Sleep Disorders – What Helps

Brief overview

Description: Problems falling asleep and/or staying asleep, feeling excessively tired during the day
Symptoms: Vary depending on the type of sleep disorder; in addition to tiredness, for example, headaches, memory problems, eating disorders, teeth grinding, movement disorders of the limbs, breathing disorders, sleepwalking
Causes: Stress or unfavorable sleeping conditions, but also psychological, organic or neurological illnesses, medication, drugs
Tips: Ensure good sleep hygiene (regular bedtimes, comfortable bedroom temperature, no coffee or alcohol in the evening), don’t try to force yourself to fall asleep, relaxation techniques (yoga, meditation, etc.), medicinal plants (e.g. as capsules, lozenges or tea), sleep-promoting baths
When to see a doctor? In the case of persistent sleep disorders; if sleep disorders are a massive burden; if you are tired and unable to concentrate during the day. The first point of contact is your family doctor. He or she will refer you to a specialist if necessary.

Sleep disorders: Description

Almost everyone experiences short-term sleep problems over a few days during stressful phases of life, during an illness (e.g. a cold with a cough and blocked nose) or due to stressful situations. They are usually harmless.

Sleep disorders are widespread and not a trifle. Chronic sleep disorders, in particular, can severely restrict the daily well-being and performance of those affected, impair their social skills and lead to accidents.

Sleep disorders: How do they manifest themselves?

Experts distinguish between more than 80 different sleep disorders, which can be divided into eight main groups according to the type of symptoms:

Insomnia: These include difficulty falling asleep, difficulty sleeping through the night, early morning awakenings and chronically unrefreshing sleep. In addition, those affected complain of fatigue, attention or memory problems, mood impairment, tension, headaches and/or worries about the sleep disorder. Insomnia is one of the most common forms of sleep disorders. They can be triggered by psychological stress (e.g. financial worries) or substance abuse (such as excessive use of sleeping pills).
Sleep-related breathing disorders: They include, for example, various forms of sleep apnea. This causes breathing to stop at night, i.e. breathing pauses briefly – often unnoticed by the sleeper.
Circadian sleep-wake rhythm disorders: Such rhythmic sleep disorders can be triggered by time zone changes (jet lag), shift work, organic illnesses or the abuse of medication or substances. They lead to insomnia and severe daytime sleepiness.
Parasomnias: These are episodic interruptions of sleep due to unusual physical phenomena or behaviors such as sleepwalking, nightmares, nocturnal moaning, sleep-related eating disorder or repeated, unconscious voiding of the bladder during sleep.
Sleep-related movement disorders: The sleep disturbances here are caused by simple, usually stereotypical movements. A common sleep-related movement disorder is restless legs syndrome (RLS). Other sleep disorders in this category include periodic limb movement disorders and night-time teeth grinding.
Other sleep disorders: This refers to all sleep disorders that cannot be assigned to any of the other categories, for example because they have not yet been sufficiently investigated or have characteristics of different categories of sleep disorders.

The various sleep disorders can overlap. For example, some people suffer from insomnia as well as sleepwalking (a form of parasomnia) and sleep-related breathing disorders. This is what makes the subject of sleep disorders so complex.

Sleep disorders: Causes and possible illnesses

Sleep disorders can be divided into primary and secondary sleep disorders according to their cause:

Primary sleep disorders

No physical or psychological cause can be found for primary sleep disorders. They are caused by stress or unfavorable sleeping conditions, for example.

Secondary sleep disorders

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

Mental illnesses such as depression, anxiety disorders (e.g. generalized anxiety disorder), psychoses or schizophrenia almost always also trigger sleep disorders (e.g. difficulty falling asleep and staying asleep).
Medication can sometimes cause sleep disorders as a side effect. These include antibiotics, certain antidepressants (e.g. MAO inhibitors, SSRIs), high blood pressure medication (e.g. alpha blockers), asthma medication (e.g. theophylline), sleeping pills such as benzodiazepines (renewed sleep disturbances after abrupt discontinuation of the preparations), cortisone, thyroid hormones, medication for dementia, diuretics, antihistamines (allergy medication) and medication that cancer patients receive as part of chemotherapy (cytostatics).
Legal and illegal drugs can also cause sleep disorders, for example in the form of difficulty falling asleep, difficulty sleeping through the night or sleep apnoea. Sleep-disrupting drugs include alcohol, caffeine (e.g. coffee, black tea, energy drinks), nicotine, cannabis, heroin, cocaine and ecstasy.

Sleep disorders: What you can do yourself

Sometimes a physical or mental illness is the cause of sleep disorders. In such cases, treatment by a doctor is of course the first priority. However, in these cases you can also do something about the sleep disorders yourself.

Rules for restful sleep

Two thirds of all sleep disorders can be improved with non-medicinal measures. Above all, this includes good sleep hygiene. It includes the following rules:

Do not sleep more than your body needs. This is particularly important for older people.
Get into the habit of having regular bedtimes.
Do not take a nap during the day (e.g. midday nap).
Ensure comfortable sleeping conditions. This includes the right bedroom temperature (around 18 °C is ideal).
Don’t drink alcohol or coffee in the evening – both have a stimulating effect. If you are sensitive to caffeine, you should avoid it from midday onwards. This also applies to cola, energy drinks and cocoa.
Make sure you eat a balanced diet and exercise regularly. If you only eat fast food and sit on the couch all day, don’t be surprised if you have trouble sleeping.
Make sure you have a relaxing evening that brings the day to a slow close. On the other hand, strenuous fitness training in the evening or an exciting thriller as an evening read can promote sleep disorders (e.g. difficulty falling asleep).

Tips against sleep disorders

In addition to good sleep hygiene, the following tips can also help against sleep disorders:

Sleep restriction: Sounds paradoxical, but it helps: healthy people with sleep problems who reduce the amount of sleep they get at night for at least a week fall asleep more quickly the following night, sleep more deeply and wake up less often at night. A therapist can calculate how long bedtime should be reduced in each individual case. To do this, you must first keep a sleep diary for two weeks in which you record the time spent in bed each night and estimate the time you fall asleep, the frequency with which you wake up and the total amount of time you spend asleep.
No convulsive attempts to fall asleep: Instead of tossing and turning restlessly for hours at night, it helps some sufferers to pick up a relaxing book or get up and actively occupy themselves (e.g. ironing).
Paradoxical intention: If you suffer from difficulty falling asleep, you can try the “wake-up command”: Ask yourself to stay awake when you lie down. This often helps you to fall asleep more quickly than if you frantically try to fall asleep.
Cognitive focusing: Concentrate on calming thoughts and images in bed.
Stop thinking: If constant thoughts and ruminations prevent you from falling asleep, you should rigorously stop such thoughts – each time anew (perhaps with a loud or thoughtful, but in any case decisive “Stop!”).
Relaxation techniques: Progressive muscle relaxation, autogenic training, biofeedback, yoga and meditation can also alleviate sleep disorders in the long term.

Treatment with medicinal plants (phytotherapy)

The effect of the measures described above, such as good sleep hygiene and relaxation techniques, can be supported with medicinal plants. They have a relaxing, calming and/or sleep-promoting effect:

Medicinal plant preparations from the pharmacy

The effect of the medicinal plants mentioned can be best utilized if you use appropriate ready-made preparations from the pharmacy. Herbal medicines (phytopharmaceuticals) have a controlled content of active ingredients and are officially approved as medicines. They are available in the form of drops, capsules, coated tablets or tablets. Many phytopreparations also combine several medicinal plants.

Medicinal plants as tea

You can also try medicinal plant teas for sleep disorders, nervousness and restlessness:

Passionflower: It can help with mild forms of nervous restlessness, difficulty falling asleep and nervous heart complaints. Passionflower herb is often found in tea blends together with other calming and relaxing medicinal plants such as lavender and valerian.
Valerian: It has a calming effect, but is not anaesthetic (narcotic) like chemical sleeping pills. A tea made from valerian root can help with sleep disorders caused by nervousness, inner restlessness or too much coffee. For chronic sleep disorders, you should drink several cups throughout the day.
Hops: They can enhance the calming effect of valerian because a strong calming agent forms in the hop cones during storage. Hops are often used in tea blends (e.g. as hop-valerian tea).
Lemon balm: Lemon balm is a well-known medicinal plant from monastic medicine. Lemon balm leaves (and the expensive lemon balm oil) have a calming effect, among other things. If you have trouble sleeping, you should drink several cups of lemon balm leaf tea throughout the day.
Lavender: With its purple flowers, it has long been valued for its calming and sleep-promoting effects. If you have trouble sleeping, drink two cups of lavender tea before going to bed.

St. John’s wort can reduce the effectiveness of the contraceptive pill and other hormonal contraceptives as well as many other medications (e.g. drugs for asthma and cardiac arrhythmia, coumarin-type blood thinners). You should therefore consult your doctor before use.

Soothing and sleep-inducing baths

Baths with medicinal herbs can also help with sleep disorders. You can either buy a ready-made calming bath from the pharmacy or drugstore or prepare the bath mixture yourself, for example a lavender bath based on lavender oil.

You will need an emulsifier such as egg yolk, milk or cream. It ensures that the non-water-soluble oil is well distributed in the bath water and does not just float on the surface or cling to the edge of the bath. How to prepare the lavender bath:

For a full bath, mix together two egg yolks, a cup of cream (or milk), two tablespoons of honey, three to four tablespoons of salt and a teaspoon of lavender oil.
Add the mixture to the bath water at a temperature of 37 to 38°C.
Soak for at least 20 minutes.

You can also use lavender flowers instead of lavender oil: Pour two liters of hot water over 100g of lavender flowers, leave to infuse for 5 minutes and add to the bath water. The bath should last at least 20 minutes.

Rubbing with lavender oil

For example, you can ask someone to warm a few drops of the oil in their hands and then rub it into your back for a few minutes (using only light pressure and avoiding the spine).

You can rub lavender oil into your feet yourself. Work from the ankle to the toes.

It is best to lie down in bed for the rubbing (back, feet) so that you can rest immediately afterwards.

Camomile compress

A chamomile compress is also a sleep-promoting heat application:

Pour half a liter of boiling water over one or two tablespoons of chamomile flowers.
Cover and leave to infuse for five minutes, then strain the flowers.
Place a compress in the brew and leave to infuse for a few minutes.
Place the soaked inner cloth close to your stomach and leave it to work for 20 to 30 minutes.

The abdominal compress against insomnia is best applied in the evening before going to sleep.

You can read more about the correct use of compresses in the article Wraps (compresses) and compresses.

Non-prescription sleeping pills

Over-the-counter sleeping pills are available in pharmacies, many drugstores and health food shops. These include, for example

Sleeping pills that contain diphenhydramine or doxylamine
Sleeping pills that contain the sleep hormone melatonin in low doses (does not apply to Switzerland)

Over-the-counter sleeping pills are a good option if non-medication measures (good sleep hygiene etc.) do not help sufficiently. Your pharmacist or doctor will tell you how to use the preparations correctly and how long you can take them.

If you are also taking other medication, discuss the use of over-the-counter sleeping pills with your doctor or pharmacist. He or she can advise you on the selection of a suitable preparation and assess possible interactions between your medications.

Sleep disorders: Home remedies

If you have problems falling asleep or staying asleep, various home remedies for sleep disorders may be able to help you.

Cold for insomnia

Cold showers: Evening showers can have a sleep-inducing effect. To do this, use cold water at around 18 degrees Celsius. Start at the foot and then slowly move the jet of water up the outside of the leg to the knee. Then let the jet move back down the inside of the leg.

Then gently wipe off the water with a towel – do not dry off! You should repeat the cold leg soaks every evening.

Cold, moist calf compresses: They have a calming and relaxing effect, especially if they are left on for a long time, for example overnight. They can also be used to help you fall asleep.

Warmth can promote sleep

Many people also find warmth in bed before going to sleep pleasant. As a simple home remedy for insomnia, you can put a hot water bottle or a warm grain pillow (e.g. cherry stone pillow) in bed. This has a relaxing effect and promotes blood circulation.

Warm milk with honey to help you fall asleep

Warm milk with honey can help you fall asleep. Not only can it soothe irritated mucous membranes in the throat (e.g. if you have a cold) – milk also contains the amino acid tryptophan. This can stimulate the release of the sleep hormone melatonin in the brain.

To do this, tryptophan needs a means of transportation: the transport protein albumin. However, other amino acids bind much better to the transport molecule. This is where honey comes into play: the carbohydrates it contains inhibit the transfer of amino acids into the brain – but tryptophan is an exception.

If you want to take advantage of this effect, heat a glass or cup of milk and dissolve a teaspoon of honey in it. Before going to bed, drink the honey milk in small sips, preferably lukewarm.

Babies under the age of one should not drink honey. It can contain bacterial toxins that are dangerous for them.

Tips against sleep disorders in children

Restful sleep is extremely important for children’s development. Here are some tips to support restful sleep and counteract sleep disorders in children:

Regular sleeping and waking times: These are particularly important for children. Make sure you strictly adhere to these times – even at weekends and during the vacations.
Small sleep rituals: A bath every evening, a quiet game, an evening bedtime story or a song can help children to fall asleep. Ensure regularity and consistency.
Darkened bedroom: The light in your child’s bedroom should be switched off or at least dimmed. A small night light is allowed if it makes the child feel more comfortable.
Fall asleep in their own bed: Do not let the child fall asleep on the sofa in the living room or on your arm, otherwise it will get used to a wrong sleeping pattern.
No pacifier or bottle: Do not try to lull a baby to sleep with a pacifier or bottle – even if it is difficult.
Openness: Unusual activities, illnesses or family events can cause temporary sleep disturbances in children. It can also help smaller children who can already talk if you talk to them about the things that are bothering or stressing them – but during the day and not before bedtime.
Protect little sleepwalkers: Sleepwalking in children usually occurs between the ages of four and eight and usually resolves itself. However, it is important to take safety precautions to prevent accidents during sleepwalking (e.g. safety bars on windows, a barrier on the stairs, an alarm bell on the door to the child’s room to wake the parents).
Safety during panic attacks: Night-time panic attacks occur mainly in four to twelve-year-old children. The child suddenly wakes up screaming and often drenched in sweat, is confused, disoriented and cannot remember any “bad dreams”. The next morning, they usually don’t remember anything about the panic attack. As parents, there is little you can do except comfort the startled child and reassure them that everything is fine. As the child gets older, the panic attacks usually subside and with them the sleep disturbances.

Sleep disorders: When do you need to see a doctor?

Sometimes sleep disorders disappear on their own as soon as the trigger (such as a stressful phase at work, moving house, illness) disappears. In other cases, good sleep hygiene (see above) can eliminate the sleep disorders. A visit to the doctor is advisable if:

the sleep disturbances persist (no restful and/or continuous sleep three nights a week for at least one month),
the disturbed night’s sleep is causing you a lot of stress and
you are often tired and unfocused during the day.

If you are experiencing stressful sleep disorders, go to your family doctor first. Based on a detailed discussion to record your medical history, he or she can often already deduce the cause of the sleep disorder, for example unfavorable sleeping conditions, an illness (such as depression, hyperthyroidism or hypothyroidism) or the intake of a certain medication (e.g. antihypertensives).

Your GP may refer you to a specialist, for example an ENT specialist in the case of heavy snoring. If necessary, he or she will also recommend a sleep specialist (sleep laboratory).

Sleep disorders: What does the doctor do?

The doctor will first investigate your sleep problems in more detail. Depending on the results, he will suggest a suitable treatment.

Clarification of sleep disorders

Type of sleep disorder (e.g. insomnia with difficulty falling asleep and/or sleeping through the night, hypersomnia with excessive tendency to sleep or daytime sleep attacks)
Duration, course and rhythm of the sleep disorder (sleep-wake rhythm)
Sleep behavior and life circumstances that influence sleep (e.g: How much time do you spend in bed? What do you do in the evening? Do you have certain sleeping habits?)
Environmental influences (e.g. noise, temperature in the bedroom)
Pre-treatment (e.g. taking sleeping pills)
Symptoms during the period of falling asleep and staying asleep (circling thoughts, brooding, tension, breathing disorders, restless legs, nightmares, etc.)
Daytime mood (e.g. performance, activity)

In some cases, doctors also ask their patients to complete a sleep questionnaire and/or to keep a sleep diary for some time.

Investigations

To get to the bottom of sleep disorders, the doctor can also carry out various examinations such as

Careful physical examination
Laboratory tests (e.g. measurement of thyroid hormones in the blood if thyroid dysfunction is suspected as the cause of the sleep disorder)
Measurement of electrical heart currents (electrocardiography = ECG)
Measurement of electrical brain waves (electroencephalography = EEG)

In the sleep laboratory

The examination in the sleep laboratory takes place at night, i.e. the patient spends the night in a separate bedroom in the laboratory where the sleep physicians can monitor their sleep: The patient’s physiological signals are recorded, which can be used to quantitatively assess sleep (with its various light and deep sleep phases), the sleep disorder and diseases associated with sleep. As part of this so-called polysomnography (PSG), the following physiological functions are measured and recorded using electrodes or sensors:

brain waves (electroencephalography, EEG)
eye movements (electrooculography, EOG)
muscle activity (electromyography, EMG)
heart activity (electrocardiography, ECG)
respiratory flow and respiratory effort
oxygen saturation
body position

Sometimes the patient’s sleep is also recorded on video. This allows any behavioral abnormalities during sleep to be taken into account later when evaluating the data.

Treatment with prescription sleeping pills

If necessary, your doctor will prescribe you a prescription sleeping pill. In principle, it is only advisable to use such medication if all other measures (e.g. sleep hygiene, sleep restriction, medicinal plants) have been unsuccessful.

Bear in mind that many of these medications can lead to habituation effects and even addiction. Stopping them can temporarily exacerbate the sleep disorder again (rebound insomnia).

Many of these sleep medications reduce muscle tension and control, which increases the risk of falling at night. This effect and a reduced ability to concentrate can last into the day and limit your performance.

You should therefore always take such sleep medication (read the package leaflet!) in the evening before going to bed and not when you wake up at night or have already been awake for a few hours.

Seek comprehensive advice from your doctor or pharmacist on the correct use of sleeping pills for sleep disorders!