Preceding falling asleep, painful ...

Preceding falling asleep, painful sensations in the legs and feet forcing patients to make movements down or walk, will resume when laying in bed and pass only enough deep sleep. For sleep disorders associated with somatic pathology, the most characteristic of shallow sleep and frequent waking, and no difficulty sleeping. In these situations, the paramount importance is the adequate therapy of the underlying disease and the use of drugs with hypnotic action is justified only when the failure of the measures taken and to meet strict contraindications for prescribing psychotropic drugs. In neurological practice, sleep disturbances were studied in detail in the organic CNS lesions involving structures for initiating and maintaining sleep, disorders of the peripheral nervous system (for vertebral diseases, neuropathies, etc.), as well as neurogenic asthenic conditions. Among all secondary sleep disorders in older age two thirds are mental disorders and diseases. The most frequently sleep disorders are a symptom of depressive states of various origins, both endogenous and neurotic, vascular. Moreover, even in shallow depression (mild to moderate severity) is usually accompanied by dissomniey. Observed depression in which the sleep disorder is the leading and determines the clinical picture of the state, while the actual depressive symptoms are revealed only through careful questioning. Shallow depression particularly frequent in somatic practice, but not always diagnosed, often because of masking depression somatic complaints and symptoms or other manifestations of atypia. Depressed patients with sleep disorders often complain of insomnia. On questioning revealed as difficulty falling asleep, and the characteristic early awakening with inability to fall asleep again, anxious restlessness in the night awakening, a painful state of mind in the early morning hours. It is characteristic of depressed patients lack a sense of sleep, often forming an obsessive fear of nightfall, and insomnia. Among the psychiatric cases with sleep disorders may be the point where patients do not complain, but there are pronounced sleep disturbance (excitation states in psychosis, manic or hypomanic states, delirious disorders, toxic and vascular origin) and in dementia of late life. In the latter case, the frequently observed inversion of sleep the night fussy waking and daytime sleepiness. Such a clinical situation is particularly difficult in the hospital and home care for dementia patients. In the geriatric practice is particularly important to consider the possibility of iatrogenic insomnia. By direct pharmacological mechanism of sleep disorders can be caused by the following medications: psychotropic drugs (antidepressants, psychostimulants, nootropics), antihypertensive drugs (clonidine, b-blockers), antiarrhythmics, bronchodilators drugs (ipratropium bromide and terbutaline, salbutamol, teofillinovye drugs); hormonal medications (glucocorticoids, thyroid hormones, progesterone), certain antibiotics (quinolones), lipid-lowering agents (statins, fibrates, cholestyramine), antiparkinsonian drugs (levodopa, selegiline), cardiac glycosides (if an overdose), anticancer drugs, antitussives.