sleep disorder
Introduction
Introduction to sleep disorders Sleep disorders (somnipathy) refers to various dysfunctions that occur during sleep-wake. The decline in sleep quality is a common complaint, and up to 15% of adults with long-term sleep disorders. Generalized sleep disorders should include insomnia, excessive sleepiness, sleep-disordered breathing, and abnormal sleep behavior caused by various causes, including sleep walking, sleep panic, restless legs syndrome, and the like. basic knowledge The proportion of illness: 10% Susceptible people: no special people Mode of infection: non-infectious Complications: insomnia
Cause
Causes of sleep disorders
(1) Causes of the disease
It is currently believed that the main "sleep regulation center" is located in the ventral region of the hypothalamus, that is, the suprachiasmatic nucleus. In addition to causing disturbances in the sleep-wake cycle, this area of the disease can also cause changes in body temperature and eating activity.
(two) pathogenesis
The medical discussion of sleep begins with the search for a sleep center. The lesions located in the hypothalamus or the lateral wall of the third ventricle can produce persistent drowsiness, but non-physiological sleep can not explain the wake-up cycle, currently considered and sleep. The relevant anatomical parts are quite extensive, including at least the frontal lobe, the temporal cortex, the suprachiasmatic nucleus, the midbrain giant cell area, the blue spot, the interstitial nucleus, the medullary reticular formation inhibition zone, and the ascending reticular system. .
Transmitters involved include acetylcholine, dopamine, norepinephrine, adenosine, gamma-aminobutyric acid, serotonin, and neuropeptides such as S factor, delta sleep leading peptide (DSIP) and the like.
For example, the suprachiasmatic nucleus and its associated retinal-hypothalamic bundle have their own rhythmic activity, which is the starting point for wake-up cycles in animals, and may be part of a complex starting mechanism in humans, such as The nucleus contains serotonergic neurons, and the interstitial nucleus that destroys the pons can inhibit the occurrence of REM, while destroying the interstitial nucleus of the midbrain, the SWS disappears; the blue and under blue areas contain noradrenergic neurons. In the arousal and REM, the frequency of discharge increases, while in SWS, the destruction of the blue spot and the area under the blue spot can also make the REM disappear. The S factor and DSIP in the neuropeptide can be concentrated into a medicament, and the SWS can be produced after the injection.
Prevention
Sleep disorder prevention
According to the World Health Organization, 27% of people have sleep problems, and the Global Sleep and Health Program sponsored by the International Mental Health Organization launched a global event in 2001 the year of March 21, the spring One day is called "World Sleep Day", and the theme of World Sleep Day 2004 is "Focus on Sleep Health."
There are many causes of sleep problems, such as certain sleep disorders, physical illnesses, emotional factors, lifestyle (excessive drinking of coffee and tea), and environmental factors (noise, crowding or pollution), etc., as long as the problem is identified, there are May find a way to solve, thus re-establishing regular sleep.
Complication
Sleep disorder complications Complications insomnia
Sleep disorders can be a complication of certain diseases. Insomnia can also cause a series of changes in the body's physiological activities, which also affect the function of other systems in the body. Long-term lack of sleep can cause many neurological, mental and sub-health symptoms, such as irritability. , depression, alertness and activity decline, autonomic dysfunction, digestive dysfunction, etc.; even reduce immune function, affect physical health and work efficiency, and reduce the quality of life; conversely, physical dysfunction can be the cause of sleep disorders, also May be a complication of sleep disorders.
Symptom
Symptoms of sleep disorders Common symptoms Sleeping drooling to maintain sleep disorders Insomnia sleepiness tension fatigue secondary insomnia pathological REM sleep falling asleep hard teeth sleep-awake time... sleepwalking
(1) Insomnia:
Or it is called the obstacle to falling asleep and maintaining sleep. This is the most common sleep disorder. It has been determined that there are three different types of insomnia, and there are complaints about chronic sleep disorders and day burnout.
1 sleep disorders insomnia, refers to difficulty falling asleep.
2 to maintain sleep disorders and insomnia, characterized by frequent nighttime wakefulness.
3 terminal insomnia, refers to wake up early in the morning, and can not fall asleep again, these types can occur alone, can also be combined, but in the environment allows sleep, overnight inhalation is relatively rare.
(2) Excessive sleepiness disorder :
The most common of these is narcolepsy, whose typical symptoms are: sleep episodes; tripping; sleep paralysis or sleep sputum; illusion before going to sleep.
Another common type of excessive sleepiness disorder is sleep apnea, in which the patient repeatedly respirates during a deep sleep and suddenly wakes up to resume breathing. This type of sleep disorder is characterized by a patient feeling awake and drowsy in the morning. It can also be seen as a barrier to falling asleep or staying asleep. Patients who complain of insomnia and apparent sleepiness during the day may have sleep apnea.
(3) Obstacles to the sleep-wake time program:
Including temporary circadian rhythm caused by high-speed flight and temporary sleep disturbance caused by changing working hours. A more persistent symptom is sleep phase delay syndrome, that is, people who can not fall asleep at the desired time for a long time. People with such symptoms When you don't need to strictly follow the time program, such as sleeping on weekends or holidays, it seems that the onset and length of sleep are affected by the species-specific biological rhythm. When these rhythms are not synchronized, sleep disorders occur.
(4) Deep sleep state:
Refers to some clinical manifestations of slow wave sleep, that is, most of the sleep III, IV, but the sleep process itself is not abnormal, one of which is sleepwalking, more common in children and adults with snoring, sleepwalking often occurs in sleep III In stage IV, after the patient has slept for a period of time at night, he will sit up from the bed, or even walk away from the bed. The behavior is more dull, the consciousness is awkward, the question is not answered or the call should be stopped, and after a while, sleep again. The next day can't be recalled, children's sleepwalking will generally disappear with age. Other such sleep disorders include sleep panic, enuresis and night molars. The more common night terror in children occurs about one hour after sleep. It is characterized by sudden screaming, adult night terror is a nightmare, can make people wake up, as if feeling the chest is suppressed by something, this situation occurs in the sleep IV period, if the nightmare does not wake up, often no dream Recall that most of the enuresis occurs in the third and fourth stages of the first 1/3 stage of sleep at night.
In order to clearly diagnose sleep disorders, clinicians must have high quality, detailed medical history, careful physical examination, and necessary auxiliary examinations.
Must be familiar with the normal sleep cycle of individuals of all ages. In the infancy, one day and night can be roughly divided into three periods, namely, awake period, NREM sleep and REM sleep; childhood sleep is intermittent; young people's sleep becomes very Regular: rarely wake up after falling asleep, short sleep latency, high quality sleep at night, in the normal sleep mode of adolescents, the highest frequency of delta wave sleep occurs, about every 45 to 90 minutes in the first half of the night. Times.
The quality and time of sleep in adults can be reduced, and the number of wake-ups after sleep increases. In the elderly, delta-wave sleep can be completely absent, sleep time is shortened, the solidity of sleep is lost, and the number of wake-ups after sleep falls more, but during the daytime Have more naps to supplement enough full-day sleep.
Multiphasic sleep chart recording can accurately determine where non-specific clinical symptoms come from. In general, the complete NPSG study is more valuable than the daytime nap study. When summarizing the data of the NPSG study, the total bed rest time should be summarized. Sleep time, sleep latency to determine the effectiveness of sleep, should have REM sleep, delta wave sleep records, should also routinely record activities, alertness, waking, apnea, lack of ventilation, sleep latency and REM latency.
Examine
Sleep disorder check
1. The most important way to understand sleep disorders is to use the EEG multi-lead tracing device to monitor the whole-night sleep process, because there are various reasons for sleep uneasiness and daytime sleepiness, and EEG multi-lead tracing It is essential for accurate diagnosis.
2. Various scales such as the Epworth Sleep Scale (ESS); nocturnal polysomnographic recordings (NPSG) recording; Multi Sleep Latency Test (MSLT) and the like.
NPSG is most suitable for the evaluation of endogenous sleep disorders such as obstructive sleep apnea syndrome and periodic leg movements or frequent deep sleep states such as REM behavior disorder or nighttime head movements, evaluation of insomnia, especially sleep insomnia. There is no benefit.
MSLT is often performed after NPSG to evaluate hypersomnia. This method can often detect daytime excessive sleep in narcolepsy and REM in the early stage of sleep. MSLT should be performed during the normal awake period of the patient, and then observe one. Normal nighttime sleep.
Based on the medical history and key neurological examinations, other necessary optional auxiliary examination items include:
3. CT and MRI examinations.
4. Blood routine, blood electrolytes, blood sugar, urea nitrogen.
5. Electrocardiogram, abdominal B ultrasound, chest penetration.
Diagnosis
Diagnostic identification of sleep disorders
Diagnosis depends mainly on medical history. MSLT can detect that patients can have several naps during the first few hours of the day, the total daytime sleep time increases, and the sleep latency is normal or shortened. The characteristic manifestations are REM-based sleep (SOREMPs). The more SOREMPs appear, the more helpful the diagnosis of narcolepsy, and it is found that more than two SOREMPs can be diagnosed as narcolepsy, but the specificity of SOREMPs for more than one diagnosis is not absolute. , arrhythmia, unplanned changes in work, chronic sleep deprivation, obstructive sleep apnea, periodic leg movements during sleep, etc. can occur 2 or more SOREMPs, clinically should pay attention to identification.
Identify the different characteristics of each type of sleep disorder.
