Almost everyone has short-lived sleep problems lasting a few days during stressful phases of life or during an illness (a cough, say, or a “blocked nose” from a cold) Most of them are harmless. With “real” sleep disorders it is different. These are sleep problems that go on for a longer stretch of time (three to four weeks, and sometimes years) and markedly reduce a person's ability to function. They can be physical as well as psychological. So the first thing to do is to find out the cause. Chronic sleep disorders in particular can seriously affect a person's health and performance, damage their social skills and lead to accidents

Sleep disorders: how do they show themselves?

Experts distinguish more than 80 different sleep disorders, which can be divided into eight main groups by the type of complaint:

Insomnia: this covers difficulty falling asleep, trouble sleeping through the night, waking early in the morning and chronically restless sleep. Those affected also complain, for instance, of fatigue, problems with attention or memory, low mood, tension, headaches and/or worry about their disturbed sleep. Insomnia is one of the most widespread forms of sleep disorder. It can be brought on, for example, by psychological stress (money trouble, say) or by drug misuse (such as excessive use of sleeping pills).

Sleep-related breathing disorders: these include, for example, the various forms of sleep apnoea. They cause breathing to be interrupted at night, meaning that breathing stops for a short while — often unnoticed by the sleeping person.

Hypersomnias (the cause lies in the central nervous system). With these sleep disorders the sufferer mainly experiences excessive sleepiness during the day, even though the amount of night-time sleep is not reduced and there is no disruption of the circadian rhythm (that is, of the individual day-and-night rhythm). Hypersomnias include, for example, narcolepsy (“sleeping sickness”) and daytime sleepiness caused by traumatic brain injury or resulting from the misuse of drugs or psychoactive substances.

Circadian sleep–wake rhythm disorders: disturbances of rhythm and sleep like these can be caused, for example, by a change of time zone (jet lag), by shift work, by organic illness or by the misuse of drugs or psychoactive substances. They lead to insomnia and to massive daytime sleepiness.

Parasomnias: these are episodic sleep disturbances brought on by unusual physical events or behaviour, such as sleepwalking, nightmares, night-time groaning, sleep-related eating disorders or repeated involuntary urination during sleep.

Sleep-related movement disorders: these sleep disorders are caused by simple, mostly stereotyped movements. A common sleep-related movement disorder is restless legs syndrome. Other sleep disorders in this category include periodic limb movements and night-time teeth grinding.

Other symptoms: this category takes in all sleep-related symptoms that sit on the border between the “normal” and the pathological, or that cannot yet be clearly classed as normal or pathological from a scientific point of view. Examples: very short sleep (needing less than five hours a day), overly long sleep (usually needing more than ten to twelve hours a day) and strong repeated muscle twitches while falling asleep. Snoring and talking in one's sleep also belong to this category, although they do not usually disturb the sleeper's own sleep.

!!! Different sleep disorders can overlap. Some people, for instance, suffer from insomnia and from sleepwalking and from breathing disorders during sleep all at once. That is what makes sleep disorders so complicated.

Primary sleep disorders

A primary sleep disorder is the name for a condition in which there are no physical or psychological causes. They are brought on, for example, by stress or by unfavourable conditions for sleep.

Secondary sleep disorders

Secondary sleep disorders have a physical (organic) or a psychological or psychiatric cause:

Mental illnesses such as depression, anxiety disorders, psychoses or schizophrenia almost always cause sleep disorders (trouble falling asleep, for instance).

Organic or neurological illnesses can also be the reason for sleep disorders such as trouble falling asleep and poor sleep quality, hypersomnia or circadian rhythm sleep disorders. Examples are chronic pain (rheumatic disease, say), cancer, hormonal disorders (an overactive thyroid, for example), restless legs syndrome, heart and lung disease, chronic kidney or gastrointestinal disease, Parkinson's disease, dementia, multiple sclerosis, meningitis, stroke, brain tumour and epilepsy.

Medicines can sometimes cause sleep disorders as a side effect. They include antibiotics, certain antidepressants, drugs for high blood pressure (alpha blockers), asthma drugs (theophylline), sleeping pills such as benzodiazepines (sleep disorders come back after the drug is stopped abruptly), cortisone, thyroid hormones, dementia drugs, diuretics, antihistamines (allergy remedies) and the agents cancer patients receive as part of chemotherapy (cytostatics).

Legal and illegal drugs can also cause sleep disorders, for example as difficulty falling asleep, difficulty staying asleep or sleep apnoea. Drugs that disturb sleep include alcohol, caffeine (coffee, black tea, energy drinks), nicotine, cannabis, heroin, cocaine and ecstasy.

What can you do yourself?

This applies all the more to sleep disorders that are not organic or psychiatric — for instance to difficulty falling asleep, difficulty staying asleep and/or early waking (insomnia) caused by stress or by unfavourable conditions for sleep. Sleep aids are usually unnecessary: as studies have shown, two thirds of all sleep disorders can be put right by non-drug measures. Proper sleep hygiene is one of them.

It includes the following rules:

• Get the amount of sleep you need. This matters especially for older people.
• Go to bed and get up at the same time.
• Do not nap during the day (an afternoon sleep, for example).
• Make the conditions for sleep comfortable. That includes the right temperature in the bedroom (around 18 °C is best).
• Do not drink alcohol or coffee in the evening. If you are sensitive to caffeine, you should stop drinking it as early as midday.
• Pay attention to a balanced diet and to regular physical training. If you eat nothing but fast food and sit on the sofa all day, do not be surprised by sleep disorders.
• Arrange a relaxing evening that brings the day slowly to a close. What is out of the question in the evening: a strenuous fitness session late in the day, a gripping thriller, work at the computer, a visit to social networks (a large flow of information that your brain will process whether you want it to or not), solving a difficult life problem, phone conversations, quarrels.

More advice against sleep disorders

Alongside sleep hygiene, the following advice can also help with sleep disorders:

• Stimulus control: use the bed and the bedroom only for sleeping, and not, say, for watching television or playing with the children. Your bedroom is the signal to the body that it is “time to sleep”.
• Sleep restriction: it sounds paradoxical, but it helps: by cutting down the amount of night-time sleep for at least a week, healthy people fall asleep faster the next night, sleep more deeply and are less likely to wake in the night. A sleep-disorder specialist can work out how far sleep time should be cut in each individual case. To do that you first need to keep a sleep diary for two weeks, writing down the time spent in bed each night and estimating the time you slept, how often you woke and the total length of your sleep.
• No exhausting attempts to fall asleep: instead of lying restlessly in bed and turning from side to side for hours at night, you should either pick up a relaxing book or get up and do something active (the ironing, for example).
• Paradoxical intention: if you have difficulty falling asleep, then as you lie there you should ask yourself not to sleep. That often makes you drop off faster than when you force yourself to.
• Cognitive focusing: in bed, concentrate on calming thoughts and images.
• Do not worry about sleep: avoid thoughts of the “I am sure I shall not sleep all night again!” or “Oh God, it is past midnight and I am still awake!” kind. Anxious thoughts like these can feed your sleep disorder.
• Stopping the flow of thoughts: if thoughts going round in circles and endless brooding keep you from falling asleep, you should carefully interrupt such thoughts — every single time, again and again.
• Relaxation techniques: muscle relaxation, a light massage, autogenic training, biofeedback, yoga and meditation can also ease sleep disorders.
• Sleeping pills. In principle, sleeping pills should only be used for a sleep disorder when all other measures (sleep hygiene, sleep restriction, medicinal plants — see below) have proved unsuccessful. It is best to consult a doctor about this. Bear in mind, however, that many medicines lose their effect and can lead to habituation and dependence. Stopping sleeping pills can temporarily make the sleep disorder worse (rebound insomnia). Many sleep medicines reduce muscle tone and muscle control, raising the risk of falls at night. This effect, together with reduced concentration, can carry on through the day and limit your performance. Always take insomnia medication (check the packaging) in the evening before bed, and not when you wake in the night or have already been awake for several hours.

Medicinal herbal teas for sleep disorders

There are various medicinal plants that can help with sleep disorders. They are mostly used as tea:

• Valerian is the medicinal plant for those who cannot fall asleep. It has a calming effect, but is not a painkiller like the chemical sleeping pills. Tea made from valerian root can help with sleep disorders caused, for instance, by nervousness, inner restlessness or too much coffee. If your sleep disorder is chronic, you should drink several cups over the course of the day. If you do not care for valerian's slightly unpleasant taste, you can use valerian-coated tablets, capsules or tasteless tablets.
• Hops can strengthen the calming effect of valerian, since a strong sedative enzyme forms in the hop cones during storage. You can use hops as a tea (as a hop-and-valerian blend, for example) or make yourself a sleep pillow: put hop cones into a cotton pillowcase. Replace the cones after a week.
• Lemon balm is an ancient plant of monastic medicine. Lemon balm leaves and lemon balm oil have a calming effect. The oil is very expensive, so the leaves are used more often. If you have trouble sleeping, you can drink several cups of lemon balm tea over the course of the day.
• Lavender with its violet flowers has long been valued for its calming, sleep-inducing effect. If you have trouble sleeping, drink two cups of lavender tea before bed.
• Passion flower can help with mild forms of nervous restlessness, with difficulty falling asleep and with heart trouble. It has a strengthening, calming and antispasmodic effect. Passion flower herb is found in tea blends together with other calming and relaxing medicinal plants such as lavender and valerian.
• St John's wort is known above all as a herbal antidepressant. Since depression often comes with sleep disorders, St John's wort can also help towards a peaceful night's sleep. The plant is taken as a tea or as a ready-made product (capsules or coated tablets, for example).

!!! St John's wort can reduce the effectiveness of contraceptive pills and other hormonal contraceptives, and also of medicines for asthma, for arrhythmia, for raising blood levels and of coumarin-type blood thinners.

Calming baths that improve sleep

Baths with medicinal herbs can also help with sleep disorders. You can buy a ready-made calming bath at the chemist's or mix a bath preparation yourself — a lavender bath, for example:

For a full bath, mix 2 egg yolks, 1 glass of cream (or milk), 2 tablespoons of honey, 3–4 tablespoons of salt and 1 teaspoon of lavender oil, and add all of it to bathwater at 37 to 38 °C. The egg yolk, the cream or milk and the honey make sure the essential oil does not simply float on the surface but spreads well through the water. Stay in the bath for at least 20 minutes.

Instead of lavender oil you can also use lavender flowers: pour 2 litres of hot water over 100 g of lavender flowers, leave for 5 minutes and add this water to the bath. Stay in the bath for at least 20 minutes.

Sleep disorders in children

Healthy sleep is extremely important for a child's development. Here is some advice on securing a good night's sleep and countering sleep disorders in children:

• A regular sleeping and waking routine: this matters especially for children — make sure you keep to those times strictly!
• A dark bedroom: the light in a child's bedroom should be switched off, or at least dimmed.
• The night is for sleeping: if the child wakes and cries at night, you should never lift them out of bed, carry them about, read aloud, give them something to eat or drink, or take them into the parents' bed. Otherwise, in time, the child may only be able to fall asleep with a parent present.
• Sleeping in bed: do not let the child fall asleep on the sofa in the living room or in your arms, or they will get used to the wrong way of preparing for sleep.
• No dummy or bottle: do not try to send the child to sleep with a dummy or a bottle — even if that is hard.
• Leave them in bed: do not lift babies and small children out of bed when they wake at night. Try to soothe the little one, and before you leave the room say as few words as you can. Children in their first to third year should normally learn to fall asleep on their own.
• Small bedtime rituals: they can help with sleep problems — an evening bath, a quiet game or a bedtime story. Keep them regular and consistent (only one story an evening, for example), otherwise children will not accept the parents' rules.
• Talk openly: unfamiliar events, illnesses or family happenings (a house move, the birth of another child) can cause temporary sleep disorders in children (and in adults too). It can help then to talk with the child about the things that trouble them — but during the day, not before bed.
• Protecting “sleepwalkers”: sleepwalking in children occurs mostly between the ages of four and eight and usually passes by itself. Even so, you should take precautions against accidents during sleep (safety bars on the windows, a barrier on the stairs, a bell on the child's door to wake the parents).
• Give reassurance in case of panic: panic attacks at night occur predominantly in children between four and twelve. The child suddenly wakes up screaming and often drenched in sweat, confused, disoriented and unable to remember the “bad dreams”. The next morning the child usually knows nothing about the attack. As parents there is little you can do about it beyond convincing the frightened child that everything is all right. With age the panic attacks usually die down, and the sleep disorders with them.

When do you need to see a doctor?

Sometimes sleep disorders go away by themselves as soon as the trigger (a stressful phase at work, a house move, an illness) ceases to exist. In other cases good sleep hygiene (see above) can put an end to the sleep disorder.

A visit to the doctor is advisable if:

• the sleep disorder persists (no calm and/or unbroken sleep for at least a month, three nights a week),
• the sleep disorder is putting you in a bad way, and you are often tired and unable to concentrate during the day.

What does the doctor do?

First the doctor will question you in detail about your sleep disorder, your way of life, any previous illnesses and the medicines you take. That way they can gather your medical history (anamnesis) and often get the first clues to the cause of the symptoms. Important information for the diagnosis includes, for example:

• The type of sleep disorder (insomnia with difficulty falling asleep or staying asleep; hypersomnia with excessive sleepiness or bouts of daytime sleep).
• The duration, course and rhythm of the sleep disorder (the sleep–wake rhythm)
• Behaviour during sleep and the circumstances of your life (how much time do you spend in bed? what does your evening look like? do you have particular sleeping habits?).
• Influences from your surroundings (noise, the temperature in the bedroom).
• Questions about the medication you take (sleeping pills, for example).
• Symptoms during sleep and around the time of sleep (thoughts going round in circles, brooding, tension, breathing disorders, restless legs, nightmares).
• How your days go (performance, activity, for example).
• In some cases the doctor will ask the patient to fill in a sleep questionnaire and/or to keep a sleep diary for a while.
• A medical examination.

To get to the bottom of a sleep disorder, the doctor may also carry out various examinations:

• A thorough examination of physical condition
• Laboratory tests (measuring thyroid hormones in the blood, for instance, if an overactive thyroid is suspected as the cause of the sleep disorder),
• electrocardiography (ECG),
• (possibly) electroencephalography.

Where do you turn if the sleep disorder has nothing to do with your health or with your surroundings?

In that case a session with a counsellor is what is needed. At the first session, which is there to get the picture, the specialist works out what is causing the sleep disorder. The work that follows is put together individually and may draw on psychological meditations, visualisation techniques, existential therapy and transactional analysis.

The psychological causes of a sleep disorder can be the following:

• stress a person is not aware of (they feel physically well and hardly notice any particular load on the psyche),
• a grown inner conflict, “mental chewing gum”,
• a veiled fear of death,
• not accepting a life situation (in sleep the person actively tries to replay it),
• a childhood trauma has “woken up”: something has happened that unconsciously recalled traumatic events in childhood,
• not accepting the death of a loved one (sleep disorders can appear several months after the loss).

As many counsellors observe, sleep disorders are bound up with fear. Sleep is associated with slipping away into non-being, and very often it is people who “like” to keep everything under control who suffer from them.

If you would like to talk about sleep disorders, to think them over together, I am waiting for you at the Freud's Legacy club.