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Sleep Problems

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Sleep Problems

Do you wake up tired and sleep deprived? That awkward feeling accompanies you all day? You may be suffering from sleep disorders.

The normal state is to always feel rested after waking up and keep that feeling throughout the day. The following conditions indicate a sleep disorder:


1. Waking up with a feeling of tiredness after seven or eight hours of sleep

spontaneous falling asleep during meetings and social events.


2. Uncomfortable feeling of crawling and tingling in the legs accompanied by an irresistible need to move the legs, especially if they occur after going to bed.


3. Very loud snoring and restless sleep.


If any of these conditions are present, it may be a sleep disorder or a medical condition associated with the disorder, the cure for which can really change a person's life.


Not only sound sleep but his alertness and dedication too are most required. Sleep has a complex structure and consists of four phases that are repeated in cycles throughout the night. During certain phases and periods of the sleep cycle, a whole range of hormones and other substances are secreted that help regulate metabolism and other factors that affect health. Changing the structure of sleep can lead to feelings of fatigue and drowsiness, and even increase the risk of developing a whole range of serious medical conditions. A distinction should be made between sleep problems , primary sleep disorders , and sleep disorders caused by a medical condition .


Sleep problems

Sleep problems are often caused by poor sleep hygiene or bad habits. These are habits and environmental factors that can be influenced and controlled. These include smoking, consuming alcohol or caffeine, exercising intensely, or consuming large meals before bed. There are also fatigue caused by changing time zones while traveling and psychological stresses that lead to difficulty falling asleep or sleeping, such as deadlines at work, exams, marital conflicts or business crises.


These problems can be alleviated by designing and implementing a good sleep hygiene program.


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Primary and secondary sleep disorders


There are more than 85 primary and secondary sleep disorders, but the most common are insomnia, sleep apnea, restless legs syndrome and narcolepsy.


Insomnia

The most common symptoms of insomnia are drowsiness, fatigue, impaired concentration and attention, muscle pain, depression, and a state of hypersensitivity such as feelings of tension, anxiety, or nervousness. It often happens that a person cannot fall asleep at night, and on the other hand, sleep catches him in front of the TV, while watching a movie, reading, and even while driving a car.


Actions that are thought to help induce sleep can even have the opposite effect and aggravate the problem , and so does the mere expectation that sleep will be bad. All these are inconveniences, sorrows and dangers of insomnia. Many people sometimes suffer from temporary insomnia that lasts for days or weeks. The causes of such insomnia are most often common life situations such as a stressful event, emotional stress, illness or acute pain, sleep hygiene disorders or circadian rhythm disorders. Such temporary insomnia usually disappears when its cause also disappears.


Sleep apnea

Apnea is a cessation of breathing that can last 10, 20 or 30 seconds, after which the person begins to convulse.This cycle can be repeated all night without the sleeper even being aware of it, but he wakes up in the morning with a dry mouth, with a headache and a hangover. Drowsiness during the day is also possible, as well as significant memory loss, difficulty concentrating, attention deficit disorder, moodiness and other problems. There are two types of apnea: obstructive and central. Obstructive sleep apnea causes a narrowing of the throat during sleep, which prevents the flow of air through the airways. When the oxygen level drops, the brain sends the message "wake up and breathe." These episodes can occur up to 100 times in one hour. Central apnea is much rarer, occurs in only 10% of cases, is caused by the brain not sending a signal to breathe, and is accompanied by various cardiac and neurological disorders.


This disorder occurs in 2% of women and in 4% of middle-aged men , so its frequency is the same as the frequency of diabetes or asthma. It is also a primary risk factor for developing high blood pressure. Fortunately, if an accurate diagnosis is made, apnea can be successfully treated through physical or mechanical therapy, surgical treatment, and nonspecific therapy. Physical or mechanical therapy involves the application of compressed air that is blown into the airways through a mask or nasal extension and keeps them open so that air circulates freely.


Another possibility is the use of devices that hold the tongue and lower jaw in a forward position , which in the milder form of apnea prevents narrowing of the airways. The devices are made for each patient separately, and are usually set up by a dentist or orthodontist. Surgical treatment consists of removing tissues such as tonsils, third tonsils, nasal polyps, and structural deformities that can close the airways. There are various procedures, but none are fully effective or risk-free. It is also very difficult to predict the outcome of surgery and possible side effects.


Nonspecific therapy refers to behavioral aspects that can be an important part of a treatment program. Some examples of this type of therapy are weight loss in obese people, which can lead to a reduction in the number of apnea episodes. It also helps to avoid consuming substances such as alcohol and sleeping pills, which increase the likelihood of prolonged episodes of apnea. Some people suffer from apnea only when lying on their back, so with the help of a pillow or some device that helps them lie on their side, the problem can be reduced.


Restless legs syndrome

About 15% of people, especially when it is time to sleep, feel tingling in the legs, internal itching or cramps, accompanied by an irresistible need to remove these unpleasant feelings by vigorously moving the legs. These are the classic symptoms of restless legs syndrome that prevents you from falling asleep, and can also wake a person from sleep, forcing him to relieve discomfort by walking. Although not considered a medically serious condition, the symptoms of this disorder can vary in severity, from discomfort to severe disturbances that significantly affect the life of the person suffering from it.


Most of these people also suffer from a disorder that consists of occasional uncontrolled movement of the legs , that is, movement of the toes, feet, sometimes knees or hips, which recurs during sleep. It often occurs in the form of short muscle twitches, sudden movements or bending of the leg. As with sleep apnea, sleepers do not need to be aware that these disorders interfere with their sleep and very often only their partners warn them of their occurrence. It is important to keep in mind that both disorders can be linked to a number of other medical conditions, including iron deficiency anemia. Therefore, medical attention should be sought.


People suffering from restless legs syndrome usually respond well to therapy , but since symptoms may occur sporadically and with spontaneous remissions, constant medication is only justified if symptoms occur for at least three nights in a week. Therapy is available only on prescription and should be performed under medical supervision.


Narcolepsy

Narcolepsy syndrome is characterized by spontaneous falling asleep. The first symptom is usually excessive sleepiness during the day. It is an irresistible desire to sleep at a time when a person wants to be awake. Narcolepsy is associated with catalepsy, sudden weakness or paralysis often caused by laughter or other intense feelings, then sleep paralysis, a very frightening phenomenon in which a person is half awake but unable to move, and hallucinations, or very vivid and frightening dreams that occur. occur at the beginning or near the end of the dream. A person may also show signs of automatic behavior, ie performing routine or boring tasks, which he does not fully remember later. This disorder can be treated behaviorally or through medication.


Behavioral therapy includes avoiding shift work, avoiding heavy meals and alcohol, adhering to a night's sleep schedule, and strategically arranged day breaks. Medications should be given in a controlled manner, their dose should be individualized, and stimulants should be prescribed to increase the level of attention, and antidepressants to control the above-mentioned conditions related to narcolepsy.


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Causes of Insomnia

Insomnia can be caused by a whole range of medical conditions, pain, and even some medications, and poor sleep hygiene makes it even more difficult. If a medical condition has caused insomnia, its treatment is primarily related to the treatment of that condition. The link between different medical conditions and sleep disorders is very complex and mutual, and it is not entirely clear how these different factors interact. However, achieving the best possible therapeutic effects also depends on the sleep component, which should definitely be taken into account. Therefore, it is very important to inform the doctor about sleep disorders that can aggravate the signs of the primary disease, so that he can include them in the overall treatment plan.

Depression is almost always associated with sleep disorders. People who suffer from anxiety may have sleep disorders caused by compulsive thoughts, inability to relax, obsessive feelings of worry, and excessive mental activity. Bipolar, panic and psychiatric disorders are also associated with sleep disorders.

Pain caused by arthritis and other rheumatic diseases , cancers and various neurological disorders such as neuropathy caused by diabetes, usually causes insomnia. Stomach and intestinal disorders such as reflux of stomach contents and stomach ulcers, and angina pectoris caused by heart disease, can cause chest pain resulting in waking up at night. In addition, cluster headaches caused by insufficient sleep may occur during certain phases of sleep.

Other illnesses that often have nocturnal symptoms and can cause insomnia include frequent urination caused by an enlarged prostate, difficulty breathing due to congestive heart failure and emphysema, immobility caused by paralysis or Parkinson's disease, enlarged thyroid gland, stroke, and alcoholism.

Another important reason to tell your doctor about sleep disorders is that these disorders can be caused or aggravated by taking medications such as antidepressants, medications to regulate high blood pressure, heart rate medications, antibiotics, antihistamines, bronchodilators, drugs to stimulate central nervous system, corticosteroids, constipation drugs, diuretics, nonsteroidal anti-inflammatory drugs, and others.

Treatment of insomnia

Insomnia is usually treated in two ways: By medication or by behavioral strategies to put it to sleep. Drug treatment includes taking hypnotics that do not belong to the group of benzodiazepines, which act quickly, do not cause a disorder of sleep structure or its quality, and do not cause addiction. Other hypnotics should be used only in certain patients because they are strong drugs that have a strong effect on sleep quality and can cause severe side effects, including daytime sleepiness and addiction. Sometimes some of the anti-depressant medications are often used, which are often associated with insomnia, which is accompanied by sedation.

Behavioral strategies include restricting sleep, that is, the place where one sleeps. The basic idea is to sleep exclusively in bed, and that the bed is used only for sleeping. It is not good to lie awake in bed for hours. If he doesn’t fall asleep within about 25 minutes, it would be good to get up and do something soothing, like reading a book. This will reduce the uncomfortable association with a bed where you can't fall asleep and eventually create a positive association with a bed where you sleep well. Such a restriction of sleep will sooner or later lead to fatigue and drowsiness early in the evening, or to the disappearance of the problem of insomnia.

However, it is necessary to pay attention to safety during these days of sleep deprivation, because drowsiness can be dangerous, for example when driving a car. Behavioral strategies include stimulus control, which means that the bedroom should not be used for watching television or consuming food, but for sleeping. Another strategy is relaxation, that is, the use of certain techniques to relax the body and mind, which will facilitate the introduction to sleep and reduce the likelihood of waking up during the night. It is also possible to conduct cognitive behavioral therapy in which the psychologist helps to remove the associations associated with bad sleep. The selection of any of these forms of therapy must be based on detailed analysis and accurate diagnosis.

Insomnia is not only very unpleasant but also dangerous. Studies show that chronic insomnia, or less than six or seven hours of sleep a night, increases mortality, even at higher risk than smoking, high blood pressure or heart disease. It is therefore important to approach insomnia very seriously, as with any other medical condition. It is definitely necessary to pay attention to sleep hygiene, and inform the doctor about all the symptoms.

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