Sleep disorders

Sleep disorders are conditions in which there is a disruption in the quantity, quality, structure, or rhythm of sleep, leading to impaired daytime functioning. From a medical perspective, sleep is a complex neurophysiological process regulated by the brainstem reticular system, hypothalamus, and circadian rhythms controlled by the suprachiasmatic nucleus.

Key clinical features of sleep disorders include:

• difficulty falling asleep (prolonged sleep latency),
• frequent nocturnal awakenings or early morning waking,
• unrefreshing sleep,
• excessive daytime sleepiness,
• behavioral disturbances during sleep.

Sleep disorders can be:

• primary – independent of other diseases,
• secondary – symptomatic of somatic, neurological, psychiatric, or endocrine disorders.

It is important to emphasize that short-term sleep problems (e.g., in stressful situations) are not equivalent to a disorder. We speak of sleep disorders when symptoms persist for at least several weeks and affect daily functioning.

The classification of sleep disorders is based on international diagnostic criteria (ICSD-3) and includes several main groups.
 

Insomnia

• difficulty falling asleep,
• difficulty maintaining sleep,
• early morning awakening,
• poor quality sleep.

Sleep-related breathing disorders

• obstructive sleep apnea,
• central sleep apnea,
• hypoventilation syndrome.

Circadian rhythm sleep disorders

• delayed sleep phase,
• advanced sleep phase,
• irregular sleep-wake rhythm,
• shift work sleep disorder.

Parasomnias

• somnambulism (sleepwalking),
• nightmares,
• night terrors,
• REM sleep behavior disorder.

Sleep-related movement disorders

• restless legs syndrome,
• periodic limb movement disorder during sleep.

Excessive daytime sleepiness

• narcolepsy,
• idiopathic hypersomnia.

Each of these groups is characterized by a different pathophysiological mechanism and requires a different diagnostic and therapeutic approach.

The causes of sleep disorders are multifactorial and often coexist, making it difficult to diagnose them definitively. In clinical practice, it is crucial to distinguish between primary and secondary factors.
 

1. Psychological and neurological factors

• chronic stress and emotional overload,
• anxiety and depressive disorders,
• neurodegenerative diseases,
• central nervous system injuries.

2. Somatic diseases

• heart and circulatory system diseases,
• chronic lung diseases,
• gastrointestinal diseases (e.g., reflux),
• chronic pain.

3. Hormonal and metabolic disorders

• hypothyroidism and hyperthyroidism,
• insulin resistance and diabetes,
• disorders in melatonin and cortisol secretion,
• menopause and andropause.

4. Environmental factors and lifestyle

• irregular sleep hours,
• exposure to blue light in the evening,
• abuse of caffeine, alcohol, and nicotine,
• lack of physical activity or excessive activity in the evening hours.

5. Medications and substances

• stimulant medications and some antidepressants,
• glucocorticosteroids,
• medications affecting the central nervous system.

For many patients, sleep disorders are the result of a vicious cycle: lack of sleep exacerbates stress and hormonal disorders, further worsening sleep quality.

The treatment of sleep disorders should be conducted depending on their nature, severity, and cause. Proper diagnosis is crucial and often requires the collaboration of several specialists.
 

• General practitioner clinics – initial assessment, basic diagnostics, qualification for further treatment.
• Neurological clinics – diagnosis of neurological disorders and parasomnias.
• Psychiatric clinics – in cases of coexisting mood disorders, anxiety, and psychogenic insomnia.
• Endocrinological clinics – assessment of hormonal disorders affecting sleep.
• Specialist sleep disorder clinics – comprehensive diagnostics, including polysomnographic studies.
• Sleep medicine centers – treatment of obstructive sleep apnea and sleep-related breathing disorders.

Collaboration with a psychologist or psychotherapist is also an important element, especially in cases of chronic insomnia.

Treatment of sleep disorders should be causal, not merely symptomatic. Simply using sleeping pills without identifying the source of the problem is a short-term solution and carries the risk of side effects.
 

1. Non-pharmacological interventions

• education on sleep hygiene,
• regular circadian rhythm,
• limiting evening exposure to light,
• cognitive-behavioral therapy for insomnia (CBT-I),
• relaxation techniques and stress reduction.

2. Pharmacological treatment

Used only after a doctor's evaluation, usually short-term, considering the risk of tolerance and dependence.

3. Treatment of comorbid conditions

• normalization of thyroid function,
• treatment of metabolic disorders,
• therapy for respiratory diseases,
• treatment of pain syndromes.

4. Specialized treatment

• breathing support devices for sleep apnea,
• light therapy for circadian rhythm disorders,
• treatment of movement disorders and parasomnias.

Effective treatment of sleep disorders requires patience, consistency, and an individualized approach. Improvement in sleep quality directly translates to better mental functioning, metabolic health, skin appearance, and overall quality of life.