By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
What are Sleep-Wake Disorders?
Are problems with sleeping or staying awake making a mess of your life? Then you may have a sleep-wake disorder on top of all your other problems. Why does this matter? Because an untreated sleep-wake disorder will make all your other problems worse.
These issues turn up in the therapist or mental health counselor’s office when people start talking about their concerns with both the quality and the quantity of their sleep. Often this is because those sleep issues are impacting their wide-awake life. When sleep issues start interfering with your job, relationship, or just plain making you not care anymore it needs attention.
This group of disorders sits at the intersection of mental and physical problems and reminds us that the distinction between body and mind is not all that clear-cut. The nervous system connects with the limbic system so your thoughts and feelings impact your immune system. You bodies physical ailments affect your mood.
With the introduction of the DSM-5 clinicians in the mental health, area are getting a chance to take another look at the connections between sleep and mental health. One rule for therapists is to not be practicing medicine. If a therapist has any doubts, they should refer you to a medical doctor to get a purely medical cause of your issues ruled out or treated before using a primarily talk method to help you.
Some sleep disorder problems can best be determined by sleep specialists. These issues look differently when you try to describe them the next day versus when you are being monitored in a sleep lab and they can be detected right then and there. Your diagnosis may depend on whether the problem occurs during REM sleep or non-REM sleep. Even medical doctors can’t get this part sometimes without sleep tests. The International Classification of Sleep disorders – 2 is a far more exhaustive than the DSM or other possible lists, but it requires a sleep specialist to run tests to get this right.
Poor sleep can be a symptom of a mental disorder. Changes in sleep and appetite are one of the things that professionals look for in diagnosing depressive disorders. But poor sleep is not specific to depression or any one particular mental disorder. Sleep-wake cycle disorders affect a host of mental, emotional and behavioral disorders.
Poor sleep, especially distressing dreams, bad dreams, and nightmares have been connected to depression, anxiety disorders, panic attacks, ADHD, borderline personality disorder, dissociative disorders, substance use disorder, substance withdrawal, an increase in suicide risk, PTSD and non-suicidal self-injury also known as cutting.
While poor sleep is found in conjunction with a lot of mental illnesses, it has also been suspected to cause mental illnesses. For example, nightmares are a key factor in maintaining Posttraumatic Stress Disorder (PTSD.) Having frequent distressing dreams in childhood predicts the development of an anxiety disorder 5 years later. While nightmares and bad dreams may change and decline as you age, the majority of people who will get diagnosed with an anxiety disorder will have symptoms in middle school at just the time disturbing dreams are at their worst.
Sleep problems are also connected to behavioral problems. Children who are treated for behavioral issues also have nightmares or bad dreams on a regular basis. People with insomnia are at risk to have more nightmares and more nightmares increase the risk of developing a stress-related disorder like PTSD.
It is easy for a therapist or counselor to overlook sleep-wake disorders. If you have depression or anxiety, those sleep issues may be considered symptoms of your depression or anxiety. Make sure you mention the sleep problems to your therapist. If you have sleep-wake cycle problems, whether they are caused by another mental illness or not, if they bother you they should get diagnosed and treated along with the other issue.
Some Nightmares are harder to treat than others. The ones found in PTSD about things that have really happened to you are harder to get rid of than other bad dreams, but there are treatments for these nightmares that do work. Bad dreams based on generalized anxiety have been treated in children with as little as one therapy session. There will be more on treatments for sleep-wake cycle issues in upcoming posts.
Here is the list of Sleep-Wake disorders based on the DSM with their most current numbers.
Scary list isn’t it? For a full discussion, you would need to check out the APA’s book DSM-5. I will try to give you the short plain language versions of these issues in upcoming posts.
Insomnia Disorder 780-52 (G47.00)
Hypersomnolence 780.54 (G47.10)
Narcolepsy (subtypes/specifiers have different numbers.)
Breathing-Related Sleep Disorders
Obstructive Sleep Apnea Hypopnea 327.23 (G47.33)
Central Sleep Apnea (subtypes/specifiers have different numbers.)
Sleep-Related Hypoventilation (subtypes/specifiers have different numbers.)
Circadian Rhythm Sleep-Wake Disorders (subtypes/specifiers have different numbers.)
Non-Rapid Eye Movement Sleep Arousal Disorders
Nightmare Disorder 307.47 (F51.5)
Rapid Eye Movement Sleep Behavior disorder 327.42 (G47.52)
Restless Legs Syndrome 33.94 (G25.81)
Substance/Medication-Induced Sleep Disorder (you need a number chart for this one)
Other Specified/ Other unspecified – Insomnia/ Hypersomnolence or Sleep-Wake Disorder (6 total)
Which sleep-wake disorders are mental health issues?
Some of these disorders are pretty straightforward, some are medical issues, some are psychological and a few are mixed, other sleep-wake disorders are even more complex. Nightmare disorder is a good example of the confusion. In common speech, nightmares are those bad dreams you have that upset you. In technical terms, bad dreams, nightmares, night terrors are all different things, sometimes. Even the researchers use different definitions in their articles.
In coming posts let’s look at the various sleep-wake disorders and treatments for them. Until then sleep well or consider getting help.
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