Stop Insomnia Naturally

Natural Insomnia Program

The Insomnia Exercise Program is a simple audio program that works to Train Your Brain to switch from normal, fast-paced brain waves to slow, delta and theta waves and put you to sleep mind and body naturally. This is a 2-part program. Part 1 is a 25 minute audio where I lead you step by step to reach those slow theta and delta stages that knock you out in a deepest sleep of your life. This is done through a combination of mind, eye and relaxation exercises. Part 2 is a 50 minute audio of sound therapy where you hear the relaxing sound that draws you into the wonderful land of dreaming. After youve listened to the audio a few times, youll most likely be sound asleep long before it even comes to this part but it is important because it will draw you into deeper and deeper sleep so you dont wake up after a few minutes and not be able to doze off again. All you have to do is listen to the audio in your bed and get ready to fall asleep! Read more here...

Natural Insomnia Program Summary


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Insomniacs Barely Sleep at

People with insomnia often announce in the morning that they didn't sleep at all last night. Although it may have seemed this L51 way, failing to get any sleep is extremely unlikely. Even in severe cases, people with insomnia typically get a few hours of sleep per night. We all tend to be poor judges of how long it takes us to fall asleep and how long we've slept. Everyone has had the experience of intending to fall asleep for a few minutes and waking up several hours later, unaware of how much time has passed. This is because we don't experience the passing of time while asleep. There is a small group of people who are convinced they get no sleep at all each night until we bring them into the sleep laboratory and show them that although they claimed to lie awake all night, they actually slept for seven hours.

Maintain Good Sleep Habits

The tips in this section and the next two fall under what is often called sleep hygiene. The idea is that just as there are things you do for your personal and dental hygiene, following certain steps will lead to healthy sleep. Develop a presleep routine. Similarly, you should develop a routine for the hours leading up to bedtime you can't expect to walk in the door, hop into bed, and fall asleep. Instead, start by setting aside fifteen to twenty minutes to resolve any mundane matters that might otherwise be on your mind if left undone when you go to bed (unwashed dishes, plans for the next day, responding to personal e-mail, and so on). Then try to wind down from the day with a nonstrenuous activity, such as reading, watching television, or listening to music. Many people find an evening shower or bath helps them relax. such as relaxation exercises, meditation, and biofeedback. We'll discuss these techniques in greater depth when we cover insomnia treatments in Chapter 8. Avoid...

Seek Help for Persistent Sleep Problems

Of course, this chapter will not be a panacea for everyone. You may already follow these guidelines, or you may make some important changes but fail to realize major improvements. If these simple steps don't improve your sleep, you should consult your physician or a sleep specialist. Much can still be done, including identifying a sleep disorder. And keep reading there are numerous treatment options we've yet to discuss, one of which may be the key to improving your sleep. That concludes our first section. In Part II, we'll look at specific sleep disorders and their treatments, beginning with a chapter on how you can narrow down the source of your sleep problem. Sleep Disorders and Their Treatments

Insomnia and Its Behavioral Treatments

My health is falling to pieces because I can't sleep. These are just some of the complaints I hear from people with insomnia. In this chapter, we'll look at insomnia and the non-pharmacologic treatments available to treat it. (We'll cover prescription sleep medications in Chapter 9 and alternative treatments in Chapter 10).

What Is Sunday Insomnia

It is not unusual for people to have trouble falling asleep on Sunday nights. While anxiety about work or school on Monday is a potential cause, another important factor is often weekend changes in sleep habits. When someone stays up later Friday night and sleeps in Saturday morning, he or she is primed to stay up even later Saturday night and sleep in the next day. By Sunday evening, the body's clock is programmed to stay up late. People who have developed a pattern of Sunday insomnia may feel their anxiety mount as they anticipate a difficult night ahead. The solution to the Sunday blues is to maintain your weekday rising schedule on the weekends. Then on Sunday night, if you have stayed on schedule, you should have no problem getting to sleep. If you have stayed up a bit later on Friday and Saturday, the sleep deprivation should help you get to sleep easily. In either case and especially if getting anxious about the coming week interferes with getting to sleep make sure to use the...

Behavioral Treatments for Insomnia

That work just as well (if not better) for chronic insomnia. Medications can be effective for short-term insomnia and have a role in trying to break the condition's downward cycle. However, the effectiveness of long-term use is not clear it may even be harm-ful and these medications can have significant side effects. I strongly believe that behavioral treatments have significant advantages and should be explored early. Research has shown that behavioral treatments are as likely or more likely than medication to succeed over the long term, and they do not carry the health risks or side effects of sleeping pills. Although the behavioral treatments in this chapter are largely used to treat primary insomnia, they can also benefit people with secondary insomnia. There is a host of behavioral treatments for insomnia. Some you can do on your own or with assistance from someone trained in behavioral therapy or stress reduction techniques others require a psychologist or a sleep specialist...

Medications for Treating Insomnia

If you have chronic insomnia, whether or not to take sleep medication is a decision you need to make in consultation with your doctor. It's not always an easy call. On the one hand, persistent sleeplessness can have negative physical and mental health effects and impair your quality of life, and sleeping pills can improve sleep. On the other hand, medications are not always effective and carry a number of drawbacks and health risks, so they're not an ideal solution for everyone.

Menopause and Insomnia

Menopause is a time of major hormonal, physical, and psychological changes, and sleep disturbance is one of the hallmark symptoms. More than half of women complain of difficulty falling asleep, less restorative sleep, and daytime sleepiness during this life stage, and these sleep problems are frequently accompanied by depression and anxiety.

Alternative Insomnia Treatments

People have used plants, herbs, and other methods to try to heal or cure themselves for thousands of years. It's not surprising that they're willing to try alternative treatments for insomnia as well. If you're considering an alternative therapy, you're probably wondering, Can they help me sleep This is a difficult question to answer. Unfortunately, few rigorous studies have examined whether alternative therapies actually benefit people with insomnia (or other chronic health problems, for that matter). Alternative therapies are not strictly regulated by the federal government, so practitioners and manufacturers have little incentive to conduct large and costly studies to prove that their techniques and products are safe and effective. Without solid research, we're largely left with anecdotal evidence, which makes it hard for physicians to make fact-based judgments. Use alternative therapies in conjunction with conventional treatments, not in place of them. If you've recently improved...

REM Sleep Behavior Disorder

Most people make subtle twitching movements during REM sleep, but a temporary muscle paralysis prevents larger movements. In some people, this paralysis evaporates during the night, freeing them to act out dreams. Most often they shout and kick or punch perceived aggressors they may even jump out of bed onto the floor or up on a table. Such episodes can be dangerous to people experiencing them as well as their bed partners injuries such as black eyes and bruised ribs are not uncommon. This phenomenon known as REM sleep behavior disorder (RBD) was identified in the 1980s. It's estimated to occur in one in two hundred people (0.5 percent). Nine out of ten people who have it are men. The disorder nearly always arises after age Episodes tend to arise in the latter half of the night, when the highest percentage of REM sleep occurs. Typically, the person is experiencing a frightening dream in which he or she feels threatened, such as by an animal, a burglar, or an enemy soldier. In the...

Falling Asleep During the Day Is a Sign of Laziness

Falling asleep during daytime hours is not a character defect it's a sign of physiological need. Lazy people may fritter away their time at unproductive or pointless tasks, but they don't necessarily have trouble staying awake in the daytime. Sleeping during the day is a sign of sleep deprivation. This can be self-induced (that is, from staying up late), or it may result from poor sleep hygiene insomnia sleep apnea, narcolepsy, or another sleep disorder or an underlying illness. It can also be a side effect of a medication.

Cant Fall Asleep

People use this phrase to describe a number of problems, all of which share the feature of an inability to get to sleep in a desired length of time. The difficulty can occur when first getting into bed, after waking up in the middle of the night, or in the early-morning hours. I Can't Get to Sleep For many people, the primary problem is sleep latency they have difficulty falling asleep. Instead, they toss and turn as the minutes, and even hours, go by. Once this pattern has been established, they may try ill-advised measures to break it, such as distracting themselves with television or drinking a nightcap before bed. Often they start to feel anxious before bedtime, fearing they won't be able to fall asleep. They may delay going to bed for several hours, convinced there's no chance they'll fall asleep. Eventually, they do fall asleep from exhaustion, but they may end up getting only a few hours of sleep before it's time to get up in the morning. The next night, the scenario repeats....

Primary Insomnia

Primary insomnia occurs independently and is not due to any other obvious cause. In rare cases, it begins in infancy, presumably because of an inborn abnormality of the mechanisms that control sleep. But in most cases, primary insomnia is learned, meaning the condition develops over time during childhood or adulthood. People who develop primary insomnia seem predisposed to the problem because they have overactive nervous systems. Studies of people with chronic insomnia show they have higher metabolic rates and produce higher levels of stress hormones than others. Some experience they've had triggers difficulty with sleep, though in most cases individuals can't recall a specific event. After experiencing a few sleepless nights, they learn to associate the bedroom with being awake. The usual cues to begin to relax, such as entering the bedroom, putting on pajamas or brushing their teeth, instead elicit anxiousness about whether or not sleep will come easily. This anxiety causes...

Secondary Insomnia

Secondary insomnia results from another cause. Chronic secondary insomnia is often caused by an illness or disease it may be a sleep disorder (such as sleep apnea or narcolepsy), a nonsleep condition (such as angina, heartburn, or depression), or a medication taken for such a condition. Substances taken for reasons other than sleep or health such as alcohol, caffeine, or recreational drugs can also lead to the development of insomnia. The most direct solution to secondary insomnia is to address the underlying source of sleeplessness. For example, if pain from arthritis keeps you awake, then treating the arthritis is the most effective way to improve your sleep. If a medication for depression is keeping you awake, switching to a different medication that does not cause insomnia is advisable. A report on insomnia issued after the 2005 National Institutes of Health State-of-the-Science Conference proposed using the term comorbid insomnia rather than secondary insomnia to describe sleep...


Staying up late of your own free will is one thing. But what if you're trying to get a good night's sleep and can't Insomnia takes different forms. Onset insomnia refers to difficulty establishing sleep common causes include anxiety and racing thoughts. Middle insomnia refers to middle-of-the-night awakening and an inability to return to sleep within a reasonable time. This type of problem is typical of people experiencing chronic pain, which may rouse them from the midst of slumber. Early morning awakening is frequently associated with depression. Whatever form insomnia takes, the net effect is the same insufficient restorative sleep leading to daytime fatigue. The detrimental effect of insomnia on memory function is twofold. Decreased sleep deprives you of adequate time for consolidation and diminishes daytime alertness, thereby undermining attentional function and new learning. All forms of insomnia become more common with age. Occasional sleeplessness is common and does not...

Synthetic Melatonin

As you'll recall from Chapter 2, melatonin is a hormone secreted by the pineal gland in the brain. Production peaks in the late evening, in conjunction with the onset of sleep. Since the 1990s, a synthetic version has been widely available in the United States as a supplement at health food stores and pharmacies. As a food sup- ,119 plement, there is no regulation of the amount or quality of the melatonin in each tablet. In Great Britain and Canada, melatonin is classified as a medicine and available by prescription only. Although some researchers initially expressed enthusiasm for synthetic melatonin's possible role as an insomnia treatment, most subsequent research has been disappointing, finding either minimal benefits or none at all. A 2004 review of the melatonin research by the federal Agency for Healthcare Research and Quality (AHRQ) concluded that the supplement is not effective in treating most sleep disorders. While melatonin is no longer seen as advantageous to the broad...


In lab studies, doses of synthetic melatonin have been shown to shift the circadian rhythm in the opposite direction from the shift with bright light, leading sleep doctors to believe that it too can play a role in treating sleep timing disorders. As with bright light, proper timing of the dosage is vital or the person's problem can be worsened. People with DSP may benefit from melatonin several hours before bedtime (which advances the circadian rhythm), and people with ASP may be helped by a dose in the morning (which delays the circadian rhythm). The usual dose is 3 to 5 milligrams. Unfortunately, since melatonin sold in stores is not regulated by the FDA, there is no guarantee that the product you buy will have the correct dose. Ramelteon (Rozerem), a new sleep medication that stimulates the same receptors in the brain that melatonin does and shifts the circadian rhythm, may be helpful in treating timing disorders. More research is needed, but it's likely this drug will become an...

Sleep Disorders

Unexpected body movements suggestive of nocturnal seizures can be associated with normal and abnormal sleep. Narcolepsy is a rare sleep disorder characterized by excessive somnolence and frequent falling asleep. Cat-aplexy is a sudden loss of body tone with falls brought on by sudden emotion, typically laughter or fright. Narcolepsy may also be accompanied by hallucinations just before sleep or on awakening and a momentary inability to move on awakening (sleep paralysis). During cataplexy (unlike seizures or syncope), the patient remains conscious throughout the fall. The only constant feature of narcolepsy is sleepiness, and the other clinical features may be absent. Sleep-monitoring studies will confirm the diagnosis.

American Academy of Neurological and

American Academy of Somnology A professional group for clinicians, researchers, and students who study sleep and sleep disorders. The academy advocates standardization of university programs in somnology and a multidisciplinary approach to the study and treatment of sleep disorders. The academy sponsors the American Board of Somnology, which evaluates qualifications of applicants, administers exams, and confers diplomate status on qualified individuals. Founded in 1986, the academy publishes the annual Journal of Som-nology and the quarterly The Somnologist. For address, see Appendix II.

Apparent Life Threatening Events

In addition to the above types of apnea, the cessation of breathing also can occur in connection with Apparent Life-Threatening Events (ALTEs). An ALTE itself is not a sleep disorder but an event that is a combination of apnea, change in color, change in muscle tone, choking, or gagging. Most ALTEs can be frightening to see, but they usually are uncomplicated and do not recur. However, some ALTEs (especially in young infants) are associated with medical conditions such as gastroesophageal reflux (GERD), infections, or neurological disorders. These medical conditions require treatment, so all children who experience an ALTE should be seen by a doctor immediately.

The Sleep Conductor at Work

Whether or not you fall asleep at any given point in time is determined by the interaction of the two aspects of the homeostatic drive, plus what might be called your circadian drive in other words, the effect of the circadian rhythm of sleep and wakeful-ness. At times, the circadian and homeostatic drives work together to promote sleep or alertness, as illustrated in Figure 2.6a at other times, these forces are in opposition, leading to difficulty falling asleep in bed or trouble staying alert during the day, as shown in Figure 2.6b. Let's look at some examples of the rhythms working together. Say you're at the tail end of a busy week during which you've had no choice but to get up at 6 a.m. and go to bed at midnight. At 12 a.m. on Friday, you've been awake eighteen hours, you've built up a medium-size sleep debt, and it's an ideal time to sleep in terms of the sleep wake rhythm. Barring unusual circumstances (a sleep disorder, a blaring car alarm, and so on), it shouldn't take you...

Functional Implications

Interestingly, some of these brain regions contain only one orexin receptor subtype. For example, the locus coeruleus, laterodorsal tegmental nucleus (LDT), and pedunculopontine tegmental nucleus (PPT) are examples of regions, densely innervated by orexin fibers, that contain solely the OX1R mRNA. These regions have been implicated in general cortical arousal, in the case of the locus coeruleus, and in REM sleep maintanance, in the case of the PPT LDT, and will be discussed elsewhere in this text. Orexin application in these regions causes neuronal excitation (50,64-67). Ultrastructural examination of noradrenergic neurons in the locus coeruleus innervated by orexin fibers has confirmed the presence of synaptic contacts (50).

Selective Serotonin Reuptake Inhibitors

Potential side effects include nausea, anorexia, more frequent or loose stools, anxiety, restlessness, sleep disturbance (insomnia or hypersomnia), headache, diminished sexual drive, orgasmic dysfunction, and apathy. Sinus bradycardia is an uncommon side effect but is rarely symptomatic. Most of these adverse effects are mild or transient, and thus most patients tolerate SSRIs well in the short term. Over the long haul, however, up to 20 percent of patients will discontinue these drugs because of persistent changes in sexual drive or function, and a smaller number will discontinue use because of apathy, gastrointestinal disturbance, or sleep disturbance. Sertra-line hydrochloride is most likely to cause diarrhea, and paroxetine hy-drochloride to cause hypersomnia.

Vitamin D and other aspects of health 3121 Behaviour

Specific vitamin D receptors are found in parts of the brain and spinal cord (Maxwell, 2001). Seasonal changes in 25-OHD and 1,25-OHD could have an effect on hormonal function, mood and behaviour. For example, seasonal affective disorders (SAD) appear to have a latitude gradient, with mood changes due to a reduction in daylight hours and altered circadian secretion of melatonin. Whether seasonal changes in UV light and vitamin D contribute is unknown.

Antiretroviral Agents

The predominant adverse effect of zidovudine is myelosuppression, as evidenced by neutropenia and anemia, occurring in 16 and 24 of patients, respectively. Zidovudine has been associated with skeletal and cardiac muscle toxicity, including polymyositis. Nausea, headache, malaise, insomnia, and fatigue are common side effects.

Electrophysiological Approach

It has been reported that serotonin (5-HT) neurons in the raphe nuclei play an important role in the regulation of sleep wakefulness because the destruction of 5-HT neurons of the raphe nuclei or the inhibition of 5-HT synthesis with p-chlorophenylalanine (pCPA) induces severe insomnia (9,10). Orexin neurons densely innervate the raphe nuclei, which express

Snoring Is Annoying but Harmless

There's no doubt that snoring is annoying. In some cases it is harmless, but in others it's a sign of obstructive sleep apnea, a sleep disorder characterized by pauses in breathing that prevent air from flowing into or out of a sleeping person's airways. As we will see in Chapter 11, sleep apnea increases a person's risk of heart disease and causes severe daytime sleepiness. Snorers who temporarily stop breathing during the night or experience severe daytime sleepiness should consult a physician.

Absorption and deficiency

When the body pool falls below 300 mg vitamin C there is evidence of impaired function (Hodges et al, 1969). Plasma vitamin C levels are sensitive to recent dietary intake with values < 11 mmol L indicating biochemical depletion (Sauberlich, 1975). The early symptoms of vitamin C deficiency are fatigue, lassitude, loss of appetite, drowsiness, insomnia, feeling run-down, low resistance to infection and petechiae (minor capillary bleeding). Those most at risk of vitamin C deficiency are cigarette smokers, alcohol users, institutionalised elderly and people on certain drugs. Deprivation of vitamin C for long periods leads to scurvy, characterised by weakening of collagenous structures, resulting in widespread bleeding. Scurvy in infants results in bone malformations. The earliest clinical signs of deficiency are bleeding gums and loosening of teeth. Today, scurvy is relatively rare. An LNRI of 10mg d for adults has been shown to prevent scurvy in the UK and elsewhere but this level...

Why study single neurons

One of the first experimentally satisfactory experiments I did on the frog's retina gave a result that made nonsense of the theory I was testing, but I was so fixated by the theory that I nearly missed an important new fact that was staring me in the face. Having previously mapped the receptive field of a retinal ganglion cell, I measured its sensitivity to circular spots of increasing size. My theory predicted that while it was within the receptive field, sensitivity would rise either in proportion to the area of the stimulus spot or in proportion to its square root, depending on the type of unit. My theory attached great importance to which of these rules it followed, but the results showed that the sensitivity rose at a rate almost exactly halfway between the alternatives expected. I went home late at night in great gloom, thinking the experiment had failed and was not worth repeating. It was only as I was falling asleep that I remembered that the sensitivity had plunged to a...

Theres Something Wrong If You Dont Remember Your Dreams

Everybody dreams, but some people remember them and some don't. Not being able to recall your dreams is perfectly normal and has no negative health effects. Whether or not you remember your dreams is determined by when you wake up in relation to having those dreams. If you wake up during or just after a dream, you're likely to remember it otherwise, you won't. It's just a matter of timing and has no bearing on sleep quality.

Immunoblotbioassay For Quantification Of Hypocretin Peptides

Because findings of low CSF hypocretin levels (i.e., less than one-third of the normal value by direct RIA) will be included in the diagnosis of narcolepsy in the second revised version of the ICSD, a simple EIA-based immunoblot can be developed for a diagnostic test (see ref. 23). There is a no need for emergency bedside diagnosis for this chronic sleep disorder, and thus there is little merit in developing a one-step immunoblot test.

Can I Irrigate More than Twice a

Twice a day, after brushing your teeth, is a good starting point. Ideally, irrigating just before you go to bed will enable you to breathe freely long enough to help you fall asleep. But during the overnight hours, mucus will eventually build up, so you want to irrigate again upon waking to clear out what's accumulated overnight.

Watching the detectives

Detectives and forensic scientists whose job it was to find and photograph fingerprints began to display the symptoms of chronic mercury poisoning, such as excessive salivation, stomach pains, insomnia, tremors, irritability, and depression, although for a long time these were not linked to the real cause. Indeed it was only in the 1940s that it was realized that the detectives were really suffering from chronic mercury poisoning.

Why Exercise Enhances Sleep

The benefit of regular exercise to people who have trouble sleeping probably occurs because it reduces stress and anxiety, factors that impede sleep. A good workout leaves you feeling relaxed and in a good mood, so later on you're more likely to fall asleep and stay asleep. Exercise also has an effect on your biological clock. Researchers have been able to shift subjects' biological clocks with properly timed exercise. They theorize that daytime exercise helps lock your circadian rhythm of sleep and wakefulness into a consistent twenty-four-hour pattern, ensuring that you're ready to fall asleep when bedtime arrives. One important caveat here is that you should not exercise too close to bedtime because this is a stimulating activity that can make it harder to fall asleep. If you finish exercising at least two hours before bedtime, you'll eliminate this risk.

Chlamydial infection See chlamydia

Chloral hydrate Chloral hydrate is a sedative used to treat insomnia. It is usually taken fifteen to thirty minutes before bedtime. Using chloral hydrate regularly for more than two weeks often reduces its effectiveness. Major side effects include stomach irritation, residual sedation, and hangover. Chloral hydrate should be used with great caution by people who are depressed, who are suicidal, or who have a history of drug abuse.

Creutzfeldt Jakob disease

Several common symptoms become evident in CJD patients as the disease runs its course. The duration of CJD from the onset of symptoms to the inevitable death is usually one year however, shorter periods of several months are common, and longer periods of two or more years have been noted, usually in the familial form and with an earlier age of onset. The initial stage of the disease can be subtle, with ambiguous symptoms of insomnia, depression, confusion, personality and behavioral changes, strange physical sensations, and problems with memory, coordination and sight. As the disease advances, the patient experiences a rapidly progressive dementia, and in most cases, involuntary and irregular jerking movements known as myoclonus. Problems with language, sight, muscular weakness, and coordination worsen. The patient may appear startled and become rigid. In the final stage of the disease, the patient loses all mental and physical functions. The patient may lapse into a coma and usually...

Food Allergy Symptoms

'Early allergy' (allergy Type I, II or III) may affect the mucous membrane of the oral cavity (OAS), the stomach (a surface or erosion-like mucous membrane inflammation), or the intestines (inflammatory changes of various degrees of intensity, from eosinophilic infiltration to ulceration or enteritis granuloma Caffarelli et al., 1998 ). Systemic manifestations may have a dramatic course, sometimes leading to death due to anaphylactic shock, which can develop in few minutes after food consumption. Early allergies may also affect internal organs, most frequently the upper respiratory tract (manifested as bronchial asthma). Delayed symptoms may affect the skin (nettle rash), joints (inflammations of single or numerous joints), muscles (myalgia), kidneys (nephrosis), and may also manifest as otitis media and recurrent pneumonia. They may also lead to changes in the central nervous system that cause character and mood changes, hypermotility or tiredness syndrome, headaches, 'chronic...

The Treatment of Noncognitive Symptoms

Behaviors, hallucinations, and delusions. Because these drugs may cause adverse side effects (e.g., parkinsonism, rigidity with falls, tardive dyskinesia), the physician should clearly justify their use in the patients chart. Most clinicians recommend the use of the newer, so-called atypical neuroleptics at low doses because they have fewer side effects. Typical starting doses are risperidone, 0.5 mg po qhs, or olanzapine, 2.5 mg po qd. These agents are expensive (e.g., at 2.5 mg qd, the monthly cost of olanzapine is approximately 150), however, and it is often possible to prescribe less-expensive drugs such as haloperidol, 0.5 mg po qd (monthly cost as low as 6), or thiothixene, 1 mg po qd (monthly cost as low as 10). In general, no more than 3 mg of risperidone, 10 mg of olanzapine, 4 mg of haloperidol, or 6 mg of thiothixene per day should be prescribed. When sleep disorder is present, the neuroleptic should be given all at night. Some physicians recommend spreading neuroleptic...

Wake Up Early in the Morning

Waking up at 4 or 5 a.m. and being unable to get back to sleep can be as troubling as having difficulty falling asleep at bedtime. As a result of the truncated sleep, the person does not feel rested and is tired during the day. Sleep maintenance insomnia (Chapter 8). This is the same problem described in the previous section, except that now there is only one early awakening, and the person never gets back to sleep. The awakening triggers the arousal alerting response, leaving the person unable to relax enough to return to sleep. Advanced sleep phase disorder (Chapter 15). In this circadian rhythm disorder, the sleep wake rhythm is shifted earlier, so that a person's natural sleep block may be from 8 p.m. until 4 a.m. The individual may find it disturbing to have to go to bed so early and then to be fully awake at an hour when nearly everyone else is still asleep. Again, this is only a problem if the person is unable or unwilling to follow this pattern. Advancing of the circadian...

Cant Sleep Because of My Partner

People with sleep problems often disrupt their partner's sleep. Snoring and bruxism are the most common complaints, but people may also report getting kicked or punched or being roused from sleep by shouts or screams. Less dramatically, a severe insomniac's constant tossing and turning and frequent bathroom trips can impair a spouse's sleep. By now you should have some leading suspects in your quest to learn which disorder lies at the root of your sleep difficulties. In the next chapter, we'll look at the most common sleep disorder of all insomnia and some possible treatments.

Federation for Children with Special Needs 107

Fatal familial insomnia An extremely rare, genetic progressive sleep disorder that has affected just nine families in the world. It manifests itself by many symptoms due to the degeneration of the thalamus in the brain (the area responsible for sleep) and the formation of amyloid plaques, a buildup of a waxy substance made of proteins. There are four stages of the disease, beginning with a progressive insomnia that develops over about four months and includes a collection of psychiatric problems such as panic attacks and bizarre phobias. The second stage includes hallucinations, panic, agitation, and sweating, and lasts about five months. The third stage lasts about three months and involves total insomnia with weight loss. Individuals at this point look much older than they are and may experience incontinence. The fourth stage lasts about six months and is recognized as dementia with total insomnia it ends with sudden death.

Conclusions And Future Directions

The orexins play multiple roles in the central control of pituitary hormone secretion. Orexin neurotransmission is also altered by changes in the organism's hormonal milieu. Some of the endocrine effects of the orexins are clearly related to their actions in sleep and appetite regulation. More studies are necessary to further define the physiological neuroendocrine roles of the orexins. A large number of gene-manipulated animal models are now available for study (2). Investigation of these models in combination with the use of specific receptor agonists and antagonists will clarify the neuroendocrine role of the orexins. Human studies will determine the contribution of orexin abnormalities to sleep disorders associated with endocrine dysfunction.

Obstructive Sleep Apnea OSA

OSA is another disorder that degrades sleep quality and leads to impairment in daytime cognitive function. Obstructive sleep apnea refers to frequent interruptions of breathing caused by blockage of the upper airway. Respiratory interruptions result in transient lowering of blood oxygen levels, causing reflexive partial awakening in order to reestablish respiration.

Orexina And B Stressresponse Mediators

Insulin-induced hypoglycemia (5) 2-DG-induced hypoglycaemia (10-12) Insulin-induced hypoglycaemia (6) 2-DG-induced hypoglycaemia (7,13,14) Food restriction (7) Noxious stimuli (16) Conditioned fear stimuli (16) Cold stress (8,9) Immobilization stress (8,9) Adrenectomy (17) Short-term sleep deprivation (18) Selective REM sleep deprivation (19) Sleep deprivation (20) Methamphetamine treatment (20) Modafinil treatment (21,22)

Arousal Circuits Activated By The Hypocretins

The densest projection of hypocretin fibers terminates in the locus coeruleus (LC) area, the main site of noradrenergic transmission. Thus, this system was one of the first targets of the hypocretinergic system to be analyzed (13,14). Noradrenergic neurons of the LC are active during wakefulness, display low activity during slow-wave sleep, are silent during REM sleep, and are thought to be critical for alternation of REM-NREM sleep (15). Most of the LC neurons express hypocretin-1 receptor but not hypocretin-2 receptor. Local administration of hypocretin-1 in the LC increases wakefulness and suppresses REM sleep in a dose-dependent manner, and this effect can be blocked by antisera that prevent binding of hypocretin to its receptors (13). Application of hypocretin to slices of the LC increased the firing rate of noradrenergic neurons, possibly by decreasing the after hyperpolarization current (16). Interestingly, recent data using retrograde tracing have shown that the...

Screening for Suicidal Thoughts

If a patient complains of or assents to feelings of sadness, loss, hopelessness, anger, or any other overwhelming, painful emotion, the physician should inquire about suicidal thoughts. If a patient complains of insomnia, loss of appetite or weight, lack of energy, or problems with memory and concentration, the primary care physician should ask about depressive moods, feelings of hopelessness, and suicidal thinking.

Circadianhomeostatic Regulation Of Sleep

It is often assumed that the pressure to sleep (sleep propensity) is lowest shortly after awakening, increases during the day, peaks at bedtime, and declines during sleep. However, if one stays awake all night, sleepiness, and therefore sleep propensity, increases until a specific cir-cadian time point, usually the individual's customary morning awakening time, at which time he she will feel less sleepy again for a while. This second signal, of circadian origin, interacts with the sleep debt to maintain alertness evenly across the day. Several models have tried to integrate these two factors. The most established model is Borbely's two-process model (24), whereby one process, process S, measures the homeostatic sleep pressure (Fig. 1). Process S is thought to be dependent on the amount of prior wakefulness and is reflected by the amount of electroencephalograph (EEG) slow-wave activity (0.5-4.5 Hz). Process S increases during extended wakefulness, thereby increasing sleepiness with...

General Concerns About Measuring Hypocretin Tonus In Relation To Vigilance Control

Double-labeled immunohistochemistry of Fos (Fos-IR) in the hypocretin neurons may be an alternative to monitoring the activity profile of hypocretin neurons (4,21), but this method does not have enough temporal resolution to study relatively brief phenomena such as non-REM and REM sleep changes in rodents. Furthermore, increased Fos-IR is not always caused by conditions that increase neuronal firing rates or neurotransmitter release, and thus caution needs to be used when interpreting the results (36).

My Perspective on Sleep Medication

While there's no doubt that insomnia is a significant problem, I'm concerned that the current onslaught of television and magazine ads telling people to ask their doctors for sleeping pills gives the What is the source of insomnia One of the first things I discuss with patients is what effort was made to determine the insomnia's source. If the insomnia is a result of another treatable illness or a side effect of a medication for such an illness that is, it's a case of secondary insomnia then we need to focus on addressing the primary source. In many cases, doing so will resolve the insomnia without the need for sleeping pills. What other treatments have been tried By the time people get to my office, they have usually been suffering from insomnia for a long time. As a result, most have experimented with many over-the-counter treatments, tried lots of home remedies, and received multiple courses of sleep medications from their primary care physicians. Often, they've been on sleep...

Dependence on Alcohol or Drugs

Although substance use disorders are mostly self-inflicted, they can be initiated or sustained through the well-intentioned treatment of a variety of common complaints (e.g., anxiety, headaches, insomnia, chronic pain). For most front-line practitioners, few days go by without repeated requests for more or stronger psychoactive medications. Once a substance use disorder has become established, it brings its own cargo of medical and psychiatric problems.

Physiological Hypocretin Release And Abnormal Sleep Characteristics In Hypocretinligand Deficit Rats

Previous human studies have suggested that problems with the maintenance of the vigilance stage (i.e., fragmented sleep wake pattern) together with cataplexy are the primary symptoms in narcolepsy. However, no apparent abnormalities have been found in sleep homeostasis and SCN function in human narcoleptics (i.e., they show compensatory responses to sleep loss and normal entrainment to light dark cycles) (61-64). Abnormal sleep patterns of prepro-orexin (preprohypocretin) gene knockout (KO) mice and hypocretin neuron-ablated (orexin ataxin-3 transgenic) mice were also characterized these mice exhibit highly fragmented vigilance states, occasional direct transition to REM sleep from wakefulness, and behavioral arrest similar to cataplexy (4,22). Thus, loss of hypocretin signaling is likely to contribute instability to vigilance states. The possible mechanism for this is well explained in a recent review by Saper et al. (65) and Chapter 15 of this volume. Despite the absence of...

Inhibition Of The Aminergic Nuclei By The Ventrolateral Preoptic Area

The HAergic neurons appear to gate the transition between waking and sleep they fire regularly during waking, slow their firing during light SWS, and are silent during deep SWS and REM sleep (18). Transitions between SWS and REM sleep are regulated by reciprocal monoaminergic (5-HT, NA) cholinergic interactions in the brainstem. The monoaminergic neurons of the brainstem are most active during waking, decrease their activity during NREM sleep, and go almost silent during REM sleep. In contrast, brainstem cholinergic activity is high during waking and REM sleep and promotes the active state during this sleep state (100). The core region of the VLPO sends an especially dense projection to the TMN and may selectively promote SWS by inhibiting the TMN neurons, whereas the more diffuse parts of the VLPO project to the raphe and LC and may turn these neurons off, to liberate the cholinergic neurons from the aminergic inhibition and thereby promote REM sleep (101). The VLPO is densely...

Noninvasive Treatments for OSA

Continuous positive airway pressure was once very cumbersome but has become more comfortable in recent years. Newer models are lighter and quieter, and many offer options such as warmed humidified air (which alleviates nasal congestion, skin dryness, and dry mouth) and a timer that slowly builds up pressure to give you time to adapt and fall asleep more easily. There are also a variety of mask styles, allowing users to find the one that best fits their face and is most comfortable. Continuous positive airway pressure generally leads to a great improvement in the amount of time spent in restorative deep sleep, which in turn leads to improved alertness the next day. In many cases, CPAP also reduces or eliminates hypertension. For some people, CPAP is a lifelong treatment.

Electroencephalogram EEG

An EEG measures brain waves, or electrical activity in the brain. Electrodes placed on your scalp and possibly your face pick up brain waves and convert them to a visual signal, which can be displayed on a machine called an electroencephalograph. Older elec-troencephalography machines traced these visual signals on continuously moving paper computers are now used to record, display, and assist in analyzing EEG data. An abnormal pattern of brain waves can help identify epilepsy, sleep disorders, neurotoxic states, and other brain disorders.

Hypothalamic Wakepromoting Systems

In the first half of the 20th century, clinical and experimental observations suggested that the hypothalamus plays a critical role in the regulation of arousal and sleep wake behavior (for historical review, see ref. 62). Following up on Von Economo's (116) reports of intense sleepiness in patients with encephalitis of the posterior hypothalamus, Nauta and others demonstrated that mechanical and electrolytic lesions of the posterior hypothalamus produced marked and persistent somnolence in rats (63,64). Additionally, Nauta observed that destruction of the anterior hypothalamus, in the region of the preoptic area, produced unrelenting insomnia. Based on these observations, Nauta agreed with Von Economo that the posterior hypothalamus probably contained a waking center and the anterior hypothalamus contained a sleep center. More recently, many studies have expanded on these early observations and verified that the hypothalamus contains specific wake- and sleep-regulating neurons. One...

Orexin And The Control Of Behavioral State

(LH) and adjacent hypothalamic regions and bind to the orexin-1 and orexin-2 receptors (84-88). Originally thought to promote feeding (84,89), extensive evidence now suggests that the orexin system modulates arousal and arousal-related processes. For example, orexin neurons heavily innervate the LC, DR, TMN, PPT, LDT, and ventral tegmental area (84,86,90,91). When injected into the ventricles, LC, or within select basal forebrain regions, orexins increase waking and suppress NREM and REM sleep (92-97). These wake-promoting actions are accompanied by marked increases in locomotor activity as well as other behaviors (96,98-100). The behavior of mice lacking orexin may be best described as behavioral state instability, with frequent transitions between sleep and wakefulness (108). These mice lack consolidated waking and NREM sleep and display episodes of cataplexy resembling REM sleep atonia during wakefulness (87). This poor consolidation of wakefulness is not caused by a circadian...

Clinical Neurophysiology

For the procedure-oriented clinician, this extremely popular subspecialty, involving both EEG and EMG, allows the neurologist to incorporate a greater number of procedures into his or her practice. By mastering how to perform and to interpret these tests, you will become a better diagnostician of epilepsy, sleep disorders, and neuromuscular disease. Clinical neurophysiologists often monitor EEG rhythms and interpret evoked potentials prior to and during surgical procedures. They also are sometimes trained in the evaluation of sleep studies. These neurologists become well-versed in the evaluation and treatment of patients with epilepsy, peripheral neuropathies, muscular dystrophy, myasthenia gravis, and amyotrophic lateral sclerosis. Clinical neurophysiology is a highly sought after fellowship, particularly by those interested in private practice.

Insertive anal intercourse See anal intercourse

Insomnia The inability to sleep, or to get enough sleep. The difficulty may be either in falling asleep or remaining asleep, or both. This sleep disorder may be primary or secondary to some other illness, condition, or circumstance. Primary insomnia exists when there are no signs or symptoms of a mental or physical condition that would account for the disorder. Secondary insomnia is usually readily explained by the existence of a condition that causes anxiety, stress, or pain or by the use of a drug that interferes with sleep. The causes of insomnia may be mental or physical. A great variety of drugs are available for primary insomnia, including over-the-counter medications. Their use on a short-term basis might be advisable, but all prescription drugs may have undesired side effects, such as overdose, habituation, tolerance, addiction, daytime drowsiness, lethargy, or amnesia. In secondary insomnia, treatment consists of determining the condition causing the insomnia and

The Quantum Unconscious

Sigmund Freud saw dreams as the royal road to the unconscious whose bizarre character was due to censorship and disguise of thwarted drives. Freud's ideas became downplayed, and dreams characterized as mental static (e. g. 102, 103 ). However, recent brain imaging shows dream-associated REM sleep activity in regions associated with emotion and gratification 215, 216 .

Excessive Daytime Sleepiness

This is usually the first symptom to appear, and everyone with narcolepsy has it. This isn't mild drowsiness that causes a yawn or two individuals with narcolepsy feel an overwhelming and recurring need to sleep at times when they want to be awake. Even if they struggle to fend it off, they often fall asleep, usually for five to ten minutes. Most sleep attacks are uneventful the person falls asleep and wakes up a few minutes later feeling temporarily rested. If REM sleep and dreaming occur immediately, the individual sometimes makes conversation in response to the dream instead of the actual situation.

Historical Perspective

Narcolepsy research began at least 125 yr ago and has since been steadily advancing (Table 1). In the late 1800s, physicians first began to notice an unusual constellation of symptoms. In 1877, Westphal (1) was the first to describe an association between hypersomnia and episodic muscle weakness that was felt to be more than simply an epileptoid phenomenon. This is usually considered to be the initial documentation of narcolepsy, although a few years before, in 1862, Caffe (2) documented a severely sleepy patient with hallucinations. Fischer (3) described a similar case in 1878. In 1880, Gelineau (4) used the term narcolepsy, derived from the Greek narke (numbness, stupor) and lepsis (an attack, seizure), to describe patients with primary hypersomnia. Loewenfeld (5) emphasized the significance of cataplexy, and during the epidemic of encephalitis lethargica from 1917 to 1927, Von Economo (6) discussed the posterior hypothalamus as an important region for the promotion of wakefulness....

Prevalence And Genetics

The prevalence of narcolepsy appears to vary across ethnic groups. In the general population, prevalence ranges from approximately 0.02 to 0.06 (25-29). In Japan, however, two studies have estimated prevalences as high as 0.16 and 0.59 (30,31). In Israel the prevalence may be as low as 0.002 (32). A recent study of 18,980 randomly selected subjects in five European countries, using the diagnostic criteria from the International Classification of Sleep Disorders (ICSD), found a prevalence of 0.047 (33). Note, that the above statistics pertain to narcolepsy with cataplexy. The prevalence of narcolepsy without cataplexy is much less clear. A recent study of all patients with narcolepsy in the medical records of the Rochester Epidemiology Project found a prevalence of 0.021 for patients with narcolepsy without cataplexy (34).

Hypocretin Deficiency And Narcoleptic Phenotype And Hypocretin Replacement Therapy

Sleepiness in narcolepsy is most likely owing to difficulty in maintaining wakefulness as normal subjects do. The sleep pattern of narcoleptic subjects is also fragmented, with bouts of insomnia (frequent wakening) at night. This fragmentation occurs across 24 h, and thus, the loss of hypocretin signaling should play a role of this vigilance stage stability, although other mechanisms may also be involved in EDS in narcoleptic subjects (86).

Attitudes Toward Psychotropic Medications

G's psychiatric complaints included a long history of emotional lability, impulsivity, multiple suicidal gestures by wrist slashing, and chronic depression. Recently, she had begun to experience severe insomnia, anger outbursts with her husband, and both auditory and visual (shadows) hallucinations. The auditory hallucinations were loud and condemning.

Disturbances of Sleep Timing DSP and ASP

As you know, the circadian rhythm of sleep and wakefulness strongly influences when you're sleepiest and most alert. Ideally, your sleep wake rhythm is synchronized with your lifestyle. In other words, if you naturally start to feel sleepy around 10 30 p.m., then you're in a good position to fall asleep at 11 00 and get up at about 7 30 a.m., which works out well for people who keep traditional daytime hours.

Animal Studies A Link Between Hypocretins And Animal Models Of Narcolepsy

The discovery of a possible link between narcolepsy and hypocretin orexin was made in 1999 by two different groups, only one year after hypocretins were first discovered (23,24). Lin and colleagues (25) reported that the sleep disorder canine narcolepsy is caused by mutation in the hypocretin receptor 2 gene with a loss of ligand binding and subsequent intracellular transduction signal (25). Chemelli et al. (26) reported that according to behavioral and electroencephalographic criteria, hypocretin knockout mice exhibit a phenotype strikingly similar to that of human narcolepsy. Subsequent studies have led to the establishment of multiple rodent models with hypocretin ligand or receptor abnormalities (27-29). Of special interest is the mouse and rat ataxin-3 transgenic model, which causes loss of hypocretin cells (30,31).

Issues of Clinical Relevance

J, a Nicaraguan man in his 40s, developed severe insomnia, flashbacks, and extreme apprehension several months after he arrived in the United States. His history revealed that while in Nicaragua, he had been imprisoned and subjected to subhuman, crowded conditions while incarcerated. He also developed intrusive, obsessional thinking and symptomatology of depression. He was given a diagnosis of PTSD. After brief psychotherapeutic intervention and temporary treatment with a sedative-hypnotic, Mr. J's symptoms remitted, and he was able to resume his normal life as a bank clerk.

Cosleeping Should We or Shouldnt We

The practice of having a newborn share your bed at night is called cosleeping and has been the source of emotional debate for years. Advocates of cosleeping think it provides the newborn with a supportive emotional environment and promotes parent-child bonding, while others feel that sleeping in separate beds is safer, allows the baby to develop better and more independent sleep habits, and improves parent's sleep as well. The choice of whether or not to cosleep has been largely cultural, with cosleeping much less common in Western societies and more common in African communities.

Pharyngeal gonorrhea gonorrhea in the throat

Phenindamine An antihistamine used to temporarily relieve runny nose, sneezing, itching of the nose or throat, and itchy, watery eyes due to hay fever or other upper respiratory allergies. In people with HIV, the drug is also used to reduce certain drug-induced allergic side effects, including skin rashes, swelling, hives, and breathing difficulties. Drowsiness is the most common side effect less often, dry mouth, nervousness, insomnia, and increased irritability or excitement may occur. Available over the counter in tablets. (Trade name is Nolahist.)

Age Three Months to One Year

As the child becomes more aware of her surroundings, you can put more effort into making bedtime a special time. Go through a certain routine, such as having a light snack, bathing, cuddling, saying good night, and reading a story or singing a lullaby. At the end of the routine, the lights go off and it's time to fall asleep. Keep it short and simple if you make too big a production of it, your baby may try to extend the routine. Baths can be playtime for young children and are often stimulating, not soothing. If this happens with your child, move the bath to the morning or more than two hours from the baby's desired bedtime. Also, make sure the routine can be used anywhere, so you can help her get to sleep when you visit friends and relatives.

Relevant Findings Of Preclinical And Clinical Studies

Depressive symptoms may be related to hypocretin effects on several fronts. Sleep disturbances, both hypersomnias and insomnias, are prominent in depression. Hypocretin promotes wakefulness and increases grooming and face washing in rodents, whereas it suppresses REM sleep. A deficit of hypocretin could contribute to fatigue and hypersomnia, and to the shortened delay in REM sleep onset in depression, but is not as readily reconciled with the frequent insomnia. An excess of hypocretin might explain REM disturbances, but the hypersomnia would seem improbable. Appetite in depression can go either way and frequently fluctuates within depressed individuals over time. Increased food intake is observed with icv injections of Hcrt (16,17) and may be related to increased wake time, but this has been argued to be a relatively weak effect, dependent on the circadian time of administration (2). Hypocretin knockout mice have normal weight (18), but ataxin-3 mutants lacking hypocretin cells have...

Aim for a Good Nights Sleep

Insomnia (chronic sleeplessness) is the most common sleep disorder, and it becomes more common with age. Approximately one in three people will experience at least one phase of insomnia at some point in their lives. But certain sleep habits can help. I recommend the following Establish and maintain a consistent sleep schedule and routine. When possible, go to bed at about the same time each night and wake up at about the same time each morning. This kind of regularity helps many people fall asleep and wake up more easily. Avoid coffee and other sources of caffeine (including many types of tea and soft drinks, some brands of aspirin, and chocolate) after midmorning. The stimulating effect of caffeine can last for many hours and interfere with your ability to fall asleep at night. Caffeine is also a diuretic, which will increase urinary frequency. Avoid or limit naps. Napping can disrupt your natural sleep cycle and prevent you from feeling tired enough to fall asleep when you really...

Biological Based Therapies

Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.

Nightmares and Sleep Terrors

Almost all kids have nightmares. They usually occur later in the night, during REM sleep, and they can be remembered at the time and in the morning. To prevent nightmares, discuss comforting things before bedtime and don't let your child watch violent or scary shows on television, especially right before sleeping. It's easy to tell the difference between nightmares and sleep terrors Nightmares don't prompt screams, they usually wake the child up, and they usually occur during the last few hours of sleep. Sleep terrors do trigger screams, don't wake up the child, and usually occur during the first few hours of sleep (often at the same time each night) during non-REM sleep.

Tourettes syndrome 311

Toxic mood disorders Personality and mood changes caused by exposure to neurotoxins that damage the brain. There are a wide variety of substances that may cause mood or personality changes, but the most common sources are lead and mercury, some solvents and gases, and pesticides. The solvent carbon disulfide, used primarily in industrial uses, can cause a severe manic depression. While regulations today require ventilation in the rayon and cellophane industries, which use this product, even regulated levels may cause toxic mood disorders and symptoms of depression, irritability, and insomnia. The symptoms of a toxic mood disorder may be subtle or wrongly associated with depression other symptoms may be obvious or subtle. They may include personality changes such as irritability, social withdrawal, and the inability to cope with even minor problems. Mental changes may include short-term memory loss, concentration problems, mental slowness, and difficulty in following instructions....

Restless Legs Syndrome

Teens tend to be fiercely independent, but you can still play a role in encouraging healthy sleep habits. For starters, you can be a role model by making sleep a high priority for yourself. Next, now that your child is old enough to understand the scientific basis of sleep's role in health, you might try discussing the basics of sleep physiology, emphasizing that getting enough sleep will help socially and academically. Make sure your teen is aware of the risk of falling asleep at the wheel. Next, keep an eye out for signs of insufficient sleep. They include difficulty waking up in the morning, irritability late in the day, falling asleep during quiet times of the day, and sleeping for extra-long periods on the weekends. If your teenager isn't getting enough sleep, have a talk about better ways to balance school, work, and social demands. Often these are tough choices, so it's important to really listen and make well-considered recommendations.

Delayed Sleep Phase Disorder

Many adolescents like to stay up late and sleep in late. While this results partly from a desire to engage in late-night social activities, the natural delay in the circadian sleep wake rhythm at this age is often a factor as well. In some cases, teens who are unable to get to sleep at a reasonable time or who constantly have trouble getting up for school have full-fledged delayed sleep phase disorder.

Diagnosis What to Expect from a Sleep Doctor or Sleep Center

By now, you've learned a lot about sleep disorders and their symptoms. You may suspect that you have a particular disorder or just know that something is wrong that isn't helped by ordinary measures such as improving sleep hygiene. Either way, you may benefit from seeing a sleep doctor, who can determine whether you have a sleep disorder and ensure that you get proper treatment if you do. In this chapter, we'll look at how physicians diagnose sleep disorders and what it's like to stay overnight at a sleep center. Falling asleep at inappropriate times during the day despite getting seven and a half to eight hours of sleep a night (This is particularly true for anyone who gets sleepy while driving.) Before you see a sleep doctor, you'll probably see or at least talk with your regular doctor first. Primary care physicians (PCPs) can help with certain sleep problems. For example, when someone is sleeping badly following a death in the family or some other stressful event, a PCP can...

Health Conditions and Medications That Disrupt Sleep

To this point, we've focused mostly on problems with sleep and wakefulness that result from primary sleep disorders such as insomnia, sleep apnea, and narcolepsy. However, many sleep-related problems result from nonsleep illnesses such as heart failure, diabetes, and Alzheimer's disease or from medications used to treat these illnesses. In most cases, treating the underlying disorder is the key to improving sleep. In this chapter, we'll review the common health conditions and medications that can make it hard to sleep at night or stay awake during the day.

Congestive Heart Failure

Heart failure patients also can be awakened just as they are falling asleep by a characteristic breathing pattern called Cheyne-Stokes respiration, a form of central sleep apnea in which a series of increasingly deep breaths is followed by a brief cessation of breathing. Treating the heart failure and improving the effectiveness of the heart is the best treatment. Some people may need to use supplementary oxygen, a positive airway pressure device, or a diuretic medicine called acetazolamide to help them breathe and sleep more normally. In mild cases, benzodiazepine sleep medications can help some people sleep through these episodes.

Alzheimers Disease Dementia

Alzheimer's disease and other forms of dementia may disrupt sleep regulation and other brain functions. Sleep is usually fragmented, with more awakenings and more time spent awake as the night progresses. Deep sleep is reduced, and REM sleep is less well organized. Wandering, disorientation, and agitation during the evening and night, a phenomenon known as sundowning, can require constant supervision and place great stress on caregivers. In such cases, benzodiazepine drugs or small doses of antipsychotic medications such as haloperidol (Haldol) and thioridazine (Mel-laril) are often helpful. However, these drugs should be used carefully since they can also increase disorientation and falls.

Current Treatment In Human Narcolepsy

For management of narcolepsy symptoms in humans, pharmacological treatment is usually employed (11,27,28). For EDS, amphetamine-like central nervous system (CNS) stimulants or modafinil (a nonamphetamine stimulant with undetermined mechanisms of action) are most often used (Table 2). These compounds possess wake-promoting effects in narcoleptic subjects as well as in control populations, but very high doses are required to normalize the abnormal sleep tendency during the daytime (29). For consolidating nighttime sleep, benzodiazepine hypnotics or y-hydroxybutyrate (GHB) are occasionally used (11,27,28). Since amphetamine-like stimulants and modafinil have little effect on cataplexy, tricyclic antidepressants, such as imipramine or clomipramine are used in addition to control cataplexy (11,27,28) (Table 2). However, these compounds can cause a number of side effects, such as dry mouth, constipation, or impotence. GHB is also used for the treatment of cataplexy its mechanism of action...

Chronic Obstructive Pulmonary Disease

People who have emphysema or chronic bronchitis may find it difficult to fall and stay asleep because of excess sputum production, shortness of breath, and coughing. These symptoms can Those with severe disease are prone to drops in blood oxygen (hypoxemia) when the respiratory rate and breath size drop during sleep, especially during REM sleep. The low oxygen levels can cause sleep fragmentation and promote heart disease. Hypoxemia is treated with supplemental oxygen therapy.

Prion Protein The Friendly

Like other chronic neurodegenerative disorders, prion disorders affect older individuals, and are invariably fatal. The affected individuals present with clinicopathological syndromes rather than symptoms reflective of individual disorders. Common symptoms include rapidly progressive multifocal dementia with myoclonus, pyramidal and extrapyramidal signs, cerebellar ataxia, cortical blindness, thalamic degeneration, sleep disorders, and a variety of other symptoms that vary with the etiology of the disorder. Sections of prion brains typically show a spongiform change, and hence the name Transmissible Spongiform Encephalopathies. Some cases present with additional pathological manifestations in the brain parenchyma such as amyloid plaques, astrocytic gliosis, and neurofibrillary tangles, whereas others show a more variable picture (8). Figure 1 exemplifies the spogiosis and neuronal loss associated with PrPSc deposits from a case of sporadic CJD. Prion disorders affect both humans and...

Seasonal Affective Disorder SAD

SAD is a phenomenon in which the reduced amount of sunlight in the wintertime leads to depression. Researchers speculate that people with SAD produce too much melatonin (or are extrasensitive to normal amounts of this drowsiness-inducing hormone) and don't make enough serotonin.

St Louis encephalitis

The most common side effects include weight loss and appetite loss, together with problems in falling asleep, although these problems may fade away as a student becomes used to the drug. Some studies have found that a child's growth begins to lag, although this usually rebounds after the first year in those who are on low or moderate doses. Children taking Dexedrine or high doses of Ritalin may experience prolonged growth lag as long as they remain on the medication, but once the drug is stopped growth begins again. For this reason, some experts recommend drug holidays during vacation to allow a child's growth to catch up.

Association for Retarded Citizens ARC A

Association of Sleep Disorders Centers A professional organization of specialists in sleep disorders that encourages high standards and training and ethics the center also serves as the accrediting agency for sleep disorder clinics and publishes various materials, including a quarterly newsletter and the journal SLEEP.

Hypertrophic pulmonary osteoarthropathy HPOA

Hypnosis During hypnosis the subject passes into a trance. This is an altered state of consciousness in which the subject's attention is intensely focused while attention to other stimuli is reduced. It is not a deep sleep or unconsciousness. The subject is awake and can respond to the therapist. Perception, memory, behavior, and suggestibility are altered. In therapy the increased suggestibility can be used to influence behavior and feelings. Hypnotherapists claim benefit in chronic pain and

Medulla oblongata Full name of the medulla

Melatonin A hormone released by the pineal gland that induces sleep and influences circadian rhythms experts now believe an abnormal level of melatonin may also suppress mood and mental quickness. The human body is regulated by a biological clock that sets the pace for everyday rhythms of sleep, activity, temperature, and cortisol and melatonin release. Most people maintain a certain flexibility in their biological clock, allowing them to synchronize their system to environmental changes. But experts suspect that some people do not synchronize their clocks so easily. It could be that some people are out of step with the world's 24-hour rhythm, so that melatonin is released too early (causing early-evening sleepiness and early-morning awakening) or too late (causing insomnia and trouble waking up). Normally, melatonin is produced in the dark during sleep, and its production peaks during the winter months. During the day, melatonin levels are low at sunset, the cessation of light...

Glucose6phosphate dehydrogenase G6PD deficiency 201

It has been suggested that Panax ginseng may increase natural killer cell activity. Panax and Eleutherococcus can produce insomnia, diarrhea, nervousness, depression, and skin rash. Ginseng can amplify the effect of certain antidepressant medications and, due to the small amount of estrogens in the plant, can affect menstruation in women.

The madness of Isaac Newton

The published correspondence of Newton contains a noticeable gap from 30 May to 13 September 1693, when he wrote a letter to Samuel Pepys in which he said that he had been suffering from poor digestion and insomnia for the past year and admitted that he had not been 'of my former consistency of mind'. In the same letter he displayed evidence of this by rebuking Pepys for suggesting that he had ever asked favours from him or from King James, and ended the letter by saying that he never wanted to see Pepys or any of his friends again. He later wrote to the philosopher John Locke, among others, to apologize for the things that he said to them earlier. He asked Locke to forgive him for saying that Locke had been trying to 'embroil me with women'. In another letter, written to a friend of Pepys, he asked him to explain to Pepys his odd behaviour and said that he had suffered 'a distemper that seized his head, and that kept him awake for about five nights together'. From these and other...

The Thyroid Hormone Axis

Since the orexins have been shown to have profound effects on sleep, wakefulness, and locomotor activity, changes in orexin levels may parallel or oppose the effects of low thyroid hormone status on these parameters. A reduction in spontaneous motor activity has been observed in hypothyroid rats, which agrees with low orexin action (32). In humans, however, sleep stages 3 and 4 and REM sleep may be markedly shortened or absent in hypothyroidism, which agrees with increased orexin action (33). The sleep effects of hypothyroidism in humans have not been observed in the rat however, there were more frequent awakenings in slow-wave sleep in hypothyroid rats (34). Interestingly, one severely hypothyroid patient whose CSF orexin-A levels were measured by Mignot et al. (35) had low levels. A larger human CSF study is necessary to substantiate this observation. There is no known association between narcolepsy and thyroid function, but subtle abnormalities cannot be excluded. The interaction...

Hypocretin Status In Hypersomnia In Various Neurological Conditions

Although treatment with continuous positive airway pressure resulted in complete resolution of their sleep-disordered breathing in these two cases, no changes in daytime somnolence occurred. Krahn et al. (56) reported on a patient who developed a narcoleptic-like sleep disorder after receiving treatment for a choroid plexus carcinoma of the pineal gland. She underwent a pinealectomy, chemotherapy, and radiation treatment. Immediately after surgery, the patient developed EDS that she attributed to severe insomnia and an irregular sleep wake rhythm. She had a few episodes of SP and HH but no cataplexy. An increased percentage of REM sleep was seen in nocturnal polysomnography, and three or four SOREMPs were seen during the MSLT. She was negative for HLA DQB1*0602 and had a normal CSF hypocretin level (518 pg mL). The author proposed that her symptoms were caused by an unknown mechanism unrelated to hypocretin depletion. (from ref. 114 with permission). The lesions from the infarctions...

The poisoning of George III

The King's illness of 1788 is worth a closer look because it has been clearly documented. Its chief features were severe constipation, colic, weakness in the limbs, difficulty in swallowing, sleeplessness, with progressive mental disturbances that started with talkativeness and advanced irritability to delirium and coma. These read like a textbook case of acute lead poisoning. It all began on 11 June 1788 when the King returned to Kew Palace after reviewing the Duke of York's Regiment on Wimbledon Common. Sir George Baker, who by now had been knighted and made the King's Physician, was called in the following day. His Majesty was suffering from colic. For two weeks the King was ill but then he left to take the waters at Cheltenham Spa from 9 July to 11 August. There he regained his health, but the recovery was only temporary. A second attack of colic started on Friday, 17 October, and again Baker was called to attend the King at Windsor Castle. He arrived to find him in great distress...

Lead and the decline of empires

Sapa was used to preserve wine, and especially Greek wines. These were popular in Rome but had a reputation for causing sterility, miscarriages, constipation, headaches, and insomnia - all of which would be true if they had been doctored with sapa. Roman prostitutes were reputed to eat sapa by the spoonful because it acted as a contraceptive, gave them attractive pale complexions (due to anaemia), and would cause abortions.

Csf Hypocretin1 Levels From Typical Narcolepsy To The Narcolepsy Borderland

Hypocretin Narcolepsy Brain

Idiopathic hypersomnia is characterized by excessive daytime somnolence and no REM sleep abnormalities. In the classic form, excessive amounts of nocturnal and diurnal sleep are reported. All patients with monosymptomatic or polysymptomatic idiopathic hypersomnia tested to date had normal CSF hypocretin-1 levels (42,43,47,48), demonstrating that hypocretin-1 dysfunction does not appear to be the final, common pathway of the pathophysiology of most hypersomnias. Fig. 2. Lumbar cerebrospinal fluid (CSF) hypocretin-1 concentrations in controls, narcoleptics, and other pathologies. Each point is the concentration of hypocretin-1 in the crude (unfiltered) lumbar CSF of a single individual. Represented are controls (samples taken during night and day) and narcoleptics, including those with typical cataplexy, with atypical cataplexy, with cataplexy but who are HLA negative, and without cataplexy, as well as narcolepsy family probands. Individuals with hypersomnia owing to idiopathic...

Psychological Consequences of War Trauma

Individuals who themselves were victims or whose family members were victims of the political violence in El Salvador frequently manifest various forms of psychological problems after arrival and settlement in the United States. Victims of torture often have the symptoms of posttraumatic stress disorder (PTSD). They include severe depression, guilt, nightmares, flashbacks, hy-peralertness, insomnia, suicidal tendencies, and withdrawal. The psychiatric evaluation of Central Americans conducted at refugee centers throughout the San Francisco Bay area concluded that a large number of people there suffered from PTSD (Cordova 1987). Ms. F, a 28-year-old woman, sought psychiatric treatment after she began to experience insomnia, recurring dreams of past traumatic events, and the inability to concentrate. She had been living in the San Francisco Bay area for a brief period and was a domestic worker. Her children were scheduled to arrive from El Salvador soon, and she feared that her...

The strange death of King Charles II

Breathing mercury vapour causes no respiratory symptoms, unless the dose is very high. The metal is absorbed by the lungs and passes into the blood stream and thence to all parts of the body but the nervous system is particularly affected. The brain is most vulnerable because mercury can move across the blood-brain barrier which is there specifically to protect this vital organ against toxins, and once inside the brain it causes all kinds of symptoms such as lack of energy, unsteady gait, insomnia, etc. In his last year of life, Charles showed some of the signs of mild mercury poisoning, and he became less physically active. We know he was exposed to mercury because the analysis of a strand of his hair showed ten times the expected level. John Lenihan and Hamilton Smith, of the University of Glasgow, used nuclear activation analysis techniques to measure this in 1967. The sample of hair had been obtained through a radio broadcast the previous year, which had prompted a listener in...

The Hypocretinorexin System And Narcolepsy

Narcoleptic Mice

Human narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness (EDS), cataplexy, and other abnormal manifestations of REM sleep, such as hypnagogic hallucinations and sleep paralysis (11). Narcolepsy is not a rare disease, affecting approximately 1 in 2000 in the general population, which is equivalent to Parkinson's disease (12) or multiple sclerosis (13). EDS in narcolepsy is overwhelming and is characterized by recurring episodes of sleep during the daytime (11). Patients also experience disturbed nocturnal sleep, although less frequently emphasized (11). The total amount of sleep that narcoleptic subjects have over 24 h does not exceed that of normal subjects (14). Therefore, narcolepsy is not an intrinsic hypersomnia but rather a pathological condition involving instability of the vigilance state (sleep wake fragmentation or problems maintaining wake sleep for longer period). Cataplexy, another disabling symptom, is the sudden onset of muscle atonia...

Pineal gland tumors 251

Pineal gland A tiny structure within the brain responsible for secreting the hormone melatonin, which induces sleep and regulates circadian rhythm, affecting mood and mental quickness. The amount of this hormone varies over a 24-hour period and is greatest at night. It is believed that the secretion of this hormone is controlled by nerve pathways from the retina light affects the secretion.

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