The sleep problem can turn a good night into a nightmare. But what are the main problems encountered? And how to control them while sleep is essential to our quality of life? Let’s not forget that sleep still occupies a third of our life. Sleeping 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.
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 sleeping 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(sleeping problem)
- 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(sleeping problem)
- 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 Consultation
- 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).
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 problem in children
Sleeping problem 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 problem 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.
List of Sleeping Problem
These are the most common sleeping problem