Sleep disorder are a fairly common problem. Frequent complaints about poor sleep are made by 8-15% of the adult population of the entire globe, and 9-11% use various sleeping pills. Moreover, this indicator is much higher among the elderly. Sleep disorder occur at any age and each age category is characterized by its own types of disorders. Thus, urinary incontinence, sleepwalking and night terrors occur in childhood, and pathological drowsiness or insomnia are more characteristic of the elderly. There are also such sleep disorders that, starting in childhood, accompany a person throughout his life, for example, narcolepsy.
Sleep disorder are primary — not related to the pathology of any organs or secondary — arising as a consequence of other diseases. Sleep disorder can occur with various diseases of the central nervous system or mental disorders. With a number of somatic diseases, patients have problems sleeping due to pain, cough, shortness of breath, angina attacks or arrhythmia, itching, frequent urination, etc. Intoxication of various origins, including in cancer patients, often cause drowsiness. Sleep disorders in the form of pathological drowsiness can develop due to hormonal abnormalities, for example, in the pathology of the hypothalamic-mesencephalic region (epidemic encephalitis, tumor, etc.).
Classification
Insomnia (insomnia, disturbances in the process of falling asleep and sleeping):
- Psychosomatic insomnia — associated with a psychological state, may be situational (temporary) or permanent
- Caused by taking alcohol or medications:
- chronic alcoholism;
- long-term use of drugs that activate or depress the central nervous system;
- withdrawal syndrome of sleeping pills, sedatives and other drugs;
- Caused by mental illness
- Caused by breathing disorders during sleep:
- syndrome of decreased alveolar ventilation;
- night apnea syndrome;
- Caused by the syndrome of “restless legs” or nocturnal myoclonia
- Caused by other pathological conditions
Hypersomnia (increased drowsiness):
- Psychophysiological hypersomnia – associated with a psychological condition, may be permanent or temporary
- Caused by taking alcohol or medications;
- Caused by mental illness;
- Caused by various breathing disorders during sleep;
- Narcolepsy
- Caused by other pathological conditions
Sleep and wakefulness disorders:
- Temporary sleep disorders — associated with a sudden change in the work schedule or time zone
- Persistent sleep disorders:
- delayed sleep syndrome
- premature sleep period syndrome
- non-24-hour sleep and wake cycle syndrome
Parasomnia — disorders in the functioning of organs and systems associated with sleep or awakening:
- somnambulism;
- bedwetting (enuresis);
- night terrors;
- night epi-attacks;
- other disorders
Symptoms
The symptoms of sleep disorders are diverse and depend on the type of disorder. But whatever the sleep disorder, in a short period of time it can lead to a change in the emotional state, attentiveness and efficiency of a person. School-age children have problems with learning, the ability to assimilate new material decreases. It happens that the patient goes to the doctor with complaints of poor health, not suspecting that it is associated with sleep disorders.
Psychosomatic insomnia. Insomnia is considered situational if it lasts no more than 3 weeks. People suffering from insomnia do not fall asleep well, often wake up in the middle of the night and cannot fall asleep. Characterized by early morning awakening, a feeling of lack of sleep after sleep. As a result, irritability, emotional instability, and chronic fatigue occur. The situation is complicated by the fact that patients are worried about sleep disorders and anxiously waiting for the night. The time spent without sleep during night awakenings seems to them 2 times longer. As a rule, situational insomnia is caused by the emotional state of a person under the influence of certain psychological factors. Often, after the termination of the stress factor, sleep is normalized. However, in some cases, the difficulties of falling asleep and waking up at night become habitual, and the fear of insomnia only aggravates the situation, which leads to the development of permanent insomnia.
Insomnia caused by taking alcohol or medications. Long-term constant consumption of alcoholic beverages leads to sleep disorders. The rem sleep phase is shortened and the patient often wakes up at night. After stopping alcohol intake, as a rule, within 2 weeks, sleep disorders disappear.
Sleep disturbance may be a side effect of drugs that excite the nervous system. Prolonged use of sedatives and sleeping pills can also lead to insomnia. Over time, the effect of the drug decreases, and an increase in the dose leads to a short-term improvement in the situation. As a result, sleep disorders can worsen, despite the increase in dosage. In such cases, frequent short-term awakenings and the disappearance of a clear boundary between the phases of sleep are characteristic.
Insomnia in mental illnesses is characterized by a constant feeling of intense anxiety at night, very sensitive and shallow sleep, frequent awakenings, daytime apathy and fatigue.
Sleep apnea syndrome or sleep apnea is a short—term cessation of the flow of air into the upper respiratory tract that occurs during sleep. Such a pause in breathing may be accompanied by snoring or motor anxiety. There are obstructive apnea, which occur as a result of the closure of the upper respiratory tract lumen on inspiration, and central apnea associated with disruption of the respiratory center.
Insomnia with restless legs syndrome develops due to a sensation arising in the depth of the calf muscles, requiring foot movements. An uncontrollable desire to move your legs occurs before going to bed and passes when moving or walking, but then it can happen again.
In some cases, sleep disorders occur due to involuntary monotonous and repetitive flexion movements in the leg, foot or thumb that occur during sleep. Usually the flexion lasts 2 seconds and repeats after half a minute.
Sleep disorders in narcolepsy are characterized by sudden paroxysmal falls asleep in the daytime. They are short-lived and can occur during a trip in transport, after a meal, during monotonous work, and sometimes in the process of active activity. In addition, narcolepsy is accompanied by cataplexy attacks — a sharp loss of muscle tone, which may even cause the patient to fall. Most often, an attack occurs during a pronounced emotional reaction (anger, laughter, fright, surprise).
Sleep and wakefulness disorders. Sleep disorders associated with a change in the time zone (“reactive phase shift”) or shift work schedule are adaptive and pass after 2-3 days.
Delayed sleep syndrome is characterized by the inability to fall asleep at certain hours necessary for normal work and rest on working days. As a rule, patients with such a sleep disorder fall asleep at 2 a.m. or closer to morning. However, on weekends or during vacations, when there is no need for the regime, patients do not notice any problems with sleep.
Premature sleep syndrome rarely serves as a reason to consult a doctor. Patients fall asleep quickly and sleep well, but they wake up too early and, accordingly, go to bed early in the evening. Such sleep disorders are common in older people and usually do not cause them much discomfort.
The syndrome of a non-24-hour sleep and wakefulness cycle consists in the inability for the patient to live according to the schedule of 24-hour days. The biological day of such patients often includes 25-27 hours. These sleep disorders occur in people with personality changes and in the blind.
Sleepwalking (somnambulism) is the unconscious performance of complex automatic actions during sleep. Patients with similar sleep disorders can get out of bed at night, walk and do something. At the same time, they do not wake up, resist attempts to wake them up and can commit life-threatening actions. As a rule, such a state lasts no more than 15 minutes. After that, the patient returns to bed and continues to sleep, or wakes up.
Night terrors occur more often in the first hours of sleep. The patient sits up in bed screaming in a state of fear and panic. This is accompanied by tachycardia and increased breathing, sweating, dilation of the pupils. After a few minutes, having calmed down, the patient falls asleep. In the morning, he usually does not remember about the nightmare.
Urinary incontinence is observed in the first third of a night’s sleep. It can be physiological in young children and pathological in children who have already learned to go to the toilet on their own.
Diagnostics
The most common method of studying sleep disorders is polysomnography. This examination is carried out by a somnologist in a special laboratory where the patient must spend the night. During his sleep, many sensors simultaneously register bioelectric brain activity (EEG), cardiac activity (ECG), respiratory movements of the chest and anterior abdominal wall, inhaled and exhaled airflow, oxygen saturation of blood, etc. There is a video recording of what is happening in the ward and constant monitoring by the doctor on duty. Such an examination makes it possible to study the state of brain activity and the functioning of the main body systems during each of the five stages of sleep, identify abnormalities and find the cause of sleep disorders.
Another method of diagnosing sleep disorders is the study of average sleep latency (SLS). It is used to identify the cause of drowsiness and plays an important role in the diagnosis of narcolepsy. The study consists of five attempts to fall asleep, which are carried out during waking hours. Each attempt lasts 20 minutes, the interval between attempts is 2 hours. The average latency of sleep is the time it took the patient to fall asleep. If it is more than 10 minutes, then this is the norm, from 10 to 5 minutes is a borderline value, less than 5 minutes is pathological drowsiness.
Treatment
The treatment of sleep disorders prescribed by a neurologist depends on the cause of their occurrence. If this is a somatic pathology, then therapy should be directed at the underlying disease. The decrease in the depth of sleep and its duration, which occurs in old age, is natural and often requires only an explanatory conversation with the patient. Before resorting to the treatment of sleep disorders with the help of sleeping pills, it is necessary to monitor compliance with the general rules of healthy sleep: do not go to bed in an excited or angry state, do not eat before going to bed, do not drink alcohol, coffee or strong tea at night, do not sleep during the day, exercise regularly, but do not exercise at night, keep the bedroom clean. It is useful for patients with sleep disorders to go to bed and wake up every day at the same time. If you can’t fall asleep for 30-40 minutes, you need to get up and do things until you have a desire to sleep. You can introduce nightly soothing procedures: a walk or a warm bath. Psychotherapy and various relaxing techniques often help to cope with sleep disorders.
Benzodiazepine-type drugs are more often used as drug therapy for sleep disorders. Drugs with a short duration of action — triazolam and midazolam are prescribed for violations of the process of falling asleep. But when taking them, there are often side reactions: excitement, amnesia, confusion, as well as a violation of morning sleep. Sleeping pills with a long—term effect – diazepam, flurazepam, chlordiazepoxide are used for early morning or frequent night awakenings. However, they often cause daytime drowsiness. In such cases, drugs of medium duration of action are prescribed – zopiclone and zolpidem. These drugs are characterized by a lower risk of developing addiction or tolerance.
Another group of drugs used for sleep disorders are antidepressants: amitriptyline, mianserin, doxepin. They do not lead to addiction, are indicated for elderly patients, patients with depressive states or suffering from chronic pain syndrome. But a large number of side effects limits their use.
In severe cases of sleep disorders and in the absence of results from the use of other drugs in patients with confused consciousness, neuroleptics with sedative effect are used: levomepromazine, promethazine, chlorprotixen. In cases of mild pathological drowsiness, weak CNS stimulants are prescribed: glutamic and ascorbic acid, calcium preparations. With severe disorders — psychotonics: iproniazid, imipramine.
Treatment of sleep rhythm disorders in elderly patients is carried out in a complex combination of vasodilating drugs (nicotinic acid, papaverine, bendazole, vinpocetine), CNS stimulants and light tranquilizers of plant origin (valerian, motherwort). Taking sleeping pills can only be carried out as prescribed by a doctor and under his supervision. After the end of the course of treatment, it is necessary to gradually reduce the dose of the drug and carefully reduce it to zero.
Prognosis and prevention
As a rule, various sleep disorder are cured. Difficulties are presented by the therapy of sleep disorders caused by a chronic somatic disease or occurring in old age.
Compliance with sleep and wakefulness, normal physical and mental stress, proper use of drugs that affect the central nervous system (alcohol, tranquilizers, sedatives, sleeping pills) – all this serves as a prevention of sleep disorders. Prevention of hypersomnia consists in the prevention of traumatic brain injuries and neuroinfection, which can lead to excessive drowsiness.
