Sleep disorders: symptoms, causes & treatment

1, 2, 3…. 99 – do you often find yourself counting sheep until you finally drop off to sleep? Or do you wake up during the night for no reason and toss and turn in bed? Then you may be suffering from a sleep disorder. This is a collective term for various medical disturbances of the sleep and the sleep-wake cycle (body clock). Sleep disorders not only affect falling asleep and staying asleep, but also breathing, sleep rhythm, movement and sleep behaviour. The types of sleep disorders differ greatly, as do the triggers. The causes of a sleep disorder can be psychological or organic, and sometimes both at the same time.

What is classed as a sleep disorder?

A few restless nights in a row are not classed as a sleep disorder. Nor are temporary sleep problems or a short period of insomnia. Whether or not such complaints indicate a disorder depends on certain criteria.

One factor to consider, for example, is whether you have sufficient opportunity to sleep in the first place. The type of complaint and its progression are also taken into account. Sleep disorders last for at least a month and occur on at least three nights a week. If the symptoms persist for more than three months, this is referred to as a chronic sleep disorder. The decisive factor is the level of suffering experienced by the person affected. Some people have what are known as “short sleeper” genes. Needs differ depending on what chronotype someone has. Some people can easily get by on fewer than six hours of sleep per night, while others need at least nine hours in order to wake up feeling rested. However, if you regularly feel irritable or tired after a night’s sleep, you should take a closer look at your sleep needs.

But when does poor sleep become a disorder? There is no general threshold beyond which poor sleep is considered pathological. Different diagnostic criteria apply to each type of disorder.

The International Classification of Sleep Disorders (ICSD-3) describes over 60 different sleep disorders. These can be classified into six main groups based on their symptoms:

1. Insomnia
   Insomnia is the most common sleep disorder and involves problems falling asleep and staying asleep. Those affected find it difficult to fall asleep in the evening, wake up during the night or wake up early in the morning. Their sleep is not very restful. Symptoms of insomnia include exhaustion during the day, irritability and low spirits. Such complaints occur briefly or persist over an extended period of time. This often leads to a cycle of tension and anxiety about the next sleepless night.
   
2. Sleep-related breathing disorders
   Sleep-related breathing disorders are conditions in which breathing repeatedly stops or becomes shallow during sleep. One common form is sleep apnoea, which causes the muscles in the throat to relax and the upper airways to narrow. Typical signs include loud snoring, pauses in breathing at nighttime and daytime tiredness. 
3. Central disorders of hypersomnolence
   Central disorders of hypersomnolence lead to severe tiredness during the daytime, despite sufficient sleep at night. The technical term for these sleep disorders is hypersomnia. These include, for example, narcolepsy. Those affected experience a sudden attack of sleepiness during the day that is extremely difficult to resist.
4. Circadian rhythm sleep-wake disorders
   Circadian rhythm sleep-wake disorders are conditions in which your own internal clock does not match the day-night rhythm. The hormone ((Link: https://www.helsana.ch/en/blog/body/knowledge-of-the-body/melatonin.html)) melatonin regulates this rhythm and prepares the body for nighttime. If the rhythm is disrupted over a longer period of time, a sleep disorder develops and the affected person remains awake despite feeling tired. Typical triggers include jet lag and shift work.
5. Parasomnias
   Nightmares, night terrors and sleepwalking are parasomnias. This term refers to unusual events during sleep and upon waking. Those affected move, act or perceive things without being fully awake. Parasomnias are less common in adults than in children, but they are still possible. One notable sleep disorder is REM sleep behaviour disorder (RBD). People with this disorder move in ways that are based on their dreams, thrash around or shout instead of lying still. This type of sleep disorder often affects men over the age of 50.
6. Sleep-related movement disorders
   Sleep-related movement disorders involve recurring movements or an urge to move, which disrupts sleep. One common example is restless legs syndrome, which involves a strong urge to move one’s legs accompanied by unpleasant tingling, usually in the evening and while at rest. This often leads to problems falling asleep. Movement disorders also include nighttime teeth grinding, in which the masticatory muscles are active during sleep.

The common causes and triggers of sleep disorders include the following:

• Mental strains: Sleep disorders are often caused, for example, by stress at work or by other worries that cause us to lose sleep at night. Persistent tension keeps the body awake and makes it harder to switch off in the evening. Mental illnesses such as anxiety disorders and depression also contribute to sleep disorders.
• Physical health problems: Pain, respiratory illnesses and cardiovascular disease can impair sleep. Neurological or other chronic underlying conditions can also prevent a good night’s rest.
• Hormonal changes: Sleep disorders occur more frequently during pregnancy and menopause. During pregnancy, physical complaints such as back pain or a frequent urge to urinate can make it difficult to sleep, especially in the last few months. During menopause, nighttime hot flushes caused by falling oestrogen levels can disrupt a good night’s sleep.
• Changes to the sleep-wake cycle: Night work and shift work sometimes cause sleep disorders. Frequent changes in working hours can also upset your body clock.
• Medications and substances: Certain medications can interfere with sleep as a side effect. Caffeine, alcohol and nicotine also make it harder to fall asleep and stay asleep.
  

In addition, external events and life circumstances can have an impact on sleep. Stressful events, noise or a baby who frequently wakes up in the night also disrupt sleep. Factors such as these often have a significant impact on how restful your night is and reduce sleep quality.

Getting a good night’s sleep is beneficial to your health, as your body and mind recover at night. This is when the brain processes the day’s experiences, the cells renew themselves and the immune system works at full speed. A lack of restful sleep in the long term can cause these processes to come to a standstill. The effects of a sleep disorder first become apparent during the daytime and, over time, in your general well-being and physical health.

In the short term, your energy and concentration will decrease and your mood will worsen. Over an extended period of time, the consequences become more serious and affect both body and mind in equal measure. Persistent sleep deprivation puts a strain on the heart and circulation and increases the risk of being overweight and developing diabetes. Sleep disorders are also linked to a weakened immune system and mental health complaints.

Sleep disorders are medically recognised diagnoses. In Switzerland, doctors classify them according to the ICD-10 international classification. This system divides sleep disorders into different diagnostic groups. The groups distinguish between organic and non-organic sleep disorders based on their cause. However, this division does not apply to all types of sleep disorders.

The diagnosis usually begins with a medical consultation, during which the type of complaint, when it began, the frequency and the duration are discussed. Sleep times and sleeping habits, as well as the impact of the sleep disorder on the day, are also explored. The consultation also looks at potential concomitant illnesses and any medications taken.

This is followed by a physical examination. A sleep diary is often used to document the nights over a period of time. Depending on the suspected condition, specialist medical examinations may follow. In some cases, spending a night in a sleep laboratory can help determine the exact cause of the sleep disorder, for example if you suffer from pauses in breathing or a movement disorder.

The right treatment for a sleep disorder depends on its type, cause, severity and any potential concomitant disorders. That’s why there’s no one-size-fits-all approach for everyone affected. Every form of sleep disorder needs its own approach.

A good example is the chronic sleep disorder insomnia, for which cognitive behavioural therapy is the first choice. This treatment focuses on thoughts, habits and behaviour related to sleep. If this approach is not sufficient, the treatment may be supplemented by medication. However, pharmaceutical sleep remedies are only suitable for a short period of time. That’s why doctors tailor any medication-based treatment to the individual situation, while carefully weighing the benefits and risks.

It’s also important to look at the cause of the sleep problems. If a physical or mental illness is behind the complaints, treating those conditions is part of the therapy. This often improves sleep while at the same time ameliorating the underlying illness.

How can you solve sleep problems yourself?

In addition to the professional treatment of sleep disorders, your own habits play an important role in getting a restful night’s sleep. Experts therefore recommend establishing good sleep hygiene and organising your daily routine with this in mind. This includes making your bedtime and wake-up time as regular as possible, and creating a quiet, pleasant and darkened sleeping environment. Reducing stress in the evening and winding down at the end of the day can also help. A regular evening ritual, a calming tea or a warm bath are effective home remedies for mild sleep disorders. These and other sleep tips can be gradually incorporated into your daily routine.

Good to know: if you can’t sleep, you can use meditation and relaxation methods to make up for some (but not all) of the rest you’ve missed. Even more effective, however, is a 20-to-30-minute power nap, for example after lunch. This can also support cellular regeneration and aid memory consolidation.

Regardless of which measure you choose, be patient with yourself. A healthy sleep routine takes time. A sleep diary will help you document your nights and recognise your progress. Natural sleep remedies such as valerian may help, but you should talk to your doctor before taking them. It’s also advisable to seek medical advice if your sleep problems persist or get worse.