Sleep – Wake Disorders
Sleep-Wake disorders are divided into two major categories: Dyssomnias and Parasomnias.
Dyssomnias involve difficulties in getting enough sleep, problems with sleeping when you want to, and complaints about the quality of sleep, such as not feeling refreshed even though you have slept the whole night. Parasomnias are characterized by abnormal behavioral or psychological events that occur during sleep, such as nightmares and Sleepwalking.
About Insomnia Disorder:
Insomnia is one of the most common Sleep-Wake Disorders. It isn't possible to go completely without sleep. After being awake for one or two nights, a person begins having micro sleeps that last several seconds or longer. In the rare occurrences of fatal familial insomnia, total lack of sleep eventually leads to death.
1. Difficulty initiating sleep (in children it is possible without caregiver intervention).
2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings.
3. Early morning awakening with inability to return sleep.
4. The sleep difficulty occurs at least 3 nights per week.
5. The sleep difficulty is present for at least 3 months.
6. The Sleep difficulty occurs despite adequate opportunity for sleep.
Insomnia accompanies many medical and psychological disorders, including pain and Physical discomfort, physical inactivity during the day and respiratory problems. Some people who can't fall asleep at night may have a delayed temperature rythm: their body temperature doesn't drop and they don't become drowsy until later at night. Among the other factors that can interfere with sleeping are drug use and a variety of environmental influences, such as changes in light, noise or temperature. Thus the cause includes pain, insufficient exercise, drug use, environmental influences, anxiety, respiratory problem and biological vulnerability.
Treatment may be medical (benzodiazepines) or Psychological (anxiety reduction, improved sleep hygiene) and combined approach is usually most effective. There are several drawbacks to medical treatments for insomnia. They can cause excessive sleepiness, people can easily become dependent on them and rather easily misuse them, meant for short term treatment and are not recommended for use longer than 4 weeks. Longer use can Cause dependence and rebound insomnia
Research shows that some psychological treatments for insomnia may be more effective than others.
COGNITIVE: This approach focuses on changing the sleeper’s unrealistic expectations and beliefs about sleep. The therapist’s attempts to alter beliefs and attitudes about sleeping by providing information on topics such as normal amounts of sleep and a person's ability to compensate for lost sleep.
GUIDED IMAGERY RELAXATION: Because some people become anxious when they have difficulty in sleeping, this approach uses meditation or imagery to help with relaxation at bedtime or after a night waking.
GRADUATED EXTINCTION: Used for children who have tantrums at bedtime of wake up crying at night, this treatment instructs the parents to check on the child after progressively longer periods until the child falls asleep on his or her own.
PARADOXICAL INTENSION: This technique involves instructing individuals in the opposite behavior from the desired outcome. Telling poor sleepers to lie in bed and try to stay awake as long as they can is used to try to relieve the performance anxiety surrounding efforts to try to fall asleep.
PROGRESSIVE RELAXATION: This technique involves relaxing the muscles of the body in on effort to introduce drowsiness.
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