Insomnia in adults.

Insomnia and other sleep disturbances.

Sleep disturbances are one of the disorders that have increased the most in recent years. Modern life has brought a hectic pace of life, focused above all on work and performance. The time we spend eating, exercising, and sleeping properly has been greatly reduced. This affects not only the quantity but also the quality of the time we invest in healthy habits.

Restful sleep has long been known to be one of the most important pillars of physical and mental performance. In recent years it has been possible to analyze which are the most common sleep disorders and the consequences that these have in the medium-long term.

“Sleep is essential for proper performance.”

As well as which risk factors are the most characteristic for them to be triggered and how we can address sleeping difficulties.

What is the dream?

Sleep is a physiological phenomenon of vital importance in humans. It is true that we are not the only species that depends on this vital function, but the mechanisms of sleep are very different in other living beings. In this article we will focus exclusively on the characteristics of sleep in the human species.

We know that sleep is a vital function and if we are deprived of it it will lead us to death, sooner or later. Our mental and physical health largely depend on how restorative our rest is.

“The dream fulfills a central biological and psychological function in the life of the human being.”

In addition, during sleep our body continues to function: it conserves energy, regulates metabolism, consolidates memory, etc.

However, although this process occurs in each of us on a daily basis, it has not been easy to study or define. Its main characteristics could be summarized as follows:

  • Decreased consciousness, muscular activity and reaction to external stimuli.
  • Easily reversible process (which does not happen in states like coma).
  • It usually occurs with a circadian (daily) periodicity, in relation to the light and dark cycles.
  • stereotyped posture while sleeping
  • Sleep deprivation leads to negative consequences at the level of behavioral, cognitive and biological alterations. In addition, a cumulative sleep “debt” will be generated that will eventually have to be recovered.
  • During sleep there are phenomena such as: metabolic, thermal and endocrine regulation, memory consolidation, activation of the immune system, etc.

That is, during sleep there are physiological activities vital for the proper functioning of the body.

“Not sleeping properly can negatively influence people.”

Sleep disturbances in children and adolescents can lead to serious difficulties in academic performance.

Insomnia negatively affects people.

Phases of sleep.

Before talking about sleep disorders, we must know that this is not a process that develops uniformly. It is usually divided into two different stages that always occur in the same way and where different processes occur. When we fall asleep we enter the well-known “sleep without rapid eye movements” (No REM / NREM). Subsequently, the phase of “sleep with rapid eye movements” (REM / REM) would be passed.

No REM / NREM sleep phase.

Phase I. Here the person enters what is known as “drowsiness.” It begins to enter the dream gradually. Your muscles relax, your conscious activity disappears, etc. However, being in a “light sleep” phase, the person is very susceptible to being awakened.

Phase II. In this phase, temperature and heart and respiratory rates gradually decrease.

Phase III It is the phase known as “slow wave sleep”. At this stage, sleep is already very deep.

REM / REM sleep phase.

In this stage there are a series of very characteristic rapid eye movements. It is a very deep sleep phase where there is a muscular atony of the somatic muscles. The heart and respiratory rates become irregular, even increasing.

“The MOR / REM phase coincides with the dream production. The person will be able to remember what they dreamed if they are awakened during this phase ”.

On average, a young person has between 70-100 minutes of non-REM sleep and 5-30 minutes of REM sleep. This cycle will be given again approximately every hour and a half during the entire time that the person spends sleeping. Now, depending on the age, the duration of the stages varies. As we age, the duration of the first two stages of the No REM phase increases. However, the duration of the REM stage decreases.

Classification of sleep disorders in adults.

To find out if an individual has a sleep disorder, the American Psychiatric Association indicates a series of criteria. These people often complain about their time, quality, and hours spent on sleep. This leads to discomfort that they carry during their hours of activity. In addition, they tend to show deterioration in various areas of their life due to poor sleep.

These types of disorders rarely occur in isolation. In fact, the norm is that they occur together with other types of pathologies, both physical and psychological in nature.

“Often, disorders such as anxiety or depression are accompanied by difficulty sleeping.”

It is estimated that about 80% of patients with schizophrenia suffer from sleep disorders. These sleep disturbances are often an indicator of medical conditions that often run alongside other psychological disorders. For example, difficulties with breathing (sleep apnea), neurodegenerative disorders (such as Alzheimer’s), etc. These disorders make it difficult to sleep and can be worse during sleep.

Depression is often accompanied by sleep disturbances.

Due to this lack of rest, the cognitive alterations that derive from them must also be addressed. Having ongoing trouble falling asleep can carry a number of health risks. For example, it is normal to develop psychological and substance use disorders. In addition, they can aid the prodromal expression of a psychological disorder.

The main sleep disorders described by the American Psychiatric Association will be presented below.

Insomnia disorder

Insomnia disorder

Insomnia is the inability or difficulty to repeatedly initiate or maintain sleep. This occurs even when there are optimal conditions for falling asleep.

The consequences of insomnia during the day translate into a decrease in energy, a feeling of fatigue, drowsiness, etc. This state has a negative impact on job performance and increases the risk of medical illnesses.

“Insomnia is also one of the most common sleep disorders in the general population. About 10-30% of the population suffers from this problem ”.

About 80% of people have suffered from insomnia at some time in their life. Its prevalence is high and usually causes deterioration in the physical, social and psychological life of the person who suffers it.

There are many factors that influence the appearance of this type of disorder. Normally the most frequent causes are: stress, physical illnesses (diabetes, asthma, hypertension …) and psychological illnesses (anxiety, depression …), some medications (such as antidepressants), environmental factors, (noises, too strong lights …), bad habits, etc.

The treatment of insomnia can be pharmacological or non-pharmacological. Psychological therapy can help establish good sleep hygiene and address the person’s problems. Thanks to this, the patient can improve their lifestyle and the emotional situations that influence their insomnia.

Regarding pharmacological treatment, the use of drugs with hypnotic properties is common. Benzodiazepines are often prescribed quite frequently in these cases. However, these should always be prescribed by a doctor and their use should be temporary.

“The use of benzodiazepines to treat insomnia should be for short periods of time and always supervised by a doctor.”

In the long term, benzodiazepines create dependence, tolerance and withdrawal syndrome. Although there are non-benzodiazepine drugs (zolpidem, zaleplon and zopliclone) that do not have such harmful effects, their use should not be chronic either.

Hypersomnia disorder.

Hypersomnia occurs when the person feels excessive drowsiness during their activity state. Although they have slept many hours, the individual is sleepy practically all day.

“In hypersomnia, sleep, despite having been prolonged, is not restorative.”

In hypersomnia, difficulties often appear to get going once you have woken up. This continuous state of drowsiness causes difficulties in the personal, work, social area, etc.

There is a feeling of inability to be awake when needed. As a result, day-to-day activities are magnified and put a strain on the person. Although some with this problem can fall asleep easily, they have a hard time getting up and being active during the day.

The consequences that can be derived from this are: drowsiness, motor clumsiness, irritability, memory deficits, spatial disorientation, feelings of dizziness, etc.

Drowsiness causes personal, work and social difficulties.

Today, hypersomnia is often caused by chronic sleep deprivation. Due to the frenetic pace of our society, this deprivation occurs “voluntarily”. The demands of the work, social, family world … subtract many individuals from hours of rest. It is important to know that this sleep deprivation is cumulative. That is, until the subject does not cover the necessary hours of sleep, he does not improve.

If a person suffers from hypersomnia and there is no sleep deprivation, there may be alterations in the Central Nervous System. It can also happen that it is associated with psychological problems (depression, bipolar disorder …) that affect this state of constant drowsiness.

Since hypersomnia is usually associated with psychological and environmental difficulties, its treatment is usually without drugs. It is important to implement good habits and healthy behaviors regarding sleep. A good diet, regular exercise, going to the psychologist if we have emotional difficulties, having a reasonable sleep schedule, etc. can help reduce hypersomnia.

Narcolepsy

Narcolepsy is a complex disorder that is not very common in the general population. Its prevalence is 0.09% and it usually has a considerable genetic component. It is a characteristic sleep disorder of the REM stage and is normally characterized by:

  • A significant daytime sleepiness where the person may fall asleep involuntarily (uncontrollable sleep attacks).
  •  A sudden and bilateral loss of voluntary muscle tone. This is known as cataplexy. This may or may not occur at the same time as the sleep attacks.
  • Auditory, visual, tactile hallucinations can occur … before the person falls asleep (hypnagogic hallucinations). They are usually very diverse in nature and tend to occur at the beginning of sleep.
  • The person may suffer from sleep paralysis (inability to move once awake, usually with hallucinations).

Now, not all people with narcolepsy have these four symptoms.

“What most characterizes narcolepsy is persistent daytime sleepiness and the appearance of unstoppable sleep attacks.”

Before these appear, there is usually a phase of intense drowsiness along with vision problems (double vision and / or blurred vision). This phase usually lasts less than 20 minutes. When the person falls asleep and wakes up, the feeling of drowsiness diminishes, but only temporarily.

The frequency of these sleep attacks are highly variable. There are subjects who suffer them about 10 times a day, others just have one a month. In its treatment, the use of stimulant drugs is very common. The most used tend to increase the levels of brain monoamines. REM sleep suppressing drugs can also be used .

In narcolepsy, unstoppable sleep attacks appear.

In a second part we will deal with other sleep disorders that may appear associated with other pathologies.

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Alexa Clark specializes in Cognitive Behavioral Therapy. She has experience in listening and welcoming in Individual Therapy and Couples Therapy. It meets demands such as generalized anxiety, professional, love and family conflicts, stress, depression, sexual dysfunction, grief, and adolescents from 15 years of age. Over the years, She felt the need to conduct the psychotherapy sessions with subtlety since She understands that the psychologist acts as a facilitator of self-understanding and self-acceptance, valuing each person's respect, uniqueness, and acceptance.

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