Sleep time inversion

Introduction Sleep time inversion refers to drowsiness during the day, and nighttime excitement, can be seen in neurasthenia, rickets, brain traumatic neurasthenia syndrome and cerebral arteriosclerosis. In this case, the patient should be arranged a reasonable schedule for the patient to urge the patient to get up on time, go to bed on time, and arrange some activities of interest to the patient during the day, such as watching TV, listening to music, etc., and let the patient do something. Do your best to do housework, try to reduce the amount of sleep during the day, and sleep at night; try to reduce bad stimuli before going to bed, do not drink tea or coffee, use hot water to soak your feet, do some massage, let the patient fall asleep quietly and comfortably. Sleep time inversion is a sleep disorder. Sleep refers to the state of inertia and non-reactivity of recurrence. The level of consciousness decreases or disappears during sleep, and most of the physiological activities and reactions enter an inert state. Through sleep, the fatigued nerve cells return to normal physiological functions, and the mental and physical strength are restored. The growth hormone secretion in the anterior pituitary is significantly increased during sleep, which is beneficial to promote the growth of the body and increase the synthesis of nuclear proteins, which is conducive to the storage of memory.

Cause

Sleep is divided into two periods according to EEG and eye movement changes, namely non-quiescent sleep period (HREM) and fast eye movement (REM). When non-fast sleep period, muscle tension is reduced, no obvious eye movement, brain The electrogram shows slow and synchronized, and wakes up during this period. During the fast eye movement period, the muscle tension is significantly reduced, and rapid horizontal eye movement occurs. The EEG shows a state similar to that of awakening. This period is awakened, clear consciousness, and no sense of tiredness. This period has a colorful dream.

The study found that the tail of the brain stem has a very important relationship with sleep. It is considered to be the center of sleep. In this part, various irritative lesions cause excessive sleep, while destructive lesions cause sleep loss. In addition, it was found that the central nervous system involved in sleep, stimulated serotoninergic neurons or injected with serotonin, which produced non-rapid eye movement sleep, and gave serotonin antagonists, resulting in reduced sleep. When a norepinephrine antagonist is used, sleep in the fast eye movement period is reduced, and norepinephrine agonist is given, and sleep in the fast eye movement is increased.

an examination

Related inspection

EEG sleep test

Sleep disorders are a symptom, and the diagnosis should focus on the time to fall asleep, the time and frequency of awakening, the total sleep time, the quality of sleep, and other systemic symptoms associated with it. In general, any reason for reduced effective sleep time, increased sleep arousal, decreased sleep quality, PSG (polysomnography) shows sleep latency > 30 min, wake time > 30 min per night, actual sleep time < 6 h per night or Sleep disorder can be diagnosed every time the apnea is >10s and the apnea is more than 30 times per hour. Sleep disorders in the elderly should be judged as a result of physiological phenomena caused by aging or diseases or drugs. Multiple nap latency tests, apnea physiological recorders, blood gas analysis, Holter, laryngoscopy, and head imaging examinations contribute to the diagnosis of sleep disorders and their causes. The course of sleep disorders is also helpful in judging the cause. Transient insomnia only shows occasional sleep difficulties for several occasions. The stressful situation is timely and the sudden change of work is the main reason, physical diseases and psychological factors (such as asthma, heart failure, Sadness and persistent tension often lead to short-term insomnia (<1 month), primary sleep disorders (such as sleep apnea, periodic limb pain, depression, multiple chronic diseases, poor sleep hygiene, drugs or alcohol) Impact) is the cause of chronic sleep difficulties (> 1 month).

Differential diagnosis

Differential diagnosis of sleep time inversion:

(A) insomnia: manifested as difficulty in sleeping or waking up early, often accompanied by sleep is not deep and dreams. Insomnia is a common sleep disorder. Insomnia can be seen in the following situations:

1. Insomnia caused by mental factors: mental stress, anxiety, fear, excitement, etc. can cause short-term insomnia, mainly due to difficulty in entering the sleep and easy to wake up. After the mental factors are relieved, insomnia can be improved. Patients with neurasthenia often complain of difficulty sleeping, sleep is not deep, and dreams, but EEG records show that sleep time does not decrease, and the time and frequency of awakening increase. These patients often have headache, dizziness, forgetfulness, and fatigue. , easy to be excited and other symptoms. Insomnia in depression often manifests as early awakening or lack of sleep, and EEG tracing shows a significant increase in arousal time. Mania shows difficulty sleeping and staying up all night. Schizophrenia can be affected by delusions and can be difficult to fall asleep.

2. Insomnia caused by physical factors: pain, itching, stuffy nose, difficulty breathing, asthma, cough, frequent urination, nausea, vomiting, bloating, diarrhea, palpitations, etc. caused by various physical diseases can cause difficulty in sleeping and not deep sleep.

3. Physiological factors: Insomnia can be caused by changes in the living and working environment and the first-time alienation, unaccustomed environment, drinking tea and coffee, and insomnia after short-term adaptation.

4. Insomnia caused by drug factors: reserpine, amphetamine, thyroxine, caffeine, aminophylline, etc. can cause insomnia, and insomnia can disappear after stopping the drug.

5. Dilated brain lesions: Chronic poisoning, endocrine diseases, nutritional metabolic disorders, cerebral arteriosclerosis and other factors caused by diffuse brain lesions, insomnia is often an early symptom, showing reduced sleep time, intermittent wake-up, deep sleep disappearance Drowsiness and disturbance of consciousness can occur when the condition worsens.

(2) Drowsiness: It means that the sleep time is too long, which is several hours longer or several days longer than the normal sleep time. There is no REM phase at the beginning of sleep, and NREM and REM sleep periods are similar to normal sleep throughout sleep.

Excessive sleep can occur in many brain diseases, such as cerebrovascular disease, brain trauma, encephalitis, brain tumors near the bottom of the third ventricle and the sella, and also in urinary poisoning, diabetes, excessive sedatives.

(3) Night terror: sudden awakening in sleep, direct eyes, two eyes, fear, shortness of breath, rapid heart rate, accompanied by loud shouting, turmoil, attack lasted 1 to 2 points, after the attack Go to sleep, and you can't recall the episode after waking up in the morning.

The study found that night terrors often appear within 15 to 30 minutes after the onset of sleep, belonging to the NREM phase, and the alpha rhythm of the arousal on the EEG is an "awakening disorder."

(4) Sleep-walking: Night tour is also called sleepwalking and sleepwalking. When the attack occurs, the patient suddenly wakes up from sleep. When he is not awake, he crawls on the bed or walks on the bed. His face is expressionless, his movements are clumsy, he walks unsteadily, mutters to himself, and sometimes he can see more complicated movements such as dressing. Each episode lasts for a few minutes, then goes back to bed, and wakes up completely after the morning.

Studies have shown that dreams are more common in children, more common in men, and children gradually disappear with age, suggesting that the disease is caused by delayed central nervous system. Dreamwalking occurs in the NREM phase, and EEG shows paroxysmal high-altitude slow waves. Some people think that dreamwalking may be a manifestation of epilepsy. If the patient is raised in the NREM period, it can induce dreams, and normal children can not induce it, denying the view that dreams are a nightmare.

(6) Narcolepsy: An irresistible sudden onset of sleep accompanied by cataplexy, sleep paralysis, and illusion of falling asleep. Can not be restrained during sleep episodes, can occur suddenly in any occasion such as eating, talking, working, walking. Monotonous work, quiet environment and easier episodes after a meal. Sleep is similar to normal sleep, and the EEG also shows a normal sleep waveform. Generally, the degree of sleep is not deep, easy to wake up, but wakes up and falls asleep again. It can occur from a few times to dozens of times a day, and the duration is usually more than ten minutes.

Trips are the most common complication of this disease, accounting for about 50 to 70%. The consciousness is clear when the attack occurs, and the muscles of the trunk and body suddenly fall and fall down, usually lasting 1 to 2 minutes.

Sleep sputum is seen in 20 to 30% of patients with narcolepsy, manifested as conscious and unable to move, systemic flaccid paralysis. When a patient is touched by a person, the episode can be stopped, and some patients have to shake hard to recover.

The illusion of falling into sleep accounts for about 25% of the disease. It is more common in audio-visual hallucinations. The content is mostly daily experience. The patient is aware of the surroundings, but it seems to be in a dream.

(7) Kleine-Levin syndrome (Kieine-Levin syndrone): is a kind of paroxysmal sleep hyperactivity, more common in men aged 10 to 20 years old, one can occur 3 to 4 times, each lasting several days to several weeks At the time of attack, only wake up when eating and urinating, the amount of food can be more than three times, accompanied by irritability, restlessness, etc., EEG occasionally sees chopping, the interval is normal, the cause is unknown, often Choose to heal after adulthood.

(8) Pickwickian syndrome: manifested as oversleeping, obesity, episodes of apnea, muscle relaxation, and bruising skin. Apnea is usually 10 to 20 seconds and can last up to 2 minutes. The seizures were mostly during the NREM sleep period, and the EEG slow wave increased. Continuous monitoring of the disease found that there were both severe arrhythmias and hypertension. The cause of the disease is unknown, and there may be a family genetic predisposition.

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