Friday, July 08, 2011

Sleep Disorders and Psychology

by Dr. R. A. R. Perera - The Island

article_imageMBBS(Cey) M.Sc. Psych.(Col)FARCGPConsultant Psychologist

Sleep disorders can be described as a situation where the sleep pattern is disrupted and includes difficulty falling or staying sleep, falling sleep at inappropriate times, excessive sleep, or abnormal behaviors associated with sleep. There is a close relationship between sleep and wakefulness and psychologists consider both sleep and wakefulness to be a part of a continuous, cyclic, tightly woven pattern of behavior. Behaviors during wakefulness will alter the quality and duration of sleep.

Sleep disorders represent a diverse group of conditions that affect both sleep and wakefulness and lead to a reduction in quality of life. Sleep disorders may produce personal injury or social disruption. Some sleep disorders are also risk factors for other serious medical problems, such as blood pressure, stroke or heart disease. Sleep disorders can be grouped in to 4 main categories.

* Problems with falling and staying asleep

* Problems with staying awake

* Problems with adhering to a regular sleep schedule

* Sleep disruptive behavior

Problems with falling and staying asleep could be due to psychological, illness, or stimulant dependent (egg. Taking tea, coffee just before sleep)

Problems may also occur with maintaining a consistent sleep and wake schedule as a result of disruptions of normal times of sleeping and wakefulness. This occurs when traveling between times zones and with shift workers on rotating schedules, particularly with nighttime workers.

The most common sleep disorder is insomnia or difficulty with falling asleep, staying asleep, intermittent wakefulness, and early morning awakening. Insomnia could be transient or short term (1-4 weeks) or it could be intermittent (short term insomnia which returns periodically over months). Chronic insomnia is when insomnia persists almost nightly for at least one month. Insomnia may be related to a medical or psychiatric illness or it may be a result of lifestyle factors. Life style factors are particularly important as causes of transient or intermittent insomnia.

The common causes are anxiety or stress, change of sleeping place or uncomfortable environment (hot/cold/humid/dress), alcohol or medication, smoking, high caffeine intake (tea, coffee, cocoa), heavy meal or exercising just before sleep. Change of hormones in pregnancy and old age also can cause insomnia.

Chronic insomnia is more likely to have a medical or a psychiatric cause. The common causes for chronic insomnia are depression, pain, hormone imbalance, chronic alcoholism, breathing difficulties and shift work.

Abnormal behaviors during sleep are called parasomnias, and are fairly common in children. The most common among them are sleep terrors and sleep walking.

Sleep terror disorder is an abrupt awakening from sleep with fear, sweating, rapid heart rate, and confusion.

Sleepwalking is not remembered by the person doing it and affects children 2 to 12 years old. A brain disease, reactions to drugs, and other medical conditions may also cause it. Sleepwalking episodes usually occur 1-2 hours after going to sleep and last from 1-30 minutes. A sleepwalker has open eyes and a blank expression, and is usually difficult to awaken. The next morning, they won’t remember the episode.

For helping a sleep terror or sleepwalking child return to normal sleep, parent should gently lead the child back to sleep. Waking the child 15 minutes before the expected time of the episode will help to get over this situation. This should be done for several days. Providing an early bedtime preceded by relaxing activities will help prevent sleep disturbances. Sleepwalking injuries should be avoided by making the bedroom and house as safe as possible.