insomnia

Synonyms

Lunatism, Noctambulism, Insomnia, Insomnia, Lunchtime, Difficulty falling asleep, Sleep disorders, Early awakening, Excessive sleep, Hypersomnia, Sleep-wake-up disturbances, Insomnia, Sleepwalking (somnolence, somnambulism), Nightmares

Please also note our topic on neurological sleep disorders

definition

A sleep disorder, also known as insomnia, is defined as trouble falling asleep, frequent awakening at night, very early morning awakenings, and / or poor sleep quality.

Epidemiology

Almost one in six adults suffers from a massive sleep disorder, equivalent to about 15%. Another 13-15% suffer from occasional and mild sleep disturbances. Older people are more affected than younger people. In the over-60s, about one in every four suffer regularly from insomnia / sleep disorder.

classification

Symptoms Sleep disorder

Sleep disorder is not the same as sleep disorder. Typically, sleep disorders are initially divided into two categories.

  • Sleep disorders caused by internal processes - intrinsic insomnia
  • Sleep disorders caused by external stimuli - extrinsic insomnia

In intrinsic insomnia, the 5 most common disorders are classified as:

  1. The so-called sleep apnea syndrome: In sleep apnea syndrome comes due to various mechanisms (eg obesity) to prolonged respiratory failure or respiratory arrest. Since these dropouts can last between 10 and 60 seconds, the patient gets into a so-called "oxygen debt". This means that the body is in an alarm condition and initiates emergency measures, as it threatens to suffocate. This means for the patient that he is very often awake or almost awake.
    Inset: Relatives, mostly wives, know this emergency "Fasterwachen". Mostly it is displayed with a bloodcurdling snorer, with which the patient almost gasps.
    Since dozens of these dropouts can occur per night, so the patient's sleep is almost constantly interrupted. The direct result is that he feels "bruised" the next morning, as he usually can not achieve a deep, relaxing sleep state. About 1-2% of adult men are more or less affected by this problem.
  2. Narcolepsy: Narcolepsy causes extreme drowsiness during the day, as well as disturbances of nocturnal sleep. Typical symptoms that can occur as part of narcolepsy:
    1. Sudden "sleep attacks" against which the patient can not defend himself
    2. Sudden loss of muscle tension and associated "collapse" of the body, without loss of consciousness (technical term: cataplexy).
    3. Hallucinations when falling asleep (hypnagogic hallucinations). Both acoustic and optical phenomena can occur here.
    4. Paralysis in the night
  3. Restless legs syndrome (RLS):
    In this disorder, the patient typically feels tingling sensations in his legs. These are usually accompanied by a compulsion to move the legs. The movement often leads to a feeling of relief. Typically, the syndrome occurs just before falling asleep, but it does happen that it comes to the urge to move at night and twitching while falling asleep.
    "Restless Legs" (RLS) is an English term that literally means "restless legs".
  4. Psychophysiological factors: These factors summarize sleep disorders in which, as it were, the "mental attitude" to sleep is disturbed or the psyche impedes sleep. Stress and anxiety thus lead to sleep disorders as well, such as the "abuse" of the bed as a place where you always think about his everyday problems or that you use for many activities of the day (telephoning, watching TV, eating, learning). Also the firm expectation of a new bad sleep will cause a sleep disturbance.
  5. Misperception of one's own sleep: About 5% of patients undergoing treatment for sleep disorders have no objectifiable findings. Ie. it comes to a so-called. Misperception of the quality of sleep. The people strongly believe that they did not sleep, but had a light sleep.

In extrinsic insomnia, the most common disorders are:

  1. Sleep Aid and Alcohol Abuse: Both sleeping pills and alcohol initially have a sleep-inducing or sleep-inducing effect. However, just as constant use of headache medication causes even headaches, aids such as sleeping pills and alcohol in turn, when used continuously, have an adverse effect on sleep. The rationale for these effects is typically habituation (ie you need more and more substance to achieve the same effect), withdrawal (ie you need at least a certain amount of substance to become calm at all) or the mixture of both.
    The typical "culprits" are mostly the so-called benzodiazepines: Diazepam, Oxazepam, Flunitrazepam, Lorazepam etc.
  2. Changes in the day-night rhythm: Each person has a so-called "internal clock" (technical term: circadian rhythm). If one tries to sleep against this clock, it comes in most cases to significant sleep difficulties. Often one finds this disorder in people who are always active at night or have to be (nursing, frequent disco, etc.)
  3. Taking stimulants: Most drugs that stimulate in any way significantly reduce the need for sleep. Typical are disturbances of falling asleep as well as frequent nocturnal awakenings.

Sometimes, simple impediments to breathing are the cause of a sleep disorder. Causes can be:

  • Nasenscheidewandverkrümmung
  • snoring
  • adenoids
  • sniff

causes

insomnia

There are many causes that can eventually lead to a sleep disorder. The following are the most important ones.

  • Physical causes
    Pain or other irritation in or on the body can cause an extremely disturbed sleep. Typical physical illnesses are eg chronic back pain , inflammatory joint diseases, " heartburn ", fibromyalgia or also the "restless leg syndrome"
  • Bad sleep and environmental conditions
    Typical environmental conditions that disturb a pleasant sleep are eg noise of any kind, too high or too low temperatures, too high brightness or even a restless bed partner
  • substance intake
    Typical "sleep killers" here are coffee, cola or other caffeinated drinks, alcohol, amphetamines , hypnotics and cocaine
  • Disorders of the day-night rhythm
    Many who have worked in a 3-shift system know that sleep can become a matter of luck. Even the so-called jet lag ensures insomnia (insomnia / sleep disorder).
    Read more about: Insomnia
  • Mental problems
    Anxiety, depression, post-traumatic stress disorder, or typically mania, are usually associated with significant sleep problems / sleep disorders

Sleep disorder due to jet lag

A jet lag can lead to insomnia after a long journey by plane. These can manifest as both asleep and as sleep disturbances. At the same time, sleep disorders often cause tiredness during the day. The body of each human being is subject to its own rhythm dependent on the time of day, the so-called circadian rhythm. This controls both sleep behavior and eating behavior. The time change disturbs this rhythm, but after a few days the body gets used to the new time.

therapy

Therapy sleep disorder

A first therapeutic approach must be the improvement of so-called "sleep hygiene". By this is meant that the patient has to analyze whether he respects the following rules regarding his sleep:

  1. "I only go to bed when I'm tired."
  2. "I only use my bed to sleep and nothing else."
  3. "If I can not sleep, I'll get up and work outside the bed and lie back down if I want it."
  4. "I keep getting up when sleep fails."
  5. "I always get up at the same time. It does not matter how many hours I slept the night. The same applies to going to bed.
  6. "I never sleep during the day!"

The aim of implementing and complying with these rules is that the bed becomes a stimulus to us, which serves only one purpose - to sleep. Often enough, the bed is a symbol of nights spent sleeping and frustration.

Keeping up is a great way to train the body for a rhythm. Sleep or nap during the day are relaxing for the moment, but at the same time they are guarantors for another bad night.

  • sleep hygiene
  • sleep better

relaxation techniques

In particular, progressive muscle relaxation according to Jacobson has proven to be suitable here. More information on this topic can be found at: progressive muscle relaxation

In addition to progressive muscle relaxation, the following procedures can be helpful:

  • Autogenic training
  • hypnosis
  • meditation
  • yoga

Psychotherapeutic interventions

Various behavioral therapy techniques have also proved helpful (in combination with the above options).

Paradoxical intervention: the patient lies down in his bed and "forbids" to fall asleep as it were. (Of course he does that only mentally.)

Thought stop: In this technique, the patient learns, for example, a neutral word, which helps him unpleasant thoughts "stop"

Cognitive restructuring: Often, patients with sleep disorders are kept awake by irrational thoughts.

"If I do not fall asleep right now, I can not make it to-morrow tomorrow anyway."

"Everybody always needs at least 8 hours of sleep."

This works well therapeutically, so that ultimately the tormenting aspect of such thoughts disappears.

drugs

It must be mentioned here that, of course, there are a variety of situations and disorders in which a drug treatment of sleep disorder is right and necessary.

In most cases, sleep disorders can be treated well with light herbal medicines. The focus here is the therapy with valerian and black cohosh. Both valerian and black cohosh have a soothing and scarf-promoting effect.
While the effect of valerian begins directly, the black cohosh does not appear until after a long period of regular intake. Therefore, black cohosh is not suitable for acute sleep disorders.

If these herbal remedies also have no effect and the insomnia persists, there are of course various sleeping pills. These should or must be prescribed by a doctor.

The bed

The bed also plays a crucial role in sleep disorders.
Bedding information can also be found at: Solid wood beds

8 Hour Sleep Music For Insomnia: Deep Sleep Music, Sleeping Music, Help Insomnia ☯207 (December 2019).


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