– For a doctor, the task of treating insomnia is primarily related to finding out its cause. First, the doctor will conduct a thorough examination of the patient. It is very important that the patient is able to describe his feelings in detail and responsibly. It is best to come to the doctor for the first time, a person suffering from insomnia, brought with him a diary of sleep . The records made in it will help the doctor determine the characteristics of the structure of sleep and find out whether the daily activity affects its structure. It’s good to start keeping a diary 1-2 weeks before the visit to the doctor. These can be arbitrary short notes made in the morning after sleep, but not before falling asleep, and in no case at night.
Collecting anamnesis (which in Greek means “memory”), the doctor will certainly focus on the specific circumstances, which are recommended to be described in the sleep diary. It should be noted:
– the time when the patient went to bed the night before;
– how long did it take to sleep; – how many times the night had to wake up;
– after how much time managed to fall asleep again; – hour of morning awakening. In the evening, on the eve of going to bed, you should write down in your diary: – when and how many cups of coffee or caffeine-containing drinks you have drunk; – how much and when alcohol is drunk; – what drugs were taken throughout the day; – whether there were stresses today; – I had to take a nap during the day and at what time.
By answering these questions daily and keeping your sleep diary for 1-2 weeks, you can gather accurate information about the features of insomnia and its causes from a particular person.
Some medical specialists may ask each morning to complete the Stanford Sleepiness Scale. On a scale, the intensity of sleepiness due to a sleepless night can be assessed in points.
1 point – energy, vivacity, vigor is preserved. The person feels completely awake.
2 points – activity at a high, but not at a peak level. Preserved ability to focus.
3 points – a state of relaxation. Awakened person easily reacts to surrounding events, but not very alert.
4 points – there is some confusion, disappointment at night rest. Performance reduced.
5 points – marked confusion, inhibition, unwillingness to maintain the state of wakefulness.
6 points – a strong feeling of drowsiness, accompanied by dizziness. A person prefers to stay in bed, struggling with sleep.
7 points – waking up, the person immediately falls asleep again, unable to overcome sleep.
The data of the observation diary on a drowsiness scale will help to objectively assess the degree and characteristics of sleep disorders. This will help to correctly establish the cause of insomnia for its effective treatment.
Careful collection of anamnesis allows, most often, to reveal such causes of situational insomnia, which the patient does not know. In most cases, this is what helps to change something in your life, which immediately allows you to completely get rid of sleepless nights. Sometimes it is enough to observe sleep hygiene and everything is getting better.
– Somnography is an instrumental method of examination, the indications for which are determined by a specialist after an interview. The decision on the need to register indicators is taken by the somnologist and is held in a specially equipped laboratory or clinic that deals with problems with sleep disorders. Most often, somnography for the diagnosis of insomnia is not needed.
In the laboratory, first of all, the correct sleeping environment is created: the patient puts on clothes in which he usually sleeps, brushes his teeth and does everything as usual at home. Then, sensors are connected to record the electroencephalogram (EEG), the number of breaths, the electrocardiogram (ECG), the electromyogram of the muscles of the chin and legs (to know when the muscles of the lower jaw are relaxed and whether there are movements of the lower extremities in a dream). All these sensors are fixed on the skin and do not cause pain. When all the wires are connected to the equipment, the person goes to bed. All night is recording electrophysiological parameters of sleep. In the morning you can go home. It will take time for several days to decipher the results, and treatment recommendations will be available in the coming days.
Indications for the use of somnografii following:
– Complaints of the patient for loud snoring.
– Indications of respiratory arrest in a dream (from the words of relatives).
– Restless sleep with frequent waking up.
– Daytime sleepiness, irritability, memory loss.
– Difficult to treat arterial hypertension.
– Nighttime hypertension according to the daily blood pressure monitoring.
– Heart rhythm disorders at night. – Nighttime choking attacks. – Night profuse sweats.
– Persistent headache in the morning awakening.
– Reduced potency.
In addition to a set of laboratory instruments, a special portable device called a wrist actograph was created . It looks like a wrist watch worn on the wrist. Records made with this device are very informative. Thanks to its electronic filling, the device allows you to record during the week day and night. The actograph records the movements of the wrists, which determine the state of sleep and wakefulness. It was found that when a person sleeps, his hands are calm, and when awake, they are in motion.
Thus, the history and, if necessary, the sonogram, allow to diagnose sleep disorders in patients and develop a treatment plan.