Sleep disturbance
Last reviewed: 23.04.2024
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Several epidemiological studies have demonstrated the widespread prevalence of sleep disorders. Sleep disorders often cause people suffering, reduce the quality of life and productivity of their activities, often cause death (in accidents caused by sleeping drivers), carry a variety of other health threats. Disturbances in sleep cause great economic damage. Studies conducted by Gallup in 1991 and 1995 showed that patients with sleep disorders often do not make complaints, and doctors often do not diagnose these conditions. Accordingly, a significant proportion of patients with severe sleep disorders remain without proper treatment.
Effective treatment of sleep disorders requires the ability to recognize symptoms that are initially not clearly expressed. The doctor should have a "trained" eye and sensitive hearing that identify such symptoms. He should be able to ask specific questions that help to identify sleep disorders. If symptoms are detected, then a comprehensive examination is needed to establish the diagnosis of the disease and, if possible, its etiology. The most rational treatment plan can be developed in the case when the leading mechanism of sleep disturbance is known and understandable.
Treatment of sleep disorders depends on their cause. In many cases, the best possible result is a well thought-out combination of medicinal and non-drug therapies. Since drugs play an important role in the treatment of a number of sleep disorders, good knowledge of the drugs is a prerequisite for optimal pharmacotherapy. It is very important to know both the strengths and weaknesses of drugs used in sleep disorders. Knowledge of even small differences in the pharmacological properties of drugs can significantly improve the effectiveness of therapy and improve its tolerability. On the one hand, the diagnosis and treatment of sleep disorders are a difficult task, but on the other hand, for the doctor it is an opportunity to get professional satisfaction, providing real qualified help and alleviating the suffering of many people.
[Epidemiology of sleep disorders
The prevalence of sleep disorders and complaints of poor sleep has been the subject of several studies. Surveys conducted in the US, European countries and Australia showed that between 30 and 40% of adults report sleep disturbances, or at least some degree of dissatisfaction with sleep, that occurred during the preceding year. For example, a study of 3,000 adults in the United States in 1985 found insomnia in 35% of cases, with 17% of the insomnias examined expressed or persistent (Mellinger et al., 1985). It is noted that 85% of people with severe, persistent insomnia did not receive any treatment.
The National Sleep Research Foundation of the United States and the Gallup Institute conducted a survey of 1,000 and 1,027 individuals in 1991 and 1995 to determine the frequency and nature of sleep disorders. The results of these surveys were, on the whole, comparable and contained a number of important and interesting observations. Like previous studies, surveys have shown that from one-third to one-half of the adult population, at least episodically, problems with sleep are noted. And 9-12% of respondents suffered from insomnia systematically or often. The 1995 survey also showed that adults with severe sleep disorders are less likely to assess their overall health.
Physiology of sleep
On average, a person spends a third of his life in a dream. Sleep (or, at least, the alternation of periods of activity and rest) is an integral mechanism of physiological adaptation in all living beings. This confirms the theory that sleep performs important functions to maintain life activity at the optimal level. Surprisingly, our ideas about such an important issue as the purpose of sleep are primitive and amorphous. To develop fundamental concepts in this area, more research is needed. Nevertheless, below are basic information about the physiology of sleep, including the basic mechanisms of its regulation and hypotheses explaining its functions.
Patients often ask the question - how much they need to sleep. Although the answer is usually about 8 hours, some individuals need only sleep 4.1 / 2 hours, while others need 10 hours of sleep. Thus, 8 hours is only an average value, and on the whole this indicator is subject to significant individual variations. Nevertheless, since people who have significantly different sleep times from the average are an absolute minority, they need an appropriate survey to identify possible sleep disorders.
Diagnosis of sleep disorders
The approach to diagnosis and treatment of sleep disorders, presented in this chapter, is geared toward physicians who conduct outpatient admission. The modern situation is such that a general practitioner, to whom a large queue sits behind the door, can spend only a very limited time on the patient's admission. Nevertheless, we strongly recommend that you ask the patient a few questions about the quality of sleep, the availability of daytime sleepiness and health status. If the patient, when answering these questions, reports on a particular violation, it should be subjected to a comprehensive and in-depth examination.
It has already been noted that not all patients suffering from sleep disorders mention it during their visit to the doctor. Even more rarely patients specifically address a doctor about this. Nevertheless, sleep disorders are very common and have an adverse effect on well-being, performance, quality of life, general health and emotional well-being. In view of these circumstances, a brief, but capacious ("screening") assessment of the state of sleep and wakefulness should become an indispensable part of an ordinary outpatient examination of the patient.
An initial assessment of the quality of sleep should include several aspects associated with frequent sleep disorders. The most common sleep disorder is insomnia, but this is not a nosological or even a syndromic diagnosis, but rather a statement that the quality of sleep is unsatisfactory.
How to examine?
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Treatment of sleep disorders
Insomnia is a symptom of disturbed sleep, which can be a manifestation of various diseases. Therefore, the first step on the path to treatment of insomnia should be persistent search for the cause of sleep disorders. Only when establishing the cause of insomnia can develop an effective strategy for its therapy. Since the reasons are different, then the treatment can vary significantly. In some cases, patients first of all need to help cope with stress - this may require the advice of a psychotherapist or psychologist. In cases where poor sleep habits or wrong actions of patients contribute to sleep disturbances, it is important to convince them to follow the rules of sleep hygiene. If sleep disorders are associated with somatic or neurological disease, substance abuse, drug use, then correction of these conditions is the most effective way to normalize sleep.
Insomnia often develops against a background of mental disorders, especially depression. If a patient is diagnosed with a major depression, he is always carefully examined for insomnia. For example, in the Hamilton Depression Rating Scale, often used to assess the severity of depression, 3 out of 21 points are devoted to sleep disorders.