The fifth edition of the Diagnostic and Statistical Manual classifies sleep-wake disorders into 10 disorders/disorder groups:
- Hypersomnolence disorder
- Breathing-related sleep disorders
- Circadian rhythm sleep-wake disorders
- Non-rapid eye movement (NREM) sleep arousal disorders
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- Nightmare disorder
- Rapid eye movement (REM) sleep behavior disorder
- Restless legs syndrome
- Substance/medication-induced sleep disorder
General characteristics of these conditions include poor quality of sleep, insufficient sleep, and sleep that comes at inopportune times. Daytime distress and impairment to function often result from sleep disorders, and depression, anxiety, and cognitive changes may also accompany these conditions. Mental health conditions and sleep-wake disorders may occur together and may have a negative impact on each other. The DSM-5 emphasizes the importance of the independent assessment and treatment of a sleep disorder, whether or not a mental health condition is present and being treated.
The DSM-5 groups together certain conditions that were separate in earlier editions of the DSM in order to facilitate ease of diagnosis. A greater understanding of what triggers certain conditions, and of the various neurobiological or genetic factors that may affect the development of the condition, also impacted the way the disorders were categorized.
Fatigue and diminished capacity for cognitive focus are two of the most noticeable concerns of a sleep disorder. Mental health conditions and sleep disorders may be associated, in some cases. Those with depression may find themselves sleeping excessively and have difficulty getting out of bed, for example, while the manic phase of bipolar is often characterized by long periods of wakefulness.
The most common sleep disorder symptoms include:
- Difficulty falling asleep or staying asleep
- Falling asleep at inappropriate times
- Troubled sleep
- Physical illness or physical discomfort
- Depression, anxiety, or stress
- Counterproductive sleeping habits such as early bedtime, daytime napping, or excessive time spent awake in bed
Some sleep disorders are attributable to a medical condition, while others may have psychological roots. A person might experience some level of trouble sleeping during a difficult transition in one’s life or as the result of anxiety or depression, and without treatment, the condition may often worsen. Regardless of what has caused a sleep disturbance, therapy is often beneficial as one works through the effects and cause, when the cause is known.
Therapy for sleep-wake disorders generally focuses on changing behaviors, setting and achieving goals, becoming more self-aware, and learning relaxation skills. Once the root cause of a sleeping disorder has been uncovered, mental health professionals can often help those in therapy develop skills to modify unwanted sleep patterns.
Methods used in therapy to address sleep-wake disorders include:
- Keeping a sleep diary. Doing so can help identify harmful sleep patterns and triggers of disturbed sleep.
- Sleep restriction therapy. This treatment, especially effective for insomnia, restricts naps and early bedtimes so that the person seeking treatment will eventually be able to fall asleep at the right time and get quality sleep.
- Stimulus control instructions. This method examines an individual's sleep habits in order to uncover actions that may prevent good sleep.
- Sleep hygiene education. Often used after an individual's sleeping patterns are analyzed, this training helps those in treatment develop a list, tailored to individual habits, of things that should and should not be done before bedtime.
- Relapse prevention. Because sleep conditions may recur in the future, relapse prevention aims to help those in treatment prepare for the potential of future sleep trouble and develop methods to address concerns before they become overwhelming.
- Phototherapy. Timed light exposure can help reset internal body clocks and is used to treat Non-24 Hour Sleep/Wake Disorder.
- Dark therapy. Restricting light in the evening, especially the blue or blue-green light from TV and computer screens, can help prevent delays to the circadian clock and help individuals get to sleep earlier. This therapy is often combined with light therapy, or exposure to a bright light when one first wakes up.
Insomnia, in particular, can often be treated with a particular type of cognitive behavioral therapy, CBT-I. This form of CBT attempts to change one's sleep habits and sleep schedule and resolve misconceptions that may lead to difficulty sleeping. Keeping a sleep diary is typically a large part of the process.
Sleep disorders may sometimes be caused by medical conditions. Mononucleosis, fibromyalgia, thyroid and kidney disease, asthma, and diabetes are just a few of the medical conditions frequently contributing to the development of sleep problems. Experiencing disturbances in sleep-wake patterns may also lead to the development of physical discomfort or illness, for which medical treatment may be necessary.
When a person experiences a sleep condition in connection with illness, medical treatment may be the most effective way to treat a sleep disturbance, but this is dependent on the conditions experienced. Medical treatment for sleep-wake disturbances may often include medication, but in some cases, therapy may also be a beneficial method of treatment.
- Therapy to address effects of loss of sleep: Rico, 28, decides to seek therapy after several months of diminished function. He tells the therapist that he has had trouble sleeping ever since he changed jobs. His new schedule is less demanding, so he does not understand why he is so tired. He experiences difficulty falling asleep, wakes up at odd intervals, and lies awake for hours. Sometimes he naps to catch up on the sleep he has missed, but this makes it even more difficult for him to sleep at night. Due to lost sleep, he is irritable during the day and experiences anxiety and fatigue as night approaches. Assuming and believing that he “will never get to sleep” also takes a toll, as he states his belief that the dread he has developed is contributing to his wakefulness. In therapy, he explores his ambivalence about the career change he recently made, general anxiety regarding the path his life has taken, and his so-far unfulfilled goals. Rico realizes in therapy that he has placed some aspects of life over others that he cares more about. With the encouragement and support of the therapist, he identifies several aspects of his life that are important to him and decides to, at least temporarily, focus on those things. As Rico becomes more content with his choices and path—particularly what he has chosen for himself—he finds himself able to achieve relaxation more easily and sleep without great disturbance. His daily function improves, and before long, his irritability diminishes.
- Cognitive Behavioral Therapy for Insomnia. (n.d.). Retrieved October 28, 2015, from https://sleepfoundation.org/sleep-news/cognitive-behavioral-therapy-insomnia
- Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
- Irregular Sleep-Wake Rhythm – Diagnosis & Treatment. (2014). Retrieved from http://www.sleepeducation.com/sleep-disorders-by-category/circadian-rhythm-disorders/irregular-sleep-wake-rhythm/diagnosis-treatment
- Lubit, R. (2015, January 28). Sleep Disorders Treatment & Management. Retrieved from http://emedicine.medscape.com/article/287104-treatment
- Non-24-hour Sleep Wake Disorder Treatment & Care. (n.d.). Retrieved from https://sleepfoundation.org/sleep-disorders-problems/non-24/treatment-care
- Schriber, A. (2015, February 2). Sleep disorders - overview. Retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/000800.htm
Sheehan, J. (2012, November 19). 10 Health Conditions That Disrupt Sleep. Retrieved from http://www.everydayhealth.com/sleep/other-disorders/disorders-that-disturb-sleep.aspx
- Sleep-Wake Disorders Fact Sheet. (2013). Retrieved from http://www.dsm5.org/Documents/Sleep-wake Disorders Fact Sheet.pdf
- Thorpy, M. (2012). Classification of Sleep Disorders. Neurotherapeutics, 9(4), 687-701.
- Treatments for Delayed Sleep Phase and Non-24. (2015, October 19). Retrieved from http://www.circadiansleepdisorders.org/treatments.php
Last updated: 11-03-2015