What are Sleep Disorders?

How Therapy Works

Goals of Therapy:

• Understand and change unhelpful sleep beliefs
• Improve sleep hygiene
• Reduce anxiety about sleep
• Establish consistent sleep routines
• Prevent relapse of sleep disturbances

Evidence-Based Therapies:

1. Cognitive Behavioral Therapy for Insomnia (CBT-I)
   • Gold-standard therapy for chronic insomnia
   • Target sleep-interfering beliefs and behaviors
   • Includes stimulus control, sleep restriction, and relaxation training
2. Mindfulness-Based Therapy for Insomnia (MBTI)
   • Combines mindfulness and cognitive techniques
   • Reduces sleep-related rumination and anxiety
3. Sleep Hygiene Education
   • Teaches proper sleep practices (e.g., regular schedule, no screens before bed, avoiding caffeine)
4. Relaxation Techniques
   • Incorporates techniques such as deep breathing, progressive muscle relaxation, and guided visualization.
5. Light Therapy

Helps reset circadian rhythms in conditions like delayed sleep phase disorder

Treatment for Sleep Disorders

Sleep Disorders are highly treatable with a combination of therapy, medication (where necessary), and lifestyle modifications.

1. Medication

Prescription based on individual needs and diagnosis:

• Sedative-hypnotics (e.g., zolpidem, eszopiclone) for short-term insomnia
• Melatonin or melatonin agonists for circadian rhythm disorders
• Dopaminergic agents for RLS
• CPAP (Continuous Positive Airway Pressure) for Sleep Apnea
• Stimulants for narcolepsy (e.g., modafinil)

2. Psychotherapy

Therapy helps modify sleep-disrupting thoughts and behaviors.

Assessment and Diagnosis

Clinical Interview and Sleep History

• Detailed evaluation of sleep patterns, duration, quality, and daytime symptoms
• Lifestyle, stressors, and sleep hygiene practices assessed

Diagnostic Criteria (DSM-5-TR or ICSD-3)

• Classification based on types, frequency, and impact on functioning

Psychological Assessments and Tools

• Epworth Sleepiness Scale (ESS)
• Insomnia Severity Index (ISI)
• Pittsburgh Sleep Quality Index (PSQI)
• Sleep logs or diaries

Medical Tests

• Polysomnography (Sleep Study): Monitors brain waves, oxygen levels, heart rate, and movement
• Actigraphy: Wrist-worn device tracking rest/activity cycles
• Blood Tests: To rule out thyroid or vitamin deficiencies
  

Causes of Sleep Disorders

Biological Factors

• Dysregulation in neurotransmitters (e.g., serotonin, GABA)
• Hormonal imbalances affecting circadian rhythm

Genetic Factors

• Family history of sleep disorders (e.g., narcolepsy, insomnia)

Psychosocial and Environmental Factors

• Stress and anxiety
• Trauma or PTSD
• Irregular sleep schedules or night shift work
• Substance use (caffeine, alcohol, drugs)

Poor sleep environment (noise, light, discomfort)

Signs & Symptoms

Sleep Disorders can manifest in various forms, each with distinct features, but common symptoms include:

Insomnia

• Difficulty falling asleep
• Frequent awakenings during the night
• Waking up too early
• Daytime fatigue or sleepiness
• Irritability, low mood, or concentration issues

Sleep Apnea

• Loud snoring
• Episodes of stopped breathing during sleep
• Morning headaches
• Gasping for air during sleep
• Excessive daytime sleepiness

Restless Legs Syndrome (RLS)

• Uncomfortable sensations in the legs (tingling, creeping)
• An urge to move legs, especially at night
• Sleep disruption due to movement

Narcolepsy

• Sudden sleep attacks during the day
• Excessive daytime sleepiness
• Cataplexy (sudden loss of muscle tone)
• Sleep paralysis or hallucinations

Parasomnias

• Nightmares
• Sleepwalking
• Night terrors

Confusion arousals

Types of Sleep Disorders

• Insomnia: Difficulty falling or staying asleep despite adequate opportunity.

• Obstructive Sleep Apnea (OSA): Breathing interruptions during sleep due to airway blockage.

• Restless Legs Syndrome (RLS): An Urge to move the legs during periods of rest.

• Narcolepsy:A  Neurological disorder affecting sleep-wake regulation.

• Circadian Rhythm Sleep-Wake Disorders: Misalignment between internal clock and external environment (e.g., shift work disorder).

• Parasomnias: Unusual sleep behaviors, including sleepwalking and night terrors.
  

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