Natural Way to Cure Insomnia

Outsmart Insomnia

Researchers at the University of Oxford have discovered the true cause of insomnia, and are here to give you the cure in this simple eBook that contains the research AND ways to beat insomnia, backed up by the recent scientific discoveries about insomnia. This guide can teach you to fall asleep in 15 minutes or less, by training your brain to allow your body to rest. This book contains only practical information, from all-new studies that have changed the way that doctors are thinking about insomnia. You don't have to wait hour after hour to fall asleep All you have to do is follow the directions in this eBook to retrain your brain to fall asleep when your body is actually tired. This cure for insomnia is permanent, and does not require you to take all manner of mystery drugs just to feel normal. You can get a real, all-natural, good night's sleep! Read more here...

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Fatal Familial Insomnia

FFI, dominantly inherited or sporadic, is characterized by intractable insomnia, autonomic dysfunction (changes in blood pressure, heart rate, temperature, and respiratory rate), myoclonus, cerebellar ataxia, and pyramidal and extrapyramidal signs. Atrophy, neuronal losses, and severe gliosis of the thalamus are distinctive features. Spongiform changes and prion amyloid plaques are not conspicuous.

Types Of Sleep Disorder

Several types of sleep disorder are recognised and their differentiation is important a simplified summary is given below but reference to DSM, ICD or ICD4 will clarify the exact diagnostic criteria insomnia not enough sleep or sleep of poor quality problems of falling asleep (initial insomnia) or staying asleep (maintenance insomnia), or waking too early ICSD American Sleep Disorders Association (1992) International Classification of Sleep Disorders Diagnostic and Coding Manual. Insomnia Insomnia is characterised by the complaint of poor sleep, with difficulty either in initiating sleep or maintaining sleep throughout the night. It can occur exclusively in the course of another physical disorder such as pain, mental disorder, e.g. depression, or sleep disorder, e.g. sleep apnoea. In a large proportion of patients it is a primary sleep disorder and causes significant impairment in social, occupational or other important areas of functioning. One survey showed similar deficits in...

Treatment Of Insomnia

Timely treatment of short-term insomnia is valuable, as it may prevent progression to a chronic condition, which is much harder to alleviate. Psychological treatments are effective and pharmacotherapy may be either unnecessary or used as a short-term adjunct. The approaches are to establish good sleep hygiene Sleep hygiene In the treatment of long-term insomnia the most important factor is anxiety about sleep, arising from conditioning behaviours that predispose to heightened arousal and tension at bedtime. Thus the

Other Sleep Disorders

Described as 'crawling', 'aching', 'tingling' and is partially or completely relieved with leg motion, returning after movement ceases. Most if not all patients with this complaint also have periodic limb movements disorder (PLMD), which may occur independently of RLS. These periodic limb movements consist of highly stereotyped movements, usually of the legs, that occur repeatedly (typically every 20-40 seconds) during the night. They may wake the patient, in which case there may be a complaint of daytime sleepiness or occasionally insomnia, but often only awaken the sleeping partner, who is usually kicked. RLS and PLMS are considered to be movement disorders and may respond to formulations of levodopa but dopamine agonists, e.g. ropinirole, and other treatments such as gabapentin are under investigation Sleep scheduling disorders. Circadian rhythm disorders are often confused with insomnia and both can be present in the same patient. With such sleep scheduling disorders, sleep occurs...

Effects on Anxiety and Insomnia

Cannabis smoking produces a relaxant effect which most users value and it has been suggested that the beneficial effects of cannabis and THC observed in neurological disorders such as motor tics, dystonias and Huntingdon's chorea are due to sedative and anxiolytic actions. In addition, sedation is by far the most common side effect of cannabis, and in particular THC, observed in clinical trials against a range of disorders. This has lead to the suggestion that cannabis and some cannabinoids may be useful in disorders accompanied by anxiety and or insomnia. Initial studies in man showed THC to be not much different from conventional hypnotics. Single doses decreased REM sleep and increased stage 4 sleep some REM rebound was observed on discontinuation of the drug (Pivik et al., 1972). When THC was given to healthy insomniacs in doses of 10, 20 or 30 mg sleep latency was reduced but subjects experienced dose-related dysphoria prior to falling asleep and similar symptoms the following...

Drugs For Insomnia

Most drugs used in insomnia act as agonists (see GABA receptor above) at the GAB A -benzodiazepine receptor and have effects other than their direct sedating action, including muscle relaxation, memory impairment, and ataxia, which can impair performance of skills such as driving. Clearly those drugs with onset and duration of action confined to the night period will be most effective in insomnia and less prone to unwanted effects during the day. Those with longer duration of action are likely to affect psychomotor performance, memory and concentration they will also have enduring anxiolytic and muscle-relaxing effects. All benzodiazepines and newer benzodiazepine-like drugs are safe and effective for insomnia, if the compound with the right timing of onset of action and elimination is chosen. However, care should be taken in prescribing them to patients with Uses. Benzodiazepines are used for insomnia, anxiety, alcohol withdrawal states, muscle spasm due to a variety of causes,...

Insomnia

A good night's sleep is whatever allows a person to feel rested, refreshed, and alert during the day. Some people need 9 to 10 hours, while others only 6 hours. Insomnia is a persistent difficulty in obtaining adequate sleep. Symptoms can include difficulty in falling asleep, frequent awakenings with difficulty falling back asleep, or poor quality, light sleep. Between 25 and 30 of adults suffer from insomnia. Insomnia can have many causes, including stress, depression, anxiety, or poor nutrition.

Diet Insomnia

For the evening meal, foods that contain a high tryptophan to total protein ratio should be eaten. Tryptophan is the precursor for brain synthesis of serotonin, a sleep-inducing neurotransmitter (see pp. 109).1 Eating a tryp-tophan-rich supper (or late-evening snack) together with ample carbohydrate can improve sleep quality. Carbohydrates stimulate production of insulin, and insulin enhances uptake of tryptophan into the brain. Although alcohol has a sedative effect that can hasten sleep onset, heavy alcohol intake often produces light, unsettled sleep and increases nighttime awakening. Because alcohol can interfere with deep sleep, alcoholic nightcaps should generally be avoided A better bedtime drink is a glass of warm milk. Milk is rich in tryptophan and calcium, both of which have a calming effect and may improve sleep quality. The more caffeine consumed during the day, the higher the risk of insomnia. Consumption of coffee, tea, or cola drinks should be avoided within 6 hours of...

Chronic Health Effects Of Repeated Lowlevel Exposure

For chronic or repeated subclinical exposures to OP compounds, be they CW nerve agents or OP pesticides, the data in regards to long-term health effects are less consistent. In regards to the nerve agents, the report of Burchfiel et al.30 about the effects of repeated low doses of sarin to rhesus monkeys producing a long-term increase in relative power in the EEG beta frequency bands is the most-cited study in support for a long-term health effect. There are no human studies known to the authors of this review other than the National Academy of Sciences report on the volunteer program mentioned earlier, that directly address the possible adverse, long-term health effects of repeated subclinical exposures to nerve agents.10 Workers exposed to small amounts of nerve agents that produced mild, non-threatening medical signs of exposure, reported CNS effects such as headache, insomnia, excessive dreaming, restlessness, drowsiness,

Signs and Symptoms of Deficiency

Unrecognized thiamin deficiency can produce ill-defined symptoms, such as irritability, depression, fatigue, and insomnia, particularly in people with increased thiamin requirements (e.g., pregnant and breastfeeding women, women taking oral contraception, adolescents, diabetics, heavy alcohol users, the chronically ill). Mental confusion, defects in learning and memory, frequent headache, insomnia

Pain Intervention 101 Techniques

Antidepressants must be taken orally for weeks to months before the onset of antinociception. When used in acute pain management, antidepressants readily improve sleep hygiene and promote restorative sleep patterns. Intravenous use of amitriptyline for acute control of mucositis pain has been cited as effective (143). Cardiac rhythm changes and orthostasis can occur with intravenous amitriptyline therefore, use in a monitored setting is encouraged (144).

Starting and stopping use

Amfebutamone bupropion may provide an alternative, or addition, to nicotine. When the drug was being investigated as an antidepressant, researchers noticed that patients gave up smoking, and it was developed as an aid to smoking cesation. Amfe-butamone selectively inhibits neuronal uptake of noradrenaline (norepinephrine) and dopamine and may reduce nicotine craving by an action on the mesolimbic system. Evidence from a small number of clinical trials suggests that amfebutamone may be at least as effective as the nicotine patch with which it may usefully be combined. It may cause dry mouth and insomnia, and is contraindicated in those with a history of epilepsy. If the patient is heavily tobacco-dependent and severe anxiety, irritability, headache, insomnia and weight gain (about 3 kg) and tension are concomitants of attempts to stop smoking, an anxiolytic sedative (or (3-adrenoceptor blocker) may be useful for a short time, but it is important to avoid substituting one...

Xanthinecontaining Drinks

Excessive prolonged consumption of caffeine causes anxiety, restlessness, tremors, insomnia headache, cardiac extrasystoles and confusion diarrhoea may occur with coffee and constipation with tea. The cause can easily be overlooked if specific enquiry into habits is not made including children regarding cola drinks. Of coffee drinkers, up to 25 who complain of anxiety may benefit from reduction of caffeine intake. An adult heavy user may be defined as one who takes more than 300 mg caffeine day, i.e. 4 cups of 150 ml of brewed coffee, each containing 80 20 mg caffeine per cup or 5 cups (60 20) of instant coffee. The equivalent for tea would be 10 cups at approximately 30 mg caffeine per cup and of cola drinks about 2.01. Plainly, caffeine drinks brewed to personal taste of consumer or vendor must have an extremely variable concentration according to source of coffee or tea, amount used, method and duration of brewing. There is also great individual variation in the...

Clinical Features

Ataxia of gait is usually the presenting cerebellar symptom, followed by ataxia of limbs, dysarthria, and ocular signs such as nystagmus, ocular dysmetria, fixation instability, and jerky pursuit movements. The parkinsonian features include rigidity, bradykinesia-akinesia, postural instability, hypokinetic dysarthria, and tremor. The autonomic failure consists of orthostatic hypotension, bladder dysfunction (urinary frequency, urgency, retention), bowel dysfunction (constipation), and sexual (male erectile) dysfunction. Spasticity, hyper-reflexia, sleep disorder, respiratory stridor, and hypoventilation add to the syndrome. The course averages from 6 to 10 years. MRI demonstrates cerebellar atrophy and

Central nervous system findings

Support for this idea comes from a study which showed that CFS patients have a disrupted circadian rhythm (Williams et al. 1996). Circadian rhythms are our natural 24-hour biological cycles which help to control our patterns of sleep and alertness. Things like international air travel and poor sleep habits can disturb these natural rhythms. The symptoms of disturbed circadian rhythms are similar to the cardinal symptoms of CFS, namely tiredness, impaired concentration, and intellectual impairment. Thus, CFS patients' disrupted daily routines may result in a feeling of constant jet lag which is reflected in subtle alteration to the HPA. The presence of disrupted circadian rhythms, coupled with the fact that sleep disturbance is one of the key symptoms described by CFS sufferers, has led some investigators to suggest that CFS may represent a primary sleep disorder. Cytokines and serotonin also have sleep-promoting properties, so the CFS findings in these areas could reflect a primary...

Clinical Use Of Agents

Tolerance and abstinence may develop with any of the barbiturates. It has been reported that abrupt withdrawal of secobarbital (given 0.8-2.2 g d for 6 weeks) causes both minor symptoms (tremors, anorexia, insomnia, and apprehension) and major symptoms (seizures, delirium, and hypothermia) that can persist for up to 2 weeks after discontinuation. Tolerance to barbiturates can develop within 2 weeks of treatment because of induction of hepatic microsomal enzymes (2). The toxic effects of an overdosage result from profound central depression and may include coma, respiratory and cardiovascular depression with hypertension, and shock leading to renal failure. Withdrawal of the drug is more frequently a problem with barbiturates than with benzodiazepines. Withdrawal of barbiturates leads to rapid eye movement (REM) sleep rebound and rebound insomnia.

Choosing the Structure and Content of Your Report

John Smith, a 53 year-old married Caucasian male, was referred for psychotherapy by his primary care physician, Nancy Jones, MD (509-555-5555). Dr. Jones described Mr. Smith as moderately depressed and as suffering from intermittent anxiety, insomnia, and general distress associated with his recent job loss. During his initial session, Mr. Smith confirmed these problems and added that troubles at home with the wife and finances were furthering his overall discomfort and shame.

Physiology And Pharmacology

Because these drugs facilitate the onset and maintenance of a state of sleep that resembles natural sleep, the physiology of sleep is of significant importance and is described below (Section 3.1). In the second part, the pharmacology is addressed (Section 3.2). (25) deployed the method of EOG for the measurement of eye mobility. Soon thereafter, Aserinsky and Kleitman (26) discovered that sleep onset is characterized by slow eye movement, which in time, changes to REM sleep. Subsequent research by Aserinsky and Kleit-man led to the conclusion that REM sleep is associated with dreaming. 3. REM sleep 4. Stage 4 NREM Sleep. This stage is characterized by 6 waves of 2 Hz with amplitudes greater than 75 juV, which constitute more than 50 of the total. Toward the end of the deep sleep (S sleep), sleep lightens, often abruptly to stage 2 NREM sleep, accompanied by body movements. After a brief period of stage 2 NREM sleep, the first REM sleep occurs about 60-90 min after sleep onset. 3.1.6...

Pretreatment Evaluation And Education

Fatigue and headache, depression and irritability, alopecia, nausea and vomiting, loss of appetite, insomnia, and the potential for disturbances in bone marrow and thyroid function. Ribavirin side effects, such as hemo-lysis and risk of teratogenicity, are discussed in detail. The patient is advised on the need for adequate contraception, and, if the patient is a female of childbearing potential, she is informed that monthly pregnancy tests will be performed while she is on therapy, and for 6 mo after stopping therapy. A detailed discussion of the authors' approach to these other side effects is found later in this chapter.

Side Effect Management

Musculoskeletal pain Psychiatric disorders Insomnia Irritability Depression Emotional lability Concentration impairment Nervousness Respiratory system disorders Dyspnea Sinusitis Skin and appendages disorders Alopecia Rash Pruritus Special senses, other disorders Taste perversion

The prevalence of fatigue and somatic symptoms in the community

Other CFS symptoms are also common in the community, with 36 per cent of primary care patients reporting headache, 34 per cent insomnia, and 59 per centjoint or limb pain (Kroenke 1998). General population surveys also show that during any two-week period up to 30 per cent of people complain of muscle aches and pains, 38 per cent of headache, and 16 per cent of sleep disturbance (Dunnell and Cartwright 1972 Hannay 1978). While it may be logical to assume that these symptom reports are a result of biological processes, there is now substantial evidence to show that how individuals interpret bodily sensations and symptoms is strongly affected by psychological processes.

Diseases with Akinetic Rigidity Idiopathic Parkinsons Disease

Lewy Body Pathology

Combinations of extrapyramidal disorders and auto-nomic dysfunctions, frequently accompanied by neuro-psychiatric symptoms, define the disease. The cardinal motor symptoms are cogwheel rigidity of muscle tone, bradykinesia akinesia, postural instability, and pill-rolling tremor at rest. A stooped posture, shuffling and festinating gait, lack of facial expression, micrographia, weak monotonous speech, and dysphagia are additional characteristic features. In some patients, akinetic-rigidity predominates in others, resting tremor. Characteristic autonomic dysfunctions include orthostatic hypotension, seborrhea, sialorrhea, hyperhydrosis, constipation, bladder disorder, sleep disorder, and, rarely, sexual dysfunction. Anxiety, depression, psychosis, hallucination, and cognitive decline may emerge at any time during the course of the disease, which ranges from 10 to 20 years. No specific diagnostic tests are available. PET and SPECT show diminished striatal dopamine uptake. iPD....

State of Consciousness

In the normal waking state (Fig. 39), when cold water is introduced into the ear there is nystagmus, with the slow component (small arrow) toward the side of stimulation, followed by a fast component (large arrow) in the opposite direction. There is no net deviation of the eyes. As the patient becomes lethargic the cortex begins to fall asleep first so the fast component of nystagmus becomes less pronounced. There still is nystagmus but also a net deviation of the eyes. With further depression (obtundation, stupor) there is deviation without the fast movement of nystagmus, for the cerebral component is defective. With coma, the brain stem becomes depressed and there is no movement at all. Whereas the last pattern occurs in true coma, the first pattern appears in the patient faking coma.

Steps in Pain Perception

There is a descending system of nerves through the spinal cord back to the dorsal horn cells which can inhibit or enhance the pain perceived. Various neurotransmitters are involved. Descending inhibition damps down incoming pain impulses, providing analgesia. It operates when, for example, someone is injured but feels no pain until away from the site of danger. Inhibitory signals travel from the brain down the spinal cord and damp down incoming pain impulses. Similarly pain may be increased. This is the mechanism by which for example, happiness or distraction will reduce pain, whilst depression, anxiety or sleeplessness will aggravate it.

Highdose Dexamethasone Monotherapy

Dexamethasone, 20 mg m2 day on days 1-4, 9-12, and 17-20, induces responses in previously untreated patients with MM 40-50 of the time,55, 56 suggesting that dexamethasone accounts for most of the benefit derived from VAD and TD (described below). Dexamethasone monotherapy may be preferred for frail patients, since the toxicity is generally less than that seen with VAD or TD. Still, primary pulse dexam-ethasone treatment is somewhat more toxic than MP,57 and patients should be monitored closely for specific side effects, including hyperglycemia, gastrointestinal bleeding, mood disorder, insomnia, weight gain, increased susceptibility to infections, and rarely pancreatitis.58

Treatment Planning Application

You are working with Michael, a 26-year-old African American male. He is single, has a bachelor's degree in business management, and is employed as a manager at a local appliance store. He reports a history of hypertension (high blood pressure), which is well-managed using medication. During the session, he complains that although he can work with his employee team effectively and regularly meet individual and team sales goals, he has a long history of heterosexual social anxiety. He also claims he can socialize outside work without significant problems. When asked what he would like to accomplish in counseling, he states, I want to have a date at least a couple times a month, and I want to ask the person out on the date without feeling like I'm going to have a heart attack every time I start to approach her. Michael also reports intermittent insomnia, muscular tension, and increased irritability, all three of which worsened after his mother passed away nine months ago. Develop a...

Cultural Issues in Treatment Planning A Case Example

Dolores, a 43-year-old American Indian woman, came to counseling because she was suffering from sadness, inability to concentrate, insomnia, and anhedo-nia. These depressive symptoms were associated with two major concerns. First, Dolores was very upset because her husband of 23 years, Gabe, was suffering from a serious gambling addiction but was refusing to go to treatment. Second, Dolores was worried that, because of her diminished functioning and her husband's gambling, she might lose custody of her adopted daughter, Sage.

Tumour Necrosis Factor Alpha Inhibition

Four studies in cancer patients are especially noteworthy. First, Bruera et al. evaluated a cohort of 72 cancer patients who received thalidomide 100 mg night over 10 days 22 . Thirty-five patients dropped out of the study as a result of cancer-related morbidity. However, among the remaining patients, the majority reported improvement in insomnia (69 ), nausea (44 ) and loss of appetite (63 ). As many as 53 reported an improvement in their overall sense of well-being. A comparison of symptom improvement between thalidomide-treated and historical mege-strol acetate-treated patients suggests a trend in favour of thalidomide mean difference standard deviation -1.09 2.67 versus 0.04 1.71 for nausea (p 0.05) -2.21 2.83 versus -1.03 2.49 for appetite (p 0.073) and -1.65 3.19 versus -0.61 1.42 for sense of well-being (p 0.033), respectively. This study was neither randomised nor double-blinded, but its specific focus on quality of life and symptom control strategies suggests that thalidomide...

Helplessness and Depression

Seligman (1975) argued that the research on learned helplessness provides a model for clinical depression. For example, there is evidence that helplessness is involved in the relationship between alcohol dependence and depression (Sitharthan, Hough, Sitharthan, & Kavanagh, 2001). More generally, thousands of people each year are diagnosed as depressive. These individuals show insomnia, report feeling tired, often say that life is not worth living, have difficulty performing routine tasks, and may be suicidal. Clinical depression is severe, long lasting, and is not easily traced to a recent environmental experience.

Gap Junctions in Neurons Electrical Synapses

Inferior Olive Gap Junctions

The thalamus, Cx36 expression is absent or weak in most thalamic nuclei, with the exception of the reticular thalamic nucleus. Interestingly, this nucleus also contains GABAergic, parvalbumin-positive interneurons that are involved in genesis of thalamocortical oscillations (Pinault and Deschenes, 1992 Destexhe et al. 1996). Furthermore, Cx36 was detected in neurons of the centrolateral thalamic nucleus, which has been assigned to the intralaminar thalamocortical cell group, and these neurons are possibly involved in the distribution of coherent 40 Hz oscillations characterizing the magne-toencephalographic activity during wakefulness and REM sleep (Llinas and Ribary, 1993 Steriade et al. 1993). Functional analysis on Cx36-deficient brain tissue demonstrated that coupling of thalamic reticular neurons is almost entirely dependent on Cx36 (Landisman et al. 2002), and it was proposed that electrical synapses coordinate the rhythmic activity of small clusters of neurons within the...

TABLE 163 Anxiety Disorders

This disorder lacks a specific traumatic event or focus for concern. Excessive anxiety and worry, which the person finds hard to control, are about a number of events or activities. At least three of the following symptoms are associated (1) feeling restless, keyed up, or on edge, (2) being easily fatigued, (3) difficulty in concentrating or mind going blank, (4) irritability, (5) muscle tension, (6) difficulty in falling or staying asleep, or restless, unsatisfying sleep. The disturbance causes significant distress or impairs social, occupational, or other important functions.

Table 92 Symptoms of Depression

Weight loss or gain Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Cognitive vegetative or somatic. These symptoms are important markers, particularly for more severe types depression. Typically, a person with severe depression has a decreased appetite, which leads in turn to weight loss. But appetite may be increased in atypical or milder depression. Likewise, insomnia is an indicator of severe depression, but people with milder or atypical depression may sleep too much. Insomnia is sometimes described as initial, middle, or terminal. Initial insomnia is trouble falling asleep, and it is usually considered significant if the person tosses and turns for more than about a half hour before dozing off. Middle insomnia is the tendency to wake up in the middle of the night and to remain awake for an hour or two, usually followed by a fitful sleep. People with terminal insomnia wake up one or two hours before their usual time and are unable to fall...

How Are Mood Disorders Treated

Other tricyclic antidepressants were subsequendy developed, as competing drug companies sought to capture a share of the growing antidepressant market with other new compounds. Soon clinicians had four or five to choose from. As more and more drugs were available, it became clear that most of the tricyclics were equally effective in reducing depressive symptoms, but they differed in side effects. Some were more sedating than others. For example, despramine (Norpramin) is the least sedating, while amitriptyline (Elavil) is among the most sedating. Clinicians have learned to exploit the side effects of these drugs by giving the more sedating ones to people who have severe insomnia and anxiety and using the less sedating ones for people who are more anxious or agitated. It also became clear that most of the tricyclic antidepressants took some time to achieve their therapeutic effects usually two to three weeks. Some of them had side effects that patients found uncomfortable, such as dry...

Marijuana Withdrawal Syndrome

These same authors point out that psychological manifestations of marijuana withdrawal may include anxiety, depression, irritability, insomnia, tremors, and chills. They add that these symptoms usually only last a few days, but subtle symptoms can persist for weeks. It seems curious to us that such symptoms as tremors and chills should be seen as psychological manifestations with no physiological basis, and one would hope that an increasing understanding of receptor site science, as it applies to marijuana, will help clarify the nature of marijuana withdrawal. Our own experience at the Haight Ashbury Free Clinics and clinical discussions with colleagues who are treating marijuana users suggests the presence of a prolonged withdrawal syndrome, primarily characterised by anxiety and insomnia. We have also seen the onset of depression during withdrawal, particularly in adolescents suffering from motivation impairment manifested in learning difficulty and family relation problems during...

Treatment of Opiate Withdrawal

Symptomatic treatment of the opiate withdrawal syndrome can often be achieved using a combination of drugs, such as benzodiazepines for anxiety and insomnia loperamide or diphenoxylate and atropine for diarrhea promet-hazine, which has antiemetic and sedative properties and paracetamol or non-steroidal antiinflammatories for generalized aches. Pupillary dilation, piloerection, Yawning or sweating Insomnia

Antidepressantassociated Chronic Irritable Dysphoria

In 1987, Akiskal and Mallya introduced the notion of antidepressant-induced, chronic symptoms that include irritability and sleep disturbance in relatives of bipolar patients who have only manifested unipolar depressions. These patients developed a syndrome that consists of 1) unrelenting dysphoria, 2) severe agitation, 3) refractory anxiety, 4) unendurable sexual excitement, 5) intractable insomnia, 6) suicidal obsessions and impulses, and 7) histrionic demeanor (Akiskal and Mallya 1987). More recently, El-Mallakh and Karippot (2005) have described a chronic irritable depressive state that develops after long-term (several years) treatment with antidepressants in both type I and type II patients. This syndrome is specifically manifested by a triad of dyspho-ria, middle insomnia, and irritability, and thus has been labeled antide-pressant-associated chronic irritable dysphoria (ACID). Patients with ACID invariably experience significant social and occupational dysfunction such as...

Newly Married Couple

Erikson (see Chapter 7), in her mid-twenties, was referred to the pain clinic for chronic head pain. The referring physician stated that she had over the past 2 months not been coping very well with her stress. She complained of frequent frontal headaches, which lasted for 2 to 3 days at a time. She was suffering from some insomnia, waking frequently during the night. There were no abnormal

Neuropsychiatric Manifestations

Include insomnia (39 ), irritability (32 ), depression (37 ), emotional lability (11 ), concentration impairment (14 ), nervousness (4 ), dizziness (23 ), and taste perversion (4 ). These disorders are not dose-dependent, and can occur at any time during therapy, and even after therapy has been completed. Insomnia is often related to ribavirin therapy, and the first step should be to advise patients to take their second ribavirin dose in the late afternoon, rather than at night. Insomnia can frequently exacerbate the fatigue that patients experience. If falling asleep is the major difficulty, then the newer sleeping pills, such as Ambien and Sonata, can be effective, with little hangover effect in the morning. Trazadone, starting at 50 mg and increasing to 150 mg, can also be effective. Valium and benzodiazepines should be avoided when possible, since they are metabolized by the liver, and can result in significant toxicity in patients with severe liver disease.

Chronic consumption

The development of dependence on alcohol appears to involve alterations in central nervous system neurotransmission. The acute effect of alcohol is to block NMDA receptors for which the normal agonist is glutamate, the main excitatory transmitter in the brain. Chronic exposure increases the number of NMDA receptors and also 'L type' calcium channels, while the action of the (inhibitory) GAB A neurotransmitter is reduced. The resulting excitatory effects may explain the anxiety, insomnia and craving that accompanies sudden withdrawal of alcohol (and may explain why resumption of drinking brings about relief, perpetuating dependence).

Chronic Pain

Individuals with chronic pain often have problems sleeping (101). Attention to sleep hygiene should be given, and medications should only be used when necessary. Amitriptyline, which may be effective in the treatment of neuropathic pain, has the useful side effect of sedation, which helps with sleep onset. Melatonin and trazodone may also be beneficial.

Depression

It is often difficult to determine whether certain symptoms (e.g. weight loss, insomnia, fatigue) represent a mood disturbance or are a direct manifestation of a general medical condition (e.g. cancer, stroke, myocardial infarction, diabetes). A variety of general medical conditions may cause mood symptoms. These conditions

Dependence

As with alcohol and heroin use, prolonged use of nicotine leads to neuroadaptation in the brain, caused by pharmacological, contextual, and behavioral factors. This neuroadaptation is responsible for the tolerance and physical withdrawal symptoms. Physical withdrawal symptoms of nicotine include a decrease in the heart rate, increased appetite, constipation, and hyperreactivity of the bronchial tubes. Some of the mental withdrawal symptoms are bad mood or depression, insomnia, irritability, anxiety, restlessness, and aggravation of psychiatric co-morbidity.

Human Prion Diseases

The group of human prion diseases encompasses kuru, a now-extinct disease, and four current conditions (see Table 7.1) Creutzfeldt-Jakob disease (CJD), Gerstmann-Straussler-Scheinker disease (GSS), fatal familial insomnia (FFI), and new-variant CJD (nv CJD). The first three afflict mostly middle-aged and elderly individuals, and the fourth one affects younger subjects. The clinical presentation varies among the diseases, but all share progressing cognitive decline and neurologic deterioration, inevitably leading to death within several months or a year, seldom more. At present, no curative therapy is available. Genetic counseling is important in familial cases. CJD, Creutzfeldt-Jakob disease FFI, fatal familial insomnia GSS, Gerstmann-Str ussler-Scheinker disease nv, new-variant CJD.

Diagnostic Issues

Disorders that would formerly have been grouped under 'neuroses' include depression in the absence of psychotic symptoms, anxiety disorders (e.g. panic disorder, generalised anxiety disorder, obsessive-compulsive disorder, phobias and post-traumatic stress disorder), eating disorders (e.g. anorexia nervosa and bulimia nervosa) and sleep disorders.

Fatigue

One of the commonest symptoms of hepatitis C is fatigue, which is more common in patients with HCV, compared to a control population. In one controlled study (21), fatigue was more common in patients with isolated hepatitis C than among those with isolated alcohol liver disease or hepatitis B (66 vs 30 and 29 , respectively). Fatigue has little correlation with either the degree of viremia or the alanine aminotransferase (ALT) level. However, in patients with advanced disease, such as cirrhosis, fatigue is even more common. IFN therapy is associated with fatigue in 23 of patients with HCV, and up to 90 of patients treated for melanoma. In the initial evaluation, it is important to determine what component of fatigue is related to IFN-induced depression or ribavirin-asso-ciated insomnia or anemia, since this type of fatigue will improve with treatment of the underlying cause. Fatigue is not dose-related, and can often worsen during the course of therapy, so that it strongly interferes...

Parasomnias

Nightmares arise out of REM sleep and are reported by the patient as structured, often stereotyped dreams that are very distressing. Usually the patient wakes up fully and remembers the dream. Psychological methods of treatment may be appropriate, e.g. a program of rehearsing the dream, inventing different endings. In a small number of cases where adverse events such as angina have been provoked by recurrent nightmares it may be appropriate to consider drug treatment with an antidepressant with a marked suppressing effect on REM sleep, such as the MAOI, phenelzine. Night Night terrors and sleep-walking arise from slow wave sleep and they are often coexistent. There is usually a history dating from childhood and often a family history. Exacerbations commonly coincide with periods of stress and alcohol will increase their likelihood. In a night terror patients usually sit or jump up from deep sleep (mostly early in the night) with a loud cry, look terrified and move violently, sometimes...

Things To Come

Pharmaceutical company research on sedative-hypnotics rose and peaked within the several decades after the introduction of the ben-zodiazepines and has waned since then because CNS-related drug discovery efforts have focused instead on improved therapy for such disorders as depression and schizophrenia and the unmet medical need of stroke, Alzheimer's disease, and other neurodegen-erative maladies. However, given the imperfections of available drugs and the high incidence of sleep disorders among the evergrowing elderly population, more efficacious and safer agents are certainly needed. The current stable of drugs typically act as CNS depressants that do not promote physiological sleep and that may cause cognitive and memory impairment, motor skills impairment (especially when ingested along with alcohol), and have potential abuse liability. Where then, should we look for better agents, agents that may be better classified as sleep normal-izers rather than sedative-hypnotics Use of...

Noncatecholamines

Ephedrine (il 2 approx. 4 h) is a plant alkaloid with indirect sympathomimetic actions that resemble adrenaline peripherally. Centrally (in adults) it produces increased alertness, anxiety, insomnia, tremor and nausea children may be sleepy when taking it. In practice central effects limit its use as a sympathomimetic in asthma.

Orofacial Pain

Structures, neuropathies, vascular inflammation, all types of headache, sleep disorders, systemic disorders, and psychoimmune neurologic sources.1,8 survey ol 45,700 American households revealed that 22 ol respondents had experienced some type ol orofacial pain in the previous 0 months, establishing a meaningful probability that the periodontal patient's list of symptoms includes pain.4 I he current list ol possible sources of orofacial pain, prepared by the American Academy ol Orofacial Pain, is depicted in Box 25-l.MS

YHydroxy Butyrate

There is a narrow margin between intoxication and coma (106), and the clinical effects are potentiated by use of other CNS depressant drugs, such as alcohol, opiates, benzodiazepines, and neuroleptics (107). Tolerance and physical dependence after high-dose use can develop with a withdrawal syndrome, which may include insomnia, muscular cramping, tremor, and anxiety (101). Symptoms of withdrawal from GHB are broadly similar to those for alcohol although of a more rapid onset. A rapid deterioration into delirium may occur in more frequent high-dose dependent users. Withdrawal is not associated with seizures, but if suspected, hospital admission should be considered (108).

Abstract

Cannabis preparations were used for central nervous system disorders for many years prior to the 1930s, when these preparations were removed from pharmacopeias throughout the world. The Dispensatory of the United States of America, published in 1892 (Wood et al., 1892), listed many indications for medicinal use, including neuralgia, convulsions, spasms, hysteria (anxiety), nervous disquietude, mental depression, delirium tremens, insanity, pain, and insomnia. Preparation of an alcoholic extract for prescription is described in the Dispensatory, as well as dosage recommendations.

Corticosteroids

The most effective dose or formulation of steroids for treatment of anorexia is unclear. As noted above, multiple steroid formulations and doses effectively stimulate appetite. Dexamethasone is generally considered the steroid of choice because of its limited mineral corticoid activity and relatively low cost. Dexamethasone is best administered as a single morning dose with breakfast to avoid the insomnia associated with evening steroid administration. Steroids are not indicated to treat anorexia in patients with a survival anticipated to be greater than 8 weeks. For patients with very advanced cancer and limited survival, less than 2 months, corticosteroids may be an excellent therapy choice for the palliation of anorexia. For bedridden patients in particular, corticosteroids may be the

Cocaine and Crack

The onset-of-action and plasma half-life varies depending on the route of use, rapidly if taken intravenously or smoked compared with when it is snorted. The duration of effects will also vary with administration route (70). Ingestion of stimulant drugs, such as cocaine or amphetamine, result in activation of the sympathetic nervous system with resulting euphoria followed by irritability, depression, insomnia, and paranoia (Table 12). Initial low dose Euphoria, insomnia, dry mouth, hyperthermia, tachycardia, Cocaine produces a physical and psychological dependence, the severity of which will vary depending on the method of administration, being more severe if the drug is smoked or injected than if snorted. Dependence may result in a particular strong craving for the drug, followed by a withdrawal syndrome, or crash, with irritability, insomnia, depression, and anxiety on cessation. In conditions of police custody, the depression and inability to sleep may lead to acts of self-harm and...

Heartsink Patients

Of six patients with a wide variety of complex physical, psychological and social problems, 1 definitely obtained benefit from nabilone, whilst 3 others probably were helped. The former preferred smoking cannabis for his neck pain and insomnia opted for this approach. The other 3 were discontinued due to difficulties with assessment.

Sibutramine

Adverse effects include constipation, dry mouth and insomnia which occur in > 10 of users. Less commonly, nausea, tachycardia, palpitations, raised blood pressure, anxiety, sweating and altered taste may occur. Blood pressure should be monitored closely throughout its use (twice weekly in the first 3 months). Contraindications include severe hypertension, peripheral occlusive arterial or coronary heart disease, cardiac arrhythmia, prostatic hypertrophy and those with severe hepatic or renal impairment. It should not be used to treat obesity of endocrine origin or those with a history of major eating disorder or psychiatric disease. Concomitant use with tricyclic antidepressants should be avoided (CNS toxicity).

Disulfiram

A single case report has described an interaction between cannabis and disulfiram (Lacoursiere and Swatek, 1983). A 28 year old man taking disulfiram 250 mg daily exhibited signs of hypomania following the smoking of cannabis. He likened this to the effects of amphetamine. He was hyperactive, euphoric and suffered from pressure of speech, irritability and insomnia. He had used cannabis prior to commencing disulfiram and had not experienced adverse reactions. Furthermore, when disulfiram was discontinued he resumed cannabis use with no ill effects. Several months later, however, the patient was prescribed disulfiram again and, although free from adverse effects initially, he again developed hypomanic symptoms upon smoking cannabis during disulfiram treatment.

Fluoxetine

THC causes aggressive behaviour in rats that have been selectively deprived of REM sleep. The administration of fluoxetine or tryptophan was found to potentiate this aggression. These drugs boost CNS levels of serotonin, but drugs with anti-serotonin effects prevented THC causing aggression (Carlini and Lindsey, 1982).

Cognitive Functions

Subjective sensory perceptions in the absence of relevant external stimuli. The person may or may not recognize the experiences as false. Hallucinations may be auditory, visual, olfactory, gustatory, tactile, or somatic. (False perceptions associated with dreaming, falling asleep, and awakening are not classified as hallucinations.)

Back to the trees

There are two ways to approach this question using real creatures or abstract symbols. I'm going to take the former approach. This is partly because I once attempted to read a book on tree construction where the whole explanation was based on the use of A, B, C etc., and their possible relationships and while I didn't actually fall asleep, it was a close thing.

Kos862 Epothilone D

In a phase II trial involving women with metastatic breast cancer who had previously received an anthracycline and a taxane, KOS-862 at a dose of 100 mg m2 was given intravenously as a weekly infusion for three weeks, followed by a week of rest (52). Of 29 patients who could be evaluated for a response, four (14 ) had confirmed partial responses. Twenty-one of the 29 patients had peripheral sensory neuropathy, which was grade-3 in three of the patients. Grade-3 ataxia and dizziness were also reported. Overall, 18.5 of patients had grade-3 neurotoxicities. Other neurotoxicities (all grade-1 or -2) included cognitive disorder, confusion, or disorientation, memory impairment or amnesia, insomnia, hallucinations, and visual changes. The principal non-neurologic toxicities were fatigue (grade-3 in one patient), nausea (grade-3 in one patient), flushing, and anorexia. Accrual continues to the second Simon stage of this trial to determine the activity of KOS-862 in patients with...

Phase Iii Studies

Intraoperative doses of HBOC-201 (up to a maximum of 245 g) were well tolerated. There were no patient deaths or withdrawals during the study. Adverse events were similar in both treatment groups in type of event and frequency of occurrence most were not associated with either treatment. Nausea, hypertension, oliguria, skin discoloration after large doses, and rash occurred somewhat more frequently in the HBOC-201 group fever, hypotension, constipation, insomnia, gastrointestinal disorder and hypomagnesemia occurred somewhat more frequently in the RL group. Administration of HBOC-201 was associated with a dose-dependent increase in methemoglobin concentrations (3.7 per cent 3.2 per cent). Systolic blood pressure was approximately 12 per cent higher in the HBOC-201 treated patients than controls following recovery room discharge other vital signs were not different. Isolated transient increases in aspartate aminotransferase and or lipase activities (that returned to normal levels prior...

Websites

The following are a number of selected websites that pertain to sleep disorders and or sedative-hypnotics. diagnostics sleep sleep4.html diagnosis and therapy of sleep disorders http www.todoc.com sleep sleep.html sleep disorders and their treatment iac 100547893 sleep disorders and their treatment http www.neuronic.com neuronics sleepand2.htm abstracts of clinical studies on sleep and sleep disorders http www.extendedcare.com library sleepprint.html sleep and sleep disorders in older adults http swdca.org seniors.html sleep disorders in the elderly http www.medinfosource.com gt g000809.html sleep disorders in the elderly http www.ascp.com public pubs tcp 1999 may r_r.shtml clinical study on treatment of sleep disorders in the elderly with sedative-hypnotic agents http www.hivdent.org mentalh mentaL sleepd.htm diagnosis and treatment of sleep disorders in HIV patients

Properties and Uses

In the advanced stages of fever, small-pox and measles, when the patient is low, weak, and exhausted, and when there are at the same time delirium, muttering, and sleeplessness, 3 grains of camphor, with an equal quantity of asafoetida, may be given every third hour turpentine stupes or mustard poultices being applied at the same time to the feet or over the region of the heart. It should be discontinued if it causes headache or increased heat of the scalp. Its use requires much discrimination and caution.

Etiologies

Signs common to both left- and right-heart failure are tachycardia, car-diomegaly. cyanosis, oliguria, nocturia, and peripheral edema. Symptoms common to both include weakness, fatigue, confusion (delirium), decreased mental status, insomnia, decreased exercise tolerance, headache, stupor, coma, paroxysmal nocturnal dyspnea, and declining functional status.

Alcohol Withdrawal

Caused by CNS and sympathetic hyperactivity, often referred to as the shakes or jitters, and can occur even when patients still have a significant blood alcohol level. In addition to the typical 6- to 8-Hz tremor, which can be violent or subtle, insomnia, anxiety, gastrointestinal upset, diaphoresis, and palpitations can occur. Tremor typically diminishes over 48-72 hours, but anxiety, easy startling, and other symptoms can persist for 2 weeks. Delirium tremens (DTs) Most dramatic and serious form of alcohol withdrawal, but occurs in only 5 of patients with withdrawal symptoms. DTs typically begin within 48-72 hours after the last drink and can last several days, often with a resolution as abrupt as its onset. Characterized by hallucinations, agitation, tremor, and sleeplessness, as well as signs of sympathetic hyperactivity dilated pupils, low-grade fever, tachycardia, hypertension, diaphoresis, and hyperventilation. Delirium tremens is a serious condition with an in-hospital...

Anabolic Steroids

Initial use may result in stimulatory effects, such as increased confidence, decreased fatigue, heightened motivation, agitation, irritability, and insomnia, which may progress to argumentative and aggressive behavior and major mood disturbances including depression, mania, and hypomania (90,91). Roid rage, which may be associated with violent crimes (92), requires a high dose of steroids over several weeks, as may occur when stacking.

Future Prospects

Therapeutic research with cannabis in the fields of depression, anxiety and insomnia has ceased. There is objective evidence that in several disorders, such as nausea and vomiting associated with cancer chemotherapy, glaucoma, pain relief and relief of muscle spasm, adjunctive use will provide benefit in some patients at certain stages of their disease. In some cases, e.g. cancer, multiple sclerosis, AIDS, the nature of the illness is such that to deny access to this potentially valuable drug without first obtaining the necessary proof of efficacy from conventional clinical trials, seems unreasonably pedantic. There is considerable evidence that selected patients would and should obtain relief from the symptoms of their disease using cannabis or derivatives thereof, when no other substance will suffice. Reasons for this may be that conventional therapy is contraindicated in terms of route, dose, side effect profile or hypersensitivity or that the cannabinoid in question has a...

Adverse Effects

Nefazodone lacks antimuscarinic effects but may cause postural hypotension and abdominal discomfort. It appears to improve sleep quality and seems not to interfere with sexual function. Adverse effects include postural hypotension (especially in the elderly) and dizziness. Less common are headache, irritability, apathy, insomnia, fatigue, ataxia, gastrointestinal disturbances including dry mouth and constipation, sexual dysfunction (especially anorgasmia), blurred vision, difficult micturition, sweating, peripheral oedema, tremu-lousness, restlessness and hyperthermia. Appetite may increase inappropriately, causing weight gain.

Super Serenity Sleepers

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