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General medicine

Saturday 14 July 2007

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The "hypo-sleep syndrome" is a concept that gathers together the set of disorders that may appear at the occasion of a lack of sleep efficiency.
In our opinion, those symptoms can be interpreted like alarm signals and appear at the stage when the subject who resists against tiredness exceeds his/her limits and uses his/her will to « draw from his/her reserves »
These alarms express themselves through four big charts that are often placed "on the border between physiological and psychological illnesses".
Their clinical characteristics and their appearance in a context of « unrestful » sleep, are the diagnosis criteria for « hypo-sleep syndrome ».

Compulsory schedules, sleep deprivation, or more widely stress linked to events of life result, in man (as in every animal), in a reduction of sleep efficiency (sleep gets lighter and divided), sometimes masked by an extension of the total sleep time.
In some individuals who present an already fragile ground, these regulating mechanisms can decompensate.
It all looks as though the body translates a qualitative lack of sleep through a multitude of more and more disabling symptoms.
In our experience, this « hypo-sleep syndrome » evolves according to a sequence of very polymorph clinical steps] that make up four charts known as : functional disorders; spasmophilia (or tetany); chronic fatigue, and fibromyalgia.
In the absence of taking their sleep into account, the sick people often feel misunderstood by the medical profession.
Those « homeless of medicine » readily describe their illness like an « assault course ».

The four clinical charts of the lack of sleep efficiency :
The "hypo-sleep syndrome":

  • 1°/ The «attack of spasmophilia» or panic attack is a fit where fear overwhelms the person to a point that he/she feels like he/she is really in danger. It is a brutal feeling that a vital organ is defective. The heart, the brain, the lung...and that he/she should call for rescue.
    At that stage, sleep is apparently not disturbed. The sick person asserts to « sleep well », but it is not rare to unravel some behavioral changes during the interview (like extended naps, out of phase sleep) or an apparent recent hypersomnia.
  • 2°/ The functional disorders or neurodystonia are worrying or painful signals that can come from any part of the body and from any system.
    The adjective "functional" implies that there is no known cause, nor specific treatment.
    For example : "common lumbalgia", "irritable bowel syndrome", "unstable bladder", migraine, some « atypical chest pains », « Ménière dizzy spells »,..., are functional disorders.
    At first sight, sleep is not disturbed, but the subject often admits to be more tired, to go to sleep earlier and sleep more than usually.
  • 3°/ Fibromyalgia is mentioned when pain prevails in a disabling fashion. The sick person wakes up very tired and uses all his/her energy to execute daily gestures. (He/she gets rest as soon as he/she can).
    In the very beginning, sleep is apparently not disturbed but, in the often late stage of diagnosis, the sick person generally intakes several sedatives.
  • 4°/Chronic fatigue is suggested if tiredness is in the foreground. Present from when the person wakes up, it carries along an objective reduction of 50% of the activity since over six months.
    The first descriptions of this curious « epidemy » insisted on the sudden characteristic of the disability that appeared in until then very dynamic subjects : « yuppies » (young urban professionals).
    This chart, that lead to looking in vain for a viral cause, is close to the American, Japanese, or Caribbean concept for overwork ("Burnout", "Karoushi", or "Blesse").
    Apparently, sleep is not disturbed, the sick person even often thinks he/she is a « big sleeper ».

"How do you feel when you wake up in the morning?"


Apparently, sleep is not disturbed because, in reality, sleep is juged « not restful ».
The question « do you sleep well », formulated that way, often induces an inaccurate answer:

- on one hand, the subject fears (often from experience) the sleeping pill that a negative answer can bring along (ravages of « on demand » sleeping pills are better known of the patients than of the prescribers).
- on the other hand, he/she doesn’t always feel that he/she is sleeping poorly because he/she goes to bed tired and sleeps a lot.
It is the equivalent of asking a person who doesn’t get enough food about his/her appetite! ...
The appropriate expression has to be : "How do you feel when you get up in the morning?"

Some questions highlight characteristic signs of an unefficient sleep :

  • difficulty to get up in the morning;
  • extension of sleep duration with nap attempts;
  • extension of sleep duration with going to sleep surprisingly early;
  • need to drink during the night (systematic presence of a bottle of water on the bedside table);
  • need to urinate during the night (usually more than once);
  • sweating during the night (change of night clothes);
  • early spontaneous arousal with the feeling of needing more sleep;
  • need to rest during the day especially around 6 to 8 PM (a period of the 24 hours when the body is normally at its highest, mentally and physically.Cf. Sleep/wake rythm regulation);
  • reduction of physical activities, stopping of sport (since at least three weeks);
  • (almost constant) presence of other assiciated functional disorders (for which the subject often already has an explanation) : his/her back, nose, throat, ears, bowels, glycemia, tension are « fragile » ...
  • (very frequent) presence of acute medical incidents without an acceptable cause despite a context of emergency close to panic in past history (spasmophilia? ...)

Those disorders are often discrete in the start but, when one highlights them for him/her, the subject admits their abnormal presence since at least several weeks and their matching with the sensation of tiredness (often in a context of difficult life events and stopping of sport caused by a lack of availability).

NB.One must not forget to investigate the existence of a snoring or an authentic sleepiness (scoring higher than 12 on the Epworth scale ) which must lead to a recording of nocturnal breathing in search for a pathological snoring.

True False-sick or False True-sick ?

In final analysis, since all complementary explorations are normal, and in the absence of taking their sleep into account, these authentic sick people become, in the eyes of the medical profession, « fake sick people », « imaginary sick people », « hypocondriacs », « anxious » or even « depressive ».
This is probably a cause of the overestimation of the number of depressions in France (a heavy consuming country for the « pill of happiness »).
We will describe them here as :"True False-sick".
In the end, used to being misunderstood by the medical profession, the sick person often turns, out of deception, towards illusory alternative practices. As his symptoms are naturally fluctuating, the subject sometimes feels like finding a solution.
The addictive power of sedatives (difficult withdrawal) is such that we often find them as supplements, « on demand » in the middle of a, moreover, « 100% natural » treatment.
In the end, the cause persists and the subject remains ill but it becomes impossible for him/her to exert his/her critical sense and make the part of things between his/her allopathic treatment and alternative beliefs.

Often, on the opposite, the multiplication of the examinations and opinions, leads to the fortuitous discovery of an other pathology.
That "illness", that finally satisfies the need for recognition of the sick person (and the doctor’s patterns of thinking) will mobilize all care and attention while the initial disorder persists.
The "False True-sick" are those who intake much to many pills.
This diagnostic bias is responsible of a therapeutic escalation and numerous complications due to medication or surgery that punctuate, still too often, the medical course of those misunderstood patients (fatigue is a strongly « iatrogenic » pathology : it induces complications in relation with care).
Apart from the medical and surgical complications, fatigue is a very expensive disease. Some papers state that useless expenses are around 100 to 400 Euros a month.... at all loss.

All in all... "Somnicology"

A better recognition of the « hypo-sleep syndrome » allows to apprehend many symptoms that were described as « psychosomatic » in the past as the outward signs of a sleep disorder. Here, we suggest to use the adjective of « somno-somatic ».

For a problem of migraine, for example, it seems more pragmatic to center the approach on the patient’s sleep rather than renew complementary explorations in search for an improbable tumor or, worse, offer him/her a tranquilizer to help him/her cope with the excess of stress...
In our experience, the growing awareness of the role of sleep in the genesis of the illness allows, on the contrary, that the subject becomes the actor of his recovery.