The spectrum is large. From the typical insomnia, through parasomnias – such as sleepwalking, nightmares, bruxism, restless legs syndrome, enuresis, sleep paralysis - to the two types of sleep apnoea (obstructive and central), we will describe the main symptoms of these pathologies and how we can control their negative effects and return to a peaceful night’s sleep.

In an interview with Dr Carlos Glória, Medical Director of the HPA Alvor Hospital and a Pulmonologist, we learned to distinguish sleep diseases, identifying them and, above all, to realise the importance of a well-rested night (adults 7 to 9 hours per night) and find out the productivity that a good night sleep can bring to our daily lives.

Realise how simple it can be to end your awful insomnia

HPA Health Group has specialists ready to help you control or even end, insomnia for good. Sometimes, medicines will not be needed and the treatment can be less invasive and without drugs.

“In most cases, the treatment for insomnia should not start with sleeping pills. This is a habit that can be difficult to break as people become addicted to the medication”, refers Dr Gloria. So, how can we end insomnia more naturally? Behaviour therapies are the answer, but first let’s distinguish between the two types of insomnia.

Difficulty in falling asleep is the more common type of insomnia and can be associated with stress, anxiety and, of course, shift work, known as early or initial insomnia. Then, if you’ve no problems in falling asleep, but wake up during night and have trouble falling asleep once again, there is another type of insomnia, which is called late insomnia.

We therefore have to always take into account that insomnia is not an occasional incident, but "a disease that happens often to people who have this pathology" which must be treated and monitored by a specialist.

It is estimated that millions of people of all ages worldwide suffer from this pathology and that it can be solved, in most cases, with what doctor’s call “sleep hygiene”. Sleep hygiene is characterised by a set of good habits which one must accomplish before going to sleep, which according to the doctor, can be summarized as: “going to sleep and waking up at the right time, at the same time and in a calm environment”.

Even during the pandemic, we should take this medical advice into account. Trying to sleep at the same time and waking up at the usual time, will prevent sleep deregulation.

Regarding this point, the doctor leaves us with a tip for our readers who often suffer from insomnia. “One shall go to bed to sleep, not to see series, movies or sports on a mobile phone, a tablet or TV. If after 10-15 minutes one doesn’t fall asleep, then it is better to get up, go to the living room sofa, try to read a book (don’t watch violent films, sports or football, especially if your team is losing…) and go to bed once again when you feel sleepy. If you still can't fall asleep, get up once again and repeat the same thing. A bed is for sleeping, but it is very difficult to make people adapt to this routine. It is a job to be done by professionals in behavioural psychology”, he explains.

Sleepwalking, Nightmares, Bruxism, Bed-wetting, Restless legs Syndrome and Sleep Paralysis

All these pathologies have something in common: they happen during the night, sometimes even without realising. These sleep disorders are called parasomnias and are more frequent in children and adolescents, but they can last into adulthood and can have consequences throughout life if we don’t treat them, when they are supposed to be treated.

As an example of parasomnias, we have somnambulism that is very common in children. Also, nightmares and bruxism, which is a condition where you grind, gnash or clench your teeth during the night, this can cause problems in the temporomandibular joints and teeth. Another frequent parasomnia is enuresis, which is when a 5-year-old child or older presents intermittent nocturnal urinary incontinence.

Abnormal movements during sleep, such as “restless legs syndrome”, will also dramatically affect your sleep quality, said the doctor.

How to treat insomnias or parasomnias? “Ideally these patients should be observed by a psychologist, neurologist or psychiatrist dedicated to sleep. Nonpharmacological approaches may be tried, as behavioural therapy, hypnosis, etc. Interesting tips may also be given. For example, if a child is having a nightmare, parents are advised that the child should not be woken up. Parents should be near, making sure that the child is not hurting himself by any movements and, if the child wakes up, parents may talk to him about the nightmare and try for example, to find a happy ending to the nightmare”, explained the doctor.

Sleep paralysis is one of the symptoms of narcolepsy, which is also a frequent parasomnia. It is a complete inability to move for one or two minutes immediately after awakening, although it may also occur just before falling asleep. Patients with this sleep disorder may also present excessive sleepiness during the day. “Sleep paralysis is one of the more complex parasomnias but there are several medications that help to relieve the symptoms. It is a disease treated by neurologists and psychiatrists”. Refers Dr Gloria.

Sleep Apnoea – how to detect it?

Finally, one of the most common type of sleep disorders is sleep apnoea. Dr Carlos Glória, who is a specialist in this area, explains that there are two types, central and obstructive apnoea.

Starting with the less common, Central Sleep Apnoea Syndrome: it occurs when “the brain does not deliver the neurological stimulus through diaphragm contraction, to initiate breathing”. It is more common in the elderly, patients with heart failure, cerebrovascular diseases or in people of any age who have suffered brain trauma or tumours, etc. It is a disease where there is no pharmacological effective treatment. Patients use a portable ventilator during sleep. This device recognises when a person is not breathing. It provides a respiratory cycle when a person is not breathing”, said the specialist.

The other type of apnoea syndrome is Obstructive Sleep Apnoea, which is responsible for 50 percent of all sleep consultations, with 500 million people suffering from obstructive sleep apnoea worldwide.

To begin explaining why this type of apnoea occurs, it is worth mentioning that for a good night's sleep you need to go through a period of time on superficial sleep, a period of profound, deep sleep and a period of dreaming, known as REM (because there are Rapid Eyes Movements during this sleep stage).

“What happens is that the patient who suffers fromobstructive apnoea, relaxes the larynx and pharynx muscles when they fall asleep. During the period of sleep the patient starts to snore, and when sleep is deep, air doesn’t pass through the airways which become completely or almost completely closed. During this period of time, our breathing part of the brain tells us to breathe, but the air does not reach the lungs, because the upper airways are collapsed. The oxygen in the blood is reduced so our brain tells us to wake up - we call this a micro-wakening - going from deep to superficial sleep. In this situation our night sleep is very fragmented, without prolonged periods in superficial, deep or REM sleep. So, “even if a patient sleeps 12 or 15 hours daily, it is a poor-quality sleep, and the individual will wake up feeling tired, and will feel sleepy all day long”, mentions Dr Gloria to The Portugal News. The treatment for this disease includes a portable device (named a CPAP) used most of the time, which delivers a continuous and variable air pressure into the upper airways, causing the airway to open during periods of deep sleep without which air can´t reach the lungs.

Risk Factors – How to find out if one suffers from obstructive apnoea?

“In children, parents soon find out if their children snore, and one of the most frequent causes is enlarged tonsils, which sometimes will need to be surgically removed. In adults, when apnoea occurs during sleep, the spouse notices loud snoring and eventually, respiratory pauses during the partner’s sleep”, explained the doctor.

So, it is usually easier to find out if we have a partner sleeping alongside, but if you don’t have a partner, there are some symptoms that we might notice ourselves such as: waking up after a long sleep with the feeling that sleep was not restful; sometimes waking up with a sensation of suffocation; and the most frequent symptom, which is excessive sleepiness during the day. Risk factors for obstructive sleep apnoea mentioned by the doctor are; overweight, age and family history. Dr Glória also said that some diseases such as hypertension, strokes or diabetes are more frequent in patients with sleep apnoea, and most of the time the treatment for sleep apnoea will result in a decrease of the usual medication needed to control hypertension or diabetes. Of course, overweighed patients will also benefit from losing weight to control obstructive sleep apnoea.

Apnoea is more frequent when sleeping on your back, but it’s not the same for everyone. HPA professionals are able to perform a test in order to find out how many times apnoea occurs while sleeping, and in which sleep position apnoeaoccurs. “Patients usually experience twice as many periods of apnoea when they are sleeping on their back rather than sleeping laterally, because this increases the chances of airway obstruction”, said Dr Carlos Glória.

If you have any doubts or suspicions that you suffer from any of these diseases or another sleep disorder, please contact the HPA Health Group, where you’ll find the right specialist to carry out all the tests and prescribe the most appropriate treatment for your specific and unique situation.