Biological Approaches

The biological approach to sleep disorders consists of medical interventions that include surgical, non-surgical, pharmacological, and nonpharmacological treatments. For example, treatment for sleep apnea consists of non-surgical as well as surgical treatments. Nonsurgical biological treatments include general behavioral changes such as weight loss, adjusting body positioning during sleep (avoiding lying on the back), or using mechanical devices to alleviate pressure, such as a CPAP or BIPAP.^[1] While breathing devices can help, patients often find the devices frustrating and do not wear them often enough. Several surgical procedures (sleep surgery) are used to treat sleep apnea, although they are normally a third line of treatment for those who reject or are not helped by CPAP treatment or dental appliances. Surgical treatment for obstructive sleep apnea needs to be individualized to address all anatomical areas of obstruction; it may involve nasal, throat, tongue, or other surgeries.

Research suggests that REM sleep behavior disorder (RBD), may have a hereditary component to it. A total of 632 participants, half with RBD and half without, completed self-report questionnaires. The results of the study suggest that people with RBD are more likely to report having a first-degree relative with the same sleep disorder than people of the same age and sex that do not have the disorder.^[2] More research needs to be conducted to gain further information about the hereditary nature of sleep disorders.

Medications and somatic treatments may provide the most rapid symptomatic relief from some sleep disturbances. Certain disorders like narcolepsy are best treated with prescription drugs such as modafinil. Others, such as chronic and primary insomnia, may be more amenable to behavioral interventions with more durable results. Major classes of prescription insomnia medications include benzodiazepine hypnotics, non-benzodiazepine hypnotics, and melatonin receptor agonists. All these medications have potential side effects, like drowsiness, dizziness, impaired sleep quality, or cognitive deficits, that may outweigh the benefits for some users.

Non-pharmacological treatments for sleep disorders such as insomnia include changing sleep habits and patterns, relaxation therapy, hypnosis, or alternative forms of medicine such as the usage of essential oils, acupuncture, or supplements.

In addressing sleep disorders and possible solutions, there is often a lot of buzz surrounding melatonin. Research suggests that melatonin is useful in helping people to fall asleep faster (decreased sleep latency), to stay asleep longer, and to experience improved sleep quality. In order to test this, a study was conducted that compared subjects that had taken melatonin to subjects that had taken a placebo pill in subjects with primary sleep disorders. Researchers assessed sleep onset latency, total minutes slept, and overall sleep quality in the melatonin and placebo groups to note the differences. In the end, researchers found that melatonin decreased sleep onset latency and increased total sleep time, but had an insignificant and inconclusive impact on the quality of sleep compared to a placebo group.^[3]

Figure 1. Acupuncture or other forms of alternative medicine may be used to treat sleep disorders.

Cognitive Approaches

The cognitive approach in treating sleep disorders focuses on reframing how people think about sleep and the act of sleeping to provoke change in their thoughts and sleeping habits. For example, cognitive therapy may be used to help some with insomnia to challenge their thoughts around sleep and reappraise their thoughts. Paradoxical intention is one technique that has a patient participate in their most feared behavior, such as staying awake, because one possible reason for their lack of sleep is something akin to “performance anxiety” that they will be unable to sleep. By tackling their fear head-on, they can reduce this anxiety and get to sleep more easily.^[4]

Mindfulness, meditation, relaxation training, guided imagery, and breathing exercises are all cognitive related techniques that aid in treating sleep disorders.

Behavioral Approaches

Stimulus control helps to build an association between the bedroom and sleep by limiting the type of activities allowed in the bedroom. An example of stimulus control is going to bed only when you are sleepy and getting out of bed if you’ve been awake for 20 minutes or more. This helps to break an unhealthy association between the bedroom and wakefulness. Sleep restriction involves a strict schedule of bedtimes and wake times and limits time in bed to only when a person is sleeping.^[5]

Psychodynamic Approaches

The psychodynamic approach originated from the work of Sigmund Freud and emphasizes unconscious psychological processes. A systematic review found that traumatic childhood experiences (such as family conflict or sexual trauma) significantly increases the risk for a number of sleep disorders in adulthood, including sleep apnea, narcolepsy, and insomnia.

Freud not only emphasized childhood experiences in contributing to disorders, but believed that dreams represented an opportunity to gain access to the unconscious. By analyzing dreams, Freud thought people could increase self-awareness and gain valuable insight to help them deal with the problems they faced in their lives. Freud made distinctions between the manifest content and the latent content of dreams.

Manifest content is the actual content, or storyline, of a dream. Latent content, on the other hand, refers to the hidden meaning of a dream. For instance, if a woman dreams about being chased by a snake, Freud might have argued that this represents the woman’s fear of sexual intimacy, with the snake serving as a symbol of a man’s penis.

Freud was not the only theorist to focus on the content of dreams. The 20th century Swiss psychiatrist Carl Jung believed that dreams allowed us to tap into the collective unconscious. The collective unconscious, as described by Jung, is a theoretical repository of information he believed to be shared by everyone. According to Jung, certain symbols in dreams reflected universal archetypes with meanings that are similar for all people regardless of culture or location.

While Freud’s and Jung’s psychodynamic contributions lacked empirical support, their theories serve as an important foundation for the current and ongoing understanding of sleep through their connection between sleep stages and dreaming, which began the scientific process of examining consciousness of sleep and dreams, mental health, and the biology of sleep disorders.