One of the most common sleep disorders, both in everyday life and in the clinical practice of doctors, is insomnia, or, more correctly, insomnia. This academic name comes from the Latin terms in - "inside", somnus - "sleep", that is, "inside sleep." That is, these are those disorders that arise in connection with the state of sleep. Either it is difficulty falling asleep, or difficulty maintaining sleep, such as frequent awakening, or early morning awakening, that is, difficulty ending sleep. All this is included in the phenomenology of insomnia syndrome.
Types of insomnia
Criteria for making a diagnosis of insomnia include the degree of satisfaction with sleep, as well as the availability of sufficient time and conditions for sleep. And the third criterion is the presence of the consequences of insomnia, that is, a violation of daytime wakefulness, which occurs due to a violation of nighttime sleep.
These violations are quite diverse. Any sleepy person can gradually recall all of them: fatigue, impaired attention, concentration or memorization, impaired interaction in society with other people, mood disorders, irritability, daytime sleepiness, decreased motivation and initiative, a tendency to make mistakes while driving and at work , muscle tension, headache, gastrointestinal disturbances, sleep anxiety. Such an abundance of complaints may be due precisely to insufficient sleep at night.
If a person has a violation of night sleep and daytime wakefulness, which he associates with a violation of night sleep, can we say with confidence that he has insomnia syndrome? No, for this, one more criterion must be met - this is the frequency of the presence of sleep disturbances. According to the international classification of sleep disorders, insomnia is a real disease when it occurs 3 or more times a week. That is, in one week a person sleeps badly for 3 nights, in another week - 4, in the third - 5, then this is already insomnia, and if 2 times - then no.
Insomnia is divided into two types. Short-term insomnia (or more commonly called acute insomnia) is a sleep disorder that lasts no more than 3 months. Chronic insomnia is a sleep disorder that lasts more than 3 months. This division is generally accepted, since it is believed that in 3 months the sleep disorder is already "torn away" from its root cause. The most common cause of acute insomnia is stress, but it cannot be the cause of chronic insomnia. During this time, psychological mechanisms are usually the cause of sleep disturbances. There is an excessive attention of a person to sleep, "fixation" on the problem of his sleep. The person begins to worry that he will not fall asleep, and this really does not fall asleep.
The presence of insomnia can lead to various disorders of the body. At the household level, everyone understands that not sleeping is bad. But the presence of health disorders in insomnia is confirmed by scientific research. It has been shown that in patients with insomnia, social consequences are manifested first of all, affecting other people or the sphere of human activity. So the working capacity is reduced by about 2 times.
It is known from population studies that the presence of insomnia is associated with a greater risk of depression (4 times the lifetime risk of depression in people with insomnia), alcohol and drug abuse. Very often, a person first of all begins to resort to available ways to improve sleep, first of all - to alcohol, getting addicted.
It has also been shown that insomnia increases the risk of being involved in a road traffic accident for drivers. This is due to the daytime consequences of sleep disturbance, when the speed of reactions decreases, attention worsens, drowsiness increases, and a person actually becomes dangerous to others.
The so-called medical risks of insomnia - the threat to the health of the person himself is proved much more difficult than social risks, because social risks are assessed according to population statistics, and in order to assess medical risks, special studies need to be carried out.
Hyperactivation model of insomnia
Currently, the hyperactivation model is being used to explain the causes of insomnia. Its essence lies in the fact that people who have insomnia are hyperactive in everything: their brains are working too intensively. This has been shown, for example, in studies using transcranial magnetic stimulation. A person was given a stimulus to the cortical region, which controls the movement of a particular muscle, and received a stronger response from people with insomnia than people without any disabilities. Although it seems that those areas of the cortex that were stimulated are in no way associated with sleep. They just provide hand movement.
This kind of hyperactivation is also noted at other levels of regulation of the body's activity, for example, in patients with insomnia, the predominance of the tone of the sympathetic nervous system over the parasympathetic one is revealed. The sympathetic is the part of the nervous system that is responsible for stress reactions, for activation, and the parasympathetic, on the contrary, for rest. In people with insomnia, the sympathetic part always dominates, even in the daytime, and when they fall asleep, regardless of which type of sleep they are in, slow or fast, their nervous system is too overactive, hence the name of the model.
At the endocrine level in patients with insomnia, the secretion of cortisol is increased, and the level of this hormone, instead of decreasing in the evening and at night, on the contrary, rises before bedtime, more precisely, before they go to bed and begin to suffer from sleep disturbances. This important hormone, which shows the intensity of the stress response, is also overproduced.
The presence of hyperactivation of the nervous system is the background, it determines a person's predisposition to the development of insomnia. In addition, there must be some provoking factor. Emotional stress is the most common factor. Such cases usually arise at the level of interpersonal interactions, conflicts: people have not shared something, then they get excited, do not sleep, they think what to do next. This stressful reaction can take a person out of the "zone of normal sleep" for a while, and he will sleep poorly for some time. But then, when the stress response ends, sleep is restored.
Sleep research and treatment
A very apt term is used abroad - "learned insomnia", that is, a person teaches himself bad things, makes him "not sleep." The action of such a supportive factor can lead to the fact that insomnia from short-term, associated only with stress, becomes chronic, constant, associated with inappropriate behavior of a person in relation to their sleep. He is afraid of his dream and stops believing in it. A person tries to force himself to sleep, and from this he goes deeper and deeper into insomnia, then he begins to take sleeping pills, gets used to them, and so on.
A separate type of chronic insomnia is paradoxical insomnia, when the main problem does not arise in the dream itself, but in its perception, when a person does not feel his dream. He comes to the doctor and says: "Doctor, I never sleep." The doctor says: "No, you are asleep, only you do not feel it." This person cannot be persuaded unless a sleep study is done on him.
Only sleep research allows us to clearly determine how much sleep a patient actually has and suggest why he does not feel it. Most often, the reason for such an underestimation lies in a psychological phenomenon, when a person remarkably remembers what happens to him in wakefulness and does not remember what happened to him in a dream. If he wakes up several times during the night, lies awake, then the next morning he remembers these periods. But if between them he plunged into a state of sleep, this information is not fixed in his memory, and he will not remember it the next morning - only the memory of a sleepless night remains. Accordingly, a person will consider himself absolutely right in his opinion and we will never convince him if we do not conduct an objective study of sleep.
Acute insomnia is quite simple to treat, most often it goes away on its own. When the stress factor ends, sleep is restored for most people, and they do not go to the doctor. Typically, patients come to the pharmacy, ask for something to sleep, they are given a collection of soothing herbs or a medicine that contains elements of these medicinal herbs with a calming effect, and the problem is resolved. Sometimes they ask for something "stronger", they don't get it in the pharmacy, because real sleeping pills are available only by prescription, and this requires a visit to the doctor.
With the treatment of chronic insomnia, which lasts 3 or more months, the situation is much more complicated, because very often patients suffer for years and do not receive qualified assistance. As a result, unfortunately, they become consumers constant of sleeping pills with the need to gradually increase the dose - this is called the “addiction phenomenon”, when more and more drugs are required to obtain the same effect: first half a tablet, then a whole tablet, then two, then four, and so on.
Sleep hygiene
For the treatment of chronic insomnia, both medicinal and non-medicinal techniques are used. According to international recommendations, non-drug methods are the method of choice in the treatment of chronic insomnia. Usually, such treatment begins not with taking pills for chronic insomnia, but with changing sleep conditions. The doctor first looks to see if the simplest rules that should promote sleep are being followed. These rules are called sleep hygiene rules. This, for example, a certain time to go to bed, the time to get up in the morning (the so-called sleep mode). It is recommended, and for good reason, that the person go to bed and get up at a certain time without changing their routine. This is necessary to form a kind of conditioned reflex to fall asleep. The conditioned reflex, discovered by Ivan Petrovich Pavlov,
The requirement for sleep hygiene is to ensure a normal sleeping environment - the bed should not be too hard, the room should not be too light, there should be no excessive noise - so that it is comfortable. Also in the concept of sleep hygiene includes elements of preparation for sleep. This means that you should not overeat before going to bed, use activating substances - alcohol, nicotine, coffee (some authors even treat chocolate as activating substances) in order not to counteract the sedation that should lead to sleep. It is also not recommended to actively engage in physical or mental activity before going to bed (at least an hour).
Sleep hygiene also includes the regulation of what is and is not allowed in bed. In general, after going to bed, nothing can be done, except for the activity associated with the procreation. Other activities are sleep disorders because they activate the nervous system and interfere with relaxation and falling asleep. First of all, the doctor looks at whether the patient follows the rules of sleep hygiene, corrects them, and then possibly prescribes the use of so-called cognitive-behavioral therapy techniques. In general, cognitive-behavioral therapy belongs to the section of psychotherapy and should be carried out by specially trained people. However, in this case, we are not talking about psychotherapy itself, but about the use of some techniques taken from this practice.
The most famous cognitive-behavioral therapy technique used for sleep disorders is the method of limiting external stimulation, when the doctor recommends removing all irritating, exciting objects or factors - bright light, ticking clock, etc., that is, to maximize a comfortable sleep environment ... In addition to such simple recommendations, this technique includes another very important one, concerning whether or not it is worth "lying" in bed at night if you do not sleep at all. The patient is given a recommendation in this case to get up, do some business, and when drowsiness finally appears, then go back to bed. However, in the morning he will need to get up at the same time, regardless of the amount of sleep received. In this way, an increase in the "sleep pressure" is achieved for the following evening and night,
There are other CBT methods used to treat chronic insomnia. Usually the doctor has his own "arsenal" of techniques, which he puts together in a suitable scheme and draws up this in a memo or brochure that he gives to the patient. This kind of technique is called bibliotherapy - "book treatment". Further, the doctor explains the contents of this brochure to the patient, solemnly hands it and then after a while calls for a second appointment in order to track whether the patient fulfills these recommendations or not, whether this method was enough for him to improve sleep or not.
If cognitive-behavioral therapy does not work, then medications are already taking over.
Types of insomnia
Criteria for making a diagnosis of insomnia include the degree of satisfaction with sleep, as well as the availability of sufficient time and conditions for sleep. And the third criterion is the presence of the consequences of insomnia, that is, a violation of daytime wakefulness, which occurs due to a violation of nighttime sleep.
These violations are quite diverse. Any sleepy person can gradually recall all of them: fatigue, impaired attention, concentration or memorization, impaired interaction in society with other people, mood disorders, irritability, daytime sleepiness, decreased motivation and initiative, a tendency to make mistakes while driving and at work , muscle tension, headache, gastrointestinal disturbances, sleep anxiety. Such an abundance of complaints may be due precisely to insufficient sleep at night.
If a person has a violation of night sleep and daytime wakefulness, which he associates with a violation of night sleep, can we say with confidence that he has insomnia syndrome? No, for this, one more criterion must be met - this is the frequency of the presence of sleep disturbances. According to the international classification of sleep disorders, insomnia is a real disease when it occurs 3 or more times a week. That is, in one week a person sleeps badly for 3 nights, in another week - 4, in the third - 5, then this is already insomnia, and if 2 times - then no.
Insomnia is divided into two types. Short-term insomnia (or more commonly called acute insomnia) is a sleep disorder that lasts no more than 3 months. Chronic insomnia is a sleep disorder that lasts more than 3 months. This division is generally accepted, since it is believed that in 3 months the sleep disorder is already "torn away" from its root cause. The most common cause of acute insomnia is stress, but it cannot be the cause of chronic insomnia. During this time, psychological mechanisms are usually the cause of sleep disturbances. There is an excessive attention of a person to sleep, "fixation" on the problem of his sleep. The person begins to worry that he will not fall asleep, and this really does not fall asleep.
The presence of insomnia can lead to various disorders of the body. At the household level, everyone understands that not sleeping is bad. But the presence of health disorders in insomnia is confirmed by scientific research. It has been shown that in patients with insomnia, social consequences are manifested first of all, affecting other people or the sphere of human activity. So the working capacity is reduced by about 2 times.
It is known from population studies that the presence of insomnia is associated with a greater risk of depression (4 times the lifetime risk of depression in people with insomnia), alcohol and drug abuse. Very often, a person first of all begins to resort to available ways to improve sleep, first of all - to alcohol, getting addicted.
It has also been shown that insomnia increases the risk of being involved in a road traffic accident for drivers. This is due to the daytime consequences of sleep disturbance, when the speed of reactions decreases, attention worsens, drowsiness increases, and a person actually becomes dangerous to others.
The so-called medical risks of insomnia - the threat to the health of the person himself is proved much more difficult than social risks, because social risks are assessed according to population statistics, and in order to assess medical risks, special studies need to be carried out.
Hyperactivation model of insomnia
Currently, the hyperactivation model is being used to explain the causes of insomnia. Its essence lies in the fact that people who have insomnia are hyperactive in everything: their brains are working too intensively. This has been shown, for example, in studies using transcranial magnetic stimulation. A person was given a stimulus to the cortical region, which controls the movement of a particular muscle, and received a stronger response from people with insomnia than people without any disabilities. Although it seems that those areas of the cortex that were stimulated are in no way associated with sleep. They just provide hand movement.
This kind of hyperactivation is also noted at other levels of regulation of the body's activity, for example, in patients with insomnia, the predominance of the tone of the sympathetic nervous system over the parasympathetic one is revealed. The sympathetic is the part of the nervous system that is responsible for stress reactions, for activation, and the parasympathetic, on the contrary, for rest. In people with insomnia, the sympathetic part always dominates, even in the daytime, and when they fall asleep, regardless of which type of sleep they are in, slow or fast, their nervous system is too overactive, hence the name of the model.
At the endocrine level in patients with insomnia, the secretion of cortisol is increased, and the level of this hormone, instead of decreasing in the evening and at night, on the contrary, rises before bedtime, more precisely, before they go to bed and begin to suffer from sleep disturbances. This important hormone, which shows the intensity of the stress response, is also overproduced.
The presence of hyperactivation of the nervous system is the background, it determines a person's predisposition to the development of insomnia. In addition, there must be some provoking factor. Emotional stress is the most common factor. Such cases usually arise at the level of interpersonal interactions, conflicts: people have not shared something, then they get excited, do not sleep, they think what to do next. This stressful reaction can take a person out of the "zone of normal sleep" for a while, and he will sleep poorly for some time. But then, when the stress response ends, sleep is restored.
Sleep research and treatment
A very apt term is used abroad - "learned insomnia", that is, a person teaches himself bad things, makes him "not sleep." The action of such a supportive factor can lead to the fact that insomnia from short-term, associated only with stress, becomes chronic, constant, associated with inappropriate behavior of a person in relation to their sleep. He is afraid of his dream and stops believing in it. A person tries to force himself to sleep, and from this he goes deeper and deeper into insomnia, then he begins to take sleeping pills, gets used to them, and so on.
A separate type of chronic insomnia is paradoxical insomnia, when the main problem does not arise in the dream itself, but in its perception, when a person does not feel his dream. He comes to the doctor and says: "Doctor, I never sleep." The doctor says: "No, you are asleep, only you do not feel it." This person cannot be persuaded unless a sleep study is done on him.
Only sleep research allows us to clearly determine how much sleep a patient actually has and suggest why he does not feel it. Most often, the reason for such an underestimation lies in a psychological phenomenon, when a person remarkably remembers what happens to him in wakefulness and does not remember what happened to him in a dream. If he wakes up several times during the night, lies awake, then the next morning he remembers these periods. But if between them he plunged into a state of sleep, this information is not fixed in his memory, and he will not remember it the next morning - only the memory of a sleepless night remains. Accordingly, a person will consider himself absolutely right in his opinion and we will never convince him if we do not conduct an objective study of sleep.
Acute insomnia is quite simple to treat, most often it goes away on its own. When the stress factor ends, sleep is restored for most people, and they do not go to the doctor. Typically, patients come to the pharmacy, ask for something to sleep, they are given a collection of soothing herbs or a medicine that contains elements of these medicinal herbs with a calming effect, and the problem is resolved. Sometimes they ask for something "stronger", they don't get it in the pharmacy, because real sleeping pills are available only by prescription, and this requires a visit to the doctor.
With the treatment of chronic insomnia, which lasts 3 or more months, the situation is much more complicated, because very often patients suffer for years and do not receive qualified assistance. As a result, unfortunately, they become consumers constant of sleeping pills with the need to gradually increase the dose - this is called the “addiction phenomenon”, when more and more drugs are required to obtain the same effect: first half a tablet, then a whole tablet, then two, then four, and so on.
Sleep hygiene
For the treatment of chronic insomnia, both medicinal and non-medicinal techniques are used. According to international recommendations, non-drug methods are the method of choice in the treatment of chronic insomnia. Usually, such treatment begins not with taking pills for chronic insomnia, but with changing sleep conditions. The doctor first looks to see if the simplest rules that should promote sleep are being followed. These rules are called sleep hygiene rules. This, for example, a certain time to go to bed, the time to get up in the morning (the so-called sleep mode). It is recommended, and for good reason, that the person go to bed and get up at a certain time without changing their routine. This is necessary to form a kind of conditioned reflex to fall asleep. The conditioned reflex, discovered by Ivan Petrovich Pavlov,
The requirement for sleep hygiene is to ensure a normal sleeping environment - the bed should not be too hard, the room should not be too light, there should be no excessive noise - so that it is comfortable. Also in the concept of sleep hygiene includes elements of preparation for sleep. This means that you should not overeat before going to bed, use activating substances - alcohol, nicotine, coffee (some authors even treat chocolate as activating substances) in order not to counteract the sedation that should lead to sleep. It is also not recommended to actively engage in physical or mental activity before going to bed (at least an hour).
Sleep hygiene also includes the regulation of what is and is not allowed in bed. In general, after going to bed, nothing can be done, except for the activity associated with the procreation. Other activities are sleep disorders because they activate the nervous system and interfere with relaxation and falling asleep. First of all, the doctor looks at whether the patient follows the rules of sleep hygiene, corrects them, and then possibly prescribes the use of so-called cognitive-behavioral therapy techniques. In general, cognitive-behavioral therapy belongs to the section of psychotherapy and should be carried out by specially trained people. However, in this case, we are not talking about psychotherapy itself, but about the use of some techniques taken from this practice.
The most famous cognitive-behavioral therapy technique used for sleep disorders is the method of limiting external stimulation, when the doctor recommends removing all irritating, exciting objects or factors - bright light, ticking clock, etc., that is, to maximize a comfortable sleep environment ... In addition to such simple recommendations, this technique includes another very important one, concerning whether or not it is worth "lying" in bed at night if you do not sleep at all. The patient is given a recommendation in this case to get up, do some business, and when drowsiness finally appears, then go back to bed. However, in the morning he will need to get up at the same time, regardless of the amount of sleep received. In this way, an increase in the "sleep pressure" is achieved for the following evening and night,
There are other CBT methods used to treat chronic insomnia. Usually the doctor has his own "arsenal" of techniques, which he puts together in a suitable scheme and draws up this in a memo or brochure that he gives to the patient. This kind of technique is called bibliotherapy - "book treatment". Further, the doctor explains the contents of this brochure to the patient, solemnly hands it and then after a while calls for a second appointment in order to track whether the patient fulfills these recommendations or not, whether this method was enough for him to improve sleep or not.
If cognitive-behavioral therapy does not work, then medications are already taking over.
