Is there a way to replace sleep?

Sleep disorder without any other illness as the cause

Primary sleep disorder: Non-restful sleep that appears as a separate clinical picture without any other detectable disease. It manifests itself as a difficulty falling asleep or staying asleep and takes the form of early awakening or a sleep rhythm disorder.

The incidence of sleep disorders is considerable. Around 30% of the population struggle with insomnia at least at times, with women being affected somewhat more often than men, and older people much more frequently after retirement than younger people in working life.

It is only when the symptoms last at least four weeks that one speaks of sleep disorders in sleep medicine. Around five million Germans suffer from severe sleep disorders that require treatment.

The treatment of non-restful sleep has made advances in recent years, primarily due to the behavioral medical forms of treatment that are now available, which require considerable cooperation on the part of those affected.

If sleep disorders are not treated, there is a risk of secondary illnesses such as depressive moods, inability to drive on the road, decline in performance at work and social isolation in private life.

Leading complaints

If you have difficulty falling asleep:

  • Lying awake for hours in the evening with brooding and circling thoughts
  • In pronounced cases "intermediate state" with daydreams that are usually experienced as unpleasant
  • Due to the persistent tiredness, the person concerned goes to bed earlier and earlier if there are no external compulsions.

If you have difficulty sleeping through the night:

  • Longer waking periods at night (but short waking periods are part of normal sleep!)
  • Brooding and circling thoughts

Premature awakening:

  • Waking up after only 2–5 hours of sleep without being able to go back to sleep within a reasonable time

For all forms:

  • Lack of restorative value in sleep
  • Pronounced daytime sleepiness and increased daytime sleep
  • Irritability
  • Difficulty concentrating
  • Increased sensitivity to stimulants such as caffeine, nicotine and alcohol
  • Loss of joie de vivre
  • Often symptoms of depression or anxiety disorders.

The illness

If a non-restful sleep occurs as an independent disease, it expresses itself

  • As Difficulty falling asleep: Excruciatingly long lying awake until sleep occurs, in extreme cases for more than three hours.
  • As Sleep disorder: Superficial and “choppy” sleep due to frequent and prolonged waking periods.
  • As premature awakening: Awakening after only a few hours of sleep without being able to go back to sleep.
  • As Sleep rhythm disorder: Disturbance of the alternation between wakefulness and fatigue phases. A sleep rhythm disorder inevitably occurs with jetlag, but is otherwise more of a consequence than the cause of the non-restful sleep.

That's what the doctor does

Sleep medicine therapy for sleep disorders without an underlying chronic disease comprises three forms:

  • Medical therapy
  • Behavior therapy
  • Self-help in the form of improved sleep hygiene.

Medical therapy. Over a third of patients with unrestful sleep receive sleep medication from their doctor. But it is an open question what percentage of these regulations actually help the person concerned. In any case, sleep doctors argue that none of these drugs has been shown to really improve the quality of life of those affected, or that it works better than a placebo or self-help measures. In contrast, sleeping pills sometimes have serious side effects, especially in older people, and are often responsible for falls and the associated fractures

The doctor will primarily prescribe sleeping pills if the sleep disorder has a clear cause, e.g. B. an upcoming event (operation, relocation, court date), a drastic experience (accident, death of a relative) or another short-term exceptional situation.

In the case of chronic sleep problems - i.e. those that have existed for months - he will only prescribe sleeping pills if the intake is accompanied by behavioral therapy measures and an improvement in sleep hygiene.

Opinions differ widely about the details and especially the duration of the intake. The German Society for Sleep Medicine initially recommends prescribing sleeping pills for two weeks. If the sleep disorder improves, but does not occur again after it has been stopped correctly, a second two-week period of therapy is permissible. If the sleep disorder persists after discontinuing it again, it can be assumed that there is no prospect of success with the previously prescribed medication. Now the diagnostics have to be checked. The doctor will initiate behavioral therapy procedures, help improve sleep hygiene, or prescribe medication from other substance classes.

However, recent studies have shown that sleeping pills can increase the risk of death - even in low doses. People who take about 18 doses a year have a more than three-fold increase in the risk of developing cancer or other diseases. At 130 cans it is even five times as high.

If behavior therapy procedures are not possible or prove to be ineffective, an evening medication with benzodiazepines can be prescribed under certain conditions by a doctor qualified in sleep medicine, if otherwise there is a significant daytime impairment due to the consequences of the sleep disorder. The prescription should be reviewed every two weeks. After 3, at the latest 6, months of unproductive treatment, the treatment should be discontinued and the patient referred to a sleep laboratory.

For many doctors (and their patients), these regulations are not always practical. Many older patients take benzodiazepines for several months and are satisfied with them - with each gradual discontinuation, however slow it may be, the sleep disorder sets in again in full. In these cases, long-term prescription of the sleeping pill is justifiable, and discontinuation is only necessary for compelling reasons

Special text: sleeping pills

Instead of a fixed prescription of a drug, the doctor can also suggest on-demand therapy to the patient. In this case, the patient only takes the sleeping pill when he really needs it. This is appropriate if the sleep disturbance occurs only occasionally (e.g. always before business trips by plane) and / or if it is foreseeable that the sleep disturbance will pass by itself (e.g. grief phase, building a house). The patient must therefore decide for himself when he needs medical help. However, there is a risk that the patient “learns” to cope with certain situations only with the help of a drug and thus loses confidence in his own strength.

Another alternative is interval therapy. The patient either receives his medication in a fixed rhythm (e.g. every third night) or on previously agreed occasions (e.g. for shift workers at the end of the night shift). This form of prescribing medication is particularly promising in the long term if the patient is trained in behavioral therapy at the same time.

Behavioral sleep therapy. Behavioral medical measures are now the therapy of first choice for sleep disorders - even those that have a different disease as the cause. In many cities there are now sleep therapy offers that are based on behavioral therapy. Their techniques include:

  • Stimulus control. The function of bed and bedroom is optimized by eliminating sleep-disrupting behaviors and practicing sleep-promoting behaviors. This includes that the bed may only be used for sleeping. Other activities such as working, reading or relaxing (with the exception of sex) are "forbidden" in bed and must be carried out elsewhere in the home.
  • Sleep restriction. The quality of sleep is improved by limiting the amount of time that the person concerned can spend lying in bed, increasing tiredness and thus avoiding strenuous attempts to fall asleep. This technique is also well suited for self-therapy, but it requires a high level of discipline.
  • Paradoxical intention. The request or the conscious intention to stay awake prevents unsuccessful attempts to fall asleep; the process of falling asleep is thus less fearful.
  • Cognitive techniques. Sleep anxiety is reduced by concentrating on calming thought images and interrupting sleep-disturbing brooding and thought circles.

If you have persistent sleep problems, you should try such offers, if available, even if the health insurance companies usually do not cover the costs.

Your pharmacy recommends

The basics of sleep hygiene

In the case of hardly any chronic illness, the person affected is so much a "scientist in their own right" as in the case of sleep disorders. The following tips and rules give the established elements of modern sleep medicine Sleep hygiene again. What is most effective for you and what to try first is up to you to find out for yourself. However, it makes sense to start at several points at the same time.

Use the clock.

Maintaining regular sleep times is especially helpful. Above all, you should take advantage of external clocks, such as sunlight, walks in the evening, but also regular social contacts, if they are not psychologically stressful.

It has been proven that physical activity during the day (but not in the evening) promotes night sleep, while passivity and immobility have a negative impact on sleep quality

Eat.

It is recommended to have dinner in the early evening if possible and to prefer easily digestible dishes. It is difficult to sleep with a full stomach. But you shouldn't go to bed hungry either. In medical practice, the food factor only plays a subordinate role because most people have already adjusted their rhythm of life accordingly. Only people who have to eat in the evening for professional reasons, for example on business trips, can find this problematic.

Most people also know how to handle the luxury foods alcohol and caffeine correctly. Caffeine - for example in the form of a cup of coffee to end the meal - is a real "sleep killer" for some. People who have already had this experience will usually do without it.

The consumption of freshly fermented beer or sparkling wine also makes some people sleep restless, while a glass of red wine usually does not cause any problems. If you are not sure what is harmful, you have to find out for yourself by consistently omitting it, whether one of the eating or drinking habits is not disturbing your sleep. These attempts should be carried out for at least a week.

Too much alcohol has a generally unfavorable effect on sleep and causes you to wake up prematurely.

Come to rest.

Normally you rarely think about how to find relaxation, because you simply relax on your own. However, if you no longer succeed, you can learn to relax. The important thing is to turn off all thoughts about things that are troubling you. Sometimes it helps to consciously listen to beautiful music while falling asleep. It is best to set the volume so low that you have to listen carefully. Audio books are also suitable for this purpose. Often, negative thoughts can be effectively driven away with breathing exercises. Concentrate on your own breathing by placing one hand on your stomach and feeling the inhalation and exhalation. When you breathe in, your stomach should rise, when you breathe out, say a soft "Ssssss" and watch the stomach drop. Even with relaxation techniques from China such as Qi Gong and Tai Chi, breathing exercises are used to find inner peace.

An old, but still very effective method of calming down is bathing: a warm full bath with lemon balm or other bath additives can effectively encourage falling asleep (more than full baths). If you have calf pain or other pain syndromes, cool calf compresses or washings may be a better choice.

Another effective way to get a grip on sleep disorders is autogenic training, a type of self-suggestion that helps you relax better. If you have not mastered the method yet, guidebooks or courses (such as those offered by community colleges) can help you learn it.

The biofeedback method for relaxation is ideal for people who have a penchant for technology. While you relax under supervision, relaxation and tension are measured by connected electrodes and displayed on a screen.

In our culture, too, meditation is now known as a way to find relaxation and inner peace. In the Indian culture, besides physical exercises, it is an important part of various yoga directions. Meditation should be practiced under guidance; however, once you have mastered the essentials, you can meditate almost anywhere, anytime.

The principle of Progressive Muscle Relaxation according to Jacobson (PMR) is based on consciously concentrating on the relaxation and tension of the individual muscle groups, from the hands to the arms, neck and shoulders, etc., to the feet. This method is also best learned in specially offered courses. Later, what you have learned can be carried out on its own using a CD or DVD.

All relaxation techniques, when properly performed, work by reducing the level of activity in the brain. This downshifting of the brain can be followed in the EEG: Those who have mastered their relaxation technique can practically at the push of a button, for example. B. increase the proportion of slower alpha waves. The decisive factor is therefore not which method you choose for yourself, it is more important that you really integrate the method you have decided on into your everyday life.

Do not expect quick successes: Apart from positive initial successes (which occur mainly under supervision or in a group), it often takes a long time, i.e. several months, for relaxation procedures to work reliably and regularly. But the way is worth it: Who z. B. has learned to use autogenic training correctly, can provide targeted relaxation even in the most stressful phases and take a short, restful nap “at the push of a button”.

Reduce the causes of stress.

Promoting the ability to relax is one of the ways to prevent insomnia. However, it is just as useful to avoid in advance that one regularly gets into situations of great tension.

Solve conflicts.

It is a well-known wisdom that a good conscience is the best pillow to rest on. So check whether you have really done everything you can to banish smoldering conflicts from your life. To do this, go through the topics that keep coming to your mind at night while pondering. Some experts also recommend psychotherapy based on depth psychology if serious conflicts are the cause of sleep disorders. It is unclear whether this works better than behavioral sleep therapy. In the acute stage of psychotherapy, sleep disorders can initially worsen.

Sleep rituals.

Adhering to certain rituals every evening is beneficial and promotes sleep. This can be a walk, a cup of herbal tea as a bedtime treat or a small glass of alcoholic drink.

Immediately before going to sleep, bedtime stories for both children and adults, and for the latter in the form of a book, have a calming, sleep-inducing effect. For believers, a good night prayer is usually one of the rituals. Television, on the other hand, is generally rather unfavorable.

Last but not least, the time before going to sleep is also the most popular time for caresses and sexual intercourse, whose sleep-promoting effect is undisputed.

Bedroom.

The bedroom plays a special role in restful sleep. First and foremost, your bedroom should be comfortable and have a calm, relaxing atmosphere. It can be cool, but not cold and uncomfortable. It is ideal if a small east window lets in the morning light, but on the other hand no light and noise sources threaten to interrupt sleep during the night.

An important stress factor for sleeping at night is noise. If the outside noise cannot be reduced, it helps to get used to the use of earplugs made of wax (Ohropax®) or foam rubber. Some people also sleep well with a second, smaller pillow that they place over their exposed ear.

If these measures are not sufficient, the installation of noise protection windows should be considered, the positive effect of which is often astonishing.If this option is not available, in extreme cases (and if the financial means allow it) only a change of residence remains, because the sensitivity to noise increases with age.

Alone or as a couple.

If your partner snores, or if it makes you nervous that he is sleeping while you are sleepless, then consider whether it might not be better to sleep alone (temporarily).

Temperature.

While warmth is beneficial when falling asleep and freezing hampers falling asleep, the opposite is the case when sleeping through the night: Here the build-up of heat under the duvet becomes a problem. The thermal requirements are therefore contradictory.

Most people solve this conflict by bringing about the lack of "warmth to sleep" with the help of bed socks, heat pillows or a hot water bottle. Large compresses are also available in pharmacies or medical supply stores, which are heated in a water bath and have a long-lasting warming effect. If you use either of these methods, the room temperature in your bedroom can be rather low. In principle, the temperature in the bedroom should be significantly lower than in the rest of the apartment. This is recommended because the body must be able to “downshift” at night. Last but not least, this corresponds to the rhythm of nature with a nightly lowering of the air temperature from 5 to over 10 ° C. Many people forego heating their bedroom entirely and instead use particularly warming bed linen or down comforters in winter.

The bed.

The bed, the mattress chosen and the bed linen also play an important role in the quality of sleep. The following should be considered:

  • The mattress should not be too soft or too hard. There are now also mattresses with different hardness zones, whereby a softer suspension is achieved, especially in the shoulder area. Pocket spring mattresses are more breathable than latex mattresses and better dissipate the heat that arises, especially at the end of the night.
  • The following applies to the duvets: Synthetic duvets are beneficial for allergy sufferers, but are more conducive to heat build-up than those made from natural materials. In winter, down and in summer wild silk or other natural materials are the better choice for non-allergic people.
  • Finally, an often neglected factor is the pillow: The traditional shape and standard size (80 x 80 cm) is rather unfavorable because the pillow slips easily when sleeping and the desired elevation of the head is often too low. This promotes pain in the cervical spine. That is why there are a large number of health pillows on the market that you should try.

In alternative medicine, the requirements go much further. Feng Shui teachings call for a harmonious room layout; An unfavorable position of the bed can therefore cause sleep problems. Other types of therapy see water veins running under the bed as causing problems; still others warn of electrosmog. The latter attach great importance to the fact that no current-carrying lines run near the bed and even avoid any kind of metal in the bed frame and in the mattress. Even if such seemingly causal relationships sometimes sound astonishingly plausible - none of these hypotheses has so far been able to prove their truthfulness.

Nocturnal urination.

Patients who have new nocturia to urinate at night should definitely consult a doctor. In connection with edema, this is an indication of a serious illness, e.g. B. Heart disease, protein deficiency, liver disease or kidney disease that needs treatment.

Even without a serious illness, going to the toilet at night is sometimes unavoidable. If you want to avoid them, drink only a little after 6 p.m. If there is no underlying serious illness, the nocturia itself can be treated with medication, for example with desmopressin (Nocdurna®). The gender-specific dosages must be observed here. Caution is particularly advisable for patients over 65 years of age. This age group has an increased risk of developing hyponatremia (sodium deficiency) with symptoms such as headache, nausea, weight gain or cramps while taking desmopressin.

Urinary drugs (diuretics) as well as herbal teas (bladder and kidney tea or tea made from nettle, goldenrod, horsetail or bearberry leaves) should, in consultation with the doctor, not be taken or drunk in the evening if possible. Fresh fruits (especially pears, peaches, grapes) have a diuretic effect and should not be eaten in large quantities before going to bed.

Brooding.

A common disruptive factor in restful sleep is the "brooding evil". Thoughts and worries that are circling in the head simply cannot be driven away. If at all possible, try to radically break off the circling of thoughts. The suggestions of some advisors to think only of beautiful things or to count sheep usually help little or not at all in practice. So you have to find the best way for you to break off circling thoughts yourself.

Sometimes persistent, unsuppressible brooding is also an indication of depression that should be treated with medication.

  • For some people it helps to get up briefly, to have a warm drink and then to lie down again soon.
  • Others find a sip of water sufficient. If there is already a glass of water on the bedside table, you avoid getting your circulation going again.
  • If you can't get a topic out of your head, it can help to have a piece of paper and a pen ready by the bed and to take short notes. It is even better if you find a place outside the bed to write your thoughts down. In doing so, you signal to yourself that the problems “have no business” in bed.
  • Often, reading an exciting book or an interesting newspaper article can also distract from pondering.
  • People who suffer from having lost a partner, a child or a parent, it is good if they have a mental dialogue with the loved one.

Complementary medicine

In hardly any other area of ​​medicine are the boundaries between alternative and conventional medical therapy methods as fluid as in sleep medicine. The relaxation-promoting therapies discussed above under self-help are definitely alternative methods for other diseases - while in sleep medicine they have already become core components of "conventional medicine" therapy. Phytotherapeutic sleeping pills are firmly established in general practitioners' practice. Another variant is aromatherapy. Before going to bed, a few drops of bitter orange oil are drizzled into the bowl of an aroma lamp. Lavender or chamomile oil can also have a calming effect due to their smell.

Methods such as acupuncture or homeopathy play only a minor role in sleep medicine.

The hormone melatonin is often advertised - also on the Internet - as a natural drug for better sleep. Scientific studies, however, give little benefit to the isolated intake:

  • In the case of primary sleep disorders, taking the drug can shorten the time it takes to fall asleep by around ten minutes; the quality of sleep and the duration of sleep remain unaffected.
  • In the case of sleep disorders caused by shift work or jet lag, melatonin increases the duration of sleep; however, the quality of sleep is not improved here either.
  • Melatonin has no effect on all secondary sleep disorders.

Further information

  • www.leitlinien.net - Via the Guidelines homepage, then Guidelines not updated, register group 063, you can access the guidelines for diagnostics and therapy of non-restful sleep of the German Society for Sleep Research and Sleep Medicine (DGSM). Even if it is listed here as out of date, it is the most detailed document in German. Very comprehensive information, unfortunately not formulated in a very layman-friendly way.
  • www.schlafgestoert.de - One of the few websites on the subject that can be recommended without restriction, operated by three sleep medicine specialists from Münster. There you will find many links, additional sources and a sleep log for download.
  • J. Zulley: My Book of Good Sleep. Zabert Sandmann, 2005. One can learn to sleep properly - that is the basic thesis of the author, who is known as a sleep researcher.
  • Stiftung Warentest (Ed.): Fit through healthy sleep. Good and balanced overview of the topic, even if the guide was published in 1994.

Authors

Dr. Bernadette Andre-Wallis, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 15:59


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.