Sleep disorders

Insomnia: the consequences of sleep disturbance and how to solve the problem

The physiology of sleep is currently well understood. The consequences of its violation are also known . The biological “clock of the brain” is involved in the regulation of sleep, which responds to changes in the level of illumination (day-night). Circadian cycle is regulated by a circadian clock supra – chiasmatic nucleus, which are synchronized with the outside world by means of light. Sleep cycle Wakefulness is regulated by adenosine and melatonin, which is produced in the pineal gland. For natural sleep homeostatic regulator adenosine – neyrotrans – Mitter, which has an inhibitory effect on the central nervous system, and          melatonin must work together. The latter serves to initiate and maintain sleep. A certain level of melatonin makes a person sleepy, lowers their body temperature, preparing the body for rest. That is, this hormone regulates the circadian sleep cycle. A lack of melatonin is associated with sleep disorders (especially in depressed patients and the elderly). When we sleep, the brain continues to work. With the help of electroencephalography, which allows you to study the neural activity of the brain, two main phases of sleep are found: rapid (REM – rapid eye movement), or REM (“rapid eye movements”) and slow (Non-REM).        

Rapid sleep (REM) is repeated 4-5 times per night and accounts for 20-25% of total sleep time. Neurons are very active in this phase, their functioning is similar to that in the waking state. In this phase, the activity of the brain is increased, there is an almost complete relaxation of the muscles of the body, an increase in blood pressure, an increase in heart rate and respiration, and rapid movements of the eyeballs. Most dreams come to us during REM sleep.            

The phase of slow sleep (Non-REM) is divided into three stages and is characterized by a decrease in indicators of the physiological activity of the body: heart rate and respiration. In this phase, dreams are rare and there is no complete relaxation of the muscles of the body. Thus, sleep has a certain sequence of phases, its own pattern.      

With age and for various reasons, the architecture of sleep can change, which leads to a feeling of “light sleep” or its absence (sleep disturbances in the form of difficulty falling asleep, frequent awakenings). The most common sleep disorder is insomnia (insomnia, dyssomnia). It is one of the main diseases among residents of developed countries of the world, the prevalence is 30-48% (according to various studies). More often women and the elderly are affected , who develop “light sleep” with age. Recent studies show that insomnia also happens in children: 10-20% of schoolchildren have sleep problems , who are prevented from falling asleep by anxiety and fears.               

However, very few people seek help from doctors with complaints of problem sleep. People try to fight on their own with increased fatigue, bad mood, difficulty concentrating and perceiving new information, impairment of short-term memory, memory problems and often do not even suspect that they are suffering from a disease that needs to be treated. Dyssomnia is a symptom of this disorder.        

Typical signs of insomnia : 1) difficulty falling asleep, lack of desire to sleep; 2) difficulty in maintaining good sleep, frequent awakenings; 3) early awakening; 4) superficial sleep and its poor quality, which does not allow you to regain strength and rest.        

Dyssomnia can be a symptom of another medical condition (such as depression) or be an illness itself. If insomnia lasts less than 4 weeks, it is called acute or short – urgent; if sleep problems persist longer (≥6 months) – chronic insomnia.    

Acute insomnia occurs when emotional stress, that result in physiological transportation – excitation of, it is impossible to relax and calm sleep. Sleep normalization occurs when the stress trigger disappears.   

Chronic insomnia , as a rule, is a consequence of the underlying disease, therefore it is also called concomitant (secondary). If it is difficult to find out the etiology of insomnia, use the term “primary”. If insomnia occurs, it is necessary to undergo a comprehensive examination.

Impact of insomnia on quality of life 

Insomnia has many consequences. Insufficient and inadequate sleep causes: daytime fatigue, feeling of tension, irritability, frequent changes – mood, decreased performance, difficulty concentrating and remembering information, samples – lems in interpersonal relations and to work.       

If insomnia bothers a person for a long time, it leads to serious health problems. The risk of neurotic disorders (anxiety, phobic, panic, depressive, etc.), heart disease, increased blood pressure, and impaired functioning of the immune system increases. Diseases further reduce efficiency, leading to “self – eating” and increase the amount of work required to improve results. And, in turn, like a snowball, it only worsens the condition.        

The reasons that most often lead to the development of insomnia  

There are many reasons for insomnia, including:

  1. Unhealthy lifestyle leading to irregular sleep: work in the evening, night shifts, daily schedule; attempts to fall asleep at different times, lack of an established sleep-wake schedule; an unfavorable environment for falling asleep (noise, bright light); frequent traumatic situations, stress; spending a long time in bed while awake, using the phone, laptop in bed, watching TV; drinking coffee, alcohol, smoking; frequent change of residence, time zones, which leads to difficulties in adaptation.       
  2. Taking medications to improve sleep, getting used to them. 
  3. Diseases in which dyssomnia is observed: mental disorders (depressive, bipolar affective, anxious, panic, schizophrenia, etc.) cause more than 50% of cases of insomnia; somatic diseases (pathology of the gastrointestinal tract, cardiovascular vascular system, thyroid disease, etc.); craniocerebral trauma, intoxication of the body.  

Insomnia therapy

In ancient times, different methods were used to treat insomnia. For example, to get rid of insomnia, people made sacrifices to the gods. So, the ancient Greeks had the god of sleep Hypnos, and the Romans had Morpheus. For a long time, insomnia and other diseases were treated with morphine, but soon doctors noticed that patients who had already improved their sleep, required more and more doses of the drug. After a while, chloral hydrate, a synthetic hypnotic and sedative , was invented .        

Of course, when sleep is disturbed and dyssomnia is observed, one should try to cope with sleep problems using non-pharmacological methods. It is very important to establish and maintain sleep hygiene. It is necessary: ​​to reduce the consumption of alcohol and coffee; not watching aggressive or too funny programs, especially before bed; do not use electronic devices in bed; get rid of bad eating habits ; adjust the sleep-wake schedule; go to bed at one and the same time; do not use the bed as a “desk”; do walks before bed; do not forget to rest and recuperate; if possible, reduce stressful situations or change attitudes towards them; improve conditions for good sleep (lack of noise, light; adherence to the recommended temperature in the room; airing the room, etc.). If possible diseases in which sleep disturbances can be observed are identified and the necessary treatment is carried out, as well as if the patient suffering from insomnia follows all the recommendations for observing sleep hygiene, and the condition does not improve and the dyssomnia continues, appropriate medications should be used. The main task of drug therapy is to improve the patient’s condition with the help of correctly selected drugs by normalizing the structure of sleep.                         

Among modern pharmacological methods, there are many different drugs to improve the quality of sleep. For the symptomatic treatment of insomnia, hypnotics or other drugs with a sedative effect are used: herbal medicines origin; benzodiazepines; barbiturates; Z-preparations; antihistamines; antidepressants with a tranquilizing component of action; nizkopotentsirovannye with – temporary antipsychotics; nutritional supplements. However, many of the commonly used hypnotics, in particular benzodiazepines and barbiturates, have a number of undesirable side effects in the form of decreased levels of daytime wakefulness, an increase in the latent time of reaction to external stimuli, impaired cognitive functions, muscle relaxation, disturbances in the structure of sleep. For nutritional supplements, there is no evidence of proven efficacy or beneficial effect on insomnia. Doxylamines are contraindicated in patients with angle-closure glaucoma and in male urethroprostatic disorders. Benzodiazepine-like drugs (zopiclone, zaleplon, zolpidem) are categorically contraindicated in patients with sleep apnea syndrome, and this is a fairly common condition that affects up to 9% of women and up to 24% of middle-aged men.          

Recently in Ukraine, the British company Amaxa Pharma registered a new herbal preparation Alluna, produced in Switzerland, which has a complex effect on the restoration of sleep architecture. Alluna is a herbal preparation that contains two basic components: standardized extracts of valerian root and hop cones. Doses of herbal components of the drug Alluna were selected in such a way as to help normalize falling asleep and regulate the circadian rhythm, restore the architecture of sleep. Valerian has adenosinergic effect (normalizes the process of falling asleep), and hops – melatonergic (regulates the circadian rhythm). Unlike tranquilizers and sleeping pills, Alluna is suitable for long-term treatment of sleep disorders, including in elderly patients and those with contraindications to other hypnotics, and is not addictive. Alluna has good tolerance, does not enter into drug interactions with other drugs, which means that it can be prescribed to patients receiving therapy due to the underlying disease.          

The effectiveness of Allune in the treatment of sleep disorders has been proven in a number of clinical studies. The drug contributed to a reduction in the time to fall asleep, a decrease in the number of awakenings during sleep, an increase in its total duration, and an improvement in the quality of sleep. At the same time, the total duration of deep sleep also increased. An open-label, multicenter study analyzed the efficacy and safety of valerian extracts and hop cones in 3,447 sleep-disturbed individuals . When taking the drug, the number of patients with continuous sleep increased from 7.6 % to 32.9%. Patients reported that they began to feel calmer and their productivity improved. The effectiveness was assessed by doctors as very good and acceptable in 74.9 and 16.3% of cases, respectively. Adverse effects were extremely rare and insignificant [1]. In a study using poly – somnografii transfer patients with benzodiazepine therapy which lead to disturbed sleep architecture, in combination valerian and hops greatly improved gipnogrammy [2]. In a clinical study that also examined polysomnographic parameters, and the inclusion criterion was an increased sleep latency (≥30 min), this indicator significantly improved (sleep latency decreased) in the group of patients taking a combination drug based on valerian and hop extracts , compared with placebo group [3]. In another study of the effectiveness of a combined product, the proportion of responders was 67%. It is best to therapy patients responded to complaints of intermittent sleep (71%), problems with falling asleep (67%) and Naru – sheniyami sleep psychological origin (67%). The improvement in sleep parameters was accompanied by an improvement in general condition. Sleep duration increased by an average of 1 hour. According to 66.9% of patients, the onset of effects was noted within the first 10 days of treatment. Tolerability of the drug was assessed as good / very good in 92% of patients [4].                                               

Drug safety Alluna has been proven in a number of studies: when it is taken, there is no feeling of sleepiness in the daytime, a good level of performance is maintained, and there is no negative effect on concentration [4-7]. Also, the drug does not affect the ability to drive and control equipment, does not interact with alcohol, does not cause drowsiness in the morning, does not lead to dependence and addiction.             

Alluna easy to use: you should take 1 – tablet for 1 hour before sleep. The tool increases total sleep time by 1 hour after 4 weeks of treatment. Drug action Alluna manifests itself after 2 weeks of admission, and full effectiveness is observed after 4 weeks of treatment.           

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