Insomnia is a common sleep disorder defined by difficulty falling asleep or staying asleep and impaired daytime functioning despite adequate opportunity to sleep. Roughly ⅓ of the adult population in the US experiences symptoms of insomnia, with ten percent of the adult population experiencing clinical levels of insomnia. The disorder may affect one for a short time (acute insomnia) or for an extended period of time (chronic insomnia). Chronic insomnia is defined as the experience of insomnia symptoms three or more nights a week for at least one month. 

There are several different types of insomnia: primary insomnia, secondary insomnia, sleep-onset insomnia, sleep-maintenance insomnia, mixed insomnia, and paradoxical insomnia.

Primary and secondary insomnia differ in that the former is not linked to any other health condition while the symptoms of the latter can be traced to other health conditions such as arthritis, asthma, or depression. Sleep-onset insomnia is when one has trouble falling asleep. Sleep-maintenance insomnia is defined by difficulty staying asleep and/or waking up too early. Mixed insomnia is a combination of sleep-onset and sleep-maintenance insomnia. Lastly, paradoxical insomnia is when one feels as if they have slept much less than they have in reality. A visit to the doctor will be helpful in diagnosing any of these types in insomnia, especially if one is able to provide the doctor with a sleep diary to identify any patterns that may exist. If the issues are more persistent, a sleep study might be in order to determine what might be affecting one’s sleep.

When it comes to insomnia, there are certain agentic and non-agentic risk factors that increase one’s likelihood of developing the disorder. Unfortunately, as one ages, the likelihood that they will experience symptoms of insomnia increases. While we cannot slow down time, there are other things we can do to mitigate our risk of developing insomnia. Some of the risk factors that can be avoided are night-shift work, the overconsumption of nicotine or caffeine, and naps during the day.

By applying the research-backed principles described in this module, we believe that you can improve your sleep. While we do not offer this as a cure-all or claim to be sleep therapists ourselves, you can think of these routines and practices as a good springboard from which to jump off and start your journey toward better sleep. If it ends up being the case that you have followed these principles faithfully for six to twelve weeks and have seen little to no improvement, there are other options available to you. Some of these would include visiting a sleep therapist and participating in Cognitive Behavioral Therapy for Insomnia (CBT-I). Sleep Restriction Therapy (SRT) may even be necessary, but please only do so under the supervision of a trusted healthcare provider.

Main Resource: https://www.nhlbi.nih.gov/health/insomnia/treatment

https://www.webmd.com/sleep-disorders/insomnia-symptoms-and-causes

https://jcsm.aasm.org/doi/10.5664/jcsm.26929

Sleep apnea is a sleep disorder that occurs when breathing stops and starts repeatedly during sleep. Unlike insomnia—where the main issue is difficulty falling or staying asleep—sleep apnea is characterized by loud snoring, gasping or choking during sleep, and excessive daytime sleepiness caused by repeated pauses in breathing. Symptoms include daytime tiredness, irritability, morning dry mouth or headaches. Besides a grumpy partner who also can’t sleep through the snoring, sleep apnea can lead to chronic impaired daytime functioning, heart and blood pressure problems, type 2 diabetes and liver problems. People with sleep apnea are most often middle-aged or older adults, men more than women, and individuals with risk factors such as obesity, large neck circumference, or certain anatomical features that narrow the airway. Although some people get by in life without knowing that they have sleep apnea, for most it is an extremely serious health risk that has major consequences to quality of life, physical/mental health, and even longevity.  

There are two types of sleep apnea. Obstructive sleep apnea, the most common type, is when the muscles in the throat relax, and as a result, cut off or narrow the airway. The brain senses you are not getting enough oxygen and wakes you up to adjust. This can happen up to 30 times in an hour, and though the person often doesn’t remember waking up, it is impossible to reach the deep restorative sleep needed. Less commonly, central sleep apnea, occurs when the brain fails to send the signal to breathe resulting in brief periods of diminished oxygen. If you are diagnosed with sleep apnea, a professional might supply you with a CPAP (continuous positive airway pressure) machine, which is a mask worn at night that delivers just the right amount of pressure to keep the airway open. Other treatments include medical interventions such as oral appliances, surgery, and nerve-stimulating implants. Other interventions involve lifestyle changes such as weight loss, abstinence from alcohol, avoiding sleeping on your back, and improving other areas of sleep health. If you suspect you may have sleep apnea, it’s important to seek a proper medical evaluation, since an accurate diagnosis is the first step toward effective treatment and better health.

It’s normal to have an occasional nightmare, but when vivid and frightening dreams begin to affect your quality of life, it becomes a nightmare disorder. A person with a mild disorder may have a nightmare once a week, while a more severe case may disturb sleep nightly. Nightmares occur during REM sleep and are thought to be caused by being in a chronic state of hyperarousal during waking hours. Trauma, PTSD, anxiety, depression, and difficulty regulating emotion are strongly associated with nightmares. Common themes include failure, helplessness, physical aggression, being chased, interpersonal conflicts and death (Goritz, 2018). Effective treatment for nightmare disorder include psychotherapy and medication. Imagery Rehearsal Therapy (IRT) is the process of recognizing the emotions experienced in the nightmares, understanding the values that the emotions are informing you about, and then imagining a different ending to the nightmare that is in line with your values. Rehearsing this more favorable and empowering ending to the nightmare in waking hours is effective in reducing the nightmares. If you have a recurring nightmare you’d like to tackle, here’s an IRT worksheet you can try.  

Restless Leg Syndrome (RLS) is a common nervous system condition that negatively affects sleep. Most people with RLS recognized and sought diagnosis of this condition after noticing repeated twitching, jerking, and/or spastic movements in their legs late at night. Researchers in the field suggest the discomfort and the need to move can disrupt sleep onset and lead to frequent awakenings during the night. This results in fragmented sleep and significant daytime fatigue. Additionally, they recognize other adverse consequences such as depression, anxiety, and decreased cognitive functioning. Interventions such as sleep hygiene practices, medications, and behavioral therapies are often recommended to those struggling with RLS, and have been a valuable source of relief for patients. For more information, click here.

Individuals who suffer from depression and anxiety are often young to middle-aged adults, more commonly women, and may present with a combination of persistent low mood, loss of interest or pleasure, excessive worry, restlessness, and physiological symptoms such as sleep disturbances or fatigue, often exacerbated by genetic, environmental, or social stressors. Although many of us understand what anxiety and depression are, many have not been taught that anxiety and depression are highly comorbid, meaning they co-occur. About half of those diagnosed with depression also experience symptoms of anxiety. Many scholars speculate that the presence of either disorder contributes to shifts in cognitive processes, behavior, and ultimately the development of the partnering disorder. For the purpose of this module, we will group Anxiety and Depression together and discuss their interesting relationship with sleep. 

The relationship that Anxiety and Depression have with sleep is bi-directional. This means that the mood disorders can create sleep disruptions, and that poor quality of sleep can contribute to the development and negative progression of anxious and depressive symptoms. A dangerous cycle may be formed if bad sleep becomes chronic insomnia, and mood disorder symptoms become all-consuming. Some research has even indicated that insomnia may cause depression more often than depression causes anxiety (Rosenström et al., 2012; Nutt et al., 2008). This means that the best way to improve some depressive symptoms may potentially be to start with improving your sleep.

To address the urgent needs of mood disorders, treatments such as Cognitive-Behavioral Therapy (CBT) and medications like selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines are commonly recommended. Similarly, Cognitive-Behavioral Therapy for Insomnia (CBT-I) has been shown to not only improve sleep disorders but also reduce symptoms of co-occurring mood disorders. In addition, practicing good sleep hygiene remains an important first step for managing sleep problems, particularly when they occur alongside depression or anxiety.

Learn more:

https://www.sleepfoundation.org/mental-health

https://www.psychiatry.org/patients-families/depression/what-is-depression 

https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders

Those suffering from chronic illnesses and chronic pain often experience sleep disturbances as a result of their diagnosis. Conditions such as diabetes, arthritis, and fibromyalgia can be negatively impact sleep quality, including the ability to fall asleep and staying asleep. As a result of sub-optimal sleep, a person may experience a weakened immune system, lower tolerance to pain and illness, and the development of additional disorders such as insomnia, sleep apnea, and restless leg syndrome. These can exacerbate symptoms of the chronic condition, creating a frustrating and detrimental feedback loop. As with other health issues that we discuss in this module, treating sleep can improve the condition, and improving the condition can also improve sleep, creating a far more favorable feedback loop. Work with a qualified healthcare professional to address your sleep concerns as they relate to your chronic pain or illness. 

Learn more:

https://www.sleepfoundation.org/physical-health/pain-and-sleep 

https://www.sleepfoundation.org/physical-health/pain-and-sleep

Narcolepsy is a chronic sleep disorder that is characterized by sudden daytime attacks of sleepiness, characterized by sudden loss of muscle tone. They may also experience sleep paralysis, disrupted sleep during regular sleeping hours, and vivid hallucinations at sleep onset or upon waking. People with narcolepsy are typically diagnosed in adolescence or young adulthood due to abnormalities in the brain’s regulation of sleep-wake cycles, often involving low levels of hypocretin (a brain chemical that promotes wakefulness).

There are two types of narcolepsy: Type 1 (more serious/disruptive) is where a person has low levels of the hormone that regulates wakefulness, hypocretin. Additionally those with type 1 narcolepsy experience cataplexy, the sudden loss of muscle tone. Type 2 narcolepsy is characterized by average levels of hypocretin, and no experiences with cataplexy. This sleep disorder affects daily activities, but can be effectively managed through sleep hygiene practices among other lifestyle adjustments, and prescription medications. 

Learn more:

https://www.ninds.nih.gov/health-information/disorders/narcolepsy 

https://www.mayoclinic.org/diseases-conditions/narcolepsy/symptoms-causes/syc-20375497

As defined earlier in the module, circadian rhythm is “the body's internal biological clock that regulates several cycles throughout the day, including metabolism, immune function, hormone production, mental function, and, most importantly, the sleep-wake cycle.” Circadian rhythm disorders can happen to anyone who often struggle with a misalignment between their internal biological clock and the external environment, leading to chronic sleep timing problems. They may present with difficulty falling asleep or waking at conventional times, excessive daytime sleepiness, impaired concentration, mood disturbances, and reduced overall functioning, with common risk groups including shift workers, frequent travelers across time zones, adolescents, and older adults. This misalignment can happen in a variety of ways and can be caused by health and/or lifestyle factors.  

• Jet lag occurs when a person travels to a different time zone and as a result their sleep wake cycle is out of sync with the new time zone. Can become a more serious problem for pilots, flight attendants, or anyone who frequently travels.

• Shift work sleep disorder occurs in those who’s working hours are at night and have trouble adjusting to a new sleep schedule.

• Delayed sleep-wake phase disorder is when a person’s natural circadian clock runs several hours later than the average person. Teenagers are more often prone to this disorder.

• Advanced sleep-wake phase disorder is when a person naturally goes to bed and wakes several hours earlier than the average person. This most often occurs in the elderly.

• Irregular sleep-wake rhythm disorder happens when the sleep wake cycle is unpredictable. This is most often seen in those with dementia or degenerative brain diseases.

• Non 24-hour sleep-wake rhythm disorder is when a person’s natural cycle is consistently either longer or shorter than a 24-hour period. For more information on circadian rhythm disorders go here.

Depending on the severity of the sleep disorder, lifestyle changes may be enough to remedy the issue. Such changes include decreasing caffeine consumption, avoiding daytime naps, and implementing a healthy sleep routine. Sometimes light therapy is prescribed to individuals who struggle with resetting their circadian rhythm. Light therapy involves special lights designed to simulate the effects that the sun would have on one’s circadian system. Medications such as melatonin can also be helpful. CRD’s are most often treated through a combination of lifestyle changes, light therapy, and medication in the form of melatonin. We cover these techniques at length in the Personal Growth Experiment section.

Exploding Head Syndrome (EHS) is a parasomnia, or undesired event that occurs during sleep. It typically manifests as a loud and frightening noise during sleep onset or awakening. This loud, sudden noise is often accompanied by a startling muscular tightening as the body reacts to the imagined noise. This event can become disruptive even on nights when it doesn’t happen if a person developes a fear or anticipation of these frightening imagined noises. While we know it is more common in females, we do not understand yet why it occurs. Some theories include sudden electrical activity in the brain, inner ear damage, or tiny seizures in the temporal lobe of the brain. The good news is that even though it can be quite alarming, it never causes any physical pain. Common interventions for exploding head syndrome focus on stress reduction and improving sleep hygiene/sleep health, as the episodes are generally benign and do not require medication for most individuals.

Parasomnias are disruptive sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, or dreams occurring while falling asleep, during sleep, or upon waking.

Sleep Talking is a condition where a person speaks unintentionally during sleep, often in incoherent or fragmented speech. It can affect people of all ages but is more common in children and those experiencing stress or sleep deprivation. While usually harmless, it can disrupt the sleep of both the person experiencing it and their bed partner.

Sleep Walking involves performing complex activities, such as walking or even leaving the house, while still asleep. It occurs when the brain partially awakens from deep non-REM sleep and the body’s muscles regain tone, causing a person to perform complex behaviors while remaining mostly unconscious. It primarily affects children and can be triggered by sleep deprivation, fever, or genetic predisposition. Sleepwalking episodes can lead to poor sleep quality and potential injury due to unawareness of surroundings.

Sleep Paralysis is a temporary inability to move or speak while falling asleep or waking up, often accompanied by hallucinations. It occurs when the brain temporarily awakens from REM sleep while the body’s muscles remain in their natural state of atonia, leaving the person conscious but unable to move. It can occur in people of all ages but is more frequent in those with irregular sleep schedules, stress, or narcolepsy. This frightening experience can cause anxiety around sleep and contribute to sleep deprivation.

Night Terrors are episodes of intense fear, screaming, and thrashing during deep sleep, often with no memory of the event upon waking. They are most common in children and can be triggered by fever, stress, or an over-aroused central nervous system. While nightmares can be recalled the next day, night terrors typically cannot be remembered. Interestingly, the best thing to do for a person experiencing a night terror is to leave them alone because they are in a deep stage of non-REM sleep. Attempting to wake them can cause confusion, disorientation, agitation, and difficulty falling back asleep. Night terrors are usually managed by ensuring safety during episodes, and treated during daytime hours by improving sleep hygiene, reducing stress, and addressing any underlying sleep disorders, with medications only used in severe or frequent cases.

Parasomnias are generally treated through good sleep hygiene, stress management, and ensuring adequate rest. In severe cases, medical intervention, including therapy, medication, or addressing underlying sleep disorders, may be necessary.