Somnology: diseases — симптомы, диагностика и лечение

Obstructive sleep apnea syndrome is a recurrent cessation of breathing during sleep due to collapse of the pharyngeal walls. The airways are blocked, air stops flowing, the level of oxygen in the blood drops, and the brain is forced to pull the person out of deep sleep for a few seconds in order to restore muscle tone. Such episodes can be repeated dozens or even hundreds of times a night, and the person does not remember about them: in the morning he simply feels exhausted, as if he had not slept at all. The key thing to understand is that regular snoring and apnea are different things, and the first person to notice the problem is almost always not the patient himself, but the one who sleeps next to him. Untreated apnea isn't just poor sleep: it means pill-resistant hypertension, arrhythmias, an increased risk of heart attack and stroke, and a real risk of falling asleep while driving.

Narcolepsy is a chronic neurological disease in which the brain loses the ability to clearly separate sleep and wakefulness. The main symptom is irresistible daytime sleepiness: a person falls asleep for a few minutes in the most inappropriate situations, and then briefly feels alert. Some patients experience cataplexy - a sudden loss of muscle tone against the background of strong emotions, often laughter, with completely preserved consciousness. The cause of the first type of disease is considered to be the death of neurons that produce orexin, a substance that maintains wakefulness. Narcolepsy is not associated with laziness or lack of sleep, it cannot be overcome by will, but modern treatment allows you to return to work.

Constant drowsiness is a condition in which a person tends to fall asleep during the day, despite a seemingly sufficient duration of night rest. This is not the same as fatigue: with drowsiness, a person actually falls asleep in a quiet environment, in transport, at a meeting, and sometimes while driving, which makes the problem dangerous. Most often, the reason is the quantity or quality of sleep: chronic lack of sleep, night awakenings, obstructive apnea syndrome with snoring and breathing pauses. Another large group of causes are physical: iron deficiency, decreased thyroid function, diabetes, depression, side effects of medications. A targeted examination helps to figure it out.

Restless legs syndrome is a neurological disorder in which at rest, especially in the evening and at night, unpleasant sensations appear in the legs and an irresistible urge to move them. People describe them as “twisting”, “whining”, “pulling”, “ant crawling”. Movement brings relief, but as soon as you lie down, the sensations return, making it difficult to fall asleep. It is based on disturbances in the metabolism of dopamine and iron in the brain. The syndrome can be hereditary, and also occurs with iron deficiency, pregnancy, chronic kidney disease, nerve damage and against the background of certain medications. It is not life-threatening, but chronic sleep deprivation reduces quality of life. Testing ferritin and changing habits often significantly improves symptoms.

Somnambulism, or sleepwalking, is a disorder of awakening from deep slow-wave sleep, when the brain partially wakes up and turns on motor programs, but the consciousness remains asleep. A person sits up in bed, gets up, walks around the room, can open doors and rearrange things, but his eyes are blank, his speech is incoherent, and it is difficult to wake him up. The episode lasts from a few seconds to several minutes and is almost always forgotten. Most often, sleepwalking occurs in children 4–12 years old and goes away on its own with age. The main danger is not the disorder itself, but the trauma during the episode, so the main focus is on the safety of the bedroom.

Snoring is a sound that occurs during sleep when the soft tissues of the pharynx vibrate: the soft palate, uvula, walls of the pharynx and the root of the tongue. During sleep, the muscles relax, the airway narrows, and the air passes through with turbulence. Snoring is very common, especially in men, overweight people and after drinking alcohol. Simple snoring itself is harmless to the health of the snorer, but it interferes with the sleep of others. Snoring is dangerous, which is accompanied by pauses in breathing, loud snoring and daytime sleepiness: these are signs of obstructive sleep apnea, which increases the risk of hypertension, arrhythmias, stroke and driving accidents. In children, regular snoring is most often associated with adenoids and tonsils and also requires examination.

Snoring in a child is a sound that occurs when air has difficulty passing through the narrowed airways and causes vibration of the soft tissues of the throat. Occasional snoring with a runny nose during a cold is normal and goes away with it. Constant snoring should be alarming: most often its cause is enlarged adenoids and palatine tonsils. It is not the sound itself that is dangerous, but the pauses in breathing associated with it during sleep. With apnea, the child’s brain regularly lacks oxygen, sleep becomes disrupted, and behavior, attention, and growth suffer. Therefore, a child who snores almost every night needs to be seen by an ENT doctor.

Insomnia is not just “I don’t sleep well,” but a condition in which sleep disturbance occurs at least three nights a week and affects daytime well-being. Its main feature is that over time it breaks away from the original cause and begins to support itself: a person is afraid of not falling asleep, goes to bed with anxiety, and it is this anxiety that prevents sleep. Therefore, sleeping pills, which seem like an obvious solution, work the worst for chronic insomnia - but the first choice is considered to be something completely different.