Sleep medicine

 

 

Definitions

Sleeplessness is one of the most common medical conditions. In Germany, about 20 - 30% of the population suffer from sleep disorders. The share of psychological causes in the total number of sleep disorders is particularly high at 70%.

Since the 1970s, great progress has been made in the field of sleep research and new therapeutic options have been developed. Various medical disciplines can be involved in the diagnosis and treatment of sleep disorders.

Obstructive sleep apnea syndrome

 

The frequent occurrence of breathing interruptions during sleep, with and without an associated waking reaction, is called obstructive sleep apnea syndrome (OSAS).  In obstructive apnea, the upper airway is closed for a longer period of time (>10 seconds) and a lack of oxygen in the organism occurs, as well as an unconscious or conscious waking reaction. Patients are often alerted by their bed partners to loud snoring with breathing interruptions. The patients themselves often notice it only through daytime sleepiness, a feeling of exhaustion, concentration problems and/or sleeping episodes during the course of the day.  Many patients visit our outpatient department because they suffer greatly from these symptoms.  Daytime sleepiness can lead to a considerable restriction in the ability to cope with everyday life, up to and including restrictions in the ability to drive a vehicle. People with OSAS have an increased accident rate in road traffic. Untreated, this disease leads to high blood pressure, cardiac insufficiency and cardiac arrhythmia as well as to increased pressure in the pulmonary circulation. The risk of suffering a stroke or heart attack is many times higher as in patients without OSAS. We therefore recommend a rapid diagnosis if OSAS is suspected. In OSAS patients, elevated blood pressure values can occur at night and subsequently during the day, which is often noticed in long-term blood pressure measurements justifies an examination for OSAS.

The following reasons are associated with the development of OSAS:

• Flaccidity and constriction of the pharynx due to disturbances in muscle function and tongue relapse during sleep

• Anatomical variations: Large uvula, enlargement of the base of the tongue large palatal tonsils, deviation of the nasal septum

• Overweight

• Comorbidities: Allergies, thyroid diseases, neuromuscular diseases

• Alcohol consumption and medication

Insomnia

Insomnia is a widespread and complex problem. It can manifest itself in the form of difficulties in falling asleep and/or staying asleep through the night. Early morning awakening, before the alarm clock, is also part of insomnia. Causes of this can be physical and mental diseases, in isolation and/or in combination with other conditions. Obstructive sleep apnoea syndrome also often occurs at the same time as insomnia. It is diagnosed with specially developed questionnaires, activity measurements (actigraphy) and the analysis of sleep and waking phases in the sleep laboratory. Therapeutic approaches range from cognitive-behavioural therapies (CBT), led by a specialist in psychosomatic medicine or a psychologist, to drug approaches/natural medicine and the treatment of concomitant diseases. Our good networking within university medicine ensures that insomnia patients are cared for and advised by the respective specialists.

Obesity hypoventilation disorder (OHS)

Simultaneously or independently of an OSAS, a so-called "obesity-associated hypoventilation syndrome" (Obesity-Hypoventilation-Syndrome, OHS) can also be present. In this clinical picture, lung function is restricted by reduced ventilation of the pulmonary alveoli and a permanent reduction in the oxygen and increase in the carbon dioxide content of the blood is present. Risk factors for this are a highly increased body mass index (BMI>35kg/m²), overweight in the trunk/belly and the presence of an obstructive sleep apnea syndrome (OSAS).  Since the symptoms of OHS and OSAS overlap (pronounced daytime tiredness and physical exhaustion), in the case of higher-grade obesity, a laboratory check (with arterial blood gas analysis) and a lung function test well be performed in addition to the sleep study (PSG). The necessity is evaluated during the inpatient stay. If a diagnosis is made, further examinations to evaluate heart and lung function may follow.

Central respiratory disorder

Central Sleep Apnea (CSA) contains a group of disorders that includes breathing interruptions without obstruction of the airway. These are disorders of the respiratory drive, localized in the central nervous system. Patients are either asymptomatic or have a similar clinical picture to obstructive sleep apnea. The possible causes are manifold. There are various neurological diseases, medication (e.g. sleeping pills), so-called central lesions (e.g. cerebral infarction, inflammation, malformation) or metabolic diseases. The examination in the sleep laboratory can reveal a central respiratory disorder and provide clues as to its cause.  Therapeutic approaches include treatment of the underlying disease as well as night-time respiratory therapy.