Disorders to fall asleep and to sleep through
Typical laments are that there is not enough and recreative sleep, frequent awakening during the night, problems to fall asleep again, too early awakening in the morning, the feeling “not to have slept deeply “.
Disorders increasing drowsiness during the day
Typical problems therefor are staying awake during the day, undesired falling asleep and dozing off during the day, the feeling of constantly being tired despite sufficient sleep. Frequently, but not always, combined with snoring during the night.
DISORDERS OCCURING DURING THE SLEEP
This includes noticeable problems during the sleep like nightmares, noctambulism, speaking during the sleep, REM-sleep connected cardiac arrest, bruxism and more.
The term parasomnia describes phenomena occurring during the sleep without interfering directly with the quality and recreation of the sleep. Since various disorders lead to activities within and off the bed and to awakening, many patients with often-occurring parasomnia depict a disturbed sleep. The parasomnia is classified based on the sleep stage occurring into NREM-sleep-parasomnia/ awakening disorder, REM-sleep-parasomnia and parasomnia which cannot be related explicitly to a certain stage of the sleep.
DISORDER OF THE SLEEP-WAKE-CYCLE
Typical complaints are no enough and relaxing sleep, problems to fall asleep, frequent awakening during the night, difficulties to fall asleep again, waking up too early in the morning and the feeling “not having a real deep sleep”.
Narcolepsy is a rare sleep-wake-disorder. Its symptoms reveal all facets of a disorder of vigilambulism, NREM-, REM sleep and its transitions. Therefore, it is regarded as a model disorder of many sleep disorders. Thus, its symptoms are complex and can easily lead to false diagnosis. Depending on the severity of the disorder its psychosocial effects can be extensive and often lead to inability to work and early retirement if it is not detected in an early stage and treated accordingly.
Although the symptoms are easy to identify, narcolepsy is often not diagnosed until years after its first appearance. The temporal differing occurrence of the two main symptoms – drowsiness during the day and cataplexies -, the often-subtle beginning and the fact that many doctors do not know this disorder thoroughly is the reason of it being diagnosed late.
RESTLESS LEGS SYNDROME
RLS is often detected on people otherwise healthy and is not connected to mental or psychiatric disorders. Although in most cases – as the name implies – the legs are concerned, this disorder can also affect the arms.
Patients experience a need for movement and frequently very painful paresthesia in form of prickling and “ant crawling” in their legs while sitting and lying, especially after going to bed. Some patients have strong pains in their calves not to be taken for cramps in the calf. The perception is different to the prickle of falling asleep limbs and the occasional feeling of burning pinpricks of diabetics. These pains and paresthesia are felt mostly in the calves and can be allayed temporarily by movement and stretching.
OBSTRUCTIVE SLEEP APNEA
The obstructive sleep apnea syndrome describes a respiration disorder during the sleep leading to life-threatening after effect diseases. Therefore, diagnosis and therapy have to be practiced with special care.
The obstructive sleep apnea provokes a reoccurring collapse in the pharynx during the sleep blocking the upper respiratory system partially or totally. The symptoms include drowsiness during the day, decline in output at the job and during daily routine as well as depressive symptoms.
The processes leading to the blocking of the upper respiratory system are extremely complex and in consequence of genetic causes, anatomical characteristics in the pharynx area, changes to the breathing- as well as sleep-wake-cycle and a result of advancing age and weight. Since the muscles in the pharynx area relax during the sleep, an occlusion of the respiratory system is more likely to happen during the sleep in contrary to being awake. The depression built up by the lung can lead to contraction of the upper respiratory system and contribute to its collapse. This procedure can be clarified by imagining how a straw collapses if you squeeze one end and suck on the other end at the same time.
SLEEP AT SENORITY
Many processes in the body change with aging. Most functions decelerate and the physical and mental capability is reduced. In individual cases it can be difficult to differentiate between a normal aging process and a pathological state. This also applies to the sleeping manner at an advanced age. Here the limits between typical behaviour at senority and pathological change are not clearly distinguishable. Another important aspect is that the reception of the sleeping behaviour is perceived differently at old age. What is considered a disturbing factor by one person, can be perceived as normal by another person. The changes in the day-night-rhythm at an increasing seniority is an additional phenomenon. Elderly people often go to bed early to wake up 7 – 8 hours later at 3:00 or 4:00 a.m..
THE SPECIFIC SLEEP OF WOMEN
The issue of specific female problems has been neglected by science for a long time. Many physicians did not take the complaints by women about bad sleep seriously. Recent new studies show an increasing interest in the sleep of women and their altering sleep patterns, sleep needs and problems subject to change within the course of a lifetime.
SLEEP DISORDERS OF CHILDREN
Have you already heard many opinions and advices what your child should be able to do and what is under no circumstances considered normal? Concerning the sleep behaviour of a child there are many different opinions and aspects. It is advisable to know some facts to get an idea of the issue.
SLEEP DISORDER CAUSED BY SHIFT WORK
Millions of people work shift in Germany. The necessity to sleep during the day and work at night leads to numerous problems for the persons concerned. By considering a few basic rules shift work will not only be more bearable, but also saver.
DISORDERS FALLING ASLEEP AND SLEEPING THROUGH
Stress contributes to sleep problems to a great extent. People with sleep disorders develop strategies to adapt to the disturbed sleep rhythm including regular naps during the day, excessive consumption of coffee, alcoholic beverages before going to sleep, working at night and irregular sleep time. Sleep disorders caused by stress occasionally continue, although the problem has already been solved.
These disorders falling asleep are based on familiarization causing a general tension and a distinctive fear of insomnia. There are behaviour patterns which can improve a sleep disorder adapted by learning. A finding of the cause should always be considered in case of a chronical sleep disorder prior to implementing a medical therapy or taking medicaments.
SNORING OF ADULTS
Public reception of the phenomenon snore has increased significantly over the past years. A profound consultation, diagnosis and therapy is necessary based on the frequency and the considerable stress of the patient. Moreover, a large number of patients seek medical attendance primarily because of the snore which can be a guidance symptom of destructive sleep apnea.
High blood pressure (hypertension) supports the development of severe cardiovascular diseases like heart attacks and strokes. Therefore, it is essential to do something against it. But what can be done if the blood pressure cannot be lowered by taking medication?
In such a case the physician should ask the patient (and best the spouse or partner) whether the patient snores or if he/she has breathing interruptions after a single snore because this type of sleep apnea can be the cause for badly-treatable hypertension.
HEART ATTACK / STROKE
SLEEP APNEA AS RISK FOR STROKES
The signs are mounting that an obstructive sleep apnea (OSA) increases the risk for strokes. Most likely several factors play a role: breath interruptions during the sleep are an established risk factor for the origin of high blood pressure and, in turn, high blood pressure increases the risk to suffer from a stroke. In fact, this risk can be contained by an effective medical treatment, but high blood pressure caused by untreated sleep apnea is, unfortunately, highly difficult to regulate: patients often need three or more medicaments to achieve a partially sufficient reduction of their high blood pressure. Therefore, patients with high blood pressure difficult to be adjusted should be examined if they suffer OSA – especially if there are additional risk factors of a breathing disorder concerning the sleep.
SLEEP APNEA NARROWS THE CAROTID ARTERY
An OSA can increase the risk to suffer a stroke independent of already existing high blood pressure. There are several possibilities: A recent study has shown that a lack of oxygen in the hypoxias caused by nightly breathing space very probably leads to an inflammation process of the vessels supporting the development of arteriosclerotic deposits in the carotid arteries. These plaques on the inside of the carotid artery walls are one of the most frequent causes for strokes, because parts of the diseased vessel walls or blood clots attached here can be displaced into the brain by the blood flow and there, they cause the dreaded “shortage”. Especially patients suffering a severe sleep apnea and long-term lacks of oxygen saturation are subject to suffer from a stroke.
THE FAVOUR OF A DEPRESSION
Each chronical disease can enhance the risk of a depression or a depressive mood. This also applies to the obstructive sleep apnea (OSAS): This disorder is often connected to depressions or depressive moods. A recent study of the Sleep Medical Center Nurnberg shows the joint appearance of depressions and OSAS at 25%. The 447 new patients of the sleep laboratory at the Nurnberg hospital were screened about the existence of depressions based on questionnaires. A further diagnosis of the depressions was initiated based on positive medical findings and if the apnea-hypopnea-index (AHI) exceeded 9 showing that people suffering sleep apnea actually suffer from depressions frequently (24,1% of the examined patients).
INCREASE OF DIABETES
Many sleep apnea patients suffer from adiposity, type-2-diabetes, high blood pressure, fat metabolism disorder and hyperuricemia at the same time. Patients with sleep apnea often suffer from an increased insulin resistance. There are several reasons. On the one hand adiposity plays an important role as a joint risk factor for the development of the sleep apnea syndrome and a type-2-diabetes. On the other hand a direct influencing driver of the obstructive sleep apnea on the insulin resistance is possible.
We know that the arousals during the sleep with patients suffering a breathing disorder are nothing else but alarm reactions considering the endocrinological standpoint. This leads to the release of corticosteroids and catecholamines like adrenalin and noradrenalin. These hormones affect the effect of the insulin and this way they can contribute to an insulin resistance.