Insomnia Food List

Natural Insomnia Program

The Insomnia Exercise Program is a simple audio program that works to Train Your Brain to switch from normal, fast-paced brain waves to slow, delta and theta waves and put you to sleep mind and body naturally. This is a 2-part program. Part 1 is a 25 minute audio where I lead you step by step to reach those slow theta and delta stages that knock you out in a deepest sleep of your life. This is done through a combination of mind, eye and relaxation exercises. Part 2 is a 50 minute audio of sound therapy where you hear the relaxing sound that draws you into the wonderful land of dreaming. After youve listened to the audio a few times, youll most likely be sound asleep long before it even comes to this part but it is important because it will draw you into deeper and deeper sleep so you dont wake up after a few minutes and not be able to doze off again. All you have to do is listen to the audio in your bed and get ready to fall asleep! Read more here...

Natural Insomnia Program Summary

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Childrens sleep problems What can I do

Develop good sleep habits in your child by Refraining from engaging in elaborate strategies to try to get your child to fall asleep. These strategies don't allow your child to develop his or her own self-soothing behaviours and force your child to rely on you to establish the conditions he or she needs to fall asleep (such as excessive cuddling and time spent with

Classification Of Sleep Disorders

People show up at sleep disorders centers with one, or a combination of, three kinds of complaints not being able to sleep, being sleepy during the day, or abnormal Table 5. The International Classification of Sleep Disorders A. Intrinsic Sleep Disorders B. Extrinsic Sleep Disorders C. Circadian Rhythm Sleep Disorders 3. Medical Psychiatric Sleep Disorders From American Sleep Disorders Association (199 ). events that occur during their sleep. However, any one of these problems may have very different underlying causes. For these reasons, sleep disorders are usually classified and discussed by causes. There are three main categories of causes called dyssomnias, parasomnias, and sleep disorders associated with medical or psychiatric disorders (see Table 5). Dyssomnias are problems with sleep that result in difficulties in initiating or maintaining sleep or in being excessively sleepy during the day. There are three subcategories of dyssomnias. Intrinsic sleep disorders have their...

Sleep disorders of breathing see

Sleep apnoea syndromes comprise those impairments of breathing, either hypoventilation or frank apnoea, that occur chiefly or solely during sleep. Obstructive sleep apnoea (OSA) is the severe end and chronic snoring is the mild end of the spectrum of conditions referred to as sleep disordered breathing (SDB) due to increased upper airway resistance. Pathogenetic mechanisms, generally worse during REM-sleep in most patients, include relaxation of the muscles of the upper airway during sleep (a process exacerbated by alcohol or sedative drugs), decreased ventilatory response to carbon dioxide during sleep, or pathological abnormalities of the upper airway, chest wall or neuromuscular function. Sedative drugs impair the arousal response to obstruction, hypoxaemia and hypercapnia, and thus prolong the apnoeic episodes. use of drugs, such as medroxyprogesterone (a respiratory stimulant) or protryptyline (to decrease REM-sleep), which may sometimes be helpful

Circadian Rhythm Sleep Disorders

He described his problem as insomnia. I just can't get to sleep. The problem started this semester, midway through the first semester of his junior year, when he had to take a required course only offered at 8 a.m. He said he was lucky when he started college to have no early-morning classes. He could take advantage of college dorm life at night without having to worry about getting up early. As a result, he typically went to sleep between 3 and 4 a.m. even later on weekends. After that, he carefully selected his courses in order to avoid those that met early in the morning until he had no choice this semester. Because he could not get to sleep early enough at night, he had missed many of his 8 a.m. classes this semester, since he just could not wake up. He had repeatedly tried going to bed at midnight, but just lay awake for several hours. He had tried everything, including warm milk and graham crackers, sleeping pills, herbal teas, exhaustive exercise, alcohol, a dull textbook, and,...

NREM Sleep

From the late 1950s to the early 1970s, the neurotransmitter serotonin was believed to be the neurotransmitter of sleep, because drugs that interfered with serotonin in the brain caused insomnia, whereas drugs that facilitated serotonin caused stronger and longer SWS. Also, long time sleep researcher, Michel Jouvet, MD of Claude Bernard University in Lyon, France, showed that damage to the raphe, the area of the brain that is the source of serotonin, produced insomnia in proportion to the degree of damage. Subsequently restoring serotonin with drugs could then reverse this insomnia. In humans, sometimes when brain damage caused insomnia, the damage included the raphe. REM Sleep Melatonin is a hormone released by the pineal gland located within the approximate center of the brain. It is a mildly sleep promoting substance that also acts as a zeitgeber. It is released during the subjective night of the nychthemeron, but sun or room light blocks its release (see Chapter 5).

Melatonin

Melatonin is a serotonin derivative, secreted by the pineal gland when the retina fails to perceive light. Its name derives from the fact that it lightens amphibian skin by aggregating melanophores (i.e. the opposite effect to that of melanocyte-stimulating hormone, MSH see Adrenocorticotropic hormone), though such an effect has not been shown in humans. Melatonin is available as an over-the-counter drug in many countries and it has become very popular in people with a variety of sleep disorders, since unlike sedatives it induces normal REM sleep. A recent small study showed it to be effective in a dose of 3 mg in improving sleep quality and preventing sleep deprivation in patients in the traditionally difficult Intensive Care environment.

Insomnia

Instead of individual case conferences for our study of insomnias, we will focus our attention upon a special symposium at the annual meeting of the Associated Professional Sleep Societies (APSS). A panel of experts on insomnia from five different sleep clinics review and discuss insomnia. Rather than relating what each said verbatim, the following is a summary of the symposium. A moderator is asking the questions. What is Insomnia Essentially, insomnia is not being able to get enough quality sleep efficiently. It has many different causes. Many have likened it to a fever. Just as a fever may be caused by many different things, insomnia is a symptom resulting from any number of causes. Since insomnia may have various causes, it may be classified either as a type of dyssomnia or as a type of sleep disorder secondary to medical psychiatric disorders. How Prevalent is Insomnia Studies of insomnia in the Western industrialized world show 30 to 35 of all people report that they have at...

REM Sleep

The Hobson and McCarley model (Alan Hobson, MD, is professor of psychiatry and director of the Laboratory of Neurophysiology at Harvard Medical School Robert McCarley, MD is Professor and Chair of the Harvard Department of Psychiatry at the Brockton West Roxbury VAMC) describes how the interaction of these REM-off and REM-on cells produces the ultradian rhythm of the NREM-REM sleep cycle (see Figure 29). Active REM-off cells inhibit the REM-on cells. REM-off cell activity is influenced by many sources including sensory input, the suprachias-matic nucleus, and other areas of the forebrain. During NREMS, the activity of REM-off cells gradually weakens and eventually become so weak that they no longer can inhibit the REM-on cells. This occurrence allows the REM-on cells to become active, causing REMS to begin. After some time, the relative activity strengths of the REM-on and REM-off areas quickly reverse, causing REMS to cease and NREMS to return. And so they alternate through the...

Melancholia Depression with Somatic Symptoms

This subtype is listed as melancholia in DSM-IV and as severe depressive episode with somatic symptoms in ICD-10. Melancholia is the oldest diagnostic term used in psychiatry and is characterized by vegetative disturbances and other clinical features that indicate a profound dysfunction of neurobiological mechanisms 7, 8, 10, 43 . The main features of its clinical identity include psychomotor retardation or agitation, late insomnia, loss of weight and appetite, anhedonia (lack of reactivity to pleasurable stimuli), diurnal variation of mood and libido disturbances. The question is still raised, however, whether this cluster of symptoms identifies a separate clinical entity discrete from the other subtypes of MD or if it should be considered as a variant of MD different only on severity measures, as inferred in the ICD-10 classification 27, 44 .

Age Loss and the Diagnostic Boundaries of Depression

That bereavement and depression have symptoms in common, such as sadness and poor sleep, cannot be contested. But the same can be said for depression and generalized anxiety disorder (initial insomnia and poor concentration), depression and old age (poor sleep, poor appetite), depression and cancer (fatigue and thoughts of death), and on and on. In none of these cases, including grief, does the overlap mean a challenging differential diagnosis should not be made, and in each case, a prompt and accurate diagnosis of major depression can be literally life-saving.

The Week Before The Exam

Get yourself onto the right time schedule. Wake up every day at the same time you will need to on the day of the exam. This will get your circadian rhythm coordinated with the exam schedule. Do not nap between 8 00 a.m. and 5 00 p.m. Otherwise, you will accustom your body to shutting down during critical exam hours. If you get up at the right time each day, you will also find it easier to fall asleep at night. By getting into the proper sleep-wake cycle, you will find it easier to get to sleep the night of the exam as well.

The Identification of Diagnostic Subtypes of Depressive Disorders

Clinical observations show that in the presence of significant loss there is frequently a reinforcement of morning dysphoria and terminal insomnia. However, such states are only similar to circadian mood fluctuations. In reality, they represent ''pseudo-circadian'' symptoms, the cause of which comprises frequent nightmares associated with loss of the loved one, encountering him in dreams, or the presence of hypnopompic hallucinations when waking up in the morning. These clinical facts are confirmed by ethnographic data in the analysis of funeral rites among Slavs and the experiences of widows (our own investigations).

Sleepiness And Tiredness

We all have used the terms sleepy and tired and alert and awake and have a notion of what these terms mean. But in science we need to be precise in the terms we use. Otherwise, we may find that we are really dealing with somewhat different things. Bill Dement, MD PhD, longtime, notable sleep researcher and retired Director of the Stanford University Sleep Disorders Center, suggests the following continuum Meanwrhile, forget the numbers. Howr are you functioning during the day Is it hard to get up in the morning Do you struggle to stay awake Do you fall asleep in class, when reading, or in quiet situations (Remember, it is not dull, monotonous lectures or warm, dim classrooms, or boring books that put you to sleep. It is only your own individual sleep need that does so.) If your answers are affirmative and you do not have a sleep disorder (see Chapter 10), you need to get more sleep and possibly more regular sleep. For a week, try increasing your nightly sleep by 15 minutes and getting...

Pharmacotherapy of nicotine addiction

The acute effects of smoking (calmness, alertness, increased concentration) can be positively reinforcing, whereas nicotine withdrawal symptoms (depressed mood, insomnia, irritability, anxiety, poor concentration, weight gain) are negatively reinforcing.49 Pharmacotherapy is an integral part of the treatment of nicotine dependence but is most effective with concurrent behavioral therapy. Both nicotine-replacement therapies and bupropion (Zyban ) double long-term smoking cessation rates and have, therefore, been recommended as first-line therapy by the Agency for Healthcare Research and Quality. Nicotine-replacement therapies (Food and Drug Administration (FDA)-approved), include 2- or 4-mg nicotine polacrilex gum, the nicotine patch, nicotine nasal spray, and the nicotine inhaler.49

Long And Short Sleepers

An individual can tell how much sleep they need by how they feel and perform during the day. Outside of undergoing a MSLT, there is really no other way. If you have trouble waking up in the morning and getting out of bed, if you feel sleepy during the day and have to light off sleep a lot, if you fall asleep in warm, quiet, boring situations or when driving, you may not be getting enough sleep (or you may have a sleep disorder see Chapter 10 for additional signs and symptoms of sleep disorders). Try getting more sleep by going to bed 15 minutes earlier each night or more if you are sleeping much less than eight hours per night and have severe daytime sleepiness for a week at a time and seeing how you feel the next morning. Maintain the sleep level that enables you to feel alert for much of the day. Some of you may be trying to sleep too much. While this is not as likely in the Western industrialized world as not sleeping enough, it does happen. This problem, too, may be due to a sleep...

The Selection of the Antidepressant in Clinical Practice

Such a mechanistically based classificatory system can help the prescriber in four specific ways. First, it can be used to anticipate and understand the pharmacological effects that these drugs will produce in most patients. Second, it can facilitate the selection of a specific agent for a patient with a specific symptom cluster (e.g. insomnia and anorexia versus hypersomnia

Problems Teens Experience With Sleep

A great deal of focus has been directed toward the sleep of teenagers in the United States and other countries such as Italy and Brazil. As mentioned, they tend to be strongly phase delayed, which can present many of them with real problems when they have to be in school early in the morning. In the United States, many teenagers have to be in class before 8 a.m., meaning many are arising an hour or two earlier than this hour. Yet, their bodies do not want to fall asleep until around 11 p.m. Adding to this problem, are the demands of work and the desire to socialize that may make bedtimes even later. The result is all too often chronic sleep deprivation in teenagers. It is not unusual to see students sleep in class, especially in the morning, say both high school students and their teachers. Even when awake, they are so out of it that paying attention and learning suffer.

College Student Sleep

The sleep ot college students is worse than that ot high school students, at least for freshmen college students in their late teens. Although not as rigidly bound to school start times, most college freshman get even less sleep than high school seniors, because they choose to go to bed so much later. Delayed bedtimes not only shorten their average night of sleep by about half an hour more than their prior amount but also tend to make them even more phase delayed. And things seem to be getting worse over recent years there has been a dramatic increase in the number of college students who report less stability in their sleep habits and less satisfaction with their sleep over the last couple of decades (Hicks, Johnson, & Pellegrini, 1992).

How The Sleep Of Women Differs

For example, Reyner and Home (1995) found some differences between the sleep of men and women previously unrecognized. Women go to bed earlier than men and fall asleep sooner. As a result, the sleep period is much longer for women. However, women do not sleep as well, with more awakenings and time spent awake during the sleep period. These differences become greater with advancing age, plus older women take longer to fall asleep. The National Sleep Foundation poll of 2001 found that adult women are more likely than men to get eight or more hours of sleep per workday but no differences on non-workdays. Even greater attention has been paid to conditions distinctive in women, notably changes in their reproductive hormones and related developmental status. Menarche, the menstrual cycle, pregnancy, and menopause all have been found to have effects on sleep quality and quantity. (Much of this research has been done by Kathryn Lee, PhD, a nurse with the Department of Family Health Care...

Check Your Answers on Next Page

Feelings of guilt about inconsequential events. Insomnia or excessive sleepiness. Feelings of hopelessness and worthlessness. Withdrawal from activities and interests. Decreased interactions with family and friends. Decreased work productivity. Decreased relationship with coworkers. Changes in bowel habits. Weight loss or gain. Decreased sexual drive.

Herbal preparations black cohosh

The German Commission E Monographs report that black cohosh has estrogen-like actions, suppresses LH, binds to estrogen receptors, and lacks contraindications to its use. Side effects include gastric discomfort, sweating, weight gain, and headache. A six-month trial funded by the manufacturer of one black cohosh product reported that women benefited from a 70 reduction in symptoms such as hot flushes, mood swings, night sweats, and insomnia. Higher doses did not improve symptoms.70

Other herbs and botanicals

There are no good studies to support the use of valerian. Potential adverse reactions include hepatotoxicity, insomnia, sedation, and cardiac disturbance. In one case report, valerian root was associated with the onset of high-output congestive heart failure from withdrawal.

The Menopausal Transition

Menopause signals the end of child-bearing capacity, and is also associated with changes in susceptibility to various chronic diseases, including breast cancer, heart disease, and osteoporosis.66 Differences in age at menopause between vegetarian and omnivorous women, should they exist, could be associated with differences in chronic disease patterns between these groups. Furthermore, some women experience unpleasant symptoms during menopause (vasomotor symptoms such as night sweats and hot flushes, mood swings, insomnia, weight gain, headaches, and fatigue),67 and these symptoms have been observed to differ among women in different cultures.67,68 Whether dietary variables contribute to these differences in symptom experiences has not been clearly established, but there is speculation that they could.68-70 Some of these dietary differences may also exist between vegetarian and omnivorous women. Accordingly, after defining and describing the menopausal transition, available research on...

Associated Factors Genetics And Consequences

A study of older adults reporting sleep difficulties indicated that they reported higher levels of worry than either self-reported good sleepers or normal controls (Pallesen et al., 2002), suggesting that insomnia may be one consequence of worry in later life. This is consistent with data from Wetherell, Le Roux et al. (2003) indicating that sleep disturbance is one of the best discriminators among older adults with GAD, those with subsyn-dromal anxiety symptoms, and normal controls.

LDL Total cholesterol HDL [Triglycerides5

The answers are 284-c, 285-a, e. (Fauci, 14 e, pp 287-289.) Nocturnal penile tumescence occurs during REM sleep, and if the man gives a history of rigid erections under any circumstances, the most likely etiology of his ED is psychological (i.e., depression, disinterest, anxiety). In the patient with a history of neuropathy, further studies to evaluate impotence are not necessary. Patients with peripheral vascular disease should be

Pharmacological Treatments Theoretical Basis

Three types of investigations have provided information on possible neuro-biological abnormalities in depressed young people. The first is the study of cortisol secretion, measured by investigationssuchasthe DST. Several studies have shown that, in comparison with non-depressed patients, depressed young people are less likely to show suppression of cortisol secretion when the exogenous corticosteroid dexamethasone is administered 11 . The specificity of the DST for depressive disorder is, however, less for young people than it is for adults 89 . The second investigation is the study of sleep. Polysomnographic (PSG) studies of depressed adults have found that they tend to show abnormalities of sleep, including shortened rapid eye movement (REM) latency (time from the start of sleep to the first period of REM sleep) and reduced slow wave sleep 90 . Many PSG studies with depressed adolescents have shown sleep abnormalities, mainly of REM sleep 91-96 . These generally positive results...

Specific Discussion

Mycoplasma or atypical pneumonia may present with a similar radiographic picture, but in the absence of an acute febrile illness, that diagnosis seems unlikely. Chronic bronchitis is a clinical diagnosis and is defined per ATS criteria as a history of chronic sputum production for most of the days in a 3-mo period for at least two successive years. The chest x-ray may show large pulmonary vessels if there is longstanding cor pulmonale and generally does not show any focal opacities. Although the patient is obese and 60 of patients with obstructive sleep apnea (OSA) are overweight, there is no history of hypersomnolence, sleep fragmentation, sleep disorder, or other clinical evidence of sleep apnea syndrome. The clinical scenario presented is suggestive of pulmonary embolism. The physical exam suggesting bilateral atelectasis and the chest radiograph depicting those changes and representing congestive atelectasis are consistent with that diagnosis.

How the Study of Early Onset Depression Challenges Us to Produce a New Paradigm for Understanding Mood Disorders

This diagnostic extension of the concept of depression is further complicated by the confusion of comorbidity, as recent debates on the diagnosis of bipolar disorder in young people have demonstrated. It is a leap of something akin to faith to believe that 60, 70 or 80 of depressed youngsters have an additional and unique psychiatric disorder Perhaps in our syndromatically based diagnostic developments we have debased the mathematical foundations of set theory and have happily developed what we feel are unique categories using shared elements. For example, a set of golf clubs cannot be confused with a set of hockey sticks, because the elements, although superficially similar, are essentially different, yet concentration and sleep problems (for example) can be used to define both depression and anxiety. Additionally, in many cases, we have assumed, and not confirmed, that diagnostic elements are part of the implied pathoetiology of a disorder (e.g. early morning awakening in...

Problems with Sleeping and Dreaming

To this point, we have concentrated on the normal processes of sleeping and dreaming, but things do not always go as intended. In this section, we will explore problems and difficulties of sleeping and dreaming. In Chapters 10 and 11, we will take a look at problems that typically come to the attention of one of the many sleep disorders treatment centers in the United States and, increasingly, in the rest of the world. Before that, Chapter 9 discusses things that are somewhat less severe in that they do not usually present themselves at a sleep disorders treatment center but are nevertheless problems of inconvenience, discomfort, and sometimes problems of great concern. In the 1970s, a new aspect of medicine evolved sleep disorders. Previously, physicians, as well as lay people, knew that sleep could be problematic however, knowledge of both the kinds of problems people could have with sleep and the extent to which people suffered from them was limited, as was the knowledge of...

Prions And Prion Diseases

Fatal diseases of humans and of other animals. A listing of TSEs is given in Table 7.2. TSEs of humans include kuru, Creutzfeldt-Jakob disease (CJD), Gerstmann-Straussler-Scheinker syndrome (GSS), and fatal familial insomnia (FFI). TSEs are characterized by neuronal loss that appears as a spongiform degeneration in sections of brain tissue, often accompanied by amyloid plaques or fibrils. The most prominent symptoms of disease are usually dementia (loss of intellectual abilities) or ataxia (loss of muscle control during voluntary movement) that results from the progressive loss of brain function. The disease always has a fatal outcome. In humans, death usually occurs within 6 months to 1 year of the first appearance of symptoms.

Difficulties With Sleep With Advanced Age38

Advanced age has several effects on sleep that can cause problems. In fact, more than half of those over age 65 report disturbed sleep. One cause is the natural change in circadian rhythms in adults. As adults age, they tend to phase advance their internal circadian rhythms. But there is evidence that the rhythms also begin to flatten, so there is less difference between the nadir and the acrophase, and the response to zeitgebers gets a bit weaker. Additionally, the amount of slow wave sleep diminishes with age in adults, as does the release of melatonin and growth hormone. The net result is that by retirement age, sleep is shorter, shallower, and more fragmented, making sleep seem like more of a problem than it was before. Also, getting to sleep and staying asleep is frequently more of a problem. Yet, it is easier to doze off more during the day when engaged in quiet activities. Many of these changes occur sooner in males than females. Additionally, as people age, they are more...

Clinical Point of View about Depression in the Elderly

Sleep disorders (insomnia, and less frequently, hypersomnia), poor appetite with loss of weight, and fatigue are the more frequent somatic symptoms observed in depression. They also raise the question of possible somatic comorbidities and of the eventual causal relations between physical illnesses and depression. Pain perception can be increased and the physician should try to find a possible objective explanation. Physical complaints are commonly the prior concern raised by old depressed patients, particularly against a background of cultural factors that can be local (rural background for example) or national (as in China for example). This tendency is also characteristic of personality profiles marked by a lack of psychological insight. Contextual parameters play important roles and contribute to triggering off, accentuating or maintaining emotional disturbances family conflicts, disagreement with nursing staff, and so on. In institutional settings, depression is not evident in...

Disorders of Sleep Part I43

The typical sleep disorders clinic in many ways resembles the sleep lab described in the prologue, since it contains the facilities to measure the nighttime and daytime sleep of patients. The standard EEG, EOG, and EMG measurements are used to assess the states of sleep, but, as we shall see, other bodily functions during sleep are also measured to aid in effective diagnosis of sleep disorders. The typical sleep disorders clinic has technicians, just as the research lab does, and clinicians researchers who are typically Ph.D.s and M.D.s. The Ph.D.s are most often psychologists or psychobiologists and the M.D.s are usually pulmonary physicians, neurologists, psychiatrists, internists, and other related specialists. They meet regularly as a team to review and discuss patient histories and to confer on newly admitted patients about possible diagnosis and potential treatments. In addition, they usually meet once a week for about an hour with other interested professionals to discuss...

Comorbidity of Depression in Older People

An interviewer visited every house in randomly chosen streets within the borough and sought an interview with every inhabitant identified as being aged at least 65. This method has previously been established as an accurate way to gather a sampling frame within an inner-city population. A total of 774 eligible subjects were approached, of whom 700 (90 ) agreed to be interviewed. The main interview instrument was the shortened version of the comprehensive assessment and referral evaluation (short-CARE, 3 ). This has scales to measure depression, dementia, sleep disorder, somatic symptoms, subjective memory problems and limitation in activities of daily living. In addition, the Anxiety Disorders Scale 4 was administered. This generates diagnoses (non-hierarchically) for phobic disorder, generalized anxiety and panic disorder.

Medications Monotherapy

Neurological manifestations include peripheral nervous system abnormalities of impotence, autonomic dysfunction, peripheral neuropathy, and postural hypotension central nervous system disturbances include behavioral changes, memory loss, hallucinations, nightmares, depressions, and insomnia.

Periodic Limb Movement Disorder

E.C. is a 51-year-old woman, who came to the clinic complaining of insomnia and serious sleepiness during the day. She was without problems as a child but has had trouble sleeping as an adult, apparently getting worse in recent years. She has been a housewife much of her adult life. She reports having to get up during the night to stretch her legs because of an uncomfortable feeling in them. When she does get to sleep, however, she says she sleeps very deeply, but awakens not feeling refreshed or rejuvenated. Her husband reports that she often shakes the bed during sleep and kicks off the bedcovers. E.C. reported trying many things for her insomnia including many drugs, both prescribed and over-the-counter, but to no avail. Likewise, six weeks off caffeine was of no help. She exercises on an Exercycle or plays tennis daily. She occasionally takes voluntary naps, which help. When trying to nap, she falls asleep quickly, but the creepy sensation in her legs awakens her every 10 minutes...

Venous Ulcers Associated with Deep Venous Insufficiency

A 46-year-old female schoolteacher and non-smoker presented with an ulcer on the medial side of the ankle. The ulcer had persisted for the past year despite compressive dressings at a hospital wound care center. Ulcers in the same general area had occurred intermittently in the past but had healed with local wound care and dressings. The ulcer was very painful, particularly with dependency of the leg (7 10 over a visual analogue scale) and frequently at night. The patient had made a habit of elevating her legs during the day whenever feasible, and to sleep with her legs elevated on a pillow at night. She had been using a nonsteroidal anti-inflammatory drug once or twice a day at work for pain relief, but lately a narcotic prescribed by her physician was required for sleep at night. Even so, on some nights, she had to walk off the pain for twenty to thirty minutes before she could fall asleep.

Pharmacological Treatment

A limited number of medications are currently available in the pediatric age group for use as adjuncts to behavioral management. Sibutramine (Meridia) is currently available for the treatment of adolescents 16 yr of age or older. Sibutramine is a norepinephrine and serotonin reuptake inhibiter and has side effects that include hypertension, tachycardia, dry mouth, headache, constipation, and insomnia. When used in conjunction with a group-based behavioral therapy, sibutramine plus behavioral therapy led to a more rapid decline in BMI than behavioral therapy alone (91). Sibutramine should not be administered in conjunction with monoamine oxidase inhibitors or other serotonin reuptake inhibitors. Another pharmaceutical alternative is orlistat (Xenical). Orlistat binds gut lipase and prevents hydrolysis of dietary fats into free fatty acids and monoacylglycerols. Its side effects, which often lead to discontinuation of the medication, include flatulence, diarrhea, steatorrrhea, and...

Idiopathic Hypersomnia

Some people are sleepier than others for no known reason. A few feel tired almost all of the time, and others sleep a great deal longer than the average. Some of these very sleepy people are classified as having idiopathic, meaning not caused by something else, hypersomnia. It is not common, but it is striking when it occurs. It is not a result of insomnia, poor sleep, or other known sleep pathologies. It just happens. Beginning sometime between ages 15 and 25, they feel almost constantly tired, but can resist naps. Short naps, when taken, are not refreshing, yet, without sufficient sleep, sufferers may begin to display automatic behavior, blackouts, and microsleeps (see Chapters 2 and 3). Most commonly, family members show a similar condition, although many report that they are unlike any relatives. They sleep deeply at night, but only slightly longer than average. They awaken easily and spontaneously in the morning. Their sleep pattern is normal, but prolonged. However, they...

Problems That Occur During Sleep

There are degrees of differences in snoring, ranging from mild and only occasional to what has been called heroic. The latter group snores virtually every night and can be heard by others in distant rooms or even by neighbors Loud and frequent snoring can be a sign of obstructive sleep apnea (see Chapter 10), but not all people who snore have apnea. It is thought that some snoring progresses to apnea over time. Snoring can occur in all sleep stages but can be more common in stages 2, 3, and 4. It may be more common in some families and some forms may have a genetic basis. Not that there is a specific gene for snoring, but predisposing characteristics of the upper airway may be inherited. The official definition (American Sleep Disorders Association, 1997) for a nightmare is a frightening dream that awakens the sleeper. The frightening aspect most commonly is intense fear but may also be anxiety, sadness, anger, guilt, disgust, helplessness, or grief. There is full alertness upon...

Schizophreniform Disorder

Difficulty falling and staying asleep for 2 months she states that the sleep she does manage to get is not restful and that she is easily awakened by noises. depression. Institute sleep hygiene measures, e.g., sleep only as much as is necessary establish regular hours for sleep exercise avoid caffeine, alcohol, tobacco, and other stimulants leave the bed when not tired. Hypnotic agents (e.g., benzodiazepines) may aid in short-term management. Discussion Complaints of insomnia are most prevalent among women and the elderly. Younger patients tend to report more difficulty in initiating sleep, while the elderly tend to have more difficulty maintaining sleep. A diagnosis of primary insomnia depends on excluding other causes. Differential diagnosis includes circadian rhythm disorder, primary hypersomnia, narcolepsy, sleep apnea, parasomnias, and sleep disorders secondary to other medical and psychiatric disorders.

Alternative Pharmacotherapy

Discussion Obesity contributes to atherosclerosis, CAD, hyperlipidemia, hypertension, and type II diabetes. Anti-obesity drugs currently on the market include orlistat and sibutramine. They are indicated lor weight loss and maintenance in conjunction with a calorie-reduced diet in patients with a body mass index 30. Orlistat is a lipase inhibitor that acts in the GI tract and blocks the absorption of dietary fat. The most common adverse effects are GI-related and include spotting, flatus, and fatty stools. Absorption of lipid-soluble vitamins (e.g., vitamin K) or medications (e.g., griseofulvin) may be decreased. Sibutramine treats obesity through appetite suppression it acts centrally by blocking serotonin and norepinephrine reuptake. Adverse effects include headache, dry mouth, constipation, insomnia, and a substantial increase in blood pressure and heart rate in some patients. Unlike the discontinued drug fenfluramine, sibutramine does not cause pulmonary hypertension or cardiac...

Recurrent Brief Depression RBD

In addition to depressive mood need to have at least two of the following poor appetite or overeating, insomnia or hypersomnia, low energy, low self-esteem, poor concentration, inability to decide and hopelessness. The symptoms have to last for at least 2 years, usually without remissions or with occasional free intervals of a short duration (of a few days or weeks). The patients, most of the time, present themselves as moody, sad, tired and anhedonic, with feelings of inadequacy, but also often as demanding and complaining, self-denigrating and at the same time reproachful to others. As a consequence, dysthymics are not particularly sociable and their relationships are neither stable nor empathetic. Insomnia

Ketamine Side Effects

HPI The patient also states he has been having palpitations and insomnia He suffers from Parkinson's disease and has been taking levodopa for a long time. levodopa, a precursor of dopamine, does. When this drug is administered, it is usually given in combination with carbidopa, an inhibitor of the peripheral dopa decarboxylase (thus increasing the half-life and plasma levels of levodopa). Dyskinesias are a common side effect, as are GI symptoms (nausea and vomiting) and postural hypotension. Arrhythmias, anxiety, depression, insomnia, and confusion have also been reported. The dose of levodopa must be slowly decreased, since abrupt cessation may result in an akinetic state. Many patients eventually experience a decline in efficacy with levodopa carbidopa. They may develop an on-off phenomenon in which they suddenly lose activity ol the levodopa and are frozen. Other patients experience a more gradual decline in which the levodopa effect lasts for shorter periods of time.

The Normal Physiology Of Sleep

Additionally, because ol the changes in breathing regulation, many people, especially the elderly, when falling asleep, alternate several deep breaths with several shallow breaths even to the point ol stopping breathing for a tew seconds. This pattern continues for 10 or 20 or even 60 minutes until the person is solidly asleep. During NREMS, your body continues to regulate its temperature using the same several methods as it does when you are awake. If you are too warm, more blood is sent to the surface of the body where it can be radiated to the air. If really hot, you will sweat. When you are cool, less blood is sent to the body surface to avoid loosing heat. It really cold, you may shiver. The only difference between sleep and wake is during NREMS when your body temperature set-point (like a thermostat setting) is a bit lower than when awake. When you first fall asleep, blood may be sent to the surface of your body to help bring your temperature down to the sleeping set-point. If...

Morning Larks And Night Owls

Research has shown that in addition to being more alert in the morning and sleepy in the evening, MTs generally fall asleep more easily than ETs and have better moods after awakening but awaken more during sleep than NTs and ETs. The circadian temperature of MTs peaks about 1 hour earlier in the nychthemeron than ETs. ETs feel more alert and believe that they perform better later in the day and on into the evening. The difference between ETs and MTs is typically a two-hour phase shift. However, when this shift interacts with process S (see Chapter 2) the result is a possible difference of 4 hours in time of peak alertness (Van Dongen & Dinges, 2001). Not only do ETs tend to go to bed later and get up later, they tend to be more irregular in their bedtime habits, especially on non-work nights from nychthemeron to nychthemeron but average the same amounts and patterns of sleep as ETs and NTs. ETs also experience less jet lag and tolerate shift work better. What causes some people to...

Electroencephalography EEG

In addition to the resting EEG described above, electroencephalography can be performed under other diagnostic conditions. Hyperventilation EEG, during which the patient is asked to breathe deeply for a specific period of time, can identify abnormalities related to cerebral vasoconstriction. Photostimulation EEG, performed by flashing a light over the patient's face, may provoke photostimulated seizure activity. Sleep EEG is used to detect sleep disorders and sleep-related epilepsy. During sleep EEG, brain activity is recorded as the patient falls asleep, during the sleep, and while the patient is awakening.

Necrotizing Ulcerative Gingivitis

Necrotizing ulcerative gingivitis is characterized by fetid breath and ulcerations covered by a whitish, yellowish, or gray pseudomembrane. They may be found in only a few areas or throughout the mouth. The most common site of these ulcers is the interproximal gingiva. The thin gray membrane covering the ulcer may be wiped off easily, exposing a highly inflamed area that bleeds very easily. There is a rapid destruction of the marginal and interproximal soft tissue. These tissues become so painful that it becomes difficult to brush the teeth and to masticate food. The onset of this infection is sudden, often with systemic symptoms of illness. In severe cases, there may be fever, an increased pulse rate, pallor of the skin, insomnia, and mental depression. Treatment includes procedures performed by the dental officer and home-care procedures performed by the patient.

Vegetative Symptoms

Vegetative symptoms constitute the most biologically rooted clinical features of depressive disorders and are commonly used as reliable indicators of severity (severe depression with somatic symptoms in ICD-10 and melancholia in DSM-IV). They are manifested as profound disturbances in eating (anorexia and weight loss, or the reverse, bulimia and weight gain), in sleep (insomnia and or hypersomnia), in sexual function (decreased sexual desire or in a minority of cases the reverse), loss of vitality, motivation, energy and capacity to respond positively to pleasant events. Additionally, concomitant bodily sensations, usually diffuse pains, and complaints of fatigue and physical discomfort are reported. Disturbances of biorhythms are frequent and are considered as characteristic features of melancholia. They are mainly manifested in sleep patterns, predominantly with early morning awakening.

Atypical Depression

The specifying criteria for atypical depression, according to DSM-IV, are basically the reverse vegetative-somatic symptoms most commonly encountered in typical melancholia (i.e. hypersomnia instead of insomnia, hyperphagia and weight gain instead of anorexia and weight loss), while the mood is responsive to actual or potential positive events. Excessive sensitivity to rejection is also listed as a criterion. The symptoms have to predominate in the past recent 2 weeks of an episode of major depression or during the past 2 years of dysthymia. Although the validity of atypical depression has been frequently challenged in the past 58 , a recent review assessing published studies on the subject and applying Kendell's criteria for clinical validity concluded that atypical depression complies with two out of six validation criteria, the clinical description and the differential treatment response, monoamine oxidase inhibitors being more effective than tricyclics 59 .

Alzheimers Disease

The diagnosis of depression in a cancer presents a challenge. There is a considerable overlap of cancer and depressive symptoms (loss of appetite, weight loss, insomnia, loss of interest and loss of energy) 105 . Also, cancer chemotherapeutics have been associated with depressive symptoms. The cancer patient with a depressive disorder is likely to be preoccupied with the illness, to develop feelings of worthlessness and guilt, with reliable differentiating symptoms from the normal emotional reaction to the cancerous disease. Recurrent thoughts of suicide are common in cancer patients but not as intense as in severe depression. Risk factors for depressive disorder in cancer include young age, female gender, active symptoms of the disease, presence of uncontrolled pain, history of mood disorder and social isolation 95 .

Hypothyroidism

Estimated to occur in 40 of such patients. Psychiatric symptoms typically begin with mental slowing, followed by a decline in short-term memory, progressive dysphoria, affective lability and emotional withdrawal. Symptoms such as insomnia, decreased self-esteem and worthlessness are reported to be more common in major depressive disorder 95 . When compared to individuals with normal thyroid function, patients with subclinical hypothy-roidism have been found in one study to have a significantly higher frequency of lifetime depression, suggesting that subclinical hypothyroidism may lower the threshold for the occurrence of depression 106 . Since most depressives are not hypothyroid, there is no necessity for a routine checking of thyroid function, unless they are under lithium prophylactic treatment. Thyroid screening should be obtained in patients with treatment refractory depression, as hypothyroidism may contribute to this condition 107 . The relationship of thyroid function and...

Credit Awarded

An individual suffering from anxiety neurosis has exaggerated uncontrollable anxiety and apprehension. Anxiety disorders are fairly common in our society. Roughly two to four percent of the population has been diagnosed, at one time or another, as having some type of anxiety disorder. Signs and symptoms include a rather constant state of tension, worry, and general uneasiness. Such individuals are often oversensitive in people-to- people relationships and frequently have feelings of inadequacy and depression. Emotional tension frequently leads to physical tensions which cause neck and upper shoulder muscular pain and sleep disturbances of insomnia and nightmares. Decision making is difficult, and after the decision is made, the individual may worry excessively over possible disasters that may occur. Obsessive-compulsive disorders are examples of anxiety neuroses. An obsessive-compulsive person feels he must do something even though he does not want to do the...

Sleep Studies

Decreased sleep continuity, diminished slow wave sleep, altered distribution of REM sleep, and most notably, short latency to the first REM sleep period as well as lengthening of the duration of the first REM period, were frequently observed in patients with major depression disorders, particularly of the ''endogenous'' severe subtype 47, 158 . Claims of specificity of this aberrant sleep pattern were not substantiated, since a similar pattern has been observed in other psychiatric disorders, although not as frequently as in depressed patients, even in those with subthreshold symptomatology 64 . Whether sleep pattern abnormalities, wherever they occur, are trait or state markers is still an open question. Some sleep complaints seem to change following therapeutic interventions and others do not 159 . A recent study indicated that short REM latency and slow wave sleep latency are familial, and polysomnographic abnormalities may precede the clinical manifestation of depression and could...

Relational aging

Clearly, the collision of several major life transitions into a concentrated period of time puts the woman atriskfor many stress-related symptoms, such as fatigue, irritability, mood swings, sleeplessness, weight changes, and generally poor self-care. Prolongation of these stressors may increase the likelihood of genuine anxiety and depressive disorders and medical illnesses that require medical and or psychological intervention. Anticipatory guidance by the provider sensitive to the multiplicity of roles and transitions facing a given woman may prevent serious negative outcomes or at least support more intentional coping strategies. Reminders about self-care are important. Perhaps more important is the respectful line of inquiry about the transitions that a given woman is facing, and empathic listening with genuine interest maybe the best intervention of all.

Aging parents

Women in mid life providing care to elderly parents or friends have a significantly higher risk of depression and anxiety, and struggle with feelings of being overwhelmed, worried, frustrated, and sad.48 Care-givers use prescription drugs for depression, insomnia, and anxiety at approximately two to three times the rate of the general population.49 About 50 of care-givers provide care without any outside assistance, and only 10-20 of family care-givers use formal services through agencies.

Ancient India

The Vedas included a life science and medical text called Ayur-Veda, part of which, the famous Charaka Samhita, deals extensively with the use of wine as a medicine. The Charaka Samhita states that wine is the 'invigoration of mind and body, antidote to sleeplessness, sorrow and fatigue . . . producer of hunger, happiness, and digestion . . . if taken as medicine, and not for

Amphetamines

The guidance counselor refers a lOth-grade student to the school nurse for weight loss, insomnia, and depression. Patients with chronic toxicity from amphetamines develop tolerance to the drug. Symptoms may include restlessness, nervousness, depression, insomnia, and suicidal behavior.

Cocaine

Cocaine gives a feeling of euphoria. Patients may have CNS stimulation, i.e., restlessness, excitement, agitation, increased motor activity, increased respiratory rate, and hypertension. Later, the patient may experience hypotension with seizure, coma, and respiratory depression. Often patients complain of chest pain secondary to myocardial injury that ranges from angina pectoris to myocardial infarction. There may be nausea, insomnia, and emaciation in the chronic user.

Declaring Attributes

The consequence of this is that when the class comes back after lunch, to listen to the discussion of attribute types and their declarations, most of them go to sleep. The fact of the matter is that there are a lot of attribute types (I voted against a few of them), there are lots of relevant details, and it is pretty tedious 3 . If you find all this tedious too, or find yourself falling asleep in the next section, focus on the first three subsections CDATA, Enumeration Lists, and IDs. You are most likely to use these attributes and will only rarely use the others.

The Brain in Sleep8

For centuries, sleep was assumed to be a passive process. It certainly seems that way to many today. To get to sleep, you have to allow your brain and body to relax their activity and arousal. You cannot actively do so you just have to let it happen. And anything, whether it is noise, light, pain, discomfort, thoughts, and so forth, that interferes can prevent sleep. During the 20th century, several scientific findings changed this notion, at least among scientists, to one of sleep being actively produced. Among these findings was a chain of research involving laboratory experiments on the cat brain.

Children Adolescents

In a controlled trial of 53 child and adolescent patients with either MDD or minor depression (8 ), Wood et al 128 compared CT to RT for 5-8 treatment sessions. Treatment consisted of a cognitive component based on Beck et al 4 , a social problem-solving component, and a symptom-focused component (e.g. sleep hygiene, activity scheduling). CT was more effective than relaxation on depression and overall outcome.

Weight Reduction

Methamphetamine (Desoxyn) and phentermine (Ionamin) are controlled substances. Phentermine was used with fenfluoramine as Phen-Fen until the combination was associated with heart valve abnormalities. These drugs are approved for short-term use only and are moderately effective when used in conjunction with diet. Adverse effects include dry mouth, hypertension, nervousness, insomnia, and sexual dysfunction. 3. Cybutrimine (Meridia). This drug is a serotonin, norepinephrine, and dopamine reuptake inhibitor. This medication has been used to safely promote weight loss over a prolonged period. Side effects include hypertension, dry mouth, and insomnia. Cybutrimine should not be used with selective serotonin reuptake inhibitors (SSRIs).

Anti Obesity Drugs

It also induced a reduction of testosterone levels, which is consistent with the reduction of testosterone levels in overweight women with PCOS after weight loss by dietary changes and exercise (139). However, it is difficult to assess the long-term clinical efficiency of the medications because the literature is rather inconclusive (small number of patients and short-term studies). Common side effects (headache, insomnia) and potentially serious cardiovascular effects (hypertension, arrythmias, etc.) limit the widespread use of sibutramine, and although orlistat generally has a safer side-effect profile, the frequent adverse effects on bowel habits (flatulence, steatorrhea, GI discomfort) are also significant hurdles to its use.

Presleep Experiences

Gayle Delaney, Ph.D., is a dream psychologist who has devoted her career to working with dreaming. In her books Living Your Dreams (1996) and All about Dnams (1998) she describes in detail her method for successfully incubating dreams. The crucial step in her method is to write down and then repeat what you want to dream about over and over again as you are falling asleep. This request could be to dream about something in particular or to answer a question. This task is all accomplished dream incubators need to do. However, neophytes need to do more in order to insure success. include your feelings on the issue. Now, and this is an important but not always easy step, compose and write a one-line request or question. As you are ready to fall asleep, repeat the request or question over and over. As soon as you awaken from a dream, or at the end of your sleep period, write down your recall of your dream(s) with as much detail as possible. Perhaps the dream obviously fulfills your request...

Review Questions

A 51-year-old man comes to the emergency department because of excruciating pain in his right knee. He describes the pain as so severe that it woke him from a deep sleep. He denies any similar episodes in the past. He has hypothyroidism and takes thyroid replacement therapy. He admits to a few drinking binges over the past 2 weeks. His temperature is 38.1 C (100.5 F)> blood pressure is 130 90 mm Hg, and pulse is 80 min. Examination shows an erythematous, warm, swollen, and exquisitely tender right knee. Blood cultures are negative. Synovial fluid analysis shows positively birefringent, rhomboid-shaped crystals. Which of the following is the most likely diagnosis

Questions 168172

The next five questions relate to this case history. Audrey is a 45-year-old woman who was brought to her local hospital's emergency room by her husband because of several days of progressive weakness and numbness in her arms and legs. Her symptoms had begun with tingling in her toes, which she assumed to be her feet falling asleep. However, this feeling did not disappear, and she began to feel numb, first in her toes on both feet, then ascending to her calves and knees. Two days later, Audrey began to feel numb in her fingertips, and had difficulty lifting her legs. When she finally was unable to climb the stairs of her house because of her leg weakness, difficulty gripping the banister, and shortness of breath, her husband urged her to go to the emergency room. The neurologist who examined Audrey in the emergency room noticed that she was short of breath while sitting in bed. He asked the respiratory therapist to measure her vital capacity (the greatest volume of air that can be...

Sexual Abuse

To diagnose sexual abuse it is important for the physician to perform a detailed history and physical examination. The patient may present to the physician with any number of complaints. Some examples of complaints that may be associated with sexual abuse are genital infections, genital or anal trauma, recurrent urinary tract infections, enuresis, encopresis, and inappropriate sexual behavior. The child may have other complaints such as sleep disorders, anxiety, phobias, fire setting, drug abuse, and eating disorders. In some instances the child tells her mother or a friend that she has been sexually abused.

Epilogue

Meanwhile, see if there is someone at your college or university, or at a local sleep disorders center, who is doing sleep research and whom you could volunteer to help. Section IV reviews some of the more common problems people have with their sleep or dreams. By the end of the 20th century, much had been discovered about these problems and how to treat them effectively. At the beginning of the 21st century, there are sleep disorder centers in almost every moderate sized city in the United States, and growing numbers in other parts of the world, where people with sleep or dream problems can have them diagnosed and treated. This opportunity has led to great improvements in the quality of life, and sometimes the longevity of life, for many people. Additional information about sleep disorders can be obtained from The National Sleep Foundation, 1522 K Street, NW, Suite 500, Washington, DC 20005 202 347-3471 nsf sleepfoundation.org e-mail www.sleepfoundation.org. This resource is...

Erik B Loucks

Initial steps towards modern anesthesia began with the work of Paracelsus, a Swiss physician and alchemist, in the mid-16th century. He mixed sweet oil of vitriol (now known as the anesthetic diethyl ether) into fowl feed and found that it is taken even by chickens and they fall asleep from it for awhile but awaken later without harm.

Answers

The answer is d. (Sadock, 7 e, p 1691.) This patient suffers from restless legs syndrome, a disorder characterized by the irresistible urge to move one's legs while trying to fall asleep. Patients describe the unpleasant feelings in their calves as worms or ants crawling. Only moving the legs or walking alleviates the discomfort. Restless legs syndrome can be caused by pregnancy, anemia, renal failure, and other metabolic disorders.

Anti Infectives

39, The answer is b, (Hardmant p 1158J Isoniazid inhibits cell-wall synthesis in mycobacteria. Increasing vitamin B6 levels prevents complications associated with this inhibition, including peripheral neuritis, insomnia, restlessness, muscle twitching, urinary retention, convulsions, and psychosis, without affecting the anti mycobacterial activity of INH.

Electrolyte Tests

Magnesium deficiencies can be corrected by the proper administration of magnesium sulfate. Early symptoms of magnesium deficit include muscle cramps, tremors, and insomnia. It should be noted that decreases in urinary magnesium may be detected before decreases in plasma magnesium. Low levels of calcium and potassium may mask the presence of hypomagnesemia.

Panic Disorder

HPI The patient has witnessed and experienced traumatic events but cannot recall certain details of these events, and he becomes anxious both when questioned about the events and when he encounters cues that remind him of them. He also reports difficulty falling asleep, hypervigilance, emotional outbursts, difficulty concentrating, and recurrent nightmares that have begun to interfere with his life.

The child

Function are contained within the technical manual, and a well-trained psychologist experienced with this test instrument should have no difficulty with interpretation. The clinical disorder scales deal with 20 DSM-IV diagnoses ADHD, conduct disorder, oppositional defiant disorder, adjustment disorder, substance abuse disorder, anorexia nervosa, bulimia nervosa, sleep disorders, somatization disorder, panic disorder, OCD, generalized anxiety disorder, social phobia, separation anxiety disorder, PTSD, major depression, dysthymic disorder, mania, depersonalization disorder, and schizophrenia. The personality disorder scales evaluate pervasive aspects of inner sense, feelings, affect, and thoughts, as well as behaviors that deviate significantly from normal characteristics of adolescence. The five personality disorder scales include avoidant personality disorder, obsessive-compulsive personality disorder, borderline personality disorder, schizotypal personality disorder, and paranoid...

Psychotic Behavior

This condition, an acute reaction, occurs in people with a low alcohol tolerance. The condition can also occur in someone whose alcohol tolerance is low at the moment from such causes as exhaustion, emotional stress, or other conditions. For these individuals, consuming even moderate amounts of alcohol can cause the person to suddenly become disoriented and go into a homicidal rage. Following the confused, disoriented state, the person usually falls into a deep sleep after which he may not remember anything that happened during the time he was confused.

Meningioma

HPI She has had similar headaches several times each year since the onset of her menstrual periods. The headaches occur on one side of her head. She also reports seeing flashing lights like lightning moving across her field of vision. Stress, sleeplessness, and anxiety usually precipitate these headaches.

Sheldon Harvard

Arendt J (1995) Melatonin and the Mammalian Pineal Gland. Chapman and Hall, London. Cardinali DP, Pevet P (1998) Basic aspects of melatonin action. Sleep Medical Review, 2 175-190. Wetterberg L (1999) Melatonin and clinical application. Reproduction and Nutrition Development, 39 (1999), pp 367-382.

Narcolepsy

L.I.*15 is a 35-year old-female who said her symptoms first appeared as a teenager wrhen she noticed a weakness in the knees when shooting free-throws during basketball games or on other occasions when she laughed at something funny. Eventually, she began to drop things she was holding, and her eyelids would often droop. Gradually, the symptoms became more frequent and more intense. She stated that she was always somewhat sleepy as a teenager, but she began to feel sleepier during the daytime at approximately the time she started college. Even after a long night of sleep, she would fall asleep in class, at movies, after dinner, and at other quiet times. These behaviors She was obliged to take frequent naps, after which she felt refreshed. If she tried to fight off' the need to nap, she would subsequently fall asleep in inappropriate places, such as the dinner table. She had tried sleeping-in in the morning but was unable to do so. Hypnogogic and hypnopomnic hallucinations (or imagery)...

Items 310312

A 16-year-old boy is diagnosed with depression following the divorce of his parents. He suffers from lack of appetite, insomnia, feelings of worthlessness, and difficulty in concentrating. He is given antidepressants and is referred to a psychologist for weekly psychotherapy visits. Which of the following is the most important risk factor for committing suicide

And Nutrition

399, The answer is e, (Hardman, p 156.3.) The toxicity of 1NH is mainly on the peripheral and central nervous systems (PNS CNS). This is attributable to competition of INH with pyridoxal phosphate for apotryp-tophanase. This results in a relative deficiency of py rid ox ine, which causes peripheral neuritis, insomnia, and muscle twitching among other effects.

Clinical Picture

The dermatitis of pellagra is bilateral and symmetric. It involves sunlight exposed skin, such as the face, neck, dorsum of the hands and feet. It is characterized by intense erythema, edema, burning, blisters and subsequently scaling, skin thickening and dark brown pigmentation. Lesions about the lower neck form a collarette of dermatitis, and are called Casal's necklace (Fig. 59.1). The dermatitis can be generalized. There can be maceration in folds and ulcerative areas. Follicular hyperkeratosis is observed in seborrheic areas such as sides of the nose and cheeks. The mouth may be sore with angular cheilitis and glossitis. This last originates as an inflammatory process with atrophy of the filliform papillae. There is pharynxitis and painful esophagitis with odynophagia as well as vomiting and diarrhea. Anemia, amenorrhea, miscarriages and weight loss may occur. Central nervous system symptoms include irritability, asthenia, anorexia, headache, insomnia, anterograde and retrograde...

Block

The answers are 8-1 c, 8-2 d. (Sadock, 7 e, p 962.) Alcohol withdrawal delirium (delirium tremens) is the most severe form of alcohol withdrawal. In this syndrome, coarse tremor of the hands, insomnia, anxiety, agitation, and autonomic hyperactivity are accompanied by severe agitation, confusion, and tactile or visual hallucinations. When alcohol use has been heavy and prolonged, withdrawal phenomena start within 8 h of cessation of drinking. Symptoms reach peak intensity between the second and the third day of abstinence and are usually markedly diminished by the fifth day. In a milder form, withdrawal symptoms may persist for weeks as part of a protracted syndrome. Wernicke's psychosis is an encephalopathy cause by severe thiamin deficiency and usually associated with prolonged and severe alcohol abuse. It is characterized by confusion, ataxia, and ophthalmoplegia. In alcohol hallucinosis, vivid auditory hallucinations start shortly after cessation or reduction of...

Measuring Sleepiness

Subjective scales of sleepiness may not always be accurate because a person may not be aware of their true sleepiness or not wish to divulge the feelings. The study of sleep requires more exact ways of measuring sleepiness than casually asking people how they feel. A better way is to have people indicate on a standardized scale how sleepy they feel. The Stanford Sleepiness Scale or SSS (shown in Figure 9), on which a person selects one of seven items to describe the current state of alertness, is well validated on average people for just this purpose. While it has been shown that sleep deprivation does increase SSS scores, there are no norms available to which to compare responses. The Epworth Sleepiness Scale (shown in Figure 10) asks questions about falling asleep in situations that typically promote sleep. It has been validated on populations How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired This refers to your usual way of...

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Natural Cures For Insomnia

Natural Cures For Insomnia

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