals can take medication to help them sleep but this is not advised as a long-term solution. In some cases, individuals may benefit from counselling or therapy to determine if there is a specific reason why they are having problems with sleeping. If symptoms persist, they may be seen in a sleep clinic where professionals who specialise in sleep disorders may be able to help them.

Narcolepsy

Narcolepsy is classed as a parasomnia, which is a condition that occurs when someone is asleep. It is a condition which causes an individual to fall asleep at inappropriate times because their sleep-wake pattern is not properly regulated. It is a rare condition and only thought to affect approximately 25,000 people within the UK.

Symptoms of narcolepsy include:

• Excessive daytime sleepiness – feeling very drowsy throughout the day, and having difficulty concentrating and staying awake
• Sleep attacks – falling asleep suddenly and without warning
• Cataplexy – temporary loss of muscle control resulting in weakness and possible collapse, often in response to emotions such as laughter and anger
• Sleep paralysis – a temporary inability to move or speak when waking up or falling asleep
• Excessive dreaming and waking in the night – dreams often come as you fall asleep (hypnogogic hallucinations) or just before or during waking (hypnopompic hallucinations)

Explanations for the causes of narcolepsy are not definite but one or more of the following factors is thought to be involved:

• A lack of the brain chemical hypocretin, which is crucial in the regulation of wakefulness
• Hormonal changes
• Major psychological stress
• An infection or the medication used to treat an infection

There is currently no cure for narcolepsy but some things are thought to help with its symptoms including encouraging individuals to reduce their stress levels, taking brief, regular naps during the day and keeping to a strict bedtime routine. Medication can also help but, like with insomnia, this is not advised as a long-term solution to the condition.