Types of sleep disorders

They can be classified into different types :

1. The amount of sleep

Insomnia

Insomnia is the difficulty in falling or staying asleep. Its prevalence varies between 10-40% and reaches 50% in people over 65 years of age. Insomnia usually occurs along with irritability, mood swings, daytime sleepiness, low concentration as well as headaches and panic attacks. Insomnia can be of 3 types:

In turn, the insomnia can be acute or transient (lasts less than a week), subacute or short-lived (lasts between one and three weeks) and chronic (lasts more than three weeks).

The most frequent causes of the latter are psychiatric illnesses, such as depression or anxiety. Also the abuse of substances and drugs (alcohol, caffeine, nicotine ...), chronic diseases, such as asthma and copd, rheumatology and chronic pain. But it can also be due to syndromes such as or OSAS.

Narcolepsy

It occurs when, together with excessive daytime sleepiness, are associated sudden sleep attacks that can last from 30 seconds to half an hour. Is usually toAdding that consists of the loss of muscular strength with possible fall to the ground. These episodes are usually triggered by intense emotion. During narcolepsy, hypnagonic hallucinations which are images experienced just before the sleep attack and sleep paralysis in which after waking up from sleep there is an inability to mobilize.

Hypersomnias

is defined as excessive daytime sleepiness, up to 25% more than normal hours.

2. The quality of sleep

Parasomnias

It is defined as alterations in the quality or content of sleep. Among them, we find:

3. The dream sequence

It occurs when there are gaps between the rhythm from sleep and wakefulness, and can be:

In the dream sequence there are two phases:

Diagnosis

He relies on questions to the patient to determine the characteristics of the dream. It is important to ask the patient for:

It is useful collect partner information to complete the questioning. Also they family background They are also useful for the diagnosis and the use of drugs or other substances of habitual consumption.

Sleep disorder treatment

It's necessary that before the use of drugs for insomnia Hygienic-dietetic measures are used for their treatment and drugs are reserved for when these fail.

Hygienic-dietary measures

If after taking these measurements, insomnia becomes persistent Regarding its duration with secondary daytime involvement, drug therapy can be used. Among the drugs with a hypnotic effect, the following stand out:

Its use is not recommended for more than four weeks, and in any case its withdrawal should be progressive until its complete withdrawal due to the possibility of causing rebound insomnia in the event of a sudden withdrawal. The use of antidepressant drugs with sedative effects It will be reserved for cases of insomnia associated with depressive symptoms. In cases of OSAS, the treatment of choice is weight control, avoiding alcoholic beverages, avoiding tobacco, and the use of CPAP if necessary. Narcolepsy is treated with central nervous system stimulants together with behavioral therapy.

If you have any questions or suspicions about sleep disorders, they have a service of Free Medical Guidance 24 hours a day.

Dra. Laura Cristel Ferrer Family and Community Medicine Specialist

• Quality of sleep (parasomnias)
• The dream sequence (sleep-wake disorders)
  • Conciliation or onset insomnia, which is the most frequent form of insomnia. Occurs when it takes more than 30 minutes to fall asleep
  • Maintenance insomnia, that is, when frequent nocturnal awakenings occur
  • Insomnia of early awakening.
  • Sleepwalking: It consists of wandering for a few minutes with the risk of falling. More common in childhood and tends to disappear during adolescence. More frequent in men with a family history of sleepwalking.
  • Night terrors: Episodes of nocturnal screaming and agitation during sleep, the patient remaining asleep. Along with sleepwalking, the patient does not remember the episode the next day
  • Nightmares: Dreams with a high degree of emotion that wake up the individual abruptly. More frequent in childhood and in adults, they are associated with certain drugs, mental illnesses and alcohol deprivation.
  • Advanced or delayed rhythm where individual wakes up earlier or falls asleep later
  • Rhythm is disorganized, when sleeping irregularly throughout the day (typical of bedridden patients)
  • Changing rhythm, especially linked to professionals with changing work shifts.
  • NON REM phase It ranges from numbness through light sleep to deeper and more restful sleep. It represents 75% of the sleep time.
  • REM phase begins at the end of the non-REM phase and is characterized by rapid eye movements. It represents 25% of an adult's dream and is when dreams are generated. In elderly people, the hours of sleep decrease to 4-6 hours, light and less restful sleep increases and more nocturnal awakenings appear.
  • Sleep pattern
  • Way of falling asleep
  • Duration
  • Way to wake up
  • How you feel during the day
  • Eating habits and the exercise you do.
  • Effect of insomnia on your daily activity
  • Know the existence of daytime sleepiness or not and when.
  • The patient may be advised to perform a sleep diary for at least a week, noting daily habits in relation to sleep, from the time you go to bed until the hours of sleep.
  • Refering to physical exploration, must be complete including a comprehensive neurological and cardiopulmonary examination.
  • In cases of suspected associated pathology, it will be necessary to perform a blood test (with request for thyroid and toxic hormones)
  • In some cases, imaging tests such as CT or brain MRI will be performed.
  • When suspected, a polysomnography will be necessary.
  • If the suspicion is anxiety or depression, there are rating scales that can help the diagnosis.
  • Perform regular physical exercise.
  • Maintain an environment in the bedroom suitable for sleeping in terms of light, temperature, noise.
  • Avoid exciting substances during the day and especially before sleeping.
  • Maintain regular hours both to go to sleep and to get up.
  • Eat a light dinner at least two hours before bedtime.
  • Avoid naps.
  • Not going to bed to fall asleep. It is preferable to go to sleep later when you are sleepy, than to wait in bed for sleep to enter. Get up if you can't sleep.
  • Avoid watching television in the bedroom.
  • Benzodiazepines
  • Clomethiazole
  • Zolpidem
  • Zoplicone.