Who permanently sleeps badly, should go to the doctor. Conversations, physical examinations and a sleeping diary usually helps to find the cause. Sometimes, even staying in a sleep lab brings clarity.
The International Classification of Diseases (ICD-10) and Sleep Disorders (ICSD-3) divides these into different groups and degrees of severity from mild to severe. The classifications are from time to time adapted to the latest findings from sleep research. They provide the doctor with helpful tools to diagnose a sleep disorder.
In the center for the doctor, however, is what the patient reports, how he perceives his sleep problems, in what form his everyday life is affected by it and what other complaints he has.
However, not a few people have the subjective impression of poor or too little sleep but feel physically and mentally fit during the day. Well-being and daytime performance are important criteria for the doctor to assess a sleep disorder. For example, sleep experts call sleep disorders more correct than non-restorative sleep.
Because on the other hand, there are people who do not perceive disturbances of their sleep, so they have the feeling of sleeping normally. During the day, however, they are not well-rested or even sleepy and suffer repeatedly from lack of concentration and performance.
Frequently asked questions about the quality of sleep the doctor wants to know:
How do the sleep problems manifest themselves? When do you go to bed, how long do you need to fall asleep. Do you wake up at night, if so, how often? When do you wake up in the morning?
What is your state of health during the day? Are you often tired and unfocused? Do you often feel depressed and listless?
Do you keep submitting during the day, maybe even in inappropriate situations?
Do you snore or have nocturnal breathing interruptions?
Do you have physical complaints? For example, breathing problems, joint or headache, heart problems, muscle pain, muscle twitching, tingling in the arms or legs?
Are you suffering from a certain illness?
Do you take medications, such as antihypertensive remedies, asthma, allergies?
Do you take sleeping pills?
What is your life and work situation? Do you need to travel often, even in other time zones? Do you do shift work?
Are you under stress in your private or professional life? Are there things that burden you, scare you?
Do you often feel drive-less, sad and depressed?
What does your sleeping area look like (bedroom, bed, mattress, temperature, air supply)? How is the environment influencing your sleep (noise, brightness, air quality)?
How much coffee do you drink a day and when? How much alcohol? What do you eat in the evening?
How do you design your evenings?
Are you worried when you go to bed that you will not sleep well again?
To capture sleep habits and discomfort even more accurately, it is very helpful to keep a sleep diary and write down the sleep habits and experiences for a week or two. The list of questions provided by the doctor provides important clues. Relevant are, for example, the bed times, the actual duration of sleep, the type and frequency of waking up, disturbing nocturnal influences, and how the sleep quality is subjectively assessed.
Also valuable are observations of the sleeping partner regarding abnormalities such as breathing pauses and recurrent leg movements of the affected partner during sleep (see also the collection of questions above).
The medical history that the doctor asks, if it is not yet familiar to him, usually follows a detailed physical examination to uncover any unknown health problems. Here, for example, high blood pressure or other cardiovascular diseases, vascular calcification (arteriosclerosis), respiratory problems or stomach ailments are eligible.
If necessary, various laboratory tests follow, for example to detect possible thyroid disorders or kidney problems. An electrocardiogram (measurement of the cardiac current curve) and ultrasound examinations provide information on the function of the heart and other internal organs, such as the liver and important vessels.
Depending on the outcome of the examinations, the family doctor may refer the patient to a doctor from another discipline. Among others, an internist, pulmonologist, otorhinolaryngologist, a dentist trained in sleep medicine, orthodontist or oral and maxillofacial surgeon, sometimes also a diabetologist or a hormone and gland specialist (endocrinologist) may be responsible.
For problems in the area of the nerves and the brain a neurologist is responsible. If the doctor suspects a mental illness behind the sleeping problems, a psychotherapist or psychiatrist will be the next contact persons.
Central tasks in the diagnosis and treatment of sleep disorders finally take over sleep medicine. Their examinations are carried out on an out-patient, semi-stationary and in-patient basis. In the beginning there are often special sleep questionnaires and point catalogs (indices, scales) with which they can more accurately record the sleep disturbance and the extent of the associated complaints. For example, they diagnose excessive daytime sleepiness (hypersomnia) with the help of so-called wakefulness or vigilance tests.
Also, examinations of, for example, motor activity (motion measurement or actometry) are initiated on an outpatient basis. A motion meter on the wrist registers the movements during sleep and wakefulness for 24 hours, of course, even when sleep is interrupted. This also runs for about two weeks and is then analyzed via a computer.
The actual sleep examinations take place during a one to three-day stay in the sleep laboratory. Sleep questionnaires and sleep diaries are also used for therapy control.
Examination in the sleep laboratory
Most of the triggers for insomnia can be clarified by the doctor by detailed questioning and the usual physical examinations. If he has the suspicion that another, inner sleep problem is behind the symptoms, such as a disturbance of the sleep-wake cycle, breathing interruption in sleep (sleep apnea) or a movement disorder such as the Restless Legs syndrome, it will be useful to examine the person concerned even more closely in this direction.
This can be done in a sleep laboratory. University clinics and large specialized hospitals sometimes have sleep departments with appropriate screening facilities.
A sleep laboratory consists of dormitories connected to an examination room. The patient is connected to various measuring devices located in the examination room and used to create a polysomnogram.
The measurements record various organ activities, such as brain waves (electroencephalogram, EEG), eye movements to classify REM sleep (electrooculogram, EOG), heart activity (electrocardiogram, ECG), muscle activity at the legs and chin (electromyogram, EMG). They also note the breathing through the nose, possible snoring, the respiratory movements of the chest and abdomen and the oxygen saturation of the blood.
Complementary video recordings can help with certain issues such as movement disorders during sleep.
Out-patient polygraphy with simpler systems is used by sleep doctors to diagnose a sleep-disordered breathing disorder when it is already likely to be due to indicative complaints.
The polygraphy can also be used to clarify a possible sleep-disordered breathing in patients with known diseases of the cardiovascular system.
The therapy of sleep disorders depends on the cause. However, it is always about improving the sleeping and living habits in such a way that sleeping and waking can take place in their natural rhythm and bring the highest possible degree of recovery. In the following chapters, you will learn more about the most important causes of restless nights.