Sleep disorders: what they are and how to recognize them

By Cristiano Antonino On Mar 17, 2023

Sleep represents a very important and indispensable biological function for all living beings

The benefits of sleep

Although falling asleep involves a general deactivation, important events from a biological point of view occur during sleep, such as the recovery of energies, both physical and mental, and the restoration of strength.

In the literature, numerous theories have highlighted how sleep is also related to cognitive functioning (think of learning processes and memory consolidation) and to motor functioning.

In general, sleep performs several functions:

recovery and rest understood as general deactivation from continuous internal and external stimuli;
preservation and conservation of available energy;
ecological function;
immunological function;
thermoregulatory function;
neuronal integrity at the level of synapses and networks.

How many hours is it recommended to sleep?

The distribution of sleep requirements varies according to age. In the neonatal age, the hours of sleep needed range from 16 to 20 hours a day, with sleep distributed in an irregular and discontinuous manner over the 24 hours and mainly determined by the nutritional needs of the little ones.

From the 6th month of life, there is a gradual consolidation of sleep during the night.

At the age of 10 the total sleep period is 9-10 hours and in adolescence it is recommended to sleep about 7 hours.

In adulthood, also thanks to the rhythms of work and daily life, a further reduction is generally observed, for which it is recommended to sleep for about 6 and a half hours.

Sleep deprivation and related disorders

Sleep, wakefulness and vigilance are primary functions of the encephalon (brain, brainstem and cerebellum): any pathology or alteration at the encephalic level can, therefore, have repercussions and negative effects on sleep.

Physiological sleep is closely related to neuronal plasticity: sleep deprivation can interfere with hippocampal activity and contribute, albeit in part, to the etiology of depressive phases.

Even at a behavioral level, states of work and social stress, associated with worries and intrusive thoughts, can negatively affect sleep by interrupting its normal flow up to the most acute cases of insomnia.

When persistent and protracted over time, insomnia can favor the onset of psychiatric pathologies due to important neurophysiological and neuroendocrine changes.

In fact, it constitutes one of the symptoms par excellence of most mental disorders and its treatment is of fundamental importance both in the process of prevention and in care and treatment.

Here are some of the disorders that are related to sleep:

Anxious states and personality disorders

Generalized anxiety or related to panic attack disorders or, again, connected to phobic and obsessive-compulsive disorders is closely related to sleep as the psychological and physiological state of arousal (awakening) typical of anxiety strongly disturbs sleep and Likewise, disturbed sleep accentuates anxiety.

Anxiety-induced insomnia manifests predominantly with difficulty initiating and/or maintaining sleep.

Depression and mania

In depressive states, sleep undergoes a reduction due to frequent awakenings and the precocity of final awakenings, while unlike anxiety, the falling asleep phase is less involved.

Stress related disorders

All related stress disorders have an important impact on sleep as a physiological state of activation persists which prevents the individual from easing daily tensions.

What and what are sleep disorders

Sleep disorders include all those disorders that compromise both the quantity and quality of sleep with important repercussions on general health and quality of life.

The international classification of sleep disorders (according to the American Academy Sleep Medicine, ICSD 3,2014) includes 6 diagnostic classes:

insomnia;
breathing disturbances in sleep;
hypersomnia of central origin;
circadian rhythm disturbances;
parasomnia;
movement disorders in sleep.

Let’s analyze together the most frequent sleep disorders

Obstructive sleep apnea syndrome (OSA)

Obstructive apnea syndrome (OSA) involves frequent interruptions in airflow due to partial or total obstruction of the airways during sleep.

The syndrome can have repercussions on the cardiovascular, respiratory and nervous systems.

Obstructive apnea is sometimes associated with arterial hypoxemia and causes cardiac ischemia.

Symptoms of OSA can be:

habitual and persistent snoring every night for at least 6 months;
respiratory pauses;
awakenings with a feeling of suffocation;
daytime sleepiness.

The therapies can be behavioral, postural, orthodontic or prosthetic-ventilatory (CPAP).

Restless Leg Syndrome (RLS)

Restless Legs Syndrome (RLS) is a neurological disorder that involves moving the legs during the night to relieve pain and discomfort.

It can lead to high cardiovascular and cognitive risk.

The pathology tends to be seasonal: it appears in the summer and then tends to become chronic.

Treatment is usually pharmacological.

The parasomnias

Parasomnias are a subcategory of sleep disorders that involve all those unwanted movements that can occur during falling asleep, during sleep or upon awakening.

Parasomnias are divided into:

parasomnias related to NREM (NON-REM sleep);
REM-related parasomnias (REM sleep).

Non-REM (REM = Rapid Eye Movement) sleep-related parasomnias can consist of episodes of incomplete awakening, low responsiveness to stimuli, and little or no memory of the episode.

These ailments include:

confusional awakenings, with possible tachycardia, tachypnea (rapid breathing), mydriasis (dilated pupils), and sweating;
sleepwalking;
pavor nacturnus (night terrors) for which the subject screams in his sleep and has a low reactivity to external stimuli. The episode lasts an average of 30 seconds to 3 minutes, and upon awakening, subjects may have no memory of the source of the terror.

REM sleep is a sleep phase characterized by rapid eye movements, increased respiration, heart rate, blood pressure, and muscle atony (functional muscle paralysis).

REM sleep-related parasomnias include:

REM sleep behavior disorder, characterized by movements during REM sleep, in response to a dream, caused by lack of muscle atonia. The disorder is more common in those taking some antidepressants and in those over 50;
sleep paralysis, characterized by the feeling of muscle atrophy when sleeping or waking up. The episode lasts about a few minutes. This disorder can cause deep states of distress;
Nightmare disorder, often a component of PTSD, is characterized by the experience of recurring and vivid nightmares with themes related to threats to survival.

Early and delayed sleep phase syndrome

Delayed sleep phase syndrome is characterized by a shift in sleep time towards the morning hours, with difficulty or inability to meet social commitments; if these are forcibly maintained, the result is a decrease in the hours of daily sleep with consequent daytime sleepiness and subsequent recovery of sleep on holidays.

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Early sleep phase syndrome, tendentially chronic, is characterized by an earlier sleep period in the evening hours and an early awakening in the morning hours.

Insomnia

Insomnia is a symptom reported by the patient as a difficulty falling asleep, maintaining sleep with frequent awakenings or early definitive awakenings.

It is important to underline that insomnia is defined by the condition of ‘disturbed sleep’ and the consequent inability of the patient to recognize sleep as restorative.

It is the most common of all sleep disorders; it is often a symptom of underlying medical, psychiatric, and neurological conditions.

It can be secondary to other sleep disorders or be drug-induced.

The persistence of insomnia is associated with behavioral adaptations such as, for example, staying awake in bed, which negatively condition the evolution of sleep disturbance up to connoting a picture of chronic insomnia, which aggravates the already high levels of daytime stress and further enhances the vicious circle.

Finally, it is well known that sleep disturbances can occur in cardiovascular diseases and mainly affect patients with ischemic heart disease, myocardial infarction or congestive heart failure.

The pain typical of ischemic heart disease can wake the patient up and therefore lead to a decrease in the effectiveness of sleep.

The most frequent symptoms that signal the presence of a sleep disorder are:

daytime tiredness and listlessness;
lack of air;
morning headaches;
difficulty concentrating;
abrupt awakenings during the night.

These effects can be confirmed thanks to an instrumental examination, non-invasive and simple to apply such as polysomnography.

Which health professionals to contact if you suffer from sleep disorders

In the presence of a sleep disorder, when 2 or more symptoms become persistent and compromise the quality of life, after having made all the pertinent specialist visits to frame from a biological and physiological point of view, one can go to a psychologist who , thanks to its specific skills, is able to favor an accurate diagnostic framework, essential for establishing the presence or absence of a sleep disorder, on the basis of which a therapeutic path is structured and indicated for taking charge and follow-up of the complex and articulated symptoms.

Among the tools used for the treatment of sleep disorders are validated and standardized relaxation techniques and imagery techniques.

The treatment of insomnia and symptoms, in general, can have a preventive and protective effect with respect to the future possible onset of psychopathologies, while in already established disorders, such as in the case of psychiatric disorders, it can positively influence the course of the pathology and carry out a relapse prevention effect.

In some cases, such as those in which there is a depressive disorder, the use of antidepressant psychoactive drugs associated with hypnotic drugs can also be integrated, with variable efficacy in relation to the severity of the depression and the type of insomnia.

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