Insomnia Cure Diet

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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Author: Christian Goodman
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My Natural Insomnia Program Review

Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the writer was capable of presenting advanced techniques in an extremely easy to understand language.

My opinion on this e-book is, if you do not have this e-book in your collection, your collection is incomplete. I have no regrets for purchasing this.

For Behavioral Insomnia Therapies

As might be surmised by the above discussion, sleeping pills remain the most popular treatment for those chronic insomnia suffers who report sleep complaints to their physicians. Indeed, as many as 50 of those patients who complain of insomnia to their physicians are treated with sedative hypnotics or sedating antidepressant medications to address such complaints. Although these agents may be useful in the management of transient insomnia, they generally fail to provide long-term relief for those with more chronic sleep disturbances. Patients who use hypnotics on a long-term basis often suffer such unwanted effects as drug tolerance, dependence, hangover, short-term memory loss, and a gradual return of their sleep problems. Side effects may be particularly problematic among elderly hypnotic users who are at increased risk for toxic drug interactions and serious falls resulting from oversedation. Although some recently developed sleeping pills hold the promise of reduced side effects,...

Primary Sleep Disorders In Patients With Epilepsy

The incidence of primary sleep disorders in the epileptic population is unknown. The literature contains mostly retrospective studies in which patients with epilepsy and suspected sleep disorders are included. Consequently, the reported incidence of sleep disorders is likely to be overestimated. Prospective studies are required to determine how these figures compare with those of the general population. In the largest retrospective study, 63 adults with epilepsy were referred for PSG for EDS and suspected OSAS (27), suspected OSAS without EDS (22), spells and EDS or suspected OSAS (10), nocturnal spells (2), or EDS alone (2) (Malow et al., 1997). Multiple sleep latency tests (MSLTs) were performed in 33 cases. Sleep disorders were suspected in 79 of patients. Obstructive sleep apnea syndrome was diagnosed in 71 . The disorder was considered mild in 14, moderate in 21, and severe in 10 patients, including 7 females. Other diagnoses included nocturnal seizures (4), mild OSAS and...

Twentyfourhour Rhythms In Plant Melatonin

As already noted, a marked nocturnal rise in melatonin has been reported in the unicell, Gonyaulax polyedra (4). The rise in melatonin in this organism begins with the onset of darkness, peaks near the middle of the dark phase of the light dark cycle and then diminishes as morning approaches this is highly reminiscent of the melatonin synthesis cycle in the pineal gland of mammals, including humans (15). A melatonin rhythm similar of that described in G. polyedra has also been measured in Chenopoduim rubrum (8). In this case, 15-day-old plants were maintained under a light dark cycle of 12 12 (in hours). Melatonin concentrations were measured in the above-ground parts of the plant sampled at 2-hr intervals over a 24-hr period during the dark period, the samples were collected with the aid of a dim green light. During the day, melatonin levels were uniformly low and in some cases undetectable. In contrast, during darkness, indoleamine concentrations began to increase to reach a peak at...

Function Of Melatonin In Plants

The functions of melatonin in animals are highly diverse and involve receptor and nonreceptor-related actions of Figure 2. Nocturnal increase in the melatonin concentration in the above-ground parts of Chenopodium rubrum plants maintained under a light dark cycle of 12 12. The dark bar at the bottom indicates the period of darkness. Source Reprinted with permission from Ref. 10. Figure 2. Nocturnal increase in the melatonin concentration in the above-ground parts of Chenopodium rubrum plants maintained under a light dark cycle of 12 12. The dark bar at the bottom indicates the period of darkness. Source Reprinted with permission from Ref. 10. this chemical mediator (1,15,16). It seems possible that melatonin in plants has some of these same functions. Melatonin's action at the level of the biological clock of mammals is well documented (17). Based on the observations of the pronounced melatonin rhythm in C. rubrum, it was assumed that this cycle may relate to other 24-hr metabolic and...

Description Of Behavioral Insomnia Therapies

Formal applications of behavioral interventions to insomnia were first reported in the 1950s but such treatments did not gain much popularity until the 1970s. Over the past 30 years, various behavioral insomnia therapies have been developed, tested, and, at times, modified. The nature and specific focus of these treatments has varied significantly in that some are composed of fairly formalized exercises designed primarily to address sleep-related performance anxiety and excessive bedtime arousal, whereas others include fairly regimented behavioral prescriptions designed to eliminate sleep-disruptive habits. The following discussion provides brief descriptions of the most commonly employed behavioral insomnia therapies.

Nature And Significance Of Insomnia

Insomnia, characterized by difficulty initiating, maintaining, or obtaining qualitatively satisfying sleep is a widespread health complaint. Like the common cold, most individuals have experienced at least transient bouts of nocturnal sleep difficulty due either to an impending stressful (e.g., final exam) or exciting (e.g., a long-awaited vacation trip) event or due to acute medical or environmental factors. However, slightly over one-third of the adult population complains of recurring, intermittent sleep difficulties whereas 9 to 10 endure chronic, unrelenting insomnia problems. Although many health care professionals as well as the lay public may minimize its significance, insomnia may have notable short- and long-term consequences. At a minimum, insomnia results in daytime fatigue, decreased mood, and general malaise. In more protracted cases it may cause impaired occupational and social functioning. In addition, there is substantial evidence that insomnia dramatically increases...

Identification Of Melatonin In Plants

Melatonin was first detected and quantified in the dino-flagellate, Gonyaulax polyedra (4,5). In this species, melatonin was found to be at concentrations similar to those measured in the pineal gland of vertebrates. In addition to its obvious presence in this autotrophic organism, melatonin also exhibited a rhythm in these unicells like that observed in the pineal gland. Thus, melatonin levels measured either by high performance liquid chromatography or gas chromatography-mass spectrometry were higher at night than during the day. This finding stimulated research directed at identifying melatonin in higher plants, and in recent years, this indoleamine has been found in a remarkably large number of taxa (Table 1). Among angio-sperms, melatonin has been identified in more than 30 species belonging to 19 different families, in both mono- and dicotyledons. Although melatonin has been reported in a rather small number of species, their diversity and the fact that almost all plants...

Developmental Aspects Of Dreaming A Rem Sleep at the Beginning of Life

The discovery of a sleep stage accompanied by dreaming and characterized by distinct physiological correlates had scientific implications of undoubted significance. It inaugurated investigation of the neu-rophysiological substratum and functional significance of REM sleep as well its ontogenetic and phylogenetic features. The developmental aspects of sleep could certainly not be ignored and very soon the sleep and dreaming laboratories started to study newborns and even premature infants. Sleep in these subjects was monitored using the classical polygraphic recording techniques. With some surprise, it was found that the REM phenomenon is clearly present from the beginning of life. However, at variance with what is observed in older children and in adults, REM sleep in the neonate is characterized by the presence of a variety of body movements. In particular, a surprising range of facial expressions can be observed that are not present in the other sleep and wake states. In fact, in...

Sleep Complaints And Sleep Hygiene

Patients with epilepsy commonly report sleep disturbances. Using a six item questionnaire, the frequency of sleep disorder symptoms was compared with 30 treated patients having epilepsy and 23 normal adults (Hoeppner et al., 1984). Patients with simple and complex partial seizures had a higher incidence of sleep symptoms than patients with generalized seizures and normal subjects. The most common complaint was frequent nocturnal awakenings. Patients with seizures at least every month had more sleep-related symptoms and nocturnal awakenings than those with yearly seizures or less. As in the general population, poor sleep hygiene is a common cause of daytime sleepiness and insomnia. In a survey of 100 patients with epilepsy, 37 reported poor sleep (Lannon and Vaughn, 1997). These patients had less exercise and more irregular sleep patterns, took more naps, and consumed more caffeine, alcohol, and tobacco within 6 h of bedtime than those without sleep complaints. Environmental barriers...


Melatonin, the ''hormone of the night,'' has received much attention over the past few decades. Circulating melatonin levels at night are elevated by about 10-fold relative to during the day. Physiologically, melatonin acts as a humoral signal to provide a highly accurate indicator of night length. In effect, melatonin acts as an endocrine code for photoperiod information. Melato-nin can also modulate the endogenous clock and influence a number of physiological functions. It is also thought to be hypnogenic. In certain vertebrates, lengthening or shortening of the nocturnal melatonin signal can alter reproduction, body weight, pelage, and seasonal behavior. Melatonin is produced from serotonin in two enzymatic steps. Serotonin is first converted to N-acetylserotonin by arylalkamine N-acetyltransferase (AANAT), which, in turn, is converted to melatonin by hydroxyindole-O-methyltransferase (HIOMT). This conversion takes place in the pineal gland and is regulated by b-adrenergic...

Sleep Deprivation

Rapid eye movement (REM) sleep is characterized by rapid conjugate eye movements, a change in electroencephalogram to a pattern similar to wakefulness, the occurrence of dreams, increase in oxygen consumption, and increased cerebral blood flow. Those with shorter sleep periods will likely have REM deprivation, which is difficult to make up. REM sleep is thought to be vital for psychological well-being. Those deprived of it complain of irritability and moodiness. They also score higher on testing of aggressive behavior. REM sleep may also be important in the consolidation of complex learning. Experimental subjects deprived only of REM sleep but allowed the other phases begin displaying a thought disorder reminiscent of psychosis within 3 to 4 days. Humans have a 25 h circadian clock. Many physiologic functions follow circadian patterns and can be transposed by keeping experimental subjects awake at night and sleeping during the day. This process is known as entrainment of the circadian...

Juvenile Myoclonic Epilepsy

In this syndrome, myoclonic and generalized tonic-clonic seizures occur characteristically in the morning in the first one to two hours after awakening. Seizures may also occur on awakening from a nap but are rare at other times during the day (Dinner, 1987). Sleep deprivation and alcohol appear to be an extremely important precipitant for seizures in this syndrome. The characteristic EEG abnormality in juvenile myoclonic epilepsy consists of spike-wave complexes at 4-6 Hz in a generalized distribution, as well as polyspikes. The discharges increase markedly at sleep onset and on awakening but are virtually absent in NREM and REM sleep and while the patient is awake.

Electrical Status Epilepticus Of Sleep

Electrical status epilepticus of sleep (ESES) refers to the occurrence of continuous epileptiform activity for at least 85 of slow-wave sleep. This syndrome is also known as epilepsy with continuous spike waves during slow-wave sleep. The syndrome was first described by Patry (1971). The EEG is characterized by generalized spike-wave complexes at 2-2.5 Hz. There is a marked attenuation of the pattern during REM sleep and in the wake EEG. The condition almost always occurs in patients with a prior history of epilepsy. With the onset of ESES, there is an associated decline in cognitive function with improvement once the ESES has resolved (Jayakar and Seshia, 1991). Seizures may manifest as nocturnal focal motor or generalized tonic-clonic seizures, or as atypical absence or myoclonic seizures.

Effect of epilepsy on sleep

Sleep disturbances are well recognized in patients with epilepsy. The changes reported in the literature with regard to the effect of epilepsy on sleep architecture include an increase of sleep onset latency, an increase in the wake time after sleep onset (WASO), increased instability of sleep stages, increased stage 1 and 2 NREM sleep (light sleep), a decrease in sleep spindle density, and a decrease in REM sleep. With regard to the pathophysiology of the sleep disturbances in these patients, one needs to consider the following mechanisms (1) the epilepsy itself may be associated with a sleep disturbance due to a mechanism intrinsic to the disease itself without the effect of the associated seizures, (2) the effect of seizures on sleep, and (3) the effect of antiepileptic drugs (AEDs) on the sleep architecture.

Brainlocalization Theory

The goal of the so-called brainwashing process procedure is the production of extreme changes in a person's beliefs and attitudes through the application of methods such as sleep deprivation, induced hunger, pain, social isolation, physical discomfort, use of good-cop versus bad-cop interrogations by alternating kind and cruel inquisitors, and use of sensory deprivation. Under conditions of sensory deprivation (SD), for example, the individual is cut off from almost all sensory stimulation from the external environment. The early SD experiments reported in the 1950s indicate that volunteer participants who remained in SD for two to four days exhibited undirected thinking accompanied by hallucinations and fantasies, as well as an inability to distinguish sleep from waking states. The concept of activation or arousal is central to most physiological theories of SD. Brainwashing as a mind-control or programming technique gained widespread attention...

Scheduling of Observations

When using an observer to collect information, an important question centers around the reliability of the information gathered. The key issue has to do with interobserver agreement, that is, the extent to which the observations are replica-ble by an independent observer. Although less frequently addressed, the reliability of self-monitored information is just as important. In either case, the use of an independent observer, when relevant, can add much to the confidence one places in the information obtained. Considering the extent to which two observers agree regarding, for example, the frequency and duration of a target behavior, lends credibility to the observational process and the information itself. The use of an independent observer with self-monitored information necessitates that the behavior being self-monitored be observable and open to public scrutiny (e.g., having a spouse monitor the amount of time it takes for an insomniac to fall asleep).

Introduction Methods and Results

Plexes and sleep spindles, and its transitional drowsy EEG arousal periods. In contrast, REM sleep, with its asynchonous cellular discharge patterns and skeletal motor paralysis, is resistant to propagation of epileptic EEG potentials and to clinical motor accompaniment even though focal IID persists at this time. The contrasting effects of NREM and REM on IIDs and clinically evident seizures are to some extent nonspecific with respect to epileptic syndrome (Shouse et al., 1996), defined by seizure type, etiology, and clinical course (Commission Report, 1989). On the other hand, clinically evident seizures, particularly generalized tonic-clonic or myoclonic convulsions, occur mainly during NREM sleep, mainly during drowsy wakefulness, or randomly in the sleep-wake cycle depending on epileptic syndrome (e.g., Janz, 1962). Interictal discharges are less likely to propagate and to lead to a clinically evident seizure during intact REM sleep than in any other state regardless of epileptic...

Behavioral Assessment

Controlling variables for a behavior problem through experimental manipulation. idiographic assessment An assessment strategy emphasizing the individual or individual case. Idiographic assessment procedures often are not standardized, and observed relations and results are not necessarily generalizable across persons or groups. level of inference (specificity) The number of elements or components subsumed by the variable label. An example of a higher level construct is depression since the label subsumes multiple lower-level phenomena such as motoric slowness, sad affect, insomnia, eating disturbances, and other more specific variables. nomothetic assessment An assessment strategy in which judgments are based on the comparison of measures from the target person with data on the same instrument gathered from other persons, such as the use of normative or comparison groups. phase-space relationship The expected, or realized, time-course context of a variable. The phase state of a...

Primary Generalized Epilepsy

The peak in GABA release that occurs during NREM, although promoting IlDs, seems to discourage clinically evident seizures such as generalized myoclonic and tonic-clonic convulsions. The moderate levels of reticular activation, chemical release, and synchronous thalamocortical discharge patterns during drowsiness are conducive to generalized epileptic EEG discharge propagation with clinical accompaniment (e.g., Gloor and Testa, 1974). In contrast to NREM and drowsiness, extreme activation of ascending brain stem afferents, particularly cholinergic cells, occurs during alert waking and REM sleep (e.g., Jones, 1994 Siegel, 1994), abolishes GABA-mediated synchronous thalamocortical discharge oscillations (Steriade, 1994), and is thought to suppress both ictal and interictal events in PGE (e.g., Guberman and Gloor, 1982 Shouse et al., 1989).

Cognitive Behavioral Therapy

This treatment strategy might best be regarded as a second-generation behavioral insomnia treatment that evolved from the above described strategies. Cognitive-behavioral insomnia therapy or CBT typically consists of one of the cognitive therapy strategies used in combination with both stimulus control and sleep restriction therapies. One presumed advantage of this treatment is that it includes treatment components that address the range of cognitive and behavioral mechanisms that perpetuate insomnia. As a result, this treatment should be more universally effective across insomnia sufferers regardless of their presenting complaint (i.e., sleep onset complaints vs. sleep maintenance difficulty). Admittedly, CBT is a multicomponent and seemingly more complex treatment than those previously described. Nonetheless, in practice, this intervention usually requires no more therapist or patient treatment time than do the less complex first-generation treatments reviewed above. Often CBT's...

Severe Epileptic Encephalopathies

Antiepileptic medications may also have an indirect effect on sleep organization. With antiepileptic medications, a decrease in the number of microarousals associated with seizures may ultimately improve both sleep organization and seizure control. Specific drugs such as phenobarbital may shorten sleep latency, increase the proportion of S2 sleep, decrease the proportion of REM sleep, and decrease the number and duration of arousals. Phenytoin alternatively may shorten sleep latency but has no effect on arousals or REM sleep percentage (Scher, 1996). Most studies, however, have centered on adults few reports have addressed antiepileptic medication effects on sleep in young infants with seizures.

Activationarousal Theory

At one end of a continuum of activation is a strong reaction to stimulation, and at the other end is the condition of quiescence, sleep, or death, with little or no reaction to stimulation. The activation arousal theory developed from work in the area of physiology, specifically on the electrical activity of the brain where the cerebral cortex was seen to be aroused by discharge of a lower center of the brain in the hypothalamic region. The general form of the activation theory is a form of the older energy-mobilization concept of emotion (e.g., Cannon, 1915) where early studies showed how the body prepares for emergency action during states of rage and fear. The use of the term activation is restricted generally to the energizing influence of one internal system, such as the reticular activating system, on another one and is not an exact synonym for either arousal (a general term) or stimulation (activation produced by specific external sources)....

Prion proteins and prion diseases

CREUTZFELDT-jAKOB-disease (CJD), GERSTMANN-STRAUSSLER-SCHEINKER-disease (GSS) and fatal familial insomnia (FFI) are rare inherited diseases in humans. CREUTZFELDT-JAKOB-disease (CJD) for example starts with neurological symptoms (difficulties with coordination, tremor), patients loose speech, then the control over body and mind. Death occurs within 6 month of outbreak. Most victims are more than 60 years old.

Clinical Significance

Migraine Cycle

Frequently, Balantidium infections can be asymptomatic however, severe dysentery similar to those with amoebiasis may be present. Symptoms include diarrhea or dysentery, tenesmus, nausea, vomiting, anorexia, and headache. Insomnia, muscular weakness, and weight loss have also been reported. Diarrhea may persist for weeks or months prior to development of dysentery. Fluid loss is similar to that

NonST Segment Elevation Myocardial Infarction Nstemi and Unstable Angina

-Morphine sulfate 2-4 mg IV push prn chest pain. -Acetaminophen (Tylenol) 325-650 mg PO q4-6h prn headache. -Lorazepam (Ativan) 1-2 mg PO tid-qid prn anxiety. -Zolpidem (Ambien) 5-10 mg qhs prn insomnia. -Docusate (Colace) 100 mg PO bid. -Ondansetron (Zofran) 2-4 mg IV q4h prn N V. -Famotidine (Pepcid) 20 mg IV PO bid OR -Lansoprazole (Prevacid) 30 mg qd.

Physiological Factors

Unlike previous theories, the somatization model embraces the idea that normal physical processes (e.g., the physical component of an emotional state) and minor pathological events may contribute to the development of unexplained symptoms. For example, anxiety is typically associated with increased auto-nomic arousal that may result in physical changes such as shaking, sweating, and tachycardia moreover, fear-related hyperventilation can produce symptoms such as breathlessness, chest pain, and fatigue. Similarly, the sleep problems and physical inactivity often associated with depression may give rise to fatigue, pain, and the feeling that increased effort is required to execute everyday tasks. Other physical processes unrelated to emotional states may also contribute to the development of medically unexplained symptoms. For example, muscle wasting resulting from illness-related inactivity may produce fatigue that perpetuates itself by preventing the resumption of physical exercise...

Acid Base and Metabolic Disorders

Children with diabetes may present in ketoacidosis. The classic presentation includes weight loss, polyuria, polydypsia, polyphagia, weakness, vomiting, abdominal discomfort, Kussmaul respirations, a fruity acetone breath, and AMS. Patients with diabetic ketoacidosis, as well as many other pediatric disease states associated with a loss of circulating volume, may develop inadequate perfusion. Patients with hypotonic or hypertonic dehydration may develop AMS with and without seizures. Poorly perfused patients or patients with inadequate air exchange have insufficient oxygen delivery to the brain and exhibit insomnia, somnolence, and confusion. Patients who develop hypercapnia as a result of primary lung disease or neurologic dysfunction may also present with AMS. Those with hepatic failure present with nausea, fatigue, and behavioral alterations and may rapidly become obtunded. Patients with inborn errors of metabolism typically present early in life with poor feeding, recurrent...

The Sleep And Dreaming Laboratories

Further confirmation of such association was obtained in the Chicago sleep laboratory. By the end of the 1950s, William Dement and Nathaniel Kleitman had obtained vivid, detailed reports of dreams with an incidence of 80 when awakenings occurred during periods of sleep characterized by rapid eye movements (REM sleep), whereas dreams could be reported in only 7 of the cases when subjects were awakened while no rapid eye movements could be observed (non-REM sleep). Various demonstrations of proportionality between objective duration of REM sleep periods and subjective length of dreaming further confirmed the relation between the two events and prompted the hypothesis that dream activity continuously progresses throughout the length of a REM phase. Beginning in the 1960s, many other sleep and dreaming laboratories were set up throughout the world in which subjects were monitored with electro-encephalographic (EEG) and polygraphic recordings throughout their sleep. The observations made...

Dreaming in the Blind

Blind people do have dreams that include visual imagery, but only if blindness occurs later than 6 or 7 years of age. It has been known, however, that dreams in congenitally blind people are nonvisual, and that their content is mostly linked to other sensory modalities. If the scanning hypothesis were true, then one might argue that subjects who have never had the opportunity to gaze upon their surroundings should not show rapid eye movements while dreaming. Sleep laboratory studies, however, have demonstrated quite the opposite (i.e., the presence of eye movements in the REM sleep of congenitally blind subjects). An even greater difficulty in accepting the hypothesis that eye movements follow dream scenes arises when we consider the dreaming of newborn babies or even animals deprived of the cerebral cortex.

Dreaming In Animals

Since it is certain that many animals have recurring periods of REM sleep, is it also reasonable to assume that they dream in the sense that humans do Anyone with a pet dog, cat, or other animal would swear that their pets dream, judging by the muscle twitches of their limbs, head, and ears that occur ocassionally when asleep. Even Lucretius, in the second century bc, having observed this kind of muscle activity in horses, suggested the possibility that it was linked to their dreaming. According to some, from the developmental

Does Dreaming Belong To Sleep

At the beginning of the 1960s, the interest evoked by the discovery of the REM stage was such that a proposal for calling it ''the third state of consciousness was often advanced. Instead of ''wake'' and ''sleep,'' it was popular at that time to speak of ''wake,'' ''dreaming,'' and ''nondreaming'' stages. Meanwhile, the occasional reports of dreaming outside of REM sleep were attributed either to recall of REM material or to the subject's waking confabulations. Later, however, on the basis of consistent empirical findings of dream-like mentation in non-REM sleep, the notion that thought modalities are completely segregated within the different physiological states was seriously questioned. It was shown that non-REM reports could not be safely ascribed to recall of mental events taking place during REM. A considerable amount of mental activity often indistinguishable from REM dreams was found even at sleep onset (i.e., before the first occurrence of a REM phase). The debate between...

Does Dreaming Have Any Meaning

Isomorphic expressions of the peculiar physiological state of REM sleep. According to Foulkes dream mentation is substantially independent from the REM physiology and under the direct control of the same narrative-linguistic generator that controls cognitive processes during wakefulness. In both cases, we are evidently a long way from the Freudian view, whereby the manifest content of dreams conveys a censored deeper latent message to be decoded that strongly points to the dreamer's unconscious problems.

Paradoxical Intention

As the name implies this treatment strategy employs a form of reverse psychology to address sleep difficulties. Designed mainly to address the excessive performance anxiety that contributes to sleep onset difficulties, this treatment instructs the insomnia sufferer to remain awake as long as possible after retiring to bed. In essence, the insomnia sufferer is placed in the paradoxical position of having to perform the activity of not sleeping when in bed. If the individual complies and genuinely tries to remain awake in bed, performance anxiety over not sleeping is alleviated and sleep becomes less difficult to initiate. Like the other treatments, an initial visit to provide treatment instructions and follow-up sessions to support the patient and ensure compliance are usually recommended when administering this intervention.

Nonpharmacologic therapy

Sleep disturbances, ranging from insomnia to excessive sleep, are common. A structured sleep schedule with consistent sleep and wake times is recommended. Sodium restriction may minimize bloating, fluid retention, and breast swelling and tenderness. Caffeine restriction and aerobic exercise often reduce symptoms.

Generalized Epilepsy and Sleep

Relations of Epileptic Seizures to Sleep-Wake Cycle Sleep Pattern of Patients with Generalized Epilepsy Relation of Epileptiform Discharges to the Sleep-Wake Cycle and Sleep Stages in Generalized Epilepsy Sleep Deprivation later recognized that epileptiform discharges occur more frequently during nonrapid eye movement (NREM) sleep than in rapid eye movement (REM) sleep and waking periods (Gibbs and Gibbs, 1947 Gloor et al., 1958 Shouse et al., 1996). Arousals and transition periods between sleep stages were considered to facilitate epileptiform discharges (Terzano et al., 1989 Hal sz, 1991 Gigli et al., 1992). In this chapter, we discuss clinical and electroencephalographic (EEG) relations between generalized epilepsy and sleep and the effects of antiepileptic drugs on the sleep of patients with generalized epilepsy. Langdon-Down and Brain (1929) were the first to subdivide epilepsy patients according to the occurrence of their seizures. They described (1) a diurnal type, that seizure...

Effects Of Seizures On Sleep And Vigilance

Seizures occurring both at night and during the day can affect sleep architecture and produce daytime sleepiness. In a study comparing the effects of generalized and focal seizures on sleep, nocturnal generalized seizures produced a decrease in sleep time and reduced REM sleep percentage, prolongation of REM latency, and more sleep fragmentation (Touchon et al., 1991). Stages 1 and 2 sleep were increased while the percentage of slow-wave sleep (SWS) was unchanged. REM rebound an increase in REM percentage after REM-suppressing situations (i.e., sleep deprivation) was not observed later in a night after a seizure or during seizure-free nights. Focal seizures occurred during REM and nonrapid eye movement (NREM) sleep. When occurring in isolation, focal seizures produced little or no sleep disruption. However, multiple focal seizures in a night produced a significant reduction of REM sleep and duration of REM periods. As compared with control subjects, patients with epilepsy had...

Complications of Migraine

Patients with acute status migrainosus may require hospitalization, particularly if the condition was induced by dependency on medication, is accompanied by dehydration, or if the patient is depressed or has a prior experience of adverse reactions to medications (Table I). The offending medication causing rebound headache phenomenon must be withdrawn. The withdrawal is usually done in an abrupt manner, but all precautions to prevent seizures and or other withdrawal reactions should be instituted. Treatment for patients with status migrainosus should be aggressive and includes rest rehydration and electrolyte replacement detoxification round-the-clock parenteral analgesic therapy symptomatic treatment of nausea, anxiety, insomnia, and withdrawal symptoms concurrent initiation of prophylactic therapy and behavioral treatment. Corticosteroids and NSAIDs are

TABLE 1817 Toxins with Delayed Onset of Symptoms or Requiring Prolonged Monitoring

Psychological factors affect health after toxicologic disasters. Victims of a hazardous materials incident may experience a post-traumatic stress disorder consisting of anxiety, depression, insomnia, amplification of symptoms, and somatization. This is estimated to occur in 25 percent of victims, as evidenced by abnormal psychological test scores.24 Early psychological debriefing and interviews with patients and personnel can help prevent postexposure stress syndrome.

Duplications Of 17p112

Estimated prevalence of 1 20,000, is characterized by mental retardation, neurobehavioral abnormalities, sleep disorders, speech and motor delays, midface hypoplasia, short stature, and brachydactyly. 3 The same deletion is seen in 90 of patients. Only recently has it been recognized that a reciprocal duplication also exists. The dup(17)(p11.2p11.2) syndrome is characterized by borderline to mild mental retardation, behavioral problems, short stature, dental anomalies, normal facies, and lack of major organ malformations 4,5 This syndrome typifies a milder phenotype that was not recognized as a syndrome until connected to the microduplication.

A EEG Arousal Is Controlled by Interconnections between the NMTs Thalamus and Cortex

Cortical Arousal Eeg

In contrast, the low-voltage, fast-wave activity, known as the desynchronized EEG, results when NMTs suppress the hyperpolarizing influences on thalamic neurons and shift the thalamic activity into the single-spike mode. This activity is initiated by ACH that is released from the terminals of basal forebrain neurons. The frequency spectrum of rhythmic activity increases substantially and high frequencies (40-60 Hz) may be frequent. Similar patterns are engendered in cortical neurons and the EEG records of this activity are seen during REM sleep and waking states. Although high-frequency EEG activity has been characterized as desynchronized, it may simply be synchronized to higher frequencies. The mechanisms underlying the burst and single-spike mode are discussed in-depth later.

Differential Diagnosis

The differential diagnosis of arousal disorders depends on the types of behaviors that occur. For patients with sleep terrors or sleepwalking, diagnostic considerations may include nightmares, REM sleep behavior disorder (RBD), epilepsy, nocturnal delirium, panic disorder, and dissociative states. Timing of episodes, the length of time required to attain full alertness after an episode, and amount of recall are helpful distinguishing features. Sleep terrors and sleepwalking usually begin with an arousal from slow-wave sleep and therefore generally occur in the first third of the night, often within an hour or two of sleep onset patients are difficult to awaken during an episode and are confused and groggy if they are awakened. Patients usually have little recall of episodes, although some report vague images or fragmentary thoughts or emotions. On the other hand, nightmares and the activity of RBD occur during REM sleep and are therefore more common later in the night full alertness...

Clinical Evaluation and Management

In patients with the persistent vegetative state, the EEG is useful in assessing cortical dysfunction and identifying the presence of occult seizure activity. The EEG may show a variety of changes. Some individuals in the persistent vegetative state have an isoelectric EEG or have periodic tracings consistent with REM sleep. If seizures develop and aggressive management is desired for the patient with the persistent vegetative state, then epileptic activity should be treated to reduce further neuronal cell loss in the cortex. Status epilepti-cus, status myoclonus, and myoclonic status epilepti-cus are associated with inability to recover consciousness in cardiac arrest survivors. In addition to issues of care, the EEG has been used to assess prognosis. In patients with terminal coma or persistent vegetative state, onset of abnormal EEG changes may be suggestive of a poor outcome.

Diagnostic Evaluation

VPSG is the preferred laboratory study, particularly for patients with episodes that occur nightly or almost nightly. It is most useful if a typical episode is recorded. An abrupt arousal from slow-wave sleep is a characteristic finding, usually associated with tachycardia. During an episode, regular, rhythmic, hy-persynchronous delta or theta activity may be seen, and high-voltage EEG slow-wave activity may occur just before the arousal that initiates the behaviors (Fig. 12.1). Even if the behaviors do not occur, the study may be helpful. For example, runs of hypersynchronous delta during arousals from slow-wave sleep are more common in persons with arousal disorders than in other individuals (Blatt et al., 1991). In patients with a history suggestive of sleepwalking or sleep terrors, the occurrence of confusional arousals supports the presence of an arousal disorder. The EEG during a dissociative episode shows a waking pattern while REM sleep behavior disorder is associated with EEG...

Sleep EEG Phenomena

Drinking Bird Images

The very slow rhythm (0.6-1 Hz), on the contrary, is generated intracortically since it survives thalamic lesions, but it is disrupted by intracortical lesions. Interestingly, note that the rhyth-micity of the very slow oscillation appears to be reflected in that of the typical K complexes of human EEG during non-REM sleep. Because this point is often misunderstood, it is emphasized that slow-wave sleep, characterized by typical EEG delta activity, does not correspond to a state in which cortical neurons are inactive. On the contrary, in this sleep state cortical neurons can display mean rates of firing similar to those during wakefulness and or REM sleep. Regarding the neuronal firing patterns, the main difference between delta sleep and wakefulness and REM sleep is that in the former the neurons tend to display long bursts of spikes with relatively prolonged interburst periods of silence, whereas in the latter the firing pattern is more continuous....

Rhythmic Movement Disorder

Rhythmic movement disorder, characterized by stereotyped repetitive movements of the head and neck, or sometimes the trunk, is also called head-banging, head-rolling, body-rocking, or body-rolling depending on the type of movement. Other terms sometimes employed include jactatio capitis nocturna and rhythmie du sommeil. The movements occur during drowsy wakefulness and stage 1 sleep at a rate of 0.5-2 Hz, rarely during deeper stages of NREM or REM sleep, and may last from a few seconds to as long as half an hour. When head-banging is the principal symptom, patients may repeatedly and forcefully bang their heads into the pillow, headboard, or wall while lying in a prone position. Rolling head or body movements and leg or arm banging may occur instead of or in addition to head-banging. They occur in the majority of infants, but have usually resolved by age 4 (Klackenberg, 1987). In occasional patients, symptoms persist into adolescence or adulthood.

The Biological Challenge To Dream Theory

The activation-synthesis explanation of dream formation of Hobson-McCarley challenged all psychoanalytic theories of dreams stating clearly that dreams are inherently meaningless, random mental activity occurring due to chemical changes accompanying movement from non-REM to REM sleep. They state the dreamer and therapist create meaning to what is essentially random brain static.

The Mucopolysaccharidoses

Intelligence varies within subtypes of MPS from average to progressive mental retardation. Behavioral issues also vary within subtypes of the MPS disorders. Individuals with Hurler syndrome, for example, are described as being anxious, restless, and having sleep problems but are not aggressive. Children with Hunter syndrome are overactive, aggressive destructive, fearful, defiant, and also have sleep problems. Children with Sanfilippo syndrome manifest the most noticeable behavioral symptoms. These children often wander aimlessly, are restless, mouth clothing and objects, have sleep problems, and can be aggressive even when not provoked.


In the outpatient setting, the EEG may be used to distinguish generalized from focal seizures and to identify specific epileptic syndromes. The diagnostic yield of EEG recordings can be increased by appropriate patient preparation (especially sleep deprivation) or by activation techniques such as hyperventilation, photic stimulation, and sleep recordings. More elaborate examinations, such as 24-h recordings or video-EEG recordings, may also be used. Consultation with a neurologist ensures that the appropriate studies are chosen.

TABLE 2245 Properties of Commonly Used Anticonvulsant Drugs

If anticonvulsant levels are adequate and the patient has had a single attack, specific treatment may not be needed if the pattern and frequency of occurrence falls within the expected range for the patient. Even well-controlled patients may have occasional breakthrough seizures. Any precipitants that have lowered the seizure threshold should be identified. If there has been a recent change in the frequency or pattern of breakthrough seizures, a change in, or adjustment of, medication may be needed. These include factors such as infection, sleep deprivation, stress, or injury. The primary care physician or neurologist should make this decision. If a medication's maintenance dose is increased, only very small increments should be made, and follow-up within one to three days should be provided, because even small dose changes may result in dramatic increases in serum levels. If the problem is noncompliance or missed medication, the patient's primary care physician or neurologist should...

Physiological Somatostatin Receptor Ligands

Because all forms of somatostatin and cortistatin bind to the different somatostatin receptor subtypes (sst's) with similar high affinities, it is not surprising that the peptides share many functional properties. However, they also produce some distinct biological effects. For example, intracerebroventricular injection of cortistatin in rats increases slow-wave sleep but not REM sleep, whereas somatostatin injection increases REM sleep. Thus, the identification of a human cortistatin selective G protein-coupled receptor (MrgX2, or Mas-related gene X2) fulfills prior predictions for the existence of distinct cortistatin-specific receptors. However, the rodent orthologue of this receptor has not been identified, and the relative roles of somatostatin receptors and cortistatin receptors in mediating the physiological actions of these peptides remain to be determined.

Brain Mechanisms in Combined RBDExtrapyramidal Disorders

The retrorubral nucleus is located near the substantia nigra, and appears to be implicated in the linked PD-RBD pathology (Lai and Siegel, 1990). The retrorubral nucleus projects to the caudate and putamen (extrapyramidal motor system) experimental lesions to the retrorubral nucleus in cats releases abnormal motor activity during both sleep and wakefulness, ranging from myoclonic twitches to rhythmic leg movements and locomotion (Lai and Siegel, 1997). In addition, the substantia nigra also is closely connected to the REM-phasic generator circuitry and may play a major role in the genesis of PGO waves, a characteristic REM sleep phasic event (Datta et al, 1991). In regard to MSA, pontine involvement has been revealed by both gross neuropathological examination and histo-chemical studies, as cited by Plazzi et al (1997). Functional magnetic resonance brain imaging studies and postmortem brain analyses are required to definitively elucidate the underlying neuropathology...

Biological Radiation Monitoring

In addition to chromosomal aberrations, other intrinsic biomarkers for genetic or metabolic changes may be applicable as biological dosimeters, such as germ line minisatellite mutation rates or radiation induced apoptosis, metabolic changes in serum, plasma or urine (e.g., serum lipids, lipoproteins, ratio of HDL LDL cholesterol, lipoprotein lipase activity, lipid peroxides, melatonin, or antibody titers), hair follicle changes, and decrease in hair thickness, triacylglycerol-concentration in bone marrow, and glycogen concentration in liver. Whereas the first three systems mentioned are noninvasive or require only blood samples for analysis, the latter systems are invasive and therefore appropriate for radiation monitoring in animals only. Dose response relationships have been described for most of the intrinsic dosimetry systems, yet their modification by microgravity remains to be established.

Excipients For Overthecounter Drugs

(eventually the number of therapeutic classes reached approximately 80). During this review, the FDA attempted to keep the task at a manageable level by not reviewing specific marketed products, but rather by creating various monographs (standards) for OTC active ingredients in numerous therapeutic classes. Expert Panels were advised only to consider excipients (or complete product formulations) when such excipients or formulations materially impacted the drug's efficacy or diminished its safety. In therapeutic classes such as antacids, laxatives, antidiarrheals, expectorates, antitussives (cough suppressants), sleep aids, and numerous oral products, excipients such as lactose, starch, methylcellulose, magnesium stearate, etc., had long been used in the manufacturing of OTC finished products without raising safety concerns, and were therefore not examined. However, there were a number of exceptions where inactive ingredients had a noticeable (and usually detrimental) impact on safety...

Contextual Therapies

Common to the contextual brief therapies is the notion that problems are constructed and not intrinsic to the individual. Once people construe a set of life outcomes as problems, they typically attempt solutions to these problems, sometimes making the initial difficulties worse in the process. The result is a circular difficulty in which problems and solutions become self-reinforcing and amplifying. A common and simple example of this is the insomniac client who tries as hard as he can to fall asleep, only to find that repeated trying keeps him awake. Contextual brief therapy proceeds from the recognition that relatively small shifts in the context of the client's problem can be sufficient to interrupt these self-reinforcing cycles and set the client along a new trajectory. The emphasis is thus not on analyzing problems or their historical roots, but in finding contextual parameters that no longer sustain the unwanted behavior patterns. The insomniac client who is instructed to...

Psychosocial Problems

Confidence as a major psychological problem. Depression may result from an interaction of several factors including left frontal lobe damage, reactions to physical loss, and impaired performance of activities of daily living. Comparatively little is known of interactions between depression, anorexia, and nutritional status in the early stages of recovery following stroke in individuals with and without physical eating problems. However, patterns of behavioral disturbance characterized by verbal expressions of depressed mood, anorexia, and insomnia have been identified and associated with weight loss. Anxiety-evoking experiences relating to being fed, or choking in the presence of dysphagia, may also result in avoidance or withdrawal from eating. General approaches to the treatment of poststroke depression can involve the use of antidepressant drugs and behavioral and psychotherapeutic techniques. Specifically, the exercise of therapeutic skills in communication, assisting eating, and...

Suggestion Laws Of See Frequency Law Of

SULLIVAN'S THEORY OF PERSONALITY. interpersonal theory. The American psychiatrist Harry Stack Sullivan (1892-1949) developed the interpersonal theory of psychiatry that defines the hypothetical entity of personality as the relatively enduring pattern of recurrent interpersonal situations that characterize a human life, and views the individual's basic existence in terms of one's relationships with other people (cf., Sullivan's term significant other - refers to the most influential person, usually the mother, in a child's environment life later usage by others gave a more colloquial meaning to the term, denoting an individual with whom someone is romantically or sexually involved). Sullivan's theory of personality favors concepts and variables from the fields of social psychology and field theory (e.g., Lewin, 1951). According to Sullivan's approach, the essential unit in personality study is the interpersonal situation, not the individual, where the structure and organization of...

Association Of Rapid Eye Movement Sleep Behavior Disorder With Specific Human Leukocyte Antigen Haplotypes

Narcolepsy, like RBD, is a prominent disorder of REM sleep dysregulation. Narcolepsy has a very strong association with HLA class II genes, with the DQB 1*0602 (DQwl group) allele being expressed in nearly all cases. Our center performed HLA class II antigen phenotyping in a group of 25 Caucasian males who had RBD but not narcolepsy 84 (n 21) were DQwl Arnulf, I., Bonnet, A.-M., Damier, P., Bejjani, B.-P., Seilhean, D., Derenne, J.-P., and Agid, Y. (2000). Hallucinations, REM sleep, and Parkinson's disease a medical hypothesis. Neurology 55 281-288. Boeve, B. F Silber, M. H Petersen, R. C., Kokmen, E., Parisi, J. E., and Olson, E. J. (1997). REM sleep behavior disorder and degenerative dementia with or without parkinsonism A syndrome predictive of Lewy body disease Neurology 48 A358-A359. Boeve, B. F., Silber, M. H., Ferman, T. J., et al. (1998). REM sleep behavior disorder and degenerative dementia an association likely reflecting Lewy body disease. Neurology 51 363-370. Cox, S.,...

Skinners Descriptive Behavior Operant Conditioning Theory

The experience of sleep is characterized by a particular loss of consciousness accompanied by a variety of behavioral and neurophysiological effects (cf., hyphic-jolts effect phenomenon - consists of a sudden single jerk of the body that occurs typically when one is just about to fall asleep apparently, its cause, as well as its cure, is unknown, and remains a mystery as to its occurrence). In modern psychology, sleep and various stages of sleep are defined and characterized typically by particular physiological events, specifically by distinctive brain-wave patterns as recorded by an electroencephalo-graph, metabolic processes, muscle tone (cf., Isakower phenomenon - named after the Austrian psychoanalyst Otto Isakower (18991972), refers to strange hallucinations usually felt in the mouth, hands, or skin they include the feelings of an object pulsating or approaching receding, and they occur mainly when falling asleep), heart and respiration rates, and the...

Parasomnia Overlap Disorder

Our center has reported on a group of 33 RBD patients with PSG-docu-mented overlapping NREM-REM sleep motor parasomnias consisting of sleepwalking, sleep terrors, and RBD (Schenck et al., 1997b). Mean age was 34 14 years mean age of parasomnia onset was 15 16 years (range 1-66) 70 (n 23) were males. An idiopathic subgroup (n 22) had a significantly earlier mean age of parasomnia onset (9 7 years) than a symptomatic subgroup (n 11) (27 23 years) whose parasomnia began with neurological disorders, n 6 congenital Mobius syndrome, narcolepsy, multiple sclerosis, brain tumor (and treatment), brain trauma, indeterminate disorder (exaggerated startle response atypical cataplexy) nocturnal paroxysmal atrial fibrillation, n 1 posttraumatic stress disorder major depression, n 1 chronic ethanol amphetamine abuse and withdrawal, n 1 or mixed disorders (schizophrenia, brain trauma, substance abuse), n 2. The rate of psychiatric disorders was not elevated group scores on various psychometric tests...

A A Biological Clock in Hypothalamus

Elucidating the connections of the SCN has been an important component of understanding how this group of hypothalamic neurons imposes its temporal message on the physiology and behavior of the parent organism. One of the most well-characterized systems in this regard is the circuitry through which the SCN exerts regulatory control over the secretion of the hormone melatonin. Melatonin is secreted by the pineal gland in a circadian manner but is also responsive to light such that light stimulation during the dark phase of the photoperiod inhibits the normally high levels of melatonin secretion. This dynamic regulatory capacity renders the temporal profile of melatonin secretion a precise measure of day length. A large literature has established that the SCN controls both the circadian and photoperiodic aspects of melatonin secretion through multisynaptic pathways that sequentially involve the paraventricular hypothalamic nucleus, the intermediolateral cell column of the spinal cord,...

Application Of Cognitivebehavioral Therapy

Most notably, psychophysiologic insomnia is recognized for its complex multifaceted etiology and manifestation, and is effectively conceptualized and treated through a CBT model. Treatment for primary insomnia with cognitive-behavioral strategies is well-documented and continues to be a rapidly growing area of research (Morin et al., 1999). Therapies such as stimulus control, progressive muscle relaxation, paradoxical intention, and cognitive therapy for insomnia (i.e., challenging dysfunctional beliefs and attitudes specifically about sleep) employ a variety of cognitive-behavioral principles aimed at improving sleep quality. For example, rumination about needing to get a full 8 hours of sleep every night or fear that insomnia will be fatal are common irrational beliefs that are likely to lead to cognitive or physiological arousal states incompatible with sleep. In turn, the inability to sleep is likely to lead to further rumination, creating a vicious cycle. Employment of...

Other Sleeprelated Paroxysmal Events

Paroxysmal nocturnal motor events characterized by complex, often stereotyped dystonic or choreic movements with sudden onset and variable duration often defy precise classification. Over the years, different hypotheses regarding their origin have been advanced, and they have been variably diagnosed as sleep disorder, movement disorder or epilepsy. More recently, evidence has been mounting that many of these motor manifestations indeed represent seizures originating from the frontal lobe, although epileptiform EEG abnormalities are often lacking. Autosomal dominant transmission has been described in several families, and different mutations affecting the alpha 4 subunit of the neuronal nicotinic acetylcholine receptor (CHRNA4) have been discovered. ICSD International Classification of Sleep Disorders Diagnostic and Coding Manual. (1990). Diagnostic Classification Steering Committee (M. J. Thorpy, Chairman). Rochester, MN American Sleep Disorders Association. Scheffer, I. E., Bhatia,...

Terence M Keane and Meredith Charney

Psychiatric Association's Diagnostic and Statistical Manual (DSM-III APA, 1980), PTSD is often a disabling condition associated with emotional avoidance and numbing, and a range of symptoms of hyperarousal including insomnia, irritability, difficulty concentrating, hypervigilance, and exaggerated startle responses. This collection of symptoms must be present for a full month if the duration of the symptoms is 3 months or less, it is referred to as acute PTSD. If the duration of symptoms exceeds 3 months, it is termed chronic PTSD. Occasionally, symptoms emerge no more than 6 months following the traumatic event and this is called PTSD with delayed onset.

Mario Giovanni Terzano

Sleep Disorders Center Department of Neurology University of Parma Italy The variations of the arousal level across the 24-h rhythm play an important role in the modulation of epileptic events. The sleep-wake cycle, and particularly the conditions of instability that occur during sleep, affect significantly the appearance of interictal electroencephalography (EEG) discharges and epileptic seizures. This interaction, either in the sense of inhibition or, more frequently, in the direction of activation, relies on the characteristics of the epileptic syndrome (type of attacks, clinical course, and etiology), on the time of the day, and on the structural components of sleep (falling asleep, EEG arousal, nonrapid eye movement (NREM) stages, and rapid eye movement (REM) sleep). In particular, the two neurophysiological states that characterize sleep (NREM and REM) have opposite consequences on interictal abnormalities and on critical manifestations. A pioneering contribution published 60...

Intensive Care Procedures 351

Stroke Volume Variation

The causes for anxiety in the intensive care unit can be secondary to an inability to communicate due to continuous noise (alarms, personnel, and equipment), continuous ambiguous lighting, excessive stimulation (inadequate analgesia, frequent measurements of vital signs, repositioning, lack of mobility, room temperature, sleep deprivation, and the underlying disease that led to ICU admission. Causes for agitation include extreme anxiety, delirium, adverse drug effects, and pain. If agitation is present, it is important to identify and treat any underlying physiological disturbances hyp-oxemia, hypoglycemia, hypotension, pain, withdrawal from alcohol, and other drug effects. Special attention should be paid to the treatment of agitation, because it can pose a serious threat to patients by contributing to ventilator dyssynchrony, increase in oxygen consumption, or inadvertent removal of devices and catheters (Jacobi et al. 2002).

Posttraumatic Stress Disorder Ptsd

The DSM-IV category of PTSD mainly concerns adults. Scheeringa et al. 39 developed a set of alternative criteria, in which re-experiencing is expressed by reiterative games, recollection of the event, nightmares, flashbacks and distress at discovering elements that recall the event. Numbing is expressed by limited play activities and social introversion, limited affect and loss of developmental skills that had already appeared. Arousal is expressed as nightmares, insomnia, waking up frequently, loss of concentration, hypervigilance and exaggerated startle response. In addition, there is a unique subgroup of symptoms, including new aggressiveness, renewed appearance of separation anxiety, fear of going to the bathroom alone, fear of the dark or any apparently baseless suddenly appearing fear. PTSD in children includes three groups of symptoms recurrent experience of the trauma, avoidance traits (such as emotional withdrawal, refusal to deal with the trauma, etc.) and arousal symptoms...

Papulocrusting dermatitis miliary dermatitis

Psychogenic alopecia is considered to be uncommon as a single primary clinical entity (Sawyer et al., 1999). It is difficult to assess how often cats with a pruritic skin disease develop a stereotypic component to the overgrooming. In some cases the initial pruritic trigger may no longer be present, but the overgrooming has become self-perpetuating. The underlying pathogenesis of stereotypic behaviour such as incessant overgrooming, hair pulling and self-licking may include pituitary hormones such as a-melatonin-stimulating hormone (a-MSH). This is produced as part of a stress response and leads to the production of endorphins that reduce further self-grooming but have an addictive reinforcement role.

Modulation Of Alertness

Foods, such as warm milk, turkey, or bananas, facilitate sleep. Turkey and bananas have a known direct physiological effect They are good dietary sources of tryptophan, which is a precursor chemical for serotonin. Milk also contains tryptophan, but the quantities are lower The value of milk, particularly, warm milk, could well have more to do with stimulus-induced expectations (the warm milk might be a conditioned stimulus, associated with a bedtime routine). Nevertheless, although a banana at bedtime might improve sleep quality (which might perhaps impact alertness the following day), it is not obvious that a banana at breakfast would make a person less alert. Indeed, there is evidence that it might improve alertness. Dietary supplements of tryptophan are reported to be useful to reduce the symptoms of depression, including psychomotor retardation. Glucose is an important substance for neural functioning. Because there are no stores of glucose in the brain, availability in the blood...

Major Clinical Syndromes Of Aggression

In patients with brain stem-mediated sleep-related disorders of violence, aggressive actions are generally nocturnal, associated with incomplete maintenance of REM or non-REM sleep states. The REM sleep behavior disorder predominantly occurs in middle-aged men. Violence most commonly occurs during a vivid and frightening dream, is often directed at a bed partner mistaken for a dream figure, and is unplanned, without the use of weapons. Affected patients are difficult to arouse from their dreaming state. Afterwards, they generally recall the dream material that provoked aggression but report believing they were attacking animal or human oneiric figures rather than their furniture or spouse. They exhibit remorse about their actions and, before a diagnosis is made, may self-treat their disorder by tying themselves in restraining devices at night. The REM sleep disorder must be distinguished from other parasomnias that may be injurious to patient and spouse, such as somnambulism, sleep...

Screening Questionnaire

Diagnosis of epilepsy is fundamentally a clinical judgment. Clinical history should elicit details of seizure semiology, seizure provoking factors, and seizure frequency in the preceding five years.7 At times there can be discrepancy in the diagnosis of epilepsy when it is based only on a screening questionnaire. In a recent epidemiological survey in Togo of the 9,155 subjects screened by a screening questionnaire, 285 subjects (3.1 ) reported loss of consciousness, 263 (2.9 ) had seizures and 142 (1.5 ) had foaming and urinary incontinence during the seizure 74 (0.8 ) had absence seizures, 68 (0.7 ) had focal symptoms. During case ascertainment of the 304 subjects studied, diagnosis of epilepsy could be established in only 170 pa-tients.8 Documenting seizure provoking factors like sleep deprivation, photic stimulation, and hyperventilation, helps the clinician in the management of people with epilepsy.9

The Functions of Dreaming

The hypothesis that memories are consolidated during sleep is a long-standing one. In particular, the diffuse brain activation that characterizes REM sleep could provide the appropriate context for the modifications of synaptic strength within the circuits activated during the wake experience. Such changes are thought to represent the neural basis of memory consolidation. The evidence in favor of this hypothesis, based mostly on animal experimental models, has been methodologically criticized and is countered by some negative findings. In particular, no damage to memory and learning has occurred after the use of major antidepressant drugs that cause a marked suppression of REM sleep. However, functional brain imaging studies have recently shown that the waking experience influences regional brain activity during subsequent sleep. Specifically, several brain areas that are activated during the execution of a task during wakefulness were significantly more active during REM sleep in...

Dynamic Behavior Of Sources

EEG waveforms recorded on the scalp are due to a linear superposition of contributions from billions of microcurrent sources or, expressed another way, by thousands to millions of columnar sources P(r',t) located in cerebral cortex, as indicted by Eq. (3). However, the underlying physiological bases for the dynamic behavior of the sources are mostly unknown. The 10-Hz range oscillations of alpha rhythm, the 1Hz range oscillations of deep sleep, and other waveforms in the EEG zoo must be based on some sort of characteristic time delays produced at smaller scales. Such delays can evidently be developed in neural networks that cover a wide range of spatial scales.

Kelly L Gilrain and Jacqueline D Kloss

Keywords sleep disorders, sleep apnea, insomnia, jet lag, narcolepsy Millions of Americans suffer from sleep disorders including, but not limited to, sleep apnea, insomnia, narcolepsy, restless legs syndrome, and circadian rhythm disorders. While the quality, extent, and severity of these symptoms depend on the nature and course of each particular condition, sleep disorders pose a serious personal and public health concern. Individuals with sleep problems may encounter a myriad of adverse nighttime and daytime sequelae ranging from frustration due to difficulty in falling or staying asleep at night, to excessive daytime sleepiness. Impaired concentration, fatigue, irritability, anxiety, depression, substance abuse (caffeine or alcohol), general physical malaise, compromised occupational performance, and interpersonal or marital distress are also among the most commonly reported symptoms. With some conditions, such as untreated narcolepsy or apnea, symptoms may even evolve into safety...

Sleep at High Altitude

Sleep stages III and IV are reduced at altitude, while sleep stage I is increased. More time is spent awake, with a significant increase in arousals, but with only slightly less rapid eye movement (REM) time. The frequent arousals are a common source of bitter complaints from skiers and others, but they are innocuous and improve with time at altitude. The typical periodic breathing (Cheyne-Stokes) in those sleeping above 2700 m (9000 ft) consists of 6- to 12-s apneic pauses interspersed with cycles of vigorous ventilation. Interestingly, the frequent awakenings are not necessarily related to the sleep periodic breathing, and neither are they related to acute mountain sickness. Presumably, the mechanism of the lighter sleep is related to cerebral hypoxia. Quality of sleep and arterial oxygenation during sleep improves with acclimatization and with acetazolamide.

Neurophysiology And Neurochemical Mechanisms Of Dreaming

The discovery of a REM stage in animals opened up new possibilities of experimental research obviously unfeasible in humans. In the early 1960s, transection studies in cats conducted by the French sleep scientist Michel Jouvet and coworkers pointed to structures in the brain stem as the source of REM sleep. More precisely, these researchers discovered the presence of both a trigger mechanism and a REM sleep clock in the pons. Investigating the pontine reticular formation through the recording microelectrode technique, McCarley and Hobson reported a series of findings that led to the formulation of a neurochemical model of the rhythmic appearance of REM sleep. They called this hypothesis the reciprocal interaction model because of its central concept During REM sleep, aminergic subsets of neurons (the so-called REM-off cells) were inhibited, while cholinergic (REM-on) cells actively discharged. The opposite pattern of neuronal activity was observed during wake. The relevance of the...

Development Of Continence

Several factors have been deemed potentially causative in NE. Included among these are small functional bladder capacity, deep sleep, arousal disorder, genetics, maturational delay, allergic reaction, abnormal anti-diuretic (ADH) activity, and psychological disturbance. However, detailed medical examination in most cases of NE are unrevealing for any medically related pathophysi-ology. Recent emphasis has been placed on maturational delay, sleep disorder, and ADH abnormality. In some cases environmental social factors may be involved. A study by J. S. Wekke, for example, noted a higher incidence of nocturnal enuresis in special education children mainstreamed in the Dutch educational system compared to those who were not.

Clinical Features Of Rapid Eye Movement Sleep Behavior Disorder

Classification of sleep disorders (ICSD) in 1990. A typical clinical presentation of RBD is as follows (Schenck et al., 1986) A 67-year-old dextral man was referred because of violent behavior during sleep He had slept uneventfully through adolescence in a small room with three brothers. But on his wedding night, his wife was scared with surprise over his sleep talking, groaning, tooth grinding, and minor body movements. This persisted without consequence for 41 years until one night, 4 years before referral, when he experienced the first 'physically moving dream' several hours after sleep onset he found himself out of bed attempting to carry out a dream. This episode signaled the onset of an increasingly frequent and progressively severe sleep disorder he would punch and kick his wife, fall out of bed, stagger about the room, crash into objects, and injure himself his wife began to sleep in another room 2 years before referral. They remain happily married, believing that these...

The psychostimulants cocaine and the amphetamines

Psychotropics Chemical Diagram

The subjective effects of all the psychostimulants depend on personality, the environment in which it is administered, the dose of the drug, and the route of administration. For example, moderate doses of D-amphetamine (10-20 mg) in a normal person will produce euphoria, a sense of increased energy and alertness, anorexia, insomnia, and an improvement in the conduct of repetitive tasks. Some people become anxious, irritable and talkative. As the dose of amphetamine is increased, the symptoms become more marked and the influence of the environment less pronounced.

Midbrain Thalamic Disorders Associated with Hallucinations

Associated with hallucinations, usually in the setting of sleep disorders such as narcolepsy or insomnia. Hypnagogic hallucinations occur prior to falling asleep, whereas hypnopompic hallucinations occur upon awakening. Both are generally multimodal, vivid, and emotionally charged. Common examples are the feeling or experience of being about to fall into an abyss or attacked, of being caught in a fire, or of sensing a presence in the room. Hallucinations in the settings of delirium and sedative drug withdrawal are also associated with disturbances in sleep and arousal.

Concluding Remarks

Studies carried out during the past 50 years, particularly those using recent neuroimaging techniques, show that the areas of the central nervous system that seem more active in REM sleep are found in the brain stem, in the limbic system, and in secondary, associative cortical areas, at variance with the alert waking state, during which the frontal lobes and the primary sensory and motor cortices are privileged. Thus, the stage of sleep in which dreaming has its greatest expression appears to be characterized by a prevalent orientation toward the inner world of memories and emotions. In line with this view, the adjective paradoxical,'' as applied to the REM stage, may sound improper. Its physiological characteristics, in fact, appear perfectly orthodox if considered as an expression of a positive and qualitative shifting toward a greater resonance of the inner world a shifting, however, that although paradigmatic for the REM state, may be available throughout the sleep and wake cycle....

Interviewing Young People with Early Psychosis

At the end of the interview, provide initial feedback to the patient together with options for the next step, and link these ideas with the problem areas that have been identified by the patient, e.g. ''I can't get to sleep . . . I don't feel comfortable with my friends I can't concentrate at work''.

Summary of the pharmacological properties of antidepressants in general use in Europe

Sertraline Muscarinic

Thereby reducing peripheral vascular tone. Other side effects include psychomotor restlessness and sleep disorder. The MAOIs are cardiotoxic but probably less so than the TCAs. Potentially fatal interactions can however occur when MAOIs are combined with SSRIs or any type of drug which enhances serotonergic function. The interaction can give rise to hyperexcitability, increased muscular tone, myoclonus and loss of consciousness. The analgesic pethidine is particularly dangerous in this respect (Figure 7.1). All the SSRIs have qualitatively similar side effects that largely arise from the increase in serotonergic function and the resulting activation of the different 5-HT receptor types in the brain and periphery. There are differences in the frequency of these effects however which would not be anticipated if all the SSRIs were essentially the same These effects include nausea, vomiting, diarrhoea or constipation, insomnia, tremor, initial anxiety, dizziness, sexual dysfunction and...

Transmissible Spongiform Encephalopathies

Human TSEs include kuru, Creutzfeldt-Jakob disease, Gerstmann-Straussler-Scheinker syndrome, and fatal familial insomnia. Human TSEs are heritable in about 15 of the cases and are considered sporadic in about 85 of the cases. Worldwide a few hundred cases have been associated with the use of tissues from infected donors (corneal transplants, cadaveric dura mater, and human pituitary extracts used to prepare growth and gonadotropin hormones), or contaminated intracranial electrodes and neurosurgical instruments. Kuru, a TSE associated with the ritual handling and cannibalistic consumption of the brain of deceased tribal members in a region of New Guinea, with a known incubation period up to 30 years, has all but disappeared due to changes in local customs (2,3).

Drugs That Change Alertness A Stimulants

The stimulants adrafinil and modafinil are agonists at the noradrenergic postsynaptic (a1) receptors. At doses that have alerting effects, these drugs are reported to have few side effects. Specifically, unlike other stimulant drugs that inhibit sleep, reports suggest that these drugs do not impair the ability to fall asleep and do not alter sleep patterns. Furthermore, they are less likely than amphetamines to result in rebound hypersomnolence, and the motor effects (tremors and hyperactivity) are much less pronounced. In addition, although modafinil increases dopamine turnover in the striatum, the motor stimulatory effects of modafinil are not antagonized by drugs that block dopamine receptors, suggesting that the mechanism of

Imageless Thought Theory

In the context of cognitive experiences, the term image refers to a mental representation of an earlier sensory stimulus or experience and represents a less vivid copy of that event cf., imagery law of compensation rivalry - proposed by the English psychologist Charles W. Valentine (1879-1964), states that in the aesthetic appreciation of poetry, visual imagery displaces, or is displaced by, auditory imagery, or by emphasized attention to rhythm, sound, or meaning . When image is used to mean a picture in one's head, it is assumed that this representation is not a literal one but merely acts as if one had a mental picture that is an analog of a real-world scene. Also, the image in this sense is assumed to be a construction or a synthesis of an earlier event and not merely a copy of some previously experienced sensory (visual, auditory, tactile, gustatory, or olfactory) stimulus cf., the discredited reproduction theory of imagery proposed by the...

Seizures in the Alcohol Abuser

Seizures and alcohol are associated through missed doses of medication sleep deprivation as an epileptogenic trigger propensity for head injury toxic coingestions electrolyte abnormalities alcohol withdrawal seizures and alcohol-related seizures. Alcohol-related seizures are precipitated by alcohol intake. The alcohol withdrawal syndrome involves a spectrum of symptoms that follow reduction or cessation of alcohol. Minor symptoms of alcohol withdrawal, which can begin within 24 h of cessation of drinking, include tremulousness, nausea, anxiety, tachycardia, hypertension, and insomnia. When autonomic hyperactivity becomes more pronounced, disorientation, visual hallucinations, paranoid ideation, or delirium may occur, in the symptom complex of delirium tremens.

Cannabis and the cannabinoids

The abrupt withdrawal of very high doses of THC from volunteers has been associated with some withdrawal effects (irritability, insomnia, weight loss, tremor, changed sleep profile, anorexia), suggesting that both physical and psychological dependence may occasionally arise.

Hypothalamic Influences upon Arousal

Certainly, the aforementioned studies that have demonstrated a role for hypothalamic nuclei in sleep indicate that the hypothalamus influences arousal states. However, recent studies have demonstrated that the influence of the hypothalamus on arousal is not restricted to the TM neurons in caudal hypothalamus. In particular, a prominent group of neurons confined to the lateral hypothalamus has recently been implicated in the sleep disorder known as narcolepsy. These neurons express novel neuropep-tides known as hypocretins or orexins and are differentially concentrated within the perifornical nucleus that surrounds the fornix in the tuberal hypothalamus. Mapping studies have shown that hypocretin orexin neurons are similar to TM neurons in that they are confined to hypothalamus and give rise to extensive projections throughout the neuraxis. However, it is also clear that these neurons densely innervate areas (e.g., locus coeruleus) involved in the control of arousal, and there is good...

Rapid Eye Movement Behavior Disorder

RBD is characterized by the emergence of prominent motor activity from sleep, associated with dream content (Schenck and Mahowald, 1990). The motor activity is often violent including punching, kicking, or running from bed with resultant injury to the patient or bed partner. The individual usually is acting out his or her dreams or nightmares. The PSG may demonstrate the presence of augmented electromyographic (EMG) tone during REM sleep. The motor phenomena such as kicking or punching activity, if recorded, occur during the REM state. As mentioned earlier, paroxysmal events in sleep characterized by prominent motor activity or complex behavior may represent manifestations of epileptic seizures or sleep disorders and on rare occasions psychogenic seizures. Frequently, it may be difficult to make a definitive clinical diagnosis based solely on the history. In this situation, video EEG-PSG may prove extremely valuable in defining the nature of the paroxysmal events. If one of the...

Empirical Studies

Since their emergence, the behavioral insomnia therapies have been studied extensively. Indeed, well over 100 published studies have tested one or more of these treatments. A critical review of this voluminous literature is a daunting task and well beyond the scope of this chapter. Fortunately, in 1995 Douglas Murtagh and Kenneth Greenwood conducted a critical review of this literature in order to determine the general and relative effectiveness of the various behavioral insomnia therapies. In this review, they employed special statistical procedures to estimate treatment effects sizes for the behavioral insomnia therapies in general and for each treatment considered individually. As used in these analyses, the term treatment effect size reflected the average amount of difference (expressed as a fraction of the pooled standard deviation) observed between treated and untreated insomnia sufferers. Hence, a hypothetical effect size of 0.5, expressed in such terms, would indicate that...

Withdrawal Phenomena 1 Delirium Tremens

Consisting of agitation, distractability, sleeplessness, visual hallucinations, disorientation, and confusion. Although, the mechanisms are not completely understood, the symptoms reflect CNS hyperactivation, and it is very likely that an imbalance between excitatory and inhibitory transmitter systems in various brain regions is responsible. Transmitter systems that have been primarily implicated are the NMDA glutamate excitatory system, the GABAA inhibitory system, and the dopamine inhibitory system. There is good agreement among investigators that chronic heavy alcohol intake causes an upregulation of the NMDA glutamate excitatory system, a condition that develops presumably as a compensatory effort of the NMDA receptor system to overcome the persistent blockade of NMDA receptors by ethanol. The upregulation consists of an increased amount of NMDA receptor protein, an increased expression of mRNA for synthesis of NMDA receptor subunits, and an enhanced capacity of this receptor...

Sleep Medicine as a Scenario for Medical Grid Application

1 Philipps-University Marburg, Faculty of Medicine, Sleep Disorders Centre 2 Philipps-University Marburg, Faculty of Mathematics and Informatics 3 Charit Universit tsmedizin Berlin, Interdisziplin res schlafmedizinisches Zentrum Sleep loss, excessive fatigue, stress and inattention constitute the social diseases of our century. Within the 24 hour society people tend more and more to exchange sleep and serenity for gain or pleasure. This gradually leads to an excessive rate of sleep disorders, roughly 20 of the population suffer from one. One major symptom, associated with the occurrence of sleep disorders, is the excessive daytime sleepiness (EDS), showing a prevalence of 5-10 in the young and middle-aged and even 2030 in the older-aged 1 . Furthermore, EDS and consecutive microsleep have become a major cause for hazardous car accidents over the last decades 2 3 . Taking these facts into consideration it is understandable that sleep medicine and also sleep related research is...

Drugs used in Parkinsons disease

Approximately 75 of patients with idiopathic Parkinsonism respond satisfactorily to L-dopa therapy with a reduction in their symptoms of at least 50 . In addition to a beneficial change in their motor symptoms, the mood changes associated with the disease also improve. In some patients, L-dopa has an alerting effect and occasionally more disturbing mental symptoms arise. These take the form of hallucinations, paranoia, mania, insomnia, anxiety and nightmares. Older patients being treated with L-dopa appear to be more prone to these effects. In addition, enhanced libido may occur in male patients, which may be socially unacceptable Approximately 15 of patients may show such symptoms, which are often controlled by lowering the dose of the drug. The more severe psychotic episodes appear to be more frequent in those patients who are dementing.

Subtypes of Depression

DSM-IV distinguishes among several subtypes of depression in order to capture some of the different patterns of depressive symptoms with which individuals present. Melancholic depression is characterized by a loss of interest or pleasure in all, or almost all, activities. Individuals with melancholic depression do not show reactivity to normally pleasurable stimuli and do not show even temporary improvements in mood following good events. In addition, at least three of the following symptoms are present the sensation that depression is worse in the morning than in the evening, significant weight loss or loss of appetite, insomnia characterized by early morning awakening, psychomotor agitation, and excessive or inappropriate guilt.

Inflammatory Lesions 1 Infections

Kidneys Spongiform Ultrasound

Creutzfeld-Jacob disease (CJD) belongs to the group of transmissible spongiform encephalopathies. This group occurs in animals (scrapie in sheep and bovine spongiform encephalopathy) and in man (Kuru fatal, familial insomnia Gerstmann-Straussler-Scheinker disease and primarily CJD and a new variant nvCJD). They all share the following features The pathological changes are neuronal degeneration and loss with

Cyclic Alternating Pattern Rate

The percentage ratio of CAP time to sleep time is referred to as CAP rate. CAP rate can be measured in NREM sleep (percentage ratio of total CAP time to total NREM sleep time) and in the single NREM stages (percentage ratio of CAP time in a given stage to the total duration of that stage throughout sleep). In human sleep, CAP rate is an index of arousal instability that shows a u-shaped evolution along the life span (teenagers, mean 43.4 young adults, 31.9 middle aged, 37.5 elderly, 55.3 ) (Parrino et al, 1998) and correlates with the subjective appreciation of sleep quality (the higher the CAP rate the poorer the sleep quality) (Terzano et al., 1990 Terzano and Parrino, 1992). When the increases of CAP rate are not accompanied by relevant variations of the sleep stages (macrostructure), it means that the flexibility of the microstructure (CAP) protects the stability of the macrostructure. However, because CAP rate is a dynamic parameter that measures the effort of the cerebral...

Clinical Presentation

Eye opening, language function, and purposive movements in response to noxious stimulation should be determined to assess the level ofconsciousness. The neuroophthalmologic examination evaluates pupillary size and response to light, spontaneous eye movements, and oculocephalic (doll's eyes) and oculoves-tibular (ice water caloric) responses. In some vegetative patients, spontaneous nystagmus during wakefulness or REM sleep may be present. The respiratory pattern may supply further information concerning the level of the insult. Increased intracranial pressure may be associated with Cheyne-Stokes respiration. In contrast, midbrain pontine lesions may result in central neurogenic hyperventilation, and low pontine lesions can cause apneustic breathing. A common issue concerning the persistent vegetative state focuses on whether patients are able to perceive pain. Careful clinical examination and postmortem studies do not support the concept that these patients experience pain or...

Cyclic Alternating Pattern And Noncyclic Alternating Pattern

CAP is organized in sequences of two or more CAP cycles. Each CAP cycle consists of a phase A and a phase B, each lasting between 2 and 60 s. All CAP sequences begin with a phase A and end with a phase B. In NREM sleep, the phase A patterns are composed of the single or clustered arousal-related phasic events peculiar to the single sleep stages In NREM sleep, the CAP sequences may extend across successive sleep stages and thus the A phases may present different patterns within the same CAP sequence. In REM sleep, due to the lack of EEG synchronization, the A phases consist exclusively of desynchronized patterns (transient activation phases or arousals). Under physiological conditions, the 3-4-min interval between these A phases in REM sleep (Schieber et al., 1971) does not meet the temporal requirements for the scoring of CAP in this sleep stage. The period of sleep between two successive A phases separated by an interval 60 s is scored as NCAP.

Nocturnal Paroxysmal Motor Phenomena

The nature of paroxysmal motor phenomena occurring during sleep has been a matter of debate for many years. Various sleep disorders associated with motor activity such as sleepwalking (somnambulism), sleep talking, night terrors (pavor nocturnus), periodic limb movement disorder, and rapid eye movement (REM)

Arousal and conscious experience

Are anxious, as opposed to relaxed, we are more excited. When we are enthused, as opposed to bored, we are more excited. Emotions such as apprehension, fear, panic, terror, euphoria, bliss, and ecstasy all contain, to varying degrees, a component of excitation or arousal. What appears to distinguish these emotions from one another is the cognition that accompanies the excitement. It may be possible to claim that terror and ecstasy involve an equivalent amount of arousal, but that they differ on a dimension of pleasure, or on our appraisal of whether we can cope with an existing situation. This idea promotes the argument that arousal is non-specific. It is simply the amount of energy (or potential energy) in the system at any point in time. For many years, this notion of non-specific or unidimensional arousal was held to be true by psychologists and physiologists alike. In 1949, Moruzzi and Magoun discovered an area of the brainstem, the reticular formation, which seemed to be wholly...

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