Categories
Ailmemts & Remedies

Narcolepsy

Definition:
Narcolepsy is chronic sleep disorder, or dyssomnia. The condition is characterized by excessive daytime sleepiness (EDS) in which a person experiences extreme fatigue and possibly falls asleep at inappropriate times, such as whilst at work or at school. A narcoleptic will most probably experience disturbed nocturnal sleep and also abnormal daytime sleep pattern, which is often confused with insomnia. When a person with narcolepsy falls asleep or goes to bed they will generally experience the 4th stage of sleep REM (rapid eye movement/dreaming state), within 10 minutes; whereas for most people, this shouldn’t occur until generally 30 minutes of slumber.
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Cataplexy, a sudden muscular weakness brought on by strong emotions (in most cases, there are many people who will experience cataplexy without having a emotional trigger), is known to be one of the other problems that some narcoleptics will experience. Often manifesting as muscular weaknesses ranging from a barely perceptible slackening of the facial muscles to the dropping of the jaw or head, weakness at the knees, or a total collapse. Usually only speech is slurred, vision is impaired (double vision, inability to focus), but hearing and awareness remain normal. In some rare cases, an individual’s body becomes paralyzed and muscles will become stiff.

The term narcolepsy derives from the French word narcolepsie created by the French physician Jean-Baptiste-Édouard Gélineau by combining the Greek narke numbness, stupor and lepsis attack, seizure.

Symptoms
The main characteristic of narcolepsy is excessive daytime sleepiness (EDS), even after adequate night time sleep. A person with narcolepsy is likely to become drowsy or fall asleep, often at inappropriate times and places. Daytime naps may occur with little warning and may be physically irresistible. These naps can occur several times a day. They are typically refreshing, but only for a few hours. Drowsiness may persist for prolonged periods of time. In addition, night time sleep may be fragmented with frequent awakenings.

Four other classic symptoms of the disorder, often referred to as the “tetrad of narcolepsy,” are cataplexy, sleep paralysis, hypnagogic hallucinations, and automatic behavior. These symptoms may not occur in all patients. Cataplexy is an episodic condition featuring loss of muscle function, ranging from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or inability to speak clearly) to complete body collapse. Episodes may be triggered by sudden emotional reactions such as laughter, anger, surprise, or fear, and may last from a few seconds to several minutes. The person remains conscious throughout the episode. In some cases, cataplexy may resemble epileptic seizures. Sleep paralysis is the temporary inability to talk or move when waking (or less often, falling asleep). It may last a few seconds to minutes. This is often frightening but is not dangerous. Hypnagogic hallucinations are vivid, often frightening, dreamlike experiences that occur while dozing, falling asleep and/or while awakening.

Automatic behavior means that a person continues to function (talking, putting things away, etc.) during sleep episodes, but awakens with no memory of performing such activities. It is estimated that up to 40 percent of people with narcolepsy experience automatic behavior during sleep episodes. Sleep paralysis and hypnagogic hallucinations also occur in people who do not have narcolepsy, but more frequently in people who are suffering from extreme lack of sleep. Cataplexy is generally considered to be unique to narcolepsy and is analogous to sleep paralysis in that the usually protective paralysis mechanism occurring during sleep is inappropriately activated. The opposite of this situation (failure to activate this protective paralysis) occurs in rapid eye movement behavior disorder.

In most cases, the first symptom of narcolepsy to appear is excessive and overwhelming daytime sleepiness. The other symptoms may begin alone or in combination months or years after the onset of the daytime naps. There are wide variations in the development, severity, and order of appearance of cataplexy, sleep paralysis, and hypnagogic hallucinations in individuals. Only about 20 to 25 percent of people with narcolepsy experience all four symptoms. The excessive daytime sleepiness generally persists throughout life, but sleep paralysis and hypnagogic hallucinations may not.

Although these are the common symptoms of narcolepsy, many people with narcolepsy also suffer from insomnia for extended periods of time. The symptoms of narcolepsy, especially the excessive daytime sleepiness and cataplexy, often become severe enough to cause serious problems in a person’s social, personal, and professional life. Normally, when an individual is awake, brain waves show a regular rhythm. When a person first falls asleep, the brain waves become slower and less regular. This sleep state is called non-rapid eye movement (NREM) sleep. After about an hour and a half of NREM sleep, the brain waves begin to show a more active pattern again. This sleep state, called REM sleep (rapid eye movement sleep), is when most remembered dreaming occurs. Associated with the EEG-observed waves during REM sleep, muscle atonia is present (called REM atonia).

In narcolepsy, the order and length of NREM and REM sleep periods are disturbed, with REM sleep occurring at sleep onset instead of after a period of NREM sleep. Thus, narcolepsy is a disorder in which REM sleep appears at an abnormal time. Also, some of the aspects of REM sleep that normally occur only during sleep — lack of muscular control, sleep paralysis, and vivid dreams — occur at other times in people with narcolepsy. For example, the lack of muscular control can occur during wakefulness in a cataplexy episode; it is said that there is intrusion of REM atonia during wakefulness. Sleep paralysis and vivid dreams can occur while falling asleep or waking up. Simply put, the brain does not pass through the normal stages of dozing and deep sleep but goes directly into (and out of) rapid eye movement (REM) sleep.

This has several consequences. Night time sleep does not include as much deep sleep, so the brain tries to “catch up” during the day, hence EDS. People with narcolepsy may visibly fall asleep at unpredicted moments (such motions as head bobbing are common). People with narcolepsy fall quickly into what appears to be very deep sleep, and they wake up suddenly and can be disoriented when they do (dizziness is a common occurrence). They have very vivid dreams, which they often remember in great detail. People with narcolepsy may dream even when they only fall asleep for a few seconds.

Causes
Although the cause of narcolepsy was not determined for many years after its discovery, scientists had discovered conditions that seemed to be associated with an increase in an individual’s risk of having the disorder. Specifically, there appeared to be a strong link between narcoleptic individuals and certain genetic conditions. One factor that seemed to predispose an individual to narcolepsy involved an area of Chromosome 6 known as the HLA complex. There appeared to be a correlation between narcoleptic individuals and certain variations in HLA genes, although it was not required for the condition to occur. Certain variations in the HLA complex were thought to increase the risk of an auto-immune response to protein-producing neurons in the brain. The protein produced, called hypocretin or orexin, is responsible for controlling appetite and sleep patterns. Individuals with narcolepsy often have reduced numbers of these protein-producing neurons in their brains. In 2009 the autoimmune hypothesis was supported by research carried out at Stanford University School of Medicine.

The neural control of normal sleep states and the relationship to narcolepsy are only partially understood. In humans, narcoleptic sleep is characterized by a tendency to go abruptly from a waking state to REM sleep with little or no intervening non-REM sleep. The changes in the motor and proprioceptive systems during REM sleep have been studied in both human and animal models. During normal REM sleep, spinal and brainstem alpha motor neuron depolarization produces almost complete atonia of skeletal muscles via an inhibitory descending reticulospinal pathway. Acetylcholine may be one of the neurotransmitters involved in this pathway. In narcolepsy, the reflex inhibition of the motor system seen in cataplexy is believed identical to that seen in normal REM sleep.

In 2004 researchers in Australia induced narcolepsy-like symptoms in mice by injecting them with antibodies from narcoleptic humans. The research has been published in the Lancet providing strong evidence suggesting that some cases of narcolepsy might be caused by autoimmune disease. Narcolepsy is strongly associated with HLA-DQB1*0602 genotype. There is also an association with HLA-DR2 and HLA-DQ1. This may represent linkage disequilibrium. Despite the experimental evidence in human narcolepsy that there may be an inherited basis for at least some forms of narcolepsy, the mode of inheritance remains unknown. Some cases are associated with genetic diseases such as Niemann-Pick disease or Prader-Willi syndrome.

How common is narcolepsy
The prevalence of narcolepsy is similar to that of Parkinson’s disease and multiple sclerosis. In the United States, the National Institute of Neurological Disorders and Stroke estimates narcolepsy affects one in every 2,000 people. However, in some countries (for example, Israel), the prevalence of narcolepsy is much lower (one per 500,000) while in other countries (for example, Japan), it is much higher (one per 600). The American Sleep Association estimates that approximately 125,000 to 200,000 Americans suffer from narcolepsy, but only fewer than 50,000 are properly diagnosed.

Narcolepsy often remains undiagnosed or misdiagnosed for several years. This may occur because physicians do not consider the diagnosis of narcolepsy frequently enough. They may think of narcolepsy only in people who have the main symptom of excessive daytime sleepiness. Narcolepsy may not be considered in the evaluation of patients who come to doctors complaining of fatigue, tiredness, or problems with concentration, attention, memory, and performance, and other illnesses (seizures, mental illness, etc.).
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Narcolepsy has its typical onset in adolescence and young adulthood. There is an average 15-year delay between onset and correct diagnosis which may contribute substantially to the disabling features of the disorder. Cognitive, educational, occupational, and psychosocial problems associated with the excessive daytime sleepiness of narcolepsy have been documented. For these to occur in the crucial teen years when education, development of self-image, and development of occupational choice are taking place is especially damaging. While cognitive impairment does occur, it may only be a reflection of the excessive daytime somnolence.

The prevalence of narcolepsy is about 1 per 2,000 persons. It is a reason for patient visits to sleep disorder centers, and with its onset in adolescence, it is also a major cause of learning difficulty and absenteeism from school. Normal teenagers often already experience excessive daytime sleepiness because of a maturational increase in physiological sleep tendency accentuated by multiple educational and social pressures; this may be disabling with the addition of narcolepsy symptoms in susceptible teenagers. In clinical practice, the differentiation between narcolepsy and other conditions characterized by excessive somnolence may be difficult. Treatment options are currently limited. There is a paucity in the literature of controlled double-blind studies of possible effective drugs or other forms of therapy. Mechanisms of action of some of the few available therapeutic agents have been explored but detailed studies of mechanisms of action are needed before new classes of therapeutic agents can be developed. Narcolepsy is an underdiagnosed condition in the general population. This is partly because its severity varies from obvious to barely noticeable. Some people with narcolepsy do not suffer from loss of muscle control. Others may only feel sleepy in the evenings.

Diagnosis
Diagnosis is relatively easy when all the symptoms of narcolepsy are present, but if the sleep attacks are isolated and cataplexy is mild or absent, diagnosis is more difficult. It is also possible for cataplexy to occur in isolation. Two tests that are commonly used in diagnosing narcolepsy are the polysomnogram and the multiple sleep latency test (MSLT). These tests are usually performed by a sleep specialist. The polysomnogram involves continuous recording of sleep brain waves and a number of nerve and muscle functions during nighttime sleep. When tested, people with narcolepsy fall asleep rapidly, enter REM sleep early, and may awaken often during the night. The polysomnogram also helps to detect other possible sleep disorders that could cause daytime sleepiness.

For the multiple sleep latency test, a person is given a chance to sleep every 2 hours during normal wake times. Observations are made of the time taken to reach various stages of sleep (sleep onset latency). This test measures the degree of daytime sleepiness and also detects how soon REM sleep begins. Again, people with narcolepsy fall asleep rapidly and enter REM sleep early.
You may click to learn more     http://www.medicinenet.com/narcolepsy/page4.htm

Treatment
Treatment is tailored to the individual, based on symptoms and therapeutic response. The time required to achieve optimal control of symptoms is highly variable, and may take several months or longer. Medication adjustments are also frequently necessary, and complete control of symptoms is seldom possible. While oral medications are the mainstay of formal narcolepsy treatment, lifestyle changes are also important.

The main treatment of excessive daytime sleepiness in narcolepsy is with a group of drugs called central nervous system stimulants such as methylphenidate, racemic – amphetamine, dextroamphetamine, and methamphetamine, or modafinil, a new stimulant with a different pharmacologic mechanism. In Fall 2007 an alert for severe adverse skin reactions to modafinil was issued by the FDA.  Other medications used are codeine and selegiline. Another drug that is used is atomoxetine (Strattera), a non-stimulant and Norepinephrine reuptake inhibitor (NRI), that has little or no abuse potential. In many cases, planned regular short naps can reduce the need for pharmacological treatment of the EDS to a low or non-existent level.

Cataplexy and other REM-sleep symptoms are frequently treated with tricyclic antidepressants such as clomipramine, imipramine, or protriptyline, as well as other drugs that suppress REM sleep. Venlafaxine, a newer antidepressant which blocks the reuptake of serotonin and norepinephrine, has shown usefulness in managing symptoms of cataplexy[citation needed]. Gamma-hydroxybutyrate (GHB), a medication recently approved by the FDA, is the only medication specifically indicated for cataplexy. Gamma-hydroxybutyrate has also been shown to reduce symptoms of EDS associated with narcolepsy. While the exact mechanism of action is unknown, GHB is thought to improve the quality of nocturnal sleep.

In addition to drug therapy, an important part of treatment is scheduling short naps (10 to 15 minutes) two to three times per day to help control excessive daytime sleepiness and help the person stay as alert as possible. Daytime naps are not a replacement for nighttime sleep. Ongoing communication between the health care provider, patient, and the patient’s family members is important for optimal management of narcolepsy. Finally, a recent study reported that transplantation of hypocretin neurons into the pontine reticular formation in rats is feasible, indicating the development of alternative therapeutic strategies in addition to pharmacological interventions.

Learning as much about narcolepsy as possible and developing a support system or finding a support group may help patients and families deal with the practical and emotional effects of the disorder, possible occupational limitations, and situations that might cause injury. Individuals with narcolepsy should avoid jobs that require driving long distances or handling hazardous equipment or that require alertness for lengthy periods. They may find it helps to take a nap before driving if possible or have a scheduled nap break during a long driving trip.
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The National Sleep Foundation, University at Buffalo, and Mayo Clinic suggest it may help sufferers if they alert their employers, co-workers and friends in the hope that others will accommodate their condition and help when needed. The foundation say it may help if the sufferer breaks up larger tasks into small pieces and focuses on one small thing at a time, and if they carry a tape recorder, if possible, to record important conversations and meetings. The clinics say taking several short walks during the day may help sufferers.

What’s in the future for narcolepsy?

The discovery that a lack of hypocretins in the cerebrospinal fluid (CSF) may be related to the cause of narcolepsy could lead to the development of tests to determine the level of hypocretins in the CSF. Such tests could help in the diagnosis of narcolepsy. The expectation is that these tests will be simple (drawing blood), and will reflect the level of hypocretins in the CSF. In addition, the discovery of the role of hypocretins in the development of narcolepsy may lead to the development of new drugs for the treatment of narcolepsy.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.


Resources:

http://en.wikipedia.org/wiki/Narcolepsy
http://www.medicinenet.com/narcolepsy/article.htm

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Categories
Ailmemts & Remedies

Breathing Disorders During Sleep

You Can Snore Your Life Away.
This sounds more like a joke than a warning. But, in fact, habitual loud snoring is the most common symptom of breathing disorders that occur during sleep. The person who snores not only sleeps restlessly, but also is at risk for serious disorders of the heart and lungs. Snoring can therefore be lifethreatening because it can lead to high blood pressure, irregular heart beats, heart attacks, and sudden death.

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Normal breathing must continue at all times whether awake or asleep. The act of breathing is an automatic, highly regulated mechanical function of the body. In healthy sleeping individuals, most muscular and neural activities will slow or even shut down but respiration goes on under a neuromuscular “auto pilot.” However, if something goes wrong with the auto pilot during sleep, breathing may become erratic and inefficient.

Understanding Sleep
Sleep is a complex neurological state. Its primary function is rest and restoring the body’s energy levels. Repeated interruption of sleep by breathing abnormalities such as cessation of breathing (apnea) or heavy snoring, leads to fragmented sleep and abnormal oxygen and carbon dioxide levels in the blood. Excessive daytime sleepiness and various disorders of the heart, lungs, and the nervous system result.

In the 1950’s scientists realized that sleep is not just a quiet state of rest. In fact, two stages of sleep occur with distinct physiological patterns-rapid-eye-movement sleep (REM), and non rapid-eye-movement sleep (NREM) or deep sleep. In normal sleep, REM occurs about 90 minutes after a person falls asleep. The two sleep stages recur in cycles of about 90 minutes each, with three non-REM stages (light to deep slumber) at the beginning and REM towards the end. The amount of sleep needed by each person is usually constant although there is a wide variation among individuals.

How sleep occurs and how it restores the body are not well understood. Scientists originally believed that sleep occurs because the brain lapses into a passive resting state from lack of stimulation. Another theory proposed that sleep occurs when the body generates and accumulates sufficient amounts of a “sleep-inducing substance.” However, research now suggests that sleep results when specific changes in brain function occur. By studying brain waves, scientists can define and measure various degrees, levels, and stages of sleep.

Sleep consists of a rhythmic combination of changes in physiological, biochemical, neurophysiological and psychological processes. When the rhythm is disturbed or the individual processes are abnormal during sleep, a variety of sleep-related disorders may result.

Sleep-Related Disorders
Sleep-related complaints appeared regularly in medical literature in the beginning of the 19th century. However, from 1900 to the mid-1960s little was published in scientific journals about the “sleepy patient” except for an occasional report on the normal or abnormal aspects of sleep physiology. Recent developments of research techniques in neurobiology, molecular biology, molecular genetics, physiology, neuropsychiatry, internal medicine, pulmonary medicine, and cardiology have allowed scientists to study the details of sleep. As a result, there has been an explosion in interest in understanding sleep and “sleep disorders.”

Some sleep-related disturbances are simply temporary inconveniences while others are potentially more serious. Sleep apnea is the major respiratory disorder of sleep. Other serious sleep-related disorders are narcolepsy and clinical insomnia. “Jet lag syndrome,” caused by rapid shifts in the biological sleep-wake cycle, is also an example of a temporary sleep-related disorder. So are the sleep problems experienced by shift workers. Sleep apnea is the condition of interrupted breathing while asleep. “Apnea” is a Greek word meaning “want of breath.” Clinically, sleep apnea, first described in 1965, means cessation of breathing during sleep.

Narcolepsy is a neurological disorder whose main symptoms in uncontrollable, excessive sleep, regardless of the time of day or whether the person has had enough sleep during the previous night. The other features of this disorder can include brief episodes of muscle weakness or paralysis caused by laughter and anger (cataplexy), paralysis for brief periods upon awakening from sleep (sleep paralysis), and dreamlike images at sleep onset (hypnagogic hallucination). Narcolepsy, which may affect several members of the same family, is a life-long condition. Medications help to reduce the symptoms but do not cure the disease.

Insomnia is the commonly experienced difficulty in falling asleep, remaining asleep throughout the night, and the inability to return to sleep once awakened. Its causes may be physical or psychological and it may occur regularly or only occasionally.

Even a partial list of all the disorders caused by or associated with disturbed sleep adds up to some 70 items. The costs to society due to loss of productivity, industrial accidents and medical bills are estimated to be over $60 billion. These staggering statistics led to the creation by the U.S. Congress in 1988 of a National Commission of Sleep Disorders Research. This group is charged with task of developing a blueprint for a national effort to reduce the medical and economic consequences of sleep disorders.

Likely Candidates for Sleep-Related Disorders

Some of the people most likely to have or to develop a sleep-related disorder include:

* adults who fall asleep at inappropriate times and places (e.g., during conversation, lecturing, driving) and who exhibit nighttime snoring
* elderly men and women
* postmenopausal women
* people who are overweight, or have some physical abnormality in the nose, throat, or other parts of the upper airway
* night-shift workers
* people who habitually drink too much alcohol
* blind individuals who tend to develop impaired perception of light and darkness and have disturbed circadian rhythms, the cycles of biologic activities that occur at the same time during each 24 hours
* people with depression and other psychotic disorders.

Click to see:->Sleep related breathing disorders in adults with Down syndrome
Sleep and Breathing Disorders
In 1944, the important observation was made that ventilation (exchange of air between the lung and environment) normally decreases during sleep. Even in “normal” people, breathing patterns during sleep may show a few irregularities. For example, a person might experience an average of seven breathing pauses of up to 10 seconds per night without any associated symptoms or problems. However if the breathing irregularities are accompanied by reduced oxygen supply to tissue (hypoxia) and repeated loss of sleep, these people are at risk of developing more serious problems.

Sleep Apnea...
Sleep apnea is the most common sleep disorder in terms of mortality and morbidity, especially in middle-age men. Perhaps the best known sleep apnea “patient” is Charles Dickens’ Fat Joe in The Posthumous Papers of the Pickwick Club, the overweight, red-faced boy in a permanent state of sleepiness, who snored and breathed heavily. The term “Pickwickian” syndrome is now used to describe patients with the most severe form of sleep apnea that is associated with reduced levels of breathing even during the day. Click to see:->Sleep apnea patients have altered cardiovascular responses during exercise recovery

Sleep apnea occurs in all age groups and both sexes, but seems to predominate in males (it may be underdiagnosed in females) and in African Americans. The Association of Professional Sleep Societies estimates that as many as 20 million Americans have this condition. The conditions associated with sleep apnea are a cascade: apnea, arousal, sleep deprivation, and excessive daytime sleepiness. Each is related to the frequency of the prior condition.

Like obesity with which it is often associated, the clustering of sleep apnea in some families suggests a genetic abnormality. Ingestion of alcohol and sleeping pills increases the frequency and duration of breathing pauses during sleep in people with or without sleep apnea.

Because of serious disturbances in their normal sleep patterns, patients with sleep apnea feel sleepy during the day and their concentration and daytime performance suffer. The common consequences of sleep apnea range from annoying to life-threatening. They include personality changes, sexual dysfunction and falling asleep at work, on the phone, or driving.

Symptoms of Sleep Apnea
Patients with sleep apnea have many repeated involuntary breathing pauses during sleep. The length of the breathing pause can vary within a patient, and among patients, and can last for 10 seconds to 60 seconds. Fewer than 30 such breathing pauses during a 7-hour sleep, or shorter breathing pauses, are not considered indicative of sleep apnea. Most sleep apnea patients experience 20 to 30 “apneic events” per hour, more than 200 per night. These pauses may occur in clusters.

The breathing pauses are often accompanied by choking sensations which may wake up the patient, intermittent snoring, nighttime insomnia, early morning headaches, and excessive daytime sleepiness, although not all patients, for some reason, complain of daytime sleepiness. During the apneic events, a person may turn blue from low blood oxygen levels.

Other features of sleep apnea include slowing down of heart beat below 60 beats per minute (bradycardia), irregular heart beat (cardiac arrhythmias), high blood pressure (both systemic and pulmonary arterial), increase in red cells in the blood (polycythemia), and obesity. The absence of restful sleep may cause deterioration of performance, depression, irritability, sexual dysfunction, and defects in attention and concentration.

Types of Sleep Apnea
Scientists have distinguished three types of sleep apnea: obstructive, central, and mixed. However, since all three types can have the same symptoms and signs, a sleep evaluation is needed to tell the difference among them.

Obstructive Sleep Apnea (OSA) is the most common type. During OSA efforts to breath continue but air cannot flow out of the patient’s nose or mouth. The patient snores heavily and has frequent arousals (abrupt changes from deep sleep to light sleep) without being aware of them.

OSA occurs when the throat muscles and tongue relax during breathing and partially block the opening of the airway. When the muscles of the soft palate at the base of the tongue and the uvula (the small conical fleshy tissue hanging from the center of the soft palate) relax and say, the airway becomes obstructed marking breathing labored and noisy. Airway narrowing may also occur due to overweigh, possibly because of the associated increases in the amount of tissue in the airway.

The reduction in oxygen and increase in carbon dioxide which occur during apnea cause arousals. With each arousal, a signal is sent to the upper airway muscles to open the airway; breathing is resumed with a loud snort or gasp. Although arousals serve as a rescue mechanism and are necessary for a patient with apnea, they interrupt sleep, and the patient ends up with less restorative and sleep than normal individuals.

Central Apnea occurs less frequently than obstructive apnea. There is no airflow in or out of the airways because efforts to breathe have stopped for short periods of time. In central apnea, the brain temporarily fails to send the signals to the diaphragm and the chest muscles that maintain the breathing cycle. It is present more often in the elderly than in younger people but often goes unrecognized.

In central apnea, there is periodic loss of rhythmic breathing movements. The airways remain open but air dose not pass through the nose or mouth because activity of the diaphragm and the chest muscles stops. Patients with central apnea may not snore and they tend to be more aware of their frequent awakenings than those with obstructive apnea.

In Mixed Apnea, a period of central apnea is followed by a period of obstructive apnea before regular breathing resumes. People with mixed apnea frequently snore.

Snoring and Sleep Apnea
Snoring is a sign of abnormal breathing. It occurs when physical obstruction causes fluttering of the soft palate and the adjacent soft tissues between the mouth, external orifices of the nose (nares), the upper part of the windpipe (trachea), and the passage extending from the pharynx to the stomach (esophagus).

Snoring always occurs with obstructive sleep apnea. When diagnosing sleep disorders, obstructive sleep apnea is excluded if snoring is not a symptom. All snorers do not necessarily have sleep apnea; however, because they almost certainly have some physical obstruction in their airways, they may develop sleep apnea.

The prevalence of snoring is greater in the older population and apparently peaks in 60-year-old men and women, declining in older individuals. Men seem to snore more than women. Men also are more likely to develop sleep-disordered breathing. It is estimated that nearly half of all males over 40 snore habitually. Snoring is also more common in overweight people.

A visit to the doctor is not necessary when a person snores unless some of the other symptoms of sleep disordered breathing also occur. However, since snoring is an annoying or irritating symptom with some negative social aspects, many people have sought a “cure” for it. More than 300 devices have been patented in the U.S. which claim to control snoring. Many of these devices were developed even before medical scientists found out that heavy snoring is a potential marker of sleep apnea.

Sleep Apnea and the Heart
Sleep apnea and snoring seems to increase the likelihood of having a variety of cardiovascular diseases. These include high blood pressure, ischemic heart disease (a condition caused by reduced blood supply to the heart muscle), cardiac arrhythmias (abnormal heartbeat rhythm), and cerebral infarction (blood clot in the brain). It is not unusual for patients with sleep apnea to be mistakenly treated for primary heart disease because cardiac arrhythmias may be more prominent than the breathing disturbances.

Nearly 50 percent of sleep apnea patients have high blood pressure. Patients with the most severe sleep apnea seem to have the highest blood pressure levels and are also more likely to have trouble controlling their blood pressure than patients who do not have sleep apnea. No one knows whether a cause and effect relationship exists between high blood pressure and sleep apnea. If it does exist, the ways these conditions interact is unknown.

Snoring alone does not appear to be a risk factor for heart disease. Only when snoring occurs with sleep apnea or obesity does it seem to be associated with these conditions.

Sleep Apnea in Infants
Before a baby is born, the mother’s breathing takes care of its respiratory needs. Although the unborn baby’s lings are filled with fluid and are not ready to take in air, its respiratory muscles make breathing motions, as if “training” to take on the responsibilities of breathing after birth.

As soon as birth occurs, the normal newborn baby begins a continuous pattern of periodic breathing characterized by a succession of apneas followed by regular breathing. Apneas occasionally lasting longer than 10 to 15 seconds are common during the newborn period. Apneas are more frequent and longer in premature newborns than in full-term infants. The frequency of apnea decreases with age during the first 6 months of life.

Babies turn blue during sleep and appear limp may be undergoing episodes of insufficient breathing. They should be checked for a sleep-related disorder.

Sleep Apnea and Sudden Infant Death Syndrome
Sleep apnea is sometimes implicated in sudden infant death syndrome (SIDS), also called crib death. About 10,000 infants die every year in this country for SIDS. Scientists do not know the reasons for these deaths but sleep apnea may play a role because these babies die when they are asleep and show no evidence of trauma. On autopsy, pinpoint hemorrhages are sometimes noted in the thoracic cavity which may be caused by lack of oxygen prior to cardiac arrest and vigorous respiratory movements.

Diagnosis of Sleep Apnea
The general physician may sometimes recognize sleep apnea, but specialists in neurology, psychiatry, pulmonary medicine and cardiology may be needed for accurate diagnosis and management. Diagnosis of sleep apnea is difficult because disturbed sleep can cause various other diseases or make them worse. Several major medical centers now have pulmonologists, neurologists, and psychiatrists with specialty training in sleep disorders on their staff. Although an evaluation for sleep apnea can sometimes be done at home, it is more reliable if it is done in a sleep laboratory.

A variety of tests can be used to diagnose sleep apnea. These include pulmonary function tests, polysomnography, and the multiple sleep latency test. Physicians continue to try to develop other simple and economic procedures for the early diagnosis of sleep apnea.

Pulmonary function tests taken by sleep apnea patients may show normal results unless the patient has a coexisting lung disease. To make a definitive diagnosis of sleep apnea, the physician may order an all-night evaluation of the patient’s sleep stages, and of the status of breathing and gas exchange during sleep.

Polysomnography is a group of tests that monitors a variety of functions during sleep. These include sleep state, electrical activity of the brain (EEG), eye movement (EOG), muscle activity (EMG), heart rate, respiratory effort, airflow, blood oxygen and carbon dioxide levels. Other tests may be ordered depending on a particular patient’s needs. Polysomnography sometimes helps to distinguish between different sleep disorders. These test are used both to diagnose sleep apnea and to determine it severity.

The Multiple Sleep Latency Test is done during normal working hours. It consists of observations, repeated every 2 hours, of the time taken to reach various stages of sleep. In this test, people without sleep apnea take more than 10 minutes to fall asleep. On the other hand, patients with sleep apnea or narcolepsy fall asleep fairly rapidly. When it takes the patient an average of less than 5 minutes to fall asleep, it is considered pathological sleepiness. There is thus some uncertainty in the diagnosis if the sleep latency period (speed of falling asleep) is between 5 and 10 minutes. This test is important because it measures the degree of excessive daytime sleepiness and also helps to rule out narcolepsy, which is associated with onset of REM sleep (dream sleep) in many of the naps.

Treatment of Sleep Apnea…...
More than 50,000 patients are treated each year for breathing disorders of sleep. Physicians tailor therapy to the individual patient based on medical history, physical examination, and the results of laboratory tests and polysomnography.

Patients with sleep apnea can help themselves by trying avoid doing anything that can worsen the disease. Sleeping in improper positions can increase the frequency of apnea. Use of alcohol suppresses the activity of the upper airway muscles so that the airway is more likely to collapse. Sleeping pills and sedativehypnotic drugs suppress arousal mechanisms and prolong apneas. Moving to high altitudes may aggravate the condition because of low oxygen levels. Overweight sleep apnea patients should lose weight.

Because the exact mechanism responsible for obstructive sleep apnea is not known, there is still no treatment that directly addresses the underlying problem. In most cases, medications have not proved successful. Surgical procedures are effective only 50 percent of the time because the exact location of the airway obstruction is usually unclear.

Since patients with sleep apnea usually have significant family and work problems, the treatment should include strategies that will help them cope with these problems. Education of the patient, family, and employers is sometimes needed to help the patient return to an active normal life.

Position Therapy
In mild cases of sleep apnea, breathing pauses occur only when the individual sleeps on the back. Thus using methods that will ensure that patients sleep on their side is often helpful.

Nasal Continuous Positive Airway Pressure (CPAP)
CPAP is the most common effective treatment for sleep apnea. In this procedure, the patient wears a mask or a pillow over the nose during sleep and pressure from an air compressor forces air through the nasal passages. The air pressure is adjusted so that it is just enough to hold the throat open when it relaxes the most. The pressure is constant and continuous. Nasal CPAP prevents obstruction while in use but apneas return when CPAP is stopped.

The major disadvantage of CPAP is that about 40 percent of patients have difficulty using it for long periods of time. Irritation and drying in the nose occur in some patients. Facial skin irritation, abdominal bloating, mask leaks, sore eyes, and headaches are some of the other problems. Because many patients stop using nasal CPAP due to the discomfort arising form exhaling against positive pressure, the search goes on for more comfortable devices. Modifications of CPAP in the treatment of sleep apnea are currently being defined.

One device, which some patients find more comfortable, is the bilevel positive airway pressure (BiPAP). Unlike CPAP where the pressure is equal during inhalation and exhalation, BiPAP is designed to follow the patient’s breathing pattern. It lowers the pressure during expiration and maintains a constant inspiratory pressure.

The ramp system, a modification of CPAP, allows the pressure to be applied only when the patient goes to sleep, increasing pressure slowly over a 30-minute period. The purpose of the ramp system is to make CPAP more comfortable.

Nocturnal Ventilation
Patients can be ventilated non-invasively during sleep with positive pressure ventilation through a CPAP mask. This technique is now used in patients whose breathing is impaired to the point that their blood carbon dioxide level is elevated, as happens in patients with obesity-hypoventilation syndrome and certain neuromuscular disease.

Pharmacologic Therapies
No medications are effective in the treatment of sleep apnea. However some physicians believe that mild cases of sleep apnea respond to drugs that either stimulate breathing or suppress deep sleep. Acetazolamide has been used to treat central apnea. Tricyclic antidepressants inhibit deep sleep (REM) and are useful only in patients who have apneas in the REM state.

Oxygen administration sometimes benefits patients without andy side effects. However, the role of oxygen in the treatment of sleep apnea is controversial and it is difficult to predict which patients will respond to oxygen therapy.

Dental Appliances
Dental appliances which reposition the lower jaw and the tongue have been helpful to some patients with obstructive sleep apnea. Possible side effects include damage to teeth, soft tissues, and the jaw joint.

Surgery
Some patients with sleep apnea may require surgical treatment. Useful procedures include removal of adenoids and tonsils, nasal polyps or other growths, or other tissue in the airway, or correction of structural deformities. Younger patients seem to benefit from surgery better than older patients.

Tracheostomy
Tracheostomy is used only in patients with severe, life-threatening obstructive sleep apnea. In this procedure a small hole is make in the windpipe (trachea) below the Adam’s apple. A T-shape tube is inserted into the opening. This tub stays closed during waking hours and the person breathes normally. It is opened for sleep so that air flows directly into the lungs, bypassing any upper airway obstruction. Its major drawbacks are that it is a disfiguring procedure and the tracheostomy tube requires proper care to keep it clean.

Uvulopalatopharyngoplasty (UPPP)
UPPP is a procedure used to remove excess tissue at the back of the throat (tonsils, adenoids, uvula, and part of the soft palate). This technique probably helps only half of the patients who choose it. Its negative effects include nasal speech and backflow (regurgitation) of liquids into the nose during swallowing. UPPP is not considered as universally effective as tracheostomy but does seem to be a cure for snoring. It does not appear to prevent mortality form cardiovascular complications of severe sleep apnea.

Some patients whose sleep apnea is due to deformities of the lower jaw (mandible) benefit from reconstruction of surgical advancement of the mandible. Gastric stapling procedures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese.

Treatment of Patients with Coexisting Lung Diseases
Asthma, chronic bronchitis, emphysema, or other lung diseases can cause breathing problems during sleep. Patients with these diseases may be frequently awakened by cough, aspiration of secretions, choking sensations, and apnea-like sleep disturbances. The treatment in these cases depends on whether the sleep disturbances are due to lung disease or sleep apnea.

Pathophysiology of Sleep and Breathing:

Highlights of the National, Heart, Lung, and Blood Institute Programs

Sleep
The modern era of sleep research started in the mid-1950’s with the discovery that sleep is not a homogeneous phenomenon. Rather it fluctuates cyclically between two distinct sequential stages of sleep.

The first sleep stage is variously called synchronized sleep, slow sleep, slow-wave sleep, quite sleep, or nonrapid-eye-movement (NREM) sleep. In this state the EEG is dominated by large-amplitude slow waves; body functioning generally slows: there are slow, rolling eye movements; the pupils constrict; the respiratory and heart rates decline; blood pressure decreases; and total body oxygen consumption is reduced. It is believed that NREM sleep is a recuperative state.

The second state of sleep is called synchronized sleep, fast sleep, fast-wave sleep, dream sleep, or rapid-eye-movement (REM sleep. The EEG is synchronized, with low-voltage fast waves and there are intermittent eye movements. It is also called paradoxical sleep because of the paradox that the EEG in this sleep stage is similar to that in wakefulness or light sleep, although this is deep sleep in terms of arousability. During REM sleep, central-nervous-system (CNS) activity generally increases, and body system are variously activated and inactivated in a complex physiological pattern. The normal adult spends some 15 to 20 percent of the sleeping hours in REM sleep; this percentage decreases with aging. In contrast, the human fetus of 30 weeks spends 80 percent of its sleep in REM sleep. This declines to 50 percent at term. The amount of quiet sleep (NREM) increases for 50 to 60 percent by 3 months and to 70 percent between 6 and 23 months.

At the biochemical level, hormone-like prostaglandins and cytokines, which are intercellular messengers found in the brain, are implicated in the mechanisms that control sleep. Some speculate that a balance between prostaglandin D2 which increases sleep, and prostaglandin E2 which increases wakefulness, may be involved in the controlling mechanism. The prostaglandins produce their effects when injected into the preoptic area of the hypothalamus, an area responsible for temperature regulation. This may explain the link between sleep and fall in temperature, and also may unify the neurophysiological and biochemical mechanisms of sleep.

Interleukin-1 is localized in the brain in areas associated with control of sleep, and is believed to play a sleep regulatory role. The amount of interleukin-1 in cerebrospinal fluid fluctuates in parallel with the normal sleep/wake cycle.

There is no clear biological answer to the fundamental question of why we sleep. A wide variety of medical and psychiatric illnesses and factors related to age and gender can pathophysiological sequelae. A major goal of sleep research is the characterization of the etiology and pathophysiology of the causes and effects of disturbed sleep.

Breathing
The two major components of breathing are inspiration and expiration. Inspiration is an active process involving contraction of the diaphragm, external intercostal, and in certain circumstances, accessory muscles. It serves to increase intrathoracic volume, decrease intrapleural pressure and allow exchange of air and carbon dioxide within the alveoli of the lungs. Oxygen is transported from the alveoli to the pulmonary bloodstream by passive diffusion and is made available to tissues. Expiration, on the other hand, is a relatively passive process, requiring little or no contraction of the muscles during quiet breathing. A main function of the breathing process is to bring about the exchange of oxygen and carbon dioxide and other gaseous products from biological system.

At birth, the baby switches from dependence on placental gas exchange to air breathing. At the moment of birth there is also a switch from intermittent breathing efforts of the fetal stage to sustained breathing efforts. Since the infants’ respiratory muscles are not well-equipped to sustain high workloads, respiratory muscle fatigue is a problem for premature infants, and apneic episodes requiring intervention occur in at least 50 percent of surviving infants weighing less than 1,500 grams.

Breathing disorders during sleep occur either when there are deficiencies in neurally generated rhythmic respiratory efforts or when there is normal generation of rhythmic efforts but mechanically impeded airflow in upper airways. Metabolic and behavioral control systems in the brain are believed to be the control mechanisms for sleep and breathing. The metabolic system that responds to changes in carbon dioxide and oxygen seems to exert its major influence over NREM sleep. On the other hand, the behavioral control system is involved in voluntary respiratory activities and appears to influence REM sleep; many of the ventilatory changes that occur in REM sleep are similar to the behavioral ventilatory activities such as swallowing, voluntary breath holding, and hyperventilation.

Subjects without any clinical problems may exhibit obstructive or central apnea during periods of REM sleep. Although severe changes in respiratory behavior often occur during the REM sleep, sleep apnea can occur in both NREM and REM sleep. However, sleep staging in patients with severe sleep apnea syndrome is difficult because of severe sleep fragmentation. Thus it is difficult to define the relative importance of abnormal respiration detected during REM or NREM sleeps.

Research Highlights
A recent basic research advance of potential clinical implication relates to the application of modern three dimensional medical imaging techniques to the study of pathogenesis of sleep apnea. Magnetic resonance imaging (MRI) and ultrafast X-ray computed tomography (CT) of the upper airways, combined with computer graphics and reconstructions, have begun to provide exquisite details of the geometry of the upper airway. These approaches now permit identification of the precise anatomical sites of collapse or areas of abnormal compliance to determine if the problem is in a specific area or is a more generalized multifocal abnormality. This information will impact on the treatment options, particularly if there is more diffuse involvement since this wold predict failure of localized surgical procedures.

Only 50 percent of patients with sleep apnea undergoing uvulopalatopharyngoplasty benefit from this procedure. Investigators are exploring ways to identify those patients most likely to benefit from this procedure. A small scale clinical trial conducted to determine predictors of success for UPPP revealed that 86 percent of patients who had documented (by fiberoptic endoscopy) preoperative nasopharyngeal obstruction at the level of the soft palate, showed significant improvement in the number of apneas, arousals and in the cumulative time in apnea-hypopnea following surgery. In contrast, only 18 percent of the patients who had a collapsing segment in regions of the pharynx other than the soft palate showed any improvement following UPPP. This is the first prospective clinical study to demonstrate that closure of the passive pharynx at the level of the soft palate predicts a favorable surgical outcome.

An important opportunity for research on the pathophysiology and treatment of sleep apnea has open up with the finding that the English bulldog seems to be a suitable animal model of sleep apnea. This model is permitting the study of the regularly occurring periodicities in neural activity of the upper airways and the inspiratory muscles, and the role of neural mechanisms in the genesis of sleep apnea. Studies with this model revealed that the consequences of intermittent apnea (sleepiness or hypox emia) serve to increase the magnitude and frequency of neural inhibitory activity, thereby worsening the apnea.

Other studies exploring new treatments for obstructive sleep apnea in animals and humans have identified buspirone, a hypnotic agent as a potentially effective drug for sleep apnea. Buspirone seems to increase ventilation in both anesthetized and awake rats and cats without producing the traditional respiratory depressive effect. In a small scale, controlled clinical trial, this drug decreased sleep apnea and improved respiratory status in the patients receiving the drug.

Associations between snoring, hypertension, heart disease, and stroke raise the possibility of common factors and/or causal relationships between sleep apnea and cardiovascular disorders. Such links may be related to biochemical factors such as insulin, catecholamine, or cortisol that are increased in stress. Sleep apnea may itself be a stress that produces hormonal imbalances that lead to the hypertensive state. Alternately obesity, sleep apnea, and other cardiovascular risk factors may share common metabolic pathways and therefore may be genetically determined. These relationships are being explored by studying families with a history of sleep apnea and/or sudden infant death syndrome as well as by studying racial and genetic differences in the prevalence of sleep apnea-related illnesses.

THE MOST EFFECTIVE  TREATMENT IS REGULAR YOGA EXERCISE  WITH MEDITATION (BREATHING EXERCISE)

Research Opportunities
Since 1986, the Division of Lung Diseases, National Heart, Lung, and Blood Institute, has been engaged in a concerted national program in cardiopulmonary disorders in sleep designed to fill critical gaps in the understanding of the pathogenesis, diagnosis, treatment, and prevention of sleep-disordered breathing. Some research areas of current emphasis include the following.

1. Natural history of sleep apnea with the goal of determining the magnitude of the problem and designing the most effective therapy.
2. Scientific basic for the influence of age, gender, ethnicity, smoking obesity, and snoring on the development of sleep apnea.
3. Assessment of the severity of sleep apnea and defining the relationships of disease severity, response to treatment and prognosis.
4. Cellular and molecular basis of the role of hypoxia in excessive daytime sleepiness and sleep apnea.
5.Cardiovascular consequences of sleep apnea and the underlying neural cellular and respiratory mechanisms.
6.Improved therapeutic modalities for sleep apnea when associated with blood pressure, asthma, chronic heart failure, angina pectoris, chronic pulmonary disease and stroke.
For More Information
Additional information about breathing-related sleep disorders and other disorders of sleep can be obtained form your local sleep disorders center and the following sources:

Unites States
American Sleep Apnea Association
P.O. Box 3893
Charlottesville, VA 22903

The American Sleep Disorders Association 604 Second Street Southwest
Rochester, MN 55902

Association of Sleep Disorders Centers

P.O. Box 2604
Del Mar, CA 92014

AWAKE NETWORK
P.O. Box 534
Bethel Part, PA 15102

American Narcolepsy Association
P.O. Box 1187
San Carlos, CA 94070

Narcolepsy Network
155 Van Brackle Rd.
Aberdeen, NJ 07747

National Heart, Lung, and Blood Institute (NHLBI) Communications and Public Information Branch 9000 Rockville Pike
Bethesda, MD 20892

(Other institutes at NIH that have information about sleep disorders include the National Institute of Neurological Disorders and Stroke, National Institute od Child Health and Human Development, National Institute of Mental Health, National Institute on Aging. The address for each is 9000 Rockville Pike, Bethesda, MD 20892.)

Centers for Disease Control and Prevention 1600 Clifton Road, NE
Atlanta, GA 30333

International
Sleep Apnea Research Association, Inc.
65 Kitchener Avenue
Earlwood NSW 2206
Australia

Sleep Apnea Society of Alberta
Faculty of Nursing
University of Calgary
2500 University Drive NW
Calgary, Alberta T2N 1N4

Nederlandse Vereniging Van Slaap Apnoe Patienten De Nye Oanliz 25
9084 AN GOUTOM
The Netherlands

British Sleep Society
Sleep Disorder Clinic
Leicestershire General Hospital
Leicester, LE5 4PW
United Kingdom

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Sources:http://www.medhelp.org/lib/breadiso.htm

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Dream

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Definition:Dreams are the images, thoughts and feelings experienced while sleeping, particularly strongly associated with rapid eye movement sleep. The contents and biological purposes of dreams are not fully understood, though they have been a topic of speculation and interest throughout recorded history. The scientific study of dreams is known aoneirology.

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Our brains are in constant activity. Different states of consciousness (like awake, asleep alert, drowsy, excited, bored, concentrating or daydreaming) cause different brain wave activity. Our conscious mind, or the part we think with, our “window” into life, only takes up a very small portion of our brain activity. (some say this is only 10%) Other areas control things like breathing, heartbeat, converting light to vision, sound to hearing, balance when we walk, etc. etc. This too has it’s own percentage (small). Another area controls imagination. This area is widely an undiscovered frontier. Imagination is more then dreaming of a new car or picturing someone with their cloths off! When you look at clouds and see shapes, or wood grain and see images, this is the “order from chaos” part of your imagination. The mind cannot deal with chaos very well, in fact it will resist it and sometimes manufacture order. (very important to the dreaming process.)This too occupies a small percentage of brian activity. Then there is memory. Memory is vast!

Neurology of sleep and dreams:-

There is no universally agreed biological definition of dreaming. General observation shows that dreams are strongly associated with rapid eye movement (REM) sleep, during which an electroencephalogram shows brain activity to be most like wakefulness. Participant-nonremembered dreams during non-REM sleep are normally more mundane in

comparison. During a typical lifespan, a human spends a total of about six years dreaming (which is about 2 hours each night). It is unknown where in the brain dreams originate, if there is a single origin for dreams or if multiple portions of the brain are involved, or what the purpose of dreaming is for the body or mind. It has been hypothesized that dreams are the result of naturally occurring dimethyltryptamine (DMT) in the brain.

During REM sleep, the release of certain neurotransmitters is completely suppressed. As a result, motor neurons are not stimulated, a condition known as REM atonia. This prevents dreams from resulting in dangerous movements of the body. Studies show that various species of Mammals and Birds experience REM during sleep.

Discovery of REM

In 1953 Eugene Aserinsky discovered REM sleep while working in the surgery of his PhD advisor. Aserinsky noticed that the sleepers’ eyes fluttered beneath their closed eyelids, later using a polygraph machine to record their brain waves during these periods. In one session he awakened a subject who was wailing and crying out during REM and confirmed his suspicion that dreaming was occurring. In 1953 Aserinsky and his advisor published the ground-breaking study in Science.

Dream theories

Activation-synthesis Allan Hobson and Robert McCarley proposed a new theory that changed dream research, challenging the previously held Freudian view of dreams as unconscious wishes to be interpreted. The activation synthesis theory asserts that the sensory experiences are fabricated by the cortex as a means of interpreting chaotic signals from the pons. They propose that in REM sleep, the ascending cholinergic PGO (ponto-geniculo-occipital) waves stimulate higher midbrain and forebrain cortical structures, producing rapid eye movements. The activated forebrain then synthesizes the dream out of this internally generated information. They assume that the same structures that induce REM sleep also generate

sensory information.

Hobson and McCarley’s 1976 research suggested that the signals interpreted as dreams originated in the brain stem during REM sleep. However, research by Mark Solms suggests that dreams are generated in the forebrain, and that REM sleep and dreaming are not directly related. While working in the neurosurgery department at hospitals in Johannesburg and London, Solms had access to patients with various brain injuries. He began to question patients about their dreams and confirmed that patients with damage to the parietal lobe stopped dreaming; this finding was in line with Hobson’s 1977 theory. However, Solms did notencounter cases of loss of dreaming with patients having brain stem damage. This observation forced him to question Hobson’s prevailing theory which marked the brain stem as the source of the signals interpreted as dreams. Solms viewed the idea of dreaming as a function of many complex brain structures as validating Freudian dream theory, an idea that drew criticism from Hobson. Unhappy about Hobson’s attempts at discrediting him, Solms, along with partner Edward Nadar, undertook a series of traumatic-injury impact studies using several different species of primates, particularly howler monkeys, in order to more fully understand the role brain damage plays in dream pathology. Solms’ experiments provedinconclusive, however, as the high mortality rate associated with using an hydraulic impact pin to artificially produce brain damage in test subjects meant that his final candidatepool was too small to satisfy the requirements of the scientific method.

Dreams and memory

Eugen Tarnow suggests that dreams are ever-present excitations of long-term memory, evenduring waking life. The strangeness of dreams is due to the format of long-term memory,reminiscent of Penfield & Rasmussen’s findings that electrical excitations of the cortex give rise to experiences similar to dreams. During waking life an executive function interprets long term memory consistent with reality checking. Tarnow’s theory is a reworking of Freud’s theory of dreams in which Freud’s unconscious is replaced with the long-term memory system and Freud’s “Dream Work” describes the structure of long-term memory

Hippocampus and memory

A 2001 study showed evidence that illogical locations, characters, and dream flow may help the brain strengthen the linking and consolidation of semantic memories. These conditions may occur because, during REM sleep, the flow of information between the hippocampus and neocortex is reduced.[10] Increasing levels of the stress hormone cortisol late in sleep (often during REM sleep) cause this decreased communication. One stage of memory consolidation is the linking of distant but related memories. Payne and Nadel hypothesize that these memories are then consolidated into a smooth narrative, similar to a process that happens when memories are created under stress.

Functional hypotheses:
There are many hypotheses about the function of dreams, including:

*During the night there may be many external stimuli bombarding the senses, but the mindinterprets the stimulus and makes it a part of a dream in order to ensure continued sleep.The mind will, however, awaken an individual if they are in danger or if trained to respond to certain sounds, such as a baby crying.

*Dreams allow the repressed parts of the mind to be satisfied through fantasy while keeping the conscious mind from thoughts that would suddenly cause one to awaken from shock.

*Freud suggested that bad dreams let the brain learn to gain control over emotions resulting from distressing experiences.

*Jung suggested that dreams may compensate for one-sided attitudes held in waking consciousness.

*Ferenczi proposed that the dream, when told, may communicate something that is not being said outright.

*Dreams are like the cleaning-up operations of computers when they are off-line, removing parasitic nodes and other “junk” from the mind during sleep.

*Dreams create new ideas through the generation of random thought mutations. Some of these may be rejected by the mind as useless, while others may be seen as valuable and retained. Blechner calls this the theory of “Oneiric Darwinism.”

*Dreams regulate mood.

*Hartmann says dreams may function like psychotherapy, by “making connections in a safe place” and allowing the dreamer to integrate thoughts that may be dissociated during waking life.

*More recent research by Griffin has led to the formulation of the ‘expectation fulfillment theory of dreaming’, which suggests that dreaming metaphorically completes patterns of emotional expectation and lowers stress levels.

*Coutts hypothesizes that dreams modify and test mental schemas during sleep during a process he calls emotional selection, and that only schema modifications that appear emotionally adaptive during dream tests are selected for retention, while those that appear maladaptive are abandoned or further modified and tested.

*Dream is a product of “dissociated imagination”, which is dissociated from conscious self and draws material from sensory memory for simulation, with sensory feedback resulting in hallucination. By simulating the sensory signals to drive the autonomous nerves, dream can effect mind-body interaction. In the brain and spine, the autonomous “repair nerves”, which can expand the blood vessels, connect with pain and compression nerves, and are grouped into many chains called meridians by the Chinese. Dream also exploits the chain-reacting meridians to repair body by sending out very intensive movement-compression signals when the level of growth enzyme goes high.

Dreams and psychosis

A number of thinkers have commented on the similarities between the phenomenology of dreamsand that of psychosis. Features common to the two states include thought disorder, flattened or inappropriate affect (emotion), and hallucination. Among philosophers, Kant, for example, wrote that ‘the lunatic is a wakeful dreamer’. Schopenhauer said: ‘A dream is a short-lasting psychosis, and a psychosis is a long-lasting dream.’In the field of psychoanalysis, Freud wrote: ‘A dream then, is a psychosis’,and Jung: ‘Let the dreamer walk about and act like one awakened and we have the clinical picture of dementia praecox.’

McCreery has sought to explain these similarities by reference to the fact, documented by Oswald, that sleep can supervene as a reaction to extreme stress and hyper-arousal. McCreery adduces evidence that psychotics are people with a tendency to hyper-arousal, and suggests that this renders them prone to what Oswald calls ‘microsleeps’ during waking life. He points in particular to the paradoxical finding of Stevens and Darbyshire that patients. suffering from catatonia can be roused from their seeming stupor by the administration of sedatives rather than stimulants.

Cultural history:

Dreams have a long history both as a subject of conjecture and as a source of inspiration. Throughout their history, people have sought meaning in dreams or divination through dreams. They have been described physiologically as a response to neural processes during sleep, psychologically as reflections of the subconscious, and spiritually as messages from God or predictions of the future. Many cultures practiced dream incubation, with the intention of cultivating dreams that were prophetic or contained messages from the divine.

Judaism has a traditional ceremony called hatovat chalom – literally meaning making the dream a good one. Through this rite disturbing dreams can be transformed to give a positive interpretation by a rabbi or a rabbinic court.

Dream content

From the 1940s to 1985, Calvin S. Hall collected more than 50,000 dream reports at Western Reserve University. In 1966 Hall and Van De Castle published The Content Analysis of Dreams in which they outlined a coding system to study 1,000 dream reports from college students. It was found that people all over the world dream of mostly the same things. Hall’s complete dream reports became publicly available in the mid-1990s by Hall’s protégé William Domhoff, allowing further different analysis. Personal experiences from the last day or week are frequently incorporated into dreams.

Emotions:

The most common emotion experienced in dreams is anxiety. Negative emotions are more common than positive ones.The U.S. ranks the highest amongst industrialized nations for aggression in dreams with 50 percent of U.S. males reporting aggression in dreams, compared to 32 percent for Dutch men.

Sexual content

The Hall data analysis shows that sexual dreams occur no more than 10 percent of the time and are more prevalent in young to mid teens. Another study showed that 8% of men’s and women’s dreams have sexual content. In some cases, sexual dreams may result in orgasm or nocturnal emission. These are commonly known as wet dreams.

Recurring dreams

While the content of most dreams is dreamt only once, many people experience recurring dreams—that is, the same dream narrative is experienced over different occasions of sleep. Up to 70% of females and 65% of males report recurrent dreams.

Common themes
Content-analysis studies have identified common reported themes in dreams.

These include: situations relating to school, being chased, running slowly in place, sexual experiences, falling, arriving too late, a person now alive being dead, teeth falling out, flying, embarrassing moments, falling in love with random people, failing an examination, not being able to move, not being able to focus vision and car accidents. Twelve percent of people dream only in black and white

Relationship with mental illness

There is evidence that certain medical conditions (normally only neurological conditions) can impact dreams. For instance, people with synesthesia have never reported black-and-white dreaming, and often have a difficult time imagining the idea of dreaming in only black and white.

Therapy for recurring nightmares (often associated with posttraumatic stress disorder) can include imagining alternative scenarios that could begin at each step of the dream.

Dream interpretation:

Dreams were historically used for healing (as in the asclepieions found in the ancient Greek temples of Asclepius) as well as for guidance or divine inspiration. Some Native American tribes used vision quests as a rite of passage, fasting and praying until an anticipated guiding dream was received, to be shared with the rest of the tribe upon their return.

During the late 19th and early 20th centuries, both Sigmund Freud and Carl Jung identified dreams as an interaction between the unconscious and the conscious. They also assert together that the unconscious is the dominant force of the dream, and in dreams it conveys its own mental activity to the perceptive faculty. While Freud felt that there was an active censorship against the unconscious even during sleep, Jung argued that the dream’s bizarre quality is an efficient language, comparable to poetry and uniquely capable of revealing the underlying meaning.

Fritz Perls presented his theory of dreams as part of the holistic nature of Gestalt therapy. Dreams are seen as projections of parts of the self that have been ignored, rejected, or suppressed. Jung argued that one could consider every person in the dream to represent an aspect of the dreamer, which he called the subjective approach to dreams.

Perls expanded this point of view to say that even inanimate objects in the dream may represent aspects of the dreamer. The dreamer may therefore be asked to imagine being an object in the dream and to describe it, in order to bring into awareness the characteristics of the object that correspond with the dreamer’s personality.

Other associated phenomena:-

Lucid dreaming
Lucid dreaming is the conscious perception of one’s state while dreaming. In this state a person usually has control over characters and the environment of the dream as well as the dreamer’s own actions within the dream.The occurrence of lucid dreaming has been scientifically verified.

“Oneironaut” is a term sometimes used for those who explore the world of dreams. For example, dream researcher Stephen LaBerge uses the term. It is often associated with lucid dreaming in particular.

Dreams of absent-minded transgression
Dreams of absent-minded transgression (DAMT) are dreams wherein the dreamer absentmindedly performs an action that he or she has been trying to stop (one classic example is of a quitting smoker having dreams of lighting a cigarette). Subjects who have had DAMT have reported waking with intense feelings of guilt. One study found a positive association between having these dreams and successfully stopping the behavior.

Dreaming and the “real world”
Dreams can link to actual sensations, such as the incorporation of environmental sounds into dreams such as hearing a phone ringing in a dream while it is ringing in reality, or dreaming of urination while wetting the bed. Except in the case of lucid dreaming, people dream without being aware that they are doing so. Some philosophers have concluded that what we think as the “real world” could be or is an illusion (an idea known as the skeptical hypothesis about ontology). The first recorded mention of the idea was by Zhuangzi, and was also discussed in Hinduism; Buddhism makes extensive use of the argument in its writings.It was formally introduced to western philosophy by Descartes in the 17th century in his Meditations on First Philosophy.

Recalling dreams
The recall of dreams is extremely unreliable, though it is a skill that can be trained. Dreams can usually be recalled if a person is awakened while dreaming. Women tend to have more frequent dream recall than men. Dreams that are difficult to recall may be characterized by relatively little affect, and factors such as salience, arousal, and interference play a role in dream recall. A dream journal can be used to assist dream recall, for psychotherapy or entertainment purposes. Ingesting large amounts of magnesium can help to make dreams more vivid, and therefore easier to recall.

Déjà vu
One theory of déjà vu attributes the feeling of having previously seen or experienced something to having dreamt about a similar situation or place, and forgetting about it until one seems to be mysteriously reminded of the situation or place while awake

Dream pre-programming
Dream pre-programming is a hypnotic practice used among some medical and stage hypnotists. It allows the hypnotist to control (or let the patient control) their own dreams. One way that a hypnotist will use this is by telling the person that when they fall asleep that they see a button. And that if they want to enter “DreamScape” that they should press that button. Then they will enter a world just like Earth, but they will have complete control. They will control things with their mind. Dream pre-programming can also help someone for a test or a big event in life. The hypnotist would make the subject dream that event as occurring perfectly, so the subject will get a level of confidence.

Dream incorporation
In one use of the term, “dream incorporation” is a phenomenon whereby an external stimulus, usually an auditory one, becomes a part of a dream, eventually then awakening the dreamer. There is a famous painting by Salvador Dalí that depicts this concept, titled “Dream Caused by the Flight of a Bee around a Pomegranate a Second Before Awakening” (1944).

The term “dream incorporation” is also used in research examining the degree to which preceding daytime events become elements of dreams. Recent studies suggest that events in the day immediately preceding, and those about a week before, have the most influence


Resources:

http://en.wikipedia.org/wiki/Dream
http://www.sleeps.com/basics.html

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Ailmemts & Remedies

Sleepwalking(Somnambulism)

Definition:
Sleepwalking (also called somnambulism or noctambulism) is a parasomnia or sleep disorder where the sufferer engages in activities that are normally associated with wakefulness while he or she is asleep or in a sleep-like state. Sleepwalking is usually defined by or involves the person affected apparently shifting from his or her prior sleeping position and moving around and performing normal actions as if awake (cleaning, walking and other activities). It is a disorder characterized by walking or other activity while seemingly still asleep.Sleepwalkers are not conscious of their actions on a level where memory of the sleepwalking episode can be recalled, and because of this, unless the sleepwalker is woken or aroused by someone else, this sleep disorder can go unnoticed. Sleepwalking is more commonly experienced in people with high levels of stress, anxiety or psychological factors and in people with genetic factors (family history), or sometimes a combination of both.

click to see the pictures

A common misconception is that sleepwalking is acting out the physical movements within a dream, but in fact, sleepwalking occurs earlier on in the night when rapid eye movement (REM), or the “dream stage” of sleep, has not yet occurred.

A majority of people move their legs while sleeping; however, sleepwalking occurs when both legs move in synchronization[citation needed], which is much less common.

Sleepwalking can affect people of any age. It generally occurs when an individual moves during slow wave sleep (during stage 3 or 4 of slow wave sleep—deep sleep) (Horne, 1992; Kales & Kales, 1975). In children and young adults, up to 80% of the night is spent in SWS (50% in infants). However, this decreases as the person ages, until none can be measured in the geriatric individual. For this reason, children and young adults (or anyone else with a high amount of SWS) are more likely to be woken up and, for the same reasons, they are witnessed to have many more episodes than the older individuals.

Causes:
This causes REM atonia, a state in which the motor neurons are not stimulated, and thus the body’s muscles do not move. Lack of such REM atonia causes REM Behavior Disorder.

The normal sleep cycle involves distinct stages from light drowsiness to deep sleep. Rapid eye movement (REM) sleep is a different type of sleep, in which the eyes move rapidly and vivid dreaming is most common.

During a night, there will be several cycles of non-REM and REM sleep. Sleep walking (somnambulism) most often occurs during deep non-REM sleep (stage 3 or stage 4 sleep) early in the night. It can occur during REM sleep near morning.

In children, the cause is usually unknown but may be related to fatigue, prior sleep loss, or anxiety. In adults, sleepwalking is usually associated with a disorder of the mind but may also be seen with reactions to drugs and alcohol, and medical conditions such as partial complex seizures. In the elderly, sleepwalking may be a symptom of an organic brain syndrome or REM behavior disorders.

Incidence:

The sleepwalking activity may include simply sitting up and appearing awake while actually asleep, getting up and walking around, or complex activities such as moving furniture, going to the bathroom, dressing and undressing, and similar activities. Some people even drive a car while actually asleep. The episode can be very brief (a few seconds or minutes) or can last for 30 minutes or longer.

One common misconception is that a sleep walker should not be awakened. It is not dangerous to awaken a sleep walker, although it is common for the person to be confused or disoriented for a short time on awakening. Another misconception is that a person cannot be injured when sleep walking.

Sleep walking occurs at any age, but it occurs most often in children aged 6 to 12. It may occur in younger children, in adults, or in the elderly, and it appears to run in families.

Risk Factors:

Sleepwalkers are more likely to endanger themselves than anyone else.Actually, injuries caused by such things as tripping and loss of balance are common for sleep walkers. When sleepwalkers are a danger to themselves or others (for example, when climbing up or down steps or trying to use a potentially dangerous tool such as a stove or a knife), steering them away from the danger and back to bed is advisable. It has even been reported that people have died or were injured as a result of sleepwalking. Sleepwalking should not be confused with psychosis.

Sleepwalking has in rare cases been used as a defense (sometimes successfully) against charges of murder.

Symptoms:

* eyes open during sleep
* may have blank facial expression
* may sit up and appear awake during sleep
* walking during sleep
* other detailed activity during sleep, any sort
* no recall of the event upon awaking
* confusion, disorientation on awakening
* sleep talking is incomprehensible and non-purposeful

Diagnosis:

Usually, no further examination and testing is necessary. If sleepwalking is frequent or persistent, examination to rule out other disorders (such as partial complex seizures) may be appropriate. It may also be appropriate to undergo a psychologic evaluation to determine causes such as excessive anxiety or stress, or medical evaluation to rule out other causes.

Treatment:

Usually no specific treatment for sleepwalking is needed.

Safety measures may be necessary to prevent injury. This may include modifying the environment by moving objects such as electrical cords or furniture to reduce tripping and falling. Stairways may need to be blocked off with a gate.

In some cases, short-acting tranquilizers have been helpful in reducing the incidence of sleepwalking.

For kids who sleepwalk often, doctors may recommend a treatment called scheduled awakening. This disrupts the sleep cycle enough to help stop sleepwalking. In rare cases, a doctor may prescribe medication to help someone sleep.

Prognosis:
Sleepwalking may or may not reduce with age. It usually does not indicate a serious disorder, although it can be a symptom of other disorders.

Prevention:
# Relax at bedtime by listening to soft music or relaxation tapes.
# Have a regular sleep schedule and stick to it.
# Keep noise and lights to a minimum while you’re trying to sleep.
# Avoid the use of alcohol or central nervous system depressants if prone to sleepwalking.
# Avoid fatigue or insomnia, because this can instigate an episode of sleepwalking.
# Avoid or minimize stress, anxiety, and conflict, which can worsen the condition

Statistics:-

* Eighteen percent of the world’s population is prone to sleepwalking.
* Somewhere between 1% and 16.7% of U.S. children sleepwalk, and juveniles are more prone to the activity.[citation needed]
* One study showed that the highest prevalence of sleepwalking was 16.7% for children of 11–12 years of age.[citation needed]
* Males are more likely to sleepwalk than females.[citation needed]

Activities such as eating, bathing, urinating, dressing, driving cars, whistling, and committing murder have been reported or claimed to have occurred during sleepwalking. Contrary to popular belief, most cases of sleepwalking do not consist of walking around (without the conscious knowledge of the subject). Most cases of somnambulism occur when the person is awakened (something or someone disturbs their SWS); the person may sit up, look around and immediately go back to sleep. But these kinds of incidences are rarely noticed or reported unless recorded in a sleep clinic.[citation needed]

Sleepwalkers engage in their activities with their eyes open so they can navigate their surroundings, not with their eyes closed and their arms outstretched, as often parodied in cartoons and films. The subject’s eyes may have a glazed or empty appearance, and if questioned, the subject will be slow to answer and may be unable to respond in an intelligible manner.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:

http://www.medicinenet.com/sleepwalking/article.htm
http://en.wikipedia.org/wiki/Sleepwalking
http://kidshealth.org/kid/stay_healthy/body/sleepwalking.html

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Why Do Some People Sleepwalk?

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Sleepwalking or somnambulism runs in families, indicating a genetic component. Studies show that it is also associated with sleep deprivation, fever, stress and intake of drugs, especially sedatives, hypnotics, antipsychotics, stimulants and antihistamines. Somnambulism occurs because normal physiological systems are active even at inappropriate times. Why the brain issues commands to the muscles during certain phases of sleep is not known, but these commands are usually suppressed by other neurological mechanisms. At times this suppression can be incomplete and actions that normally occur during wakefulness emerge in sleep.

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In children, it is believed to be related to fatigue, prior sleep loss or anxiety. Children, mostly aged six to 12 years, are afflicted, perhaps because they spend more time in the “deep sleep” phase of slumber.

Physical activity happens only during the non-rapid eye movement (NREM) cycle of deep sleep, which precedes the dreaming state of rapid eye movement (REM) sleep. During this phase, the body releases a chemical that paralyses the body. However, sleepwalkers do not have this chemical trigger, hence the behaviour. With several cycles of non-REM and REM sleep in a night, sleepwalking occurs mostly during deep non-REM sleep early in the night or near morning.

In adults, sleepwalking is associated with a disorder of the mind but may also be seen with reactions to drugs and/or medications and alcohol, and medical conditions like partial complex seizures. In the elderly, it may be indicative of an organic brain syndrome, REM behaviour disorders or a personality disturbance.

Sources: The Telegraph (Kolkata, India)

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