Somnologist: sleeping pills are contraindicated for patients with sleep apnea

Treatment of insomnia requires special attention from a psychotherapist or psychiatrist. This is due to the fact that sleep disturbance is a direct signal of a disturbance in higher nervous activity, the beginning of the formation of some kind of mental disorder. That is why the sooner you start treating insomnia, the easier the recovery will be and prevent the development of a mental spectrum disorder.

Insomnia is a complex painful condition of the brain that prevents it from getting proper rest. If problems with falling asleep occur at least once a week or become natural, caused by some event or state of the body (for example, a woman’s period), then you should think about the need to treat insomnia.

Neurological origin of chronic insomnia

Stress and insomnia often go hand in hand. Regular psychological stress disrupts the functioning of the nervous system, including the areas of the brain responsible for sleep and wakefulness. Less sleep hormone is produced compared to the norm, and, on the contrary, more adrenaline-like substances. Therefore, the nervous system is overexcited, making it difficult for a person to fall asleep.

Neurosis is the second most common neurological factor causing insomnia. It is a consequence of a traumatic situation, an unfavorable situation in the family or at work, interpersonal and intrapersonal conflicts, and is sometimes associated with endocrine disorders. In most cases, chronic stress turns into neuroses.

In anxiety disorders, insomnia has the most striking manifestations. Most often, sleep problems occur during panic attacks, which are accompanied by severe fear, breathing problems, tachycardia (rapid heartbeat), and sweating.

Somatic form of the disease

Various diseases can contribute to sleep disturbances:

• hypertension;
• diabetes;
• itchy dermatoses and other skin diseases;
• pain of various etiologies (headaches, joints, tumors);
• peptic ulcer;
• hormonal imbalances, for example, thyrotoxicosis (increased levels of thyroid hormones of the thyroid gland);
• angina pectoris.

With somatic pathologies, a person cannot fall asleep for a long time because he does not feel well. He wakes up at night due to pain, and during the day he feels exhausted and sleepy.

A restless night's sleep can be associated with impaired circulation of the spinal cord and brain, leukemia and other blood diseases.

Insomnia is caused by urinary incontinence. It can be caused not only by nervous disorders, but also by urinary system infections, diabetes, and allergies. At the same time, the sleep is superficial, sensitive, there is a fear of getting the bed wet, which provokes even greater tension in the person. Frequently waking up to go to the toilet reduces the quality and overall duration of sleep.

Drug therapy

When people suffer from sleep disorders, the first option to combat this disease most often becomes sleeping pills and other pills or medications that relax the nervous system. But this option is only suitable for people who have previously tried to eliminate the problem using traditional methods without pills. But if the patient has decided to fight insomnia with the help of medications, then their choice should be especially responsible.

• A drug that improves sleep should be selected individually by the treating psychiatrist. This could be an antidepressant with a sedative effect, an antipsychotic, a tranquilizer, or another drug. Some drugs should be prescribed for a short time, others can be prescribed for a long time. The necessary medicine is selected individually, according to the existing problem. In case of somatic diseases, it is often enough to remove pain, frequent urination at night or itching to restore sleep.
• The drug should provoke sound sleep and maintain it until awakening;
• After waking up, residual drowsiness should be minimal;
• The drug should not be addictive;
• Side effects should be minimal.

Insomnia should be treated wisely, without going to extremes. The disease will recede if you treat it without excessive fanaticism, without stuffing yourself with drugs indiscriminately. Contact a psychiatrist-psychotherapist and he will definitely select the necessary treatment for you. It is often enough to teach a person relaxation techniques and self-hypnosis in order for the sleep problem to be solved once and for all.

You can contact the clinic’s specialists by phone in Moscow

Insomnia due to mental disorders

This group of causes is much more serious than neurological disorders, since we are not talking about stress and neuroses, but about mental illnesses.

In depression, insomnia manifests itself differently depending on the severity of the nervous disorder. The mild form is accompanied by increased drowsiness and disruption of the sleep-wake cycle (hypersomnia). But with moderate and severe depression, the nature of sleep (or its cycle) changes, and chronic insomnia develops. It is difficult for a person to fall asleep, sleep is unstable, and in the morning it is difficult to wake up and be alert.

At-risk groups

According to statistics, older people and middle-aged women are most susceptible to chronic sleep disorder. These are the main risk groups.

Elderly people often experience insomnia that lasts for months and even years, and the person cannot do anything about it. The main reasons for this are brain aging, low physical activity, and loneliness. In addition, in old age, the body's need for night sleep decreases physiologically.

For women over 40, lack of sleep can last for weeks. This is due to many factors - emotional sensitivity, suspiciousness, anxiety for older children, menopausal changes.

Other risk factors:

• poor nutrition;
• chronic lack of sleep, night shift work;
• overwork;
• frequent flights, time zone changes;
• uncontrolled use of medications and stimulants;
• intense mental work.

Treatment for chronic insomnia depends on the symptoms. To determine an accurate diagnosis and prescribe a course of treatment, it is recommended to consult a specialist.

Specifics of sleep disorders in the elderly

Elderly people suffering from insomnia are characterized by features that distinguish this pathology. Patients of the younger generation mainly experience problems with falling asleep, while insomnia in older people is expressed mainly by the problem of frequent awakenings, too light sleep and dreams of an anxious and disturbing nature. Sleep does not bring a sense of rest to elderly patients, and often grandparents prefer not to sleep at all rather than undergo such suffering every night.

Drugs for the treatment of insomnia

About a fifth of patients, especially those with mental or physical illness, require sleeping pills. In other cases, eliminating the cause of insomnia, using mild over-the-counter remedies and non-drug relaxation techniques may be sufficient.

You should not take sleeping pills without prior diagnosis and a doctor’s prescription. They have a number of strict contraindications and side effects.

Doctors always prescribe such drugs in the minimum possible dosage, since depression of the central nervous system, as well as its overexcitation, are equally dangerous to health.

Sleeping pills are prohibited for pregnant and lactating women, patients with breathing problems during sleep, and people whose activities involve concentration and quick reactions.

Prescription drugs

Different groups of drugs are indicated for the treatment of insomnia. It is up to the doctor to choose the appropriate medicine for treatment.

Tranquilizers calm the nervous system, relieve irritability, fear and anxiety, eliminate neurotic manifestations and muscle spasms. Prescribed in low or medium dosages, in high dosages they cause severe drowsiness. Examples of tranquilizers:

• Phenazepam;
• Tenoten;
• Buspirone;
• Mebicar;
• Afobazole;
• Diazepam;
• Phenibut;
• Grandaxin.

Barbiturates reduce anxiety and depression, but can cause drug dependence. When taken for a long time, they cause a state of weakness and depression, so they are prescribed in short courses. Examples of barbiturates:

• Nembutal;
• Etaminal sodium;
• Surital;
• Repozal;
• Barbamil.

Visiting a therapist and neurologist

To understand which doctor cures insomnia, you need to carefully evaluate the type of activity of each doctor. As you visit the therapist and complain to him about poor quality of sleep, he first of all asks the patient what is involved in going to sleep at night. This can be done:

• noise from households and (or) neighbors;
• taking certain types of tonics;
• taking medications, the side effects of which are considered to be insomnia.

Before visiting a doctor, you will need to prepare for him to prescribe tests and additional examinations that will help identify the causes of insomnia, as well as assess the person’s general condition. If this is not done, there will be no result from therapy.

If such a condition was caused by taking medications, the doctor will most likely cancel them or replace them with similar compounds that have a more gentle effect on health.

If the doctor finds the cause of insomnia, but cannot completely cure it, he will give a referral to a specialist with a narrower profile, for example, a neurologist.

The neurologist accepts those patients who have been diagnosed with:

• Parkinson's disease;
• narcolepsy;
• problems related to blood circulation in the brain;
• history of stroke;
• dementia that was acquired during life;
• high pressure inside the skull.

If the cause of disturbed sleep is accurately identified, treatment of insomnia will be quick and quite successful.

If a person suffers from diseases of the brain or blood vessels, sleeping pills will lead to a deterioration in memory.

A neurologist will prescribe drugs to a patient only after making a correct diagnosis - if the disease that has caused deterioration in sleep quality falls within his specialty, the doctor will prescribe a comprehensive treatment. Its correct implementation will help restore healthy and complete sleep in 2-4 weeks.

To establish the correct diagnosis, the doctor will prescribe the patient polysomnography - this is a modern study in which a special instrument records sleep parameters when the patient is asleep.

Since narcolepsy cannot be completely cured, comprehensive treatment is aimed at reducing the signs of the disease. During its course, the doctor’s duty is to normalize the quality of sleep at the maximum level. Of course, this is not always possible to do fully - in this case, the somnologist will prescribe medications to the patient that stimulate the central nervous system.

Such drugs will not allow a person to suddenly fall asleep during the daytime. And before going to bed, the patient will need to drink a gentle sleeping pill, which will allow the person to fall asleep quickly and soundly. Sometimes somnologists prescribe behavioral therapy to patients to fully cure insomnia.

However, this is not so - a psychologist will be able to correctly identify the cause of insomnia, as well as understand the psycho-emotional state of the patient. If insomnia occurs in an advanced form, the patient will need to undergo hypnoanalysis to carefully understand the person’s condition.

If a person develops insomnia due to a mental disorder, which is considered a common problem of the modern generation, patients will need to see a psychiatrist. After diagnosis, he will prescribe the following types of medications to the patient:

• neuroleptics;
• sedatives;
• antidepressants.

It is prohibited to take such medications on your own, since only a doctor can choose the correct dosage of a particular drug, as well as choose the safest and most effective treatment.

In the event that insomnia was caused by depression or stress, the doctor prescribes medications to help the person get enough sleep, after which he sends him to a psychologist to fully solve the problem.

Non-drug treatment

Massage, relaxing baths, and physiotherapy are effective in treating insomnia. Aromatherapy, evening meditation, and yoga classes will be useful.

Massage normalizes blood circulation near the brain and spinal cord, relieves muscle tone. It is especially useful to conduct a session immediately before bedtime. The course includes 10–20 procedures.

Physiotherapeutic methods of treatment use magnetic therapy, electrophoresis with sedatives, reflexology (acupuncture). Baths are an affordable way to relax after a working day, step away from everyday problems, and relieve muscle and mental tension.

Aromatherapy for calm and relaxation recommends using essential oils of lavender, chamomile, valerian, lemon balm or jasmine (5-7 drops in an aroma lamp or 3-4 drops in an aroma pendant).

Other effective and safe treatments for insomnia are cognitive therapy and behavior modification. This work is carried out by a psychologist or psychotherapist and includes teaching relaxation techniques, maintaining sleep hygiene, and destroying human stereotypes about the causes of insomnia.

Case from practice:

One day, adult children came to an appointment with their 65-year-old father, who, according to them, had been spending days and days in bed lately, had no initiative, complained of pain in his legs, an unsteady gait, which made him afraid to even get up to go to the toilet.

The man had a history of stroke and cancer of the root of the tongue, for which effective treatment was carried out in a timely manner.

Based on complaints of severe pain, the patient’s relatives suggested a recurrence of cancer, manifested by metastases in the bones of the legs. During the conversation and questioning, the man burst into tears and talked about his fears, the meaninglessness of life without work, the loss of all interest in life.

It turned out that he took sleeping pills day and night to sleep and forget. But he did this together with painkillers, and if he did not get the desired effect, then he added a little alcohol.

During the conversation and collection of information, a depressive disorder was diagnosed, a course of antidepressants was prescribed, additional therapeutic examination (which did not further confirm the children’s fears), the use of sleeping pills was adjusted, and a daily routine and social activity were prescribed.

Methods for preventing chronic insomnia

The following measures can help avoid the development of insomnia:

• refusal to abuse alcohol and energy drinks;
• limiting coffee, strong tea;
• adherence to sleep and wakefulness – refusal of daytime sleep and nightlife, fixed times of rising and falling asleep;
• regular exercise (home gymnastics, fitness, swimming, jogging, going to the gym, etc.);
• light dinner - fruits, dairy products, vegetables.

Melatonin is a hormone that regulates circadian rhythms and makes it easier to fall asleep. It can only be produced in sufficient quantities in complete darkness, so you need to make sure that the bedroom is dark.

Before going to bed, it is recommended to ventilate the room and not load the brain with reading, watching videos, listening to energetic or heavy music, or physical activity for 2 hours.

General recommendations

Each of the specialists mentioned, in addition to specific treatment, will give the patient general recommendations regarding behavior in everyday life:

1. Do not smoke before bed, because the stimulant effect of nicotine interferes with normal sleep and prevents you from falling asleep.
2. Do not drink alcohol before bed - it affects the deep sleep phases.
3. Do not abuse coffee and caffeine-containing products (cola, tea and chocolate). Since caffeine remains in the body for at least 12 hours, it is recommended to consume such products only in the first half of the day or not at all.
4. Do not overeat shortly before bedtime - a heavy stomach prevents you from falling asleep. If you want to have a snack, it is better to drink a glass of warm milk or eat 1 tsp. honey
5. The bedroom should be quiet and dark. If noise from behind the wall bothers you, you can try using earplugs, but some people cannot fall asleep precisely because of the sensation of a foreign body in their ears.
6. Before turning off the lights, it is better to read for a few minutes until you feel drowsy.
7. Avoid watching horror films, thrillers and melodramas that cause anxiety in the evening.

Usually it takes at least 3 months to normalize sleep, especially in the case of insomnia due to stress. If a person has been weakening his nervous system for several years, then he will not be able to cope with the problem in a week.

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