Sleep disorders: narcolepsy, parasomnias
Anyone who suffers from narcolepsy has regular sleep attacks during the day. Parasomnias are nocturnal actions of the sleeping person, such as sleepwalking, teeth grinding, bedwetting
Narcolepsy – Sleepiness
Narcolepsy is a pronounced form of hypersomnia. Here the sufferer torments an excessive need for sleep during the day, without first having apparent sleep disturbances. The chronic disease often begins at adolescence.
The cause is not yet known. In addition to a hereditary system, an autoimmune disorder may play a role. Misdirected bodily defensive activities could lead to an imbalance between the neurotransmitters in the brain that regulate the sleep-wake cycle. Research has shown that in people with narcolepsy, REM sleep begins immediately after falling asleep, without previous light and deep sleep stages (see chapter “Why sleep is so important” ).
In REM sleep, muscles usually relax . Narcolepsy sufferers also do this during the daytime when awake. Doctors speak of cataplexies. The social consequences of the disease are often significant.
Symptoms : Narcolepsy usually shows in the beginning in heavy daytime sleepiness , which occurs even after sufficient night sleep. Over time, however, is disturbed by the frequent sleep during the day and the night’s sleep. It comes at night to sleep-through and on the day to regular sleep attacks. The affected people inadvertently nod in often completely inappropriate, indeed sometimes highly dangerous situations, at work, in social groups with friends, while driving.
Another major symptom of narcolepsy is cataplexy, the sudden slackening of the support and support muscles. Those affected then get weak knees, collapse, drop objects and fall easily. These “paroxysms” often happen when feelings are involved, in pleasure, anger, stress .
! Unlike, for example, a fainting spell, those affected are conscious.
Other common symptoms include being half asleep, unconsciously performing further actions, paralysis even at night, and regular muscle twitching in the legs. In many cases, those affected also experience daydreams or illusions when falling asleep or waking up.
Diagnosis : The disease is often recognized late. People suffering from narcolepsy often have numerous visits to the doctor’s office with a variety of diagnoses. Sometimes ten years or more pass until the disease is properly diagnosed. And that, although the symptoms, except in the initial stages, are very striking.
The medical history and possibly records from sleep diaries often provide important clues. With appropriate physical examinations, the doctor excludes possible organ diseases. Most of the time, a digestion brings a stay in a sleep medicine center. In the sleep laboratory, the course of night sleep is recorded (polysomnography). Here are the premature REM sleep phases. The degree of daytime sleepiness can be measured by a multiple sleep latency test (MSLT).
Therapy : The condition is not completely curable, but there are treatment options that help those affected to get a better grip on the symptoms. As a rule, a sleep specialist assembles the treatment path individually for his patient. Often, a combination of medications is indicated. These are, depending on the prevailing symptoms, for example, stimulating agents (stimulants) that work against the daytime tiredness. The doctors use them but only under control and timed, otherwise a habituation effect occurs.
There are also strict dose requirements for sodium oxybate (gamma-hydroxybutyric acid), which is approved for the treatment of narcolepsy. In addition, antidepressants can once act against the cataplexy, but also be useful in hallucinations or sleep paralysis. Careful technical diagnosis offered!
Helpful are behavioral measures that regulate sleep during the day, such as short naps in between on a fixed schedule. Narcolepsy patients often manage to stay awake for a few hours at a time.
Basic support is a healthy lifestyle, with sports , no or little alcohol and sound sleep hygiene. Families, friends and employers should be aware of the condition so they do not misinterpret the person’s behavior.
Parasomnia – disturbances during sleep
The term parasomnia is used by physicians to summarize disturbing events that happen to the sleeping person or in which he himself is actively involved. During sleep, unadapted impulses of the nerves control the movement system or involuntary bodily processes. As a rule, the person does not wake up, his sleep is sometimes impaired, but not always. Often, the symptoms are harmless, but in some, such as sleepwalking and nocturnal states of fright, those affected may endanger themselves or others.
Children and adolescents have more to do with parasomnias than adults. But these too can suffer greatly. There are waking up disturbances from the deep sleep as well as actions, which take place in the REM sleep or are connected with falling asleep. Abuse of medication , stress, mental and some physical illnesses can cause parasomnia as symptoms.
Nightmares , sleep paralysis : These recovery disorders arise from REM sleep. They can, for example, happen after a vivid dream and scare the person affected.
Sometimes, the sleeper also accompanies his dreams with unconscious actions, in which he can harm himself and others. REM sleep behavior disorders occur more frequently from the age of 60 years.
The most important nocturnal incidents include:
Sleepwalking : Here is a waking up disturbance from deep sleep. The sleeping person only wakes up in part and performs actions without becoming aware of them. He can then straighten up in bed, leave it and walk around. Most sleepwalkers lie down after a short time and go to sleep.
Some, however, are highly active, discarding items in the apartment, leaving the house. In the morning they can not remember their nocturnal actions. Some people also have binge eating during sleepwalking. They keep getting up to eat something, sometimes so much that they put on a lot of weight .
Sleep drunkenness and nocturnal panic states (Pavor nocturnus) : Frequently, children suffer from sleep drunkenness. They seem to wake up suddenly, screaming and moving violently. In this phase, sleeping drunks can not be soothed. After a while, they calm down and go back to sleep.
The waking up disturbance of Pavor nocturnus is more threatening. Those who experience such a nocturnal state of anxiety often startle with a piercing cry from their sleep and display the symptoms of a panic attack, such as dilated pupils, fear-distorted faces, palpitations, sweating . Some also beat themselves in this condition, get up, walk around and endanger not only themselves, but also the bed partner. They do not know anything about their experiences in the morning.
Nocturnal enuresis : Mostly, this form of sleep disturbance settles with puberty. Therefore, it is important that especially the parents do not make too much fuss about it, if your child soaks at night. Corresponding mattress pads, a relaxed atmosphere and possibly psychotherapeutic support help to better deal with the problem. In adults, physical or mental illness can lead to unwanted nocturnal urination.
Nocturnal teeth grinding (bruxism) : Many people who are under intense mental stress and strain literally bite their “teeth on each other” during their sleep. They grind and rub, “grating” with their teeth, often so violently that damage to the enamel develops. Stress reduction as well as bite splints adapted by the dentist can successfully counteract this. Read more in the article “Teeth grinding at night”.
Other parasomnias include rhythmic head batting and other smooth movements involving a part of the body or the whole body, twitching, hallucinations at the onset of sleep.
Diagnosis of parasomnias :
Since those affected usually have no memory of their nocturnal actions, the reports of the family or the partner give the doctor important information. The doctor will interview the person concerned in order to get an idea of possible psychological stress and medication income. He also examines him thoroughly to determine any unknown physical illness.
For nocturnal events that have no relation to a clinical picture, sometimes the clarification in a sleep laboratory is possible, especially if it is pronounced, possibly dangerous actions. There, the doctors also rule out neurological examinations epileptic diseases.
Therapy of parasomnias :
Many parasomnias are harmless and have no consequences for the daily form. They usually do not need to be treated. It has a positive influence on the disorders, if the affected persons avoid or reduce particular stress and stress and observe a regular sleep-wake rhythm.
In wake-up disorders such as sleepwalking, the most important treatment usually involves protective measures that protect the sleepwalker and, where appropriate, its surroundings. At night, attached to the body so-called biofeedback devices can arouse particularly violent actors from sleep, so as to prevent dangerous acts. In certain potentially violent restlessness and movement disorders from REM sleep, doctors may use melatonin or clonazepam (a seizure medication from the benzodiazepine group) after careful diagnosis.
Sometimes help with drugs such as certain antidepressants and psychotherapeutic therapies, such as in sleep panic, pronounced nightmares or enuresis. With orthodontic measures such as bite splints, nocturnal teeth grinding can be avoided.