Millions of people in Germany do not sleep well, many can be treated with strong medication. There are more sustainable therapies.
Stephan König* must have been in his mid-20s when he was prescribed the first medication to treat his sleep problems. The poor sleep began with him in the nights from Sunday to Monday. We all know that: staying up late at the weekend and starting the new week with a disturbed rhythm. With König, this disturbed rhythm solidified at some point, he couldn’t sleep on Tuesdays and Wednesdays either, woke up at night, stared at the ceiling for hours. So he went to the doctor and came out with a prescription for Lorazepam.
The doctor didn’t ask too many questions and prescribed pills for the then student, so-called benzodiazepines, which are used for severe anxiety disorders, i.e. have a calming effect and thus promote sleep. And can make dependent.
König doesn’t know that yet when he initially only takes them on Sunday evenings. “Whoa! I thought so,” he says. “But they’re great!” He can sleep again, he quickly takes the pills not just on Sundays, but four or five times a week. For a new prescription he only has to call the practice. König is aware that the pills cannot be a permanent solution. But after graduation comes the job, then the family, he has a lot to do and they let him sleep. And not being able to sleep would be worse.
benzodiazepines and antidepressants
Nevertheless, he goes to the sleep laboratory twice. There they only rule out that he has sleep apnea, i.e. breathing stops, and that he should see a neurologist. He, in turn, lets him wean off the lorazepam, but then prescribes a neuroleptic that is not supposed to be addictive. König sleeps worse with it, but five hours at a time is okay for him.
However, the drug has not been available for many months. Now he’s on antidepressants, which have sleep-inducing side effects but aren’t helping him. And for the first time since the problems started, König has to ask himself if he can’t get out of it without medication.
Estimated According to a survey by the health insurance company DAK, 34 million people in Germany cannot sleep well, about 1.5 million took sleeping pills every day in 2021. With such numbers, people in this country always like to speak of a “widespread disease” or a completely “society that hasn’t had enough sleep”. Appropriate?
The reason is not the lack of discipline
Yes, says sleep researcher Christine Blume from the University of Basel. However, only about 6 to 10 percent of those who sleep poorly also have insomnia, a full-blown difficulty falling asleep or sleeping through the night. For this to happen, the problems must occur at least three times a week over a long period of time.
A large part of the population, according to Blume, does not sleep enough out of more or less “voluntarily”, they simply go to bed too late. This has less to do with a lack of discipline than with disposition. “Most of us prefer to go to bed between 11 p.m. and 1 a.m. Before that, falling asleep is often difficult,” says Blume.
There are also social activities that often last until late in the evening. And then the children have to be at school by 8 a.m., need breakfast beforehand, and then commute to work. So you’re forced to wake up again at 6 o’clock.
Blue light from digital consumption
According to the DAK, sleep disorders among employed persons have worsened significantly since 2010. Blume sees the reasons as being constant availability on the smartphone, social networks and streaming providers that are designed in such a way that it is difficult to get rid of. This media use increases the artificial light consumption in the evening. In addition there are Corona, climatewar, so health and financial worries.
But Blume also believes that at least one positive development is likely, which could affect future figures. Especially since the pandemic, we would communicate more openly if we weren’t feeling well. “During this time we got away from the pull yourself together mentality a bit because the situation was just difficult for all of us.”
According to the medical guideline, the recommended form of treatment for insomnia is so-called cognitive behavioral therapy. In eight sessions, the causes are addressed and behavioral patterns are trained out. “Patients should regain the feeling of being in control of their sleep situation.” To do this, they learn to calm down with relaxation exercises and to discard false beliefs – such as that more time in bed means more sleep.
therapy for anxiety
For many, the bed is a place where one waits in vain for sleep. Before you start to fear again in the morning. This fear in particular is counteracted in therapy. There are now also digital offers, i.e. therapy apps that can be prescribed – among other things to bridge the time until the therapy place. And that brings us to the problem.
Stories of woe like Stephan König’s are also so common because psychotherapeutic care in Germany is inadequate. In addition, many of those affected ask family doctors for a quick solution and some doctors simply do not have behavioral therapy on their screens. “If sleep problems occur in an acutely stressful life situation, medication can also be helpful,” says Blume. “The danger of dependence should not be underestimated in the case of long-term use.”
In the case of Stephan König, the lack of sleep is now also having an impact on his health. During the day he feels like he drank two bottles of red wine the night before. König has high blood pressure and thus an increased risk of heart attack, extreme concentration problems and repeated episodes of depression. Over a long period of time, lack of sleep can also lead to metabolic diseases, obesity or dementia. Almost worse than the physical consequences is not being able to really confide in anyone, he says. Even in the closest circle of friends, sleep problems are trivialized.
Effects on everything interpersonal
The reasons for not being able to sleep are individual, some more common than others. For example, there is Sandra Frings*, a mother of two, who has not had a restful sleep since her first pregnancy twelve years ago. It started a few weeks before the birth, then the child was there and didn’t sleep through the first four years.
For a while it had pauses in breathing due to enlarged tonsils, Frings hardly closed an eye during this phase. When the tonsils were out and the child eventually sleeps through the night, she becomes pregnant again. She is now 46, the first-born almost a teenager, but she still hasn’t had enough sleep.
“The worst part is that irritation, that feeling like my kids aren’t getting the best version of me,” she says. It feels like her brain never works at 100 percent, and in general she is much more negative than before. Christine Blume says it’s harder for people who haven’t had enough sleep to see the big picture.
Undoubtedly, lack of sleep has an impact on everything interpersonal, dwindling resources for self-control. Researchers from the USA recently discovered that the willingness to help is declining. Also, sleep deprived people make more impulsive decisions. “According to the motto: ‘I don’t have a nerve for it now!'”
People aren’t made for night shifts
Anja Singer* knows this from her everyday work, which always requires patience, composure and attention. In which she also has responsibility for frequently changing, unskilled assistants. The 28-year-old is a remedial nurse in a residential home for people with disabilities. In the third year of the apprenticeship, the nights on call began and with them the sleep disturbances.
“You have to leave work at 10 p.m., then spend the night at work, start again at 6 a.m., and if something happens in the meantime, you just have to get out.” When she confides in colleagues who have been on the job for a long time , she only hears that she shouldn’t behave like that, that’s just part of it.
“People are not made for night shifts,” says Blume. There are aids such as special glasses that you can use to filter out the blue light that wakes you up on the way home so that you can sleep better afterwards. But in general, if there are problems, you have to try to find a way out.
Hoping for more than just a recipe
Singer has negotiated for herself not to do any more night shifts and only night shifts if she has free time before and after. She is in a good position, you cannot do without her in her facility. In the long term, however, she would like to have a job with regular hours, perhaps as a school supervisor or teacher in an integrative kindergarten. Hoping it will get better then.
Stephan König says that in all these years he has not once been asked about a possible cause of his sleep problems. And then he thought that it probably doesn’t matter. He will soon have an appointment at an interdisciplinary clinic in Essen. And hopes that it’s not just a new recipe that comes along.
*Names changed by editors