Insomnia Causes and Treatment

Natural Insomnia Program

Natural Insomnia Program is credited to Christian Goodman, who is a health expert, and he is willing to help those people suffering from insomnia for long. Many people end up suffering from the sleepless night, which ends up affecting their following day schedule. For instance, the author sleepless night has destructed his marriage and also career, but with the help of the program, he has been to overcomes this problem. Through the various studies, it shows that most of the people sleep after 45 minutes, but with the help of the program, this would be reduced to 10 to 15 minutes. The most common solution to relaxing the body is through linguistic audio, which would help the brain to relax and thus sleep effectively. Many people have used the program, and they have ended solving the problem entirely. The program is available either in the video series and e-Book and works within the shortest time possible. More here...

Natural Insomnia Program Summary

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Study of Sleep Deprivation

Although a description of sleep stages can be provided with relative ease, identifying a clear function for sleep is a more difficult proposition. Yet applications of sleep research are inextricably linked with the functions of sleep. For the typical layperson, the seemingly obvious function of sleep is to repair and restore the body after daily mental and physical exertion. This commonsense approach has been formalized by science as the repair and restoration theory. One of the most frequently used methods to assess this theory is to examine the mental and physical effects of sleep deprivation. If the primary function of sleep is to repair the body, then loss of sleep should disrupt cognitive, motor, and behavioral processes. Early laboratory research with animals seemed to support this position. If sleep deprivation persisted for a sufficient time, usually between three and twenty days, death ensued in laboratory animals. Unfortunately, to maintain sleep deprivation in animals, it...

REM Sleep and Its Control by the Brainstem The REMDream Equation

Brainstem Ppt

In search of an objective measure of the process of falling asleep, and motivated by an article on blinking in the wake-sleep transition 15 , in 1953 Kleitman and Aserinsky described the presence of rapid eye movements (REMs) in deep sleep 16, 17 . They observed that REMs appear approximately 90 min after sleep onset, are associated with desynchro-nized cortical low-voltage fast EEG activity and a significant increase and instability in heart and respiratory rates, and occur at regular intervals throughout the whole night. To test the hypothesis that REM sleep may be linked with dreaming, ten probands were awakened during periods with and without REMs. Vivid dreams were reported in 74 when awakened during periods with REMs, but in only 17 when awakened in the absence of REMs. The neurosurgeon and neurophysiologist Jouvet discovered muscle atonia of REM sleep in 1959 18 . The combination of REMs, activated EEG and muscle atonia suggested the term paradoxical sleep as a synonym of REM...

Sleep Disorders Narcolepsy

Dream Disorders

Lee et al. compared polysomnographic findings and dream reports between 24 patients with insomnia and 16 patients with narcolepsy, both diseases associated with disturbing dreams 63 . Compared to insomniacs, narcoleptics had more frightening, recurrent dreams and shorter REM segments. No correlation was found between dream content and polysomnographic findings such as REM segment length or REM density.

REM Sleep Behavior Disorder

This disorder was formally first described in 1986 82 , although single reports had described features of this entity already before. RBD presents with dramatic, often violent, motor behaviors occurring during sleep in association with vivid, frightening dreams. Since RBD occurs during REM sleep, it typically appears in the second half of night-time sleep, when REM sleep predominates. Injuries and assaults on bed partners have been reported to occur in up to 32 and 64 of patients, respectively (Fig. 6) 83 . In a study of 49 patients with polysomnography-confirmed RBD, Fantini et al. found dreams in these patients to be characterized by an elevated proportion of aggressive contents, despite normal levels of daytime aggressiveness 84 . Polysomnography demonstrates excessive muscle tone during REM sleep (e.g., in the chin EMG), which may represent the first sign of RBD 85 , an enhanced phasic muscle activity with corresponding excessive or abnormal motor behavior and vocalizations....

NREM Sleep and Dreaming

The awaking studies of Aserinsky and Kleitman had already shown that subjects can report dreams or dream-like experiences even when awakened from non-REM (NREM) sleep. This observation was confirmed by several other authors and consequently challenged the so-called REM-dream equation 26-28 . The persistence of dream experiences despite complete pharmacological REM sleep suppression gives further support for the existence of a dream-like mentation in NREM sleep 29 . On the other hand, Aserinsky and Kleitman found that so-called non-dreamers had REMs just like those of subjects with frequent dream recall. Dream reports from patients awakened from REM sleep are more frequent, more real, more emotional and more bizarre, and their content is more often visual and or motor 30, 31 .

Insomnia

Insomnia is the most common sleep-related complaint and affects up to 47 of patients attending general practices 95 . A substantial number of investigations have suggested that in healthy individuals a significant correlation exists between the frequency of dream recall, frequency of nocturnal awakenings and low sleep quality 96-98 . Schredl et al. have recently confirmed that insomniacs' dream recall frequency is elevated and dream reports are longer 99 . Dreams of insomniacs are characterized by more negative emotions, frequent reports on health themes, depression and aggression and a reduced degree of explicit visual perception. If on the one hand insomnia can increase dream recall frequency, there might on the other hand exist a subcategory of insomnia that is explicitly produced by dreaming. This condition is called dream interruption insomnia 100 . Patients complain about repetitive nocturnal awakenings and typically mention frequent episodes of nightmares prior to the onset of...

Pharmaceutical Therapy

Pharmaceutical agents used to slow the progression of AD include acetylcholinesterase inhibitors (tacrine, donepezil, rivastigmine, and galanta-mine). These agents block the breakdown of neurotransmitters in the brain and are used to lessen symptoms of mild to moderate AD. Their action extends cognitive function and improves behavioral symptoms for twelve months up to two years. Vitamin E or selegiline delays the progression of AD. Estrogen has been associated with a decreased risk of AD and enhanced cognitive functioning. Its antioxidant and anti-inflammatory effects enhance the growth of neuron processes for memory function. Ginkgo biloba has provided moderate cognitive improvement with few ill effects. Delusions and hallucinations often develop in moderately impaired patients. In the absence of agitation or combativeness, the best treatment is reassurance and distraction. Delusions and hallucinations accompanied by agitation and combativeness can be treated with low doses of...

European Organization for Research and Treatment of Cancer Eortc Qlqc30

The EORTC QLQ-C30 is a cancer-specific 30-item questionnaire (Aaronson et al., 1993) see Appendix E6. The QLQ-C30 questionnaire was designed to be multidimensional in structure, appropriate for self-administration and hence brief and easy to complete, applicable across a range of cultural settings, and suitable for use in clinical trials of cancer therapy. It incorporates five functional scales (physical, role, cognitive, emotional, and social), three symptom scales (fatigue, pain, and nausea and vomiting), a global health-status QoL scale, and a number of single items assessing additional symptoms commonly reported by cancer patients (dyspnoea, loss of appetite, insomnia, constipation, and diarrhoea) and perceived financial impact of the disease.

Variations in Consciousness

Physiological psychologist Karl Pribram lists the following states of consciousness states of ordinary perceptual awareness states of self-consciousness dream states hypnagogic and hypnopompic states (the transition states, characterized by vivid dreamlike imagery, that occur as one goes into and comes out of sleep) ecstatic states (such as the orgiastic experience) socially induced trance or trancelike states drug-induced states social role states linguistic states (for example, a multilingual person thinking in one, rather than another, language) translational states (as when one linguistic universe is being recorded or translated in another) ordinary transcendental states (such as those experienced by an author in the throes of creative composition) extraordinary transcendental states that are achieved by special techniques other extraordinary states (such as those that allow extrasensory awareness ) meditational states dissociated states, as in the case of pathological multiple...

Benefits of Meditation

Research on the physiological effects of meditation led to the application of meditative techniques as a treatment to combat stress-related illnesses. Meditators have often experienced significant decreases in such problems as general anxiety, high blood pressure, alcoholism, drug addiction, insomnia, and other stress-related problems. Researchers have also found that the scores of meditators on various psychological tests have indicated general mental health, self-esteem, and social openness. Many psychologists argue, however, that these effects are not unique to meditation and can be produced by means of other relaxation techniques. Meditation researcher Robert Ornstein has suggested that the long-term practice of meditation may induce a relative shift in hemispheric dominance in the brain from the left hemisphere, which is associated with such linear processes as language and logical reasoning, to the right hemisphere, which is associated with nonlinear processes such as music...

Gene expression in the eye

Cells, the rods and cones, which appose the retinal pigment epithelium. The additional proximal layers of the retina consist of secondary neurons and their processes, and are involved in the first steps of visual processing. The output from the retina is via the axons of the retinal ganglion cells which form the optic nerve, projecting to the visual centers of the brain. In addition to the primary image-forming role in vision, recent studies have highlighted an additional photoreceptive pathway within the eye, based upon directly light-sensitive retinal ganglion cells expressing the photopigment melanopsin (Provencio et al., 2000 Berson et al., 2002 Sekaran et al., 2003 Foster and Hankins, 2002). This pathway is involved in detecting gross changes in light levels (irradiance) and is involved in the regulation of circa-dian rhythms as well as regulating other non-image forming tasks such as the pupillary light response and acute suppression of pineal melatonin (Lucas et al., 2001 Lucas...

Advances and Insights from Convergent Functional Genomic Studies

Familial advanced sleep phase syndrome (FASPS) is an autosomal dominant circadian rhythm variant affected individuals are morning larks'' with a 4-hour advance of the sleep, temperature and melatonin rhythms. Human genetic linkage studies localized the FASPS gene near the telomere of chromosome 2q. A strong candidate gene (hPER2), a human homologue of the period gene in Drosophila, maps to the same locus. Affected individuals were shown to have a serine-to-glycine mutation within the casein kinase Is (CKIs) binding region of hPER2, which causes hypophosphoryla-tion by CKIs in vitro 86 . A stable alteration in human sleep behaviour can

Synthesis in the Functional Significance of Dreams

Vation can lead to organic loss of condition with severe degeneration of organs such as the heart and kidneys, and even death in animals such as the monkey 74 . Sleep, from the evolutionary viewpoint, is certainly part of an individual's adaptation to his environment. An example is the dolphin, whose synchronous sleep alternates between the two hemispheres, and who has no REM sleep, for reasons of adaptation and survival 75 . It is generally believed that non-REM sleep is needed for metabolic activity, homeostasis, and thermoregulation, while REM sleep-which interests us more here in relation to mental activity-is required to elaborate and memorize information the brain has received during waking hours. During development, starting with the fetus, REM sleep acts as an endogenous stimulus to synaptogenesis and maturation, particularly of the neocortex. It is also necessary for restoration of the catecholaminergic system. This is interesting, since the catecholamines help regulate mood....

Dreaming in Neurological Patients

The brain mechanisms involved in dream changes are, with the exception of REM sleep behavior (see below), essentially unknown. Neurochemical1 and or structural changes in the above-mentioned thala-molimbic-temporo-occipital dreaming circuits can generally be postulated. In many instances clinical symptomatology can be understood as a dissociated state arising from the loss of the physiological boundary between the different states of being (wakefulness, NREM and REM sleep). The exact pathophysiology is expected to vary according to the specific form of altered dreaming. In patients with narcolepsy and Parkinson's disease, visual hallucinations may represent, at least on some occasions, the intrusion of REM sleep mentation into wakefulness 39 . In out of body experiences a dysfunction of body- and self-processing at the temporoparietal junction has been suggested 40 . In addition to brain dysfunction per se, other factors such as age, personality, mood, current physical and psychic...

Changes in Dream Contents Accompaniments

Dreams with increased vividness, violent or aggressive contents and increased or uncontrolled motor activity (enacted dreams) suggest the presence of a REM sleep behavior disorder (RBD). The diagnosis is proven by the polysomnographic demonstration of a loss of physiologic atonia and increased motor phasic activity during REM sleep. RBD can be observed in the course of neurodegenerative disorders, brainstem lesions, narcolepsy, drug or alcohol abuse, and in the so-called parasomnia overlap syndrome.

Sleep Terror and Sleepwalking NREM Parasomnias Arousal Disorders

In sleep terrors subjects abruptly sit up, producing a loud scream in association with a facial expression of extreme fear. The attacks are accompanied by a sudden and pronounced increase in heart and respiratory rate and muscle tone. Most characteristically, the extremely worried parents are usually unable to arouse and comfort their child. The combination of features of arousal disorders with REM sleep behavior disorder has been called overlap parasomnia. Sleep terrors and sleepwalking are more common in children but may be present in up to a few per cent of the adult population. They are not associated with specific physical findings. Developmental, genetic, psychological, and organic factors can contribute to their occurrence. About one-third of individuals with frequent nightmares have a positive family history, and an association with the HLA haplotype DQB1*05 has been suggested. Sleepwalking can be triggered by fever, stress, sleep deprivation, acute brain disorder (stroke,...

Nightmares Posttraumatic Stress Disorder

Nightmares are parasomnias of the middle of the night or early morning when REM sleep is more common. Nightmares are typically dreams of physical danger (e.g., being chased) or psychological threat (e.g., being teased). Typical contents include monsters, ghosts, animals, and bad individuals. Vocalizations, movement and autonomic symptoms are typically minimal. When awakened, subjects are rapidly oriented, can be calmed and usually recall the details of the dream. These features distinguish nightmares from sleep terrors (see above) and REM sleep behavior disorder (see below).

Traumatic Brain Injury

With decreased dream recall in the acute phase of brain damage and subsequent gradual recovery 113 . Loss of dreaming following traumatic brain injury has not been found to be correlated with an analogous reduction or loss of REM sleep 109 . The recovery phase of traumatic brain injury is sometimes complicated by the appearance of hallucinations, which are thought to reflect intrusions of REM sleep into wakefulness 114 . A few cases of post-traumatic narcolepsy and Kleine-Levin syndrome with the appearance of hallucinations and alterations of dreaming have been reported 115-117 .

Delirium Tremens and Other Withdrawal Syndromes

Polysomnography in acute alcohol withdrawal syndrome may show a markedly reduced sleep efficiency, reduction or absence of NREM sleep and long periods of wakefulness alternating with abruptly emerging periods of REM sleep without atonia observed by Plazzi et al. 157 . The patient repeatedly presented with intense enacting dreams with violent fighting behavior, jerks and talking throughout the night and also during daytime episodes of drowsiness. Whenever awakened he reported vivid dream content.

Clinical Features

Most infections are asymptomatic but patients often present with pruritis ani and perineal pruritis. Symptoms are typically worse at night and may produce insomnia and restlessness. Heavily infected children may develop blood loss, poor concentration and emotional disturbance and enuresis. Local eczematous reactions and dermatitis artefacta may be seen. Chronic abdominal pain is probably more common than is currently recognised (see above). In girls, vulval vaginitis, acute urinary infections, enuresis and incontinence are associated with infection. In addition to this, many parents become anxious about the appearance or stigmata of worm infection.

Effects of Alcohol and Drugs

Alcohol consumption before bedtime leads to a shortened sleep latency, increased NREM sleep and reduced REM sleep during the first hours of sleep. Since alcohol has a relatively short half-life, symptoms related to alcohol withdrawal occur in the second half of the night, such as shallow disrupted sleep, sympathetic arousals and increased REM sleep with more vivid dreams and nightmares. Similar symptoms may appear during the weeks after alcohol withdrawal in alcoholic patients. Hershon found that 29 of a group of 100 alcoholics reported that they started again drink Numerous classes of drugs have been associated with nightmares, including sedative hypnotics, beta-blockers, amphetamines and dopamine agonists 166 . Suppression of REM sleep with subsequent increased intensity of the REM episodes is thought to be the pharmacological mechanism responsible for nightmares induced by beta-blockers 167 . Dopamine receptor stimulation may be another common mechanism involved in the generation...

Clinical Applications

The functions of sleep are extremely important in clinical applications. If the repair and restoration theory lacks strong scientific support, attempting to recover lost sleep time may serve no functional purpose. Indeed, most subjects expect to sleep for several hours longer than normal after staying awake for twenty-four hours, presumably because they believe sleep is required for repair and restoration of the body. In practice, however, most subjects report only four to six total hours of poor-quality sleep following such deprivation. Even after 264 hours of sleep deprivation, Randy Gardner slept for only fourteen hours and forty minutes the first evening, then resumed a normal nocturnal sleep pattern of eight hours per evening. Knowledge of sleep stages may be especially valuable in diagnosing and treating sleep disorders, because the frequency, patterns, and symptoms of these disorders may be associated with specific stages of sleep. For example, knowledge of the muscular...

Emergence of Research

Because sleep is a universal human experience, it has probably interested people since the dawn of humanity however, scientific inquiry into sleep is a relatively recent phenomenon. Early interest in sleep arose during the late nineteenth century from a need to isolate the brain structure responsible for lethargy syndromes. Similarly, the electrophysiological study of sleep originated with a discovery in 1875 by the English physiologist Richard Caton that the brain continually produces low-voltage waves. This discovery was largely ignored until 1929, when a German psychiatrist, Hans Berger, found that he could record from large groups of neurons by attaching electrodes to the scalp and the forehead. Berger's discovery marked the beginning of modern electroencephalography. With the advent of EEG recordings, it was not long before A. L. Loomis, E. N. Harvey, and G. A. Hobart found, in 1937, that EEG recordings could be used to differentiate stages of sleep. In 1952, Nathaniel Kleitman...

Sources for Further Study

New York Free Press, 1997. A wide-ranging exploration of sleep research. Coren is one of the major researchers in the relationship between sleep deficit and major industrial accidents, such as the 1989 Exxon Valdez oil spill, the 1986 Chernobyl nuclear plant disaster, and the 1986 Challenger space shuttle explosion. Dement, William C. The Promise of Sleep. New York Dell, 2000. Dement, founder of the sleep disorders clinic at Stanford University, provides a nontechnical, personal report of current findings in sleep research, drawing a connection between sleep and general health. Offers a guide to remedying sleep deficits and alleviating insomnia. Empson, Jacob, and Michael B. Wang. Sleep and Dreaming. 3d ed. New York St. Martin's Press, 2002. An overview of scientific sleep research and popular beliefs about sleep. Hobson, J. Allan. Sleep. Reprint. New York W. H. Freeman, 1995. A broad and interdisciplinary view of sleep research, combining knowledge...

Multiple Oscillators

In addition to multiple oscillators within the SCN, recent evidence suggests that certain non-SCN neural and neuroendocrine tissues are capable of expressing at least damped autonomous oscillations. Thus, cultured mammalian retinae display persisting circadian rhythmicity in melatonin secretion (Tosini and Menaker, 1996), while more recent studies have demonstrated self-sustaining oscillations of Per gene expression in cultured endocrine tissues (pineal, pituitary), diencephalic nuclei (e.g., hypothalamic arcuate and paraventricular nuclei, thalamic paraventricular nucleus), and in the olfactory bulbs (Abe et al, 2002b). While the relationships between these extra-SCN neural oscillators and the SCN pacemaker have not been elucidated, it appears that at least certain types of rhythm splitting may indeed involve dissociations between intra- and extra-SCN clocks (Abe et al., 2001, 2002a).

Correcting Protein Misfolding as a Novel Therapeutic Approach

Benzofuran-based compounds (29), rifampicin (30), melatonin (31), nicotine (32), estrogen (33), glycosaminoglycans mimetics (34), nitrophenols (35), tetracycline (36), anthracycline 4'-iodo-4'-deoxydoxorubicin (37), clioquinol (38), ibuprofen (39), and (40). The activity of some of these compounds has also been studied in vivo using AD animal models and even some of them are under clinical evaluation in AD patients. However, the usefulness of these small molecules as amyloid inhibitors is compromised by their lack of specificity and their (in most of the cases) unknown mechanism of action, which makes it difficult to improve them. In addition, many of these compounds are highly toxic.

Mental Health and Violence

Recently, the mental health of refugees and other migrants affected by conflicts has attracted more attention and become a priority for WHO (Brundtland, 2000). Studies conducted in the field have shown a high prevalence of traumatic events with high levels of mental morbidity (50 ) and PTSD symptoms (De Jong et al, 2000 Lopes Cardozo et al., 2000). In refugees and asylum seekers arriving in European countries, similar rates have been observed. Over 60 of asylum seekers arriving in Geneva, Switzerland reported having been exposed to trauma, 18 to torture and 37 reported at least one severe symptom during the previous week, most often of a psychological nature, such as sadness most of the time, insomnia, nightmares and anxiety (Loutan et al., 1999). Exposure to war-related trauma or torture may jeopardise seriously their capability to adjust to a new environment and a new society. Adaptation difficulties can be numerous and the administrative status may or may not facilitate this...

Childhood Amnesia Dreams Dream Content and the Fragility of Dream Recall

Dreaming refers to any image, thought, or emotion attributed by the individual to the condition of sleep, before awakening. This sleep condition consists of various sleep stages that are manifested by repeated changes of the brain's functional state as recorded in the EEG they are characterized in terms of EEG macrostates by systematic slowing of EEG wave frequency from wakefulness to NREM stages and subsequent appearance of faster wave frequencies during REM stages. The flow of information to the brain from the internal and external realities and the dynamic and selective interaction with these realities are not interrupted by the EEG changes from waking to sleep. During all sleep stages (NREM and REM) the sleeping individual (1) perceives incoming information, (2) evaluates the significance of this information for the Based on the similarities of EEG patterns between developmental states of the awake brain with the states of the adult sleeping brain, we propose that sleep stages-and...

Categories of Weight Loss Drugs

Affect catecholamines dopamine and norepinephrine. These noradrenergic agents are useful for short term treatment and include the drugs phenteremine, diethylpropion, phendimetrazine and benzphetamine. Stimulants act via catecholamine neurotransmitters, such as amphetamines and phenylpropanolamine. Phenylpropanolamine, which was an over-the-counter medication, was removed secondary to an association with hemorrhagic stroke. Side effects of this class of medications include insomnia, dry mouth, constipation, euphoria, palpitations and hypertension.

Horowitzs Cognitive Analytic Approach

Traumatized individuals will predictably go through a series of alternating phases between acknowledging the trauma and avoiding it. As this process goes on, the eventual goal should be a reformulation or reschematization of the event in relation to the person and the person in relation to him- or herself and others. This is sometimes referred to as working through, which was mentioned earlier. The goal of treatment is to help the person work through the linkage between the self and the stressor events so that all such symptoms can be attenuated or terminated (Horowitz, 2001, p. 182). The goal is to strike a balance between a state of emotional numbness and of being emotionally flooded or overwhelmed. There are also the general goals of helping the patient establish a sense of safety develop decision-making skills and more adaptive coping develop a realistic sense of self as stable, coherent, competent, and worthwhile develop competence with family and community and develop a rational...

GABAa receptor agonists antagonists and allosteric modulators

Many drugs bind at sites on the GABAA receptor distinct from the GABA-binding site these drugs change the shape of the receptor oligomer so that the efficacy of GABA at opening the channel is either increased (positive allosteric agonists, e.g., diazepam) or decreased (negative allosteric agonists, e.g., the p-carboline, DMCM). A few allosteric modulators occur naturally in the brain (e.g., Zn2 + , neurosteroids). Generally, positive allosteric agonists are used widely in medicine (e.g., for the induction and maintenance of general anaesthesia or to treat anxiety disorders, states of agitation, epilepsy or sleep disorders) and there is scope to further develop these drugs to produce receptor subtype-selective drugs with fewer side-effects (Whiting, 2006 Rudolph and Moehler, 2006) however, negative allosteric agonists also have potential clinical applications for example, the drug L-655 708 works selectively at a5pg2 receptors (a subtype mainly expressed in the hippocampus) and by...

Consequences of Deficit and Excess Energy Intake

Excess energy intake and positive energy balance are promoted by readily available, energy-dense foods and sedentary lifestyles 11 . The consequences of excess energy and obesity are well described in children 12 . Obesity-related co-morbidities include type-2 diabetes, hyperlipidemia, hypertension, hyperandrogenism in girls, sleep disorders, respiratory difficulties, nonalcoholic fatty liver disease, gallbladder disease, orthopedic problems, and idiopathic intracranial hypertension. Serious psychosocial problems including poor self-esteem and depression also are common. Childhood obesity and its co-morbidities have a significant likelihood of persisting throughout adolescence and into adulthood.

Consequences of Exposure to Traumatic Stressors

Difficulty falling or staying asleep. As J. F. Pagel (2000) states, nightmares are a defining symptom of PTSD. They are also considered a very common symptom amongst many clinicians. Pagel defines a nightmare as a vivid and terrifying nocturnal-sleep episode. The content of nightmares typically involves the traumatic experience and occurs during REM sleep but has been observed during sleep onset. Complications from nightmares can include insomnia, daytime memory impairment, and anxiety. Alan Siegel holds that PTSD nightmares are different than non-PTSD nightmares in that PTSD nightmares are considered more emotionally intrusive and anxiety provoking.

Pacemaker Inputs Role of the Mesencephalic Raphe Nuclei

In addition to modulating photic entrainment, serotonergic mechanisms also directly regulate the circadian pacemaker during subjective day. The circadian pacemaker can be phase shifted by electrical stimulation of the midbrain raphe nuclei (Meyer-Bernstein and Morin, 1999 Glass, DiNardo, and Ehlen, 2000) as well as by in vivo (Tominaga et al., 1992 Edgar et al., 1993 Cutrera, Saboureau, and Pevet, 1996 Ehlen, Grossman, and Glass, 2001) or in vitro (Prosser, Miller, and Heller, 1990 Shibata et al, 1992 Prosser, 2000) administration of serotonin and or 5HT1A 5HT7 receptor agonists, including 8-OH-DPAT. The PRC for serotonergic stimulation is characterized most consistently by large phase advances during midsubjec-tive day, and closely resembles the PRCs for novelty-induced activity, sleep deprivation, and benzodiazepine and NPY administration, as described above. The ability of direct 5HT application to the in vitro SCN to evoke circadian phase shifts indicates that stimulation of...

Creutzfeldt Jakob Disease

Fatal familial insomnia (FFI) is a hereditary, occasionally sporadic prion disease with prominent neurodegenerative changes affecting mainly the anteroventral and mediodorsal thalamic nuclei the disease was described in 1986 151 . The clinical features of FFI consist in progressive insomnia, sympathetic overactivation (perspiration, tachycardia, hypertension, evening pyrexia) and motor disturbances (dysarthria, myoclonus, disturbed coordination). Patients typically show peculiar episodes of vivid dream enactment that may spontaneously intrude into wakefulness, during which they are in a stupor-like state ( oneiric stuporous state ) and perform complex jerk-like movements, corresponding to the dream content reported afterwards 152, 153 . Polysomnography reveals profound sleep EEG changes with progressive disappearance of the hallmarks of NREM sleep including sleep spindles, K-complexes and slow-wave sleep 154 . Recently, Landolt et al. described similar sleep-wake disturbances in

Antenatal and Neonatal Life

There has been strong interest in fetal psychic life for many years among the international psychoanalytical community 83 . Particular interest has been shown in the different physiological components of the fetus sensori-motor activity, general behavior, and integrative functions, especially related to the various states of sleep and wakefulness 81 . The early behavior of the fetus, from the 10th to the 20th week of gestation, is particularly interesting (Piontelli, Chap. 15, this volume). Early functions have been observed, such as generalized movements, respiratory movements, clonus and hiccups, as well as other movements and behaviors. It has been observed that groups of movements (generalized and respiratory) are organized in alternate clusters. Given that the neuronal structures of the pons are the earliest to be organized 12, 80 , it can be hypothesized that these preside over the ascending and descending motor and synaptogenic functions. The alternation of the clusters...

Positioning and Handling

Because of their physiological instability, critically ill preterm infants receive minimal handling and stimulation but are repositioned on a regular basis according to nursing protocols (Aucott et al., 2002). Attention to how they are positioned can easily be incorporated into their routine care. More comfortable breathing, better oxygenation, and more time in deep sleep have been noted in preterm and sick infants in the prone position than in infants in the supine position (lying on their side) (Grunau et al., 2004 Clin J Pain 20 76 Wells et al., 2005).

General Adaptation Syndrome

The first stage begins when an individual becomes frightened, anxious, or even merely concerned. The body immediately undergoes numerous physical changes to cope with the stressor. Metabolism speeds up. Heart and respiration rates increase. The hormones epinephrine, norepinephrine, and cortisol are secreted. Sugar is released from the liver. The muscles tense. Blood shifts from the internal organs to the skeletal musculature. These and a host of other changes are aimed at helping the body cope, but the price paid for this heightened state of arousal typically includes symptoms such as headache, upset stomach, sleeplessness, fatigue, diarrhea, and loss of appetite. The body's increase in alertness and energy is accompanied by a lowered state of resistance to illness.

The Effects of Hormones on Behavior

The pineal gland, located in the posterior cerebrum, releases the hormone melatonin, which regulates the body's circadian rhythms and possibly its sexual cycles as well. Melatonin is normally synthesized and secreted beginning shortly after dusk throughout the night and ending around dawn. It thus corresponds with the individual's normal sleep-wake cycle. Melatonin may play an important role in humans adapting to shift work. It is promoted as a nutritional supplement to help people get a good night's sleep.

Importance to Psychology of Consciousness

Gists are often presented with patients who suffer from physical or psychological stress as a function of sleep disorders. These professionals are interested in developing effective drug and psychological therapies that can be used to treat sleep-disordered patients. Sleep is a concern in many areas of psychology. Because sleep is universal in humans, it will continue to play a major role in consciousness studies and throughout the discipline of psychology. Future research will likely focus on applications of sleep research to industrial settings that employ shift workers. The emphasis will be on reducing fatigue and improving performance among employees by gradually adjusting them to shift work and by changing employee work schedules infrequently. In addition, research will seek ways to improve diagnostic procedures and treatments for a variety of sleep disorders, including insomnia, hypersomnia, sleep apnea, narcolepsy, and enuresis. The focus will be on developing effective drug...

Dream Theories before 1953

Tury BC) observed the twitching leg movements of a sleeping dog and linked them to a presumed ongoing dream about a chase. In the same century, Petronius Arbiter (author of the Satyricon) had to interpret Nero's frightful dreams he comforted him by explaining that dreams were not of divine origin, but simply the product of ourselves. The same opinion was also held by Cicero. In the second century Artemidorus gave a detailed description and a first classification of dreams in his Oneirocriticon, supporting the idea of a premonitory value of dreaming. Galen wrote in his Diagnosis from Dreams that dreams can have a premonitory character ( somnia ) but also reflect natural processes, changes in the body humors ( insomnia ). Johannes M ller (1801-1858) and Jan Purkyne or Purkinje (1787-1869) were among the first to study the peculiar mental imagery during sleep onset, which are most marked in youth. Weir Mitchell (1829-1914) remarked that he had been able from his childhood to summon...

Cognitive Activity Cycles During Sleep

REM Sleep REM Sleep It was once assumed that dreams only occur in REM sleep, but it is now common knowledge that dreams of a different variety occur in stages three and four. These dreams are not of the narrative or storylike variety found in REM sleep rather, they resemble nonsequential thoughts, images, sensations, or emotions. As might be expected in the deepest sleep stage, it is quite difficult to awaken the sleeper who is in stage four. Paradoxically, a subject awakened in stage four will often claim not to be sleeping. Finally, sleepwalking, night terrors, and bed-wetting, all of which are developmental disorders, occur predominantly in stage four. Stage three lasts approximately ten minutes, while the first episode of stage four usually lasts about fifty minutes. Suddenly, about ninety minutes after falling asleep, the subject rapidly regresses back through the stages of NREM sleep to a special stage usually called stage one-REM sleep, or sometimes simply REM sleep. Three...

Designing Meaningful Experiments

These problems might be addressed by using inducible systems, for example inducible promoters as the Tet-on and Tet-off systems 14 to regulate transgene expression, together with carefully designed time courses. Experimental animal models for cardiovascular diseases should be analyzed at various time points to account for the onset, progression, and chronic phase of the disease. Integrating the gene expression profiles of different models with related phenotypic pathology, for example comparing mouse models of cardiac hypertrophy induced by transgenic overexpression of hypertrophic stimuli with models of pressure-overload induced hypertrophy, will help to further discriminate between primary causes and secondary changes associated with the disease that is being investigated. Currently, cross-species and cross-platform comparisons are hindered by the fact that individual microarray platforms interrogate different sets of genes, and by the lack of standardized RNA processing and...

Brain Metabolism Activation During Sleep and Dreaming

Neuroimaging studies using positron emission tomography (PET), singlephoton emission computed tomography (SPECT) and functional magnetic resonance imaging (fMRI) 32-35 have shown, in line with neurophys-iological observations, different patterns of brain activation during the different states of being (wakefulness, NREM sleep, REM sleep). REM sleep is characterized by sustained neuronal activity, high cerebral energy requirements and high cerebral blood flow. Compared to wakefulness, in most studies a deactivation of the dorsolateral prefrontal cortex and associative parietal areas during both NREM and REM sleep, and an activation of pontine tegmentum, thalamus, limbic paralimbic structures (including the amygdala) and temporo-occipital areas (other than primary visual cortex) during REM sleep were reported. Medial pre-frontal cortex, however, remained as active during REM sleep as during wakefulness, whereas it is significantly decreased during NREM sleep 36, 37 . These profiles of...

N Sleep EEG Changes with Aging

With respect to the evoked potential (i.e., the electrical activity generated by stimulation of the cortex through internal or external stimuli), the data suggest that latency is prolonged after stimulation involving a variety of sensory modalities, perhaps due to decreased conduction velocity or a change in the sensory organs (Chapter 8). Alterations in spontaneous and evoked potential are aggravated in individuals with Alzheimer's disease (AD). As illustrated in Figure 1, when people fall asleep, they go from a state of quiet wakefulness through four consecutive stages of SW sleep and several episodes of REM sleep. In the normal adult, the total amount of sleep per day is approximately seven hours, of which 23 is spent in REM sleep and 57 in stage 2 SW sleep. Of the other stages, stage 1 accounts for 7 and stages 3 and 4 for about 13 (Fig. 2). Generally, the episodes of REM sleep occur at about 90-minute intervals. They lengthen as the night progresses this is the stage in which...

Stroke and Other Focal Brain Diseases

Following the seminal papers by Charcot and Wilbrand on cessation of dreaming 42, 43 , a few authors reported on dream characteristics of patients with stroke 44,46,48,105-107 . More recently, Hobson has given a first-person account of abnormal visual percepts in association with total insomnia and dream suppression following a lateral medullary stroke 108 . Solms' work is of paramount value but has some limitations. First, no awakenings from REM sleep were undertaken. The possibility that Charcot-Wilbrand syndrome (CWS) may in some cases be due to amnesia therefore cannot be ruled out. Second, the anatomical data are based mainly on CT scans, which do not always allow particularly in the posterior fossa determination of the exact extent of the underlying lesion. Third, the patients suffered from a variety of diseases and were examined at different intervals following disease onset, factors which can significantly influence oneiric experiences. Following this unusual dream, the...

Origins and Significance

Theories about the origins of dreams can be divided into two main categories naturalistic and supernaturalistic. Proponents of naturalistic theories of dreaming believe that dreams result from either physiological activities or psychological processes. Aristotle was one of the first people to offer a physiological explanation for dreams. His basic thesis was that dreams are the afterimages of sensory experiences. A modern physiological approach to dreaming was put forth in the 1970's by J. Allan Hobson and Robert McCarley. According to their activation-synthesis theory, emotional and visual areas of the brain are activated during REM sleep, and the newly alerted frontal lobe tries to make sense of this information plus any other sensory or physiological activity that may be occurring at that time. The result is that ongoing activity is synthesized (combined) into a dream plot. For example, a man enters REM sleep and pleasant memories of playing in band during school are evoked....

Tranche of Analysis

When she was two a baby sister was born, taking her mother's already cool, scant attention from her even more. This was an extremely important early infantile trauma that surfaced insistently in the transference in the shape of unrestrainable anger, resentment, dissatisfaction, often sadness, insomnia, and fierce anxiety that she should not cope with, originating from this old fear of being ousted and abandoned.

The Role of the Reticular Activating and the Limbic Systems

The reticular activating system, formed of an afferent and efferent network of interconnecting neurons distributed in the core midbrain, controls conscious alertness and, thus, makes sensory, motor, and visceral perception possible. Changes in sleep patterns with aging may be related to alterations in the level of alertness as manifested by the EEG changes discussed above and shifts in neurotransmitters, primarily serotonin (60,61) (Chapter 6). Serotonin appears to function as an inhibitory neurotransmitter that modulates the effects of light on circadian rhythmicity and regulates several cyclic hormonal secretions (62,63). It is also the precursor of the pineal hormone melatonin, which, in some, has potent sedative and hypnotic (sleep-inducing) activity (Chapter 12). Insomnia, frequent in the elderly, may depend on several factors superimposed on the aging process. Anxiety, depression, and stress that often affect sleep, are prevalent among many elderly and may account for some of...

The Neurosciences Contribute to Dreams

It was only in 1953 that neurophysiologists started taking any real interest in the mental aspects of sleep. This was when Aserinsky and Kleitman 38 observed a paradoxical phase, which we now know as REM sleep, opening the gates of dream to physiologists and experimental psychologists. These researchers noted that children sleeping deeply presented eye movements visible under their eyelids, with twitching of the limbs, Neurophysiological research in the 1960s 39 clarified the electrophysiological parameters and structures responsible for REM sleep, distinguishing it from the non-REM phases EEG desynchronization, atony of postural muscles, rapid eye movements, monophasic waves in the visual system, known as ponto-geniculo-occipital (PGO) waves, and neurovegetative turbulence, involving respiratory and cardiac arrhythmias and changes in blood pressure. The endocrine system too showed significant changes during REM sleep. The cholinergic reticular organization of the pons was found to be...

Disturbances Of The Central Nervous System

Toxic substances can interfere with normal neurotransmission in a variety of ways, ether directly or indirectly, and cause various central effects. For example, cholinesterase inhibitors such as the organophosphate insecticides cause accumulation of excess acetylcholine. The accumulation of this neurotransmitter in the CNS in humans after exposure to toxic insecticides leads to anxiety, restlessness, insomnia, convulsions, slurred speech and central depression of the respiratory and circulatory centres.

Repression the Unconscious Mind and Unconsciousness

Literally, through many long hours he held my two hands clasped between his, almost like an umbilical cord, while I lay, often hidden beneath the blanket silent, inert, withdrawn, in panic, rage or tears, asleep and sometimes dreaming. Sometimes he would become drowsy, fall asleep and wake with a jerk, to which I would react with anger, terrified and feeling as if I had been hit a failed now moment 26 author's comment . He must have suffered much boredom and exhaustion in these hours, and sometimes even pain in his hands 59 .

Memory and Unconscious

Along these lines we can speculate that the repressed unconscious is located in the same structures as the explicit, autobiographic memory. This is to some extent upheld by Anderson et al. 62 , who showed that purposely forgetting mental experiences, which they compare to Freudian repression, is accompanied by increased activity in the dorsolateral prefrontal areas and a parallel reduction in hippocampal activity1. This is the opposite of the de-repression in dreams (during REM sleep), when hip-pocampal activity increases and there is disactivation of the dorsolateral prefrontal cortex 64 . The organization of the unrepressed unconscious, however, with the implicit memory, would be facilitated by activation of the amygdala which, as we said before, governs emotions 19-21 this would be in the posterior associative cortical areas (temporo-parieto-occipital) of the right hemisphere, the basal ganglia, and the cerebellum. There is experimental and clinical proof of this implicit...

Dreams

Psychoanalysis before any other scientific discipline took an interest in them 48 , and have involved oneiromancers, theologians, poets, artists and philosophers of all times 47 . With the discovery of REM sleep, the doors to dreaming were opened to the neurosciences. Neurophysiological research focused particularly on identifying the mechanisms of sleep and the structures involved, the phases of sleep, and the neurophysiological characteristics defining them. It was psychophysiology that became interested in the mental states that occur during the different phases of sleep. Research in this field has led to a dichotomous model of sleep (REM and non-REM), in which the characteristics of a biological frame within which dreaming could occur were attributed only to REM sleep (Mancia, Chap. 3, this volume). On this basis, some authors 49 have denied any psychological significance to dreaming, relegating it to the sphere of biology. However, other psychophysiological research 50,51 has...

Mood Disorders

Most people know what it is like to be down in the dumps for a day or two. Some have had longer bouts of feeling sad, perhaps accompanied by insomnia or a change in appetite. By contrast, consider the following (4) Insomnia or hypersomnia excessive sleep nearly every day.

The Midbrain

The superior and posterior part of the midbrain is called the tectum. There are two enlargements on both sides of the tectum known as the colliculi. The superior colliculus controls visual reflexes such as tracking the flight of a ball, while the inferior colliculus controls auditory reflexes such as turning toward the sound of a buzzing insect. Above and between the colliculi lies the pineal gland, which contains melatonin, a hormone that greatly influences the sleep-wake cycle. Melatonin levels are high when it is dark and low when it is light. High levels of melatonin induce sleepiness, which is one reason that people sleep better when it is darker. Another structure near the colliculi is the periaqueductal gray (PAG) area of the ventricular system. Stimulation of the PAG helps to block the sensation of pain.

Others

Commercial products which deliver drugs either buccally or sublingually are available for lorazepam for anxiety and insomnia, nicotine for smoking cessation and ergotamine for migraine treatment. The buccal route has been tried with variable degrees of success for several other drugs, including metronidazole, metoclopramide, phenazocine, propranolol, timolol, salbutamol, fenoterol and insulin. Calcium channel blockers (nifedipine, verapamil) both produce effects similar to oral doses when administered sublingually or buccally71 72. The buccal route has also been explored for the delivery of peptides since the mucosa is reported to lack surface-bound peptidases, and preliminary work in dogs demonstrated significant absorption of a hydrophobic lauroyl derivative of a tripeptide35. Thyrotropin-releasing hormone, vasopressin analogues and insulin have been investigated as potential candidates for buccal and sublingual drug delivery. Oxytocin can be delivered by the buccal route, but this...

Postoperative Period

The postoperative period is a stressful one and patients often require a pharmacologic intervention for a preexisting or a new psychiatric disorder. The first issue for the psychiatrist is to determine whether symptoms represent a psychological response to stress or are secondary to medications or medical disorders. For example, the immunosuppressants have neuropsychiatric side effects associated with their use. Cyclosporine may commonly produce fine tremors, apathy, insomnia, anxiety, or agitation. Less common side effects are psychosis and delirium. Tacrolimus may produce tremulousness and sleep disturbances, especially if administered intravenously. OKT3 (a drug for acute organ rejection) may cause delirium. The use of corticosteroids may result in neuropsy-

Stages of Sleep

Sleep itself is not a unified state but consists of five distinct stages one stage of rapid eye movement (REM) sleep and four stages of nonrapid eye movement (NREM) sleep. During a typical night's sleep, one moves in and out of these stages four or five times. REM sleep is primarily associated with periods of dreaming. Sleeping subjects awakened during a period of REM sleep report having just experienced a dream about 80 percent of the time, compared with less than 10 percent when NREM sleep is interrupted. Psychologists are still unclear on exactly why humans need to sleep, but the need for periods of REM sleep might be part of the reason. When sleeping subjects are deprived of REM sleep (and their NREM sleep is undisturbed), they often show many of the symptoms of not having slept at all. Also, when later given the opportunity for uninterrupted sleep, they spend a greater percentage of time in the REM stage, as if making up for the lost REM sleep (this is referred to as the...

Hormones and Aging

Another hormone that greatly influences human behavior and development is human growth hormone (HGH). This hormone is produced by the anterior pituitary (adenohypophysis) gland under the control of the hypothalamus. HGH production peaks during adolescence, corresponding to the growth spurt. While it is produced throughout life, it declines with age in all species studied to date. In humans, HGH production tends to drop quickly beginning in the thirties so that by age sixty, HGH production is only about 25 percent of what it was earlier in life, and it continues to decline until death. The decrease in HGH production with age has been tied to thinning of skin and wrinkle formation, muscle wasting, sleep problems, cognitive and mood changes, decreased cardiac and kidney function, lessening of sexual performance, and weakening ofbones, contributing to osteoporosis. Nutritional supplements including the amino acids arginine, lysine, and glutamine are being investigated as growth hormone...

Passenger Behaviour

Incidents may lead to increased conflict between passengers and crew. The strained relationship between passengers and crew has been suggested as contributing to the increase incidence of 'air rage' (Bor, 1999). Fatigue and sleep deprivation are additional factors that may affect personal well-being and crew-passenger relations.

Treatment

Zaleplon (Sonata) is a benzodiazepine receptor agonist that is rapidly absorbed (TMAX 1 hour) and has a short elimination half-life of 1 hour. Zaleplon does not impair memory or psychomotor functioning at as early as 2 hours after administration, or on morning awakening. Zaleplon does not cause residual impairment when the drug is given in the middle of the night. It can be used at bedtime or after the patient has tried to fall asleep naturally.

Joses Story

Jose is a 36-year-old man who has struggled with bipolar disorder for more than 10 years. After graduating from high school, Jose got a job selling office supplies and attended a community college at night. He obtained a certificate in computer programming that helped him to get a better job at a computer software company. After a few years in this job, Jose realized that if he wanted to move up the career ladder he would need more education. He decided to pursue a bachelor's degree in computer science. Jose found the ordeal of dealing with admissions, registering for classes, and securing financial aid to be frustrating and annoying but no more so than the other students did. However, attending classes at night after working all day was very difficult. Jose had trouble falling asleep at night, which meant he was tired the next day. He found himself making mistakes at work and he started to feel extremely anxious. He was not aware that these were prodromal signs of serious mental...

Emergency Phase

Since most of the health requirements during the emergency phase are related to non-mental issues, the endeavour during this stage should be to make correct assessment of the situation and intervene immediately in cases of acute stress disorder due to physical or sexual trauma. Some of the common problems that require immediate intervention are fear and anxiety, sleep problems, reduced interest in work and self, and feelings of guilt, bereavement, anger. Many of these issues can be managed easily through community-based discussions of these issues and enumerating means to tackle them. Proper venting of emotions helps and a psychiatrist can help in catharsis, though it should be borne in mind that catharsis is not mandatory for all cases. The individuals should be taught to look for experiences of solidarity in their new environment. New coping skills should be taught. Mental health workers can also help by educating the community on issues of stigmatization, so that an already...

Warning

Because depression, anxiety, agitation, and insomnia often complicate clinical disorders in the elderly, a variety of drugs are administered to stimulate or tranquilize, depending on the condition. Use of drugs, such as psychotropics to treat insomnia is part of the medicinal armamentarium for old people. None of these drugs are without side effects, and the distribution, metabolism, and excretion of these drugs as of most drugs may be impaired in the elderly (64) (Chapter 22).

The Transition

The early perimenopause is characterized by slowly declining ovarian function, increasing frequency of anovulatory cycles, irregular cycle lengths, fluctuating gonadotropin levels, and an overall increase in FSH and luteinizing hormone (LH) levels. FSH levels, in particular, may fluctuate widely, changing with each cycle, largely due to a decrease in the number of ovarian follicles. With loss of ovarian follicles as well as granulosa cells, inhibin levels, which normally provide negative feedback on the pituitary FSH secretion, decrease. This results in the loss of the negative feedback loop between inhibin and FSH, leading to an elevation of FSH levels. FSH levels trend upward starting in the late reproductive years, even before changes in the menstrual cycle, once inhibin levels fall low enough to allow a rise in FSH levels. Thus, the routine measurement of serum FSH to determine if a woman is perimenopausal can be misleading. Therefore, clinical evaluation becomes important in...

The Impact of Birth

In the first half of the last century, Isakower 14 and Lewin 15 reported on hypnagogic hallucinations and dream screen phenomena. The observations were made from children in a state of just falling asleep, especially when somatically ill and with a fever, and from adult regressive patients with severe psychopathology. Isakower and Lewin concluded that the hypnagogic hallucinations and the dream screen phenomena sometimes discernible behind adult dream images both represent sensory memories stemming from infantile breastfeeding. These observations lent the first clinical support to the notion of Freud that the early experiences of care involve a principle of psychical projection, i.e. sensory memoryformation by body surface stimulation.

The ROR Family

RORP is expressed in the brain and retina and functions as a cell-type-specific activator with constitutive activity. RORP is activated by melatonin, the pineal gland hormone, and a class of thiazolidine-diones having antiarthritic activity. However, these observations are controversial because they have not been reproduced in other laboratories.

Black cohosh root

Black cohosh was one of the medicinal plants widely used by various American Indian tribes and adapted by early European settlers as a treatment for rheumatism. The use of black cohosh for menopausal symptoms became widespread during the 1800s in both America and Europe. At present, virtually all significant clinical and laboratory investigation on black cohosh have been performed by European investigators. Numerous clinical trials, including randomized controlled trials, have compared Remifemin with placebo and a variety of estrogen preparations commonly used as hormone replacement therapy for women. It is now well documented that this herbal preparation effectively reduces hot flashes in women. Remifemin also appears to be effective in countering the depression, insomnia and other psychiatric complications of female menopause. In addition, this black cohosh extract appears to prevent bone loss in animals after surgical removal of the ovaries, raising the possibility that it might...

The Role of Stress

Stress Etiology

Episodes of the illness can be triggered by various stressors, many of which may appear to be normal in their intensity, but which can lead to the catastrophic symptoms and events of mental illness. Stressors that have the potential to bring on an acute episode include personal losses, developmental transitions, and stressful life events such as marriage, graduation, and moving. Physical illness, injury, substance abuse, and other physiological factors such as sleep deprivation have also been associated with the onset of psychiatric symptoms. Even in the absence of a time-limited stressor, vulnerable individuals can succumb to ambient levels of challenge, tension, or conflict in their environment . . . (Anthony & Liberman, 1986 pp. 542-543).

Parkinsons Syndromes

REM sleep behavior disorder is seen in about 25-50 of patients with PD and in more than 50 of patients with DLB and multisystem atrophy (MSA) 83, 85,123-126 . In non-synucleinopathies (progressive supranu-clear palsy, corticobasal degeneration) RBD is conversely rare. RBD can precede the onset of these conditions by years to decades and often exhibits a fluctuating course after its onset.

Epilepsy

Patients with complex partial seizures have a higher frequency of dream recall than those with generalized seizures 139 . In a sleep laboratory study the frequency of dream recall was lower in patients with complex partial seizures after awakening from stage 2 NREM sleep than REM sleep, regardless of the side of epileptic focus, while the length and structural organization of dreams did not significantly differ in REM and NREM sleep 140 . Vercueil reported a 74-year-old woman who suffered from temporal lobe epilepsy due to a left dysplastic amygdala and who dreamed about a typical seizure accompanied by intense emotionality 141 .

The Hindbrain

Brain Reticular Formation

REM sleep is characterized by repeated horizontal eye movements, increased brain activity, and frequent dreaming. The reticular system (sometimes called the reticular activating system, or RAS) stretches from the pons through the midbrain to projections into the cerebral cortex. Activation of the reticular system, by sensory stimulation or thinking, causes increases in arousal and alertness in diverse areas of the brain. For the brain to pay attention to something, there must be activation from the reticular formation. The raphe system, like the reticular system, can increase the brain's readiness to respond to stimuli. However, unlike the reticular formation, the raphe system can decrease alertness to stimulation, decrease sensitivity to pain, and initiate sleep. Raphe system activity is modulated somewhat by an adjacent structure called the locus coeruleus. Abnormal functioning of this structure has been linked with depression and anxiety.

Types of Dreams

When people fall asleep, brain activity changes throughout the night in cycles of approximately ninety minutes. Research with the electroencepha-lograph (which records electrical activity) has demonstrated a sequence of four stages of sleep occurring in these cycles. The first two stages are called D-sleep (desynchronized EEG), which constitutes essential psychological rest consolidation of memories and processing of thoughts and emotions. The other two stages, which constitute S-sleep (synchronized EEG), are necessary for recuperation from the day's physical activity physical rest. S-sleep usually disappears during the second half of a night's sleep. Dreaming occurs in both S-sleep and D-sleep but is much more likely to occur in D-sleep. A further distinction in the physiology of sleep is pertinent to the type of dreaming activity likely to occur. During stage one sleep there are often accompanying rapid eye movements (REM) that are not found in other stages of sleep. Researchers...

Physiology of Sleep

Sleep can be divided into five stages stages 1 to 4 and rapid eye movement (REM) sleep. Stage 1 is a transitional phase between waking and sleeping and this normally lasts around 10 min as an individual falls asleep. Sleep then becomes deeper, with 15 min in stage 2 sleep and a further 15 min in stage 3 sleep before moving into stage 4. Approximately 90 min after sleep onset, REM sleep will occur. The cycle of REM sleep and stages 1-4 sleep repeats during the course of the night in 90 min cycles, each succeeding cycle containing greater amounts of REM sleep. An 8 h sleep period will typically contain about 4-5 bouts of REM sleep. Most stage 4 sleep happens early in the night. It is thought that stages 1-4 sleep is related to body restoration, whereas REM sleep may be related to strengthening and organising memory. When learning new tasks, an increased proportion of REM sleep is seen.

Dream Content

Three human characteristics that influence dreams are age, gender, and personality. It has been found that children are more likely to report dreams (probably because they experience more REM sleep), and their dreams are reported to have more emotional content, particularly nightmarish themes. Environmental factors occurring before and during sleep can shape the content of dreams. What people experience prior to falling asleep can show up in dreams in blatant, subtle, or symbolic forms. People watching movies that evoke strong emotions tend to have highly emotional dreams. In fact, the greater the emotionality of a daily event, the greater the probability that the event will occur in a dream during the subsequent sleep period. Those who are wrestling mentally with a problem often dream about that problem. Some have even reported that the solutions to their problems occurred during the course of dreaming. The German physiologist Otto Loewi's Nobel Prize-winning research with a frog's...

Antianxiety Drugs

Barbiturates were introduced in Germany in 1862 and were widely used for treatment of anxiety and sleep problems until the 1960's. Barbiturates are still available today, including pentobarbital, secobarbital, amobarbital, and phenobarbital. Their major adverse effect is respiratory depression, particularly when used in combination with alcohol, another central nervous system depressant. With the advent of the safer benzodiazepines, use of the barbiturates has declined steadily. Benzodiazepines are used for two major problems anxiety and insomnia. Anxiety disorders appropriate for this kind of treatment include generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, phobic disorder, and dissociative disorder. The benzodiazepines commonly used for anxiety include alprazolam, chlordiazepoxide, clonazepam, cloraze-pate, diazepam, lorazepam, and oxazepam. For most of these disorders, however, behavioral, cognitive, group, and social therapy, or one of these therapies...

Sleep mentation

To understand dreaming, it must be distinguished from related phenomena. If the person is fully awake and perceives episodes departing from natural reality, the person is said to have experienced a vision. Experiencing an unintended perceptual distortion is more properly called a hallucination. A daydream is a purposeful distortion of reality. In the twilight realm of dreamlike imagery occurringjust before falling asleep or just before becom

Psychostimulants

Attention-deficit hyperactivity disorder (ADHD) is found in both children and adults. Children with ADHD have difficulties at school because of impulsivity and inattention. The underlying cause of ADHD is extremely complex, and the ways in which drugs used to treat it work are equally complex. The most successful treatments are with drugs that actually stimulate the central nervous system. Drug therapy is most effective when combined with behavioral treatments. The most commonly used psychostimulants are methylphenidate and pemoline, but amphetamines are sometimes used as well. Formerly, depressed patients were treated with amphetamines and similar compounds occasionally this use is still found. These stimulant drugs do improve school performance however, they may cause growth retardation in both height and weight. They may also cause insomnia and nervousness. Importantly, these drugs may be abused, leading ultimately to addiction, paranoia, and severe depression during withdrawal.

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