What is a sleep disorder?
Though there is a strong chance that we will all find ourselves lying awake on rare occasions when we are either anxious, excited or roused by a bad dream, it is likely that we will be able to return to our normal routine when things have settled down. However, for others problem sleeping is a far more common occurrence and is now considered to be one of the most common 21st century health complaints, seriously affecting the physical, mental and emotional functioning of many individuals.
Sleep disorders is the term used to describe any problems relating to sleep, such as insomnia, excessive sleep, night terrors, sleep bruxism (teeth grinding) and nocturnal enuresis (bedwetting during sleep). Some sleep disorders may stem from an underlying medical condition such as a psychological disorder, some may occur as side effects of prescribed medication and others may have no known explicable reason.
There are a variety of warning signs which may be indicators of a sleep problem, for example if you feel as though you have had sufficient sleep but are feeling very tired throughout the day, if you drift off mid conversation, if your partner is disturbed regularly by either snoring, physical movements, sleep talking or sleep walking or if you have started new medication and have found your sleep to be affected.
Please note that not everyone who exhibits all or some of these symptoms will necessarily have a sleep problem and each person will have their own experience of sleep disorders.
The sleep cycle
Even though to us sleep may seem like one long continued state of unconsciousness it is actually a process made up of several stages. Sleep is a reoccurring cycle which can be split into two main categories of Rapid Eye Movement (REM) and Non Rapid Eye Movement (NREM).
The first phase of the sleep cycle we experience is known as non-REM sleep, which occurs in four key stages. The first of the phases is often referred to as ‘light sleep’, during which muscle activity slows down and though we are technically sleeping we can still be easily roused. Around ten minutes into the ‘light sleep stage we begin to move into stage two which has an average duration of around 20 minutes during which our breathing pattern and heart rate slow. The final stages see us enter into deep sleep where our brain begins producing delta waves and the rate of breathing and heart rate slow to their lowest levels during the sleep cycle. After this we enter the final phase of non-REM sleep which is characterised by a combination of limited muscle activity and rhythmic breathing. In this state of deep sleep we tend to feel disorientated when woken.
During non-REM sleep the body has the opportunity to fix any wear and tear from throughout the day, repairing and regenerating tissue, building muscle and bone and strengthening the immune system.
Approximately 25% of the sleep cycle is spent in REM sleep, with this phase first occurring between 70 and 90 minutes into sleep. During this stage the brain is at its most active, our breathing rate and blood pressure rise and our eyes dart from side to side. Despite increased activity in the brain, our muscles remain paralysed which is presumably the body’s way of preventing us from acting out our dreams. We experience between three and five REM episodes each night and after REM sleep the whole cycle begins again.
As the night progresses each cycle will become less dominated by the non-REM phases and progressively more dominated by REM sleep. Dreams can occur throughout any sleep stage but the most vivid dreams tend to be reported when people are awoken from REM sleep.
Types of sleep disorders and parasomnias
Parasomnia is the term used to describe a group of sleep disorders which involve unnatural behaviour, movements, perceptions, emotions and dreams that occur during various stages of sleep. Listed below are a few of the most common sleep disorders and parasomnias which are affecting people today:
Confusional arousals are episodes during which individuals awake from sleep but remain in a confused state. Sufferers will react very slowly to commands and may have difficulty understanding any questions asked. More often than not episodes are fairly mild and only last a maximum of a few minutes before the individual returns to sleep. Generally confusional arousals themselves are harmless, though they can be an indicator of a further sleep disorder which could be what is causing the arousals from sleep. Conditions such as sleep apnea and restless legs syndrome may cause increased movement during light sleep which could result in confusional arousals. This means that although it is not necessary to treat the arousals directly there may be an underlying sleep disorder which needs to be diagnosed and treated appropriately.
Restless legs syndrome
This neurological disorder causes unpleasant and uncontrollable sensations in the legs which result in an overwhelming urge to move them. Symptoms occur when a person is relaxing so predominantly during the night and moving the legs tends to help in relieving some discomfort.
Sufferers will usually find that the severity of the pain and irritation increases when they lay down and try to relax which means that going to sleep and staying asleep becomes difficult and uncomfortable for many. If left untreated this condition can result in extreme fatigue and exhaustion which could have a domino effect on an individuals work, relationships and daily activities, subsequently increasing the risk of depression.
Sleepwalking is characterised by an individual performing a series of complex actions such as walking and roaming the house when they are still asleep. Sufferers commonly appear clumsy and confused and will usually have their eyes open with a staring appearance. It is also not unusual for sleepwalkers to be quite vocal, but both talking and responses may be nonsensical. If the individual is not woken and then returns to bed they may have no recollection of the event in the morning.
As discussed above there are five stages of sleep, the first four of which are non-REM sleep and the fifth which is REM sleep. Each complete sleep cycle lasts approximately 90-100 minutes before it is repeated and sleepwalking most commonly occurs during the first or second sleep cycle during stages three and four of non-REM sleep.
Though the disorder can occur in adults it is far more common among children and adolescents and is said to be more likely to occur if a first degree relative has a history of the problem.
Other contributing factors include sleep deprivation, stress, alcohol intoxication and drugs such as sleeping aids, neuroleptics (used to treat psychosis), antihistamines (used to treat allergies), tranquilisers and stimulants.
Physiological factors can also play a part with pregnancy and menstruation thought to increase the occurrence of sleepwalking in some individuals. In addition, certain medical conditions such as psychiatric disorders (e.g post traumatic stress disorder, panic attacks, multiple personality disorder), sleep apnea (pauses in breathing during sleep), arrhythmia (abnormal heart rhythm) and gastroesophageal reflux (a condition in which the stomach contents leak backwards from the stomach into the esophagus) are also said to increase the risk of sleepwalking.
Sleep bruxism (teeth grinding)
Sleep bruxism is characterised by involuntary teeth grinding and clenching during sleep which can result in dental damage and jaw discomfort. For many sufferers bruxism occurs as a side effect of a psychiatric or medical condition such as parkinson’s disease, anxiety or depression and experts have also found links between the condition and certain medications such as recreational drugs (cocaine and ecstasy) and antidepressants.
An individual experiencing sleep paralysis will find that they are unable to move their body or limbs either at sleep onset or upon awakening. According to sleep experts this tends to happen in the REM stage when sleep is suddenly interrupted during a dream. As discussed in the above, paralysis is normal whilst we are sleeping as the body secretes hormones which relax the muscles to prevent us from acting out our dreams. However, when we wake suddenly in the midst of a dream these hormones are unable to wear off quickly enough meaning that though our minds are conscious our bodies are not.
This effect will wear off quickly and can also be ended by touch or sound such as a spouse shaking or talking to you. Though this disorder does not cause the sufferer any harm, it is a frightening experience which can be an isolated incident or a reoccurring problem.
Nightmares are vivid and frightening dreams which tend to rouse the dreamer from their sleep during the rapid eye movement (REM) stage. These kinds of dream are a natural part of our lives and we will all experience them at one time or another. However, for some individuals nightmares begin to occur frequently and can become a worrying and disruptive issue especially in vulnerable groups such as young children.
Nightmare disorder is not to be confused with night terrors, which is a condition characterised by episodes of extreme panic and confusion of which the dreamer has no memory.
According to the Diagnostic and Statistical Manual of Mental Disorders the criteria for nightmare disorder suggests sufferers will consistently awake from sleep with a detailed memory of long and terrifying dreams which usually involve a threat to survival. Sufferers may also find that their nightmares commonly occur in the second half of their sleep period and upon waking will usually be extremely alert.
In the case of nightmare disorder though dreams are not exclusively associated with a mental disorder, some sufferers may have experienced a previous trauma which reoccurs in their dreams.
Nocturnal Enuresis (bed-wetting)
Nocturnal enuresis or bed-wetting as it is otherwise known is the unintentional passing of urine whilst asleep. There are two main forms of the condition, primary and secondary enuresis. The term secondary enuresis is used to describe a relapse in an individual who had previously had urinary control. Primary enuresis on the other hand is when an individual has consistently struggled to maintain bladder control and may find that medical conditions such as diabetes, sleep apnea and psychiatric disorders can act as contributing factors.
According to the NHS the condition is far more common among children, especially in those aged under seven. Experts have said that the reason for its high prevalence among children is because some children are unable to produce enough of the antidiuretic hormone, ADH, which controls urine production throughout the night. Furthermore, some children simply take longer to develop bladder control than others and some may also be affected by psychological issues either at home or at school which could act as contributing factors.
Nocturnal enuresis also occurs in adults and can be very embarrassing and uncomfortable. If the condition begins quite suddenly in someone with no previous history of bedwetting then it is likely that something has acted as a trigger such as a physical trauma or another sleep disorder.
Sufferers may attempt to mask their symptoms which could eventually impact their emotional state and relationships. In some severe cases where the bed-wetting is frequent it may prevent adults from entering relationships for fear of their partner finding out and they also may not feel comfortable going on business trips or holidays which require them to be away from home.
Night terror sufferers will wake suddenly from sleep in a panic-stricken state. Though at this stage it may seem as though the sufferer is awake they will often be disorientated, confused and incapable of communicating. The length of time the terror lasts will vary from person to person but during this time the sufferer will generally be very difficult to awaken and after a while will usually lay down and appear to fall back asleep. In the morning sufferers will usually have no recollection of the nights events.
How can hypnotherapy help?
If you are experiencing a sleep disorder then it is important that you visit your GP who will be able to provide you with a diagnosis and advice as well as being able to rule out any serious underlying medical conditions. At this stage your doctor may then recommend or refer specialist treatment and services, one of which may be hypnotherapy.
Hypnotherapy is all about changing patterns of behaviour and that is why it works so effectively as a treatment for many sleep disorders. Though the cause of each sleep disorder will vary from person to person, there are many conditions which are thought to factor into an increased prevalence of some sleep problems in certain individuals. Certain psychiatric disorders, sleep deprivation, various medical conditions and medications as well as previous trauma are all thought to be underlying causes of many a sleep disorder.
Hypnotherapy has long since been used as a way of altering and reconditioning negative patterns of behaviour and it is able to do so by accessing the unconscious mind so it can seek out the root cause of the problem and alter an individuals perception of it.
For example, many sleep disorders are fuelled and worsened by stress and anxiety, issues which can be effectively resolved with the use of hypnotherapy. Usually it is not a situation itself which causes stress but the way in which we react to it. By inducing a state of deep relaxation in an individual a hypnotherapist will be able to gain access to the unconscious mind so that negative thought patterns and reactions to a particular situation can be turned into more positive ones.
Other techniques used may include that of hypnoanalysis which is a combination of hypnosis and psychotherapy, neuro-linguistic programming (NLP) which explores limiting patterns of behaviour, and visualisation techniques. Visualisation may involve asking a person to imagine themselves in a particular situation feeling relaxed and calm. For example a hypnotherapist may use the guided imagery technique among children with nocturnal enuresis, asking them to imagine something creative like locking their bladder up with a strong colourful key.
A hypnotherapist may use a combination of the techniques mentioned or may feel that the best approach for treating your disorder effectively is just to use one. Either way, your practitioner will be able to tailor treatment to your personal circumstances to achieve the most successful outcome.