Sleep Disturbance: Causes and Possible Treatment
What is sleep disturbance? For centuries, sleep has been understood as a passive state of absolute rest in the brain. It wasn’t until 1953, with the discovery of rapid eye movement (REM) and slow eye movement (NREM) stages, that it became clear that sleep is an active process fundamental to the functioning of the brain.
That is, sleep is not just going into a state of rest: closed eyes, fell asleep, woke up, opened eyes. This is a fairly active process from the point of view of the brain’s work, which has its own characteristics and structure.
For this reason, it is impossible to assess the quality of sleep only by such parameters as “I began to fall asleep faster and sleep longer.“
Sleep Architecture
In medicine, the gold standard for assessing sleep is polysomnography, which includes electrophysiological recordings of brain activity, muscle activity, and eye movements, broken down into various variables that determine the continuity and architecture of sleep. The sleep continuity variables, for example, are:
- Sleep efficiency index (SEI): the ratio of total sleep time (TST) to time in bed (TIB) x 100% (or to the time from the beginning of sleep to the final awakening, i.e., the time of the sleep period-SPT);
- Sleep Onset Delay (SOL): time from lights out to sleep onset
- Total Sleep Time (TST): the total time spent sleeping during the night;
- Number of awakenings (NA): the total number of awakenings during the night.
- Wakefulness after sleep onset (WASO): the duration of wakefulness during the night is usually defined as the difference between SPT and TST;
“Sleep architecture” refers to the distribution of the various sleep/wake stages: sleep stage 1, sleep stage 2, slow-wave sleep (SWS), rapid eye movement (REM) sleep – which occur in cycles throughout the night. Cycles mean that the change of one stage by another is cyclical, repetitive.
The sleep architecture variables are:
- The total waking time during the night: the number of stages of wakefulness identified by polysomnography records, usually presented as a percentage of SPT or TST;
- Stage 1 (naps): Stage 1 sleep duration is usually presented as a percentage of SPT or TST;
- Stage 2 (light sleep): Stage 2 sleep duration is usually presented as a percentage of SPT or TST;
- Stage 3 slow-wave sleep ((SWS) – moderately deep sleep): SWS duration is usually presented as a percentage of SPT or TST;
- Rapid eye movement (REM) sleep: REM duration is usually expressed as a percentage of SPT or TST.
Effects of Drugs and Supplements on Sleep Quality
When we talk about the positive effects of drugs or supplements on sleep quality, we mean that they have effects on certain characteristics. And not all changes we can notice on our own without the help of polysomnography.
Some medications or supplements help to fall asleep faster and less often to wake up during sleep – we ourselves can notice, others improve its architecture, changing the duration of the stages – this can only be tracked using special diagnostic equipment.
For example, in a study [1], supplementation of tryptophan (1000 mg before bedtime) increased by a quarter the duration of the 4th stage of sleep – REM sleep, when we have the most vivid dreams, the brain processes the memories at this time.
And in another study [2], magnesium supplementation (500 mg/day for 8 weeks) in elderly patients with insomnia increased sleep time (SPT), decreased sleep time (SOL), and sleep efficiency index (SEI).
Melatonin 3 mg for four weeks was effective in improving aspects of sleep quality such as total sleep time (TST), percentage of time in rapid eye movement (REM), and early morning awakening in middle-aged patients with insomnia [3]
100 mg of GABA at bedtime resulted in a 5.3-minute reduction in sleep delay (SOL).
In medicine, the types of sleep disorders are also divided, depending on their structure, into:
- presomnic (poor falling asleep);
- intrasomnic (superficial sleep, which is associated with an imbalance between the stages, frequent awakenings, and difficulty falling asleep again);
- postomnic (early awakening).
Sleep Disturbance Causes
To solve a problem with sleep, you need to know the reason that caused it. Treatment should be aimed at eliminating this cause, which requires different approaches, including non-drug ones. Otherwise, the effectiveness of any measures will be low. In simple terms, the causes of sleep disorders can be divided into several groups.
Adaptive
Sleep disturbances are formed as a result of a sudden change in lifestyle, for example, moving to a new place of residence, changing jobs, moving to a region with a different time zone, changing where you fall asleep, for example, at a party, on the road, a new bed.
This group of disorders does not need treatment. The disorders go away on their own as they adapt to changes. Although melatonin is recommended when changing the time zone.
Emotional
Severe disturbances associated with emotional arousal. Moreover, both negative and positive. Both grief and joy, which throw a person out of balance, can cause sleep disturbances. In this case, non-drug treatment is recommended, activities of a relaxing, distracting nature. For example, a warm bath, meditation, reading a book, a walk, anything that will help you distract yourself from thoughts that excite the nervous system.
Additionally, “sedative” drugs can be used to inhibit the activity of the sympathetic nervous system. Of the safe, these are extracts of valerian, motherwort, lemon balm, passionflower. They have the effect of both a single dose and systemic use, which is much more effective. With regular emotional stress, it is recommended to supplement the diet with magnesium, the deficiency of which reduces stress resistance, does not allow the nervous system to return to normal.
However, the treatment will be based on activities that reduce emotional arousal.
Climacteric
Sleep disturbance, which is quite common in women during menopause. This is associated with a decrease in the level of sex hormones, which leads to a deterioration in the absorption of magnesium. Magnesium is involved in relaxation processes, so its deficiency also leads to sleep disturbances.
In addition, with menopause, women are haunted by a depressive state, which also interferes with proper sleep. Antidepressant drugs and magnesium supplements can be prescribed here.
Psychogenic Sleep Disturbance Cause
A group of sleep disorders caused by mental illness. For example, schizophrenia, depression, phobias. People with mental illness often have nightmares in their dreams. Here, the main treatment is directed at the mental disorder, including medication.
Medication
In this group of disorders, the main cause of insomnia is taking medications (psychostimulants, hormones, nootropics). For treatment, it is necessary to adjust the dose or cancel the intake. The doctor can prescribe the appropriate medications and from dietary supplements. For example, there is evidence that GABA reduces the sleep disturbance caused by caffeine [4]. However, the protocol of reception in such cases requires study.
Idiopathic Sleep Disturbance Cause
Sleep disorders of an unexplained nature. These disorders can be influenced by a hereditary factor, peculiarities of the psyche. Here, treatment with dietary supplements may be ineffective.
Organic
A group of sleep disorders associated with the presence of diseases that cause discomfort and pain. For example, joint diseases. Treatment targets the underlying cause of pain and discomfort, but it can also be symptomatic. That is, pain relief is controlled by pain relievers.
Dietary supplements, in this case, should also be used. Buy those that help with the underlying disease – reducing pain. For example, chondroprotectors (glucosamine, chondroitin, collagen, hyaluronic acid), anti-inflammatory (MSM, extracts of turmeric, ginger, Cissus, Boswellia, Proboscidea), neuroprotective (agmatine sulfate).
Thus, the understanding that sleep disturbance can be caused by different reasons and the quality of sleep is characterized by different parameters should push the patient towards a qualitative diagnosis of the existing problem.
This means more targeted elimination of it.
Dietary supplements are often composed of several components to provide a comprehensive effect on different sleep parameters. But treatment is not always based on taking medications and dietary supplements.
Sources about Sleep Disturbance
- Sleep Induced by L-tryptophan. Effect of Dosages Within the Normal Dietary Intake E Hartmann, C L Spinweber. J Nerv Ment Dis. 1979 Aug;167(8):497-9.
- The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. Behnood Abbasi, Masud Kimiagar,Khosro Sadeghniiat,Minoo M Shirazi,Mehdi Hedayati,Bahram Rashidkhani. J Res Med Sci. 2012 Dec;17(12):1161-9.
- Efficacy of melatonin for sleep disturbance in middle-aged primary insomnia: a double-blind, randomised clinical trial. Huajun Xu, Chujun Zhang,Yingjun Qian, Jianyin Zou, Xinyi Li,Yupu Liu, Huaming Zhu. Sleep Med. 2020 Dec;76:113-119.
- Treatment of GABA from Fermented Rice Germ Ameliorates Caffeine-Induced Sleep Disturbance in Mice. Darine Froy N. Mabunga, Edson Luck T. Gonzales, Hee Jin Kim and Se Young Choung. Biomol Ther (Seoul). 2015 May; 23(3): 268–274.
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