Sleep Wake Failures: Understanding The Reasons Behind Them

Sleep-wake disorders are among the most common clinical problems encountered in medicine and psychiatry. Sleep-wake disorders often co-occur with medical conditions or other mental health conditions, such as depression, anxiety, or cognitive disorders. Sleep difficulties are linked to both physical and emotional problems and can both contribute to and exacerbate mental health conditions. Sleep-wake cycles are governed by a complex group of biological processes that serve as internal clocks. The suprachiasmatic nucleus, located in the hypothalamus, is thought to be the body's anatomic timekeeper, responsible for the release of melatonin on a 25-hour cycle. The pineal gland secretes less melatonin when exposed to bright light, and so levels of this chemical are lowest during the daytime hours of wakefulness.

Sleep disorders and mental health

Sleep disorders, or sleep-wake disorders, are characterised by problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. Sleep-wake disorders often co-occur with other mental health conditions, such as depression, anxiety, or cognitive disorders. Sleep difficulties can both contribute to and exacerbate mental health conditions, and they can also be a symptom of these conditions.

Insomnia is the most common sleep-wake disorder, with about one-third of adults reporting symptoms and 4-22% meeting the criteria for insomnia disorder. To be diagnosed with insomnia disorder, sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems in important areas of daily functioning. Other sleep-wake disorders include obstructive sleep apnea (OSA), parasomnias, narcolepsy, and restless leg syndrome (RLS). RLS can cause difficulty falling asleep and frequent awakenings, leading to daytime sleepiness.

Sleep disorders are among the most common clinical problems encountered in medicine and psychiatry. They can markedly impair a patient's quality of life and are a common reason for patient visits. Sleep-wake cycles are governed by a complex group of biological processes that serve as internal clocks. The suprachiasmatic nucleus, located in the hypothalamus, is thought to be the body's timekeeper, releasing melatonin on a 25-hour cycle. The pineal gland secretes less melatonin when exposed to bright light, which is why the chemical's levels are lowest during the daytime.

Circadian rhythm sleep-wake disorders occur when a person's sleep-wake rhythms (body clock) and the external light-darkness cycle become misaligned. This misalignment leads to significant ongoing sleep problems and extreme sleepiness during the day, causing distress or problems with functioning. Shift work, jet lag, and changes in altitude can disturb the sleep cycle. Additionally, an overly warm sleeping environment, environmental noise, or frequent intrusions can contribute to sleep deprivation.

Mental health professionals play a crucial role in diagnosing and treating sleep disorders. A comprehensive assessment for insomnia or other sleep problems may involve a patient history, a physical exam, a sleep diary, and clinical testing, such as a sleep study or polysomnography. Educating patients and their families about proper sleep hygiene is essential, as sleep disorders can also impact the lives of those close to the patient.

Circadian rhythm disorders

The types of circadian rhythm disorders include advanced or delayed sleep-wake phase disorder, irregular or non-24-hour sleep-wake rhythm disorder, shift work disorder, and jet lag disorder. Advanced sleep-wake phase disorder (ASWPD) is characterized by early sleep onset and waking up earlier than desired, interfering with social and professional responsibilities. Delayed sleep-wake phase disorder (DSWPD), on the other hand, leads to falling asleep later than intended and difficulty waking up on time. This disorder can also disrupt daily activities and is one of the most common circadian rhythm disorders.

Symptoms of circadian rhythm disorders include extreme daytime sleepiness, decreased alertness, memory issues, and problems with decision-making. These disorders can have a significant impact on an individual's quality of life and may increase the risk of accidents if left untreated. Diagnosis and treatment depend on the specific type and cause of the disorder and may involve sleep studies, bright light therapy, chronotherapy, and improving sleep habits.

Insomnia and other sleep disorders

Sleep-wake disorders, or sleep disorders, involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. Insomnia is the most common sleep-wake disorder, with about one-third of adults reporting insomnia symptoms and 20% reporting chronic insomnia. To be diagnosed with insomnia disorder, sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems in daily functioning.

Insomnia can be primary or secondary to other conditions or substances. Primary insomnia results from an endogenous disturbance in sleep-wake generating or timing mechanisms, often complicated by behavioral conditioning. Secondary insomnia can be caused by medication side effects, substance misuse, depression, or other physical and mental illnesses. A comprehensive assessment for insomnia may involve a patient history, a physical exam, a sleep diary, and clinical testing such as a sleep study or polysomnography.

Other sleep-wake disorders include obstructive sleep apnea (OSA), parasomnias, narcolepsy, and restless leg syndrome (RLS). Parasomnias are unusual experiences or behaviors that occur during sleep, such as sleep terror disorder, sleepwalking, and nightmare disorder. RLS can cause difficulty falling asleep and frequent awakenings, leading to daytime sleepiness. It typically begins in a person's teens or twenties and affects up to 3% of the population.

Sleep disorders are common, with approximately one-third of Americans experiencing a sleep disorder at some point in their lives. Sleep difficulties can be caused by various factors, including shift work, jet lag, changes in altitude, an overly warm sleeping environment, environmental noise, or frequent intrusions. Sleep is a basic human need and is critical to both physical and mental health, so it is important to practice good sleep hygiene.

Sleep deprivation causes

Sleep-wake disorders, also known as sleep disorders, involve problems with the quality, timing, and amount of sleep, resulting in daytime distress and impaired functioning. Sleep deprivation, a common symptom of sleep-wake disorders, can be caused by various factors, leading to insufficient sleep and adverse effects on physical and mental health. Here are some detailed causes of sleep deprivation:

Circadian Rhythm Disorders: Circadian rhythm sleep-wake disorders occur when an individual's sleep-wake rhythms, or body clock, become misaligned with the external light-darkness cycle. This misalignment results in significant ongoing sleep problems and extreme daytime sleepiness, causing distress and functional impairment. Internal factors, such as a person's unique body clock, and external factors, like shift work or jet lag, can contribute to this type of sleep disorder.

Insomnia: Insomnia is the most common sleep disorder, affecting about one-third of adults. It is characterised by persistent sleep difficulties occurring at least three nights a week for a duration of at least three months. Insomnia causes significant distress and negatively impacts daily functioning, including work and school performance. It can be a primary disorder or secondary to other conditions, medications, or substance misuse.

Medical and Psychiatric Conditions: Sleep disorders are often associated with medical and psychiatric conditions. Certain medical conditions, such as restless leg syndrome, can cause difficulty falling asleep and frequent awakenings during the night. Psychiatric disorders, including depression, anxiety, and cognitive disorders, frequently co-occur with sleep-wake disorders, creating a bidirectional relationship where sleep problems can contribute to or exacerbate mental health issues.

Age-Related Factors: Advancing age is a predisposing factor for sleep disorders. Older adults tend to experience a decrease in total sleep time and more frequent awakenings during the night. Additionally, the incidence of sleep disorders increases with age, affecting 5% of individuals aged 30-50 years and rising to 30% in those aged 50 years or older.

Environmental Factors: The sleeping environment can significantly impact sleep quality. An overly warm sleeping environment, environmental noise, and frequent intrusions can disrupt sleep. These factors may include sleeping in a noisy or crowded place, uncomfortable temperatures, or external noises that disturb sleep.

Addressing these causes of sleep deprivation and seeking appropriate treatment for sleep-wake disorders are crucial for maintaining optimal physical and mental well-being.

Sleep disorders and age

Sleep disorders are among the most common clinical problems encountered in medicine and psychiatry. Sleep-wake disorders often occur alongside medical conditions or other mental health conditions such as depression, anxiety, or cognitive disorders.

Sleep patterns change with age, and older adults may experience disrupted sleep patterns, including problems falling or staying asleep, excessive sleep, or abnormal behaviours with sleep. Primary sleep disorders are more common in the elderly than in younger persons.

Older adults may experience a decrease in total sleep time, with more frequent awakenings during the night. They may also experience less time in the deeper stages of sleep, early-morning awakening, and excessive daytime sleepiness. Poor sleep habits, such as irregular sleep-wake times and daytime napping, can contribute to insomnia. Additionally, caffeine, alcohol, and some medications can interfere with sleep.

Restless legs syndrome and periodic limb movement disorder are also common in older adults and can disrupt sleep. These disorders may respond to low doses of antiparkinsonian agents or other drugs. Sleep apnea is another common cause of excessive daytime sleepiness in older adults.

Treating any underlying medical or mental health conditions, improving sleep hygiene, and making lifestyle changes can help improve sleep in older adults.

Frequently asked questions