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About sleep disturbances
Sleep Disorders are medical or psychiatric disorders that cause poor sleep. There may be problems getting to sleep, to maintain sleep or to sleep at socially acceptable times. Sleep may be of unsatisfactory quality as measured by or example polysomnography, or as experienced by the person who sleep poorly. Different combinations of these issues may exist.
Sleep disorders can lead to significantly impaired quality of life, both physically, mentally and emotionally. Research shows that as much as 40% of the adult population periodically or chronically are struggling with sleep disorders.
Sleep disturbance can be a specific disease in the nervous system where the ability to sleep well or enough is the prominent symptom.
Sleep disturbance can be a symptom of a physical or mental disease.
Sleep disturbance can be a secondary problem that are caused by pain or discomfort from a physical and mental disease.
Sleep disturbances are are classified into many types according to the way they occur. These are shown below.
Principles of scientific classification of sleep disturbances
Sleep disturbanses are classified as primary where the disease process leads directly to poor sleep and secondary where a disorder gives symtoms that keep the pationt awake or gives the pationt an activity pattern that disturbes the sleep.
Sleep disturbances are further classified as dyssomnia where the sleep problems are the main and primary complaint of the patient, and parasomnia where sleep problems are symptoms among others more prominent.
Primary sleep disorders
Primary sleep disorder are those where the sleep problems are a consequence of the disease process intsel. The disease is either of neurologic or mental (psychiatric) nature. The primary sleep disorders can be divided in several cathegories:
- Primary dyssomnia without organic (anatomic or physiological) neurologic changes. These are sleep disturbances in the nervous system where the main symptoms are related to the sleep pattern, like insomnia or lack of sleep, hypersomnia or tendency to sleep too much and sleep rhythm disturbances.
- Primary dyssomnia caused by organic changes in the nervous system: These are conditions where it is possible to measure physiological changes in the nervous system. Examples are delayed sleep phase syndrome, advanced sleep phase syndrome, and non-24-hour sleep-wake syndrome.
- Primary parasomnia without physiological neurologic changes: These are chronic mental or nervous syndroms comprizing processes where a disturbance of sleep is an integral component, like Sleepwalking (somnambulism), teeth grinding, night terror, nightmares, RLS (restless legs, periodic load movements). Some of parasomnia are commoner in children than in adults.- Parasomnia by psychiatric disorders. Conditions like, anxiety, depression and schizofrenia can have sleep disturbances as a symptom.
Secondary sleep disorders
Sleep disorders can also occur secondary to various diseases or other disorders. In these cases the disease causes pain, discomfort or altered body functions. These in turn disturb the sleep pattern.
- Parasomnia secondary to physical conditions: The sleep problems can be a direct consequences of symptoms or pain from the disease or the disease forces the person to habits that disturb the sleep. A frequent type is sleep apnea where a persons temporarily stops to breath and then wakens before beginning to breath again.
- Parasomnia secondary to psychiatric condition. Anxiety can keep a person away from sleep. Paranoid aymptoms can lead to a pattern where a person keeps himself awake performimg activities of various kind.
- Bad habituation leading to sleep problems. Many types of bad habits can lead to problems with the sleep, like drinking too much of caffeinated beverages in the evening, like going too late to sleep for a long period or habits caused by demands from the work. It is difficult to classify this type of sleep problems either as primary or secondary, becuase they contains both primary and secondary aspects.
Some common causes that can lead to bad sleep
Sleeping problems may be of several kinds, often blended together: Difficulty to fall to sleep, too light sleep or bad sleep quality, waking too early, waking many times during the night and not feeling restored an wake after sleep. Several factors can cause sleeping problems:
- Stress: Stress at work or in the family life. Wen you get exposed to too much stress, demanding a too high performance level over some time, the brain gets into a hyperactive state that does not fall to rest during the night, and problems falling to sleep and bad sleep quality is the result.
- Obstructive sleep apnea. By this syndrome the toncillar region, the uvular region or the tongue root are too lax so that these structures fall back or collapse and prop the breath. The person then awakes due to lack of oxygen and begins breathing again. The pattern can reapeat itself many times each night. The same physiological changes will also lead to storing in the night.
-Anxiety or fear: If you are is some kind of constant danger, real or immaginal, the brain gets into a state of constant high awareness and this will also cause problems falling to sleep. Anxiety or worry about unhappy things actually having occured in the past can continue to disturbe the sleep for many years.
-Bad habits: Sometime the problem is just caused by bad habits connected to the process of going to sleep, for example the habit of thinking about the activities of the day or the following day.
- Going to sleep too late. When you go to sleep too late in a long period, your nervous system gets accustomed to override the inner impulses to induce a sound sleep. When you eventually feel ned for a good night's sleep and go to bed earlier, the automatic actions thus set up will hinder your sleep until later, so that you still do not get that sleep you finally feel you must have.
- Depression, bipolar disorder or manic disorder: In the manic face of bipolar disorder or in pure manic disorder insonia is a symptom. Depression often have elements of the manic state, and insomnia may also be a symptom here, but the opposite can also occur by depression - too heavy sleep.
- Lack of some neurotransmittors or hormonal substances, like GABA (gamma-amino-butyric acid ) or serotonine: This may in turn be a consequence of bad nutrition that does nor allow the body to get the building substances or the chemical tools it needs to produce these substances.
- Disturbing sounds or light: The sounds or lights from roads, machines, aeroplanes or human activities can cause bad sleep. Often the sounds have a frequency too low to be detected by the ear. Some persons are more sensitive to such disturbances than others and get insomnia.
- Stimulants: Drincing koffee, tea or other coffein containing drinks in too great quantities or just before bedtime will often give an unwanted wakefulness.
- Night shift: People used to work night shift tend to get disturbed sleep when trying to sleep to normal hours.
- Aging: Aged people tend not to sleep well. This may be a common tarit of aging or due to medication that aged persons often take. Aged persons also have less activity during the day and will therefore not get tired enough in a sound manner so that a good sleep is not induced.
- Bad bedding: A too hard bed or a too soft one may feel unconfortable and cause bad sleep. Too heavy blankets can also give this effect. A too cold sleeping room or a too warm one will also disturbe the sleep.
- Smoking: The stimulation from nicotine will in the long run decrease the value of the sleep. Respiratory problems caused by smoking with cough and clogged airways also have the effect of holding a person awake during night.
- Physical pain: Physical pain from any condition will also make it more difficult to fall to sleep and will disturbe the sleep during the night. One can be used to cronic pain, so that the pain is not recognized very well conciously, but the stimulus upon the pain receptors will nevertheless give problems with the sleep pattern.
- Fibromyalgia: This condition implies painfull points throughout the body that disturb the sleep, and there mey also be some more fundamental mechanism by this syndrome that gives poor sleeping quality.
- Urge to urinate during night: Both men and women can suffer from cramps in the bladder producing an urge to urinate that distroys the ability to sleep for a long period. Drinking too much just before bedtime will give the same effect. Drinking koffee before bedtime can increase the urine production and give the same effect. Men having prostate problems can get too little space in the bladder or not be able to empty the bladder completely before bedtime, so that the urge to urinate once again soon apears and disturbes the sleep.
- Circadian rhythm disturbance: The circatian rhytm is the rhytm of biological activities in the brain and body during day and night. A circadian rhythm is a roughly-24-hour cycle in the biochemical, physiological or behavioral processes of living beings, including plants, animals, fungi and cyanobacteria (see bacterial circadian rhythms). The formal study of biological temporal rhythms such as daily, tidal, weekly, seasonal, and annual rhythms, is called chronobiology.
Circadian rhythms are endogenously generated, but can be entrained by external cues, called Zeitgebers, the primary one of which is daylight. These rhythms allow organisms to anticipate and prepare for precise and regular environmental changes.
The rhytm can get out of order and result in sleep disturbances or in another sleep rhytm than teh 24-hours rhythm generally concidered normal. There are several variants of this disorder: Jet Lag or Rapid Time Zone Change Syndrome, Delayed Sleep Phase Syndrome (DSPS), Advanced Sleep Phase Syndrome, Non 24-Hour Sleep Wake Disorder
Restless leg syndrome - This is a condition where neurological disturbances cause itching, cripling and constant urges to move the legs during rest. These symptoms will then often badly disturbe the sleep.
Treatment and advices for sleep disturbances
Since many conditions cause disturbances in the sleep pattern, the treatment wil vary. Basically, the physical or mental disorder should be treated. However, sometimes the problems with the sleep is the basic disorder, and a bad habit is also nearly allways a component in the problem. Therefore the sleeping problems must also be managed separately.
It is necessary to establish good habits of going to sleep. One must try to go to bed early enough, around 10 PM, and try to stay in bed until early morning.
Traditionally sleep disturbances has been treated mith relaxing medication, for example barbiturates or benzodiacepins. Such substances will however cause development of tollerance and addiction. Therefore such medications are only used in accute situations.
A habit of regular physical exercise will often improve the ability to fall in sleep and sleep well during the night.
Dayly meditation can also improve the ability to get a good sleep. The meditation should be done in the afternoon, but not too late. Meditation just before going to bed can give the opposite effect.
Having sex with a partner or masturbating before sleep so that it that leads to orgasm is a very good method to fall in sleep and sleep well during night.
elatonin is the body's own sleep hormone. Melatonin is formed from serotonin and secreted by the Pineal gland, also called the cone gland.
This excretion occurs during darkness. When light hits the eyes, melatonin in the blood is broken down and the secretion stops. Melatonin is said to have an effect on so-called winter depression, a problem for many people in the northern countries.
When the secretion of melatonin lasts for several more hours in the winter than in the summer, this may lead to fatigue and weakness. Simple treatment with light, the right time, can counter this, in that melatonin, when broken down.
Melatonin also has an effect as antioxidant, and strengthens the immune system by increasing production of white blood cells, called T-cells.
Melatonin also has an impact on libido in some animal species. In animals that reproduce in the summer, the melatonin inhibits an effect on the secretion of LH and FSH from anterior pituitary. For animals that reproduce in winter, the opposite effect occur.
The hormone was first isolated by Professor Aaron B. Lerner of Yale in 1958.
While melatonin in many countries is a hand-purchase product (excl. U.S. and Canada), it is on presciption in others.
Melatonin is used in small doses (0.1 to 1 mg) in the treatment of arrhythmias day, often in combination with light therapy.
Melatonin admistered as a long-release drug is sometimes recommended for insomnia in patients over 55 years.