What is Sleep Walking?

By David Joel Miller.

Can people really do all that stuff while asleep?

Sleep Walking?

Sleep Walking?
Photo courtesy of Pixabay.com

Turns out that people can do a number of things while mostly asleep. Sleep Walking (Was DSM-IV 307.46 Now DSM-5 F51.3) and Sleep Terrors (DSM-IV 307.47 now DSM-5 F51.4)) use to be considered separate disorders. In the New DSM-5, they have been combined into one category, Non-Rapid Eye Movement Sleep Arousal Disorders. Despite now being one disorder with subtypes they get coded with two different numbers. (DSM is a registered trademark of the APA.) In the new lists, ICD-9, ICD-10 and oh my ICD-11, these numbers may all keep changing, sorry about that.

The Sleep Walking part also covers some other behaviors that can take place while the person is mostly asleep. It is also possible to engage in Sleep Eating and Sleep Sex. Sex while mostly asleep has also been called sexsomnia. Sleep Eating and Sleep Sex are specifiers added onto the Sleep Walking diagnosis. These specifiers do not get their own numbers.

For someone to get this diagnosis these things must happen repeatedly not just occasionally.

And yes these things are considered real diseases not just excuses for things people do that may bother others.

Sleepwalking along with sleep eating and sleep sex are all things people do early in the sleep cycle before REM sleep, hence the name Non-Rapid Eye Movement Sleep Arousal Disorders.

One characteristic of Sleepwalkers is the blank look on their faces. Other clues that this person is not awake and is functioning on autopilot are the difficulty you will have in waking the sleepwalker up.

There was a belief that you should never wake someone up who was sleep walking. I see no evidence that this is particularly harmful other than the sudden jolt that comes from waking up in a place other than where you went to bed. On the other hand as hard as it is to wake sleep walkers most of us will elect to just lead them back to bed and try to get them in the correct posture for sleep.

Sleepwalkers are also unresponsive to efforts to communicate with them. You can talk to them all you want but they just keep wandering around. Picture the actors you see in those zombie movies and you have a close approximation to the characteristic sleep-walker.

These episodes of sleep walking happening in Non-REM sleep come without memories. This is described as having an “amnesia” for the events that happened during the sleep walk.

The full diagnostic criteria are in the DSM-5. As with most other disorders, this one does not get used if the cause of this event is drugs or medications or if it seems to be caused by some other medical or psychological condition.

Sleep Walking Disorder is separate from Nightmares for several reasons. Nightmares and Bad dreams happen later in the sleep cycle predominantly during REM sleep. People remember what happened during nightmares and bad dreams. Nightmares often are connected to real life events as in PTSD. Sleepwalking just happens out of nowhere.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5, some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

You might want to take a look at other posts on:      Sleep   Dreams and Nightmares

More “What is” posts will be found at What is.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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Dreams reduce and nightmares increase fears.

By David Joel Miller.

Good sleep and dreaming can help reduce anxiety.

Dreams and Nightmares

Dreams and Nightmares
Photo courtesy of Pixabay.com

Sleep and the dreams that inhabit the sleep-land can help us make sense of life experiences or they can magnify those fears and impact your awake life. One theory about nightmares is that normal dreams make sense of things and reduce fears but nightmares are a failure of that fear reduction system. This idea is often expressed in some rather technical language but let me try to make it clear using a story to illustrate the possibility that dreams can help you make sense of the world.

Good dreams and bad dreams.

People tend to remember nightmares where the experience becomes so intense it wakes you up. Occasionally you have a “bad dream” which does not wake you up but was so disturbing that you remember it upon awakening. Most of us have occasionally had a “good dream” and remembered the wonderful place or person we experienced in the dream land. The more good dreams you have the more likely you are to forget them. Bad dreams and nightmares, in particular, you tend to remember.

Dreams continue your awake thoughts.

Nightmares usually feature fear, anxiety, and trauma but many other themes are possible. One theory about dreams is a “continuity” theory. You tend to dream about things in your sleep that you think about when awake. School students dream more about tests, creative people may dream about creative outcomes. Love, friendship or happy times may take place in a dream. Some writers have described those positive dreams as “wish fulfillment.” Which dreams get remembered? That would be the ones with strong emotional content, mostly which are the negative emotion dreams.

Dreams can reduce fear.

Let’s look at how a dream might help make sense of an experience and reduce fear. Say you are in a minor auto accident. There is some damage to your car’s fender. You handle what you need to while awake, but you can’t stop thinking about that accident and when you go to bed it is still on your mind. Thinking about that accident may even make it hard to get to sleep but eventually, you do fall off and then you dream. Your dream is likely to feature some elements of the accident.

The dream pulls up your experience and begins looking at all the parts of the memory. It remembers the car you were in, the people you were with and the garage your car went to for repairs. Your dream may also include the medical attention you received and things you thought about during the accident.

Your brain now takes the experience apart and begins to file the information away for future use. The friends in the car get filed under friends. The garage gets filled under fixing things and so on.

In dreams, information gets stored in useful ways.

So you dream about your day and your car accident again. Only this time your brain pulls us different bits and pieces to make a new experience. You are driving along and this time your doctor and your chiropractor are in the car. You are going to meet your friends at the garage. When you get there you, not the car, get repaired. You get new clothing and a haircut. While waiting for the car you eat lunch in the waiting room only now they are serving you a gourmet meal at your favorite restaurant and you look out the window you are looking at the ocean and the beach. When you get up to go from lunch your mechanic is in the car and you drive through a bank drive-up where they fill up your lap with money.

You dream has now helped you use the recent event to see ways to have happy experiences with friends, get things fixed and secure the money you need to pay for those repairs. None of this is very scary, right? By disassembling experiences and saving facts your brain catalogs your experiences for future use. At least this is the way this particular theory sees dreaming.

Traumatic experiences do not need to result in a mental disorder.

The majority of people exposed to traumatic events do not develop a stress or trauma-related disorder. Those who have some trauma immediately after the event often find the trauma and the dreams about the event go away over time. Your distress may fade over a few days. It may hang on for a while and become Acute Stress Disorder which usually dissipates in a month. But some people do not get better. They develop long-term mental problems. Their experience may result in Posttraumatic Stress Disorder and last for years. Why?

Some dreams do not get disassembled.

Some dreams are so connected together by the negative emotional content they are too painful for the brain to disassemble. In these asleep experiences, the sharp painful edges of the experience are so tied together by the fear or other negative emotions that they will not disassemble. These whole dreams cause a sort of “sleep indigestion” and result in the dreamer waking up often screaming or in intense fear. Panic like symptoms may occur.

Technically it is a nightmare if it wakes you up and a “bad dream” if you do not awaken but just have memories of the dream that are distressing when you awaken. Hopefully, you got that this explanation of dreams and how some dreams become nightmares is not scientifically exact but a simplified story to try to illustrate complex neurochemical processes.

Can Nightmares be cured?

Eventually, most nightmares can be reduced or eliminated with good treatment. I would like to think we will find treatments for them all eventually. How hard it is to treat your particular nightmare problem partially depends on the nature of the nightmares and the nature of the trauma.

Imaginary happenings, contaminated memories from video media respond quite well to treatment. Nightmares in children are often very treatable. Some real, trauma based, nightmares fade on their own. Treatments for entrenched nightmares have had mixed results.

From my reading on this topic, it appears that if you have multiple nightmares about several experiences they may be more readily treated than those people who have a single horrific experience that recurs in their nightmare. There are also differences in results in treating childhood abuse versus adult abuse and trauma. Military type trauma is especially resistant to treatment sometimes.

Currently, there are several treatments that are showing promise. More on that in an upcoming post. Treating entrenched nightmares is something that requires you to be an active participant if the process is to work. Treating nightmares is not something you can do alone. If you or someone you know has recurrent or frequent nightmares, look for professional help.

You might want to take a look at other posts on:

Sleep

Dreams and Nightmares 

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

Bad Bedtime Behaviors sleep or nightmare disorder?

By David Joel Miller.

Children may turn terrible at bed time because of sleep problems.

Child falling asleep

Sleepy Child
Photo courtesy of Pixabay.com

Children who have sleep disorders try to avoid the problems these disorders cause. If you have nightmares the bed and sleep land are not friendly places. Night Terrors get noticed by most parents because the child makes noise and wakes you up but other sleep issues may go unnoticed until the child begins acting up at bedtime.

Below are some of the behavioral changes that occur in children and occasionally in adults that indicate the problems may be related to a sleep disorder.

Long bedtime rituals can be caused by a sleep problem.

When we anticipate something bad happening most of us will put it off as long as possible. Children who experience bad dreams or nightmares will try to avoid the bed and sleep. One way to do this is to draw out the pre-bed routine as much as possible.

If you find your child is avoiding bed with a passion, look for things in the environment. Are adults still up and having fun? But if the whole house is quiet and still your child is finding ways to avoid getting into bed ask them about their sleep and about what happens in that sleep.

Bad dreams and nightmares are not something that children should have to endure. Expecting them to just “grow out of it” is not a good plan. Some children never do outgrow nightmares. Poor and disrupted sleep can result in many emotional problems.

Bedtime resistance suggests a sleep issue.

Long rituals are about what you tell yourself. All those things you need to do before you can sleep. Bedtime resistance is about what you tell or do to others. If the child resists bed like they might resist the doctor’s office then ask yourself why the bed and sleep land is traumatic rather than a friend.

Try making bedtime a positive thing, read a story, say a prayer, whatever fits for your family. If, despite your efforts to reassure your child there is still resistance, try to not dismiss this as bad behavior. Explore with your child what happens when they try to fall asleep and what happens when they dream. If there are problems consider some professional help before the problem becomes serious.

Insomnia Disorder. 

When dream land is full of nightmares you will avoid it. If delaying bedtime does not work many folks will lie awake. Worry about the future, rumination and anxiety disorders result in not being able to fall asleep.

In another post, I talked about the problems with Insomnia Disorder

Insomnia is a very real physical and mental disorder. It is treatable and the treatment does not have to be restricted to medication.

Avoiding sleep may be the result of a sleep disorder.

Once through the bedtime routine and into bed, there are a host of ways that children can avoid sleep. The result of this avoidance can show up in poor behavior, impaired attention or emotional regulation issues the next day.

Today electronic avoidance is becoming all too common. Some children’s bedrooms have more electronic equipment than the store. Spending all night playing games, chatting on social media and generally staying stimulated has its consequences the next day. Over time this sleep avoidant behavior adds up.

If your child starts the day off in a bad mood and you do not know why, look for poor sleep habits or a sleep disorder.

Thoughts I must not sleep.

People with nightmare disorder, night terrors or just plain old bad dreams will start telling themselves that the solution is to just not sleep. Younger children may not be verbalizing these thoughts but if they are having them some exploration of the reasons can help your child move from struggling with a sleep disorder to a child who routinely gets a restful night’s sleep.

If your child avoids bed or sleep do not automatically jump to a severe conclusion. Poor sleep does not mean your child has experienced abuse or a trauma. There are plenty of other reasons they may be having bedtime issues.

If your child is avoiding bed and sleep explore the issue and get help as needed. If it is an adult that is resisting sleep you need help now. Untreated sleep issues undermine your physical and mental health.

You might want to take a look at other posts on:

Sleep

Dreams and Nightmares 

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

Sleep Skills – Sleep hygiene

By David Joel Miller.

Do you have good sleep skills?

Cat Sleeping

Sound Sleeper
Photo courtesy of Pixabay.com

How did you learn to get a good night sleep? If you are like many of us, the sleep skills you learned taught you how to have insomnia, bad dreams and a host of other sleep issues.

When you are young you do not want to go to sleep. Many children resist sleep and bedtimes with a vengeance. What you may have been taught, by example if not by words, was that sleeping was a punishment and staying awake as long as possible was some sort of reward for becoming that mythical creature we all aspire to become “an adult.”

Sleep, too many of us, appears to be the result of doing and going until you wear yourself out and then you drop into an exhausted state of unconsciousness that passes for sleep. What gets missed in this equation are the many benefits of getting a good night’s sleep and how you develop the skills to have that restful sleep. One name for sleep skills is sleep hygiene.

The benefits of being a good sleeper.

Lots of good things happen to you when you sleep. Memories get consolidated and stored. Poor sleep reduces your ability to remember things and make sense of the world around you. A well-rested person is more alert and finds it far easier to “pay attention.”

During the day your brain does a lot of work. Even if you are engaged in a physically demanding endeavor you mind still consumes a lot of calories thinking about and directing all the other things you do. Your brain consumes somewhere between 20% and 25% of all the calories you use every day. Burning all those calories creates a lot of waste.

Most people understand that more exercise means more waste products. You eliminate the waste and you feel better. Exercise more and if calories taken in stay constant, you can expect to lose some weight. Wastes accumulated in your brain get cleared out at night while you sleep.

Poor sleep and you end up with a “trashy” mind which has difficulty with focus, concentration, and creativity.

Sleep skills can be learned.

Being a good sleeper is a matter of choices you make. There are secrets to most things in life. A good teacher or coach can show you how to improve your game. You can learn how to be a better, more rested sleeper by learning and then practicing a few basic sleep skills. Here are a few of the basic sleep skills.

To sleep, you need a cool down period.

Between running around and falling asleep give yourself some time to decompress. Most people go and go and then leap into bed expecting to fall right to sleep. You need some cooldown time. Stop activities thirty to sixty minutes before bedtime. If you do any exercise do the slow mindful type not the strenuous kind in those last few minutes.

Unplug from electronics. Those bright lights hitting your eye condition you for more awake time. Reduce the light. Relax and get yourself in the state to sleep.

Avoid stimulants at bedtime.

Do not drink coffee, tea, energy drinks or other stimulant beverages in the afternoon. Pay attention to the last one you had and see how this impacts your sleep. Some people can drink coffee late in the day and still sleep, others are more sensitive and even coffee at lunch will impact their sleep.

Train your brain to expect to sleep in bed.

Our brains quickly associate places with the thing you do there. Do not abuse the bed. Lounging around in bed reduces the sleep-bed connection. Use the bed only for sleep and sex. Your brain can connect sex with lots of locations but it won’t connect sleep with standing up. Do not confuse the default setting in your brain by expecting it to stay awake and social media surf one time while another time you ask it to sleep in bed.

Clear your mind of worries before going to bed.

Use whatever practice works best for you to clear out the problems and worries from the day before trying to sleep. Pray and turn the worries over to your higher power, journal out those thoughts. You may be able to call someone and talk about your concerns before bedtime.

Empty your head of things you need to remember to do in the future. Writing this down can help get them off your mind.

Have a set bedtime and a time to get up.

It can be hard to adjust to changes. Sleep is no exception to that rule. If every night you hit the sack at a different time your brain does not know when to let you get sleepy. Set a constant time and do your best to stick to it. People who stick to a wake-up time even on the days off find that their body adjusts and lets them know when it is time to sleep.

If you have different times for getting up and going to bed on the weekend it makes it more difficult to switch back and forth. The result may be waking up at the right time despite staying up late. Many people create a sleep deficit over the weekend.

Avoid daytime naps.

Taking daytime naps results in not being able to sleep when bedtime comes. Staying up till your tired can leave you exhausted the next day. Over time these daytime naps shift your schedule and can make it harder to switch back when you have to stay awake for the full day.

Develop a bedtime routine.

Running around frantically at bedtime wakes you up. You need a routine to let you wind down and get ready to sleep. Having a pre-bed routine reduces those last-minute things that need to be done and keep you up late.

Create a comfortable sleep place.

Dark sleep places help you sleep. Look for ways to reduce stray light. Turn off the electronics. Screen light tricks your brain into thinking you need to stay up a bit longer.

Do you sleep better when it is quiet? Do your best to curtail ambient noise. Ear plugs work for some. If you prefer noise to drown out other sounds around you look for something that will not be diverting your attention. Background music may be helpful in managing the sound environment.

Cool temperatures help get the body ready for sleep. In hot climates or in the summer mouths coolness may be at a premium. If you don’t have or can’t afford air conditioning opt for a fan or fans that move the air over you. Feeling cooler at night than you did while awake will increase the chances of a restful night’s sleep.

Weed out life factors – shift work or recent stressful events.

Shift work can alter your sleep cycle. Some people can adjust while others never seem to. If you work when others sleep and sleep when others are up you will need to look for ways to accommodate that schedule. Some of this will be environmental things like darkness and consistency.

If you find that stress, anxiety or trauma is impacting your ability to sleep, consider counseling or other help in reducing that stress. Mindfulness or meditation training can help.

Those are some thoughts on developing good sleep skills. Have you found any other things that improve your ability to sleep?

You might want to take a look at other posts on:

Sleep

Dreams and Nightmares 

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

Can’t sleep? Is it Insomnia Disorder?

By David Joel Miller.

Frequently poor sleep might be Insomnia Disorder.

Insomnia

Insomnia
Photo courtesy of Pixabay.com

Most people have an occasional night with poor sleep. That does not rise to the level of being a diagnosable illness. But if you have those nights often, you just might be having Insomnia Disorder. There are many connections between your physical health, mental health, and biological functions. Sleep is a very important one of these connections.

Poor sleep can be a symptom of a mental or emotional disorder.

Poor sleep often accompanies Major Depressive Disorder. People who are depressed either sleep way too much or they find it hard to sleep at all. High levels of anxiety, any of the anxiety disorders, may interfere with your ability to sleep. Low need for sleep can be a part of bipolar disorders. Lack of sleep now can also be a warning sign that an emotional problem is just around the next bend in the road of life.

Poor sleep can be a primary disorder all by itself.

Poor sleep, if it gets to be a big enough problem, needs to be treated before it disrupts the rest of your life. Treating poor sleep is often a problematic issue. Medical doctors may treat it with medication which is a temporary solution but long-term you need to look at the connection between your sleep disorder and your mental and emotional health.

Counselors often see the connection between your sleep and your anxiety, depression or other mental illness but what may be missing is counseling about how to reduce the impact of your Insomnia or other sleep disorder on your life. Treating both problems at the same time is the recommended approach most of the time.

Mental Health practitioners use the DSM-5 as their guide to diagnosing and treating mental, emotional and behavioral disorders. (DSM is a registered trademark of the APA.)

For a full description of the way Insomnia Disorder gets diagnosed you should look at the DSM-5 but below is my plain language explanation of some of the things that would make a professional think that your sleep problems might justify a separate diagnosis of insomnia disorder.

Can’t fall asleep?

Most people experience occasional times when they have difficulty falling asleep. But if this happens to you a lot you should start looking at why. For many people, this is simply a lack of good sleep skills sometimes referred to as poor sleep hygiene.

Sleep hygiene involves things like having a regular bedtime, avoiding caffeine and other drugs that interfere with sleep close to bed time, not watching an exciting sports event and then rushing to bed while still all wound up and so on.

Many people can cure their insomnia issues by practicing good sleep skills. Watch for an upcoming post on how you could do this.

If you have an anxiety, Major Depressive Disorder, or another mental illness, getting that emotional issue treated can improve your sleep. Nightmares, Bad dreams, and Sleep Terrors also need treatment. The nightmares that accompany Posttraumatic Stress Disorder (PTSD) especially need treatment. You can treat those nightmares without having to relive all those traumatic life events. More on that also in an upcoming post.

A rough rule of thumb is, if it routinely takes more than a half hour to get to sleep, you need to take a look at why.

Can’t stay asleep, could be Insomnia Disorder.

People with Insomnia Disorder wake up a lot throughout the night. This frequent wakening reduces the quality of their sleep. Awakenings also reduce the total amount of sleep. Get poor quality sleep or too little sleep and you will be tired all day. These sleep deficits pile up over time. Sleeping in on the weekend may feel like it helps a little but just like overdrawing your bank account cost you fees, overdrawing your sleep accounts all week comes with costs that can’t be made up with a few extra minutes on the week-end.

People with Insomnia Disorder will find that even when they stay in bed extra time they can’t sleep anyway.

Is your poor sleep or lack of sleep a problem?

If you find that your concentration is off all day that may be because of sleep issues. Do you find yourself getting sleepy or dozing off during the day? Look at your nighttime sleep. If you are one of those people who can get by on less sleep and still feel fine then you probably will not get a sleep disorder diagnosis. If the number of hours of sleep gets too low and you think you are fine but others tell us you are off the hook we may start looking at a bipolar disorder as a possibility.

Take a hard look at your daytime problems and consider if many of your emotional problems may be connected to your insomnia or other sleep problem.

Insomnia disorder can look like ADHD.

Poor sleep can also impair your attention. Lots of client’s referred for ADHD treatment turn out to have insomnia disorder or another sleep-related problem. I have lost track of the number of people who came in for an assessment, especially teens, and it turned out they were staying up all night on social media, texting or the internet. That is a lack of sleep skills, not ADHD.

Drugs, medications, and foods can keep you from sleeping.

Most people know that street drugs, methamphetamine, and cocaine, will keep you from sleeping. When you are high you don’t sleep. Then when you come down you crash and sleep for a very long time trying to make up for the awake run.

Caffeine from many sources can interfere with sleep. We miss how high the doses of caffeine little children are getting. Most sodas are loaded with caffeine. More and more people are drinking energy drinks and those beverages can also keep you awake long after you wish the effects had worn off.

There are lots of other medications that can mess up your sleep-wake cycle. If you are experiencing insomnia or another sleep problem talk with your doctor about the possibility that something you are talking is causing that. Do not forget to mention over the counter and herbal products also. Remember those over the counter headache pills you take? Some of them are high in caffeine also.

You can’t sleep if you do not go to bed.

Lots of people who complain about insomnia, poor sleep quality, and bad dreams are chronically sleep deprived. They are stressed or anxious about their awake life. Do not expect to fall asleep the second your head hits the pillow. Budget enough hours of your life to getting sleep if you want to have a happy, productive life.

Sleep times and cycles change as we age.

Sorry folks all of us are getting older. When we are young most of us want to stay up all night despite needing more than average sleep. Young kids need more sleep. If they do not get it they get grouchy, irritable and can’t concentrate.

Seniors and the elderly may need less sleep, they may also develop more sleep disorder problems.

What should you do if you have Insomnia Disorder?

Good treatment for most people with Insomnia Disorder involves three things. Talk with your medical doctor and see if there are underlying medical issues. Work on sleep skills, sleep hygiene, relaxation and other skills. Get your mental health issues treated. Nightmares, trauma, anxiety and depression are all treatable and they all interact with sleep quality.

Thanks for reading all this way. Sleep well and live well.

You might want to take a look at other posts on:

Sleep

Dreams and Nightmares 

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

 

Why are sleep disorders listed as mental illnesses?

By David Joel Miller.

What are Sleep-Wake Disorders?

Dream or Nightmare

Dream – Photo courtesy of Flickr (Melody Campbell)

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.

Sleep-Wake Disorders

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.)

Parasomnias

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.

You might want to take a look at other posts on:

Sleep

Dreams and Nightmares 

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

Do you have Nightmare Disorder?

By David Joel Miller.

Do you have bad dreams or is that Nightmare Disorder?

Nightmare Zombie

Nightmare Disorder
Photo courtesy of Pixabay.com

We know there are connections between sleep, sleep disruptions and a number of mental illnesses. The connection between nightmares and Posttraumatic Stress Disorder (PTSD) is fairly well-recognized. Dreams related to your trauma is one of the symptoms of PTSD. What often goes unnoticed is just how connected poor sleep and having a mental or physical health issue can be.

Sleep disturbances can be both the result of and the cause of significant life problems. Many people ignore their bad dreams and nightmares. You shouldn’t. Disturbed sleep may be a warning that something much worse is on its way. Some of these issues can threaten your life and your sanity. Frequent nightmares increase the risk someone will attempt suicide. Drinking to shut off the nightmares increases the suicide risk even more.

Nightmare Disorder is included as a Mental Disorder in the DSM-5.

Nightmares fall along a continuum which runs from an occasional upsetting dream through frequent bad dreams that leave you feeling upset when you wake up, to those severe things like Nightmares and ends at the point of Sleep Terror Disorder where people wake up screaming. Sleep Terror Disorder along with Sleep Walking was combined in the DSM-5 getting the new name Non-Rapid Eye Movement Disorders, but that’s a topic that needs to wait for a future post.

Bad sleep is a symptom found in several other mental Illnesses so the sleep disorders get little attention from most Therapists. Given the human tendency to pretend there is nothing wrong with us until we hit the wall so to speak, it is not surprising a lot of sleep disorders go undiagnosed or get diagnosed as something else.

Nightmare Disorder is part of a group of conditions called Sleep-Wake Disorders.

Sleep-Wake disorders do not get diagnosed or treated by therapists of counselors all that often. Usually, sleep problems get one of two problematic treatments. They could be referred to a sleep disorder specialist who uses the International Classification of Sleep Disorders (ICSD-2) with its myriad subcategories. The other possibility is that sleep disorders are often taken as a symptom of a more common mental illness.

Poor sleep could be anxiety, depression or PTSD.

Nightmares or Bad Dreams can be a part of some anxiety disorders. Changes in sleep and appetite are key symptoms of depression. But just having bad dreams in and of itself does not automatically get you an anxiety or depression diagnosis.

Many nightmares are a part of Posttraumatic Stress Disorder (PTSD.)

Trauma- and Stressor-Related Disorders are such major factors in mental health that the Trauma- and Stressor-Related Disorders now have their own DSM chapter. Bad dreams and nightmares are one major factor in PTSD and other similar disorders that once you say you have bad dreams expect the professional to ask about any trauma history and any recent or current stressors.

If you have PTSD or another Trauma-Stress related issue nightmares are likely, but just because you have bad dreams does not mean you have PTSD. When I decide to write this post on Nightmare Disorder I looked up a hundred or so recent research articles on Nightmares and Bad Dreams. The largest part, a strong majority of those articles, were about Nightmares in people with PTSD. But there were a bunch of other mental health conditions that were connected to poor sleep also.

Nightmares and Bad dreams are connected to Borderline Personality Disorder, OCD, DID, GAD and aging.

That is only part of the list. OCD stands for Obsessive Compulsive Disorder, DID is Dissociative Identity Disorder and GAD is for Generalized Anxiety Disorder. Each of these diagnosis has related OCD like, Dissociative and Anxiety Disorders.

All these related disorders including bad dreams of one kind or another which makes me wonder if many people with one mental illness should also be getting a diagnosis of Nightmare Disorder. That and sleep disorders are one of the factors leading to the development of other mental health issues. In that vein, sleep disorders also greatly increase the risk of relapse in those with a substance use disorder.

What are the symptoms of Nightmare Disorder?

For the full text of the symptom see the official DSM-5 but here is my short, plain language version.

  1. Frequent, upsetting, bad dreams that really scare you.
  2. You can wake up quickly.
  3. These bad dreams are getting in the way of you living your life (family friends, job etc.)
  4. Drugs, alcohol or another mental illness are not the best explanation for why this is happening.

On top of these and a few other more specific criteria, Nightmare Disorder has a bunch of “specifiers” about when how often and how bad these dreams are.

A word of caution here. This is post is an effort to explain some kind-of complicated stuff. Diagnosis should not be a do-it-yourself project. There are a bunch of other Sleep-Wake Disorders that might also need to be ruled in or out. Some sleep problems are a sign of life-threatening physical conditions. You may also have some other mental issue or guess what?

Your bad dreams may be a normal reaction to some stress in your life right now.

Drinking alcohol to quiet bad dreams is a really bad idea. The amount it takes to knock you out is very close to the amount that will kill you. Especially do not mix alcohol with prescribed sleep or anxiety meds. You can work with your doctor on meds for bad dreams but when the meds wear off the dreams can get worse.

If you are having sleep disruption, bad dreams, nightmares, night terrors or related sleep problems, talk with your doctor or other professional and see if medication, therapy or some other treatment might be helpful to you. Don’t put it off. Even normal sleep issues if left untreated can eventually impair your physical or mental health.

You might want to take a look at other posts on:

Sleep

Dreams and Nightmares 

Stay tuned, more on sleeps connections to mental health, wellness and recovery are coming.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books