The fifth edition of the Diagnostic and Statistical Manual (DSM-5) describes sleep issues. It classifies sleep-wake disorders into ten groups:
- Hypersomnolence disorder
- 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
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- Restless legs syndrome
- Substance/medication-induced sleep disorder
These conditions have a few main symptoms in common. These are:
- Poor quality of sleep
- Not enough sleep
- Sleeping at the wrong time
Sleep disorders may also affect people during the day. Daytime distress can make it harder to complete daily tasks. Sleep issues can impact ability to do well at school or work. They can also affect relationships and quality of life.
The DSM-5 groups certain conditions together that were separate in earlier editions of the DSM. This was done to make diagnosis easier. Greater knowledge of triggers for certain conditions influenced these changes. Neurobiological and genetic factors are a couple of these triggers.
Two big signs of a sleep disorder are fatigue and trouble focusing. Mental health conditions and sleep disorders may also co-occur. People with depression may find themselves sleeping for longer than usual. They may have difficulty getting out of bed. People with bipolar may also have sleep issues. The manic phase of bipolar often comes with long periods of wakefulness.
Signs you may have a sleep disorder include:
- Difficulty falling asleep or staying asleep
- Falling asleep at unlikely times
- Troubled sleep
- Increased anxiety or depression
- Persistent illness or discomfort
- Poor sleep hygiene. Sleep hygiene is the group of habits that facilitate good sleep. Poor sleep hygiene might look like very early or late bedtimes, daytime napping, or too much time spent awake in bed.
Mental health issues and sleep-wake disorders can occur together. They may also have a negative impact on each other. The DSM-5 highlights the importance of separate assessment and treatment for sleep disorders. It states that sleep disorders should be treated on their own whether or not a mental health issue is present and being addressed.
It can help to recognize if a sleep disorder is causing a mental health issue. It is also important to know if poor mental health is affecting your sleep.
Some mental health conditions linked to sleep disorders include:
- Depression. People with depression may have hypersomnia. This causes people to oversleep. They may also sleep for long hours and still feel fatigued throughout the day.
- Anxiety. Anxiety is known to cause trouble falling asleep, and sometimes insomnia. People may be kept awake at night by anxious and difficult to control thoughts.
- Stress. A lack of sleep may increase stress, but stress can also impact sleep. Like anxiety, stress may increase alertness. This can lead to wakefulness and insomnia.
- Bipolar. Many people with bipolar experience sleep issues. Mania may cause periods of sleeplessness, while depression may cause hypersomnia.
- Substance abuse. Chronic sleep issues may cause someone to misuse substances to prompt sleep. Substances like alcohol can help people fall asleep. But it can greatly reduce the benefits of sleep. Other people may take stimulant substances that obstruct their ability to sleep.
- Obsessions and compulsions (OCD). Some studies report that certain obsessive behaviors may disrupt sleep. In addition, lack of sleep may make OCD symptoms more extreme.
- Posttraumatic stress (PTSD). Nightmares are known to affect people with PTSD. They may also have difficulty falling and staying asleep.
Some research suggests sleep issues can cause mental health issues. One study showed that lack of sleep can worsen paranoia and hallucinations. Getting enough sleep can vastly improve mental health. Practicing good sleep hygiene may facilitate good sleep. Treatment with a therapist may help if your sleep issues are related to mental health.
Sleep disorders can be caused by medical conditions. A few medical conditions that often contribute to sleep issues include:
- Thyroid and kidney disease
Disruptions in sleep-wake patterns may also cause discomfort or illness. You may need medical treatment for these issues.
Medical treatment may be most effective when sleep issues occur with a medical problem. But this depends on the conditions present. Medical treatment for sleep-wake disturbances can include medication. In some cases, therapy may also be a beneficial form of treatment. It may help people improve their mental health despite sleep issues.
- 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
- Maher, M. J., Rego, S. A., & Asnis, G. M. (2006). Sleep disturbances in patients with post-traumatic stress disorder: Epidemiology, impact and approaches to management. CNS Drugs, 7(20), 567-590. doi: 10.2165/00023210-200620070-00003
- Miller, S. G. (2017, September 6). Lack of sleep may be a cause, not a symptom, of mental health conditions. Retrieved from https://www.livescience.com/60329-online-insomnia-therapy-mental-health-symptoms.html
- 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 disorders. (n.d.). Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Sleep-Disorders
- Sleep-wake disorders fact sheet. (2013). Retrieved from http://www.dsm5.org/Documents/Sleep-wakeDisordersFactSheet.pdf
- Thorpy, M. (2012). Classification of sleep disorders. Neurotherapeutics, 9(4), 687-701. doi: 10.1007/s13311-012-0145-6