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The Review: A Journal of Undergraduate Student Research

Volume 18 Article 3

2017

Sleep-Wake Disorders and a Look at through Biological and Behavioral Perspectives

Mia Fontanarosa St. John Fisher College, [email protected]

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Recommended Citation Fontanarosa, Mia. "-Wake Disorders and a Look at Insomnia through Biological and Behavioral Perspectives." The Review: A Journal of Undergraduate Student Research 18 (2017): -. Web. [date of access]. .

This document is posted at https://fisherpub.sjfc.edu/ur/vol18/iss1/3 and is brought to you for free and open access by Fisher Digital Publications at St. John Fisher College. For more information, please contact [email protected]. Sleep-Wake Disorders and a Look at Insomnia through Biological and Behavioral Perspectives

Abstract Insomnia is defined yb difficulties in falling asleep, maintaining sleep, and oblemspr with early morning awakenings. Unfortunately, due to these symptoms daytime often follows. Daytime fatigue may have a severe impact on an individual’s day. Insomnia symptoms may not exist alone, however. Individuals who are diagnosed with insomnia have another disorder present as well. Often insomnia is paired with anxiety and mood disorders. Therefore, insomnia can be viewed through the biological and behavioral perspectives. Insomnia is a disorder that can be treated. The most common treatment would be cognitive behavioral therapy for insomnia, but treatment is not limited to just that.

Keywords insomnia, biological perspective, behavioral perspective

This article is available in The Review: A Journal of Undergraduate Student Research: https://fisherpub.sjfc.edu/ur/ vol18/iss1/3 Fontanarosa: Sleep-Wake Disorders: Insomnia

Sleep-Wake Disorders and a Look at Insomnia through Biological and Behavioral Perspectives Mia Fontanarosa ABSTRACT Insomnia is defined by difficulties in falling asleep, maintaining sleep, and problems with early morning awakenings. Unfortunately, due to these symptoms daytime fatigue often follows. Daytime fatigue may have a severe impact on an individual’s day. Insomnia symptoms may not exist alone, however. Individuals who are diagnosed with insomnia have another disorder present as well. Often insomnia is paired with anxiety and mood disorders. Therefore, insomnia can be viewed through the biological and behavioral perspectives. Insomnia is a disorder that can be treated. The most common treatment would be cognitive behavioral therapy for insomnia, but treatment is not limited to just that.

Sleep-Wake Disorders: An Overview acknowledges that sleep-wake disorders consist of 11 diagnostic groups: insomnia Normal sleep is what many hope to get disorder, hypersomnolence disorder, when falling asleep. Getting what is referred , obstructive to as “normal sleep” is important to one’s (OSA), , health. Blythe, Doghramji, Jungquist, sleep-related hypoventilation, circadian Landau, and Valerio (2009) address the rhythm sleep-wake disorders, non-rapid eye features that constitute normal sleep in their movement (NREM), sleep arousal disorders, article “Screening & Treating Patients with disorder, and /Wake Disorders.” Those who engage (REM) sleep behavior disorder. For as many in regular sleep tend to fall asleep within people who are already diagnosed with a 15-20 minutes, have very brief awakenings sleep-wake disorder, there is evidence that in the middle of the night, and on average suggests sleep-wake disorders regularly go get between 7-9 hours of sleep, leaving the undiagnosed (Blythe et al., 2009). Those individual feeling refreshed in the morning who suffer from sleep-wake disorders tend and ready to start their day. Many though do to have a poor night’s sleep continually. not get this kind of sleep. Often individuals This poor quality of sleep may begin to have trouble falling asleep, staying asleep, affect an individual’s daily life, whether that and just overall having what would be be at home, work, or in a social context. considered good quality sleep. Having excessive grogginess during the day Are you one of the many million Americans may also impair driving or operation of who suffer from a sleep-wake disorder? heavy machinery. A few hours of sleep Unfortunately, there are nearly 50 to 70 deprivation, alone, can be hindering to an million people who have some type of individual. Can you imagine what it would sleep-wake disorder (Blythe et al, 2009). In be like to constantly be sleep deprived? You “A Review of Changes in DSM-5 develop a loss of energy, possible mood Sleep-Wake Disorders,” Khurshid (2015) swings, and can have a hard time

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concentrating or being fully alert. Notably, psychological disorders, and anxiety all may these things can occur with just a few hours affect sleeping habits (Barlow & Durand, of but having continuous 2015). When conducting a , sleep deprivation may really begin to take its researchers find it helpful to know an course. individual’s sleep efficiency (SE). This is defined as the percentage of time you spent Many who suffer from a sleep-wake sleeping rather than just lying awake in disorder have complaints about amount, (Barlow & Durand, 2015). This information quality, or timing of sleep. This is known as can be useful because it may determine how . Those who are prone to well and how much an individual sleeps. abnormal behavior during sleep or the night would be classified as having a . Sleep-wake disorders can also influence an (Barlow & Durand, 2015). It is important individual’s health. Blythe et al. (2009), that sleep disturbances or problems are suggest that excessive tiredness has been discussed with your doctor so a proper linked to an increased risk of death and diagnosis can be made or so help can be psychiatric or other medical conditions. provided. If your doctor does not first Although sleep-wake disorders may cause address if you have any problems sleeping the above, the reverse can be true as well. initiate the conversation. Your doctor may Sleep-wake disorders may exist due to some then end up having additional questions. It is other condition an individual may have. For important to keep track of your nighttime instance, Chasens and Luyster (2016) write and daytime symptoms. In regard to the “Effect of Sleep Disturbances on Quality nighttime symptoms, be aware if you have of Life, Diabetes Self-Care Behavior, and trouble falling asleep, if your mind starts Patient-Reported Outcomes” to show the thinking about anything and everything, how relationship between type 2 diabetes and much you wake up in the middle of the sleep-wake disorders. Statistics show that night, and how long you believe this has individuals with type 2 diabetes have an been going on for. During the daytime pay 8-17% rate pertaining to difficulty falling attention to how drowsy you feel, how often asleep. Another 23-40% report difficulty in you have a when waking up, and if staying asleep. There is evidence that your memory seems to be impaired. suggests comorbidity of diabetes and sleep related problems are associated with a If sleeping habits become a constant decline in an individual’s quality of life and concern, then a sleep study may be self-care behaviors needed for diabetes. conducted. Accordingly, Barlow and Durand (Chasens & Luyster, 2016). Reportedly, (2015) propose that a polysomnographic patients with type 2 diabetes, coronary (PSG) evaluation provides the most accurate artery , and also have a higher picture of an individual’s sleep patterns. If prevalence of OSA (Blythe et al., 2009). individuals choose to participate in a sleep study they may spend a night or two in a Generally, this section provides a glimpse at sleep laboratory so their sleep can be what sleep-wake disorders consist of. With monitored. Some things that are measured as many as there are, knowing the general during this time are airflow, leg movements, criteria is important. Each sleep-wake brain wave activity, heart activity, etcetera. disorder has specific diagnostic criteria, Regular day time activities are taken into however. It is important to be aware of your consideration as well. , own sleep patterns and habits during the

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day. Although there are many sleep-wake who believes they are an insomniac. disorders, insomnia is the most prevalent Sleep diaries may be crucial in today. distinguishing if someone has insomnia. A Insomnia: The Most Pertinent sleep diary may help to keep track of the Sleep-Wake Disorder times that the individual finds themselves getting up in the middle of the night. It’s a Among the many subcategories of good tool to use because the individual has a sleep-wake disorders insomnia would be the place to record the problems they want to most common. According to Riemann, discuss with their doctor. Accordingly, Nissen, Palagini, Otte, Perlis, and Blythe et al. (2009) suggest that many Spiegelhalder (2015), “chronic insomnia is patients cannot recall sleep and wake times defined by difficulties in falling asleep, accurately. Perlis, Giles, Mendelson, maintaining sleep, and early morning Bootzin, and Wyatt (1997) acknowledge that awakening, and is coupled with daytime patients may have the tendency to consequences such as fatigue, attention overestimate their symptoms. For instance, deficits, and mood instability.” In other an individual may “overestimate how long it words, insomnia would be classified as a takes them to fall asleep” (Perlis et al., dyssomnia. Per the DSM-5 diagnostic 1997). Investing in a sleep diary may be criteria for insomnia, an individual tends to useful in accurately explaining symptoms. have a constant complaint of dissatisfaction Having a sleep diary “may reveal issues that in regards to sleep quantity and/or quality. did not surface during questioning” between Like sleep-wake disorders in general, the doctor and patient (Blythe et al., 2009). The complaints may be around difficulty in types of things that are typically recorded in initiating or maintaining sleep. There also a sleep diary are , wake time, total may be complaints of wakening in the early hours that were slept, when an individual morning and not being able to fall back to believes they fell asleep, how many times sleep (American Psychiatric Association, they woke up during the night, daytime 2013). To be diagnosed with insomnia the alertness, during the day, and sleep problem must cause an impairment to medication use (Blythe et al., 2009, Laar et the individual’s life, both with sleeping and al., 2014). Individuals may even record their daytime fatigue. Riemann et al. (2015), amount of caffeine or nicotine use, stressful suggests that insomnia may be diagnosed, events, or amount of exercise (Blythe et al., per the DSM-5 and ICSD-3, by an 2009). All of these elements are important individual reporting a sleep complaint. This and can have an impact on an individual’s problem must occur three times each week quality of sleep. Keeping track of these over a 3-month period. Other diagnostic different features will allow for more clarity criteria include that insomnia cannot be as to where an individual may be explained by some other sleep disorder such experiencing sleep problems. as narcolepsy. It also is important to acknowledge whether or not the problem Insomnia used to be looked at through two can be attributed to some kind of substance different perspectives, that being primary abuse (American Psychiatric Association, and secondary insomnia. Pullen, Mayes, and 2013). Having these diagnostic criteria is Horton (2013), define primary insomnia as useful when trying to diagnose someone having no other attributed problems. These may include medical, psychiatric, or

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environmental influences. Chauvin, variables depending on presence and type of Thibault-Stoll, Chassagnon, Biry, Petiau and psychiatric comorbidity and that patients Tassi (2015), add that primary insomnia with comorbid psychiatric disorders will affects nearly 15% of the general generally show more severe insomnia.” population. Secondary insomnia is the exact What Laar and his colleagues found in 2015 opposite of primary insomnia. This occurs in was that those who had comorbid mood relation to other disorders that may already disorders had higher Insomnia Severity be existent. Individuals may already be Index (ISI)-scores compared to those who abusing substances or may already be did not have any comorbidity with insomnia. diagnosed with psychiatric or mental Patients with comorbid anxiety disorders illness(es) (Pullen et al., 2013). However, had higher subjectivity to sleep efficiency upon the DSM-5, secondary insomnia is no (SE) as well. longer used when diagnosing insomnia. The Relatedly, is one of the reasoning for this is due to the comorbid many mood disorders that are comorbid with nature that exists within insomnia. Many insomnia. All types of sleep disturbances are times, insomnia is co-occurring with some common among individuals diagnosed with other disorder and both need to be treated being bipolar (Pullen et al., 2013). This is (Khurshid, 2015). significant, according to Pullen et al. (2013), Comorbidity because there have been “11 studies performed on 631 patients with bipolar How often is insomnia diagnosed without disorder.” This “revealed that insomnia was being comorbid with some other psychiatric the most common precursor of and disorder? Laar, Pevernagie, Mierlo, and the sixth most common symptom associated Overeem (2015) acknowledge that about with the condition” (Pullen et al., 2013). 50% of those who utilize a sleep clinic have Unfortunately, insomnia can make the a psychiatric disorder comorbid with symptoms of bipolar disorder more insomnia. Now this does not include all predominant. Knowing this, however, may diagnoses of insomnia. Blythe et al. (2009) be crucial to the individual who is diagnosed conclude that there is a very small with bipolar disorder. Individuals may be percentage of insomnia cases that are able to better gage when they are about to unrelated to other conditions. For the most have a manic episode if they know that their part, insomnia is often comorbid with mood insomnia symptoms are worsening. and anxiety disorders, like most sleep-wake disorders. Having a diagnosis of anxiety or Insomnia and other sleep-wake disorders may very well effect how may have quite an effect on young adults individuals sleep at night. Accordingly, with psychiatric disorders. Robillard et al. depression may increase sleep latency, REM (2016) conducted a study evaluating how sleep, and how many awakenings occur sleep-wake and circadian activity cycles of during the night or early morning (Pullen et young adults with anxiety, depression, and al., 2013). This can be attributed to the bipolar disorders are related to psychiatric depressive state that the individual may be symptoms and psychotropic medications. It in or excessive thoughts that are running was hypothesized that those who had through their head. Laar et al. (2015), persistent, severe symptoms would have a predicted that “there are clear differences in delay in their sleep-wake schedule and nature and severity of subjective sleep poorer sleep consolidation in general. The

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results determined that those who took (Floam et al., 2014). medication actively had earlier Although research is scarce, Floam et al. times (p=0.001), longer sleep periods (2014) conducted a study looking at the (p=0.001), and just an overall longer amount extent to which sleep characteristics predict of sleep (p=0.001) (Robillard et al. 2016). variables for the inflammatory, autonomic, What can be acknowledged is that those and hypothalamus-pituitary-adrenal (HPA) taking “were significantly systems, presuming that insomnia may have predictive of longer sleep period and longer an effect on the mentioned systems. To test total sleep time” (Robillard et al., 2016). The this, researchers used regression analyses to severity of symptoms did not seem to make determine whether -based sleep a difference in sleeping habits. This study is variables were predictors of the important because it can open the idea that inflammatory, autonomic and HPA systems. medicine prescribed for a psychiatric Accordingly, their findings demonstrated disorder may help the individual sleep that “HPA upregulation (as indicated by better, whether it be in young adults or older increased cortisol levels) was significantly individuals. Accordingly, Khurshid (2015) associated with wake after sleep onset suggests that the only way for optimal (WASO)” (Floam et al., 2014). This would treatment to be achieved in people with then correspond to the prior research. As for psychiatric disorders and insomnia is for the autonomic component, Floam et al. both to be targeted during treatment. (2014) found that blood pressure was not Biological and Neurobiological Focus significant, even when higher in the insomnia group. On the other hand, heart So far, some biological perspectives have rate variability, blood pressure and been touched upon. We have looked at the norepinephrine levels were found to be use of (PSG) and how increased in those who have insomnia airflow, leg movements, brain wave activity (Floam et al, 2014). Again, although there is and heart activity can all influence an limited research this information may be individual’s sleep. This section will be a useful to an individual who believes they continuation of other biological components. have insomnia. The individual can pay The biological perspective in psychology attention to if and when these factors are allows researchers to look at the impact that elevated how they have been sleeping. one’s brain, immune system, nervous system, and genetics function in Specifically looking at sleep-wake correspondence with an individual. regulation the neurobiological perspective is Depending on the disorder each one of these going to have a major impact on insomnia. can play a different role. Floam, Simpson, Sleep-wake regulation is relatively Nemeth, Scott-Sutherland, Guatam, and important in trying to maintain normal sleep. Haack (2014) acknowledged that variations But how is this controlled? For starters, in sleep patterns may occur. Accordingly, according to Georgina Casey (2015), the research has noted that low sleep efficiency suprachiasmatic nucleus (SCN), may be associated with higher levels of ventrolateral preoptic nucleus (VLPO), cortisol, as seen from PSG. Furthermore, noradrenaline (NA), serotonin (5HT), and higher blood pressure may also be gamma aminobutyric acid (GABA) can all associated with a reduced amount of sleep have an influence on sleep-wake regulations. To better understand how these all work in

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sync, refer to Figure 1.

Figure 1: From Casey, G. (2015). Resting Easy in Sleep. Kai Tiaki New Zealand, 21(11), 20-24. ​ ​

Riemann et al. (2015) suggest there are two (sleep pressure) as a function of the main processes that govern sleep-wake time since the last adequate sleep, is an rhythms. These would include a circadian indicator of homeostatic sleep drive. process and a homeostatic process. Riemann This process can be measured et al. (2015) indicated: retrospectively by the amount of slow wave activity during sleep; the longer The circadian process reflects the fact someone has been awake, the more that, from the cellular to the system slow wave activity will be recorded in level, the variation in intrinsic activity his or her electroencephalogram (EEG). over 24 hours follows a sinusoidal curve. This activity is controlled by an This two-fold system is an indicator as to internal located in the what happens during sleep-wake regulation, suprachiasmatic nuclei and or what should happen. Assumingly, this synchronized to the time of day by process can be related to insomniacs and external cues, predominantly the their sleep-wake patterns. When a person is light-dark cycle. The homoeostatic not obtaining an adequate amount of sleep process, which is the need for sleep this is when an individual’s sleep-regulation

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becomes imbalanced. An individual may be Yet, the insomnia episodes are elicited due so deprived of sleep they have a hard time to precipitating factors. This implies that life catching up. stressors or stressful events are often associated with insomnia (Barlow & Other aspects of sleep-wake regulation Durand, 2015, Perlis et al., 1997). include adenosine. Adenosine is a Regardless of what the trait or precipitating “byproduct of the breakdown of adenosine factor is, there is clearly some link to triphosphate (ATP), which is the main insomnia cases. energy molecule in cells” (Casey, 2015). Often it is when an individual is awake for As mentioned in previous sections, insomnia long periods of time that they then desire an tends to cause daytime fatigue. This fatigue urge to sleep. Casey (2015) suggests that can lead to specific impairments. These this is due to the buildup of adenosine found impairments may include inability to pay in the brain. Accordingly, adenosine is attention or focus. These, however, are not commonly viewed as a sleep promoter and the only impairments that may be caused allows arousal by blocking activity taking from engaging in sleepless nights. Another place in the system (Riemann et al., effect loss of sleep may have would be on 2015). Coinciding, orexin is found in the emotion. According to Cronlein, Langguth, hypothalamus, released in the brain and is Eichhammer, and Busch (2016), evidence critical to wakefulness (Casey, 2015). These suggests that sleep disturbances directly are only a few of the components found to influence emotional processing. To better affect sleep regulation. understand this Cronlein et al. (2016) examined the effect of “chronically Behavioral Perspective disturbed sleep on emotional processing by A change in your biological or investigating two samples of patients with neurobiological components may be sleep disorders.” These groups included interrelated with those of the behavioral those who had insomnia and those who had perspective. As we have seen, fatigue may sleep apnea. To determine what effect little affect your home, work, and social life due sleep had on emotional processing the Facial to a loss of energy. It is in psychology that Expressed Emotion Labelling (FEEL) was the behavioral perspective is often viewed as used for the measurement of one’s ability to the way someone acts out certain behaviors recognize emotions through facial due to the environment or learned expressions. The results found in this study experiences. Perlis et al. (1997) believe that supported the researchers’ hypothesis. Those insomnia can be understood through the who fell under the insomnia and sleep apnea behavioral aspect, that “the perspective groups performed significantly less on the provides a compelling conceptualization and FEEL test when compared to those who the treatments that derive from the theory were considered to have normal sleep have demonstrated clinical efficacy” (Perlis (Cronlein et al., 2016). Interestingly enough, et al., 1997). It is believed that an individual sleep deprivation does have an effect on may be predisposed to insomnia due to whether or not someone can identify specific trait characteristics. These traits can different emotions. Individuals may not be found in all different biopsychosocial realize what processes sleep deprivation is perspectives. The traits can extend from really affecting. This study can be important hyperarousal to simply excessive worry. to sleep-wake disorders because it adds

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another dynamic of how sleep disturbances activation prior to sleep. may cause an impairment other than fatigue. These three solutions may be referred to as Just like for the rest of the sleep-wake what Riemann et al. (2015) calls cognitive disorders the behavioral perspective is behavioral therapy for insomnia (CBT-I). pertinent in insomnia. The amount of sleep CBT-I tends to be the most common one gets is correlated with how tired one is treatment for insomnia. CBT-I would be the next day. If an individual is more tired more associated with the behavioral than usual their behavior may be differently perspective in psychology. Other then it normally is. Again, this can be due to components of CBT-I include a sense of fatigue which may cause and cognitive techniques. This treatment perceptions and other functions to be off appears to be more effective in the long run imbalance. (Riemann et al., 2015). It may be the little things that you do or do not do throughout Treatment your day that are causing your sleep Treatment is something every individual difficulties. If a quick change in your routine with a disorder hopes to receive to get does not solve your difficulties with sleeping themselves better. Treatments can be used there are still other options that might work. for any of the psychological perspectives. As mentioned previously, something as Generally, for treatment of insomnia a simple as sleep hygiene can be used in medical professional is the one who needs to maintaining sleep. Knowing what truly prescribe you something. These options are affects sleep is extremely important. Blythe not necessarily limited to just the et al. (2009) and Casey (2015) suggest the pharmacology aspect, however. For treating following principles regarding sleep insomnia there is a list of treatments that hygiene. Applicable to everyone, individuals may be beneficial. Doctors may suggest should only sleep for the time needed to feel stimulus control, sleep restriction, or refreshed the next day, try to stay between relaxation training. Stimulus control can be 7-9 hours of sleep, keep a consistent sleep used to dismantle associations between a schedule, caffeine should not be consumed person’s and troubles sleeping. at least 6 hours before bed, alcohol and Often, patients are told to leave their heavy meals should be limited in the late bedroom if they are not asleep within 20 evening, exercising is great but excessive minutes of them being in there (Blythe et al., exercise should be avoided 3 to 4 hours 2009). On the other hand, Blythe et al. before going to bed, and television and (2009) note: computer use should be limited before bed. Sleep restriction limits time in bed at The use of phones should be limited as well night and bans daytime napping in an due to the light that it gives off. effort to promote sleep consolidation. Furthermore, pharmacology and This option should be considered for pharmacotherapy may be used in treating patients who spend too much time in insomnia. It is important to have the right bed in a misguided attempt to facilitate medication for specific sleep symptoms. sleep. Relaxation training, including When an individual has trouble falling guided imagery, progressive muscle asleep and has no other symptoms, Blythe et relaxation, yoga, or meditation, is al. (2009) suggests the use of Zaleplon. intended to lower physical and mental

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Zaleplon has a short half-life and may be insomnia. Insomnia is one of the most used to reduce onset sleep time. However, predominant sleep-wake disorders known to drugs with a short half-life are not always date. Many suggest that the causes of the answer to the solution. In some cases, a insomnia may be due to life stressors, a drug with a longer half-life is needed. Those preexisting medical condition, or some who have trouble staying asleep may need to biological dysfunction. All of these are take something like zolpidem CR. The CR important to keep track of so proper formulation may help some individuals treatment can be provided. Treatments can more (Blythe et al., 2009). Among the most include a wide range of things from common pharmacological uses, cognitive behavioral therapy for insomnia to benzodiazepines and just knowing the proper sleep hygiene tips to benzodiazepine-receptor agonists are often pharmacology uses. used for treatment (Riemann et al., 2015). When looking at the biological and It’s important to acknowledge that behavioral perspectives the symptoms of benzodiazepines and insomnia remain the same. They differ in the benzodiazepine-receptor agonists seem to fact that the biological perspective is viewed only have short term effects. In the long run, as being internal and the behavioral they may end up causing more harm to the perspective is viewed as being external. individual because dependency can become However, they are related. The processes a problem. (Riemann et al., 2015). occurring inside of your body may affect Essentially, it can be inferred that the your behavior if something is not pharmacology treatments are more functioning properly. Although related, there associated with those of the biological and is a difference in the type of treatment for neurobiological perspectives in psychology. each. The biological perspective focuses on This type of treatment would, assumingly, the use of pharmacology and help regulate if something was off in the pharmacotherapy while the behavioral body. perspective tends to use cognitive behavioral Conclusion therapy. Regardless, it has been shown that insomnia can really begin to affect an This paper intended to provide an overview individual; if you are an individual who has of what a sleep-wake disorder may consist trouble sleeping be sure to talk to your of while specifically focusing on the doctor about your symptoms. symptoms, causes, and treatments of

References

th American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Disorders (5 ​ ed.). ​ ​ ​ Washington, DC.

Barlow, D. H., & Durand, V. M. (2015). and Sleep-Wake Disorders. In Abnormal Psychology (7th ed., pp. ​ ​ 295-300). Stamford, CT: Cengage Learning.

Blythe, J., Doghramji, P., Jungquist, C., Landau, M., and Valerio, T. (2009). Screening and Treating Patients with Sleep/Wake Disorders. Haymarket Medical Education, 1-20. ​ ​ Casey, G. (2015). Resting Easy in Sleep. Kai Tiaki Nursing New Zealand, 21(11), 20-24. ​ ​ Chasens, R. E., and Luyster, F. S. (2016). Effect of Sleep Disturbance on Quality of Life, Diabetes Self-Care

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Behavior, and Patient-Reported Outcomes. American Diabetes Association, 29(1), 20-23. ​ ​ Chauvin, B., Thibault-Stoll, A., Chassagnon, S., Biry, S., Petiau, C., and Tassi, P. (2015) Sleep-related Cognitions Mediate the Impact of on Insomnia. American Journal of Health Behavior, 39(5), 623-631. ​ ​ ​ ​ doi:10.5993/AJHB.39.5.4

Cronlein, T., Langguth, B., Eichhammer, P., and Busch, V. (2015). Impaired Recognition of Facially Expressed Emotions in Different Groups of Patients with Sleep Disorders. Plos One, 11(4), 1-9. ​ ​ Floam, S., Simpson, N., Nemeth, E., Scott-Sutherland, J., Gautam S., and Haack, M. (2014). Sleep Characteristics as Predictor Variables of Stress Systems Markers in Insomnia Disorder. European Sleep Research Society, 24, ​ ​ 296-304. doi:10.1111/jsr.12259

Laar, M., Pevernagie, D., Mierlo, P., and Overleem, S. (2015). Subjective Sleep Characteristics in Primary Insomnia Versus Insomnia with Comorbid Anxiety or . Sleep and Biological Rhythms, 13, 41-48. ​ ​ Khurshid, K. A. (2015). A Review of changes in DSM-5 Sleep-Wake Disorders. Psychiatric Times, 1-5. ​ ​ Perlis, M. L., Giles, D. E., Mendelson, W. B., Bootzin, R. R., and Wyatt, J. K. (1997). Psychophysiological Insomnia: The Behavioral Model and a Neurocognitive Perspective. J. Sleep Red, 6, 179-188. ​ ​ Pullen, L., Mayes, W., & Horton, K. (2013). Insomnia and Mental Health Disorders. Mental Health Today, 24-26 ​ ​ Riemann, D., Nissen, C., Palagini, L., Otte, A., Perlis, M. L., and Spiegelhalder, K. (2015). The Neurobiology, Investigation, and Treatment of Chronic Insomnia. The Lancet, 14, 547-558. ​ ​ Robillard, R., Oxley, C., Hermens, D. F., White, D., Wallis, R., Naismith, S. L., Whitwell, B., Southan, J., Scott, E. M., and Hickie, I. B. (2016). The Relative Contributions of Psychiatric Symptoms and Psychotropic Medications on the Sleep-Wake Profile of Young Persons with Anxiety, Depression, and Bipolar Disorders. Research, ​ ​ 243, 403-406.

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