“Doctor, worms crawl under my skin and interfere with sleep”: an interview with somnologist Roman Buzunov
Miscellaneous / / April 02, 2023
Why some people stop breathing at night, how to and not to treat insomnia, and what is the problem with drug therapy.
Until the 1990s, few people in Russia knew how to treat sleep disorders. Somnology was not taught in medical schools, and in order to get rid of sleep apnea, one had to buy an apparatus for the price of a Moscow apartment.
Roman Buzunov was one of the first to popularize this science. He told us how his career path developed, what has changed in somnology in 25 years and what you should pay attention to at night.
Roman Buzunov
What was somnology like in the 90s
It was 1995, I worked in a sanatorium on Barvikha. They called me to the head doctor. We were told that a foreign specialist had come to us and no one could understand him except me, since he only speaks in English and French.
The specialist turned out to be a somnologist. The fact is that shortly before this, one of the leaders of our state was cured of sleep apnea in Germany. The treatment proved to be effective, so it was decided to open several [somnology] centers in Russia. One of them is in our sanatorium.
I met this Frenchman and found out that we would be engaged apnea sleep. The first thought is “What is this?”. I have 6 years of institute, 2 years of residency, 5 years of work as a doctor, and I have not heard anything about this disease. We were not taught somnology. I thought: “Probably, this is something completely strange, nobody needs it, and most importantly, it’s rare and it’s impossible to make a diagnosis.”
The doctor said: "We need to find a complete man." We found. Man. Height - 155 cm, weight - 140 kg, 45 years old. He has hypertension, atherosclerosis, diabetes, initial renal failure - everything is in full swing. He agreed to participate.
The Frenchman installed 18 sensors, thanks to which we were able to track the patient's breathing, blood saturation oxygen, brain activity, sleep structure, cardiogram, motor activity, body position during sleep.
The results were deciphered in the morning. We saw that the patient slept 8 ocloc'k, 6 of which were not breathing in total. He had 80 breath stops per hour, sometimes for 2 minutes. At the same time, blood oxygen saturation (saturation) dropped to 50%.
For you to understand:
- 94-99% - saturation rate;
- 85% - very bad, the person begins to choke;
- 70% - a person turns blue, confusion develops;
- 60% - loss of consciousness;
- 50% - after 30 seconds, death of the cerebral cortex occurs.
I looked at it and thought: “God, he could have died several times already! And somehow he lives."
My colleague from France said: “Severe apnea. We will heal." "And how to treat?" I asked him. “The big apparatus is called CPAP. He'll sleep under it and everything will be fine."
I asked how much this pleasure costs. "$5,000," replied the Frenchman. So much at that time cost a one-room apartment in Kuzminki!
“What idiot would give away a one-room apartment to sleep at night in a mask and snorkel?” I thought.
The patient was of the same opinion: “I have to work on this device for five months!” And he also held some government post with a good salary. For comparison: I received a salary equivalent to 20 dollars a month.
To convince a person to at least test the device, we invited our chief pulmonologist A. G. Chuchalin. He asked in a simple way: “Do you have children?” The patient replied: “Yes. Seven years old son. The pulmonologist concluded: "Well, by 12 at the most he will be an orphan." The man became thoughtful and agreed to sleep with the apparatus.
So what is the beauty of CPAP therapy? She helps the first night. Immediately eliminates respiratory arrest, normalizes blood oxygen saturation, the structure of night sleep, eliminates snoring, headache, frequent urination.
In the morning the patient got up, for the first time sleepy. It is always interesting for me to observe the reaction after using the device: “My God, did I sleep for a week? Everything else. The grass is green, the air is airy, the girls are pretty.” In the end, he bought it.
Then I realized: if a person is ready to pay an amount equivalent to the cost of a one-room apartment in Moscow for a few days of treatment, then this is a promising direction. Since then, I have been involved in somnology.
What sleep problems do people face?
There are over 70 sleep diseases with different symptoms that can occur in a person of any gender and age.
For example, once a three-year-old child came to see me. Mom sounded the alarm: he practically stopped talking, lost weight, stopped growing. His chest was deformed. Mom took him to the doctors, but they said: "Nothing, it will outgrow."
As a result, this woman wrote to me, sent a video where the baby is sleeping. From it it became clear that child severe apnea.
We gave him a polysomnogram. 141 respiratory arrests per hour is an absolute “record”. The minimum saturation is 58%. Severe lack of oxygen.
That is why the boy stopped in development. He did not speak well, because in his sleep his brain could not absorb information and form a long-term memory.
The fact is that it is at night that the processing of what is seen and heard during the day takes place. For the first 6 years, babies learn about 80% of all information in their life in a dream. In addition, the brain coordinates all processes in the body. He is responsible for physical and mental development.
If sleep is disturbed, children grow up physically and mentally handicapped. They form an elongated "adenoid" face: a hooked nose, a lower jaw displaced backwards, crowding of the lower teeth. There may be mental retardation. Most often this is justified by the features of the size and location. adenoids and tonsils. If they interfere with sleep, they should be removed.
The boy's mother did just that. The enlarged palatine tonsils were removed from the child and the elongated uvula was cut. Two months later, his sleep was perfect. The child talked incessantly and grew, recovered by 3 kilograms.
But another patient came to me at the age of 80. There is a condition known as restless leg syndrome. From the name, it might seem that this is some kind of funny thing. But in fact, some patients because of this, there are specific suicidal tendencies.
In 1685, Thomas Willis wrote: “Some people, when they are about to sleep and lie down in bed, stir tendons, arms and legs, accompanied by colic and such restlessness that the patient cannot sleep, as if he were under torture."
It's a very depressing feeling. Imagine that you go to bed and you have an indescribable, but extremely unpleasant feeling that forces you to move your legs. Moved - gone.
Just trying to fall asleep again, as this feeling returns. As if under the skin some kind of electrical impulses. Got up, walked around - all is well. Lie down - it started again. And this situation has been going on for years. Moreover, unfortunately, even 5–10 years ago, most doctors did not know what it was.
Yes, symptoms restless leg syndrome appeared in my patient in 1944, during her first pregnancy. She hesitated for a long time, but eventually went to the doctor.
“Doctor, some worms crawl under my skin and interfere with sleep,” she said. She was sent to a psychiatrist: “The worms under the skin are tactile hallucinations. I'm prescribing neuroleptics for you." They made restless leg syndrome worse.
Grandmother had veins removed from her legs, injections into her joints, radon baths were prescribed, and she was put in a psychiatric clinic.
So what's the deal? Restless Leg Syndrome Caused by Traffic Disorder gland in the brain. It is involved in the synthesis of dopamine, which, in turn, regulates motor activity. And if dopamine is not enough, there is such an unpleasant sensation as "worms under the skin."
In order to recover, you need to take iron supplements or dopamine receptor stimulants. When my grandmother came to me, I explained this and prescribed pills.
In the morning I went into the ward, and she was crying: “Son, I have lost most of my life. Sleep for the first time in 80 years.
However, the main problem for most people is insomnia. Due to severe stress, about 30% of the adult population has a chronic form of this disease. For comparison: in 2020, the figure was half that.
How to deal with insomnia
Faced with insomnia, a person makes a mistake when he begins to fight it. He lies and tries to sleep.
However, sleep from this no longer becomes. On the contrary, a person develops a persistent reflex of fear of not falling asleep. Even when the primary cause of the disease may no longer be, he will still have the association: "Bed - insomnia."
He will go to bed and think: "What a hateful pillow. What a terrible mattress. From the window it blows, shines, makes noise. Flies are flying. It's all terrible." This is called conditioned reflex insomnia.
Even if initially a person wanted to sleep, his sleep will disappear. Because of the fear of being awake, stress hormones will be released - and he will again toss and turn painfully for midnight. This can go on for years and decades.
But there is salvation from this. If we have disorders of thinking and behavior, we need to apply techniques that will change them. I'm practicing cognitive behavioral approach in the treatment of insomnia: methods of sleep restriction, control of stimuli, relaxation, lifestyle changes, and so on. It's harder than just taking a pill, but much more effective.
Let me explain how this might work in practice. Let's say a patient comes to me and says, "I'm not sleeping. I used to have enough 7 hours, now I'm in bed 10 and still don't get enough sleep. I tell him: “You can not sleep, the main thing is not to lie in bed and allocate only 5 hours for sleep.” At the same time, you can't sleep anymore.
I can assure you: after a week, this person begins to understand what true daytime sleepiness is, and at night he falls on the pillow, because the horror wants to sleep like that.
It is enough to go to bed for 2-3 weeks against the background of severe drowsiness, as it begins to be perceived in a completely different way: “My dear bed!”
Then we gradually add time to sleep. You let a person sleep for 15 minutes longer, and he says: “Thank you, doctor, what a happiness!”
On average, such therapy takes about 6 weeks: 3 weeks for habit formation and 3 for fixing it.
Why in Russia there is little attention to sleep problems
In over 25 years as a somnologist, I have seen over 40,000 patients. Passed internships and additional training in Sweden, Germany, Israel, USA. Wrote a doctoral dissertation on the topic of sleep apnea. From 2012 to 2022, he headed the Russian Society of Somnologists.
During this time, there has been significant progress in the treatment of sleep apnea and insomnia. Somnology began to be considered a serious science. One thing has not changed: many doctors still continue to treat the symptoms, not the causes.
Imagine two situations:
- The patient says: "Doctor, I have not been sleeping well for the last three months." What does a doctor do? Most often, he simply prescribes sleeping pills.
- The patient says: "Doctor, for the last three months I have had a temperature of 38 ° C." What does the doctor do? Most likely, appoints an examination. Because he understands that there is some reason that provokes a high temperature - a tumor, an abscess, arthritis, and many others. He doesn't say, "Go get an aspirin."
So why, in a similar situation with insomnia, do we see a completely different picture? deficit vitamin D, deficiency of B vitamins, lack of iron, excess thyroid hormones - there are a lot of reasons that can cause insomnia. Why does the doctor not send the patient for polysomnography, does not study his tests?
Because at the institute they didn’t explain to him that we have 70 sleep diseases, and insomnia can have many causes. They told him: "If you are not sleeping well, take sleeping pills." But most often, chronic insomnia cannot be cured with pills.
Moreover, they can even kill a person. If a patient with sleep apnea is prescribed sleeping pills, his brain will fall asleep deeper, there will be more pauses in breathing, less oxygen. There is a good expression: thousands of people die from sleeping pills, no one died from insomnia.
At the same time, the services of somnologists are still not covered by the costs. CHI. You will not find such specialists in polyclinics and will not consult for free. Alas and ah, the salvation of the drowning is the work of the drowning themselves.
In the world, somnology began to develop in the middle of the last century, and in Russia only at the end of the 90s. Now there are about 3,000 sleep centers in the United States, and we have no more than 50. Once the English neurologist John Jackson said: “It takes 50 years to drive out a false idea from medicine, but 100 years to introduce the right one.” We will have to wait for a couple more generations of doctors to change, so that somnology is firmly established not only in the curricula of universities, but also in the minds of our doctors.
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Text worked on: interviewer Lera Babitskaya, editor Natalya Murakhtanova, proofreader Olga Sytnik