SLEEP DISORDERS

Sleep disorders affect a growing portion of the population—an estimated 30% of people experience various sleep problems. The most common condition of this type is insomnia—its symptoms can affect even healthy adults, and about 10% are diagnosed with a chronic form. Because sleep is a fundamental physiological human need that regulates many vital bodily functions (including hormonal balance and brain functions such as memory, learning, and concentration), sleep disorders significantly affect our mood and intellectual performance during the day.

Types and characteristics

Currently, psychiatrists are more likely to use the American International Classification of Sleep Disorders (ICSD) to categorize sleep-related disorders. The disease entities in this classification are divided into primary and secondary conditions. Secondary disorders accompany other mental and somatic illnesses or result from previously used chemicals (drugs, stimulants). Primary disorders are divided into dyssomnias and parasomnias.

Among the dyssomnias are:

• insomnia – the patient has difficulty falling asleep or maintaining sleep for more than 3 nights within a week. When this situation lasts longer than a month, it is considered chronic insomnia. The most common causes of insomnia are mental disorders and illnesses (50–60%), especially depression and anxiety. This condition may also be a result of restless legs syndrome (RLS),
• hypersomnia – sleeping too long (more than 9 hours) or excessive sleepiness that occurs during the day despite a full night’s sleep. Hypersomnia is a common symptom of depression and of taking excessively high doses of psychotropic drugs or alcohol.
• narcolepsy – This is a condition consisting of several symptoms:
  – sleep attacks (the patient needs only 5 minutes to fall asleep in any situation, even during activities requiring concentration, for example during a conversation);
  – cataplexy – a sudden decrease in muscle tone, causing the patient to slump to the ground;
  – hypnagogic hallucinations – the occurrence of very realistic imagery during sleep;
  – sleep paralysis – a feeling of complete body paralysis while remaining conscious, occurring when falling asleep or upon waking.
• Sleep-wake rhythm disorders – a type of dyssomnia that occurs as a result of disturbances in the functioning of the internal biological clock. It involves a lack of synchronization between one’s own sleep rhythm and environmental demands. Often caused by changing time zones or shift work.

The most common parasomnias are:

• sleepwalking – sitting up in bed, getting up, and walking during sleep without conscious awareness;
• sleep drunkenness – a disoriented feeling immediately after waking, accompanied by incoherent speech, chaotic movements, and a brief lack of contact with the surroundings;
• night terrors – a feeling of intense fear interrupting sleep, manifested by screaming, crying, and sometimes aggression
• nightmares – very realistic, anxiety-inducing dream imagery that the dreamer remembers long after waking. They may be caused by traumatic experiences from childhood or post-traumatic stress disorder.

Causes

Sleep disorders may be a symptom of other mental and somatic conditions, such as depression, drug and stimulant dependence, pain syndromes, and metabolic and endocrine disorders (including hyperthyroidism). Therefore, every person with sleep problems should undergo a set of general medical tests, on the basis of which it will be possible to determine whether the disorders they experience are secondary (resulting from another illness) or primary.

In the case of primary sleep disorders, the most common causes are:

• genetic conditions – from childhood, the patient shows symptoms of sleep disorders; their sleep is shallow, interrupted, and short. With age, as a result of an unhealthy lifestyle and the natural mechanisms of aging, these symptoms worsen and become chronic.
• psychophysiological reasons – related to a difficult life situation, e.g. divorce, the death of a loved one, financial problems, and other situations that cause prolonged stress. If the patient’s mental state does not improve for a long time, sleep disorders become permanent and develop into a chronic form.
• failure to follow the rules of sleep hygiene – an irregular lifestyle and harmful habits can lead to the development of chronic sleep problems. Particularly vulnerable are people who wake up and fall asleep at different times, spend a lot of time in bed, eat late, spend a lot of time under artificial light, or do not engage in regular physical activity.

Treatment

Diagnosis of sleep disorders should begin with a visit to the GP, who will assess the patient’s general health and perform basic laboratory tests. If the specialist rules out somatic illness, the next step should be a visit to a psychiatrist. Examinations will then be carried out to rule out mental disorders. If secondary insomnia is detected, sleep disorders are treated by addressing the symptoms of the underlying illness. For example, in the case of depression, treatment involves antidepressants; in the case of an overactive thyroid, treatment involves thyrostatic medication. If a patient is diagnosed with primary sleep disorders, the most common treatment is the use of sleep medication in combination with cognitive behavioral psychotherapy.