Chapter 19: Sleep-Wake Disorders in Mental Health

Sleep-Wake Disorders in Mental Health comprehensively details the critical significance of sleep-wake disorders, which are now recognized as a national health priority by initiatives such as Healthy People 2030, underscoring the necessity of high-quality sleep for overall well-being. The serious ramifications of sleep deprivation are explored, ranging from short-term issues like reduced quality of life and impaired cognition to long-term consequences such as increased risk for metabolic syndrome, cardiovascular disease, and all-cause mortality. Notably, sleep loss can lead to psychomotor impairments comparable to driving while legally intoxicated, posing significant risks to personal and community safety. Normal sleep physiology involves a dynamic neurological process categorized into non–rapid eye movement (NREM, stages N1, N2, N3) and rapid eye movement (REM) sleep, which cycle over 90- to 120-minute intervals and form the structural organization known as sleep architecture. Sleep regulation is controlled by the homeostatic process, or sleep drive, and the circadian drive, which is wake-promoting and influenced by external cues (zeitgebers) relayed through the suprachiasmatic nucleus (SCN). The chapter reviews major disorders identified by the DSM-5, including the most common complaint, Insomnia Disorder, which is effectively assessed using Spielman’s 3P model: predisposing, precipitating, and perpetuating factors. Other serious conditions covered are Narcolepsy, characterized by uncontrollable sleep urges and frequently accompanied by cataplexy and sleep paralysis; Hypersomnolence Disorder; Breathing-Related Sleep Disorders, such as obstructive sleep apnea; and Parasomnias, like NREM sleep arousal disorders and REM sleep behavior disorder. Due to the high comorbidity between sleep disturbance and nearly all psychiatric disorders, the nursing process emphasizes thorough assessment using objective tools like polysomnography, the Epworth Sleepiness Scale (ESS), and subjective sleep diaries. Nursing management focuses primarily on nonpharmacological interventions, including rigorous adherence to sleep hygiene, the application of sleep restriction and stimulus control techniques, and Cognitive Behavioral Therapy for Insomnia (CBT-I) to improve sleep quality and ultimately enhance clinical outcomes.