It is normal to sleep poorly from time to time. There are many reasons: travel in a different time zone, an upcoming exciting event, pain, or noise. In most cases such a transient sleep problem resolves on its own or through elimination of the triggering factor. Sleep disorders are characterised by recurrent and persistent sleep problems happening at least three times a week for one to three months. Affected individuals have difficulty initiating or maintaining sleep or have poor sleep quality. Some wake up early in the morning and cannot go back to sleep. In general, night sleep does not bring the rest that it should provide. As a result, affected individuals are frequently tired and irritable during daytime; their concentration and performance are lower. Their general well-being suffers.
What are the types of sleep disorders?
Sleep disorders can present in various forms. They can have physical or mental causes. Basically, a sleep disorder can be a primary health problem or it can be a symptom of another disease. For instance, people with depression, anxiety, obsessive-compulsive disorder or bipolar disorder frequently suffer from sleep disturbances as a consequence of their primary disease.
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Sleep disorders can initially be seen in difficulties related to sleep itself:
- Laying awake for a long time without being able to sleep, frequently associated with brooding and anger over the disturbed sleep
- Frequent awakening at night, with inability to fall asleep again
- Early awakening with inability to go back to sleep
- Feelings of lack of fitness and not being refreshed in the morning
- Difficulty getting up due to poor quality of the night sleep
Affected individuals typically notice that sleep does not bring them the expected recovery. Sleep disorder thus impacts the daytime as well. Wakefulness is marred by fatigue, lack of energy, irritability, concentration difficulty, and poor performance. Thoughts start to revolve around the disturbed sleep, and progress to fear of going to sleep. The mind is also affected.
How do I recognise if I have a sleep disorder?
- I have trouble falling asleep at night, I toss and turn in bed, and I worry that I am not yet asleep
- I wake up often early in the morning and cannot sleep any more
- I wake up several times during the night and it takes me a long time to go back to sleep
- I don`t know why, but I often feel exhausted instead of rested in the morning
- During the day I am tired, irritable, and out of sorts because my nights are so bad
- My everyday life is negatively impacted by the sleep problems, my general wellbeing suffers
How does a medical doctor recognise that I have a sleep disorder?
In most cases, consult a doctor when the symptoms are very severe. This perception in and of itself is for treating professionals an important element in making a diagnosis.
Your doctor will take a history, including your sleep pattern and problems. Also, your doctor will ask about your life situation, medicines taken, general health situation, and lifestyle. External factors that can affect sleep are also addressed. Some patients are asked to keep a sleep diary to give treating professionals better insight into the problem.
Various diagnostic studies can be used to rule out physical causes. In certain cases, the work-up includes a visit to a sleep laboratory, where various parameters are measured during a sleep study.
The treatment of a sleep disorder depends on its cause. If it is a symptom of another disease, this disease must be treated first. If sleep itself is the problem, behavioural therapy or sleep therapy are usually used. In addition, sleep hygiene must be improved. This means behaviour that promotes good sleep. You can contribute significantly to this:
- Eliminating the midday nap
- Using a cool, dark, well-ventilated sleeping room only for sleep
- Getting up at the same time every day
- Set up a sleep ritual (e.g., a yoga session, a cup of tea, reading several pages)
- Avoid heavy meals in the evening, avoiding alcohol, avoiding nicotine
- Go to bed only when very tired
- Eliminate caffeine after lunch
- Eliminate electronic devices or TV from the bedroom
- Practice regular physical activity
- Use relaxation techniques (e.g., self-training, meditation)
Internal restlessness often prevents affected individuals from sleeping. Ongoing conflicts, persistent stress, worry, and physical or mental overload can also impair sleep. It is important to look for the concrete causes of these types of stress and to find better coping mechanisms. Psychotherapy can help.
Sleep disorders can very directly affect relatives. A typical example is the sleepless partner tossing and turning in bed, or constantly turning the light on. Relatives should avoid reacting in an irritable or angry way, even if that is sometimes difficult. Affected individuals in most cases suffer markedly and are tense due to their inability to sleep. Anger and blame do not help. If the situation lasts longer, separate beds can help prevent sleep deprivation.
Understanding for the situation and consideration for decreased daytime fitness and concentration bring temporary relief. In the long run, the affected individual must deal with the sleep disorder and seek help. Relatives can motivate them and show their support.
Sleep disorders have multiple causes. These include physical and mental issues, certain medicines, the sleep environment, lifestyle issues, or certain periods in life. A frequent physical problem is sleep apnoea, consisting of periods of nocturnal breathing arrest. Other common physical causes are restlessness in the legs (restless-legs syndrome), pain syndromes, or cardiovascular disorders. Sleep disturbances can also accompany several mental diseases, such as depression, anxiety, or bipolar disorder.
Other common triggers are noise, shift work, bruxism (teeth grinding), use of drugs or alcohol, sleepwalking, or the special circumstances of pregnancy and menopause. Also, the influence of worry, stress and burdensome events on sleep should not be underestimated.
The main thing is to find the cause of the ongoing problem to fall asleep. The sleep disorder can be conquered over the long term with targeted measures, therapy, or lifestyle changes. Difficulty in sleeping is often exacerbated by worry about not being able to sleep and not being in best shape the next day. Affected individuals should also try to relax as best they can, even though inability to relax may be the main problem.
The following recommendations could help:
- Getting out of bed and seeking distraction with a relaxing activity
- Doing breathing exercises
- Writing down thoughts, worries and feelings to get them out of mind
- Listening to a relaxing podcast, a piece of meditation, or some relaxing noise such as the sound of the sea
- Reading something that does not provoke excitement or tension
Depression can be both a trigger and a consequence of sleep disorders. Ongoing sleep problems for long time mean persistent stress for the body. This can overload the body and mind. This can lead to depression. At the same time, disturbed sleep is one of the most common symptoms of depression.
Many sufferers have difficulty going to sleep or wake up too early in the morning. As a result, their energy and wellbeing are reduced. A sleep disturbance should also be addressed during therapy.
At the time of menopause, women go through a change in their hormonal balance and their fertility. Oestrogen and progesterone (sex hormones) production decreases. This leads on the one hand to shortened deep-sleep phases, and on the other hand to frequent night hot flashes. Both can severely impair sleep.
Internal restlessness and mood swings also develop frequently during menopause. The extensive internal and external changes of this life phase put many women under stress. All these circumstances can lead to sleep disorders. Age also plays a role. The body produces less melatonin sleep hormone and the depth of sleep decreases.
Sleeping pills, even plant-based, should never be taken without medical supervision or for a long time. The danger of becoming dependent is very high. Doctors prescribe sleeping pills in most cases only as a short-term temporary solution. In healthy people, the natural sleep-wakefulness cycle regulates itself without outside help. That is why the most important goal in the management of sleep disturbances is to find the cause and correct it.