Considering that, right or not, Google has become the first friend we ask for advice when we have a problem, the spike in sleep disorder searches gives a measure of how current the topic is. Since the beginning of the pandemic, the term insomnia is among those that, worldwide, have registered the greatest increases in typing. A constant growth – in Italy the first (impressive) surge occurred between May and July 2020 – which highlights both the spread of the problem and its awareness, and the concerns it has triggered (spin-off: in the last 12 months the correlated research “insomnia vaccine” marked a + 800%).
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World Sleep Day on March 18th
In short, the World Sleep Day that the World Association of Sleep Medicine has been organizing since 2008 (and which this year falls on March 18) can play a truly significant role in bringing attention to the importance of good sleep. in the balance of our life. And vice versa, on the negative impact of the lack of a good rest.
Also because the data says that, in absolute terms, we sleep less than we should and often we don’t even do it well. According to the Italian Association for Research and Education in Sleep Medicine (Assirem), about 45% of Italians experience difficulty falling asleep over the course of a year. Results in line with this percentage also emerged from a survey conducted by Eurodap (European Association for Panic Disorders) on 900 people: 7 out of 10 would experience sleep disturbances, 4 out of 10 difficulties when closing their eyes, and 3 out of 10 repeated awakenings during the night. However, to circumscribe the problem more clearly, taking as a parameter the duration of the symptom and referring to the International Classification of Sleep Disorders, we can speak of chronic insomnia only when the difficulties in falling asleep and the conditions of insufficient and non-restful sleep occur for 3 months at least 3 times a week.
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Three million Italians have difficulty sleeping
“Epidemiological studies conducted in our country say that the incidence of insomnia among the adult population is between 7 and 10%, in line with the numbers of Western countries”, explains Dr. Alessandro Oldani, a neurologist at San Raffaele in Milan and an expert in sleep disorders. “Even underestimating the percentage, it means that about 3 million Italians have a serious disorder to deal with. In general, the trend in recent decades has been a progressive reduction in the time spent in bed: if once our rhythms were regulated more directly from those of light, social life and the stimuli to which we are exposed today influence habits. All this determines a chronic and voluntary deprivation of sleep, because less hours in bed naturally also reduce those in which we sleep. consequences are of various kinds, but all relevant “.
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The three levels of “sleep disorders”
The American Academy of Sleep Medicine distinguishes three levels of sleep disorders: insomnia, difficulty with rest and consequent daytime sleepiness are the primary disorders. Attention deficit, reduced cognitive performance, less alertness (with increased risk of accidents) and alterations in mood are among the secondary disorders. Finally, there are the actual pathologies that can increase the onset: it is proven that the lack or poor quality of rest are correlated over time with increased blood pressure and cardiovascular pathologies, metabolic dysfunctions and diabetes, as well as pathologies neurodegenerative such as Alzheimer’s.
It should also be added that insomnia can, in turn, be secondary to factors such as physical ones (painful diseases that hinder sleep, syndromes such as “restless legs”, hormonal changes related to menopause and so on) or primary and linked, for the most part, to problems of the emotional sphere.
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How the pandemic has affected sleep disorders
These last two years of the Covid era – with the long periods forcibly at home, the additional sources of stress, the change in habits and nutrition, the reduction of physical activity and, conversely, the increase in the hours spent in front of a screen – aggravated an already negative trend situation. Since the start of the pandemic, Dorelan Research’s scientific committee has conducted two different nationwide surveys, involving a total of nearly 1300 respondents, investigating both changes in habits (following social isolation, changed lifestyle and new rhythms of work) and the perception of the quality and quantity of sleep (ie how much Italians would like to sleep, and how much they actually sleep). Among other things, it emerged that 76% of the sample goes to sleep later – the precise average is at 23.24, with a difference of 33 minutes compared to the desired time – and to wake up almost 35 minutes earlier than they would like (at 7.06 instead of 7.40).
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The emotional sphere of the person
“Becoming aware of the problem and giving insomnia the dignity of a pathology is the first step to tackle it” continues Dr. Oldani. “In 85% of cases the disorder is psychogenic (originating as we said from the emotional sphere, ed) while in the remaining 15% the causes are organic. To understand what leads to the development of insomnia as a symptom, however, it is necessary to consult a specialist. It is up to him to exclude any pathologies and evaluate, for example, whether it is useful to resort to psychotherapy, in the face of which still today many patients offer preventive resistance. It is important to insist on this point, because insomnia is often the final outcome of a path that has been going on in a karstic way for a long time (even decades), but it can still be cured. Among those who deal with the problem correctly, 80% have significant improvements, and in the remaining 20% the so-called misperception must be inserted, because the chronic insomniac loses the real perception of their sleep: the brain is no longer able to understand if you are really sleeping “.
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Cognitive-behavioral therapies
Naturally, cognitive-behavioral therapy requires that in addition to a series of interviews with the specialist, indications for sleep and lifestyle hygiene are followed. From the distribution of physical activity in the first parts of the day to the correct rhythms of work, up to some nutrition rules (do not have dinner in the three hours before bedtime, because the increase in basal metabolism hinders rest, and avoid any excess of both food and alcohol), and the now strange contraindications of blue light and the use of devices in the evening.
Also the neurologist: “Light is the most powerful regulating element of our biorhythm, because it inhibits the production of melatonin and must be used in such a way as to increase daytime wakefulness and normalize the state of activation in the evening. In the clinic (the Sleep Medicine Center of San Raffaele, ed) we use special lamps, but there are also patented goggles on the market to carry out light therapy at home “.
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Supplements and relaxing baths
As for supplements, herbal teas, hot baths, relaxing fragrances and other accompanying strategies, Dr. Oldani concludes: “The placebo effect and suggestion count for at least 30%, so if something causes us benefits, it is welcome. you assume nothing, just taking melatonin causes a detectable effect the first few times. Similar consideration for the hot bath: if on the one hand a lowering of body temperature is necessary for a good sleep, on the other the relaxing effect must be considered individually “.
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Even smells can help you sleep
One last interesting fact, about individual variables and the importance of perceived relaxation, comes from another front: the strong increase in demand for the so-called “goodnight blends”, scents that usually have lavender and chamomile as the dominant essences. He confirms it Paolo PersicoCEO of Scent Company, an olfactory branding company that has hotels all over the world among its customers: “We study fragrances to characterize the different environments, and improve the guests’ experience thanks to aromas. These two years of pandemic have led to a change in the needs expressed by those who have continued or resumed traveling. It is difficult to quantify the phenomenon numerically, because the hospitality sector data are still evolving, but certainly compared to the pre-pandemic, the relaxing fragrance used in rooms (or left directly on the bedside tables, available to the guest) has become one of the most requested “.
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In short, not only are the rituals the essence of good relaxation, but sometimes even the olfactory essence can do the ritual.
And also drugs
Create innovative drugs thanks to twenty years of know-how in the development of small molecules, and promote as much as possible the awareness and involvement of the patient in the management of the disease. And a few days ago, the Swiss biopharmaceutical startup Idorsia entered the Italian market with a specific drug for insomnia.
Daridorexant, this is the name of the product shortly on the market, will act as a double antagonist of orexin receptors (a neuropeptide responsible, among other things, for regulating the sleep-wake rhythm), facilitating falling asleep and the continuity of sleep, without however interfering with the performance of normal activities during the day. For several years, the new generation drugs against insomnia have focused on the orexin antagonists (and not, as in the past, on the benzodiazepine receptor), but the molecule developed by Idorsia and presented this week on the occasion of the 16th World Sleep Congress is the first double antagonist to have received a positive opinion, for use in the European Union, by the Committee for Medicinal Products for Human Use (CHMP), after substantial studies recently published in The Lancet Neurology.