Sleep Disorders – Causes of Sleep Problems, Symptoms, and Treatment for Poor Sleep, Sleep Deprivation, and Insomnia

Sleep is one of the essential human needs. Sleep disorders can therefore cause significant distress and lead to secondary problems such as reduced performance and accidents.

However, the many functions of sleep are still only partially understood. In addition to relaxation, it is likely responsible for

• learning and memory,
• the immune system, and
• metabolism

.

Generally speaking, a distinction can be made between sleep disorders caused by

• physical causes
• and those without a physical cause

Sleep disorders without a physical cause

When people regularly have difficulty falling asleep or staying asleep for an extended period of time—without any organic causes—to the point that their well-being and performance are significantly impaired, this is referred to as primary insomnia.

Primary insomnia can usually be treated effectively with behavioral therapy. The goal of this therapy is to reduce factors that disrupt sleep and thereby enable normal sleep. Factors that disrupt sleep can include, for example:

• caffeine and alcohol consumption,
• heavy meals in the evening,
• daytime napping.

Sleep disorders can severely impair daily life © stokkete | AdobeStock

Patients also learn to break the cycle of worrying about their poor sleep and to master relaxation techniques. Medications should only be used in conjunction with psychotherapy.

Primary hypersomnia refers to an increased need for sleep without an organic cause over an extended period of time. Those affected are constantly tired during the day despite a long night’s sleep or repeatedly fall asleep. Like insomnia, it is primarily treated with psychotherapy (improved “sleep hygiene”) and only in individual cases with stimulant medications.

The occurrence of occasional nightmares is relatively normal in childhood. In adults, they are often associated with highly stressful life events or mental health conditions. If they occur frequently, nightmares can be managed through psychotherapy and, if necessary, medication.

The term “pavor nocturnus” (“night terror”) is used when affected individuals sit up in bed or jump up in a panic, without recalling the event afterward. They also cannot be calmed down. Pavor nocturnus often occurs in combination with sleepwalking (somnambulism).

Sleep Disorders with Physical Causes

Poor sleep can also be caused by a variety of organic factors. These primarily include physical illnesses or the use of medications that disrupt sleep or addictive substances.

Conditions that can affect sleep include, for example,

• heart or lung diseases,
• hormonal disorders, 
• dementia,
• polyneuropathies
• and many others.

Many mental health conditions, such as depression, are also often associated with poor sleep.

Medications and substances that disrupt sleep include, for example,

• beta-blockers,
• asthma medications,
• hormone preparations,
• certain antibiotics,
• caffeine,
• nicotine, and
• alcohol.

In what is known as sleep apnea syndrome (SAS), breathing pauses lasting 10 to 60 seconds occur during sleep. Those affected snore loudly and irregularly. Sleep apnea can lead to heart problems.

Risk factors for SAS include

• nasal polyps,
• being overweight, and
• alcohol consumption.

Therapeutic measures such as weight loss and abstinence from alcohol and nicotine are therefore recommended. In severe cases, a special ventilation method (CPAP ventilation) is used.

In narcolepsy, fatigue and sudden sleep attacks occur. Additional symptoms include

• paroxysmal muscle weakness,
• vivid sensory perceptions upon falling asleep, and
• a kind of brief paralysis upon waking.

Restless Legs Syndrome manifests as nocturnal

• diffuse sensations of discomfort,
• pain, and
• a strong urge to move the legs.

It often takes a very long time for it to be recognized as a serious disorder. Restless Legs Syndrome can often be effectively treated with medication.

When dealing with sleep disorders, the type of sleep disorder and the accompanying circumstances must first be accurately assessed. Those affected should document relevant events:

• Sleep times
• Sleep duration
• Daytime sleepiness
• Nighttime rumination
• Daytime sleep
• Time spent in bed
• Evening activities
• Noise and light in the bedroom, etc.

It is also important to document any potential shifts in sleep patterns, such as those caused by shift work. Additionally, drug and medication use, as well as the patient’s overall mental state and internal medical findings, should be considered.

To obtain a detailed picture, it is often recommended that the patient keep a sleep diary to record their sleep times. Often, no cause can be identified after the initial examination. In such cases, an evaluation in a sleep laboratory should be conducted to identify other causes of the sleep disorder.

The primary treatment for sleep disorders without a physical cause is cognitive behavioral therapy. This can be effectively conducted as a short group program. During the program, participants receive information about normal sleep and healthy sleep habits (“sleep hygiene”) and learn relaxation techniques.

Sleep hygiene includes, for example,

• regular nightly sleep periods of no more than 8 hours,
• avoiding daytime naps and falling asleep in front of the TV,
• avoiding caffeine, alcohol, and heavy meals after 4 p.m., and
• regular exercise during the day.

Patients

• should only go to bed when they feel very tired,
• should not look at the clock at night, and
• should not lie in bed brooding if they find themselves awake for a long time at night, but should instead get up and read or do something similar.

Medications should be prescribed only in exceptional cases. Herbal remedies such as valerian or hop tea should be the first line of treatment. In rare cases, the use of other psychotropic medications may be appropriate. For sleep disorders with physical causes, there are specific medications and other therapeutic approaches.

Many people with sleep disorders suffer from chronic fatigue, difficulty concentrating, and a significant reduction in their quality of life. Anyone who sleeps poorly or has trouble falling asleep or staying asleep should have the causes of their sleep disorder investigated early on.

There are different types of sleep disorders, which can have both psychological and physical causes. Chronic sleep disorders are often caused by stress, sleep-related breathing disorders, physical illnesses, or the use of medications. Restless sleep and a lack of sufficient sleep can also have long-term health consequences.

The German Society for Sleep Research and the Society for Sleep Research and Sleep Medicine recommend targeted diagnosis and treatment of sleep disorders to help patients regain restful sleep. The basis for this includes, among other things, the S3 guideline on non-restorative sleep. An examination in a sleep laboratory may be particularly useful if sleep apnea or other sleep-related breathing disorders are suspected. Cognitive behavioral therapy for insomnia is now considered particularly effective in promoting better sleep and a normal sleep rhythm.

Since sleep disorders can lead to reduced performance and health, those affected should take the many causes seriously and seek treatment early on.