Sleep disorders are divided into 3 main groups, dyssomnias, parasomnias and those related to other diseases. The symptoms will be different depending on the type of disorder. The proposed treatments will also depend on the specificity of the disorder.
Sleep disorders: definition
Sleep disorders are divided into 3 main groups:
Dyssomnias: insomnia of psychological origin (inability to sleep at night), altitude insomnia, insomnia of external origin (extrinsic), sleep disorders related to alcohol or drugs, narcolepsy. Insomnia is a frequent complaint of the subject over 60 years old. Sleep onset insomnia, sleep maintenance insomnia, and early awakening insomnia are distinguished. Temporary insomnia can last up to 3 weeks; beyond that, we speak of chronic insomnia;
Parasomnias are sleep disturbances associated with nocturnal awakenings but without significant disruption of sleep or impaired alertness during the day. They are mostly observed in children but may persist in adults with a pathological character. Parasomnias include sleepwalking, night terrors, sleep disturbances associated with REM sleep, night bruxism , and bedwetting (urinary incontinence during the night); Check here the best sleeping matters online to sleep well.
Sleep disorders of psychiatric origin, neurological or related to other diseases.
Causes of sleep disorders
Chronic insomnia of psychological origin is due to emotional stress;
Insomnia of extrinsic origin occurs as a result of a change in the sleeping environment (hospital bed, noise, and light, snoring of the partner) or following an important event (illness, loss of a close individual, change of professional activity, examination);
Insomnia can occur during a stay at high altitude (related to the decrease in oxygen in the air);
Sleep disorders may be related to taking alcohol or drugs. In some patients, the consumption of 5 cups of coffee may be responsible for sleep disorders. Insomnia may occur during the withdrawal period of hypnotics;
The narcolepsy has a genetic origin.
The cause of sleepwalking remains unknown;
Nocturnal bruxism (grinding of teeth) begins at the end of the second decade and usually disappears spontaneously at the age of 40. Stress seems to play an important role in the genesis of this disorder;
The causes of secondary enuresis are emotional disorders, urinary tract infections, urinary tract malformations and epilepsy.
Sleep disorders are frequently observed during mental disorders (depression, manic depression), neurological disorders (migraine, cluster headache, Parkinson’s disease, Gilles de la Tourette syndrome and Huntington’s chorea) or other disorders. Diseases (asthma, gastro-oesophageal reflux).
Symptoms of dyssomnias
Psychogenic insomnia: the patient falls asleep more easily at unscheduled periods (when not trying to fall asleep);
Insomnia of extrinsic origin: there is an increase in the time of falling asleep, frequent awakenings at night and early morning awakenings;
Insomnia of altitude: disorders of the breathing (pauses breathing) appear during the sleep. The subject complains of frequent awakenings and poor sleep, especially during the first nights at high altitude;
Insomnia related to taking drugs: Caffeine is responsible for an increase in sleep latency, more frequent nocturnal awakenings and a decrease in total sleep time for 8 to 14 hours after ingestion. Alcohol is responsible for an increase in nocturnal awakenings, although it increases drowsiness and reduces sleep latency;
Narcolepsy: The patient experiences excessive sleepiness during the day, which may be accompanied by involuntary episodes of sleep during the day. It is accompanied by nocturnal sleep disorders, cataplexy (sudden muscular weakness triggered by an emotion), and sometimes visual hallucinations when falling asleep and paralysis of sleep (the patient feels a paralysis of his muscles when falling asleep).
The symptoms of parasomnias
Sleepwalking is characterized by automatic activities during sleep (getting up, walking); the patient remains unconscious and does not communicate. The awakening is often difficult;
Night terrors occur during the first hours after falling asleep. The child cries suddenly and has significant sweating, increased heart rate and shortness of breath. The awakening can be difficult and the child rarely remembers this episode the next morning. Recurrence is rare;
Nightmares (anxiety during a dream period) sometimes cause complete awakenings and a reminder of this episode;
The sleep disorders associated with REM sleep (sleep period where dreams happen is) is characterized by violent behavior during sleep that may be responsible for injury to the patient or his entourage. Upon waking, the patient remembers unpleasant images;
Night bruxism is an involuntary grinding and forced teeth during sleep. Patients are not aware of this squeaking;
Nocturnal enuresis occurs most often in young subjects. Before the age of 6, it should not be considered pathological. It becomes rare at puberty. It is traditional to distinguish primary enuresis from secondary enuresis (defined by enuresis in patients who have not had a problem with urinary incontinence before).
Sleep disorders associated with mental disorders
During depression, it is common to experience sleep insomnia, sleep-keeping insomnia, and early morning awakenings. Seasonal depression (fall / winter) is often characterized by hypersomnia;
In mania (manic-depressive psychosis), the time of falling asleep is often lengthened.
The examination of the patient must be complete (neurological examination) even if it is the interrogation of the patient that guides the diagnosis. Examination of the teeth in a patient suffering from nocturnal bruxism may reveal destruction of tooth enamel.
Complementary examinations and analyzes
They can be practiced when the precise diagnosis is made difficult despite the data of the interrogation. They are based on polysomnographic recording (recording during the night of electrical activity of the brain and muscles of the eye).
Evolution of the disease
It depends on the underlying cause.
In case of psychogenic insomnia: behavioral therapy is often beneficial. Relaxation sessions improve the sleep of patients who have significant anxiety. The hypnotic may be prescribed in some cases.
In case of extrinsic insomnia, healing usually occurs within a few weeks by eliminating the responsible factor and advising to have a sleep-inducing bedtime ritual (avoid heavy meals, intense physical exercise or hot shower just before sleep) and adapt the environment of the bedroom to sleep.
In cases of altitude insomnia: prior treatment with acetazolamide may be effective.
In case of sleep disorders related to the intake of alcohol or drugs: the treatment consists in the eviction of the responsible drug which can be difficult in certain cases and need a specialized care of the patient (psychological support …). As a preventive measure, the doctor should prescribe as few hypnotics as possible for routine use (the duration of treatment should be as short as possible and the dosage reduced).
The treatment of narcolepsy is symptomatic. It uses stimulants (methylphenidate) to improve drowsiness. The treatment of cataplexy, hallucinations and sleep paralysis is based on antidepressants.
There is no effective treatment for sleepwalking.
The treatment of night terrors is mainly to reassure parents (rare recurrence).
The treatment of sleep disorders associated with REM sleep appealed to clonazepam or antidepressants.
The treatment of nocturnal bruxism is necessary because of the risk of dental deterioration in the most severe cases: rubber dental gutter, psychotherapy in case of significant stress. No drug has proven effective.
The treatment of primary enuresis involves behavioral therapy and a bladder retraining. The treatment of secondary enuresis is the cause of this enuresis.