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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.
Click to learn more-> 1.Medication 2.Non Medication treatment

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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News on Health & Science

Naps with Dreams Improve Performance

[amazon_link asins=’B01IAQLKD6′ template=’ProductCarousel’ store=’finmeacur-20′ marketplace=’US’ link_id=’d724b984-36dd-11e7-8247-599b7f9894b4′]Have to solve a problem? Try taking a nap. But it has to be the right kind of nap — one that includes rapid eye movement, or REM, sleep, the kind that includes dreams.

………..

Researchers led by Sara C. Mednick, an assistant professor of psychiatry at the University of California, San Diego, gave 77 volunteers tests under three before- and-after conditions: spending a day without a nap, napping without REM sleep, and napping with REM sleep. Just spending the day away from the problem improved performance; people whostayed awake did a little better on the 5 p.m. session than they had done on the 9 a.m. test. Taking a nap without REM sleep also led to slightly better results. But a nap that included REM sleep resulted in nearly a 40 percent improvement over the pre-nap performance.

Source:
The study is published June 8 in the Proceedings of the National Academy of Sciences.

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It’s Dreams We Miss, Not Sleep

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We need to dream regularly as a vital release for our emotions, a leading psychologist says. Like yoga for the soul.

It has become one of the most cherished neuroses of Western culture that we exist in a state of acute sleep deprivation, a dearth to which legions of casual complaints and magazine headlines testify. Nevertheless, the psychologist and sleep guru Rubin Naiman is equally disturbed by another deficit: namely, that 21st-century society is undergoing an epidemic of dreamlessness.

In tones of soporific calm, Dr Naiman, Clinical Assistant Professor of Medicine at Dr Andrew Weil‘s University of Arizona Centre for Integrative Medicine, explains: “We are at least as dream deprived as we are sleep deprived.”

He says it is vital to dream. “An essential function of dreaming is psychological stretching, a kind of yoga for the soul: gently expanding, releasing, opening, and softening.” Like stretching a muscle, a dream can release emotional pain, tightness from earlier in the day – or even hurt from childhood. Dreaming provides “a poetic cushion” for our sharply literal lives, he says.

Modern lifestyles interfere with healthy dreaming. Overexposure to light at night suppresses melatonin and thus dreaming. Many commonly used medications, including sleeping pills, also restrict our ability to dream, or the REM [rapid eye movement] sleep that yields it. Sleep apnoea, usually associated with snoring, can significantly diminish dreaming too. “And, last, but certainly not least,” Dr Naiman says, “we live in a world where the dream has become devalued. ‘Forget it,’ we say to a loved one who has a nightmare, it’s just a dream’.”

The majority of dreams flit by in episodes of between five and 20 minutes, four or five times a night. Nevertheless, during an average life span, this nightly couple of hours will add up to a good six years enmeshed in fantasy. From the 1940s to 1985 the psychologist Calvin S. Hall collated more than 50,000 dream narratives at Case Western Reserve University, Ohio. He argued that sleepers the world over conjure the same sort of visions. Universal motifs include: education, being chased, an inability to move, tardiness, nudity and humiliation, flying, shedding of teeth, death, falling in love with or having intercourse with random individuals, car accidents and being accused of a crime.

Anxiety is the most common emotion experienced and negative sentiments tend to be more prevalent (or better recalled). America ranks the highest among industrialised nations for aggression in dreams, while sexual themes occur about a tenth of the time.

Theories about the function of dreams differ radically from the notion that they are Nature’s own form of psychotherapy to their being merely the brain’s mode of dejunking. Dr Naiman’s take is a fusion of the practical and the poetic. “Dreaming plays a critical role in learning and the formation of certain kinds of memory. It also helps us to heal from emotional losses.

“Much of the depression explosion we witness today is associated with an actual loss of dreams,” he says. If we cannot sleep on it, so the evidence suggests, the “it” in question may threaten to overwhelm us.

How might such a deficit be rectified? Better sleep as a whole will conjure better dreams. Thus, the dreamless are advised to avail themselves of the potions born of Dr Naiman’s collaboration with Origins, the natural skincare company: products designed to get us back to what he terms “deep-green sleep”, that is, chemical-free repose in a nurturing environment.

Beyond this, it may not be too complicated. “The simple act of directing our attention back towards our dreams will encourage them to come out of hiding,” he says. Once they begin to flow, make a note of them and share them. “The bottom line is about befriending our dreams and remaining open to all they bring.”

Another reason that we turn away from dreams is that so many of them are, in fact, “bad”. One study suggests that about two thirds of the emotional content of our dreams is negative. But they are bad only when viewed from a waking perspective. “We are a wake-centric culture,” he says. “We presume that waking consciousness is it: the gold standard for our experiences, happiness, sanity.”

He says that youngsters should be encouraged to talk about their dreams. “So many learn that dreams are of little consequence in the adult world … so, although they may experience them vividly, they tend to avoid discussing them and lose interest.” Parents, he says, should ask their children about their dreams, as well as share their own.

So what he advocates is an embrace of deep-green dreaming? “Why not? Healthy dreaming and healthy sleep are reciprocal. I dream best in deep-green forests.”

Sweet dreams :-

Limit your exposure to artificial light

This includes television screens, because the blue component restricts melatonin and thus dreaming. Invest in some blue light-eliminating bulbs and glasses (www.lowblue lights.com) or opt for candlelight.

Avoid excess alcohol and dream-suppressing medications
But you must treat conditions such as sleep apnoea that may interfere with dreaming. Melatonin, which requires a prescription in the UK, is a safe way to rekindle dreaming.

Look at dreaming as a form of psychological stretching
Keep a dream journal and discuss your dreams with your family and friends. Encourage children not to feel inhibited about sharing their nocturnal adventures.

Try to foster an awareness that you are dreaming when it’s happening
This is especially important when it comes to nightmares. Yield to the message of a nightmare rather than becoming embroiled in it

CLICK TO SEE:-
>Beating insomnia without popping sleeping pills
>Why can’t I get to sleep?

Sources:TIMES ON LINE  DATED:28TH.FEB ’09

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Health Quaries

Some Health Quaries & Answers

Q: I have terrible dreams every night when I feel I am falling over a mountain or am locked in a box. I don’t feel refreshed when I wake up. I am also drowsy all day.

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A: No one knows exactly why people dream, where dreams originate, what they mean or what the purpose of dreaming is for the body or the mind. But we do know that dreams are strongly associated with REM (Rapid Eye Movement) sleep. This can be picked up by an EEG (electroencephalogram) which records electrical signals in the brain. REM shows up as typical wave patterns. During an average lifespan, a human being spends about six years’ time dreaming. This works out to almost two hours each night. Most dreams last for only 5-20 minutes.

One way to sleep well is to go for a 45-minute walk half an hour after dinner, and then drink a cup of warm milk before going to bed.

I suspect cancer :
Q: My father has been taking aryuvedic medicine for his arthritis. He has developed black patches on his skin and tongue. I am afraid it is cancer.

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A: Cancer of the tongue is more likely to appear as a painless white patch or a nodule. Black patches on the skin and tongue are probably due to consumption of metals like silver, gold, mercury and lead which are present in Aryuvedic medications. These metals are not eliminated from the body. The concentration builds up and they get deposited in the bones and muscles. It is advisable to stop the medications and see an allopathic physician. If necessary, have a biopsy done to rule out cancer.

That unrelieved feeling:
Q: I have problem moving my bowels. I never manage to finish the business before leaving for work. The whole day I feel the “urge” but cannot evacuate as I do not use the office toilet, which is unhygienic.

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A: Constipation, especially long standing, can be due to improper diet lacking in sufficient fibre and fluids. It may also be due to a disease process like thyroid malfunction or a block in the intestine. In your case the former seems more likely as you have suffered for years and your health does not seem to have deteriorated in any way.

If there is no disease process (ascertained by a medical evaluation), try increasing water intake to three litres a day and eating 4-6 helpings of fruit and vegetables. If this does not work, you can try 2tsp isabgol husk in a glass of water at night to increase the bulk in your food. Walking for 45 minutes a day and doing abdominal exercises will help tone your muscles. This in turn will help regulate your bowels. Also try getting up earlier so that you can spend time in the toilet without tension and anxiety.

Otitis media
Q: My five-year-old daughter has enlarged adenoids (I don’t know what that is) and because of that (according to the paediatrician) she has frequent attacks of middle ear infection. She has been advised pneumococcal vaccine. Is it necessary?

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A: Adenoids are paired structures situated at the back of the throat, close to the opening of the middle ear into the throat. With bacterial and viral infections they can also get enlarged, the condition being called otitis media. They can block the opening of the middle ear and cause unequal pressures, build up of secretions and ear ache, eventually leading to infections.

Two common bacterial organisms causing ear infection are the H. influenza and pneumococcus. Immunisation against H. influenza is given with DPT/HepB at six weeks, 10 weeks and 14 weeks of age as part of the recommended extended immunisation schedule. Prevanar (against pneumococcus) can be given at the same time. If this is missed, Pneumo 23 can be given after the age of two years. The vaccines are safe.

Vaporising mosquito repellents can lead to allergic swelling of the adenoids. Use of a feeding bottle while sleeping, particularly at night, compounds the problem. These two factors should be removed, otherwise the infections will self perpetuate despite immunisation.

High BP at youth
Q: I am 26 years old and have hypertension, which is well controlled. I also have anxiety. I am on medications which I want to discontinue.

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A: You are too young to have hypertension. This needs to be evaluated as there are several correctable diseases that cause secondary hypertension. Continue the medications at present and try to consult an endocrinologist or nephrologist to evaluate the hypertension and hopefully find a cause. Meanwhile, to reduce anxiety, try jogging for 40 minutes a day and practise meditation or yoga regularly.

Sources: The Telegraph (Kolkata, India)

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Ailmemts & Remedies

Nightmare

Alternative Names: Dreams – bad; Bad dreams

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Definition:
A nightmare is a dream occurring during rapid eye movement (REM) sleep that arouses feelings of intense, inescapable fear, terror, distress, or extreme anxiety that usually awakens the sleeper.It is a bad dream which causes a strong unpleasant emotional response from the sleeper,it is typically fear or horror (scary stuff), being in situations of extreme danger, or the sensations of pain, falling, drowning or death or sometimes getting caused by giant animals. Such dreams can be related to physical causes such as a high fever, turned faced down on a pillow during sleep (most often in the case of drowning nightmares), or psychological ones such as psychological trauma or stress in the sleeper’s life, or can have no apparent cause. If a person has experienced a psychologically traumatic situation in life—for example, a person who may have been captured and tortured—the experience may come back to haunt them in their nightmares. Sleepers may waken in a state of distress and be unable to get back to sleep for some time. increased stress in daiy routines may also trigger nightmares and Eating before bed, which triggers an increase in the body’s metabolism and brain activity, is another potential stimulus for nightmares.

Occasional nightmares are commonplace, but recurrent nightmares can interfere with sleep and may cause people to seek medical help. A recently proposed treatment consists of imagery rehearsal. This approach appears to reduce the effects of nightmares and other symptoms in acute stress disorder and post-traumatic stress disorder.

Practitioners of lucid dreaming claim that it can help conquer nightmares of this type, rather than of the traditional type.

Nightmares, unlike night terrors, can be recalled afterward and are accompanied by much less anxiety and movement. These frightening dream experiences, which tend to occur at times of insecurity, emotional turmoil, depression, or guilt, can occur in all age groups.

Nightmares occur exclusively during REM sleep. REM sleep phases grow longer in the latter part of the sleep cycle, and the majority of nightmares occur from the middle of the night onward.

Night terrors, by contrast, take place in non-REM (nondream) sleep. During night terrors people wake up sweating heavily, their hearts pounding, and screaming in fear. They are unaware of their surroundings and unresponsive to attempts to comfort them. They may not calm down for 10 or 15 minutes, although they return to sleep quickly once the episode ends. Generally they do not remember what scared them, but rarely a person will retain a vague image of something terrifying. A few children and adults who experience night terrors will sleepwalk during the episode.

Considerations:-
Nightmares tend to be more common among children and become less frequent toward adulthood. About 50% of adults have occasional nightmares, women more often than men.

Eating just before going to bed, which raises the body’s metabolism and brain activity, may cause nightmares to occur more often. Adults who have repeated nightmares that become a significant problem should seek help.

Historic use of term
Nightmare was the original term for the state later known as (cf. Mary Shelley and Frankenstein‘s Genesis), and more currently as sleep paralysis, associated with rapid eye movement (REM) sleep. The original definition was codified by Dr Johnson in his A Dictionary of the English Language and was thus understood, among others by Erasmus Darwin and Henry Fuseli, to include a “morbid oppression during sleep, resembling the pressure of weight upon the breast.”

Such nightmares were widely considered to be the work of demons and more specifically incubi, which were thought to sit on the chests of sleepers. In Old English the name for these beings was mare or mære (from a proto-Germanic *mar?n, related to Old High German, -in modern german it would become “Nachtmar”-, and Old Norse mara), hence comes the mare part in nightmare. Etymologically cognate with Anglo-Saxon /mara/ (‘incubus’) may be Hellenic /Mar?n/ (in the Odusseid) and Samsk?ta /M?ra/ (supernatural antagonist of the Buddha).

Folk belief in Newfoundland, South Carolina and Georgia describe the negative figure of the Hag who leaves her physical body at night, and sits on the chest of her victim. The victim usually wakes with a feeling of terror, has difficulty breathing because of a perceived heavy invisible weight on his or her chest, and is unable to move i.e., experiences sleep paralysis. This nightmare experience is described as being “hag-ridden” in the Gullah lore. The “Old Hag” was a nightmare spirit in British and also Anglophone North American folklore.

Various forms of magic and spiritual possession were also advanced as causes. In nineteenth century Europe, the vagaries of diet were thought to be responsible. For example, in Charles Dickens‘s A Christmas Carol, Ebenezer Scrooge attributes the ghost he sees to “… an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato…” In a similar vein, the Household Cyclopedia (1881) offers the following advice about nightmares:

“Great attention is to be paid to regularity and choice of diet. Intemperance of every kind is hurtful, but nothing is more productive of this disease than drinking bad wine. Of eatables those which are most prejudicial are all fat and greasy meats and pastry… Moderate exercise contributes in a superior degree to promote the digestion of food and prevent flatulence; those, however, who are necessarily confined to a sedentary occupation, should particularly avoid applying themselves to study or bodily labor immediately after eating… Going to bed before the usual hour is a frequent cause of night-mare, as it either occasions the patient to sleep too long or to lie long awake in the night. Passing a whole night or part of a night without rest likewise gives birth to the disease, as it occasions the patient, on the succeeding night, to sleep too soundly. Indulging in sleep too late in the morning, is an almost certain method to bring on the paroxysm, and the more frequently it returns, the greater strength it acquires; the propensity to sleep at this time is almost irresistible.

Causes  and Risk Factors :-
Anxiety and stress are the most common causes of nightmares. A major life event occurs before the nightmare in most cases.

Other causes of nightmares include:
*Illness with a fever
*Death of a loved one (bereavement)
*Reaction to or side effect of a drug
*Recent withdrawal from a drug, such as sleeping pills
*Excessive alcohol consumption
*Abrupt alcohol withdrawal
*Breathing disorder in sleep (sleep apnea)
*Sleep disorder (narcolepsy, sleep terror disorder)

Particularly among adults, prescription drugs such as levedopa, reserpine, beta blockers, and antidepressants, as well as withdrawal from addictive drugs, all can provoke nightmares. Heavy drinking also is strongly associated with nightmares.

Other drugs suspected of causing nightmares include heart drugs, antibiotics such as ciprofloxacin, antihistamines, appetite suppressers such as fenfluramine, antidepressants, Parkinson’s drugs such as levodopa, and ulcer drugs (cimetidine). However, many drugs cannot be stopped abruptly without side effects, so it is necessary to consult your physician before altering the use of medications.

In both adults and children, nightmares and night terrors can be caused by unresolved psychological conflicts or traumatic events. They are a frequent feature of post-traumatic stress disorder. Emotional traumas that disturb the sleep of children can be overlooked easily by adults – such as the loss of a favorite toy or overhearing a loud argument between parents.

Although nightmares and night terrors are considered normal developmental events in children, disappearing by adolescence, frequent episodes at any age warrant professional evaluation. Crisis intervention techniques can be very effective in dealing with the trauma.

Diagnosis:
Diagnosis will be based upon history and the absence of any underlying organic problems.

Tests that may be done include:
*Blood tests (such as CBC or blood differential)
*Liver function tests
*Thyroid function tests
*EEG

If therapies for stress and anxiety, medication side effects, and substance use do not treat the problem, your health care provider may want to send you to a sleep medicine specialist for a sleep study (polysomnography). In very rare cases, patients need to take special medications that suppress or reduce REM sleep to prevent nightmares.

Treatment :-
Some people have significant psychological problems that are causing bad dreams. It is important to consider psychotherapy to pinpoint major life stressors, past traumatic events and depression that might be causing bad dreams.

If one is taking medications, it is advisable to ask the prescribing physician if the pills might be the culprit.

Chronic nightmares have also been treated by a desensitization method that uses instruction about rehearsal of the nightmare and the imagining of a different ending.

In one study, patients were instructed to select a recent nightmare and write it down, change the nightmare in any way they wished, write down the changed version and rehearse the changed nightmare in an imagery relaxed state. Patients were instructed to rehearse the changed version once a day for three consecutive days after each nightmare or until the nightmare went away.

It was concluded that the use of desensitization or rehearsal techniques can reduce the frequency of nightmares and decrease distress.

Home Care
If you are under severe stress, you should ask for support from friends and relatives. Talking about what is on your mind can really help. Also, follow a regular fitness routine, with aerobic exercise if possible. You will find that you will be able to fall asleep faster, sleep more deeply, and wake up feeling more refreshed. Learn techniques to reduce muscle tension (relaxation therapy), which also will help reduce your anxiety.

Practice good sleep hygiene. Go to bed at the same time each night, and wake up at the same time each morning. Avoid long-term use of tranquilizers, as well as caffeine and other stimulants.

If you noticed that your nightmares started shortly after you began taking a new medication, contact your health care provider. He or she will let you know how to stop taking that medication if necessary, and recommend an alternative.

For nightmares caused by the effects of “street drugs” or regular alcohol use, ask for advice on the best ways to quit. An Alcoholics Anonymous group, for example, might suggest a safe way for you to stop drinking without putting your health at risk. You can also attend their regularly scheduled meetings. See also: Alcoholism – support group.

Also, look at your lifestyle — friends, work, family — to find and change factors that encourage substance abuse.

Questions To Ask Your Doctor About Nightmares:-
*Are these nightmares or night terror?
*Is there a psychological cause such as depression, emotional trauma, or stress?
*Is it related to any medications that are currently being taken?
*Should any changes be made in the medications currently being taken?
*Would psychotherapy help?
*What can be expected from psychotherapy?

Medical investigation:
Studies of dreams have found that about three quarters of dream content or emotions are negative.

One definition of “nightmare” is a dream which causes one to wake up in the middle of the sleep cycle and experience a negative emotion, such as fear. This type of event occurs on average once per month. They are not common in children under 5, more common in young children (25% experiencing a nightmare at least once per week), most common in adolescents, and less common in adults (dropping in frequency about one-third from age 25 to 55).

Fearfulness in waking life is correlated with the incidence of nightmares.

Scientists speculate that negative dreams are evolutionarily adapting, purging the brain of memories or associations which trigger fear.

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/Nightmare
http://www.healthscout.com/ency/68/612/main.html#cont
http://www.nlm.nih.gov/medlineplus/ency/article/003209.htm

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