For the past year, Laurent, a thirty-year-old executive, sporty and full of energy, has fallen asleep in front of his screen every early afternoon. This daytime sleepiness started when he started waking up at night. Fearing being taken for a slacker, he doesn’t tell anyone. Like Lawrence, “many people don’t know that insomnia is a disease. However, it is a real syndrome listed as such in the international classification of sleep disorders”, explains Damien Léger, head of the sleep and vigilance center at the Hôtel-Dieu, in Paris, where this invisible handicap is taken care of free of charge thanks to funding from the Ile-de-France regional health agency. .
Damien Léger sees more and more young, athletic men, with no known pathology, but who suffer from “insomnia disease” after a triggering event, family or professional. “They get up every night and come up against the incomprehension of those around them, who are looking for a cause for their behavior, without understanding that they are sick”, he says. The syndrome is very debilitating, especially in professional life: lack of motivation and initiative, loss of concentration, mood disorders, increased anxiety and increased risk of accidents and errors. Insomnia also induces an absenteeism rate twice as high as the average.
Severe chronic pathology, the syndrome corresponds to very specific criteria. The affected person must have at least one of the following three disorders: taking more than thirty minutes to fall asleep, waking up two to three times a night with difficulty falling asleep again or waking up early, sixty minutes before bedtime. chosen time, without being able to go back to sleep. And this at least three times a week for three months, with consequences for the next day.
Biological clock
In France, about 20% of the population is affected by this disease. The prevalence is higher in women (25%) than in men (17%), and it tends to increase with age. Or with context. Thus, it increased in 2020 during the confinements due to Covid-19, before falling to 20% in 2021. For Damien Léger, “the level of anxiety has risen with the traumatic images conveyed by the media – resuscitation, death – and the contradictory injunctions”. And as Sylvie Royant-Parola, president of the Morphée network, which organizes insomnia workshops in Ile-de-France, observes in a video: “Telework establishes a different rhythm of life, more sedentary – less sport and physical activity – and more centered on screens, with schedules often shifted towards the evening. This throws the biological clock out of sync. » This clock, also called circadian, gives rhythm to our sleep-wake cycles by adjusting to daylight. The blue light from the screens disrupts it and the sleep time decreases.
However, explains Damien Léger, “The second sleep disorder, which is also an invisible disease, is the shortening of rest time to less than six hours per twenty-four hours. This sleep debt affects a third of the working population”. And lack of sleep has serious consequences on the metabolism. The body no longer secretes enough hormones necessary for its balance, such as leptin (satiety) or cortisol (stress). Tired, nervous, people snack more and move less. This promotes many diseases: overweight, obesity, type II diabetes, hypertension, stroke, depression and hormone-dependent cancers.
This too short sleep is due to two main causes: working hours (especially at night), with the travel time, and the screens, with their blue light. People are often caught in a vicious circle, like the director of a dynamic industrial site, who only sleeps three to four hours a night, in a hotel near his place of work. “As a result, he has major health problems, overweight, hypertension, back pain”observes Damien Léger.
Light therapy and nap
Can these two pathologies be treated? For sleep debt, there are fairly simple methods. The patient must first become aware of his syndrome, for example using a connected ring that measures sleep time. Then he is offered countermeasures – twenty-minute light therapy session in the morning, nap, physical exercise, switching off the screens an hour before bedtime – in order to anchor new habits. For installed insomnia, “cognitive-behavioral therapy treatment [TCC] is effective with 90% of the people we receive”, notes Damien Léger. Patients follow group sessions, two hours a week, for a few months, in order to find their optimal schedules and sleep times. They learn breathing and relaxation exercises.
Still, access to TCC, not reimbursed in private practice, is not always easy. So 10% of French people take sleeping pills, at the risk of becoming dependent on benzodiazepines, such as zolpidem (Stilnox) or zopiclone (Imovane). A new molecule could change the game, daridorexant (Quviviq) from the Swiss company Idorsia. “During the night, it inhibits a neurotransmitter that stimulates wakefulness, orexin, without causing daytime sleepiness”, comments Damien Léger, who participated in the clinical trial on this molecule. It will soon be available in France, as it has just obtained marketing authorization at European level.
This article was produced as part of the 3e University edition of the Network of Disability Advisors, organized by Agefiph.