EN
Sleep problems are rarely taken seriously until they start breaking the day: exhaustion in the morning, irritability, an inability to concentrate. By the time someone looks for help abroad they have usually already tried sleeping pills whose effect gets shorter and shorter. German sleep medicine begins not with a tablet but with the question of what exactly is disturbed, because “insomnia” is not one diagnosis but dozens of different conditions.
Why sleep is worth entrusting to specialists
Sleep disorders are commoner than they seem: by various estimates about one adult in ten has chronic insomnia, and far more have trouble sleeping from time to time. And poor sleep is not only about tiredness. Metabolism, the immune system, memory and mood all depend on it, and it is during sleep that the body repairs itself.
The difficulty is that entirely different causes can lie behind the same complaint of “sleeping badly”. So in German hospitals sleep is handled across specialities: neurologists, psychotherapists, ENT doctors and physicians look together for what is getting in the way of proper rest.
First, establish what is disturbed
Sleep is cyclical: several cycles of about an hour and a half follow one another through the night, each alternating slow-wave and REM sleep. In the slow phase the body recovers; in the rapid phase the brain processes and files what the day has brought. When that structure is disrupted, a person can spend the requisite hours in bed and still not be rested.
To see where the fault lies, polysomnography is done — a sleep study in a special room. Through the night, brain activity, breathing, movement, heart rhythm and oxygen levels are recorded together. That reveals what only shows itself during sleep — pauses in breathing in apnoea, for example, which the person does not notice.
What is treated
The range of sleep disorders is wide: insomnia proper (difficulty falling asleep or staying asleep), excessive daytime sleepiness, restless legs syndrome, narcolepsy with sudden sleep attacks, parasomnias (sleepwalking, nightmares, bedwetting in children), and pauses in breathing during sleep — apnoea. Secondary disorders stand apart, where sleep suffers because of another illness, neurological, psychiatric or physical.
That is why it matters not to “treat insomnia” in general but to establish its type. Apnoea and chronic insomnia call for completely different approaches, and a sleeping pill in apnoea, for instance, can even do harm.
How the treatment is chosen
For chronic insomnia the principal method is not a drug but cognitive behavioural therapy — structured work on the sleep routine, on habits and on the thoughts that disturb it. It unpicks the vicious circle of “I cannot fall asleep — I worry — I sleep even worse”. Medication is used as temporary support rather than a permanent solution.
If the cause is in the breathing, the approach differs: in apnoea, continuous positive airway pressure therapy (CPAP) helps — a device that keeps the airway from collapsing during sleep. In restless legs syndrome, narcolepsy and secondary disorders, the underlying condition is treated first. Either way the plan follows from the results of the assessment, and where treatment is long, specialists stay with the patient.
Why not to put this off
Chronic lack of sleep is not merely an inconvenience. Over time it tells on the heart and blood vessels, on metabolism, on mood and on the ability to concentrate, and untreated apnoea raises the risk of serious cardiovascular complications. Yet many people put up with poor sleep for years, or suppress it with sleeping pills that eventually stop working and become a problem in themselves.
The point of seeing a specialist is precisely to break that circle: not to find a stronger tablet but to find the cause and give sleep back its normal structure. The sooner that is done the easier it is — before poor sleep has become a fixed habit of the body.
This material is for information only and does not replace a consultation with a doctor. Whether treatment is possible, what it will involve and what it will achieve can be determined only after an examination at the clinic in person.