What is it about ?
We distinguish between sleep problems and insomnia:
- The sleep problems are disorders that relate to sleep / wake habits, but which have no impact on daily functioning. If you have a bad night every now and then or sometimes you are sleepy during the day you have sleep problems.
- THE’insomnia is a sleep disorder which prevents you from getting good sleep at least three times a week, which has a negative influence on your functioning during the day. This negative influence is manifested by a tired, irritability, drowsiness, loss of focus and reduced performance.
The cause of sleep problems can be both a physical ailment and a psychosocial problem.
Underlying physical conditions
- Sleep Apnea ;
- restless leg syndrome and periodic leg movements ;
- overactive thyroid (hyperthyroidism) ;
- abnormal behaviors during sleep, such as sleepwalking, seizures, etc. (parasomnias);
- disturbance of the sleep / wake rhythm of the biological clock;
- substance use (alcohol and drugs);
- side effects of drugs;
- narcolepsy (uncontrollable sleep attacks during the day).
Psychosocial issues
- psychosocial problems: traumatic or stressful events such as the death of a loved one, a divorce, financial problems,…;
- psychosis : psychiatric disorder associated with delusions and hallucinations, the perception of unreal things;
- mood disorders and anxiety disorders, such as depression and a mania.
How to recognize them?
Your sleeping habits are disrupted. You have difficulty falling asleep or you wake up several times a night. During the day you are sleepy, you find it difficult to concentrate on your work, you feel irritable and tiredness. The complaints are repeated more than three times a week.
- In case of’Sleep Apnea, you stop breathing while you sleep. Everyone does it but, in theSleep Apnea, these respiratory stops are unusually long (more than 10 seconds) and unusually frequent (more than 5 times per hour). Your partner may testify that you stop breathing for a long time and start breathing again with a loud snoring. You wake up every time, without necessarily realizing it, so you never sleep very long without a break. When you get up, you therefore do not feel rested, you are tiredness during the day and you have difficulty concentrating.
- If you are suffering from restless leg syndrome, you perceive an unpleasant sensation in the legs, eg. a feeling of numbness or tingling sensations. You can alleviate these perceptions by wiggling your legs. The sensation appears when you are resting and lying down, especially in the evening and at night. The periodic leg movements are movements sudden, lively and restless things you do with your legs while you sleep. They can even wake you up or disturb your spouse.
- A overactive thyroid (hyperthyroidism) is associated with a fast, sometimes irregular heartbeat, from tremors, from sweats, a diarrhea, agitation and weightloss.
- The disturbances in the sleep / wake rhythm of the body clock denote a disruption of the normal cycle of activity and rest. It is as if your body does not know when it is time to activate or sleep. This can cause you to be quite awake when you go to bed, or collapse under the drowsiness and the tired while you have to work. Known examples are time differences after long haul flights and the consequences of working in shifts (by system of breaks).
- If you are suffering from parasomnias, you are awake without really being. You can therefore have behaviors or perceptions without realizing it. Sleepwalking is a well-known example.
- The narcolepsy is characterized by uncontrollable sleep attacks and restorative naps during the day. There is no question of narcolepsy if the affection lasts at least 3 months. Fortunately, this is a rare condition.
How is the diagnosis made?
The doctor will question you at length about your problem, your concerns and your expectations. It will try to rule out possible underlying physical causes.
The doctor will ask you to keep a sleep diary, in which you must write down all the information about your sleep and your sleep problems. The goal is to be able to get a good idea of the causes and the nature of the problem. You write down what time you go to sleep, how long it takes you to fall asleep, how many times you wake up during the night, how long you wake up, when you wake up, how often you wake up form, … The doctor can thus draw up a picture of your sleep rhythm. Often, however, there is a disconnect between reality and what you think of your sleep.
What is the best treatment?
We distinguish between drug and non-drug treatments.
Non-drug treatments
It all starts with a sleep diary, good sleep information and sleep hygiene advice.
- The doctor explains to you how the day / night rhythm works, what a healthy sleep rhythm looks like, what is still considered normal and what is no longer normal. For example, there is no specific standard for how many hours you sleep or how long you fall asleep. Older people sleep lighter and wake up more often. They also sleep more during the day.
- Even so, there is no point in staying longer in bed. Catching up on sleep during the day is also not a good idea. This only compounds the problem.
- Tips for good sleep hygiene:
- Go to bed when you start to doze off.
- Be sure to darken and not overheat your bedroom.
- Get up at a fixed time and don’t stay in bed to compensate for a long period of nighttime wakefulness.
- Try to relax before bed.
If these tips don’t work, there are all kinds of techniques you can try to improve your sleep.
- relaxation techniques: eg. learn to relax, schedule a decompression hour before bed, make a list of things to do for the next day, etc. ;
- cognitive behavioral therapy : a treatment based on thoughts and ideas about sleep and sleep problem and tries to change them through speech;
- stimulus control, i.e. learn to :
- do not go to sleep until you are drowsy;
- get up and do something that relaxes you if you can’t sleep (instead of rolling over in bed);
- get up at the same time every day;
- do not take naps.
- restriction of time spent in bed: stay in bed only as long as you are actually sleeping;
- physical activity.
Drug treatments
The doctor may choose to prescribe a sleeping pill for a short time. Given the highly addictive properties of sleeping pills or benzodiazepines, these drugs are indicated only in a crisis that seriously disturbs normal functioning. As a general rule, the doctor will choose a medication with an intermediate duration of action and limit its intake to 1 week if possible. Great care should be taken in the elderly. The sleeping tablets reducing the state of alertness, they increase the risk of falling, eg. when an elderly person gets up at night to use the toilet. The doctor will always ask you to come back to his home after 1 week to assess the effect of the treatment.
If all of the above give insufficient results, or if the doctor suspects a potentially serious underlying problem, they will refer you to a sleep clinic for a sleep exam, to a psychiatrist or to a psychotherapist.
Want to know more?
- Physical activity – Eat Move – Health question
- Cognitive-behavioral therapy for insomnia – Hôpital Erasme ULB
- Sleeping pills and sedatives, think of other solutions first (video) – SPF Public health, food chain safety and the environment
- Sleeping pills and sedatives, think before consuming – FAMHP – Federal Agency for Medicines and Health Products
- Sleeping pills or tranquilizers, the point on your consumption – Stop or else?
- Benzodiazepines – CBIP – Belgian Center for Pharmacotherapeutic Information
- Drugs and driving a vehicle – Federal Agency for Drugs and Health Products
Are you looking for more specialized help?
- Mental Health Services – The Social Guide
- Find a therapist – AEMTC – Association for the Study, Modification and Therapy of Behavior
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