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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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Ailmemts & Remedies

Blindness

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Blindness is the condition of lacking visual perception due to physiological or neurological factors.

Various scales have been developed to describe the extent of vision loss and define “blindness.” Total blindness is the complete lack of form and light perception and is clinically recorded as “NLP,” an abbreviation for “no light perception.” Blindness is frequently used to describe severe visual impairment with residual vision. Those described as having only “light perception” can see no more than the ability to tell light from dark. A person with only “light projection” can tell the general direction of a light source.

CLICK & SEE

In order to determine which people may need special assistance because of their visual disabilities, various governmental jurisdictions have formulated more complex definitions referred to as legal blindness.[2] In North America and most of Europe, legal blindness is defined as visual acuity (vision) of 20/200 (6/60) or less in the better eye with best correction possible. This means that a legally blind individual would have to stand 20 feet (6 m) from an object to see it with the same degree of clarity as a normally sighted person could from 200 feet (60 m). In many areas, people with average acuity who nonetheless have a visual field of less than 20 degrees (the norm being 180 degrees) are also classified as being legally blind. Approximately ten percent of those deemed legally blind, by any measure, have no vision. The rest have some vision, from light perception alone to relatively good acuity. Low vision is sometimes used to describe visual acuities from 20/70 to 20/200.

By the 10th Revision of the WHO International Statistical Classification of Diseases, Injuries and Causes of Death, low vision is defined as visual acuity of less than 6/18, but equal to or better than 3/60, or corresponding visual field loss to less than 20 degrees, in the better eye with best possible correction. Blindness is defined as visual acuity of less than 3/60, or corresponding visual field loss to less than 10 degrees, in the better eye with best possible correction.

Legal blindness:
In 1934, the American Medical Association adopted the following definition of blindness:

“Central visual acuity of 20/200 or less in the better eye with corrective glasses or central visual acuity of more than 20/200 if there is a visual field defect in which the peripheral field is contracted to such an extent that the widest diameter of the visual field subtends an angular distance no greater than 20 degrees in the better eye.” The United States Congress included this definition as part of the Aid to the Blind program in the Social Security Act passed in 1935. In 1972, the Aid to the Blind program and two others combined under Title XVI of the Social Security Act to form the Supplemental Security Income program[4] which currently states:

“An individual shall be considered to be blind for purposes of this title if he has central visual acuity of 20/200 or less in the better eye with the use of a correcting lens. An eye which is accompanied by a limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered for purposes of the first sentence of this subsection as having a central visual acuity of 20/200 or less. An individual shall also be considered to be blind for purposes of this title if he is blind as defined under a State plan approved under title X or XVI as in effect for October 1972 and received aid under such plan (on the basis of blindness) for December 1973, so long as he is continuously blind as so defined.”
Kuwait is one of many nations that share the same criteria for legal blindness.

Epidemiology:
In 1987, it was estimated that 598,000 people in the United States met the legal definition of blindness. Of this number, 58% were over the age of 65. In 1994-1995, 107.3 million Americans reported legal blindness.

In November 2004 article Magnitude and causes of visual impairment, the WHO estimated that in 2002 there were 161 million (about 2.6% of the world population) visually impaired people in the world, of whom 124 million (about 2%) had low vision and 37 million (about 0.6%) were blind.

Causes of blindness:

Serious visual impairment has a variety of causes:

Diseases

Most visual impairment is caused by disease and malnutrition. According to WHO estimates in 2002, the most common causes of blindness around the world are:

click to see
………………. Artist’s depiction of blind people

People in developing countries are significantly more likely to experience visual impairment as a consequence of treatable or preventable conditions than are their counterparts in the developed world. While vision impairment is most common in people over age 60 across all regions, children in poorer communities are more likely to be affected by blinding diseases than are their more affluent peers.

The link between poverty and treatable visual impairment is most obvious when conducting regional comparisons of cause. Most adult visual impairment in North America and Western Europe is related to age-related macular degeneration and diabetic retinopathy. While both of these conditions are subject to treatment, neither can be cured. Another common cause is retinopathy of prematurity.

In developing countries, wherein people have shorter life expectancies, cataracts and water-borne parasites—both of which can be treated effectively—are most often the culprits. Of the estimated 40 million blind people located around the world, 70–80% can have some or all of their sight restored through treatment.

In developed countries where parasitic diseases are less common and cataract surgery is more available, age-related macular degeneration, glaucoma, and diabetic retinopathy are usually the leading causes of blindness.

Abnormalities and injuries:
Eye injuries, most often occurring in people under 30, are the leading cause of monocular blindness (vision loss in one eye) throughout the United States. Injuries and cataracts affect the eye itself, while abnormalities such as optic nerve hypoplasia affect the nerve bundle that sends signals from the eye to the back of the brain, which can lead to decreased visual acuity.

People with injuries to the occipital lobe of the brain can, despite having undamaged eyes and optic nerves, still be legally or totally blind.

Genetic defects:
People with albinism often suffer from visual impairment to the extent that many are legally blind, though few of them actually cannot see. Leber’s congenital amaurosis can cause total blindness or severe sight loss from birth or early childhood.

Recent advances in mapping the human genome have identified other genetic causes of low vision or blindness. One such example is Bardet-Biedl syndrome.

Poisoning:
A small portion of all cases of blindness are caused by the intake of certain chemicals. A well-known example is methanol , found in methylated spirits, which are sometimes used by alcoholics as a cheap substitute for regular alcoholic beverages.

Willful actions:
Blinding has been used as an act of vengeance and torture in some instances, to deprive a person of a major sense by which they can navigate or interact within the world, act fully independently, and be aware of events surrounding them. An example from the classical realm is Oedipus, who gouges out his own eyes after realizing that he fulfilled the awful prophecy spoken of him.

Blindness prevention:
There exist a number of organizations, such as International Agency for the Prevention of Blindness, ORBIS International, and Seva Foundation, who have developed programs aimed at preventing blindness.

On September 10, 2007, in a 6-year study, researchers, led by John Paul SanGiovanni of the National Eye Institute, Maryland found that Lutein and zeaxanthin (nutrients in eggs, spinach and other green vegetables) protect against blindness (macular degeneration), affecting 1.2 million Americans, mostly after age 65. Lutein and zeaxanthin reduce the risk of AMD (journal Archives of Ophthalmology). Foods considered good sources of the nutrients also include kale, turnip greens, collard greens, romaine lettuce, broccoli, zucchini, corn, garden peas and Brussels sprouts.

Adaptive techniques:

Visually impaired and blind people have devised a number of techniques that allow them to complete daily activities using their remaining senses. These might include the following:

click & see
.A tactile feature on a Canadian banknote.

  • Adaptive computer software that allows people with visual impairments to interact with their computer via audio or screen magnifiers.
  • Adaptive mobile phones that allows people with visual impairments to interact with their phones via audio or screen magnifiers. These mobile phones uses software called Mobile Speak a screen reader from Code Factoryhttp://www.codefactory.es. It provides audio feedback to every functionality on the phone.
  • Adaptations of banknotes so that the value can be determined by touch. For example:
    • In some currencies, such as the euro, and pound sterling,the size of a note increases with its value.
    • Many blanknotes from around the world have a tactile feature to indicate denomination in the upper right corner. This tactile feature is a series of raised dots, but it is not standardBraille
    • It is also possible to fold notes in different ways to assist recognition.
  • Labeling and tagging clothing and other personal items
  • Placing different types of food at different positions on a dinner plate
  • Marking controls of household appliances

Most people, once they have been visually impaired for long enough, devise their own adaptive strategies in all areas of personal and professional management.

For corrective surgery of blindness, see acquired vision.

Tools:
Designers, both visually impaired and sighted, have developed a number of tools for use by blind people.

Mobility:
Many people with serious visual impairments can travel independently assisted by tactile paving and/or using a white cane with a red tip – the international symbol of blindness.

A long cane is used to extend the user’s range of touch sensation, swung in a low sweeping motion across the intended path of travel to detect obstacles. However, some visually impaired persons do not carry these kinds of canes, opting instead for the shorter, lighter identification (ID) cane. Still others require a support cane. The choice depends on the individual’s vision, motivation, and other factors.

……………………………..click & see
………………………...Watch for the blind

Each of these is painted white for maximum visibility, and to denote visual impairment on the part of the user. In addition to making rules about who can and cannot use a cane, some governments mandate the right-of-way be given to users of white canes or guide dogs.

A small number of people employ guide dogs. Although the dogs can be trained to navigate various obstacles, they are not capable of interpreting street signs. The human half of the guide dog team does the directing, based upon skills acquired through previous mobility training. The handler might be likened to an aircraft’s navigator, who must know how to get from one place to another, and the dog is the pilot, who gets them there safely.

Orientation and Mobility Specialist are professionals who are specifically trained to teach people with visual impairments how to travel safely, confidently, and independently in the home and the community.

Reading and magnification:
Most blind and visually impaired people read print, either of a regular size or enlarged through the use of magnification devices. A variety of magnifying glasses, some of which are handheld, and some of which rest on desktops, can make reading easier for those with decreased visual acuity.

The rest read Braille (or the infrequently used Moon type), or rely on talking books and readers or reading machines. They use computers with special hardware such as scanners and refreshable Braille displays as well as software written specifically for the blind, like optical character recognition applications and screen reading software.

Some people access these materials through agencies for the blind, such as the National Library Service for the Blind and Physically Handicapped in the United States, the National Library for the Blind or the RNIB in the United Kingdom.

Closed-circuit televisions, equipment that enlarges and contrasts textual items, are a more high-tech alternative to traditional magnification devices. So too are modern web browsers, which can increase the size of text on some web pages through browser controls or through user-controlled style sheets.
Computers:
Access technology such as Freedom Scientific’s JAWS for Windows screen reading software enable the blind to use mainstream computer applications. Most legally blind people (70% of them across all ages, according to the Seattle Lighthouse for the Blind) do not use computers. Only a small fraction of this population, when compared to the sighted community, have Internet access. This bleak outlook is changing, however, as availability of assistive technology increases, accompanied by concerted efforts to ensure the accessibility of information technology to all potential users, including the blind. Linux distributions (as Live CDs) for the blind include Oralux and Adriane Knoppix, the latter developed in part by Adriane Knopper who has a visual impairment. The Macintosh OS also comes with a built-in screen reader, called VoiceOver. Later versions of Microsoft Windows include an Accessibility Wizard & Magnifier for those with partial vision.

The movement towards greater web accessibility is opening a far wider number of websites to adaptive technology, making the web a more inviting place for visually impaired surfers.

Experimental approaches in sensory substitution are beginning to provide access to arbitrary live views from a camera.

Other aids
People may use talking thermometers, enlarged or marked oven dials, talking watches, talking clocks, talking scales, talking calculators, talking compasses and other talking equipment.

Social attitudes towards blindness:
The story of the Blind Men and an Elephant uses blindness as a symbol of limited perception and perspective. Stories such as The Cricket on the Hearth by Charles Dickens provided yet another view of blindness, wherein those affected by it were ignorant of their surroundings and easily deceived. H. G. Wells’ story The Country of the Blind explores what would happen if a sighted man found himself trapped in a country of blind people to emphasise societies atttitude to blind people by turning the situation on its head.

The authors of modern educational materials (see: blindness and education for further reading on that subject), as well as those treating blindness in literature, have worked to paint a different picture of blind people as three-dimensional individuals with a range of abilities, talents, and even character flaws.

The Moche people of ancient Peru depicted the blind in their ceramics.

Young mammals:
Statements that this or that species of mammals are “born blind” refers to them being born with their eyes closed and their eyelids fused together; the eyes open later. One example is the rabbit.

In humans the eyelids are fused for a while before birth, but open again before the normal birth time, but very premature babies are sometimes born with their eyes fused shut, and opening later.

Source: http://en.wikipedia.org/wiki/Blindness

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Categories
Herbs & Plants

Eryngium Foetidum (Long Coriander)

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Botanical Name: Eryngium foetidum
Family: Apiaceae
Genus:     Eryngium
Species: E. foetidum
Kingdom: Plantae
Order:     Apiales

Common Names: Culantro, Long coriander, Mexican coriander, Wild coriander, Recao, Shado beni (English-speaking Caribbean), Spiritweed,, Sawtooth, Saw-leaf herb, or Cilantro cimarron) is a tropical perennial and annual herb in the family Apiaceae.

Habitat :Eryngium Foetidum is native to Mexico and South America, but is cultivated worldwide. In the United States, where it is not well-known, the name culantro sometimes causes confusion with Coriandrum sativum, the leaves of which are known as cilantro, and which culantro is even said to taste like. The two plants are in the same family, Apiaceae.

Today, is has been introduced to large parts of South East Asia (Indochina, Malaysia, Indonesia).

Etymology
The derivation of culantro and racao, two names by which the plant is known in Central America, the former is maybe just a variant of cilantro.

Many names in languages that are spoken outside the natural habitat of long coriander compare it to the common coriander, e.g. Thai pakchi farang “foreign coriander”, Chinese ci yuan sui  pricky coriander, Hindi bhandhania “broad coriander” or Malay ketumbar Jawa “Jawanese coriander  (although I haven’t seen it in Jawa). Note, however, that the Thai name pak chi farang may also mean parsley, which also deserves to be called foreign coriander, the similarities being more visual than olfactory.
The Thai term farang foreign, Western, European has a complex history and derives, in last consequence, from the name of a Germanic people, the Franks! In Medieval Europe, the Franks had occupied a powerful position (see also lovage for the herbal edict of Charlemagne), and a large percentage of the Crusaders were Franks. So it was natural to call the continent Europe just firanja Frank country  in Arabic. Modern Standard Arabic forms are ifranji (noun), faranj (adjective) European, where the initial variation (ifra vs. far) results from different strategies to avoid the initial consonant cluster. From Arabic, the word spread eastward, e.g. Urdu frangistan , Sanskrit phiranga and Kannada paramgi Europe”, and Kurdish farangi , Dhivehi faranjee , and Khmer barang foreigner.

English saw leaf herb refers to the serrated leafs, which loosely remind to a saw.
The botanical genus name Eryngium goes back to the Greek name of the related sea holly (Eryngium vulgare), which was called eryngion; the name is probably related to er spring time(cognate to Latin ver). The genus name foetidus is Latin and means stinking, bad smelling, ugly.

Plant Description:
Eryngium comprises over 200 tropical and temperate species (Willis 1960). Most are spiny ornamental herbs with thick roots and fleshy waxy leaves with blue flowers in cymose heads. Eryngium foetidum is a tap-rooted biennial herb with long, evenly branched roots (Fig. 1). The oblanceolate leaves, arranged spirally around the short thick stem, form a basal rosette and are as much as 30 cm long and 4 cm broad. The leaf margin is serrated, each tooth of the margin containing a small yellow spine. The plant produces a well-branched cluster of flower heads in spikes forming the characteristic umbel inflorescence on a long stalk arising from the center of the leaf rosette (Morton 1981; Moran 1988). The calyx is green while the corolla is creamy white in color.

click to see the pictures..>….(01)...(1)..…..…(2)..……..….(3)….…....

CULINARY USES AND NUTRITIONAL VALUE
The appearance of culantro and cilantro are different but the leaf aromas are similar, although culantro is more pungent. Because of this aroma similarity the leaves are used interchangeably in many food preparations and is the major reason for the misnaming of one herb for the other. While relatively new to American cuisine, culantro has long been used in the Far East, Latin America, and the Caribbean. In Asia, culantro is most popular in Thailand, Malaysia, and Singapore where it is commonly used with or in lieu of cilantro and topped over soups, noodle dishes, and curries. In Latin America, culantro is mostly associated with the cooking style of Puerto Rico, where recipes common to all Latin countries are enhanced with culantro. The most popular and ubiquitous example is salsa, a spicy sauce prepared from tomatoes, garlic, onion, lemon juice, with liberal amounts of chiles. These constituents are fried and simmered together, mixed to a smooth paste and spiced with fresh herbs including culantro. Salsa is usually consumed with tortilla chips as an appetizer. Equally popular is sofrito or recaito, the name given to the mixture of seasonings containing culantro and widely used in rice, stews, and soups (Wilson 1991). There are reportedly as many variations of the recipe as there are cooks in Puerto Rico but basically sofrito consists of garlic, onion, green pepper, small mild peppers, and both cilantro and culantro leaves. Ingredients are blended and can then be refrigerated for months. Sofrito is itself the major ingredient in a host of other recipes including eggplant pasta sauce, cilantro garlic butter, cilantro pesto, pineapple salsa, and gazpacho with herb yogurt.

Culantro is reported to be rich in calcium, iron, carotene, and riboflavin. Fresh leaves are 86-88% moisture, 3.3% protein, 0.6% fat, 6.5% carbohydrate, 1.7% ash, 0.06% phosphorus, and 0.02% iron. Leaves are an excellent source of vitamin A (10,460 I.U./100 g), B2 (60 mg %), B1 (0.8 mg %), and C (150-200 mg %) (Bautista et al. 1988). On a dry weight basis, leaves consist of 0.1   0.95% volatile oil, 27.7% crude fiber, 1.23% calcium, and 25 ppm boron.

Sensory quality
Aroma strong, very similar to fresh coriander leaves; taste similar, but even stronger.

Main constituents
The essential oil from the leaves of long coriander is rich in aliphatic aldehydes, most of which are α,β unsaturated. The impact compound is E-2-dodecenal (60%), furthermore 2,3,6-trimethylbenzaldehyde (10%), dodecanal (7%) and E-2-tridecenal (5%) have been identified. Aliphatic aldehydes appear also in other spices with coriander-like scent (e.g., Vietnamese coriander).

Yet another essential oil can be obtained from the root; in the root oil, unsaturated alicyclic or aromatic aldehydes dominate (2,3,6-trimethylbenzaldehyde 40%, 2-formyl-1,1,5-trimethyl cyclohexa-2,5-dien-4-ol 10%, 2-formyl-1,1,5-trimethyl cyclohexa-2,4-dien-6-ol 20%, 2,3,4-trimethylbenzaldehyde ).

In the essential oil from the seeds, sesquiterpenoids (carotol 20%, β-farnesene 10%), phenylpropanoids (anethole) and monoterpenes (α-pinene) were found, but no aldehydes.

MEDICINAL USES
The plant is used in traditional medicines for fevers and chills, vomiting, diarrhea, and in Jamaica for colds and convulsions in children (Honeychurch 1980). The leaves and roots are boiled and the water drunk for pneumonia, flu, diabetes, constipation, and malaria fever. The root can be eaten raw for scorpion stings and in India the root is reportedly used to alleviate stomach pains. The leaves themselves can be eaten in the form of a chutney as an appetite stimulant (Mahabir 1991).

Medicinally, the leaves and roots are used in tea to stimulate appetite, improve digestion, combat colic, soothe stomach pains, eliminate gases and as an aphrodisiac.

In Carib medicine as a cure-all, and, specifically for epilepsy, high blood pressure, and fevers, fits, and chills in children.  In Suriname’s traditional medicine fitweed (culantro) is used against fevers and flu.  It is used as a tea for diarrhea, flu, fevers, vomiting, diabetes and constipation. In India the root is used to alleviate stomache.

Disclaimer:
The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider.

CONCLUSION
Although used widely throughout the Caribbean, Latin America, and the Far East, culantro is still mistaken for and erroneously called cilantro. The herb is rapidly becoming an important import item into the US mainly due to the increasing ethnic immigrant populations who utilize it in their many varied dishes from around the world. It is closely related botanically to cilantro but has a distinctly different appearance and a much more potent volatile leaf oil. Recent research to prevent bolting and early flowering will increase its leaf yields and consequently its demand. Successes in prolonging its postharvest life and storage under refrigeration will undoubtedly increase its export potential and ultimately its popularity among the commonly used culinary herbs.

References:

http://www.hort.purdue.edu/newcrop/proceedings1999/v4-506.html
http://www.uni-graz.at/~katzer/engl/spice_photo.html#eryn_foe
http://en.wikipedia.org/wiki/Eryngium_foetidum

http://www.herbnet.com/Herb%20Uses_C.htm

Categories
Herbs & Plants

Wormwood

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The name of this plant derives from its bitterness, from absinthia, the Roman word for “bitter”. This property is used for providing bitter taste to some well known beverages and liquors. Wormwood has a marked tonic effect on the stomach, the gallbladder and in adjusting weak digestive problems. It is used to expel roundworms and threadworms. By improving the functions of the digestive system it helps in many conditions, including anaemia. It is also a muscle relaxer occasionally used to treat rheumatism. The leaves of wormwood have antiseptic properties which may derive from the azulenes that the plant contains.

MAIN PROPERTIES:
Bitter, carminative, muscle relaxer, antiseptic.

Wormwood has various varieties…..three most popular are described below: 1.Wormwood common, 2. Wormwood Roman 3. Wormwood Sea

1.WORMWOOD COMMON
___________________

Botanical Name : Artemisia absinthium (LINN.)
Family: N.O. Compositae
Synonym: Green Ginger.

Common Name :Afsanteen
Parts Used: The whole herb – leaves and tops – gathered in July and August, when the plant is in flower and dried.
Habitat: Europe, Siberia, and United States of America.
The Common Wormwood held a high reputation in medicine among the Ancients. Tusser (1577), in July’s Husbandry, says:
‘While Wormwood hath seed get a handful or twaine
To save against March, to make flea to refraine:
Where chamber is sweeped and Wormwood is strowne,
What saver is better (if physick be true)
For places infected than Wormwood and Rue?
It is a comfort for hart and the braine
And therefore to have it it is not in vaine.’
Besides being strewn in chambers as Tusser recommended, it used to be laid amongstuffs and furs to keep away moths and insects.
According to the Ancients, Wormwood counteracted the effects of poisoning by hemlock, toadstools and the biting of the seadragon. The plant was of some importance among the Mexicans, who celebrated their great festival of the Goddess of Salt by a ceremonial dance of women, who wore on their heads garlands of Wormwood.

With the exception of Rue, Wormwood is the bitterest herb known, but it is very wholesome and used to be in much request by brewers for use instead of hops. The leaves resist putrefaction, and have been on that account a principal ingredient in antiseptic fomentations.

An Old Love Charm
‘On St. Luke‘s Day, take marigold flowers, a sprig of marjoram, thyme, and a little Wormwood; dry them before a fire, rub them to powder; then sift it through a fine piece of lawn, and simmer it over a slow fire, adding a small quantity of virgin honey, and vinegar. Anoint yourself with this when you go to bed, saying the following lines three times, and you will dream of your partner “that is to be”:
“St. Luke, St. Luke, be kind to me,
In dreams let me my true-love see.” ‘
Culpepper, writing of the three Wormwoods most in use, the Common Wormwood, Sea Wormwood and Roman Wormwood, tells us: ‘Each kind has its particular virtues’ . . . the Common Wormwood is ‘the strongest,’ the Sea Wormwood, ‘the second in bitterness,’ whereas the Roman Wormwood, ‘to be found in botanic gardens’ – the first two being wild – ‘joins a great deal of aromatic flavour with but little bitterness.’
The Common Wormwood grows on roadsides and waste places, and is found over the greater part of Europe and Siberia, having been formerly much cultivated for its qualities. In Britain, it appears to be truly indigenous near the sea and locally in many other parts of England and Scotland, from Forfar southwards. In Ireland it is a doubtful native. It has become naturalized in the United States.

 

Description:
It is a herbaceous perennial plant, with a hard, woody rhizome. The stems are straight, growing to 0.8-1.2 m (rarely 1.5 m) tall, grooved, branched, and silvery-green. The leaves are spirally arranged, greenish-grey above and white below, covered with silky silvery-white hairs, and bearing minute oil-producing glands; the basal leaves are up to 25 cm long, bipinnate to tripinnate with long petioles, with the cauline leaves (those on the stem) smaller, 5-10 cm long, less divided, and with short petioles; the uppermost leaves can be both simple and sessile (without a petiole). Its flowers are pale yellow, tubular, and clustered in spherical bent-down heads (capitula), which are in turn clustered in leafy and branched panicles. Flowering is from early summer to early autumn; pollination is anemophilous. The fruit is a small achene; seed dispersal is by gravity.

click to see the pictures.>……..(01)....(1).…….(2).……..(.3)..…………...(4)....

It grows naturally on uncultivated, arid ground, on rocky slopes, and at the edge of footpaths and fields.

The root is perennial, and from it arise branched, firm, leafy stems, sometimes almost woody at the base. The flowering stem is 2 to 2 1/2 feet high and whitish, being closely covered with fine silky hairs. The leaves, which are also whitish on both sides from the same reason, are about 3 inches long by 1 1/2 broad, cut into deeply and repeatedly (about three times pinnatifid), the segments being narrow (linear) and blunt. The leaf-stalks are slightly winged at the margin. The small, nearly globular flowerheads are arranged in an erect, leafy panicle, the leaves on the flower-stalks being reduced to three, or even one linear segment, and the little flowers themselves being pendulous and of a greenish-yellow tint. They bloom from July to October. The ripe fruits are not crowned by a tuft of hairs, or pappus, as in the majority of the Compositae family.

The leaves and flowers are very bitter, with a characteristic odour, resembling that of thujone. The root has a warm and aromatic taste.

Cultivation: Wormwood likes a shady situation, and is easily propagated by division of roots in the autumn, by cuttings, or by seeds sown in the autumn soon after they are ripe. No further care is needed than to keep free from weeds. Plant about 2 feet apart each way.
Collect only on a dry day, after the sun has dried off the dew. Cut off the upper green portion and reject the lower parts of the stems, together with any discoloured or insect-eaten leaves. Tie loosely in bunches of uniform size and length, about six stalks to a bunch, and spread out in shape of a fan, so that the air can get to all parts. Hang over strings, in the open, on a fine, sunny, warm day, but in half-shade, otherwise the leaves will become tindery; the drying must not be done in full sunlight, or the aromatic properties will be partly lost. Aromatic herbs should be dried at a temperature of about 70 degrees. If no sun is available, the bunches may be hung over strings in a covered shed, or disused greenhouse, or in a sunny warm attic, provided there is ample ventilation, so that the moist heated air may escape. The room may also be heated with a coke or anthracite stove, care being taken that the window is kept open during the day. If after some days the leaves are crisp and the stalks still damp, hang the bunches over a stove, when the stalks will quickly finish drying. Uniformity in size in the bunches is important, as it facilitates packing. When the drying process is completed, pack away at once in airtight boxes, as otherwise the herbs will absorb about 12 per cent moisture from the air. If sold to the wholesale druggists in powdered form, rub through a sieve as soon as thoroughly dry, before the bunches have had time to absorb any moisture, and pack in tins or bottles at once.

Constituents-
: The chief constituent is a volatile oil, of which the herb yields in distillation from 0.5 to 1.0 per cent. It is usually dark green, or sometimes blue in colour, and has a strong odour and bitter, acrid taste. The oil contains thujone (absinthol or tenacetone), thujyl alcohol (both free and combined with acetic, isovalerianic, succine and malic acids), cadinene, phellandrene and pinene. The herb also contains the bitter glucoside absinthin, absinthic acid, together with tannin, resin, starch, nitrate of potash and other salts.

Therapeutic uses:
The leaves and flowering tops are gathered when the plant is in full bloom, and dried naturally or with artificial heat. Its active substances include silica, two bitter elements (absinthine and anabsinthine), thujone, tannic and resinous substances, malic acid, and succinic acid. Its use has been claimed to remedy indigestion and gastric pain, it acts as an antiseptic, and as a febrifuge. For medicinal use, the herb is used to make a tea for helping pregnant women during pain of labor. A wine can also be made by macerating the herb. It is also available in powder form and as a tincture. The oil of the plant can be used as a cardiac stimulant to improve blood circulation. Pure wormwood oil is very poisonous, but with proper dosage poses little or no danger. Wormwood is mostly a stomach medicine.

Medicinal Action and Uses: -Tonic, stomachic, febrifuge, anthelmintic.

A nervine tonic, particularly helpful against the falling sickness and for flatulence. It is a good remedy for enfeebled digestion and debility.

Preparations: Fluid extract, 1/2 to 1 drachm. Wormwood Tea, made from 1 OZ. of the herb, infused for 10 to 12 minutes in 1 pint of boiling water, and taken in wineglassful doses, will relieve melancholia and help to dispel the yellow hue of jaundice from the skin, as well as being a good stomachic, and with the addition of fixed alkaline salt, produced from the burnt plant, is a powerful diuretic in some dropsical cases. The ashes yield a purer alkaline salt than most other vegetables, except Beanstalks and Broom.

The juice of the larger leaves which grow from the root before the stalk appears has been used as a remedy for jaundice and dropsy, but it is intensely nauseous. A light infusion of the tops of the plant, used fresh, is excellent for all disorders of the stomach, creating an appetite, promoting digestion and preventing sickness after meals, but it is said to produce the contrary effect if made too strong.

The flowers, dried and powdered, are most effectual as a vermifuge, and used to be considered excellent in agues. The essential oil of the herb is used as a worm-expeller, the spirituous extract being preferable to that distilled in water. The leaves give out nearly the whole of their smell and taste both to spirit and water, but the cold water infusions are the least offensive.

The intensely bitter, tonic and stimulant qualities have caused Wormwood not only to be an ingredient in medicinal preparations, but also to be used in various liqueurs, of which absinthe is the chief, the basis of absinthe being absinthol, extracted from Wormwood. Wormwood, as employed in making this liqueur, bears also the name ‘Wermuth’ – preserver of the mind – from its medicinal virtues as a nervine and mental restorative. If not taken habitually, it soothes spinal irritability and gives tone to persons of a highly nervous temperament. Suitable allowances of the diluted liqueur will promote salutary perspiration and may be given as a vermifuge. Inferior absinthe is generally adulterated with copper, which produces the characteristic green colour.

The drug, absinthium, is rarely employed, but it might be of value in nervous diseases such as neurasthenia, as it stimulates the cerebral hemispheres, and is a direct stimulant of the cortex cerebri. When taken to excess it produces giddiness and attacks of epileptiform convulsions. Absinthium occurs in the British Pharmacopoeia in the form of extract, infusion and tincture, and is directed to be extracted also from A. maritima, the Sea Wormwood, which possesses the same virtues in a less degree, and is often more used as a stomachic than the Common Wormwood. Commercially this often goes under the name of Roman Wormwood, though that name really belongs to A. Pontica. All three species were used, as in Culpepper’s time.

Dr. John Hill (1772) recommends Common Wormwood in many forms. He says:
‘The Leaves have been commonly used, but the flowery tops are the right part. These, made into a light infusion, strengthen digestion, correct acidities, and supply the place of gall, where, as in many constitutions, that is deficient. One ounce of the Flowers and Buds should be put into an earthen vessel, and a pint and a half of boiling water poured on them, and thus to stand all night. In the morning the clear liquor with two spoonfuls of wine should be taken at three draughts, an hour and a half distance from one another. Whoever will do this regularly for a week, will have no sickness after meals, will feel none of that fulness so frequent from indigestion, and wind will be no more troublesome; if afterwards, he will take but a fourth part of this each day, the benefit will be lasting.’
He further tells us that if an ounce of these flowers be put into a pint of brandy and let to stand six weeks, the resultant tincture will in a great measure prevent the increase of gravel – and give great relief in gout. ‘The celebrated Baron Haller has found vast benefit by this; and myself have very happily followed his example.
2.WORMWOOD, ROMAN
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Botanical Name: Artemesia pontica
Family:
N.O. Compositae
Part Used: Herb.
Roman Wormwood (Artemesia Pontica) is not indigenous to this country, being a native of Southern Europe. It grows about the same height as the Common Wormwood, but has smaller and more finely cut leaves, the segments being narrower, the upper leaves more resembling those of Southernwood; the leaves are white with fine hairs on both upper and under surfaces. The flowers, which blossom in July, are numerous, at the tops of the branches, and are darker and much smaller than those of Common Wormwood.

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This is the most delicate though the least strong of the Wormwoods; the aromatic flavour with which its bitterness is mixed causes it to be employed in making the liqueur Vermuth.

Medicinally, the fresh tops are used, and also the whole herb, dried. Much of the A. Pontica in commerce is A. maritima.

Culpepper considered the Roman Wormwood ‘excellent to strengthen the stomach.’ Also that ‘the juice of the fresh tops is good against obstructions of the liver and spleen. . . . An infusion of the flowering tops strengthens digestion. A tincture is good against gravel and gives great relief in the gout.’

Dr. John Hill says of this plant that it is the ‘most delicate, but of least strength. The Wormwood wine, so famous with the Germans, is made with Roman Wormwood, put into the juice and work’d with it; it is a strong and an excellent wine, not unpleasant, yet of such efficacy to give an appetite that the Germans drink a glass with every other mouthful, and that way eat for hours together, without sickness or indigestion.’
3.WORMWOOD SEA
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Botanical Name:
Artemesia maritima
Family: N.O. Compositae
Synonym: Old Woman.
Parts Used: Young flowering tops and shoots.
Habitat: In Britain it is found as far-as Wigton on the West and Aberdeen on the East; also in north-east Ireland and in the Channel Islands.
The Sea Wormwood, in its many variations of form, has an extremely wide distribution in the northern hemisphere of the Old World, occurring mostly in saltish soils. It is found in the salt marshes of the British Isles, on the coasts of the Baltic, of France and the Mediterranean, and on saline soils in Hungary; thence it extends eastwards, covering immense tracts in Southern Russia, the region of the Caspian and Central Siberia to Chinese Mongolia.

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Description: It somewhat resembles Artemesia Absinthium, but is smaller. Thestems rise about a foot or 18 inches in height. The leaves are twice pinnatifid, with narrow, linear segments, and, like the whole plant, are covered on both sides with a white cottony down. The small, oblong flower-heads – each containing three to six tubular florets – are of a yellowish or brownish tint; they are produced in August and September, and are arranged in racemes, sometimes drooping, sometimes erect.

Popularly this species is called ‘Old Woman,’ in distinction to ‘Old Man’ or Southernwood, which it somewhat resembles, though it is more delicate-looking and lacks the peculiar refreshing scent of ‘Old Man.’

Dr. Hill says of this species:
‘This is a very noble bitter: its peculiar province is to give an appetite, as that of the Common Wormwood is to assist digestion; the flowery tops and the young shoots possess the virtue: the older Leaves and the Stalk should be thrown away as useless. . . . The apothecaries put three times as much sugar as of the ingredient in their Conserves; but the virtue is lost in the sweetness, those will not keep so well that have less sugar, but ’tis easy to make them fresh as they are wanted.’
The plant abounds in salt marshes in which cattle have been observed to fatten quickly, and thus the herb has acquired the reputation of being beneficial to them, but they do not eat it generally, and the richness of maritime pasturage must be regarded as the true reason of their improvement under such circumstances.

Medicinal Action and Uses: The plant possesses the same properties as the otherWormwoods, but is less powerful. It is a bitter tonic and aromatic.

Although it is not now employed in regular medical practice, it is often made use of by country people for intermittent fever, and for various other medicinal purposes instead of the true Wormwood.

Thornton, in his Family Herbal, tells us that:
‘beat up with thrice its weight of fine sugar, it is made up into a conserve ordered by the London College, and may be taken where the other preparations disgust too much.’
It acts as a tonic and is good in worm cases, and Culpepper gives the following uses for it:
‘Boiling water poured upon it produces an excellent stomachic infusion, but the best way is taking it in a tincture made with brandy. Hysteric complaints have been completely cured by the constant use of this tincture. In the scurvy and in the hypochondriacal disorders of studious, sedentary men, few things have a greater effect: for these it is best in strong infusion. The whole blood and all the juices of the body are effected by taking this herb. It is often used in medicine instead of the Roman Wormwood, though it falls far short of it in virtue.’

Resources:

http://en.wikipedia.org

www.botanical.com