Sleep Disorders, Problems: Causes and Treatments

Sleep is a physiological, active and rhythmic process essential for maintaining vital functions and good health. Adequate sleep plays a critical role in early brain development, learning and memory consolidation, and on the other hand, sleep disturbances are directly related to behavioral problems and poor emotional regulation.

Individual sleep needs are highly variable and are usually between 6 and 10 hours a day. Most people sleep at night. However, many have to sleep during the day to fit into their work schedules, resulting in sleep disturbances.

What is the Sleep Cycle? 

According to polysomnographic criteria, human sleep is basically divided into REM (R) sleep (rapid eye movement) and Non-REM (NREM) sleep, which are repeated in four or five cycles per night at 90-120 minute intervals. 

NREM sleep, characterized by synchronized electroencephalographic activity, consists of three stages: Shallow sleep or stage 1 sleep (N1), intermediate sleep or stage 2 (N2) and deep sleep or stage 3 (N3).

REM sleep is active: heart and respiratory rates are irregular, blood pressure is variable and muscle tone is reduced. Oxygen consumption increases, and the individual becomes poikilothermic, so that he or she becomes cold, because he or she adjusts his or her temperature to the ambient temperature. There is a lot of brain activity and dreams occur. This stage plays a fundamental role in learning and memory, which is reinforced during non-REM sleep. The REM and non-REM stages are interspersed and there are four or five cycles during the 8-9 hours of night rest. 

During the non-REM stages sleep deepens and slows down and is usually slow and very restorative; heart rate, respiratory rate, blood pressure and muscle tone remain constant and temperature control is maintained. The function of non-REM sleep is to restore neuronal protein structure, increase the production of neuroendocrine factors, neurotransmitters and immunologic factors, of which growth hormone is the main exponent.

Sleep Hours by Age

Age is a determining factor for the number of hours of sleep. The newborn sleeps between 14 and 18 hours, the infant between 12 and 14 hours, the school-age child between 11 and 12 hours and in adulthood the majority sleep between 7 and 8 hours a night.

It is well known and accepted that the ideal for maintaining health and well-being is 7-8 hours of sleep a night, but there are studies that show that each individual needs to fill their "sleep quota" to feel good. 

Another important change related to the normal architecture of sleep and age group is the typical changes seen in the elderly, especially after the age of 60. There is more difficulty in falling asleep and maintaining sleep, an increase in nocturnal awakenings, a decrease in deep sleep in the N3 phase and, to a lesser extent, a decrease in sleep efficiency. 

Sleep Disorders

A sleep disorder is a condition that affects the quality or duration of a person's sleep or affects the ability, timing or impact of being able to function properly while awake. There are different symptoms that can reflect a sleep disorder and depending on the presence of each one, the type of sleep disorder present can be classified. 

Insomnia 

Insomnia is a sleep disorder that involves the inability to initiate or maintain sleep or to achieve sleep of sufficient duration and quality to restore energy and normal alertness. 

The WHO has stated that for insomnia to be diagnosed, the inability to initiate or maintain sleep or to achieve restful sleep should last for at least one month and be accompanied by daytime fatigue, significant personal discomfort and impairment in social, occupational or other important personal activities. 

Insomnia causes individuals to wake up tired, lack energy during the day, have trouble focusing, and have a negative impact on their mood. Individuals who do not get regular and adequate sleep are more unhappy, absent-minded and pessimistic, and this negatively affects their quality of life.

Sleep Apnea

Sleep apnea is a disorder characterized by recurrent periods of breathlessness during sleep lasting at least 10 seconds or longer. There are two main types of sleep apnea:

● Obstructive sleep apnea

● Central sleep apnea

Obstructive sleep apnea is one of the most common in older adults. It is a pathology characterized by recurrent breathing interruptions (apneas) lasting longer than ten seconds, leading in most cases to inadequate oxygenation for two or more hours in a single night, accompanied by various symptoms or complications. Treatment of obstructive sleep apnea involves the use of non-invasive ventilation (NIV), which applies positive pressure to the airways to reduce the number of apnea episodes.

Central sleep apnea (CSA) is a disorder characterized by the absence of breathing during sleep, caused by spinal depression that inhibits inspiratory effort. It is characterized by the absence of the desire to breathe during sleep when the patient does not make any respiratory effort. In central sleep apnea, apnea periods are not caused by obstruction of the airway. They occur because the part of the brain that controls breathing is not working properly.

Restless Leg Syndrome

Restless Legs Syndrome (Willis-Ekbom disease) is a disorder of neurological origin in which uncomfortable sensations in the limbs (especially the legs) occur during rest, for example when sitting or lying down. This discomfort causes the need to stand up, walk and move. The discomfort is alleviated or disappears with movement.

Parasomnias

Parasomnias are episodic sleep interruptions due to unusual physical events or behaviors such as sleepwalking, nightmares, night moaning or screaming, sleep-related eating disorders, or repeated unconscious emptying of the bladder during sleep.

If this disorder is intense and recurrent, it can negatively affect the patient's daily life. Although it is more common in childhood, it can also occur in adulthood. The frequency and severity of stressful situations and traumatic events increase.

Narcolepsy

Narcolepsy is a sleep disorder of neurological origin characterized by excessive daytime sleepiness, often accompanied by cataplexy (bouts of muscle hypotonia). The prevalence of the disease in Europe is 3-5 per 10,000 inhabitants and usually manifests itself between the second and third decades of life. 

Many factors are taken into account when treating the disease, including age, associated diseases, lifestyle and the impact of drowsiness and/or cataplexy on the patient's quality of life.

Hypersomnia

It is a condition characterized by excessive daytime sleepiness and falling asleep suddenly during the day. However, excessive daytime sleepiness (ESD) can be defined as sleepiness that occurs almost every day for at least three months. 

● ESD syndromes are believed to occur in 25% of the population.

● ESD leads to problems with concentration, memory and mood and affects activities of daily living.

● Many neurological diseases, especially Alzheimer's disease and other dementias, can be associated with excessive daytime sleepiness. 

Symptoms of Sleep Disorders

The most common symptoms are:

● Inability to fall asleep,

● Early awakening

● Physical fatigue,

● Exhaustion in social life,

● Daytime sleepiness,

● Difficulty in fulfilling obligations at work, family or daily life, etc

What Causes Sleep Disorders?

Sleep can be affected by many factors, including irregular bedtime and wake-up time, bedtime activities, stress, diet, illness and the use of certain medications. 

● Anxiety, hyperthyroidism, psychiatric illnesses or disorders that cause pain are the most common causes of sleep disturbance.

● Environmental influences such as light and temperature can alter the circadian rhythm (internal sleep clock) and lead to sleep disturbance.

● In hypersomnia, the causes may be related to anxiety or severe depression, hypnotic abuse or sleep apnea.

● Snoring is caused by temporary mechanical obstruction of the upper airways and is more common in men over 40, especially if they suffer from obesity. In many cases, it is accompanied by obstructive sleep apnea.

● Depression, post-traumatic stress disorder, psychosis or schizophrenia, anxiety disorders and eating disorders can trigger sleep disorders.

● Medications such as tranquilizers, antihistamines, neuroleptics or antidepressants can also exacerbate symptoms.

● Artificial light emitted from different screens (television, computer, cell phone) and the state of wakefulness created by these devices suppress the release of melatonin, a hormone involved in sleep onset.

How Are Sleep Disorders Diagnosed?

An accurate diagnosis requires polysomnography, or sleep testing with simultaneous video recording, which involves recording physiological variables such as electroencephalogram, nasal flow, oxygen saturation and heart rate throughout the night.

Polysomnography, or sleep testing, is a standardized test used to diagnose sleep problems. It is performed in sleep laboratories in the neurology departments of hospitals and allows the measurement of brain and body activity during sleep.

Do Sleep Disorders Affect Brain Health?

Sleep is an excellent indicator of an individual's state of health. Research has shown that getting a good night's sleep is linked to better performance the next day. 

How to Treat Sleep Problems?

Recent research shows that about 30% of people have poor sleep quality, meaning changes in sleep duration, latency and number of awakenings. 

When correctly diagnosed and treated by a multidisciplinary team, sleep disorders have a high cure rate. Treatments to address sleep problems range from good sleep habits to other lifestyle changes such as healthy eating and exercise. 

Supplements to Help You Sleep

Since ancient times, different chemical substances derived from plants have been used to induce and maintain sleep. Valerian, lime blossom, passionflower and opioids are some of the most common plant extracts. Valerian has been the subject of many clinical studies showing that it plays a role in improving sleep quality and reducing the time it takes to fall asleep.