Insomnia Defined
Insomnia Disorder is a sleep disorder characterized by difficulty falling asleep, staying asleep, or both, despite adequate opportunity for sleep, resulting in impaired daytime functioning. The essential feature of insomnia is dissatisfaction with sleep quality or quantity. Additional criteria include waking up too early and/or non-restorative sleep, causing clinically significant distress or impairment in social, occupational, or other important areas of functioning (American Psychiatric Association, 2013). Causes of insomnia include medical conditions, medications, psychiatric disorders, poor sleep hygiene, and certain lifestyle factors including irregular sleep schedule, caffeine intake, and screen use, among others (Roth, 2007; Baglioni et al., 2011).
Understanding Sleep Disorders
Insomnia Disorder is a diagnostic classification listed in the DSM-5 under Sleep-Wake Disorders. Sleep-wake disorders encompass a list of 10 disorders including insomnia disorder, hypersomnolence disorder, narcolepsy, breathing-related sleep disorders, circadian rhythm sleep-wake disorders, non–rapid eye movement (NREM) sleep arousal disorders, nightmare disorder, rapid eye movement (REM) sleep behavior disorder, restless legs syndrome, and substance/medication-induced sleep disorder (American Psychiatric Association, 2013). Individuals with these disorders typically present with complaints of dissatisfaction regarding the quality, timing, and amount of sleep. Resulting daytime distress and impairment in cognitive and physical functioning are core features shared by all of these sleep-wake disorders as well.
Signs and Symptoms of Insomnia and Related Disorders
Insomnia and related sleep-wake disorders have some distinct signs and symptoms, as well as some which are a bit harder to determine. Of the many possible indicators that qualify a sleep disorder diagnosis, sleep behaviors such as difficulty initiating and maintaining sleep, excessive daytime sleepiness, snoring, breathing difficulties during sleep, restless legs, nightmares or terrors, sleepwalking or talking, teeth grinding, as well as thrashing or crying during sleep can all be considered markers of a possible sleep disorder.
In addition, poor performance at work, school, or other daytime activities, including difficulty concentrating, memory, focus, or attention issues, are possible markers of sleep-wake disorders, especially if performance impairment is paired with sleepiness or fatigue. Changes in mood or behavior, including anxiety and depressed symptoms, as well as significant distress are also possible measures of insomnia or related sleep-wake disorders, which would need to be further assessed by a medical provider to determine their cause and course.
Diagnosing Sleep Disorders
The diagnostic process for sleep disorders typically involves a combination of assessing client history, specific testing procedures, as well as a physical examination by a sleep specialist in many cases. Due to the variability of sleep disorders and their specific symptomatology, each client might experience a different set of tests to determine what is taking place, and a clinician would be able to walk through the necessity for each assessment based on the presenting concerns and sleep functions in question.
Sleep disorders can necessitate a complex diagnostic process, and often require a team of doctors and clinicians to ensure the correct diagnosis and treatment are given. If you or someone you know might be suffering with insomnia or another sleep-wake disorder, book an appointment with a New York Behavioral Health (NYBH) clinician who can begin the assessment process and recommend the necessary testing to help further determine your needs.
Therapeutic Treatment for Insomnia and Sleep Disorders
Treatment for insomnia typically involves behavioral and/or pharmacological interventions, such as cognitive behavioral therapy for insomnia (CBT-I), sleep hygiene education, and sometimes medication, depending on the severity of the underlying cause of the problem (Morin et al., 2006). CBT-I is a form of psychotherapeutic treatment that focuses on changing negative thoughts and behaviors related to sleep. This approach can include a combination of sleep restriction therapy, stimulus control therapy, and various relaxation techniques to promote higher sleep quality and more satisfying sleep.
CBT-I has been found to be an effective treatment for insomnia, and its techniques can frequently be applicable for other sleep disorders (Kapur et al., 2017). According to the American Academy of Sleep Medicine, a medical device may also be necessary to help with sleep behaviors during sleep, such as a continuous positive airway pressure (CPAP) machine for conditions like sleep apnea.
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Managing Insomnia and Related Sleep Disorders
Managing sleep disorders involves a variety of approaches that may include aforementioned cognitive and psychopharmacological treatments, as well as certain lifestyle changes to facilitate more comfort and an improved quality of life. It is important to note that, as with other factors surrounding sleep disorders, the type and severity of the sleep disorder, as well as the individual’s needs and preferences are all involved in managing and mitigating symptoms. Establishing a regular sleep routine, including following, or attempting to follow, a consistent sleep and wake schedule can help to regulate the body’s sleep-wake cycle, making it easier to fall asleep and stay asleep at night.
Creating a relaxing bedtime routine can also help the body wind down as it prepares for sleep, which can include the use of relaxation techniques such as breathing exercises and meditation, and incorporating a relaxing bath or steamy shower. It is also important to avoid activities in the few hours prior to sleep that would combat relaxation such as eating, which can keep your digestive system active, and the use of screens, which prevent our minds from restful shutdown (Grandner et al., 2015).
Improving your sleep environment can also help to promote better sleep. These include curating the sensory experience for sleep; regulating the temperature to your liking, getting black-out curtains and/or a sleep mask to promote darkness, using a sound machine, sleep meditation, or earplugs to help lull, maximizing bed comfort with suitable bedding, pillows, mattress pad, and/or weighted blankets, and removing electronics and other distractions can all help to foster an optimal sensory experience for sleep.
Regular exercise has also been shown to improve sleep duration and quality, if completed in the first half of a person’s day. Finally, checking-in on, and managing daily stress levels can be very important for sleep health and hygiene management. Discussing your management plan with a qualified therapist is important to determine the best strategies for your sleep condition and needs.
Supporting Someone with a Sleep Disorder
Supporting someone with a sleep disorder or any mental health condition can feel challenging, but there are many ways to be there for your friend or loved one if you recognize they are struggling. Listening can be one of the most powerful tools in providing emotional support to someone struggling. Paired with this, encouragement to seek professional help is always recommended as this can bring clarity and guidance for appropriate care. Help in establishing a sleep and wake routine can also be a powerful way to support a loved one, inclusive of ensuring their comfort and environment for sleep are optimal for relaxation and rest.
Multicultural Considerations for Sleep Disorders
As with all disorders, there are multicultural considerations to keep in mind for insomnia and related sleep disorders. One important consideration is the understanding that sleep practices and beliefs differ cross-culturally. A study published in the Journal of Clinical Sleep Medicine found that cultural factors can influence sleep behaviors and attitudes towards sleep, particularly noting that beliefs about the importance of sleep, sleep hygiene, and the role of sleep in daily life are weighted differently from culture to culture (Morgenthaler et al., 2015).
These attitudes and beliefs can also influence the type of treatment an individual is willing to consider, noting that cultural factors, inclusive of age, gender, ethnicity, as well as regional location and occupation can all influence an individuals preferences for different approaches to, and treatments for, sleep disorders (Grandner et al., 2015).
Helpful Resources for Sleep Disorders
Given the variability of sleep disorders, there are several helpful resources available providing research, guidance, treatment, information, and support for individuals experiencing sleep concerns and/or diagnosed with a sleep disorder. The National Sleep foundation (NSF) is a non-profit organization that provides education and related resources on sleep health, including helpful tips as well as a directory of sleep clinics and specialists.
The American Academy of Sleep Medicine (AASM) is a professional organization for healthcare professionals which also produces information and research helpful to those with different sleep conditions. AASM also has a sleep education website which provides an interactive sleep quiz which can help individuals determine if they may have a sleep disorder. Additionally, the World Sleep Society is a nonprofit professional membership organization dedicated to advancing sleep health worldwide. These organizations, as well as others targeting more specific sleep disorders, are available online to access for more information.
Final Thoughts
Insomnia and associated sleep-wake disorders are characterized by a marked difficulty in initiating and maintaining sleep and impact sleep processes and daily function. Though there are several disorders within the sleep-wake classification, the connection linking them together is noted by impairment to sleep and/or sleep processes. Difficulties indicated before, during, or after sleep can help to determine if there is underlying cause for a sleep disorder diagnosis, but most diagnoses require additional medical input and specialist testing to determine the cause, classification, and treatment route for clinical care.
Psychotherapeutic treatments such as CBT-I can help with insomnia and related sleep conditions by promoting sleep quality and increasing satisfaction during sleep. Psychopharmacological care and sleep devices are also possible options for treating certain sleep conditions. Managing symptoms and supporting someone with a sleep disorder can both be achieved through adjusting the sleep environment for optimal comfort, among several other strategies.
It is important to note that sleep behaviors and practices can also be interpreted differently cross-culturally, and for more information around these considerations as well as emerging research and resources on sleep and sleep disorders, there are local, national, and worldwide organizations set up for continued support. If you or someone you know are struggling with insomnia or a related sleep condition, reach out to us today to get set up with the quality care you deserve.
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References
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