sleep disorders

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

Sleep disorders are common. Research has shown that around 5 to 19 percent of the population in Europe suffer from a sleep disorder. Not all sleep disorders are the same: There are, for example, difficulty falling asleep and sleeping through the night (insomnias), different types of daytime sleepiness (hypersomnia), sleep-related movement disorders (such as restless legs syndrome) and sleep-related breathing disorders (e.g. sleep apnea syndrome). Read more about the causes and types of sleep disorders and what you can do about it here!

Brief overview

Description: Problems falling asleep and / or staying asleep, feeling excessively tired during the day
Symptoms: Different depending on the type of sleep disorder; In addition to fatigue, for example, headaches, memory problems, eating disorders, teeth grinding, movement disorders of the limbs, breathing disorders, sleepwalking
Causes: Stress or unfavorable sleeping conditions, but also psychological, organic or neurological diseases, medication, drugs
Tips: Ensure good sleep hygiene (regular bedtime, comfortable bedroom temperature, no coffee or alcohol in the evening), do not want to force yourself to fall asleep, relaxation techniques (yoga, meditation, etc.), medicinal herbs (teas), sleep-inducing baths
When to the doctor With persistent sleep disorders; when insomnia is a massive burden; for tiredness and lack of concentration during the day. The first point of contact is the family doctor. If necessary, he will refer you to a specialist.

Sleep disorders: description

Almost everyone has short-term sleep problems over a few days in stressful phases of life, during an illness (e.g. cough, "nose closed" with runny nose) or due to stressful situations. Most of them are harmless.

It is different with "real" sleep disorders. These are sleep problems that occur over a longer period of time (from three to four weeks) and which significantly impair the person's performance. They can be both physical and psychological. Therefore, you should have the cause clarified.

Sleep disorders are widespread and not a trivial matter. Chronic sleep disorders, in particular, can severely limit the day-to-day wellbeing and performance of the person concerned, impair their social skills and lead to accidents.

Sleep disorders: how do they manifest themselves?

Experts differentiate between more than 80 different sleep disorders, which can be divided into eight main groups according to the type of complaint:

Insomnias: These include difficulty falling asleep, difficulty sleeping through the night, early morning awakening and chronically unrestful sleep. In addition, those affected complain, for example, of tiredness, attention or memory problems, impaired mood, tension, headaches and / or worries about the sleep disorder. Insomnias are one of the most common forms of sleep disorders. For example, they can be triggered by psychological stress (e.g. financial worries) or drug abuse (such as excessive use of sleeping pills).
Sleep-related breathing disorders: They include, for example, different forms of sleep apnea. This leads to nocturnal pauses in breathing, i.e. breathing pauses briefly - often unnoticed by the sleeper.
Hypersomnias of central nervous origin: With these sleep disorders, those affected primarily suffer from excessive sleepiness during the day, although the amount of sleep at night is not reduced and there is no circadian rhythm disturbance (i.e. a disturbance of the individual day-night rhythm). Hypersomnias include, for example, narcolepsy ("sleeping sickness") and daytime sleepiness due to traumatic brain damage or as a result of drug or substance abuse.
Circadian sleep-wake rhythm disorders: Such rhythm sleep disorders can be triggered by time zone changes (jet lag), shift work, organic diseases or the abuse of drugs or substances. They lead to insomnia and massive daytime sleepiness.
Parasomnias: These are episodic interruptions to sleep due to unusual physical phenomena or behavior such as sleepwalking, nightmares, nocturnal moans, sleep-related eating disorder or repeated, unconscious emptying of the bladder during sleep.
Sleep-related movement disorders: The sleep disorders are caused by simple, mostly stereotypical movements. A common sleep-related movement disorder is restless legs syndrome (RLS). Other sleep disorders in this category include periodic movement disorders of the limbs and nocturnal teeth grinding.
Isolated symptoms, norm variants, unsolved problems: This category includes all sleep-related symptoms that are on the border between "normal" and pathological (pathological) or that cannot yet be clearly classified as normal or pathological from a scientific point of view. Examples: short sleepers (need less than five hours of sleep per 24 hours), late sleepers (usually need more than ten to twelve hours of sleep per 24 hours) and strong, repeated muscle twitches when falling asleep (twitches to fall asleep).Primary (benign) snoring and speaking during sleep are also assigned to this category, although they usually do not disturb the sleep of the person concerned - but that of the person next to them.
Other sleep disorders: This refers to all sleep disorders that cannot be assigned to any of the other categories, for example because they have not yet been adequately investigated or have characteristics of different categories of sleep disorders.

The different sleep disorders can overlap. For example, some people suffer from difficulty falling asleep and staying asleep (insomnia) as well as sleepwalking (form of parasomnia) and sleep-related breathing disorders. This is what makes the subject of sleep disorders so complex.

Sleep disorders: causes and possible diseases

According to their cause, sleep disorders can be divided into primary and secondary sleep disorders:

Primary sleep disorders

No physical or emotional cause can be found for primary sleep disorders. They are caused, for example, by stress or poor sleeping conditions.

Secondary sleep disorders

Secondary sleep disorders have a physical (organic) or psychological or psychiatric cause:

Mental illnesses such as depression, anxiety disorders, psychoses or schizophrenia almost always trigger sleep disorders (e.g. difficulty falling asleep and staying asleep).
Organic or neurological diseases can also be the reason for sleep disorders such as difficulty falling asleep and staying asleep (insomnias), hypersomnias or circadian rhythm sleep disorders. Examples are chronic pain (e.g. in rheumatic diseases), cancer, hormonal diseases (e.g. hyperthyroidism), restless legs syndrome, heart and lung diseases, chronic kidney or gastrointestinal diseases, Parkinson's, Dementia, multiple sclerosis, meningitis, stroke, brain tumor and epilepsy.
Medication can sometimes cause insomnia as a side effect. These include antibiotics, certain antidepressants (e.g. MAO inhibitors, SSRIs), high blood pressure drugs (e.g. alpha blockers), asthma drugs (e.g. theophylline), sleeping pills such as benzodiazepines (new sleep disorders after abrupt withdrawal of preparations), cortisone, thyroid hormones, drugs for dementia, water tablets (diuretics), antihistamines (allergy drugs) and drugs that cancer patients receive as part of chemotherapy (cytostatics).
Legal and illegal drugs can also cause sleep disorders, for example in the form of difficulty falling asleep, difficulty sleeping through the night or sleep apnea. Drugs that disrupt sleep include, for example, alcohol, caffeine (e.g. coffee, black tea, energy drinks), nicotine, cannabis, heroin, cocaine and ecstasy.

Sleep Disorders: What Can You Do By Yourself?

Sometimes a physical or mental illness is the cause of a sleep disorder. In such cases, of course, their treatment by the doctor comes first. In these cases, you can also do something to help against sleep disorders.

This applies even more to sleep disorders that are not based on a disease, for example when stress, inner restlessness or unfavorable sleep conditions are the cause of difficulty falling asleep, staying asleep or waking up early in the morning (insomnias).

Sleep pills are rarely needed to treat sleep disorders - and should only be taken for a short time, as they are quickly addictive.

Rules for a good night's sleep

Two thirds of all sleep disorders can be improved with non-drug measures. Above all, this includes good sleep hygiene. It includes the following rules:

Don't sleep more than your body needs. This is especially important for the elderly.
Get into the habit of regular bedtime.
Do not take a nap during the day (e.g. nap).
Ensure comfortable sleeping conditions. This also includes the right bedroom temperature (around 18 ° C is optimal).
Do not drink alcohol or coffee in the evening - both have a stimulating effect. If you are sensitive to caffeine, you should avoid it from midday onwards. This also applies to cola, energy drinks and cocoa.
Eat a balanced diet and exercise regularly. If you only eat fast food and sit on the couch all day, you shouldn't be surprised by insomnia.
Make sure you have a relaxing evening that slowly ends the day. On the other hand, strenuous fitness training in the evening or an exciting thriller as evening reading can promote sleep disorders (e.g. difficulty falling asleep).

Tips against insomnia

In addition to good sleep hygiene, the following tips can also help against sleep disorders:

Stimulus control: Use bed and bedroom only for sleeping and not for example for watching TV. Going to bed is then the signal "bedtime" for the body.

Sleep restriction: Sounds paradoxical, but it helps: Healthy people with sleep problems who reduce their nightly sleep for at least a week, fall asleep faster the following night, sleep more deeply and wake up less often at night.

A therapist can calculate how long the bedtime should be shortened in individual cases. To do this, you must first keep a sleep diary for two weeks, in which you record the time spent in bed for each night and estimate the time you fell asleep, wake-up frequency and total sleep duration.

No convulsive attempts to fall asleep: Instead of tossing and turning restlessly for hours at night, you should pick up a relaxing book or get up and do something active (e.g. ironing).
Paradoxical Intention: If you have difficulty falling asleep, ask yourself to stay awake while you are lying down. This often makes you fall asleep faster than trying hard to fall asleep.
Cognitive Focus: Concentrate on calming thoughts and images in bed.
Don't be afraid of bad sleep: Avoid thoughts like "Today I will certainly not be able to sleep through the night again!" or "Oh God, it's past midnight and I'm still awake!" Such anxious thoughts can make your sleep disorder worse.
Thought freeze: If constant thoughts and brooding keep you from falling asleep, you should rigorously break off such thoughts - every time anew.
Relaxation methods: Progressive muscle relaxation, autogenic training, biofeedback, yoga and meditation can also alleviate sleep disorders in the long term.

Sleeping pills (hypnotics)

Sleep pills should in principle only be used in sleep disorders if all other measures (e.g. sleep hygiene, sleep restriction, medicinal plants - see below) have not been successful. It is best to get advice from a doctor.

Bear in mind that many drugs lose their effectiveness and can lead to habituation effects and even addiction. Stopping it can temporarily worsen the sleep disorder (rebound insomnia).

Many sleep medications decrease muscle tension and control, which increases the risk of falling at night. This effect and a reduced ability to concentrate can persist into the day and limit performance.

You should therefore always take such sleep medication (see the package insert!) In the evening before going to bed and not when you wake up at night or have already been awake for a few hours.

Sleep disorders: home remedies

If you have problems falling asleep or staying asleep, various home remedies for insomnia may help you.

Medicinal herbal teas for insomnia

There are various medicinal plants that can help with insomnia. They are mainly used as a tea:

Valerian: Valerian is the medicinal plant of first choice for those with difficulty falling asleep. It has a calming, but not numbing (narcotic) effect like chemical sleeping pills. A tea made from valerian root can help with sleep disorders caused by nervousness, inner restlessness or too much coffee. If you have chronic insomnia, you should drink several cups of it throughout the day. If you don't like the somewhat unpleasant valerian taste, you can use tasteless valerian dragees, capsules or tablets.

Hops: It can increase the calming effect of valerian because a strong calming agent forms in the hop cones during storage. You can use hops in tea form (e.g. as a hops-valerian tea mixture) or make yourself a sleeping pillow: Put hop cones in a cotton pillow and lay your head on them to sleep. Replace the hop cones after a week.

Melissa: Melissa is a well-known medicinal plant from monastery medicine. Lemon balm leaves and lemon balm oil have a calming effect (and strengthen the digestive system). Lemon balm oil is quite expensive, so you can use lemon balm leaves as a substitute. If you have trouble sleeping, you should drink several cups of lemon balm leaf tea throughout the day.

Lavender: With its purple flowers, it has long been valued for its calming and sleep-inducing properties. If you have trouble sleeping, drink two cups of lavender flower tea before bed.

Passion flower: It can help with mild forms of nervous restlessness, difficulty falling asleep and nervous heart problems. It has a strengthening, calming and antispasmodic effect. Passion flower is found in tea blends along with other soothing and relaxing medicinal herbs such as lavender and valerian.

St. John's wort: The herb is primarily known as a herbal antidepressant. Because depression is often associated with insomnia, St. John's wort can also contribute to a restful night's sleep. The medicinal plant is taken as a tea or as a ready-made preparation (such as capsules, coated tablets).

St. John's wort can reduce the effectiveness of the contraceptive pill and other hormonal contraceptives as well as drugs for asthma, cardiac arrhythmias, high blood values and blood thinners of the coumarin type.

Soothing and sleep-promoting baths

Baths with medicinal herbs can also help with sleep disorders. You can either get a ready-made calming bath from the pharmacy or drugstore, or you can prepare the bath mix yourself, such as a lavender bath:

For a full bath, mix 2 egg yolks, 1 cup of cream (or milk), 2 tablespoons of honey, 3 to 4 tablespoons of salt and 1 teaspoon of lavender oil and pour the whole thing into the 37 to 38 ° C warm bath water. Egg yolks, cream or milk and honey ensure that the essential oil not only floats on the surface of the water, but that it is well distributed in the water. You should bathe in it for at least 20 minutes.

Instead of lavender oil, you can also use lavender flowers: Pour 2 liters of hot water over 100g of lavender flowers, let it steep for 5 minutes and add to the bath water. Bathing time again at least 20 minutes.

Rub with lavender oil

The essential oils of lavender (alternatively also thyme oil) can also be used for rubs. To do this, warm a few drops of the oil in your hands and rub it on the person's back for several minutes. When rubbing in, do not exert too much pressure and avoid the spine.

If you suffer from insomnia yourself, you can rub the lavender oil on your feet. Work from ankle to toe.

The rubbing in has a relaxing effect and promotes sleep. Therefore, the person concerned should already be in bed and then rest.

Cold against insomnia

Cold casts: Evening casts can have a sleep-inducing effect. To do this, use water at around 18 degrees Celsius. Start at the foot and then slowly move the water jet up the outside of the leg to the knee. Then let the beam wander down the inside of the leg.

Then gently wipe off the water with a towel - do not dry off! You should repeat the cold leg kiss every evening.

Damp and cold calf compresses: They have a calming and relaxing effect. Especially when they are in place for a long time, for example overnight. Then they can also be used as a sleep aid.

How to use the wrap correctly and what you need to consider when using it can be found in the article Leg wrap.

Warmth can promote sleep

Many also find warmth in bed to be pleasant before going to sleep. As a simple home remedy for sleep disorders, you can put a hot water bottle or a warm grain pillow (cherry stone pillow) in bed. This has a relaxing effect and promotes blood circulation.

Belly pad with chamomile: A warm belly pad with chamomile can have a sleep-promoting effect. To do this, pour half a liter of boiling water over one to two tablespoons of chamomile blossoms and leave to stand covered for a maximum of five minutes. Then strain the flowers.

Put a wrap in the brew and let it steep for a few minutes. Place the soaked inner cloth close to your stomach and let it work for 20 to 30 minutes. It is best to use the tummy support against insomnia in the evening, before going to bed.

You can read more about the correct use of wraps in the article Wraps (envelopes) and pads.

Warm milk with honey to help you fall asleep

Warm milk with honey can help you fall asleep. Not only can it soothe the irritated lining of the throat, milk also contains the amino acid tryptophan. It can stimulate the secretion of the sleep hormone melatonin in the brain when it reaches the brain.

To do this, tryptophan needs a means of transport: the transport protein albumin. However, other amino acids bind much better to the transport molecule. This is where honey comes into play: The carbohydrates contained in it inhibit the transfer of amino acids into the brain - but tryptophan is an exception.

If you want to take advantage of this effect, warm milk for a glass or a cup and dissolve a teaspoon of honey in it. Before going to bed, drink the honey milk in small sips, preferably lukewarm.

Babies under one year of age are not allowed to consume honey. It can contain bacterial toxins that are dangerous for them.

Sleep disorders in children

Restful sleep is extremely important for children's development. Here are some tips to help you get a good night's sleep and counteract insomnia in children:

Regular sleep and wake times

They are especially important for children. Make sure to strictly adhere to these times - even on weekends and during holidays.

Small sleep rituals

They can help with difficulty falling asleep, such as having a bath in the evening, a quiet game, or a bedtime story or song. Make sure you do it regularly and consistently.

Darkened bedroom

The light in the child's bedroom should be switched off or at least dimmed. A small night light is allowed if the child then feels more comfortable.

Fall asleep in your own bed

Do not let the child fall asleep on the sofa in the living room or on your arm, or they will get used to the wrong sleep pattern.

No pacifier or bottle

Do not try to lull a baby to sleep with a pacifier or bottle, even if it is difficult.

Calm

If your child is very distraught, pick them up straight away and rock them gently. Otherwise, try to calm it down differently for now. Bend over them so they can see your face and speak to them gently. If that's not enough, put your hand on his stomach. If she can't calm down, piss her off.

openness

Unfamiliar activities, illnesses, or family events can cause temporary sleep disorders in children. Then it can also help smaller children, who can already speak, if you talk to them about the things that occupy or stress them - but during the day and not before going to bed.

Protecting little sleepwalkers

Sleepwalking in children occurs primarily between the ages of four and eight years and usually gives itself up again. You should, however, take safety precautions to avoid accidents during sleepwalking (e.g. safety bars on windows, barrier on the stairs, alarm bell the door of the children's room to wake up the parents).

Provide security in case of panic attacks

Nocturnal panic attacks are most common in children between the ages of four and twelve. The child suddenly wakes up screaming and often bathed in sweat, is confused, disoriented and cannot remember any “bad dreams”. The next morning the child usually doesn't know anything about the panic attack. As a parent, there is little you can do about it other than comfort the startled child and reassure them that everything is fine. As you get older, the panic attacks usually subside, and so do the sleep disorders.

Sleep disorders: when do you need to see a doctor?

Sometimes sleep disorders go away on their own as soon as the trigger (such as a stressful phase at work, moving house, illness) disappears. In other cases, good sleep hygiene (see above) can eliminate the sleep disturbances. Going to the doctor is advisable if:

the sleep disorders persist (no restful and / or continuous sleep for at least one month for three nights a week),
the disturbed night sleep massively burdens you and
You are often tired and unable to concentrate during the day.

If you have stressful sleep disorders, the first thing you should do is see your family doctor. On the basis of a detailed conversation to record the medical history (anamnesis), he can often already infer the cause of the sleep disorder, for example in the case of unfavorable sleep conditions, a disease (such as depression, hyperthyroidism) or the use of a certain medication (e.g. antihypertensive agents).

Your family doctor may refer you to a specialist, for example an ENT doctor if you snore heavily. If necessary, he will also recommend a sleep doctor (sleep laboratory) to you.

Sleep disorders in children: when to see a doctor?

In the long run, sleep disorders in children can put a strain on both the child and the whole family. In this case, you should go to the doctor. If necessary, they will refer you to a pediatric sleep specialist who is very familiar with sleep disorders in children.

Sleep disorders: what does the doctor do?

The doctor will first ask you in detail about your sleep disorder, your lifestyle, any previous illnesses and the use of medication. In this way, he can collect your medical history (anamnesis) and often gain initial clues as to the cause of the complaints. Important information for diagnosis are, for example:

Type of sleep disorder (e.g. insomnia with difficulty falling asleep and / or staying asleep, hypersomnia with excessive tendency to sleep or sleep attacks during the day)
Duration, course and rhythm of the sleep disorder (sleep-wake rhythm)
Sleep behavior and living conditions that influence sleep (e.g. how much time do you spend in bed? What is the evening plan like? Do you have certain sleeping habits?)
Environmental influences (e.g. noise, temperature in the bedroom)
Pretreatment (e.g. taking sleeping pills)
Symptoms during falling asleep and sleeping periods (circles of thought, brooding, tension, breathing disorders, restless legs, nightmares)
Daytime well-being (e.g. performance, activity)

In some cases, the doctor will ask the patient to fill out a sleep questionnaire and / or keep a sleep diary for a period of time.

Medical examinations

In order to get to the bottom of sleep disorders, the doctor can also carry out various tests:

a thorough physical exam
Laboratory tests (e.g. measurement of thyroid hormones in the blood if hyperthyroidism is suspected as the cause of the sleep disorder)
Measurement of electrical heart currents (electrocardiography = EKG)
(possibly) measurement of electrical brain waves (electroencephalography = EEG)

In the sleep laboratory

A measurement of the sleep process in the sleep laboratory is the most complex procedure for diagnosing sleep disorders. It is only carried out if a sleep disorder cannot be clearly identified and assessed using the diagnostic steps mentioned above (such as questioning the patient, sleep protocol, physical examinations). Usually these are sleep disorders with an internal cause (e.g. psychological cause).

The examination in the sleep laboratory takes place at night, which means that the patient spends the night in his own bedroom in the laboratory, where the sleep specialists can monitor his sleep: the patient's physiological signals are recorded, with the help of which sleep (with its various light - and deep sleep phases), the sleep disorders and sleep-associated diseases can be assessed quantitatively. As part of this so-called polysomnography (PSG), the following individual physiological functions are measured and recorded with the help of electrodes or sensors:

the brain waves (electroencephalography, EEG)
the eye movements (electrooculography, EOG)
muscle activity (electromyography, EMG)
cardiac activity (electrocardiography, EKG)
the flow of breath and the effort required to breathe
the oxygen saturation
the body position

Sometimes the patient's sleep is also videotaped. Any abnormal behavior during sleep can later be taken into account when evaluating the data.

If sleep-related breathing disorders are suspected as the cause of sleep disorders, a shortened procedure can also be used - the so-called polygraphy for sleep-related breathing disorders: Only oxygen saturation, respiratory flow, breathing effort, heart and pulse rate and body position during sleep are recorded. The results help the doctor identify sleep-related breathing disorders and assess their severity. Appropriate measures can then be taken to alleviate the resulting sleep disorder.

Tags: tcm Diseases travel medicine