Table of Contents  
Year : 2022  |  Volume : 54  |  Issue : 2  |  Page : 101-111

Sleep disorders and its consequences on biopsychosocial health: A narrative review

1 Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Sansthana, Bengaluru, Karnataka, India
2 Department of Panchkarma, Uttarakhand Ayurved University, Dehradun, Uttarakhand, India

Date of Submission28-Jun-2022
Date of Decision25-Aug-2022
Date of Acceptance15-Sep-2022
Date of Web Publication15-Dec-2022

Correspondence Address:
Ms. Kanika Verma
Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ym.ym_82_22

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Sleep disorders are often underdiagnosed and undertreated. Fewer than 20% of people with insomnia are correctly diagnosed and treated, even though a significant portion of the population suffers from severe sleep disorders that necessitate medical attention. Excessive sleepiness and restless leg syndrome have even worse statistics, with only limited cases correctly diagnosed and treated. Insomnia and excessive sleepiness have a wide range of effects on people's lives, including their professional, social, and family lives, concentration, and memory. In addition, a sleepy person is more likely to be involved in a car, workplace, or domestic accident. This review aimed to search and explore literature regarding sleep and normal physiology and its impact on physical and mental health. We also searched for sleep disorders and their consequences on cognitive dysfunction and clinical and complementary approaches to managing sleep disorders. We browsed Embase, Scopus, PubMed, Cochrane, and Google Scholar databases till November 30, 2021. The high prevalence rates of insomnia indicate a significant public health concern that necessitates education and prevention efforts and increased attention from health-care professionals. This review highlighted the importance of timely screening and managing sleep disorders to prevent their consequences and discussed the evidence of complementary and alternative therapy for managing them.

Keywords: Biopsychosocial health, complementary and alternative therapy, insomnia, psychology, sleep deprivation, sleep disorders

How to cite this article:
Verma K, Singh D, Srivastava A. Sleep disorders and its consequences on biopsychosocial health: A narrative review. Yoga Mimamsa 2022;54:101-11

How to cite this URL:
Verma K, Singh D, Srivastava A. Sleep disorders and its consequences on biopsychosocial health: A narrative review. Yoga Mimamsa [serial online] 2022 [cited 2023 Jun 6];54:101-11. Available from:

  Introduction Top

Sleep is a naturally occurring mental and physical phenomenon. It is a vital activity for all beings. It is distinguished by altered consciousness, reduced sensory activity, inhibition of nearly all voluntary muscles, and decreased interaction with the surroundings. Sufficient sleep time is essential for both physical and mental well-being.[1] Sleep is vital for brain function and systemic physiology, including metabolism, appetite regulation, and immune, hormonal, and cardiovascular system functions.[2] Sleep is critical for the optimal operation of essential cognitive functions linked to academic success. All mental processes require sleep, including memory consolidation, learning, decision-making, and critical thinking.[3] Sleep differs from physiological rest since it does not make individuals conscious and aware of their environment. Moreover, most hormonal changes during sleep are absent in regular physiological rest. While the muscles may have some downtime to repair themselves, rest periods are not long enough to restore them, like an entire night of sleep.[4] The functioning of sensory information is always evident with some modifications during sleep. All the sensory systems present (visual, auditory, vestibular, somaesthetic, and olfactory) influence sleep; meanwhile, sensory systems also undergo changes depending on the sleep or waking state of the brain. Therefore, different sensory modalities encoded by their specific receptors and pathways may change the sleep and waking physiology, and the sleeping brain directs the incoming information.[2] It has been proposed that sensory inputs actively modulate the neural networks responsible for sleep and wake cycles to function correctly. In addition, sensory stimulation and deprivation may alter the sleep/waking neural networks. This indicates that the central nervous system and sensory input have reciprocal interactions, which regulate the normal sleep/waking cycle.[3] Sleep disorders are often underdiagnosed and undertreated. Fewer than 20% of people with insomnia are correctly diagnosed and treated, even though a significant portion of the population suffers from severe sleep disorders that necessitate medical attention.[4] Excessive sleepiness and restless leg syndrome (RLS) have even worse statistics, with only limited cases correctly diagnosed and treated. Insomnia and excessive sleepiness have a wide range of effects on people's lives, including their professional, social, and family lives, concentration, and memory. In addition, a sleepy person is more likely to be involved in a car, workplace, or domestic accident.[5] In this review, the authors focused on exploring the answers to arising questions. What are the normal physiology behind sleep and its stages? What are the factors affecting sleep pattern? How sleep quality affects physical and mental health? What are the prevalent sleep disorders? What are the approaches to managing sleep disorders?

  Search Strategy Top

A literature search was initiated to describe sleep and normal physiology and its impact on physical and mental health. We also searched for sleep disorders and their consequences on cognitive dysfunction and clinical and complementary approaches to managing sleep disorders. We browsed EMBASE, Scopus, PubMed, Cochrane, and Google Scholar databases till November 30, 2021. Search strategy used with Mesh terms are as follows; (sleep) OR (sleep*[MeSH Terms]) OR (circadian rhythm sleep disorders[MeSH Terms]) OR (adjustment sleep disorder [MeSH Terms]) AND (sensory process [MeSH Terms]) OR (sensory process [MeSH Terms]) OR (narcolepsy [MeSH Terms]) OR (sleep, rem, parasomnias [MeSH Terms]) OR (RLS [MeSH Terms]) AND (biological factors [MeSH Terms]) AND (Biopsychosocial Health [MeSH Terms]) AND (psychosocial factors [MeSH Terms]) AND (association, mental health [MeSH Terms]) AND (bipolar depression [MeSH Terms]) OR (Depression [MeSH Terms]) OR (Anxiety [MeSH Terms]) AND (suicidal ideation [MeSH Terms]) AND (cognitive dysfunction [MeSH Terms]) OR (apnoea [MeSH Terms]) OR (sleep hypopnea [MeSH Terms]) OR (sleep apnea syndromes [MeSH Terms]) OR (sleep quality) OR (sleep pattern) OR (sleep risk factors) OR (stress [MeSH Terms]) OR (electronic [MeSH Terms]) AND (sleep [MeSH Terms]). Reference lists were explored to find the relevant literature. We have also accessed relevant news websites to get sufficient literature.

  What are the Normal Physiology Behind Sleep and its Stages? Top

Normal human sleep is generally divided into two stages: nonrapid eye movement sleep (NREM) and rapid eye movement sleep (REM). NREM sleep is further subdivided into stages N1, N2, and N3 based on unique Electroencephalogram (EEG) and electromyographic criteria. Stage N3 has significance since it is a period of slow-wave EEG activity associated with the growth hormone release.[2] REM sleep, commonly known as dream sleep, is marked by the presence of REM s, as noted by electrooculography. Human beings experience sleep through these stages, starting with N1, and ultimately reaching REM sleep. In most individuals, sleep cycles occur four to five times per night.[3] Nocturnal arousals are experienced by episodes lasting at least three seconds characterized by acute changes in EEG activity. They are also ubiquitous during sleep, with an average of 27 arousals/h observed in healthy older individuals without sleep complaints, compared to 10–20 arousals/h in younger age groups.[6]

Sleep is essential for brain function and systemic physiology, including metabolism, appetite regulation, and immune, hormonal, and cardiovascular system functions. Furthermore, many changes have been known to occur in the human body during sleep. Sometimes individuals with vulnerable systems, such as those with cardiovascular diseases, exhibit risk factors. Physiological changes also appear in the following systems.[7]

  • In the cardiovascular system, the changes in blood pressure and heart rate occur during sleep. These are primarily determined by autonomic nervous system activity. For example, a slight increase in blood pressure and heart rate occurs with K-complexes, arousals, and large body movements. Moreover, there is an increased risk of myocardial infarction in the morning due to the sharp rise in blood pressure and heart rate.[8] Sympathetic-nerve activity decreases with deep NREM sleep, yet, there is a burst of sympathetic-nerve activity during NREM sleep because of the transient increase in blood pressure and heart rate that follows K-complexes. Compared with wakefulness, there is a rise in activity during REM sleep[9]
  • Several changes occur in ventilation and respiratory flow during sleep in the respiratory system. It becomes rapid and more erratic, specifically during REM sleep. It has been suggested that hypoventilation (deficient ventilation of the lungs that results in the reduction of the oxygen amount or increase in the amount of carbon dioxide in blood or both) occurs in quite a similar way as during NREM sleep. The ventilation and respiratory flow exhibit less effective adaptive responses during sleep[7]
  • The cough reflex, customarily known to react to irritants in the airway, is suppressed during REM and NREM sleep. The hypoxic ventilatory response is also found to be less in NREM sleep than during wakefulness and decreases more during REM sleep. The arousal response to respiratory resistance (for instance, resistance in breathing in or out) in stage 3 and stage 4 of sleep is deficient[8]
  • During NREM sleep, significant reductions in cerebral blood flow and metabolism occur, while total blood flow and metabolism in REM sleep can be compared to wakefulness. However, compared to insomnia, metabolism and blood flow are found to increase in some brain regions during REM sleep[9]
  • In renal function, a reduction in sodium, potassium, chloride, and calcium excretion can be noticed during sleep, associated with more concentrated and reduced urine flow. The changes in the renal system during sleep are complex and involve changes in renal blood flow, glomerular filtration, hormone secretion, and sympathetic neural stimulation[8]
  • Endocrinal activities such as growth hormone, thyroid hormone, and melatonin secretion get influenced by sleep. Growth hormone secretion occurs during the first few hours after the sleep onset and typically during slow-wave sleep, while thyroid hormone secretion occurs in the late evening. Melatonin, which causes sleepiness, likely by reducing an alerting effect from the suprachiasmatic nucleus, gets impacted by the light-dark cycle and suppressed by light.[9],[10]

  What are the Factors Affecting Sleep Pattern? Top

Biological factors

Borbély's two-process sleep regulation model, which includes a homeostatic sleep-wake constituent (Process S) and a circadian constituent (Process C), is used to guide adolescent sleep theory and research.[11] In a nutshell, the homeostatic sleep-wake component refers to an individual's increased need for sleep (i.e. sleep pressure), which increases the longer they stay awake and decreases as they fall asleep. On the other hand, the circadian component of the two-process model is an intrinsic, “internal clock” system that regulates the daily, 24-h rhythmic cycle and is not driven by prior sleep-wake duration. Melatonin secretion, a hormone produced by the pineal gland in humans, has been conclusively demonstrated to be associated with the circadian system.

  • This homeostatic sleep-wake and circadian systems should ideally work in harmony to regulate sleep, but biological, psychosocial, and contextual changes in adolescence frequently disrupt this balance
  • The transformation from childhood to adolescence is accompanied by significant neurodevelopmental biological changes, such as brain reorganization and synaptic pruning.[12] As children enter adolescence, these changes have an impact on sleep architecture. Slow-wave sleep decreases throughout adolescence, with delta power (measured with a sleep electroencephalogram [EEG]) beginning to decline around age 11 and theta power declining sharply from 11 to 16.5 years old. These changes in the adolescent EEG correspond to a decrease in grey matter brain tissue as adolescence progresses[13]
  • In the same way that biological factors influence sleep in adolescence, it is becoming increasingly clear that sleep function impacts how the human body functions. Poor sleep quality, for example, has been linked to an unhealthy heart rate variability pattern over time, which could be particularly important to consider in studies looking into the possible correlation between sleep and cardiovascular risk factors like childhood obesity[13]
  • Telzer et al. used a functional magnetic resonance imaging study to investigate how poor sleep quality affects brain function and risk-taking in adolescence. A biopsychosocial model may help further our understanding of the effects of sleep. It has been discovered that children with poor sleep had lower dorsolateral prefrontal cortex (DLPFC) activation during cognitive control, higher insula activation during reward processing, and lower functional coupling between the DLPFC and affective brain regions. The authors concluded that “poor sleep quality in adolescents may have a greater orientation towards risk and compromised decision-making.” Based on behavioral findings, adolescents who reported poorer sleep were mainly oriented to rewards and less motivated to engage in cognitive control.[14]

  Psychosocial Factors Top

Many psychosocial factors can influence sleep patterns, and sleep can reciprocally affect psychosocial functioning. Family, peers, academics, employment, and mental health are the factors, though they are all interconnected in complex ways.[15]

  Biopsychosocial Health Top

Sleep is believed to be intertwined with biological, psychological, and contextual factors in a person's life – not only at any particular time but also throughout development. We recognize that the borders between these numerous criteria are frequently ambiguous, but for clarity, it is an attempt to specify them as much as possible.[15] For example, we recognize that family and peer factors are contextual. Still, we consider these family and peer factors as psychosocial factors below and use the term “contextual factors” to refer to aspects of adolescents' environments such as school, community, and cultural factors [Figure 1].[11]
Figure 1: Biopsychosocial and contextual model of sleep in adolescence

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  Contextual Factors Top

Although conditions a century ago were likely to allow people to sleep for as long as they wanted, these words seem even more poignant against the backdrop of the twenty-first century, when, at least for many young people, the phrase “24/7” seems apropos, as they juggle increasing academic and job demands, extracurricular activities and employment, and a barrage of technological outlets and influences. Now, we will look at how these environmental elements influence what we know about sleep.[11]

  Family Factors Top

The family environment has been clean as a critical context for understanding sleep throughout one's life. However, the role of the family environment in promoting adolescents' optimal or disturbed sleep is unclear. In addition, as Adams et al. recently reviewed, evidence suggests that attachment style is linked to sleep across the lifespan. However, most studies have been conducted with infants or school-aged children, and no studies with early-to-mid adolescents have been identified.[16]

Finally, sleep functioning has recently been recognized as a critical mechanism by which parent-child conflict relates to internalizing and externalizing symptoms. Kelly et al. observed in 3-year longitudinal research that physical parent-child conflict at age 9 predicted worse sleep functioning (as measured by actigraphy) at age 10, which expected internalizing and externalizing symptoms at age 11. This study is notable for several reasons, including its longitudinal design, child/parent assessments, actigraphy sleep measurements, and the distinction between different sleep domains.[17]

  Peer Factors Top

Surprisingly, few researchers have examined how teenage peer interactions influence sleep behavior and vice versa. Existing findings hint at the need for more research in this area. Adolescents with a history of loneliness report more significant sleep issues than their peers, and adolescents with sleep problems report more loneliness than adolescents without sleep problems. Roberts et al. observed that children with high levels of sleep issues had more problems in their peer interactions, even after adjusting for initial levels of peer functioning, in 12-month longitudinal research.[18] In a recent study of 11,788 children from 11 European nations, shorter school night sleep duration was linked to higher self-reported peer issues. Furthermore, there is evidence that loneliness worsens the relationship between teenagers' self-reported daytime stress and actigraphy-assessed nocturnal sleep performance.[19] An early study in this field discovered that loneliness was connected with more sleep issues in early and middle adolescence but not in later adolescence, possibly due to the increasing importance of friends as providers of peer support in early/mid-adolescence.[20]

  Electronic World Top

Almost everyone in India (97%) has at least one electronic gadget in their bedroom, with older youth having more electronic devices than younger teenagers.

Furthermore, 62% of people admit to using a mobile phone after “lights out” (for calls or text messages). Research linking media usage to poor sleep performance in teenagers, including shorter sleep duration and delayed sleep start.[21]

  Community Factors Top

When looking at the determinants and implications of insufficient or inadequate sleep, it is crucial to include the larger community and neighborhood context in addition to the professional or educational setting. Several studies have found a correlation between communal violence and poor sleep.[22]

  Sleep Disorders Top

A sleep disorder can be defined as changes in sleeping patterns or habits that can negatively impact health.[1] Normal healthy sleep is characterized by adequate duration (7–8 h), good quality, optimal timing, and the absence of sleep disruption and disorder.[7] Inadequate sleep impacts neurocognitive function, psychological well-being, everyday activities, and productivity. Sleep disorders are usually caused by psychological, physical, or environmental rationales.[14] Many variables impact sleep patterns, including more significant academic obligations, diminished or eliminated parental influence, economic stresses, increased Internet and social media use, and alcohol and caffeinated beverages before bedtime.[23]

Sleep deprivation can have significant consequences, such as poor academic or occupational performance, a weakened coping mechanism, and an increased risk of motor accidents. Insomnia is the most prevalent sleep condition. Insomnia affects around 10%–15% of the population. It affects women more than men.[24] Insomnia can be acute or chronic. Moreover, primary insomnia can be defined as an individual experiencing sleep disorder due to stress or emotions, while comorbid insomnia is sleeplessness that arises from a prior illness. Except in primary insomnia, insomnia was usually reported as a subsequent symptom of some underlying medical, neurological, or mental problem. While insomnia is comorbid with psychiatric illness, sleep initiation and maintenance disruption is the most prevalent type. Mental illnesses affect 35% of people with insomnia symptoms, and half of these patients have mood disorders.[25] The prevalence of sleep-related eating disorders is 4.5%, while sleep-related sexual activity is 7.1%. The bulk of REM sleep behavioral disorders varies but can reach up to 30%.[26]

NREM sleep arousal problems are most prevalent in children. Sleepwalking has been reported to occur in 10%–30% of children. The prevalence of sleep nightmare episodes in children is estimated to be 36.9%. It gradually diminishes as one ages.[27]

  What are the Prevalent Sleep Disorders? Top

The American Academy of Sleep Medicine classified sleep disorders and published it in the International Classification of Sleep Disorders, Second Edition (ICSD-2), to standardize definitions and create a systematic approach to diagnosis.[28]

The eight main types of sleep disorders are:

  1. Narcolepsy
  2. Parasomnias
  3. Breathing sleep-related disorders
  4. RLS
  5. The circadian rhythm sleep disorders
  6. The hypersomnias of central origin
  7. The sleep-related movement disorders
  8. Other sleep disorders.

  Narcolepsy Top

Researchers attempted to estimate the prevalence of narcolepsy in various parts of the globe. Most prevalence figures are based on clinical samples or are not representative of the general public. Only three of the studies used representative examples of the population. According to these studies, narcolepsy is quite prevalent in Europe and North America, ranging from 20 to 67 per 100,000 people.[29],[30] This figure was estimated to be 590 narcoleptics per 100,000 people in a Japanese study and 160 narcoleptics per 100,000 people in another study.[31] The prevalence of narcoleptics was estimated to range between 1 and 40 per 100,000 in Hong Kong and 40 per 100,000 in Saudi Arabia.[32] Another research on Jewish Israelis found a frequency of 0.23 per 100,000 people, despite the population's low rate of human leukocyte antigen (DR2), a narcolepsy marker.[33]

  Parasomnias Top

Parasomnias are unpleasant feelings or behaviors that occur during the transition from sleep to waking. They are caused by the activation of the central nervous system and the intrusion of wakefulness into REM or non-REM sleep, resulting in nonvolitional motor, emotional, or autonomic activity. Confusional arousals and sleep terrors are non-REM sleep parasomnias, whereas nightmares and sleep behavior disorder (RBD) are REM sleep-associated parasomnias.[34]

  Breathing-Related Sleep Disorder Top

Sleep apnea is breathing for at least 10 s while sleeping. The respiratory disturbance index or apnea/hypopnea index (AHI), which measures the number of apnea and hypopnea (respiratory disturbances) episodes per hour, is used to detect whether breathing patterns are abnormal. An AHI of 5 or above usually indicates a high number of respiratory sleep disorders.[35] Few studies have used representative samples of the general public to determine the prevalence of sleep apnea or obstructive sleep apnea syndrome [Table 1].
Table 1: Prevalence of sleep apnoea syndrome in community-based studies

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  Restless Leg Syndrome Top

In the last decade, the general population has examined RLS more thoroughly. Nine studies used a limited set of questions to assess RLS (one or two questions). When studies covered the entire adult population (18 years or older), prevalence rates varied from 7% to 23%, with an average of approximately 10%. The greater prevalence was found in elderly samples (55 years and older) [Table 2]. In nearly every study, RLS was more common in women than men. Europe and North America also increased steadily until age 65, but not in Asia. RLS affects about 2% of European and North American men in their 20s and 25s and about 6% of men 65 and up. RLS affects roughly 4.5% of 20–25-year-old European and North American women and about 11% of 65 years old. RLS affects 1.8% of men and 3% of women in Asian countries.
Table 2: Prevalence of restless leg syndrome in community-based studies

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  Circadian Rhythm and Sleep Disorders Top

The body's internal timing system, known as circadian rhythm, synchronizes its rhythmic cycles to external stimuli to follow a 24-h day. Sleep and wake cycles, cortisol release, body temperature, melatonin levels, and other physiologic variables are all affected by circadian rhythms. Because of a misalignment between their endogenous circadian timing and external influences, patients with circadian rhythm disorders have chronic or recurring sleep disturbances (insomnia or hypersomnia).[26]

Excessive drowsiness and hypersomnia are terms that are sometimes used interchangeably. This approach is only half right; hypersomnia is characterized by extended nocturnal sleep, naps, and the inability to stay awake or aware in settings requiring attention (excessive sleepiness). Excessive drowsiness is increasingly being labeled as a sickness or a problem. According to current classifications, excessive drowsiness is a sign of a sleep disorder or another condition. Excessive drowsiness is specified as a critical feature (i.e. required for diagnosis) for only three sleep disorders in the ICSD: behaviorally induced inadequate sleep syndrome, hypersomnia (idiopathic, chronic, or posttraumatic), and narcolepsy.[71] In most cases, research on excessive drowsiness in the general population may be separated into two categories: those that examine the inclination to fall asleep while awake and those that test the excessive quantity of sleep.

With patients aged 65 and above, several studies were conducted just to confirm the presence or absence of excessive drowsiness. The incidence of excessive sleepiness using a yes/no response ranged between 3.9% and 16% in research based on the entire adult population. For example, one study on Mexico's general population found a prevalence of 21.5%, while another in Japan found a rate of 2.5%.[72]

Few studies have evaluated different questionnaires used to measure excessive drowsiness in the general population. According to a survey by Stiefel and Stagno,[71] Three subjective sleepiness measurements revealed a modest connection (r between 0.22 and 0.35). Another study found that the Epworth Sleepiness Scale results were marginally correlated with other subjective measures of excessive sleepiness (feeling sleepy during the day (r = 0.36) or feeling tired during the day (r = 0.24).[73] The lack of a standardized definition of extreme drowsiness results in unacceptably wide prevalence rates. It is unclear if its prevalence rises or falls with age, as both tendencies have been recorded. Poor sleep hygiene, employment, and psychotropic medications can all contribute to excessive drowsiness. It has also been linked to sleep disturbance caused by breathing difficulties, psychological diseases, particularly depression, and physical conditions.[33],[74]

  How Sleep Quality Affects Physical and Mental Health? Top

Sleep disorders and biopsychosocial health

Patients with frequent nocturnal or early morning awakenings associated with nonrestorative sleep may complain of difficulty falling asleep (sleep-onset insomnia) or staying asleep (sleep-maintenance insomnia). According to a recent National Institutes of Health consensus, insomnia is a disorder that occurs despite the patient's having adequate opportunity and circumstances to sleep.[75] It must be associated with impairment of daytime functioning or mood symptoms. Inattention, impaired memory and concentration, poor performance in vocational or social settings, increased errors at work or while driving, tension headaches, gastrointestinal symptoms, or fatigue are signs of daytime impairment. Reduced energy and motivation, irritability, restlessness, and anxiety are signs of a bad mood. According to National Institutes of Health, 63% of Brazilians have some sleep disorder, with insomnia affecting 33% of them. Similar scenarios were discovered in a Dutch epidemiological survey, where 32.1% of people had some form of sleep disorder.[76] In New Zealand, however, sleep disorders were reported in 9% to 14% of adults, revealing contextual differences in their conditioning factors.[77] The measurement method, such as perception or diagnosis, causes differences in the estimates. The correlation between mental illness and insomnia is well established. According to epidemiological studies, 30%–60% of people with mental disorders also suffer from insomnia.[78] According to some studies, up to 80% of people with major depressive disorder have insomnia.[77] Few studies have studied the persistence of insomnia and the onset of mental disorders. Insomnia that persisted over time was linked to an increased risk of developing a mental illness by 4–8 times. According to some studies, nearly half of those with insomnia have multiple persistent or chronic health issues. The most frequently reported associations are upper airway, rheumatic, chronic pain, and cardiovascular diseases. Several epidemiological studies have found tobacco, alcohol, and antihypertensive drugs to be significantly associated with insomnia symptoms. Around 40% of people with insomnia in these groups used alcohol to help them sleep.[79]

Sleep disorders and mental health

Sleep and mental health are inseparably intertwined, and disrupted sleep is a sign of various psychiatric diseases. Although sleep functioning is likely to be related to most, if not all, aspects of mental health, the focus is on anxiety, depression, suicidal ideation/behaviors, externalizing behaviors, and substance use.[80]

Depression and Anxiety

The relationship between sleep function and internalizing symptoms like anxiety and depression has received much scientific attention. Poor sleep quality, shorter sleep duration, and daytime drowsiness are all linked to anxiety and depression.

According to several research, sleep issues have been linked to a higher chance of developing depression symptoms later in life. After adjusting for toddlerhood levels of anxiety/depression, Gregory and O'Connor. conducted 11-year longitudinal research and discovered that sleep issues at age 4 predict anxiety/depression symptoms in adolescence.[80] The opposite relationship between anxiety/depression symptoms in toddlerhood and sleep issues in adolescence was not genuine.

Suicidal ideation and behavior

Sleep issues have been associated with melancholy, anxiety, and changes in emotion control in studies, so researchers looked into whether they might increase the risk of suicidal thoughts and conduct. Poor sleep functioning has been linked to adolescent-reported suicidal thoughts in several studies.

Poor sleep was also associated with suicidal attempts in Roane and Taylor's. population-based study.[81] Even after adjusting for age, sex, and depressive symptoms, Liu. Discovered a similar link, with teenagers who got less than 8 h of sleep each night having a higher chance of committing suicide. Having frequent dreams was found to be specifically associated with both suicidal thoughts and suicide attempts.[82] Researchers used data from the Study of Adolescent Health to find that sleep problems predict suicidal thoughts and attempts over time, even after controlling for depression, alcoholism, drug use, and youth characteristics such as age, sex, and chronic health problems.[83]

  What are the Approaches to Managing Sleep Disorders? Top

Clinical approach to sleep disorders

Some sleep disorders can be diagnosed clinically, but some require additional testing in a sleep laboratory. A full-night polysomnogram (PSG) is recommended, followed by CPAP titration in cases of suspected sleep-related breathing disorders. PSG is also used to treat severe parasomnias, such as REM and RBD.[25] Patients with possible narcolepsy should undergo a daytime nap study, the multiple sleep latency tests, for objective quantification of hypersomnia and a PSG the night before to document total sleep time and rule out other comorbid sleep disturbances. Insomnia and RLS, however, do not always necessitate PSG because the diagnosis is primarily clinical.[25] In some cases, a PSG may be beneficial for people who have insomnia resistant to traditional treatment and are also suspected of having other sleep disorders (e. g., sleep apnea and motor disorders of sleep).

  Complementary and Alternative Therapy for Sleep Disorders Top

However, psychological interventions and pharmaco-therapies are necessary for managing sleep disorders; complementary and alternative medicines (CAM) have been developed over the past two decades. A study observed that 4.5% of them practiced CAM to treat their sleep disorders.[84] Standard CAM therapies for insomnia can be discussed as acupuncture, acupressure, herbal and nutritional medicine, mind-body practices, yoga, and tai-chi.[85],[86] Acupuncture and acupressure seem to contribute to neurochemical modulatory activity comprising serotonin, dopamine, and endogenous opioids. These can also be employed to increase the γ-amino butyric acid content and enhance sleep quality.[85],[86] Irwin et al. revealed a significant effect of tai chi in reducing insomnia severity but with poor effects on sleep duration and quality.[87] Interventional tai chi studies showed improved subjective sleep quality in diverse patient populations, specifically older adults, but objective measures need further research.[88],[89],[90] Yoga impacts the activity of the autonomic nervous system and represents multicomponent interventions for managing sleep disorders.[91],[92],[93] Yoga, as a mind-body practice, also helps manage stress, anxiety, and sleep disorders.[94] According to a review, valerian, combined with other herbal medicines, did not have positive effects in improving sleep quality.[95] Taibi et al. stated that most studies had no significant difference between valerian and placebo.[96] Valerian, combined with hops or kava, provides a prospective alternative for managing insomnia.[97] L-tryptophan is also suggested as an herbal and natural medicine increases sleep quality. Research shows its effects on mild insomnia with long sleep latency, without medical or psychiatric comorbidity.[97],[98] CAM generally includes extensive therapies based on geographical ranges.[99]

  Conclusion Top

Sleep disorders can significantly impact physical, mental, and emotional health. This review outlines risk factors for sleep disorders in biopsychosocial health. Untreated sleep disorders can lead to a variety of serious complications. Sleep deprivation can cause false memories to form and cognitive function to deteriorate. Along with pharmacotherapies and psychological interventions, the role of complementary and alternative therapies cannot be neglected. Health-care professionals of all specialties should screen the patients for sleep disturbances and, if necessary, refer them to a sleep specialist. Meanwhile, research and policy must address the contextual forces that lead to the inequitable sleep episode. More likely, identifying the sleep behavior is most significant to help researchers, clinicians, and policy-makers plan successful interventions to close the gaps in healthy sleep.

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Conflicts of interest

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