Mental Disorders

'I think the most common cause of insomnia is simple; it's loneliness'
-Heath Ledger, actor

Introduction

Remember a night when it was extremely hard to fall asleep and how it felt? Staying up against your will? While for some this might be a rare occurrence, for others it is a serious problem affecting their quality of life. Insomnia is “the subjective complaint of difficulty falling or staying asleep or poor sleep quality” [1]. 

Signs and Symptoms

An average adult needs 7 to 8 hours of sleep. One might need to be aware of the problem and seek help if they start having trouble in sleeping or develop any of the following symptoms: 

  • Difficulty in falling asleep
  • Waking up frequently during night
  • Waking up earlier than desired
  • Lethargy and fatigue during day time
  • Poor focus
  • Frequent headaches due to lack of sleep
  • Difficulty in engaging with others
  • Stomach problems
  • Worrying about sleeping

Types of Sleep-Wake Disorders

1) Insomnia Disorder

It involves complains with the amount and the quality of sleep which includes trouble falling asleep, staying asleep or awakening after falling asleep with the inability to go back to sleep again. Lack of sleep causing fatigue and tiredness continues for a period of 3 months with the episodes causing impairment for more than 3 days in a week.

2) Hypersomnolence Disorder

It involves the feeling of fatigue and tiredness even after 7+ hours of sleep. The attained sleep does not result in feeling refreshed or energetic during the day. Excessive need for sleep continues for a period of 3 months with the episode causing impairment for more than 3 days in a week.

3) Narcolepsy

Involves sleep attacks where an individual suddenly falls asleep during random times of the day. This can prove to be fatal in instances such as driving. This disorder is diagnosed after an individual suffers from multiple episodes in a given month for a period of 3 months.

4) Breathing-Related Sleep Disorders

The umbrella term for four subtypes, which are as follows:

  • Obstructive sleep apneahypoapnea: Nighttime breathing issues cause daytime sleepiness
  • Central sleep apnea: Involves pauses in breathing during sleep where the brain does not send signal to the muscles. The breathing stops and starts
  • Sleep-related hypoventilation: Involves reduced levels of breathing that result in reduced levels of oxygen
  • Circadian rhythm sleep-wake disorders: A disturbance in the sleep-wake pattern that results in either hypersomnolence or insomnia

5) Parasomnias

The umbrella term for four sub-types, which are as follows:

  • Non-rapid eye movement sleep arousal disorders: Involves sleepwalking or sleep terrors where the individual has no memory of the physical activity they engaged in
  • Restless legs syndrome: Involves leg movement followed by an unpleasant sensation
  • Nightmare disorder: Awakening after a terrifying dream that is recalled in detail
  • Rapid eye movement sleep behavior disorder: Involves acting out the content of one’s dream while remaining asleep

The problem is more common and the experience is debilitating, not only for the individual, but also for their families. According to a research, 31.3% of the adult Pakistanis living in urban areas suffer from insomnia [2]. The distress causes one to lose peace of mind, leading to daily life being significantly impacted. It can occur at any stage in one’s life. [3]


References:

[1] Morrison, J. (2014).  DSM-5 made easy: The Clinician’s guide to Diagnosis. New York: Guilford Press.   

[2] Kidwai, E., & Ahmed, A, H. (2013). Prevalence of insomnia and use of sleep medicines in urban communities of Karachi, Pakistan. Journal of Pakistan Medical Association. Retrieved from http://jpma.org.pk/full_article_text.php?article_id=5182

[3]American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.


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