Insomnia Holistic Treatment

Natural Insomnia Program

Natural Insomnia Program is credited to Christian Goodman, who is a health expert, and he is willing to help those people suffering from insomnia for long. Many people end up suffering from the sleepless night, which ends up affecting their following day schedule. For instance, the author sleepless night has destructed his marriage and also career, but with the help of the program, he has been to overcomes this problem. Through the various studies, it shows that most of the people sleep after 45 minutes, but with the help of the program, this would be reduced to 10 to 15 minutes. The most common solution to relaxing the body is through linguistic audio, which would help the brain to relax and thus sleep effectively. Many people have used the program, and they have ended solving the problem entirely. The program is available either in the video series and e-Book and works within the shortest time possible. Read more here...

Natural Insomnia Program Summary


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Health Supplement Alert Melatonin

Melatonin is a hormone produced by the pineal gland in the brain. The use of melatonin obtained from animal pineal tissue is not recommended because of the risk of contamination. The synthetic form of melatonin does not carry this risk. However, melatonin is an over-the-counter dietary supplement and has not been evaluated for safety, effectiveness, and purity by the FDA. All of the potential risks and benefits may not be known. Supplements should be purchased from a reliable source to minimize the risk of contamination. Melatonin has been used in treating insomnia, overcoming jet lag, improving the effectiveness of the immune system, and as an antioxidant. The most significant use is for the short-term treatment of insomnia at low doses. Individuals wishing to use melatonin should consult with their primary health care provider or a pharmacist before using the supplement. Possible adverse reactions include headache and depression. Drowsiness may occur within 30 minutes after taking...

Sleep Disorders in General

The parasomnias and neurological disorders of sleep, such as narcolepsy, may be confused with epilepsy due to their paroxysmal nature. The difficulty in differentiating epileptic and nonepileptic events is compounded by the fact that paroxysmal nonepileptic sleep events are more common in children with epilepsy or learning disabilities than in the general childhood population (6). Sleep disorders remain a largely neglected and poorly understood area in pediatrics. However, with careful attention to the timing and semeiology of events and the use of video-EEG and nocturnal polysomnography, these conditions can be classified and distinguished from epileptic seizures (see also Chapter 16).

Melatonin is involved in biological rhythms and photoperiodicity

Melatonin Photoperiod Seasonal

The pineal gland is situated between the two hemispheres of the brain and is connected to the brain by a little stalk. It produces the hormone melatonin from the amino acid tryp-tophan. The release of melatonin by the pineal occurs in the dark and therefore marks the length of the night. Exposure to light inhibits the release of melatonin. In various vertebrates, melatonin is involved in biological rhythms, including photoperiodicity the phenomenon whereby seasonal changes in day length cause physiological changes in animals. Many species, for example, come into reproductive condition when the days begin to get longer (Figure 42.13). Humans are not strongly photoperiodic, but melatonin in humans may play a role in entraining daily 42.13 The Release of Melatonin Regulates Seasonal Changes (a) Melatonin is released in the dark and inhibited by light exposure. The duration of daily melatonin release thus changes as day length (photoperiod) changes, inducing dramatic seasonal...

Nonrem Sleeprelated Symptoms

Increased daytime sleepiness is well described in human patients.7'13 Human patients often complain of involuntary or irresistible urge to sleep, which can occur while talking, standing, walking, eating, or driving. In addition to REM sleep-related abnormalities, another prominent feature of sleep wake patterns in orexin-' mice or orexin ataxin-3 mice was shortened durations of both wakefulness and non-REM sleep in the dark phase, causing increased fragmentation of sleep wake cycle (Fig. 3). OX2R- - mice also showed sleep wake fragmentation, while occurrence of REM sleep-related abnormalities was very rare as compared to orexin- - mice (Fig. 3). This fragmentation was accompanied by statistically insignificant tendency toward reduced amounts of wakefulness and increased amounts of non-REM sleep during the dark phase (Fig. 4). Fragmentation of vigilance states suggests the inability to maintain sleep and wakefulness states. Presumptive excessive sleepiness in orexin- - mice was further...

Nonorganic sleep disorders

In many cases, a disturbance of sleep is one of the symptoms of another disorder, either mental or physical. Whether a sleep disorder in a given patient is an independent condition or simply one of the features of another disorder classified elsewhere, either in this chapter or in others, should be determined on the basis of its clinical presentation and course as well as on the therapeutic considerations and priorities at the time of the consultation. Generally, if the sleep disorder is one of the major complaints and is perceived as a condition in itself, the present code should be used along with other pertinent diagnoses describing the psychopathology and pathophysiology involved in a given case. This category includes only those sleep disorders in which emotional causes are considered to be a primary factor, and which are not due to identifiable physical disorders classified elsewhere. Excludes sleep disorders (organic) ( G47.- )

Sleep Disorders

Nocturnally occurring seizures may resist antiepileptic therapy. Both seizure-related sleep disruption and antiepileptic drugs may produce excessive daytime sleep and mental sluggishness. Several nonepileptic parasom-nias share features with epileptic conditions by interrupting sleep. These also lead to daytime fatigue and sleepiness, possibly compounded by unnecessary antiepileptic medication. Sleep deprivation from para-somnias could aggravate a true epileptic tendency. The foregoing considerations require that the investigation and management of possible seizure disorders include a description of such somnogenic events and scrutiny for symptoms of sleep deprivation (see also Chapter 16). Broughton (102) described three phenomena that superficially resemble dyscognitive (formerly known as complex partial) seizures confusional awakenings (CA), sleep terrors (ST), and sleep walking (SW). CA develop from sleep stages 3 or 4 in the early night (103). The EEG consists of diffuse medium...

REM Sleep Disorders

Nightmares and sleep paralysis are the principal REM sleep disorders that may be confused with epilepsy. They are both common. Ten to twenty percent of individuals have some experience of sleep paralysis. This is a frightening experience of paralysis when waking from REM sleep without abolishing the physiological REM atonia that prevents us from acting out our dreams. Nightmares are usually easier to distinguish from epileptic seizures than night terrors, as the child will have a memory of both waking and of the dream, and will then move into normal wakefulness rapidly. Nocturnal epileptic seizures rarely arise out of REM sleep. Behavioral management and treatment of any comorbid medical conditions are the appropriate treatment strategies. The onset of a REM behavior disorder may rarely be the first clinical sign of a brainstem lesion, and neu-roimaging may be appropriate.


The most common causes of insomnia are mental conflict, emotional disturbances, and depression. Heart failure, however, also may cause insomnia. The patient with Cheyne-Stokes respirations (see above) may sleep during the apneic phase and wake during the hyperpneic phase of the condition. Occasionally, patients with pulmonary congestion due to heart failure have insomnia before they develop nocturnal

Have You Considered Or Gathered Information About Medicalorganic Etiology

The nonmedical clinician is advised to inquire of clients as to whether any medical evaluation of their condition has been performed prior to initiating an hypnotic intervention. Common presentations to the hypnotherapist such as headaches, insomnia, and back pain may have organic etiologies that require surgical or pharmaceutical treatment (Olness & Libbey, 1987). A hasty hypnotic intervention may delay proper diagnosis, cloud symptoms or actually worsen a client's condi

F431 Posttraumatic stress disorder

Arises as a delayed or protracted response to a stressful event or situation (of either brief or long duration) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone. Predisposing factors, such as personality traits (e.g. compulsive, asthenic) or previous history of neurotic illness, may lower the threshold for the development of the syndrome or aggravate its course, but they are neither necessary nor sufficient to explain its occurrence. Typical features include episodes of repeated reliving of the trauma in intrusive memories ( flashbacks ), dreams or nightmares, occurring against the persisting background of a sense of numbness and emotional blunting, detachment from other people, unresponsiveness to surroundings, anhedonia, and avoidance of activities and situations reminiscent of the trauma. There is usually a state of autonomic hyperarousal with hypervigilance, an enhanced startle reaction, and insomnia. Anxiety and...

Long Term Supplemental Oxygen Therapy

Long-term oxygen therapy should be prescribed to patients, who, while breathing room air, have an arterial PO2 (PaO2) of 55 mm Hg or less, or an arterial oxygen saturation (SaO2) of 88 or less (see Table 2). This could be at resting state, during exercise or during sleep. Oxygen supplementation is also indicated when the resting PaO2 is between 56 and 59 mmHg or SaO2 is 89 , with evidence of erythrocytosis (hematocrit greater than 56 ), cor pulmonale, or right-sided heart failure. In addition, oxygen supplementation should be used during sleep when there is a drop of more than 10 mmHg in PaO2 or 5 in SaO2, in the presence of symptoms and signs of hypoxemia, such as impaired cognitive function, restlessness, or insomnia. Continuous oxygen therapy is not justified if hypoxemia is not present during awake hours or at rest, even though there is hypoxemia during sleep or exercise, which can be corrected by oxygen use during sleep or exercise only.

Dreaming and the Autonomy of the Imagination

No one has explained the biological function of sleep, and we know even less of the biological function of dreaming. We know that sleep is as necessary to life as is breathing, because sleep deprivation can lead to death. We do not know the effects of prolonged dream deprivation. Neurosci-entists Borbely and Tononi (1998, p. 212) suggest that sleep and dreaming reorganize and reactivate patterns of brain activity experienced during waking. They believe that only the activity of the waking conscious brain (Freud's day residue) is reorganized. However, there is little agreement regarding the nature of the reorganization that takes place during sleep. Some hypothesize that sleep is a time for restoration, while others view sleep as a time for stimulation. These two processes may not prove to be contradictory, for stimulation may prove to be restorative. activity in the hippocampus that accompanied a repeated daytime task (finding food in a circular run) appeared during REM sleep. The...

Herbal Alert Passion Flower

The term passion flower is used to denote many of the approximately 400 species of the herb. Passion flower has been used in medicine to treat pain, anxiety, and insomnia. Some herbalists use the herb to treat symptoms of parkinson-ism. Passion flower is often used in combination with other herbs, such a valerian, chamomile, and hops, for promoting relaxation, rest, and sleep. Although no adverse reactions have been reported, large doses may cause CNS depression. The use of passion flower is contraindicated in pregnancy and in patients taking the monoamine oxidase inhibitors (MAOIs). Passion flower contains coumarin, and the risk of bleeding may be increased when used in patients taking warfarin and passion flower.

Adverse Reactions

The adverse reactions associated with the administration of adrenergic drugs depend on the drug used, the dose administered, and individualized patient response. Some of the more common adverse reactions include cardiac arrhythmias, such as bradycardia and tachycardia, headache, insomnia, nervousness, anorexia, and an increase in blood pressure (which may reach dangerously high levels). Additional adverse reactions for specific adrenergic drugs are listed in the Summary Drug Table Adrenergic Drugs.

Upper Airway Tone May Be Compromised During Sleep

A prominent feature during REM sleep is a general reduction in skeletal muscle tone. Muscles of the larynx, pharynx, and tongue share in this relaxation, which can lead to obstruction of the upper airways. Airway muscle relaxation may be enhanced by the increased effectiveness of the lung inflation reflex. A common consequence of airway narrowing during sleep is snoring. In many people, usually men, the degree of obstruction may at times be sufficient to cause essentially complete occlusion. In these people, an intact arousal mechanism prevents suffocation, and this sequence is not in itself unusual or abnormal. In some people, obstruction is more complete and more frequent, and the arousal threshold may be raised. Repeated obstruction leads to significant hypercapnia and hypoxemia, and repeated arousals cause sleep deprivation that leads to excessive daytime sleepiness, often interfering with normal daily activity.

Inhibitors of Reverse Transcriptase Zidovudine and Homologs

Zidovudine is rapidly absorbed following oral administration and rather rapidly metabolized by hepatic glucuronidation (half-life about 1 hour) so that the drug needs to be given 2 or 3 times daily. Very ill hospitalized patients may be treated by continuous intravenous infusion. Side effects of zidovudine are frequent. The most important result Irom the toxicity of the drug for bone marrow, namely, macrocytic anemia (often requiring red cell transfusions) and granulocytopenia (neutropenia). Headache, nausea, and insomnia are common, and many patients develop a myopathy resulting in (reversible) wasting of proximal muscle groups. Severe side effects may demand suspension of treatment, reduction in the daily dosage, combined therapy with another nucleoside analog or interferon a or another cytokine displaying synergism, or replacement or alternation with another drug.

Monitoring and Managing Adverse Drug Reactions

The adverse drug reactions that may occur with the use of an amphetamine, such as insomnia and a significant increase in blood pressure and pulse rate, may be serious enough to require discontinuation of the drug. In some instances, the adverse drug effects are mild and may even disappear during therapy. The nurse informs the primary care provider of all adverse reactions. When use of the CNS stimulants causes insomnia, the nurse administers the drug early in the day (when possible) to diminish sleep disturbances. The patient is encouraged not to nap during the day. Other stimulants, such as coffee, tea, or cola drinks, are avoided. In some patients, nervousness, restlessness, and palpitations may occur. The vital signs are checked every 6 to 8 hours or more often if tachycardia, hypertension, or palpitations occur. Many times these adverse reactions will diminish with continued use as tolerance develops. If tolerance develops, the dosage is not increased.

Gerontologic Alert

Older adults are especially sensitive to the effects of the CNS stimulants and may exhibit excessive anxiety, nervousness, insomnia, and mental confusion. Cardiovascular disorders, common in the older adult, may be worsened by the CNS stimulants. Careful monitoring is important because the presence of these reactions may result in the need to discontinue use of the drug.

Psychogenic Nonepileptic Events

Magnetic resonance imaging (MRI) studies were normal. An interictal EEG showed right anterior temporal slowing. No interictal epilepti-form discharges occurred during the awake and sleep states, and there were no epileptiform discharges during a recording obtained following a night of sleep deprivation.

Inferences For General Twoway Tables

Veterans Administration conducted a health survey of 11,230 veterans. The advantages of this survey are that it includes a large random sample with a high interview response rate, and it was done before the public controversy surrounding the issue of the health effects of possible exposure to Agent Orange. The data shown in Table 6.13 relate Vietnam service to having sleep problems among the 1787 veterans who entered the military service between 1965 and 1975. We have

Limitations And Perspectives

Hcrt-1 levels in the CSF increase under specific conditions such as sleep deprivation and decrease under REM sleep rebound in rats suggesting that REM sleep deprivation and rebound activate and inhibit respectively the hcrtergic system.45 Increased hcrtergic tone during REM sleep deprivation may be important to interpret changes, or lack of changes, in hcrt dosages in the CSF of patients since REM sleep deprivation might be a secondary indirect consequence of a sleep disorder. This might explain some of the discrepancies between studies. The detailed analysis of the effect of REM deprivation on the hcrt tone shows an increase in the hcrt levels during the rest period but not at the end of the active period45 because of high spontaneous levels at that time of the day. Indeed, hcrt-1 release is under the control of the clock, since lesion of the suprachiasmatic nucleus eliminates the daily rhythm of hcrt-1 release in the rat. An effect mediated via the dorsomedial hypothalamic nucleus,...

Flexibility In The Hypnotic Management Of Pain

Hypnotherapy is often ineffective with pain of a psychological nature, particularly when pain is seen to be a depressive equivalent. Masked depression is one of the conditions where hypnosis should be avoided unless the hypnotist is able to deal properly with depression, using medication and psychotherapy. This situation should be suspected if the patient gives a history of sleep disorder, fatigue, lack of interest in sexuality or in general, or inability to work or a tendency to stay in bed. This is particularly so if the patient functioned effectively previously such patients can respond dramatically to antidepressant therapy. Hypnosis may be used after the depression is controlled.

Seasonal Effects on Testicular Function

Although humans are considered to be nonseasonal mammals, we are undoubtedly sensitive to photoperiod (9), as exemplified by seasonal affective disorder and by seasonal trends in the frequency of births and in the incidence of twins. Such effects are most obvious in northern Europe, where photoperiodic changes are most extreme (10). Furthermore, both longitudinal and cross-sectional studies have demonstrated that sperm counts in men are consistently approx 30 lower in summer than in winter (11,12), although not all studies have reported such effects, and they may be less apparent or absent in tropical countries (13). An alternative explanation is that it is exposure to the higher summer temperature that is responsible for lowering sperm production (see section on scrotal temperature), although temperature changes do not account for all of the seasonal trends in births, especially in northern Europe (3). If the reported seasonal changes in sperm counts are an echo from our seasonally...

Role Of Hypocretin In Sleep Regulation

The hypocretin system is a crucial regulator of (REM-)sleep and wakefulness cycle, and seems to be particularly involved in sustained wakefulness since sleep deprivation is associated with an upregulated activity of the system.46 It integrates the activity of nuclei involved in these states including the motor nuclei. Absence of hypocretin leads to attenuated daytime wakefulness and the earlier discussed loss of state boundary control .47 In this context it is important to realize that the hypocretin system is not required to generate wakefulness or other vigilance states, since these states still occur in almost the normal amounts, when there is no hypocretin transmission. Hypocretin merely stabilizes sleep and wakefulness states. This regulatory role is corroborated by neuro-anatomical findings. The hypocretin system comprises a small group of cells exclusively located in the lateral hypothalamus with efferent connections to virtually all parts of the How to view the role of...

Treatment Of Sleep Apnoea And Snoring

Some studies have suggested that reduction of smoking and alcohol consumption will lead to reduced self-reported snoring and reverse mild sleep apnoea (89). Sleep deprivation may reduce upper airway tone and chemosensitivity and should be avoided. Drugs such as benzodiazepines or opiates should be avoided at bedtime, particularly in patients with severe OSA or OHS. upper airway through a nose or face mask, providing a 'pneumatic' splint which prevents upper airway closure. CPAP treatment leads to normalization of sleep architecture, decreased upper airway oedema and a reduction in daytime sleepiness (91,92). CPAP improves cognitive function and quality of life, as well as the associated symptoms listed in Table 27.1 for patients with all degrees of severity of OSA (93). CPAP is not a cure for sleep apnoea. Cessation of treatment will lead to a recurrence of sleep-disordered breathing and accompanying symptoms. Figure 27.3 Efficacy of nasal ventilation in a patient with OHS. (a)...

Clinical Focus Box 311

Like many other peptide hormones, growth hormone secretion occurs in a pulsatile fashion. The most consistent pulse occurs just after the onset of deep sleep and lasts for about 1 hour. There are usually 4 to 6 irregularly timed pulses throughout the remainder of the day. In order to ob

Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis a Syndrome

Electroencephalographic studies demonstrate interictal sharp and slow wave activity from the anterior temporal regions. Interictal activity is usually increased during stage 1 sleep and may become bilateral with slow sleep stages. Ictal scalp recordings usually show lateralizing rhythmic theta activity, and with intracranial recordings focal discharges originating in the hippocampus and amygdala are commonly seen.

Multiparameter Biosignal Database

As a case study for a biosignal database the European project SIESTA is introduced here 4 , 9 . Sleep recordings in sleep laboratories are performed in order to objectify sleep disorders after having evaluated the subjective symptoms of insomnia ( I cannot sleep ) and hypersomnia ( I am always tired and I do fall asleep even when trying to stay alert ). In order to objectify a sleep disorder diagnosis a sleep recording must be done in a sleep laboratory. Biosignals reflecting neurophysiological, respiratory and cardiac activities are recorded for 8-10 hours during the night. During the recording, the signals are also monitored, thus allowing the attending personnel to take notes on movements, talking during sleep or other events being of possible relevance. After recording the raw data are evaluated by sleep experts using rules developed by a committee chaired by A. Rechtschaffen and A. Kales in 1968. These traditional rules are based on chart recordings of electroencephalography,...

Altered States Of Consciousness Internal Influences

At the end of each 90-minute sleep cycle, a period of heightened brain activity, increased cerebral blood flow, and rapid eye movement REM) occurs. Waking someone during this period produces the report of a dream more than 80 percent of the time. (Waking someone during non-REM sleep produces reports of dreams less than 15 percent of the time.) Rapid-eye movement REM) sleep gets longer with each successive sleep cycle, often lasting 30 to 60 minutes by the end of a night's sleep. REM sleep sometimes is called paradoxical sleep because the subject's heart rate, respiration rate, and EEG patterns closely resemble those observed when the subject is awake. Interestingly, however, activity of the cranial and spinal motor neurons is inhibited during this period, leading to loss of muscle tone and a considerably diminished chance of movement. EXAMPLE 6.7. Studies have shown that some patients suffering from severe depression have disturbing dreams during REM sleep and awaken only...

Biosignal Archiving Considerations

Digital storage space becomes low in terms of cost and is also more condensed in terms of physical volume dimensions. Using the signal specifications given in Table 13-1 a digital recording of one night of sleep with 16 channels being recorded for eight to ten hours requires approximately 130 megabytes of digital memory. A recordable CD-ROM can hold four recordings of this size. The database of sleep recordings produced by the SIESTA project consists of 200 healthy volunteers and 100 patients with selected sleep disorders 4 . Each subject was recorded for two nights resulting in 600 recordings. This equals approx. 150 CD-ROMs. In order to have an easy and systematic access to all data files and all information a database which holds all data recorded and the related files was installed. The database holds all medical information on the subjects, file information about the available data, technical reports and signal information with artifact...

Subacute Spongiform Encephalopathy

The reader is referred to Chapter 10 for a detailed discussion of the role of putative subviral infectious agents known as prions in degenerative diseases of the brain classified as subacute spongiform encephalopathies, of which scrapie in sheep is the paradigm. Kuru was the first human model of these intriguing diseases to be unraveled, but the family has now been extended to include Creutzfeldt-Jakob disease (CJD), Gerstmann-Straussler-Scheinker syndrome, and fatal familial insomnia, in the last two of which an inherited mutation in a particular gene can produce a disease clinically identical to that seen in kuru or in most cases of CJD where an infectious agent is responsible.

Altered States Of Consciousness External Influences

Psychoactive drugs are drugs that affect the central nervous system, causing subjective changes in perception, emotion, and other conscious processes. These agents include depressant drugs, narcotic drugs, stimulants, hallucinogens, and many more. The primary reason for using psychoactive drugs appears to be social influence from peers. Other reasons for use may involve a physical problem such as insomnia, or a psychological need such as relief from anxiety. The study of the psychological effect of drugs is called psychopharmacology. Depressants. Also known as downers, central nervous system (CNS) depressants slow the operation of the CNS. In therapeutic use, they often are prescribed to relieve anxiety or combat insomnia. Barbiturates. Another category of depressant drugs is barbiturates. These drugs frequently are prescribed by physicians to induce sleep (counteracting insomnia, for example) or relieve stress. Nembutal and Seconal are common barbiturates.

Periodic Limb Movements Of Sleep

In addition to the nonepileptic conditions previously discussed, two sleep related conditions can occasionally be confused with convulsive epileptic seizures. These are periodic limb movements of sleep (PLMS) and REM sleep behavior disorder (RBD) (see also Chapter 16). PLMS is characterized by recurrent muscle contractions, primarily of the lower extremities, during sleep (50-53). Simultaneous movements of the upper extremities may occur. The movements tend to occur in clusters, each movement occurring approximately 20 to 30 seconds after the preceding movement, and each cluster lasting from minutes to hours. The movements tend to be more prominent in stage I and stage II sleep and tend to occur early in the night. The movements are characterized by extension of the great toe and flexion at the ankle, knee, and hip. Patients may complain of frequent awakenings, insomnia, or daytime sleepiness, all symptoms that are commonly associated with disrupted sleep. As one might expect, spouses...

Polypeptides as Neurotransmitters

Spinal motor neurons that innervate skeletal muscles, the intravenous infusion of benzodiazepines acts to inhibit the muscular spasms in epileptic seizures and seizures resulting from drug overdose and poisons. Probably as a result of its general inhibitory effects on the brain, GABA also functions as a neurotrans-mitter involved in mood and emotion. Benzodiazepines such as Valium are thus given orally to treat anxiety and sleeplessness.

Case Study for Chapter

This patient is suffering from what has been known as pickwickian syndrome, a disorder that occurs with severely obese individuals because of their excessive weight. The pickwickian syndrome was named after Joe, the fat boy who was always falling asleep in Charles Dickens' novel The Pickwick Papers. Pickwickian patients suffer from hypoventilation and often suffer from sleep apnea as well. Pickwickian syndrome is no longer an appropriate name because it does not indicate what type of sleep disorder is involved. About 80 of sleep apnea patients are obese and 20 are of relatively normal weight.

Common abnormalities

Upper Motor Neuron Clonus Test

Myoclonus is a sudden shock-like muscle contraction which involves one or more muscles of a whple limb. Myoclonic jerks may be focal or diffuse and may occur singly or repetitively. They may occur in normal people, particularly when falling asleep. Some patients with primary generalised epilepsy experience myoclonic jerks, especially after waking. Less common causes of myoclonic jerks arc rare diseases such as Creutzfeld-Jakob disease, subacute sclerosing panencephalitis, familial myoclonic epilepsies, and anoxic cerebral damage.

Inheritance Of Narcolepsy In Canines

Narcolepsy And Cataplexy

Percent of Time Spent in, Mean Frequency of, and Mean Duration for Each Vigilance State of Narcoleptic and Control Canines during Daytime 6-Hour Recordings (10 00 to 16 00). (a, b) No significant difference was found in percent of time spent in each vigilance state between narcoleptic and control dogs. However, the mean duration of wake, drowsy, and deep sleep episodes were significantly shorter in the narcoleptics, suggesting a fragmentation of the vigilance states (wake and sleep) in these animals. To compensate for the influence of cataplectic episodes on wake and drowsy those episodes interrupted by the occurrence of cataplexy were excluded. (c) Mean latency (min) to each sleep stage and occurrences (number total sessions) of cataplexy and sleep onset REM periods (SOREMPs) during the multiple sleep latency test (MSLT) in narcoleptic and control Dobermans. Drowsy and light sleep occurred in all sessions. Deep sleep, REM sleep or cataplexy (for narcoleptic dogs) occurred...

Hypocretin Deficiency And Narcoleptic Phenotype

Sleepiness in narcolepsy is most likely due to the difficulty in maintaining wakefulness as normal subjects do. The sleep pattern of narcoleptic subjects is also fragmented and they exhibit insomnia (frequent wakening) at night. This fragmentation occurs across 24 hours, and thus, the loss of hypocretin signaling are likely to play a role of this vigilance stage stability (see ref. 88), but other mechanism may also involved in EDS in narcoleptic subjects. One of the most important characteristics of EDS in narcolepsy is that sleepiness is reduced, and patients feel refreshed after a short nap, but this does not last long as they become sleepy within a short period of time. We have observed that hypocretin levels in the extracellular space and in the CSF of rats significantly fluctuate across 24 hours, and build-up toward the end of the active periods.89 Several manipulations (such as sleep deprivation, exercise and long-term food deprivation) are also known to increase hypocretin...

Monoaminergic and Cholinergic Interactions and Cataplexy

The importance of increased cholinergic activity in triggering REM sleep or REM sleep atonia is well established (see ref. 32). Similarly, activation of the cholinergic systems using the acetylcholinesterase inhibitor physostigmine also greatly exacerbates cataplexy 33. This cholinergic effect is mediated via muscarinic receptors since muscarinic stimulation aggravates cataplexy, while its blockade suppresses it, and nicotinic stimulation or blockade has no effect.33 Monoaminergic transmission is also critical for the control of cataplexy. All therapeutic agents currently used to treat cataplexy (i.e., antidepressants or monoamine oxidase inhibitors MAOIs ), are known to act on these systems. Furthermore, whereas a subset of cholinergic neurons are activated during REM sleep, the firing rate of monoaminergic neurons in the brainstem (such as in the locus coeruleus (LC) and the raphe magnus) are well known to be dramatically depressed during this sleep stage.34,35 Using canine...

Psychiatric Disorders

Sleep disturbances are common and early symptoms in depression. The relationship between depression, sleep and circadian rhythms has been strongly documented. In some cases insomnia, stress and depression are even seen as continuum and a significant number of narcoleptic patients suffer from depression. Depression is associated with short REM sleep latencies in many cases. REM sleep is suppressed by almost all antidepressant medications and sleep deprivation. REM sleep deprivation has antidepressant effect. The neurochemistry of depression has focused on monoaminergic dysfunction, especially noradrenergic and serotoninergic pathways. The hypocretins, two neuropeptides that promote wakefulness and inhibit REM sleep are upregulated under REM sleep deprivation45 and might be involved in his antidepressant effect. In addition, the projections distribution of the hypocretins is coherent with a direct involvement in depression since these projections are noted in aminergic cell groups i.e....

Effects Of Powerfull Magnet On Humanbeings

Arsonval Great Solenoid

Recently endorsed in a report by the National Research Council (1997) support previous findings that electromagnetic fields induce changes in the brain's electro-encephalographic (EEG) activity (Bell et al., 1991), produce measurable changes in polypeptide synthesis in salivary glands (Goodman and Henderson, 1988), and are able to influence the levels of calcium and melatonin in cells exposed to highlevel fields (Graham et al., 1996). Additionally, recent double-blind studies have confirmed the effects of low-frequency pulsed electromagnetic fields greater than 0.5 mT on growth induction in bone. Indeed, their use is now the treatment of choice for certain recalcitrant problems of the musculoskeletal system, including salvage of surgically resistant nonunions in children and adults and chronic refractory tendinitis (Bassett, 1989). Graham, C., Cook, M.R., Riffle, D.W., Gerkovich, M.M. and Cohen, H.D. (1996). Nocturnal melatonin levels in human volunteers exposed to intermittent 60 Hz...

NonREM Partial Arousal Disorders Arousal Parasomnias Night Terrors

Brief nocturnal arousals are normal in children. They occur typically in stage 4 non-REM sleep, 1 to 2 hours after sleep onset. They vary from normal events such as mumbling, chewing, sitting up, and staring to arousals that can be thought of as abnormal because of the disruption they cause the family. These include calm and agitated sleepwalking, and a spectrum from confusional arousals to night terrors or pavor nocturnus. The child may exhibit automatic behavior, but the events are not truly stereotyped. The affected children may be very agitated and look frightened, as if they do not recognize their parents. They are in an intermediate stage between waking and sleep, so they may respond, but not normally. They look awake and may be partially responsive but in fact are still in deep slow-wave sleep (stage 4). These events typically only occur once a night, especially 1 or 2 hours after falling asleep and nearly always in the first half of sleep. Children have no memory for them....

Hypocretin Deficiency In Human Narcolepsy

Despite the lack of an identified genetic cause, hypocretin deficiency as cause of human narcolepsy remained an attractive hypothesis. To further study this an assay for the measurement of hypocretin was developed and cerebrospinal fluid (CSF) hypocretin-1 measurements were performed blindly in a small series of patients and controls.15 The astonishing finding was that 7 out of 9 patients had an undetectable low hypocretin-1 level, in contrast to the control group having levels about 7 times the detection limit, and all in a narrow range. Subsequently, a large extension study was performed to confirm these findings and establish the sensitivity and specificity.16,17 Several hundreds of subjects were included healthy controls, patients with typical narcolepsy, atypical narcolepsy, idiopathic hypersomnia, sleep apnea, restless legs, periodic limb movements disorder, insomnia patients as well as patients suffering from a wide variety of neurological disorders. From these data the...

Symptoms Of Canine Narcolepsy

Affected dogs exhibit very pronounced attacks of cataplexy (which are mainly triggered by positive emotional experiences), such as being fed a favorite food or engaging in play. Cataplectic attacks in dogs often begin as a buckling of both hind legs, and this is often accompanied by a drooping of the neck (see Figure 1). The dog may collapse to the floor and remain motionless for a few seconds or several minutes. In contrast to the some forms of epilepsy, excess salivation or incontinence are not observed during cataplectic attacks. During long cataplectic attacks, rapid eye movements, muscle twitching and or slow repetitive movement of the fore and hind limbs may occur. These phenomena are related to the active phase of REM sleep. The muscle is always flaccid and never stiff during cataplectic attacks, and this is also different from most forms of seizure attacks. Dogs usually remain conscious (especially at the beginning of attacks) with eyes open, and are capable of following...

Sleep Wake Transition Disorders

Rhythmic movement disorders such as nocturnal head banging (jactatio capitis nocturna), body rocking, and head rolling typically occur in infants and toddlers as they are trying to fall asleep. They can be present in deep sleep and in wakefulness. They are more common in children with learning disabilities. They typically remit by 5 years of age, but may persist into adult life. Management relies on good sleep hygiene and padding the headboard so the rest of the house is not wakened. Rhythmic movement disorders that are not clearly associated with the sleep-wake transition state respond less well to behavioral management techniques and (rarely) medications such as benzodiazepines may be helpful.

Rem Behavior Disorder

The second sleep disorder that may mimic convulsive epileptic seizures is REM behavior disorder (RBD) (58,59). RBD is characterized by recurrent episodes of vigorous motor activity occurring during REM sleep, movements that often awaken the patient or spouse. The primary presenting complaints are interrupted sleep or injuries during sleep. RBD is more common in older adults, usually beginning after the age of 50. It is two to five times more common in men than in women. It is possible that rare episodes such as these occur in a large percentage of the population. I am familiar with people who have had rare such episodes throughout their adult life. The movements seen in RBD vary from minor movements of an individual extremity to complex behavior, such as laughing, shouting, or throwing one's self from the bed (58,59). Commonly, the movements are related to a dream the patient is having during REM sleep, and the patient is often able to describe the dream. The frequency of episodes...

The Hibernation Inducement Trigger

Woodchucks accumulate as much body fat as possible before hibernation, sometimes achieving a weight of ten pounds. During their deep sleep, they take nourishment from their layers of fat, although they may waken at times to nibble seeds stored in their dens. By the time they emerge from

Fibromyalgia Syndrome

Fibromyalgia syndrome (FMS) is a difficult-to-diagnose condition involving the muscles. It is associated with widespread muscle aches, tenderness, and stiffness along with fatigue and sleep disorders in the absence of neurologic abnormalities or any other known cause. The disorder may coexist with other chronic diseases, may follow a viral infection, and may involve immune system dysfunction. Treatments for FMS may include a carefully planned exercise program and medication with pain relievers, muscle relaxants, or antidepressants.

Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) involves persistent fatigue of no known cause that may be associated with impaired memory, sore throat, painful lymph nodes, muscle and joint pain, headaches, sleep problems, and immune disorders. The condition often occurs after a viral infection. Epstein-Barr virus (the agent that causes mononucleosis), herpesvirus, and other viruses have been suggested as possible causes of CFS. No traditional or alternative therapies have been consistently successful in treating CFS.

Uc Davis Sleep Hypocretin

Human narcolepsy is a chronic sleep disorder that affects 1 2000 of the general population. One of the major research aims of the Stanford Sleep Research Center is to find the etiology of the disease and to develop better treatments for human narcolepsy. However, human narcolepsy is very complex and multifactorial, and is (1) genetically heterogeneous, (2) a polygenic trait and (3) environmentally influenced.1 The development of a simpler animal model of narcolepsy was thus the high priority in the Center to pursuer this aim. In 1972, the Stanford Sleep Research Center (directed by Dr. William C. Dement) had an educational exhibit about human narcolepsy at the annual convention of the American Medical Association in San Francisco. As part of the exhibit, a film clip of narcoleptic patients having cataplexy was shown, and one member of the audience (a faculty member from the school of veterinary medicine at UC-Davis), mentioned that he took care a dog that had the same attacks....

An Electroencephalogram Records Electrical Activity of the Brains Surface

Abnormal Eeg Waves

The influence of the ascending reticular activating system on the brain's activity can be monitored via electroen-cephalography. The electroencephalograph is a sensitive recording device for picking up the electrical activity of the brain's surface through electrodes placed on designated sites on the scalp. This noninvasive tool measures simultaneously, via multiple leads, the electrical activity of the major areas of the cerebral cortex. It is also the best diagnostic tool available for detecting abnormalities in electrical activity, such as in epilepsy, and for diagnosing sleep disorders. units discharge asynchronously. At the opposite end of the alertness scale, when sensory input is at its lowest, in deep sleep, a synchronized EEG has the characteristics of low frequency and high amplitude. An absence of EEG activity is the legal criterion for death in the United States. Sleep and the EEG. Sleep is regulated by the reticular formation. The ascending reticular activating system is...

Role Of Csf Hypocretin In The Diagnosis Of Narcolepsy

These new neurobiologic (hypocretin deficiency) and genetic (HLA) findings have lead to a redefinition of narcolepsy. Whereas the MSLT has been classically used to distinguish, for example, narcolepsy without cataplexy from idiopathic hypersomnia, the expanded disease continuum of the narcolepsy clinical borderland has made the diagnosis of narcolepsy more difficult. As such, the use of CSF Hcrt-1 levels as a biologically-based diagnostic test for narcolepsy has been particularly useful in establishing a new pathophysiologically-based criterion for its classification (Table 2). Indeed, the MSLT is not entirely specific or sensitive, in that 15 of narcoleptic patients have a negative test,67,68 whereas normal subjects or patients with other sleep disorders associated with EDS may also have abnormally short sleep latencies on the MSLT. Quantitative Receiver Operating Curves (QROC) analysis in a large number of lumbar CSF Hcrt-1 samples has indicated that the value of 110 pg ml, one...

The Onset of Puberty Depends on Maturation of the Hypothalamic GnRH Pulse Generator

Reduction in the effectiveness of intrinsic CNS inhibition over the GnRH pulse generator. The mechanisms underlying these changes are unclear but might involve endogenous opioids. As a result of disinhibition, the frequency and amplitude of GnRH pulses increase. Initially, pulsatility is most prominent at night, entrained by deep sleep,- later it becomes established throughout the 24-hour period. GnRH acts on the gonadotrophs of the anterior pituitary as a self-primer. It increases the number of GnRH receptors (up-regulation) and augments the synthesis, storage, and secretion of the gonadotropins. The increased responsiveness of FSH to GnRH in females occurs earlier than that of LH, accounting for a higher FSH LH ratio at the onset of puberty than during late puberty and adulthood. A reversal of the ratio is seen again after menopause.

Electrodiagnostic Monitoring

The routine EEG is useful for diagnosing spells, but the interpretation of the EEG must be cautious. Many normal variants, such as asymmetrical vertex waves, wicket spikes, small sharp spikes, 14- and 6-per second positive spikes, and rhythmical temporal theta bursts of drowsiness (formerly called psychomotor variant), can be mistaken for interictal spikes and sharp waves (109 and see Chapter 1). Additionally, a few percent of the normal American population exhibit interictal epileptiform discharges in a baseline EEG (110,111). The combination of an ambiguous history for a seizure and normal variants in the EEG can be an invitation to inappropriate treatment. Conversely, many individuals who have epilepsy lack abnormalities on an interictal EEG (112). Repeat EEGs to a total of about four EEGs may increase the yield (113). Other procedures useful for eliciting abnormalities in the EEG are activating procedures such as sleep deprivation or use of extra scalp (114) or sphenoidal...

Clinical Presentation

Hypercalciuria with subsequent renal calculi, glucocorticoid-induced osteopenia osteoporosis, menstrual irregularities (e.g., amenorrhea), loss of libido in both genders (hypogonadism secondary to hypercortisolism), and muscle weakness in association with proximal muscle atrophy are common features of CD CS. Avascular necrosis of the hip can be the presenting manifestation of an ACTH-secreting pituitary adenoma and requires immediate attention to save the femoral head and avoid subsequent disability (15). Cataracts (classically posterior subcapsular) and glaucoma frequently occur in patients with exogenous CS but not in those with endogenous hypercortisolism (16). Psychiatric manifestations in CD include cognitive deficits with memory loss and poor concentration, anxiety with insomnia, irritability, atypical depression, acute psychosis, and mania (17-19).

Paul B Pritchard III MD

Normal adults exhibit little change in serum PRL during waking hours, except for brief elevations after naps (2). Multiple nocturnal PRL surges occur which, unlike growth hormone (GH), are not entrained to specific sleep stages (3). Serum PRL returns to daytime values within 90 minutes of waking.

Behavioral Disorders Anxiety Disorders

Anxiety is a feeling of fear, worry, uneasiness, or dread. It may be associated with physical problems or drugs and is often prompted by feelings of helplessness or loss of self-esteem. Generalized anxiety disorder (GAD) is characterized by chronic excessive and uncontrollable worry about various life circumstances, often with no basis. It may be accompanied by muscle tensing, restlessness, dyspnea, palpitations, insomnia, irritability, or fatigue.

Hypnotic Strategies For Pain Management

Another view of hypnosis is that it reflects a stable capacity of the individual. The hypnotic experience may involve an ability to readily change states of awareness or levels of consciousness. These changes may be either interpersonally-or self-induced (Bowers, 1976 Evans, 2000 Hilgard, 1965, 1977). Hypnosis is considered in terms of neodissociation or multiple cognitive pathways. The patient simultaneously knows, but is unaware of, pain severity, at different levels of awareness. Pain awareness and analgesia are co-conscious. Hypnosis may involve a more general ability of cognitive flexibility, or switching mechanism, that allows one to change psychological, cognitive or physiological processes, or readily access different levels of consciousness (Evans, 2000, 1991). Hypnotizability correlates with several related measures including the ability to utilize imagery effectively napping and the ease of falling asleep the ability to become absorbed in engaging experiences such as being...

Arousal Mechanisms Protect the Sleeper

Several stimuli cause arousal from sleep,- less intense stimuli cause a shift to a lighter sleep stage without frank arousal. In general, arousal from REM sleep is more difficult than from slow-wave sleep. In humans, hypercapnia is a more potent arousal stimulus than hypoxia, the former requiring a Paco2 of about 55 mm Hg and the latter requiring a Pao2 less than 40 mm Hg. Airway irritation and airway occlusion induce arousal readily in slow-wave sleep but much less readily during REM sleep. All of these arousal mechanisms probably operate through the activation of a reticular arousal mechanism similar to the wakefulness stimulus. They play an important role in protecting the sleeper from airway obstruction, alveolar hypoventilation of any cause, and the entrance into the airways of irritating substances. Recall that coughing depends on the aroused state and without arousal airway irritation leads to apnea. Obviously, wakefulness altered by other than natural sleep such as during...

Endocrine Actions Of Hypocretins


On the other hand, it is possible that hypocretins play a role in the regulation of adrenal axis during the sleep cycle in normal healthy humans. In this sense, in humans deep sleep has an inhibitory effect on the HPA axis and sleep deprivation has a stimulatory effect on it.127-129 Whether these changes are mediated by the hypocretinergic tone in humans merits further investigation. sleep in humans and in several animal species.29,30,149 Furthermore, functional alteration in the somatotropic axis can lead to marked changes in the regulation of sleep-wake activity. Thus, GH-deficiency in children is often associated with decreases in REMs.29,155,156 Also, data obtained in genetic strains of GH-deficient rats, e.g. dwarf Lewis rats157 or in transgenic models,158 linked to an impairment in GH secretion, showed the presence of sleep alterations. Although the nature of the hypothalamic mechanisms through which the different components of GH-axis influences sleep is poorly understood,...

Clinical Aspects Of Narcolepsy

Severe daytime sleepiness, often combined with nocturnal sleep fragmentation, leads to a feeling of constant tiredness in narcoleptics. This chronic sleep pressure coupled with poor sleep wake state boundary control may underlie the commonly observed sudden, uncontrollable bouts of sleepiness or sleep attacks during the day. Cataplexy (Gk., to strike down ), another cardinal symptom of narcolepsy, was first used by Loewenfeld (1902) to describe the sudden, bilateral loss of muscle tone without loss of consciousness. Triggered by any situation that requires sudden action or strong emotion (laughing and mirth are the most commonly reported triggers), these attacks may be partial (isolated muscle groups) or complete (causing complete collapse), but rarely involve all muscles simultaneously. The knees (buckling) and head neck muscles (head bobbing, jaw sagging and slurred speech) are most commonly affected, with such episodes lasting for seconds to (rarely) minutes. Muscle weakness...

Therapeutic Intervention With Hypnosis

When evaluating a new patient, I listen to the patient's communication regarding dysphoric feelings of helplessness, anxiety, hopelessness, inner tension, insomnia, fear, restlessness, and so on. I introduce the idea of using hypnosis by making it relevant to the patient's presenting symptoms, saying to the patient something like this, 'Would you like to learn an exercise of how to reduce your anxiety and promote a sense of calmness and relaxation ' Patients generally respond affirmatively. I then proceed by teaching the patient a self-hypnosis exercise loaded with suggestions and images of calmness and comfort, asking the patient to select a place associated in their mind with such feelings. Some patients select a mountain trail, an inland lake or a state park, many select an ocean beach.

History of Interventions in the Brain Using Psychotropic Substances

Fantasies of intervening in the psyche and the use of psychotropic agents have a venerable history in mankind. Even in prehistoric times, substances like opium, cannabis, coca, peyote and alcohol were used, especially in the context of religious and magic rituals and other cultural practices. In ancient Greece, for example in the Hippocratic writings and the writings of Dioscourides and Galen, the use of opium was recommended for the treatment of pain and sleep disorders, particularly in women. Helleborus was the treatment of choice in psychiatric diseases. The Greek authors distinguished the black helleborus, a purgative, from the white helleborus, a substance which induced vomiting. Ancient Greek medical writings show that doctors believed psychiatric illnesses to have somatic foundations. They therefore tried to heal through the extraction of illness-inducing substances using emetics or purgatives. As can be seen, the concept of the so-called biological psychiatry , meaning...

Subsequent Responses

The above changes in patient-ventilator interaction need not only occur when assist level is increased. Downregulation of inspiratory output for any reason (sleep, administration of a sedative, correction of metabolic acidosis) may result in the same changes at the same PSV level. Thus, a patient may switch from the pattern of Figure 1B to that of 1A, or may develop recurrent central apneas, upon falling asleep or upon receiving a sedative. Conversely, a slow deeper pattern (e.g., Fig. 1A) may become rapid and shallow upon awakening or with any intervention that increases ventilatory drive (nursing intervention, visitors, etc.) giving rise to the false interpretation of respiratory distress. Thus, paradoxically, during PSV, Vt may decrease as inspiratory output increases (compare Fig. 1A and 1B).

Slow Infections

The term subacute spongiform encephalopathy is used as a generic name for several lethal neurodegenerative diseases that have strikingly similar clin-icopathologic features and causative agents, namely, scrapie of sheep and goats, bovine spongiform encephalopathy, mink and feline encephalopathy, wasting disease of deer and elk, and kuru, Creutzfeldt-Jakob disease, Gerstmann-Straussler-Scheinker syndrome, and fatal familial insomnia in humans. The basic lesion is a progressive vacuolation in neurons and, to a lesser extent, in astrocytes and oligodendrocytes, an extensive astroglial hypertrophy and proliferation, and finally a spongiform change in the gray matter (Fig. 10-3). The importance of Gajdusek's discovery was enhanced when it was demonstrated that a similar or identical agent causes the more widespread sporadic human presenile dementia, Creutzfeldt-Jakob disease (CJD), and that both agents bear a striking resemblance to that of scrapie of sheep. In all human populations that...


The RAS, through its nonspecific arousal of the cortex, helps to maintain a state of alert consciousness. Not surprisingly, there is evidence that general anesthetics may produce unconsciousness by depressing the RAS. Similarly, the ability to fall asleep may be due to the action of specific neurotransmitters that inhibit activity of the RAS.

Clinical issues

By definition, atypical angina pectoris needs to be suspected before it can be diagnosed. It is also important to consider recent studies that conclude that many women with coronary artery disease do not present with chest pain. Their presenting complaints often are fatigue and insomnia.


These drugs may also be helpful in the management of narcolepsy, a disorder manifested by an uncontrollable desire to sleep during normal waking hours even though the individual has a normal nighttime sleeping pattern. The individual with narcolepsy may fall asleep from a few minutes to a few hours many times in one day. This disorder begins in adolescence or in the young adult and persists throughout life.

Herbal Alert Ginseng

Adverse reactions are rare, but sleeplessness, nervousness, and diarrhea have been reported in individuals taking large amounts of the herb. The herb should not be taken in combination with stimulants including those containing caffeine. Dosage is 200 to 500 mg day of the standardized extract or 1 to 4 g of powdered root a day. Ginseng is contraindicated in individuals with high blood pressure and during pregnancy.


Menopause is the cessation of monthly menstrual cycles. This generally occurs between the ages of 45 and 55 years. Levels of reproductive hormones decline, and egg cells in the ovaries gradually degenerate. Some women experience unpleasant symptoms, such as hot flashes, headaches, insomnia, mood swings, and urinary problems. There is also some atrophy of the reproductive tract with vaginal dryness. Most importantly, decline in estrogen is associated with weakening of the bones (osteoporosis).


The side effects of intrathecal steroids have already been addressed. When injected into the epidural space, corticosteroids can and do cause systemic effects, although these are generally much less prominent than those seen when systemic treatment with steroids is used. There is a depression of the hypothalamic-pituitary-adrenal access with ESIs. There is depression of plasma cortisol levels up to 3 wk after an epidural administration of the commonly used doses of steroids (38). Insomnia, anxiety, fluid retention, and headache have all been recorded as complaints by patients following epidural steroid injections, but these are limited in time and severity in almost all cases. Diabetic patients can experience a transient elevation of their blood sugar although this has been rarely reported (39).

Figure 134

The EEG record of a person (a) passing from the awake state to deep sleep (stage 4) and (b) during REM sleep. A typical night's sleep in an average young adult. The lavender colored lines indicate periods of REM sleep. A typical night's sleep in an average young adult. The lavender colored lines indicate periods of REM sleep. REM sleep is also called paradoxical sleep because the sleeper is difficult to arouse despite having an EEG that is characteristic of the alert, awake state. When awakened during REM sleep, subjects generally report that they have been dreaming. This is true even in people who do not remember dreaming when they awaken later spontaneously. If uninterrupted, sleep continues in this cyclical fashion, moving from stages 1, 2, and 3, to 4 then back up from 4 to 3, 2, and 1, where NREM sleep is punctuated by an episode of REM sleep. Continuous recordings of adults show that the average total sleep period comprises four or five such cycles, each lasting 90 to 100 min...

Symptomatic Therapy

A variety of medical therapies are utilized in the care of patients with leptomeningeal metastasis irrespective of whether the patient is offered aggressive neoplastic meningitis-directed therapy. A minority of patients will manifest seizures as a consequence of neoplastic meningitis and the use of non-sedating anticonvulsant drugs is appropriate for this group of patients. Patients with difficult to control pain may be managed with narcotics or, in the instance of neuropathic pain, either anticonvulsant drug or tricyclic antidepressant drug therapy. Depression is a very common symptom in patients with cancer and is often neglected or not recognized. Early recognition and initiation of antidepressants in symptomatic patients is recognized to improve quality of life and benefit both patients and families. In addition, antidepressants, especially tricyclic agents, are also useful for chronic insomnia. Corticosteroids are most useful to control vasogenic edema secondary to parenchymal...

Thermal modalities

Psychiatric and psychological interventions. Many patients with RSD present with a history of mistaken diagnoses, perceptions (which may or may not be accurate) that their pain has been dismissed (by professionals and family), irritability, demoralization, and sleep deprivation because of pain. These often lead to anger at the medical system and strained relations between the patient and family members. Stress, anxiety, and depression, which are common in these patients, are well-known to exacerbate pain from any cause, and because of their effects on the autonomic nervous system (association with increase or dysregulation of circulating catecholamines), they also may play a more specific role in RSD. 10. Antidepressants. It should be noted that tricyclic antidepressants, which may be used to treat depression and relieve pain while also leading to a transient increase in norepinephrine, may cause a decrease in norepinephrine turnover and hence be considered sympatholytic....

Depressive disorders

Belong to the subgroup of affective disorders in the ICD-10. Depressive episodes could be classified as either mild, moderate or severe according to the ability of the depressed individual to participate in everyday life. Symptoms include depressed mood, diminished interest or pleasure in most activities, loss of weight or appetite, fatigue or loss of energy and sleep disorders. Depressive episodes which are followed by manic episodes constitute the subclass of so-called bipolar disorders.


Tertiary Structure Ginsenoside

And Canada, and P. notoginseng (Sanchi-ginseng) from China, have been widely used in China and Russia for the treatment of a number of diseases including anaemia, diabetes, gastritis, insomnia, sexual impotence, and as a general restorative. Interest in the drug has increased considerably in recent years and ginseng is widely available as a health food in the form of powders, extracts, and teas. The dried and usually peeled root provides white ginseng, whereas red ginseng is obtained by steaming the root, this process generating a reddish-brown caramel-like colour, and reputedly enhancing biological activity. Ginseng is classified as an 'adaptogen', helping the body to adapt to stress, improving stamina and concentration, and providing a normalizing and restorative effect. It is also widely promoted as an aphrodisiac. The Korean root is highly prized and the most expensive. Long term use of ginseng can lead to symptoms similar to those of corticosteroid poisoning, including...

Pineal Gland

Human Gland Locations

The principal hormone of the pineal gland is melatonin. Production and secretion of this hormone is stimulated by activity of the suprachiasmatic nucleus (SCN) in the hypothalamus of the brain via activation of sympathetic neurons to the pineal gland (fig. 11.32). The SCN is the primary center for circadian rhythms in the body rhythms of physiological activity that follow a 24hour pattern. The circadian activity of the SCN is automatic, but environmental light dark changes are required to entrain (synchronize) this activity to a day night cycle. Activity of the SCN, and thus secretion of melatonin, begins to increase with darkness and peaks by the middle of the night. During the day, neural pathways from the retina of the eyes to the hypothalamus (fig. 11.32) act to depress the activity of the SCN, reducing sympathetic stimulation of the pineal and thus decreasing melatonin secretion. The pineal gland has been implicated in a variety of physiological processes. One of the most widely...

GM2 Gangliosidosis

Gangliosidosis Mri

Occur, as in other disorders of the lower motor neuron. Various extrapyramidal features have been described in late-onset GM2 gangliosidosis, either in isolation or in combination with the more common motor neuron and cerebellar syndromes. Dystonia, rigidity, choreiform movements, and athetoid posturing have been noted. Another clinical characteristic of late-onset GM2 gangliosidosis is the high incidence of recurrent psychosis. In addition, psychic changes include anxiety, depression, insomnia, aggressiveness, severe behavioral problems, and disintegration of the personality. The psychic changes may precede all other manifestations or may appear later. Neurovegetative disorders are common and take the form of sweating impairment, loss of libido, impaired esophagus motility, fixed cardiac frequency, and orthostat-ic hypotension. Intellectual deterioration is frequent. Epilepsy may occur, but is not obligatory. Blindness occurs late in the course of the disease. On ophthal-moscopic...

Future challenges

Psychiatric disorder and are severe enough to warrant clinical intervention Palinkas et al. 1995a Palinkas et al. 2004a). Psychiatric debrief-ings of 313 men and women conducted at McMurdo and South Pole between 1994 and 1997 revealed that 3.8 of personnel experienced mood disorders (depression), 3.8 experienced adjustment disorders, 2.6 experienced sleep disorders, 1.3 experienced alcohol or drug-related disorder, and 1.0 experienced personality disorders (Palinkas et al. 2004a). Although these rates are lower than what might be experienced in the general population in the United States, they are noteworthy in that these men and women are required to undergo psychiatric screening prior to the austral winter. However, if a serious psychiatric problem developed in space, for example, a paranoid reaction or immobilizing depression, this could seriously jeopardize the mission. Therefore, the development and implementation of psychological, pharmaceutical, and other countermeasures to...

Candidate Hormones

A substance that fits the first category described above is the amino acid derivative melatonin, which is synthesized from serotonin. This candidate hormone is produced by the pineal gland, an outgrowth from the roof of the diencephalon of the brain (shown but not labeled in Figure 8-38). The exact functions of melatonin in humans are uncertain, but this hormone probably plays an important role in the setting of the body's circadian rhythms and in sleep (Chapter 7). Its secretion is stimulated by sympathetic neurons that constitute the last link in a neuronal chain primarily triggered by receptors in the eyes darkness stimulates melatonin secretion, and light inhibits it. Melatonin secretion, therefore, undergoes a marked 24-h cycle, being high at night and low during the day. Environmental lighting does not cause the circadian rhythm, which is of internal origin, but entrains it (see Chapter 7) . Melatonin's ability to reduce the symptoms of jet lag when administered in small amounts...


The fourth criterion involves hyperarousal symptoms trouble falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance, and an exaggerated startled response. Two such symptoms are required. The reader may notice that in many ways these symptoms seem inconsistent. How can one be

Drug Idiosyncrasy

Drug idiosyncrasy is a term used to describe any unusual or abnormal reaction to a drug. It is any reaction that is different from the one normally expected of a specific drug and dose. For example, a patient may be given a drug to help him or her sleep (eg, a hypnotic). Instead of falling asleep, the patient remains wide awake and shows signs of nervousness or excitement. This response is an idiosyncratic response because it is different from what the nurse expects from this type of drug. Another patient may receive the same drug and dose, fall asleep, and after 8 hours be difficult to awaken. This, too, is abnormal and describes an overresponse to the drug.

Sleep Disturbances

The general term dyssomnia includes a variety of possible disorders that result in excessive sleepiness or difficulty in beginning or maintaining sleep. Simple causes for such disorders include schedule changes or travel to different time zones (jet lag). Insomnia refers to insufficient or nonrestorative sleep despite ample opportunity to sleep. There may be physical causes for insomnia, but often it is related to emotional upset caused by stressful events. Narcolepsy is characterized by brief, uncontrollable attacks of sleep during the day. The disorder is treated with stimulants, regulation of sleep habits, and short daytime naps. Sleep disorders are diagnosed by physical examination, a sleep history, and a log of sleep habits, including details of the sleep environment and note of any substances consumed that may interfere with sleep. Study in a sleep laboratory with a variety of electric and other studies, composing a polysomnography, may also be needed. Sleep studies characterize...


Dysthymic disorder involves at least 2 years of a depressed mood that occurs for most of the day on more days than not. At least two of the following symptoms must be present poor appetite or overeating insomnia or hypersomnia low energy or fatigue low self-esteem poor concentration or difficulty making decisions feelings of hopelessness. Additional criteria to be met The person has never been without the symptoms for more than 2 months at a time, and the mood disturbance is not easily distinguished from the person's usual functioning. (In contrast, a major depressive episode represents a change from the person's previous functioning.)

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Salvation For The Sleep Deprived The Ultimate Guide To Sleeping, Napping, Resting And  Restoring Your Energy. Of the many things that we do just instinctively and do not give much  of a thought to, sleep is probably the most prominent one. Most of us sleep only because we have to. We sleep because we cannot stay awake all 24 hours in the day.

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