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Are You Aware Of These Common Problems Which Are Stealing Your Sleep?

Understand how menstruation, pregnancy and menopause affect a woman’s sleep and how to minimize these conditions for improving sleep.

Women face difficulty in falling and staying asleep than men.

They also experience more daytime sleepiness. Poor concentration, poor performance at job and school and increased illnesses can result with lack of sleep.

Many issues can affect women’s sleep. Hormone level changes, illness, stress, lifestyle and sleep environment are some of the issues. Some unique conditions such as menstrual cycle, pregnancy and menopause can interfere with quality of sleep in women.

Phases of menstrual cycle and their effects on sleep:

50 percent of women face sleep problems during menstrual cycle. Changes in fluctuating levels of hormones present in menstrual cycle before ovulation, during ovulation and after ovulation can interfere with the quality of sleep.

Understand your menstrual cycle phases:

Before ovulation: Disturbances in sleep can occur before ovulation that is from 1st day to 12th day of menstrual periods in some women. Menstrual period continues for five days. Egg ripens in the ovary after the end of the period. During the period of menstrual bleeding, you will get less sleep.

During ovulation: Egg releases during ovulation period that is between 13th to 15th days. If egg fertilizes, pregnancy can occur. If not, your cycle continues and menstrual period occurs in 14 days.

After ovulation: If there is no occurrence of pregnancy after ovulation period, uterine lining wall starts to break down and is discarded during menstrual period. Around 19 to 21 days, levels of progesterone become high and reach the peak level during the beginning of the phase. At the end of the phase, levels of progesterone start to decrease. You will find difficulty in sleeping due to the falling progesterone levels.

Premenstrual syndrome: Premenstrual syndrome(PMS) symptoms occur during 22 to 28 days that is at the later phase. These symptoms include anxiety, mood swings, nervousness, depression, irritability, bloating, abdominal cramps, and headaches, which can all cause disturbances in sleep. Sleep problems such as insomnia, daytime sleepiness and hypersomnia can result if you have PMS.

Lessen the effects of menstrual symptoms: Follow sleep hygiene and stimulus control techniques to prevent the sleep problems during menstrual cycle. Maintain a sleep routine, follow a healthy diet, plan to do something if you can’t sleep during night, and reduce stress to get a better sleep. If the problem is severe, visit the doctor so that he/she will prescribe medications for reducing the symptoms.

Host of discomforts that disrupt sleep during pregnancy:

Why sleep difficulties begin suddenly in pregnant women? The reason is many emotional and physical factors can contribute to sleep problems during pregnancy. Some of the factors that contribute to sleep loss during pregnancy are given here:

Emotional factors that contribute to sleep loss:

Emotional factors that are prevalent during this period are depression, anxiety and emotional liability, which can contribute to lack of sleep. During pregnancy, estrogen and progesterone, the two hormones, cause mood swings. Feelings of depression are common due to the changes in body during pregnancy. You will find hard to express feelings of happiness or sadness.

At the time of first trimester, mood swings are common. Emotional feelings are present in the second trimester. In the third trimester, you worry about everything you think of. The worry and anxiety in pregnant women is due to labor, delivery and baby care. Abdominal growth can make you uncomfortable and you feel irritated with lack of sleep.

Physical factors that contribute to sleep loss:

Uncomfortable sleep positions due to changes in your body can disturb your sleep. During pregnancy, urinary bladder holds less fluid. If you take more amounts of fluids before bedtime, you need to wake up several times at night to urinate. Normal pains such as nausea, heartburn, and hemorrhoids are common during pregnancy, which keep you awake at night. Heart rate increases for pumping more blood during pregnancy. As more blood goes to the uterus, your heart works harder for sending sufficient blood to the rest of the body, making your sleep restless. Restless leg syndrome (RLS) is one of the most common problems in pregnancy. Tingling, crawling and burning sensations are the common symptoms in RLS. These symptoms make uncontrollable urge to move the legs. Moving legs can give temporary relief. Snoring occurs in the last trimester due to narrowed airways and increased pressure on the lungs. Snoring can sometimes lead to hypertension, putting you and your child at risk. When airways block, sleep can occur. Breathing stops for few seconds when you have sleep apnea. It results in lack of oxygen to your body. Oxygen deficiency can prevent you from getting sleep, which harms you and your baby.

Get more sleep during pregnancy with these sleep tips:

Exercise is the best treatment for controlling mood swings. Talk to your doctor about which exercises are preferred during pregnancy. Pamper yourself to reduce depressed feelings. You can go for shopping to buy maternity clothes or with partner to dating, or visit a friend to share your feelings. Comfortable sleep position is essential as pregnancy progresses. Sleeping on your side is preferred. Burden on the heart lessens with this position. Avoid drinking lots of fluids two to three hours before bedtime to avoid frequent urination during night. Nausea can occur on an empty stomach, so have light snacks before going to bed. Do not eat before going to bed to avoid heart burn and indigestion. Have several small meals instead of a larger meal. Press your feet against wall or stand on your feet to lessen the cramps. Calcium deficiency can make the cramps worse, so make sure to include calcium such as milk and dairy products in your diet. Get a massage, use cold or hot packs, or practice relaxation techniques to relieve from symptoms of RLS. To overcome the symptoms of snoring, sleep on your side and elevate your head slightly. Sleep consequences with hormonal changes during menopause:

Side effects due to hormonal changes can occur during menopause stage. At this stage, sleep disorders are common. Insomnia is a common problem and you will not recognize that you are in perimenopause stage in late 30s and early 40s if you have this problem.

Discomfort with menopausal symptoms can obstruct your nighttime sleep. Ovaries produce less estrogen and progesterone when you enter perimenopause and menopause stages. Progesterone hormone helps in promoting sleep. Trouble in sleeping arises when progesterone levels drop.

You can also experience mood disorders that disrupt your sleep at this stage. Hot flashes can result as temperature of the body rises due to hormonal changes at this stage. Hot flashes can occur during daytime or nighttime; but nighttime flashes can interrupt your sleep.

Hot flashes that occur at night are called as night sweats because of excessive perspiration. Excessive sweating interrupts night sleep [Treating menopause night sweats].

Sleep problems in menopause stage can make you tired. These sleep problems continue to post menopausal stage. Post menopausal women are likely to snore and also experience life threatening condition called sleep apnea.

Sleep better with menopause Hormone replacement therapy (HRT) is one of the treatments for menopause. HRT can also help to reduce sleep disturbances associated with menopause. HRT treats the hormonal changes to reduce night sweats and hot flashes. Side effects are common with HRT medications. Consult and discuss with your physician about the risks associated with HRT and whether the treatment is suitable for you or not. Healthy diet is vital to lessen sleeping difficulties in menopausal st
age. Cut down the intake of spicy foods, caffeine and alcohol. These stimulants cause hot flashes, which affect your sleep quality. Avoid large meals and maintain healthy weight. Consume foods rich in soy to improve quality of sleep. Maintain a cool sleep environment to reduce hot flashes that disrupt your sleep. Maintain a regular sleep routine which helps in promoting sleep. Wear light weight cotton clothes during sleep. Use air conditioners and fans to keep the room cool and comfortable for sleep. Good sleep habits, healthy diet and good sleep environment will improve your insomnia problem and help you to sleep better.

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New Age Dawning: Breathe Well, Sleep Well, Age Well

Sleep May Not Be the Number One Factor In staying Young and Healthy

“Early to bed, early to rise, makes a man healthy, wealthy and wise.”

This short proverb can be traced as far back as 1496, and even earlier if you count all its variations. It seems that people have always understood the necessity of a good night’s sleep, but these days quality sleep has become a luxury rather than a necessity. But going without sleep may not be so easy since it’s not something your body can easily do without.

The Growing Sleep Deficit
According to a recent Harvard Health Publications survey, “more people are sleeping less than six hours a night, and sleep difficulties confound 75% of us at least a few nights per week.” Most people are shown to be getting inadequate sleep, and as a result chronic fatigue is a major problem for millions of Americans.

But even with the sleep “catch up” on the weekends there are still those who are tired and listless no matter how many hours of sleep they get. In these circumstances, something else may be awry: the sleepiness patients feel is usually the end result and not the actual cause of their sleepiness. In fact, it may be their poor breathing at night and not the quantity of sleep they’re deprived of.

Breath Well To Sleep Well
Whenever you undergo any form of exercise training, you’re almost always reminded to take long deep breaths and to focus on your breathing. From Pilates, to yoga to running and Tai-Chi, exerting control over one’s breath, especially as it pertains to one’s stamina and endurance, is key to maintaining good form and gaining mastery.

But think what would happen if you couldn’t breathe well while you slept. You’d get more than a flabby body. You’d be headed for some serious health problems. But if you’re suffering from obstructive sleep apnea, or OSA for short, this is exactly what’s happening.

Having Trouble Breathing While Sleeping?
Although all humans have varying degrees of airway narrowing, those with sleep apnea, or its milder variant upper airway resistance syndrome (UARS) have anatomies that are more prone to collapse than others. If you have a triangular facial structure or if you have a long neck or if you have a thick, stocky neck, like a football player, or if your tongue happens to sit higher up on your arches (see diagram), all of these anatomical factors can predispose you to airway obstruction or breathing problems while you sleep. Obesity, or one’s weight is not the primary indicator as once believed for having sleep apnea.

This is why for some OSA and UARS patients, sleeping on their sides or stomaches is an important prerequisite for getting a good nights rest. The reason being that this position, as opposed to sleeping on their backs, gives the tissue around their airway a bit more openness, and their tongues don’t tend to collapse as easily if they were lying flat on their backs, especially in deep sleep when throat muscles tend to relax more.

Although many OSA and UARS patients think they prefer to sleep this way just because this is how they’ve always slept, they may very well have made a choice to sleep this way for very good reason. It’s almost like a reflexive survival mechanism, since these preferences to sleep on our sides or stomachs, may have been formed not by any conscious effort, but as a reflexive coping mechanism for something that’s ailing us. This is why oftentimes when patients come to me with sinus and or chronic fatigue issues, I always ask: “Which position do you prefer to sleep in?” It’s almost a given that if patients like to sleep on their sides or stomaches their airways will look like the opening of a coffee stirrer when I look at their airway with my video endoscope.

Breathing For Life
Although many of us intuitively know that breathing is necessary for life, those with sleep apnea and UARS aren’t breathing for their lives. Even though they’re sleeping and therefore should rest allowing time for their brain, muscles, and organs to reset and replenish, their apneas or frequent breathing cessations are constantly interrupting this process. It’s like their “fight or flight” response is on all the time, even though it needs some time off. Think what would happen to your car if the ignition was never turned off. Well, this is what’s happening with sleep apnea patients.

Problems with Sleep Apnea
There are many serious consequences to having sleep-breathing problems—many of which are preventable yet as I’d mentioned before, this is not very likely because so many people who have this condition are unaware.

For one thing, research has found that sleep apnea is inked with a higher incidence of high blood pressure and heart disease. Many patients that come to me already on high blood pressure medications or have a history of heart disease are found on examination to have some sort of a sleep-breathing disorder.

Some other chronic conditions related to sleep apnea are diabetes, depression and many anxiety issues. Many fatigue and attention deficit problems like ADHD (attention deficit hyperactivity disorder) in children have also been linked to sleep apnea. A recent study showed that some children having undergone tonsillectomies (where a high percentage of them present with obvious symptoms of OSA) showed significant improvement in their ability to focus and pay attention in schools if not a significantly noticeable decrease in their behavior problems as a result. As you can see, not breathing well while you sleep can have serious consequences for both the old and the young.

When Being Young Is Not Enough
Because sleeping well is almost synonymous in people’s minds with feeling well, looking young and healthy, many people neglect their breathing as a simple fact of life. Little do we realize that this is wherein life originates.

People don’t often ask themselves, “How well did I breathe last night” when they feel groggy and listless in the morning. Instead, most people fixate on the amount of sleep they got or not. This may be the reason why sleeping pills and anti-anxiety medications are so popular in America today.

Moreover, as everyone jumps on the latest new anti-aging rage, breathing is becoming not a secondary, but a tertiary issue in the medical community. In the scheme of holistic or preventative medicine, breathing is often taken as a matter of fact. Although many proponents of these therapies often tout breathing exercises as a means to reducing stress and improving mental wellness they nonetheless overlook this matter when they provide dietary regiments or herbal supplements as sleep aids with little or no regard to the fact that none of these regiments are all that effective unless the mechanism that allows for efficient sleep is working well too. It’s almost like an auto shop owner shoving premium gasoline at customers with cars with broken fuel lodges. Sooner or later, that car is either going to break down or stop dead in its tracks, or at the very least, waste the very good thing you put in to it to make it work better. Similarly, if your sleep problems originate from an anatomical issue, like your airway, no amount of pills or supplements, no matter how potent, can effectively cure your problems with sleep. These problems need to be addressed from the source where it originates—the airway.

Your Breathing Problems Solved
In lieu of giving out bottles of air to my OSA and UARS patients, there are simple measures you can take on your own to improve your breathing while you sleep if you suspect that this may be the source of your problems.

The first most obvious thing I recommend to all my patients who suffer from fatigue issues is to avoid sleeping on their backs. This is one of many reasons why snoring sometimes ceases when people turn over while they sleep. The next best thing to do, if you’re not able to change your sleep position in this way due to an injury or habit, is to lose any excess weight you’ve gained recently. Yet, if you’re still feeling tired or having trouble maintaining focus at work my recommendation will be to get a formal sleep study or polysomnography to determine the root cause of your day time fatigue or exhaustion.

You Want Me To Sleep Where?
A typical “sleep study” takes place in a sleep laboratory where a sleep technician can hook you up to a monitor while you sleep, and a “sleep doctor” can use the readings to objectively measure and quantify the real source of your sleep problems. (Watch meundergo a sleep study.)

Although you may or may not be officially diagnosed with OSA even after the sleep study, I’ve seen many if not a great majority of these patients gain useful information to address any other sleep problems they may be having. Yet, most if not in all cases, patients who I suspect have these conditions, are found to have some mild to moderate breathing component that goes along with their sleep problems. And for these patients, in lieu of treating the underlying breathing problem, no amount of sleeping pills will cure the airway blockage that’s at the root of their sleep problems.

Decelerating the Aging Process
To understand how essential it is to get the sleep you need, it’s equally if not more important to understand how you can get the restorative sleep you need as well.
Essentially, sound sleep offers vital services to your body. After spending a full day learning new skills and having new experiences, sleep allows your brain to shut down its learning mode and consolidate and commit the newly acquired information to memory. Adequate sleep also allows the body to produce the right balance of hormones to help stabilize weight and use carbohydrates efficiently (this may be why research studies show that inadequate sleep is often linked with weight gain). Getting enough sleep also helps to ensure your safety by keeping your brain more alert and in tune with your reflexes preventing injury, and keeping you happy and well adjusted.

Sleep also helps keep the body healthy by boosting your immune function, reducing your chances of getting certain cancers and lowering your blood pressure too. In a nutshell, if you’re not sleeping well, you’re missing out on one of the most valuable methods for keeping you young and healthy for a very long time.

However, ensuring that your good night’s sleep isn’t impaired by breathing problems like Obstructive Sleep Apnea may be more important than sleeping that extra hour of shut eye. As the new-age gurus of aging are telling us, it’s not how old you are chronologically as how old you are biologically. Similarly, if your breathing is impaired while you’re sleeping, your health may not depend so much on how much you sleep every night but how well you’re sleeping through the night, and moreover, how well you’re breathing while you’re asleep. In short, take a closer look at what’s happening on the inside and not on the outside for the answers to your sleep problems. You may be surprised by what you find.

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Sleep Disorders

Sleep Disorders

 

Poor sleep is a major cause of serious morbidity including accidents, psychiatric sequelae and reduced quality of life, and has a major economic impact

v Stages of Sleep and the EEG:

Non-REM sleep: (REM: Rapid Eye Movement)

Stage 1: mixed frequency, low voltage. Alfa ? (8-12 Hz) and Theta ? (4-6 Hz). Stage 2: low voltage, slower frequencies. Contains sleep spindles (12-14 Hz) and high amplitude ‘k’ complexes Stage 3 & 4: high amplitude, low frequency Delta ? (2 Hz) waves. Stage 3 characterized by < 50% ? waves with sleep spindles. Stage 4 by > 50% ? waves but no sleep spindles. Stage 3 & 4 comprise slow wave sleep (SWS). As sleep progress through stages 1 to 4 low frequencies increase at the expense of the higher frequencies which are characteristic of waking.

REM sleep (paradoxical sleep):

The EEG shows a low voltage, mixed frequency spectrum with characteristics of cortical activation. It is associated with rapid eye movements, signs of autonomic arousal and paradoxical low muscle tones, and this is when dreams occur.

Sleep architecture:

From waking, individuals pass through stages 1 to 4, then into REM sleep. REM sleep then alternates with non-REM. REM compromise 20% of total sleep time, and occurs at 80 to 90 minutes intervals. Stages 3 and 4 comprise 15-20% of total sleep time. The majority of time is spent in stage 2. SWS occurs mainly early on in sleep with REM sleep later. SWS and REM sleep are highest in neonates, and decrease in amount with increasing age.

Function of sleep:

Theories about the function of sleep include conservation of energy versus brain or body restoration. REM sleep has been proposed to reflect brain functions, and SWS to be associated with bodily functions (related to the amount of energy expanded, it is increased with exercise and decrease with hypothyroidism). It has been suggested that sleep can be core and optional sleep based on observations that:

Only 30% of total sleep lost is regained after sleep deprivation, especially SWS and REM. Short sleepers have similar early sleep pattern to longer sleepers Gradual sleep reduction down to five hours is well tolerated.

Control of sleep:

The reticular activating system is involved in arousal, and the induction of sleep is active rather than passive process. The Yerkes-Dodson curve describes the phenomena of increasing then decreasing performance with increasing arousal. The peak is reached and exceeded more quickly for difficult than easy tasks. Poor sleep affects the ability to perform simple, mundane tasks but not more complex ones which require more attention. Drugs can affect both performance (via drowsiness) and sleep, for example, antidepressants, antipsychotics, benzodiazepines, antihistamines and alcohol.

v Clinical Syndromes:

Epidemiology:

Insomnia: 30% in one year Nightmares: occasional in 50% of adults, regular in 1% Sleep apnoea: 4-8% of men; 2-4% of women Narcolepsy: 0.15%

Classifications:

Dysomnias: poor sleep Medical/psychiatric sleep disorder: i.e. secondary Parasomnias: abnormalities during sleep Specific sleep disorders.

1. Insomnia: this represents lack of sleep, poor quality of sleep or reduced daytime performance. It is probably the commonest complaints presented to primary health care; for example in the USA 42% prevalence. Hypnotic use is still common despite changes in guidelines (esp. in this country). Primary insomnia is rare. Causes of insomnia include:

Psychiatric disorders (36%) Psychophysiological insomnia ‘sleeplessness phobia’ (16%). Features include: the complaint of insomnia and reduced performance when awake, trying too hard to get to sleep, tension, physical symptoms, increased sleep latency, reduced sleep efficiency and increased number of awakenings. Medications, illicit drugs and alcohol (12%) Periodic limb movement disorders (12%) Sleep apnoea (6%) Pseudo-insomnia (6%) Sleep-wake schedule disorder (6%) Medical disorders (6%)

However, social and personal factors are also very important in determining who present, for example women report insomnia twice as often as men, and rates are higher in the unemployed

2. Parasomnias: these are acute, undesirable, specific, episodic physical phenomena which occur during, or are exacerbated by sleep. There is an interaction between psychological (esp. stress) and biological factors. Generally treat with reassurance, education and practical advice. These occur in different stages of sleep:

Ø SWS: disorders of arousal; sleepwalking and night terrors. Sleepwalking is often exacerbated by excessive sleepiness. Night terrors occur early in sleep, the individual is difficult to rouse and generally has no recall. Ø REM sleep: patients rouse easily. These are usually nightmares or dream anxiety attacks which are frightening, with clear recall. They may be related to psychological precipitants, fever or drug withdrawal (BDZ, antidepressant, alcohol). Other disorders are sleep-related cluster headaches and sleep related asthma; the REM sleep behaviour disorders which involve loss of the usual atonia in REM sleep so the individual acts out dreams which are often violent. Ø Other Parasomnias: Enuresis (patients may have different sleep patterns and therefore not able to sense the need to urinate); bruxism (teeth-grinding); head banging; familial sleep paralysis.

3. Specific sleeps disorders:

Ø Narcolepsy: characterized by hypersomnolence, cataplexy, sleep paralysis and hypnogogic hallucinations (tetrad is Gelineau’s syndrome). 50% also have major affective disorder and / or personality problems. Aetiology suggests genetic cause as family history is common and HLA-DR2 found in 99%. Onset is generally in the teens or twenties. Sleep attacks are irresistible in boring situations (like this lecture!), and cataplexy is often related to emotions. There is a short REM latency. Narcolepsy can be treated with psychostimulants, and support groups are helpful. Ø Periodic limb movement disorder: there are repetitive and stereotyped movement during sleep and the patient is often unaware. It may lead to poor sleep and daytime fatigue, also depression and anxiety. Found in narcolepsy, obstructive sleep apnoea, Parkinson’s disease and metabolic disorders. It can be aggravated by tricyclics and withdrawal from BDZ. Ø Kline-Levine syndrome: this occurs generally in adolescent boys, and is characterized by periods of hypersomnia and overeating, often with change in libido.

4. Other sleep-related problems:

Ø Circadian rhythm disorders: this describes changes in the timing of sleep, for example in people on shifts and with jetlag. Ø Daytime sleepiness: Narcolepsy, obstructive sleep apnoea, sleep-related motor disorders, depression, post-viral fatigue, head injury, metabolic, toxic and drug related factors, essential hyper-somnolence, and older age can all cause daytime sleepiness. v Assessment Patient’s description of the problem, including the onset, length and quality of sleep, and any daytime drowsiness or reduced performance Objective observations by patient and spouse/relative. Possible general medical, psychiatric or drug problems. Details of sleep environment and hygiene Drug history, both prescribed and recreational. Current circumstances and stress Sleep diary including caffeine, alcohol and drugs.

People often overestimate the length of time to get to sleep, even to the extent that good and poor sleepers can have similar sleep pattern. However the quantity of sleep can be relied on in assessing the presence of insomnia.

v Management

1. General advice:

Treatment of any underlying cause. Education and advice on sleep hygiene. Optimizing the temperature at the room Encouraging a regular routine Exercising late in the afternoon Small food intake in the evening Relaxation techniques Advice about problem solving and dealing with intrusive thoughts (CBT can be used and has good evidence based results).

2. Role of drugs in sleep:

•a)    Drugs used to improve sleep:

Particularly benzodiazepines (BDZ), which can be used in short-term treatment for poor sleep associated with acute stress. BDZ reduce REM and SWS, increase stage 2. Tolerance and REM sleep rebound occur on discontinuation. Barbiturates are no longer should be used due to its narrow therapeutic window, high addictiveness, tolerance and death in overdose.

 Zopiclone (new generation partial BDZ, only used as hypnotic) increase SWS, and although early reports claimed less tolerance and dependence, recently this has been disputed.

New Melatonin derivatives medication has been just licensed for sleep, some evidence point toward better results with elderly, and may be autism. These have few side effects and do not interfere with sleep architecture.

•b)    Drugs used to reduce sleepiness:

These are for example amphetamine, pemoline and selegiline. These reduce total sleep, REM and SWS, delay sleep onset and cause fragmented sleep.

•c)     Drugs used to treat psychiatric disorders:

Antidepressants: some are alerting e.g. Prozac (fluxoetine), MAOI; some are sedatives, which is generally related to their anticholinergic properties (most tricyclic), or antihistaminic (Mirtazepine). In general, antidepressants suppress REM sleep. Interestingly, sleep deprivation is still used as treatment for depression and the target is to reduce REM sleep. Mood-stabilizers: Lithium reduces REM sleep and delay onset. Carbamazepine reduces REM sleep and increase SWS, and can cause initial drowsiness. Anti-psychotics: These reduce periods of wakefulness, increase or decrease REM sleep, depending on the dose. Total and REM sleep are reduced on stopping.

•d)    Non-psychotropic drugs:

These can affect sleep by crossing the BBB, or by causing or exacerbating a disorder which disrupt sleep (e.g. sleep apnoea). Common causes of sleep disturbance include appetite suppressants, anti-emetics, anti-histamine, corticosteroids, cardiovascular drugs and hormones.

 

•e)     Recreational drugs:

Alcohol promotes sleep in small amounts nut in larger amounts causes insomnia later in the night due to rebound and withdrawal effects. Its effect depends on the level of sleep deprivation, and interactions with other drugs. Nicotine can disrupt sleep. Caffeine causes an increase number of arousal and decrease REM sleep. It has a half-life of five hours. Withdrawal symptoms also occur which disrupt sleep.

•f)      Illicit drugs:

Cannabinoids reduce REM sleep, and increase SWS initially but decrease it after several days. Habitual use leads to excessive sleeping and lassitude, with sleep disturbance on withdrawal. Narcotic analgesics cause a drowsy state followed by reduce REM and SWS. Sleep disturbance occurs on withdrawal. Cocaine reduces total sleep, SWS and REM sleep. Excessive sleeping occurs on withdrawal (rebound). Hallucinogens (e.g. LSD) do not affect sleep directly except by ‘ bad trips’

•g)    Drugs withdrawal:

Sedatives and hypnotics cause rebound insomnia usually for one week but can be for up to two months. Insomnia is more severe but less prolonged for drugs with shorter half-life. Chloral hydrate gives fewer problems with withdrawal but is less efficacious.

Abrupt withdrawal of antidepressant can lead to short-lived rebound insomnia and panic. Antipsychotics rarely cause dependence or withdrawal (therefore small dose, below the therapeutic dose for psychosis treatment, are used to aid sleep in some patients)

Reference:

1. Shapiro C. ABC of sleep disorders. London: BMJ Publishing Group, 1993.

2. Steple D. Oxford Handbook of Psychiatry, Oxford University Press, 2006

3. Smith G et al. Key topics in Psychiatry. Bios scientific publisher limited, 1996.

4. Boyle D, Davies S. Psychiatry, Mosby’s crash course 2002

 

 

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Should I Go For Otc Or Natural Sleep Aids

Are you getting difficulty sleeping? Rest – it appears like it must be so effortless however above 50% of men and women will, at some stage in their living, have trouble falling asleep. You can find a number of various sorts of insomnia -short term, chronic, difficulty falling asleep, difficulty staying asleep, waking up early or poor sleep in general. Stress, anxiousness, depressive disorders, drugs, tobacco, alcohol as well as caffeine can trigger or worsen difficulty sleeping. What do we do for the next morning to fight our sleepiness? Caffeine! -which worsens stress/anxiety/depression as well as quite frequently alcohol the next night -all in attempt to trick our bodies as well as thoughts into feeling “well rested.” Our thoughts do not assistance either…we now have problems slipping asleep, what do we start thinking? “Oh bother, I can’t fall asleep…now I will only get 5 several hours of slumber…what if I do not fall asleep…then tomorrow is proceeding to suck…” as well as on as well as on -a vicious cycle! When we have sleep disorders as well as invest our nights rolling restlessly on our bed and also staring in the ceiling we can get desperate to discover a very good all natural sleep aid. In our desperation, we are able to attempt so numerous solutions as well as all natural sleep aid with out examining whether or not they are trustworthy rest products and also whether or not they are very good for our wellness. We will need to not believe all that’s discovered on the internet. Numerous companies are keen only in marketing their all natural sleep aids plus they are not worried about buyer security. So it gets really essential that you just grow to be a accountable buyer by selecting only trusted products. You should not topic your self to unnecessary dangers by deciding on unwarranted goods for the sleep.

You can discover a number of all natural sleep aids on the internet for slumber problems. Most on the items which you come across are compound products that attempt to induce rest by means of chemical substances. This isn’t a natural method of falling asleep. Although you might uncover short-term relief via such goods, you might be really likely to possess complications at a later stage. You may experience a lot of side effects and also wellbeing connected troubles which are extremely complex. You must consequently attempt to stay clear of these kinds of products and solutions and also only consider naturall or herbal sleep remedies with no any unwanted effects. As long as you are going to pick compound supplements you can suffer this kind of complications.

The only reputable sleeplessness remedy therefore is all natural sleep aid. You will likely be in a position to save yourself from unwanted effects along with other wellness issues only by selecting healthy rest aid. If your rest ailments are connected to dietary deficiencies, you are going to be in a position to rectify your troubles in a very healthy way by getting pure sleep minerals. These all natural sleep aid compensate for that minerals which are deficient in our food. As these minerals don’t force your body to rest by means of chemical compounds, it is a organic sleep help. Also these all natural sleep aid do not have any unwanted effects. Even if you take these all natural sleeping aids all of your existence, you won’t produce any dependency or addiction. As opposed to quite a few other sleep products as well as pills, you won’t suffer any hangovers. You are going to be able to carry out normally not having any problem the following day.

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