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Insomnia to Ondine's Curse


Insomnia to Ondine's Cause

Unlike insomnia, which is relatively well tolerated in a short period of time and does not impair human health, there are sleep disorders that can have serious health consequences, such as diabetes or hypertension . Despite the fact that most of these dissomnias and parasomnias are very successfully treated, sleep disorders are neglected or unrecognized in our country, even though they affect a large number of people.

Sleep apnea

Obstructive sleep apnea, or cessation of breathing, is one such disorder. The fact that this is a serious illness is vividly suggested by the myth of the nymph Ondina in love with an ordinary mortal, who cursed him because of his unrequited love that when he falls asleep he stops breathing and dies. Obstructive sleep apnea is very common in the population older than 50 years ( up to 40%) and is one of the most widespread sleep disorders. In our environment, it is neglected and insufficiently diagnosed, despite the fact that it poses a serious risk to health, and it is very successfully treated. In other parts of the world, sleep disorders are recognized as one of the most common causes of traffic accidents, so examinations of professional drivers to determine whether they have sleep apnea (sleep apnea) are a mandatory part of their systematic examinations.

Obstructive sleep apnea most often occurs in people who snore , usually in obese men in the fifth and sixth decades of life, manifesting as cessation of breathing that can last up to 45 seconds, and sometimes so long that a person floods due to lack of oxygen. If such cessation of breathing occurs a couple of times during the night, it does not matter much, but if it is repeated 300 or 500 times a night, apnea leaves consequences on several organ systems. There is a load on the so-called right heart, an increase in pulmonary blood pressure, but also systemic pressure - the growth of intrapulmonary and systemic pressure burdens the heart, causes its weakness, arrhythmias, heart attack, stroke (stroke) , and metabolic disorders and diabetes .

Unlike other chronic diseases with similar consequences, there is a very effective therapy for obstructive sleep apnea . The surgical treatment of apnea, which was previously used, has been largely abandoned. Today, this disorder is treated with the help of the CPAP ( Continuous Positive Airway Pressure ) device, which is placed over the nasal mask and ensures that the patient stops breathing interruptions as well as snoring. If the patient has a respiratory arrest for more than 10 seconds, the CPAP responds by inserting an appropriate volume (inspiratory volume) of humidified air and breathing resumes normally. Moreover, the effect of CPAP is to completely stop all the consequences of apnea, and a person suffering from apnea completely recovers and continues to live without problems.

Narcolepsy with cataplexy

Another significant sleep disorder, narcolepsy , is characterized by two key symptoms : excessive daytime sleepiness and so-called cataplectic crises. Constant drowsiness in a narcoleptic person can turn into a dream at any time, which can be very dangerous in traffic. People with narcolepsy, in addition to constant drowsiness, often reluctantly fall asleep several times during the day.- It can happen to them ten times a day, but the most common frequency is several times a week, and they can also have cataplexy crises. Cataplexies are losses of complete muscle tone of non-epileptic nature in which the patient loses muscle tone and strength, so he is often forced to sit or even lie down because he has no strength, but is fully conscious and sleeps at the time of the event, although cataplexy can be extended to sleep.

Narcolepsy with cataplexy can put a patient to sleep / sleep with incredible speed, and so dramatically that he can fall to the floor and fall asleep in the middle of a conversation, have a bite left in his mouth during a meal or his head falls into a plate, fall asleep immediately. and as soon as he sat down and leaned well. The disease is especially interesting because the causes of cataplexy crisis and sudden falling asleep are strong emotions (surprise, anger, joy), and it is interesting that narcolepsy is mostly a disease of young people, aged 15 to 30. This sleep disorder occurs in one or two out of a thousand people, and is not so rare - it is ten times less common than epilepsy, but ten times more common than motor neurone disease, and many compare it to multiple sclerosis or Parkinson's disease.

Narcolepsy was first described in 1880 in a patient who had several hundred cataplexy crises a day. The number of crises in a person with narcolepsy depends on the severity of the disease, usually from a few a month or a week to a few a day, and they certainly incapacitate the patient for regular work and life.

Narcolepsy is treated with drugs that are not available in our country . The drowsiness drug modafinil is relatively expensive, but it can be purchased abroad, while the drug that prevents cataplexy, gamma hydroxybutyrate, is very difficult to obtain. It is a type of narcotics that completely frees the patient from narcolepsy from cataplexy crises, but on the other hand, it completely erases the memory, so it is taken only at night. It is distributed from a pharmacy in the United States, and the procurement procedure is stricter than for narcotics.

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REM and non-REM parasomnias

Unlike disorders in the intensity, quality or quantity of sleep (insomnia, apnea, narcolepsy), which are considered dysomnias, parasomnias are sleep disorders (NREM parasomnias), or sleep disorders (REM parasomnias), which include unusual behaviors or non-physiological events that are not directly related to the sleep process itself, but to the process of transition from sleep to wakefulness and vice versa.

In the so-called REM ( Rapid Eye Movements ) phase of sleep in which he dreams, a healthy person who has nightmares in his sleep makes movements, even performs blows in defense of the attacker in his sleep. A patient with REM sleep behavioral disorder gets out of bed and runs away from danger, so it happens that he gets injured or attacks the person sleeping next to him in an attempt at self-defense. It is a disease in which people play their dreams, and that is why it can be dangerous for the environment if the sick people are aggressive, and most often they are. It affects less than 1% of the population, in 95% of cases it is men. They are mostly middle-aged and older people in the fifth and sixth decades of life, and younger people much less often. Sufferers of this disease, however unusual it may be,they respond very well to the drug from the group of benzodiazepines, the use of which in small doses completely relieves the patient of the problem, without getting used to the drug.

Awakening with confusion, sleepwalking (somnabulism) and night terrors are parasomnia characteristic of the sleep period (NREM parasomnia group).

Awakening with confusion

Morning "sleep hangover" is the best description for waking up with confusion, a disorder which is characterized by the fact that the sick person is not fully awake sometimes for half an hour or more than the first awakening. It is a kind of "half-awakeness" in which a partially awakened person can even communicate with other people, even though he is still asleep. This condition is explained by a newer hypothesis, the so-called "flip-flop" mechanism - a sudden change in wakefulness and sleep - according to which disorders such as waking up with confusion or narcolepsy do not have direct information that goes to the cerebral cortex, but some other (cingular) ) a pathway that modulates the main awakening pathway. This means that the patient never wakes up directly, but in a roundabout way, so his alertness is not complete, but partial and in such a state he can be very aggressive.


Somnabulism or sleepwalking is a far better known type of non-REM parasomnia, also a disorder in which the patient does not fully wake up. When it comes to treatment, sleepwalking is controlled by applying safety and special hygienic-dietary measures for the patient.

Night Fears ( Pavor nocturnus )

Night fears are practically inseparable from walking in sleep , but this disorder is characterized by more pronounced vegetative activation (sweating, palpitations, deep breathing, fear). Episodes of night terrors, which most often continue (or begin) with sleepwalking / sleepwalking, form one entity, and are similar in their mechanism of awakening to confusion.

Changes in circadian rhythm

One group of sleep disorders occurs as a consequence of changes in the circadian rhythm (daily rhythm of wakefulness and sleep). Among them is the phenomenon known in our country under the English name " jet lag " ( jet lag ) or sleep disorder due to travel through multiple time zones. A traveler who, for example, leaves Serbia for America and returns from the road "lost" his night's sleep, and many people find it very difficult to bear because a biological clock is not easy to cheat.

There is also Advanced Sleep Phase Syndrome , which refers to a person's biological need, dictated by circadian rhythms, to go to bed earlier, for example at three in the afternoon, to sleep the usual seven to eight hours and wake up and work normally all night. (instead of working during the day). The big problem of these patients is that they are socially unsuitable - it is easier for them to eventually work night shifts, and otherwise they are completely healthy.

The so-called idiopathic hypersomnia of the central nervous system is a disorder similar to narcolepsy, accompanied by increased daytime sleepiness, but not that which occurs in seizures, but is constantly present. People who are affected by it sleep 12, 16, and even 20 hours a day, and after waking up and eating - they go to sleep again. The true cause of this disease of extreme sleep is not known and it reacts poorly to drugs, but fortunately, it is very rare.

Restless legs syndrome in the narrow sense does not belong to sleep disorders because it occurs in wakefulness, before bedtime or, better said, whenever a person calms down. Restless legs syndrome patients describe as a feeling of "movement of ants through the legs" or "flow of acidic water through the veins", and as a feeling of tickling and an irresistible need to move the legs. But as soon as they get up to "stretch" their legs, these unpleasant sensations disappear. Often, these patients, due to the constant anxiety that accompanies their rest and attempt to sleep, are unable to fall asleep because they have to get up and walk a little to eliminate the discomfort in the legs, which is repeated several times during the process of falling asleep.

Periodic Limb Movements in Sleeping ( PLMS )

It's a correlate of this disease, but in sleep. A person with this disease, unconsciously and reluctantly, suddenly moves his legs upwards during sleep, bending the wrist at the knee and hip and flexing the whole foot. This sudden movement that the patient reluctantly works relatively often, in clusters of a few tens of seconds to a few minutes, greatly disturbs the sleeper, but it is also a nuisance for the person sleeping next to him. Both disorders, both restless legs syndrome and PLMS, which in 80% of cases are combined, respond well to therapy with levodopa preparations or levodopa agonists, which, in 90% of cases, relieve patients with problems with restless legs.

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