For the last few months, Mark, a middle-aged businessman, had only been able to sleep for three or four hours every night. He decided to consult his doctor about his problem since it was interfering with his work and married life. He had become unusually grouchy with his wife and was losing weight rapidly.
On the other hand, nineteen-year-old Jo-Anne went to see her doctor because she was sleeping too much. For the last six months, Jo-Anne had been sleeping between ten and twelve hours every night and, as a result, was having difficulty keeping up with all her commitments. She also complained about frequent headaches, stomachaches and other general body pains.
Sleep is designed to energise us both physically and mentally, but bad sleep patterns can result in fatigue and irritability. Relationships suffer and productivity is hampered. Research also suggests that people with sleeping disorders appear to be more susceptible to illness.
There is often a complex relationship between sleep disorders and mental health. Although people can suffer from “pure” sleep disorders, a lot of the time sleep problems are warning signs that an individual might be suffering from associated disorders such as major depression, bipolar or anxiety-related disorders.
One of the most classic symptoms of depression is a drastic change in an individual’s sleep patterns. Depressed individuals either have great difficulty falling asleep and sleep fitfully, or find that they sleep far more than they ever used to. Recent research found that cognitive-behaviour therapy with depressed individuals not only improved depressed symptoms in the individuals but also normalised their dream sleep (REM) patterns1.
Interestingly enough, the area of the brain stem is involved with both the experience of anxiety and with our REM sleep. This shared biological connection suggests that anxiety and sleep are interrelated in an important way2. Sure enough, anxiety sufferers often have very disturbed sleep patterns. If one sufferers from panic disorder, sleep can sometimes be interrupted by panic attacks or an over-alert mind.
How exactly do sleep disorders develop? Firstly, people can have a biological predisposition to sleep disorders, for example, a family history of insomnia. These predisposing factors interact with “sleep stress” – any events that negatively impact on sleep – to create sleep disturbances. Whether these sleep disturbances improve or worsen depends largely on the kind of medical management a sufferer receives.
Management of sleep problems, especially those associated with other disorders as well, can involve a number of treatments. If you suspect that you may have a sleep disorder, it is important to present yourself to a professional armed with a thorough knowledge of all your sleep habits. It is far better to seek the advice of a professional than to self-prescribe with a cocktail of over-the-counter medications.
There are several benzodiazepine medications (tranquilisers) that are commonly used to treat sleep disorders. The short-acting benzodiazepine are preferred because they do not cause drowsiness during the daytime and move out of the system fairly quickly. However, if an individual also experiences extreme anxiety during the day, then it is advisable to make use of a longer-acting benzodiazepine which will stay in the system for a longer period.
It is recommended that individuals use benzodiazepines for a short period of time. The ideal medication should work quickly, be well-tolerated by the individual and restore normal sleep patterns whilst not affecting an individual’s cognitive performance the next day.
Psychology plays an important part in sleep disorders as well. There are many psychological treatments that can help individuals to combat sleep problems. In cognitive therapy, the therapist focuses on changing the individual’s unrealistic expectations and beliefs by providing factual information about sleep. Clients are also taught medication, imagery and other techniques to help them relax at bedtime. It is obviously useful for clients to discuss daytime stresses and problems that could be interfering with a good sleep routine.
It can also be beneficial to get in touch with other sufferers who have problems with sleeping, anxiety or depressive disorders. The Depression and Anxiety Support Group, open 8am – 8pm Monday to Friday, and 8am – 5pm on Saturdays, can provide counselling, referrals and information. The Support Group can be contacted on (011) 783-1474/6.
Lastly, merely changing your daily sleep habits can make a noticeable difference in your quality of sleep. Below are a number of practical guidelines that can help improve one’s sleep routine.
· Go to bed and get up at regular times, even if you’re tired in the morning.
· Avoid heavy meals or alcohol consumption before bedtime.
· Reduce caffeine and nicotine consumption as much as possible.
· Exercise during the day – preferably in the late afternoon or early evening.
· Wind yourself down during the last hour of the day – avoid physical or mental
activity, emotional upsets etc.
· Cultivate a sleep ritual before bedtime – some activity you do every night
before going to bed eg: hot shower/bath.
· Eliminate non-sleep activities in bed eg: reading or working. Strengthen your
association between bed and sleeping.
· Avoid napping during the day.
· Vary the firmness of your mattress
· Make sure the room temperature is just right for you.
· Try and accept those nights when you don’t sleep well and don’t let yourself be afraid of insomnia.
1. Barlow D.H. and Durand V.M. Abnormal Psychology. California: Cole Publishing Company. 1995
2. Barlow D.H. and Durand V.M. Abnormal Psychology. California: Cole Publishing Company. 1995
3. Bourne E.J. The Anxiety and Phobia Workbook.