SLEEP

The sleep cycle refers to the sequence of stages during sleep according to research on the subject.

A healthy person has four to seven sleep cycles of about 70 to 110 minutes every night, in which the NREM stages N1, N2 and N3 and again N2 are followed by REM sleep. In the following cycles, the proportion of deep sleep decreases and disappears completely in the later cycles; whereas the REM part increases towards the end of sleep period.

The stages in a total night’s sleep for a healthy thirty year old person are as follows:

• Stadium N1 about 5%
• Stage N2 about 45-55%
• Stage N3 about 15-25%
• REM sleep at about 20-25%
• Growth rate of under 5%

A polysomnography shows the measurement of the periods of sleep in relation to the sleep cycles and is demonstrated in the sleep profile (hypnogramme).

Significant deviations from this basic pattern often cause sleep to be perceived as less relaxing. The sleep-interrupting reactions to waking, like the arousals in sleep apnea syndrome count as well as changes in the sequence. Particular features such as REM sleep a few minutes after falling asleep, so-called sleep-onset-REM periods (SOREMP), can be indications of certain sleep disorders.

Insomnia is widespread in our society and there are different causes:

• Emotional troubles such as stress, anxiety, anger or tenseness
• Disagreeable external conditions such as noise, bright lights, inappropriate bedding, irregular lifestyle or shift work
• High caffeine or alcohol consumption
• The side effects of some medications (see below)
• Other basic diseases associated with sleep disorders (see below)

For many people, the process of falling asleep in itself generates a great amount of stress. Following these measures may help:

• A hot shower or a bath will help relaxation before sleep. In addition, soothing essences such as lavender, hops and melissa are known sleeping aids.
• Refrain from drinking coffee or energy drinks in the evening. Caffeine is a stimulant.
• Breathe fresh air. Open the windows in the bedroom for a few minutes before going to bed to let the air in.
• Regular exercise is a good antidote to restlessness at night-time; however, sports’ activities should be finished two hours before going to bed, otherwise they will have the opposite effect.
• A midday nap can be wonderful; but in the evening there is a risk of being awake for longer; so, forget the siesta.
• Pay attention to your diet! Spinach, for instance, has a high magnesium content, which lowers the levels of the stress hormones. Light meals in the evening are also to be recommended.
• Artificial partitions in a room create the impression that it is daytime; consequently, fewer sleep hormones (melatonin) are produced. However, in the evening, reading a real book is always preferable.
• To maintain a good sleep rhythm, people should always try to go to bed at night and to get up in the morning at the same times.
• If you don’t fall asleep immediately, don’t worry, just focus on looking at the clock all the time.
• Many men fall asleep quickly after sex whereas women tend to waken up.
• The principle of “the earlier the better” does not apply when it comes to falling asleep; it is better to not go to bed until genuinely tired.

Possible causes of sleep disorders:

• Cardiovascular disease
• Respiratory problems, stomach ailments, heartburn
• Joints and muscular diseases
• Fibromyalgia
• Headaches and migraines
• Neurological diseases
• Hormonal disorders
• Sleep apnea (central or obstructive sleep apnea)

Possible drug triggers for sleep disorders, an overview of drug groups:

• Hypertensive agents such as beta-adrenergic blockers, calcium antagonists and other cardiovascular medications
• Statins against fat metabolism disorders (hypercholesterolemia)
• Hormone preparations such as thyroid medications or some contraceptives, for example, certain “anti-baby-pills”
• Appetite suppressants
• Energy boosting antidepressants
• Psychotropic drugs, for example, remedies against psychosis (neuroleptics), tranquilizers
• Medications for asthma and other respiratory diseases
• Medications for the treatment of Parkinson’s disease
• Remedies for inflammatory joint diseases such as non-steroidal anti-inflammatory medicines, malaria agents or drugs from the group of sulphonamides
• Antibiotics
• Cortisone
• Pain and migraine remedies
• Caffeine-containing pain, cough and flu remedies
• Some antihistamines, for example certain remedies for allergies, itching or stomach ailments

Sleeping agents are substances that promote sleep and are therefore used for the treatment of sleep disorders. Modern medicines promote sleep but without forcing it.

Synthetic sleeping agents are not a strictly-defined group of active substances, but nevertheless can be divided into different groups:

• Benzodiazepines are among the most commonly used sleeping agents. They have an anxiety-solving, cramp-releasing and sleep-promoting effect. The active ingredients are flurazepam, nitrazepam, temazepam and triazolam. They should not be used over long periods for the treatment of sleep disorders, as they can create a dependency.
• Non-benzodiazepine agonists are also used often for treatment. They have a different structure from benzodiazepines, but they connect with the same receptors. Typical examples are zolpidem and zopiclone. They have the advantage over benzodiazepines in that users are less likely to become dependent on them.
• Nowadays, barbiturates are only used as sleeping agents if the discomfort cannot be alleviated by other sleeping agents. This is because they have unpleasant side effects and overdosage can be fatal.
• Antidepressants help not only with depression, but also with sleep disorders, especially amitriptyline, doxepin and trimipramine which have a soothing and calming effect and thus encourage sleep. Antidepressants are particularly used for sleep disorders caused by depression. They are also used when anxiety develops as a result of a broken sleep pattern.
• Neuroleptics are also not typical sleeping agents; but they are used for the treatment of mental illnesses. They can also help with sleep disorders due to their soothing and calming properties.
• First-generation antihistamines not only alleviate allergic reactions, but also have a sedating effect. Certain active substances such as doxylamine, meclizine and promethazine are therefore proposed as sleeping agents.
• Substances of organic origin are the amino acids tryptophan and the hormone melatonin.

Side effects of synthetic sleeping agents

Sleeping agents should only be prescribed taking into consideration the possible side effects, where absolutely necessary. The particular medicine proposed will determine whether there will be side effects and if so, how strong they will be.

With remedies that are metabolised only slowly due to their long action, tiredness, fatigue, dizziness, and reduced responsiveness can occur the following day (the hang-over effect).

Some sleeping agents, such as benzodiazepines, are known to create a dependency relatively quickly. They should be taken only for short periods and under medical supervision. If longer-term treatment is necessary, other sleeping agents are often prescribed. These medicines usually have a lower dependency risk, but the range of effects normally remains the same.

With people who have been on sleeping medication for a long time, they should not stop taking it overnight. Reduce the dosage slowly, step by step to prevent any unpleasant withdrawal symptoms (rebound effect).

Today, sleeping agents are used more and more frequently to treat sleep disorders. Although medicine can promote better sleep in the short term, many agents disturb the pattern of sleep in the long term; for example, certain medications such as benzodiazepines suppress the restful deep sleep phases which significantly decreases the quality of sleep.

Due to the influence of the drugs on the structure of sleep, those affected may sleep even more badly after discontinuing taking the medication than before; then often, further medications are required which only serves to create a vicious circle. For this reason, synthetic sleeping agents should always be taken as a last resort.

Herbal sleep agents have the advantage that they have no or only slight side effects. However, their sleep-promoting effect and their duration of action are also lower; therefore, they are usually used only to help people sleep, but not for treating sleep disorders.

Herbal sleeping pills with valerian, hops, lemon balm, passion flower and St. John’s wort are all appropriate for the treatment of sleep disorders. They should usually be taken for a few days before their effect is felt.

Soporin – herbal sleep drops

Soporin is a mixture of 4 herbal mother tinctures produced by the company Herbamed. It has the following composition:

1 ml contains

The individual components have the following effects:

Valeriana officinalis

Valeriana officinalis helps to relieve restlessness, nervous sleep disorders, heart problems arising from nervousness and cramps in the gastrointestinal area. The active ingredients are, depending on the origin, different compound essential oils with bornyl acetate and bornyliso valerianat being the main components. These ingredients are also responsible for the typical odour of valerian that is apparent when the drug is dried.

Humulus lupulus

Humulus lupulus is used as a sedative for nervous tension, restlessness, anxiety and insomnia. It is antibacterial, and its preservative properties are useful when brewing beer though it is not fully clear which ingredients are responsible for these effects. It is thought that the bitter substances in hops are the principal factors.

Melissa officinalis

Melissa officinalis is effective against nervousness, inner tension, restlessness and irritability. It promotes a sound gastrointestinal function and is also used externally against herpes simplex, due to its antimicrobial and antiviral properties, in particular from its content of rosemary acid.

Passiflora incarnata

Passiflora incarnata is used to treat nervous tension, anxiety, restlessness, irritability and sleep difficulties. In addition to having a component that acts as a mild sedative, the passion flower extract has effective anxiolytic properties, both on the psychic as well as, though slightly less pronouncedly, on somatic phenomena.

Indication

For sleep disorders, particularly those due to nervous states and examination anxieties, insomnia and general restlessness.

Dosage

Adults should take 20 – 30 drops in a little water before sleeping, children from 6 years of age, 10 – 15 drops.

Contraindications or application limitations

As a general precaution, taking medication should be avoided during pregnancy and lactation. If in doubt, a physician or pharmacist should always be consulted.

Side effects

None known