Sleep Disorders

Sleep, Insomnia and Sleep Hygiene Measures

Sleep is a universal behavior that has been demonstrated in every animal species studied, from insects to mammals. It is one of the most significant of human behaviors, occupying roughly one third of human life. According to the Greek Mythology, Hypnos was the God of sleep and his son Morpheus, the creature of the night, who brought dreams in human forms.

Sleep Requirements:

Requirement of sleep varies widely. Some persons are normally short sleepers who require fewer than 6 hours of sleep each night to function adequately. Long sleepers are those who sleep more than 9 hours each night to function adequately. Short sleepers are generally efficient, ambitious, socially adept, and content. Long sleepers tend to be mildly depressed, anxious, and socially withdrawn.

Sleep Disorders:

There are many classifications of sleep disorders. According to Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association (APA), there are types of sleep-wake disorders as mentioned:

  1. Insomnia Disorder
  2. Hypersomnolence Disorder
  3. Narcolepsy
  4. Breathing-Related Sleep Disorders
  5. Circadian Rhythm Sleep-Wake Disorders
  6. Parasomnias
  7. Non-Rapid Eye Movement Sleep Arousal Disorders
  8. Nightmare Disorder
  9. Rapid Eye Movement Sleep Behavior Disorder
  10. Restless Legs Syndrome
  11. Substance/Medication-Induced Sleep Disorder

Insomnia

Insomnia is difficulty in initiating or maintaining sleep. It is the most common sleep complaint and may be transient or persistent. A brief period of insomnia is most often associated with anxiety, either as a sequale to an anxious experience or in anticipation of an anxiety-provoking experience (e.g., an examination or an impending job interview). In some persons, transient insomnia of this kind may be related to grief, loss, or almost any life change or stress. Specific treatment for the condition is usually not required.

Persistent problems (at least 3 days/wk for 1 mth) in falling asleep, maintaining sleep, or poor quality of sleep can be a complex situation & demands clinical attention. Individuals are preoccupied and excessively concerned with their sleep problems, distressed by them, and social or occupational functioning is affected.

Prevalence:

Population surveys show a 1-year prevalence rate of 30 to 45 percent in adults, F > M, greater in the elderly. Clinically significant insomnia, when it causes marked personal distress or interference with social and occupational functioning.

Management:

  • Identifying and addressing the underlying problems (drug dependency, medication issues, primary medical or psychiatric conditions)
  • Education regarding sleep cycle, physiology and usual changing
  • Sleep hygiene measures
  • Relaxation training
  • Sleep restriction
  • Use of pharmacotherapy
  • Other necessary measures

Here only Sleep hygiene measures are detailed as it is only the behavioral changes, that benefits much.

Sleep Hygiene Measures

Sleep Environment:

  • Familiar & comfortable
  • Dark
  • Quiet

Encouragement for:

  • Bedtime routines
  • Consistent time for going bed & waking up
  • Going to bed only when tired
  • Exercise regularly & routinely
  • No work in the bed except sex

Avoidance of:

  • Late evening exercise
  • Caffeine, excess alcohol & smoking
  • Large late meals
  • Too much time in bed lying awake
  • Avoid bright light in night & self expose in the morning

References

  1. Synopsis of Psychiatry, 11th edition by Kaplan & Sadock
  2. Oxford Handbook of Psychiatry, 3rd edition by Semple & Smyth
  3. Shorter Oxford Textbook of Psychiatry, 6th edition by Cowen, Harrison & Burns
  4. Stahl’s Essential Psychopharmacology-Neuroscientific Basis Practical Applications, 4th edition by Cambridge

About Author

S.M. Yasir Arafat, MBBS, MD Psychiatry Resident at BSMMU, Dhaka, Bangladesh.

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