Sleep disorders

Sleep disorders are a whole complex of various sleep disorders: insomnia, pathological drowsiness during the day, bedwetting, somnambulism and much more. Many people suffer from various forms of sleep disorders. About 8-15% of adults complain of insufficient or poor sleep. It is also proven that at least 11% of adults constantly use sleeping pills.

The content of the article:
Classification of sleep disorders
Symptoms of sleep disorders
Diagnosis of sleep disorders
Treatment of sleep disorders
Prognosis for sleep disorders
Prevention of sleep disorders
Sleep disorders
Sleep disorders can occur in people of different ages. However, they are specific for each age group: for example, children are most often diagnosed with nightmares and urinary incontinence, and the elderly — insomnia and drowsiness during the day. Such a disease as narcolepsy (daytime sleepiness attacks) is not treated and accompanies the patient all his life.

The causes of sleep disorders are diverse. However, it is worth remembering that most often a sleep disorder is secondary, since it occurs against the background of illness or stress. The most common causes of sleep disorders include the following:

Psychoemotional overstrain and stressful situations. Sleep disturbance caused by stress on the body is a psychophysiological reaction. After the elimination of traumatic factors, sleep gradually returns to normal.
Emotional disorders. Disorders such as anxiety, depression, mood disorders negatively affect the duration and quality of sleep.
Chronic somatic diseases. Sleep disorders can become a reaction to the manifestations of certain diseases. Usually, sleep problems in patients occur due to coughing, pain, shortness of breath, itching, attacks of arrhythmia and angina pectoris, frequent urination. Pathological drowsiness can develop against the background of hormonal disorders.
Classification of sleep disorders
In neurology , the following types of sleep disorders are distinguished:

Insomnia is a pathological condition in which the patient’s sleep onset process and its maintenance are disrupted. At the same time, there are difficulties with falling asleep, disturbances during sleep and after waking up, a decrease in the effectiveness and quality of sleep, frequent night awakenings. Insomnia can be triggered by stress, neurosis, depression, somatic diseases (pneumonia, pleurisy, atherosclerosis), organic lesions of the central nervous system (brain tumors, epilepsy, stroke, schizophrenia).
Hypersomnia is a significant increase in the duration of sleep, which is accompanied by pathological daytime sleepiness. Patients have a sleep duration of more than 10 hours, poor health after waking up, difficulty waking up. Hypersomnia can occur after severe fatigue or lack of sleep for a long time, be a side effect of taking medications, accompany somatic diseases and organic brain lesions.
Sleep and wakefulness disorders. Patients often experience temporary sleep and wakefulness disorders. They are usually caused by a change in the time zone or work schedule, when a person is forced to start working at night. Less frequently, permanent sleep disorders are observed: delayed or damaged sleep syndrome, as well as a syndrome characterized by a daily shift in the time of falling asleep and waking up by 1-2 hours.
Parasomnia is a whole complex of disorders that occur during periods of falling asleep, sleeping and after waking up. This complex of sleep disorders includes night terrors and nightmares, somnambulism, night moans, sleep paralysis, bruxism. In most cases, these disorders do not disrupt the social adaptation of the patient and do not require special treatment. However, some of them can still provoke hypersomnia and insomnia, accompanied by dangerous behavior of the patient, so in such cases it is impossible to do without treatment.
Symptoms of sleep disorders
The clinical picture of sleep disorders is very diverse, since they can be provoked by various causes. Symptoms of disorders are directly related to the types of sleep disorders and their etiology. Nevertheless, there are several main clinical manifestations of sleep problems: a change for the worse in the emotional state of the patient, his working capacity and concentration of attention.

The symptoms of sleep disorders are due to their nature. For example, presomnic disorders (difficulty falling asleep) are accompanied by an obsessive feeling of anxiety and fear on the eve of sleep. People with intrasomnic disorders complain of constant waking up during sleep, after which it is very difficult to fall asleep again. Early awakening is characteristic of postsomnia disorders. All sleep disorders inevitably lead to a decrease in the patient’s performance and activity during the day.

Insomnia. People who have been diagnosed with insomnia complain of difficulty falling asleep and frequent awakenings. Because of this, the quality and effectiveness of sleep is disrupted, so patients after waking up feel irritability, severe fatigue, emotional instability. Often, patients begin to worry a lot about this and anxiously wait for the night. Insomnia is mostly situational and passes immediately after the traumatic factor has been eliminated. Nevertheless, the aggravation of the disease can lead to its transition into a permanent form, which requires serious and prolonged treatment.
Insomnia due to taking stimulants (medications, alcohol). If a person often drinks alcohol, over time this leads to a violation of the organization of sleep. Namely, the rem sleep phase is sharply reduced, so the patient often wakes up at night. It is noteworthy that after the cessation of alcohol abuse, sleep normalizes within two weeks. Insomnia can be provoked by prolonged use of sedatives and hypnotics that excite the nervous system. In this case, the alternation of sleep phases is disrupted in patients and frequent short-term awakenings occur.
Sleep apnea syndrome is a short—term cessation of air flow in the respiratory tract that occurs during sleep. Usually this condition is accompanied by motor restlessness or heavy snoring. Sleep apnea can occur due to a malfunction of the respiratory system or the closure of the airway lumen during inhalation.
Insomnia due to restless legs syndrome. This condition is accompanied by an uncontrollable desire to move your legs during sleep. Sometimes patients have repetitive or monotonous flexion movements in the foot, leg or thumb during sleep. Such bends last about two seconds, and then repeat again after 30 seconds.
Narcolepsy. This disease is manifested by bouts of pathological drowsiness and falling asleep during the day. Such attacks are short-lived and occur in any place and situation: during meals, trips in transport and even active activities. Patients have cataplexy — a sudden loss of muscle tone, which may cause the patient to fall. Cataplexy attacks usually occur after some emotional reaction: laughter, anger, fright.
Sleepwalking. This sleep disorder is characterized by the unconscious performance of automatic actions by the patient in a dream. Patients can even get out of bed, walk around the house and make various movements. At the same time, while walking, they do not wake up and often commit life-threatening actions. The episode of sleepwalking lasts about 15 minutes. After its completion, the patient returns to bed on his own and sleeps on.
Night terrors. Often nightmares bother children. They occur mainly in the first hours after falling asleep. After another nightmare, the patient wakes up screaming, he is worried about panic and fear. Such an attack is accompanied by rapid breathing, pupil dilation, tachycardia, increased sweating. After waking up in the morning, the patient usually does not remember about nightmares.
Bedwetting. This problem can bother both children and adults. In children under 5 years of age, enuresis passes by itself with age, no additional treatment is required. Only about 1% of those who had enuresis in childhood continue to suffer from this disease in adulthood. In mature patients, urinary incontinence can be provoked by a decrease in the capacity of the bladder, loss of elasticity by its walls, stress, diabetes mellitus.
Sleep and wakefulness disorders. This disorder can manifest itself in different ways. For example, for the delayed sleep period syndrome, the problem of falling asleep at a certain time is characteristic — often patients fall asleep after midnight or even closer to morning. Premature sleep syndrome is accompanied by normal and timely falling asleep, but early awakening. In patients with non-24-hour cycle syndrome, there is a failure of the normal sleep and wakefulness schedule. Usually, such patients have not 24 hours in a day, but 25-27.
Insomnia caused by affective mental states. Patients who suffer from this disorder complain of a constant feeling of anxiety at night, apathy and fatigue during the day. Frequent awakenings, light sleep and earlier awakening are also noted.

Nocturnal epilepsy attacks. In 25% of patients with epilepsy, tonic-clonic seizures occur during sleep, which are accompanied by urinary incontinence, muscle soreness, tongue biting. Other forms of epileptic seizures are characterized by sleepwalking, nightmares, enuresis.
Bruxism. In patients with bruxism, gnashing of teeth is observed during sleep, which lasts for a couple of minutes. Several such attacks may occur during the night. Symptoms of pathology can be jaw pain, morning migraines, neck, back and shoulder pain, insomnia, daytime drowsiness.
Diagnosis of sleep disorders
Polysomnography
Polysomnography is considered to be the most accurate and reliable method of studying sleep disorders. It is carried out in a special room in which the patient must spend the whole night. A variety of sensors are connected to the patient, which during sleep register cardiac activity (ECG), bioelectric brain activity (EEG), respiratory movements of the anterior abdominal wall and chest, oxygen saturation of blood, inhaled and exhaled airflow.

This diagnostic technique allows us to comprehensively study the state of brain activity and the functioning of body systems at all stages of sleep. The results of the study enable the doctor to detect sleep disorders and determine their causes.

SLS
Another common method of diagnosing sleep disorders is SLS — the study of average sleep latency. This technique is used mainly for the diagnosis of narcolepsy (pathological daytime sleepiness). The patient should make five attempts to fall asleep during the day. The duration of each attempt is 20 minutes, and the break between them is 2 hours. The diagnosis is made based on the time it took the patient to fall asleep. The norm is an indicator of 10 minutes, the boundary value is 5-10 minutes. Narcolepsy is diagnosed if the patient falls asleep in 5 minutes.

Treatment of sleep disorders
A neurologist treats sleep disorders. The selection of treatment tactics is due to the cause of the disease. For example, if a sleep disorder was caused by symptoms of somatic diseases (pain, cough, itching), treatment should be aimed at their complete elimination. The same applies to the psychoemotional etiology of sleep disorders. If problems with falling asleep, sleep quality and waking up in patients have arisen due to stress or emotional overstrain, in this case it is simply necessary to eliminate them. It is considered natural to reduce the duration and decrease the quality of sleep in the elderly.

Before starting medical treatment, the patient needs to normalize sleep and wakefulness, as well as begin to observe the rules of sleep hygiene. Namely, it is advisable not to eat before going to bed, but to eat light and low-fat food for dinner, do not go to bed excited or irritated, do not drink alcohol, strong tea and coffee, ventilate the room before going to bed, avoid daytime sleep. Patients are also advised to go to bed at the same time every day. Psychotherapy and relaxing techniques can help to cope with sleep disorders.

Medical treatment
If the problem could not be solved with the help of normalization of sleep and wakefulness modes, in this case, doctors prescribe drug therapy:

Benzodiazepine-type drugs. To eliminate problems with falling asleep, short-acting medications (imidazole and triazole) are prescribed. However, they can often not be taken because of side effects: amnesia, agitation, confusion, sleep disturbance in the morning. With frequent night awakenings and early morning prescribes drugs with a long-term effect (diazepam, flurazepam, chlordiazepoxide). If such drugs cause daytime sleepiness attacks in the patient, they are replaced with medium-acting medications (zopiclone and zolpidem).
Antidepressants (mianserin, amitriptyline, doxepin). These drugs are indicated for patients of different ages, they are not addictive, they can be taken by patients suffering from depressive conditions. However, antidepressants are prescribed quite rarely because of their side effects.
Neuroleptics with sedative effect (promethazine, tizercin, chlorprotixen). This group of medications is prescribed for the treatment of severe forms of the disease, as well as in the absence of the effect of treatment with other drugs.
CNS stimulants of weak action (calcium preparations, ascorbic and glutamic acids). These drugs are indicated for the treatment of pathological drowsiness of mild form.
Prognosis for sleep disorders
Most sleep disorders can be cured. However, there are some that it is impossible to get rid of.

For example, nowadays it is impossible to completely get rid of narcolepsy, you can only eliminate its most pronounced symptoms with the help of drug therapy.
The prognosis of the acute form of insomnia is quite favorable. In addition, the treatment does not provide for the appointment of tranquilizers and hypnotics. The chronic form of insomnia, on the contrary, requires long and complex treatment.
Hypersomnia is treated successfully in most cases, unless it develops against the background of narcolepsy. Despite the fact that the disease does not pose a threat to the patient’s life, the risk of death from an accident while driving a car or working at work is very high.
Somnambulism in children usually has a favorable prognosis and may eventually pass. In elderly patients, this sleep disorder indicates developing dementia.
Prevention of sleep disorders
The prevention of sleep disorders is based on the observance of a normal sleep and wakefulness regime. Failures of this mode always lead to problems with falling asleep and sleeping. In addition, it is extremely important to observe sleep hygiene, avoid stress and emotional overload, and properly take medications that affect the central nervous system (sedatives, tranquilizers, sleeping pills). Regular physical activity has a positive effect on sleep. However, it is desirable to exclude them an hour before falling asleep.

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