The following article discusses sleep disorders. If you have disturbing symptoms, it is worth using an online medical consultation with an e-prescription. You will be sure that the correct course of treatment will be chosen.
It is commonly accepted that sleep is a cure for all ailments, during which the whole body regenerates, in particular your brain repairs damage, gets rid of unnecessary toxins that can cause Parkinson’s and Alzheimer’s diseases, and the immune system works with the greatest efficiency .
Moreover, the synthesis and secretion of some hormones, such as melatonin and prolactin, occurs mainly in the night phase [1]. Therefore, we should spend almost 1/3 of our time on sleep during our lives.
Abnormal sleep is a problem that affects a wide group of society regardless of age. It is estimated that as much as 15-25% of the elderly report serious problems with falling asleep or staying asleep [2]. This has serious consequences for the functioning of our body. Insomnia, which we focus on in this article, is classified as a civilization disease.
Dyssomnias (sleep disorders) come in different forms:
- Insomnia (insomnia)
- Excessive sleepiness (hypersomnia)
- Disturbances in the rhythm of sleep and wakefulness
- Parasomnia (night anxiety, nightmares)
The genesis of the emergence of such a problem that affects many people can have many causes. The most frequently mentioned are: chronic pain syndromes or mental disorders, such as depression, in which 80% is accompanied by insomnia. It is predicted that it is not mood disorders but sleep problems that are the main cause of depression [4]. The etiology of insomnia also includes genetic predisposition, rapid mood swings, stress, and life events.
An important aspect that specialists should pay attention to when looking for the underlying cause of sleep disorders is the type of pharmacotherapy used by patients. There are classes of drugs that disrupt the circadian rhythm of sleep and wake. for example oral contraceptives, antidepressants, glucocorticosteroids and psychoactive substances: alcohol, caffeine, nicotine, theophylline.
When starting treatment, you should first seek herbal substances: lemon balm, valerian or antihistamines, e.g. doxylamine.
The only drugs registered in Poland for the treatment of insomnia are zopiclone, zolpidem, zaleplon. Therapy with them should be discontinued and last as short as possible, because long-term use carries a high risk of addiction and the development of a tolerance effect, which may translate into their ineffectiveness. Therefore, they are NOT recommended in the de novo initiation of sleep disorder treatment! (in intermittent therapy, the longest to use these drugs for 3 consecutive nights and no more than 15 tablets per month) – for example, the patient can be advised not to take the drug on weekends and additionally to skip the dose in the middle of the week.
If, however, long-term treatment of sleep disorders is necessary (over 4 weeks), there are other effective sleep-promoting drugs that do not carry the risk of addiction and develop high drug tolerance, as in the case of drugs from the “z” group, where there is a high the risk of the patient using increasingly higher doses of the drug and the lack of cooperation between the doctor and the patient.
It is worth repeating at this point: Drugs from the “z” group are: zaleplon, zolpidem, zopiclone (popular trade names such as: nasen, zolpic, onirex, zolpigen, zolsana, stilnox, polsen, apo-zolpin) – their long-term use is DAMAGED and carries with it serious, negative consequences for patients!
Other drugs used in Poland in the treatment of sleep disorders, including:
Trazodone CR, chlorprothixene, quetiapine, levomepromazine, olanzapine, promethazine, promazine, hydroxyzine, doxepin, mianserin, mirtazapine
A very important aspect in the treatment of insomnia is the recognition of factors that may aggravate insomnia, such as: stress, age, illness, poor sleep hygiene, increased mental tension, fear of sleep disorders, mental exhaustion, increased time spent in bed, saving yourself. , sleeping. According to Spielman’s cognitive-behavioral model of the genesis of insomnia [Spielman et al., 1987], such factors may be of key importance in establishing the problem of insomnia in a patient, hence the cognitive-behavioral therapy of insomnia (CBT) plays a significant role in the treatment of sleep disorders. as a result, it can break the vicious cycle that perpetuates insomnia.
Sleep disorders affecting people over 65 are about 1/3 of the group of patients struggling with the problem of insomnia. It is associated with a decrease in the number of neurons and a significant shortening of deep sleep. In menopausal women there is an increased secretion of follicle-stimulating and luteotropic hormones and a decrease in progesterone and estrogen secretion, which may result in difficulty falling asleep or poor sleep quality, and very often mood swings.
Patients complain of low quality of life [3]. Patients with diagnosed insomnia show symptoms related to a decrease in well-being, cognitive impairment, difficulties in daily functioning or somatic symptoms.
To sum up, sleep pathology should not be underestimated, as it is essential for proper general health. Inadequate its length may have serious negative health effects, therefore – sleep disorders should be lurk in doctor’s offices, under the watchful eye of specialists.
It is also a good idea to take advantage of an online medical consultation, during which the doctor will advise you on what medications should be used in your case.
mgr farm. Natalia Małachowska, MD med. Marcin Łata
Bibliography:
[1] Sassin J.F., Frantz A.G., Weitzman E.D., Kapen S.: Human prolactin: 24-hour pattern with increased release during sleep. Science 1972;177(4055):1205–1207)
[2] Mutschler, Farmakologia i toksykologia Podręcznik Geisslinger Gerd, Kroemer Heyo K, Mutschler Ernst
[3] Mayers AG, van Hooff JC, Baldwin DS. Quantifying subjective assessment of sleep and lifequality in antidepressant treated patients. Hum. Psychopharmacol. 2003; 18: 21–27.
[4] Goodwin FK, Jamison KR. Manic-depressive illness. Oxford, England: Oxford University Press;1990
[5] Jarema M., Psychiatria Podręcznik dla studentów medycyny;2017
