Insomnia Cure Diet

Outsmart Insomnia

Researchers at the University of Oxford have discovered the true cause of insomnia, and are here to give you the cure in this simple eBook that contains the research AND ways to beat insomnia, backed up by the recent scientific discoveries about insomnia. This guide can teach you to fall asleep in 15 minutes or less, by training your brain to allow your body to rest. This book contains only practical information, from all-new studies that have changed the way that doctors are thinking about insomnia. You don't have to wait hour after hour to fall asleep All you have to do is follow the directions in this eBook to retrain your brain to fall asleep when your body is actually tired. This cure for insomnia is permanent, and does not require you to take all manner of mystery drugs just to feel normal. You can get a real, all-natural, good night's sleep! Read more here...

Outsmart Insomnia Overview


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Primary Sleep Disorders Dyssomnias

Psychogenic insomnia is characterized by increased mental tension (inability to relax, anxiety, brooding) and excessive 1 1 concern about sleep itself (constant complaining about an inability to fall asleep or stay asleep, or about waking up too early). Sleep often improves in a new environment (e. g., on vacation). Pseudoinsomnia is a subjective feeling of disturbed sleep in the absence of objective evidence (i.e., normal polysomnography). Restless legs syndrome (RLS) is characterized by ascending abnormal sensations in the legs when they are at rest (e.g., when the patient watches television, or before falling asleep) accompanied by an urge to move the legs. It is sometimes present as a genetic disorder with autosomal dominant inheritance. Periodic leg movements during sleep are repeated, abrupt twitching movements of the legs that may persist for minutes to hours. These two movement disorders may appear together or in isolation both may be either primary...

Diagnosis of insomnia

The diagnostic criteria for insomnia can indeed become very precise. Insomnia in the ICSD 3 was defined as the complaint of an insufficient amount of sleep or not feeling rested after the habitual sleep episode, which might denote that sleep quantity and quality should be considered as equivalent. However, there were actually two quantitative requirements in ICSD for the diagnosis of insomnia at least 20 min sleep latency and at the most 6.5 hours total sleep time, otherwise the condition was considered as sleep state misperception also called pseudoinsomnia 3 . According to ICD-10 4 , the sleep disturbance must have occurred at least three times per week for at least 1 month. The 1-month timeframe is essential also for primary insomnia in the American Psychiatric Association's DSM-IV classification 5 . Also the patient must complain either of difficulty falling asleep or maintaining sleep, or of poor quality of sleep. However, the presence of the complaint of unsatisfactory sleep is...

Treatment of insomnia

The effective management of insomnia begins with recognition and adequate assessment. Family doctors and other health care providers should routinely enquire about sleep habits as a component of overall health assessment. Identification and treatment of primary psychiatric disorders, medical conditions, circadian disorders, or specific physiological sleep disorders, such as sleep apnea and periodic limb movement disorder, are essential steps in the management of insomnia 8 . Insomnia may be distinguished in two different states. The first is a state of transient insomnia due to an acute event, while the second is the state of chronic insomnia. What is required in the first case is a treatment lasting for a few days only, i.e., for the period of the underlying event that caused insomnia. Such a case requires a medicine able to induce sleep immediately, while its effect quickly diminishes, so that the individual does not experience after effects when awakened. In the case of chronic...

Secondary Sleep Disorders

Secondary Sleep Disorders

Depression (of various types) can impair sleep, though paradoxically sleep deprivation can ameliorate depression. Depressed persons typically complain of early morning awakening, nocturnal restlessness, and difficulty in starting the day. Sleep disturbances are also common in patients suffering from psychosis, mania, anxiety disorders, alcoholism, and drug abuse. Neurogenic sleep disorders. Sleep can be impaired by dementia, Parkinson disease, dys-tonia, respiratory disturbances secondary to neuromuscular disease (muscular dystrophy, amyotrophic lateral sclerosis), epilepsy (nocturnal attacks), and headache syndromes (cluster headaches, migraine). Fatal familial insomnia is a genetic disorder of autosomal dominant inheritance (p. 252). Sleep disorders due to systemic disease. Sleep can be impaired by pulmonary diseases (asthma, COPD), angina pectoris, nocturia, fibromyalgia, and chronic fatigue syndrome.

Physiology Of Healthy Sleep

Normal sleep is made up of rapid eye movement (REM) sleep and non-REM sleep. In non-REM sleep, the sleeper passes from wakefulness into stage I, a light sleep that is easily disrupted by environmental stimuli. Stage II is deeper and most stimuli will pass unnoticed by the sleeper. Stages III and IV are deeper still and the sleeper's electroencephalogram (EEG) shows higher-voltage slow waves, leading to these stages of sleep being described as deep, slow-wave, or delta-wave sleep. Here environmental stimuli go unnoticed unless extreme and prolonged. The normal sleep cycle consists of passage from wakefulness to stage I, then through the stages to the deeper levels of sleep. The sleeper then returns to stage II, which occupies the greater part of the night, and from that level into a period of REM sleep. During REM sleep, the sleeper is dreaming and exhibits high levels of cortical activation but with muscle atonia that prevents the movements usually associated with such activation....

Alcohol Induced Sleep Disorder

Alcohol consumed at bedtime may decrease the time required to fall asleep but typically disrupts the second half of the sleep cycle, resulting in subsequent daytime fatigue and sleepiness. Even a moderate dose of alcohol consumed within 6 hours prior to bedtime can increase wakefulness during the second half of sleep (Vitiello, 1997). Alcohol use prior to bedtime will also aggravate obstructive sleep apnea, and heavy drinkers or those with alcoholism are at increased risk for sleep apnea. Patients with severe obstructive sleep apnea are at a fivefold increased risk for fatigue-related traffic crashes if they consume two or more drinks per day compared to obstructive sleep apnea patients who consume little or no alcohol (Bassetti & Aldrich, 1996). In alcoholics, heavy drinking eventually leads to increased time required to fall asleep, frequent awakenings, and a decrease in subjective quality of sleep. Slow-wave sleep is interrupted, and during periods of withdrawal there is...

Sleep disorders

Research into sleep disorders (see 6.06 Sleep) has intensified over the last decade given new generations of hypnotics and the success of the novel wake-promoting agent modafinil. The sleep spectrum involves insomnia, narcolepsy, and excessive daytime sleepiness (EDS). Dyssomnias are primary sleep disorders characterized by an abnormal amount, quality, or timing of sleep, and include primary insomnia, narcolepsy, and breathing-related sleep disorder. Primary insomnia is defined as a difficulty in initiating or maintaining sleep, or an inability to obtain restorative sleep. Insomnia is a highly prevalent sleep disorder estimated to affect 35 of the population during the course of a year, with 60 of those afflicted reporting chronic insomnia lasting longer than 1 month. Chronic insomnia is often accompanied by impairments in social and occupational function. Insomnia is roughly twice as common in females as in males, is more frequently observed in patients 60 years and older, and is...


Melatonin is a hormone produced in the pineal gland, a small gland in the brain. Melatonin is involved in regulating circadian rhythms, the regular daily cycles of the body, such as sleeping and waking. Blood levels of melatonin are high at night and low during the day. Many therapeutic benefits have been claimed for melatonin. Most studies have evaluated its effects on sleeping problems. For insomnia, some, but not all, clinical investigations have shown a therapeutic effect with melatonin. Melatonin also may be effective for the prevention of jet lag. A possible role of melatonin in causing MS has been proposed. In one study, high blood levels of melatonin were associated with a later age of onset of the disease and a shorter duration of the disease. The significance of these findings in relation to melatonin causing MS or the effect of taking melatonin supplements on MS is not known People with MS should be aware that melatonin may activate the immune system. The effects of...

Primary insomnia

The high prevalence of insomnia is well documented. One national phone survey estimated that 9 of the population reported difficulties sleeping on a consistent basis, and 27 indicated occasional sleeping problems 7 . A large survey-based epidemiological study conducted in France 8 found that 19 of the population met criteria for insomnia as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) 9 . Another recent study assessed the sleep of 772 individuals using 2 weeks of sleep diaries and found that 16 of individuals reported consistent sleeping problems for at least 6 months, including reported daytime impairment 1 . The prevalence studies noted above only consider the general population without regard for differences between specific groups. Research has identified many characteristics that may influence the frequency severity of insomnia complaints including age, gender, socioeconomic status, and ethnicity. It is well documented that insomnia complaints...

Introduction and history

The word 'narcolepsy' refers to a syndrome of unknown origin that is characterized by abnormal sleep tendencies, including excessive daytime sleepiness and often disturbed nocturnal sleep and pathological manifestations of REM sleep. The REM sleep abnormalities include sleep onset REM periods and the dissociated REM sleep inhibitory processes, cataplexy and sleep paralysis. Excessive daytime sleepiness, cataplexy, and less often sleep paralysis and hypnagogic hallucinations are the major symptoms of the disease 12 .

Pharmacological studies

Systematic pharmacological studies have also been conducted in canine narcolepsy. Pharmacological studies performed in these animals suggest that both the choliner-gic and monoaminergic systems are critically involved. The administration of choli-nomimetic drugs known to increase REM sleep exacerbates cataplexy in narcoleptic dogs, while the administration of anticholinergic substances decreases cataplexy 78 . These results are similar to the facilitation of REM sleep obtained in animals after pharmacological increase of the central cholinergic transmission 79 . On the other hand, drugs that block the reuptake of noradrenaline have a powerful anti-cataplectic effect 80, 81 , as opposed to dopamine-reuptake inhibitors, which seem to have little effect on canine cataplexy. Animal studies also looked at the pharmacology of a and 3 adrenergic receptors. a-1 adrenergic antagonists (prazosine, phenoxyben-zamine) facilitated, whereas a-1 adrenergic agonists (methoxamine, cirazoline)...

Obstructive sleep apnea

Factors that predispose to OSA include obesity, gender, age, ethnic (including genetic) factors, and craniofacial structure, and OSA may be aggravated by use of certain drugs and smoking. It is pathophysiologically characterized by repetitive episodes during sleep of upper airway narrowing and or closure, accompanied by increased breathing efforts in attempts to overcome such narrowing closure, also by arousals and or outright wakenings from sleep, as well as attendant respiratory and cardiovascular perturbations such as hypoxia, systemic and pulmonary hypertension and tachy- and bradycardia. The adverse effects of OSAS are well documented, and include poor sleep quality and consequent neurobehavioral dysfunction, reduced daytime vigilance and excessive daytime sleepiness, and risk for motor vehicle and other accidents, and cardiovascular morbidity and mortality 3-8 . A full description of the epidemiology, the diagnosis and clinical correlates of OSA has been presented recently 1, 2,...

Other drug therapies

There may be some amelioration of sleep-disordered breathing in OSA patients treated with tricyclic antidepressants, such as protriptyline and imipramine, possibly through a REM stage-restricting effect 68, 69 . Improvement in the OSA symptom of daytime sleepiness, independent of any effect on sleep quality or architecture, has been reported in some studies with protriptyline 70 . However, a recent Cochrane Systematic Review comparing studies using protriptyline and placebo found no significant advantage for the active drug in terms of AHI or any other objective measure of respiratory disturbance in sleep 70 . Chronic systemic hypertension is certainly a common association of OSA. Acute blood pressure rises also occur during termination of apneas. Short-term trials of antihypertensives in OSA have had varying modest effects on indices of sleep-disordered breathing. Cilazapril, an ACE inhibitor, and the -blocker metoprolol both reduce AHI by about 30 in OSA patients 77 . Some calcium...

Clinical features

Narcoleptic individuals experience EDS, usually associated with REM sleep phenomena, such as sleep paralysis, cataplexy (emotion-induced weakness), and hypnagogic hallucinations (visual, tactile, kinetic, and auditory phenomena occurring during sleep onset) 37 . Disrupted nocturnal sleep occurs frequently. Sleepiness is usually the first symptom to appear, followed by cataplexy, sleep paralysis and hypnagogic hallucinations 6, 37-40 . Cataplexy onset occurs within five years after the occurrence of daytime somnolence in approximately two thirds of the cases 38, 40 . The mean age of onset of sleep paralysis and hypnagogic hallucinations is also 2-7 years later than that of sleepiness 39, 41 . In most cases, EDS and irresistible sleep episodes persist throughout the lifetime. Several tests have been designed to objectively evaluate sleepiness. Yoss et al. 52 described the electronic pupillogram as a method of measuring decreased levels of sleepiness. Schmidt and Fortin 53 reviewed the...

Current Clinical Neurology

Sleep Disorders in Women From Menarche Through Pregnancy to Menopause, edited by and Peter J. Kelly, 2004 Clinical Handbook of Insomnia, edited by Hrayr P. Attarian, 2004 Critical Care Neurology and Neurosurgery, edited by Jose I. Suarez, 2004 Alzheimer's Disease A Physician's Guide to Practical Management, edited by

Affective disorders depression and bipolar disease

Major depression (see 6.03 Affective Disorders Depression and Bipolar Disorders) is a chronic disorder that affects 10-25 of females and 5-12 of males. Suicide in 15 of chronic depressives makes it the ninth leading cause of death in the USA. Presenting complaints for depression include depressed or irritable mood, diminished interest or pleasure in daily activities, weight loss, insomnia or hypersomnia, fatigue, diminished concentration, and recurrent thoughts of death. The World Health Organization (WHO) has estimated that approximately 121 million individuals worldwide suffer from depression and that depression will become the primary disease burden worldwide by 2020. In the majority of individuals episodes of depression are acute and self-limiting. The genetics of major depression are not well understood and have focused on functional polymorphisms related to monoaminergic neurotransmission as the majority of effective antidepressants act by facilitating monoamine availability....

Studies in MS and Other Conditions

Symptoms of MS that have been investigated in some aromatherapy research are anxiety, depression, pain, and insomnia. For anxiety, studies of variable quality indicate that beneficial effects may be obtained with the use of lavender oil, Roman chamomile oil, and neroli (orange) oil. However, no large, well-designed clinical studies have examined this antianxiety effect. Preliminary information suggests that a lower dose of antidepressant medication may be needed by depressed men when the medication is used in combination with aromatherapy using a citrus fragrance. Lavender in bath water does not appear to relieve childbirth-associated pain. Positive and negative results have been obtained in other studies of aromatherapy and pain. Several fragrances, especially lavender, have been evaluated in sleep studies in animals and humans. Some positive results have been reported, but these studies are of variable quality.

Medical Implications of OSA

Severe cardiovascular disease is also common in patients with OSA. Hypertension, cardiac arrhythmia, left ventricular dysfunction, myocardial infarction, pulmonary hypertension, stroke, and sudden death are all more common in patients with this condition.10 Systemic hypertension has been reported in up to 50 of patients with OSA, and one report implicated undiagnosed OSA in as many as 40 of patients with essential systemic hypertension.11 In an often quoted study by He et al.12 in 1988, a large cohort of patients with OSA were evaluated at the Henry Ford Hospital Sleep Disorders Center and followed for up to 9 years. Untreated subjects with an AHI of > 20 had significantly increased mortality compared with those with less severe AHI scores. Aggressive treatment with nasal continuous positive airway pressure (CPAP) appeared to reverse this trend, clearly implicating OSA for the increased mortality.

Selective norepinephrine reuptake inhibitors

SNRIs are a class of antidepressants characterized by a mixed action on both major monoamines of depression NE and serotonin. In essence, SNRIs are improved TCAs with less off-target activity, e.g., muscarinic, histaminic and -adrenergic receptors, and MAOI. The combination of inhibition of 5HT and NE uptake confers a profile of effectiveness comparable to TCAs and is reported to be higher than SSRIs, especially in severe depression. SNRIs are purported to be better tolerated than TCAs and more similar to SSRIs without the associated sexual dysfunction seen with the latter. Venlafaxine (38) and milnacipran (4) have been approved so far, and several others are in development. They are active on depressive symptoms, as well as on certain comorbid symptoms (anxiety, sleep disorders) frequently associated with depression. SNRIs appear to have an improved rate of response and a significant rate of remission, decreasing the risk of relapse and recurrence in the medium and long term and...

Preparation for Quitting

The physician should then provide the patient with some basic didactic information about quitting smoking. (1) Smoking represents an addiction to nicotine. Therefore smoking cessation must be undertaken as seriously as one would approach any other drug addiction. Willpower alone is insufficient. The patient must make quitting smoking his her top priority. (2) The goal should be total tobacco abstinence after the quit date. (3) The patient can expect to experience unpleasant nicotine withdrawal symptoms (e.g. mood disturbance, insomnia, irritability,

Current Classification Systems

Inappropriate Stimulus Control of Behavior. Maladaptive responses may arise from formerly innocuous and inappropriate stimuli that have acquired the capacity to elicit highly intense emotional reactions. This category involves autonomic reactivity and the physiological response. Disorders are reflected in a wide variety of somatic complaints, including muscular tension, anxiety, phobia, insomnia, fatigue, gastrointestinal disorders, and cardiovascular disturbances. Control of the previously innocuous stimuli is brought about through aversive and vicarious classical conditioning. There are serious questions about the validity of these assumptions. It is not at all clear that conditions such as tics, stuttering, phobias, compulsive rituals, obesity, and sleep disorders can be viewed as disorders of interpersonal relations or maladaptive styles of interacting. Even though a number of conditions, such as the personality disorders, may

New Research Areas

The multiple receptor systems involved in sleep-wake regulation11 could provide avenues for future research as the biology becomes more fully elucidated. Histamine receptor (H3) antagonists are an active area of research where NCEs have reached clinical evaluation but proof of concept is still required. The orexin pathway has a clear link to the pathophysiology of narcolepsy, and selective OX2 antagonists are being targeted for clinical proof of concept. Drugs that can target the circadian clock mechanisms and related regulatory systems may offer new therapeutic approaches. Drugs targeting receptors for transforming growth factor a (TGFa) and prokineticin are two potential avenues for circadian rhythm modulation.12 Recent studies suggest a role for urotensin II receptors in the regulation of REM sleep through direct activation of cholinergic neurons in the brainstem but it is too early to know whether agents could be identified that could directly target the CNS receptors avoiding the...

Background and Introduction

The female sex hormone estrogen plays an essential role in reproduction and is important for the overall maintenance of physiologic homeostasis in a woman's body.1'2 During menopause, which occurs in women at an average age of 51, the amount of estrogen produced by the ovaries decreases and this estrogen deficiency causes menstrual periods to become less frequent and then stop.3-5 The loss of estrogen is responsible for many of the uncomfortable symptoms associated with menopause, including hot flashes, mood swings or depression, sleep disorders, vaginal dryness, and urinary dysfunction.6 Osteoporosis or bone loss is another consequence of reduced estrogen levels after menopause.7-11 In women, bone density increases until ages 30-35,12 but slowly declines after menopause.13 Postmenopausal women are also at increased risk for coronary heart disease (CHD)14,15 and Alzheimer's disease,16-18 as a result of estrogen deficiency. The realization that the symptoms reported by postmenopausal...

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.

Pharmacologic Therapy

Fluoxetine (Sarafem) and sertraline (Zoloft) have been approved for the treatment of PMDD. SSRIs are recommended as initial drug therapy in women with PMS and PMDD. Common side effects of SSRIs include insomnia, drowsiness, fatigue, nausea, nervousness, headache, mild tremor, and sexual dysfunction. Insomnia, drowsiness, fatigue, nausea, nervousness, headache, mild

Causes of hypothyroidism

Hyperthyroidism symptoms include nervousness, anxiety, insomnia, tachycardia, palpitations, atrial fibrillation, heat intolerance, weight loss, diarrhea, menstrual irregularities (hypomenorrhea), increased appetite, and thyroid stare. Check thyroid function tests. Usually TSH is low, andT4 (primary) is high. Exophthalmos and pretibial myxedema are specific for Graves' disease. Treatment begins with antithyroid drugs (propylthiouracil or metliimazole). Most patients eventually require further therapy. Use surgery for patients under 25 or pregnant women and radioactive iodine for patients over 40. For patients 24-40, treatment is controversial, and either approach is acceptable. Propranolol is used for thyroid storm (the patient decompensates, physically and mentally, from very high thyroid hormone levels) and sympto matic tachycardia, palpitations, and arrhythmias.

Pharmacology Of Alcohol

More important than the disruption of the cell membrane is the effect of alcohol on the gamma-aminobutyric acid (GABA) system and glutamate system of the brain. The brain has three types of GABA receptors A, B, and C. GABA A receptors are the targets for alcohol, benzodiazepines, barbituates, and neurosteroids. Stimulation of the GABA receptor by the binding of these compounds causes an ion channel to open temporarily and emit chloride ions into the cell. Alcohol enhances the influx of chloride ion, and the result is sedative and anxiolytic effects. Chronic use of alcohol down-regulates the GABA system, and the neuron eventually becomes dependent on alcohol to enable GABA to function. If alcohol is withdrawn, the opening of the chloride ion channel fails, because GABA is no longer capable of performing the task secondary to the cell, having adapted to the role of alcohol. Thus, the cell becomes hyperexcitable, leading to irritability, insomnia, hypertension, tachycardia, and possibly...

Trauma History and Response to Trauma History

A history of trauma is significant in evaluating for trauma sequelae including dissociative phenomena, hyperarousal, depression, eating disorders, substance use disorders, psychiatric disorders (especially posttrau-matic stress disorder), domestic violence, and commercial sex work. Specific questions about posttrau-matic stress disorder include those about dissociation, intrusive thoughts, flashbacks, nightmares, easy startle, hypervigilance, insomnia, and a sense of a foreshortened future.

Sleep Wake Cycle and Hypnotics

Pharmacotherapeutic measures are indicated only when causal therapy has failed. Causes of insomnia include emotional problems (grief, anxiety, stress), physical complaints (cough, pain), or the ingestion of stimulant substances (caffeine-containing beverages, sympa-thomimetics, theophylline, or certain antidepressants). As illustrated for emotional stress (B2), these factors cause an imbalance in favor of excitatory influences. As a result, the interval between going to bed and falling asleep becomes longer, total sleep duration decreases, and sleep may be interrupted by several waking periods. Depending on the type of insomnia, benzodiazepines (p. 226) with short or intermediate duration of action are indicated, e.g., triazolam and brotizolam (ti 2 4-6 h) lormetazepam or temaze-pam (t1 2 10-15 h). These drugs shorten the latency of falling asleep, lengthen total sleep duration, and reduce the frequency of nocturnal awakenings. They act by augmenting...

General Appearance Manner and Attitude

And neatness of attire, responsiveness, cooperation, and ability to maintain eye contact. Observation for psychomotor retardation (slowing) or agitation can be helpful. The psychiatrist can listen carefully for rate, quality, tone, audibility, modulation, and form of speech, including evidence ofprosody, aphasias, or dysphasias. Additionally, observation of skin for icterus, pallor, cyanosis, edema, rashes, or other lesions can be helpful. The psychiatrist should also evaluate whether the patient appears healthy or ill, robust or cachectic, with signs of wasting and protein energy undernutri-tion. Obvious signs ofspecific medical illness or organ impairment include seizures, involuntary movements, tremors, paresis, paralysis, facial droop or asymmetry, exophthalmos, neck fullness, spider angiomata, asci-tes, anascarca, dyspnea, clubbing, and pedal edema. The psychiatrist can look for signs of delirium such as fluctuating levels of consciousness, mood, and behavior and falling asleep...

Single global question and psychometrics

Usually subscales are made up of items that are positively correlated. However, there maybe problems with the statistical methodology, factor analysis, that often underlie this approach, as described by Fayers and Hand 49 who have attempted to divide symptoms into causal and effect indicators. Thus, increased nausea might cause a decrease in overall QL (i.e. nausea is a causal indicator), whereas poor overall QL might result in depression (i.e. depression is an effect indicator). In addition, some factors, such as insomnia, may be considered as both causal and effect indicators (see Fig. 6.5).

Endogenous Depression

In this condition, the patient experiences profound misery (beyond the observer's empathy) and feelings of severe guilt because of imaginary misconduct. The drive to act or move is inhibited. In addition, there are disturbances mostly of a somatic nature (insomnia, loss of appetite, constipation, palpitations, loss of libido, impotence, etc.). Although the patient may have suicidal thoughts, psychomotor retardation prevents suicidal impulses from being carried out. In A, endogenous depression is illustrated by the layers of somber colors psychomotor drive, symbolized by a sine oscillation, is strongly reduced. Fluoxetine, along with sertraline, fluvoxamine, and paroxetine, belongs to the more recently developed group of SSRI. The clinical efficacy of SSRI is considered comparable to that of established antidepressants. Added advantages include absence of cardiotoxicity, fewer autonomic nervous side effects, and relative safety with overdosage. Fluoxetine causes loss of appetite and...

The Course Of Acute Stress Reactions

Across the literature, there are reports of high rates of emotional numbing (Feinstein, 1989 Noyes, Hoenk, Kuperman, & Slymen, 1977), reduced awareness of one's environment (Berah, Jones, & Valent, 1984 Hillman, 1981), derealization (Cardena & Spiegel, 1993 Noyes & Kletti, 1977 Sloan, 1988 Freinkel, Koopman, & Spiegel, 1994), depersonalization (Noyes et al., 1977 Cardena & Spiegel, 1993 Sloan, 1988 Freinkel et al., 1994), intrusive thoughts (Feinstein, 1989 Cardena & Spiegel, 1993 Sloan, 1988), avoidance behaviors (Cardena & Spiegel, 1993 North, Smith, McCool, & Lightcap, 1989 Bryant & Harvey, 1996), insomnia (Feinstein, 1989 Cardena & Spiegel, 1993 Sloan, 1988), concentration deficits (Cardena & Spiegel, 1993 North et al., 1989), irritability (Sloan, 1988), and autonomic arousal (Feinstein, 1989 Sloan, 1988) in the weeks after a traumatic experience. Despite the high prevalence of acute stress reactions, it appears that

Dill Anethum graveolens Apiaceae

Dill is native to the Mediterranean and west Asia, where both leaves and fruit have long been used. Dill was present in Late Neolithic lake settlements in Switzerland, 7th century bc Samos, and the tomb of Amenophis II in Egypt. It figures in Theophrastus' Inquiry into Plants and Apicius' recipes. In the Middle Ages, burned dill seeds placed on wounds reputedly speeded healing. Dill was also used for indigestion and insomnia. It has been cultivated in England since 1570, but grown commercially in the United States only from the early 19th century. It is an ingredient of curry powder.

Soon After The Earthquake

After 1 week, the focus of health care was shifted from emergency medical care to care for chronic patients, including those with hypertension, diabetes mellitus, and mental disorders 4,5 . Care for demented elderly and mentally handicapped people in shelters posed difficult problems. Insomnia was common at crowded shelters. Acute stress responses and nightmares were reported. Psychiatric emergency care was established at some shelters. The Hyogo Prefectural Mental Health Center played a key role in coordinating mental health care to victims. After 10 days, the life in shelters became very stressful for many victims. An increase of acute stress responses, including serious stress peptic ulcer, was reported. The Department of Internal Medicine of Kobe University Medical School was busy with the treatment of many cases of extremely serious bleeding ulcers. Anxiety reactions and sleep disorders were common 6 . An increased occurrence of pneumonia and bronchitis was reported among the...

Benzodiazepine Dependence

Benzodiazepine Biotransformation

Prolonged regular use of benzodiaze-pines can lead to physical dependence. With the long-acting substances marketed initially, this problem was less obvious in comparison with other dependence-producing drugs because of the delayed appearance of withdrawal symptoms. The severity of the abstinence syndrome is inversely related to the elimination t1 2, ranging from mild to moderate (restlessness, irritability, sensitivity to sound and light, insomnia, and tremulousness) to dramatic (depression, panic, delirium, grand mal seizures). Some of these symptoms pose diagnostic difficulties, being indistinguishable from the ones originally treated. Administration of a benzodiazepine antagonist would abruptly provoke abstinence signs. There are indications that substances with intermediate elimination half-lives are most frequently abused (violet area in B).

Suicide by Motor Vehicles

A small number of single motor vehicle accidents are suicides. Typically, drivers crash their cars head-on into a fixed object such as a concrete bridge, an embankment, or a utility pole. The individual turns off the road and drives a significant distance, straight into the object, without using the brakes. It is usually obvious from a study of the tire tracks that such individuals had sufficient time to turn back onto the road or avoid the obstacle if they had accidentally gone off the road. In addition, if the death was witnessed, no brake lights would have been observed. There are probably other such suicides that go undetected. The cause of the accident in such cases is attributed to drinking or falling asleep at the wheel.

Initial Evaluation Of The Patient With Substance Use Disorders

Sleep disorders Sexual dysfunction Delirium Dementia Amnestic disorders ally begins crossing the blood-brain barrier within 15-20 seconds. Physical signs of acute opiate intoxication include euphoria and tranquility, sedation, slurred speech, problems with memory and attention, and miosis. Signs and symptoms of opioid withdrawal can be both objective (rhinorrhea and lacrimation, nausea and vomiting, diarrhea, piloerection, mydria-sis, yawning, and muscle spasms) and subjective (body aches, insomnia, craving, dysphoria, anxiety, hot and cold flashes, and anorexia). Heroin withdrawal usually begins within 4 to 8 hours after last use, whereas with methadone, with its longer elimination half-life, withdrawal may not begin until 24 to 48 hours after last use.

Harold W Goforth Mary Ann Cohen and James Murrough

Mood disorders have complex synergistic and catalytic interactions with HIV infection. They are significant factors in nonadherence to risk reduction and to medical care. Mood disorders associated with HIV include illness- and treatment-related depression and mania, responses to diagnoses of HIV, and comorbid primary mood disorders such as major depressive disorder and bipolar disorder. While persons with HIV and AIDS may have potentially no or multiple psychiatric disorders, alterations in mood are frequent concomitants of HIV infection. They have a profound impact on quality oflife, level ofdistress and suffering, as well as direct and indirect effects on morbidity, treatment adherence, and mortality. In this chapter we will describe the significance of each of the mood disorders and their impact on the lives ofpersons with HIV and AIDS and on their families and caregivers. More detailed discussions of the epidemiology and prevalence of mood disorders are found in Chapter 4....

Pharmacologic Highlights

If the patient develops signs of alcohol withdrawal (restlessness, insomnia, thirst, and tremors progressing to fever, hallucinations, and combative and irrational behavior), notify the physician and decrease stimulation as much as possible. Place the patient in a quiet, darkened room with a cool temperature. Provide frequent sips of water and fruit juices, but avoid fluids with caffeine. Place the patient in a room where she or he can be monitored frequently to decrease the risk of injury.

General Health Questionnaire

The GHQ focuses on the client's ability to carry out normal functions and the appearance of any new disturbing phenomena. Designed for use by doctors, psychiatrists and researchers, the GHQ is ideal for use in community and non-psychiatric settings and has four different versions GHQ-60 the fully detailed 60-item questionnaire, GHQ-30 a short form without items relating to physical illness, GHQ-28 a 28 item scaled version - assesses somantic symptoms, anxiety and insomnia, social dysfunction and severe depression, and GHQ-12 a quick, reliable and sensitive short form - ideal for research studies

Valerian root Valeriana officinalis Valerianaceae

The combined root and rootstock of the (common) valerian with its characteristic old socks smell is used pharmaceutically to treat sleep disorders and other related conditions. It is a licensed medicine in many European countries and is currently grown commercially in Russia, Japan, the United States, Belgium, Holland, and Germany. The species has been used through the centuries in many European regions. L. Fuchs lists a variety of uses including as a diuretic and gynecological aid, but he does not include uses for sleep disorders.

Machine Readable Descriptions of Chemical Structure

In order to undertake virtual screening, it is first necessary to convert chemical structure into an easy to interpret machine readable format. While a number of methods have been proposed for two-dimensional (2D) structure depiction of chemical entities,10 connection tables are the most important representation to emerge. Perhaps the most widely applied of these is the structure data (SD) file. This file was designed to permit the movement of large numbers of molecules and their associated data between databases. Chemical structures are stored in a connection table which houses x and y atom coordinates based on bond lengths (z coordinates can be added when three-dimensional (3D) data is to be stored) together with associated atom type, chirality, and bond connection data.11 A connection table is in essence a graph containing the complete and explicit description of molecular topology and forms an easily analyzable repository of 2D chemical data for VS. Graph theory forms the...

Differential Diagnosis

Reports of sudden-onset depression and suicidal ideation after treatment with interferon alpha 2a (discussed above) and or efavirenz. Early reports suggested that efavirenz may be associated with at least transient neuropsychiatric side effects in excess of 50 of patients (Staszewski et al., 1999). Reported effects are protean and include depression, suicidal ideation, vivid nightmares, anxiety, insomnia, psychosis, cognitive dysfunction, and antisocial behavior (Bartlett and Ferrando, 2004). Some, but not all, reports suggest that patients with a prior history of substance use or other psychiatric disorders are at greater risk for the neuropsy-chiatric side effects of efavirenz (Bartlett and Ferrando,

G Electroencephalogram

Electroencephalography is used as a diagnostic neurological tool (classification of seizure type, localisation of epileptogenic focus and recognition of specific epileptic syndromes) and for the intra-operative monitoring of global cerebral hypoxia. Activation procedures in clinical use include Hyperventilation for 3-4 minutes Natural sleep recording 24 hour sleep deprivation

Description Medical Nonmalignant Breast

In reviewing breastfeeding history, note if the frequency or regularity of feedings has changed. Fully investigate (1) the length of time the infant spends feeding (2) the time between feedings (3) if the infant is falling asleep at the breast (4) if the infant is sleeping through the night (5) if the infant receives supplementary water, juice, or formula and (6) if the infant receives bottled breast milk.

Tobacco Nicotiana spp Solanaceae

Other early accounts corroborate this description of native tobacco use. Edmund Gardiner, writing at the beginning of the 17th century, describes native enchanters (i.e., shamans) getting drunk on tobacco smoke and then falling into a deep sleep. On awakening they would tell of the visions they had seen and divine their meaning. Although Gardiner, in line with most of his contemporaries, interpreted Native American experiences with tobacco as delusions of the devil, it is clear that the plant was attributed with inebriating and hallucinogenic properties by early Europeans as well as by the native peoples themselves.

Culturing Immortalized Xenopus Melanophores

The following day, add melatonin or MSH to the cells in serum free medium. Aggregation or dispersion, respectively, should occur within 15 min but takes about 1 h to reach completion. 12. Scrape up aggregated or dispersed cells with a rubber policeman and place in Xenopus lysis buffer containing either melatonin or MSH.

Recovery after a Stroke

After a stroke, many people experience feelings of depression (see page 345). They may feel frustrated or isolated, especially if they have not been able to return to their usual routine or if they are having problems communicating with others. Symptoms of depression include sleeplessness, indifference, and withdrawal. For most of these people, the depression is temporary. It may be helpful for the person to join a support group to share experiences and information with others who are in a similar situation. Talking with a psychiatrist or another mental health professional may help the person cope with and overcome his or her depression. To treat prolonged depression, a doctor may prescribe antidepressant medications such as tricyclic antidepressants, serotonin reuptake inhibitors, monoamine oxidase inhibitors, or bupropion.

Amitriptyline hydrochloride

Action Kinetics Amitriptyline is metabolized to an active metabolite, nortriptyline. Has significant anti-cholinergic and sedative effects with moderate orthostatic hypotension. Very high ability to block serotonin uptake and moderate activity with respect to norepinephrine uptake. Effective plasma levels of ami-triptyline and nortriptyline Approximately 110-250 ng mL. Time to reach steady state 4-10 days. tV2 31-46 hr. Up to 1 month may be required for beneficial effects to be manifested. Amitriptyline is also found in Limbritrol and Triavil. Uses Relief of symptoms of depression, including depression accompanied by anxiety and insomnia. Chronic pain due to cancer or other pain syndromes. Prophylaxis of cluster and migraine headaches. Non-FDA Approved Uses Pathologic laughing and crying secondary to forebrain disease, bulimia nervosa, antiulcer agent, enuresis. Contraindications Use in children less than 12 years of age. How Supplied Injection 10 mg mL Tablet 10 mg, 25 mg, 50 mg, 75...

Star anise Illicium verum Illiciaceae

Star anise is the only non-poisonous species of Illicium. The tree is native to southwest China. The fruits and seeds are used in Chinese cooking and also medicinally for colic, constipation, insomnia, and other purposes. They contain a volatile oil, similar in composition to those of dill and aniseed. The first known record of trade in the fruits is from the Philippines in 1588. Clusius bought star anise fruits in London in 1601 and later they were traded to Europe along the tea route from China via Russia as Siberian cardamoms. Production today remains concentrated in China.

Sleep and The Reticular Formation

The EEG obtained during sleep suggests that the brain passes through several stages of sleep. Wakefulness is characterized by high frequency, low voltage activity. During the early phases of sleep, after about 90 minutes, high frequency, low voltage activity is observed, accompanied by movements of the eyeball and dreaming. This is the so-called rapid eye movement (REM) sleep phase. With time during sleep, the EEG becomes progressively more low frequency, high voltage in character (so-called slow-wave sleep) until eventually the order is back to REM sleep. This sequence may be repeated about five or six times during each physiological sleep period. During the sleep period, intervals between REM episodes decrease, and the length of REM periods increases. The reticular formation is important also in the factors that cause the animal to fall asleep. If the reticular formation is le-sioned in the mid-pons, the animal is no longer able to fall asleep. Furthermore, if a hypnotic drug such...

Yohimbe and Yohimbine

Limited studies have evaluated the effectiveness and safety of yohimbe for sexual disorders. Some studies indicate that yohimbe may be beneficial for erectile dysfunction in men and decreased libido in women. However, it has many serious side effects, including severely decreased blood pressure, abnormalities of heart rhythm (arrhythmias), heart failure, and death. Other side effects include insomnia, anxiety, tremor, high blood pressure, rapid heart rate, headache, nausea, and vomiting. The FDA has determined that yohimbe is not safe or effective and that it should not be available for over-the-counter use. Yohimbine, the active ingredient in yohimbe, is available by prescription in the United States.

Generalized Anxiety Disorder351

Tic worry or dread about the circumstances of daily life. The excessive worries often pertain to many areas of the affected person's life, including work, relationships, finances, personal health, the well-being of one's family, perceived misfortunes, and impending deadlines. Affected people can experience a variety of symptoms, including feelings of fear and dread, restlessness, muscle tension, a rapid heart rate, light-headedness, poor concentration, insomnia, increased perspiration, cold hands and feet, and shortness of breath. Symptoms typically worsen during stressful periods.

Distinguishing Medical And Nonmedical Use Of Benzodiazepines

Is the substance used to treat a diagnosed medical problem, such as anxiety or insomnia, or is it used to get high (or to treat the complications of nonmedical use of other drugs) Typical medical use of a benzodiazepine or other controlled substance occurs without the use of multiple nonmedical drugs, whereas nonmedical use of the benzodiazepines is usually polydrug abuse. Although alcoholics and drug addicts sometimes use the language of medicine to describe their reasons for using controlled substances nonmedically, self-administration or self-medication of an intoxicating substance outside the ordinary practice boundaries of medical care is a hallmark of drug abuse (DuPont, 1998).

NHypothalamicpituitary axis

A circadian rhythm of pituitary hormone release is superimposed on the pulsatile release mechanisms. This rhythm is generated by the paired supra-chiasmatic nuclei in the anterior hypothalamus, which receive afferent information from the retina and convey efferent information to the pineal gland, thereby affecting melatonin release. Sleep-wake cycles thereby influence pituitary hormone release. The pulsatile release of pituitary hormones is altered at puberty, during ovulatory menstrual cycles and with advancing age.

Identification Of Problems Among Longterm Benzodiazepine Users

Physicians frequently encounter patients, or family members of patients, who are concerned about the possible adverse effects of long-term use of a benzo-diazepine in the treatment of anxiety or insomnia. In helping to structure the decision making for such a patient, we use the Benzodiazepine Checklist (DuPont, 1986 see Table 10.2). There are four questions to be answered

As Sources Of Distress

Insomnia One area that has been linked to distress and a reduction in quality of life in HIV is insomnia. Complaints of lack of sleep from persons with HIV disease are ubiquitous, but etiologies are varied and often include a combination of comorbid Axis I conditions, medical conditions affecting sleep quality, and potentially a direct role of HIV on the brain. In a review of insomnia in the setting of HIV, Reid and Dwyer (2005) noted that up to 60 ofHIV-positive individuals experienced sleep disturbances, and greater psychological distress appeared to be related to greater sleep difficulties and lower numbers of CD3 and CD8 cells. This review highlights the importance of effective interventions designed to improve sleep quality and in turn potentially reduce distress and improve life quality. Further details of HIV-associated sleep abnormalities are addressed in Chapter 15.

Longterm Dose And Abuse

Other common nonmedical patterns are to use benzodiazepines (often alprazolam or lorazepam) concomitantly with stimulants (often cocaine or methamphetamine) to reduce the unpleasant experiences of the stimulant use, and or to use benzodiazepines (often triazolam Halcion ) to treat the insomnia that accompanies stimulant abuse. Daily use of benzodiazepines, even when there is no dose escalation and no abuse of alcohol or other nonmedical drugs has led to controversy. Clinical experience has shown that even over long periods of daily use, benzodiazepines typically do not lose their efficacy and do not produce significant problems for most patients. An example of this experience was a study of 170 adult patients treated for a variety of sleep disorders continuously with a benzodiazepine for 6 months or longer over a 12-year period. The study found sustained efficacy, with low risk of dose escalation, adverse effects, or abuse (Schenck & Mahowald, 1996).

Newer Sedative and Hypnotic Agents

In recent years, a variety of alternatives to the benzodiazepines have become available to treat both anxiety and insomnia. Buspirone (Buspar) has been shown to reduce anxiety in generalized anxiety disorders, but it does not suppress panic attacks, and is not used as a primary treatment of obsessive-compulsive disorder. Buspirone is not abused by alcoholics and drug addicts, and it does not produce withdrawal symptoms on abrupt discontinuation. Like the antidepressants, buspirone requires several weeks of daily dosing to produce antianxiety effects, which are less dramatic from patients' point of view than are the effects produced by the benzodiazepines (Sussman & Stein, 2002). The antidepressants as a class have been shown to possess antipanic and antianxiety effects opening a new range of uses for these medicines in the treatment of anxiety disorders. The selective serotonin reuptake inhibitors (SSRIs) have emerged as the first-line treatment for many anxiety disorders...

Mary Alice ODowd and Maria Fernanda Gomez

Shakespeare's Macbeth recognized the vital role of sleep in the renewal and nourishment of mind and body, but until recently, medical science has tended to give sleep disorders scant attention. Insomnia, the most common sleep disorder, can be a symptom of many disorders and has been described as a major public health problem that impacts the lives of millions of individuals, their families, and communities (NIH, 2005). However, random studies of adults have found that the majority of those with sleep complaints are unlikely to broach the topic with a health care provider (Martin and Ancoli-Israel, 2003). When a patient does complain of insomnia, the complaint may be either given short shrift by the clinician or a sleep medication maybe prescribed for short-term use without much attention to the etiology of the complaint or to follow-up. Insomnia is not just an annoyance. It has been shown to affect cognitive functioning, quality of life, and even longevity (Martin and Ancoli-Israel,...

Clinical and Medical Uses of Chronometry

Cognitive effects of normal aging, mild cognitive impairment, senile dementia, traumatic brain and closed head injuries, mortality, under-nutrition and malnutrition in children, eating disorders, parasitic infections, neurological effects of HIV and AIDS, drug effects and addictions, multiple sclerosis, sleep disorders, diabetes, attention deficit and hyperactivity disorder (ADHD), stroke, vascular dementia, degenerative brain diseases associated with aging (Huntington, Alzheimer, Parkinson), epilepsy, chronic fatigue syndrome, hypoxia, post-traumatic stress disorder (PTSD), psychiatric disorders (anxiety, schizophrenia, depression, bipolar), yoga and meditation, chemical, pharmaceutical, and nutriceutical (e.g., Gingko biloba) agents.

Sleep Disturbance In

Clinicians have long been aware of the frequency with which insomnia and fatigue figure in the complaints of individuals living with HIV. Fatigue and sleep disturbance can affect a wide range of activities and even health itself in this population, as the healing benefits of sleep are lost at the time when patients have the greatest need of rest and renewal. A study that compared HIV-positive and HIV-negative homosexual men found that the HIV-infected patients were significantly more likely to report a problem with fatigue, although they slept more and napped more than the HIV-negative subjects. This fatigue interfered with important activities such as employment and driving and was also correlated with measures of immunosuppression and inflammation (Darko et al., 1992). Why do HIV-positive individuals feel fatigued and sleep poorly Although these two complaints are obviously interrelated, they are not synonymous. Some patients with HIV infection may sleep relatively well, wake up...

GABAa Receptor Agonists

The GABAA receptor is an important target for the development of new drugs for a wide array of CNS disorders such as epilepsy, sleep disorders, anxiety, stress, depression, and cognitive failure.85-87 The development of novel GABAA receptor ligands as innovative drugs is specifically directed toward the design of partial agonists with an improved selectivity of action, inverse agonists for the treatment of cognitive failure, and receptor subtype selective ligands.

Sedative Hypnotic or Anxiolytic Induced Disorders

Dependence Abuse Intoxication Withdrawal Intoxication delirium Withdrawal delirium Induced persistent amnesic disorder Induced psychotic disorders With delusions With hallucinations Induced mood disorder Induced anxiety disorder Induced sexual disorder Induced sleep disorder

Assessment and Case Formulation

Results of the pretreatment assessment indicated that Danielle met full diagnostic criteria for PTSD, characterized primarily by symptoms of avoidance and intrusive thoughts related to the sexual abuse. Danielle was also exhibiting moderate levels of anxiety, including fear of men, difficulty falling asleep, and difficulty separating from her mother and grandparents. Similarly, Ms. Williams's responses to standardized measures revealed that she was experiencing moderate symptoms of depression, such as excessive guilt and self-blame, PTSD-related symptoms such as intrusive thoughts and avoidance of topics related to the sexual abuse, and excessive anger about the sexual abuse.

Restless Legs Syndrome

Restless legs syndrome (RLS) features nocturnal involuntary limb movements that can cause insomnia because of frequent sleep disruption, and often affects bed partners because of frequent myoclonic-type jerking. It generally begins in early adulthood and affects from 2 to 5 of the population. RLS may run in families, with susceptibility genes identified on chromosomes 12q and 14q. RLS has also been associated with Parkinson's disease, pregnancy, end-stage renal disease, iron deficiency anemia, peripheral neuropathy, and diabetes.

Minimal criteria B plus C or A plus D plus E plus G Severity criteria

Adapted from The International Classification of Sleep Disorders, Revised Diagnostic and Coding Manual. Rochester American Sleep Disorders Association, 1997. criteria for both obstructive and varieties of central sleep apnea are located in the section on sleep in the criteria adapted from the American Sleep Disorders Associations International Classification of Sleep Disorders Diagnosis and Coding Manual.

Classification Antitubercular drug

Uses Prevention of disseminated Mycobacterium avium complex (MAC) disease in clients with advanced HIV infection. Contraindications Hypersensitiv-ity to rifabutin or other rifamycins (e.g., rifampin). Use in clients with active tuberculosis. Lactation. Special Concerns Safety and efficacy have not been determined in children, although the drug has been used in HIV-positive children. Side Effects Oral Taste perversion, discolored saliva (brownish-orange). GI Anorexia, abdominal pain, diarrhea, dyspepsia, eructation, flatulence, N& V. Respiratory Chest pain, chest pressure or pain with dyspnea. CNS Insomnia, seizures, paresthesia, aphasia, confusion. Musculoskeletal Asthenia, myalgia, arthralgia, myo-sitis. Body as a whole Fever, headache, generalized pain, flu-like syndrome. Dermatologic Rash, skin discoloration. Hematologic Neutro-penia, leukopenia, anemia, eosino-philia, thrombocytopenia. Miscella

Ensuring Utilization of Services

In the Hoge et al. (2004) study of Iraq or Afghanistan War returnees, concern about stigma as a result of seeking help was greatest among those most in need of help. Although most of those screening positive for a mental health problem acknowledged having a problem (78 ), many indicated that they don't trust mental health professionals, that mental health care doesn't work, that they would be seen as weak if they sought help (65 ), that participation in mental health services would harm their career, or that seeking help would be too embarrassing (41 ). Difede et al. (in press) reported that, among emergency services workers who responded to the World Trade Center collapse, distress at trauma reminders was seen as a normal reaction to the events and not a reason to seek treatment. Rather, anger, irritability, and sleep problems were seen as reasons to seek help. Zatzick et al. (2001a) conducted an open-ended assessment of the concerns expressed by...

Diagnostic Criteria for Central Sleep Apnea Syndrome

Complaint of insomnia or excessive sleepiness. The patient may occasionally be unaware of clinical facts that are nevertheless apparent to others. c. Oxygen desaturation associated with the apneic episodes (criteria included in the International Classification of Sleep Disorders).

National Heart Lung and Blood Institute NHLBI

NHLBI is one of the constituents of the National Institutes of Health, established to provide leadership in programs related to diseases of the heart, lungs, and blood as well as sleep disorders. NHLBI conducts and supports research and demonstration projects in all aspects of heart, blood, and lung disorders. It also operates an information center to disseminate information, including relevant publications on matters of the heart, lungs, and blood.

Other CAM Therapies

Homeopathy is a low-risk approach of uncertain effectiveness for sleep problems. Several supplements are promoted for insomnia. As discussed elsewhere in this book, melatonin may be beneficial, but in people with MS it is associated with a theoretical risk because of its immune-stimulating activity. 5-HTP, another supplement, has unclear effectiveness for insomnia and may be harmful. Marijuana has produced positive results in some studies. However, it also may cause significant side effects and is illegal in most states. Kava kava sometimes is recommended for insomnia, but most studies of this herb have actually only evaluated its effectiveness for anxiety. In any case, kava kava should be avoided because of possible liver toxicity.

Assessing Psychopathology Across Cultures

Additional challenges arise when these systems are used with non-Western cultural and ethnic groups. First, because these systems rely primarily on clinical diagnosis, they may obscure cultural differences and or similarities in specific symptoms. Thus, cultural differences in prevalence rates of clinical depression, for example, may belie cultural differences in the specific symptoms of depression, such as depressed mood, loss of energy, and sleep problems. Second, behavior that is defined as abnormal by these Western classification systems may fall well within the realm of normal behavior in other cultural contexts. In Puerto Rico, for instance, dissociative states are considered normal aspects of religious and spiritual practices, whereas in many Western contexts, they are considered symptoms of mental illness (Lewis-Fernandez, 1998). Third, abnormal behaviors in non-Western cultural contexts may be excluded in

Biopharmaceutical Considerations

Factorial design and artificial neural networks have been used in the optimization of transdermal drug delivery formulations using in vitro skin permeation techniques (62-64). For example, Kandimalla et al. (63) optimized a vehicle for the transdermal delivery of melatonin using the response surface method and artificial neural networks. Briefly, three solvents (water, ethanol, and propylene glycol) were examined either as single solvents or binary and ternary mixtures. Measurements of skin flux, lag time, and solubility were made for ten vehicles and compared with values predicted from both a response surface generated from a quartic model and an artificial neural network employing a two-layered back-propagation network with all ten design points in the hidden layer. Predictability of flux using both statistical techniques was good (Table 6), suggesting that such models may be useful in preliminary formulation optimization. Table 6 Experimental Versus Predicted Fluxa of Melatonin...

Acute Disturbances of Consciousness

Coma (from the Greek for deep sleep) is a state of unconsciousness in which the individual lies motionless, with eyes closed, and cannot be aroused even by vigorous stimulation. Coma reflects a loss of the structural or functional integrity of the RAS (p. 116) or the areas to which it projects. Coma may be produced by an extensive brain stem lesion or by extensive bi-hemispheric cerebral lesions, as well as by metabolic, hypoxic ischemic, toxic, or endocrine disturbances. In the syndrome of transtentorial herniation (see p. 162), a large unihemispheric lesion can cause coma by compressing the mid-brain and the diencephalic RAS. Even without herniation, however, large unihemispheric lesions can transiently impair consciousness.

Indications for UPPP in Snoring

Surgery for snoring has followed national trends in our department. Increasing numbers of patients are electing to undergo LAUP and somnoplasty, rather than traditional UPPP. All patients requesting surgery for snoring have a thorough preoperative clinical evaluation similar to that for OSA. Patients with marked tonsillar hypertrophy, redundant pharyngeal mucosa, or nasal obstruction requiring correction under general anesthesia are encouraged to undergo UPPP. All others are considered candidates for LAUP or somnoplasty. Although the American Sleep Disorders Association recommends that all surgical candidates for snoring procedures such as LAUP undergo PSG to screen for OSA, we do not believe that it is cost effective. However, all our candidates for LAUP or somnoplasty are informed of the risks of missing the diagnosis of OSA, and patients suspected of suffering from OSA based on the information obtained from the history and physical examination are encouraged to undergo PSG.

Swedish Health Related Quality Of Life Survey

Likert Survey Healthy Lifestyle

The Swedish Health related Quality of Life Survey (SWED-QUAL) was developed by Brorsson et al. from the measures used in the US Medical Outcomes Study (MOS). The questionnaire, which is designed to measure health related quality of life, consists of 70 items, of which 63 forms two single-item and 11 multiitem dimension scales of Likert type physical functioning (7 items), mobility (1 item), satisfaction with physical ability (1 item), role limitations due to physical health (3 items), pain (6 items), emotional well-being positive affect (i.e. positive feelings 6 items), emotional wellbeing negative affect (i.e. negative feelings 6 items), role limitations due to emotional health (3 items), sleep problems (7 items), satisfaction with family life (relations with parents, siblings, children etc. 4 items), relation to partner (6 items), sexual functioning (4 items) and general health perception (9 items). - Sleep problems (6 items)

Maintaining a Healthy Weight

Being overweight is a major health problem in the United States, and there are many good reasons to keep your weight within a healthy range. You will feel better, look better, and have more energy than men who are overweight. Having more energy makes you more likely to exercise, which can help you fall asleep faster and sleep more restfully. But the most important reason to keep your weight within a healthy range is that you will lower your risk for certain chronic diseases, including heart disease, high blood pressure, diabetes, and certain forms of cancer. Doctors no longer believe that it is acceptable to gain a few pounds as you age. Maintaining your weight at a reasonable level throughout your life is key when it comes to reducing your risk for disease.

Other Sedatives and Hypnotics

Despite the continued widespread use of antihistamines to treat insomnia, the Food and Drug Administration (FDA), noting the prominent sedative side effects encountered in the administration of antihistamines (including doxylamine, diphenhydramine, and pyrilamine), concluded that the antihistamines are not consistently effective in the treatment of sleep disorders. Tolerance rapidly develops to the sedating effects of these medicines, and the antihistamines can produce paradoxical stimulation. In addition, the antihistamine doses currently approved for the treatment of allergies are inadequate to induce sleep. Antihistamines used to treat sleep disorders can produce daytime sedation because of their relatively long half-lives (Charney et al., 2001). The use of sedating antidepressants such as Desyrel (trazodone) and Elavil (amitriptyline) to treat insomnia at dose levels lower than are effective for the treatment of depression, such as the use of sedating antihistamines for this...

Sedatives Hypnotics and Benzodiazepines

The sedatives and the hypnotics, especially the benzodiazepines, are widely used in medical practice in the treatment of anxiety, insomnia, epilepsy, and for several other indications (Baldessarini, 2001). The combination of abuse by alcoholics and drug addicts, and the withdrawal symptoms on discontinuation leads to the view that these are addictive drugs (DuPont, 2000 Juergens & Cowley, 2003). The pharmacology and the epidemiology of sedatives and hypnotics are reviewed in this chapter, which focuses on the needs of the clinician. As the benzodiazepines became more controversial, and as various regulatory approaches were employed to limit their use in medical practice, there was a danger that clinicians would revert to the older and generally more toxic sedatives and hypnotics, which, in the era of the benzodiazepines, had become unfamiliar (Juergens & Cowley, 2003). Thus, there is more than historical interest in looking at these earlier sedatives, because for some younger...

Univariate Studies of Mood and Anxiety Disorder Symptoms

Kendler et al. (1996) were interested in determining whether various alternative manifestations of depression would show different etiologies. They performed a latent class analysis of the DSM-III-R symptoms of major depression in a population-based sample of female twins. The analysis yielded three classes of clinically significant depressive symptoms, which were termed severe typical depression (distinguished by frequent weight loss and decreased appetite rather than weight gain and increased appetite, insomnia rather than hypersomnia, and frequent co-occurrence of anxiety and panic), ''mild typical depression'' (characterized by similar but less severe symptoms than severe typical depression), and atypical depression (characterized by frequent hypersomnia, increased appetite, and weight gain, associated with co-occurring bulimia). They found that among twins concordant for major depression, concordance for the specific subtype was more common than would be predicted by chance. The...

NOC Child Development Infant

Promotes longer periods of alert and or deep sleep which will enhance the body's own natural defenses providing rest periods will allow infant to recover prior to initiation of additional caregiving prevents sudden disruptions in sleep promotes stability and adaptive behaviors.


Selective 5HT6 agonists and antagonists (e.g., WAY466 (68), Ro-63-0563 (69), SB-171046, and GW 742457) may show therapeutic promise while a selective 5HT7 receptor antagonist (SB-656104-A (70)) has recently been reported to modulate REM sleep, part of the sleep architecture that has long been associated with depression.

Sleep traits

Sleep is a deceptively complex phenomenon, which has physiological, behavioural, psychological and environmental components. It can be identified by sustained physical quiescence in a species-specific posture and site accompanied by reduced responsiveness to external stimuli and characteristic electroencephalogram (EEG) patterns, but where a wakeful condition may be quickly achieved (Zepelin, 1994). The timing and structure of daily sleep are species-specific and refer to the activity pattern of that species, such as diurnal, nocturnal or arrhythmic. The transition from a waking state into sleep in mammals is associated on a cortical level with a change from irregular, low-voltage, fast EEG waves to high-voltage, slow waves. This is called non-REM (NREM) or slow-wave sleep (SWS). Occasionally, the cortical waves change to a desynchronised, regular, low-voltage, fast pattern known as rapid eye movement sleep (REM), or paradoxical sleep (PS). In primates, non-REM sleep has been...

Thyroid Drugs

Special Concerns Geriatric clients may be more sensitive to the usual adult dosage of these hormones. Use with extreme caution in the presence of angina pectoris, hypertension, and other CV diseases, renal insufficiency, and ischemic states. Use with caution during lactation. Side Effects Thyroid preparations have cumulative effects, and over-dosage (e.g., symptoms of hyperthy-roidism) may occur. CV Arrhythmias, palpitations, angina, increased HR and pulse pressure, cardiac arrest, aggravation of CHF. GI Cramps, diarrhea, N& V, appetite changes. CNS Headache, nervousness, mental agitation, irritability, insomnia, tremors. Miscellaneous Weight loss, hyper-hidrosis, excessive warmth, irregular menses, heat intolerance, fever, dyspnea, allergic skin reactions (rare). Decreased bone density in pre- and postmenopausal women following long-term use of levothyroxine.

Blood Brain Barriers

The brain is not uniformly impermeable to blood-borne components. Circulating macromolecules can breach the blood-brain barrier at the circumventricular organs. These are seven areas at the ependy-mal border of the third and fourth ventricles, where hydrophilic solutes can pass through capillaries. The pineal body makes melatonin, and is thought to be involved in certain brain rhythms. The neurohypophysis or posterior pituitary gland releases vasopressin and oxytocin into the peripheral blood stream. The median eminence is where brain neuropep-tides such as CRF and GnRH are released in the portal system (see pp. 301, 303). The area postrema, which lies at the caudal end of the fourth ventricle, is in close contact with the nucleus of the tractus solitar-ius (solitary tract). This site allows passage of chemical stimuli that trigger, for example, the vomiting reflex. The organum vasculosum of the lamina terminalis (OVLT) lies in the wall of the third ventricle, and seems to mediate...

Disease State Classification of Primary Sleep Disorders Sleep disorders encompass a wide variety of clinical syndromes that prior to 1979 lacked a formal classification system. For instance, narcolepsy was considered a neurological disorder while insomnia was classified as a psychiatric disease. The International Classification of Sleep Disorders (ICSD) classified primary sleep disorders into two categories, the dyssomnias (insomnia or excessive sleepiness disorders) and parasomnias (abnormal behaviors or psychological events occurring during sleep) which are distinct from psychiatric sleep disorders.24 The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) (Table 1) divides sleep disorders into four major categories by etiology (1) primary sleep disorders (2) sleep disorders related to other mental disorders (3) sleep disorders due to general medical conditions and (4) substance-induced sleep disorders.25 Primary sleep disorders are divided...

Jnj5207852 Primary Insomnia Tricyclic antidepressants (TCAs) and other antidepressants including amitriptyline, 28, trimipramine, 29, doxepine, 30, mirtazapine, 31, trazodone, 32, and nefazodone, 33, are used to treat insomnia,23 but their therapeutic hypnotic benefit derives from their sedative side effect profiles.

Sleep Profile

The sleep-wake rhythm changes with age. Neonates sleep 16-18 hours a day at irregular intervals. By age 1 year, the sleep pattern stabilizes to roughly 12 hours of sleep alternating with 12 hours of waking. Adults sleep for 4-10 hours nightly, with the median value ca. 8 hours. As adults age, they tend to take longer and more frequent naps, sleep less deeply, and lie in bed longer in the morning. The sleep architecture changes with age neonates have 50 REM sleep, but adults only 18 . After age 50, stages 3 and 4 account for only about 5 of sleep. Persons differ in their sleep-wake patterns (somno-types) there are morning types (larks) and night types (night owls) bedtimes vary by two or more hours among these individuals.

Stress Management

Muscles tighten as stress starts, often causing intense headaches, backaches, and gastrointestinal problems. Stress also can cause testosterone levels to decrease and blood vessels in the penis to constrict, often resulting in erection problems. The rush of hormones caused by a stressful situation can bring on an asthma attack in a person with a history of asthma. Stress also draws the blood supply away from the abdominal area and encourages overproduction of acids in the digestive system, often leading to indigestion and other gastrointestinal problems. Other problems related to stress include insomnia and irritability.


Ness, drowsiness, fatigue, hallucinations, insomnia, lethargy, mental changes, memory loss, strange dreams. GI Diarrhea, ischemic colitis, nausea, mesenteric arterial thrombosis, vomiting. Hematologic Agranulocytosis, thrombocytopenia. Allergic Fever, sore throat, respiratory distress, rash, pharyngitis, laryngos-pasm, anaphylaxis. Skin Pruritus, rash, increased skin pigmentation, sweating, dry skin, alopecia, skin irritation, psoriasis. Ophthalmic Dry, burning eyes. GU Dysuria, impotence, nocturia. Other Hypoglycemia or hyperglycemia. Respiratory Bronchospasm, dyspnea, wheezing. Drug Interactions See also Drug Interactions for Beta-Adrenergic Blocking Agents and Antihypertensive Agents.

Soporifics Hypnotics

During sleep, the brain generates a patterned rhythmic activity that can be monitored by means of the electroencephalogram (EEG). Internal sleep cycles recur 4 to 5 times per night, each cycle being interrupted by a Rapid Eye Movement (REM) sleep phase (A). The REM stage is characterized by EEG activity similar to that seen in the waking state, rapid eye movements, vivid dreams, and occasional twitches of individual muscle groups against a background of generalized atonia of skeletal musculature. Normally, the REM stage is entered only after a preceding non-REM cycle. Frequent interruption of sleep will, therefore, decrease the REM portion. Shortening of REM sleep (normally approx. 25 of total sleep duration) results in increased irritability and restlessness during the daytime. With undisturbed night rest, REM deficits are compensated by increased REM sleep on subsequent nights (B). All hypnotics shorten the time spent in the REM stages (B). With repeated ingestion of a hypnotic on...


Therapeutic indications for benzo-diazepines include anxiety states associated with neurotic, phobic, and depressive disorders, or myocardial infarction (decrease in cardiac stimulation due to anxiety) insomnia prean-esthetic (preoperative) medication epileptic seizures and hypertonia of skeletal musculature (spasticity, rigidity). Triazolam (ti 2 of elimination -1.5-5.5 h) is especially likely to impair memory (anterograde amnesia) and to cause rebound anxiety or insomnia and daytime confusion. The severity of these and other adverse reactions (e.g., rage, violent hostility, hallucinations), and their increased frequency in the elderly, has led to curtailed or suspended use of triazolam in some countries (UK).


Hypothermia occurs more commonly in those individuals who have underlying disease or are incapacitated, such as under the influence of alcohol. People can die from improperly heated homes or apartments or if they are caught outside in the cold. Alcoholics can become hypothermic if they fall asleep in the cold while inebriated. Nursing-home patients can succumb to the cold after becoming confused and walk outdoors during winter months.


Regulations at the various levels of government historically mandated that outpatient detoxification be accomplished within 21 days. Unfortunately, this period was too short for all but the most minimally addicted individuals and frequently resulted in relapse. Fortunately, the regulations have been liberalized, largely because of recognition that HIV AIDS is spread very rapidly among intravenous drug abusers who share needles. Changes in the regulations are intended to allow more addicts to enter and stay in treatment. As a practical matter, 30 days is the minimum amount of time required for successful detoxification, and often 45 days or more may be needed relapse still is a definite risk. For those individuals with long abuse histories and high doses of opioids, 6 months or more may be required. Veteran opioid users are extremely sensitive to even small reductions in their daily dose of methadone. The critical stage of detoxification occurs below 20 mg of methadone daily, and the...

Pineal gland

The pineal gland is attached to the roof of the third ventricle, and lies outside the blood-brain barrier. It weighs 100-150 mg and has a length of about 9 mm. It is a homologue of the third or parietal eye of the lower vertebrates. The pineal starts to involute just prior to puberty. The gland consists of neurons, neuroglial cells and pinealocytes, which secrete melatonin into the CSF. The environmental light-dark cycle and autonomic circadial stimulation by the suprachiasmatic nuclei of the hypothalamus (the endogenous circadian oscillator) modulate the secretion of melatonin by the pineal (which takes place in the dark phase of the cycle). This contributes to the maintenance of biological rhythms. Melatonin is derived from circulating L-tryptophan. It is not stored in the pineal. There is a gradual increase in levels of melatonin at night and a reduction in the morning of serum melatonin levels. Melatonin can induce a phase shift in the circadian oscillation of activity of the...


Allergic Rhinitis An allergic disorder of humans caused by pollen, house dust, animal dander, or spores of fungi characterized by wheezing, sneezing, coughing, copious flow of watery discharges, itching nose, mouth, excessive flow of tears, headache, and insomnia (also called hay fever and pollenosis).

Child Psychiatry

Attention-deficit hyperactivity disorder (ADHD) as the name implies, affected children are hyperactive and have short attention spans. Males are affected more often than females. Look for a fidgety child who is impulsive and cannot pay attention but is not cruel. Treat with stimulants (paradoxical calming effect) such as methylphenidate (Ritalin) and dextroamphetamine, both of which may cause insomnia, abdominal pain, anorexia, and weight loss or growth suppression.


Valerian may produce its effects by an action similar to that of Valium (diazepam) and related prescription drugs (benzodiazepines). However, the active chemicals and their exact biological activities have not been determined. Ten clinical studies over the past 20 years have suggested that valerian is effective for insomnia. These studies are of variable quality. Sleep disorders are common in MS and may contribute to MS-associated fatigue. Sleeping difficulties may be associated with stress and anxiety. Because of the complexities of diagnosing and treating sleep disorders, this condition should be discussed with a physician. diazepam Valium ) or alcohol. Other side effects include headache, excitability, insomnia, and possible liver toxicity.

Sirens Sleep Solution

Sirens Sleep Solution

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