Getting enough restorative sleep is important for humans. Sleep disorders include trouble falling asleep or sleeping through the night (insomnia), as well as non-restorative sleep. There are also patients who exhibit episodic nighttime abnormalities, such as sleepwalking or sleep apnea. Then there are people who are always tired and who sleep excessively (hypersomnia). Insufficient, disrupted sleep or excessive sleep interferes with a person’s ability to function during the day.
Insomnia is a common symptom of neurological diseases. It may be a direct result of neurological disorders or occur concomitantly with pain, depression, other sleep disorders or when a person is taking certain medications. If sleep disorders or insomnia last for longer than three months or a person sleeps very restlessly, their breathing is interrupted or there are any other abnormal motor phenomenon, the person should undergo a neurological examination and possibly testing in the sleep lab.
A lack of undisturbed sleep impairs a person’s ability to function during the day. Non-restorative sleep leads to sleepiness during the day. Trouble concentrating and memory lapses may occur, often resulting in irritability, anxiety and depression. Insomnia can cause problems in a person’s relationships, at work and in their day-to-day activities.
What will the doctor want to know?
Is the patient having trouble falling asleep or sleeping through the night? How long has the sleep disorder been occurring? Is the patient tired and falling asleep during the day? Does the patient speak, scream or thrash about in their sleep? Does the patient take mid-day naps? Does the patient snore or have interrupted breathing? Does the patient have a burning sensation in the legs while in bed, forcing them to get up?
Sleep disorders are diagnosed by looking at the person’s detailed medical history. Keeping a sleep journal is helpful. A standard sleep questionnaire is used to precisely assess the patient’s sleep.
Actigraphy is one diagnostic method used to identify disturbances to a person’s circadian rhythm.
For differential diagnostics and to measure the duration of sleep, cardiorespiratory polysomnography can be used in the sleep laboratory. This involves monitoring the patient’s sleep, breathing and cardiovascular system along with their movements during sleep. One disorder that can be identified in the sleep laboratory is REM sleep behavioral disorder (RBD), which is sometimes an early symptom of Parkinson’s disease. Sleep-related breathing disorders (SBAS) increase the risk of stroke and should be treated, as they can cause severe daytime sleepiness.
Common causes of sleep disorders
- Age, menopause
- Overstimulation, people who do not live in sync with their internal clocks.
- Changing one’s normal daily routine, e.g. due to shift work, jet lag
- Physical and mental strain
- Poor sleeping habits
- Thoughts that prevent sleep
- Fears of illness due to sleep disorders
- Sleep apnea syndrome
- Illnesses, e.g. with pain
- Neurological disorders, such as stroke, Parkinson’s disease, dementia
- Heavy meals in the evening
- Caffeinated beverages, such as cola, energy drinks shortly before bedtime
Sleep has various normal states and is affected by a person’s age. There are many misconceptions about sleep, which is why before the patient is prescribed any sleep aids, they will be educated about sleep and advised on good sleep hygiene. Behavior and habits that promote poor sleep should be changed in favor of habits that promote quality sleep. In some cases, behavioral therapy, i.e. cognitive behavior therapy (CBT) or relaxation exercises will be recommended.
Sleep aids (hypnotics) should only be prescribed for short-term use. When selecting a medication, it is important to examine the cause and to treat any underlying conditions.
Every substance used as a sleep aid has its own mechanisms, which also include specific risks and side effects. The decision is made depending on the severity and type of sleep disorder. The age of the patient is also relevant and requires a close risk assessment.