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Sleep Disorders

Find out how to treat the most common sleep disorders, besides apnea and insomnia

One in three adults worldwide is affected by obstructive sleep apnea and between 85% and 90% of those affected by this sleep disorder are far from aware of this, according to the Brazilian Society of Endocrinology and Metabology. Sleepwalking, bruxism, night terror and narcolepsy, among so many other sleep disorders, are stealing people’s quality of life and – which is much more serious – can be fatal.

But how to identify a sleep disorder? And what to do in the face of the diagnosis? Read the following article prepared by our experts and find out what they are and how to treat the most common sleep disorders, in addition to apnea and insomnia. Enjoy!

What are sleep disorders?

How has your regular night’s sleep been? If you have experienced tiredness, irritation, mood swings, drowsiness throughout the day, lack of attention and even a drop in performance at work or school, know that these are the most common symptoms of sleep disorders.

Sleep disorders are diseases that affect your sleep regularly. The best known are insomnia and sleep apnea, but there are several other disorders, which rob you of quality of life and can even cause depression, strokes, or even cardiovascular diseases. That is, they are serious and need to be investigated. The good news is that there is treatment.

Sleep medicine: how did it start?

Still not very well known to the general public, sleep medicine emerged in the 70s, when doctors from the most varied specialties – such as neurologists, psychiatrists and pulmonologists, and psychologists – began to study the subject more deeply and created the first schools of sleep medicine in the United States and Europe.

In Brazil, sleep medicine started almost 20 years later, therefore in the mid-90s. A curiosity on the subject: many believe that sleep disorders appeared with the appearance of artificial light, which confuses the human body regarding day and night. However, the philosopher Aristotle already linked the regulation of sleep with digestion.

Only on August 1, 2011, Sleep Medicine was recognized as a medical practice area in Brazil. On this very day, Resolution 1973/2011 of the Federal Council of Medicine was published in the Federal Official Gazette, establishing the criteria for the recognition and designation of specialties and areas of expertise in Medicine

To be certified in Sleep Medicine, the doctor must have the title of specialist of the Brazilian Medical Association (AMB) in neurology, otorhinolaryngology, pneumology or psychiatry.

The main sleeping diseases: insomnia

Certainly, insomnia is the best known sleep disorder. It can happen in three different ways: the person has difficulty sleeping, staying asleep or wakes up well before the desired time. The main symptoms are excessive tiredness, lack of focus, irritability, change in appetite and headache and body aches.

According to the Brazilian Association of Sleep Medicine, one in three Brazilians suffers from this sleep disorder. Anxiety is the main cause of insomnia, that is, psychophysiological factors such as excessive expectation, worry and stress cause this disorder. But other known causes are the prevalence of body aches, the use of certain medications and respiratory and rheumatic diseases

Experts warn that mental health, physical health, menopause, pregnancy, time zone change, hospitalization, environmental factors (such as too high or low temperature and noise), unhealthy lifestyle, with excessive consumption of alcohol and caffeine, lack of physical activity, shift work and the natural aging process are also risk factors.

It is very difficult to find someone who has never suffered from insomnia. But it ceases to be a symptom and becomes a chronic disorder when it becomes regular, in which case it is necessary to consult a doctor specialized in sleep medicine. Neurologists explain that insomnia is the result of an imbalance in areas of the brain that contribute to the maintenance of the sleep / wake cycle, in order to disrupt sleep.

How to treat insomnia

Sleep doctors recommend those that suffer from insomnia at least three times a week to seek professional help. A well-developed history can point out daytime and nighttime symptoms that are interfering with the patient’s quality of sleep. Most likely, the doctor will ask your patient to keep a sleep diary, which in these cases may be more useful than tests.

The actigraph can also be used, an instrument capable of detecting oscillations in the patterns of sleep activity to understand the expression of the patient’s circadian rhythm. Thus, it is able to offer information about the patient’s daily routine, in addition to providing access to information about the times he was exposed to ambient light and the rhythm of body temperature, which has a great association with endogenous daily regulation throughout the morning.

Treatment can be pharmacological or not – avoiding pharmacological use, if possible. In general, professionals are advised to avoid the prescription of benzodiazepines. When medications are used, antidepressants, selective agonists of receptors sensitive to benzodiazepine medications, melatoninergic agonists and melatonin are chosen, among others. There are those who recommend the use of herbal medicines, such as valerian and passionflower, but there are no scientific studies that prove the success of these treatments.

Among many possible applications, some actions of non-pharmacological treatment consist of:

• therapy in handling the patient’s sleep routine;

• fight the fear of going to sleep and not being able to fall asleep;

• cognitive behavioral therapy for insomnia (ICC).

Failure to treat insomnia can lead to heart problems, stroke, diabetes, weight gain, depression and asthma. Therefore, treating this sleeping sickness is critical.

Sleep apnea

Not everyone knows exactly what sleep apnea is, but it is much more common than you think. A survey carried out by the Instituto do Sono, in São Paulo, through analyzes carried out in 2007 and 2017, found that the percentage of Brazilians affected by apnea went from 38% to 69%.

Obstructive sleep apnea (OSA), popularly known only as apnea, can affect anyone, including babies. The Heart Hospital of São Paulo (HCor) estimates that 20% of children who snore may suffer from apnea.

Apnea causes a brief interruption of breathing during sleep, and this can be repeated between a few and hundreds of times in the same night. The air travels from the mouth and nose to the lungs all the time, but for those affected by this sleeping sickness, the air flow is interrupted, and this is because the airway space in the throat of those who have sleep apnea is obstructed by congenital or acquired causes over time, as a consequence of obesity or alcohol consumption, for example.

Snoring is the main feature of obstructive sleep apnea, caused by the flow of air through the tight space in the person’s airways. An untreated apnea can have serious consequences for the patient, such as the development of hypertension, heart disease, stroke and diabetes.

Signals and symptoms

• Dry or sore throat upon waking;

• Loud snoring;

• Drowsiness and lack of energy during the day;

• Headache in the morning;

• Very restless sleep, with sudden awakenings or even insomnia;

• Mood swings and decreased sexual appetite.

Apnea treatment

The diagnosis of sleep apnea is made through the patient’s history and physical exams. Some tests may also be ordered by the doctor, such as the use of a polysomnography. This test measures the activity of different organ systems associated with sleep, which may include electroencephalogram, electro-oculogram, electromyogram, electrocardiogram, pulse oximetry test and arterial blood gases. Sleep apnea patients should see an otorhinolaryngologist who specializes in sleep disorders.

There are different ways to treat the disease. Respiratory diseases, overweight, enlarged tonsils and craniofacial changes can cause apnea and must be controlled. Many doctors also recommend the use of intraoral devices, which reposition the jaw or tongue, in order to keep the airways open during sleep.

There are countless devices of this type on the market, from low-cost solutions without the need for a prescription, to personalized devices made by a specialized dentist. Many doctors also recommend so-called positive pressure devices (CPAPs), which allow a continuous flow of air with enough pressure to open the air to the lung.

Surgery is also an option in more serious cases. Before deciding on surgery, however, it is important to carry out therapy with an experienced and specialized speech therapist, because this treatment helps to firm the muscles of the mouth and throat, in order to avoid obstruction during sleep, when the muscles are relaxed.

It is also recommended:

• Weight loss;

• Do not sleep on your back;

• Do relaxing activities at night;

• Do relaxing activities at night;

Night terror

Although it can affect adults, night terror is more common among children between two and five years old. It is very important that this sleep disorder is not confused with nightmares. The night terror lasts between seconds and a few minutes, when the affected child can sit on the bed, scream, open his eyes, cry and even run around the house, but the next day he doesn’t remember anything. Adults tend to be more aggressive during episodes of night terror.

Other symptoms are:

• Appearing intense fear;

• Kicking or struggling deliberately;s

• Sweating

• Difficulty waking up;

• Abnormal breathing and fast heartbeat

• Intense crying;

• Eyes wide open and stare;

Sleep medicine does not yet know the exact cause of nocturnal terror, but it is believed to be the result of an exaggerated stimulus in the central nervous system during sleep.

Doctors explain that this sleep disorder may be related to sleep deprivation, extreme tiredness, stress, fever (for children), sleeping in an unfamiliar place, excess light and noise in the environment, family history, breathing disorders during sleep, migraine and the use of certain medications, among other factors.

Night terror: what it is and how to treat it

The diagnosis is made by describing the events. In general, cases of night terror do not need treatment, as they disappear over time. Parents should not hold the child during an episode, as such an attitude can prolong them. What is recommended are preventive measures to prevent the child from getting hurt during the events.

If the child has very violent episodes and is at risk of serious injury, the doctor may recommend the use of some medications for three to six weeks. But drug treatment is not very common.

The doctors who can be consulted on the subject are the general practitioner, pediatricians, sleep doctors, neurologists, psychologists and psychiatrists. A consultation is very relevant when the episodes become more frequent, when the child is afraid of going to sleep, or when there is the risk of the patient getting hurt, as well as if the problem persists even during adolescence or adulthood.

In the case of adults, usually those affected by the disease have a history of depression or anxiety. In these cases, psychology can help a lot in eliminating this sleep disorder

Narcolepsy

Narcolepsy is due to an alteration in the balance of some chemicals in the brain. It is characterized by excessive sleepiness during the day, even when the person has slept very well and sufficiently. It is not uncommon for a narcolepsy patient to have an episode of sleep while standing on a bus, for example.

At first, sleep begins with the disconnection of muscle control, when it is characterized by slow waves. About 90 minutes after this stage, the person enters the sleep phase called REM, when the brain activity is intense. Narcolepsy patients skip the stage of slow sleep, entering directly into the phase of REM sleep.

The main and exclusive symptom of this sleep disorder is the sudden and reversible loss of muscle strength during wakefulness. The other symptoms are: excessive daytime sleepiness, abnormalities in the REM sleep phase, muscle paralysis and even hypnagogic hallucinations.

Treatment of narcolepsy

The doctor may order a polysomnography and a multiple latency test to diagnose the disease. Treatment is drug-based, and you can use a combination of small doses of stimulants and antidepressants. If possible, an afternoon nap is also highly recommended.

Sleepwalking

Sleepwalking is also a sleep disorder with no known cause. It manifests itself during the deepest stage of sleep, through motor activities without the person’s consciousness. This is because brain functions remain dormant, but the person is in a transition stage between sleep and wakefulness. The next day, the somnambulist remembers nothing about what happened.

Anyone, of any age, can suffer from sleepwalking, but the disease mainly affects children up to 12 or 13 years old. Interestingly, in the past it was believed that it was enough to wake up a somnambulist, during an episode of the disease, by means of a fright to cure them for good. The fact is that the best thing to do is to take the person back to their bed, that’s all.

The sleepwalker can sit on the bed, close or open doors and windows and even go to the bathroom or eat something, all without the slightest awareness. In general, the actions are routine, without interference from the brain, which can cause accidents. There are many cases, for example, of sleepwalkers who cut themselves with a knife while preparing food. They are uncommon, but there are cases of people walking down the street or even driving a car.

Does sleepwalking have treatment?

Predisposing factors for sleepwalking are sleep deprivation, psychiatric disorders (such as depression and anxiety), breathing problems, alcohol and other drug use, a full bladder and unpleasant noise and temperature during sleep. This sleep disorder is considered a benign disorder, which can disappear spontaneously.

The treatment is proposed by the doctor only when the episodes are very frequent and offer risk of accidents or embarrassment for the patient. Relaxation and psychotherapy techniques are used, but the doctor may also, in some cases, prescribe medications. It is recommended to lock doors and windows, removing the keys from the locks, blocking access to stairs and keeping the environment tidy, so that the sleepwalker does not trip or bump into objects that may hurt him.

Restless legs syndrome, what it is and how to treat

Also known as Ekbom’s syndrome, restless legs syndrome is characterized by changes in sensitivity and involuntary motor agitation of the legs, but in more severe cases it can affect the arms as well. Most of the time, the symptoms appear at night, disrupting – a lot – the person’s sleep. Consequently, the affected person is sleepy during the day and feels tired and irritated.

This disease greatly compromises the quality of life. Often, the victim cannot even go to a cinema or theater, or even take longer trips. The main symptoms are: discomfort and the need to move the legs, pain, tingling, chills and stinging. The cause is not yet known, but scientists explain that there is a genetic predisposition and dopamine and iron deficiency in motor areas of the brain.

The diagnosis is predominantly clinical, but the doctor may request a polysomnography and the measurement of the levels of ferritin and transferrin in the blood. These substances are responsible for transporting iron in the blood, hence the request for examination. It is worth noting that this syndrome can affect people of all ages, but it is rare in childhood.

The treatment uses medications, which depend on the severity of the case. It is strongly recommended not to consume caffeine, alcohol and cigarettes.

Bruxism

The involuntary grinding of teeth, pain in the jaw and wear of the teeth are the main characteristics of bruxism. It is a functional disorder, the more serious cases of which can lead to bone problems in the gums. Bruxism is linked to genetic factors and stress, anxiety and physical problems of occlusion or improper closing of the mouth.

When it happens during the day, this sleep disorder is called briquism. Those affected by it can also suffer from pain and ringing in the ear, pain in the neck and in the muscles of the face. The diagnosis is clinical, but the doctor or dentist may request a polysomnography.

There is no fully effective treatment for bruxism, but anxiolytic drugs are used to control stress. In general, specialized doctors or dentists recommend the use of flexible silicone interocclusal plates or rigid acrylic plates. This feature is shaped according to the shape of the patient’s dental arch, and helps to reduce the friction caused by bruxism.

Using actigraphy to treat sleep disorders

Also known as actimetry, actigraphy is a method of monitoring cycles of activity and rest, capturing, compiling and processing information to study the rhythm of sleep and wakefulness. The actigraphy is performed by means of the actigraph.

Several actigraph models are very similar to a wristwatch, which is worn on the person’s non-dominant arm. Basically the device records and compiles the individual’s movement using accelerometers, and more modern devices have temperature and light sensors, among others, which further contribute to the analysis made by the device.

Actigraphy detects sleep disorders and circadian rhythmicity, assesses sleep quality, quantifies time in bed, indicates sleep episodes during the day and is used for studies in the field of sleep medicine, but also in psychiatry, occupational medicine, behavioral psychology and other areas where circadian rhythmicity plays a fundamental role in the study of disorders.

Conclusion

Only properly qualified professionals can diagnose and treat sleep disorders, and seeking help is extremely important in restoring the quality of your sleep. It never hurts to remember that a good night’s sleep is a basic condition for our health.

The most varied sleep disorders affect the quality of our sleep and whoever sleeps next to us. The biggest problem, however, is the lack of awareness of the need for treatment, as the disease can evolve and even have fatal consequences. Treating snoring just as a nuisance is a mistake.

There are treatments and solutions for all sleeping disorders. And the first step, without a doubt, is to recognize that there is a problem and that you need help from an expert.

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