Sleep disorders are a common concern among individuals seeking mental health treatment. According to research, approximately 10-20% of patients report experiencing some form of sleeping problem (Huh et al., 2017). Adequate sleep is essential for maintaining optimal health, and most studies recommend that adults should aim for 7-8 hours of sleep per night (Grandner et al., 2016). In the context of mental healthcare, it is crucial for psychiatric mental health nurse practitioners (PMHNPs) to have a thorough understanding of the diagnostic criteria, evidence-based psychotherapy, and psychopharmacologic treatment approaches for sleep/wake disorders.
One of the primary diagnostic criteria used to assess sleep disorders is found in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) (American Psychiatric Association [APA], 2013). This manual provides a comprehensive classification system that aids clinicians in diagnosing mental health disorders, including sleep/wake disorders. The DSM-5 identifies several sleep/wake disorders, such as insomnia disorder, hypersomnolence disorder, narcolepsy, and circadian rhythm sleep-wake disorders, among others. Each disorder has specific criteria that must be met in order to make a diagnosis.
Insomnia disorder, for example, is characterized by difficulty initiating or maintaining sleep, along with marked distress or impairment in functioning due to sleep disturbances (APA, 2013). Additionally, the symptoms must occur at least three nights per week for a duration of three consecutive months. Conversely, hypersomnolence disorder is characterized by excessive daytime sleepiness or prolonged nighttime sleep, occurring at least three times per week over a period of three consecutive months. The symptoms should also result in significant distress or impairment in functioning (APA, 2013).
Aside from insomnia and hypersomnolence disorders, an understanding of evidence-based psychotherapy for sleep/wake disorders is important for PMHNPs. Cognitive-behavioral therapy for insomnia (CBT-I) is an example of a psychotherapeutic approach that has been shown to be effective in treating insomnia disorder (Qaseem et al., 2016). CBT-I focuses on addressing maladaptive sleep habits, distorted beliefs about sleep, and anxiety or arousal that contributes to sleep difficulties. It utilizes techniques such as stimulus control therapy, sleep restriction, relaxation training, and cognitive restructuring. Numerous studies have demonstrated the efficacy of CBT-I in improving sleep outcomes, with enduring effects even after treatment cessation (Palagini et al., 2017).
In addition to psychotherapy, psychopharmacologic treatment options may be considered for individuals with sleep/wake disorders. Medications such as benzodiazepines and non-benzodiazepine hypnotics are commonly used to treat insomnia. These drugs act on the gamma-aminobutyric acid (GABA) receptors in the central nervous system, promoting sleep and reducing sleep latency. However, PMHNPs should exercise caution when prescribing these medications due to the potential for misuse, dependence, and other side effects (Qaseem et al., 2016).
It is important for PMHNPs to carefully assess the individual’s symptoms and overall mental health status before selecting a treatment approach for sleep/wake disorders. Consideration should be given to the severity and duration of the symptoms, as well as any comorbid mental health conditions. Collaborative decision-making with the patient is also crucial to ensure that their values and preferences are taken into account during the treatment planning process.
In conclusion, sleep/wake disorders are common concerns among individuals seeking mental health treatment, and it is essential for PMHNPs to have a solid understanding of the diagnostic criteria, evidence-based psychotherapy, and psychopharmacologic treatment options. The DSM-5 provides a comprehensive classification system for diagnosing sleep/wake disorders, and evidence-based psychotherapy such as CBT-I has shown positive outcomes in improving sleep. Psychopharmacologic treatments, such as benzodiazepines and non-benzodiazepine hypnotics, may also be considered. Careful assessment and collaborative decision-making with the patient are vital for developing an effective treatment plan. By addressing sleep problems, PMHNPs can contribute to improving the overall mental health and well-being of their clients.
