Dyssomnia: Types And Treatments
The American Psychological Association defines dyssomnia as “a broad classification of various sleep disorders marked by abnormalities in the amount, quality, or timing of sleep.” While the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) no longer lists “dyssomnia” as a separate designation, the manual includes a list of sleep-wake disorders.
Dyssomnias can have wide-reaching effects on a person’s physical and mental health. They are usually distinguished from parasomnias, which typically involve unwanted behavior during sleep. Parasomnias may include sleep terrors, sleepwalking, or urination during sleep. Dyssomnia may require different types of treatment, including prescription medication, therapy, and lifestyle adjustments.
Types of dyssomnia
Intrinsic sleep disorders
Intrinsic sleep disorders are typically caused by some type of internal malfunction. The following are some common intrinsic sleep disorders:
Insomnia
Insomnia generally refers to difficulty falling asleep or maintaining restorative sleep. While some types of insomnia can be related to physical health conditions (in these cases, insomnia may be referred to as a secondary sleep disorder), insomnia is not always the result of another condition.
When insomnia occurs on its own, it’s usually called primary insomnia. For example, some people may experience psycho-physiological insomnia, which occurs when a person is nervous about not being able to fall asleep, and this anxiety keeps them awake. This is generally seen as primary insomnia because it doesn’t stem from another condition.
A doctor may diagnose insomnia after ordering an actigraphy, which involves the use of a watch-like device that records a person’s sleep and wake cycles over the course of days or weeks.
Restless legs syndrome
The DSM-5-TR defines restless legs syndrome (RLS) as follows: “Restless legs syndrome (RLS) is a sensorimotor, neurological sleep disorder characterized by a desire to move the legs or arms, usually associated with uncomfortable sensations typically described as creeping, crawling, tingling, burning, or itching.”
A person living with RLS may experience more symptoms at night than during the day, and the symptoms may dissipate if the person moves their legs. This disorder can significantly affect a person’s sleep quality if it's left untreated. Additionally, a person living with RLS may experience sleepiness during the day.
Periodic limb movements in sleep
Periodic limb movements in sleep (PLMS) typically refers to sudden, involuntary movements of the arms or legs while a person is sleeping. While researchers don’t know the exact cause of PLMS, they believe it could be related to the nervous system. A person experiencing PLMS may feel sleepy during the day as a result of interrupted sleep from the sudden twitching or flexing of the muscles.
Obstructive sleep apnea
People experiencing obstructive sleep apnea usually experience pauses in their breathing throughout the night. This can happen when their upper airway collapses during sleep, which may lead to snoring or a choking sound that occurs multiple times as they sleep. A person living with sleep apnea may wake up with the sense that they are unrested and experience tiredness throughout the day.
Extrinsic sleep disorders
Extrinsic sleep disorders normally refer to those caused by factors that are external to the body.
Nocturnal eating syndrome
A person living with nocturnal eating syndrome tends to eat 25% or more of their daily calories sometime after dinner, including during the night. Individuals with this syndrome may also experience a depressed mood at night and believe that they must eat to fall asleep.
Poor sleep hygiene
Given that poor sleep hygiene is not caused by internal factors, it can be considered an extrinsic sleep disorder. Some people may not have a regular sleep schedule, which can make it difficult to get quality sleep. Other factors that can contribute to poor sleep hygiene may include consuming caffeine or alcohol late in the day and using electronic devices in the hours immediately preceding bedtime. These devices often emit blue light, which can affect a person’s sleep cycle.
Circadian rhythm sleep disorders
Circadian rhythm sleep disorders tend to be related to the body’s internal sleep regulation system or the circadian clock. When a person’s circadian rhythm is disrupted, it can contribute to problems with sleep, which can affect numerous body systems. The following circadian rhythm sleep disorders are listed in the DSM-5-TR:
Delayed sleep phase type
The DSM-5-TR states that individuals with delayed sleep phase syndrome have “a history of a delay in the timing of the major sleep period (usually more than 2 hours) in relation to the desired sleep and wake-up time, resulting in symptoms of insomnia and excessive sleepiness.”
Individuals with this type may experience daytime sleepiness and difficulty falling asleep or waking up. When they have the freedom to create their own schedules, sleep duration and quality typically return to normal.
Advanced sleep phase type
This sleep phase type typically involves having a sleep-wake schedule that is earlier than what is normal or preferred. Individuals living with this disorder may have insomnia early in the morning and experience sleepiness during the day. People with advanced sleep phase syndrome also tend to experience normal sleep duration and quality if they have the freedom to set their own schedules.
Irregular sleep-wake type
Individuals living with the irregular sleep-wake type often have an irregular circadian rhythm. Rather than having a main sleep period, they typically have three fragmented sleep periods over the course of 24 hours, and the longest of these periods normally has a duration of less than four hours and occurs between 2:00 a.m. and 6:00 a.m.
Non-24-hour sleep-wake type
This sleep-wake type is typically characterized by a misalignment of a person’s endogenous circadian rhythm and the 24-hour cycle of light and dark. People living with this condition may experience insomnia and sleepiness. However, they typically experience brief asymptomatic periods as well. After one of these periods, their sleep latency, or the time it takes them to fall asleep, often increases gradually until they find themselves feeling tired during the day.
Getting support for dyssomnia
Regardless of the type of dyssomnia a person experiences, it can have a significant effect on their daily life. Aside from the physical effects, such as excessive sleepiness, dyssomnia can have an impact on a person’s mental health. A lack of quality sleep can affect a person’s mood and relationships, both personal and professional.
Individuals experiencing dyssomnia may benefit from speaking with a mental health professional about the emotional challenges that often arise from disrupted sleep and primary sleep disorders. Those whose altered sleep schedule makes it difficult to attend traditional in-person therapy might consider online therapy.
With online therapy, anyone can connect with a licensed therapist from home at a time that suits their schedule. Online therapy generally allows individuals living with dyssomnia to communicate with a therapist in a way that’s comfortable for them, such as audio, video, or live chat. Some online therapy platforms also allow people to reach out to their therapist 24/7 through in-app messaging. This may be useful for those who experience insomnia in the middle of the night. They can contact their therapist with any questions or concerns, and they will usually respond as soon as they can.
In recent years, many peer-reviewed studies have shown that online therapy can be just as effective as in-office therapy. In one study published in Cognitive Therapy and Research, researchers found that cognitive behavioral therapy for insomnia (CBT-I) generally improved sleep quality and reduced anxiety symptoms.
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