Understanding Sleep Disorder

by Stuart Sorensen – RMN

Disorders in sleeping can be extremely distressing and confusing. This is particularly true when they are part of a wider mental disorder. Problems sleeping can result in a range of difficulties including lethargy, irritability, appetite problems, inability to concentrate and physical pain.

Interestingly however many of the problems associated with sleep disorder are caused more by our attitudes to sleep than by insomnia itself. This handout aims to examine the nature of sleep itself as well as suggest a number of ways to deal with disorders of sleep.

Let’s begin by understanding what we mean by normal sleep. Often this information alone will be enough to reassure sufferers. Following that we’ll examine abnormal sleep and discuss some of it’s causes.

Normal sleep varies considerably from person to person. Although the average seems to be around 8hrs of unbroken sleep some people need much longer whilst others exist quite happily on only a few hours each night. It’s also worth remembering that people generally need less sleep as they get older. It’s also quite normal for most people to have occasional periods of insomnia, particularly at times of stress, illness or change.

Doctors divide sleep disorders into three main categories. These are;

1. Initial insomnia (difficulty getting to sleep)
2. Broken sleep
3. Terminal insomnia (early morning waking)

People can suffer from any or all of these problems depending upon their individual diagnosis and the severity of their disorder. The exact nature of the problems can be useful in diagnosing other disorders but may not necessarily be a problem in its own right. For example people suffering initial insomnia often find that once they do get to sleep they sleep extremely well and wake fully rested – albeit later than they used to. This may not be so much a sleep disorder as a problem in sleep ‘pattern’. The most significant factor is how rested the insomniac feels. If you feel rested and alert when you wake it really doesn’t matter how ‘long’ you sleep. Actually people often sleep for much longer periods of time than they realize. This is because we only remember the time we spend awake and assume that if we remember being awake at two am and then again at five am that we must have been awake for the three hours in between. This isn’t always the case.

Sometimes people become very anxious about insomnia and convince themselves that they will never sleep properly again. In most cases this is quite wrong but the anxiety itself serves to increase the sleep disorder and can lead to a vicious circle of insomnia.

The problem is often to do with people’s expectations about sleep. Even though it’s reasonable and almost inevitable that we all have brief episodes of sleeplessness many people expect to sleep perfectly every night of their lives. When this breaks down they tend to think of themselves as ill – sometimes incurably so – and effectively make a mountain out of a molehill. This leads them to try a number of ‘remedies’ which are described below.

Sleeping tablets (hypnotics)

Sleeping tablets are often extremely effective as an artificial method of inducing sleep. However they can present major problems. This is because they often only work for a short time, allowing us to get to sleep but not stay asleep. Also some people report that the quality of their sleep is impaired when using sleeping medication.

In addition sleeping tablets are often extremely addictive and a few of them, particularly those which combine sedation with antidepressant medication can be dangerous in overdose. Most doctors agree that sleeping tablets are best used as a short-term measure and only then if other factors are evident such as mental illness for example.

Non-prescribed hypnotics

Often people who aren’t prescribed hypnotic medication resort to other substances such as alcohol or illicit drugs. This can be dangerous and often makes the problem worse in the long term. There are far too many substances which people use to induce sleep to mention here so I’ll deal with one of the most common – alcohol.

Natural sleep depends upon the action of a chemical in the brain known as serotonin. The more serotonin we have in the brain the more likely it is that we’ll sleep well. If we deplete our brain’s supply of serotonin we inevitably develop sleep disorders. Alcohol will sedate us for a short time and help us get to sleep but continued use of alcohol destroys serotonin and actually causes early morning wakening and broken sleep.

Incidentally low serotonin levels are implicated in depressive illness which is why alcohol is a depressant and why depressed people often have trouble sleeping. It really is a vicious circle isn’t it?

Trying to force yourself to sleep

Most people actually make their sleep disorder worse by lying awake trying to ‘think’ themselves to sleep. This actually increases brainwave activity and stimulates wakefulness. Sleep is only possible when our brainwaves are particularly slow so trying to think yourself to sleep will just keep you awake. Yet another vicious circle!

SO WHAT WILL HELP?

First of all stop over-reacting. Sleeplessness won’t kill you and you will sleep when you’re tired enough. The very act of accepting this truth will go a long way towards curing your insomnia anyway. However, if you really can’t sleep try this:

Get out of bed. As we’ve already covered lying awake wishing yourself asleep or worrying about the fact that you can’t sleep doesn’t help. Get up, read a book, have a warm milky drink and don’t return to bed until you feel ready to sleep.

Get comfortable. The more comfortable you are physically the more likely you are to sleep. Keep the room warm and choose a comfortable bed to sleep in or a comfortable chair to sit in before you retire.

Avoid stimulants. Coffee and tea contain caffeine which will stimulate the body and keep you awake. Nicotine from cigarettes has a similar effect. So will sugar.

Avoid alcohol and other non-prescribed substances. These really will only make the problem worse. If you are prescribed hypnotic medication take it only as instructed. Do not ‘double up’ on the dose – particularly with anti-depressant hypnotics.

Make a decision. If you’re not sleeping because you’re worrying make a plan to deal with your problems – IN THE MORNING! If you’re not sure what to do for the best make a plan to make a plan in the morning. No one can do everything all at once and the middle of the night is not the time to worry about big decisions. For more information on mental anxiety see the handouts – understanding anxiety 1 & 2.

Establish a sleep routine. This doesn’t mean going to bed when you’re not tired. As we know that only creates problems. The most effective method is to stay up when you are tired. Don’t cat-nap. If you force yourself to stay awake until bedtime you’ll be much more likely to sleep at the right time and will quickly re-establish a normal sleep pattern.

Above all – don’t worry about it!

 

Compliments of Stuart Sorensen – RMN