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Tourette Syndrome

Alternative Names: Tourette’s syndrome, Tourette’s disorder, Gilles de la Tourette syndrome, GTS or, more commonly, simply Tourette’s or TS

Definition:
Tourette syndrome  is an inherited neuropsychiatric disorder with onset in childhood, characterized by multiple physical (motor) tics and at least one vocal (phonic) tic; these tics characteristically wax and wane. Tourette’s is defined as part of a spectrum of tic disorders, which includes transient and chronic tics.

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Tourette’s was once considered a rare and bizarre syndrome, most often associated with the exclamation of obscene words or socially inappropriate and derogatory remarks (coprolalia), but this symptom is present in only a small minority of people with Tourette’s. Tourette’s is no longer considered a rare condition, but it may not always be correctly identified because most cases are classified as mild. Between 1 and 10 children per 1,000 have Tourette’s; as many as 10 per 1,000 people may have tic disorders, with the more common tics of eye blinking, coughing, throat clearing, sniffing, and facial movements. Tourette’s does not adversely affect intelligence or life expectancy. The severity of the tics decreases for most children as they pass through adolescence, and extreme Tourette’s in adulthood is a rarity. Notable individuals with Tourette’s are found in all walks of life.

Tourette syndrome can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood.

Clacification
Tics are sudden, repetitive, stereotyped, nonrhythmic movements (motor tics) and utterances (phonic tics) that involve discrete muscle groups.[8] Motor tics are movement-based tics, while phonic tics are involuntary sounds produced by moving air through the nose, mouth, or throat.

Tourette’s is one of several tic disorders, which are classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM) according to type (motor or phonic tics) and duration (transient or chronic). Transient tic disorder consists of multiple motor tics, phonic tics or both, with a duration between four weeks and twelve months. Chronic tic disorder is either single or multiple, motor or phonic tics (but not both), which are present for more than a year. Tourette’s is diagnosed when multiple motor tics, and at least one phonic tic, are present for more than a year. Tic disorders are defined similarly by the World Health Organization (International Statistical Classification of Diseases and Related Health Problems, ICD-10 codes).

Although Tourette’s is the more severe expression of the spectrum of tic disorders, most cases are mild. The severity of symptoms varies widely among people with Tourette’s, and mild cases may be undetected

Symptoms:
Tics — sudden, brief, intermittent movements or sounds — are the hallmark sign of Tourette syndrome. Symptoms range from mild to severe and debilitating.

Tics are classified as either:
*Simple tics, which are sudden, brief and repetitive and involve a limited number of muscle groups

*Complex tics, which are distinct, coordinated patterns of movements involving several muscle groups

Tics involving movement (motor tics) — often facial tics, such as blinking — usually begin before vocal tics do. But the spectrum of tics that people experience is diverse, and there’s no typical case.

Some of the more common tics seen in Tourette syndrome
Motor tics:-

Simple tics:
*Eye blinking
*Head jerking
*Shoulder shrugging
*Eye darting
*Finger flexing
*Sticking the tongue out

Complex tics :
*Touching the nose
*Touching other people
*Smelling objects
*Obscene gestures
*Flapping the arms
*Hopping

Vocal tics:-

Simple tics :
*Hiccuping
*Yelling
*Throat clearing
*Barking

Complex tics :
*Using different voice intonations
*Repeating one’s own words or phrases
*Repeating others’ words or phrases
*Using expletives

Tics can vary in type, frequency and severity over time. They may worsen during periods of stress and anxiety, fatigue, illness, or excitement. They can occur during sleep. You’ll likely experience an urge, called a premonitory urge, before the onset of motor or vocal tics. A premonitory urge is an uncomfortable bodily sensation, such as an itch, a tingle or tension. Expression of the tic brings relief.

Different tics may develop over time. Tourette symptoms are usually at their worst during the teenage years and sometimes improve during the transition to adulthood.

With great effort, some people with Tourette syndrome can sometimes temporarily stop a tic or hold back tics until they find a place where it’s less disruptive to express them.

 

Causes:
The exact cause of Tourette’s is unknown, but it is well established that both genetic and environmental factors are involved. Genetic studies have shown that the overwhelming majority of cases of Tourette’s are inherited, although the exact mode of inheritance is not yet known, and no gene has been identified. In some cases, Tourette’s is sporadic, that is, it is not inherited from parents. In other cases, tics are associated with disorders other than Tourette’s, a phenomenon known as tourettism.

A person with Tourette’s has about a 50% chance of passing the gene(s) to one of his or her children, but Tourette’s is a condition of variable expression and incomplete penetrance. Thus, not everyone who inherits the genetic vulnerability will show symptoms; even close family members may show different severities of symptoms, or no symptoms at all. The gene(s) may express as Tourette’s, as a milder tic disorder (transient or chronic tics), or as obsessive–compulsive symptoms without tics. Only a minority of the children who inherit the gene(s) have symptoms severe enough to require medical attention. Gender appears to have a role in the expression of the genetic vulnerability: males are more likely than females to express tics.

Non-genetic, environmental, infectious, or psychosocial factors—while not causing Tourette’s—can influence its severity. Autoimmune processes may affect tic onset and exacerbation in some cases. In 1998, a team at the US National Institute of Mental Health proposed a hypothesis that both obsessive–compulsive disorder (OCD) and tic disorders may arise in a subset of children as a result of a poststreptococcal autoimmune process. Children who meet five diagnostic criteria are classified, according to the hypothesis, as having Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS).  This contentious hypothesis is the focus of clinical and laboratory research, but remains unproven.

The exact mechanism affecting the inherited vulnerability to Tourette’s has not been established, and the precise etiology is unknown. Tics are believed to result from dysfunction in cortical and subcortical regions, the thalamus, basal ganglia and frontal cortex. Neuroanatomic models implicate failures in circuits connecting the brain’s cortex and subcortex, and imaging techniques implicate the basal ganglia and frontal cortex.

Some forms of OCD may be genetically linked to Tourette’s. A subset of OCD is thought to be etiologically related to Tourette’s and may be a different expression of the same factors that are important for the expression of tics.   The genetic relationship of ADHD to Tourette syndrome, however, has not been fully established

Risk factors
Having a family history of Tourette syndrome or other tic disorders may increase the risk of developing Tourette syndrome.

Complication:
People with Tourette syndrome have a normal life span and often lead a healthy, active life. However, having Tourette syndrome may increase the risk of learning, behavioral and social challenges, which can mar self-image.

In addition, having Tourette syndrome means you’re likely to have other related conditions, such as:

*Attention-deficit/hyperactivity disorder (ADHD)

*Obsessive-compulsive disorder

*Learning disabilities

*Sleep disorders

*Depression

*Anxiety disorders

Diagnosis:
According to the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), Tourette’s may be diagnosed when a person exhibits both multiple motor and one or more vocal tics (although these do not need to be concurrent) over the period of a year, with no more than three consecutive tic-free months. The previous DSM-IV included a requirement for “marked distress or significant impairment in social, occupational or other important areas of functioning”, but this requirement was removed in the most recent update of the manual, in recognition that clinicians see patients who meet all the other criteria for Tourette’s, but do not have distress or impairment.[44] The onset must have occurred before the age of 18, and cannot be attributed to the “direct physiological effects of a substance or a general medical condition”. Hence, other medical conditions that include tics or tic-like movements—such as autism or other causes of tourettism—must be ruled out before conferring a Tourette’s diagnosis.

There are no specific medical or screening tests that can be used in diagnosing Tourette’s; it is frequently misdiagnosed or underdiagnosed, partly because of the wide expression of severity, ranging from mild (the majority of cases) or moderate, to severe (the rare, but more widely-recognized and publicized cases). Coughing, eye blinking and tics that mimic asthma are commonly misdiagnosed.

The diagnosis is made based on observation of the individual’s symptoms and family history, and after ruling out secondary causes of tic disorders. In patients with a typical onset and a family history of tics or obsessive–compulsive disorder, a basic physical and neurological examination may be sufficient.

There is no requirement that other comorbid conditions (such as ADHD or OCD) be present, but if a physician believes that there may be another condition present that could explain tics, tests may be ordered as necessary to rule out that condition. An example of this is when diagnostic confusion between tics and seizure activity exists, which would call for an EEG, or if there are symptoms that indicate an MRI to rule out brain abnormalities.  TSH levels can be measured to rule out hypothyroidism, which can be a cause of tics. Brain imaging studies are not usually warranted. In teenagers and adults presenting with a sudden onset of tics and other behavioral symptoms, a urine drug screen for cocaine and stimulants might be necessary. If a family history of liver disease is present, serum copper and ceruloplasmin levels can rule out Wilson’s disease. Most cases are diagnosed by merely observing a history of tics.

Secondary causes of tics (not related to inherited Tourette syndrome) are commonly referred to as tourettism. Dystonias, choreas, other genetic conditions, and secondary causes of tics should be ruled out in the differential diagnosis for Tourette syndrome.  Other conditions that may manifest tics or stereotyped movements include developmental disorders, autism spectrum disorders, and stereotypic movement disorder;  Sydenham’s chorea; idiopathic dystonia; and genetic conditions such as Huntington’s disease, neuroacanthocytosis, Hallervorden-Spatz syndrome, Duchenne muscular dystrophy, Wilson’s disease, and tuberous sclerosis. Other possibilities include chromosomal disorders such as Down syndrome, Klinefelter’s syndrome, XYY syndrome and fragile X syndrome. Acquired causes of tics include drug-induced tics, head trauma, encephalitis, stroke, and carbon monoxide poisoning. The symptoms of Lesch-Nyhan syndrome may also be confused with Tourette syndrome. Most of these conditions are rarer than tic disorders, and a thorough history and examination may be enough to rule them out, without medical or screening tests
Treatment:
There’s no cure for Tourette syndrome. Treatment is intended to help control tics that interfere with everyday activities and functioning. When tics aren’t severe, treatment may be unnecessary.

Medications:
No medication is helpful to everyone with Tourette syndrome, none completely eliminates symptoms, and they all have side effects to be weighed against the benefits. However, some medications can be used to help control or minimize tics or to control symptoms of related conditions, such as attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD). These may include:

*Drugs that block or deplete the neurotransmitter dopamine in the brain, such as fluphenazine or pimozide (Orap). Used to control tics, these medications may have side effects such as weight gain and a dulling of the mind.

*Botulinum Toxin Type A (Botox) injections. For simple or vocal tics, an injection into the affected muscle may help relieve the tic.

*Stimulant medications, such as methylphenidate (Concerta, Ritalin, others) and dextroamphetamine (Dexedrine, others). These are used to help increase attention and concentration for people with ADHD.

*Central adrenergic inhibitors, such as clonidine (Catapres) or guanfacine (Tenex). Typically prescribed for high blood pressure, these drugs may help control behavioral symptoms, such as impulse control problems and rage attacks. Side effects may include sleepiness.

*Antidepressants, such as fluoxetine (Prozac, Sarafem, others). These may help control the symptoms of OCD.

Therapies
*Psychotherapy. Psychotherapy can be helpful for two reasons. It can help with accompanying problems, such as ADHD, obsessions, depression and anxiety. Therapy can also help people cope with Tourette syndrome.

*Deep brain stimulation. For debilitating tics that don’t respond to other treatment, deep brain stimulation (DBS) may help. DBS consists of implanting a battery-operated medical device (neurostimulator) in the brain to deliver electrical stimulation to targeted areas that control movement. Further research is needed to determine whether DBS is beneficial for people with Tourette syndrome.

 

Prognosis:
Tourette syndrome is a spectrum disorder—its severity ranges over a spectrum from mild to severe. The majority of cases are mild and require no treatment. In these cases, the impact of symptoms on the individual may be mild, to the extent that casual observers might not know of their condition. The overall prognosis is positive, but a minority of children with Tourette syndrome have severe symptoms that persist into adulthood. A study of 46 subjects at 19 years of age found that the symptoms of 80% had minimum to mild impact on their overall functioning, and that the other 20% experienced at least a moderate impact on their overall functioning. The rare minority of severe cases can inhibit or prevent individuals from holding a job or having a fulfilling social life. In a follow-up study of thirty-one adults with Tourette’s, all patients completed high school, 52% finished at least two years of college, and 71% were full-time employed or were pursuing higher education.

Regardless of symptom severity, individuals with Tourette’s have a normal life span. Although the symptoms may be lifelong and chronic for some, the condition is not degenerative or life-threatening. Intelligence is normal in those with Tourette’s, although there may be learning disabilities. Severity of tics early in life does not predict tic severity in later life, and prognosis is generally favorable, although there is no reliable means of predicting the outcome for a particular individual. The gene or genes associated with Tourette’s have not been identified, and there is no potential “cure”. A higher rate of migraines than the general population and sleep disturbances are reported.

Several studies have demonstrated that the condition in most children improves with maturity. Tics may be at their highest severity at the time that they are diagnosed, and often improve with understanding of the condition by individuals and their families and friends. The statistical age of highest tic severity is typically between eight and twelve, with most individuals experiencing steadily declining tic severity as they pass through adolescence. One study showed no correlation with tic severity and the onset of puberty, in contrast with the popular belief that tics increase at puberty. In many cases, a complete remission of tic symptoms occurs after adolescence. However, a study using videotape to record tics in adults found that, although tics diminished in comparison with childhood, and all measures of tic severity improved by adulthood, 90% of adults still had tics. Half of the adults who considered themselves tic-free still displayed evidence of tics.

It is not uncommon for the parents of affected children to be unaware that they, too, may have had tics as children. Because Tourette’s tends to subside with maturity, and because milder cases of Tourette’s are now more likely to be recognized, the first realization that a parent had tics as a child may not come until their offspring is diagnosed. It is not uncommon for several members of a family to be diagnosed together, as parents bringing children to a physician for an evaluation of tics become aware that they, too, had tics as a child.

Children with Tourette’s may suffer socially if their tics are viewed as “bizarre”. If a child has disabling tics, or tics that interfere with social or academic functioning, supportive psychotherapy or school accommodations can be helpful.  Because comorbid conditions (such as ADHD or OCD) can cause greater impact on overall functioning than tics, a thorough evaluation for comorbidity is called for when symptoms and impairment warrant.

A supportive environment and family generally gives those with Tourette’s the skills to manage the disorder.  People with Tourette’s may learn to camouflage socially inappropriate tics or to channel the energy of their tics into a functional endeavor. Accomplished musicians, athletes, public speakers, and professionals from all walks of life are found among people with Tourette’s. Outcomes in adulthood are associated more with the perceived significance of having severe tics as a child than with the actual severity of the tics. A person who was misunderstood, punished, or teased at home or at school will fare worse than children who enjoyed an understanding and supportive environment

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/Tourette_syndrome
http://www.mayoclinic.com/health/tourette-syndrome/DS00541

http://www.sfn.org/index.aspx?pagename=brainBriefings_tourette#full

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Treatment of Fit


The child stared into space grimacing at bystanders. “Stop it,” said the mother, embarrassed by the responses her actions evoked. But the child ignored her, then blinked and followed her obediently. Nobody realised that the little girl had just suffered a fit of atypical epileptic seizure.

You may click & read this
In classical epilepsy, typically, there is a cry followed by rolling up of the eyes and uncontrolled repetitive thrashing of the arms and legs. It usually lasts a few minutes after which the person falls to the ground. There may be no recollection of the event later.

To the untutored bystander, it may appear that the person has lost control of his or her body and been possessed by some “demonic force”. This is why the illness is called epilepsy, from the Greek word “seized”. But epilepsy actually occurs because of sudden unregulated rapid electrical discharges in the brain. It has nothing to do with demons, and exorcism will not help.

All seizures are not the same. Only one half the body, or even just a part — like the arms or face — may be affected. The rapid movements may resemble an uncontrolled tic or twitch. A sudden temporary interruption in the electrical pathways may affect consciousness, awareness, movements or bodily posture. This can result in unfocused staring (absence attacks), or “feelings” of jamais vu (unreality) or déjà vu (familiarity), or disturbances in vision, hearing and balance. In children, the seizures may be even more atypical. The child may just stare inattentively and blankly for a few minutes, suddenly fall forward, or start nodding.

About 2 per cent of adults have a seizure at some time in their life. Often, it is a one-off occurrence. Children are more prone to seizures, particularly when the temperature rises. Such “febrile seizures” occur during an episode of fever, in 3 to 4 per cent of otherwise normal children from the age of nine months to five years. This may recur three or four times during subsequent episodes of fever.

A person is labelled as suffering from a seizure disorder or is an “epileptic” if there have been two or more episodes in the preceding six months, without an obvious precipitating cause. Seizures can occur if:

There is a genetic predisposition (around 30 per cent of epileptics have a close relative with seizures)

The brain structure is abnormal, producing alterations in the electrical pathway. These may be developmental or acquired as a result of trauma or surgery

The person has infections of the brain like encephalitis, meningitis or abscess

There are brain tumours

There is excessive alcohol consumption or sudden withdrawal

The person uses illegal recreational drugs

There are biochemical abnormalities like low blood sugars and other metabolic or electrolyte imbalances

There are disturbances in the blood supply to the brain.

The condition may also be precipitated by physical factors such as flickering lights, sleep deprivation or music.

Seizures are investigated with blood tests, electroencephalogram (EEG), computed tomography (CT) scan and / or magnetic resonance imaging (MRI).

Seizure disorders require regular treatment with medications. These have negligible side effects and most can be taken safely during pregnancy as well. With the patient’s compliance, and correct and adequate medication, seizures are well controlled in 75 per cent of sufferers.

After regular treatment for three to five years, the medications are usually tapered off under supervision. Medication should never be abruptly discontinued or doses missed.

People with seizures can lead normal lives. Their academic performance need not suffer if the disease is managed well. However, driving, operating heavy machinery or working in areas with loud music or flickering lights should be avoided.

In women with epilepsy, fluctuating levels of natural hormones during the course of a normal menstrual cycle can cause an increase in the incidence and frequency of epileptic attacks premenstrually. Fertility is not affected by seizures.

Seizure medications (with the exception of sodium valporate) reduce the efficacy of oral contraceptives. Women with epilepsy who wish to practise contraception need a combination pill containing at least 50 mg of oestrogen. But instead of these higher dose pills, barrier contraception — such as condoms and diaphragms, or an IUCD (intra uterine contraceptive device like copper T) — may be a better option.

During pregnancy, good seizure control should be achieved for the safety of both the baby and mother. The overall risk of birth defects in epileptic women is around 7 per cent as against 3 per cent in the general population. If a woman is planning to become pregnant, she should immediately start folic acid supplements (5mg a day). Folic acid has a protective effect on the baby’s brain and spinal cord development in the first 40 days after conception.

Epilepsy is not a contraindication to breast-feeding, although small amounts of medication do cross over to breast milk. Epileptics can lead normal and productive lives if the condition is adequately controlled with proper medication.

Source:This article is written by Gita Mathai & published in the Telegraph (Kolkata, India)

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Hope for Clumsy Clods

Right handed or left? Worldwide, about 90 per cent of the people prefer to use their right hand for doing things. Not surprisingly, life in all cultures is geared to the right-handed individual. Implements like nuts and bolts are difficult to handle for the left-handed. Incidentally, “right” also means “correct”. The word “left” is derived from the Anglo-Saxonlyft” which means “weak” or “useless”.
……………CLICK & SEE
Our brains are wired for handedness. During the process of evolution, the centre for language moved to the left hemisphere in the majority of the people. The human brain functions such that the left and dominant hemisphere controls the right side of the body, making the majority (80 per cent) totally right-handed. The dominance does not extend to the use of the hand alone — such people are also are “right sided”. Their dominant eye, ear and leg are on the same side of the body.

Problems arise in 20 per cent of the population that doesn’t have a dominant hemisphere to determine laterality or handedness. Their brains are “cross wired”, giving them mixed handedness or laterality, cross dominance, mixed dominance or cross laterality. In short, the right hand may be matched with the left foot or the left hand with the right eye. This leads to confused, crossed signals in the brain when complex tasks are performed. The electrical and chemical signals have to criss-cross the midline before they eventually reach their final destination in the designated area of the brain. Therefore, such individuals are accident prone, and have things around them explode, collapse, catch fire or fall apart. Day-to-day objects are misplaced, and navigation from one place to another (with left to right confusion) — even along familiar roads — becomes a nightmare.

These adults evolved from clumsy children, who kept bumping into things and frequently fell down. Their bodies have scars and evidence of healed fractures. Their school projects get “excellent” for imagination and “zero” for execution. Life is difficult for people with mixed laterality. Career choices are affected, with professions like driving or piloting a plane remaining distant dreams.

People with mixed laterality alternate hands when writing and legs when kicking. They hold the telephone to the ear opposite to their writing hand. They subconsciously use one hand first and then the other to perform complex tasks. Earlier, such people were considered ambidextrous, but true ambidexterity is almost unknown.

The uncertainty also extends to the mental image of their own limbs or body surface. This causes an inability to rapidly execute commands to turn right or left. The march past becomes a formidable hurdle, with everyone doing a “right turn”, while the affected individual wanders off in the wrong direction. Hesitation is evident if they are asked to perform complicated tasks with alternating hands initiating the movement. Slowed reactions preclude split second decisions, causing frequent accidents. Also, people with mixed laterality do not perform well in track and field events. Their feet do not alternate quickly enough. Running is slow and uncoordinated. The good news, however, is that they excel in games involving a bat (such as hockey, cricket, tennis, badminton and table tennis). This is because the bat is held across the body on the dominant side.

Mixed laterality also has its advantages. The criss-crossing of brain signals uses and strengthens many normally unused brain synapses and pathways. Hence such people are exceptionally talented, creative and artistic. If portraits or photographs of some famous artists — such as Leonardo da Vinci and Rembrandt — are scrutinised, you will see that they may paint with one hand, while tilting the head to the other side and crossing the opposite leg. This demonstrates mixed laterality.

To check your laterality, figure out —

* Which hand you use to write, pick up objects or dial the telephone

* Which leg you use to kick or which is uppermost when your legs are crossed (this remains constant all through life)

* If you cannot hear clearly, to which side you tilt your head

* The side of your jaw you use to chew (this is also constant unless there is a dental problem)

If you have mixed laterality, it is possible to overcome the “defects” and strengthen both sides equally, in a way that it “compensates” for mixed laterality. These exercises, that require 10 repetitions, may be of help

CLICK & SEE

• While walking, clench and unclench your hands, alternating them with the foot you use to step forward (right hand and left foot)

• Standing on one leg at a time

• Close one eye first and then the other

• Close one ear at a time

• Doing yogic breathing through one nostril at a time.

If a child is “left” handed, that may be the “right” laterality for him or her. Punishment, ridicule or forceful correction messes up the brain connections. Desist from interference, or you might just have sabotaged the emergence of the next Einstein.

CLICK & SEE


Source:
The Telegraph (Kolkata, India)

The Latest on Exercise During Pregnancy

Physicians should recommend low to moderate levels of exercise to their pregnant patients, even if they have not exercised prior to pregnancy, according to a new report.

Exercise can strengthen and improve overall musculoskeletal and physiologic health as well as pregnancy related symptoms.

Exercise such as aerobics, impact and nonimpact activities, resistance training and swimming:

•Eases back and other musculoskeletal pain
•Lowers maternal blood pressure
•Reduces swelling
•Improves post-partum mood, including sadness

Resources:
Eurekalert August 3, 2009
Journal of the American Academy of Orthopaedic Surgeons August 2009; 17(8):504-14

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Few Sleep Disorders That Keep You Awake

Learn some sleep barriers ,discover and find out strategies for getting a good night’s sleep that you deserve most.

INSOMNIA ->
The type of insomnia that causes you to wake through the night or in the early morning hours can be caused by both external and internal factors, explains Dr. Yan-Go, a neurologist and psychiatrist, as well as the medical director of the UCLA Sleep Disorders Center.

While it’s normal to experience an occasional bad night of sleep, if your sleep problems become chronic, it’s time to do something about them.

SOLUTIONS:
Some 30 million Americans suffer from insomnia. Here, our expert panel provides you with four different solutions for getting some rest:

The sleep specialist. Try behavior changes and proper use of medication. At night, keep away from bright light. In the a.m., open the shades and go out for a walk, to tell your brain, “This is the start of the day.” You can try OTC sleep aids, but if you suffer for more than three weeks, see a doctor. Prescription drugs are safe when used judiciously, and better than the consequences of not sleeping.
— Neil B. Kavey, MD, Director, Sleep Disorders Center, New York-Presbyterian Hospital

The alternative source
. Stress often plays a role in insomnia, so try to change your reaction to it. Don’t exercise or eat at the end of the day, and avoid or limit caffeine, alcohol and nicotine. Enjoying a warm bath can help. Also, try taking 1,000 mg of calcium (it may calm your muscles and nerves, helping you sleep). Ask your doctor about melatonin supplements.
— Gerald Lemole, MD, Associate Medical Director, Christiana Care Center for Heart and Vascular Health, Wilmington, Delaware

The nutritionist. Go to bed and get up at the same time daily. Keep your room dark and quiet, and remove distractions (no working in bed). Have a cup of herbal tea, such as chamomile, to relax your body. And remember, people who eat a healthy diet of whole grains, fruits and vegetables, and low-fat protein feel better and sleep better.
— Lisa Derosimo, MD, Owner, The Weight and Wellness Center, Jupiter, Florida

The mind/body pro. Lying in bed, starting from your legs and moving up to your head, tense your muscles one at a time, then release. Your body will feel more relaxed, like a rubber band after it’s been stretched. And try soothing alternate-nostril breathing. Exhale through one nostril, using your fingers to close the opposite nostril. Breathe in and out; then switch back and forth.
— Sandra McLanahan, MD, Medical Director, Integral Health Center, Buckingham, Virginia

Bottom Line

Don’t underestimate the dangers of insomnia, including accidents from drowsiness. If you’re overweight, sleep apnea could be the cause; even a 5% weight loss can reduce many symptoms. A combination of all the advice here offers the best chance to sleep robustly, but if you’re still counting sheep, see a sleep disorders specialist for a diagnosis and advice on wise use of medications.

 

SLEEP-APNEA->
If you wake in the morning feeling sleepy, irritable, sad, forgetful, and headachy, there’s a good chance that you have sleep apnea, a sleep-related breathing disorder that affects 20 million of us — particularly when we’re pregnant. There are three types of sleep apnea: obstructive, central, and complex

SOLUTIONS:-
•Do you snore loudly? About half of all people who snore loudly have obstructive sleep apnea (OSA). It’s a sign that your airway is partially blocked.

•What’s your neck size?
The size of your neck can be a telltale sign. Women with OSA often have a neck size of more than 16 inches (17 inches for men).

•Are you waking often to take bathroom breaks
? “Most adults who don’t drink lots of water before bed and are not uncontrolled diabetics or on high doses of water pills should not have to wake repetitively to use the bathroom,” says Rochelle Goldberg, M.D., president of the American Sleep Apnea Association.

Block That Snore
There are a variety of treatments available for sleep apnea, but what works for you will depend on the severity of your problem and your commitment to treatment. Making the following lifestyle changes will help you get a good night’s sleep.

Keep that airway toned. Avoid alcohol, sedatives, sleeping pills, and any medication that relaxes the central nervous system, making it more difficult to keep your throat open while sleeping.


Dump pounds.
Work with your doctor on a weight-loss plan if you are overweight. Even a small drop in weight can improve your symptoms. Unfortunately, sleep apnea can make losing weight more difficult because it interferes with leptin and ghrelin, two brain chemicals that signal the body that it’s full.


Quit smoking.
Add sleep apnea to the long list of reasons why you should kick the habit. If you have sleep apnea, your body is hungry for oxygen. Unfortunately, smoking will reduce the amount of oxygen available.

Sleep on your side. You’re more likely to snore loudly when you sleep on your back. Try special pillows that make back sleeping impossible or at least uncomfortable. For example, you can wedge a pillow stuffed with tennis balls behind your back to make rolling over unpleasant.

See a sleep specialist. If your apnea is moderate to severe or you’ve made lifestyle changes and you still have symptoms of sleep apnea, then you need to see a sleep specialist who can observe and evaluate your sleep and help you find the best solution for you and your problem. A sleep doctor will check your mouth, nose, and throat and make a recording of what happens with your breathing while you sleep. This may require an overnight stay at a sleep center.

SLEEP-EATING->
If you’re gaining weight and discovering a mess in the kitchen every morning, talk to your doctor about whether or not you might have Sleep-Related Eating Disorder.
SOLUTIONS:

Out of Control
Sometimes the only clue you have to SRED is the trail of bread crumbs you leave behind. You wake up on the groggy side, feeling stuffed and a little anorexic, walk to the kitchen, and there you find the remnants of a midnight snack — usually high-fat, high-calorie foods. There are probably no fruits or vegetables, but there may well be such oddities as buttered cigarettes, dog food, salt sandwiches, even eggshells, and — dangerously — kitchen cleaners.

The out-of-control eating occurs almost nightly, sometimes more than once a night. It begins after a period of sleep. The next morning the sleep eater may be able to recall vague images of what she did. Or not.

Scientists are just beginning to unravel the complicated brain circuitry that connects eating and sleeping. But they have been able to figure out that SRED is sometimes associated with sleep disorders such as restless legs, narcolepsy, or obstructive sleep apnea and can be triggered by medications such as zolpidem (Ambien), triazolam (Halcion), and lithium (Lithobid). It can also apparently be triggered by major relationship stress, by dieting, and by the cessation of cigarette smoking, alcohol, and recreational drugs.

SRED, or sleep-related eating disorder, is a serious problem. It not only can make you gain serious amounts of weight and disrupt your sleep, it may also cause you to inadvertently eat toxic substances or foods to which you’re allergic. Here’s how to get a handle on it.

See your doctor. If you’re gaining weight and discovering a mess in the kitchen every morning, talk to your doctor about whether or not you might have SRED. Tell her about any medications you’re taking that she might not know about, including any recreational drugs or alcohol. Tell her about your eating habits, relationships, and any recent dieting. Even if she can’t find the precise cause of your eating, there are medications she can prescribe that will help you control the disorder.

Stay off diets. Dieting is a natural response to the weight gain you’re experiencing, but it may be counterproductive. In fact, it may be exacerbating your problem. Run any low-calorie eating plans by your doctor.

Rebuild relationships. If a close relationship with a parent or partner is stressing you out, see a therapist pronto. You could be paying the price of a nonfunctional relationship with your health.

Frisk your home. Get everything out of your home that would be harmful if you ate it. That means kitchen cleaners, bathroom cleaners, paint, lamp oil, whatever. Leave medication at the office or with a trusted friend — anywhere you can get it when you need it, but not at home while you’re sleep eating.


JET-LAG->

There are 15 million of us who fly across multiple time zones every year, with 500,000 of us in the air at any given moment. And for those of us who fly more than a couple of time zones from home—particularly those who fly eastward around the globe—jet lag can be a serious challenge. It takes away our edge, makes us groggy, and disrupts our sleep.

SOLUTIONS:-> You may click to see some ways to get rid of it

 

MENOPAUSE->

Unfortunately, the closer women get to menopause itself, the less they sleep. According to a 2007 National Sleep Foundation poll, by the time women actually stop menstruating, somewhere between the ages of 45 and 51, a full 61 percent will report that they can’t get to sleep or stay asleep several nights each and every week.
SOLUTIONS:->Click to see Menopause & Sleep Problems

 

NARCOLEPSY->
Narcolepsy is thought to be caused by a genetic glitch that prevents the body from either absorbing or producing enough of the neurochemical hypocretin. In either case the brain’s sleep/wake switch behaves erratically, and those with the condition unexpectedly fall asleep multiple times throughout the day and, conversely, wake up unexpectedly throughout the night.
SOLUTIONS:->Click to see  Narcolepsy Symptoms and Strategies

 

RESTLESS  LEGS->
Restless legs syndrome is a condition that ranges from a creepy-crawly sensation that runs up and down your legs to quivers, jerks, pins and needles, numbness, pain, or a burning sensation. It affects millions of individuals every day, and their chief complaint is difficulty falling asleep — and staying asleep.

SOLUTIONS:->Click to learn how to get rid of it

Source: The Reader’s Digest