Insomnia: sleep disorders

Of all the conditions that make for human efficiency and well-being sleep is one of the most important. A whole array of symptoms may occur when human beings are deprived of sleep, ranging from the obviously increasing fatigue and irritability, to difficulties with concentration and coordination, and illusions and hallucinations. Although the effects of serious sleep deprivation are not in doubt, it is difficult to define exactly what normal sleep involves and how much of it we actually need. We probably all know at least someone who is able to function perfectly well on three or four hours of sleep, whilst others who sleep for long hours never seem to obtain the maximum benefit from it and always seem to lack energy and vitality.

So, how can we try and make sense of this?

Western science has focussed on the brain zones that are involved in day and night rhythm, and on the brain activity, as registered by an EEG (electro-encephalogram), during sleep. This established that there are two different brain wave patterns, identified as REM and non-REM. REM stands for rapid eye movement, indicating a state of absolute relaxation as measured in the body's musculature. This type of research may establish that an individual is not getting enough REM sleep time. It may even show up low levels of certain neuropeptides (brain chemicals) that are known to induce sleep, such as serotonin and norepinephrine. It will, however, not deliver answers to the question why a person begins to suffer from insomnia, or why there is such a wide gap between the hours and quality of sleep on the one hand and the symptoms displayed by different individuals on the other. But before we delve into the deeper background of sleep disorders and shed some light on the reality behind the obvious, I will give you a overview of the traditional way in which derangements of sleep have been categorised.

Allopathic Classification

Insomnia

This word signifies want of sleep and is used popularly to indicate any impairment in the duration, depth or restorative properties of sleep. Quantitative precision as to what constitutes insomnia is impossible, because of the uncertainty as to the natural requirement of sleep and also its role in the economy of the human body.
Two classes of insomnia may be defined: one in which there appears to be a primary disturbance of the normal sleep mechanism, the other in which sleep impairment is secondary to another disease or condition.
The term primary insomnia should be reserved for those persons who throughout their lives have never enjoyed restful slumber, and in whom none of the usual symptoms of neurosis, depression, or other psychiatric or medical diseases can be elicited.
Severe insomnia is a frequent complaint of patients suffering from psychiatric disease. Also, vigorous mental activity late at night or excitement which leaves the muscles tense, counteracts drowsiness and sleep. Under these circumstances there is difficulty in falling asleep and a tendency to sleep late in the morning.
Sleeplessness is also commonly recorded in the histories of patients suffering from psychoneurosis and psychosis. Illnesses in which anxiety and fear are prominent symptoms usually result in difficulty in falling asleep and light, fitful or intermittent sleep. Also, disturbing dreams are frequent and may awaken the patient.

Disturbances in the transitional period of sleep

As sleep comes on, certain nervous centres may be excited to a burst of insubordinate activity. The result is a sudden start that arouses the incipient sleeper. It may involve one or both legs or the trunk, less often the arms. Sensory centres may be disturbed in a similar way, either as an isolated phenomenon or in association with phenomena that induce motion. The patient may drop off to sleep, but be aroused by a sensation that darts through the body. Or a sudden clang or crashing sound disturbs commencing sleep. Sometimes there is a sudden flash of light or a sensation of being lifted and dashed to earth or of being turned.

Sleep palsies

Curious and at times distressing paresthetic disturbances develop during sleep. Everyone is familiar with the phenomenon of a leg "going to sleep". This is essentially caused by pressure on nerves in superficial places and a similar thing can develop during sleep. This condition usually lasts only a few minutes to hours, but if the compression is prolonged, the nerve may be severely damaged. Unusually deep sleep, as in alcoholic intoxication, renders the patient especially liable to sleep palsies, merely because the patient does not heed the discomfort of an unnatural posture.

Nightmares and night terrors

Awakening in a state of terror has happened to nearly everyone. Children are especially susceptible. Fever disposes to it, as may many other conditions such as indigestion. Nightmares differ from night terrors only in the greater intensity of the anxiety. In addition there is more vocalisation and motor activity, even to the point of running as if pursued.

Somnambulism and sleep automatism

This condition occurs more often in children than in adults. After being asleep for a time, the patient arises from the bed, walks about the house, and may turn on a light or perform some other familiar act. There is no outward sign of emotion; the eyes are open, and the sleeper is guided by vision. If spoken to, there is no response. Sometimes strange phrases or sentences are muttered over and over again. The following morning there is usually no memory of the episode.

Nocturnal epilepsy

Occasional abnormalities of the brain waves of the type seen in epilepsy tend to occur in epileptic patients during or shortly after the onset of sleep. Not infrequently an individual subject to grand mal attacks will have them only at night during sleep.
Nocturnal jerks of the legs are another troublesome symptom because they interfere with sleep night after night. This condition differs from the restless leg syndrome in that involuntarily movements occur.

In general there are three varieties of wakefulness.

One type is the inability to fall asleep. Individuals affected by this type have become more and more tense during the day and are unable to relax. After about 1 to 3 hours the individual sinks into an exhausted, deep sleep which continues throughout the night. For these patients any fairly quick-acting hypnotic (sleeping tablet) given 15 to 30 minutes before going to bed is useful in inducing and maintaining sleep.
The second type of insomnia is exhibited by patients who are able to go to sleep but who awaken in 2 or 3 hours and lose sleep in the middle of the night. They awaken during the period when sleep normally lightens, and some are alternately awake and asleep all the rest of the night. Often these are sick persons with a debilitating or painful illness which generates more pain and restlessness as muscles relax and leave painful areas unsplinted. In others, fever, sweats, shortness of breath, or other distressful symptoms develop and demand attention. Heavier and longer read more