Primary sleep disorder: Non-restful sleep, which occurs as its own clinical picture, without any other detectable illness. It manifests itself as a disorder of falling asleep or sleeping through the night and takes the form of waking too early or a sleep rhythm disorder.
The frequency of sleep disturbances is considerable. Around 30% of the population has to struggle with sleep disorders at least some of the time, with women being affected slightly more often than men, and older people being affected much more often after retirement than younger people who are in working life.
Only when the complaints last at least four weeks, one speaks in sleep medicine of sleep disorders. About five million Germans suffer from severe sleep disorders requiring treatment.
Treatment of nonrestorative sleep has made progress in recent years, primarily due to the behavioral medicine treatments now available, although these require significant cooperation from the affected person.
If sleep disorders are not treated, there is a risk of secondary diseases such as depressive moods, inability to drive on the road, loss of performance at work and social isolation in private life.
In the case of difficulty falling asleep:
- Lying awake for hours in the evening with brooding and circling thoughts
- In pronounced cases, "intermediate state" with daydreams usually experienced as unpleasant
- Due to persistent fatigue, the sufferer goes to bed earlier and earlier in the absence of external constraints.
In sleep-through disorder:
- Longer periods of wakefulness during the night (short periods of wakefulness are, however, part of normal sleep)!)
- Musings and circling thoughts
- Waking up after only 2-5 hours of sleep without being able to fall back asleep within a reasonable amount of time
In all forms:
- Lack of recovery value of sleep
- Pronounced daytime sleepiness and increased daytime sleepiness
- Concentration problems
- Increased sensitivity to stimulants such as caffeine, nicotine and alcohol
- Loss of zest for life
- Frequent symptoms of depressed mood or anxiety disorders.
If non-restorative sleep occurs as an independent disorder, it manifests itself as follows
- As Sleep disturbance: Agonizingly long periods of lying awake until sleep occurs, in extreme cases for over three hours.
- As Through-sleep disorder: Shallow and "choppy" sleep due to frequent and prolonged periods of wakefulness.
- As premature awakening: Awakening after only a few hours of sleep without being able to go back to sleep.
- As Sleep rhythm disturbance: Disturbance in alternating between periods of wakefulness and sleepiness. A sleep rhythm disturbance occurs inevitably with on jet lag, but is otherwise rather consequence than cause of the nonrecovering sleep.
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What the doctor does
Sleep medicine therapy for sleep disorders without underlying chronic disease includes three forms:
- Drug therapy
- Behavioral therapy
- Self-help in the form of improved sleep hygiene.
Drug therapy. More than one third of patients with non-restorative sleep receive sleep medication from their doctor. But it is an open question, which percentage of these prescriptions helps the affected person at all. In any case, sleep physicians argue that none of these medications has been shown to really improve the quality of life of the sufferer, or to work better than a placebo or. Self-help measures. In contrast, sleep medications sometimes have serious side effects, especially in older people, and are often responsible for falls and associated fractures
The doctor will prescribe sleeping pills mainly if the sleep disorder has a clear cause, if z. B. there is an upcoming event (surgery, moving house, court date), a drastic experience (accident, death of a relative), or another short-term exceptional situation.
In the case of chronic sleep problems – i.e. those that have existed for months – he will only prescribe sleeping pills if the intake is accompanied by behavioral therapy measures and an improvement in sleep hygiene.
Opinions differ widely on the details and especially on the duration of taking the medication. The German Society for Sleep Medicine recommends initially prescribing sleeping pills for two weeks. If the sleep disorder improves but recurs unchanged after proper discontinuation, a second two-week period of therapy is allowed. If the sleep disorder persists after discontinuation, it can be assumed that there is no prospect of success with the previously prescribed medication. Now the diagnostics need to be reviewed. The physician will initiate behavioral therapy procedures, help improve sleep hygiene, or prescribe medications of other substance classes.
However, recent studies have shown that sleeping pills can increase the risk of death – even at low doses. Sufferers who take about 18 doses a year more than triple their risk of developing cancer or other conditions. At 130 doses it is even five times as high.
If behavioral therapy methods are not possible or prove ineffective, evening medication with benzodiazepines can be prescribed under certain conditions by a physician qualified in sleep medicine if there is otherwise a significant daytime impairment due to the consequences of the sleep disorder. The prescription should be reviewed every two weeks. After 3, at the latest 6, months of unproductive treatment, the treatment should be discontinued and the patient referred to a sleep laboratory .
Instead of prescribing a fixed drug, the doctor may suggest an as-needed therapy to the patient. In this case the patient takes the sleeping pill only when he really needs it. This is appropriate if the sleep disturbance is only occasional (z. B. always before business trips by plane) and/or if it is foreseeable that the sleep disorder will pass by itself (z. B. mourning period, house construction). The patient must therefore decide for himself when he needs medical help. However, there is a risk that the patient "learns" to cope with certain situations only with the help of a drug and thus loses confidence in his or her own powers.
Another alternative is interval therapy. Either the patient receives his medication in a fixed rhythm (z. B. every third night) or on pre-arranged occasions (e.g. B. in the case of shift workers, at the end of night shifts). This form of medication prescription is particularly promising in the long term if the patient is trained in behavioral therapy in parallel.
Behavioral sleep therapy. Behavioral medicine is now the treatment of choice for sleep disorders – even those caused by other illnesses. In many cities there are now sleep therapy services based on behavior therapy. Their techniques include:
- Stimulus control. The function of bed and bedroom is optimized by eliminating sleep-disturbing behaviors and practicing sleep-promoting ones. This includes only allowing the bed to be used for sleeping. Other activities, such as working, reading or relaxing (with the exception of sex) are "forbidden" in bed and must be carried out elsewhere in the home.
- Sleep restriction. The quality of sleep is improved by limiting the amount of time the person is allowed to spend lying in bed, thus increasing tiredness and avoiding strenuous attempts to fall asleep. This technique is also suitable for self-therapy, but requires a high level of discipline.
- Paradoxical intention. By the request resp. the conscious intention to stay awake prevents unsuccessful attempts to fall asleep; the process of falling asleep is thus less anxiety-provoking.
- Cognitive techniques. Sleep fears are reduced by concentrating on calming thought images and interrupting sleep-disturbing ruminations and circling of thoughts.
If you have persistent sleep problems, you should try such offers, if available, even if health insurers do not usually cover the costs.
Your pharmacy recommends
The basics of sleep hygiene
With hardly any chronic illness is the affected person as much of a "scientist in his own cause" as with sleep disorders. The following tips and rules give the sleep-medically established elements of modern sleep therapy Sleep hygiene again. What is most effective for you and what you should try first, you have to find out for yourself. However, it makes sense to start at several points at the same time.
Keeping regular sleeping hours is especially helpful. You should take advantage of external clocks, such as sunlight, walks in the evening, but also regular social contacts, if they are not psychologically stressful.
It has been proven that physical activity during the day (but not in the evening) promotes nighttime sleep, while passivity and immobility have a negative impact on sleep quality
It is recommended to have dinner in the early evening, if possible, and to prefer easily digestible foods. With a full belly one sleeps badly. But also hungry one should not go to bed. In medical practice, the food factor plays only a subordinate role, because most people have already adjusted their life rhythm accordingly. Only people who have to eat in the evening for professional reasons, such as on business trips, may find this problematic.
Most people also know how to deal with the stimulants alcohol and caffeine. Caffeine – in the form of a cup of coffee at the end of a meal, for example – is a real "sleep killer" for some people. People who have already made this experience with themselves will normally refrain from doing so.
The consumption of freshly fermented beer or sparkling wine also makes some people sleep restlessly, while a glass of red wine usually does not cause any problems. If you are not sure what is harming you, you have to find out for yourself whether one of your eating or drinking habits is not disturbing your sleep by consistently cutting it out. These attempts should be kept up for at least a week.
Too much alcohol has a fundamentally unfavorable effect on sleep and causes you to wake up prematurely again.
Getting to rest.
Normally, you rarely think about how to relax, because you simply relax on your own. However, if this is no longer possible for you, you can learn how to relax. The important thing here is to eliminate all thoughts of things that worry you. Sometimes it helps to consciously listen to beautiful music to fall asleep. It is best to set the volume so low that you have to listen carefully. Audio books are also suitable for this purpose. Often negative thoughts can be effectively dispelled with breathing exercises. Focus on your own breathing by placing a hand on your abdomen and tracking your inhales and exhales. When you inhale, your belly should rise; when you exhale, say a soft "Ssssss" and watch how your belly lowers. Breathing exercises are also used to find inner peace in relaxation techniques such as Qi Gong and Tai Chi, which originated in China.
An old, but still quite effective method to come to rest is bathing: A warm full bath with lemon balm or other bath additive can effectively promote falling asleep (more on full baths). If there is calf pain or other pain syndromes, cool calf wraps or wash-offs may be a better choice.
Another effective method of controlling sleep disorders is autogenic training, a type of self-suggestion that helps you to relax better. If you have not yet mastered the method, you may find advice books or courses (such as those offered by. B. (such as those offered by adult education centers) can help you to learn them.
The biofeedback method for relaxation is ideal for people who have a preference for technology. While you relax under guidance, relaxation and tension are measured by connected electrodes and made visible on a screen.
Meditation is also known in our culture as a way to find relaxation and inner peace. In Indian culture, along with physical exercises, it is an important part of various yoga movements. Meditation should be practiced under guidance; however, if you have mastered the essentials, you can meditate almost anywhere and anytime.
The principle of Jacobson’s Progressive Muscle Relaxation (PMR) is based on consciously concentrating on relaxing and tensing individual muscle groups, starting with the hands and moving on to the arms, neck, shoulders, etc., all the way down to the feet. This method is also best learned in courses offered for this purpose. Later, you can practice what you have learned on your own with the help of a CD or DVD.
All relaxation techniques, when done correctly, work by lowering the brain’s activity level. This downshifting of the brain can be tracked in the EEG: If you master your relaxation technique, you can virtually z. B. increase the proportion of slower alpha waves. Therefore, it is not important which method you choose for yourself, it is more important that you really integrate the method you have chosen into your everyday life.
Reduce causes of stress.
Promoting the ability to relax is one of the ways to prevent sleep disorders. Equally useful, however, is to avoid getting into situations of great tension on a regular basis beforehand.
It is a well-known fact that a clear conscience is the best pillow of peace. So check if you have really done everything to banish smoldering conflicts from your life. To do this, go through the topics that keep coming to mind at night when you are brooding. Some experts also advise depth psychology-oriented psychotherapy if serious conflicts are the cause of sleep disorders. However, it is not clear whether this works better than behavioral sleep therapy. In the acute stage of psychotherapy, sleep disorders can even initially worsen.
Adhering to certain rituals every evening is beneficial and promotes sleep. This can be a walk, a cup of herbal tea as a "bedtime snack" or even a small glass of an alcoholic beverage.
Immediately before falling asleep, bedtime stories for both children and adults, for the latter in the form of a book, have a calming, sleep-inducing effect. For devout people, a good night prayer is usually part of the rituals. Watching television, on the other hand, is generally not a good idea.
Last but not least, the time before falling asleep is also the most popular time for tenderness and sexual intercourse, the sleep-promoting effect of which is indisputable.
The bedroom plays a special role in restful sleep. First and foremost, you should feel comfortable in your bedroom, and it should have a quiet, relaxing atmosphere. It may be cool, but not cold and uncomfortable. It is ideal if a small east window lets in the morning light, but on the other hand, during the night there are no sources of light or noise to interrupt your sleep.
An important stress factor for night sleep is noise. If outside noise can’t be reduced, it helps to get used to using wax ( Ohropax® ) or foam rubber earplugs. Some people also sleep well with a second smaller pillow placed on the exposed ear.
If these measures are not sufficient, the installation of noise protection windows should be considered, the positive effect of which is often astounding. If this option is not available, in extreme cases (and if the financial means allow it) the only option is to change the apartment, because the sensitivity to noise increases with age.
Alone or in pairs.
If your partner snores, or if it makes you nervous that he is sleeping while you are sleepless, then you should consider whether it might be better to sleep (temporarily) alone.
While warmth is beneficial when falling asleep and freezing severely hinders falling asleep, the opposite is true when sleeping through the night: here the accumulation of heat under the comforter becomes a problem. So the thermal requirements are contradictory.
Most people solve this conflict by bringing about the missing "warmth to fall asleep" with the help of bed socks, heat pads or a hot water bottle. In the pharmacy or in the medical supply store also large compresses are available, which are warmed up in the water bath and have a long-lasting warming effect. If you use one of these methods, the room temperature in your bedroom can be rather low. In principle, the temperature in the bedroom should be significantly lower than in the rest of the house. This is recommended, because the body must be able to "downshift" during the night. Last but not least, this corresponds to the rhythm of nature with a nightly drop in air temperature from 5 to over 10 °C. Many people completely abandon the heating of their bedroom and instead use especially warm bedding or down blankets in winter.
The bed, the chosen mattress and bedding also play an important role in the quality of sleep. The following should be considered:
- The mattress should be neither too soft nor too hard. There are now also mattresses with different hardness zones, which provides softer springing especially in the shoulder area. Pocket spring mattresses are more breathable than latex mattresses and dissipate the heat generated especially at the end of the night better.
- The following applies to comforters: synthetic comforters are advantageous for allergy sufferers, but tend to promote heat accumulation more than those made of natural materials. In the winter down and in the summer wild silk or other natural materials are thus for Nichtallergiker the better choice.
- Finally, an often neglected factor is the pillow: The traditional shape and standard size (80 x 80 cm) is rather unfavorable because the pillow easily slips during sleep and, in addition, the desired head elevation is often too low. This favors pain in the cervical spine. In the trade, there are therefore a variety of health pillows that you should try out.
In alternative medicine, the requirements go much further. Feng Shui teachings call for a harmonious room layout; an unfavorable position of the bed can therefore cause sleep problems. Other therapy directions see under the bed running water veins as problem causers; again others warn before electrical smog. The latter attach great importance to the absence of live wires near the bed and even avoid any kind of metal in the bed frame and mattress. Even if such seemingly causal relationships sometimes sound surprisingly plausible – none of these hypotheses has yet been able to prove their truthfulness.
Patients who have a new onset of nocturia (urination at night) should consult a doctor. In connection with edema, this is an indication of a serious illness, z. B. Heart disease, protein deficiency, liver disease or kidney disease that needs treatment.
Even without a serious illness, sometimes going to the bathroom at night is unavoidable. Those who want to avoid them should drink very little after 6 p.m. If there is no serious underlying disease, nocturia itself can be treated with medication, such as desmopressin (Nocdurna®). What should be noted here are the gender-specific dosages. Caution is especially advised for patients over 65 years of age. This age group has an increased risk of developing hyponatremia (sodium deficiency) with symptoms such as headaches, nausea, weight gain or cramps when taking desmopressin.
Diuretics as well as diuretic herbal teas (bladder and kidney teas or teas made from nettle, goldenrod, horsetail or bearberry leaves) should not be taken in the evening, if possible, in consultation with your doctor. be drunk. Fresh fruits (especially pears, peaches, grapes) also have a diuretic effect and should not be eaten in large quantities before going to bed.
A widespread disruptive factor of restful sleep is "brooding". Thoughts and worries circling in the head simply cannot be banished. If at all possible, try to radically stop mind circling. The suggestions of some advisors to think only of nice things or to count sheep usually help little or not at all in practice. So you have to find the best way for you to break off circling thoughts yourself.
Sometimes permanent, unsuppressible brooding is also an indication of depression, which should be treated with medication.
- Some people find it helpful to get up briefly, drink something warm in peace and quiet and then lie down again soon after.
- Others find a sip of water sufficient. If there’s already a glass of water on the nightstand, you avoid having to restart your circulation by getting out of bed.
- If a topic can’t be put out of your mind at all, it can help to have a piece of paper and a pen ready by your bedside and make brief notes. It is even better if you go to a place outside the bed to write down your thoughts. This signals to yourself that the problems in bed "have no place".
- Often, reading an exciting book or an interesting newspaper article can also distract from brooding.
- People who are suffering from the loss of a partner, child or parent can benefit from a mental dialogue with their loved one.
In hardly any other field of medicine do the boundaries between alternative and conventional therapy methods run as fluidly as in sleep medicine. For example, the relaxation-promoting therapies discussed above under self-help are definitely among the alternative methods for other diseases – while in sleep medicine they have already become core components of "conventional" therapy. Thus phytotherapeutic sleep aids are firmly established in family doctor’s practice. Another option is aromatherapy. A few drops of bitter orange oil are drizzled into the bowl of a fragrance lamp before going to bed. Lavender or chamomile oil can also have a calming effect through their scent.
Methods such as acupuncture or homeopathy play only a minor role in the practice of sleep medicine.
The hormone melatonin is often advertised – even on the Internet – as a natural medicine for better sleep. Scientific studies, however, attribute little benefit to isolated ingestion :