Experience in the development of somnology in a medical institution. Somnology. Tasks solved by somnologists of the Integramed sleep clinic

Sleep is not a time "crossed out" from our active life. Sleep is a vital, complex physiological process that has been formed in the course of evolution. Modern research shows that sleep is important for the processes of recovery, immunity, memory and normal mental state. Sleep deprivation is associated with an increased risk of arterial hypertension, diabetes mellitus and reduces overall life expectancy.

Sleep disorders and the peculiarities of its regulation are the cause of the development of various diseases that have an extremely negative impact on the health status and quality of life of patients. Numerous studies show that breathing disorders during sleep are associated with a high risk of life-threatening cardiovascular complications (myocardial infarction, stroke, heart rhythm disturbances) and sudden death during sleep.

Sleep disorders are often accompanied by excessive daytime sleepiness, which patients do not adequately assess and usually believe that they are generally in control of their actions. Studies show that in such situations, the risk of traffic accidents, accidents and accidents at work increases significantly. This leads to significant economic losses and poses a danger to everyone around.

Awareness by society and doctors of the consequences of sleep disorders has led to the emergence and active development of a new direction in medicine - sleep medicine (somnology). The diagnosis and treatment of sleep disorders requires specialized training, practical experience and appropriate technical capabilities.

The somnology room is equipped with modern equipment that allows for basic diagnostic examinations: polysomnography, cardiorespiratory monitoring, computerized pulse oximetry, and actigraphy. The equipment allows to carry out diagnostic researches both in the conditions of a hospital, and at home. The cabinet is equipped with the most modern devices for the treatment of respiratory disorders during sleep. The staff of the office have a great experience of practical work and regularly visit all major world forums on sleep medicine.

Practical question: “When should I seek help from a sleep doctor?”

Below are the standard, generally accepted provisions when a consultation is indicated and the choice of the correct tactics of medical actions is necessary.

• Increased daytime sleepiness (for example, falling asleep in the theater, at a meeting, while driving, etc.).
• Stops breathing during sleep.
• Waking at night with a feeling of suffocation, shortness of breath.
• Weakness, fatigue, headache on waking in the morning, despite sufficient sleep.
• Intense regular snoring, especially in combination with high blood pressure, type II diabetes, lung diseases.
• Sustained, elevated blood pressure in the morning, despite active antihypertensive therapy.
• Paroxysms of atrial fibrillation that occur at night or shortly after waking up.
• Poor quality of sleep: “It takes me more than 30 minutes to fall asleep” “I often wake up at night and have difficulty falling asleep” “I wake up very early, I struggle and cannot fall asleep.”
• Long-term use of sleeping pills with the formation of dependence.
• Sleep problems when flying across time zones.
• Rhythm of sleep "owl" with the inability to timely "turn on" in the daily business activity.
• Extremely unpleasant sensations in the arms and legs (burning, crawling, etc.), causing a steady desire to move the limbs and subside when moving.
• Episodes of sudden sharp weakness in the muscles of the body with strong emotions (joy, anger, anger, etc.), sometimes combined with a fall.
• Regular nightmares.
• Attacks, seizures, unusual behavior during sleep (sleepwalking, violent motor activity corresponding to dreams, gnashing of teeth, etc.).

Diseases caused by a violation, the quality of sleep and its structure are solved by the medical direction - SLEEPING.
somnologist- a doctor who deals with the treatment, diagnosis of these problems.

We will be glad to see you in the sleep department of the Moscow clinic "IntegraMedservice"

• Respiratory-somnological center "IntegraMedservice" is accredited in ROS (Russian Society of Somnologists).
• Since 2014, 406 people have been admitted on the problems of snoring, apnea, and hypoventilation.
• Head of the respiratory and sleep center "IntegraMedservice" Ph.D. Kuleshov A.V. worked in the laboratory of respiratory disorders during sleep at the Research Institute of Pulmonology of the Federal Medical and Biological Agency of Russia for more than 12 years.
• Since 2014, the somnologists of our clinics have performed 173 cardio-respiratory tests, 233 cardio saturation tests.
• 82 patients with obstructive sleep apnea, snoring, hypoventilation underwent CPap therapy.

Andrey Vladimirovich Kuleshov

Somnologist, pulmonologist, therapist, candidate of medical sciences, chief physician of the clinic "IntegraMedservice"

Muldasheva Aliya Amangalievna

Doctor Somnologist, otorhinolaryngologist, Candidate of Medical Sciences

"Facts from Morpheus"

Good sleep is an essential part of everyone's life. If a person does not get enough sleep, his body works with overload.

Healthy people should sleep between 7 and 9 hours at night. There are "sleepy" not capable of active work without 10 hours of sleep.

It is not uncommon for people to be able to get enough sleep for 6 hours of sleep.

Divorced, widowed, single people often complain of insomnia.

Sleep snoring statistics 44 percent men, 28 percent women aged between 30 to 60 years old snore.

Seasonal mood swings, depression are associated with the distribution of light and dark hours of the day that occur in winter.

Multidisciplinary studies based on a sufficient sample have consistently found an increasing number of cases of hypertension in patients suffering from OSAS (sleep apnea).

The Department of Somnology and Sleep Medicine at IntegraMedservice solves the following problems related to sleep disorders

Obesity hypoventilation:

Diagnostics, treatment

Insomnia (insomnia):

Diagnostics, treatment

normal sleep is an essential part of everyone's life. If a person does not get enough sleep, his body works with overload. The person gets sick more often. The quality of life in this situation is reduced. Contacting a somnologist solves the problem.

Somnology ( from lat. somnus - sleep) is a “young” direction in medicine, but as it turns out, it is necessary for a person.

Sleep centers engaged in the diagnosis, treatment, prevention sleep disorders. The sleeping person is unconscious. The unconscious state determines the complexity of the course of chronic diseases. These diseases include: bronchial asthma, strokes, heart attacks, arrhythmias, arterial hypertension.

Stopping breathing during sleep (sleep apnea) causes headaches, hypertension, decreased sexual activity, potency, obesity, sometimes sudden death in a dream. The cause of such deviations as somnambulism, teeth grinding or enuresis can often be too deep sleep or, conversely, not deep enough.

Tasks solved by somnologists of the Integramed sleep clinic

• Diagnosis, treatment of snoring;
• Diagnosis, treatment of apnea - obstructive, central;
• Diagnosis, treatment of insomnia;
• Diagnosis and treatment of obesity hypoventilation.

Helping patients with pulmonary pathology, our doctors are focused on breathing problems during wakefulness, as well as during dreams.

We use in diagnostics:

• Computer pulse oximetry is a screening method for diagnosing sleep hypoxemia;
• Cardio-respiratory test - diagnoses OSA, hypoventilation, central apnea.

A project is underway to purchase polysomnographic equipment with video monitoring. During the study, the equipment registers indicators that are recorded on a computer. These data are processed by a computer and as a result, the somnologist doctor receives a record - hypnogram. Hypnogram describes the phases of sleep, their duration in a particular patient. If necessary, treatment is prescribed.

Treatment includes medications, dental protectors, non-invasive ventilation, psychotherapy, reflexology, phototherapy (treatment with bright white light). Phototherapy appointed in the morning hours. But if you need activity at night, then phototherapy is carried out in the evening. For example, to medical staff before night duty.

Do not self-medicate- Find out the reasons for feeling unwell. For insomnia, daytime sleepiness, snoring, constant sleepiness, seek the help of a somnologist. Even if you think your problem is minor, still contact a specialist.

During the last decades sleep medicine- a field of medicine dedicated to the diagnosis and treatment of sleep disorders ( somnology), has evolved from a rare and somewhat exotic field of medical activity into a real-life clinical discipline with its own fundamental principles and standards of practice.

ATTENTION: You can get advice on sleep disorders by calling: +7-495-992-14-43

The number of sleep laboratories and centers is growing, more and more doctors are dealing with problems of sleep disorders, scientific research in the field of sleep medicine provides answers to questions that have worried doctors and their patients for a long time.

The public interest in sleep problems is not accidental and is largely due to the significant impact that sleep disorders have on health, the duration and quality of life of people, public safety and the state of the economy.

Currently, sleep disorders are usually considered as a large independent group of diseases, which includes more than 80 nosological forms. Some of these disorders are quite rare and are mostly of research interest, others, such as insomnia, affect tens or hundreds of millions of patients.

A number of sleep disorders do not pose an immediate threat to the patient's life. others may be associated with an increased risk of dangerous complications.

Thus, the results of a significant number of studies indicate that obstructive sleep apnea syndrome may be a risk factor for the development of acute myocardial infarction or cerebrovascular accidents. Some sleep disorders occur predominantly in patients at a certain age, others haunt patients throughout their lives.

To date, diagnostic criteria and guidelines for the treatment of most of the known sleep disorders have been developed. At the same time, the level of provision of specialized medical care to this category of patients is still far from desirable. Not only patients, but also many doctors do not know well enough the features of the clinical picture of sleep disorders, the possibilities of their diagnosis and treatment. The level of teaching in sleep medicine and related disciplines in most medical schools, as well as in the system of postgraduate training of doctors, is clearly insufficient. There are no necessary teaching aids and methodological materials, and special training programs for sleep medicine have not been developed. Therefore, one of the goals of this Internet resource, in our opinion, may be to solve the problem of increasing the level of knowledge of doctors of various specialties in the field of diagnosis and treatment of the most common sleep disorders.

The history of somnology and the current state of the problem

Throughout the history of mankind, the problem of sleep and its disorders has attracted the close attention of scientists, artists and ordinary people. In the writings of philosophers of antiquity, we meet the first attempts to explain the essence of sleep, its nature, and its significance for human life. People's interest in this problem at that time was mainly due to such an incomprehensible and partly mystical phenomenon as dreams. In the ancient world, the prevailing belief was that dreams were sent by the gods, that dreams, especially prophetic, prophetic dreams, were capable of revealing the future and discovering ways to fight diseases. But already Aristotle approached the interpretation of dreams from a more scientific position, highlighting the role of sensations and emotions in the mechanism of the emergence of dreams. However, it was not until the 19th century that belief in the supernatural nature of dreams began to wane.

By this time, many of the currently known sleep disorders were known and described (often in fiction). Thus, one of the characters in The Pickwick Papers has for many years been considered one of the best descriptions of patients with obstructive sleep apnea syndrome (and obese hypoventilation syndrome). The first detailed report on narcolepsy, made in 1880 by Zhelino, drew the attention of doctors to patients suffering from excessive sleepiness.

The problems of sleep and dreams also occupy a large place in the works of the founder of psychoanalysis, Z. Freud, who developed a psychoanalytic model of the theory of dreams in his work “Die Traumdeutung” (“Interpretation of Dreams”). According to Freud's theory, the events in a dream, clearly manifested in its content, are the result of the so-called dream creation, the purpose of which is to express subconscious desires. Therefore, the main therapeutic method used in psychoanalysis is the interpretation of the patient's dreams as a way to understand the workings of his subconscious.

Real advances in sleep medicine were achieved after researchers got their hands on tools that make it possible to objectively assess various physiological parameters of a sleeping person, and primarily the activity of the brain. In 1875, the English surgeon R. Caton showed for the first time that the electrical activity of the brain can be recorded in an animal. More than fifty years passed before similar observations were made in humans. The Austrian psychiatrist Hans Berger (Berger, 1929) discovered that brain waves could be recorded from the surface of the skull. In addition, he found that the electrical characteristics of these waves depend on the state of the subject. Berger's contemporaries were skeptical of his report, and "brain waves" became a generally accepted fact only after Adrian and Matthews made a visual demonstration of the EEG recording at a meeting of the English Physiological Society in 1935. In subsequent years, research was continued in various countries, and the main EEG rhythms of wakefulness and sleep in humans were established.

A revolutionary discovery for modern somnology was the discovery in the early 1950s of a phase of sleep with rapid eye movements. Y. Azerinsky, a student at the University of Chicago, while studying the motor activity of sleeping babies, drew attention to the fact that in addition to periodic general movements, babies often have periods when they begin to move their eyes under closed eyelids. In subsequent studies, Azerinsky and his supervisor N. Kleitman found that adults also have several periods of rapid eye movements during nighttime sleep; moreover, if a person was awakened at that moment, then he reported a dream he had just seen. The results of the observations were published in 1953 in the journal Science (Aserinsky, Kleitman, 1953). In further studies conducted with the participation of W. Dement, it was convincingly shown that there are three main, significantly different states in which a person's life passes: wakefulness, sleep without rapid eye movements and sleep with rapid eye movements.

In the 60s of the XX century, the accumulation of knowledge about sleep was especially fast, which required the systematization and ordering of new information. Gasteau for the first time in modern literature in 1965 gave a detailed clinical description of the syndrome of obstructive sleep apnea. The result of the work of a group of experts led by A. Rechtshaffen and E. Keils - "Guide to the standardized terminology, technique and calculation of sleep stages in humans" (1968) remains the fundamental document for all somnologists to this day.

The 70-80s in North America and Europe were marked by a rapid growth in the number of sleep laboratories and centers, the emergence of sleep medicine as an independent clinical specialty. A great impetus in the development of practical somnology was given by the introduction by the Australian scientist K. Sulivan in 1981 of the most effective method to date for the treatment of respiratory disorders during sleep - constant positive airway pressure therapy - CPAP therapy. In the works of K. Gilmino and other scientists, it was convincingly shown that even the initial manifestations of respiratory disorders during sleep (the so-called upper airway resistance syndrome) can have a significant impact both on the general health of patients and on the activity of their cardiovascular system. .

In the 1980s and 1990s, public interest in the problems of sleep disorders and deprivation also increased significantly. For example, in the United States in 1989, the National Commission for the Study of Sleep Disorders was organized, the report of which, called “Wake America: Warning the Nation about Sleep Problems,” contains a significant amount of information about the prevalence of sleep disorders and the impact they have on people's health. and life of the whole society.

Medicine in Russia also has its own rich and interesting history. The work of leading Russian clinicians and physiologists was devoted to the study of sleep: I. P. Pavlov, A. A. Ukhtomsky, P. K. Anokhin. One of the first experimental studies that investigated the effects of sleep deprivation was a study conducted by M. M. Manasseina.

Scientific somnology in the modern concept of the word began to develop in our country in the mid-60s, when the first polygraphic studies of sleep were carried out (Vane A.M., Rotenberg V.S., Yakhno N.N.).

Subsequently, domestic researchers performed a large number of works on the features of the course of sleep disorders in patients with neurological and the most common somatic diseases.

Since the mid-90s, the somnological service has been actively developing in the system of “Kremlin medicine”. The first sleep laboratory appeared in 1995.

Equipped with modern equipment and using in their work the most stringent standards of practical activity, the sleep departments of medical institutions of the Main Medical Directorate of the Department of Internal Affairs of the Russian Federation are, in a certain sense, reference centers for sleep disorders, whose experience deserves the most active dissemination.

The current state of sleep medicine is characterized by a combination of a number of trends that have clearly emerged over the past decade. This period is characterized by the rapid development of somnology as a science and a new direction of practical medical activity. The growth in the number of sleep laboratories and centers, the increase in the number of specialists employed in this field, the emergence of new types of medical equipment and equipment for the diagnosis and treatment of sleep disorders, the growth of public interest in sleep problems were not accidental and are associated with the significant impact that sleep disorders have on health status, duration and quality of life of people.

Sleep disorders are one of the most common pathological conditions in medicine. To date, more than 80 types of sleep disorders have been studied and classified. The prevalence and clinical significance of these disorders vary considerably. The data of epidemiological studies are widely known, according to which at least a third of the population of developed countries suffer from various types of insomnia, while a significant part of them have a chronic problem.

sleep apnea, a disease potentially life-threatening for patients and capable of causing such formidable complications as a stroke, heart attack or heart failure affects at least 5-10% of the adult population; the prevalence of less pronounced sleep breathing disorders, which, according to modern concepts, are also capable of influencing the health status of patients, significantly exceeds these figures.

Narcolepsy, a neurological disease, accompanied by symptoms that significantly worsen the patient's quality of life and call into question his professional activity, occurs in approximately one person in a thousand, which amounts to tens and hundreds of thousands of people nationwide.

A special place is occupied by sleep disorders that occur in patients with various somatic, neurological and mental diseases; the prevalence of these disorders is often very difficult to ascertain.

The most pressing problem with sleep is excessive daytime sleepiness problem. One of the causes of excessive sleepiness, along with sleep disorders, is sleep deprivation (lack of sleep). Studies conducted in different countries have shown that most modern people have a significant sleep deficit accumulated over many months and even years. The consequences of sleep deprivation can be the most serious, both for the health and life of an individual, and for the safety of society as a whole. To date, a large amount of data has been accumulated that the causes of a significant number of accidents and disasters in transport, energy, industry and the army are associated with a sharp decrease in the working capacity of people suffering from sleep deprivation.

The presence of a large number of patients suffering from sleep disorders, and the emergence of real effective methods for their treatment (first of all, this can be attributed to the emergence of a technique for treating patients with obstructive sleep apnea - CPAP therapy, proposed in 1981 by K. Sullivan) became the basis for the emergence of a large number of centers and laboratories for sleep disorders, first in North America, Australia, and later in Europe, including our country.

It is now known that in order to provide the necessary volume of assistance for the diagnosis and treatment of sleep disorders to the population served by this medical institution, it is necessary to have 2 beds for polysomnography for every 100,000 inhabitants. With this in mind, the volume of somnological assistance provided to the population of our country remains clearly insufficient.

Currently, medical assistance for the diagnosis and treatment of sleep disorders is available mainly to the population of large cities (Moscow, St. Petersburg, Yekaterinburg), while the amount of assistance provided is significantly different from the optimal one. Even in the Moscow region with a population of more than 15 million people, the number of somnological beds does not exceed 40, which is almost 10 times less than necessary.

Scientific work in the field of somnology also has a number of features that should be noted. Significant advances have been made in basic sleep research over the past five decades. In many ways, the mechanisms of the emergence of various phases and stages of sleep have been understood, the role of individual brain structures and systems has been studied, circadian mechanisms and neurochemical processes underlying sleep have been studied. At the same time, many fundamental theoretical questions have not yet been answered.

Clinical studies in somnology over the past two decades have been devoted to the most pressing problems of sleep medicine: the epidemiology of sleep disorders, the cardiovascular consequences of sleep breathing disorders, new methods of drug therapy for narcolepsy and movement disorders during sleep, non-drug methods of treating insomnia, etc.

In recent years, a significant number of studies have been conducted in our country on the epidemiology of sleep disorders among the working adult population, hemodynamic disorders in patients with obstructive sleep apnea syndrome, sleep disorders in patients with a cardiological profile, etc.

Summing up, it should be noted that despite the great successes achieved in previous years, somnology has not yet fully realized all the potential of this new direction of medicine.

The science and practice of sleep medicine has good prospects for development in our country, which will undoubtedly benefit millions of patients suffering from sleep disorders.

For citation: Levin Ya.I. Somnology: sleep, its structure and functions; insomnia // RMJ. 2007. No. 15. S. 1130

Somnology - the science of sleep - is one of the most dynamically developing areas of modern medicine. A product of the 20th century, somnology has taken a stormy start in the 21st century, starting it with ideas about the orexin-hypocretin hypothalamic system. Modern somnology is a science with its own special goals and objectives, research methods, fundamental and clinical achievements. It is also undoubted that somnology is the most important component of neuroscience and modern medicine.

“Sleep is a special genetically determined state of the body of warm-blooded animals (i.e. mammals and birds), characterized by a regular successive change of certain printing patterns in the form of cycles, phases and stages.” [V.M. Koval-zon, 1993]. There are three strong points in this definition: first, the presence of sleep is genetically predetermined; secondly, the structure of sleep is most perfect in the higher species of the animal world, and thirdly, sleep must be recorded objectively. It is shown that the main signs of slow and fast (paradoxical) sleep, described in humans, are observed in all warm-blooded animals - mammals and birds. At the same time, it is characteristic that, despite some differences associated with the characteristics of the ecology of this species, in general, no significant complication of the quantitative and qualitative manifestations of sleep during progressive encephalization and corticolization is found in a number of mammals.
An objective study of sleep - polysomnography - is a methodological basis and has developed into a modern system, starting with the description in 1953 by Aserinsky E. and Kleitman N. of the REM sleep phase (FBS). Since then, the minimum somnological set, absolutely necessary for assessing the stages and phases of sleep, is the electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG).
The next most important stage is the creation of the "bible" of modern somnology - the book Rechtchaffen A., Kales A. "A manual of standardized terminology, techniques and scoring for sleep stages of human subjects", which made it possible to largely unify and standardize the efforts of somnologists from all countries when deciphering polysomnograms.
Currently, the greatest diagnostic and therapeutic possibilities of somnology are developing in the following areas: 1) insomnia (I); 2) hypersomnia; 3) sleep apnea syndrome and other breathing disorders during sleep; 4) restless legs syndrome, periodic limb movement syndrome and other movement disorders during sleep; 5) parasomnia; 6) daytime sleepiness; 7) impotence; 8) epilepsy. The list of these areas indicates that we are talking about very common problems that are of great importance for modern medicine. In addition, sleep is a special state in which many pathological processes can arise or, conversely, be facilitated, therefore, in recent years, sleep medicine has developed significantly, studying the features of the pathogenesis, clinic and treatment of pathological conditions that occur during sleep. Naturally, all this cannot be investigated only with the help of the triad - EEG, EMG, EOG. This requires registration of a much larger number of parameters, such as blood pressure (BP), heart rate (HR), respiratory rate (RR), galvanic skin reflex (GSR), body position in bed, limb movements during sleep, oxygen saturation. , oronasal air flow, respiratory movements of the chest and abdominal walls, the degree of blood filling of the cavernous bodies and some others. In addition, it is often necessary to use video monitoring of human behavior in a dream.
All the wealth of modern polysomnography is no longer possible to put together without the use of modern technology, therefore, a significant number of special programs have been developed for computer processing of the sleep polygram. In this direction, the main problem was that these programs, which work well on healthy individuals, are not effective enough in pathological conditions, and they must be monitored visually. To a large extent, this is determined by the now insufficient standardization of algorithms for assessing sleep stages and phases in all their diversity. To some extent, the latest classification of sleep-wake cycle disorders of 2005 (American Academy of Sleep Medicine. International classification of sleep disorders, 2nd ed.: Diagnostic and coding manual. Westchester, Ill.: American Academy of Sleep Medicine) contributes to the solution of this issue. , 2005.), however, it does not already correspond to the current situation. Another way to overcome the above difficulties was the creation of a single format for polysomnographic records (EDF - European Data Format).
Human sleep represents a whole range of special functional states of the brain - stages 1, 2, 3 and 4 of the non-REM sleep phase (SMS) and the REM sleep phase (FBS). Each of the listed stages and phases has its own specific EEG, EMG, EOG and vegetative characteristics.
The 1st stage of FMS is characterized by a slowdown in the frequency of the main rhythm (characteristic of the relaxed wakefulness of this person), the appearance of beta and theta waves; decrease in heart rate, respiratory rate, muscle tone, blood pressure. The 2nd stage of FMS (the stage of "sleepy spindles") is named after the main EEG phenomenon - "sleep spindles" - sinusoidal oscillations with a frequency of 11.5-15 Hz (some authors expand this range from 11.5 to 19 Hz) and an amplitude of about 50 μV, in addition, K-complexes are also presented in the EEG - high-amplitude waves (2-3 times higher than the amplitude of the background EEG, mainly represented by theta waves) (Fig. 1), two or multiphase, from the point in terms of vegetative and EMG parameters, the trends described for the 1st stage of FMS develop; in small quantities, episodes of apnea lasting less than 10 seconds may occur. The 3rd and 4th stages are called delta sleep, since the main EEG phenomenon is delta activity (in the 3rd stage it ranges from 20% to 50%, and in the 4th stage - more than 50%); breathing in these stages is rhythmic, slow, blood pressure is reduced, EMG has a low amplitude. FES is characterized by rapid eye movements (REM), very low EMG amplitude, and a "sawtooth" theta rhythm, combined with an irregular EEG (Fig. 2); at the same time, a “vegetative storm” is noted with respiratory and cardiac arrhythmia, fluctuations in blood pressure, episodes of apnea (lasting less than 10 seconds), erection of the penis and clitoris. The stages of FMS and FBS make up one sleep cycle, and in a healthy person there are from 4 to 6 such cycles per night.
sleep functions. It is traditionally believed that the main function of the FMS is restorative, and there is a lot of evidence for this: in delta sleep, the maximum secretion of somatotropic hormone, replenishment of the amount of cellular proteins and ribonucleic acids, phosphatergic bonds are revealed; If physical activity is carried out before going to bed, then the representation of delta sleep will increase. At the same time, in recent years it has become clear that the function of slow sleep may also include optimization of the control of internal organs. The functions of the FBS are the processing of information received in the previous wakefulness and the creation of a program of behavior for the future. During FBS, brain cells are extremely active, however, information from the "inputs" (sense organs) does not come to them and is not fed to the "outputs" (muscular system). This is the paradoxical nature of this state, reflected in its name.
Sleep cycles also have special functions. I sleep cycle is a hologram (matrix) of the entire sleep, containing information about the indicators of the entire sleep as a whole. The holographic function of the first cycle is sufficiently resistant to damaging effects and "works" even in conditions of severe cerebral pathology (stroke). II and III sleep cycles are necessary to adjust (correct) the main matrix of cycle I in order to adapt the structure of sleep to the corresponding current human needs.
Insomnia. The state of sleep is an integral part of human existence, and its disorders are reflected in all areas of human activity - social and physical activity, cognitive activity. One of the most common sleep disorders is insomnia. The previously used term "insomnia" was recognized as unsuccessful, since, on the one hand, it carries a negative semantic "charge" for the patient (it is unlikely to achieve a complete absence of night sleep - agripnia), and on the other hand, does not reflect the pathophysiological essence of the processes occurring at this time ( the problem is not in the lack of sleep, but in its improper organization and flow).
Insomnia is the most common sleep disorder and is a clinical problem for 12-22% of the population. According to the latest 2005 International Classification of Sleep Disorders, insomnia is defined as “recurring disturbances in the initiation, duration, consolidation, or quality of sleep that occur despite sufficient time and conditions for sleep and manifest as disturbances in daytime activities of various kinds.” In this definition, the main features can be distinguished, such as: 1) the persistent nature of sleep disorders (they occur over several nights); 2) the possibility of developing various types of sleep structure disorders; 3) the availability of sufficient time to ensure the function of sleep in a person (one cannot consider insomnia a lack of sleep in intensively working members of an industrial society); 4) the occurrence of daytime functioning disorders in the form of a decrease in attention, mood, daytime sleepiness, autonomic symptoms, etc.
In everyday life, the most common cause of sleep disorders is adaptive insomnia, a sleep disorder that occurs against the background of acute stress, conflict or environmental changes. The consequence of this is an increase in the overall activity of the nervous system, which makes it difficult to enter sleep during the evening falling asleep or awakening at night. With this form of sleep disorders, it is possible to determine with great certainty the cause that caused them; adaptive insomnia lasts no more than 3 months.
If sleep disturbances persist for a longer period, they are “overgrown” with psychological disorders, the most characteristic of which is the formation of “fear of sleep”. At the same time, the activation of the nervous system increases in the evening hours, when the patient tries to “force” himself to fall asleep sooner, which leads to aggravation of sleep disorders and increased anxiety the next evening. This form of sleep disturbance is called psychophysiological insomnia.
A special form of insomnia is "pseudo-insomnia", when the patient claims that he does not sleep at all, however, when conducting a study that objectifies the picture of sleep, the presence of 6.5 or more hours of sleep is confirmed. Here, the main symptom-forming factor is a disturbance in the perception of one's own sleep, associated primarily with the peculiarities of the sense of time at night (periods of wakefulness at night are well remembered, and periods of sleep, on the contrary, are amnesic), and fixation on problems of one's own health associated with sleep disturbance.
Insomnia can develop against the background of inadequate sleep hygiene, i.e. features of human life, which lead either to an increase in the activation of the nervous system in the periods preceding the laying down. This can be coffee drinking, smoking, physical and mental stress in the evening, or activities that prevent the onset and flow of sleep (laying down at different times of the day, using bright lights in the bedroom, an uncomfortable environment for sleeping). Similar to this form of sleep disturbance is behavioral insomnia of childhood, when children form incorrect associations associated with sleep (for example, the need to fall asleep only when motion sickness), and when you try to remove or correct them, the child’s active resistance appears, leading to a reduction in time sleep.
Of the so-called "secondary", i.e. Associated with other diseases, sleep disorders are the most common insomnia in mental disorders (in the old way, in diseases of the neurotic circle). 70% of neurotic patients have disturbances in the initiation and maintenance of sleep. Often, sleep disturbance is the main “symptomatic” radical, due to which, according to the patient, numerous “vegetative” complaints develop (headache, fatigue, blurred vision, etc.) and social activity is limited (for example, they believe that they can't work because they don't get enough sleep). Complaints about sleep disturbances are also common in patients with "organic" diseases, such as hypertension, diabetes mellitus, and cerebral stroke. In this case, a diagnosis of insomnia associated with a disease of the internal organs is made.
A special form of insomnia are sleep disorders associated with a disorder of the body's biological rhythms. At the same time, the “internal clock”, which gives a signal for the onset of sleep, is either late and provides preparation for the onset of sleep too late (for example, at 3-4 am), or too early, even in the evening. Accordingly, this disrupts either falling asleep when a person unsuccessfully tries to fall asleep at a socially acceptable time, or awakening in the morning, which comes too early according to standard time (but at the “correct” time according to the “internal clock”). A common case of sleep disturbance due to a disorder of biological rhythms is the “jet lag syndrome” - insomnia that develops when moving quickly through several time zones in one direction or another.
Along the course, both acute (lasting less than 3 weeks) and chronic (lasting more than 3 weeks) are distinguished. Insomnia lasting less than 1 week is defined as transient.
The clinical phenomenology of I includes presomnic, intrasomnic, and postsomnic disorders.
Presomnic disturbances are difficulty initiating sleep, and the most common complaint is difficulty falling asleep; with a long course, pathological "rituals of going to bed", as well as "fear of the bed" and fear of "non-sleep" can be formed. The emerging desire to sleep disappears as soon as the patients are in bed, painful thoughts and memories appear, motor activity intensifies in an effort to find a comfortable position. The coming drowsiness is interrupted by the slightest sound, physiological myoclonus. If falling asleep in a healthy person occurs within a few minutes (3-10 minutes), then in patients it is sometimes delayed up to 120 minutes or more. A polysomnographic study of these patients shows a significant increase in the time to fall asleep, frequent transitions from stages 1 and 2 of the first sleep cycle to wakefulness. Often falling asleep is ignored by patients, and all this time it is presented to them as continuous wakefulness.
Intrasomnic disorders include frequent nocturnal awakenings, after which the patient cannot fall asleep for a long time, and sensations of "superficial" sleep.
Awakenings are caused by both external (primarily noise) and internal factors (terrifying dreams, fears and nightmares, pain and autonomic shifts in the form of respiratory failure, tachycardia, increased motor activity, urge to urinate, etc.). All these factors can also awaken healthy people with good sleep. But in patients, the awakening threshold is sharply lowered and the process of falling asleep after an episode of awakening is difficult. The decrease in the awakening threshold is largely due to insufficient sleep depth. Poly-som-graphic correlates of these sensations are an increased representation of light sleep (1 and 2 stages of non-REM sleep), frequent awakenings, long periods of wakefulness within sleep, a reduction in deep sleep (delta sleep), and an increase in motor activity.
Postsomnic disorders (disorders that occur in the immediate period after waking up) are a problem of early morning awakening, reduced performance, "brokenness". Patients are not satisfied with their sleep. Postsomnic disorders include non-mandatory daytime sleepiness. Its feature is the difficulty of falling asleep even in the presence of favorable conditions for sleep.
The causes of insomnia are diverse: 1) stress (psychophysiological insomnia), 2) neurosis, 3) mental illness; 4) somatic diseases; 5) psychotropic drugs, 6) alcohol, 7) toxic factors, 8) endocrine-metabolic diseases, 9) organic brain diseases, 10) syndromes that occur during sleep (sleep apnea syndrome); motor disturbances in sleep), 11) pain phenomena, 12) external unfavorable conditions (noise, humidity, etc.), 13) shift work, 14) change of time zones, 15) disturbed sleep hygiene.
Syndromes that occur during sleep (sleep apnea syndrome, restless legs syndrome, periodic limb movement syndrome during sleep) are leading as the cause of intrasomnic disorders. Insomnia in the syndrome of "sleep apnea" is combined with snoring, obesity, imperative daytime sleepiness, arterial hypertension (mainly morning and diastolic), morning headaches. Frequent nocturnal awakenings in these patients (insomnia in sleep apnea syndrome is mainly characterized by this phenomenon) are a kind of sanogenetic mechanism, since they are aimed at turning on an arbitrary circuit of respiratory regulation. The most serious problem is that the prescription of benzodiazepines and barbiturates in this case is fraught with serious complications, since they reduce muscle tone and inhibit the activating systems of the brainstem.
Patients of older age groups undoubtedly have a greater “insomnia potential”, which is due to the combination of insomnia with physiological age-dependent changes in the “sleep-wake” cycle. In these patients, the role of somatic diseases, such as atherosclerotic vascular disease, arterial hypertension, chronic pain, etc., significantly increases as the cause of I.
It should be emphasized that insomnia is most often associated with mental factors and therefore can be considered as psychosomic disorders. Anxiety and depression play a special role in the development of insomnia. So, with various depressive disorders, night sleep disturbances are observed in 83-100% of cases. Insomnia in depression can be either the main complaint (masking depression) or one of many. Insomnia in depression may have its own characteristics, namely: early morning awakenings and a short latent period of REM sleep. Increased anxiety is most often manifested by presomnic disorders, and as the disease progresses, both intrasomnic and postsomnic complaints. Polysomnographic manifestations with high anxiety are nonspecific and are determined by prolonged falling asleep, an increase in superficial stages, motor activity, wakefulness, a decrease in the duration of sleep and deep stages of non-REM sleep.
The I diagnostic paradigm is based on: 1) an assessment of the individual chronobiological stereotype of a person (owl-lark, short-sleeping), which is possibly genetically determined; 2) taking into account cultural characteristics (for example, afternoon sleep - siesta - in hot countries); 3) professional activities (night and shift work, transtemporal flights); 4) a certain clinical picture, 5) the results of a psychological study; 6) the results of a polysomnographic study, 7) an assessment of the accompanying I (somatic, neurological, psychiatric pathology, toxic and medicinal effects).
Existing approaches to the treatment of insomnia can be divided into drug and non-drug approaches.
Non-drug methods include the following approaches: 1) sleep hygiene, 2) psychotherapy, 3) phototherapy, 4) encephalophony (“brain music”), 5) acupuncture, 6) biofeedback, 7) physical therapy, 8) homeopathy.
Sleep hygiene is an important and integral component of the treatment of any form of insomnia and consists of the following recommendations:
. Go to bed and get up at the same time.
. Eliminate daytime sleep, especially in the afternoon.
. Do not drink tea or coffee at night.
. Reduce stressful situations, mental stress, especially in the evening.
. Organize physical activity in the evening, but no later than 2 hours before bedtime.
. Regularly use water procedures before going to bed. A cool shower can be taken (a slight cooling of the body is one of the elements of the physiology of falling asleep). In some cases, you can apply a warm shower (comfortable temperature) until you feel a slight muscle relaxation. The use of contrast water procedures, excessively hot or cold baths is not recommended.
These recommendations should be discussed individually with each patient and the importance of this approach explained.
Ideally, one should not talk about the treatment of insomnia, but about the treatment of the disease that caused it, since insomnia is always a syndrome. However, in most cases, the identification of the etiological factor is difficult (or the causes of insomnia in a particular patient are numerous), and the main goal of the doctor is to "sleep" the patient. To achieve this goal, preparations of different groups were used. Until the beginning of the 20th century, these were bromine and opium. Since 1903, barbiturates have been on the first place. Since the beginning of the 1950s, antipsychotics (mainly phenothiazine derivatives) and antihistamines have been used as sleeping pills. With the advent of chlordiazepoxide in 1960, diazepam in 1963, and oxazepam in 1965, the era of benzodiazepine hypnotics began. The appearance of this class of hypnotics was a significant step in the treatment of insomnia, however, it also introduced certain problems: addiction, dependence, the need for a constant increase in the daily dose and increased manifestations of the "sleep apnea" syndrome (as a result of the muscle relaxant action of benzodiazepines). In this regard, new sleeping pills have been developed: doxylamine (early 80s), zopiclone (1987), zolpidem (1988), zaleplon (1995), melatonin (early 90s), ramelteon (2005 - not registered in Russia) .
One of the most commonly used hypnotics is Donormil (doxylamine). Doxylamine succinate is an H1-histamine receptor antagonist with a time to peak plasma concentration of 2 hours and an elimination half-life of 10 hours. Approximately 60% of doxylamine is excreted in the urine unchanged, and its metabolites are inactive. The sedative properties of the drug have also been studied: the hypnotic effect of doxylamine succinate at a dose of 25 and 50 mg is more pronounced than that of secobarbital at a dose of 100 mg, and is almost equivalent to secobarbital at a dose of 200 mg. Other work has demonstrated that doxylamine succinate is a worthy alternative to benzodiazepines and has generated interest in the use of this drug as a hypnotic, given its low toxicity. In many countries, including France, the United States and Germany, doxylamine succinate is marketed as a sleep aid. A special randomized, double-blind, crossover, placebo-controlled study of the effect of doxylamine on sleep structure and the state of cognitive functions, memory, and reaction speed was conducted with a single dose of 15 mg of doxylamine succinate or placebo in healthy volunteers.
Total sleep duration, number of awakenings during sleep, and number of sleep cycles did not differ between the doxylamine and placebo groups. After taking doxylamine, the total duration of awakenings during sleep was significantly reduced. Doxylamine leads to a significant shortening of the first stage and lengthening of the second stage. At the same time, doxylamine does not affect the duration of the third and fourth stages and FBS. After taking doxylamine, subjects assessed that sleep characteristics were generally comparable to those for sleep under normal conditions. A more detailed analysis showed that after taking doxylamine, compared with placebo, there was a significant improvement in the quality and increase in the depth of sleep, while clarity of consciousness and the state on awakening with both drugs were not different. When taking doxylamine, none of the 18 subjects showed any changes in short-term memory and reaction speed. The results of subjects' self-assessment of the level of energy, clarity of consciousness, possible signs of anxiety or drowsiness on a visual analogue scale did not differ in the doxylamine group and the placebo group. The re-sleep test showed no significant difference between the doxylamine and placebo groups up to 18 hours after dosing.
Another multicentre, randomized, double-blind, 3-parallel study compared the efficacy and tolerability of doxylamine succinate (15 mg) with zolpidem tartrate (10 mg) and placebo in the treatment of insomnia (with a withdrawal study). The study, which involved 338 patients aged 18 to 73 years, on the one hand, confirmed the advantage of doxylamine over placebo in terms of hypnotic effect and, on the other hand, showed a similar efficacy of doxylamine and zolpidem, and also confirmed the good tolerability of doxylamine and zolpidem and did not reveal a withdrawal syndrome upon discontinuation of doxylamine.
Drowsiness, dizziness, asthenia, headache, nausea, and vomiting are the most common side effects of zolpidem. Drowsiness, dry mouth and headaches were the most common side effects of doxylamine. In all studies with these two active drugs, tolerability was considered good, as in this study, in approximately 85% of patients. No withdrawal syndrome was detected in either doxylamine or zolpidem when observed for 3-7 days.
Our open non-comparative study of the drug Donormil showed that under the influence of Donormil, both subjective and objective sleep characteristics improved, which was combined with good tolerability of the drug.
Pharmacotherapy of insomnia is based on the following principles:
1. predominant use of short- and medium-living preparations;
2. The duration of the appointment of sleeping pills should not exceed 3 weeks (optimally - 10-14 days) - the time during which the doctor must understand the causes of I; during this period, as a rule, addiction and dependence are not formed;
3. patients of older age groups should be prescribed half (in relation to middle-aged patients) daily dosage of sleeping pills, and also take into account their possible interaction with other drugs;
4. in the case of at least minimal suspicion of the presence of sleep apnea syndrome, only doxylamine (Donormil) and melatonin can be used as the cause of insomnia and the impossibility of polysomnographic verification;
5. if, with subjective dissatisfaction with sleep, the objectively recorded duration of sleep is more than 6 hours, the appointment of sleeping pills seems to be ineffective, and psychotherapy should be used;
6. Patients receiving long-term sleeping pills need to spend "drug holidays", which allows you to reduce the dose of this drug or change it.
7. the use of sleeping pills as needed.
Thus, insomnia is a disease common in general medical practice, an adequate assessment and treatment of which is possible only taking into account the whole variety of causing factors and ideas about modern sleeping pills.

The term "somnology" in translation from Latin and Greek ("somnus" - sleep and "logos" - teaching) means - the science of sleep. Today, this is a fairly young medical discipline that is engaged in a deep and internal study of the physiology of human sleep and its disorders. Somnology develops methods for diagnosing sleep problems and therapeutic interventions for the treatment of sleep disorders.

Since somnology belongs to the section of neurobiology, in addition to all of the above, it studies and investigates the effect of sleep on the quality of a person’s life, on his health, and on his psyche. The biological spheres of a person and the characteristics of diseases that may arise and develop in connection with impaired sleep function or during sleep itself are also studied. These diseases include impotence, heart attacks and strokes.

Modern somnology is an advanced and promising field of medicine in its relevance. And this follows from the fact that sleep disorders are not just a medical problem, but also a problem with a social bias, since sleep not only contributes to the health of the human body, but also to the professional qualities and working capacity of a person. And there is no person in the world who has not experienced sleep disorders at least once in his life.

Sleep disturbance can occur for various reasons. Sleep can be negatively affected by overloads of any nature (nervous, psychological or physical), stress, external stimuli (stuffy air, bright light, loud noise), and ordinary overeating. Sleep can be affected by various drugs (psychotropic, for example) taken by a person to treat any disease. Also, sleep disorders develop against the background of drug addiction or alcoholism, somatic diseases of internal organs, endocrine or organic lesions of the brain. Change of time zones (when moving) and shift work also leave a negative imprint on a person’s sleep.

And, in turn, sleep disorders can cause complications such as hypertension, cardiovascular disease, neurological, sexual disorders.

Symptoms

A person's sleep, or rather its violations, can manifest itself in more than eighty forms. And one of the most common sleep disorders is insomnia, that is, insomnia. Insomnia is manifested by a simple inability to fall asleep for two to three hours at night, the so-called superficial (sensitive) sleep, or extremely early awakening.

Another symptom of sleep disturbance is snoring. This symptom is a sharp sound and vibration during the breathing of a sleeping person. It is usually caused by the presence of an anatomical narrowing of the airways. And when air enters the narrowed paths, the tissues of the pharynx or larynx vibrate.

Sleepwalking or sleepwalking, and in scientific terms - somnambulism - is another manifestation or symptom of sleep disturbance. Sleepwalking is a state into which a person falls in a dream, and at the same time, performs unconscious and uncontrolled, although quite ordered, actions. This condition lasts no more than an hour, and can occur in a sitting and walking position.

Another manifestation in somnology is hypersomnia. This condition is characterized by excessive nighttime sleep with recurrence of daytime sleepiness. Usually, hypersomnia is of a psychophysiological nature (it occurs, for example, against the background of severe stress, as a protective reaction of the body), but pathological hypersomnia also occurs. Pathologies include narcolepsy, the symptoms of which are attacks of sudden falling asleep and hallucinations during sleep, idiopathic hypersomnia, post-traumatic and medicinal.

Sleep stupor or paralysis is an extremely rare disease, usually manifested between the ages of 12 and 20, with the onset of muscle paralysis, a feeling of difficulty breathing, and a feeling of fear. It is worth noting that the state of sleep stupor is extremely unpleasant for a person, but it lasts no more than two minutes and is completely safe for the person himself.

Another symptom of sleep disturbance is the phenomenon of suffocation. This disease is manifested by a feeling of severe suffocation, fear, panic and the presence of something strong and suffocating.

In childhood, sleep disorders are manifested by frequent waking up at night in a state of fear or crying, gnashing of teeth, talking in a dream and various rhythmic movements during sleep (shaking the body, hitting the head, etc.).

Diagnostics

First of all, to diagnose sleep disorders in a patient, a method such as polysomnography is used. This is a laboratory method for examining the human body. The patient spends the night in the lab, where numerous sensors record his heart rate during sleep, brain activity, respiratory system function, chest movements, inhaled and exhaled air volume, blood oxygen saturation, and other data. At the same time, a video recording of everything that happens in the room is also carried out, which is constantly monitored by the doctor on duty.

Such an examination makes it possible to fully study all five stages of human sleep and accurately diagnose disorders, as well as identify the causes and deviations of these disorders.

The second method for diagnosing sleep disorders is the study of average sleep latency. This method is used to diagnose narcolepsy.

Also, methods of personal interviews, special surveys and tests are necessarily applied to the methods of diagnosing sleep disorders.

In any case, human sleep disorders, the diagnosis is carried out comprehensively, that is, several methods are necessarily carried out at once. Also, during the diagnosis in somnology, it is considered mandatory to analyze the collected information during tests and special surveys, psychological, clinical and neurological research is also carried out, the individual biological chronological type of the patient (owl or lark) is determined. And when analyzing all the collected data, the type of work of the patient is necessarily taken into account.

Prevention

Preventive methods of sleep disorders and disorders include the following activities:

• adherence to a strict regime of sleep and wakefulness;
• exclusion of daytime sleep;
• exclusion from the evening diet of strong alcoholic and coffee drinks;
• avoidance of stress and physical and mental overload;
• physical activity to perform no later than three hours before bedtime;
• do not gamble before going to bed, do not watch emotional programs and TV shows;
• carry out water procedures before going to bed.

Treatment

Treatment in somnology is prescribed by a neurologist. The most commonly used therapeutic methods of treatment.

To begin with, before taking sleeping pills, the patient is asked to observe a certain sleep and wakefulness regimen for several weeks. At the same time, certain rules must be observed, for example, do not go to bed in a state of overexcitation of the nervous system, do not eat before bedtime, do not drink alcohol and coffee drinks at night, do not go to bed during the day, regularly exercise in the morning or afternoon, keep the bedroom clean and darken the room while sleeping.

The following activities are also included in the therapeutic treatment of sleep disorders: thirty to forty-minute walks in the fresh air every night (in any weather) and warm baths.

In most cases, psychotherapeutic and relaxing techniques help to cure sleep disorders.

In drug therapy for sleep disorders, benzodiazepine drugs are used. Depending on the degree of the disease, drugs with a short, medium or long duration of action are prescribed.

Also, for some types of sleep disorders associated with mental disorders, antidepressants are prescribed.

In the most severe cases, when all the above drugs do not help, the doctor prescribes antipsychotics with a sedative effect.

With pathological drowsiness, weak CNS stimulants are prescribed. Vasodilators and mild herbal tranquilizers are prescribed for the treatment of disturbed sleep rhythms in elderly patients.

In any case, taking medications should be carried out under the strict supervision of a doctor and exclusively on his prescription.

And any complex of treatment is selected individually for each patient.

In modern somnology, very effective and absolutely safe for health methods of treating sleep disorders have begun to be used - phototherapy and encephalophony. The first method is a treatment that is carried out with a very bright white light. The second method is the conversion of the electroencephalogram of the brain into music using computer programs.