Morning headache as a symptom of obstructive sleep apnea

Constant headaches are a common reason for patients to turn to neurologists at the Yusupov Hospital. People experience headaches in the evening, in the morning after sleep, which do not go away after taking painkillers, and at night. Frequent headaches in men can occur in the presence of pathology of cerebral vessels or brain tumors.

Persistent headache is an indication for a comprehensive examination of the patient. Neurologists conduct instrumental analyzes using the latest equipment from leading global manufacturers. Analyzes are performed by experienced laboratory technicians. Patients are advised by candidates and doctors of medical sciences. Leading specialists in the field of headache treatment collectively develop tactics for managing patients whose headache does not go away for several days.

Non-pathological causes of daily headaches

Brain activity is disrupted due to minor disturbances in blood supply, metabolism, and innervation. Night headaches occur for the following reasons:

• lack of oxygen;
• high temperature in the bedroom;
• drinking alcohol in the evening;
• overwork.

Healthy sleep depends on bedding and posture. On a high pillow, the cervical spine bends strongly. Even in the absence of discomfort during sleep, muscle tension occurs and cerebral blood flow is disrupted. Sleeping without a pillow can also cause pain in the head and neck. Low-quality fabric dyes and softeners used to wash bed linen often contain harmful ingredients that cause breathing problems and headaches in the morning.

Experiences and intense mental activity in the evening lead to brain overstrain. At night he cannot switch off. The patient cannot sleep and often wakes up. After waking up, you feel discomfort, pain in the head, and fatigue. He gets morning headaches.

How to treat sleep-related headaches

It all depends on the reasons for its appearance, but, in any case, symptomatic therapy, that is, mindlessly taking analgesics, is not the answer. As you understand, there are many causes of headaches. Sometimes it’s just an uncomfortable pillow, and sometimes it’s a sign of a serious illness. It is important to understand why it occurs as early as possible and consult a sleep specialist to identify the connection between headaches and sleep.

Do you have night or morning headaches? Contact our Center and we will help you effectively! Make an appointment by phone: +7.

Pathological causes of headaches

A common cause of nighttime headaches is oxygen deficiency. It may be caused by abnormalities of the nasal passages and respiratory tract diseases. Night headaches occur after sleep apnea.

Blood supply to the brain is impaired during hypotension. The outflow of venous blood worsens due to a decrease in the tone of the intracranial veins. In the morning the patient feels it in his head.

With arterial hypertension, blood pressure may increase during sleep. The reason is the patient’s age, disruption of sleep and rest patterns. Vascular tone is impaired in diseases of the thyroid gland and heart. Nocturnal hypertension is dangerous for the development of heart failure and stroke. Headache occurs at night or in the morning.

Stress, anxiety, and mental trauma affect the central nervous system and change vascular tone. This provokes an increase in blood pressure and irritation of pain receptors in the walls of blood vessels. Night headaches that occur under the influence of psychogenic factors are varied in nature. They are accompanied by irritability, rapid heartbeat and are not relieved by analgesics.

Diseases of the cervical spine and temporomandibular joint can provoke night headaches. With back pain, a person is forced to take an uncomfortable position, which causes spasms of the neck muscles. They cause headaches.

Failure to comply with the dosage of glucose-lowering medications or refusal to eat dinner in diabetes mellitus results in a sharp decrease in blood glucose levels and severe headaches. Histamine disease is characterized by prolonged attacks of acute headache in the orbital area in the evening and at night.

In the presence of brain tumors, patients complain of night and morning headaches. As the disease progresses, it intensifies. The head hurts when changing position, the patient's hands go numb.

Throbbing morning headaches are felt during migraines. They often intensify when the light is turned on and are accompanied by nausea and vomiting. Constant headaches that bother the patient night and day are characteristic of brain infections.

Treatment

To treat hypnic headaches, a person can consume caffeine before bed. In some cases, the doctor may recommend:

• melatonin
• flunarizine
• methindol
• lithium carbonate

People with stomach ulcers should avoid taking indomethacin.

People who are dehydrated, are using diuretics, or have kidney or thyroid disease should consult a doctor before taking lithium carbonate.

Although there is currently no cure for cluster headaches, there are treatments available to relieve the pain. Cluster headaches cause severe pain quickly, which is why many pain medications are not effective enough. To effectively treat headaches use:

1. Oxygen
   : Inhaling oxygen at a rate of 7-12 liters per minute can stop a headache attack. This may take 15-20 minutes.
2. Sumatriptan
   : People can take this drug as an injection, which will relieve pain within 10 minutes. You can take Sumatriptan as a tablet or nasal spray, but these forms work more slowly.
3. Zolmitriptan nasal spray
   : may be effective in treating cluster headaches in some people, but is slow to act.

Using preventive treatments is an effective way to stop cluster headaches before they start. Preventive medications include:

• verapamil
• methysergide
• lithium
• corticosteroids
• ergotamine
• topiramate

Some of these preventative treatments may have side effects, so the doctor should monitor the patient while he or she is taking them.

If a person experiences tension headaches at night, taking pain medications before bed may help. Applying a warm compress to the forehead or taking a warm bath or shower before bed can relax muscles and relieve tension.

There is currently no cure for migraine, although symptoms can be treated. People can take the drug either to relieve pain during an attack or to prevent migraines from developing. Managing stress through relaxation techniques and regular exercise can also prevent the severity and frequency of migraine attacks.

When to see a doctor

A person should see a doctor if they have frequent or severe headaches at night. The doctor will perform tests to identify underlying causes and find out what type of headache the person is experiencing.

You should consult a doctor if the following symptoms appear:

• changes in personality or mental state
• headaches appeared after a blow to the head
• headaches interfere with daily activities
• fatigue or muscle weakness

Cluster headaches

Attacks of cluster (bundle) headaches occur in paroxysms and are difficult for patients to tolerate. The pain has the following characteristics:

• localized in the eye area;
• radiates to the forehead, temple, cheek;
• accompanied by lacrimation, sweating of the forehead, a rush of blood to the face;
• more acutely felt when the patient is lying down;
• starts and goes away suddenly.

Night headaches begin without cause between 9:00 p.m. and 9:00 a.m. The peak of pain occurs at night, from zero to three o'clock. Attacks occur cyclically, followed by painless periods. Attacks are observed mainly in men. Pain occurs after drinking alcohol.

Men whose relatives suffer from cluster pain are at risk. The risk of developing a painful attack increases with head injuries, migraines, sleep disorders, mental and physical stress. Neurologists include possible causes of cluster headaches:

• abnormalities of the hypothalamus;
• pathology of blood vessels;
• disruption of circadian rhythms.

Patients relieve an acute attack at home with lidocaine drops in the nose. For symptomatic therapy, neurologists prescribe special medications and oxygen inhalations. In difficult cases, electrical stimulation of the brain is performed and the nerves that cause pain are removed. During the cluster period, doctors recommend giving up alcohol and nicotine.

Night shift work and sleep

So, you need to go to bed at a time so that the body produces a sufficient amount of melatonin. But what about those who work the night shift? Experts advise such people to follow the example of residents of southern countries and introduce the tradition of relaxing in the afternoon. In the Mediterranean this is called siesta.

Between 1 and 3 p.m., a person’s body temperature drops and activity drops sharply. This is the best time to sleep, a good way to avoid physical and nervous overload.

It is quite common to hear that people have a headache after a nap. To avoid this problem, you need to sleep for 30 or 80-120 minutes. The fact is that after about half an hour of rest, the deep phase of sleep begins, and waking up during this period will be painful, and sleep will not help restore strength. After one and a half to two hours, this phase ends, and the person has every chance of waking up alert and rested.

Diagnosis of headache

Neurologists at the Yusupov Hospital determine the cause and type of persistent headache based on data from a clinical examination of the patient, instrumental and laboratory research methods. Doctors at the Neurology Clinic prescribe the following diagnostic procedures:

• Doppler ultrasound of head and neck vessels;
• electromyography;
• electrocardiography;
• diagnostic spinal puncture (if a neuroinfection is suspected).

Computed tomography and magnetic resonance imaging are performed if a brain mass is suspected. To determine the condition of the cerebral vessels, contrast angiography or multislice tomography is performed.

“Fight or flight”: why it is harmful to disrupt circadian rhythms

Oxford sleep researcher Russell Foster describes how a nightly schedule can throw off your body clock. According to him, the main problem of this regime is not long hours of work in the dark, but the morning light that night owls see when getting ready to rest. A person is preparing for sleep, and his photoreceptors, on the contrary, send a signal “It’s time to wake up” to the suprachiasmatic nucleus. If you deceive biorhythms in this way for long enough, your stress level will increase. The body can produce a “fight or flight” response, which normally helps to escape from a specific threat.

In this state, the body prepares for increased activity. Glucose is sharply released into the blood to provide the muscles with energy for attack or flight, blood pressure rises, and the heart begins to beat faster.

The “fight or flight” response works great in case of real danger, but it is impossible to constantly be in this state - it exhausts the body.

If at the same time a person does not have enough sleep, the opportunity to regain strength becomes even less.

If you live long enough in a state of constant rhythm disturbances, high levels of stress and associated reactions will become additional risk factors for the development of disease. But there are also other factors - for example, age, overeating, lack of exercise and bad habits. They increase the likelihood of heart and vascular diseases, which already bear a heavy burden during the night schedule. Lack of sleep can also lead to excess weight (and this is another risk factor for many diseases): it disrupts the balance of the hormones leptin and ghrelin, which control feelings of hunger and fullness.

According to Professor Foster, it is the floating mode and lack of sleep that are dangerous. Nighttime activity in itself is not harmful if it is regular (you are always active at night and sleep during the day) and you manage to avoid bright light in the morning.

What is the difference between apnea headache and classic migraine?

In typical cases, it is quite simple to distinguish headaches due to obstructive apnea from migraine headaches.

Sleep disorders

Sleep disorders are diverse. They occur very often. Thus, in France, a national program to combat insomnia was adopted in 2006, as it turned out that a third of the French suffer from serious sleep disorders. Sleep disorders occur in various mental and somatic diseases. It is important to note that dissomnia is often one of the earliest signs of a mental disorder. Normalization of sleep, in turn, usually characterizes the state of recovery. Let us describe currently known sleep disorders.

Hypersomnia is an increased need for sleep and an increase in daily sleep norms that are not subject to conscious control. The duration of sleep increases to 15–16 hours a day or more, and the disturbance can last for several weeks and months. Increased activity in the waking state, as well as a feeling of satisfaction from sleep, usually does not occur with hypersomnia. Hypersomnia may be followed by periods of shortened night sleep. There is practically no information in the literature about the structure of sleep in hypersomnia, especially considering that it is observed in various diseases and painful conditions.

It should be emphasized that the important fact is that hypersomnia is not a state of somnolence observed in epilepsy after seizures, vegetative-vascular paroxysms, hypoglycemia, encephalitis, meningoencephalitis, acute intoxication, as some authors do (Vein, 1974, etc.). In psychiatric practice, hypersomnia is especially common in states of apathy, anergy, asthenia and mild depression. The number of dreams does not increase; on the contrary, it decreases significantly. Some patients develop something of a sleep addiction: they would like to sleep more if they do not experience unpleasant sensations while sleeping. For example, this disorder occurs in depression. An increased need for sleep may be accompanied by a shortening of daily sleep norms. Such patients constantly feel a drowsy state with a desire to fall asleep, but they cannot fall asleep for a long time, which is why they resort to taking sleeping pills.

Short-term states of hypersomnia, characterized by short episodes of excessive sleepiness and subsequent disturbances of various kinds, often occur. Thus, the patient reports: “If I feel unusually strong sleepiness, I already know that something is wrong with me. I fall asleep quickly, but only for a short time. Then I suddenly wake up and at this time I feel as if I am falling somewhere, flying away somewhere. At the same time, I feel as if something is in the way in my hands, my heart turns over and begins to pound rapidly. The next morning after this, I get up broken, with a headache, my head hurts somewhere inside, in the depths.”

Narcolepsy - attacks of irresistible drowsiness with immersion in short-term sleep, lasting up to 20-30 minutes. It was first described within the framework of Gelineau's syndrome (1880). In its complete form, this syndrome, in addition to sleep attacks, includes attacks of cataplexy, states of sleep paralysis, disturbances of nighttime sleep and daytime sleepiness. The disorder most often appears before the age of 30. Then it progresses or flows stationary.

Along with essential narcolepsy associated with the influence of genetic factors, various variants of symptomatic narcolepsy are described that occur in diseases such as meningoencephalitis, brain tumors, the gummous form of cerebral syphilis, and vascular damage to the diencephalic region of the brain. Narcoleptic sleep is MDH sleep. Narcolepsy not associated with MDH sleep has also been described. This disorder is characterized by periodic sleepiness during the daytime, but no sleep attacks are observed. Apparently, epileptic seizures occur in the form of sleep attacks. Due to sleep attacks, narcolepsy can lead to such adverse consequences as car accidents, falls from heights, burns, frostbite, and drowning. We will describe the following symptoms of narcolepsy: sleep attacks, cataplexy attacks, sleep paralysis states, night sleep disorders, concomitant disorders.

a) Sleep attacks occur suddenly and autochthonously, that is, without the influence of any external causes. They begin with the appearance of a growing and irresistible need to sleep, so that patients fall asleep within a few seconds or a matter of minutes. They can fall asleep in any circumstances. Sleep attacks occur only during the daytime. There can be up to 3–5 or more of them per day. They can occur daily and occur at the same time. At the beginning of the attack, a pattern of MDH sleep is revealed, and at the height of the attack, REM sleep is revealed. It is very difficult or impossible to awaken patients, since the threshold for perceiving external stimuli increases sharply. Patients fall asleep with a feeling of rapidly falling into sleep, and sometimes wake up with the feeling that they have woken up, and not woken up, as happens with normal awakening. The pupils, if this is not an epileptic attack, are constricted. There are no cramps, muscle tone is reduced, and there is no loss of urine, feces, or semen. There are no dreams.

b) Attacks of cataplexy are usually provoked by emotions, both positive and negative (fun, fear, etc.). There is a sharp and significant drop in the tone of all voluntary muscles or only in individual muscle groups, sometimes different from attack to attack. At the same time, patients may fall as if knocked down, like a “sheaf,” or lose objects from their hands, cannot speak, their jaw suddenly drops, their head falls, etc. Consciousness is not impaired, and there is no drowsiness. During prolonged attacks, lasting up to half an hour, drowsiness may occur; however, patients do not fall asleep. This reveals the pattern of MDH sleep.

c) Conditions of sleep paralysis are observed during falling asleep, as well as upon awakening from sleep. More often, perhaps, they arise upon awakening. Apparently, they are confined to the first and second phases of slow-wave sleep. As a rule, there is no feeling of sleep; patients feel as if they are not yet asleep or have already woken up. Actually, dreams do not occur at this time. Patients are partially aware of external impressions, understand where they are, autopsychic orientation is not impaired. The most characteristic disorder is a feeling of complete motor numbness.

Patients report that they cannot perform even simple voluntary movements, for example, they are unable to open their eyes, mouth, raise their voice, raise their hand, move their fingers, etc. At the same time, they make extraordinary and unsuccessful efforts to perform some kind of activity. that movement. During repeated attacks, the painfulness of the condition is often realized. A feeling of helplessness appears, and the need for outside help arises. The patient says, for example, that he tries to call someone for help so that he can be “pushed away.” The duration of states of sleep paralysis does not exceed a few seconds, however, there is often a disturbance in the perception of the sense of time, so that, according to patients, up to 10–15 minutes pass until the moment of final awakening from sleep.

Hypnagogic or hypnopompic delusions of perception almost always occur, especially auditory, tactile and visual hallucinations. An acute feeling of fear and a feeling of an alien physical presence are often experienced. Perceptual deceptions are not identified by dream patients. In many patients, a critical attitude towards hallucinations does not appear immediately even after awakening. Having finally woken up, some patients experience palpitations, difficulty breathing, and trembling in the body. Some of them have a fear of repeating states of paralysis.

Let’s give one observation: “Starting at the age of 18 and for more than 15 years, almost every morning before waking up, it seems to me that a brownie is crushing me. I'm scared, it's hard to breathe, I'm suffocating. I know that the brownie needs to be asked whether this is for good or for bad. If it's good, it should get hot, and if it's bad, then a cold breeze should blow. But no matter how hard I try, I can’t say anything, I can’t open my eyes, I can’t even move a finger. I feel that all this is happening in reality, I am no longer sleeping and I am not dreaming of anything. I hear my mother walking around the room or talking to someone. Some time passes until I finally manage to open my mouth or move my arm or leg. The stiffness immediately goes away after this. It lasts a very long time, 5–10 minutes. Then I finally come to my senses. Previously, I didn’t believe in any brownies, but now I think they exist.” Sleep paralysis can also occur during daytime sleep.

d) Night sleep disturbances are manifested by too rapid or, on the contrary, delayed falling asleep. Sleep can be superficial and interrupted by night awakenings, both spontaneous and associated with some kind of external interference. As a rule, night sleep does not bring rest and satisfaction; it is also filled with unpleasant dreams and nightmares. When falling asleep and waking up, deceptions of perception and episodes of oneirism may occur.

e) Various associated disorders are also observed. During the daytime, patients report lethargy and drowsiness. Mental asthenia, irritability, torpidity of mental processes, and apathy are often detected. Disorders such as subdepression, sexual problems, menstrual disorders, obesity, and hyperthyroidism are also possible. Metabolic disorders, loss of appetite, loss of performance, and phenomena of autonomic dysfunction are also often detected.

In its expanded form, Gelineau syndrome is quite rare. Much more often and in various painful conditions, its individual components are observed, especially the state of sleep paralysis.

Pickwickian syndrome (J.Elliot, 1781) is manifested by disorders of consciousness (stunning) or involuntary attacks of daytime sleep in combination with myoclonic hyperkinesis. The disorder is caused by hypoventilation of the lungs due to pathologies such as obesity, certain lung diseases, rapid or shallow breathing. Patients usually fall asleep in a sitting position. Hyperkinesis that occurs during sleep can cause patients to fall. In addition, the “Pickwickian personality type” is considered characteristic: good nature, optimism, sociability, sufficient physical and mental activity, practicality and success, as well as excess in food. The hereditary nature of the disorder is assumed (autosomal recessive inheritance). The name of the disorder is borrowed from Charles Dickens's novel The Pickwick Papers, one of whose characters, servant Joe, suffered from this disorder.

Kline-Levin syndrome (1925, 1936) is characterized by alternating periods of hypersomnia and normal sleep-wake cycles. This happens one or more times a year. During periods of hypersomnia, which last up to several weeks, the daily sleep rate increases and reaches 15–16 hours or more. During such sleep, patients can be awakened, but at the first opportunity they fall asleep again. There are no dreams.

Sleep does not provide a feeling of rest. Bulimia often occurs at the beginning of the period of hypersomnia and after it ends. While awake during the period of hypersomnia, other disorders may occur: apathy, irritability, depression, aggressiveness, hypersexuality. Sometimes delusions and hallucinations, confusion, psychomotor agitation and incoherent speech also occur. Some patients develop fever of central origin. The disorder usually begins in childhood and adolescence and is more common in boys. Remissions of varying durations are possible. In rare cases, it is complicated by narcolepsy. The nature of the disorder has not been established.

Hysterical hypersomnia is manifested by states that are externally similar to deep sleep and occur in connection with traumatic situations. During painful episodes, muscle hypertonicity, delayed urination and defecation, analgesia of the skin and mucous membranes with various configurations are detected. The EEG records a picture of wakefulness, which most likely indicates the fact of a dissociative disorder of consciousness. Subjectively, it is sometimes experienced not as an attack of drowsiness, but as a memory loss. Let us present an observation that meets the mentioned criteria. The patient reports that she recently received news that her boyfriend is cheating on her with her friend. She was shocked by this news and decided to talk to her friend. After an explanation with her, as the patient says, “I felt better and at the same time even more painful.” Returning home, she immediately went to bed without undressing. “I immediately forgot. When I came to my senses in the morning, my first thought was “it’s good that I didn’t die.” There was no feeling that I fell asleep, slept and woke up. I didn't dream of anything that night. It seemed to me that I had simply forgotten everything that had happened the day before. After that, I rarely remembered the betrayal, calmly, as if nothing special had happened. I slept off troubles in the same way before.”

Another variant of the dissociative reaction to stress is hysterical stupor. At the same time, patients freeze in an expressive pose depicting suffering. There seems to be no normal sleep at night. In the waking state, consciousness is narrowed, this can be judged by the fact that many questions, including those related to well-being, as well as changes in the situation, are not accompanied by responses; patients’ requests are ignored. Nevertheless, contact with the outside world is not completely interrupted. Understanding of the speech of others is preserved. Muscle tone is slightly increased.

When reminded of a traumatic situation, psychologically adequate and understandable facial and vegetative reactions arise: tears appear, patients may blush, turn pale, close or open their eyes, and clench their teeth. The state of stupor lasts from several hours to a number of days. Signs of hysterical psychosis (Ganzer syndrome, etc.) are not observed either at the beginning or at the end of the painful condition. The exit from the latter is critical, after which dissociative amnesia is revealed. Another, much milder form of hysterical stupor is the state of hysterical mutism, which occurs with clear consciousness and without subsequent amnesia.

Hypersomnia with sleep apnea is associated with impaired respiratory function during sleep. Usually more common in elderly and obese patients. Sleep apnea is defined as stopping breathing for 10 seconds or more. With pure apnea (i.e. apnea of ​​central origin), respiratory movements are completely interrupted. With pure obstructive apnea, respiratory movements, on the contrary, increase, but the flow of air into the lungs stops for mechanical reasons. Sometimes both of these forms of the disorder are combined. Pathology is considered to be five or more episodes of apnea per hour or 30 or more episodes during the night. Patients may not have complaints about sleep disorders.

This apparently indicates that the structure of sleep in some cases is significantly disturbed, which is why sleep during breathing stops turns into a state of somnolence. Normal night sleep is practically non-existent. After breathing stops, its activation begins with loud intermittent snoring followed by convulsive breathing. In addition to the mentioned signs of the disorder, headaches in the morning, increased fatigue, a tendency to depression, fluctuations in blood pressure and cardiac arrhythmia are also observed. Sleep apnea can have extremely dangerous consequences, including death from pulmonary and cardiovascular failure, as well as death from other, as yet unknown causes. There is evidence that sleep apnea is associated with crib death syndrome or nursing death in infants and children. Some authors tend to identify sleep apnea with Pickwickian syndrome. While awake, patients with sleep apnea may also experience sleep attacks, suggesting a possible connection with narcolepsy.

Alveolar hyperventilation syndrome is characterized by disturbances in pulmonary ventilation and external respiration function. It is believed that the disorder is associated with insufficient blood flow to the lungs, as well as decreased breathing during sleep. In some cases, patients experience insomnia or, more precisely, a sharp reduction in sleep norms, but much more often they experience excessive drowsiness. Death may occur during sleep.

Insomnia is manifested by an absolute lack of sleep for a long time. Insomnia in this understanding occurs in psychiatric patients in acute psychotic states. A complete lack of sleep is usually short-lived and rarely lasts more than a week.

Sleep deficiency syndrome is much more common The disorder is manifested by the following symptoms:

• decreased need for sleep;
• difficulty falling asleep;
• night awakenings;
• early morning awakenings;
• decreased sleep quality, apparently associated with disturbances in its structure; such a dream usually does not bring rest.

The result of this is a significant reduction in sleep time at night. If previously some patients could at least partially compensate for the lack of night sleep by resting and sleeping during the day, then with the onset of insomnia, daytime sleep may disappear. The causes of sleep deficiency are varied.

With great consistency, this disorder occurs in the prodromal period of acutely emerging and rapidly occurring psychoses. With rare exceptions, it is observed in states of melancholic and anxious depression, especially if anxiety and fears intensify or appear closer to the night, and drowsiness disappears or even a rise in mood and activity occurs. As a rule, the norm of daily sleep is sharply reduced in manic states of various types, in the acute period of post-stress disorder, in a state of alcohol and drug withdrawal. Persistent sleep disturbances occur in chronic pain syndrome, psychotic states with delusional, hallucinatory and catatonic psychomotor agitation.

A significant reduction in daily sleep norms is also observed outside of psychotic conditions, for example, due to overwork, inability to relax, influxes of thoughts, excessive fears of insomnia and attempts to lull oneself to sleep in one way or another (by counting, for example), fear of dying in sleep, fear of repetition of nightmares, conditions sleep paralysis and other sleep-related disorders.

Very often, sleep is disturbed due to anxiety about what happened the day before or what is to come the next day, anticipation of recurring panic attacks at night, vegetosomatic crises, worsening pain and senestopathies. Children, adolescents and even adult patients often cannot fall asleep for a long time due to fear of the dark and frightening fantasies. Some patients report interference with the onset of sleep, such as myoclonus or fibrillary muscle twitches that occur at the very beginning of sleep. There are patients who, for various reasons, fall asleep only in the morning.

Quite common causes of difficulty falling asleep are frequent flights to other time zones, long-term work at night (on duty, emergency situations, military operations), living in northern latitudes in conditions of the polar night changing to polar day, changing time from winter to summer and vice versa.

Night awakenings can occur for various reasons: frequent night urination, snoring of other people, extraneous sounds, lighting, fear of oversleeping at the right time of awakening, nightmares, after which patients wake up in fear or wake themselves up. Some researchers have linked nighttime awakenings during MDH sleep to an activation response that protects patients from nightmares.

Nighttime awakenings are observed most consistently in depression. In this case, patients wake up suddenly, sharply, without any external reasons, sometimes at the same time of the night. Such awakenings can occur both in the first and second half of the night. Patients often report that they wake up feeling as if they have already had enough sleep and they no longer want to sleep. Others report waking up anxious, sad or afraid, with a feeling of heart palpitations, or sweating. Nighttime intervals of wakefulness can last up to half an hour or more, and some patients no longer manage to fall asleep. The number of spontaneous night awakenings sometimes reaches 4–5 or more.

Early awakening from sleep is common in elderly patients, as well as in a significant number of depressed patients. Patients wake up 1–3 hours or more earlier than usual, as if missing 1–2 sleep cycles with the longest time of paradoxical sleep.

In cases of absolute and forced insomnia, psychotic disorders may develop after a few days.

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