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Sleep disorders


Sleep disorders - the phenomena rather eurysynusic. From 8 to 15% of adult population of the world show frequent or constant complaints to a bad or insufficient dream, from 9 to 11% of adults use sedative hypnagogues, and among people of advanced age this percent is much higher.

Sleep disorders can develop at any age. Some of them are most characteristic of certain age groups, for example bed wetting, nightmares and noctambulation at children and teenagers, and also sleeplessness or pathological drowsiness at people of middle and advanced age. Other frustration, for example a narcolepsy cataplexy syndrome, can begin in the childhood and remain during all life.

Физиологическая электроэнцефалограмма во время сна

Physiological electroencephalogram during sleep

Symptoms of Sleep disorders:

Insomniya. The term the insomniya, or sleeplessness, use everywhere for the description of any deteriorations in duration, depth and the refreshing influence of a dream. Sleeplessness can develop as primary disease, in the form of secondary manifestation at mental disorders, alarming states, the use of medicines or therapeutic diseases, and also in combination with other sleep disorders, for example with an apnoea in a dream.

To establish the sleeplessness reasons, it is necessary to analyze signs of frustration of a dream carefully. The diary of a dream which is kept the patient and also messages of relatives on what the patient snores in a dream makes various movements or incomplete awakening, will help to assume more specific diagnosis. At clarification of the anamnesis it is necessary to establish what is the reason of frustration of a dream: disturbance of a sleep pattern and wakefulness and periods of awakening, short-term dream in the afternoon, discomfortable conditions of a night dream, self-treatment by medicines or alcohol intake, tobacco or caffeine and its derivatives. Features of complaints to a sleep disorder can also give certain information of rather possible reasons of these disturbances. Inability to fall asleep or wake up, having overslept 2-3 h, it can be caused by the use of medicines and alcohol, a serious illness, the periodic movements in a dream or the apnoea of not obstructive character which occurred in a dream. In some cases patients quickly fall asleep and the most part of night well sleep, but wake up in the morning too early. Often people with depressive and alarming states, and also people of advanced age who can fill up and waken spontaneously in the afternoon belong to this category.

Psychosomatic sleeplessness. A situational insomniya call the sleeplessness proceeding less than 3 weeks and having, as a rule, the emotional nature. The people having psychosomatic sleeplessness fall asleep hardly, often wake up at night, at them note constant awakening early morning hours that leads to chronic overfatigue and excessive irritability. The condition of the patient can be aggravated with concern because of similar sleep disorders. Having woken up at night and with irritation trying to fall asleep, such patients can lie without dream of 1-2 h, but at the same time it seems to them that there passed 3-4 h. Signs alarming or a depression at similar patients reveal not always.

Now the best drugs for prolonged treatment of sleeplessness consider benzodiazepines. Efficiency at long (more than 30 days) use of any of hypnagogues is not established. The USA most often appoints flurazepam (Flurazepam) in a dose - 60 mg before going to bed. Chlorali hydras and barbiturates belong to well-known sedatives, however high tolerance and a withdrawal limit their use. Some authors suggested to use L-tryptophane in a dose of 1-5 g, however its clinical performance was not convincingly proved.

Broad use of benzodiazepines as night sedatives was complicated by identification of some undesirable side effects now. First, to them there is moderately expressed accustoming, but also, cross tolerance at combinations is noted them with each other and alcohol. Secondly, tolerance or a withdrawal of these drugs (see below) can provoke reactive sleeplessness. Thirdly, active products of exchange of flurazepam and some other benzodiazepines cause negative biological effects lasting 36-48 h (in people of advanced age even longer).

When psychosomatic sleeplessness gets a chronic current, only one drug treatment seldom happens effective. The vicious circle as usual awakening of the patient at night and fears concerning loss of a dream aggravate sleeplessness develops. It can become one of the main difficulties and demands the combined, psychosocial and behavioural approach to purpose of hypnagogues.

Sleeplessness at affective mental states. Sleep disorders at affective frustration are characterized by constant or periodic impossibility to sleep during a necessary span, Patients complain of constant concern at night and feeling of fatigue and apathy in the afternoon. A clinical picture frequent awakenings during the night supplement, a superficial dream and early awakening in the morning.

Affective frustration divide into big depressions and bipolar states (maniac-depressive). Sleep disorders at a unipolar depression are characterized by frequent awakenings with the shortened REM sleep phase stage of latency (time from backfilling till the first period of a REM sleep) and shortening of III and IV stages of a slow dream. The similar phenomena are also observed at patients with bipolar depressions, but at them often note the increased drowsiness in the afternoon (drowsy states) and the extended dream periods at night. During episodes of a hypomaniacal state there can be partial or full sleeplessness proceeding century a current of several days.

Sleeplessness owing to the use of medicines and alcohol. Can lead the broad use of the substances exerting the oppressing impact on the central nervous system to sleep disorders and sleeplessness (somnolent and sedative drugs, tranquilizers or alcohol before going to bed). As at long reception the somnolent effect of such medicines is lost, the patient and the doctor begin to increase a dose. In spite of the fact that the patient continues to accept drug, frustration of a dream can be aggravated in this connection the dose of drug continues to increase. At patients, it is long and regularly accepting hypnagogues, the dream is interrupted by frequent awakenings (for 5 and more minutes), especially in the second half of night. III and IV stage of a slow dream are shortened, differentiation of stages of a dream becomes less accurate. These phenomena indicate considerable extent of disorganization of a dream.

The specific maintenance of a phase of a REM sleep substantially increases after sharp cancellation of the hypnagogues which were accepted is long also in high doses. At this time there can periodically be a night myoclonus. Besides, a certain symptomatology arises also in the afternoon, for example concern, nervousness, mialgiya and in hard cases the drug withdrawal signs including confusion of consciousness, a hallucination and convulsive epileptic seizures. These complications most often arise after cancellation of barbiturates and Noxyronum, can be observed at a withdrawal of benzodiazepines. If the patient it is long accepted several various somnolent drugs in high doses, it is necessary to cancel them gradually and under observation of the doctor. After that at many patients note significant improvement of both objective, and subjective features of a dream though the normal dream can be recovered and not so quickly.

The long use of overdoses of alcohol considerably breaks the organization of a dream. The periods of a REM sleep are shortened, the patient begins to wake up often at night. The acute abstinence alcoholic syndrome of v of chronic alcoholics leads to lengthening of stage of latency of backfilling, shortening of a phase of a slow dream and lengthening of a phase of a REM sleep with short stage of latency. In hard cases the acute toxic abstinence syndrome (delirium tremens) can develop. At the alcoholics abstaining from the use of alcoholic drinks, pathological character of a dream can remain within several weeks though, as a rule, the normal dream is recovered during 2 weeks.

Sleeplessness at the myoclonus arising in a dream. In some cases the patients having primary sleeplessness and very often at patients with other kinds of an insomniya in a dream have a periodic motive concern, especially during a phase of a slow dream. The similar phenomena consist in stereotypic repeated bending of the lower extremity sometimes in knee and coxofemoral joints or, what is much more often, bending of foot and a thumb of a leg back. These hyperkinesias last about 2 with and each 20-30 pages repeat. They should be distinguished from the so-called high-quality night starts arising when backfilling. Registration of a dream shows that periodic hyperkinesias in a dream note at people of middle age at many frustration of a dream, such as narcolepsy cataplexy, apnoea in a dream and the sleeplessness caused by reception of medicines. Therefore the symptomatology is secondary in relation to chronic disturbance of a cycle of a dream and wakefulness rather, than primary frustration. Though pathophysiological mechanisms of periodic hyperkinesias in a dream are unknown, recently note good effect of clonazepam reception before going to bed in a dose of 1 mg.

At a syndrome of "uneasy legs" patients have insuperable desire to move legs, generally in a sitting position or lying, especially before going to bed. This feeling is localized in the depth of calves and disappears at the movement, loading or walking; it prevents the patient to fall asleep and can repeat during the night. Usually by the morning the symptomatology decreases and the patient falls asleep. Periodic motive concerns arise in all cases of a syndrome of "uneasy legs" that is confirmed with data of a polisomnografiya.

Other causes of sleeplessness. Complaints to a defective dream and frequent awakenings can show sick, subject to stops or delay of breath in a dream, especially not obstructive character. The people having painful diseases at which relaxation of muscles leads to opening of pan and strengthening of pains and concerns can complain of a bad dream. Sleeplessness can develop at such diseases as a paroxysmal night asthma, night asthma, rheumatism and gastrointestinal frustration.

Disturbances of a sleep pattern and wakefulness. The dream is one of many day-night rhythms synchronized in relation to a terrestrial 24-hour geophysical cycle. At the healthy people inspected in vitro in the absence of information on surrounding time revealed that is endogenous the caused duration "freely current" the circadian period makes about 25 h. In such isolated temporary conditions interface of rhythms of body temperature, level of hormones and cycles of a dream at disorder of synchronization of bonds between them is broken.

Distinguish two categories of disturbances of a circadian cycle of a dream and wakefulness: passing and constant. Passing frustration of a dream at fast changing of a zone time ("reactive shift of phases") are known long ago as well as the similar states observed at sharp change of the working schedule. Resulting from this frustration of a dream are caused by both a dream deprivation, and change of the scheme of circadian rhythms. Are characteristic short duration of a dream with frequent awakenings of a similar state and drowsiness in the afternoon. Recovery of synchronization takes several days to 2 weeks.

Treat permanent frustration of a cycle of a dream and wakefulness a syndrome of the slowed-down dream period; syndrome of premature approach of a dream; a syndrome not - a 24-hour cycle of a dream and wakefulness. The syndrome of the slowed-down period of a dream can be separated from other forms of sleeplessness. Patients cannot fall asleep in the hours necessary for observance of the corresponding operating mode or study; usually they eventually fall asleep between the 2nd and 6th one o'clock in the morning. However if there is no need to adhere strictly to the mode (for example, on the weekend, holidays and during issue), the patient sleeps normally if it has an opportunity to go to bed and rise in time, convenient for it. At such people note the normal duration of a dream, however disturbance of the choice of time of a dream within a day takes place. In similar cases the good effect brings treatment by means of the accruing dream span delay (hronoterapiya). Withdrawal time delay to a dream on 3 h daily (the 27-hour cycle of a dream and wakefulness) a dream can be normalized and the patient will be able to fall asleep in socially acceptable hours.

The syndrome of the premature period of a dream is characterized by the normal duration and structure of a dream, but inadequately early withdrawal to a dream in the evening and awakening in the mornings. In similar cases people seldom ask for medical care. With age there occur characteristic changes of the choice of time of withdrawal to a dream. Elderly people usually spontaneously wake up early - in the morning and go to bed early in the evening.

The syndrome not - a 24-hour cycle of a dream and wakefulness (gipernikhtermalny) is characterized by inability of the patient to adapt by the standard 24-hour days. At such people, despite performance of certain social functions by them, the 25-27-hour duration of biological days develops. The blindness or certain changes of the personality can contribute to this state.

Parasomniya. In connection with all process of a dream and its separate stages there can be a set of the unpleasant behavioural and physiological phenomena. As their origin and relationship are not clear, they can be considered as separate clinical units.

Lunacy (noctambulation). The people having this disease suddenly sit down in beds, go or make the automatic semi-purposive difficult movements. Patients are in unconsciousness and oppose to awakening. Sometimes they make the actions menacing to their health for example try to get out in a window. The attack lasts usually less than 15 min. and comes to the end with return of the patient to a bed or awakening (without story about dreams). Lunacy arises during III and IV stages of a slow dream. To and during an attack do not note signs of convulsive readiness though on clinical manifestations this state should be distinguished from the night epileptic seizure arising at defeat of temporal shares.

Noctambulation occurs at children and teenagers: at 15% from them noted one or several similar episodes. At insignificant number of children (from 1 to 6%) attacks can often repeat at night. Existence of attacks and their constancy during puberty can be a psychopathological sign.

Reasons of Sleep disorders:

Insomniya - disorder of backfilling and ability to stay in a condition of a dream

    * Psychosomatic - situational or constant
    * Owing to mental diseases, especially affective states
    * Owing to the use of medicines and alcohol:
          otolerantnost to sedative drugs or a withdrawal;
          odlitelny administration of drugs, the activating TsNS
          odlitelny reception or withdrawal of other drugs
          okhronichesky alcoholism
    * Owing to the respiratory frustration caused by a dream:
          o an apnoea Syndrome in a dream
          o Syndrome of alveolar hypoventilation
    * Owing to night myoclonias and a syndrome of "uneasy legs"
    * Various - at other medicamentous, toxic and idiopathic morbid conditions, and also the states caused by influence of external factors

Hypersomnias: the defeats which are followed by pathological drowsiness

    * Psychophysiological - situational or resistant
    * Owing to mental diseases, especially affective states
    * Owing to the use of medicines and alcohol
    * Owing to the respiratory frustration caused by a dream (as well as in point G above)
    * Narcolepsy cataplexy
    * Various - at other medicamentous, toxic, exogenous and idiopathic states

Disturbances of a sleep pattern and wakefulness

    * Temporary - reactive shift of phases, change of the working schedule
    * Constants:
          o the Syndrome of the slowed-down dream period
          o Syndrome of the premature period of a dream
          o the Syndrome not - a 24-hour cycle of a dream and wakefulness

Parasomniya - the functional frustration connected with a dream, phases of a dream and incomplete awakening

    * Circulation in a dream
    * Nightmares and alarming dreams
    * Enuresis
    * Night epileptic seizures
    * Other functional frustration of a dream

Treatment of Sleep disorders:

Treatment is carried out in the accounting of a basic disease, against the background of котороо there were frustration of a dream.
At affective disturbances for normalization of a dream treatment has to be directed to elimination of the main mental disorder and includes use of tricyclic antidepressants or monoamine oxidase inhibitors preferential at night. Some new not medicamentous ways of treatment, including management of dream time within a day are now developed. Observations of some patients with bipolar states which have a deprivation of a phase of a REM sleep or the prevention of the progressing phase of backfilling are described promoted disappearance of a depression.

Drugs, drugs, tablets for treatment of Sleep disorders:

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