Sleepwalking and sleeptalking both belong to a group of behaviors called parasomnias—unusual or harmful behaviors that occur during sleep. Sleep talking is one of the most common parasomnias. A 2010 study found that 68.8% of people talk during their sleep at some point during their lives. According to the same study, 22.4% of people have sleepwalked at least once.

Both sleepwalking and sleeptalking can happen for many reasons. Sometimes they are symptoms of a mental health condition, and both may cause psychological distress and interfere with relationships, work, and even overall life satisfaction.

What Causes Sleepwalking?

Sleepwalking, known sometimes as somnabulism, happens in deep sleep when a person is very difficult to wake up. Normally, when a person sleeps, the body paralyzes skeletal muscles—the muscles responsible for walking and other complex behaviors. GABA, a neurotransmitter, is one of the primary chemicals involved in preventing sleepwalking. When GABA doesn’t work to paralyze the skeletal muscles, a person may walk, make food, or even try to drive during their sleep.

Sleepwalking is more common in children. Some research suggests this might be because the neurons that release GABA are still developing in children. Sleepwalking in children tends to peak between 8 and 12 years old. Children who sleepwalk may also have a condition called confusional arousal, which occurs when a person appears to be awake but is confused or unaware.

Though it’s difficult to wake a sleepwalking person, it’s a myth that doing so is dangerous. However, a person who is woken up from a sleepwalking episode may be confused or alarmed.

What Causes Sleep Talking?

Sleep talking, which used to be called somniloquy, is more common in children than adults. It typically happens during rapid eye movement (REM) sleep. Adults are more likely to talk in their sleep if they have depression, are experiencing a nightmare, or are under the influence of drugs or alcohol.

Is Walking or Talking in Your Sleep a Sleep Disorder?

Sleepwalking and sleeptalking are both considered sleep disorders. They are more common in people who have other sleep disorders, such as sleep apnea, insomnia, or sleep behavioral issues. Both sleepwalking and sleeptalking tend to run in families.

Sleepwalking and sleeptalking are more common in boys than in girls, though researchers don’t know why. Both tend to decrease or disappear by the age of 12, but when they don’t, a person may be diagnosed with a sleep disorder.

Sleep behavioral disorders, which cause people to do unusual things when they are asleep, are closely related to sleepwalking. For instance, a person might drive their car or attempt to have sex with their partner while sleeping. Rarely, do people even become violent in their sleep. A handful of rape defendants have successfully used a “sexsomnia” defense, arguing they did not intend to rape someone and instead were sleepwalking. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes sexsomnia as a mental health diagnosis.

Therapy can help with sleepwalking or sleep talking when these issues are due to a mental health condition or stress.

Mental Health Issues Associated with Sleepwalking and Sleep Talking

A number of mental health issues can cause sleepwalking and sleeptalking. When sleep issues are related to a mental health issue, seeking treatment for the underlying mental health condition is usually the fastest way to resolve the sleep problem.

Any mental health condition can interfere with sleep and lead to unusual behavior at night. Sleep issues are especially prevalent in people who have:

• Nightmares, night terrors, and other nighttime sleep issues
• Depression
• Anxiety
• Posttraumatic stress (PTSD)
• Neurological injuries such as a traumatic brain injury (TBI)
• Schizophrenia

Drugs and alcohol can cause some people to talk or walk in their sleep. Due to this, people with substance abuse issues, as well as those going through drug or alcohol withdrawal, may experience sleepwalking or sleeptalking.

Medical Issues Linked to Sleepwalking and Sleep Talking

Certain medical issues have been linked to sleepwalking and sleeptalking. Those include:

• Sleep apnea, a disorder that causes frequent nighttime wakings due to breathing issues.
• Breathing disorders such as asthma and chronic obstructive pulmonary disorder (COPD).
• Cardiovascular health issues such as heart arrhythmias.
• Infections and illnesses, especially when they cause a high fever.
• Brain health issues such as tumors or a brain injury. This is a rare cause of sleep issues but is more likely if sleep issues appear suddenly or are severe.

Certain medications have also been linked to sleepwalking and sleeptalking. Some sleeping medications, such as Ambien and Lunesta, can cause unusual nighttime behavior. Sleep eating is one of the most common medication-related behaviors, but driving and other unusual behaviors have also been reported.

Therapy can help with sleepwalking or sleep talking when these issues are due to a mental health condition or stress. Many people also find therapy helps them deal with the challenges of parasomnias, such as sleep deprivation or conflicts with a partner oversleep. The right therapist can help you craft a healthy sleep environment, set healthy sleep goals, and get better sleep.

According to the National Sleep Foundation, therapy can help with many sleep issues. Cognitive behavioral therapy (CBT) has proven especially effective.

Sleep issues can affect an entire family. When a child sleepwalks, parents may struggle to get a good night’s sleep, and siblings may feel anxious. A spouse who sleepwalks or sleep talks can trigger sleep issues in their partner. Nighttime sleep issues, such as sexsomnia or nighttime eating, can even be a source of marriage or relationship problems. Family or couples therapy can help families manage and understand these issues.

References:

1. Bjorvatn, B., Grønli, J., & Pallesen, S. (2010). Prevalence of different parasomnias in the general population. Sleep Medicine, 10(11), 1031-1034. doi: 10.1016/j.sleep.2010.07.011
2. Cognitive behavioral therapy for insomnia. (n.d.). Retrieved from https://www.sleepfoundation.org/sleep-news/cognitive-behavioral-therapy-insomnia
3. Mohebbi, A., Holoyda, B. J., & Newman, W. J. (2018). Sexsomnia as a defense in repeated sex crimes. The Journal of the American Academy of Psychiatry and the Law, 46(1), 78-85. Retrieved from http://jaapl.org/content/46/1/78.long
4. Oliviero, A. (2008, February 1). Why do some people sleepwalk? Retrieved from https://www.scientificamerican.com/article/why-do-some-people-sleepwalk
5. Pediatric parasomnias. (n.d.). Retrieved from https://www.childrens.com/specialties-services/specialty-centers-and-programs/sleep/programs-and-services/sleep-medicine/nightmares-sleepwalking-sleep-talking-sleep-terror
6. Post-traumatic stress disorder (PTSD) and sleep. (n.d.). National Sleep Foundation. Retrieved from https://www.sleephealthfoundation.org.au/pdfs/Post-Traumatic-Stress-Disorder.pdf
7. Sexsomnia: A new DSM-5 diagnosis. (2014, October 28). Retrieved from https://www.psychiatryadvisor.com/sleep-wake-disorders/sexsomnia-a-new-dsm-5-diagnosis/article/379644
8. Sleep talking: Causes. (n.d.). Retrieved from https://www.sleepfoundation.org/sleep-disorders-problems/sleep-talking/causes
9. Sleep talking: What is it? (n.d.). Retrieved from https://www.sleep.org/articles/sleep-talking
10. Sleepwalking. (n.d.). Retrieved from https://www.sleepfoundation.org/sleep-disorders-problems/abnormal-sleep-behaviors/sleepwalking

Nearly 7% of Americans will be diagnosed with posttraumatic stress (PTSD) at some point during their lives. In any given year, 3.5% of Americans have PTSD. Many struggle with sleep problems such as insomnia, sleeping too much, and nightmares. For people struggling with trauma during the day, nighttime can feel like a battleground that offers little respite from traumatic memories and intrusive thoughts.

Are Sleep Problems a Symptom of PTSD?

Trauma changes the brain, and these changes can also affect sleep. The Diagnostic and Statistical Manual (DSM) lists sleep disturbances—such as insomnia, frequent waking, or nightmares—as one of many potential symptoms of PTSD. Specifically, to be diagnosed with PTSD, a person must show at least two of six “alterations in arousal and activity.” Those changes include:

• A heightened startle response
• Trouble concentrating
• Sleep disturbances
• Hypervigilance
• Self-destructive or reckless behavior
• Irritability or aggression

For some people, other symptoms of arousal play a role in sleep problems. For instance, a person who is anxious and hypervigilant may be too afraid to fall asleep, while a person with a heightened startle response may startle awake at every sound as they drift off to sleep. This change in sleep can also exacerbate other PTSD symptoms. A chronically exhausted person may be more irritable or have greater difficulty concentrating.

Some research suggests that sleep problems are more than just a symptom of PTSD. Instead, they may be a core component of the diagnosis. Research published in 1989 suggests that disturbances in rapid eye movement (REM) sleep are a PTSD hallmark that play a key role in other PTSD symptoms. Subsequent research has yielded mixed results. While some studies, including of animals, find a pattern of REM disturbances associated with PTSD, others do not.

A 2013 review of the literature argues that disturbances in sleep, especially REM sleep, may increase the risk of PTSD. Sleep issues may also worsen outcomes in people with PTSD. The study further argues that sleep issues can decrease the effectiveness of many PTSD treatments and that targeted treatments for sleep issues may speed recovery.

How Does PTSD Affect Sleep?

People with PTSD often find that their traumatic memories intrude on their ability to sleep. Some common PTSD-related sleep symptoms include:

• Being unable to fall asleep because of anxiety or agitation.
• Difficulty staying asleep because of frequent nightmares.
• Poor quality sleep because of nightmares. Some people report waking up many times each night and struggling to fall back asleep each time. This is called maintenance insomnia.
• Sleep problems related to drugs or alcohol. Some people with PTSD use alcohol or drugs to cope, which can cause sleep problems. Some medications for PTSD and anxiety may also cause sleep problems. For example, benzodiazepines may make it difficult to wake up in the morning.

A study that compared people with insomnia who did not have PTSD to those with combat-related PTSD and insomnia found important differences in the two groups. Those included:

• More repetitive nightmares in people with PTSD. People with PTSD were more likely to say their nightmares made it difficult to go back to sleep.
• More anxiety during the day in people with PTSD.
• More fatigue during the day among people with PTSD.

This suggests a feedback loop between sleep issues and other PTSD symptoms. Sleep problems can intensify daytime PTSD symptoms, which may make it even more difficult to sleep at night. People who feel anxious or fatigued during the day may ruminate more on their traumatic memories, increasing the risk of nightmares and other issues when they try to sleep.

Sleep problems can intensify daytime PTSD symptoms, which may make it even more difficult to sleep at night. People who feel anxious or fatigued during the day may ruminate more on their traumatic memories, increasing the risk of nightmares and other issues when they try to sleep.

Other Sleep Problems and PTSD

Sleep issues are common, even in people without PTSD. A 2009 study found that about 30% of people experience insomnia in a given year. Some people also struggle with sleeping too much or with not feeling rested after sleeping. This may be due to:

• Shift work sleep disorder, a condition that alters the “internal clock” of people who work nights or unusual hours.
• Sleep apnea, a disorder that affects breathing during sleep, causing people to briefly wake many times during the night.
• Sleep behavior disorder, which causes people to do unusual things while sleeping, such as sleepwalking, driving, or eating.

People with PTSD who have a pre-existing sleep disorder may find their symptoms get worse following a traumatic experience. Conditions that affect sleep can also compound the effects of PTSD, leading to depression, anger, difficulty concentrating, and more trouble coping with PTSD symptoms.

Even when the symptoms of a sleep disorder are not directly related to PTSD, it’s important to get help. Getting quality sleep is an important component of PTSD self-care.

Strategies for Coping with PTSD-Related Sleep Problems

Lifestyle changes can help some people with PTSD sleep more soundly. The National Sleep Foundation emphasizes that sleep is a habit, so the right changes can help the body adopt healthy sleep habits that offer better sleep. Try the following:

• Design a comfortable sleeping area, with a firm and supportive mattress and comfortable pillow.
• Develop a relaxing bedtime ritual.
• Stick to the same sleep schedule every day, even on weekends or vacations.
• Avoid napping during the day if you have trouble sleeping at night.
• Exercise every day, but not right before bed.
• Keep your bedroom cool, between 60-67 degrees Fahrenheit.
• Keep your bedroom quiet. Some people find that a white noise machine helps.
• If you can’t fall asleep, get up and do something else.
• Use your bed only for sleeping—not to play, read, or do work.
• Eat a light snack 45 minutes before bed if you tend to wake up hungry.
• Avoid heavy meals, alcohol, caffeine, and cigarettes before bed. Some people find drinking caffeine in the afternoon makes it harder to sleep.

Stress and anxiety management strategies can be especially helpful for managing PTSD-related sleep problems. Some people find relief from meditation or yoga. Others find that guided imagery or positive mantras as they try to sleep can help.

Medications, including anti-anxiety and sleeping medications, may help some people. However, when the underlying PTSD symptoms remain, sleep problems will likely return when you stop using medication.

Therapy can help with both sleep issues and PTSD. A compassionate therapist will help you work through your trauma in a safe space, free of judgment. Your therapist can help you set goals, cultivate new tools for managing stress, help you understand how trauma changes the brain, and work with your doctor to decide which, if any, medications are appropriate.

PTSD can feel overwhelming. Some people become depressed because they think things will never change. Others are too exhausted to work or enjoy time with their family. It doesn’t have to be this way. Reach out to a therapist who is highly skilled at treating PTSD.

References:

1. Germain, A. (2013). Sleep disturbances as the hallmark of PTSD: Where are we now? American Journal of Psychiatry, 4(170), 372-382. doi: 10.1176/appi.ajp.2012.12040432
2. Gradus, J. L. (2007, January 31). Epidemiology of PTSD. Retrieved from https://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp
3. Healthy sleep tips. (n.d.). Retrieved from https://sleepfoundation.org/sleep-tools-tips/healthy-sleep-tips
4. Inman, D. J., Silver, S. M., & Doghramji, K. (1990). Sleep disturbance in post-traumatic stress disorder: A comparison with non-PTSD insomnia. Journal of Traumatic Stress, 3(3), 429-437. doi: 10.1007/BF00974782
5. Phillips, K. (2015, February 4). What are the types of sleep disorders? A full list of sleep disorders. Retrieved from http://www.alaskasleep.com/blog/types-of-sleep-disorders-list-of-sleep-disorders
6. Sleep and PTSD. (2015, August 13). Retrieved from https://www.ptsd.va.gov/public/problems/sleep-and-ptsd.asp
7. Yehuda, R., Hoge, C. W., Mcfarlane, A. C., Vermetten, E., Lanius, R. A., Nievergelt, C. M., . . . Hyman, S. E. (2015). Post-traumatic stress disorder. Nature Reviews Disease Primers, 15057. Retrieved from https://www.nature.com/articles/nrdp201557#t1

It’s 3 a.m. You see the clock and realize you have four hours left before your alarm sounds. You think about everything you must do the next day and how miserable it will feel doing it exhausted. You toss and turn. You try counting sheep. You’re awake, and it feels like the entire world is sleeping.

You’re not suffering alone. Nearly 60% of adults lack sufficient sleep (Jacobs, 2009). How did this happen? Let’s start by looking at root causes of sleep problems and then identify ways to address them.

Root Causes of Sleep Problems

Behavioral

Bad habits breed many of our sleep problems. Staying up too late doing projects. Playing on the phone or computer. Responding to text messages or emails at all hours of the night. Engrossing oneself in a television show, particularly one with disturbing content, can negatively impact sleep. All these behaviors teach the brain that nighttime is a great time to be awake. The fear of missing out (i.e., FOMO) on an important post or text can keep our brains combing through social media or emails for hours.

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Environmental

Having a dark, quiet, and comfortable place to sleep promotes rest. The glow of an energy-efficient light bulb, computer screen, TV, or phone can stimulate the wake center of the brain (“Blue Light Dark Side,” 2017). Environmental disturbances including noisy neighbors, a snoring partner, or a playful pet in bed can make it challenging to catch some Z’s. Having a bed that is too firm or provides inadequate support can leave you tossing and turning. Sleep can also feel elusive when the temperature is too hot or cold.

Emotional Distress

Stress, anxiety, and depression can adversely impact sleep (Jacobs, 2009, van Mill et al., 2013). When our brains perceive some type of threat (e.g., a meeting with a difficult coworker tomorrow, loss of a loved one), it activates the limbic system. This system controls the brain’s emergency response signal. It sends chemicals into our bodies which prepare us to fight or flee danger. We cannot fight of flee if we’re asleep, so the limbic system shouts, “Stay awake!” This response is wonderful if we’re being chased by a bear, but it creates problems when we need to rest. The limbic system can become particularly sensitive and activated when one has experienced a traumatic event.

Beliefs About Sleep

Negative thoughts about sleep, such as, “I’ll never sleep well again … I am not going to sleep tonight … If I don’t sleep, I am going to fail my test/perform poorly at work,” can perpetuate sleep problems (Jacobs, 2009). Additionally, beliefs that one must have sleep medication to sleep can interfere with the body’s ability to sleep on its own.

Substance Use

Caffeine, nicotine, and alcohol can negatively affect sleep (Lichstein, 2000). In addition to the common sources of caffeine (e.g., coffee, soda, and energy drinks), we also need to consider hidden sources. Certain protein bars, decaf coffee, chocolate, and some over-the-counter medications contain caffeine. A review of major sleep studies suggests alcohol users may fall asleep faster, but the second half of sleep will be poorer compared to those who don’t drink (Ebrahim, Shapiro, Williams, & Fenwick, 2013). Both prescribed and illegal substances can leave one feeling wound up, depending on amount and frequency of use. Common contributors include stimulating antidepressants, anti-hypertensives, bronchodilators, diuretics, beta blockers, and corticosteroids (Litchstein, Gellis, Stone, & Nau, 2006).

Health Conditions

Individuals with the following physical conditions commonly experience sleep problems: heart disease, asthma, lung disease, gastrointestinal disorders (e.g., heart burn), kidney disorders, endocrine disorders (e.g., hypothyroidism), diabetes, HIV infection, fibromyalgia, menopause, and cancer (Parish, 2009).

Ways to Address Root Causes

Behavioral

Creating a bedtime routine can play a vital role in getting good sleep. My grandmother followed the same routine every night. She would take a bath, put on her pajamas, feed her cat, turn down her bed, make a cup of tea, read for an hour, and then go to bed. She did this every night and never complained of poor sleep. Bedtime routines teach our brains it is time to go to sleep. Tips for a good bedtime routine include:

1. Avoid blue light (e.g., TV, smartphone, computer) approximately one hour before you want to fall asleep.
2. If you shower or bathe at night, do so at least one hour prior to bedtime. You could have trouble falling asleep if your body temperature is too warm.
3. Cover the clock once your bedtime routine starts. Go to bed when your body feels tired (e.g., eyelids are heavy, head is drooping) as opposed to when a certain time shows on the clock. If you lay in bed awake more than 30 minutes, your brain could associate your bed with wakefulness instead of sleeping.
4. Wake up at the same time every day, even on weekends. You may feel groggy the first several days. However, sticking with this wake time teaches the body to go to sleep earlier and faster.
5. Do something relaxing and enjoyable before bedtime, such as reading a light-hearted book, knitting, or coloring. If you can’t think of something relaxing to do, consider listening to a guided relaxation recording. You can find many free ones online.

It may seem like you’ll never have a good night’s sleep again, but there is hope. Addressing the root causes of sleep problems and enlisting support can lead to better sleep.

Environmental

Create a comfortable sleep space. If possible, keep electronics such as TVs, computers, and smartphones out of the bedroom. Consider room-darkening shades or curtains if your room is exposed to bright light. A sleep mask is also an inexpensive alternative. If your bed is uncomfortable, explore options for supportive bedding. A new mattress can be expensive, but mattress toppers can be found for a fraction of the cost and make a positive difference in the coziness of one’s bed. A supportive pillow can also provide great comfort. If intermittent noise keeps you awake at night, consider a white noise machine, fan, and/or earplugs. If your partner is snoring, consider sleeping in a separate location (if possible) until your sleep is back on track.

Emotional Distress

Consider establishing care with a therapist if emotional distress is playing a role in poor sleep. Often, sleep improves over the course of therapy. Enlisting the support of caring others, such a friends and family members, can be helpful when you’re trying to regulate your sleep. For example, it could be helpful to ask for support with implementing some of the strategies discussed in this article. It can be frustrating when well-intentioned others ask, “How did you sleep last night?” when you’re having sleep problems. It may be beneficial to ask them to support you in ways which feel more helpful—for example, having them ask, “How can I support you right now?” or sending a funny meme or encouraging quote.

Beliefs About Sleep

Reframing our thoughts about sleep problems can help reduce the of suffering of sleeplessness. Some helpful sleep thoughts include:

• “I am taking positive steps to get my sleep back on track.”
• “I will likely sleep better tomorrow night.”
• “I have lived through sleepless nights before.”
• “My sleep will improve as I work through some of these stressful events/health issues.”

Substance Use

Stopping caffeine use can help if you’re having trouble sleeping. If giving it up completely feels too intimidating, try limiting use to the morning or decreasing the amount (e.g., half-caffeinated coffee). Scrutinizing labels on food and over-the-counter medicines can help you make informed choices about the amount of caffeine you consume. Talk to your primary care physician or a therapist if you are using illegal/nonprescribed drugs to learn how they impact sleep and to obtain support with stopping use. If insomnia is a side effect of a prescribed medication, talk with your prescriber about ways to manage this.

Health Conditions

Consider scheduling a checkup with your doctor, particularly if you have not had a physical within the past year. Your doctor can determine if lab work or other testing would be helpful in ruling out physical causes for sleep problems. If you have a preexisting condition but continue to experience sleep problems, scheduling an appointment with your provider to discuss concerns could help.

Conclusion

Most importantly, be kind to yourself. Talk to yourself as you would a friend who can’t sleep: “I know this is tough. You’re taking steps to sleep better, and it will improve in time.” It may seem like you’ll never have a good night’s sleep again, but there is hope. Addressing the root causes of sleep problems and enlisting support can lead to better sleep.

References:

1. Blue light has a dark side. (2017, December). Harvard Health Letter. Retrieved from https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side
2. Ebrahim, I. O., Shapiro, C. M., Williams, A. J., & Fenwick, P. B. (2013). Alcohol and sleep I: Effects on normal sleep. Alcohol Clinical and Experimental Research, 37, 539–549. doi:10.1111/acer.12006
3. Jacobs, G. D. (2009). Say good night to insomnia. The 6-week program proven more effective than sleeping pills. New York, NY: St. Martin’s Press.
4. Lichstein K. L. (2000). Secondary sleep problems. In K.L. Lichstein & C.M. Morin (Eds.), Treatment of late-life sleep problems (297-319). Thousand Oaks, CA: Sage.
5. Lichstein, K. L., Gellis, L. A., Stone, K. C., & Nau, S. D. (2006). Primary and secondary insomnia. In S. R. Pandi-Perumal & J. M. Monti (Eds.), Clinical pharmacology of sleep (133-152). Basel, Switzerland: Birkhauser Verlag.
6. Parish, James M. (2009). Sleep-related problems in common medical conditions. Chest, 135(2), 563–572. doi:001: lO.1378/chest.08-0934
7. van Mill J. G., Hoogendijk W. J., Vogelzangs N., van Dyck R. & Penninx, B. W. (2010). Sleep problems and sleep duration in a large cohort of patients with major depressive disorder and anxiety disorders. The Journal of Clinical Psychiatry,71, 239–46. doi: 10.4088/JCP.09m05218gry

Dear GoodTherapy.org,

My husband and I have been married for 27 years. About 10 years ago, his snoring became intolerable, and they ran some tests and diagnosed him with sleep apnea. They told him he could stop breathing and die if he didn’t get a CPAP machine. He refuses to get one, though, because he doesn’t like the way they feel at night.

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Because of his selfishness, I’ve started sleeping in the den because I can’t sleep through the night if we’re in the same room. It’s so disturbing. He literally stops breathing for a minute or two at a time and then suddenly explodes with noise as all the air comes rushing back into his body. Our neighbors have told us they can hear it in the summer months, when their windows are open. Still, he won’t budge. He said if he dies, he dies.

I miss sleeping with my husband, but even more than that, I miss feeling like he cares. I am so frustrated by his unwillingness to do what he needs to do. I don’t know what I can do if he’s going to be stubborn like this. What do you think? —Wide Awake

Dear Wide Awake,

No doubt when your husband continues to not do what you and/ or the doctor have asked him to do, this can be extremely frustrating. I couldn’t help but notice you use the words “unwilling,” “stubborn,” and “selfish” to describe your husband. I also hear how distressed you feel because it seems like he doesn’t care. I imagine there are probably multiple things going on. From your description, he won’t deal with this health issue because it is more uncomfortable for him to wear the CPAP mask than to do something that could potentially save his life and improve the quality of your sleep (and, presumably, your relationship satisfaction).

In order to address your concerns, I want to disentangle these pieces a little. There are multiple things going on, and consequently different ways to approach solving this issue. First is the untreated sleep apnea and possible health-related consequences. This, unfortunately, is not an uncommon issue. Many who are prescribed a CPAP mask find it unpleasant and soon become noncompliant with wearing one, even despite stern warnings from their treating physician.

Consult with the Medical Team

Does the treating physician know about your husband’s noncompliance? What has the physician’s response been? Perhaps the health care team can help increase his openness to giving this another try, as they likely see this issue regularly and may be able to directly intervene.

I imagine your husband, at this point, knows very well that his snoring disturbs you (and the neighbors), but perhaps he does not fully realize you really miss sleeping in the same bed as him and feeling like he cares. Perhaps hearing this expressed explicitly may open up a new path for your conversations to take.

Education can be a strong component—for example, explaining exactly what his test results revealed (e.g., oxygen levels, prognosis if his sleep apnea is left untreated), or simply communicating to your husband that for many people with sleep apnea, it is normal to take time to adjust to the CPAP before it feels comfortable enough to not feel burdensome.

That said, educational approaches may not be enough to change his mind. Additionally, if you feel the medical team is not empathetic to your struggles, you may want to speak with a different provider. Finally, have you explored other options for sleep apnea management? There may be other devices or procedures that may be able to help.

The second issue to address is how his refusal is affecting you. It clearly impacts the quality of your sleep, both in terms of not being able to sleep through the night because of his loud snoring and because of the frustration you feel. It is also clear that physically relocating to get a restful night of sleep is not your ideal. And when he nonchalantly states, “If I die, I die,” this seems to evoke a host of negative emotions in you, including hurt, sadness, and perhaps rejection and resentment.

Tell Him How You Feel

I imagine you have told your husband many times how you feel about his snoring. I imagine you have told him many times he should be using his CPAP. You’ve surely reminded him what his doctor has to say on this topic. How have you communicated to him about your own experience with this issue? Have you told him about the emotional impact his words and actions (or lack thereof) have on you? If so, how have you communicated this?

The way we talk to others about the impact they have on us plays a large role in the success of this communication effort. For example, consider how each of these statements might sound: Stating to your spouse, “Because of your selfishness, I can’t sleep in my own bed,” compared with something like, “I feel frustrated because I feel like you haven’t heard my concerns” or “I feel hurt because it feels like my concerns are dismissed.” While all of these statements may be accurate, not all of them are likely to be heard the same way. I imagine your husband, at this point, knows very well that his snoring disturbs you (and the neighbors), but perhaps he does not fully realize you really miss sleeping in the same bed as him and feeling like he cares. Perhaps hearing this expressed explicitly may open up a new path for your conversations to take. Sometimes, taking a closer look at how we communicate key messages may uncover new approaches that ultimately yield a desired effect.

Lastly, you may find that additional support via therapy—with or without your husband present—may be useful to you to help manage frustration and continue to identify solutions. Good luck!

Marni Amsellem, PhD

Rona and Crandall have been married for many years. When they first got together, Rona learned Crandall had a history of talking in his sleep. He thought it was just a cool fact about himself, but Rona didn’t think it was cool at all—he scared her sometimes when he shouted and thrashed at invisible demons, but he usually calmed at her touch or the sound of her voice. Sleep talking is fairly common, and they lived with it.

With aging, his conditioned worsened. One night, Rona woke up after he banged her in the head with his elbow. She thought it was an accident, but it began to happen more and more often. When she told him what was happening, he didn’t know what she was talking about. Once or twice his elbow found her eye socket, and that was frightening. She pushed him off and he usually responded, but sometimes she had to push him really hard. The next morning she’d complain about his behavior, and he’d either deny it or get angry.

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A few times when Crandall woke during the night to go to the bathroom, he became confused and couldn’t find the bed. Once, Rona woke up to see Crandall pressing his body against the bedroom window; she was scared he would fall out. He was sleepwalking. She was afraid he would hurt himself, maybe fall down the stairs leading to their bedroom, but he laughed and said that would never happen.

They had a nightlight in the bathroom, but to be safe Rona suggested they add another light in the bedroom. Rona thought there was a chance the added light would wake Crandall when he was sleepwalking, but it didn’t seem to have much effect. The attacks on Rona’s head became more frequent, happening a few nights a week and sometimes repeatedly on those nights.

Rona thought Crandall had a sleep disorder. She told him that she didn’t feel safe sleeping with him and would sleep in the spare bedroom. That caught his attention and he decided to consult a sleep doctor. Except he didn’t. Crandall was a procrastinator in general, and consulting a sleep doctor was frightening. He wanted to consult “the best” sleep doctor. When Rona asked him how he was going to find the right doctor, he said he hadn’t thought about it, so Rona suggested he consult his physician and ask for a referral. Crandall got angry, accused Rona of making a big deal out of nothing, and denied his strange behavior, but later agreed some of what she said was accurate. Crandall was very frightened; as many people do, he denied his fear and felt mad and suspicious instead.

Crandall had a problem with REM sleep—REM, which stands for rapid eye movement, is a normal state of sleep that happens several times a night and is characterized by vivid dreaming. The eyes move rapidly, and often the body is restless; pulse and breathing rates speed up, but ordinarily the person remains asleep. During REM sleep, voluntary movement of the body is suppressed.

A REM sleep disorder describes a condition where body movement is not suppressed and the person acts out dreams by shouting or thrashing or sleepwalking, or even by attacking a sleep partner. Often the REM disorder is discovered not by the sleeper but by the partner. REM sleep behavior disorder, or RBD, can be dangerous to both the sleeper and the partner.

RBD has punched a hole in the intimacies of their marriage. They will have to work to find other ways to nourish their bond.

A person with RBD consults a sleep doctor for appropriate diagnosis and treatment and to see if there are underlying neurological or other issues needing treatment. If the person is on several medications, RBD could signal a drug interaction problem. Medication can also help with RBD.

RBD presents serious safety issues for both Rona and Crandall. Crandall’s sleep environment will have to be made safe. Potentially dangerous objects must be removed from the room, and stairway and window protections may be necessary. Until Crandall’s treatment is successfully under way, Rona would be wise to sleep in the spare bedroom. Crandall might find sleeping separately hard to handle; Rona may adjust more easily.

The emotional fallout may be tough. Rona can’t trust Crandall at night, and now she can’t sleep as soundly as she needs. Her body tells her to stay away from him. He can’t trust himself not to hurt her. RBD has punched a hole in the intimacies of their marriage. They will have to work to find other ways to nourish their bond.

RBD is a condition best treated by a medical doctor, but the effects of living with RBD need other kinds of intervention too. Perhaps Rona and Crandall can consult a marriage counselor or individual therapists to work on alleviating the harm caused by RBD, which places them both in physical and emotional jeopardy. They need to develop different kinds of closeness, ways, and places they can feel safe together again.

Note: The couple depicted in the preceding account is fictional and used for illustrative purposes only.

Dear GoodTherapy.org,

Sleep is supposed to be restful, right? For a few years now, my nights have been anything but. I wake up exhausted because my dreams are more tiring than being awake. They typically involve a chase of some sort, sometimes by car or boat, but usually on foot. It always feels like I’m trying to move in mud, or like there are invisible arms holding me back when I try to run, and I can never get anywhere as fast as I think I can. When I try to shout in a dream, my voice comes out muffled and restrained. Very often, water is a prominent feature in my dreams—enormous pools, open seas, or floods.

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These dreams are becoming more and more violent, too. Though I almost never die in my dreams, the situation occasionally comes close. I find myself encountering and using weapons I’ve never even touched in real life, let alone used against someone. But my dreams present scenarios in which I must fight for my life, sometimes to the death. 

I am not a violent person, and the thought of killing someone, even in my dreams, horrifies me. I do feel stressed quite a bit in life, and I imagine that’s a big factor in my dreams. But it’s not like I’m encountering life-or-death scenarios or anything. My life is not filled with violence. I have never been to war. I do not play, and never have played, violent video games. Sometimes I watch scary movies or TV shows, but even those don’t fill me with the kind of terror I experience in my dreams. 

I’m growing weary of the trauma of dodging bullets in my dream life. I’ll take any hint or suggestion for how to calm my dream state, whether it’s to eat more leafy green vegetables or stop wearing socks. —Wildest Dreams

Submit Your Own Question to a Therapist

Dear Wildest Dreams,

First of all, thank you for reaching out. I have much compassion for people experiencing nightmares, especially because our brains and bodies physiologically react as if the experience is happening in waking life. Losing sleep also affects memory, everyday responses, and overall health. The good news is nightmares are normal part of human development and are often exaggerated so we may remember them. Dream pioneer Jeremy Taylor writes, “All dreams speak a universal language and come in the service of health and wholeness. There is no such thing as a ‘bad dream’—only dreams that sometimes take a dramatically negative form in order to grab our attention.” In other words, nightmares are a healthy way for us to work through whatever life-changing event or deep internal changes we are going through so we can tend to their messages. Once we face our fears, become engaged with the emotions, and tend to the dream material, we can “transform the energy.”

Take comfort in knowing that when we remember a dream, it means we can do something about it.

Here are some thoughts on the particular themes in your dreams that might shed some light on what may be going on in your waking life. It is important to note that although humans share a “collective memory,” we are also individuals. To truly engage fully with a dream, one must be mindful of these nuances, including personal associations, experiences, and emotional content.

Take comfort in knowing that when we remember a dream, it means we can do something about it.

Chased or Attacked by Someone or Something

The “chase” dream is a common one, especially with women who feel particularly vulnerable in waking life. Often the dreamer is being chased by an ominous being (or beings), which could be anything from “the dark figure” with no recognizable features to monstrous entities such as dinosaurs or zombies. It is important to note who or what is doing the chasing, paying close attentions to the characteristics. Who are you killing? What types of weapons are you using? If it is a vampire, are you dealing with lifeless bloodsucking energy in your life? Perhaps there are parts or patterns that need “killing off” in terms of character traits/people/situations/habits in your life that are no longer working for you. 

Feeling of Paralysis or Heaviness

These types of dreams are common because there is an actual physiological paralysis that occurs naturally during the REM (rapid eye movement) stage in sleep so the dreamer does not physically act out dreams (and hurt somebody!). Sometimes this state might seep into dreams as the condition of not being able to walk, run, or move, especially when in danger. It could also be a symbol of feeling helpless or stuck in a situation in waking life. 

Water in Dreams

The big wave, pool, or flood in a dream is pretty common, and it often indicates either some emotional overwhelm in the dreamer’s waking life or “big material” coming out of the unconscious. Am I feeling overwhelmed? Am I not tending to my emotions? 

Recurring Nightmares and Emotions

You mentioned the nightmares began years ago. I would explore if there was any particular event that happened when the nightmares began. One of the main symptoms of trauma is the affliction of frequent or recurring nightmares.

In my experience as a therapist specializing in dreams, I have noticed that the more engaged a person is in the healing work, the deeper the healing that can take place. This includes getting support from a professional who is trained in working with nightmares and dream analysis.

Warm regards,

Linda

Seniors who experience excessive fatigue during the day may have more brain atrophy than well-rested seniors, according to a study presented at SLEEP 2016, the 30^th Anniversary Meeting of the Associated Professional Sleep Societies (APSS). Researchers found atrophy was greatest in regions of the brain vulnerable to Alzheimer’s and age-related decline, suggesting fatigue could be an early sign of brain degeneration.

The Link Between Fatigue and Brain Atrophy

For their study, researchers worked with 1,374 cognitively normal seniors age 50 and older who participated in the Mayo Clinic Study of Aging. Participants completed surveys of sleepiness and fatigue and underwent magnetic resonance imaging (MRI) brain scans to establish baseline brain functioning.

Participants who reported high levels of daytime sleepiness had lower cognitive scores and more medical problems. They were also more likely to report sleep disturbances, pointing to a correlation between disturbed sleep and daytime fatigue.

Changes in Sleep: Early Dementia Warning Sign?

The study’s authors suggest these results may help doctors identify people at risk for dementia, increasing opportunities for early treatment. Previous research supports this claim. According to the Alzheimer’s Association, changes in sleep habits are common among people with Alzheimer’s. This may be due to the ways Alzheimer’s changes the brain. Some common Alzheimer’s-related sleep changes include:

• Insomnia and disturbed sleep.[fat_widget_right]
• Changes in dreaming patterns. Brain scans show people with dementia spend less time in both dreaming and non-dreaming sleep cycles.
• Changes in the sleep cycle, such as napping during the day, or feeling drowsy during the day.
• Sundowning, an experience characterized by behavioral and cognitive changes late in the afternoon or evening.

In the late stages of Alzheimer’s, seniors may spend as much as 40% of their nights awake, as well as a significant portion of the day sleeping.

The National Sleep Foundation says some age-related changes in sleeping are normal. The foundation recommends 7-8 hours of sleep per night for seniors 65 and older, compared to 7-9 hours for adults younger than 65. The American Academy of Pediatrics is also supporting a new revised recommendation from the American Academy of Sleep Medicine for children’s sleep guidelines. Also presented at SLEEP 2016, these recommendations now include as many as 16 hours of sleep for infants, 14 hours for young children, and 12 hours for school-age children.

References:

1. Brooks, M. (2016, June 14). New AASM guideline on optimal sleep for children. Retrieved from http://www.medscape.com/viewarticle/864846
2. National Sleep Foundation recommends new sleep times. (2015, February 2). Retrieved from https://sleepfoundation.org/media-center/press-release/national-sleep-foundation-recommends-new-sleep-times
3. Sleepiness and fatigue linked to brain atrophy in cognitively normal elderly. (2016, June 14). Retrieved from http://www.eurekalert.org/pub_releases/2016-06/aaos-saf061416.php
4. Treatments for sleep changes. (n.d.). Retrieved from http://www.alz.org/alzheimers_disease_10429.asp

Most sleep research focuses on the inability to fall asleep, but people who have trouble staying asleep may experience more negative moods. According to a new study published in the journal Sleep, interrupted sleep for three or more consecutive nights produces worse symptoms than inadequate sleep due to staying up too late. About 10% of Americans experience insomnia, and frequent wakefulness during the night is one of the most common symptoms.

The Effects of Interrupted Sleep

To study how various sleep disturbances affect well-being, researchers recruited 62 healthy men and women with normal sleep patterns, then divided them into three groups. A control group slept through the night without being interrupted, another group had a later-than-usual bedtime, and the third group was awakened eight times during the night. The pattern repeated for three days.

Researchers assessed study participants’ moods each day. The day after the first night of sleep deprivation, both the later-than-usual bedtime group and the interrupted sleep group had similarly poor moods. By the second night, clear differences had emerged. Members of the interrupted sleep group had a 31% decrease in positive mood, compared to 12% among those who went to bed later than usual. The two groups did not have any noteworthy differences in negative mood, which suggests the problem with interrupted sleep is that it interferes with positive feelings rather than creating negative ones.

The challenge with interrupted sleep, the study’s authors emphasize, is that it interferes with the body’s ability to go through all stages of sleep, including the deepest sleep that usually results in a feeling of restoration in the morning.

How Much Sleep Do You Really Need?

[fat_widget_right]The National Sleep Foundation recently changed its sleep guidelines for adults. The organization now recommends that adults ages 18-64 get between 7 and 9 hours of sleep each night. Seniors age 65 and older should aim for 7 to 8 hours of sleep.

Good sleep habits can help combat various sleep disorders and encourage better sleep quality. The National Sleep Foundation recommends the following:

• Turn off smartphones and other screens when you sleep, and do not sleep with them in the bed.
• Limit food intake directly before bedtime.
• Get plenty of natural sunlight to help regulate your circadian rhythms.
• Reduce your caffeine intake, especially in the hours before bedtime.
• Develop a sleep routine that relaxes you. Avoid upsetting conversations, stressful movies, and other things that might keep you up before bed.
• If you struggle to fall asleep at night, avoid napping during the day.

References:

1. Interrupted sleep impacts mood more than lack of sleep, study finds. (2015, November 2). Retrieved from http://www.medicalnewstoday.com/articles/301879.php
2. National Sleep Foundation recommends new sleep times. (2015, February 2). Retrieved from https://sleepfoundation.org/media-center/press-release/national-sleep-foundation-recommends-new-sleep-times
3. Preidt, R. (2015, October 30). Interrupted sleep not good for your mood, study suggests. Retrieved from http://health.usnews.com/health-news/articles/2015/10/30/interrupted-sleep-not-good-for-your-mood-study-suggests
4. Sleep hygiene. (n.d.). Retrieved from https://sleepfoundation.org/ask-the-expert/sleep-hygiene

More than a quarter of Americans experience mental health issues each year, and the World Health Organization reports that depression is the leading cause of disability worldwide. However, many Americans think mental health care is both expensive and difficult to access, according to a study jointly sponsored by the National Action Alliance for Suicide Prevention, the Anxiety and Depression Association of America, and the American Foundation for Suicide Prevention.

In a survey of 2,000 adults, most (almost 90%) said they equally valued physical and mental health. One third reported that mental health care is hard to access, and 40% said high costs are a barrier to treatment. Forty-seven percent thought they had experienced a mental health issue, but only 38% of them had received treatment.

[fat_widget_right]Among those who sought treatment, therapy was the most popular option, with 82% pursuing psychotherapy and 78% taking medication. Eighty-six percent said that they knew mental health conditions such as depression increase the risk for suicide, but only 47% knew that anxiety-related conditions could also increase one’s suicide risk.

Though federal laws mandate equal coverage for mental and physical health, a number of recent reports suggest that many insurers continue to deny mental health claims.

64% of Psychology Experiments Fail Replication Test

In May, GoodTherapy.org reported on research suggesting that the majority of psychology studies could not be reproduced by subsequent researchers. Reproducibility is a hallmark of sound science. When a study’s results cannot be recreated, this suggests that the study could have been flawed, biased, or a fluke. Now, the results of that research have been published in Science, sparking debates about a so-called crisis in psychology. The research argues that the results of only a quarter of social psychology experiments and half of cognitive psychology experiments could subsequently be reproduced.

Living Small: The Psychology of Tiny Houses

Tiny houses are trending all over social media. For young people facing an expensive housing market, more economically sized homes can be enticing. These houses encourage people to reduce their carbon footprint by living simply, offer greater mobility because they can easily be moved by a trailer, and are much more affordable than standard-size homes. Moving into a tiny home may require significant downsizing of clothing, furniture, and belongings, but the advantages may include increased control over one’s housing experience, a private alternative to keeping costs down, and the ability to personalize design to fit one’s mood.

Health Buzz: Alcohol Education Should Begin at Age 9

Parents often delay talking to their kids about alcohol until the adolescent years, but a new survey published in the American Academy of Pediatrics suggests that these conversations should begin much earlier. The survey found that two thirds of teens had consumed alcohol by their high school graduation and that a quarter have had more than just a few sips before eighth grade. Researchers also found that children and teens drink more heavily than adults, raising concerns about alcohol poisoning and addiction. To give kids accurate and relevant information, the report recommends parents begin the alcohol conversation by the time their children are 9 years old.

Religion Rarely Part of ICU Conversation

Though three quarters of people charged with making health care decisions in an intensive care unit report that religion and spirituality are “fairly” or “very” important in their lives, less than 20% of family health care meetings involve discussion of religion or spirituality with doctors and other caregivers. Particularly when discussing end-of-life decisions, religion can be important, but it is usually the caregiver, not the doctor, who broaches the subject.

Japan’s Worst Day for Teen Suicides

September is National Suicide Prevention Month. For many Japanese parents, it may also be a time of increased concern about suicide among their teens. In Japan, more school students commit suicide on September 1 each year than on any other day. Though experts have posited various explanations—such as worries regarding bullying at school after a summer break free of emotional and physical attacks from peers—suicide remains common. Japan has one of the world’s highest suicide rates, and suicide is the leading cause of death among people aged 15 to 39. Figures from the Japanese government show that more than 18,000 adolescents under the age of 18 committed suicide between 1972 and 2013.

Oliver Sacks, Renowned Neurologist Who Wrote About His Cancer, Dies at 82

Famed author and neurologist Oliver Sacks died of cancer at his home on Sunday, August 30. Sacks wrote about unusual neurological conditions, often naming books after symptoms he saw in his clinical practice, such as The Man Who Mistook His Wife for a Hat. He was the inspiration for the doctor played by Robin Williams in the 1990 movie Awakenings, which is based on Sacks’ 1973 book of the same name.

Lack of Sleep Puts You at Higher Risk for Colds, First Experimental Study Finds

According to a study of 164 healthy people, inadequate sleep could increase the risk of developing a cold. Scientists monitored participants’ sleep patterns for a week, then quarantined them in a hotel for five days and exposed them to a cold virus. Researchers also checked the participants’ blood for an antibody that fights the common cold, then removed participants who had the antibody to make sure those participants would not bias the infection rates of the group.

At the end of the quarantine period, 45.2% of those who slept less than five hours a night exhibited at least one sign of illness—revolving around mucus production—and one other immune response. Of those who slept five to six hours, the cold rate was 30%, compared to 22.7% for those who slept six to seven hours. The rate was only 17.2% for those who got more than seven hours of sleep. At the end of the study, researchers determined that people who slept less than five hours per night were 4.5 times more likely to get sick than those who slept seven hours or more.

Is it OK to allow a child to sleep with his or her parents? This is a hot-button and controversial topic. Some believe there is nothing wrong with parents sharing a bed with their child as long as the parents set aside time for their own intimacy. Others believe that parents who share a bed with their child are setting themselves and the child up for future frustration and failure when it comes time to transition the child to his or her own bed. When the child knows that the parents want him or her to transition but can’t make it happen, he or she may experience guilt and believe he or she is disappointing the parents. Even parents who have difficulty transitioning a child into his or her own bed sometimes have separation issues.

Some people see the terms “co-sleeping” and “bed sharing” as synonymous. They’re not. Co-sleeping is the act of a child sleeping in the same room as the parents, perhaps in a sleeper that attaches to the bed, while bed sharing is sleeping on the same surface.

In many cultures, children have shared a bed with their parents going back centuries. However, co-sleeping and bed sharing have a negative rap in the Unites States.

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As with most things, there are pros and cons. For nursing mothers, bed sharing is often easier and can be done safely. Often, though, there is concern around bed sharing with infants due to the possibility of suffocation.

Some parents struggle with the idea of having an infant sleep apart from them in a separate bed and room. Some believe bed sharing provides the best opportunity for secure attachment. Others disagree.

For parents, the decision to co-sleep or bed-share with a child is a personal one.

There is concern among some that bed sharing does not provide an opportunity for infants to learn how to self-soothe, that it encourages over-reliance on parents when the infant is upset. Another concern is that infants may not learn to fall asleep on their own.

For parents, the decision to co-sleep or bed-share with a child is a personal one. Parents must decide what works best for their family’s needs and structure. Having said that, parents should not have a child sleep with them in order to get their own emotional needs met, or as a solution to an infant’s inability to go to sleep.

Transitioning the Child to His or Her Own Bed

Close connection between parents and their child is crucial to the child’s healthy emotional development. Such a connection helps to facilitate the transition from the family bed to the child’s own. Some suggestions for parents to transition their child back to his or her bed while staying close emotionally include:

• Parents need to remember that weaning a child from the family bed may be upsetting to the child—and that is OK. The child may experience feelings of fear and grief. Parents should help the child work through those feelings. Through the process of providing support and opportunity for the child to express his or her emotions, the child can be expected to become more confident.
• When a child has strong feelings to dissolve, parents can help by allowing him or her to cry or scream. Parents should remind the child that there is no presence of danger. When this happens, the child may be more likely to release his or her feelings and reach a calm state of mind.
• When a child is sad or scared, parents should stay close and listen, which typically helps the child greatly. This allows the parent to stay in close proximity to the child while expressing love and attention as the child expresses his or her feelings. Parents should allow the child to fully engage in the feelings while holding the child close until he or she feels emotionally safe and confident that the parents are watching over him or her.
• Having a bedtime ritual can be helpful for the child in the transition from the family bed to his or her own. It may be helpful if parents can conceptualize the process of the child going from the family bed to his or her own as one with many steps. Each child will need varying amounts of time for this process to come full circle. When parents provide love and caring through this process, the child may slowly release stored feelings of grief and fear. This will allow for the child to cooperate and, eventually, to sleep independently.
• Parents should tell their child they are going to help him or her feel safe enough to sleep in his or her own bed. Saying this shows respect for the child’s intelligence, as children often understand more than parents assume.

When parents help their child feel safe in his or her own bed, at his or her pace, while listening to any feelings expressed along the way, they will typically see the child shed any lingering concerns and successfully transition.