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Sleep disorders

Sleep disorders are quite widespread problem. Frequent complaints to a bad dream show 8-15% of adult population of all globe, and 9-11% use various somnolent medicines. And this indicator among elderly people is much higher. Sleep disorders meet at any age and the types of violations are characteristic of each age category. So bed wetting, a snokhozhdeniye and nightmares meets at children's age, and pathological drowsiness or sleeplessness are more characteristic of elderly people. Is also such sleep disorders which beginning at children's age accompany the person all his life, for example, a narcolepsy.

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Sleep disorders

Sleep disorders are quite widespread problem. Frequent complaints to a bad dream show 8-15% of adult population of all globe, and 9-11% use various somnolent medicines. And this indicator among elderly people is much higher. Sleep disorders meet at any age and the types of violations are characteristic of each age category. So bed wetting, a snokhozhdeniye and nightmares meets at children's age, and pathological drowsiness or sleeplessness are more characteristic of elderly people. Is also such sleep disorders which beginning at children's age accompany the person all his life, for example, a narcolepsy.

Sleep disorders happen primary — not connected with pathology of any bodies or secondary — arising as a result of other diseases. Frustration of a dream can arise at various diseases of the central nervous system or mental violations. At a number of somatic diseases patients have problems with a dream because of pains, cough, short wind, attacks of stenocardia or arrhythmia, an itch, the speeded-up urination, etc. Intoxications of various genesis including at oncological patients, often cause drowsiness. Sleep disorders in the form of pathological drowsiness can develop because of hormonal deviations, for example, at pathology of gipotalamo-mezentsefalny area (epidemic encephalitis, a tumor, etc.)

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Classification of sleep disorders

1. Insomniya — sleeplessness, violations of process of falling asleep and a dream.

  • Psychosomatic — connected with psychological state, can be situational (temporary) or constant
  • Caused by alcohol intake or medicamentous medicines:
  1. chronic alcoholism;
  2. long administration of drugs of the activating or oppressing TsNS;
  3. syndrome of cancellation of somnolent, sedative and other medicines;
  1. syndrome of decrease in alveolar ventilation;
  2. syndrome night ;
  • Caused by a syndrome of "uneasy legs" or night miokloniya
  • Caused by other pathological states

2. Gipersomniya - the increased drowsiness

  • Psychophysiological - connected with psychological state, can be constant or temporary
  • Caused by alcohol intake or medicamentous means;
  • Caused by mental diseases;
  • Caused by various disorders of breath in a dream;
  • Narcolepsy
  • Caused by other pathological states

3. Violations of the mode of a dream and wakefulness

  • Temporary sleep disorders — connected with sharp change of an operating schedule or the time zone
  • Constant sleep disorders:
  1. syndrome of the slowed-down dream period
  2. syndrome of the premature period of a dream
  3. syndrome not - a 24-hour cycle of a dream and wakefulness

4. Parasomniya — the violations in functioning of bodies and systems connected with a dream or awakening:

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Sleep disorder symptoms

Symptoms of sleep disorders are various and depend on a type of violation. But any a sleep disorder, for the short period of time it can lead to change of an emotional state, attentiveness and efficiency of the person. Children of school age have problems with study, ability to acquire new material decreases. Happens that the patient sees a doctor with complaints to feeling sick, without suspecting that it is connected with a sleep disorder.

Psychosomatic sleeplessness. Insomniya is considered situational if it lasts no more than 3 weeks. The people having sleeplessness badly fall asleep, often wake up in the middle of night and cannot fall asleep. Earlier morning awakening, feeling of a nevyspannost after a dream is characteristic. In the investigation of it there are an irritability, emotional instability, chronic overfatigue. The situation is complicated by what patients endure because of sleep disorders and with alarm wait for night. Time spent without dream during night awakenings seems to them twice longer. As a rule, situational sleeplessness is caused by an emotional condition of the person under the influence of certain psychological factors. Quite often after cancellation of a stressful factor the dream is normalized. However in certain cases difficulties of falling asleep and night awakenings become habitual, and the fear of sleeplessness only aggravates a situation that leads to development of a constant insomniya.

The sleeplessness caused by alcohol intake or medicamentous medicines. The long constant use of alcoholic beverages leads to violations of the organization of a dream. The phase of a REM sleep is shortened and the patient often wakes up at night. After the alcohol intake termination, as a rule, within 2 weeks of a sleep disorder pass.

The sleep disorder can be side effect of the medicines exciting nervous system. Long reception of sedative and sleeping medicines can also lead to sleeplessness. Over time the effect of medicine decreases, and increase in a dose leads to short-term improvement of a situation. As a result of a sleep disorder can be aggravated, despite of increase in a dosage. In such cases frequent short-term awakenings and disappearance of a clear boundary between dream phases are characteristic.

Sleeplessness at mental diseases differs in constant feeling of strong concern at night, very light and superficial sleep, frequent awakenings, day apathy and fatigue.

The syndrome sleepy or in a dream is a short-term termination of current of air in the top airways, the events during sleep. Such pause in breath can be followed by snore or motive concern. Distinguish obstructive , the closings happening in the investigation on a breath of a gleam of the top airways, and central , the works of the respiratory center connected with violation.

Sleeplessness at a syndrome of uneasy legs develops because of the feeling arising in the depth of gastrocnemius muscles demanding to make the movements legs. Uncontrollable desire to move legs arises before going to bed and passes at the movement or walking, but then it can repeat.

In certain cases sleep disorders happen because of the monotonous and repeating sgibatelny movements arising in a dream involuntary in a leg, foot or a thumb. Usually bending lasts 2 sec. and repeats in half-minute.

Sleep disorders at a narcolepsy are characterized by sudden pristupoobrazny zasypaniye in the afternoon. They are short and can arise during a trip in transport, after food, during monotonous work, and sometimes in the course of vigorous activity. Besides, the narcolepsy is followed by cataplexy attacks — sharp loss of a tone of muscles because of what the patient can even fall. Most often the attack occurs during the expressed emotional reaction (anger, laughter, a fright, surprise).

Violations of the mode of a dream and wakefulness. The sleep disorders connected with change of the time zone ("jet shift of phases") or graphics of work by turns are adaptation and pass in 2-3 days.

The syndrome of the slowed-down period of a dream is characterized by impossibility to fall asleep in the certain hours necessary for a normal work-rest schedule in the working days. As a rule, patients fall asleep with such sleep disorder at 2 o'clock in the morning or are closer to morning. However on the weekend or during the holiday when in the mode there is no need, patients do not note any problems with a dream.

The syndrome of the premature period of a dream seldom is the cause for the address to the doctor. Patients quickly fall asleep and well sleep, but they too early waken and respectively in the evening early go to bed. Such sleep disorders often occur at aged people and usually do not bring them special discomfort.

The syndrome not - a 24-hour cycle of a dream and wakefulness consists in impossibility for the patient to live according to schedule 24-of hour days. Biological days of such patients often include 25-27 hours. These sleep disorders occur at people with changes of the personality and at blind people.

Snokhozhdeniye (sleep-walking) is unconscious commission of difficult automatic actions during sleep. Patients with similar sleep disorders can get at night out of a bed, go and to do something. At the same time they do not wake up, resist attempts to wake them and can make actions, dangerous to their life. As a rule, the similar state lasts no more than 15 minutes. After that the patient comes back to a bed and continues to sleep, or wakes up.

Nightmares arise during the first hours a dream more often. The patient with shout sits down in beds in a condition of fear and panic. It is followed by tachycardia and increase of breath, sweating, expansion of pupils. In a few minutes, having calmed down, the patient falls asleep. In the morning he usually does not remember a nightmare.

Bed wetting is observed in the first third of a night dream. Small children can have it physiological and pathological — at children who already learned to go to a toilet independently.

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Diagnosis of a sleep disorder

The most widespread method of a research of sleep disorders is the polisomnografiya. This examination is conducted by the somnologist in special laboratory where the patient has to spend night. During its dream a set of sensors at the same time register bioelectric activity of a brain (EEG), warm activity (ECG), the respiratory movements of a thorax and a forward belly wall, the inhaled and exhaled air stream, a blood saturation oxygen, etc. The video of the events in chamber and constant observation of the doctor on duty is made. Such inspection gives the chance to study a condition of brain activity and functioning of the main systems of an organism during each of five stages of a dream, to reveal deviations and to find a dream cause of infringement.

Other method of diagnosis of sleep disorders is the research of the average latency of a dream (ALD). It is applied to identification of the reason of drowsiness and plays an important role in diagnostics of a narcolepsy. The research consists of five attempts of falling asleep which are carried out in hours of wakefulness. Each attempt lasts 20 minutes, the interval between attempts makes 2 hours. Average latency of a dream is time which was required to the patient for immersion in a dream. If it more than 10 minutes, then is norm, from 10 to 5 minutes — boundary value, less than 5 minutes — pathological drowsiness.

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Treatment of a sleep disorder

The treatment of sleep disorders appointed by the neurologist depends on the reason of their emergence. If it is somatic pathology, then therapy has to be directed to the main disease. The reduction of depth of a dream and its duration happening at advanced age is natural and often demands only an explanatory conversation with the patient. Before to resort to treatment of sleep disorders by means of somnolent medicines, it is necessary to track observance of the general rules of a healthy sleep: not to go to bed in the excited or angry state, is not before going to bed, not to have for night of alcohol, coffee or strong tea, not to sleep in the afternoon, to regularly play sports, but not to do physical exercises for the night, to observe purity in a bedroom. To patients with a sleep disorder time is useful to go to bed and wake up every day in one and too. If it is not possible to fall asleep within 30-40 minutes, it is necessary to rise and be engaged in affairs, there will be yet no desire to have a sleep. It is possible to enter the nightly calming procedures: walk or heat bath. The psychotherapy, various relaksiruyushchy techniques helps to cope with sleep disorders often.

As medicamentous therapy of sleep disorders use medicines of a benzodiazepinovy row more often. Medicines with short time of action — to triazoles and midazolam appoint at falling asleep process violations. But at their reception often there are collateral reactions: excitement, amnesia, confusion of consciousness, and also violation of a morning dream. Somnolent medicines with long action — diazepam, flurazepam, chlordiazepoxide apply at early morning or frequent night awakenings. However they often cause day drowsiness. In such cases appoint medicines of average time of action - and zolpidy. These medicines are characterized by smaller risk of development of dependence or tolerance.

Other group of the medicines applied at sleep disorders are antidepressants: , , . They do not lead to accustoming, are shown to patients aged, to patients with depressions or suffering from a chronic pain syndrome. But the large number of side effects limits their use.

In hard cases of a sleep disorder and in the absence of result from use of other medicines for patients with the confused consciousness use neuroleptics with sedative effect: , , chlorprothixene. In cases of pathological drowsiness of easy degree appoint weak stimulators of TsNS: glyutaminovy and ascorbic acid, calcium medicines. At the expressed violations — psychotonics: , .

Treatment of violations of a rhythm of a dream at elderly patients is carried out in a complex by a combination of vasodilating medicines (nicotinic acid, a papaverine, , ), stimulators of TsNS and easy tranquilizers of a phytogenesis (a valerian, a motherwort). Reception of somnolent medicines can be carried out only on doctor's orders and under its observation. After the termination of a course of treatment gradual decrease in a dose of medicine and careful data it is necessary on is not present.

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Forecast and prevention of sleep disorders

As a rule, various sleep disorders recover. Difficulties are presented by therapy of the sleep disorders caused by a chronic somatic disease or occurring at advanced age.

Observance of the mode of a dream and wakefulness, normal physical and mental activity, the correct use of the medicines influencing TsNS (alcohol, tranquilizers, sedative, somnolent), - all this serves as prevention of sleep disorders. Prevention of a gipersomniya consists in the prevention of craniocereberal injuries and a neuroinfection which can result in excess drowsiness.

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Sleep disorders - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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