Sleep Issues

Getting enough sleep is essential for normal functioning, but almost everyone has an occasional sleepless night. How much sleep is needed? There is no such thing as a ‘normal’ amount of sleep. On average adults sleep about 7 – 8 hours per night, but some people require more or less sleep than others.

As we age we tend to sleep fewer hours and we get less deep, restorative sleep.

Sleep Problems and Disorders

Many people have difficulties sleeping including:

  • Problems with falling and staying asleep
  • Problems with staying awake
  • Problems with adhering to a regular sleep schedule
  • Sleep-disruptive behaviors (e.g., nightmares) 1

However, if you have one of these problems it does not necessarily mean that you have a Sleep Disorder. Sleep Disorders affect approximately 20% of the American population, and sleep-related problems affect 50-70 million Americans of all ages.4 Of the various types of Sleep Disorders, insomnia is more common with about 30% of adults experience transient insomnia (lasting a month or less) and 15% of adults experience chronic insomnia (lasting 4 or more weeks).5

Just because you or someone you know do not meet criteria for a “Sleep Disorder” does not mean that you cannot benefit from information and self-help tools provided by this site. Many of us have occasional difficulty sleeping due to changes in our mood, medications, alcohol or drug use, and medical conditions.

Defining Sleep Disorders

According to the Diagnostic and Statistical Manual of Mental Disorders-4th Edition, which is the handbook used most often in diagnosing mental disorders, Primary Sleep Disorders are diagnosed when sleep problems cannot be attributed to another mental disorder, a general medical condition, or use of a substance. Whereas Secondary Sleep Disorders are sleep problems that are associated with medical, neurological, or substance misuse disorders.1 There are two categories of Primary Sleep Disorders: Dyssomnias and Parasomnias.

FAQs

Many people have difficulties sleeping including:

  • Problems with falling and staying asleep
  • Problems with staying awake
  • Problems with adhering to a regular sleep schedule
  • Sleep-disruptive behaviors (e.g., nightmares) 1

However, if you have one of these problems it does not necessarily mean that you have a Sleep Disorder.

According to the Diagnostic and Statistic Manual of Mental Disorders, Edition IV, Primary Sleep Disorders are diagnosed when sleep problems cannot be attributed to another mental disorder, a general medical condition, or use of a substance. Whereas Secondary Sleep Disorders are sleep problems that are associated with medical, neurological, or substance misuse disorders.1 There are two categories of Primary Sleep Disorders: Dyssomnias and Parasomnias.

  • Dyssomnias involve difficulty initiating sleep (falling asleep), maintaining sleep (staying asleep) or sleeping too much. These disorders cause disruptions in the amount, quality, or time of sleep. Types of Dyssomnias:
    1. Primary Insomnia
    2. Primary Hypersomnia
    3. Narcolepsy
    4. Breathing-Related Sleep Disorder
    5. Circadian Rhythm Sleep Disorder
  • Parasomnias involve abnormal behavioral or physiological events that occur in association with sleep, specific sleep stages, or sleep-wake transitions. Specifically, the autonomic nervous system (system that controls involuntary actions of internal organs), motor system, or cognitive processes are activated at inappropriate times during the sleep-wake cycle. People with these disorders usually complain of unusual behavior during sleep rather than insomnia or sleepiness during the day. Types of Parasomnias:
    1. Nightmare Disorder
    2. Sleep Terror Disorder
    3. Sleepwalking Disorder

Sleeping difficulties are sometimes symptoms of other disorders. For example, people who suffer from depression may have trouble falling or staying asleep (insomnia), or may sleep too much (hypersomnia). People with Posttraumtic Stress Disorder may have nightmares. It is not uncommon to experience low-level or occasional sleeping difficulties (i.e., during stressful periods of time) without meeting criteria for a specific disorder.

If you think you might be suffering from a sleep disorder, check out this Sleep Self Assessment Quiz. If you are flagged as having a possible Sleep Disorder this tool will offer you more information that may be relevant to your difficulties.

Primary Insomnia

The essential feature of Primary Insomnia is difficulty falling or staying asleep, or nonrestorative sleep (sleep was light, restless, or of poor quality). People with Insomnia often become distressed about their difficulties, which in turn impacts their ability to sleep. In order to meet diagnostic criteria for Primary Insomnia these symptoms must be present for at least one month, and must cause significant distress or impairment in functioning. Physical illness, depression, anxiety or stress, poor sleep environment (physical discomfort, too much light), alcohol or other drugs (especially caffeine), certain medications, heavy smoking, and counterproductive sleep habits (e.g., daytime napping, early bedtimes, excessive time spent awake in bed) can impact insomnia.1 If you think you might be suffering from insomnia check out the this online quiz, Is Insomnia Affecting Your Life?

Primary Hypersomnia

The essential feature of Primary Hypersomnia is excessive sleepiness. People with Primary Hypersomnia often take long naps (an hour or more) that do not lead to improved alertness or feeling refreshed. Also, people can inadvertently fall asleep during low-stimulation and low-activity situations, such as attending a lecture, reading, watching television, or taking a long drive. In order to meet diagnostic criteria for Primary Hypersomnia these symptoms must be present for at least one month, and must cause significant distress or impairment in functioning.

Narcolepsy

The essential features of Narcolepsy are repeated irresistible attacks of refreshing sleep. Sleepiness usually decreases after the attack, but returns several hours later. In order to meet DSM-IV criteria for Narcolepsy, these symptoms must occur daily over at least a three month period. Also, one or more of the following must be present:

  • Attacks of cataplexy, which are episodes of muscular weakness. Signs of cataplexy may include a barely perceptible slackening of the facial muscles to the dropping of the jaw or head, weakness at the knees, or total collapse on the floor.
  • Recurrent intrusions of elements of rapid eye movement (REM) sleep into the transition between sleep and wakefulness as evidenced by hallucinations or paralysis at the beginning or end of sleep episodes.

Breathing-Related Sleep Disorder

The essential feature of Breathing-Related Disorder is sleep disruption caused by breathing abnormalities that lead to excessive sleepiness or insomnia. Sleep apnea and central alveolar hypoventilation syndrome are examples of this disorder. Sleep apnea is most common in obese young adult males, but it may affect anyone with a short neck or a small jaw, regardless of weight.1

Circadian Rhythm Sleep Disorder

The essential feature of Circadian Rhythm Sleep Disorder is a persistent or recurrent pattern of sleep disruption that leads to insomnia or excessive sleepiness that is caused by a mismatch between the sleep-wake schedule required by a person’s environment and his or her circadian sleep-wake pattern. For instance, some “night owls” have a difficult time falling asleep at socially acceptable times, and therefore have difficulty awakening on time for work or school.

Nightmare Disorder

The essential feature of Nightmare Disorder is repeated nightmares that lead to awakenings from sleep. People are able to recall their dreams in detail. The content of dreams usually involves threats to survival, security, or self-esteem. Unlike Sleep Terror Disorder (see below), individuals with Nightmare Disorder quickly become oriented and alert when they awaken. Since nightmares are common, dream experiences or sleep disturbances caused by awakening must cause significant distress or impairment in functioning in order to meet criteria for Nightmare Disorder.

Sleep Terror Disorder

The essential feature of sleep terror disorder is the repeated occurrences of abrupt awakenings from sleep usually beginning with a panicky scream or cry. Sleep terrors are sometimes mistaken for nightmares, however they occur during deeper stages of sleep and are not manifestations of a dream.2 Episodes generally last one to ten minutes and are accompanied by:

  • Intense fear and signs of autonomic arousal, such as rapid heart beat and breathing, and sweating during each episode.
  • Relative unresponsiveness to efforts of others to comfort the person during the episode.
  • No detailed dream is recalled and there is amnesia for the episode (i.e., it is not remembered).
  • Additionally, these episodes must cause significant impairment or distress in the individual’s functioning.

Sleepwalking Disorder

The essential feature of Sleepwalking Disorder is repeated episodes of rising from bed and walking about, which is initiated during sleep. Other symptoms:

  • While sleepwalking the person has a blank, staring face and is relatively unresponsive to the efforts of others to communicate with him or her. Awakening the individual is very difficult.
  • When the individual awakens he or she has amnesia for the episode (i.e., does not remember it).
  • Within several minutes after awakening from the sleepwalking episode there is no impairment of mental activity or behavior, although the person might initially be confused or disoriented.
  • Sleepwalking must cause significant distress or impairment in functioning.

Medical conditions, psychiatric disorders, and psychosocial and environmental factors impact sleep problems:

  • People with common medical illnesses such as, asthma, cancer, cardiopulmonary diseases, chronic fatigue syndrome, diabetes, end-stage renal disease, fibromyalgia, human immunodeficiency virus (HIV), irritable bowel syndrome, and temporomandibular joint disorders frequently experience sleep disturbances.1
  • Restless leg syndrome usually causes insomnia. This syndrome is characterized by an uncomfortable sensation in the legs, primarily at night, which diminishes when the legs are moved.3
  • The rate of insomnia among individuals with depression is very high: 40-60% for outpatients, and 90% for inpatients.5 Additionally, anxiety or stress can impact sleep.3
  • Sleep apnea is most common in obese young adult males, but it may affect anyone with a short neck or a small jaw, regardless of weight.3
  • Sleep difficulties may be related to poor sleeping environment such as excessive noise or light or physical discomfort.3
  • Caffeine, alcohol or other drugs, heavy smoking, and certain medications can impact sleep.
  • Sleep issues, including frequent daytime napping, excessive time spent awake in bed, 3 and inconsistent wake up time, is associated with sleep difficulties.
  • Sleep is affected

Sleep disorders affect approximately 20% of the American population, and sleep-related problems affect 50-70 million Americans of all ages.4 However, 50% or more of patients remain undiagnosed and therefore do not receive needed treatment.4 For instances it is estimated that 60-64% of chronic insomnia cases are not recognized by primary care physicians.5 Of the various types of Sleep Disorders, insomnia is more common with about 30% of adults experience transient insomnia (lasting a month or less) and 15% of adults experience chronic insomnia (lasting 4 or more weeks).5 Sleep-related problems have the same clinical relevance in women as men 3, but some sleep problems are more common in women (e.g., Nightmare Disorder) and some are more common in men (e.g. sleep apnea). Increased age is associated with increased prevalence of insomnia complaints, daytime sleepiness, and Breathing-Related Sleep Disorder.4

Treatments vary depending upon the type of disorder. Behavior therapy, drug treatments, and several alternative interventions can be helpful for a variety of sleep difficulties. Most people also benefit from basic education about normal sleep (may reduce patient’s anxiety about sleep) and sleep issues (activities that interfere with sleep).5

Insomnia

Short-term insomnia may resolve on its own. Treatment for insomnia can include a trial of hypnotic medication (followed by supervised withdrawal).5 More about medications for insomnia. Cognitive-behavioral treatment (CBT) or a combination of CBT and hypnotic medication may be a beneficial treatment.5 CBT for insomnia addresses problematic beliefs about sleep or lack thereof, teaches relaxation skills, and targets stimulus control, which helps an individual learn to associate bedtime and the bedroom with being able to sleep. More about CBT for insomnia. When insomnia is caused by another disorder (e.g., depression, medical illness) that disorder should be treated first. If symptoms of insomnia do not improve a referral to sleep specialist may be helpful.5

Hypersomnia

Stimulant, antidepressant, and other medications may be beneficial for treating hypersomnia. It is also important to implement habits to promote sleeping at night and staying awake during the day, such as avoiding activities that delay bed time and avoiding alcohol and caffeine.6

Narcolepsy

Stimulant medications may help reduce daytime sleepiness, Anticholinergic (medications that calm muscle spasms) antidepressant agents for cataplexy may help with cataplexy symptoms.7 Regular scheduled naps, in addition to medication is recommended.7

Breathing-Related Disorder

For patients with obstructive sleep apnea, treatment may include behavioral interventions, oral/dental appliances, and surgical interventions, depending upon the severity of the disorder. Many patients are treated with nasal continuous positive airway pressure (CPAP).8 The machine blows air into your nose via a nose mask, keeping the airway open and unobstructed.

Circadian Rhythm Disorder

Light therapy (properly timed exposure to bright light to promote a normal sleep-wake cycle and decrease sleep disturbances) and behavioral interventions may be beneficial in the treatment of Circadian Rhythm Disorder.9 Behavioral interventions include implementing habits to promote normal sleep/wake cycles and gradually shifting the time of sleep.9

Sleep Terror Disorder

Before beginning treatment it is recommended that sleep terrors be waited out to see if they resolve. 2 If the problem persists, a trial of antidepressants or antianxiety medications may be beneficial, however the effectiveness of these drugs has not been clearly demonstrated.2Sleep terrors may be impacted by a failure to get enough sleep therefore getting more sleep might be helpful. Scheduled awakening may also be beneficial for the treatment of sleep terrors.2 Scheduled awakening involves waking the person approximately 30 minutes before the he or she normally awakens, then slowly eliminating the scheduled awakenings as spontaneous awakenings decrease.2

Nightmare Disorder

Behavioral interventions may be beneficial in the treatment of recurrent nightmares.10, 11 Treatment may include imagery rehearsal for nightmares (practice of how to respond to the event without actually experiencing it) and sleep issues (implementing habits that promote good sleep).

Sleep Walking Disorder

Sleep walking does not necessarily require treatment, and may go away on its own. It is important to implement habits to promote good sleep and treat any underlying medical conditions that may impact sleep problems.12 Safety measures may be necessary to prevent injury, including locking windows and doors, removing obstacles in the room, adding alarms, or blocking stairways.12 Medications, such as certain sedatives or antidepressants, may be helpful, particular if the potential risk for injury is great, if other interventions have not been helpful, or if the individual is experiencing excessive daytime sleepiness.12 Behavioral techniques, such as relaxation and scheduled awakening may also be beneficial for the treatment of sleep walking.12 Scheduled awakening involves waking the person up approximately 15-20 minutes before the usual time her or she sleep walks and then keeping him or her awake through the time during which the episodes usually occur.12

Find a Sleep Specialist is a handout that provides resources about locating sleep specialists.

References:

1 Buscemi, N., Vandermeer, B., Hooton, N., Pandya, R., Tjosvold, L., Hartling, L., Vohra, S., Klassen, T. P., & Baker, G. (2006). Efficacy and safety of exogenous melatonin for secondary sleep disorders and sleep disorders accompanying sleep restriction: meta-analysis. British Medical Journal, 332, 385-393.

2 Durand, V. M. (in press). Sleep terrors. In J. Fisher and W. O’Donohue (Eds.), Practice guidelines for evidence based psychotherapy. New York: Kluwer Academic Publications.

3 Allen J. Blaivas, D.O., Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospital, Newark, NJ. Review provided by VeriMed Healthcare Network.

4 National Institutes of Health.National Center on Sleep Disorders Research Plan. 2003.

5 McCrae, C. s., Sidney, D. N., Taylor, D. J., & Lichstein, K. L. (in press). Insomnia. In J. Fisher and W. O’Donohue (Eds.), Practice guidelines for evidence based psychotherapy. New York: Kluwer Academic Publications.

6 National Institutes of Health, National Institutes of Neurological Disorders and Stroke. NIDS Hypersomnia Information Page. Updated 1/14/06. Accessed 2/26/06.

7Littner, M., Johnson, S. F., McCall, W. V., McDowell Anderson, W., Davila, D., K. Hartse, Kushida, C. A., et al. (2001). Practice Parameters for the Treatment of Narcolepsy: An Update for 2000. Sleep, 24, 4, 451-466.

8 National Institutes of Health, National Heart, Lung, and Blood Institute (1997). Problem Sleepiness in Your Patient. Accessed 2/26/06.

9 Cataletto, M. E., & Hertz, G. (2005). Sleeplessness and Circadian Rhythm Disorder. Updated 9/27/05. Accessed 2/26/06.

10 Krakow, B., Johnston, L., Melendrez, D., Hollifield, M., Warner, T. D., Chavez-Kennedy, D., & Herlan, M. J. (2001). An Open-Label Trial of Evidence-Based Cognitive Behavior Therapy for Nightmares and Insomnia in Crime Victims With PTSD. American Journal of Psychiatry, 158,2043-2047.

11 Pagel, J. F. (2000).Nightmares and Disorders of Dreaming. American Family Physician, 61, 7, 2037-2050.

12 Sharp, S. J., & D’Cruz, O. F. (2006). Somnambulism (Sleep Walking). Updated 1/3/06. Accessed 2/26/06.

Professional Help

Community Resources

Association for the Advancement of Behavior Therapy – Find a Therapist
or call 1-212-647-1890.

American Psychological Association – Find a Psychologist
or call 1-800-964-2000.

National Association of Social Workers – Search Clinical Register

Locate a Psychiatrist, call toll-free 1-888-35-PSYCH. Outside the U.S. and Canada call 1-703-907-7300.

Vet Center Counseling Services

Self-Help Resources

Sleep information and tools are organized here, with links to additional resources. Individuals experiencing a Sleep Disorder may also be struggling with depression, substance abuse, Posttraumatic Stress Disorder or any number of other physical and/or behavioral health conditions. You may also find the self-help information available within other behavioral health categories on this web site to be helpful.

Depression

Identifying Depression

People often say “I’m depressed” when what they are really experiencing is sadness. Clinical depression is more than just feeling blue or down after a bad day at work or during a difficult period of life.

People who are clinically depressed feel down, sad, or hopeless all the time, for weeks on end, and can experience the following symptoms:

  • Loss of interest in pleasurable activities
  • Lack of energy
  • Difficulty sleeping, or sleeping too much
  • Persistent feelings of sadness, worthlessness, guilt
  • Appetite loss or overeating
  • Restlessness or irritability
  • Thoughts of death or suicide
  • Difficulty thinking clearly, remembering or concentrating well enough to read or watch television

These symptoms can be similar to the experiences associated with grieving the death of a loved one. However, in depression, these feelings arise without such a loss, or they last much longer than the usual cycle of grief.

Depression may occur along with related conditions such as substance abuse, Posttraumatic stress disorder (PTSD), or any number of other physical and mental health disorders. Early identification of depression at any age is important, but for children and adolescents, the likelihood of developing one of these related disorders in adulthood is greater than for children who do not have depression.

In addition to the symptoms identified above, children and adolescent symptoms may include:

  • Somatic complaints like headache, and stomachache (without a readily identifiable cause)
  • Decline in school performance
  • Withdrawal or decrease in interactions with peers
  • Extreme sensitivity to rejection of criticism

Younger children tend to externalize their behavior (either by acting out or expressing physical symptoms) while teens and adolescents tend to withdraw and isolate themselves.

Substance Use

Identifying a Substance Use Disorder

When substance use interferes with daily functioning, or is influencing an individual’s work, parenting, safety, or health, it is a problem and needs to be addressed.

Anyone can develop a substance use disorder to street or recreational drugs, prescription medications, or other toxins. Typically substances are divided into 11 classes:1

  • Alcohol
  • Caffeine
  • Cocaine
  • Inhalants
  • Opioids
  • Sedatives, hypnotics, and anxiolytics
  • Amphetamines
  • Cannabis
  • Hallucinogens
  • Nicotine
  • Phencyclidine (PCP)
Commonly Abused Drugs

National Institute on Drug Abuse
To learn more about these substance categories, including street and commercial names, intoxication effects, and potential health effects.

PTSD

Identifying Posttraumatic Stress Disorder (PTSD)

Posttraumatic Stress Disorder, or PTSD, is an anxiety disorder that can occur when an individual has experienced a terrifying ordeal or event. This experience could occur during military combat, a natural disaster, serious accident, or a violent personal assault. People with PTSD often relive the experience through nightmares and flashbacks.

Some individuals may detach to avoid reminders of the traumatic event. They may in turn end up feeling disconnected or estranged from family and friends.

What are some of the symptoms of PTSD?

It’s important to know the signs of PTSD so treatment can begin as soon as possible. Symptoms can be severe and can make daily life difficult.

Individuals may experience:

  • difficulty sleeping
  • trouble concentrating
  • irritability
  • feeling tense or on guard at all times
  • Restlessness or irritability

PTSD is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, alcohol or drug abuse, or any number of other mental health problems. PTSD is also associated with low functioning in social or family groups, including job instability, and marital or parenting issues.

Fact Sheets and Handouts

Tips for a Good Night’s Sleep
Identifies sleep patterns and suggests daytime and bedtime routines that may improve sleep.

Sleep Disorder Information: Fact Sheets
Offers information about the following Sleep Disorders:

Myths and Facts about Sleep
There are many common myths about sleep. Sometimes they can be characterized as “old wives tales,” but there are other times the incorrect information can be serious and even dangerous.

Sleep and Post-traumatic Stress Disorder
A National Center for PTSD Fact Sheet explains how sleep problems, such as difficulty falling asleep, waking frequently, and having distressing dreams or nightmares, are common to those suffering with PTSD.

Sleep Disorders and Depression
Lack of sleep alone cannot cause depression, but it does play a role. Lack of sleep caused by another medical illness or by personal problems can make depression worse. An inability to sleep that lasts over a long period of time is also an important clue that someone may be depressed.

Books & Workbooks

No More Sleepless Nights with No More Sleepless Nights Workbook
P. Hauri & S. Linde

Get a Good Night’s Sleep
K. A. Albert

Goodbye Insomnia, Hello Sleep
S. Dunkell

Web Resources

Web MD Sleep Disorders Health Center
Self-help resources and information about a variety of Sleep Disorders and related issues.

American Sleep Apnea Association
Resources and support group information for individuals struggling with sleep apnea.

American Sleep Association
A national organization focused on improving public awareness about sleep disorders and sleep health.

Sleep Disorder Help Guide
More on Sleep Disorders, including types, diagnosis, risk factors, and prevention.

Veteran and Military Family Health
U.S. National Library of Medicine and the National Institute of Health

Real Warriors Campaign
Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury

Treatment for Sleep Disorders

Treatments vary depending upon the type of disorder. Behavior therapy, drug therapy, and several alternative interventions can be helpful for a variety of sleep difficulties. Most people also benefit from basic education about normal sleep (may reduce patient’s anxiety about sleep) and sleep issues (activities that interfere with sleep).5

Treatment for Insomnia: Short-term insomnia may resolve on its own. Treatment for insomnia can include a trial of hypnotic medication (followed by supervised withdrawal).5 More

Additionally, cognitive-behavioral treatment (CBT) or a combination of CBT and hypnotic medication may be beneficial.5 CBT for insomnia addresses problematic beliefs about sleep or lack thereof, teaches relaxation skills, and targets stimulus control, which helps the person learn to associate bedtime and the bedroom with being able to sleep. If insomnia is a secondary health condition, or is caused by another disorder, like depression, or another medical illness, the primary disorder should be treated first. If symptoms of insomnia do not improve as a result of getting treatment for the primary condition, a referral to a sleep specialist may be helpful.5 More

Treatment for Hypersomnia: Stimulants, antidepressants, and other medications may be beneficial for treating hypersomnia. It is also important to implement habits to promote sleeping at night and staying awake during the day, such as avoiding activities that delay bed time and avoiding alcohol and caffeine.6

Treatment for Narcolepsy: Stimulants, antidepressants and other medications may be beneficial for treating narcolepsy. Taking scheduled naps in addition to medication is recommended.7

Treatment for Breathing-Related Disorder: For patients with obstructive sleep apnea, treatment may include behavioral interventions, oral/dental appliances, and surgical interventions, depending upon the severity of the disorder. Many patients are treated with nasal continuous positive airway pressure (CPAP).8 A C-PAP is a machine that blows air into your nose via a nose mask, keeping the airway open and unobstructed. More

Treatment for Circadian Rhythm Disorder: Light therapy (properly timed exposure to bright light to promote a normal sleep-wake cycle and decrease sleep disturbances) and behavioral interventions may be beneficial in the treatment of Circadian Rhythm Disorder.9 Behavioral interventions include implementing habits to promote normal sleep/wake cycles and gradually shifting the time of sleep.9 More

Treatment for Sleep Terror Disorder: Before beginning treatment it is recommended that sleep terrors be waited out to see if they resolve.2 If the problem persists, a trial of antidepressants or antianxiety medications may be beneficial, however the effectiveness of these drugs has not been clearly demonstrated.2 Sleep terrors may be impacted by a failure to get enough sleep, therefore getting more sleep might be helpful. Scheduled awakening may also be beneficial for the treatment of sleep terrors.2 Scheduled awakening involves waking the person approximately 30 minutes before the he or she normally awakens, then slowly eliminating the scheduled awakenings as spontaneous awakenings decrease.2 More

Treatment for Nightmare Disorder: Behavioral interventions may be beneficial in the treatment of recurrent nightmares.10, 11 Treatment may include imagery rehearsal for nightmares (practice of how to respond to the event without actually experiencing it) and sleep issues (implementing habits that promote good sleep). More

Treatment for Sleepwalking Disorder: Sleep walking does not necessarily require treatment, and may go away on its own. It is important to implement habits to promote good sleep and treat any underlying medical conditions that may impact sleep problems.12 Safety measures may be necessary to prevent injury, including locking windows and doors, removing obstacles in the room, adding alarms, or blocking stairways.12 Medications, such as certain sedatives or antidepressants, may be helpful, particular if the potential risk for injury is great, if other interventions have not been helpful, or if the individual is experiencing excessive daytime sleepiness. 12 Behavioral techniques, such as relaxation and scheduled awakening may also be beneficial for the treatment of sleep walking.12 Scheduled awakening involves waking the person up approximately 15-20 minutes before the usual time he or she sleep walks and then keeping him or her awake through the time during which the episodes usually occur.12 More

Can’t Sleep? Sleep Talk with Your Doctor
Learn what to do to prepare for your appointment and the best way to share information about your sleep patterns, and difficulties.

Find a Sleep Specialist

References:

5 McCrae, C. S., Sidney, D. N., Taylor, D. J., & Lichstein, K. L. (in press). Insomnia. In J. Fisher and W. O’Donohue (Eds.), Practice guidelines for evidence based psychotherapy. New York: Kluwer Academic Publications.

6 National Institutes of Health, National Institutes of Neurological Disorders and Stroke. NIDS Hypersomnia Information Page. Updated 1/14/06. Accessed 2/26/06.

7 Littner, M., Johnson, S. F., McCall, W. V., McDowell Anderson, W., Davila, D., K. Hartse, Kushida, C. A., et al. (2001). Practice Parameters for the Treatment of Narcolepsy: An Update for 2000. Sleep, 24, 4, 451-466.

8 National Institutes of Health, National Heart, Lung, and Blood Institute (1997). Problem Sleepiness in Your Patient. Accessed 2/26/06.

9 Cataletto, M. E., & Hertz, G. (2005). Sleeplessness and Circadian Rhythm Disorder. Updated 9/27/05. Accessed 2/26/06.

10 Krakow, B., Johnston, L., Melendrez, D., Hollifield, M., Warner, T. D., Chavez-Kennedy, D., & Herlan, M. J. (2001). An Open-Label Trial of Evidence-Based Cognitive Behavior Therapy for Nightmares and Insomnia in Crime Victims With PTSD. American Journal of Psychiatry, 158, 2043-2047.

11 Pagel, J. F. (2000). Nightmares and Disorders of Dreaming. American Family Physician, 61, 7, 2037-2050.

12 Sharp, S. J., & D’Cruz, O. F. (2006). Somnambulism (Sleep Walking). Updated 1/3/06. Accessed 2/26/06.

TRICARE policy for reimbursement requires that services must be medically necessary for a diagnosed psychological disorder. The disorder must be one referenced in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and must be of a severity not only to cause the patient distress but also to interfere with the patient’s usual activities.

Sleep Self Assessment Quiz

If you think you might be suffering from a sleep disorder, take this quiz. Answers are automatically scored and resource recommendations are provided.