Sleep Disorders

insomniaPrimary Sleep disorders are divided into two subcategories: Dyssomnias are those disorders relating to the amount, quality, and timing of sleep. Parasomnias relate to abnormal behaviour or physiological events that occur during the process of sleep or sleep-wake transitions. We use the term primary to differentiate these sleep disorders from other sleep disorders that are caused by outside factors, such as another mental disorder, medical disorder, or substance use. Sleep difficulties might not appear as mental health issues (or disorders). However, it is part of the holistic approach of CBT psychological intervention to address sleep problems and to teach relevant skills. We know that the lack of restorative sleep can aggravate and even cause other difficulties (e.g. depression, anxiety, pain) and therefore we will always include sleep improving strategies into our treatment package.

Please remember that the definitions and criteria for diagnoses are constantly evolving and changing (the DSM-IV has been revised several times and is in revision right now). Therefore you will find that not all professionals will agree all the time in regards to certain diagnoses. Thus, we would like to repeat and stress again that it is most important how much YOU are bothered by certain issues, feelings, behaviours and reactions and how much YOU perceive that these interfere in your life. This is where the personal, open and honest discussion with your individual psychologist will be so important and crucial in order to help you to find a way forward in YOUR life (irrespective of diagnosis or not).

Primary Insomnia

The criteria for a diagnosis of primary insomnia include a difficulty falling asleep, remaining asleep, or receiving restorative sleep for a period no less than one month. This disturbance in sleep must cause significant distress or impairment in social, occupational, or other important functions and does not appear exclusively during the course of another mental or medical disorder.

Primary Hypersomnia

The criteria for primary hypersomnia include excessive sleepiness for at least one month as evidenced by prolonged sleep at night or excessive daytime sleep. This must cause significant distress or impairment for the individual.

Sleep Apnea

Breathing-Related Sleep Disorder, also known as Sleep Apnea, causes the sufferer to stop breathing during the night for periods lasting from 30 seconds to 2 minutes. This may happen as much as 400 times per night. Sleep Apnea is a serious, potentially life-threatening condition that is far more common than generally understood. There are two types of Sleep Apnea: central and obstructive. Central Sleep Apnea, which is less common, occurs when the brain fails to send the appropriate signals to the breathing muscles to initiate respirations. Obstructive Sleep Apnea is far more common and occurs when air cannot flow into or out of the person’s nose or mouth although efforts to breathe continue. These breathing pauses are almost always accompanied by snoring between apnea episodes, although not everyone who snores has this condition. Sleep Apnea can also be characterized by choking sensations. The frequent interruptions of deep, restorative sleep often leads to excessive daytime sleepiness and may be associated with early morning headaches.

Narcolepsy

Narcolepsy is diagnosed when an individual has repeated sudden occurrences of sleep for a period of at least three months. To be diagnosed, at least one of the following must be present: cataplexy (brief episodes of sudden loss of muscle tone) and REM intrusions (REM sleep occurs at unexpected times and results in hallucinations or sleep paralysis).

Nightmare Disorder

This disorder is typified by repeated awakenings from sleep with detailed recall of frightening dreams. These dreams are typically vivid and quite extended and usually include threats to survival, security, or self-esteem. Often there is a recurrence of the same or similar themes. The dream experience or the sleep disturbance resulting from the awakenings causes significant distress.

Sleep Terror Disorder

When a person awakens from a dream crying or screaming, they may be experiencing Sleep Terror Disorder. Usually the person is difficult to wake-up and the episode may last several minutes. Once awakened, the individual is confused and finds it difficult to relay the details of his/her dream. Sleep terror usually only occurs once per night. Sometimes the person experiencing a sleep terror will attempt to punch or swing his/her fists at others. Main characteristics are: on numerous occasions, the patient awakens abruptly, usually during the first third of sleep and usually begins with a scream of panic; during each episode the patient shows evidence of marked fear and autonomic arousal, such as rapid breathing, rapid heartbeat and sweating; during the episode, the patient responds poorly to the efforts of others to provide comfort; and the person cannot recall any dream in detail at the time and cannot recall the whole episode later.

Sleepwalking Disorder

Sleepwalking Disorder, also called somnambulism, is characterized by repeated episodes of motor activity during sleep, such as sitting up in bed, rising, and walking around, among others. The person appears to be awake because their eyes are usually open and they can manoeuvre around objects, but is considered asleep.

Sleeping problems however, do not need to reach the level of disorders in order to cause problems and distress. Part of the intervention is a clear description of the issues with a strict plan to follow.