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sleep disorders

1. What is sleep?

Sleep is vital to human life. However, the functions and effects of sleep have not yet been explored in great detail. An important hallmark of healthy sleep is that it can be finished very quickly. Although a sleeper appears unconscious, unlike a person under anesthesia or coma, he or she can be awakened very easily and return to a normal waking state within seconds to minutes.

Even if sleep is characterized by very little physical activity and hardly any awareness of the environment, it is still an active, highly organized sequence of events and physiological states. Sleep is made up of two clearly distinguishable state forms: Non-REM sleep (non rapid eye movement sleep), i.e. a sleep phase without rapid eye movements, and REM sleep (rapid eye movement sleep), the phase that rapid eye movements is characterized. Dreams mainly take place in REM sleep, but dream contents are sometimes also described after waking up from non-REM sleep.

Non-REM sleep is further divided into stages N1, N2 and N3, which differ in terms of the amplitude and speed of the brain waves generated by the sleeper. Stage N 3 of non-REM sleep is characterized by the largest and slowest brain waves and is therefore summarized in the expression "slow wave sleep" (sleep with slow waves). It has been found that this stage of the sleep phases is the most difficult to awaken a sleeper, so it is also referred to as "deep sleep".

Especially in this phase of non-REM sleep, growth hormone is released from the pituitary gland, the so-called pituitary gland. This is the basis for the assumption that the body regenerates from the tiring activities of the waking state during sleep.

During the REM phase, sleepers react very differently to wake-up stimuli: Sometimes the slightest noise is enough to wake them up, other times it requires much stronger stimuli. This fact suggests that a phase of deep sleep also occurs in REM sleep. During REM sleep, one can observe how the sleeper's eyes move under closed eyelids. With the exception of the diaphragm and the eye muscles, the voluntary muscles are paralyzed and temperature regulation is partially suspended.

2. Why do we sleep?

Sleep is necessary for the brain to function properly and for the entire organism to survive. It is now believed that sleep has a number of functions.

The importance of sleep becomes clear from the consequences of lack of sleep. These include the impairment of cognitive functions and weight gain. Persistent sleep deprivation can lead to cell damage.

On the one hand, sleep serves to save energy. During sleep, a person can fast for a fairly long period of time. There are close connections between sleep and metabolism.

An important role sleep in memory formation is also well documented. A night spent in sleep, but also a short sleep, a "nap" during the day, means that knowledge and previously acquired motor skills can be mastered better than without sleep.

The feeling of tiredness is just one of several factors influencing the willingness to sleep. Time of day fluctuations also play a role. It has been well researched that every living being has a circadian (i.e. approximately 24 hours) period of activity and rest phases. The timing and control of this sleep-wake cycle depend on one or more biological clocks in our body. These inner clocks are sensitive to light and over time have almost synchronized themselves with the 24-hour light-dark cycle of the external environment. Sleep thus appears to be an indispensable part of behavior. Physiologically, humans are programmed to sleep every day.

3. How much sleep do we need?

There is no generally accepted "normal" sleep measure. The average sleep duration for adults is 7-8 hours. However, there are people who feel well recovered after just 5 hours, while others need more than 10 hours to be rested during the day. Your optimal amount of sleep is exhausted when you can concentrate on an activity during the day, even if you sit down for long periods of time, without becoming sleepy.

We cannot force ourselves to exceed or fall below our optimum sleep considerably over a longer period of time. One hour of sleep less than usual, and this for several nights, leads to a feeling of tiredness and fatigue during the day. On the other hand, exceeding our optimal sleep duration over a longer period of time causes poor sleep with frequent waking, especially in the morning hours.

Scientists assume that the optimal length of sleep required in each case differs biologically from person to person. Our individual sleep needs are largely determined by genetic makeup.

4. Do you need less sleep as you get older?

Recent studies show that healthy older people sleep just as much as they did as young adults. The widespread assumption that older people need less sleep is likely that physical impairments such as pain often interfere with healthy sleep in old age. For this reason, most older people have a so-called polyphasic sleep pattern, with only "light", sometimes interrupted, sleep at night, with additional short sleep episodes during the day.

5. Can you make up for lost sleep?

To a certain extent, you can make up for lost sleep. After major sleep losses, there may be a shift in favor of deep sleep in the following nights, although people hardly sleep more than 2-4 hours longer than usual. This is related to the sleep-wake rhythm, which is shaped by our need for sleep and our internal clock.

6. What can you do yourself for a healthy and restful sleep?

The following recommendations can be useful:

  • Stick to regular, individually adjusted sleeping and getting up times.
  • Be consistent about napping: either sleep every afternoon or not at all. Occasional afternoon naps generally make it difficult to get a good night's sleep.
  • Get your circulation going regularly in the morning or early afternoon, but avoid vigorous physical activity just before bed.
  • Avoid rich and difficult to digest meals before bed.
  • Use luxury foods in moderation and avoid alcohol consumption after dinner. A nightcap disturbs the flow of sleep more than it promotes it and can be responsible for early morning awakening.
  • Find out the right room temperature for yourself and make sure that it stays constant throughout the night.
  • Be careful when using sleeping pills. Such medications should only be taken on a doctor's prescription and for a short period of time. Prolonged use can lead to increased insomnia or addiction.
  • Let the day end and try to relax before you go to bed. Take a warm bath, read a good book, listen to music, and try to avoid stressful situations. And very important: don't think too much about sleep.
  • Do not use the bed to eat, watch TV or work. The bed should only be there for sleep and sex.

7. How common are sleep disorders?

Most people complain of difficulty falling asleep and staying asleep from time to time. About 20 to 30% of the population report frequent but short-term sleep disorders caused by problems such as family crises, the death of a loved one or loss of job.

In contrast, around 4% of the population suffer from permanent sleep disorders, which can also lead to impaired performance during the day.

8. What sleep disorders are there, what are the causes?

Today we speak of disorders of the sleep-wake behavior. A distinction is made here between over 90 different disorders with different causes. These include:

  • Difficulties falling asleep and staying asleep, for example due to situational stress
  • Pronounced sleep disturbances, especially early waking up in the morning, as symptoms of severe depression
  • Nocturnal breathing disorders (e.g. sleep apnea syndrome)
  • Severe daytime sleepiness (e.g. due to narcolepsy)
  • Parasitic sensations and urge to move with periodic movements of the legs at night (restless legs syndrome)
  • Unusual nocturnal behaviors, so-called parasomnias (e.g. sleepwalking, self-harming and / or self-harming behavior during sleep, epileptic seizures during sleep)
  • Difficulty sleeping from overdosing on medication or alcohol
  • Sleep disorders as a result of painful conditions
  • 9. What is the best way to treat insomnia?
  • Once a specific diagnosis has been made, treatment will aim to combat the cause. For example, if excessive consumption of alcohol is the cause of insomnia, it must be reduced. Serious breathing disorders during sleep can be effectively treated with a breathing mask (CPAP therapy). Restless legs syndrome usually responds very well to specific drug treatment.
  • Classic sleeping pills are best reserved for patients who have developed reactive severe insomnia. These medications should not be taken for longer than four weeks and preferably not every night and should be supplemented or replaced by other sleep-promoting measures.
  • A consistent sleep-wake scheme, regular exercise after getting up and avoiding caffeinated foods have a supportive effect. Physical activity is helpful when exercising regularly. Irregular exercise, however, is more likely to disturb rather than promote sleep the following night. Regular daily exercise, preferably in the morning, supports a steady sleep-wake cycle and increases the likelihood of getting a good night's sleep.

10. What are the signs of sleep apnea syndrome?

Frequent symptoms are loud, irregular snoring, breathing pauses reported by the bed partner, profuse night sweats, morning headaches and pronounced fatigue, as well as difficulty concentrating.

Apnea is caused by obstruction of the airway during respiration. The patient struggles for breath, the exertion opens the airways a little so that some air can flow in again. This causes a sudden snoring noise that is very loud after the respite. This process can be repeated very often during the night, with sleep being briefly interrupted each time, which contributes to pronounced fatigue during the day.

Sleep apnea can have dangerous consequences in the event of an existing heart disease or reduced oxygen content in the blood. If sleep apnea causes unpredictable sleep attacks during the day, it can lead to life-threatening situations (microsleep at the wheel).

Sleep-related breathing disorders are often found in connection with excessive weight and high blood pressure and lead to diseases of the cardiovascular system in the long term. Early diagnosis and treatment is therefore helpful in preventing these diseases.

11. How does "snoring" develop and does it have to be treated?

Snoring is a sound that is made by the air flowing past irregularities and constrictions in the throat and windpipe. It can arise when you inhale or exhale.

Snoring is usually harmless and in most cases there is no indication for treatment, unless the snoring is accompanied by frequent wake-up reactions (so-called arousals), narrowing of the airways and increased daytime sleepiness. In this case, it is also referred to as "obstructive snoring".

Snoring can also be the first step in developing sleep apnea. Gaining weight, taking sleeping pills or alcohol and anything that contributes to a further narrowing or obstruction of the oropharynx can lead to sleep apnea syndrome that requires treatment.

12. What is narcolepsy?

Narcolepsy is a congenital or genetic disorder associated with a chemical imbalance in the area of ​​sleep-wake regulation in the brain. Because of this, the patient has sudden attacks of sleep during the day. This can take place anytime and anywhere, e.g. B. during a conversation, while eating, on the street, etc.

The appearance of narcolepsy also includes the components of REM sleep, such as paralysis of the voluntary muscles and hallucinations, which can occur involuntarily and at a completely abnormal time. Narcoleptic paralysis, also known as cataplexy, is characterized by sudden muscle weakness, which leads to the knees becoming “soft” or even completely collapsing, especially as a result of emotional stress.

Narcolepsy is the second most common cause of pronounced daytime sleepiness after sleep apnea and is not uncommon in humans. With a frequency of around 1: 2000, it is almost as important as multiple sclerosis. Men and women are affected about equally often.

It is currently assumed that mediated by environmental factors, there is a reduction or loss of orexin-containing nerve cells in the brain. An autoimmune process may play a central role here. Orexin is made by a small group of nerve cells in the hypothalamus. These cells influence many areas of the brain. The orexin level can be determined in the nerve water.

Narcolepsy is a chronic condition that can be treated with medication.

13. What does it mean if one cannot move for a short time when falling asleep or waking up?

This phenomenon is called "sleep paralysis" and occurs sporadically and without further serious disturbances in up to 30% of adults. Some patients report the uncomfortable experience of falling and a "fearful awakening" in connection with a subjective feeling of paralysis.

Scientists assume that this paralytic condition is to be equated with an incompletely triggered REM phase, which primarily paralyzes the muscles. Those affected are sometimes completely overwhelmed by the feeling of fear, even if they know that this state of "paralysis" only lasts for a short time and is harmless. In pronounced cases, drugs are used that suppress REM sleep (e.g. certain antidepressants).

14. What can be done to prevent movement, especially of the legs, during sleep?

Nocturnal twitching, nocturnal myoclonus, or periodic leg movements while sleeping are a common problem. Most people are unaware of these twitches and do not wake up, while in others the movements disturb their sleep. Many sufferers do not notice this problem and may complain of insomnia or tiredness during the day. If the leg movements lead to insomnia, a specialized center should be visited. However, if the person is not disturbed by these twitches in their sleep, then the bed partner must learn not to let this impair their sleep.

There is another form of sleep disorder known as REM sleep behavior disorder. The movements that occur are different from the periodic leg or arm movements. This disorder can cause arm, leg, or head movements that are very violent and occur especially in the last hours of the night when there is a lot of REM sleep. These conditions, often associated with speaking, are caused by changes in the brain that normally initiate the muscular paralysis in REM sleep. In patients with this disorder, muscle tension is retained so that dreams can be actively lived out. Excessive nocturnal leg movements and REM sleep behavior disorder can usually be effectively treated with specific medications.

15. What is Restless Legs Syndrome?

This phenomenon is also known as "restless legs syndrome" and is relatively common, especially in the case of iron deficiency, during pregnancy and with kidney dysfunction. Women are more often affected than men, why is not yet clear.

The patients describe - usually only after a specific request - typically difficult to describe abnormal sensations (tingling, pulling, rumbling, but also pain) mostly in the lower legs, an urge to move at rest (i.e. lying or sitting), a clear improvement through movement and an increase the complaints in the evening or at night.

Difficulty falling asleep and staying asleep are therefore a very common consequence of this disease; in severe cases, psychological impairments such as depressive moods can also occur. Often sleep is disturbed by periodic leg movements occurring at the same time.

The cause of this neurological disease is not yet fully understood, but genetic factors seem to play an important role. Again and again family trees are described with a large number of affected persons.

If the symptoms are very pronounced, specific drug treatment can bring about a significant improvement. However, if the symptoms are not very severe or occur only occasionally, medication can be dispensed with. It is important to have a previous examination with regard to the iron metabolism. In the case of iron deficiency, an improvement can be achieved by taking an iron supplement.

16. Where can morning headaches come from?

Morning headaches can have many causes, the most important of which are nocturnal breathing disorders or sleep-related vascular changes in the brain.

People who have difficulty breathing during sleep do not have enough oxygen in their blood, so awakening can be accompanied by headaches and a feeling of exhaustion.

Nocturnal vascular headaches are caused by spasm of small brain vessels, most common during REM sleep. Both forms can be treated well.

17. How does sleepwalking come about?

Sleepwalking, also known as somnambulism, is a state of altered consciousness in which phenomena of sleep and wakefulness occur at the same time. Sleepwalkers act as if they were awake. However, the brain waves show that the affected person is in deep sleep.

Sleepwalking often begins with a sudden straightening up in bed. Those affected look around and appear confused. Either they lie down again and go back to sleep or they get up, get out of bed and perform seemingly meaningful, quite complex actions. For example, patients are able to have a seemingly sensible conversation with another person or to prepare food for themselves. Sleepwalkers can, however, expose themselves to a considerable risk of injury because they are not consciously aware of their surroundings: it can happen that they leave the apartment at night and go out onto the street or mistake a door for a window. In exceptional cases, sleepwalkers also behave irritably and aggressively. Most sleepwalking episodes only last a few seconds to a few minutes, rarely much longer. The next morning there is usually no memory of what happened.

Sleepwalking occurs most frequently between the ages of 4 and 8 (around 15-20% of all children sleepwalking once), much less often in adulthood. The reason for the frequent occurrence in childhood is assumed to be an incomplete maturation of the brain. As a rule, the episodes disappear with the onset of puberty. Fever, sleep deprivation and emotional stress factors can be the trigger. In adulthood, certain medications or night breathing pauses can also trigger episodes of sleepwalking.

Usually no drug treatment is necessary. The focus is on measures to ensure the safety of the person concerned (e.g. securing windows and doors), calm accompaniment back to bed or the avoidance of possible triggers such as sleep deprivation or irregular sleep times. However, if it comes to self-harm or harm to others, a specific drug treatment is recommended.

Sleepwalking often occurs with pavor nocturnus. Pavor nocturnus, also known as "sleep terror", is characterized by a sudden awakening from deep sleep with a piercing scream and signs of intense fear. In this state, the person concerned does not react to encouragement; the excitement usually subsides on its own after a few minutes. In this case, too, the person concerned usually does not know anything about the nightly event the next morning.

Sleepwalking and pavor nocturnus, as well as grinding teeth, beating the head, certain forms of wetting and knocking around during sleep, belong to the group of parasomnias. These sleep disorders should be examined in the sleep laboratory if there is a risk of injury to yourself or your bed partner or if epileptic seizures are suspected as a differential diagnosis during sleep.

18. When is an examination necessary in the sleep laboratory and what happens there?

Important symptoms of disturbed sleep are drowsiness during the day, pronounced concentration disorders, morning headaches, heavy snoring and sweating as well as irregular breathing during sleep. The diagnosis and treatment regimen are drawn up by experienced doctors who have the opportunity to collaborate with psychiatrists, neurologists, pulmonologists, ear, nose and throat specialists and psychologists in an interdisciplinary manner.

The examination in a sleep laboratory is used to measure physiological functions during sleep. This diagnostic procedure typically requires two nights in the sleep laboratory, during which all sleep parameters are carefully monitored and recorded. This registration is safe and painless and is carried out in a quiet room with the help of trained personnel.

For this purpose, sensors are attached to the head, sides of the eyes and to the extremities. In addition, the respiratory movements of the chest and abdomen as well as the oxygen content of the blood, the heart activity and other physiological values ​​that are of interest for making a diagnosis are recorded. Video recording is also often performed to record specific nighttime behaviors, such as sleepwalking. See sleep laboratory.

After the recordings in the sleep laboratory, the data must be evaluated in relation to the various phases of sleep and pathological factors. This work takes a lot of time. The overall picture from the results of the sleep derivation (technical term: polysomnography), the medical history, the physical examination findings and other laboratory data enables the doctor trained in sleep medicine to make a diagnosis and recommend treatment.