Can’t sleep? Is it Insomnia Disorder?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Insomnia.
Photo courtesy of Pixabay.com

Frequently poor sleep might be Insomnia Disorder.

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 bedtime, 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 

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – 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 my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Why are sleep disorders listed as mental illnesses?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

View of dreamland.

Dreamland.

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.

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 

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – 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 my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.