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  • Sleeping Problems Complete Details

    Sleeping Problems

    Sleep problem are divided into 3 main groups, dyssomnias, parasomnias and those related to other diseases. The symptoms will be different depending on the type of disorder. The proposed treatments will also depend on the specificity of the disorder.

    Sleeping probems its types and how to get over it

    Sleep problem: definition

    Sleep problem are divided into 3 main groups :
    • Dyssomnias : insomnia of psychological origin (inability to sleep at night), altitude insomnia, insomnia of external origin (extrinsic), sleep problem related to alcohol or drugs, narcolepsy. Insomnia is a frequent complaint of the subject over 60 years old. Sleep onset insomnia, sleep maintenance insomnia, and early awakening insomnia are distinguished. Temporary insomnia can last up to 3 weeks; beyond that, we speak of chronic insomnia;
    • Parasomnias are sleep disturbances associated with nocturnal awakenings but without significant disruption of sleep or impaired alertness during the day. They are mostly observed in children but may persist in adults with a pathological character. Parasomnias include sleepwalking, night terrors, sleep disturbances associated with REM sleep, night bruxism , and bedwetting (urinary incontinence during the night);
    • Sleep problem of psychiatric origin, neurological or related to other diseases.

    Causes of sleep problem


    • Chronic insomnia of psychological origin is due to emotional stress;
    • Insomnia of extrinsic origin occurs as a result of a change in the sleeping environment (hospital bed, noise, light, snoring of the partner) or following an important event (illness, loss of a close individual, change of professional activity, examination);
    • Insomnia can occur during a stay at high altitude (related to the decrease in oxygen in the air);
    • Sleep problem may be related to taking alcohol or drugs. In some patients, the consumption of 5 cups of coffee may be responsible for sleep problem. Insomnia may occur during the withdrawal period of hypnotics;
    • The narcolepsy have a genetic origin.


    • The cause of sleepwalking remains unknown;
    • Nocturnal bruxism (grinding of teeth) begins at the end of the second decade and usually disappears spontaneously at the age of 40. Stress seems to play an important role in the genesis of this disorder;
    • The causes of secondary enuresis are emotional problem, urinary tract infections, urinary tract malformations and epilepsy.
    Sleep problem are frequently observed during mental problem (depression, manic depression), neurological problem (migraine, cluster headache, Parkinson’s disease, Gilles de la Tourette syndrome and Huntington’s chorea) or other problem. diseases (asthma, gastro-oesophageal reflux).

    Symptoms of dyssomnias 

    • Psychogenic insomnia : the patient falls asleep more easily at unplanned periods (when not trying to fall asleep);
    • Insomnia of extrinsic origin: there is an increase in sleep time, frequent awakenings at night and early morning awakenings;
    • Insomnia of altitude: problem of the breathing (pauses breathing) appear during the sleep. The subject complains of frequent awakenings and poor sleep, especially during the first nights at high altitude;
    • Insomnia related to taking drugs: Caffeine is responsible for an increase in sleep latency, more frequent nocturnal awakenings and a decrease in total sleep time for 8 to 14 hours after ingestion. Alcohol is responsible for an increase in nocturnal awakenings, although it increases drowsiness and reduces sleep latency;
    • Narcolepsy: The patient experiences excessive sleepiness during the day, which may be accompanied by involuntary episodes of sleep during the day. It is accompanied by nocturnal sleep problem, cataplexy (sudden muscular weakness triggered by an emotion), and sometimes visual hallucinations when falling asleep and paralysis of sleep (the patient feels like paralysis of his muscles when falling asleep).

    The symptoms of parasomnias 

    • Sleepwalking is characterized by automatic activities during sleep (getting up, walking); the patient remains unconscious and does not communicate. The awakening is often difficult;
    • Night terrors occur during the first hours after falling asleep. The child cries suddenly and has significant sweating, increased heart rate and shortness of breath. The awakening can be difficult and the child rarely remembers this episode the next morning. Recurrence is rare;
    • Nightmares (anxiety during a dream period) sometimes cause complete awakenings and a reminder of this episode;
    • The sleep problem associated with REM sleep (sleep period where dreams happen is) is characterized by violent behavior during sleep that may be responsible for injury to the patient or his entourage. Upon waking, the patient remembers unpleasant images;
    • Night bruxism is an involuntary grinding and forced teeth during sleep. Patients are not aware of this squeaking;
    • Nocturnal enuresis occurs most often in young subjects. Before the age of 6, it should not be considered pathological. It becomes rare at puberty. It is traditional to distinguish primary enuresis from secondary enuresis (defined by enuresis in patients who have not had a problem with urinary incontinence before).

    Sleep problem associated with mental problem 

    • During depression, it is common to experience sleep insomnia, sleep-keeping insomnia, and early morning awakenings. Seasonal depression (fall / winter) is often characterized by hypersomnia;
    • In mania (manic-depressive psychosis), the time of falling asleep is often lengthened.


    The examination of the patient must be complete ( neurological examination ) even if it is the interrogation of the patient that guides the diagnosis. Examination of the teeth in a patient suffering from nocturnal bruxism may reveal destruction of tooth enamel.

    Complementary examinations and analyzes

    They can be practiced when the precise diagnosis is made difficult despite the data of the interrogation. They are based on polysomnographic recording (recording during the night of electrical activity of the brain and muscles of the eye).

    Evolution of the disease

    It depends on the underlying cause.


    • In case of psychogenic insomnia : behavioral therapy is often beneficial. Relaxation sessions improve the sleep of patients who have significant anxiety. The hypnotic may be prescribed in some cases.
    • In case of extrinsic insomnia , healing usually occurs in a few weeks by eliminating the responsible factor and advising to have a sleeping ritual promoting sleep (avoid copious meals, intense physical exercise or hot shower just before sleep) and adapt the environment of the bedroom to sleep.
    • In cases of altitude insomnia : prior treatment with acetazolamide may be effective.
    • In case of sleep problem related to the intake of alcohol or drugs : the treatment consists in the eviction of the responsible drug which can be difficult in certain cases and need a specialized care of the patient (psychological support … ). As a preventive measure, the doctor should prescribe as few hypnotics as possible for routine use (the duration of treatment should be as short as possible and its dosage reduced).
    • The treatment of narcolepsy is symptomatic. It uses stimulants (methylphenidate) to improve drowsiness. The treatment of cataplexy, hallucinations and sleep paralysis is based on antidepressants .
    • There is no effective treatment for sleepwalking.
    • The treatment of night terrors is mainly to reassure parents (rare recurrence).
    • The treatment of sleep problem associated with REM sleep appealed to clonazepam or antidepressants .
    • The treatment of nocturnal bruxism is necessary because of the risk of dental deterioration in the most severe cases: rubber dental gutter, psychotherapy in case of significant stress. No drug has proven effective.

    The treatment of primary enuresis involves behavioral therapy and a bladder retraining. The treatment of secondary enuresis is the cause of this enuresis.

    sleep problem in children

    • Sleep disorders are expressed when the child has difficulty falling asleep, waking up at night or early morning awakening. It can be awakened by dreams, nightmares or night terrors. These situations are often benign but parents must be vigilant as they can impact the child’s development.
    • The dreams and nightmares occur during the second part of the night, during sleep phases REM said. They play an important role in memorizing knowledge. Dreams are often related to events that occurred during the child’s day. Intense and repeated nightmares can be a sign of deeper anxiety, such as fear of going to school.
    • The night terrors , not to be confused with nightmares, are common in children . They occur during so-called deep sleep (less than 3 hours after falling asleep). The child seems awake, fidgeting, sweating, and screaming while sleeping. The state is transient, with a return to calm quite fast. When you wake up, the child does not remember anything. It is useless to wake him during this period.

    Causes of sleep problems in children

    • Sleep disorders in children can have various causes:
    • – nightmares or disturbing dreams. But these also allow to evacuate the tensions and anxieties of the day;
    • – ENT infections (nose, throat, ears) or digestive disorders;
    • – failure to respect the natural rhythm of the child or too irregular schedules;
    • – an uncomfortable room, a change of place or non-compliance with bedtime rituals;
    • – family troubles or school difficulties (problems of parents’ couple, illness of a family member, etc.);
    • – problems in the emotional relationship between the child and his parents (indifference or overprotection, parents anxious or too rigid …).

    Treatment of sleep problems in children

    • Several actions are possible and recommended to relieve the sleep disorders of the child:
    • – identify the external causes of the disorders and resolve them;
    • – respect the basic rules that promote the child’s sleep: a regular rhythm of sleep day or night, a comfortable place with familiar objects and a comforting presence;
    • – If the child wakes up at night after a nightmare, it is advisable to make him feel the presence of a parent, calm him down and give him a hug. Do not hesitate to talk about it the next day with him and reassure him.
    • – medicines are not recommended for infants and children except medical advice;
    • – consult a specialist (pediatrician or child psychologist) for disorders revealing other difficulties such as anxiety.

    Sleep walking

    Sleep walking is quite common, mostly with children, adults also occasionally suffer from this. Sleep walking always starts between sleep stages three and four.
    After a sleepwalker gets out of bed, they can put on their clothes, walk around or just stand still. Sleep walkers usually return to their bed after a while to continue sleeping. During sleep walking, people are able to avoid obstacles and respond to instructions from people who are awake. Waking sleepwalkers is not dangerous, but very difficult; it is best to carefully guide a sleepwalker to bed. The next day, a sleepwalker generally doesn’t remember what happened that night. The only thing that can remind them Sleepwalkers are things that are in other ‘strange’ places in the room.
    Sleep walking usually passes by itself as children get older.


    If you are very sleepy during the day or sleep very long at night, you may suffer from hypersomnia. These people sleep at least a month or regularly much more than they actually wanted / could reasonably be expected.
    Because of their many sleep at night or their sleep during the day they get into trouble with the rest of their day. They are less able to meet with people or do not function well at work simply because they have to sleep too much.
    When this disorder is caused by another sleep disorder, by physical or psychological problems, you cannot of course speak of hypersomnia; in these cases it is a consequence of the other problems.


    People who suffer from insomnia sleep poorly. The main complaints are: having difficulty falling asleep, not falling asleep or not being rested after sleep. People who suffer from insomnia usually lie awake for hours, worry about spinning and whatever they do they fall asleep badly. The next day these people are very tired, easily irritable and dazed. Because people are so tired, they sometimes try to sleep during the day, which in turn causes insomnia at night.
    There are different types of insomnia, the most important distinction being made between insomnia related to falling asleep and insomnia related to falling asleep. People can also suffer from both types.

    Restless legs

    Most people sometimes have their legs suddenly shake or move. Usually this happens just before you fall asleep and this is accompanied by a feeling of falling. People who suffer from restless legs have this much more often (an estimated five to ten percent of all people over the age of twenty suffer from this). The official name for this condition is “restless legs syndrome” (RLS). What exactly happens is not clear, but in deep sleep something goes wrong between the communication between the brain and the legs. The legs start to move and kick automatically; approximately every twenty to thirty seconds. These movements are often so bad that the sleeper wakes up and in the case of a partner it is often (sometimes painful) awakened.
    The restless legs at night are sometimes part of “periodic limb movement disorder” (PLMD). Restless legs syndrome is a neurological (physical) disorder that is characterized by an irritating, burning sensation deep in the calves. The condition can also occur in the upper legs, feet, torso and arms. It is not painful but very annoying and annoying, and creates an irresistible urge to move. The symptoms mainly occur when there is little or no movement.


    Sleep apnea is temporarily not breathing during sleep so your breath stops. For people who suffer from this, breathing stops several times a night for a few tens of seconds at a time. Because they catch their breath, they shoot dozens of times a night to a lighter sleep stage, so that sleep is fragmented.
    Snoring is a symptom of sleep apnea. Partners who lie next to this person often suffer from this snoring and often worry because they hear the breathing (or snoring) stop.
    In some of the apnea patients, the windpipe is closed off by a combination of resonating muscle mass and excess fat. That is why in overweight people it is often a possibility to get rid of this condition. In addition, there is the possibility of using a CPAP (Continuous Positive Airway Pressure) device, a cap that is placed on the mouth and nose and blows in a continuous air stream, so that the windpipe does not get a chance to close

    Disorder in the sleep-wake rhythm

    In this disorder, people have a persistent pattern of sleep disruption. The person with this disorder has a sleep-wake rhythm that is not in accordance with what is required of this person. This disorder of the rhythm is often due to people going to bed or getting up for a longer period of time at irregular times.
    A cause for this disorder is likely to be found in the fact that every person has a natural sleep-wake rhythm. One person is more of a morning type, the other person more of an evening type. This rhythm seems to be genetic. If this rhythm cannot be followed, problems may arise. If people with an extreme evening rhythm (eg get tired around half past one) do go to bed at noon, they often lie awake for an hour and a half.
    This lying awake then looks a lot like insomnia. Insomnia is therefore strongly linked to the disorder in the sleep-wake rhythm. an early rhythm is connected with sleep insomnia; a delayed rhythm is associated with insomnia.
    Problems with the sleep-wake rhythm are more common among people who work shift work or who have to work irregular shifts for their work. In addition, it is a disorder that affects quite a few students because they are awake at such irregular times.

    Scary dreams

    A degree less than a nightmare is a bad dream and this dream can be frightening. The biggest difference between a bad dream and a nightmare is that you usually sleep through with a bad dream. You probably remember the story, theme or images when you wake up, or sometimes later in the day, but these annoying dreams generally cause less fear than nightmares. Bad dreams are generally more common than nightmares.

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