Insomnia. Classification of insomnia. Insomnia: what it is, causes, types, signs and treatment Mixed type of insomnia

– a pathological condition in which the process of onset and maintenance of sleep is disrupted. Depending on one or another clinical form of insomnia, difficulties in falling asleep (presomnic form), disturbances during the sleep period (intrasomnic form) and after awakening (postsomnic form) are observed; There is also a decrease in sleep efficiency and night awakenings. The diagnosis is established on the basis of a physical examination, history taking, and polysomnography. Treatment of insomnia includes maintaining sleep hygiene, prescribing drug therapy, physical therapy, and psychotherapy.

ICD-10

G47.0 Disturbances in falling asleep and maintaining sleep [insomnia]

General information

Insomnia is a disorder of the sleep-wake cycle. Pathology is determined by a deficiency in the quality and quantity of sleep, which are necessary for normal human functioning. The disease occurs in 30-45% of the world's population. For some of them (10-15%), insomnia is a serious problem requiring medication. It should be noted that with age, problems with falling asleep and maintaining physiologically sound sleep arise more and more often, so older people experience insomnia more often than young people.

Insomnia, a more popular name for the pathology, used by patients and even doctors, is incorrect, since the disease is not accompanied by a complete loss of sleep.

Causes of insomnia

Insomnia may be based on physiological predisposition, psychogenic disorders, diseases of the nervous system and internal organs. Insomnia often occurs in people suffering from neuroses and neurosis-like conditions: psychoses, depression, panic disorders, etc. Difficulties falling asleep and quality of sleep are usually complained about by patients with somatic diseases that cause night pain, shortness of breath, heart pain, breathing disorders (arterial hypertension, atherosclerosis, pleurisy, pneumonia, chronic pain, etc.). Sleep disorders can accompany organic lesions of the central nervous system (stroke, schizophrenia, parkinsonism, epilepsy, hyperkinetic syndromes); pathologies of the peripheral nervous system.

Predisposing factors also have an influence on the development of sleep disorders, namely: life in a metropolis; frequent change of time zones; long-term use of psychotropic drugs; drinking alcohol; constant intake of caffeinated drinks; shift work and other occupational hazards (noise, vibration, toxic compounds); violation of sleep hygiene.

The pathogenesis of insomnia is considered not to be fully understood, however, scientific research and experiments in the field of neurology have shown that patients experience the same increased brain activity during sleep as during wakefulness (this is indicated by a high level of beta waves); increased levels of hormones at night (cortisol, adrenocorticotropic hormone) and a high metabolic rate.

Classification of insomnia

According to the duration of its occurrence, insomnia is divided into:

• Transitional, lasting no more than a few nights
• Short-term (from several days to weeks)
• Chronic (three weeks or more)

Insomnia is also divided into physiological (situational) and permanent (permanent). Based on its origin, a distinction is made between primary insomnia, which occurs as a result of personal or idiopathic (unexplained) causes, and secondary insomnia, which occurs against the background or as a result of psychological, somatic and other pathologies.

According to the severity of clinical symptoms, insomnia is:

• Mild (weakly expressed) - rare episodes of sleep disturbance
• Moderate severity - clinical manifestations are moderately expressed
• Severe - sleep disturbances occur every night and have a significant impact on daily life.

Symptoms of insomnia

Clinical signs of insomnia, depending on the time of their manifestation, are divided into groups: presomnic, intrasomnic and postsomnic disorders. Disturbances before, after and during sleep can occur individually or in combination. All 3 types of disorders are observed only in 20% of middle-aged patients and in 36% of elderly patients with insomnia.

Insomnia leads to decreased daytime activity, impaired memory and alertness. In patients with mental pathology and somatic diseases, the course of the underlying disease is aggravated. Insomnia can cause slow reactions, which is especially dangerous for drivers and workers servicing industrial machines.

Presomnia disorders

Patients complain of problems with sleep onset. Typically, the falling asleep stage lasts 3-10 minutes. A person suffering from insomnia may spend 30 to 120 minutes or more falling asleep.

An increase in the period of sleep onset may be a consequence of insufficient fatigue of the body when waking up late or going to bed early; pain reaction and itching of a somatic nature; taking drugs that stimulate the nervous system; anxiety and fear that arose during the day.

As soon as a person finds himself in bed, the desire to sleep instantly disappears, heavy thoughts arise, and painful memories emerge in the memory. At the same time, some motor activity is observed: the person cannot find a comfortable position. Sometimes there is causeless itching and unpleasant sensations on the skin. Sometimes falling asleep occurs so imperceptibly that a person perceives it as being awake.

Problems falling asleep can create strange bedtime rituals that are unusual for healthy people. Fear may arise from lack of sleep and fear of bed.

Intrasomnia disorders

The patient complains of a lack of deep sleep; even a minimal stimulus causes awakening followed by a prolonged fall asleep. The slightest sound, lights on and other external factors are perceived especially acutely.

Spontaneous awakening can be caused by bad dreams and nightmares, a feeling of bladder fullness (repeated urge to urinate), vegetative breathing disorder, and rapid heartbeat. A healthy person who does not suffer from insomnia can also wake up, but his threshold for awakening is noticeably higher, subsequent falling asleep is not problematic, and the quality of sleep does not suffer.

Intrasomnia disorders also include increased motor activity, manifested by “restless legs” syndrome, when a person makes shaking movements with his legs in his sleep. The cause of sleep apnea syndrome, which is often observed with insomnia, is the activation of a voluntary breathing regulation mechanism. Occurs most often in obesity and is accompanied by snoring.

Post-somnia disorders

Insomnia also manifests itself in the waking state after awakening. It is difficult for a person to wake up early; he feels exhausted throughout his body. Drowsiness and decreased performance may accompany the patient all day. Non-imperative daytime sleepiness is often observed: even with all the conditions for good sleep, a person cannot fall asleep.

There are sudden mood swings, which adversely affects communication with other people, often exacerbating psychological discomfort. For some time after waking up, a person complains of headaches, and a rise in blood pressure (hypertension) is possible. This is characterized by a more pronounced increase in diastolic pressure.

Diagnosis of insomnia

Insomnia is diagnosed based on the patient's complaints and physical condition. In this case, the actual duration of sleep is not decisive; The 5-hour mark is a kind of minimum: shorter sleep over 3 days is equivalent to one night without sleep.

There are 2 clear diagnostic criteria for insomnia: a delay in falling asleep by more than 30 minutes and a decrease in sleep efficiency to 85% or lower (the ratio of the time of actual sleep to the time the patient spent in bed).

Disturbance of the circadian rhythm (early falling asleep and early rising - a “morning person” or late falling asleep and late rising - a “night owl”) is diagnosed as a pathology if a person experiences post-somnia disorders and is unable to sleep longer or fall asleep early.

Sometimes a person suffering from chronic insomnia is asked to keep a diary for a month, in which periods of wakefulness and sleep are recorded. In cases where insomnia is accompanied by impaired breathing (obstructive apnea) and motor activity, as well as when drug therapy is ineffective, a consultation with a somnologist and polysomnography are prescribed. Computer research provides a complete picture of sleep, determines the duration of its phases and evaluates the functioning of the entire body during sleep.

Diagnosing insomnia is not difficult; it is often more difficult to determine the true cause or combination of factors that caused insomnia. Consultations with specialized specialists are often required in order to identify somatic pathology.

Treatment of insomnia

Transient insomnia usually goes away on its own or after eliminating the causes of its occurrence. Subacute and especially chronic insomnia require a more careful approach, although treatment of the root cause is a fundamental factor.

Successful relief from insomnia involves maintaining sleep hygiene. Falling asleep at the same time every day, avoiding daytime naps, and being active during the day can completely relieve insomnia in older people without the use of medications.

Psychotherapy can eliminate psychological discomfort and restore sleep. Acupuncture and phototherapy (high-intensity white light treatment) have shown good results in the treatment of insomnia.

The use of sleeping pills promotes rapid sleep and prevents frequent awakenings, but hypnotics have a number of adverse effects, ranging from addiction to dependence and rebound effects. That is why drug treatment of insomnia begins with herbal preparations (motherwort, mint, oregano, peony and other medicinal herbs that have a sedative effect) and products containing melatonin. Drugs with a sedative effect (neuroleptics, antidepressants, antihistamines) are prescribed to increase sleep duration and reduce physical activity.

The drugs imidazopyridines (zolpidem) and cyclopyrrolones (zopiclone) have a short duration of action and do not cause post-somnia disorders - these are among the safest chemical hypnotics. A group of tranquilizers - benzodiazepines (diazepam, lorazepam) inhibit brain processes to a greater extent, thereby reducing anxiety and increasing latency to sleep. These drugs are addictive, seriously affect the speed of reaction, and at the same time enhance the effect of barbiturates and analgesics.

Rules for taking medications for insomnia include: compliance with the duration of treatment with sleeping pills - on average 10-14 days (no more than 1 month); drugs can be prescribed in combination, taking into account their compatibility; one or another drug is selected depending on the concomitant somatic pathology and the minimum set of side effects. For preventive purposes, sleeping pills are prescribed 1-2 times a week. It is important to understand that the use of sleeping pills is purely symptomatic treatment. This fact and the mass of undesirable consequences force us to limit their use as much as possible.

Forecast and prevention of insomnia

To completely get rid of insomnia, you should adhere to the following rules: do not delay a visit to a neurologist if there are obvious signs of insomnia; do not take medications without a doctor’s prescription. It is necessary to adhere to a daily routine (proportionate loads, walks and sufficient time for sleep) and to develop one’s own resistance to stress; Emphasis should be placed on psychological techniques and minimal use of medications.

The prognosis for acute and subacute insomnia is favorable; its treatment in most cases does not require the use of hypnotics and tranquilizers. Treatment of advanced chronic insomnia is a long process; Only close interaction between the patient and the doctor will allow choosing an effective treatment regimen and achieving a positive result.

Insomnia (insomnia, dissomnia, from the Latin somnus - sleep) is a periodic or constant sleep disorder characterized by long and painful falling asleep, changes in sleep duration, frequent awakenings at night, early awakening or general unsatisfactory sleep during its normal duration. The condition of insomnia is familiar to varying degrees to many people, regardless of age category. Patients with neurological diseases and the elderly are more susceptible to the problem. How to get rid of insomnia? Successful treatment of insomnia depends on determining its type, severity and etiology. Timely measures taken prevent the disorder from becoming chronic, requiring specialist supervision and long-term drug treatment.

Many people do not pay much attention to short-term sleep disturbances, ignoring the symptoms and not taking action to eliminate them. This can lead to a worsening of the condition and the development of the next stage of the disease. To avoid serious consequences, it is necessary to identify the problem in time and take the necessary measures.

The following signs may indicate the presence of insomnia syndrome:

In addition, a person’s sleep disorders can be determined by their appearance. Red, swollen eyes, bags under the eyes, dry lips, pale skin, depression and lethargy - all this indicates problems with sleep.

Symptoms of insomnia should not be ignored. For people who have had a heart attack, sleep disturbances are especially dangerous. Regular manifestations of it can worsen the healing process and cause a relapse.

Insomnia is classified according to etiology (reasons for occurrence), severity, and duration. The answer to the question, what to do about insomnia, directly depends on the correct definition of its type.

Etiology

Sleep disturbances can be caused by various reasons - both internal and external.

The central nervous system is responsible for all life processes occurring in the human body.

The following CNS irritants can cause insomnia:

• stress and emotional overload;
• absence or violation of the daily routine;
• external factors (noisy neighbors, loud music, uncomfortable bed, uncomfortable room microclimate, etc.);
• night work schedule;
• change of time zone during business trips and travel;
• taking medications that affect the psyche;
• a hearty dinner and energy drinks;
• bad habits (alcohol, smoking);
• excessive physical and mental stress;
• watching action-packed films before bed;
• various diseases, physical pain, painful conditions of the legs (night cramps);
• pregnancy;
• elderly age.

Depending on the causes, there are two types of insomnia - primary and secondary. Primary insomnia is provoked by psychophysiological factors. These include the individual characteristics of the body and its internal state, namely anxiety, depression, fears, and mental disorders.

Secondary insomnia occurs as a result of various physical and mental illnesses, long-term use of certain drugs or products. Thus, pain syndromes, heartburn, alcohol or coffee abuse, and more can disrupt sleep.

Severity

Insomnia can affect a person’s life in different ways: from mild fatigue to confusion, from banal irritability to indifference to everything that happens around.

Based on the level of destructive influence of insomnia, the following types are distinguished:

• weak (symptoms occur irregularly and not every night, mental and physical indicators decrease slightly);
• moderate (attacks occur every night, becoming regular, professional and social functions are impaired);
• pronounced (regular attacks of insomnia, significant impairment of labor and social functions).

Duration

Experts can determine the degree of influence of insomnia on various areas of a person’s life, knowing the period of its duration.

Based on the duration of the syndrome, the following types of insomnia are distinguished:

• acute or transistor – lasts up to 7 days;
• subacute or short-term – up to 3 weeks;
• chronic – more than 3 weeks.

Transistor insomnia occurs as a consequence of psycho-emotional experiences - both negative and positive. Symptoms occur sporadically and are often associated with external stimuli - loud noise, uncomfortable posture, etc. If measures are taken in a timely manner, acute insomnia goes away quickly and without consequences for human health.

Subacute insomnia indicates the presence of some kind of adaptation process in life associated with moving, changing time zones, or a state of grief (death of a loved one). Sometimes it is caused by restless legs syndrome or apnea (prolonged cessation of breathing due to snoring). Short-term insomnia without proper treatment is dangerous by becoming chronic and manifests itself in decreased performance, irritability and fatigue.

Chronic insomnia is not an independent disease, but a sign of various somatic or hidden mental illnesses. More than half of patients suffering from chronic insomnia have previously unidentified disorders and depression. Additionally, drugs such as marijuana or LSD can trigger this type of sleep disorder. The severe consequences of chronic insomnia manifest themselves in serious deterioration in memory, concentration and work activity.

Timely identification of the causes of insomnia helps to eliminate the provoking factor and quickly heal the patient.

Insomnia therapy has a positive effect if a set of measures is followed, such as behavior correction, drug treatment and the use of folk remedies.

Behavioral therapy

First of all, before consulting a doctor, you should try to improve your sleep by applying the following practical recommendations:

1. Sleep hygiene. This concept includes the formation and strict adherence to a daily routine. Going to bed and getting up should be strictly at the same time, while the duration of night rest should be at least 8 hours for an adult. An important condition for this is getting rid of daytime sleep.
2. Relaxation techniques. Breathing exercises, yoga, auto-training, muscle relaxation methods relieve nervous excitement that occurs after increased mental and physical stress.
3. Cognitive therapy. Fear and anxiety about the inability to fall asleep and the upcoming insomnia at night should not completely occupy the mind. It is necessary to distract yourself from obsessive thoughts with the help of positive emotions.
4. Correct stimulation. The bed should be associated with rest and sleep, so its use during the day is not recommended.
5. Correction of biorhythms with light. The patient's internal clock can be adjusted by using blackout curtains, creating the illusion of night by going to bed and waking up early.
6. Rejection of bad habits. Alcohol, energy drinks, and smoking negatively affect sleep cycles, disrupting it and making it shallow.

By analyzing your own behavior and habits, you can significantly help yourself in restoring healthy sleep and do without the help of a doctor.

Drug treatment

The next step in the fight against insomnia after applying behavioral correction may be taking mild sedatives, such as tincture of motherwort or valerian herb. Their use is possible without a doctor’s prescription, but should not be uncontrolled and prolonged.

More serious hypnotics are prescribed only after the conclusion and recommendations of the treating doctor. Their use is carried out in courses, but not more than a few weeks.

With prolonged and unsystematic use of sleeping pills, patients may experience addiction and side effects:

• allergic reactions;
• drowsiness;
• deterioration of attention and memory;
• lethargy.

Their frequent use causes unhealthy sleep and lack of satisfaction from rest.

Therapy with sleeping pills is not carried out in people whose professions require increased attention (drivers, pilots, builders). To carry out treatment, such patients are temporarily suspended from work.

Medications do not completely eliminate the symptoms of insomnia. Their task is to provide an opportunity to relax and fall asleep quickly. When combined with sleep hygiene, proper routine, and positive emotions during the day, these medications can have a positive therapeutic effect.

Folk remedies

The use of traditional medicine recipes is an effective and safe addition to behavior correction and sleep hygiene in the fight against debilitating insomnia. Simple natural remedies act gently, without causing addiction and with virtually no side effects or contraindications. To avoid causing harm to the body, you will have to discuss natural remedy therapy with your doctor if the underlying disease requires it, and insomnia is only a concomitant symptom.

Decoctions, tinctures, solutions:

1. Since ancient times, honey has been used to calm and relax the body. Diluted in a glass of warm milk or a cup of weak tea at night, honey helps both adults and children fall asleep quickly.
2. Turnip decoction. Pour the chopped root vegetable into a glass of water, bring to a boil and cook for 15 minutes. Drink 1 glass of decoction at night or divide 1 glass into 4 doses during the day.
3. Celery root infusion. The medium-sized root of the plant is crushed and poured with chilled boiled water in a volume of 1 liter. The mixture is infused for about 8 hours, filtered and taken 1 teaspoon 3 times a day.
4. Tincture of hawthorn fruits. Dry fruits (2 tablespoons) are crushed and poured with 1.5 cups of boiling water. The tincture is taken half an hour before meals 3 times a day. The product is recommended for people suffering from cardiovascular diseases.
5. Dill tincture. Chopped fresh dill (1 tablespoon) is poured with 1.5 cups of boiling water and infused for 1 hour. The mixture is divided into 4-5 doses per day.
6. Hop tincture. The cones of the plant are crushed and poured with vodka in a ratio of 1:4. The product is infused for two weeks in a dark place, filtered and taken 2 times a day, 5 drops dissolved in a spoon of water.

Scented pillows - to quickly fall asleep, it is recommended to use special sleeping pillows. You can make them yourself without much expense.

To do this, a pillowcase made of thick natural fabric is stuffed with any suitable herbs that have a hypnotic effect:

• mint;
• lemon balm;
• immortelle;
• wormwood;
• rose petals;
• valerian;
• lavender.

An interesting solution would be small hand-made pillows placed throughout the house. An unusual pattern of pillowcases and a pleasant filling in the form of herbal infusions of geranium, laurel, oregano, and hops will add a designer touch to the room and create a pleasant atmosphere for relaxation.

Taking baths with a relaxing effect significantly reduces stress, calms the nervous system and normalizes sound, healthy sleep:

1. The water should be warm and pleasant to the body.
2. You can dissolve your favorite foam and sea salt in it.
3. If you add a few drops of essential oil (mint, orange, chamomile, lavender, fir, pine) to the water, you can enjoy aromatherapy, which helps relieve fatigue, stress and excessive excitement.

An excellent way to combat painful insomnia is a body massage using the same essential oils. To do this, add a few drops of essential oil to ordinary vegetable oil, which is the base, and rub it into the feet, hands, neck, and back with light movements. For a comfortable procedure, the container with oil is slightly warmed up in a cup of warm water.

Experts have proven that a lack of magnesium in the body can cause insomnia. To compensate for magnesium deficiency, it is necessary to take medications based on it or supplement the diet with foods containing this microelement: nuts, seeds, cereals, vegetables, fruits, legumes, seaweed and bran.

To avoid the development of a chronic form of insomnia, which requires a qualified specialist approach and long-term therapy, it is necessary to carry out a number of preventive measures:

• follow the sleep regime and rules of hygiene, going to bed and getting up at the same time;
• exclude daytime naps, if you really can’t bear it, you can fall asleep for 15-20 minutes;
• have dinner 4 hours before bedtime with light dishes, excluding fatty, fried, salty, smoked, spicy, and excessively high-calorie foods;
• take a walk before bed, this will help saturate your brain with oxygen and help you fall asleep quickly;
• thoroughly ventilate the bedroom or open the window all night if weather conditions permit;
• after 12 days, do not drink stimulating drinks (coffee, black and green tea, hot chocolate);
• exclude alcohol and, if possible, smoking after 18.00;
• do not engage in intense mental work or intense physical activity in the evening;
• give up negative emotional stress (scandals, disputes, showdowns);
• eliminate the light source - the sleep hormone melatonin is produced in complete darkness;
• do not practice watching movies before bed; it is better to replace TV with reading light literature 2 hours before bedtime;
• put all gadgets in another room - blue radiation is harmful to health and restful sleep;
• pay attention to the comfort of the bed (the mattress and pillow should be comfortable, the blanket should be appropriate for the season and temperature in the room, the linen should be fresh and without irritating elements);
• do not use the bed during the day and in the evening if you are not going to sleep;
• try to distract yourself from obsessive thoughts by meditation, deep breathing, auto-training, yoga, visualization or listening to a relaxing, pleasant melody;
• do not think about plans and do not solve complex issues at night, leave it for the morning;
• if you don’t want to sleep, don’t force yourself, get up and try again to fall asleep after 30-40 minutes;
• in the morning, when you wake up, do not stay in bed for more than 15 minutes;
• When you wake up at night, don’t look at the clock.

If sleep disturbances do occur periodically, it is necessary to resort to introspection and identify possible causes of the disorder.

It is important to understand that sleeping pills do not cure insomnia. To avoid worsening the problem, their use should be limited to exceptional cases and short courses. The focus should be on non-drug methods of combating insomnia.

An integrated approach, including correction of lifestyle and behavior, getting rid of bad habits, moderate physical activity during the day, relaxing techniques before bed, comfortable bedroom conditions and the ability to abstract from problems, allows you to quickly improve sleep and facilitate the process of falling asleep.

If there is no positive therapeutic effect from using all the described methods, excluding taking sleeping pills, you should seek help from a doctor. Perhaps insomnia is a symptom of some hidden disease. In this case, qualified diagnostics and correctly prescribed treatment will help restore sleep.

Insomnia, or insomnia as it is popularly called, is a sleep disorder manifested by difficulty falling asleep, frequent interruptions and general instability. With chronic insomnia, the general condition of the whole body worsens, headaches appear, reaction and the ability to think quickly deteriorate. The cause of insomnia and sleep disorders can be both mental and physiological, as well as external factors that surround a person, such as noise, etc. There are two types of insomnia: short-term and systematic, the second type is a problem that deserves special attention.

Why do you need healthy sleep?

A person needs sleep to restore the physical and psychological strength of the body. It occurs cyclically almost every 24 hours and these cycles are called the circadian rhythm. The circadian rhythm is regulated by the production of melatonin. Melatonin is a pituitary hormone that is produced only in complete darkness. Therefore, an important condition for healthy and long sleep is the illumination of the room. Consequently, failure to adhere to the regime, sleeping during the day, or working at night can cause circadian rhythm disturbances and cause insomnia.

Inadequate sleep caused by insomnia worsens metabolism and over time can cause obesity and then type 2 diabetes, but this is in the long term. In the short-term, there is a risk of dying from a myocardial infarction or stroke without waiting for diabetes. Since lack of sleep or lack of sleep primarily affects the cardiovascular system, you need to treat this problem with due attention.

Main causes of insomnia

It is very important to identify the cause of insomnia in you, because in order to get rid of this disease you need to eliminate the cause itself, and not its consequence, in our case, sleep disorder. The reasons can be physical and mental. Common causes of insomnia are:

• psycho-social stress;
• depression of various types;
• increased brain activity, overexcitation;
• elderly age;
• discomfort, both mental and physical;
• non-compliance with the daily routine and biorhythms;
• drinks containing alcohol, caffeine;
• taking medications (sympathomimetics, anorectics), drugs, etc.;
• infectious diseases accompanied by fever, itchy skin and pain;
• endocrine diseases accompanied by hypoglycemia, frequent urination, dry mouth;
• neurological diseases such as dementia, Parkinson's disease, traumatic brain injury.

As we can see, the causes of insonomia can be divided into:

• functional - disorders of organs and systems of the body;
• behavioral - related to human activity.

Insomnia can also be classified into several types based on duration:

• Temporary insomnia (up to a month). This species is the most harmless to the human body. The cause may be, for example, a flight to another time zone or stress caused by conflict in the family or at work.
• Short-term insomnia (up to 3 months). Here everything is much more serious and eliminating the cause of the appearance will be more difficult. As a rule, disorders of this nature can arise with the loss of a loved one or, for example, unrequited love. This can be treated with time or by switching attention to other life circumstances.
• Prolonged insomnia (more than 3 months). This species is the most dangerous and determining the cause of its appearance requires a detailed study of the entire organism. Very often, the cause of chronic insomnia can be provoked by a complex of both physical and psychological diseases. This disease is eliminated through the elimination of the main causes that provoked the sleep disorder.

Nutritional Features

Proper nutrition and especially foods consumed before bedtime play an important role in healthy sleep. As you know, falling asleep on a full stomach is no less harmful than falling asleep on an empty stomach. There are foods that inhibit and worsen sleep - alcohol, caffeine, chocolate, various energy drinks, as well as fatty and difficult-to-digest protein foods of animal origin.

Carbohydrates, which are abundantly present in sweets, bring quick energy and motivation to action to the body. Consumption of such products should be avoided before bedtime. If you suddenly have an appetite before bed, don’t ignore it, eat a piece of fruit or a piece of whole grain bread with cool water.

Restless legs syndrome

These are unpleasant sensations in the lower extremities that force you to move your legs and roll over from side to side in the hope of relief. These actions prevent you from falling asleep quickly and cause insomnia. Researchers claim that this syndrome is the cause of 15% of cases of chronic insomnia. It occurs at any age, but in the vast majority of middle-aged and elderly people. The cause of this syndrome can be either heredity or a neurological disease. Very often this disease is diagnosed in experienced diabetics and in people with chronic venous insufficiency.

Depending on the etiology, it is treated both with the use of medicinal drugs and non-drug therapy, for example:

• lifestyle correction, moderate physical activity;
• a balanced diet, excluding coffee and strong tea from the diet;
• giving up bad habits, alcohol, smoking,
• normalization of the daily routine, restoration of the circadian rhythm;
• warm bath, foot massage before bed;
• evening walks, warm shower.

Poor sleep hygiene

Improper sleep hygiene is a very common companion to an unhealthy lifestyle. By creating uncomfortable conditions for living and sleeping, a person himself sometimes, without noticing it, increases sleep disorders caused by other reasons. The main sleep hygiene disorders include:

• dry air;
• incorrect temperature in the room, cold or hot;
• not dark enough;
• irritating noise;
• uncomfortable bed, uneven bed;
• overeating before bedtime;
• go to bed on an empty stomach;
• lie in bed all day;
• thinking about irritating topics before going to bed;
• engaging in mental activity before bed that requires excessive concentration;
• swear or have conflicts before going to bed.

Sleep hygiene is simple rules that will improve your sleep and can save you from insomnia.

Treatment methods

Before starting therapeutic treatment, the doctor must identify the cause and main manifestations of insomnia. And only after a thorough study of the patient’s medical history, prescribe any therapeutic interventions. Such interventions may include:

• working with a psychotherapist or psychologist;
• correction of the daily routine and wakefulness, normalization of the circadian rhythm;
• explanations on sleep hygiene;
• discontinuation or replacement of medications taken that have side effects on sleep;
• treatment of the underlying somatic or neurological disease.

If the cause of insomnia is an unfavorable environment, which the patient cannot change. Special sleep aids are prescribed, such as those that will provide protection from noise. And it will create a favorable environment for the eyes at any time of the day.

The fundamental method of treating insomnia should be teaching the patient the principles of sleep hygiene. To monitor hygiene, the patient should keep a sleep diary, which will display factors that negatively affect the quality and duration of sleep. As for drug therapy, it should play a supporting role. Also, the doctor should set the patient up for a quick result, which will increase motivation and increase the chances of a positive effect of treatment.

Over the past decades, sleep disorders have become so widespread that experts have created a separate branch of medicine that deals exclusively with solving this problem and developing methods for its treatment. Relatively recently, the World Health Organization published data from a survey of residents of more than 15 countries. Insomnia (the scientific name for a similar illness is insomnia) was the reason 27% visited a doctor, but the real numbers are still unknown.

According to doctors, we can talk about sleep disorders if one (or more) of the following signs are present:

• a person cannot fall asleep after being in bed for 30 minutes or more;
• characterized by frequent awakenings at night, not associated with external stimuli (noise, crying of a child, etc.);
• reduction in the duration of night sleep;
• feeling groggy and tired after waking up.

Sleep is one of the ways our body interacts with the environment; moreover, the correct biorhythm is the key to a person’s full health and adequate resistance to infections and other diseases. Roughly speaking, during wakefulness, certain information is accumulated, and it is consolidated at night during the deep sleep phase.

According to experts, when the human body is resting, the brain analyzes the received information and “develops” a further strategy for constructing responses. At the same time, secondary data is excluded, and what remains outside the scope of attention due to external stimuli comes to the fore. It is these processes that explain the improvement of memory, the inspiration that comes to people of a creative mind, and even such a phenomenon as intuition.

In addition, during sleep, the functioning of the nervous system, endocrine glands, and, consequently, hormonal levels is regulated. In addition, insomnia significantly increases the risk of damage to the corneal vessels, myocardial infarction, strokes and other disorders of the cardiovascular system.

With a lack of sleep, the level of one of the main markers of the inflammatory process, C-reactive protein, increases in the body. During a clinical study, experts noted that people who had full rest 4 hours less than normal for just three nights had impaired tissue tolerance to glucose. After 5 days, pronounced disorders of the psychoemotional state were noted, which manifested themselves in the form of attacks of irritability, anxiety and other neurological disorders. Stress resistance is also noticeably reduced.

How to improve your sleep yourself

Their range is quite wide:

• antidepressants;
• blockers of histamine receptors type H1;
• neuroleptics;
• anticonvulsants;
• melatonin-based preparations.

However, the most widely used medications are those that the patient can purchase at the pharmacy independently without a prescription.

One such drug is the antihistamine doxylamine, which is sold in pharmacies under the trade names:

• Valocordin - Doxylamine;
• Reslip;
• Donormil.

Take the medicine 15 mg per day half an hour before bedtime. Among the advantages are the possibility of use during pregnancy (in any trimester), the absence of withdrawal syndrome. But Doxylamine is contraindicated in:

• lactation;
• in childhood and adolescence;
• glaucoma;
• hypertrophy of prostate tissue;
• urinary disorders.

Over-the-counter medications also include medications containing melatonin. This substance is synthesized in the human body (epiphysis, retina and intestines). Its concentration increases significantly in the dark, which is manifested by a decrease in temperature, depression of emotional activity, and the functions of the gonads. In this way, the body “prepares” for the upcoming sleep.

This group of medications includes:

• Melaxen;
• Sonnovan;
• Melarithm.

In addition to the hypnotic effect, melatonin also has antidepressant, antioxidant, and immunomodulatory effects. It is also prescribed to restore daily biorhythms when changing time zones. The recommended dosage is from 2 to 6 mg.

If there is no effect from over-the-counter drugs, doctors switch to strong sleeping pills.

Most of them are well tolerated by patients, but the likelihood of complications is quite high. Such medications include:

• Zolpidem (Ivadal, Nitrest, Sanval, Snovitel), prescribed 10 mg;
• Zopiclone (Imovan, Somnol, Relaxon, Thorson), take 7.5 mg;
• Zaleplon (Andante), drink 10 mg;
• Clonazepam, take 2 mg;
• Trazodone (Trittico), prescribed 75 - 150 mg.

Good results can be achieved using various methods of physiotherapy. Unlike medications, they are safe and do not cause any side effects.

Thus, patients are offered:

• Phototherapy. This treatment technique involves the influence of light impulses on the visual organ system, and through them on certain structures of the brain, which makes it possible to normalize and restore biorhythms.
• Encephalophonia. This is a relatively new method of physiotherapy, which consists of processing the bioelectrical activity of the brain during relaxation and wakefulness. The received signals are converted into music, which the patient is offered to listen to. This leads to the gradual restoration of normal sleep and proper rest.

To solve problems with falling asleep and staying asleep, they often resort to other methods. Meditation and auto-training programs and yoga classes in the afternoon help a lot. Massage of reflex biologically active points located on the feet, face and ears is also very effective. To overcome insomnia, some resort to relaxing music, recorded sounds of nature, sea surf, etc.

Sleep disorder: features in different categories of patients, physiotherapy and other treatment methods

Doctors pay special attention to sleep disorders in certain categories of patients. Representatives of the fair sex often experience insomnia during menopause. This is associated with hormonal fluctuations, deterioration of well-being, and depressive mood. Treatment of this condition is carried out comprehensively. From the neurological side, insomnia is corrected with the help of mild herbal sedatives. Additionally, hormonal medications may be prescribed.

In old age

After 40 years, the incidence of sleep disorders increases significantly. In older people, sleep is “blurred” throughout the day; many prefer to rest during the day, which negatively affects the quality of night sleep. Lack of physical activity and social communication also plays a role.

30% of elderly patients experience disturbances in sleep biorhythms (early falling asleep and early awakening). Sometimes they complain of difficulty falling asleep and decreased depth of sleep. This irreversibly entails daytime sleepiness and deterioration of well-being, weakness. In addition, with the onset of certain age-related diseases, many are prescribed medications that can cause insomnia.

For this category of patients, behavioral therapy for insomnia comes first. It is recommended to refrain from napping during the day and go for a walk in the evening. Review the list of medications taken and, if necessary, adjust prescriptions.

Children's

Primary behavioral insomnia is often diagnosed at an early age. As a rule, it occurs when certain associations or attitudes are formed when falling asleep. For example, the habit of motion sickness, sleeping in the parent’s bed, at the mother’s breast, etc. Therefore, when trying to change such habits, the child actively resists, which leads to sleep disorders.

In older children, their academic performance deteriorates and constant conflicts with friends and parents begin. A tendency to hysterics and tearfulness is often noted. However, for the treatment of insomnia at an early age, medications are prescribed only as a last resort in the absence of results from other treatment methods. Parents are advised to strictly observe the daily routine and adhere to the rules of sleep hygiene. A variety of herbal baths and massages are also useful.

The effect of alcoholic drinks on sleep

Often, a heavily drunk person completely falls asleep, reacting poorly to external stimuli. Ethyl alcohol and its metabolic products inhibit the functional activity of the central nervous system, but this will not help solve the problem of insomnia. Under the influence of alcohol, sleep is superficial, and proper rest and restoration of the body does not occur. That is why drinking alcohol shortly before bed is not recommended.

Homeopathy

Sleep disturbances can be gently corrected using safe medications that are suitable for long-term use and practically do not cause unwanted reactions. This:

• Ignacy - Gummacord;
• Nervoheel;
• Gelarium Hypericum.

Alternative Therapies

Water procedures have a positive effect on the process of falling asleep and quality of sleep. But their effectiveness can be increased by using decoctions of medicinal herbs. Suitable:

• valerian;
• mint;
• Melissa;
• series;
• hop cones;
• pine or fir needles.

Prepare a steep decoction (200 - 300 g per two liters of boiling water), which is poured into the finished bath. Instead of medicinal plants, you can use essential oils (sandalwood, orange, mint).

Music plays a special place in the treatment of insomnia. A lullaby sung by a mother is known to calm a crying baby. But certain melodies have a similar effect on an adult. There are enough collections of various music on the Internet for relaxation and relaxation, but classical works work best.

Sanatorium-resort treatment provides excellent results. A clear daily routine, physical therapy, a change of environment, abstraction from work problems, and walks in the fresh air work wonders. In general, health, sleep and wakefulness biorhythms are restored.

Consequences of insomnia and prevention of disorders

Without appropriate treatment, sleep disorders are dangerous with severe and often fatal consequences for a person:

• the risk of mental disorders increases 2.5 times;
• the likelihood of depressive disorders increases 4 times;
• dependence on taking strong sleeping pills;
• various psychosomatic pathologies;
• immunity disorders;
• metabolic disorders;
• impact on driving (lack of sleep during the day is comparable to 0.1% blood alcohol concentration);
• productivity and efficiency halved.

In many cases, this can all be prevented. It is enough to follow a daily routine, limit your time in front of the computer, use of a smartphone and tablet, especially in bed. Attention should also be paid to diet and physical activity. Doctors recommend giving up bad habits, limiting coffee consumption, and strictly planning your work schedule.

Chronic insomnia or chronic long-term insomnia is a sleep disorder that lasts longer than three to four weeks. There is a clear diagnostic criterion for diagnosing insomnia - a delay in falling asleep for more than half an hour and sleep efficiency less than 85%. Sleep efficiency in this case refers to the ratio of sleep time to the time the patient spent in bed. The patient’s opinion about his own sleep is also important. If this condition lasts longer than a month, then insomnia has entered the chronic stage.

Not diagnosed as chronic insomnia:

• circadian rhythm disorders as a result of night shift work;
• delayed sleep syndrome (delay of falling asleep by 2 hours or more from the usual time);
• voluntary deprivation syndrome.

Chronic insomnia occurs in 10-15% of people, but it is most often diagnosed in women of childbearing age, the elderly and people suffering from mental illness. May be a consequence of somatic or mental pathology. It develops after several cases of acute or short-term insomnia. The reasons for the transition of short-term insomnia to long-term insomnia can be medical, psychiatric, behavioral problems, as well as taking certain medications. Behavioral disorders are the root cause of chronic sleep disorders.

Any stressful event can become a provoking factor for the development of chronic insomnia: biological stress (exacerbation or onset of the disease); psychological (conflict at work or in the family, divorce). The onset of chronic insomnia can be triggered by events such as the birth of a baby or a flight to a different time zone.

The consequences of chronic insomnia are:

• decreased quality of life;
• chronic fatigue;
• deterioration in performance;
• mood swings;
• increased risk of suicide.

Primary or secondary

For effective treatment of chronic insomnia, it is important to correctly determine the causes of its occurrence. By origin they distinguish:

1. primary insomnia resulting from personal reasons;
2. secondary, resulting from psychological or somatic diseases.

Secondary insomnia is more common than primary insomnia. Since the clinical pictures are very similar, the following rule applies when diagnosing: “if symptoms persist despite the elimination of secondary causes, then treatment of primary insomnia is required.” But even in this case, there is a high risk of diagnostic error, since one patient may have several causes of the disease.

The best way to treat a disease is to identify and then eliminate the causes that led to it. When diagnosing a type of insomnia, specialized specialists are involved to identify possible somatic diseases.

Causes of the disease

The causes of primary insomnia are still unknown. Secondary insomnia can be caused by the following diseases:

• chronic pain pathologies (pain interferes with proper sleep);
• heart failure associated with shortness of breath;
• COPD;
• diseases of the urinary system;
• diseases or injuries of the brain, etc.

Taking certain medications can also contribute to its development:

• alpha and beta blockers;
• respiratory drugs – theophyllines;
• decongestants;
• hormones;
• anticonvulsants;
• antidepressants;
• NPVO.

Short-term insomnia can turn into long-term under the influence of the following provoking factors: stress, anxiety, depression, worsening of the disease that caused insomnia, long-term use of benzodiazepines. After only 3 months, untreated persistent insomnia breaks away from its root cause and begins to exist as an independent pathology.

The most common reason for the transition of short-term insomnia to the long-term phase is certain psychological mechanisms: a person experiencing periodic problems with sleep develops excessive attention to the process of falling asleep, he becomes fixated on the problem of sleep and begins to worry that he will not be able to fall asleep. It is for this reason that he does not fall asleep.

Treatment

If acute insomnia is treated quite simply: that is, when the factors provoking it stop, insomnia gradually goes away, then chronic insomnia, lasting longer than three months, cannot be cured at once. What to do in this case? To treat chronic insomnia, drug and non-drug methods are used.

In 1999, the US Medical Academy of Sleep published experimentally proven non-drug treatments for chronic insomnia. These included stimulus-control therapy, sequential muscle relaxation therapy, cognitive behavioral therapy, sleep hygiene education, etc.

About sleep hygiene and non-drug methods

The simplest techniques to promote sleep are called sleep hygiene rules. These are the rules that form the conditioned reflex to fall asleep. Among them are:

1. Sufferers of chronic insomnia are not recommended to nap during the day.
2. Also, some physical activity during the day will be useful, with the help of which you can accumulate fatigue in the evening.
3. 2-4 hours before bedtime, you should stop physical activity.
4. No need to drink or eat at night. You can allow yourself a glass of warm milk before bed.
5. You should not drink alcohol or smoke before bed.
6. 2 hours before bedtime, you should not take a cold or excessively hot bath or shower.
7. An hour before bedtime, you should stop active mental activity.
8. Using meditation practices to relax and relieve anxiety before bed.
9. You need to go to bed only when you feel sleepy, and you need to get up at the same time.
10. There should be no distractions in the bedroom: loud sounds, bright lights.
11. What to do if you don't fall asleep within 15 minutes? Get up and engage in quiet activities for half an hour, then go back to sleep.

All the described methods are quite difficult to use because they require discipline and adherence to treatment from the patient. Keeping sleep diaries or filling out special questionnaires, which include questions not only about bedtime, time of waking up, the number of awakenings per night and their duration, but also questions about periods of physical activity, taking medications, times of food and alcohol consumption, have become more effective in motivating patients. .

Relaxation techniques are effective (conscious thinking, imaginative thinking, meditation, concentration training). Their goal is not to reduce the time it takes to fall asleep, but to relieve general anxiety before falling asleep.

Cognitive therapy is aimed at changing the patient’s destructive beliefs about sleep, which are the main supporting factor in chronic insomnia. The tools of the method are the formation by the patient himself of correct judgments in relation to sleep. The main objectives of cognitive therapy are:

• formation of correct ideas about a person’s need for sleep;
• giving up the desire to fall asleep so as not to cause hyperactivation;
• refusal to give sleep central importance;
• refusal to catastrophize the consequences of insomnia.

If cognitive behavioral therapy does not bring the desired result, drug treatment is necessary. Cognitive behavioral therapy should not be carried out simultaneously with the use of sleeping pills, since such a combined method worsens its benefits and effectiveness in the long term. It is believed that this is because insomnia patients are much less likely to learn cognitive therapy techniques when they have the support of medication.

Drug therapy

Drug treatment for those suffering from chronic insomnia is not as effective as short-term treatment and has its own characteristics. In clinical practice, there are 5 principles of pharmacotherapy for chronic insomnia:

1. Use of minimum effective doses.
2. Using intermittent doses.
3. Prescribing medications for short-term use.
4. Gradual withdrawal of the drug taken.
5. Elimination of the rebound effect of insomnia after withdrawal.

All existing groups of drugs have their own advantages and disadvantages. There is no ideal treatment for chronic insomnia. The choice of drug depends on the cause of the sleep pathology and on the pharmacodynamics of the drug, as well as on the patient’s individual reaction to it.

The use of pharmacotherapy is justified in the treatment of patients with chronic primary insomnia that does not respond to behavioral psychotherapy. To treat insomnia associated with problems falling asleep, Zolpidem and Zaleplon are most often prescribed. If the patient often wakes up at night, he is recommended to prescribe benzodiazepines for a medium duration. If the patient wakes up in the second half of the night, a short-duration benzodiazepine is prescribed. Long-term benzodiazepines are ineffective for the treatment of chronic insomnia (except in cases where the pathology is accompanied by depressive disorders).

Imidazopyridine drugs, which include Zolpidem and cyclopyrrolones, and the representative Zopiclone, are among the safest chemical sleeping pills. Benzodiazepines cause rapid addiction, impair reaction speed, and have serious side effects - agitation, amnesia, daytime drowsiness, etc.

A more physiological medical intervention may be the use of adaptogens, which normalize the sleep-wake cycle. These include melatonin preparations. The use of melatonin preparations is accompanied by a shortening of the time to fall asleep, as well as an increase in sleep duration.

List of used literature:

• Levin Ya. I., Kovrov G. V. Some modern approaches to the treatment of insomnia // Attending physician. - 2003. - No. 4.
• Kotova O. V., Ryabokon I. V. Modern aspects of insomnia therapy // Attending physician. - 2013. - No. 5.
• T. I. Ivanova, Z. A. Kirillova, L. Ya. Rabichev. Insomnia (treatment and prevention). - M.: Medgiz, 1960.