Let's start this time with a small survey:
Please tick if any of the following apply to you:
- I often sleep less than I should.
- My sleep is restless, fragile.
- I have trouble staying awake while sitting still, watching TV, or reading.
- I feel very tired or even fall asleep while driving.
- I have difficulty concentrating at home, work or school.
- I have had trouble getting things done at work or school.
- Others often tell me that I look tired.
- I have a hard time controlling my emotions.
- I feel that I am slow to react or respond.
- I feel like I need a nap almost every day.
If you ticked any of the statements, you may be having trouble sleeping.
A person spends 1/3 of his life in sleep. Sleep is not always full-fledged and almost everyone experiences sleep disorders during their life, which can be caused by stressful situations at home, emotional experiences, mental or physical illnesses. Sleep disorders can last for a few sleepless nights, for some even years of poor quality sleep. Anyone who has experienced sleep disorders will be able to confirm how much it affects their daily life – fatigue, low mood and mood, difficulty concentrating, lowered immunity and, perhaps, even worse sleep quality because of all this.
Sleep disorders are one of the most common problems in medicine and often require a multidisciplinary approach to solve them. Despite the fact that sleep disorders are common, in practice, doctors often come across a situation where they find out about sleep disorders only by the way, by questioning the patient or his relatives in more detail. If younger patients more actively complain about sleep disorders, then older people have often already accepted it as a daily norm.
Many of the substances that provide the sleep and wakefulness regulation system are also involved in the functioning of the psyche. So mental health and sleep disorders are closely related. Up to 40% of people suffering from depression have sleep disorders, they are often also present with generalized anxiety and panic, but in the case of post-traumatic stress syndrome, people complain of vivid unpleasant dreams in which they relive episodes from the traumatic situation.
Nowadays, the quality of sleep is also affected by various environmental factors – rapidly changing life creates stressful situations – many people work in shifts, longer flights to countries in other time zones are also important.
The same “vicious circle” principle works with sleep disorders, as elsewhere in medicine – mental or physical illnesses can cause sleep disorders, which, in turn, worsen the health condition even more, but it should be taken into account that sleep disorders, which are supposedly primary, i.e. they are not based on physical or mental illness, if left untreated will sooner or later cause other complaints. Chronic insomnia is associated with an increased risk of depression, anxiety and suicide, intellectual and physical impairments. People who have not slept at home, who are tired, make mistakes at work and driving vehicles, which makes sleep disorders not a problem of one individual, but of the whole society.
How to recognize?
Sleep is divided into two phases, which are mainly characterized by different activity of the central nervous system, which can be observed by electroencephalography:
- REM (rapid eye movement) sleep – it is characterized by muscle relaxation. During this phase, people dream.
- Non-REM sleep.
In the case of sleep disorders, the course and cyclicity of these phases are very often altered.
The sleep-wake cycle, on the other hand, is determined by a relatively complex regulatory system, in which such biologically active substances as serotonin, norepinephrine, dopamine, etc., play an important role, forming the human “internal clock”. On the other hand, a “broken clock tells the wrong time” by altering the course of REM and Non-REM sleep.
Sleep disorders can manifest themselves as primary – deviations in the rhythm and regulation of falling asleep and waking up -, as well as secondary – consequences of some other illness, medication use, etc… Primary sleep disorders are divided into two categories:
- Parasomnias – disturbing movements and behavior related to sleep – these phenomena are observed by a person when he is asleep, waking up in the morning, which he does not remember. Examples include talking, hitting, or walking in your sleep.
- Dyssomnias – a group of sleep disorders characterized by sleep disturbances, frequent awakenings during the night, early morning awakenings or, on the contrary, excessive sleepiness.
Often the symptoms of sleep disorders are anxiety, a depressed state of mind, signs typical of depression. It is important to understand whether these symptoms are the cause of the sleep disorder or the result.
There can be many reasons for sleep disorders and that is why you should not live with them, but seek the help of specialists. Heart diseases, neurological diseases, hormonal disorders, lung diseases can be “disguised” behind sleep disorders. That is why, excluding somatic reasons, let’s focus on psychological aspects in more detail.
In order to help a patient with sleep disorders, it is important for the doctor to understand the cause of these disorders. An important role is played by fellow human beings who have noticed the patient’s sleep disorders, for example – the person is snoring or talking, or even walking in his sleep. The specialist will want to know about daily habits, daily and work schedule, other illnesses and medication use.
A person who has decided to fight with sleep disorders must be ready to observe sleep hygiene. This is a relatively new term that includes various measures that should be followed to improve the quality of sleep.
A panacea for sleep disorders.
- Observing a certain sleep-wake regime, even on holidays, however, if you do not manage to fall asleep within 20 minutes after lying down, do not continue to be awake in bed, it is better to get out of bed and focus on some calming or even boring activity without turning on bright lights;
- Avoid alcohol and caffeine-containing drinks, as well as nicotine, at least 4-6 hours before sleep;
- The rule must be observed that the bed is only for sleeping or sex, it is not intended for eating, watching TV, working with the computer, paying bills;
- Try not to take a nap during the day, if it is difficult without it, at least make sure that the nap is no longer than an hour and no later than 3:00 p.m.;
- Set up individual rituals to be performed every night shortly before sleep to signal the body that it is time to sleep. For others, it’s slow relaxing exercises, for others it’s sitting quietly on the couch with a cup of warm milk or tea.
- Bathing before going to sleep – a couple of times a week you can relax in a warm bath before going to bed. According to research data, a phenomenon has been observed that bathing increases the body temperature, but when you get out of the bath and the body cools down, drowsiness increases.
- Don’t look at the clock – people who can’t fall asleep often look at the clock, but this can wake you up even more and lead to gloomy thoughts like: “..look how long it takes to fall asleep!” or “It’s already so late, I’ll never be able to sleep!”, or “it’s too early, I’ve only slept for a few hours…”;
- Implement a sleep diary – it will be useful and will help to collect sleep habits and possible disturbing factors, sleep duration, time of falling asleep and facilitate cooperation with the doctor;
- Physical activities are a good helper to fight sleep disorders, but it should be noted that it is preferable not to do them later than 4 hours before going to bed;
- Following a healthy diet and moderation, do not go to bed hungry or after eating a heavy, rich meal. A light snack before going to bed or a glass of warm milk can help you fall asleep more easily;
- The atmosphere in the bedroom – the room should preferably be quiet, calm and rather have a lower air temperature;
- Keep the daily routine – even if you didn’t manage to sleep as well as you wanted during the night, you should try to keep the usual routine during the day so as not to disrupt the circadian rhythm.
In most cases, however, a good commitment to follow these not-so-simple rules is not enough, you have to deal with the causes of sleep disorders and, perhaps, with the consequences as well. In some cases, it is also useful to apply psychotherapy – a cognitive-behavioral approach, which also includes sleep hygiene as a lifestyle modification with the aim of improving sleep.
As for medications, sleeping or hypnotic drugs are not recommended for long-term use, they are usually prescribed for up to a 1-month course to help regulate the sleep rhythm. However, in the case of chronic insomnia, the doctor may also consider using these medications for a longer period of time.
Means such as melatonin receptor agonists have been available in Latvia for a relatively short time. You may have seen food supplements containing melatonin in the pharmacy, whose function is to improve the quality of sleep. Melatonin is a hormone that is produced naturally in the body of humans and animals and regulates the sleep-wake cycle, so these remedies aim to work in a similar way.
Some antidepressants are also used to treat sleep disorders, taking into account whether the patient’s sleep disorders are associated with depressive symptoms.
Orexin receptor antagonists are a relatively new approach – if orexins are a biologically active substance in the body that promotes awakening, then substances that prevent their attachment to receptors provide the opposite effect.
Since sleep disorders are a widespread problem, new means with as few side effects as possible are being sought to combat them. Currently available medications, like all medicinal substances, help, but when used incorrectly or in excessive amounts, cause harm. Unfortunately, often the patient has “lived” with sleep disorders for too long to be able to get by only with a change in household habits, besides, the most important thing is to look for the cause of sleep disorders, because perhaps they are a signal of some other health disorders and their treatment is the key to returning to a better quality of life.