Fundamental categorizations in medicine naturally separate psychological and physiological dimensions. For example, insomnia, supposedly a mental sleep disorder, is usually treated with psychiatric tools like cognitive-behavioral therapy (CBT), whereas sleep-disordered breathing, a physical sleep disorder, is treated with positive airway pressure (PAP) therapy. In a patient who suffers from both disorders, they receive both CBT and PAP.
Insomnia and sleep-disordered breathing (SDB for short) are the two most common sleep disorders, and many sleep patients do in fact suffer from both conditions. However, this dichotomy is overly simplistic. In our clinical and research experience, the overlap between insomnia and SDB is much greater than expected. Here's what we mean when we say overlap:
For SDB patients, the breathing disorder causes an array of psychological symptoms, not the least of which is damage to the nervous system, which leads to significant problems with memory, concentration, and attention. The decline in your thinking skills is called cognitive impairment. And, remarkably, this impairment makes it much more difficult for SDB patients to fully understand the impact of the breathing disorder on their health. Worse, even when patients realize they have breathing disorders, there are numerous psychological barriers to learning how to use PAP therapy. Therefore, SDT elects not to think of SDB as a purely physical disorder, because these psychological factors greatly influence how well a patient responds to treatment.
For insomnia patients, the unwanted sleeplessness causes an array of physiological symptoms, such as daytime fatigue and sleepiness, low energy, and chronic aches and pains induced by chronic sleep deprivation. This physical drain of energy destroys the insomnia patients' motivation to use the necessary tools to overcome their bouts of sleeplessness. Therefore, SDT elects not to think of insomnia as a purely mental disorder, because the physiological factors greatly influence how well a patient responds to treatment.
Now, having said all that, it should be fairly clear why it's so important to view these sleep disorders as mind-body problems. But wait, there's even more here than you might think! In our work, we are persuaded that not only do sleep breathing problems cause insomnia but insomnia often appears to cause sleep breathing problems. In other words, the two disorders overlap even more than we first suggested.
How could this be so? The SDB part is easy, because we know that breathing interruptions cause the brain to awaken from sleep. Therefore, if one of these awakenings goes on long enough, insomnia will emerge. For insomnia, our theory is based on the research of other scientists who have shown that when a person's sleep is fragmented as occurs with insomnia, breathing becomes unstable. In fact, one research study purposely fragmented a group of normal sleeper's sleep with subtle bell tones, after which these individuals showed new breathing patterns similar to patients with sleep apnea.
In sum, insomnia and SDB may in fact be joined at the hip. In Sleep Dynamic Therapy, we think of the disorders as two sides of the same coin because we have seen so many patients who suffer from both conditions. Ultimately then, we favor an approach to sleep disorders that appreciates that an array of mental and physical components are at work, and attending to all of them simultaneously leads to a much greater chance for treatment success. Above all, this is the language that we use to communicate with our patients, so that they understand as soon as possible that their sleep conditions are caused by mental and physical factors. Talking about all the factors makes for a more satisfying treatment experience.