Sleep disorders have an enormous negative impact on health and quality of life. Long-term disturbances in healthy sleep can even encourage serious illnesses such as depression. Difficulty falling asleep and staying asleep (insomnias) are often symptoms of serious illnesses.
According to the DAK Health Report 2017, 80 percent of working people in Germany are affected by sleep disorders. Almost everyone knows occasional problems falling asleep and staying asleep, especially under stress and everyday stress. However, difficulty falling asleep and staying asleep can also become chronic. These so-called insomnias lead to daytime sleepiness, exhaustion and reduced performance in private and professional life.
Sleep disorders have different characteristics
Not only difficulty falling asleep and staying asleep fall under sleep disorders, but also phenomena such as restless legs syndrome, sleepwalking or clenching your teeth at night (bruxism). According to the International Classification of Sleep Disorders (ICSD), sleep disorders are classified as follows:
Insomnia: Difficulty falling asleep or staying asleep, insufficient sleep time or unrefreshing sleep
sleep-related breathing disorders (sleep apnea syndrome)
Hypersomnia: increased need for sleep (more than ten hours a day) and / or daytime sleepiness
circadian sleep-wake rhythm disorder: inability to sleep according to the day-night rhythm, for example due to jet lag or
Parasomnia: disturbed sleep due to psychological or physical events such as nightmares, bruxism or nocturnal enuresis (bed wetting)
sleep-related movement disorders such as restless legs syndrome
The most common forms of sleep disorders are insomnias: studies show that ten to 30 percent of the world's population suffer from these problems falling asleep and staying asleep. These sleep disorders can be divided into:
primary insomnia: From a medical point of view, no organic or mental illnesses can be proven as the cause.
secondary insomnia: They usually result from a proven previous illness and are diagnosed as such.
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Symptoms: recognize insomnia
The main features of insomnia are:
- Difficulty falling asleep
- prolonged nocturnal waking phases
- frequent awakening
- lack of recovery
- Affected people feel tired all the time
You can feel the strong tiredness during the day. Irritation, fatigue and difficulty concentrating as well as headaches are typical. Social and professional performance is reduced. Sufferers sometimes feel a high level of suffering and worry about their insomnia and its consequences both at night and during the day and think about what can help them sleep well.
Causes of Insomnia
Insomnias can be triggered by diseases such as depression, anxiety or stress disorders, kidney, cardiovascular or neurological diseases. Hormonal changes, for example during pregnancy or menopause, drugs and other substances can be causes of sleep disorders. Alcohol is considered a good sleep aid by many. But that's a myth: while it can help you fall asleep faster, it disrupts sleep continuity.
Overview of causes:
physical illness, such as sleep apnea syndrome, restless legs syndrome, hormonal changes (e.g. due to thyroid disorders during pregnancy or menopause), diseases of the metabolism, respiratory tract (e.g. bronchial asthma), eyes or kidneys; physical causes such as snoring
psychological and psychiatric factors: Stress, stressful situations, psychiatric illnesses such as depression, anxiety disorders, eating disorders, schizophrenia
sleep-disrupting substances: certain medications (such as drugs for high blood pressure, corticoids, activating antidepressants, antihistamines, some antibiotics, diuretics, appetite suppressants and many more), caffeinated drinks such as coffee, alcohol, nicotine, other drugs and sleeping pills (if the latter is dependent)
Disorders of sleep hygiene or the sleep-wake rhythm: Too long nap, excitement in the evening, too bright or too warm bedroom, jet lag, shift work
Primary sleep disorders: Often due to excessive tension during the day
The idiopathic sleep disorder is one of the primary sleep disorders, the cause of which is not certain. It is believed that a neurological disorder affects the sleep-wake cycle. People with an idiopathic sleep disorder suffer from it in childhood and usually keep it for a lifetime.
Another primary form of sleep disorders is one's own misjudgment of the state of sleep, in which the person concerned subjectively regards their sleep behavior as faulty, although no objective evidence can be provided for this. Example: The person concerned thinks they haven't closed their eyes all night. In reality, however, he slept for many hours.
For the psychophysiological sleep disorder as the third primary form, stress and stress play a major role in everyday life. Body and psyche get into a state of constant tension and overexcitation (hyperarousal), which is noticeable in muscle tension, palpitations, inner restlessness and circles of thought. The fear of not being able to sleep is also typical. These factors negatively affect sleep, creating a vicious circle. The person concerned associates the sleep situation with insomnia, which further promotes this. The difficulty falling asleep and staying asleep becomes chronic.
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Thorough diagnosis of insomnia is important
According to the ICD-10 classification system of the World Health Organization, an insomnia is only present if the difficulty falling and staying asleep has existed for at least one month. The International Classification of Sleep Disorders (ICSD), on the other hand, does not provide a time frame, but focuses on the permanent state of non-recovery through sleep.
To diagnose a sleep disorder, the symptoms must be recorded precisely. The doctor must have sufficient experience to be able to track down any psychiatric and organic causes of the insomnia and to initiate appropriate causal treatment instead of just combating the symptoms (e.g. with sleeping pills). If the cause is not treated – for example neurological diseases – the sleep disorder becomes chronic and dependence on sleeping pills is promoted.
Medical history, sleep diary and sleep laboratory
In the first step of the diagnosis, the anamnesis, all symptoms reported by the person concerned are recorded. In addition, it is precisely asked whether and, if so, which sleep-disturbing substances (e.g. caffeinated drinks, medication, drugs, alcohol, …) are consumed.
Sleep diaries provide information about which events, moods, situations and behaviors of the patient influence the quality and duration of sleep. There are also questionnaires to record sleep quality, such as the PSQI (Pittsburgh Sleep Quality Index).
Through actigraphy phases of rest and activity can be recorded using a measuring instrument that is worn around the wrist like a watch.
If the causes of the sleep disorder cannot be clarified in this way, a polysomnography is an option. It comprises various examinations of sleep quality, depth and course, which are usually carried out in an inpatient sleep laboratory and last up to three nights. Among other things, breath, heart rate, eye movements and brain activity are measured in order to create a sleep profile for the patient, which can provide information about possible causes of the insomnia and appropriate therapy.
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Treatment: what to do if you have insomnia?
In order to treat sleep disorders, a thorough diagnosis is important, as the therapeutic approaches differ greatly depending on the causes. Caution applies to purely symptomatic treatment that does not eliminate the triggers of the sleep disorder, so that the problems falling asleep and staying asleep can sometimes become chronic.
If a psychiatric illness – such as depression or an anxiety disorder – has been identified as the cause of the sleep problems, it should be treated with a combination of psychotherapy and psychotropic drugs. Sleeping pills can also be prescribed temporarily.
If there are physical causes, there are various therapies. Hormonal changes during menopause can be countered, for example, with hormone therapy, whereas the treatment spectrum for kidney failure ranges from drugs such as diuretics to dialysis and transplantation.
Psychophysiological insomnia, which is quite often caused by stress, can be treated with behavioral therapy. Behavioral medicine strategies that are developed in group therapies, for example, also have a positive effect on physical tension. In some units, techniques are developed that can help people to relax and rest during the sleep phase. This can be done as an inpatient in so-called sleep centers or on an outpatient basis.
Healthy sleep hygiene is also important: the bedroom should be cool and dark at night. Noise pollution should be countered as much as possible. Mattresses and slatted frames also play an essential role in ensuring a good night's sleep. In addition, you should avoid late meals and excitement before going to bed and switch off your smartphone, laptop, tablet and television at least half an hour before bedtime.
Treat sleep disorders with medication
Although sleep disorders are so common, only just under five percent of those in employment turn to a doctor. More than a third of them receive psychotherapy to treat their sleep problems. According to the DAK 2017 health report, half of the patients are prescribed sleeping pills. However, many also resort to over-the-counter products from the pharmacy.
In the beginning, sleeping pills are sometimes useful to break the vicious circle of fear of insomnia and the resulting sleep problems. However, they are not suitable for long-term therapy. It is important against it a cause-specific treatment for the sleep disorder rather than just addressing the symptoms.
Temporary use of sleeping pills to help you fall asleep should generally not exceed four weeks. The choice of sleeping pill depends on the underlying disease.
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Over-the-counter and prescription drugs
The synthetic sleeping pills include both over-the-counter and prescription-only active ingredients, both of which should only be used for a short time and only after consulting a doctor or pharmacist.
The over-the-counter active ingredients include certain antihistamines such as doxylamine or diphenhydramine, which were originally used as a remedy for allergies, but are also known for their depressant and sleep-promoting effects and are actually used almost exclusively as sleep aids today.
Prescription sleeping pills include benzodiazepines such as flurazepam or diazepam. Due to the risk of dependency and possible side effects such as daytime sleepiness, use should be made with caution and only for a short time.
Other prescription drugs for insomnia include:
- Benzodiazepine receptor agonists such as zopiclone, zolpidem or zaleplon
- synthetically produced melatonin
- certain antidepressants
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Herbal helpers for sleep disorders
Herbal preparations are also available for treating mild sleep disorders. For example, the active ingredients lavender, valerian, hops, St. John's wort, lemon balm and passion flower are suitable. Herbal sleeping pills should also only be used after consulting a doctor or pharmacist.
Sleep disorders in children
In preschool age, sleep disorders are most common in children; Statistically speaking, they are less common with the onset and progression of puberty. In most cases, sleep disorders in children resolve on their own. Most intermittent sleep disorders in children are not a cause for concern. However, if they appear permanent or massive, it is advisable to see a pediatrician.
Symptoms of insomnia in children
Depending on the type of sleep disorder, the child will show different symptoms. Sleep disorders in children can basically be divided into difficulty falling asleep and difficulty sleeping through the night. Difficulty falling asleep is characterized above all by the fact that the children do not or only with difficulty fall asleep despite regular bedtime and rituals before going to sleep.
Children who have trouble sleeping through the night wake up again and again. Sleep disorders include, for example Pavor nocturnus – also known as night terrors or night terrors. The nighttime anxiety usually occurs before midnight, in the first third of sleep. The children wake up scared, fearful and often panic. Pavor nocturnus is therefore assigned to anxiety disorders.
Sleepwalking is also one of the sleep disorders in children. Sleepwalking only occurs in deep sleep. This leads to actions that can be completely different. Children usually get out of bed and run around the apartment, moving things or the like. All sleepwalkers have one thing in common: they cannot remember anything afterwards (amnesia). Sleepwalking can also lead to risky behavior by the child or to injuries, which is why affected children should not be left out of sight if possible.
Causes of sleep disorders in children
Sleep disorders in children can also occur due to illnesses as well as psychological causes.
Unresolved psychological conflicts are the most common reasons for problems falling asleep and staying asleep. Events that – in a positive or negative sense – were perceived as particularly stressful can also cause problems falling asleep.
It can also happen that chronic or painful illnesses are a possible cause of sleep disorders in children. These diseases are often responsible for:
Sleeping too long at night can also affect healthy sleep. If children sleep too long in the morning, they may not be sufficiently tired at bedtime in the evening.
Diagnosis of infantile insomnia
When diagnosing sleep disorders in children, the most important thing is the observations of the parents (in younger children) and the children themselves. That is why the diagnosis begins with a detailed discussion with the doctor, who asks about sleeping habits, evening rituals, mood within the family and much more. This is the only way to identify possible psychological stress as the cause.
A physical examination follows to rule out illness as a cause. Doctors use EEG to rule out possible brain disorders.
Therapy: what to do if the child cannot sleep
The treatment of children's sleep disorders depends on the type, severity and cause. If chronic illness is the cause of insomnia in children, the underlying illness is treated – the problems usually go away on their own.
If psychological stress is the trigger for sleep disorders in children, it may be useful to work with a child psychologist. This is especially true for depression, which also occurs in children. Problems in the family environment can be brought under control with family therapy if everyone involved wants to work on them. The focus is on relieving the child's emotional stress.
Medicines against sleep disorders in children are only used in exceptional cases and in severe cases.
Evening rituals make it easier to fall asleep
If children cannot switch off and fall asleep in the evening, it is advisable to develop and adhere to evening rituals. It makes sense to define the processes together with the children. In most cases, the sleep disorders subside by themselves after a while and do not require any therapy. The following are recommended against disturbances when falling asleep:
- a regular rhythm with fixed bedtime
- time together before bed
- talk about the events of the day together in the evening
- quiet activities in the evenings, for example reading (aloud), cuddling
- Refraining from grueling activities such as romping around, computer games, watching TV and playing with tablets or smartphones
- do not eat dinner too late or feed the toddler