What are sleep-wake disorders?
Sleep-wake disorders do not only affect the duration of sleep. Sleep can also be disturbed if the sleep cycles or sleep stages deviate from normal sleep or if the daytime state of the person affected is restricted. This means that sleep is either too short or too long, is interrupted too often or is not restful, or that wakefulness is impaired.
The ICSD-3 (International Classification of Sleep Disorders, 3rd version) divides sleep-wake disorders into the following groups:
- Insomnia: This is the term we use to describe problems falling asleep and sleeping through the night. A sleep onset disorder is when you have difficulty falling asleep. If you have difficulty sleeping through the night, you wake up frequently and cannot fall asleep again for a long time. Waking up too early in the morning also belongs in this group. Insomnia is the most common form of sleep-wake disorder.
- Hypersomnia: These are characterized by the occurrence of excessive daytime sleepiness. In the case of excessive daytime sleepiness, those affected suffer from an increased urge to sleep and extreme sleepiness during the day despite sufficient sleep duration and sometimes feel the need to sleep for more than ten to eleven hours a day. Narcolepsy is an important hypersomnia disorder.
- Sleep-related breathing disorders: During sleep, breathing is unconsciously controlled by the autonomic nervous system. In the case of a sleep-related breathing disorder, for example, breathing stops for short periods, as is the case with obstructive or central sleep apnea syndrome.
- Sleep-related movement disorders: Movement disorders can also disturb sleep. Restless legs syndrome (RLS, “restless legs”) is one of the most common sleep-related movement disorders.
- Parasomnias: This refers to behavioral abnormalities at the transition between sleep and wakefulness. Sleep is interrupted by sudden processes or events such as sleepwalking or fearful awakenings.
- Circadian sleep-wake disorders: The circadian rhythm comprises approximately 24 hours. The natural sleep-wake rhythm is influenced by the alternation of light and dark during the day and night. In the case of a circadian rhythm disorder, the daily cycle and therefore the sleep phase shifts forward or backward, or if the individual rhythm is significantly longer than 24 hours, sleep times shift backward from day to day. As a result, individual sleeping and waking times get mixed up, for example due to a time difference (jet lag) or shift work.
Sleep-wake disorders – frequency and age
Sleep-wake disorders are among the most common health complaints.
Sleep-wake disorders: Causes and risk factors
The causes of sleep-wake disorders can vary greatly, depending on their form. Sometimes there are several causes at the same time. In general, these can be divided into two groups:
- External influences: These include, for example, noise, bright light, heat and cold, but also substances such as coffee, alcohol, nicotine, medication or drugs. Poor sleep hygiene or irregular sleeping times due to shift work or jet lag as a result of long-haul flights with time differences can also play a role. Stress often makes it difficult for people to fall asleep or sleep through the night.
- Internal influences: Mental illnesses such as depression and anxiety disorders as well as symptoms resulting from organic illnesses such as hormonal disorders, cardiovascular diseases or cancer can have a lasting effect on sleep. Occasionally, defined deficits in the central nervous system such as the destruction of certain cells (e.g. hypocretin in narcolepsy) are the cause.
It is not always possible to identify the actual cause of the sleep disorder. This is the case with idiopathic insomnia, for example. This has often existed since childhood without any recognizable cause.
Symptoms: Sleep-wake disturbances
Sleep-wake disorders can – depending on the type and form of the disorder – lead to various complaints. Chronic sleep-wake disorders are characterized by the fact that the affected person sleeps poorly several times a week over a longer period of time. This is noticeable, for example, through tiredness and fatigue. If your body lacks sleep or the quality of your sleep is poor, this can also be reflected in
- Poor concentration and performance,
- Nervousness and irritability,
- Muscle tension,
- Mood swings,
- depressive mood,
- Headaches, neck pain and toothache or a
- Increased sensitivity to pain
become noticeable.
A sleep-wake disorder often goes unnoticed by the person affected. However, relatives or partners notice frequent movements of the person next to them in bed, screams, startling, breathing disturbances or interruptions and sleepwalking.
Sleep-wake disorders: Diagnosis with us
Since sleep-wake disorders can have different or multiple causes, some of which go back a long way, the diagnosis often has to be very comprehensive. In order to obtain as accurate a picture as possible of the symptoms, various diagnostic procedures are generally used for sleep-wake disorders.
In order to make an exact diagnosis, we will ask you about your medical history and rule out possible illnesses as the cause (medical history). It is also important for us to know whether you are taking medication that disrupts your sleep or consume large amounts of caffeine or alcohol.
Sleep diary and sleep questionnaire
A sleep diary or sleep questionnaire provides important information about the diagnosis. In it, you document your sleep behavior, for example in the form of
- Bedtime and sleeping times,
- consciously perceived waking phases,
- Your subjective perception of sleep,
- your life situation and
- certain occurrences and abnormalities such as sleepwalking or teeth grinding.
We can measure the subjective perception of daytime sleepiness using the “Epworth Sleepiness Scale” (ESS). The “Pittsburgh Sleep Quality Index” (PSQI) is used to determine objective sleep quality. Other questionnaires are used depending on the situation.
Sleep-wake disorders: Examination in the sleep laboratory
An important diagnostic option is a nocturnal examination in the sleep laboratory, also known as polysomnography (PSG) in medical jargon. To do this, you or those affected spend a night in the sleep laboratory. This serves to get to the bottom of the sleep disorder. We can also monitor the progress of treatment in the sleep laboratory and adjust it if necessary.
Polysomnography makes it possible to record the exact sleep structure and consists of several examinations:
- Breathing control
- Electroencephalogram (EEG)
- Electrocardiogram (ECG, heart function)
- Electromyogram (EMG, muscle activity on legs and chin)
- Electrooculogram (EOG, eye movements)
- Position of the body
- Oxygen content in the blood
Sleep-wake disorders: additional examinations
Before PSG, we generally carry out an actigraphic examination over a period of 2 weeks. This examination, which is embedded in everyday life, uses a sensor on the wrist to record data that provides information about your sleep-wake rhythm, sleeping habits or daytime sleep phases. It can also be used to monitor the success of the therapy.
After PSG, we carry out daytime tests on hypersomnia and other patients to measure daytime sleepiness (e.g. multiple sleep latency test) or to determine the ability to stay awake in non-stimulating situations (e.g. multiple wakefulness test).
Sleep-wake disorders: Prevention, early detection, prognosis
If sleep-wake disturbances are a side effect or consequence of another illness, you should have this treated first. This often improves the sleep-wake disturbances or eliminates them completely.
In many cases, you can avoid sleep-wake disturbances simply by adopting the right behavior in everyday life. Simple measures such as avoiding caffeine, nicotine and alcohol as well as regular bedtimes are important in this context. These and other important rules on sleep hygiene can be found under the menu item Treatment.
Progression and prognosis of sleep-wake disorders
In the long term, poor sleep can damage your health. In addition to reduced physical and mental performance, a lack of sleep increases the risk of numerous illnesses such as depression, obesity and diabetes. Less growth-promoting hormones are produced, which we need for cell renewal and which keep us fit and healthy. Studies also show that people who regularly sleep less than five hours a night are more likely to suffer from cardiovascular disease and even have a lower life expectancy. Recent literature also indicates that poor sleep can promote neurodegenerative diseases such as Alzheimer’s or Parkinson’s disease.
It is therefore important to do something about sleep-wake disturbances in good time. The same applies to complaints that make it difficult for you to fall asleep or stay asleep, such asrestless legs(restless legs syndrome) or if you snore. You should also pay attention if you suffer from constant tiredness and exhaustion despite getting enough sleep. This can be a sign of sleep apnea syndrome, which causes breathing to stop at night and is associated with an increased risk of heart attack and stroke.
Sleep-wake disorders: Treatment
If you experience sleep-wake disturbances over a longer period of time, you should consult a doctor because of the possible negative consequences for your health.
It is therefore important for the therapy to find out the exact causes and – if possible – to eliminate them.
- Sleep apnea: treatment with a breathing mask
- Sleep-wake disorders: Rules for sleep hygiene
- Sleep-wake disorders: Tips for relaxation
- Sleep-wake disorders: Rituals for children
- Restless legs syndrome
