The link between sleep disorders and mental health is now well established. At any given time, nearly half of all adults are affected with one or more sleep problems. Sleep problems can be secondary to other conditions, like stress, they can be a side effect of medications, or they can signal underlying physical or brain-based disturbances.
Sleep problems like insomnia can occur when people react to life stressors with obsessive worry. Some antidepressants may worsen or induce primary sleep disorders like restless legs syndrome, sleep bruxism (teeth grinding), REM sleep behaviour disorder (sleep-walking), nightmares, and sleep apnoea.
Lifestyle-related factors like poor diet or lack of exercise with weight gain can result in disorders like sleep apnoea. Pain is a common physical cause of sleep problems. And in some cases, changes to brain function such as a fault in the "internal body clock" (circadian rhythm) or mismatch between this and the external environment is the cause. This is often found in shiftworkers, and increasingly found in young people who spend many hours at night on their smartphones.
Snoring is estimated to be the most common sleep problem. Snoring occurs when the muscles in the throat that hold open the pharynx (at the back of the of the tongue) relax, partially choking the airway. This blocking causes the pharyngeal walls to vibrate, giving the sound of snoring. A UK study found that 41.5% of the adult population snore. The male to female ratio is approximately 2:1, with about twice as many males snoring compared to females. It affects 2–5% of all children and is associated with cognitive and behavioural problems, resulting in poor school performance.
Whilst snoring alone might not be a major problem for the snorer, it can cause sleep disorders for their partners. This is because regularly disturbed sleep can reset your own brain’s circadian rhythm (sleep-wake cycle).
Sleep deprivation has serious physical and mental consequences including mood instability, impaired memory, decreased concentration, changes to brainstem activity resulting in hyper-aroused sympathetic system activity, and even specific changes to your genes. To check whether you might be suffering from sleep problems, try the Epworth Sleepiness Scale at https://www.kinnect.com.au/wp-content/uploads/2014/09/Epworth-Sleepiness-Scale-Questionnaire1.pdf
Snoring doesn’t necessarily predict sleep apnoea, but it can be an easy frontline indicator. One study showed that 76% of the habitual snorers and 64% of the non-habitual snorers had apnoea-hypopnoea scores >0 presumably with snoring (that is, they showed signs of brain oxygen deprivation). Diagnosis of sleep apnoea, especially when it comes to monitoring reduction in airflow, oxygen saturation, cardiac activity, and EEG, is a complex process and often considered too intrusive so many people go undiagnosed. Home-based portable devices are proving more acceptable and can provide a primitive diagnosis sufficient to start therapy. Given the severity of health impacts of sleep apnoea, though, routine screening and early intervention are highly recommended.
Guidelines published in 2017 by the American Academy of Sleep Medicine recommend that doctors routinely screen for risk factors linked to sleep apnoea. Warning signs include:
- Frequent reports of low energy, daytime fatigue, or difficulty staying asleep throughout the night
- Loud snoring, witnessed apnoea or gasping or choking
- Diagnosed hypertension (high blood pressure)
- Overweight or neck circumference> 40cm
- Waking in the morning with a sore throat or dry mouth
- Morning headaches
- Frequent night-time urination (often between 2:00 a.m. and 4:00 a.m.)
- New onset of symptoms during perimenopause or menopause in women.
To find out more about Apnoea and other sleep disorders, including non-medical treatment approaches, join the half-day workshop on Tuesday 26 June with Professor Leon Lack from Flinders University.
Dr Kate Lemerle, Psychologist
Chrysalis Counselling & Coaching, Norfolk Island
WEB: www.chrysaliswellnessservices.com
TEL: 52112 or email drkate@iinet.net.au
Please 'contact us' for more information.
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