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Sleep disturbance
Last reviewed: 12.07.2025
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Several epidemiological studies have demonstrated the high prevalence of sleep disorders. Sleep disorders often cause suffering, reduce the quality of life and productivity of their activities, are often the cause of death (in road accidents caused by sleepy drivers), and pose many other health risks. Sleep disorders also cause enormous economic losses. Gallup studies in 1991 and 1995 showed that patients with sleep disorders often do not complain about them, 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 may not be obvious at first. The doctor must have a keen eye and sensitive ear to detect such symptoms. He or she must be able to ask specific questions that will help identify sleep disorders. If symptoms are detected, a comprehensive examination is necessary to establish a diagnosis of the disease and, if possible, its etiology. The most rational treatment plan can be developed when the diagnosis is known and the underlying mechanism of the sleep disorder is understood.
Treatment of sleep disorders depends on their cause. In many cases, the best result is achieved by a well-thought-out combination of medicinal and non-medicinal treatments. Since medicinal drugs play an important role in the treatment of a number of sleep disorders, a good knowledge of the drugs is a prerequisite for optimal pharmacotherapy. It is very important to know both the strengths and weaknesses of the drugs used for sleep disorders. Knowing even small differences in the pharmacological properties of drugs can significantly increase the effectiveness of therapy and improve its tolerability. On the one hand, diagnosing and treating sleep disorders can be a difficult task, but on the other hand, for a doctor it is an opportunity to gain professional satisfaction by 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 in the United States, Europe, and Australia have shown that 30 to 40% of adults report sleep disturbances or at least some degree of sleep dissatisfaction during the previous year. For example, a 1985 study of 3,000 adults in the United States found insomnia to be 35%, with 17% of those surveyed having severe or persistent insomnia (Mellinger et al., 1985). Of those with severe, persistent insomnia, 85% were not receiving any treatment.
In 1991 and 1995, the National Sleep Research Foundation and the Gallup Institute surveyed 1,000 and 1,027 individuals, respectively, to determine the frequency and nature of sleep disorders. The results of these surveys were generally comparable and contained a number of important and interesting observations. Like previous studies, the surveys showed that between one-third and one-half of the adult population report at least occasional sleep problems, with 9-12% of respondents suffering from insomnia systematically or frequently. The 1995 survey also showed that adults with severe sleep disorders rate their overall health lower.
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Physiology of sleep
On average, a person spends a third of their life sleeping. Sleep (or at least 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 in maintaining vital activity at an optimal level. Surprisingly, our understanding of such an important issue as the purpose of sleep is primitive and amorphous. Further research is needed to develop fundamental concepts in this area. However, below is a basic overview of the physiology of sleep, including the main mechanisms of its regulation and hypotheses explaining its functions.
Patients often ask how much sleep they need. Although the most common answer is 8 hours, some individuals need 4.5 hours of sleep, while others need 10 hours. Thus, 8 hours is only an average, and in general, this figure is subject to significant individual variations. However, since people whose sleep duration deviates significantly from the average constitute an absolute minority, they need appropriate examination to detect possible sleep disorders.
Diagnosis of sleep disorders
The approach to the diagnosis and treatment of sleep disorders presented in this chapter is aimed at physicians who see patients in outpatient clinics. The current situation is such that a general practitioner with a long queue outside the door can only spend a very limited amount of time seeing a patient. Nevertheless, we strongly recommend that you ask the patient several questions about the quality of sleep, the presence of daytime sleepiness, and the state of performance. If the patient reports any disturbances in answer to these questions, he or she 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 a visit to the doctor. Even more rarely, patients specifically contact the doctor about this. Nevertheless, sleep disorders are quite common and have an adverse effect on well-being, performance, quality of life, general health and emotional well-being. Given these circumstances, a brief but comprehensive (“screening”) assessment of the state of sleep and wakefulness should become an indispensable part of the patient’s routine outpatient examination.
The initial assessment of sleep quality should include several aspects related to common 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?
Who to contact?
Treatment of sleep disorders
Insomnia is a symptom of sleep disturbance, which can be a manifestation of various diseases. Therefore, the first step towards treating insomnia should be a persistent search for the cause of the sleep disorder. Only by establishing the cause of insomnia can an effective strategy for its treatment be developed. Since the causes are different, the treatment can vary significantly. In some cases, patients first of all need help to cope with stress - this may require a consultation with a psychotherapist or psychologist. In cases where sleep disorders are caused by bad habits or incorrect actions of patients, it is important to convince them to follow the rules of sleep hygiene. If sleep disorders are associated with a somatic or neurological disease, abuse of psychoactive substances, the use of drugs, then the correction of these conditions is the most effective way to normalize sleep.
Insomnia often develops against the background of mental disorders, primarily depression. If a patient is diagnosed with major depression, he or she is always carefully examined for insomnia. For example, in the Hamilton Depression Rating Scale, often used to assess the severity of depression, 3 of the 21 items are devoted to sleep disorders.