[On the therapy of sleep disorders].
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Complaints of insomnia, i.e. problems to fall asleep or maintain asleep and/or non-restorative sleep are very common in general practice. This article presents the clinical algorithm non-restorative sleep which was devised by the German Society for Sleep Research and Sleep Medicine. This algorithm presents a guideline for the diagnosis and the treatment of insomnia.
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Sleep apnoea (SA) has a prevalence of 1-10% in men. The physiological sleep is disturbed. SA is associated with cardiopulmonary disease (systemic arterial hypertension, cardiac arrhythmics, cor pulmonale) and the quality of the patient's life is reduced. Thirty male patients participated in a study to investigate the influence of an oral dose of theophylline on sleep apnoea. Under theophylline a significant reduction of apnoea events and of the apnoea index was seen.
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The authors studied the dynamics of changes in the serotonin content in the brain of albino rats in development of experimental neurosis along the type of desynchronization and under the effect of essential amino acid L-tryptophan. It was found that disturbance in the sleep-awake cycle in desynchronization is attended with decrease in the serotonin level in the hemispheres and brain stem and leveling out the interhemispheric asymmetry. Injection of 80 mg/kg L-tryptophan in this condition leads to increase of the brain serotonin content and restoration of the normal physiological structure of the sleep-awake cycle.
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The management of sleep disorders in elderly patients with internal diseases consists in the first line in rectifying pathophysiological disregulations. Only in the second line, proper hypnotics are to be prescribed. When considered as indispensable, these medicaments are selected according to their toxicity and side effects. In present time, Benzodiazepines are definitely preferred, whereas neuroleptic, anti-depressant and the older drugs are to be taken secondarly in account.
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