Sleep disturbance in adults is a list of diseases. Sleep disturbance: causes and treatment. Circadian sleep-wake rhythm disorders

Sleep disorders are not so much a lack of sleep (insomnia), but a disturbance in falling asleep, a disturbance in the sleep process itself (intermittent sleep, premature awakening, shallow sleep). Sleep disorders concern 28-45% of the population, being for most of them a significant problem requiring special diagnosis and treatment. Insomnia in people over 60 years of age is 3-4 times more common than in middle age.

The normal duration of sleep varies greatly among different people - from 4-5 hours to 10-12 hours, i.e. There are healthy short sleepers and long sleepers. The main indicator of normal sleep is the feeling of rest after it. If there is no feeling of rest, then we can talk about a violation of the sleep-wake cycle. Insomnia can be primary or secondary, caused by mental illness, anxiety and fear, medication or physical illness. It can be a temporary problem or occur throughout life.

Causes

The most common causes of sleep disorders in healthy people:

• Eating later than 3-4 hours before bedtime, eating spicy foods.
• Excited state: previous intense physical or mental activity, strong emotions (both positive and negative); working with a computer, watching TV shows, loud, rhythmic music, etc.; consumption of activating drinks (strong tea, coffee and drinks containing caffeine, etc.).
• Sedentary lifestyle, lack of adequate physical activity, late awakening, daytime sleep.
• Uncomfortable sleeping conditions: uncomfortable mattress, pillow, bed linen, high or low air temperature, noise, lighting, etc.
• Frequent changes in time zones, night work.

A pathological increase in sleep duration (hypersomnia) can occur in a number of diseases, including endocrine, neurological, and rheumatological. However, hypersomnia most often occurs as a manifestation of depression and can be accompanied by irritability and causeless anxiety. After waking up, a person does not feel rested, and during the day he is bothered by drowsiness and increased cravings for sweets.

Insomnias, disorders of falling asleep and maintaining sleep, are more common than hypersomnias. They are manifested by a feeling of insufficient depth of sleep, frequent awakenings and difficulty falling asleep after them. In the morning, sleep seems insufficient; sometimes there may be a feeling of complete insomnia at night, although objectively the duration of sleep is 6-7 hours. And somnia can occur both in mental (neurosis, depression, drug addiction, alcoholism) and somatic diseases (endocrine, liver and kidney diseases, chronic pain syndromes, skin diseases, especially with skin itching, etc.).

Sleepy (night) apnea syndrome. These are breathing disorders during sleep, characterized by snoring and pauses in breathing lasting 10-120 seconds. In severe cases, up to 500 respiratory arrests may occur during the night. During the day, such patients experience attacks of drowsiness, decreased attention, headache, and arterial hypertension. Sleep apnea occurs 20 times more often in men than in women, most often between the ages of 40-65 years. About 2/3 of patients are overweight or obese.

Treatment

Treatment of sleep disorders should be comprehensive, combining physical exercise, relaxation techniques, psychotherapy, aromatherapy, and drug therapy. In each specific case, treatment is selected individually. We must remember that insomnia cannot be cured with sleeping pills. The use of sleeping pills gives a short-term result, which decreases with prolonged (more than 3 weeks) use of the drugs, and in some cases (for example, with sleep apnea syndrome), treatment with sleeping pills can be dangerous.

However, before you begin drug therapy for sleep disorders, you need to apply the simplest but very effective rules:

1. Stick to the same time to get out of bed, even on weekends.
2. Try to go to bed only when you feel sleepy.
3. If you can't fall asleep within 20 minutes, leave the bedroom and do some quiet activity somewhere else. Return to bed only when you feel sleepy again. At the same time, do not allow yourself to fall asleep outside the bedroom.
4. Form a strong association of the bedroom with sleep. To do this, use it only for sleeping - it should not be a place for working, watching TV, or reading.
5. Avoid eating large meals 4 hours before bedtime and taking caffeine six hours before bedtime.
6. Avoid daytime naps.
7. Establish a relaxing pre-bed ritual, such as a light walk, a warm bath, ten minutes of reading.

And remember: good sleep at night means good health during the day!

You can undergo diagnosis and treatment of the disease in the neurology department of the Spinal Cord Pathology Center of our clinic.

A good night's sleep can tell you a lot about a person. In particular, it indicates a healthy body and a healthy lifestyle. Sleep disturbances (light sleep, frequent waking up at night, inability to fall asleep for a long time) indicate disruptions that occur inside the body. To answer the question why I fall asleep and often wake up or cannot fall asleep for a long time, we need to establish the root causes of poor sleep. In this article we will also talk about effective ways to normalize the process of falling asleep and the ability to make your night's rest more productive.

Features and dangers of sleep disorders

According to doctors, sleep disturbance can be primary (not associated with a particular disease) or secondary. The latter option involves sleep problems in adults due to certain pathologies. If you often ask yourself the question as to why I don't sleep well at night, listen to your body. Perhaps the cause should be sought in diseases of the heart, kidneys and other vital organs.

As for the types of sleep problems, there are three.

• Firstly, this is insomnia (classical insomnia) - a sleep disorder in which the patient cannot fall asleep for a long time or often wakes up.
• Secondly, hypersomnia is excessive sleepiness.
• Thirdly, parasomnia is a sleep disorder caused by malfunctions of the body due to somatic, mental, and neurological diseases.

If the quality of your night's rest is constantly declining, you can't sit idly by. In the future, this can cause obesity, type 2 diabetes, tachycardia, worsen mental work and lead to many other equally dangerous consequences.

Shallow sleep or its lack causes the body to function in emergency mode and release a huge amount of neurotransmitters into the blood. They provide additional resources for the so-called overtime wakefulness. As a result, the optimal functioning of the heart and blood vessels is disrupted.

Causes

Sleep disturbances can be caused by seemingly trivial reasons. Sometimes we don’t even pay attention to them and this is our big mistake. Among the factors that cause sleep difficulties are the following:

The causes of sleep disturbances should also be looked for in the air temperature in the room. To make your vacation better, create an optimal microclimate. The air temperature should be in the range from 18 to 19 degrees. Humidity - 60-80 percent.

Disease as a cause

Regular sleep disturbances in adults are often caused by neurological and somatic diseases. In particular, pulmonary heart failure, enuresis, apnea and restless leg syndrome can lead to this. For example, light sleep can be a consequence of oxygen starvation (pulmonary heart failure). Symptoms of this pathology: headaches, pallor, fainting, chest pain, and so on.

If you find yourself experiencing interrupted sleep and have no idea what to do, pay attention to restless leg syndrome. We are talking about vascular insufficiency of the lower extremities. Poor circulation causes an unconscious need to move the legs. If during the day we do not pay attention to this, then at night such a pathology manifests itself very clearly - it provokes light sleep and its frequent interruptions.

Problems falling asleep may be associated with obstructive sleep apnea. Typically, it is diagnosed in people who snore occasionally.

Due to laxity of the throat and nasopharyngeal tissues, the respiratory opening is briefly blocked. The result of this is a short-term interruption of breathing (no more than 30 seconds) and the patient wakes up from a lack of oxygen. Eliminate snoring and interrupted sleep will no longer bother you.

Medications

Frequent sleep disturbances, the treatment of which should be carried out after a visit to the doctor, can be eliminated with the help of ready-made medications. They are sold in the form of tablets, capsules, drops and taken orally:

Pay attention to the means described above. They are good at eliminating the symptoms of insomnia (insomnia) and are sold at any pharmacy without a prescription.

Healthy herbal recipes

Poor sleep at night in an adult can be effectively treated with dry infusions of sedative herbs. They are used for decoctions and infusions.

Herbal sedatives are an excellent analogue of synthetic drugs. To avoid waking up at night and forget about disturbing dreams, take herbs in courses of 2-3 weeks.

Regular changes in preparations and the use of Melatonin at the very beginning of treatment will help increase therapeutic effectiveness.

If you are wondering why I don’t sleep at night, where I sleep, and what to do about it all, pay attention to the algorithm for treating insomnia. Therapy is performed in stages and involves:

• determining the type of sleep disorder;
• identification of possible mental pathologies;
• development of an effective treatment strategy;
• selection of optimal medications.

Do not self-medicate in an attempt to eliminate light sleep. It is best to entrust such a responsible matter to a doctor.

Don't sleep regularly? Go to bed at the same time every day. Unfortunately, the lost amount of night rest cannot be made up with daytime rest.

But why does a person fall asleep slowly? The key reason lies in the excessive activity of the nervous system. Therefore, immediately before going to bed, do not watch bright and emotional films, do not gamble. In a word, completely eliminate any actions that excite the psyche.

Effective prevention of sleep disorders also involves eliminating any external irritants that interfere with normal sleep. First of all, we are talking about excessively bright light and loud sounds. Never fall asleep while watching TV. The room should be dark, quiet and cool. This is the right decision if you can’t fall asleep or can’t sleep normally.

People suffering from lack of sleep should eliminate coffee and chocolate from their diet at night. They invigorate the psyche, activate the work of internal organs and, in particular, the brain. If you consume such products before bed, then you shouldn’t be surprised and complain why I don’t sleep well at night.

Before a night's rest, a warm (but not hot) bath helps to relax. To prevent loss of sleep from becoming a chronic illness, do not use sedatives and sleeping pills without medical advice.

If a person has not slept for a long time, he may experience difficulty falling asleep due to overexcitation of the nervous system. In this case, we advise you to do some monotonous task, and sleep will soon come.

Sleep disorders- symptoms and treatment

What are sleep disorders? We will discuss the causes, diagnosis and treatment methods in the article by Dr. Mikhail Viktorovich Bochkarev, a somnologist with 14 years of experience.

Publication date September 13, 2019Updated December 11, 2019

Definition of disease. Causes of the disease

Sleep disorders are a group of diseases associated with disturbances in the quality or structure of sleep. The manifestation of symptoms of these diseases during sleep leads to a worsening of the condition while awake.

The main sleep disorders in adults include:

1. Insomnia (insomnia)- difficulty falling asleep and/or staying asleep.
2. Breathing disorders during sleep- snoring and sleep apnea (most often this is obstructive sleep apnea syndrome - OSA);
3. - inability to fall asleep at a socially acceptable time due to a shift in sleep-wake rhythms.
4. - the need to move the legs before and during sleep (for example,).
5. Hypersomnias- severe drowsiness, not associated with low quality or low quantity of night sleep (the most common diseases are narcolepsy and idiopathic hypersomnia).
6. Parasomnias- certain undesirable conditions, movements, emotions, sensations that occur when falling asleep, when changing stages of sleep or during night awakenings: screams, fears, sexual arousal and activity, movements of the arms or head, sleepwalking, eating, grinding teeth (bruxism), etc.

Short or long sleep is not a disorder, but it can seriously affect your health, and therefore also requires correction.

More than half of the population suffers from one sleep disorder or another, and the frequency of sleep disorders increases with age. For example, the estimated prevalence of obstructive sleep apnea syndrome (stopping breathing during sleep due to blockage of the oropharynx) among the adult population 30-69 years old in Russia is 51%. Moderate and severe degrees of this disease occur in 26% of people. Due to the lack of attention of the patient and doctors to the symptoms of OSA, this disorder remains unrecognized in 85-90% of cases. Snoring, which always accompanies the disease, is noted by 58% of Russians. The prevalence of insomnia is 13-18%, and is twice as high among women. Circadian disorders account for up to 40% of the causes of insomnia.

Sleep disorders often coexist: one person can have several diseases, for example, obstructive sleep apnea and insomnia.

The causes of sleep disorders are numerous. Among the reasons for the development insomnia First of all, it is worth noting the violation of sleep-wake hygiene:

• late going to bed;
• irregular wake-up time;
• lack of daylight in the morning and excess of artificial lighting in the evening and at night.

Increased anxiety and depression are factors leading to chronic insomnia.

Sleep-wake rhythm disorders can be caused by improper sleep hygiene, shift work and frequent flights, which disrupt the synchronization of the work of internal organs with the main regulator of biological rhythms - lighting.

Reason snoring and is a narrowing and blocking of the lumen of the oropharynx during sleep. Narrowing of the airway lumen occurs due to pathology of the nose and tonsils, backward displacement or underdevelopment of the lower jaw, increased thickness of oropharyngeal tissue with acromegaly (dysfunction of the anterior lobe of the pituitary gland) and (lack of thyroid hormones). A provoking factor in this case may be the use of alcohol and sleeping pills.

Lack of iron in the body is one of the reasons movement disorders during sleep.

Hypersomnias may be secondary to diseases of the nervous system: tumors and brain injuries, diseases affecting the hypothalamus, thalamus and brain stem, stroke, neurodegenerative diseases. They can also occur with mental disorders.

Causes parasomnia in most cases unknown. This disorder can be triggered by certain mental illnesses, brain pathologies, and taking various medications. In addition, stressful situations, lack of sleep, sleep apnea, etc. affect.

If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of a sleep disorder

A combination of several sleep disorders is very common, so it is necessary to clarify all the symptoms. The main sign of disorders is drowsiness or fatigue during the day. But there are other characteristic symptoms that can help identify a specific disorder.

Insomnia:

• it takes more than 30 minutes to fall asleep;
• night and early morning awakenings, after which it takes more than 30 minutes to fall asleep.

Breathing disorders during sleep:

• snore;
• stopping breathing or suffocation during sleep.

Circadian sleep-wake rhythm disorders:

• difficulty falling asleep at a socially acceptable time, more than two hours different from the actual one.

Movement disorders:

• the need to move your legs or walk around before going to bed;
• regularly occurring contractions of the muscles of the lower extremities.

Parasomnias:

• various actions and sensations that occur during sleep.

Hypersomnias (narcolepsy):

• daytime attacks of irresistible drowsiness;
• attacks of sudden falling asleep;
• attacks of sudden loss of muscle tone with clear consciousness.

People with sleep disorders may not have active complaints, since the sleeper himself is not always aware of the presence of snoring, pauses in breathing during sleep, or periodic movements of the limbs. But the consequences of these and any other sleep disorders are felt in the form of fatigue or drowsiness during the daytime.

However, you need to keep in mind that daytime sleepiness can be a symptom of other diseases (hypothyroidism, cancer problems), as well as a side effect of taking certain medications.

Pathogenesis of sleep disorders

Short term insomnia may be caused by stress. Subsequently, people with hyperactivation of the nervous system begin to worry about difficulties falling asleep and maintaining sleep. They worry about the possible consequences of lack of sleep, resulting in poor sleep hygiene. In this case, insomnia becomes chronic.

When there is a violation of the patency of the upper respiratory tract and their regular closure, which makes it difficult for oxygen to enter the lungs. With an acute lack of oxygen, a stress reaction of the body occurs, the sympathetic nervous system is activated and blood pressure rises, which leads to micro-awakenings that are not felt during sleep. At this moment, the brain opens the airways and breathing is restored.

Such micro-awakenings disrupt the structure of sleep, reduce stages of sleep, which are important for the recovery of the body, resulting in symptoms of varying severity:

In the pathogenesis of development circadian sleep disorders An important role is played by the pineal gland hormone melatonin, which is responsible for establishing the sleep-wake cycle. Normally, it is produced only in the evening and night hours. The start time of its secretion (19.30-22.00) determines the onset of biological evening in the body and promotes falling asleep after about two hours. Under the influence of lighting, the onset of melatonin production may shift to later or earlier hours. This will lead to difficulty falling asleep at the desired time or early morning awakenings.

Movement sleep disorders arise when disruption of the process of transmitting electrical impulses from neurons to muscle tissue, which is associated with a lack of dopamine.

Narcolepsydevelops as a result of decreased production of the neurotransmitter orexin A and B, stimulating wakefulness. It happens due to the development of an autoimmune reaction, that is, the body itself destroys brain cells that produce orexin, which leads to its deficiency.

At parasomniassleep dissociation occurs, that is, the person perceives the situation as if it were not happening to him. This state activates stereotypic motor activity, and due to this, certain movements are performed during sleep.

Classification and stages of development of sleep disorders

According to the international classification of sleep disorders, there are the following forms of disorders:

Insomnia has two forms:

• acute - lasts up to three months;
• chronic - lasts more than three months.

Breathing disorders during sleep divided into three groups depending on the type of sleep apnea:

• obstructive sleep apnea syndrome - stopping breathing during sleep due to blocking of the oropharynx, in which chest movements remain, but there is no nasal breathing;
• central sleep apnea syndrome - absence of chest movements and nasal breathing;
• mixed sleep apnea syndrome - no nasal breathing and chest movements at first, then movements appear.

Separate symptoms are also identified - snoring and catophrenia (moaning during sleep).

Sleep apnea is assessed when it lasts more than 10 seconds. Depending on the severity of the stops, there are complete stops - apnea and incomplete stops - hypopnea.

Severity of sleep apnea:

• light - 5-14.9 episodes of apnea-hypopnea per hour of sleep;
• average - 15-29.9 episodes of apnea-hypopnea per hour of sleep;
• severe - more than 30 episodes of apnea-hypopnea per hour of sleep.

Circadian sleep-wake rhythm disorders They are divided into two categories depending on the reasons:

1. Endogenous (internal causes):
2. delayed sleep-wake syndrome;
3. syndrome of advanced sleep-wake rhythm;
4. irregular sleep-wake rhythm.
5. Exogenous (external causes):
6. insomnia during shift work;
7. jet lag (sleep disorder due to time zone changes).

Movement disorders during sleep:

• periodic leg movement syndrome and disease;
• restless legs syndrome.

Hypersomnias:

1. Narcolepsy:
2. Narcolepsy type 1;
3. Narcolepsy type 2.
4. Idiopathic hypersomnia- causeless episodes of drowsiness that occur during the daytime;
5. Kleine-Lewin syndrome (sleeping beauty syndrome)- a sleep disorder in which a person can sleep up to 18 hours a day or more.

Parasomnias are distinguished depending on what stage of sleep the disturbances occur:

1. Parasomnias associated with slow-wave sleep:
2. confused awakening - awakening with a confused consciousness;
3. sleepwalking (somnambulism);
4. night terrors (fears);
5. syndrome of eating while sleeping.
6. Parasomnias associated with REM sleep:
7. REM sleep behavior disorder syndrome;
8. sleep paralysis - the inability to move or speak during sleep, despite being conscious or semi-conscious;
9. nightmares.
10. Other parasomnias
11. Exploding head syndrome - a sharp, loud noise in the ears during sleep or falling asleep;
12. sleep hallucinations;
13. enuresis.

Complications of sleep disorders

A sleep-deprived person cannot enjoy life well. Fatigue, impaired attention, coordination and memory, drowsiness, irritability are common consequences of sleep disorders.

The duration of sleep and its quality are important. Thus, even the usual short duration of sleep (less than 6 hours) has a negative effect on health compared to normal sleep (7-8 hours).

Long episodes of short sleep and disruption of its quality lead to serious problems with a person’s physical and mental health, including the appearance of suicidal thoughts. The risk of developing the following diseases increases:

• - persistent increase in blood pressure due to activation of the sympathetic nervous system.
• Obesity due to a decrease in the level of the hormone leptin (which regulates energy metabolism) and an increase in the hormone ghrelin (which stimulates food consumption). Hormonal imbalance leads to changes in eating habits: decreased feelings of satiety, increased appetite, cravings for fatty foods and quickly digestible carbohydrates.
• Metabolic syndrome and.
• Colorectal cancer.
• Depression.
• Decreased sexual desire due to decreased levels of sex hormones
• Frequent colds.
• Deterioration of skin condition due to decreased production of collagen and somatotropic hormone (regulating the processes of human growth and development).

At circadian sleep disorders In addition to the disorders described above, gastrointestinal disorders often occur: increased or decreased frequency of stools associated with desynchronization of the internal organs and impaired absorption of food.

The most severe health consequences occur when obstructive sleep apnea syndrome .

In addition, there are other negative consequences, for example, those suffering from OSA are more likely to get divorced.

During episodes of sudden sleep onsethypersomniasthe likelihood of injuries and traffic accidents increases. Due to high drowsiness, professional activities are difficult or significantly limited in time.

At parasomniasthere is a high risk of self-harm, as well as harm to a partner.

Diagnosis of a sleep disorder

Diagnosis of sleep disorders is carried out on the basis of data from a patient interview, examination, instrumental and laboratory tests.

To make a diagnosis of insomnia, it is enough for the patient to complain about difficulty falling asleep, waking up at night or early with difficulty falling asleep later, and worsening daytime well-being. However, additional studies may be needed to rule out other sleep disorders that lead to symptoms of insomnia. For the diagnosis of OSA, periodic limb movement syndrome, parasomnias and all major sleep disorders polysomnography is used. Circadian sleep-wake rhythm disturbances are detected using actigraphy.

The most optimal type of diagnosis of major sleep disorders is polysomnography- research that allows you to evaluate the changes that occur in a person during sleep. This is the only examination method with which you can record an encephalogram, simultaneously evaluate the stages of sleep, breathing during sleep, and identify the relationship of various events (snoring, stopping breathing, leg movements, masticatory muscles, body position and electrocardiogram) with the stages of sleep and awakenings. However, the complexity of setting up and analyzing the study, the need to be in a separate room, the cost of equipment and diagnostics limit its use.

a method for assessing the basic characteristics of sleep and the sleep-wake rhythm over a long period of time - from one to four weeks. This method allows you to assess the stability of your sleep rhythm, for example, changes in the time of falling asleep and waking up on weekends and weekdays, and your sleep rhythm during shift work. Used for insomnia and circadian sleep disorders. An actigraph is a compact wristwatch-sized device that is worn on the wrist and uses an accelerometer to measure motor activity and lighting.

When diagnosing obstructive sleep apnea syndrome, during the examination, attention is paid to the presence of pathology of the ENT organs: enlarged tonsils, chronic rhinitis, thickening of the tongue. The total airway clearance is assessed using the Mallampati scale when the patient opens his mouth and protrudes his tongue. If in this position the back wall of the pharynx and tonsils are not visible, the likelihood of breathing problems due to blocking the lumen of the oropharynx by the root of the tongue is high. Surgical treatment of ENT pathology in this case will be ineffective. Neck circumference is assessed - an important prognostic parameter of obstructive sleep apnea syndrome. Its risk increases significantly with a neck circumference greater than 43 cm in men and greater than 41 cm in women.

The most accurate method for diagnosing OSA is polysomnography, but Russian recommendations for determining obstructive sleep apnea in various diseases more often mention computer pulse oximetry or respiratory monitoring.

A method for assessing breathing disorders during sleep on an outpatient basis, when some of the device’s sensors are installed on the chest in the clinic, and the patient places the rest independently during sleep: in the nasal passages to record nasal breathing and on the finger to assess the saturation of hemoglobin in the blood with oxygen. Sensors on the chest, in addition to its movements, record an electrocardiogram and allow one to evaluate the effect of breathing disorders during sleep on the heart rhythm and their relationship with arrhythmias.

A simple research method in which a pulse oximetry sensor is placed on a finger. Another screening method for assessing breathing is reopneumogram recording with Holter monitoring of the electrocardiogram. In this case, movements of the chest are recorded according to data from ECG sensors. If abnormalities are detected by a pulse oximeter or rheopneumogram, then a more complete examination is necessary to make a diagnosis.

It is worth suspecting OSA if 24-hour blood pressure monitoring reveals a disturbance in its circadian rhythm - no decrease in blood pressure or an increase at night.

For high daytime sleepiness to exclude narcolepsy The patient's condition is assessed using the multiple sleep test. Moreover, after polysomnography, all sensors remain on the patient and he is given the opportunity to fall asleep during the day for 20 minutes every two hours.

To diagnose sleep disorders, questionnaires that assess the main symptoms are additionally used.

• The Pittsburgh Questionnaire assesses sleep quality and includes symptoms of major sleep disorders over the past month.
• The Berlin questionnaire and the STOP-BANG questionnaire are used to assess the risk of OSA.
• The Epworth Daytime Sleepiness Scale assesses the severity of sleepiness in different situations.
• The Munich chronotype assessment scale identifies the duration and time of sleep on weekdays and weekends, and determines the severity of social jet lag.

Treatment for sleep disorders

Treatment for sleep disorders depends on the specific sleep disorder.

The main method of treatment chronic insomnia is cognitive behavioral therapy - correction of behavior and attitudes related to sleep. The standard treatment regimen consists of six sessions and requires completion of a sleep diary and/or the use of actigraphy to assess sleep duration and patterns.

To treat insomnia, sleeping pills can be used for a short period of time to help you fall asleep faster, reduce nighttime awakenings, and increase sleep duration. However, it must be borne in mind that sleep disordered breathing is a limitation, and in some cases a contraindication, to taking most sleeping pills. This is due to the fact that the drugs relax the muscles of the soft palate and the walls of the pharynx, which leads to blockage of the airways and worsening breathing problems. Slow-release melatonin preparations are used in patients over 55 years of age.

During treatment obstructive sleep apnea syndrome It is recommended to quit smoking and drink alcohol, lose weight (reduces the severity of OSA by 20-25%), and treat chronic pathology of the ENT organs. The main method of treating moderate and severe OSA, especially when combined with pathology of the cardiovascular system, is non-invasive ventilation of the lungs in the continuous positive pressure mode ( CPAP therapy or CPAP therapy, from English. Continuous Positive Airway Pressure Therapy). Therapy is carried out using a CPAP machine. This is a small compressor that constantly supplies a stream of pressurized air through a flexible tube and a sealed nose mask. This airflow prevents the airways from closing and blocking the flow of oxygen. The device is used every night. The device records all readings on a memory card, which is accessible to the patient. The doctor sees more detailed information after downloading the data using special programs.

Also in the treatment of OSA, intraoral devices (mouth guards) are used, which are made by orthodontists. Mouth guards are installed during sleep and move the lower jaw 6-10 mm forward.

If there is pathology of the ENT organs, surgical treatment by an ENT doctor can be used. Surgeries performed on individual structures, such as removal of the uvula or tonsils, have not proven effective. The most optimal are complex operations when nasal breathing is restored and plastic structures in the oropharynx are performed.

If there is a connection between OSA and body position, it is recommended not to lie on your back (most often, breathing problems occur in this position). You can use a tennis ball, place it in a pocket sewn on a T-shirt between the shoulder blades, it will interfere with lying on your back. If nasal breathing is preserved, it is possible to use Provent disposable stickers on the nasal passages; they approximately halve the severity of OSA.

Periodic limb movement syndrome is being treated by a neurologist. When ferritin levels are less than 75 µmol/l, iron supplements are used, and avoidance of tea, coffee and other stimulating drinks is also recommended. If ferritin levels are normal, the neurologist prescribes special medications.

Circadian rhythm disorders sleep-wake changes require, first of all, changes in sleep hygiene. If possible, you should give up shift work and frequent flights or optimize your work schedule. It is possible to adjust the circadian system by changing the intensity and timing of lighting, which is achieved using different approaches.

• To shift the circadian rhythm to earlier hours, you need to use bright light when waking up and reduce the light intensity in the evening. In this case, in the evening, melatonin preparations are used 4-6 hours before bedtime. Melatonin in the form of a drug, taken before the start of the secretion of its own melatonin, adjusts internal biological rhythms to earlier hours of falling asleep.
• If it is necessary to shift the sleep-wake rhythm to a later time, use bright lighting in the evening and melatonin during the day. There are special calculators for calculating the time and duration of melatonin intake, the time of additional lighting for quick adaptation and prevention of the development of circadian disorders during flights.
• In addition, it is important to change other factors that significantly affect internal biological rhythms: the time of physical activity and food intake.

At parasomnias, which manifest themselves as nightmares, consultation with a psychologist and image repetition therapy are effective. Drug therapy for parasomnias includes the use of:

• clonazepam, imipramine, paroxetine or melatonin for somnambulism;
• antidepressants or benzodiazepines are used for nightmares;
• topiramate or selective serotonin reuptake inhibitor (SSRI) antidepressants for night eating syndrome;
• Clonazepam is used in the treatment of parasomnias that occur during REM sleep;
• for sleep paralysis, antidepressants of the SSRI group are used;

Treatment hypersomnia in Russia is limited by current legislation, since drugs suitable for this are included in the list of narcotic and psychotropic drugs (for example, modafinil).

Forecast. Prevention

To prevent sleep disorders, you should follow the following recommendations:

• maintain a sleep-wake schedule;
• adults sleep at least 7 hours a day;
• observe the light regime;
• stop smoking and drinking alcohol;
• promptly treat pathologies of the ENT organs;
• control weight;
• exercise regularly;
• Take sleeping pills only as prescribed by your doctor.

At parasomniasTo prevent self-harm, you should not sleep on the second floor of a bunk bed. It is necessary to remove sharp objects and furniture near the bed, place a mattress on the floor, and persons with somnambulism should not sleep near a window. If there are provoking drugs, they should be avoided.

Experimental work on increasing sleep duration by 30-60 minutes (due to earlier going to bed and/or waking up later) led to positive changes in health: decreased weight and blood pressure, decreased appetite and tendency to snack, and increased performance.

Without treatment insomnia serious health consequences described earlier occur. The main method of treating insomnia - cognitive behavioral therapy - allows you to get rid of sleep disorders in six sessions and has a more long-term effect than taking sleeping pills. Relapses are possible with repeated violations of sleep hygiene, undiagnosed other sleep disorders, and lack of treatment for concomitant anxiety and depression. Taking sleeping pills in the treatment of insomnia without changing lifestyle (correction of sleep hygiene, light regime and physical activity) will most likely lead to the return of insomnia after discontinuation of sleeping pills.

Timely surgical treatment of ENT pathology helps prevent negative consequences obstructive sleep apnea syndrome for good health. When moderate to severe OSA was detected, only weight loss and CPAP therapy showed a significant reduction in the risk of developing severe cardiovascular diseases (heart attack and stroke). If the factors leading to OSA are not treated, then CPAP therapy is carried out for a long time, sometimes for life.

Circadian sleep-wake rhythm disorders caused by internal rhythm shifts take longer to treat than disorders associated with external factors. Thus, taking melatonin for insomnia during shift work is necessary only after the shift, and may not be required on other days. The use of light therapy may be more necessary in winter hours, while natural light is sufficient in summer.

Movement disorders during sleepare effectively treated by taking iron supplements or dopamine agonists.

In the absence of provoking factors, abolition of drugs that stimulate parasomnia, treatment of concomitant sleep disorders (for example, obstructive sleep apnea syndrome), maintaining sleep hygiene,parasomniascan also be cured.

Essential medicines for treatment are banned in Russia narcolepsy, therefore treatment is difficult and the prognosis is unfavorable. People with narcolepsy can fall asleep at any time, for example, while driving a car. However, Increasing sleep duration, reducing triggers, and planning activities will help reduce sleepiness duringhypersomnias.

Sleep disturbance is a very common phenomenon. Approximately 8-15 percent of adults complain of poor sleep, and 9-11 percent take various drugs with a hypnotic effect. Moreover, these statistics among pensioners are much higher. Intermittent restless sleep can occur at any age, even in infants.

Each age group has its own types of disorders. Nocturnal enuresis, sleepwalking, and fears occur in childhood, while pathological feelings of drowsiness, insomnia, and sensitive, anxious sleep are more common in older people.

Women over 50 who have started menopause are especially susceptible to various disorders. Sleep problems occur in those over 60 years of age 3 or even 4 times more often than in middle-aged people.

There are also sleep problems that begin in childhood and accompany a person throughout life, for example, narcolepsy. In such cases, it is necessary to urgently contact a specialist to prescribe treatment.

The normal duration of the period when a person sleeps varies from person to person – from 4-5 to 10-12 hours a day. This means that there are healthy short sleepers and long sleepers. The main indicator of normal sleep is the feeling of rest. Losing it is a reason to suspect complications in the sleep-wake cycle.

If performance during the daytime hours has decreased significantly due to chronic fatigue, which persists for a long time, despite regular sleep at night, then it is worth carefully examining the body.

Causes and types of violations

Studying the pathogenesis of sleep disorders, scientists have identified a number of factors that provoke them. Poor sleep in a healthy person can occur for the following reasons:

1. The habit of having dinner late (3-4 hours before falling asleep).
2. Restless state (overexcitement). It is caused by: intense training or mental work, the presence of strongly expressed emotions (can be either positive or negative due to stress); working at the computer, watching TV, loud sounds; abuse of energy drinks (strongly brewed tea, coffee drinks).
3. Low mobility during the day, lack of physical exercise and physical activity, waking up late, sleeping during the day.
4. Discomfort in the sleeping area: poorly selected mattress with pillow and bedding, increased or decreased air temperature, etc.
5. Frequent changes in time zones, working at night.

Sleep disturbances can be primary (no connection with pathology in the organs) and secondary, caused by various ailments. Sleep disorders are often caused by diseases of the central nervous system. It may be a consequence of mental disorders.

Many somatic diseases lead to difficulties associated with night rest due to pain, coughing attacks, heart problems such as angina or arrhythmia, and itching. The problem is often observed with intoxications of various origins.

Loss of sleep can also occur due to disrupted hormonal levels. Women encounter the phenomenon of shallow short sleep during pregnancy (especially in the third trimester due to a drop in progesterone levels before childbirth) and during menopause.

Among the hormonal disorders that lead to such deviations are diseases characterized by pathology of the hypothalamic-mesencephalic region. We are talking about epidemic encephalitis and tumors.

Violations can be classified into four main types:

Insomnia

One of the most common is insomnia - insomnia. This is a disorder associated with the process of falling asleep and staying asleep. Insomnia is characterized by insufficient depth of sleep (it can be called superficial), numerous awakenings, and difficulty falling asleep after each of them.

A person can toss and turn all night, periodically falling into a short and light sleep, and in the morning feel exhausted and tired, completely sleep-deprived. A similar problem can be observed in people suffering from hypertension, especially if it appeared after a stroke.

It is also caused by neuroses, depression, drug addiction, alcoholism, diseases affecting the liver and kidneys, and chronic pain syndromes. Insomnia often occurs in those who have skin ailments accompanied by itching, which disrupts night rest. Insomnia happens:

1. Psychosomatic (depending on the psychological state). Has a situational (temporary) or permanent nature.
2. Caused by exposure to alcohol (especially during binge drinking) or medications taken that affect the central nervous system, depressing or toning it.
3. Provoked by mental disorders.
4. Accompanied by apnea or decreased alveolar ventilation.
5. Caused by a syndrome called "". This disease is often observed in those suffering from Parkinson's disease.
6. Arising due to other pathological problems.

You can learn more about the causes of insomnia and ways to combat it from the program “Live Healthy” with Elena Malysheva.

Hypersomnia

Another common disorder is hypersomnia. We are talking about a pathological increase in sleep duration (excessive drowsiness). Neurological, endocrine, and rheumatological diseases have an impact on this problem.

It is usually accompanied by depression, increased irritability, and causeless anxiety. After waking up, a person does not have the feeling that he rested during the night. He lacks sleep, walks around nervous, lethargic, drowsy all day, and wants sweets. Hypersomnia can be:

1. Psychophysiological origin with a temporary or permanent nature.
2. Provoked by alcoholic beverages or medications;
3. A consequence of mental illness;
4. Combined with breathing disorders at night;
5. Caused by narcolepsy.
6. Resulting from other pathological conditions.

Wrong mode

Failure to comply with night and daytime routines causes sleep disorders:

1. Temporary. They can occur with a sudden change in work schedule or time zone.
2. Permanent. With them, slow premature falling asleep is observed.

Parasomnia

Another type of deviation is parasomnia. We are talking about disturbances in the functioning of organs associated with sleep or getting up in the morning. The following manifestations are classified as parasomnia:

• Somnambulism is unconscious actions performed by a person while he is sleeping. In this state, people can get out of bed in the dark, move and even do something. Moreover, they perform these actions without waking up. When trying to bring them to consciousness, they show resistance and can be dangerous at such moments for themselves and others. Basically, this state lasts no longer than 15 minutes. Then the somnambulist goes back to bed, continuing to sleep, or wakes up. It is noted that somnambulism has a connection with the phases of the lunar calendar. The deterioration of the condition, according to experts, occurs during the full moon;
• Enuresis – involuntary urination at night;
• fear and anxiety. Fears often appear at the beginning of dreams. A person jumps out of bed screaming, he experiences panic attacks, which are accompanied by a rapid heartbeat, increased sweating, intermittent breathing, and dilated pupils. A few minutes later, the person comes to his senses and falls asleep again. When he wakes up, he remembers nothing of his nightmares;
• other.

Symptoms

Common signs of sleep disorders include the following:

1. Feeling of insufficient rest at night.
2. Presomnia disorders, expressed in the inability to fall asleep in the evening, turning over from side to side. They are often accompanied by anxiety, obsessions and fear.
3. Intrasomnic worsening. They can be recognized by shallow, restless sleep with periodic awakenings.
4. Post-somnia disorders. When falling asleep well, the patient gets up earlier than usual, then he is unable to fall asleep again, or he falls into a restless sleep. It often manifests itself in the fairer sex and older men, as well as in people who are depressed.
5. Feeling of lack of restored strength in the morning.
6. Feeling sleepy. The patient begins to doze throughout the day.
7. State of fatigue.
8. Anxiety before falling asleep.

Diagnosis

Problems with night rest can serve as evidence of the presence of various diseases, and quite serious ones at that.

Diagnosis of such disorders is prescribed for difficulty breathing, snoring, abnormal behavior in children, difficulty getting out of bed, fear, enuresis, narcolepsy, ADHD syndrome, developmental pathologies, apnea, epilepsy and insomnia.

To find out the reasons why there are difficulties with falling asleep and resting in the dark, you should resort to polysomnography (PSG).

PSG is a diagnostic method that includes recording an EEG (4 channels), an oculogram, an ECG, a myogram, recording the oxygen content in the blood, recording the movements of the arms and legs, measuring respiration and humidity.

Treatment

Elimination of disorders associated with a state of rest at night is a set of measures aimed at improving the patient’s condition. We are talking about special physical exercises, relaxation techniques, psychotherapy, aromatherapy, and drug treatment.

For each individual case, the specialist selects therapy individually. Many disorders such as insomnia cannot be treated with pills that have a sleeping effect. Taking such medications does not provide long-term results, and in some cases is completely contraindicated.

Thus, treating a problem caused by apnea with sleeping pills or sedatives carries a danger to the patient’s life. To get rid of insomnia or hypersomnia that arises against the background of such a disease, you can only strictly follow the instructions of your doctor.

Any drug therapy for sleep disorders should be prescribed by a specialist.

It is usually prescribed when other methods, including psychotherapy, do not produce a positive effect. Medicines are selected carefully, especially regarding their dosage. Self-medication is unacceptable, as it can aggravate the situation and lead to serious consequences.

Home methods that can be used to combat this problem include the following:

1. Compliance and wakefulness.
2. Going to bed at night with the first signs of drowsiness.
3. The habit of falling asleep exclusively in bed. Many people fall asleep while watching TV or reading a book in a chair, and then are forced to interrupt it to go to the bedroom. This negatively affects the quality of rest in the dark.
4. Avoid eating heavy food four hours before going to bed.
5. Train yourself to stop dozing during daylight hours.
6. Introduce a relaxing evening ritual into your life. They may have the habit of walking outside in the wee hours of the night, taking a warm bath, or reading.

Many herbal remedies help effectively combat sleep disorders at home. There are many effective traditional medicine recipes used for this problem:

1. Herbalists recommend drinking a decoction of valerian roots the night before going to bed.
2. Melissa infusion has a good effect.
3. You can solve the problem of insomnia with warm baths with a decoction of hop cones. It can also be taken orally.
4. A medicinal mixture that includes marjoram flowers, lavender and hawthorn will help overcome disorders. It is advisable to drink an infusion of these herbs warm before falling asleep.

Most cases of sleep disorders can be eliminated through adequate therapy with elimination of the symptoms of the underlying disease. In order to prevent them, it is recommended to follow a daily routine, lead a healthy lifestyle with normal physical and mental stress, and not abuse medications that affect the functioning of the brain and nervous system.

Sleep disturbance is a common problem that has many causes. This disorder requires urgent treatment, as it significantly worsens life.

Types of disorders and symptoms

Depending on what provoked such a violation, the following types are distinguished:

• Insomnia;
• Hypersomnia;
• Parasomnia.

The first type means nothing more than insomnia. The process of falling asleep with it is complicated for several reasons. There are psychosomatic, also associated with taking drugs or due to organic disorders.

Hypersomnia manifests itself as excessive sleepiness throughout the day due to lack of sleep at night. Parasomnia occurs for internal reasons, due to the malfunction of certain organs. This type of disorder can manifest itself through sleepwalking and enuresis.

Regarding the nature, the violation is conventionally divided into:

• Problems falling asleep;
• Restless sleep during the night;
• Consequences of insomnia during the day.

Signs of sleep disturbance include:

• Inability to sleep for an hour or more;
• Headache after waking up;
• Irritability;
• Frequent awakenings at night;
• Exhaustion;
• Memory problems.

Causes

There can be many reasons for sleep problems, and they are associated with both internal and external factors. The most common provoking factors are:

• Systematic lack of sleep due to the birth of a child, a change in work schedule;
• Taking alcoholic beverages, psychostimulating caffeine-containing drugs, coffee;
• Consequences after taking certain medications;
• Excessive anxiety;
• Frequent stress;
• Presence of diseases;
• Relapse of a chronic disease;
• Age-related changes;
• Poor nutrition, eating before bedtime;
• The presence of irritants in the form of noise, light at night;
• High temperature in the room, hot blanket, uncomfortable pillow and other sleep hygiene disorders;
• Change of environment (moving to another place);
• Long-distance travel (an abrupt change in time zone leads to a disruption in the body’s biorhythms).

Some of these causes of sleep disturbance are eliminated quickly, while others require long-term treatment.

Important information

Therefore, if the disorder recurs systematically, you should not put off the problem, hoping that it will go away on its own.

The consequence of restless sleep can be a serious illness, which, if not properly treated, will lead to complications.

What diseases interfere with sleep?

Diseases can cause sleep disturbances, as well as be a consequence of its course. The most common diseases that accompany insomnia include:

• Sleep apnea. People suffering from this disease feel exhausted and overwhelmed in the morning. This is caused by frequent coughing, whistling and snoring during sleep, as well as stopping breathing for 10 seconds or more. Such stops make sleep anxious, superficial, and intermittent. An advanced form of the disease can manifest itself through prolonged and multiple stops in breathing, which is fraught not only with lack of sleep, malfunction of organs due to lack of oxygen, but also with death;

• Narcolepsy. Characteristic features of narcolepsy are a person spontaneously falling asleep, often in an inappropriate place. The disease may be accompanied by catalepsy, the symptoms of which are spontaneous loss of muscle tone, which leads to falls and injury. This disease manifests itself against a background of increased emotionality.

• Restless legs syndrome. This syndrome manifests itself through jerking of the legs at night, which leads to lack of sleep. This happens due to a persistent feeling that someone is running on the calves of the legs, from which the person, reflexively, tries to throw it off. The cause of this event may be a lack of certain vitamins and microelements in the body. For example, magnesium with iron and folic acid, as well as varieties of vitamin B with thiamine. A similar syndrome is also typical for those who suffer from alcoholism, diabetes, and thyroid diseases;

• Sleep paralysis. This strange and scary phenomenon for many occurs due to the untimely awakening of certain parts of the brain that respond to muscle tone. Therefore, it turns out that the person woke up, but cannot move. In a normal state, these processes are activated even before awakening. If there is pathology or persistent problems with sleep, the likelihood of this phenomenon increases;

• Sleepwalking. Somnambulism manifests itself not only in the form of sleepwalking, but also performing other simple actions, sitting on the bed. The fact that some parts of the brain are active at this moment leads to an inadequate night's rest. There are no exact causes of sleepwalking, presumably it is nervous excitability, a sign of mental disorder, as well as genetic determination.

Poor sleep is also observed in depression, osteochondrosis, arthritis, multiple sclerosis, atherosclerosis, bronchial asthma and other diseases.

Which doctor should I contact?

If you experience insomnia, you should consult a therapist or somnologist. After that. how additional diagnostics will be carried out. The patient may be referred to a cardiologist, neurologist, psychiatrist, endocrinologist or psychologist. The choice depends on what caused the sleep disorder.

Many people decide to deal with the problem on their own, taking medications and using traditional medicine methods. There is nothing wrong with alternative medicine if they are not abused, but it is worth remembering that insomnia is a manifestation of some problem, so it should be considered as a signal to action.

But with regard to drug therapy, you need to be more careful when it comes to self-medication. The reason is that some strong sleeping pills are addictive. And the further you go, the less effective they become. And if you refuse them, sleep disturbances can manifest themselves with even greater force.

An advanced form of sleep disorder can lead to increased signs of disease and increased symptoms of insomnia.

Diagnostics

Before starting the treatment process, the doctor must conduct a diagnosis. It is necessary to identify the cause of the problem. Since sleep disturbance can be caused by many reasons, including serious illnesses, this stage is the most important.

Important information

Even if we are talking about a temporary disorder, the patient should consult a doctor to receive qualified advice and prevent complications from occurring.

The most common diagnostic methods are:

In addition to the methods presented, additional methods are used for sleep disorders. These include tests, MRI, and CT scans. They are necessary to confirm or refute the suspected diagnosis.

Methods for treating sleep disorders

After determining the cause of poor sleep, therapy is prescribed. It may involve taking medications, performing physiotherapeutic procedures, or using traditional medicine methods.

Drug treatment is the most effective, so it should not be neglected. The most popular groups of funds are:

• benzodiazepines;
• antidepressants;
• neuroleptics;
• central nervous system stimulants.

First-line drugs are used in a short course to eliminate the causes of sleep disturbances. These include Triazole with Imidazole. Long-term use of them leads to side effects, such as memory loss and confusion. Therefore, it is not recommended to drink such remedies on your own. For long-term use, Flurazepam with Diazepam is recommended. But since these representatives can cause drowsiness, they are sometimes replaced with Zolpidem with Zopiclone.

Doxepin with Mianserin and Amitriptyline are used as antidepressants. Their peculiarity is that they can be prescribed to patients of different ages, and they also do not cause addiction. But despite this, they are prescribed only in extreme cases, as they can cause side effects.

Drugs of the third group like Tizercin, Chlorprothixene and Promethazine are antipsychotics with a sedative effect, which are prescribed only in severe cases, and only after other drugs have been ineffective.

Weak stimulants include ascorbic and glutamic acids. They are suitable for those who suffer from mild drowsiness.

Folk remedies

Sleep disturbances can be eliminated using traditional methods. But before you start, you should consult your doctor, as some medications can cause a negative reaction in the body in the form of allergies or other manifestations.

Effective traditional medicines are

Consequences of sleep disorders

Most sleep problems can be treated with medications and other methods. But there is a risk of complications that cannot be eliminated in any way. They arise after an advanced form of some disease that provoked insomnia.

Sleep disturbance can lead to complications and frequent relapses of chronic diseases. Often treatment is superficial, using only medications. Some ailments are not completely cured, but simply healed, which does not eliminate insomnia, but only strengthens it.

Also, untimely contact with a specialist or self-medication can increase sleep problems if inappropriate drugs or traditional medicine methods were used.

The most dangerous complication is the death of the patient. Its occurrence is possible in advanced forms of sleep apnea.

Prevention

To prevent poor sleep, you need to:

• Maintain good sleep hygiene. It lies in creating favorable conditions. Since sleep disturbance occurs due to an uncomfortable bed, noise, heat and other factors, it is worth excluding them. The mattress should be moderately firm, the room should be dark and cool. The temperature should not exceed 18 degrees;
• Get treatment in a timely manner. If left untreated, diseases develop into a chronic form, and they also lead to various kinds of disorders, including insomnia;
• Maintain a sleep schedule. Failures in the external regime lead to internal failures, which can lead to insomnia;
• Take a walk before bed. A 15-minute walk every day before bed can reduce the likelihood of poor sleep to zero;
• Avoid physical and mental stress before bedtime.

A few hours before falling asleep, you should postpone all important matters and physical exercises, as they lead to overexcitation of the nervous system and muscle tension.

Trouble falling asleep is a problem for many people in the 21st century. But with the use of preventive measures it can be avoided. As a last resort, it can be quickly eliminated if you consult a doctor for help at the first symptoms.

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