"God! Give me patience to endure what I must endure, strength to change what I must change, and intelligence to separate one from the other” (Prayer of King David).
Often, people who have experienced severe stress in the recent past come to see a neurologist - the death of a loved one, moving from another city or country with a change in the entire environment, divorce, betrayal of a friend, death of a beloved pet, loss of a job, serious illness or surgery that left serious consequences. consequences, etc.
Different people have different stresses: one person’s house burned down - he did not grieve for long and built a new one, another cannot recover for several years after a much less serious loss... Adaptation happens differently for everyone. But its disorders are often combined with psychosomatic disorders.
Patients suffering from a grief reaction that has not been fully experienced, for various reasons, do not want to go to a psychologist or psychotherapist - they do not believe in verbal treatment, are afraid to open their souls to a stranger, or believe that their poor health has nothing to do with stress and strive to find another reason. They can go from one doctor to another for months (gastroenterologists, cardiologists, allergists, and sometimes surgeons often encounter such patients), never finding relief for their condition, because the cause of their suffering lies not in the physical, but in the psychological, mental sphere ...
We call this dream a song
“Everyone already knows: if there is an ambulance near the conservatory, it’s coming to me,” says Lyubov Lvovna.
She is 52 years old. She devoted 48 years to music, and 29 to the fight against insomnia. She once took part in concerts, but due to insomnia she moved to the position of manager of concert halls, and now works at the conservatory. “In my youth, I could sleep in any condition - sitting, standing. Until a night without sleep happened in 1992. I still remember that first sleepless night. I was 23 years old, and like a stupid girl, I knocked on my mother’s door and burst into tears: “Mom, I can’t sleep.” My mother never went to the doctors, there were almost no pills at home, and no attention was paid to insomnia: well, anything can happen. Years later, I analyzed what could have been the cause: there was an unhappy love, even before that we went to the gym from the conservatory and there we hung upside down on a rope... I think if we had immediately gone to the doctors then, there would have been some effect .
A year later, I already had two days in a row without sleep. I started to get scared. I realized that something terrible was happening. And my mother took me to a psychoneurological hospital. The psychiatrist prescribed me a “cocktail” of drugs. But no one tried to find out the reason. At that moment, the medications helped me fall asleep. But this couldn’t last forever...
Collage: Anna Lukyanova
Lyubov Lvovna decided to undergo a full examination. What was happening was reminiscent of an episode of House, only everything was in reality, and the medical detective was in no way approaching the denouement. At one time it was believed that the cause was a nodule on the thyroid gland, but the hormones were fine; diagnosed with depression. Lyubov Lvovna did not believe in depression. “I said: “Give me one night of sleep, and I’ll set the whole city on fire, everyone will have fun.” I still do. Sleep for one night - humor will be beyond all praise. It will be possible to work as a clown,” says Lyubov Lvovna.
But then - a series of sad and tragic circumstances: in the sixth month of pregnancy: separation from the child’s father, health problems in the newborn baby and, worst of all, the death of Lyubov Lvovna’s mother from cancer. And all this against the backdrop of an ongoing search for salvation from insomnia. “I was left completely alone in the whole world,” recalls Lyubov Lvovna. “It became scary because I had to control everything myself.” I went to another psychoneurological hospital. I was diagnosed with depression again, I didn’t believe it again, I didn’t take the pills that were prescribed for sleep. As a result, I didn’t sleep, an ambulance came every night: my blood pressure was high, my heart wasn’t functioning well - well, of course, you can’t sleep that much. When five doctors said it was very similar to depression, I finally believed it.”
Lyubov Lvovna was treated for depression, but this did not become a final victory over the disease. At the same time, she had problems with the thyroid gland; in 2021, she had the node removed. “I thought that the reason for my insomnia was him, and I clearly understood that now I would sleep,” says Lyubov Lvovna. “And at first I finally fell asleep on my own.” But when I fell asleep, I began to be “thrown out” of sleep screaming. I recorded this on my phone. These are screams, as if they were sticking a knife into you, as if they were inserting a defibrillator... I brought the recording to the doctor: in 38 minutes I fell asleep six times and woke up screaming six times. I simply don’t have the money for polysomnography, for overnight video EEG, or for treatment from some outstanding specialists: I need to take out a loan and, most importantly, I need to try to fall asleep with a bunch of sensors. This is an impossible task for a person who does not sleep in his usual environment. I wrote to famous doctors on TV, tried traditional medicine, but there was no result anywhere.
Collage: Anna Lukyanova
I am still sure: I have some physical reason, blood vessels or neck. I should go for a CT scan soon - I hope this will help me understand. I was told that I had problems with my vertebral arteries. I'm glad at least that there is such a diagnosis. The doctor said that theoretically this could be the cause of insomnia.”
Olga Moiseeva from Crimea has a similar story: after two and a half years of struggling with insomnia, she had to leave her job in advertising, and the problem began in the same way, one might say, for no apparent reason. “I encountered insomnia in May 2021,” Olga recalls. “I didn’t sleep for four nights in a row.” I immediately notified everyone at work that there was no sleep and I would work as best I could. Fortunately, the work is sedentary and not related to finance. At first, everyone said that this happens and that, they say, you’ll sleep off tomorrow... But no. Naturally, work became more and more difficult. To be honest, I still don’t understand how I coped. The third night had already become a nightmare, and on the fifth day, in tears, I ran to the neurologist for prescriptions.” Olga doesn’t know the specific preconditions: there were no severe stresses. There was an unsuccessful IVF, but Olga doubts that this could have been the reason.
Olga Shabutdinova from the Moscow region, on the contrary, knows what triggered the illness: “At night, after severe stress, I couldn’t sleep at all. Of course, the next day at work I felt bad, I just waited for the evening to sleep. But the next night passed without sleep, with a terrible feeling of causeless anxiety. I went to the pharmacy, bought over-the-counter sedatives and before going to bed I realized that I was afraid to go to bed and spend another night like this. After a week of such torment, I could no longer sit quietly in a chair at work. My colleagues, of course, noticed my condition, but I didn’t want to tell anything at all.”
Sleep, alarm, sleep
President of the Russian Society of Somnologists, head of the Center for Sleep Medicine at the Rehabilitation Clinic in Khamovniki, Professor, Doctor of Medical Sciences Roman Buzunov explains: “Sleep disturbance is considered insomnia if a person experiences at least one of the following symptoms three times a week or more often: falling asleep for more than 30 minutes , night awakenings with a total cumulative duration of wakefulness of 30 minutes or more, early morning awakenings 30 minutes before the alarm or earlier, unrefreshing sleep, even with normal sleep duration. One-time episodes of poor sleep are not a cause for concern. For some people this is generally the norm. There is such a thing as “sleep reactivity”: when a person reacts to some stress with difficulty falling asleep or other symptoms, as with insomnia. For example, many people sleep poorly the night before important events or trips, after an emotional day, or even just on those nights when they need to get up earlier the next morning. Reactive sleep is an individual physiological norm that can occur even in completely healthy people.”
Buzunov says that there are quite a few causes of insomnia and not all of them are associated with psychological disorders: “Insomnia can be caused by diseases of organs and systems: thyroid diseases with impaired hormone production, pain syndrome, diseases of the central nervous system, deficiency of certain vitamins and microelements , taking a number of medications and much more. In general, insomnia has about a hundred causes of various origins. About 20% of people who have had coronavirus suffer from acute or chronic insomnia. The most common causes in this case are stress and lifestyle disorders. A person who has been diagnosed with coronavirus experiences about the same stress as someone who has been told about cancer, heart attack and stroke. While he is being treated, he moves little, worries a lot, spends more time in bed, sleeps more. All this can disrupt sleep."
Buzunov advises contacting a specialist if insomnia persists for a month; if treatment is not addressed, the problem can remain with a person for decades. Some people are predisposed to insomnia due to heredity, psychological characteristics, or dependence on bad habits. Buzunov points out: “Restless, responsible, punctual people often suffer from insomnia. Also at risk of acquiring it are those who are heavily dependent on public opinion, want to please everyone, are not self-confident and have the habit of taking on too many obligations. Anxiety disorders, depression and addictions in parents increase the likelihood of insomnia in a child. Drinking alcohol and smoking can themselves disrupt sleep. Also strong risk factors (and sometimes direct causes) are a sedentary lifestyle and stress.”
Dmitry Zanosov, psychiatrist, author of the blog “Psychiatrist Online”. Collage: Anna Lukyanova
Psychiatrists interviewed by AIDS.CENTER say that sleep disturbances are a common symptom of many mental disorders.
“Insomnia is treated quite often,” says Dmitry Zanosov, a psychiatrist and author of the “Psychiatrist Online” blog, about his experience. — As a rule, this is not the only complaint; it is most often a secondary sleep disorder. Insomnia is observed with depression, anxiety disorder, during the manic phase - with the entire spectrum of mental disorders, sleep can be disturbed. There are cases when sleep is disturbed on its own - then it is better to go not to a psychiatrist, but to a somnologist.”
“Insomnia can be caused by almost all mental disorders that exist,” says Irina Korobkova, psychiatrist, psychotherapist, somnologist, candidate of medical sciences, head of the Center for Post-Stress Conditions and Sleep Disorders of the Family Doctor clinic network. - These can be both disorders of “major” psychiatry: psychoses, psychotic disorders, and what is classified as “minor”, “borderline” psychiatry - anxiety disorders, depressive disorders. I work in “borderline” psychiatry, and patients with various types of anxiety disorders almost always come with complaints of sleep disturbances. Sleep problems are not a mandatory symptom for diagnosing certain types of disorders, however, sleep complaints are almost always present in this category of patients. And about 80% of calls regarding insomnia are caused by psycho-emotional disorders.”
What do these patients usually complain about to the neurologist?
The most common complaint is insomnia . It is difficult for them to fall asleep, sleep can be intermittent, the patient wakes up at 4-5 o'clock in the morning and then cannot fall asleep, although he needs to get up for work at 7.
Headache is also a common symptom. Patients may have dull, aching and pressing, monotonous headaches of moderate intensity (although there may be more severe pain), sometimes they feel heaviness in the head, staleness, difficulty concentrating, memory and performance deteriorate .
Some patients notice that they have become more irritable, anxious, or, on the contrary, more lethargic and apathetic.
Sometimes the patient complains of dizziness, which is felt inside the head; such dizziness can occur spasmodically in the subway, elevators, airplanes, large supermarkets, or simply when going outside from home.
Very often, patients may experience constant pain in the lumbar, thoracic or cervical spine. And, despite small and harmless changes revealed by X-ray or tomography of the spine, the use of various medicinal and non-medicinal treatment methods (tablets and injections, physiotherapy, massage, acupuncture, etc.), the pain does not go away.
Only with careful and confidential questioning is it possible to find out that the patient is depressed by the psychological trauma that happened, he is often (or constantly) in a bad mood, he has forgotten how to enjoy life as before, he does not see prospects in the current situation...
An experienced doctor understands that stress contributes to a decrease in the body's adaptive reserve, and other chronic diseases may also worsen in the patient - for example, peptic ulcer disease, chronic pancreatitis, psoriasis or rheumatoid arthritis. Stress provokes the occurrence of type 2 diabetes mellitus, essential arterial hypertension, autoimmune thyroiditis and other diseases.
But in our patient, all blood, urine, ultrasound, gastroscopy and other examinations are normal or slightly changed and cannot explain the patient’s poor health.
Tablet in hand
When Lyubov Lvovna believed in the diagnosis of depression, she began to see a doctor as a day patient. She recalls: “When the doctor heard my story, he said to me: “How are you holding up? Any healthy man would have collapsed already. You must be very strong.” I deceived the doctor: I took a smaller dose of pills. I gained a lot of weight on this antidepressant and was afraid of gaining even more weight. But at least she started sleeping, and there was no ambulance for six months. I worked on pills, there were concerts. When I came to work, they told me: “My God, what bruises you have under your eyes, how can you still walk.” I can’t say this: I’m getting completely scared, it seems to me that I’m dying.”
“The process of selecting medications is simple,” recalls Olga Moiseeva about her treatment of insomnia. — Doctors have a list of drugs that are used for insomnia (but only for acute insomnia, which does not last long). These drugs are the same for everyone. Some are just weaker, others are stronger. Doctors begin to get confused when the patient says that they have tried everything and there is no point. None of them should be taken for more than a month, and all pills have withdrawal symptoms. They offered sports as an alternative to pills, but it didn’t help me. I worked out two or three times a week, but sleep didn’t always come after training. That is, it turned out that after a sleepless night I went to work, and then to fitness, and I really risked my heart at such moments. My coach told me that I can’t do this. I was also offered cognitive behavioral therapy. But, having found out the price for the session, I was forced to refuse: no guarantees were given, and the price tag for the course was equal to my salary.
Collage: Anna Lukyanova
All the doctors, such as a neurologist, a somnologist, a psychotherapist, cost me a lot of money. All of them are only in private clinics. We don’t treat insomnia for free - a compulsory medical insurance neurologist at the clinic offered me valerian. But, as it turns out, they don’t know how to pay either. Now, while taking vitamins, I feel better, I began to fall asleep on my own. I’m sure that with a problem like insomnia, you need to look everywhere, even where traditional medicine is not used to looking.”
Olga Shabutdinova’s story with insomnia ended in victory over the problem: “I was able to cope with insomnia with medication. My case was not treated with vitamins, teas, meditation, lavender baths... I did not expect to sleep immediately after the appointments. At the beginning of treatment, I took a week off. The antidepressants were taken for about a year. But I was able to sleep normally without tranquilizers after a month and a half. Of course, the doctor cannot always immediately select antidepressants; sometimes this happens the second or third time. It’s very good when during such a period there are people who have gone through this and can support you. My depression and insomnia were partly triggered by moving to another city, so there was no one around.”
Sleep's eyes are big
When treating insomnia, somnologists rely on American, European and Russian recommendations for its treatment. If it is carried out without drugs, the method of cognitive behavioral therapy is used - a technique that helps to bring a person’s unconscious motivations to a conscious level.
This therapy, according to the recommendation, is the most effective, says Buzunov: “This treatment is indicated for the most common form of sleep disorder - chronic inorganic (conditioned reflex) insomnia. It is enough for a person to go to bed several times and not fall asleep, and he begins to form a conditioned reflex of fear of not falling asleep: he expects bad results from the coming night and is automatically activated at the thought of sleep. In an attempt to sleep more, he begins to lie in bed longer: he goes to bed earlier in the evening, gets up later in the morning, and tries to lie down during the day. But the longer a person stays in bed, the more he tries to “stretch out” his sleep, the worse, the more shallow he sleeps. When he can't fall asleep, he makes another mistake: he tries his best to put himself to sleep. But efforts have the opposite effect: the more you try, the less you manage to sleep... Spending a lot of time in bed without sleep, a person creates conditions for the formation of the “bed = insomnia” reflex - and then all drowsiness goes away as soon as he goes to bed. The sleepless person begins to focus on the problem more and more, take medications... He begins to feel afraid of falling asleep without a pill, “winds up” himself, and catastrophizes the situation. Against the background of the above, insomnia is consolidated, worsened and can persist for years and decades.
In such cases, cognitive behavioral therapy can help restore healthy sleep without medication. It eliminates the negative factors of behavior and thinking that cause a person to maintain their insomnia. Teaches relaxation techniques and trains the systems responsible for sleep. Therapy takes four to eight weeks and has a positive effect in 80% of cases. Self-selection of medication is undesirable and even harmful. Insomnia medications should be selected by a doctor if necessary. And methods such as osteopathy, hypnotherapy, acupuncture, have no proven effectiveness against insomnia.”
Roman Buzunov, President of the Russian Society of Somnologists. Collage: Anna Lukyanova
Psychiatrists prescribe medication to treat insomnia. Experts interviewed by AIDS.CENTER note that fear of this type of treatment is most often exaggerated.
Korobkova states: “The use of antidepressants and some other drugs does not always give any serious side effects. The vast majority of modern drugs are well tolerated and have a high level of safety. With adequate dosages and the correct choice of the drug itself, as a rule, a person does not feel any negative effects. It is important here that it is selected by a doctor, so that there are no self-prescriptions, because each case is individual. There are certain drugs that can cause an increase in appetite and, as a result, weight gain, but in fact, there are quite a few of them. Reducing dosages is generally an unpromising tactic in the case of psychopharmacological drugs. Half measures don't work with antidepressants. The two cornerstones of how antidepressants work are dosage and duration of use. If these two points are not correctly selected and observed, then, unfortunately, no full therapeutic effect can be expected.”
“In most cases, the fear of antidepressants is excessive,” Zanosov is sure. — Many patients are afraid because they have read all sorts of garbage forums. But, indeed, an antidepressant can both disrupt and improve sleep. Whenever a person experiences a side effect, they should contact their doctor and discuss it. Sometimes it seems that there is a side effect, but in fact it is not from the drug. And sometimes there are effects that require correction, preferably faster.”
Indications
In 95% of subjects, treatment of insomnia has a positive result. Trance acts comprehensively and helps solve several problems at once:
- reduce anxiety and anxiety;
- overcome uncertainty and internal fears;
- get rid of phobias;
- dull pain;
- relieve fatigue.
Influence on the subconscious is effectively used for virtually any disturbance of the state of rest, but is more often used for:
- single and multiple overvoltages;
- psychoemotional disorders;
- fatigue;
- improper daily routine;
- changing the daily alternation of night rest;
- external stimuli, for example, the noise of neighbors, the light of street lamps, air temperature, and so on.
Treatment of night rest disorder can be complex and alternate with other methods. Such as: physiotherapy, gymnastics, meditation for sleep.
Bed - for sleep and sex
Buzunov reminds about the rules of sleep hygiene, which are the prevention of insomnia.
- Follow a strict sleep schedule—you should have the same bedtime and wake-up time on weekdays. On weekends, it is permissible to wake up no more than two hours later compared to weekdays.
- Don't sleep too long. Most people require seven to eight hours of sleep per night.
- Don't sleep during the day.
- Use your bed only for sleep and sex.
- Avoid consuming caffeine-containing foods and drinks eight hours or less before bedtime.
- Exercise for 40 to 60 minutes five times a week, but avoid exercising in the last two hours before bed.
- Take care of comfort in the bedroom: sleep in silence, darkness and on a comfortable bed.
- Do not drink alcohol or smoke for at least two hours before bed.
- Spend the last two hours of your waking hours in a calm environment.
- One hour before bedtime, stop using gadgets.
Stages
Using an electroencephalograph, it was possible to conduct studies of the physiological state of the subject during sleep. This process has two cycles, which consist of two phases:
- slow;
- fast.
During the slow phase, the patient falls into a sound, deep sleep. The duration is ¾ of the cycle. All physiological processes slow down. In this state, cells are renewed, information is processed, and energy reserves are replenished.
The fast phase is much shorter and is only a quarter of the cycle. During the fast phase, the work of internal organs is activated, the heartbeat quickens, the temperature rises, and the work of the brain is activated.
The phases occur cyclically and are repeated several times. The duration of the fast phase increases each time.
