Sleep disorders: list, consequences, who to consult?

We speak of sleep disorders when we can’t sleep well. These disorders include insomnia (lack of sleep) and hypersomnia (excess sleep). What are the causes of a sleep disorder ? Suggestive symptoms according to the type of disorder? How is a sleep disorder diagnosed? What are treatments ? natural or not ? When and who to consult? Answers from Dr Nicolas Vitello, neurologist and sleep doctor at the Polyclinic la Pergola in Vichy (Elsan Establishment).

Definition: what is a sleep disorder?

A person is said to have a sleep disorder when they complain ofhave bad sleep : in other words, of not getting enough sleepof sleep too much or of restless sleep. Sleep disorders cover a very wide range. In all there would be 85 different sleep disorders according to’American Academy of Sleep Medicine. “We can all be subject to a sleep disorder during our lifetime. But it becomes problematic when these disorders settle, multiply, and become chronic. Please note that a sleep disorder does not mean not necessarily a pathological disorder. If you are told bad news, for example, you will sleep poorly and therefore you do not have an illness. In this context, the poor quality of sleep will be justified by a psychological reason. To define a sleep disorder, it must be chronic (or appear suddenly), have an impact on quality of life and have an impact during the day.“describes our specialist.

Falling asleep is long beyond 30 minutes, and pathological beyond an hour.

What are the different types of sleep disorders?

There are two main families of sleep disorders:

► Insomnia which result in a lack of sleep, among which we find several types of insomnia:

• Sleep onset insomnia
• Poor perception of sleep
• Chronic insomnia
• Early awakening insomnia
• Insomnia from poor sleep quality
• Idiopathic insomnia…

► hypersomnia which result in a excessive increase in sleep timeamong which there are several types of disorders:

• Narcolepsy (or narcolepsy-cataplexy)
• Idiopathic hypersomnia
• Kleine-Levin syndrome…

There are other pathologies that cause sleep disorders such as: restless leg syndrome, obstructive sleep apnea syndrome (Sleep Apnea), circadian rhythm disorders… These are not sleep disorders strictly speaking, but causes of sleep disorders.

What are the symptoms of a sleep disorder?

► Symptoms of insomnia:

• Difficulties falling asleep
• Waking up during the night or waking too early associated with difficulty falling back to sleep
• A repercussion during the day: fatigue or lack of energy, drowsiness, attention disorder, concentration disorder, change in mood, irritability…

► Symptoms of hypersomnia:

• Daily excessive daytime sleepiness
• Irrepressible bouts of sleep
• Great difficulty waking up in the morning (called “sleep drunkenness“)
• Automatic behaviors
• Spatio-temporal disorientation behaviors
• Sometimes sleep paralysis
• Hallucinations,
• Disturbance of attention and concentration during the day (slow thought and speech)

What are the causes of a sleep disorder?

► Occasional or acute insomnia (which only lasts a few nights) is often linked to an environment that is not conducive to sleep (too much noise, too much light, it is too hot, too cold, the bedding is of poor quality, etc.), to a stressful event , coffee absorption… As soon as the root cause of the disorder disappears, the insomnia ceases. Its consequences are not significant, since one is generally able to quickly recover a normal sleep.

► chronic insomnia (which occurs at least 3 times a week for at least 3 months) can be caused by:

• A disease: hyperthyroidism, gastroesophageal reflux disease (GERD), nocturnal asthma, rheumatism, depression…
• restless leg syndrome
• sleep apnea
• A circadian rhythm disorder…

► Hypersomnia (manifested by excessive need for sleep) can be caused by:

• a lack of secretion of hypocretin (neurotransmitter produced at the level of the hypothalamus) in the case of narcolepsy-cataplexy
• poor functioning of certain wakefulness systems, with a genetic predisposition in the case of idiopathic hypersomnia
• In the case of Kleine-Levin syndrome: the cause is still unknown.

What are the consequences of a sleep disorder?

“In the long term, sleep disorders have very deleterious consequences on daily life (fatigue, lack of energy, drowsiness during the day, attention disorders, irritability, etc.) and increase the risk of comorbidities (psychiatric and cardiovascular diseases, etc.)“, warns the sleep doctor.

Who to consult in case of sleep disorders?

“From the moment the sleep disturbance is disabling in daily life, a person must consult. First, she can talk to his attending physician who can refer him if necessary to a specialist, such as a sleep doctor who will be able to determine the cause of the disorder and set up appropriate care“, says Dr. Vitello.

To diagnose a sleep disorder, the doctor must ensure that the evolution of sleep is abnormal. “We ask the patient about sleep, but also about lifestyle, work, medical history, diet, sport, lifestyle to be able to take into account the environment as a whole and sort it out. among all the possible causes of a sleep disorder“, specifies our interlocutor. Then, sleep tests can be performed in a sleep laboratory (public or private). There are several types depending on the information sought: the polysomnography (the reference test), nocturnal oximetry, the wakefulness test… Note that there are centers and units specializing in sleep disorders in all regions of France.

→ See the list of approved sleep centers by the French Society for Sleep Research and Medicine

What are the treatments (drugs or natural) for a sleep disorder?

Once the problem is targeted, the underlying cause of insomnia must be treated. “We have solutions, which are medicinal or not, to treat sleep disorders“, indicates the professional. Depending on the cause, we will be able to offer the patient an appropriate solution:

Our sleep time is cut off and it is considered a waste of time. However, sleep repairs physically and allows cognitive recovery.

► Solutions to treat insomnia:

• The support by cognitive behavioral therapy (CBT)) in case of chronic insomnia, to regain good sleep hygiene.
• The support by thehypnosis, acupuncture, sophrology or yoga…
• The drug treatment by the sleeping pills which can be a transitional aid if taken appropriately and over a short period of time. However, “The solution is rarely to take sleeping pills. Ultimately, the sleeping pill is not effective on insomnia and can lead to other disorders, such as concentration disorders, or drowsiness or falls during the day“, warns the specialist.
• If the insomnia is caused by sleep apnea, one can resort to respirators or mandibular advancement devices.

► Solutions to treat hypersomnia:

• The use of “awakening” treatments to artificially keep the person awake (for example, modafinil or methylphenidate)
• The use of treatments for attacks of cataplexy, hallucinations during sleep, sleep paralysis (if narcolepsy is associated with other symptoms), such as certain antidepressants or gamma-hydroxybutyrate, or drugs that promote continuity of sleep.

“On lives in a society where you have to move quickly, with a lot of stress. Consequence: our sleep time is reduced and it is considered a waste of time. However, sleep repairs physically and allows cognitive recovery. We really need let us listen to our fatigue and make time for quality sleep. you have to observe the first signs of fatigue and know how to interpret them. Healthy living is essential: do not expose yourself to screens in the evening, light dinner, do not consume stimulants (coffee, tea, alcohol, tobacco, etc.) before sleeping, practice regular physical activity, respect feeding patterns…“, concludes Dr. Vitello. We generally advise to stop exposing yourself on the screens one to two hours before falling asleep.

Thanks to Dr Nicolas Vitello, neurologist and sleep doctor at the Polyclinic la Pergola in Vichy (Establishment Elsan)