Dyssomnia - sleep disorder, how to cope

Dyssomnia is a condition in which a person is not satisfied with the quality or duration of sleep. To understand what dyssomnia is in adults and how this disorder affects the patient’s condition, you need to have an idea of ​​the limits of normal sleep duration, as well as how physiological certain conditions are.

For example, a person who sleeps only 5 hours and still feels great is most likely healthy. Anyone who spends more than 9 hours sleeping but still feels sleepy may be seriously ill. To determine the type of dyssomnia, medical studies are carried out, which make it possible to establish a diagnosis with high accuracy and help the patient regain healthy sleep.

What is dyssomnia

Neurology unites under the term “dissomnia” all sleep disorders associated with its quality, duration and time of day. According to statistics, this syndrome is present in some form in the vast majority of older people.

Dyssomnias occur very often in children. Any minor factor can affect the course of sleep. And although in young patients the frequency and severity of disorders is less than in adults, pediatricians treat this very carefully, since sleep plays an important role in the mental development of a child. In children under one year of age, the pathology manifests itself mainly in the form of insomnia, and from 1 to 5 years of age - in the form of walking and talking in sleep, night terrors and bruxism.

Symptoms of the disease in adults are varied, the main ones are:

1. Loss of coordination.
2. Hypertension.
3. Inability to concentrate.
4. Daytime sleepiness.
5. Slowing down the reaction.
6. Increase in body weight.

Dyssomnia can have an organic, neurosis-like, neurotic or epileptic etiology. Symptoms in this case include signs characteristic of the underlying disease.

SLEEP, MY JOY, SLEEP. Sleep disturbance in infants and young children

No. 102 (November 2015) Our little man

Complaints about sleep disorders are common in the practice of pediatricians and pediatric neurologists. The causes and structure of this phenomenon depend significantly on both the age, level of psychomotor development and health status of the child, and on the behavior pattern of the parents.

Vera Evgenievna Babicheva,

neurologist, children's clinic "YugMed"

It has been proven that difficulty falling asleep and frequent awakenings at an early age are usually associated with the behavior of parents when putting their children to bed.

WHY DO YOU NEED SLEEP?

A person spends approximately a third of his life sleeping. Sleep is a physiological phenomenon, the functions of which have not yet been fully elucidated. There are several theories explaining the purpose of sleep, two of which are the most popular: strengthening and educational/developmental. Strengthening (restorative) theory: during sleep, metabolism slows down, due to which the energy spent by the body during wakefulness is replenished. Learning/developmental theory: During sleep, information is reorganized and stored.

REASONS FOR VIOLATION

Sleep disorders are divided into dyssomnias and insomnias. Dyssomnia is defined as difficulty falling asleep lasting more than 30 minutes and/or frequent awakenings at night with the absence of a continuous six-hour night sleep. According to epidemiological studies, one or another variant of dyssomnia occurs in 25–35% of children aged 5 months to 5 years who are considered healthy!

The most common causes of dissomnia in infancy and early childhood are recognized as: the habit of staying awake at night, the habit of waking up early, learning to feed at night, disruption of the day-night rhythm, hunger and incorrect parental tactics when going to bed and waking up at night, i.e. Most dyssomnias in infancy and early childhood are behavioral disorders. Incorrect parental tactics for dyssomnia:

• the child goes to bed with a scandal;
• the child goes to bed already asleep, and not at the moment of falling asleep;
• the child is used to falling asleep in his arms, with a bottle or pacifier;
• the child is used to falling asleep with one of the adults.

OBSTRUCTIVE SLEEP APNEA SYNDROME. The syndrome is characterized by repeated episodes of upper airway obstruction (breathing disorder) that occur during sleep. Usually accompanied by a decrease in blood oxygen saturation. Enlarged tonsils and adenoids in combination with obesity are recognized as the main risk factors for sleep apnea in school-age children.

PARASOMNIA - unwanted physical phenomena of non-epileptic origin that occur when falling asleep and during sleep, which are not considered disorders of the sleep-wake cycle.

DISORDERS ASSOCIATED WITH INCOMPLETE AWAKENING. Confusion upon awakening (sleep intoxication). The disorder is characterized by disorientation in place and time upon awakening, slowing of thought processes, difficulty and incorrect answering questions and following commands, and amnesia. Confusion may last from a few minutes to several hours. Easily provoked by forced awakening, especially in the first third of the night. The maximum prevalence occurs before the age of 5 years.

SLEEPWALKING (somnambulism). This is a special form of sleep behavior that occurs in the stage of slow-wave sleep and consists of movements, actions and deeds that have the appearance of voluntary and purposeful. The duration of sleepwalking is 1-30 minutes. After the sleepwalking episode ends, the patient continues to sleep. When fully awakened, the child does not remember what happened. In most cases, the onset occurs at an early age, but the disorder can first appear in older children

NIGHT FEARS. This disorder is characterized by abnormal behavior that suddenly appears during the slow-wave sleep phase, demonstrating severe fear in the form of a high-pitched scream, motor restlessness, severe autonomic disorders (tachycardia, profuse sweating, pallor or flushing of the skin, tachypnea). There is no reaction to external stimuli; it is extremely difficult to wake the patient. Upon awakening, amnesia of the attack is noted. There is usually a positive family history of the disorder.

Sleep is a physiological phenomenon, the functions of which have not yet been fully elucidated.

DISORDERS THAT ARISE WHEN CHANGING SLEEP STAGES. The disorder is characterized by the occurrence of stereotypical, repetitive movements during sleep that involve large muscle groups, usually the head and neck. Movements are noted before reaching the third and fourth stages of slow-wave sleep. The most common variation is to rock the head from side to side while lying on your back. Less common are movements of the “shuttle” type (in a position on all fours, the child rocks back and forth or diagonally), beatings (in a position lying on his stomach, the child hits his head on a pillow or headboard, or a combination of beatings and movements of the “shuttle” type is observed). . The maximum debut occurs at the age of 2.5 years.

PARASOMNIA USUALLY ASSOCIATED WITH REM SLEEP. Nightmares (terrifying dreams). A sleep disorder that looks very similar to night terrors (severe motor restlessness with an affect of fear, severe autonomic symptoms). However, patients always remember the episode and explain its occurrence as a terrible dream. Immediately after waking up, an absolute understanding of what is happening is typical; falling back to sleep is difficult; episodes occur in the second half of sleep.

OTHER PARASOMNIAS. Bruxism is the rhythmic, unconscious grinding of teeth during sleep. This disorder is most unfavorable if it persists after 6 years, since it has been proven that it can lead to pathological tooth abrasion, dental hypersensitivity, gum irritation and is often associated with headaches.

Most cases of sleep disorders in children are relatively benign and transient.

SLEEP APNEA IN INFANTS. Apnea refers to episodes of breathing cessation in premature infants for more than 20 seconds, as well as cessation of breathing for less than 20 seconds, but with symptoms (cyanosis, severe pallor and hypotension). Approximately two-thirds of sleep apnea episodes occur during sleep and are accompanied by increased motor activity in the child, giving the impression of being awake. Apnea can occur spontaneously or be provoked by passive flexion of the neck, painful stimuli, or hiccups. The pathogenesis is due to the immaturity of the regulation of the respiratory system, namely the low sensitivity of the respiratory center to the concentration of carbon dioxide in the blood in combination with low minute ventilation. Apneas usually resolve spontaneously. Obstructive sleep apnea syndrome is characterized by repeated episodes of cessation of breathing due to airway obstruction during sleep. When the child awakens, diffuse muscle hypotonia and drowsiness are detected for some time. Sometimes the only sign may be a delay in the child's development. Cessation of breathing during sleep is accompanied by:

• changes in skin color (pallor or cyanosis);
• changes in muscle tone (usually hypotension, less often increased tone);
• noisy breathing in sleep.

Diagnosis of sleep disorders in children includes analysis of anamnesis and neurological and somatic examination data, the use of questionnaires, parents keeping a diary of the child’s sleep and wakefulness, as well as laboratory and instrumental examination - polysomnography.

Sleep disorders in childhood are quite common and occupy an important place in the practice of pediatric neurologists and pediatricians. Fortunately, most cases of sleep disorders in children are relatively benign and temporary. This applies, first of all, to dyssomnias of infancy and early childhood and some types of parasomnias. The task of a neurologist is to inform parents about the characteristics of children's sleep, its hygiene, the prevention of certain types of insomnia and the exclusion of more severe pathologies of the central nervous system.

GENERAL RECOMMENDATIONS for reducing signs of sleep disturbance in children:

• observe the bedtime ritual;
• maintain a daily routine;
• baby sleeping in his own bed;
• fresh bed linen;
• sleep in a ventilated area;
• exclusion of external stimuli;
• avoiding watching TV and playing computer games before bedtime;
• avoidance of stimulant medications.

Classification of syndromes

Presumably, every fourth adult periodically experiences some kind of disturbance in the duration and depth of sleep. Many neurological and somatic diseases are accompanied by dyssomnia, and disorders most often occur with depression and mental disorders.

Based on the nature of its occurrence, dyssomnia is divided into the following types:

1. Endogenous disorders . Appear when exposed to internal factors. The most common of them are physiological and idiopathic insomnia, central and obstructive apnea, restless legs syndrome, and narcolepsy.
2. Exogenous disorders. Occurs when exposed to external factors. This category includes alcohol insomnia, disruption of sleep patterns and conditions.
3. Circadian disorders . They are caused by a change in the normal circadian rhythm.

Patients do not always note discomfort during dyssomnia. For example, with restless legs syndrome or apnea, a person wakes up dozens of times at night, which affects the duration of rest, and there are difficulties with waking up and falling asleep, but these symptoms are sometimes noticeable only to the patient’s close people.

Causes of insomnia

• Stress, both physical and psycho-emotional; overwork or lack of stress;
• Lack of silence during sleep and unfavorable conditions for falling asleep (increased levels of humidity, noise, heat or cold, unusual place in bed, etc.);
• Changes in the sleep-wake cycle due to a change in time zone or work schedule;
• Taking certain medications or psychostimulants;
• Selected somatic (internal) and psychoneurological disorders (increased function of the thyroid gland (thyrotoxicosis), cardiovascular diseases, substance dependence, epilepsy, dementia, Parkinson's disease, asthenia, restless legs syndrome, anxiety disorders, depression, etc.) .

It is extremely important to initially establish the causes of emerging disorders. For this purpose, in addition to examining the patient who applied, the doctor studies in detail the patient’s daily routine and the characteristics of his diet. Concomitant diseases that may affect sleep quality are identified.

For diagnosis, methods such as polysomnography, 24-hour or night-time video monitoring with recording of an electroencephalogram, or electroencephalography during sleep can be used.

Treatment of dissomnias is carried out under the supervision of a neurologist. In case of sleep disorders caused by somatic diseases or psychological disorders, treatment is carried out in close cooperation with other specialists (therapist, cardiologist, psychotherapist, endocrinologist, etc.).

It is worth remembering that independent uncontrolled use of sleeping pills can lead to the development of drug dependence and worsening sleep disorders.

Our clinic specialists have extensive experience in diagnosing and treating sleep disorders. The clinic is equipped with modern equipment that allows us to identify physiological disorders in the nervous system that cause insomnia.

Main types

Based on the time from the onset of sleep disorders, episodic (about 7 days), short-term (1-3 weeks) and chronic dyssomnia (more than a month) are distinguished. Moreover, the first two forms can be provoked by taking certain medications that have a stimulating effect on the central nervous system.

There are four main types of dissomnia disorders:

1. Insomnia is characterized by difficulty falling asleep, interrupted sleep, difficulty waking up, and a feeling of inadequate rest.
2. Profundosomnia is expressed in excessively deep sleep (in children this can cause fecal and urinary incontinence).
3. Hypersomnia is characterized by persistent daytime sleepiness and increased overall rest time.
4. Parasomnia is characterized by motor, autonomic or behavioral disorders that occur during sleep, but are not always associated with it.

Chronic dyssomnia causes decreased performance, deterioration in quality of life, and in severe cases is associated with the risk of developing depressive disorders, anxiety, panic attacks and suicide.

Causes

Dyssomnia often occurs in pregnant women, the elderly and people with chronic diseases.

The main factors in the development of sleep problems in adults:

1. Neurosis, stress and depression.
2. Endocrine pathologies.
3. Injuries and organic diseases of the brain.
4. Use of certain medications (corticosteroids, antihistamines and bronchodilators).
5. Mental disorders.
6. Alcohol intoxication or abuse.
7. Somatic diseases.

Common reasons include hunger and thirst, disruption of routine, time zone change, and worry about unfulfilled tasks.

In children under one year of age, proper nutrition and daily routine are of great importance in the prevention of sleep disorders. The main reason for the appearance of dyssomnia in infants is improper organization of a place to rest, non-compliance with the feeding schedule, changes in sleep associations and other conditions that help calm the baby.

Dyssomnia in older children occurs due to pathological factors:

1. Emotional lability.
2. The influence of stressful situations and mental turmoil.
3. Presence of hyperactivity syndrome.
4. Epilepsy.

Kleine-Levin syndrome occurs most often in young men and has common symptoms with hysterical hypersomnia. Adolescents with this neuropsychiatric disorder are characterized by increased sexuality and aggressiveness, and they experience bouts of sleepiness during the daytime. The etiology of this syndrome has not yet been clarified.

Diagnostics

In order to diagnose the type and variety of dyssomnia, you need to contact a neurologist and undergo an examination.

When looking for the cause of sleep disturbance, the doctor evaluates the following criteria:

1. Peculiarities of work and life of the patient.
2. Results of psychological research.
3. Character traits and temperament of the patient.

Diagnosis is carried out based on the results of a polysomnographic examination.

The procedure makes it possible to determine the cause of the disorder: whether dyssomnia is primary or whether it appeared as a result of a somatic disease. Treatment is prescribed by a neurologist based on the diagnostic results.

Sleep disorders in children

Sleep disorders (dyssomnia) in children are a group of disorders associated with the quantity or quality of sleep.

Children are often susceptible to various sleep disorders, starting from a very young age. Most often, these disorders include insomnia, sleepwalking, sleep talking, nightmares, bruxism, and enuresis.

Causes of sleep disorders

The development of dyssomnia in children may be based on emotional shock, somatic or neurological problems.

The most common cause of sleep disturbances is emotional overstimulation of the child immediately before going to bed: noisy outdoor games, computer games, watching TV. Children's fears play an important role. Children are often very impressionable and may not cope with emotional experiences after watching scary films, computer games with elements of aggression, as well as after stressful situations in the family and school. As a result, insomnia, nightmares, and restless sleep occur.

Some types of dissomnias are caused by the immaturity of the nervous system and disappear with age, however, those dissomnias that significantly affect the child’s quality of life require correction by a specialist. For example, when sleepwalking (somnambulism, sleepwalking), a child can get injured. With insufficient sleep, frequent awakenings, the child is depressed and distracted during the day, which can affect the quality of learning and academic performance.

Diagnostics

If a child has severe sleep disturbances, parents should contact a pediatric neurologist. The doctor will conduct a detailed diagnosis of the child’s nervous system and determine the cause of the development of dyssomnia.

First of all, it is necessary to exclude somatic pathology, as a result of which a secondary sleep disorder could arise (disorders of the respiratory, cardiovascular systems, gastrointestinal tract, dysfunction of the thyroid gland).

Otherwise, the neurologist will refer you to the appropriate specialist - a pediatrician, gastroenterologist or endocrinologist. Also, such a phenomenon as nocturnal enuresis may be a manifestation of a disease of the genitourinary system and requires examination by a nephrologist or urologist. The main methods for diagnosing sleep disorders are polysomnography and EEG - these methods record various physiological indicators during sleep and allow you to evaluate each phase of sleep separately.

Treatment

Treatment of dyssomnia in children begins with parents adjusting their sleep-wake schedule and the process of getting ready for bed. Due to the immaturity of the child’s nervous system, the child’s processes of inhibition and relaxation may be disrupted, which leads to difficulties falling asleep. A neuropsychologist will help correct this disorder. It is necessary to set the same time for falling asleep and waking up, stop active games and noisy activities an hour before bedtime.

It is best to take short walks in the fresh air, to occupy the child with something calm, monotonous - drawing, embroidery, reading. The child may be indicated for therapeutic massage, osteopathy, reflexology, as well as consultation with a psychologist if the child has fears, phobias and problems with emotional background. Also, a neurologist can prescribe medications that strengthen the nervous system - vitamins and herbal remedies.

Treatment

Polysomnography reveals disturbances in sleep phases. The principle of therapy, accordingly, depends on the clinical form of dyssomnia. In each specific case, a certain effect is required (for example, deepening the slow phase, lengthening or shortening the fast phase).

Therapy usually begins with mild sedatives, pain relief, physical therapy and relaxing massage. If the pathology has a psychological etiology, then treatment is carried out with the participation of a psychotherapist.

In addition, you should change your sleep and wakefulness patterns. Refuse to frequently change time zones, work shifts, and do not abuse food and drinks containing caffeine. It is important to properly organize your sleeping area and create comfortable conditions for relaxation.

Taking medications with a hypnotic effect is permissible only if you have difficulty falling asleep, as well as with a significant reduction in the duration of night sleep. In case of phase cyclicity disorders and parasomnias, if the total duration of rest is normal, medications containing melatonin are prescribed.