The sleep disorders are a lack of normal sleep patterns that occur when there is sleep deprivation, desynchronization or there is a little restful sleep and poor quality. They can occur in babies, children, adults and the elderly.
In the last decades, sleep disorders and especially the apnea or hypopnea syndrome, has generated a growing interest in the medical and scientific community (National Consensus on sleep apnea-hypopnea syndrome, 2005).
The dream is about a basic need, both for children and adults, such as eating, drinking or breathing. Therefore, sleep is a vital function and will be essential to have an optimal state of health and well-being throughout life (National Heart, Lung and Blodd Institute, 2012).
Sleep Disorders in children
When some type of pathology or alteration occurs, a serious alteration of the normal sleep pattern will occur. Therefore, it will produce significant consequences at the functional level that will have a strong impact on the quality of life of the individual, as well as increase their chances of suffering from other types of pathologies: physical and mental health problems, and even the risk of death.
Dream: Concept and stages
Sleep is usually divided into two basic phases: REM (rapid eye movement) and non-REM (National Heart, Lung and Blodd Institute, 2012) sleep.
While the non-REM phase refers mainly to the stage of deep sleep or slow waves, the REM phase is a lighter phase of sleep in which dreams usually appear. Both phases, usually happen regularly form following a pattern of 3 to 5 cycles of 90 min.
Our “biological” clock, that is, the circadian rhythms, will allow our body to correctly regulate the phases of sleep and wakefulness throughout the 24 hours of the day.
Types of most common sleep disorders
In the classification of sleep disorders, the one proposed by the Association of Seleep Disorders Centers, called the International Classification of Sleep Disorders (ICSD), is usually used (Peraita-Adrados, 2005).
Sleep disorders are usually divided into:
- Disorders associated with medical or psychiatric pathologies.
It refers to the difficulties that appear in the beginning and maintenance of sleep (insomnia) or the presence of daytime sleepiness (hypersomnia).
Insomnia manifests as the perception of insufficient sleep, difficult to get or little refreshing. Generally, the individual will feel tired during the day, attention problems, concentration, memory, irritability or depressive mood.
The term hypersomnia refers to a state of daytime sleepiness that predisposes to sleep in involuntary or inappropriate situations. This type of pathology will have important repercussions at school, work, family, social, etc.
In the case of parasomnias, episodic phenomena will occur that will disturb the sleep at night, without the control mechanisms or the wakefulness phase being involved. It will produce an activation of the nervous system.
Disorders of the waking-sleep transition (rhythmic sleep movements, hypnotic startles, somnilochia, nocturnal cramps), wakefulness disorders (confusional awakening, night terrors or sleepwalking), deep sleep disturbance (nightmares, sleep paralysis, painful erections) may occur. ).
There may also be another type of secondary parasomnias related to enuresis, bruxism or paroxysmal dystonia.
Disorders associated with medical pathologies
Among the most frequent disorders associated with medical-type pathologies are snoring, sleep apnea or narcolepsy.
Sleep apnea or apnea-hypnea syndrome is one of the most prevalent disorders and with more functional consequences for the individual who suffers from it and who are undervalued on many occasions.
Sleep apnea: Apnea-hypopnea syndrome
The apnea-hypopnea syndrome is classified within the respiratory disorders of sleep and in it, there is an alteration of the respiratory pattern, interrupting the breathing for brief periods of time.
Breathing is a vital function. When we are sleeping, the control of the breathing happens to be an automatically regulated activity (Culebras, 2006). Neuomotaxic nerve centers assume control of respiratory function (Culebras, 2003).
If an interruption of this regulation occurs, the individual may die. Therefore, when it occurs, the nervous system generates a safety measure producing the awakening of the person, thus ensuring the continuity of the respiratory function (Culebras, 2003).
The continuous and persistent irruption of respiratory pattern, produces a remarkable decrease in the quality of sleep. This fact will be associated with a severe daytime drowsiness and therefore the quality of life of the person suffering from it will be affected.
The data derived from different medical researches have shown that sleep apnea is associated with the presence of arterial hypertension, development of cardiovascular diseases, cerebrovascular accidents, increase of the prevalence of traffic accidents and of a remarkable deterioration of the quality of life in general (National consensus on sleep apnea-hypopnea syndrome, 2005).
Prevalence of sleep disorders
The prevalence of sleep apnea-hypopnea is estimated at approximately 2% in women and 4% in men (Culebras, 2006).
The national consensus on sleep apnea-hypopnea syndrome (2005) shows that different epidemiological studies conducted in the USA and Europe have estimated the prevalence of this syndrome between 4-6% of men and 2.4% of women in the general adult population.
In the case of the pediatric population, the presence of snoring (as a common sign of increased resistance of the airway to the normal passage of oxygen) is estimated at 10%. There is a maximum peak between 2 and 3 years of age, and later after 9 years there is a significant decline in their presence (Sans-Capdevila and Gonzal, 2008).
However, frequently the sleep apnea syndrome remains undiagnosed (National Heart, Lung, and Blood Institute, 2012). Most people who suffer from it partially awaken during the sleep phase to recover their breathing but in the morning they are not usually aware of these events (National Institute of Neurological Disorders and Stroke, 2014).
In Spain, there are between 1,200,000 and 2,150,000 subjects who suffer from an important sleep apnea syndrome, therefore, they can be treated. They not , however, only have been diagnosed and treated between 5-9% of the population (National Consensus on apnea-hypopnea syndrome Sleep, 2005).
Types of sleep apnea
The person who suffers from these types of pathologies, performs one or several pauses of breathing (apnea) or has shallow and diminished breaths throughout the night (hypopnea).
Breathing pauses usually occur for a short period, seconds or several minutes and can occur between 30 times or more per hour (National Heart, Lung, and Blood Institute, 2012).
According to the National Consensus on sleep apnea-hypopnea syndrome (2005), defines the apnea-hypopnea syndrome as follows:
It is characterized by the appearance of recurrent episodes in which there is a limitation of the passage of air and oxygen as a result of an anatomical or functional alteration of the pathways areas. A collapse occurs which implies a decrease in oxyhemoglobin saturation and micro-awakenings that give rise to poor sleep, excessive sleepiness, psychiatric, respiratory and cardiac disorders.
On the other hand, the American Academy of Sleep (AASM), American Academy of Sleep Medicine, makes a classification of the types of apneas that can appear in sleep breathing disorders (Culebras, 2006):
- Obstructive apnea : there is a suspension of air flow for a minimum period of 10 seconds. It is obstructive persists respiratory effort
- Central apnea : there is a suspension of air flow for a minimum period of 10 seconds. It is central if there is no respiratory effort during the episode .
- Mixed apnea : there is a suspension of the air flow during a minimum period of 10 seconds. It is mixed if the episode begins as central but at the end the respiratory effort appears.
- Hypopnea : a normalized respiratory episode occurs, with a reduction of at least 30% of the thoracoabdominal movement, or airflow, lasting at least 10 seconds or more and with a decrease in oxygen saturation of 4% or more.
- Awakening related to respiratory effort : a respiratory pattern occurs with exponential increase in respiratory effort leading to an
The apnea-hypopnea syndrome produces an increase in blood pressure, increases the risk of suffering from cardiovascular diseases and strokes, causes excessive sleepiness and significantly diminishes the quality of life of patients (Culebras, 2006).
- Cardiovascular risk : Apnea carries important repercussions in the cardio-vascular system. Snoring and persistent awakenings are associated with hypertension, cardiac ischemia and altered cardiac hemodynamics, among others. Night awakenings can raise blood pressure to reach 200/100 mmHg, although its duration is short, repeated episodes, hundreds of times every night, will cause a sustained increase in blood pressure. Thus, sleep apnea causes various cardiac pathologies, such as arrhythmias, arthroventricular block , atrial fibrillation, etc. Several studies show that 20% of myocardial infarctions and 15% of sudden deaths occur between midnight and six in the morning (Culebras, 2006).
- Cerebrovascular risk : due to the alteration of heart rate, a decrease in the speed of cerebral blood flow may appear . Therefore, this persistent alteration may involve brain regions with little hemodynamic reserve and therefore contribute to the increased risk of suffering from stroke episodes (Culebras, 2006).
- Daytime sleepiness : it is a subjective or objective tendency to fall asleep. The consequences are the reduction of the quality of life, cognitive and behavioral disorders, psychosocial decline, traffic accidents and labor, etc. (snakes, 2003).
- Decrease in the quality of life : the continuous tendency to fall asleep and the effort to stay awake during the day, cause a subjective decrease in the quality of life. The individual tends to be uncomfortable and their social and family contacts tend to decrease (snakes, 2003).
- Cognitive behavioral disorder : individuals will show complaints of poor memory, reduced attention and concentration, lack of initiative, passivity, depression and even impotence. As a consequence of this, there will be a significant psychosocial decline, reduced labor productivity, job dismissals, school failure or family pathologies (Culebras, 2003).
- Accidents : different statistical data show that in the US, more than 100,000 traffic accidents per year are caused by drowsiness. At least 23% of drivers recognize having fallen asleep at the wheel. Of these accidents, 1,500 individuals die and another 71,000 have injuries (snakes, 2003).
Depending on the clinical history and the severity of the pathology, several treatments may be used.
Mainly, at the beginning modifications of the habits of life are made: to avoid the consumption of alcohol, relaxing medicines, reduction of weight and to stop smoking.
Many individuals improve with basic adaptations such as special pillows, devices that prevent sleeping on their backs, or oral devices that keep the airways open (National Heart, Lung and Blodd Institute, 2012).
On the other hand, when any of the aforementioned methods is not effective, many specialists recommend a continuous airway pressure device (CPAP), the individual must wear a mask connected to a tube and a machine that sends air to maintain the open way.
Surgical procedures can also be used to remove tissues or expand the airway (National Heart, Lung and Blodd Institute, 2012).
There are a large number of cases that are never diagnosed, since in many cases it is not known that there is a therapeutic approach or simply underestimate the long-term consequences of this type of pathologies.
Offering treatment and counseling for sleep disorders is essential to stop the medical and social consequences that may have for the individual.