Sleep problems: causes, symptoms

Sleep is an important element of human life. And although we do not sleep 16 hours a day, like cats, we need sleep no less. During the 6-9 hours that the average person spends on sleep, the body has time to rest and recover enough for productive work during the day. The body needs such rest to improve thought processes, restore energy and strength, stabilize protective functions, therefore, when problems with sleep arise, we do not just feel sleepy and broken during the day, our health suffers.

Do not think that during the night sleep the body switches off completely. Its organs and systems continue to function, but less actively, which makes it possible to save and accumulate energy necessary for work during the day. Quiet work without stress is a full rest for our organs, which they really need, otherwise they wear out and gradually begin to fail. Isn't this a reason to think about the quality of your sleep and what it is for the body: rest or an additional, exhausting load?

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Causes sleep problems

Without being distracted by all the variety of sleep disorders, let's try to determine the main pathological and physiological causes that can cause such disorders:

• Mental disorders. Probably, many immediately imagine a schizophrenic or paranoid person, who, of course, are characterized by sleep disorders. In fact, we are talking about more everyday pathologies, such as stress, neuroses, depression, strong emotional experiences, phobias.
• Overfatigue of the body and the brain in particular as a result of excessive physical or mental stress.
• Failure to observe the sleep-wake cycle (conscious or unconscious).
• Neurological and other syndromes manifested by increased unconscious physical activity or breathing disorders at night.
• Alcohol abuse, drug use, smoking.
• Intoxication of the body of any etiology.
• Abuse of heavy, fatty and sweet foods in the evening, overeating, late dinner.
• Active therapy with psychotropic drugs and medications that stimulate or, conversely, inhibit the activity of the central nervous system, uncontrolled use of sleeping pills.
• Acute and chronic diseases of internal organs.
• Metabolic disorders, hormonal imbalance due to disruptions in the endocrine system.
• Organic pathologies of the brain, including benign and malignant neoplasms.
• Pain syndrome of various localizations.

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Risk factors

Risk factors for various sleep problems include unfavorable conditions for a night's rest: an uncomfortable bed, extraneous irritating odors, intense light, loud sounds, unsuitable temperature conditions and humidity in the room. Sleep problems can be expected if you strain your brain too much the night before going to bed, which happens when working on a computer in the evening, reading, watching TV, etc.

In school age, the cause of insomnia and sleep disorders can be the habit of doing homework late at night, after which the brain remains awake for a long time. In older schoolchildren and students, pre-exam insomnia or sleep disorders due to love experiences can be observed.

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Pathogenesis

Sleep problems are a general concept that combines various disturbances of a person's night rest. The most common problem is, of course, insomnia. According to statistics, 10 to 20% of the population have difficulty falling asleep. And this is only the complaint we are talking about. But insomnia means not only problems with falling asleep, but also early awakenings long before the appointed hour, episodes of interrupted sleep in the middle of the night, half-sleep. That is, everything that does not allow the body to fully rest during the night.

This is one side of the coin. On the other hand, we see only those cases where a person actually sought help from specialists regarding sleep disorders. But most of us are in no hurry to visit doctors with such a problem, considering it temporary and not dangerous. It turns out that if you dig deeper, the statistical picture will be completely different, but even less comforting.

In addition to insomnia, which is scientifically called “insomnia,” there are other sleep disorders:

• Hypersomnia (by analogy with insomnia, we can understand that we are talking about excess sleep or increased sleepiness),
• Parasomnia (in this case, it refers to disturbances in the functioning of various organs that occur only during sleep),
• Disruption of biological rhythms.

Let us consider these sleep pathologies in more detail, based on the fact that each of them has its own psychological and pathological causes.

Insomnia

Insomnia is a disorder of the processes of falling asleep, sleeping and waking up, as a result of which the total number of hours of sleep during the night is insufficient for a full rest. A person either does not sleep at night at all, or sleeps from 0.5 to 4 hours, while for the normal functioning of the body it usually requires from 6 to 9 hours of sleep for recovery.

It is clear that all these figures are approximate, because each person is individual. For someone, 4 hours of deep, restful sleep may be enough to have a good rest, while another will feel exhausted even after 9 hours of rest.

The time we need for a good rest depends on:

• depending on age (children, who grow and get stronger in their sleep, as well as the elderly, whose bodies are worn out and need a long rest, need more time than young adults),
• from lifestyle (an active lifestyle with high energy expenditure requires more time for rest and recovery of the body than a sedentary one),
• depending on the type of activity (engaging in heavy physical or intellectual work should be compensated by 8-9 hours of normal sleep so that work productivity is maintained for a long time),
• from the state of health, etc.

But the issue now is not so much about sleep time, but about the fact that a person cannot use the time allotted for sleep as intended. He cannot fall asleep, wakes up in the middle of the night or early in the morning, although there is no need to get up early.

We are used to thinking that insomnia is the result of our tense psycho-emotional state. There is some truth in this. If a person is overly excited by thoughts or memories of some important event, it is very difficult to fall asleep in such a state. In this case, we are talking about psychosomatic insomnia, which can be either temporary or permanent. In the first case, we have episodic (situational) insomnia associated with a certain event. In the second, we are talking about sleep disorders in people with increased excitability of the nervous system or depressive individuals.

In healthy people, insomnia can be caused by both an excited state of the nervous system (vivid memories, exciting thoughts, dreams, etc.) and the conventions that we ourselves set regarding sleep. For example, it is generally accepted that:

• you need to sleep with the curtains closed,
• with the TV turned off,
• you need to go to bed at 9 o'clock,
• get up at 6,
• you need to sleep at least 8 hours and only in silence, etc.

But who is doing this, and on what grounds? By forcing ourselves to act according to such rules, we only disrupt our sleep. Try falling asleep at 9 p.m. if you don’t feel like sleeping at all. The result will be 2-3 hours of tossing and turning in bed before falling asleep, restless sleep, and exhaustion in the morning.

By following the rule of sleeping in silence and darkness, we only accustom the body to the fact that it will only rest in such conditions. It is worth finding ourselves somewhere on the road at night or in a room near it, and we will no longer be able to fall asleep because of the noise. The same applies to illuminated rooms (for example, some people can have a great rest at the station while waiting for a train, while others will not be able to fall asleep because of the light in the hall).

The situation is identical with the ban on eating before bed or at night, because the digestive system also needs to rest. But you can't fall asleep so easily on an empty stomach, and you can't even dream of a good night's sleep. And is it worth limiting yourself so much, sacrificing a good night's rest?

Night is a time for rest, not for violence against oneself. Therefore, in bed, you should not think about the number of hours for sleep, about suitable and undesirable conditions, about the consequences of insufficient sleep, about possible insomnia or fighting it with sleeping pills, etc. Otherwise, even 8-9 hours allotted for sleep will not be enough, because such thoughts only sharpen our senses, so everything that can interfere with normal, in our opinion, sleep begins to irritate: smells, noises, the sound of a clock, a hard or too soft pillow, snoring behind the wall, etc.

But insomnia is not always the fruit of our thoughts and prejudices. Insomnia can be caused by a large portion of food or an invigorating drink (for example, coffee or an energy drink) taken before bed. Insomnia can be a consequence of regular alcohol abuse or taking medications that have a stimulating or inhibitory effect on the central nervous system. Sleep disturbances can also be caused by abrupt withdrawal of drugs with a sedative or hypnotic effect.

Insomnia can be a symptom of various mental illnesses, restless legs syndrome, breathing disorders (sleep apnea, alveolar ventilation syndrome). With restless legs syndrome, a person cannot fall asleep because of unpleasant sensations in the legs, with breathing disorders, the cause of insomnia can be the fear of the onset of symptoms of the disease (respiratory arrest), thoughts about it, the breathing disorders themselves.

It is clear that sleep problems in the form of insomnia can appear during periods of exacerbation of various diseases, with metabolic disorders affecting the functioning of the brain and central nervous system, and pain syndrome.

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Hypersomnia

This is a condition opposite to insomnia, as a result of which a person constantly wants to sleep, even if he sleeps at least 9 hours a day. The psychophysiological type of hypersomnia, which can also be episodic or constant, is associated with overexertion, both physically and psychoemotionally. In this case, a loss of strength is felt, requiring more time to restore the body's functions. Hypersomnia on a permanent basis can be associated with a physiological feature of a particular individual.

Like insomnia, hypersomnia can be caused by alcohol consumption or certain medications that list drowsiness as a side effect, mental illness, and sleep-disordered breathing (in this case, a lack of rest at night manifests itself as daytime sleepiness).

The category of hypersomnias also includes such a neurological pathology as narcolepsy, in which a person can "switch off" for a short time several times during the day. This presumably hereditary disease has specific symptoms:

• sudden falling asleep awakening, accompanied by muscle paralysis (consciousness is activated earlier than the ability for motor activity; in the first moments after awakening, only the eyes and eyelids move),
• a sharp weakness of the muscles of the postures under the influence of strong emotions (cataplexy), which causes falls and injuries,
• daydreams that appear before a person falls asleep or immediately after waking up (visions are vivid and can be accompanied by sounds and sensations, so they are difficult to differentiate from real ones).

It is clear that increased sleepiness can be observed with various health problems, both acute and chronic, which indicates weakness as a result of illness.

Parasomnia

This term does not mean a specific disease, but a whole list of pathologies in which malfunctions of various organs and systems are observed during sleep or awakening. The most common on this list are: somnambulism (sleepwalking), nightmares and horrors, bruxism associated with increased activity of the brain during sleep, as well as enuresis, which everyone knows as urinary incontinence at night.

Sleepwalking is a disorder in which a person's motor activity during sleep is virtually no different from that during periods of wakefulness. A person can walk, orient themselves in space quite well, perform routine household chores, and answer questions without waking up. Despite the fact that a sleepwalker's eyes are usually open during movement, and his actions and answers seem quite meaningful, he cannot remember anything after waking up.

Sleepwalking is an episodic phenomenon. A person does not walk at night regularly. Sleepwalking attacks can be caused by sleep deficiency, inadequate night rest, taking certain medications, alcohol and drug abuse, stress, neuroses, epilepsy, anxiety. Episodes of sleepwalking can be observed during fever during illness.

Nightmares and horrors are something that has haunted each of us at least once in our sleep. At the same time, awakening did not promise anything pleasant. And although there were no clear memories of what we saw in the dream after waking up, anxiety and despair were felt in the soul.

Nightmares are a type of normal dreams that occur during the REM phase. They leave only heavy emotions. But horrors are something atypical, since they occur during the deep sleep phase, which is abnormal in itself. Waking up from horrors is considered even more difficult, since a person cannot immediately understand where the dream is and where reality is.

Why do such dreams occur that interrupt a full sleep and do not allow one to fall asleep quickly and peacefully after them? It is quite possible that a person has previously experienced a strong mental shock, which the subconscious subsequently translated into fairy-tale images, fantasy elements, etc. The same nightmares can be a signal from the subconscious about the onset of an illness. But they can also be a consequence of a wild imagination after reading books, watching films or participating in computer games that contain elements of horror.

It is clear that such dreams can haunt a person whose mind is occupied with anxious thoughts. Such sleep disorders are typical for depression and can cause insomnia. Nightmares can often be dreamed by those who already have certain fears (phobias). At the same time, they seem to stimulate such mental disorders from within.

Night terrors can be a side effect of certain medications, such as antidepressants and blood pressure medications.

Bruxism, or involuntary grinding/tapping of teeth in sleep, is a problem not so much for the sleeper as for those around him. Episodes of pathology can be isolated or repeated several times a night. The person himself usually does not wake up, mainly the teeth and jaws suffer, because the sleeper does not control the force of pressure on them. But people who sleep in the same room with such a person have a hard time.

There are also several other types of parasomnias:

• nocturnal myoclonus, which includes restless legs syndrome, night cramps, rhythmic movements of the limbs,
• nocturnal epileptic seizures,
• nocturia or frequent urination at night,
• a hereditary pathology characterized by paralysis of the muscles of the limbs upon sudden awakening (sleep paralysis).

Previously, it was believed that the cause of such a sleep problem is helminths, but this theory has not found its scientific basis. Most likely, the provoking factor is still stress, strong anxiety, great mental stress, a state of mental fatigue after experiencing grief. This pathology is also characteristic of people with an incorrect bite.

Rapid eye movement disorder is another pathology in which a person begins to move actively in their sleep. But if in somnambulism such movements are unhurried and meaningful, then in this disorder they are spontaneous and abrupt. Moreover, motor activity is observed only in the rapid eye movement phase.

Normally, the REM phase of sleep is characterized by active brain function, the appearance of dreams, while only the muscles of the heart and respiratory system can contract. The tone of the remaining muscles is reduced, so the person remains motionless.

With REM sleep disorder, muscle paralysis does not occur. On the contrary, a person actively reacts to their dreams, as a result of which they may scream, cry, jump out of bed, wring their hands, wave their arms and legs, etc. Such behavior not only prevents others from sleeping, but can also cause injuries to both the patient and those around them.

The causes of this disorder are not fully known. There is a connection between REM sleep disorder and some severe neurological pathologies, including Parkinsonism and senile dementia. But statistics show that this disorder often accompanies the use of alcoholic beverages and antidepressants.

Sleep-wake rhythm disorders

Here we are talking not so much about a separate pathology, but about the development of syndromes that ultimately lead to the appearance of insomnia (slow and premature sleep syndromes, syndrome of a non-twenty-four-hour sleep-wake cycle).

The states of sleep and wakefulness (circadian rhythms) are regulated by our biological clock, which is oriented to the time of day. The impetus for the production of melatonin (sleep hormone) is considered to be a decrease in illumination in the evening. It begins to get dark, and we are inclined to sleep, since the brain gives a signal to go to bed. Light is an irritant to the senses, which leads to the awakening of the brain, and then all other organs.

Sleep problems begin when circadian rhythms are disrupted. This can be caused by:

• change of time zones,
• shift work (it is difficult for the body to get used to getting up and going to bed at different times, it is unnatural for it to sleep when it is light outside and to be awake in the dark),
• changes in work schedule,
• excessive physical and especially mental stress, which slows down the production of sleep hormones,
• changing the clocks in spring and autumn (many people experience sleep problems for a month or more due to this).
• lack of a daily routine, when a person disrupts circadian rhythms by going to bed at a different time on weekends (usually later than on weekdays),
• creative insomnia (the situation is similar to the previous one, but the person regularly postpones going to bed until later, claiming that he works better at night),
• unfavorable environmental conditions (strong odors, loud noise, bright lighting in the evening, too high or low air temperature, high or very low humidity).

Moreover, sleep disturbances can be either temporary (they go away after the microclimate in the room is normalized or the load on the body is reduced) or permanent (for example, if a person travels regularly and the body has to adapt to changing time zones).

To avoid such failures, you should always go to bed and get up at the same time. Then you won't have to force yourself to sleep, which is basically impossible.

Symptoms sleep problems

The clinical picture of various sleep problems is always unique, as is the body of each of us. Sometimes patients' complaints about difficulties falling asleep and restless sleep speak for themselves, and it is not difficult for a doctor to determine a diagnosis. In other cases, a person simply does not suspect what is causing his deterioration in health, so the topic of sleep is not even touched upon.

But in any case, sleep problems cannot go unnoticed, because they negatively affect not only a person’s ability to work productively mentally and physically, but also their general condition, causing irritability, headaches, constant fatigue, drowsiness, and apathy.

The symptoms of various sleep disorders should be considered not only in relation to a specific pathology, but also taking into account the causes that caused it. At the same time, the clinical picture of the same pathology can have its own distinctive features, which is especially noticeable in the example of insomnia.

Psychosomatic insomnia

Insomnia due to strong emotions is most often a temporary phenomenon and lasts no more than three weeks. If the problem persists, although the emotions are no longer so acute, it is better not to postpone a visit to a specialist.

A person with psychosomatic insomnia complains that he/she cannot fall asleep for a long time while in bed, then wakes up in the middle of the night more than once and again has difficulty falling asleep. In the morning, such patients usually wake up long before the alarm clock rings, but not because the body has had enough rest. During the day, they feel that they have not slept enough, they want to sleep, everything irritates them.

According to patients, the time spent awake at night drags on too slowly, which makes them even more tired. A person waits for sleep to come or for morning to break this torment. Everything is complicated by the fact that in a person’s thoughts, situations related to lack of sleep begin to scroll: he counts the time until he gets up, thinks about how he will feel after a sleepless night, worries about fulfilling his work duties and the impossibility of resting during working hours, makes plans for the future that include going to bed early. This makes the brain work even more actively and there can be no talk of a full rest.

But these are only the first signs of pathology. Then a person develops chronic fatigue, which greatly affects labor productivity. A person may feel weak and exhausted during the day, he or she has headaches and drowsiness. But despite a strong desire to sleep, it is impossible to do so during the day due to the tension of the nervous system, which reacts to the slightest irritants.

Patients become emotionally unstable, which is accompanied by a violent reaction to any irritants. As a result, we have conflicts at work and at home, failure to fulfill professional duties, demotion, depression, etc.

Usually, situational depression does not have serious consequences. Sleep returns to normal as soon as the person's psycho-emotional state is normalized. Unfortunately, this is not always the case. There is a certain percentage of cases when you have to turn to specialists for help in restoring normal night rest, because insomnia becomes permanent, which is fraught with various complications.

Drug and alcohol insomnia

Insomnia caused by taking medications is similar in its symptoms to insomnia caused by long-term alcohol consumption. In this case, a person falls asleep normally, but the REM phase becomes shorter, and sleep is constantly interrupted.

Sleep problems after a binge are typical for both men and women. After all, the cause of such disorders is the toxic effect of alcohol on the nervous system. Nerve cells suffer, which results in the inability to conduct impulses, circadian rhythms are disrupted, and sleep phases are blurred.

Insomnia can be a result of drinking large amounts of alcohol. But in this case, it lasts only for a couple of days. In chronic alcoholism, intoxication in any case leads to disruptions in biological rhythms (alcoholics often confuse night and day, so it is difficult to put them to bed in the evening and wake them up in the morning), which is more difficult to correct and can lead to constant insomnia.

Symptoms of alcohol insomnia:

• the person regularly does not get enough sleep,
• feels tired (even in the morning),
• sleep, although deep, is short or intermittent,
• the appearance of nightmares and an anxious feeling upon awakening is observed,
• symptoms of REM sleep behavioral disorder appear in the form of screaming and sudden movements in sleep.

Treatment of insomnia in alcoholism is possible only after getting rid of alcohol addiction. Usually, as soon as a person stops poisoning himself with alcohol, sleep gradually improves within 2-3 weeks.

An identical picture is observed when taking sedatives, sleeping pills or antidepressants. If such medications are taken for a long time, addiction to them appears, which significantly reduces the effect of taking the medications. As a result, it is necessary to increase the doses, which also leads to intoxication and complication of the condition. So, insomnia medications can only worsen the situation if taken for a long time and without doctor's supervision.

Sleep problems in adults usually come down to insomnia or hypersomnia. And one usually follows from the other. It is clear that if a person does not sleep normally at night, then during the day he feels tired and sleepy, and if after that he manages to rest during the day, there may be difficulties falling asleep at night.

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Smoking and insomnia

But adults burdened with multiple bad habits have another riddle: they quit smoking and started having problems sleeping. It would seem that why does quitting alcohol help normalize sleep, while quitting cigarettes, on the contrary, causes insomnia, although the person has never had such a problem before? Insomnia manifests itself mainly in the fact that a person cannot fall asleep without first lighting a cigarette. If you do not smoke, your sleep will be restless, and you may wake up early, caused by the same desire to get a sip of nicotine.

It must be said that insomnia when quitting smoking is a fairly common problem. 95-97% of those who quit smoking experience sleep disorders. It is already difficult for a person to get rid of the addiction, and then there are problems with sleep, which only increase irritability. But what is the connection between nicotine and normal sleep?

Firstly, nicotine reduces the production of the mediator of excitability of nerve cells in the body - acetylcholine, because it itself acts in the same way. The brain begins to experience dependence on nicotine in order to start working actively, therefore an uncontrollable desire to smoke appears, which does not allow the nervous system to relax, which contributes to falling asleep.

Secondly, smoking before bed or in the morning has become a kind of ritual for many smokers. Smoking cigarettes on an adult has an effect similar to a pacifier, which helps a child calm down and fall asleep. It is psychologically difficult for a former smoker to give up the opportunity to calm his nerves in such a pleasant way. In addition, he simply does not remember other ways to relieve the tension accumulated during the day in order to quickly fall asleep.

It is important to understand that nicotine, like alcohol or drugs, has a negative effect on the nervous system, causing increased blood pressure, decreased performance, headaches, and disruption of many organs and systems, including circadian rhythms. That is, sleep disorders could have appeared in a person earlier, but the smoker began to feel this especially acutely only after he decided to give up the bad habit.

"Pathological" insomnia

If the cause of insomnia is serious mental disorders, including depression, sleep disturbance will consist of constant nighttime restlessness, light sleep, which can rather be called half-sleep, and frequent awakenings. In the morning, the patient becomes apathetic, tired, inhibited.

Insomnia due to sleep apnea occurs due to sudden cessation of breathing. A person begins to snore or move restlessly in his sleep, and wakes up from this. It is clear that difficulty breathing and the danger of suffocation can sow fear in the soul of the patient, because of which he will be afraid to fall asleep and die in his sleep. Over time, the problem of waking up in the middle of the night develops into difficulties with falling asleep.

Insomnia associated with restless legs syndrome manifests itself in the fact that a person first cannot fall asleep because of an unpleasant sensation that makes them move their legs (but this sensation only goes away when they get out of bed and walk around), and then in waking up in the middle of the night for the same reason. Only now, with involuntary flexion movements of their legs, feet, or toes, the person wakes themselves up. They have to get up again to get rid of the unpleasant feeling.

Now let's talk a little about the symptoms of other sleep disorders.

Hypersomnia

The first signs of increased sleepiness are, of course, a constant desire to go to bed, so they look sluggish and lacking initiative (especially in the morning and evening, when it gets dark). Such people usually fall asleep quickly (they are said to switch off instantly, just by putting their head on the pillow) and sleep for a long time (9-12 hours a day, and sometimes more). The exception is situations that cause strong anxiety. But even here, the process of falling asleep will not be too long.

Sometimes hypersomnia is a sign of fatigue of the body due to overexertion or illness, but very often doctors are faced with a physiological feature of the body that makes no sense to treat.

An interesting form of hypersomnia is considered to be narcolepsy. Scientists believe that the cause of the pathology is insufficient production of the hormone orexin in the patient's body, which is responsible for the body's wakefulness. Thus, a person even during the daytime feels the need for sleep, he seems sleepy and can fall asleep at any moment, and not just fall asleep, but relax to such an extent that he simply falls to the floor.

Episodes of sudden falling asleep in narcolepsy occur not only during rest or monotonous work. Nothing prevents a person from switching off during a trip in transport (even while driving) or other active activity. In this case, he can sit or stand, and the next minute find himself on the floor. This most often happens against the background of strong excitement (fear, joy, anger, etc.).

Circadian rhythm disorders

Sleep problems due to time zone changes or clock changes manifest themselves in difficulties adapting to the new time. If a person is used to falling asleep at 10 pm, then at 8-9 am he may not yet feel the need for rest, and falling asleep will be delayed for obvious reasons. But if the time shift is in the other direction, then in the evening the person will feel sleepy, and in the morning he will wake up earlier than local time and will feel sleep-deprived.

It is especially difficult for people who have to travel frequently to other countries where the time zone difference is 3 or more hours, as well as for those who work shifts. The body simply stops understanding when it is time to sleep and when to be awake. A person will simply fall asleep during the day and have problems falling asleep at night. Waking up in the middle of the night is also possible, and it will be very problematic for a person to fall asleep a second time.

Slow sleep syndrome is a disorder in which a person has difficulty falling asleep at the right time. Before 12 midnight, such people feel very alert, so going to bed is out of the question. After 12, activity decreases somewhat, but a person cannot fall asleep before 1-2 am, or even later. It is clear that such people also cannot wake up on time, so they get enough sleep mainly on weekends, when there is no need to stick to a schedule.

Premature sleep syndrome is a condition opposite to the one described above. People with this syndrome go to bed early and wake up early, which is typical for most old people. They are quite alert during the day and reduce their activity when it starts to get dark. In principle, the problem of lack of sleep does not arise here, so the help of specialists and correction of the daily routine are not required.

A syndrome in which the biological clock of a real person counts not 24 hours, but more, is characterized by constant shifts in the phases of sleep and wakefulness. Most often, this pathology occurs in the blind, because their brain does not receive a command to produce a sleep hormone from the eye, so the body measures time approximately, which causes failures. A similar situation can be observed in personality disorders.

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Parasomnias

This is a combination of sleep disorders and disorders of various organs and systems. We have already mentioned somnambulism in detail. This pathology is characterized by sleepwalking, unconscious movements that seem quite conscious until they become dangerous for the person, talking in sleep, eyes often open, the ability to answer questions (usually in monosyllables). At the same time, the person seems quite calm, but putting him back to bed will not be so easy.

Night terrors and nightmares rarely occur in the middle of the night or in the early morning. Most often, a person wakes up from them shortly after falling asleep. One look at him is enough to understand the reason for such a sudden awakening: fear and panic on the face, eyes wide open, pupils dilated, the body covered in sweat, breathing and pulse rapid. The patient may scream in fear upon awakening, sit up in bed or grab his feet.

Usually, after a few minutes, when the understanding comes that it was just a dream, the person calms down and quickly falls asleep. In the morning, he may not remember anything about the nightmare or remember only individual moments.

Nocturnal enuresis has only one symptom – involuntary urination during sleep, which mainly affects children. The patient may not even wake up. For babies who do not yet know how to use a potty, this is normal. In older children, this condition is often associated with mental disorders that arise against the background of stress or nervous shock. And the older the child becomes, the more problems arise on this basis. Fearing condemnation from adults or peers, a child or teenager is afraid to sleep in a common room with other children, because he will not be able to control the release of urine in his sleep, and in the morning it will be even more problematic to hide the traces.

Sleep problems in different groups of people

It should be said that sleep disorders are equally characteristic of people of different sexes and ages. The causes and types of such disorders may differ. For example, old people usually suffer from increased sleepiness and disturbances in biological rhythms, which is quite understandable against the background of age-related physiological changes in various organs and systems. Young people and middle-aged people, mired in everyday problems, relationship difficulties and professional tasks, are more prone to insomnia, while many teenagers and schoolchildren may "suffer" from hypersomnia due to early rising and high physical activity.

Sleep problems during pregnancy are one of the most common problems for expectant mothers. We are talking mainly about insomnia, the reasons for which in this delicate period become more and more numerous with each new day.

About 80% of pregnant women suffer from sleepless nights. Most often, this condition is a direct sign of pregnancy, since it occurs in the first months after the baby is conceived. The cause of sleep problems during this period are hormonal changes that prepare the woman's body for increased work. Progesterone and other hormones simply do not allow the expectant mother to relax, reminding her that her task is to bear and give birth to a healthy baby.

Sleep problems can start from the moment a woman learns about her pregnancy. For some, this is an incredible joy, for others, it is a terrible tragedy that requires a choice to be made as soon as possible: to keep the child or have an abortion. In any case, the body experiences emotional overload, which does not allow the woman to sleep peacefully.

Next come hormonal changes and a bunch of other problems that haunt a pregnant woman at every step:

• the belly grows and it becomes increasingly difficult to choose a position in which it is possible to fall asleep and have a peaceful sleep (we all get used to sleeping in our own way, some on our stomachs, others on our sides or backs, and changing positions will be difficult in any case),
• pain in the back and lower back appears, which is in no hurry to subside, even when the woman is resting,
• the baby in the womb begins to move, so it can easily wake up its mother in the middle of the night (after all, it can’t see whether it’s day or night outside),
• you have to go to the toilet more often to pee, including at night, and all because the growing uterus begins to put pressure on the bladder, which now has a smaller capacity,
• problems with the digestive system appear, which also does not have the best effect on night rest,
• during pregnancy, it is not uncommon for leg cramps to appear, especially if the mother wants to pull her socks in her sleep, it is clear that the appearance of cramps leads to a sharp awakening, which makes it harder to fall asleep further,
• in the abdominal area, many pregnant women note an annoying itch that does not subside even at night, preventing them from falling asleep,
• a growing belly puts pressure not only on the bladder, but also on the lungs, resulting in shortness of breath and breathing problems during sleep,
• a pregnant woman's body works for two, so it is not surprising that over time the young mother begins to experience chronic fatigue, which on the one hand causes drowsiness, but on the other hand does not allow her to rest normally at night,
• During the entire pregnancy, a woman experiences not only joy, but also anxiety for her unborn baby. The fear of harming the child in a dream, thoughts about the upcoming birth and further life in a new capacity absorb the woman so much that they lead to nervous tension, leading to insomnia. And if some complications arise and there is a reason for concern, nightmares can join insomnia, which further exhausts the woman who is ready to become a mother.

As we can see, there are more than enough reasons for sleep disorders during pregnancy, and lack of sleep cannot but affect the health of the expectant mother, while the health and life of the child in her womb directly depends on this moment. Lack of adequate sleep in conditions of increased body work can lead to premature birth or weak labor.

Unfortunately, the problems of young mothers usually do not end with childbirth. Seven to nine months of waiting and worrying do not pass in vain. The woman's nervous system has already become quite fragile during this time, so any irritant is now perceived with hostility. Fatigue after childbirth, the need to take care of the baby every minute, worrying about his health against the background of a weakened nervous system naturally cause problems with sleep.

Despite the fatigue that literally knocks the new mother off her feet in the evenings, she cannot fall asleep easily. The thing is that nervous and physical overstrain plus the well-known suspiciousness of young mothers who are afraid of not hearing their baby cough, burp or, God forbid, stop breathing in their sleep, do not allow a tired woman to fall asleep normally. And over time, fatigue only accumulates.

There is no escape, pregnant women and young mothers are prone to increased suspiciousness, caused by the maternal instinct to protect their child from all adversity. Only support and care from relatives, as well as learning self-control and self-control techniques can help.

Childbirth is hard work and possible tissue damage. The new mother needs time for the body to return to normal. In the first days, she may be tormented by pain in the lower abdomen associated with the contraction of the uterus and return to its previous state. Severe discomfort can also be caused by aching stitches after a cesarean section. These inconveniences against the background of reverse hormonal changes do not have the best effect on the night's rest of the woman, who at first cannot fall asleep, and then seizes up in the middle of the night as if on cue.

Another problem is the fear that after the period of bearing a child and giving birth, a woman's figure has become less attractive. A young woman worries that her husband may cool towards her and seek pleasure elsewhere.

Most often, problems with sleep after childbirth arise in women with their first child. The desire to be everywhere and do everything perfectly runs into a lack of experience. The young mother gets upset and very tired from the overwhelming tasks, which affects the quality of her sleep.

In young families, with the birth of the first child, the first quarrels often begin. A man may complain about the lack of affection and attention, the absence of sex, the appearance of a quarrelsome woman. Disputes arise about who should get up at night to look after the child. All this additionally shakes the nervous system of a woman after childbirth, which negatively affects the process of falling asleep and the quality of sleep.

But mothers of the first, second and subsequent children face the need for night feeding and getting up from bed at the first call of the baby, who has not yet adapted to this world, so he can be worried about literally everyone. Caring for a newborn is not limited to daytime, so a mother can only dream of a full night's sleep, if her family and friends do not help her with this.

A woman's task is not only to bear and give birth, but also, if possible, to feed the newborn with mother's milk for at least a year, so that he has a strong immune system that protects him from various diseases in the future. And so that a mother can breastfeed her child, she must eat well and rest enough, which will allow her to be less nervous. After all, everyone knows that nerves are the most common cause of milk loss in nursing women.

But during the lactation period, in addition to the causes of sleep disorders that were typical for the postpartum period, new ones appear, which only aggravate the problem, and therefore pose an additional risk of milk loss. So, sleep problems in a nursing mother can be caused by:

• unpleasant sensations in the breast until it gets used to the new quality (the breast becomes engorged, heavy and a little sore, milk may leak, which requires taking additional measures to avoid the mammary glands getting wet and overcooled, etc.),
• overeating in the evening (on the one hand, a woman needs to eat a lot so that the baby has enough milk for night feeding, but on the other hand, a late or heavy dinner negatively affects falling asleep),
• various neurological and mental disorders that make themselves felt after childbirth,
• taking various medications (if prescribed by a doctor).

Again, you have to look for a comfortable position, because lying on your stomach or back as before becomes uncomfortable and even painful, but some women, even during pregnancy, can get used to sleeping in an unusual position for them.

Pregnancy, childbirth, the need to feed and care for a newborn - all this does not contribute to a woman's restful sleep, which she simply needs in conditions of increased stress on the body. And the task of relatives is to do everything possible to help the young mother successfully survive this difficult period, so that chronic fatigue and malaise do not overshadow the joy of motherhood and do not become an obstacle to the full development of the child.

Complications and consequences

Even isolated cases of insomnia can throw us off track for the whole day, not to mention constant problems with sleep. And if a person can still somehow put on a brave face until 10 am, then later on he begins to feel terrible fatigue, he wants to lie down and rest, and in the absence of such an opportunity, episodes of drowsiness and lethargy periodically give way to irritability and anger.

Moreover, the body that has not rested overnight begins to malfunction. Headaches, weakness, and increased fatigue appear. On a day off, you can allow yourself to rest a little in the morning or at lunchtime, but again, it is worth oversleeping a little, and the night's sleep will be preceded by long minutes of vigil in bed with open or forcibly closed eyes. On the other hand, if the body does not get rest either at night or during the day, severe fatigue begins to manifest itself in the same insomnia.

But how can you rest on workdays? Few people manage to sleep during their lunch break, and nighttime sleep problems in the afternoon usually result in a noticeable decrease in productivity. If this happens once or twice, the company's management will at best make a remark. But constant lack of sleep and poor performance will become an absolute reason for dismissal without discussion of the reasons.

Lack of sleep at night and the associated deterioration in well-being very often become the cause of domestic scandals and conflicts at work. All this only complicates the situation, and a person begins to experience chronic fatigue from everything, and this is a direct path to depression.

Chronic fatigue always causes a decrease in the internal strength of the body, which finds it harder to fight negative environmental factors. And failures in the immune system will lead to the fact that a person (an adult or a child) will begin to suffer from infectious diseases more often, they may develop previously dormant hereditary pathologies, and their metabolism will be disrupted. And these are only the consequences that a healthy person may have.

But sleep problems themselves can be a consequence of various diseases. Not paying attention to them means allowing the disease to develop further, causing various complications, affecting a person’s well-being and mood.

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Diagnostics sleep problems

When a person has problems falling asleep and sleeping, it is very difficult to immediately say what exactly is causing them. After all, even stress and anxiety, which are the strongest stimulants for the nervous system, affecting the quality of sleep, do not exclude the development of some pathology in the body, which can also negatively affect night rest. That is, a person can take sedative infusions and drink sleeping pills, but the problem with sleep will remain, causing more and more new complications.

If a person sleeps only 6 hours a day, and at the same time feels good, maintains sufficient activity and efficiency throughout the day, there is no reason to see a doctor. Each organism is individual. Therefore, for one, six hours of sleep is enough, while another may feel sleepy even after 8-9 hours of full sleep. By the way, the latter is exactly what should be alarming, especially if the sleepy state persists after waking up for more than half an hour, creating difficulties in work, communication, and perception of information.

What other symptoms are considered alarming and require more thorough investigation than a debriefing with girlfriends and friends? Difficulty breathing during sleep and snoring, sleep apnea, frequent nightmares, unexplained awakenings at night - all this is a reason to consult a doctor. But no less of a problem can be sleepwalking and talking in sleep, grinding teeth, involuntary urination in bed (nocturnal enuresis), sudden episodes of falling asleep (narcolepsy), which also require detailed study and identification of the causes of the pathology.

Diagnostics should be carried out if insomnia occurs in the absence of reasons for anxiety and worries and is not associated with physical overwork, as well as if taking sedatives does not help solve the problem. People whose insomnia is caused by pathological reasons (night cramps, pain, phobias, fears, etc.) should also visit a doctor.

If it concerns a child, you need to seek help from specialists (pediatrician, somnologist, psychologist) if lack of sleep begins to affect the well-being of the little person, his/her academic performance at school, mental and physical abilities, psycho-emotional state. In principle, you can contact a psychologist earlier. Especially for those parents who themselves cannot solve the problems of sleep disorders in their child, which they themselves provoked with excessive care or a permissive attitude.

But if visiting a general practitioner or pediatrician, neurologist, cardiologist, endocrinologist and even psychologist in most cases does not present any difficulties, then diagnostics from a doctor specializing in sleep problems (somnologist) may be unavailable if there is no such specialist in the clinic. In small towns, regional centers, villages, such specialists may not be found, so you will have to rely on the knowledge and experience of existing doctors, as well as on the usual diagnostic procedures:

• laboratory tests of urine and blood, which will tell about the condition of the body as a whole and its individual organs,
• measuring blood pressure and pulse,
• ECG,
• ultrasound,
• X-ray and other possible examinations,
• examination by an ophthalmologist, cardiologist, urologist, endocrinologist and other medical specialists.

Such diagnostics can be quite tedious, because it will not be so easy for a non-specialist to find the cause of sleep disorders. It may be necessary to undergo many examinations and wait for their results so that after differential diagnostics one can count on a more or less specific diagnosis. So it is better to find an opportunity to visit a somnologist and undergo specialized examinations (polysomnography and SLS).

And even here, hypersomnia, for example, will have to be differentiated from asthenic syndrome, depression, chronic fatigue. In addition, it is always important to understand what the appearance of sleep disorders is associated with: with a psycho-emotional state or with organic health pathologies.

Polysomnography is a study that helps to understand the causes of insomnia and other sleep disorders. It can be performed by a doctor in a special room or at the patient's home (especially if the patient is a child). There is no need to perform any complex tasks, the only task of the subject is sleep.

The study is conducted at night. Various sensors are connected to the human body, each of which records certain parameters. As a result, the doctor has EEG information (brain examination), cardiogram (heart function), chest movement chart, information on the volume of inhaled and exhaled air, blood oxygen supply, etc.

During the examination, a video recording is made, but the doctor on duty also constantly monitors the patient's condition, noting any changes. Since instrumental diagnostics are carried out continuously during the night, the somnologist has the opportunity to track the readings of the devices and video camera at all stages of sleep, which makes it possible to more clearly determine the cause of sleep problems.

The SLS (average sleep latency) method is of great value in hypersomnias, in particular for diagnosing narcolepsy. It helps to determine the causes of increased sleepiness.

During the day, the patient will have to try to fall asleep 5 times. The duration of the sleep is 20 minutes, the interval between attempts is 120 minutes. The time during which the patient manages to fall asleep is recorded.

A healthy person without sleep disorders falls asleep in 10 minutes or more. If the result is between 5 and 10 minutes, this condition is considered borderline. If the subject needed less than 5 minutes to drown in the arms of Morpheus, we are talking about pathological sleepiness (hypersomnia).

Diagnostics of human biological rhythm failures and related sleep disorders is performed using a special device – actigraph. The patient walks with a watch-shaped device on his hand for 1-2 weeks, and the device records all his movements during this time. There is no need to try to fall asleep and wake up at the specified time. The patient should sleep and wake up when he wants to.

Parasomnias are diagnosed using polysomnography. But this is not the only test. The patient undergoes a general and biochemical blood test, undergoes various examinations by different doctors. The final diagnosis is usually made at a consultation, in which different specialists participate.

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Prevention

As for preventing sleep disorders, everything is extremely simple. To sleep well, you need to:

• create comfortable conditions for rest: a comfortable bed, a soothing aroma in the bedroom, a switched off computer and phone, dim soft lighting, natural bed linen, no loud sounds and noises, etc.
• take daily active walks in the fresh air, but not right before bed, but during the day or at least a couple of hours before going to bed,
• in bed try to forget about all the day's problems and worries, about past troubles and failures, do not try to make plans for the future; special breathing techniques, relaxation, yoga can help with this,
• find calming activities to indulge yourself in before bed: knitting, embroidery, listening to pleasant slow music, reading lyrical works, etc., but all these activities should be done outside the bed (the bed is only for sleeping and making love!),
• if your nerves are overstrained and you can’t relax, you should take herbal calming drops (for example, motherwort tincture),
• Before going to bed, always ventilate the room and create conditions suitable for sleep: appropriate temperature and humidity, oxygen-rich air, absence of irritating smells of cigarette smoke, perfume, fried food, etc.
• pay attention to bedding, which should be clean and have a pleasant aroma,
• maintain a sleep and wakefulness regime: try to go to bed and get up at the same time every day, develop certain settings by which the body will understand that it is time to sleep (for example, make the lighting in the room less intense half an hour to an hour before bed),
• do not eat later than 2 hours before bed, but do not go to bed hungry (if necessary, you can have a snack of an apple, a cracker or ½ a glass of kefir),
• take a warm, relaxing bath half an hour to an hour before going to bed,
• do not do things the night before bed that can have a stimulating effect on the nervous system (active games, watching TV, especially news, thrillers, detectives, working on a computer, communicating online, etc.),
• If you experience symptoms of ill health, consult a doctor, as this can help prevent the development of diseases that cause sleep problems.

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Forecast

Let's first talk about what patients with sleep disorders can expect after undergoing treatment. It should be said right away that any sleep problems are not a reason to panic. Almost all of them are solvable, and the course of treatment allows you to restore the normal functioning of regulatory systems.

The prognosis for primary sleep disorders is generally favorable. The conditions are considered temporary and are easily corrected. Parasomnias are the most difficult to combat. Although they do not have a strong effect on the patient's health, a phenomenon such as somnambulism can be dangerous for patients, since they do not control their nighttime movements.

Attacks of narcolepsy can also pose a danger to the patient. After all, a person can "switch off" in the middle of the road, at work (and it's good if he works in an office, not at a machine or in a hot shop), while driving a car, which means he can die himself or destroy those who are nearby.

In principle, with the help of medical and psychotherapeutic methods, it is possible to improve the sleep of patients whose problems with falling asleep and waking up early are associated with various diseases. But, for example, such a hereditary pathology as sleep paralysis is very difficult to treat. And in the treatment of bruxism, along with the above methods, dental procedures are also used, because the disease is fraught with tooth decay.

In the treatment of adult patients, it is especially important that the person himself recognizes his problem and wants to solve it, therefore drug treatment is almost always combined with psychological help.

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