Sleep issues
While the occasional disturbance to our sleep is normal, long-term sleep issues are often a symptom of wider mental health issues, such as depression and anxiety. In turn, however, chronic sleep disturbances can also trigger mental health issues, or make them more severe.Lake, J. (2009). Integrative Mental Health Care. New York, NY: W.W. Norton and Co., p. 289.
Sleep issues fall into several different categories. Three of the most common are insomnia (an inability to fall asleep or stay asleep), hypersomnia (sleeping too much), and what are known as ‘night terrors’ (episodes of screaming, flailing and intense fear while still asleep).
Insomnia
Insomnia is the most common sleep issue. It prevents people from falling or staying asleep.NHS. (2015). ‘Insomnia’. [online] Available at: https://www.nhs.uk/Conditions/Insomnia/Pages/Introduction.aspx [accessed 31 Oct. 2017].
The symptoms of insomnia can include:
- Trouble falling asleep, whether initially, or after waking during the night
- Waking up several times during the night
- Rising too early in the morning
- Exhaustion whilst awake
- Irritability
- Poor concentration and attention
- Memory issues
- Anxiety
- Depression
- Mood swings
In severe cases, the sufferer may not be able to sleep for multiple days at a time.
Insomnia can be divided into different types.
‘Primary insomnia’, or ‘idiopathic insomnia’
Primary insomnia is ‘not attributable to a medical, psychiatric, or environmental cause’. Its defining symptoms are ‘difficulty initiating or maintaining sleep, or suffering from non-restorative sleep, for at least one month’.McVearry Kelso, C. (2014). ‘Primary insomnia’. [online] Medscape. Available at: http://emedicine.medscape.com/article/291573-overview [accessed 29 Sept. 2017]. If it lasts for several months, it can lead to mental health issues such as anxiety and depression.
‘Secondary insomnia’
By contrast, secondary insomnia is associated with and possibly caused by mental health issues such as anxiety or depression, or by other factors such as:
- Substance abuse
- Some medications (antidepressants, anti-anxiety pills, blood pressure pills)
- Bipolar disorder
- Cancer
‘Acute insomnia’
Acute insomnia refers to a phase of sleeping difficulty caused by a temporary change in circumstance, such as:
- Jet lag
- Moving house
- Changing job
- The end of a relationship, separation, or divorce
- The loss of a loved one
‘Chronic insomnia’
Chronic insomnia refers to a long-term state of disturbed sleep, usually defined as lasting three months or longer. Its causes include:
- Long-term stress
- Physical discomfort
- Anxiety
- ADD or ADHD
- Depression
- Negative thinking habits
To diagnose insomnia, a doctor will take a medical history and a record of your recent sleep. You can keep track of your sleep patterns by making a note of:
- How long you sleep each night
- How long it (roughly) takes you to fall asleep
- How often you wake up in the night
- What time you go to bed
- What time you get up the next day
Symptoms must persist for approximately three months before a diagnosis can be made.
There are several technical tools which can help you measure your sleep. Known as sleep trackers, these can be worn while you sleep and measure how long you spend in light, deep and REM sleep, and other variables which will help give you a comprehensive picture of your sleep patterns.
Hypersomnia
Hypersomnia is when the sufferer has trouble staying awake, and can sleep for long periods of time.
It can be extremely dangerous, as they risk falling asleep while driving or operating machinery.NHS. (2015). ‘Idiopathic hypersomnia’. [online] Available at: https://www.nhs.uk/conditions/hypersomnia/Pages/Introduction.aspx?nobeta=true [accessed 31 Oct. 2017].
It can diminish productivity and quality of life.
The symptoms of hypersomnia can include:
- Sleeping excessively (over ten hours a day)
- Feeling drowsy during the day
- Falling asleep at inappropriate times
Like insomnia, hypersomnia can be divided into a ‘primary’ or ‘idiopathic’ type (not associated with another disorder) and a ‘secondary’ type (linked to another disorder).
Secondary hypersomnia
Secondary hypersomnia is most frequently connected to ‘sleep apnea’. This is a condition where the sufferer experiences shallow breathing, or involuntary pauses in their breathing, during sleep.
Secondary hypersomnia may also be a symptom of the following issues:
- Depression
- Anxiety
- Bipolar disorder
As with insomnia, it can be caused by substance abuse, or certain kinds of medication.
As with insomnia, a doctor will diagnose hypersomnia by asking for a medical history and a record of your recent sleep. You can keep track of your sleep patterns by making a note of:
- How long you sleep each night
- How long it (roughly) takes you to fall asleep
- How often, and how long, you sleep during the day
- What time you go to bed at night
- What time you get up the next day
Symptoms must persist for approximately three months before a diagnosis can be made.
As with insomnia, there are several technical tools which can help you measure your sleep. Known as sleep trackers, these can be worn while you sleep and measure how long you spend in light, deep and REM sleep, and other variables which will help give you a comprehensive picture of your sleep patterns.
Night terrors
Night terrors are when the sufferer undergoes a state of fear and dread while being unable to wake up. They sometimes occur in tandem with sleepwalking.NHS. (2015). ‘Night terrors and nightmares’. [online] Available at: https://www.nhs.uk/conditions/night-terrors/Pages/Introduction.aspx [accessed 31 Oct. 2017].
Night terrors usually happen within the first three or four hours of sleep. Because the sufferer is asleep throughout, they differ from nightmares, which often wake us up.
This sleep issue is more common in children, but it can affect adults as well.
The symptoms of night terrors include:
- Screaming or shouting
- Making violent movements
- Heavy breathing, sweating, and crying
They may, in turn, cause problems such as anxiety. For instance, children who experience night terrors are often afraid of going to sleep.
Night terrors can be caused by a range of factors, including:
- Severe sleep deprivation
- High levels of stress
- A high temperature (especially in children)
- Breathing difficulties or asthma
- Head pain (headaches, migraines, head injuries such as concussion)
With the help of a partner, friend, or family member, you can record your night terrors by making a note of:
- How long they last
- Which symptoms you show during them
- What time you go to bed at night
- What time you get up the next day
You should seek medical attention if night terrors occur regularly for longer than a month.