Monday, December 7, 2009

Effects of Obstructive Sleep Apnoea

Obstructive Sleep Apnoea is a significant cause of Excessive Daytime Sleepiness.

The following are effects of OSA: Metabolic Effects
Sympathetic overload; Supra Renal effects; Nocturia; Frontal Symptoms

Friday, October 2, 2009

Stroke
SDB and Sleep-wake disorders have Detrimental
? Psychiatric function
? neurological function
o Increased stroke recurrence
o Increased Long term mobidity post stroke
Definition: Stroke is a focal neurological deficit of acute onset and vascular origin
2 to 18% p.a.
Types:
? TIA ? neurological deficit resolves within 24 hours. 20% of acute CVA
? Intracerebral hemorrhage 15%
?
Ischemic Stroke 65%


Risk factors:
1. Arterial fibrillation
2. Age >65
3. Arterial HT
4. Heart Disease
5. Asymptomatic Carotid stenosis
6. History of TIA
7. Alcohol and Tobacco use
8. DM
9. Hypercholesterolemia
10. Sleep Disordered Breathing (Toast Trial 2004 ? 10172 patients

Management of Acute Stroke
1. Stroke unit
2. Fibrinolytic agents in the 1st 3-6 hours after ischemic stroke
3. Neuroprotective agents
4. Endvascular stenting / balloon dilatation
5. Surgery for haemorrhage
Primary Prevention: Manage risk factors, anticoagulation for AF, endarterectomy for carotid stenosis >70%. Aspirin and anti HT treatment


Chynes Stokes breathing follow stroke
Hypersomnia follows stroke (1830) ? Thelamic and mesencephalic stroke (midbran)


SDB
Epidemiology:
? 60 to 70% of all stroke patients exhibit SDB ? AHI>10 (Neurology 1996)
? SDB precedes stroke
? Prestroke cerebrovascular disease and white matter disease on CT were linked with more severe poststroke SDB
Pathogenesis:
? SDB as a consequence of stroke
? OSA is aggravated by stroke
? OSA appears denovo after stroke
? Disturbed coordination of upper airways, intercostals muscles, diaphragm due to brainstem or hemispheric lesions
? Rostrolateral medullary lesions
? CSB ? Chyne

Thursday, October 1, 2009

Insomnia

[Enter Post Title Here]


Insomnia
? Who:
o 30 to 50% of the population (8-18% DSM IV ? 4-11%)
o 9-15% report adverse daytime consequences
? Risk:
o Increasing age, female sex, psychiatric and medical disorders, genetic basis
o Non-restorative sleep
? PSG Definition: WASO or SL is greater than 31 minutes; 3x per week after 6 months
? Morbidity:
1. pronounced negative impact on daytime functioning and general well being
2. increased daytime fatigue,
3. poorer mood, more anxiety or stress,
4. less vigour,
5. greater coping difficulties,
6. less ability to complete tasks,
7. greater impairment of family and social functioning
? QOL: health related QOL score is similar to congestive cardiac failure and depression
o Risk for depression and cognitive decline over time (1,5 to 3 years)
? Diff diagnosis:
o Comorbidity with psychiatric disorders
? 50% have a current or past psychiatric disorder
? Insomnia precedes
? mood disorder 41% and
? anxiety disorder 18%
? primary sleep pathologies ? PLMS, RLS, SDB (also exclude infrequent parasomnias)
? Chronic pain
? Assessment:
o Rheumatologic (arthritis and fibromyalgia)
o Pulmonary ? Asthma and COPD
o Cardiac
o GIT ? reflux and peptic ulcer disease
o Neurologic ? seizure disorders
o Endocrine ? hyperthyroidism
o Menopausal status / prostate disease
? Lab
o PSA; TFT; Ferritin levels for PLMS
? Psychiatric history
o Anxiety and depression
? Medication use:
o Steriods, stimulents, anti-depressants and anti-hypertensives
? Self reporting questionnaire
? Psychological testing: Becks Depression inventory ? 1979
? Sleep Logs
? PSG ? unless clinically indicated
? Actigraphy ? with sleep log for a minimum of 3 nights (SPC ? AASM ? 2003)
Eitiology and pathophysiology of Insomnia:
3 models:
1. Physiological
2. Cognitive
3. Behavioural

1. Physiological
? HR, RR, Temp, skin conductance/resistance, peripheral blood flow or vasoconstriction
? Whole body metabolic rate ? VO2
? Heart rate variability = increase HR, increased sympathetic activity, decrease parasympathetic activity
? Caffine induced hyperarousal and insomnia
? Neuro-endocrine measures = HPA hypothalamus pituitary adrenal axis
? HPA axis:
? Urine
? u-free cortisol (proportionate to Total Wake Time)
? catacholamines (DHPG)
? DOPAC proportionate to S1 % and WASO
? Growth Hormone
? Plasma ? Increased ACTH and Cortisol levels over 24 hours


2. Cognative Model of arousal
? Rumination and worry
? predisposing personality trait;
? precipitated by life stressors -;
? perpetuating factors ? worry and remuneration about inability to sleep Maladaptation.
? Selective attention: Sleep related threats in the internal and external environment, increasing cognitive and physiological arousals
? Distorted Perception of Daytime Deficits: increased attention on the effects of poor sleep, fatigue, sleepiness and performance deficits
? Increased safety behavious ie work or tasks that are mentally or physically taxing

3. Behavioural model
? Sleep hygiene model
? Stimulus control Model
? Spielman model:
? Inhibitor to wakefulness
Behavioural therapy for primary insomnia
CBT ?
? sleep restriction ? adjust by 15 to 30 minutes per week to SE>80%.
? Stimulus control therapy
? Go to bed only when sleepy ? not just fatigued, but sleepy
? Get out of bed when unable to sleep (eg 20 minutes) go to another room and return only when sleep is imminent
? Curtail all sleep incompatible activities ? overt and covert-, no eating, TV watching, radio listening, planning or problem solving in bed
? Arise at a regular time every morning regardless of the amount of sleep the night before
? Avoid daytime napping
? Relaxation training
? Cognitive therapies
Secondary insomnia
? Latelife insomnia
? Hypnotic insomnia HDI
? Secondary insomnia SI
Pharmacological therapy:
Benzodiazepine receptor agonists BzRA works on the GABA1 ? opens the Chloride channels and facilitates GABA inhibition.
? WHY GABA1: Sedation, amnesia and some anticonvulsive - no anxilytic or myorelexation
? SAFETY: and improved daytime functioning
? SE:
? Residual effects
? Amnesic effects ? antrograde amnesia
? Discontinuation Effects
? Dependence Liability is low
? Falls cognitive effects and other considerations for older adults

Sedative Antidepressants
? Trazidone 100mg MOLIPAXIN? 100 mg - a triazolopyridine antidepressant unrelated to any of the aforementioned antidepressants. It affects the serotonin neurotransmitter system working on pre- and postsynaptic neurones (SSRI?s exert their effects on presynaptic neurones only). The main side effect is sedation. Priapism (sustained penile erection) has been reported and may result in irreversible impotence, but this is not a common side effect.
? Amitriptaline TREPILINE?-10 TABLETS

? Mitazepine Remeron - belongs to a new class of antidepressant called NaSSA?s (noradrenergic and specific serotonergic antidepressants) which are particularly useful if anxiety and insomnia are problems. Side effects include sedation and weight gain.
? SE:
? Dry mouth, headache, dizziness, and nausea
? Orthostatic hypotension, weakness and light headedness
? Abusive potential with lower margin of safety than BzRA

BzRA = caution with
? Sleep Apnoea
? Concomitant alcohol use
Pregnancy

Insomnia

Insomnia
? Who:
o 30 to 50% of the population (8-18% DSM IV ? 4-11%)
o 9-15% report adverse daytime consequences
? Risk:
o Increasing age, female sex, psychiatric and medical disorders, genetic basis
o Non-restorative sleep
? PSG Definition: WASO or SL is greater than 31 minutes; 3x per week after 6 months
? Morbidity:
1. pronounced negative impact on daytime functioning and general well being
2. increased daytime fatigue,
3. poorer mood, more anxiety or stress,
4. less vigour,
5. greater coping difficulties,
6. less ability to complete tasks,
7. greater impairment of family and social functioning
? QOL: health related QOL score is similar to congestive cardiac failure and depression
o Risk for depression and cognitive decline over time (1,5 to 3 years)
? Diff diagnosis:
o Comorbidity with psychiatric disorders
? 50% have a current or past psychiatric disorder
? Insomnia precedes
? mood disorder 41% and
? anxiety disorder 18%
? primary sleep pathologies ? PLMS, RLS, SDB (also exclude infrequent parasomnias)
? Chronic pain
? Assessment:
o Rheumatologic (arthritis and fibromyalgia)
o Pulmonary ? Asthma and COPD
o Cardiac
o GIT ? reflux and peptic ulcer disease
o Neurologic ? seizure disorders
o Endocrine ? hyperthyroidism
o Menopausal status / prostate disease
? Lab
o PSA; TFT; Ferritin levels for PLMS
? Psychiatric history
o Anxiety and depression
? Medication use:
o Steriods, stimulents, anti-depressants and anti-hypertensives
? Self reporting questionnaire
? Psychological testing: Becks Depression inventory ? 1979
? Sleep Logs
? PSG ? unless clinically indicated
? Actigraphy ? with sleep log for a minimum of 3 nights (SPC ? AASM ? 2003)
Eitiology and pathophysiology of Insomnia:
3 models:
1. Physiological
2. Cognitive
3. Behavioural

1. Physiological
? HR, RR, Temp, skin conductance/resistance, peripheral blood flow or vasoconstriction
? Whole body metabolic rate ? VO2
? Heart rate variability = increase HR, increased sympathetic activity, decrease parasympathetic activity
? Caffine induced hyperarousal and insomnia
? Neuro-endocrine measures = HPA hypothalamus pituitary adrenal axis
? HPA axis:
? Urine
? u-free cortisol (proportionate to Total Wake Time)
? catacholamines (DHPG)
? DOPAC proportionate to S1 % and WASO
? Growth Hormone
? Plasma ? Increased ACTH and Cortisol levels over 24 hours


2. Cognative Model of arousal
? Rumination and worry
? predisposing personality trait;
? precipitated by life stressors -;
? perpetuating factors ? worry and remuneration about inability to sleep Maladaptation.
? Selective attention: Sleep related threats in the internal and external environment, increasing cognitive and physiological arousals
? Distorted Perception of Daytime Deficits: increased attention on the effects of poor sleep, fatigue, sleepiness and performance deficits
? Increased safety behavious ie work or tasks that are mentally or physically taxing

3. Behavioural model
? Sleep hygiene model
? Stimulus control Model
? Spielman model:
? Inhibitor to wakefulness
Behavioural therapy for primary insomnia
CBT ?
? sleep restriction ? adjust by 15 to 30 minutes per week to SE>80%.
? Stimulus control therapy
? Go to bed only when sleepy ? not just fatigued, but sleepy
? Get out of bed when unable to sleep (eg 20 minutes) go to another room and return only when sleep is imminent
? Curtail all sleep incompatible activities ? overt and covert-, no eating, TV watching, radio listening, planning or problem solving in bed
? Arise at a regular time every morning regardless of the amount of sleep the night before
? Avoid daytime napping
? Relaxation training
? Cognitive therapies
Secondary insomnia
? Latelife insomnia
? Hypnotic insomnia HDI
? Secondary insomnia SI
Pharmacological therapy:
Benzodiazepine receptor agonists BzRA works on the GABA1 ? opens the Chloride channels and facilitates GABA inhibition.
? WHY GABA1: Sedation, amnesia and some anticonvulsive - no anxilytic or myorelexation
? SAFETY: and improved daytime functioning
? SE:
? Residual effects
? Amnesic effects ? antrograde amnesia
? Discontinuation Effects
? Dependence Liability is low
? Falls cognitive effects and other considerations for older adults

Sedative Antidepressants
? Trazidone 100mg MOLIPAXIN? 100 mg - a triazolopyridine antidepressant unrelated to any of the aforementioned antidepressants. It affects the serotonin neurotransmitter system working on pre- and postsynaptic neurones (SSRI?s exert their effects on presynaptic neurones only). The main side effect is sedation. Priapism (sustained penile erection) has been reported and may result in irreversible impotence, but this is not a common side effect.
? Amitriptaline TREPILINE?-10 TABLETS

? Mitazepine Remeron - belongs to a new class of antidepressant called NaSSA?s (noradrenergic and specific serotonergic antidepressants) which are particularly useful if anxiety and insomnia are problems. Side effects include sedation and weight gain.
? SE:
? Dry mouth, headache, dizziness, and nausea
? Othostatic hypotention

Tuesday, August 25, 2009

Melatonin, Dr Yacoob Omar Carrim

Melatonin - has rapid, transient, mild sleep inducing effects and lowers alertness and body temperature during the 3-4 hours after low dose
Eastward travel - early evening (6 pm) treatment before departure for 3 to 4 days and melatonin at bedtime.
Westward travel - melatonin for 4 days at bedtime (11pm or later) - dont take melatonin before you fly.

Shiftworkers - early morning melatonin treatment improves daytime duration and quality if sleep and nighttime alertness. Maybe used to aid afternoon sleep.

Other: Timed exercise, Vit B12 - sensitises the circadian system to light induced phase shifts.

Shift work - basic principles

Sleep - Jet Lag - Dr Yacoob Omar Carrim

Sleep - Jet Lag and other circadian rhytm disorders

Other Circadian disorders
  • Shift work sleep disorder
  • circadian sleep-wake disorder of blindness
Symptoms
  • Disrupted female mestruation cycle - female flight attendents
  • Meals eaten out of phase - result in inappropriate pancreatic and metabolic responses and may be long term risk factors for heart disease
  • Life span can be shorterned by phase shifting
SWSD - shiftworkers - sleep problems, GIT problems, metabolic syndrome, heart disease and cancer

Suprachiasmic nucleus of the hypothalamus
  • Central pacemaker
Melatonin, light, body temperature

Management:
Sleep hygine
  • reduce noise, unwanted stimuli, earplugs, eye patches
  • avoid alcohol and caffine
  • jet leg diet - carbs at night for seratonin synthasis and protien in the day - thyrosine, catacholamine production
  • Naps
  • Hypnotic agents - short acting "Z" drugs
  • Light - Lab studies - 460 to 465 nm (Blue); field studies
Melatonin: produced at night for the duration of the night. ? effect on reproduction

Dr Yacoob Omar Carrim
zasleep@gmail.com




Circadian Factors - Dr Yacoob Carrim

Enviromental zertgeber effects of:
  • bright light 3000 Lux (suppresses melatonin)
  • Bedroom light proofing
  • Welders sunglasses on commute home from night work
Enhance circadian adjustment - Rx Melatonin
  • ? effect on enhancing daytime sleep
Humans are diurnal - work in the day and sleep at night
Circadian alignment affects mood, well being and performance efficiency
Circadian reallignment leads to desynchronosis
  • Malaise, gastrointestinal dysfunction, performance decrements
Sleep Factors

  • Shift workers get 10 hours less sleep per week
  • - less S2 and REM. SWS is consistant. reduced sleep latency
  • Drive home from night shift - most dangerous activity
  • Domestic and social factors
  • - childcare
  • - hosehold maintenance functions
  • - risk of divorce 57%
  • -- sexual partner, social companion, protector and caregiver roles are compromised
  • Social isolation from daywork friends, religious and community organisations
Dr Yacoob Omar Carrim
zasleep@gmail.com

Circadian Factors

Enviromental zertgeber effects of:
  • bright light 3000 Lux (suppresses melatonin)
  • Bedroom

Friday, August 14, 2009

10 STEPS TO PEACEFUL BEDTIME By Claire Marketos

10 STEPS TO PEACEFUL BEDTIME
By Claire Marketos

“Sweet dreams, my darling, sleep well, is every parent’s wish for their child. Yet, bedtime can sometimes be a nightmare with youngsters throwing tantrums. If sleep is vital for all of us, why are there so many children who don’t want to go to bed and struggle to fall asleep?

Physical, emotional, and environmental factors all play a part in how easily your child goes to bed and how well she sleeps. You know your child better than anyone else and so it is important to tune into her needs not only at bedtime but during the day as well. Here are some simple guidelines based on what children need to help you make bedtime a pleasure.

DAY TIME AND NIGHT-TIME
In order for your child to develop good sleeping habits, “You must follow the biological forces of sleep. Sleep should happen during night- time hours (the circadian rhythm) and children need to be awake for long enough to be sleepy (homeostatic force),” says Dr. Alison Bentley of The Wits Dial-a- Bed Research Laboratory.

 “It is not fair to insist on a specific bedtime unless your child has been awake long enough for her to get sleepy, emphasizes Dr. Bentley, “You have to take daytime sleep into account.” If your child needs a nap, it should happen early in the afternoon. Toddlers, who fall asleep in the car after 3pm in the afternoon, will not be able to sleep easily at night.

ROUTINE 
“The key to getting your child to sleep is consistency, consistency, consistency,” stresses Dr.Irshaad Ebrahim of The Constantia Sleep Centre in Cape Town. “Children of all ages respond to rules and routine, as this provides them with an element of predictability in their life and hence security, and they need this especially when they are tired,” explains Ebrahim. “Bedtime should happen in the same way, at the same time every night, as long as day time naps finish early enough,” Bentley points out.

Children can go to bed later on the weekend and during the holidays, once a bedtime routine has been established, and “both parents clearly and consistently explain that this is a variation from the routine,” stresses Ebrahim. The bedtime ritual you use may vary to the one outlined below. Nevertheless, it should get them to bed calmly and quickly, so that they can sleep for at least 8-12 hours a night.  

When the child begins slowing down and is tired, it is time to start the bedtime routine. Don’t wait too long, otherwise she may get a second wind and then it becomes difficult to get her to sleep. Announce in a firm matter of fact tone, that it’s bedtime. “Time to say goodnight to everyone, brush your teeth, and go to the toilet.” This should take 5-10 minutes. You can make bedtime more fun by telling your child that her favourite teddy is waiting for them to cuddle, or by describing how snug her bed is going to be. A positive tone from you will reassure her that bedtime can be enjoyable.

For the next 10 minutes you can read a story, and your child can have a drink of warm milk. Give her a favourite soft toy or blanket. The bed and its surroundings should be free of any stimulating toys or pictures. Then, sit with your little one and gently stroke her if necessary to help her relax. Do not engage in conversation, say, “We’ll chat tomorrow.” If she keeps chatting say, “Go to sleep now, I’m going to pack things away in the kitchen.” “Make a slight noise,” Ebrahim advises, “to let your child know that you are still there.” Leaving a bathroom light on also makes children feel safe.

If your child comes out of her bedroom, calmly return her to bed. Be firm and reassuring but don’t resort to hitting or shouting, as “this can arouse the child and make them excitable and alert – the exact opposite of what you are trying to achieve,” explains Ebrahim. Sit with her until she is asleep. If you are implementing this routine for the first time, you may have to return your child to bed several times in the first week. Be tenacious, especially if you have to undo bad habits.

REASON
“Why do I have to go to bed now?”
Giving children an explanation of why they need to go to bed helps them to understand the importance of caring for themselves and being healthy. Tell your child: “You are tired. Your body needs to rest so you can grow big and strong, and so you can have lots of energy to play with your friends tomorrow.” Even very young children will listen to your explanation although they may not understand everything you are saying.

Acknowledge their feelings of not wanting to go to bed. “I know you don’t want to go to bed. I know you want to play with your toys. Tomorrow you will have play time again. It is bed time now.” Doing this initially, will relax and reassure your child, and you won’t have to say it every night.

PEACE AND QUIET

In order to sleep well, children need a peaceful environment with positive, calm parents who are in control. Stick to the bedtime routine, and support the parent, who is carrying it out. If you have ideas to make bedtime easier, discuss them with your partner once the children are sleeping. Be creative, and devise a plan together that makes bedtime a joy, rather than a chore.

Stop all stimulating activity including TV, an hour before bedtime, to help your kids calm down. They cannot sleep if they are not calm.

PHYSICAL NEEDS
In order to sleep well, children’s physical needs have to be met. A warm bath and a healthy, sit down dinner, (not in front of the TV), should take place in the hour before bedtime. Avoid sugary and salty foods, or foods which may have colourants and caffeine in them. After dinner, chat, read, or listen to classical music. Rough-and-tumble games with Mom or Dad should take place earlier in the evening.

On the other hand, physical activity during the day is imperative for good rest at night. If your children are sitting in front of the TV all afternoon, they will have more problems falling asleep than if they’ve had a fun day outdoors.
Always check for symptoms of illness which may be preventing your child from resting peacefully. If your child has persistent nightmares and anxiety at bedtime, consult your family doctor, or a child psychologist as there may be underlying issues of which you are not aware.

SECURITY AND SAFETY
You play a significant role in making your child feel safe and secure, which is important if she is to rest peacefully. Be aware of what you say in front of your children, especially when talking about violence. Keep arguments and fights with your partner private where the children can’t hear you. Kids usually blame themselves if there is conflict in the home and may spend many hours at night worrying about how to fix the problem, rather than sleeping.
Talk to your children about concerns they may have, such as the birth of a new sibling, the beginning of a new school year, disputes with friends and exams. Sometimes you may have to initiate chats and bring up topics, even if your child doesn’t tell you what’s bothering her. These conversations should always make the child feel secure. It is counterproductive to create more issues for them to worry about at bedtime.
Take your child’s fears of monsters hiding in her room seriously. Pretend to fight them off “or give them a torch to make them feel a little in control,” recommends Dr. Bentley.

Children should feel comfortable going to bed, so let them help you make their room and bed an inviting sanctuary.

YOUR FEELINGS IMPACT YOUR CHILD’S ABILITY TO SLEEP
“Children are extremely sensitive to their parent’s feelings. They will know from the way you hug them, look at them, and the tone of your voice, how you are feeling.” Ebrahim explains. “If they sense you are anxious, they may cry at bedtime for reassurance. If you allow them to stay up when they cry, they could interpret you actions as caring for them, or that they are not safe in bed. It depends slightly on the emotional situation in which this happens as to how various messages will be interpreted. Not all of the signals from your children relate to how your child is feeling, but how they think you might be feeling as well,”clarifies Ebrahim. 

Give yourself enough time to de-stress before bedtime, and to sit with your child in their bedroom.

MOTIVATION
Having a goal to work towards gives children a sense of accomplishment when they achieve it and it also enhances their self esteem. Find positive ways to motivate your children. Having incentives such as a sticker chart to get them started may help. However, they should learn that sometimes we do things because it is the right thing to do and because it’s good for us. Never reward youngsters with food.

If a child throws a tantrum and resists having to go to bed, understand that she is trying to express her frustration and anger at having to make the change from playtime to bedtime. Acknowledge her feelings with the same exuberance she is expressing them- “You’re cross! You don’t want to go to bed. I understand. Tomorrow you can play again,” while calmly continuing with the bedtime routine.
Praise your children by telling them how proud you are of them when they are successful at bedtime.

LOVE AND COMPASSION
Children need to feel love and acceptance to sleep calmly. Show them patience and compassion when they are tired, and especially if they have been through a life changing experience, such as the birth of a sibling, divorce or death.

During these times, children may need more assurance and attention from you during the day, to help them feel secure at night. In severe cases they may also need play therapy from a professional child psychologist, especially if anxiety persists.  

A child often regresses during difficult times, especially if there is a newborn in the parent’s room, and then it may be necessary for a mattress to be placed in the parent’s room for your older child to sleep on. Give her what she needs and then after several weeks, slowly help her to make the transition back to her own bedroom.

Attention from you is essential for peaceful sleep. If you are away from your child all day, she will want to attach to you from the moment she sees you, and therefore may act out at bedtime to be close to you.
Feelings of guilt should not prevent you from being firm and doing what is best for your child.

FOLLOW YOUR INSTINCTS
Most children who wake at night can be soothed back to sleep quickly. However, Dr Bentley explains “Children who have a very disruptive sleep disorder can wake up to seven times a night and demand either milk or rocking to go back to sleep. This is usually not due to any physical need but rather a behavioural disorder for which you may need professional help.” (See essential signs of seep disorders.)

ESSENTIAL SIGNS OF SLEEP DISORDERS IN CHILDREN:
1. Snoring and associated hyperactivity or sleepiness in the daytime
2. Interrupted breathing while asleep
3. Excessive limb movements in sleep
4. Sleepwalking
5. Sleep/night terrors (not the same as nightmares)
6. Inability to fall asleep, despite adequate parenting

If you feel your child may have a sleep disorder, talk to your general practitioner or paediatrician. 

Chat to your partner and come up with a plan for the middle of the night you both agree on. If junior can climb into your bed without waking you or your partner, it will provide an excellent opportunity for you to all bond and cuddle, especially if you are separated during the day. If you are unable to sleep with junior in your bed, a mattress next to it may be an alternative, or follow the same routine you used at bedtime. Ensure your little one’s room is warm enough. You may want to use a sleeping bag if she kicks her blankets off. Letting her have one of your T-shirts that smells like you to cuddle with can provide solace.

If she has a nightmare or wakes up afraid during the night, gently reassure her that she is safe and that you are there for her. If the nightmares continue speak to your family doctor or a child psychologist. When you say goodnight to your child, remember to always tell her you love her and say: “With a butterfly kiss and a ladybug hug, sleep tight little one like a bug in a rug." A good night to you all.

Useful Contacts: Dr Yacoob Omar Carrim http://zasleep.blogspot.com

Tuesday, July 14, 2009

Smells Can Influence Dreams

Smells Can Influence Dreams, Scientists Say

Scientists discovered that specific aromas can "sweeten" your dreams. Boris Stuck of University Hospital Mannheim, Germany, tried to discover whether smells are able to influence what a person dreams about.
The scientist analyzed the effect of aromas on 15 sleeping volunteers who were exposed to chemicals that had the smell of either rotten eggs or roses. Mr Stuck said that the majority of everyday smells feature two components: the real smell and an element that can irritate your nose.
"By exposing the patients to chemicals chosen to only incorporate the smelly component, we were able to stimulate them with really high doses of the smell without them waking up," he said.
Together with his colleagues Mr Stuck waited until the participants entered the REM phase of sleep, which represents a stage at which most dreams occur. Then the team exposed the subjects to a high dose of malodorous air for ten seconds and one minute later they woke the volunteers up. After the experiment the subjects were asked about the dreams they had and how a dream made on feel.
Those who were exposed to the rose smell reported having a positive dream experience. A negative effect was reported from people who were exposed to rotten eggs. According to scientists, smells are able to influence the emotional coloration of the dream.
Now scientists look forward to observe the effect of smells on people suffering from nightmares.
Irshaad Ebrahim of The London Sleep Centre said: "The relationship between external stimuli and dreaming is something we are all at some level aware of. This initial research is a step in the direction towards clarifying these questions and may well lead to therapeutic benefits."
The scientific work of Mr Stuck was presented at the annual meeting of American Academy of Otolaryngology in Chicago.
Source: NewScientist

Chris and Charlotte Martins discover the costs of sleep deprivation during residential conferences, and find that the industry is awakening to the problem

Why sleep-friendly meetings matter

Chris and Charlotte Martins discover the costs of sleep deprivation during
residential conferences, and find that the industry is awakening to the problem

A Daily Telegraph report on January 3 notes that better sleep can ‘wake up your
mind and increase your brain power’, and that sleep deprivation will ‘affect
decision-making and the ability to absorb and adapt to new information.’
Professor Jim Horne of the Sleep Research Centre at Loughborough University
comments that tired people ‘become more rigid in their thoughts, tend to
express themselves in clichés, and become more prone to making errors’.
So sleep, or rather the lack of it, is now on everyone’s agenda. Media
commentaries reveal that an extra hour’s sleep boosts alertness by 25% the
following day … that 1 in 5 of us suffers from insufficient sleep …. and that
almost half of British personnel now fret at night about either work or domestic
issues.
It seems that the meetings industry is already aware of the issue. An email poll
of conference agencies, undertaken specifically for this column by Great
Potential, asked respondents to rank the importance of good sleep as one of
half-a-dozen possible variables contributing to delegate productivity. In a
significant majority of cases (71%), it was placed as first or second choice and
well above the hierarchy of other considerations that included air-conditioned
meetings suites, the availability of leisure facilities, and excellent dining.
pet hates
Contributing to the survey, Peter Rand, chairman of RAND, focused on those pet
hates that he experiences in ‘so many noisy hotels’. His list includes banging fire
doors, creaking pipes, waste water from above flowing through pipes located
just behind the bedhead, bathroom fans that keep humming long after the lights
are turned off, noisy mini-bars, outside generators, early morning delivery trucks,
and assorted other mechanical nasties. Oh, he says, and ‘don’t forget the
rumble of underground trains, lorries graunching away from traffic lights just
outside your bedroom window, and the alarm clock set by a previous guest at an
ungodly hour, and which housekeeping staff had forgotten to re-set’. So
concerned about noise is Robin Aubrey-Edwards (of Amadeus event
management) that he will even accept a downgraded type of bedroom if this
decision will guarantee quietness. Anticipating the problem for her clients, the
reaction of Dena Jones (Goldmark Events) is to raise the issue of noise levels in
advance with the hotel general manager, rather than to hope that delegates will
merely ‘put up and shut up’ the following morning. Many others confirm such
sensitivities: Fiona Sidway (Exclusive Events) describes hotel noise levels as ‘a
nightmare issue’, whilst Joy Montmorency of ACE, who frequently overhears loud
conversations and TVs from neighbouring bedrooms, considers such intrusions as
‘hell’. This, she says, applies even more so for the organiser who has to be alert
throughout, whereas delegates can get away with feeling and looking jaded next
day.
Balancing such critical comments are the views of, for example, Chris Wilson
(Tailor-made Conferences) who blames delegates for the self-inflicted overindulgence
that frequently spoils their sleep, and on the same lines Susan Spibey
(SJS Business Services) believes that the sensible answer is to maintain home
routines whilst travelling. Sarah Byrne (Mosaic Events) points out that some
(herself included) can sleep through anything, but admits that noisy hotels must
be terrible for light sleepers.
Specialists
Specialists confirm that poor sleep will impair executive performance. Dr.
Irshaad Ebrahim, medical director at the London Sleep Centre, recognises
symptoms that include inattentiveness and perceived memory problems, with the
result that delegates ‘function well below peak performance’. He cites stress
associated with travelling, and the ‘first night effect’ of being placed in unfamiliar
surroundings, as further causes of the problem. There is also the ‘on-call effect’,
a syndrome in which busy people sleep badly because they are always half
expecting the ‘phone to ring from head office. Sister Carol Hoy at the Edinburgh
Sleep Centre underlines the influence of these psychological factors – being away
from home, coupled with a change of habits – and suggests that conference
organisers should ‘deliberately choose those hotels that work most seriously to
improve the sleep experience of their guests’.
It quickly becomes apparent that the global accommodation brands are indeed
trying harder. Holiday Inn offer a five-category ‘pillow menu’ that seeks to
match what guests are most used to, from synthetic types (firm, medium, soft)
to those that are stuffed naturally with down and feathers. Speaking from their
York hotel, housekeeping manager George Mathai reports that several guests a
night now opt for one of these pillow variants. A visionary Holiday Inn ‘concept
room’ for the future predicts seemingly sci-fi ideas to encourage relaxation that
include the diffusion of soporific aromas, the calming sounds of nature, twinkling
ceiling lights that evoke the universe, and wall-sized plasma screens that conjure
lifelike scenes of waves splashing onto an empty beach.
‘Heavenly Beds’
Similarly, Marriott Hotels are beginning to introduce a ‘SleepWell’ package (for
example, at their India Quay property in London) that features rest-enhancing
suggestions like allergy-free pillows and sheets made of Egyptian cotton. From
Starwood Hotels and Resorts comes such branded products as Westin’s
‘Heavenly Beds’ and Sheraton’s ‘Sweet Sleepers’. Featured in the latter are a
custom-designed top mattress intended to promote good sleeping posture, a
cosier fleece blanket, a plumper duvet, and a choice of cushier pillows.
(Surprise, surprise, but this new Starwood focus on sleeping arose because the
company’s then CEO discovered how difficult it was to sleep in hotels!) Also on
the way is Hilton’s ‘Sweet Dreams’ product (to include 250-thread-count sheets),
and the ‘Grand Bed’ thicker mattress concept at Hyatt Regency and Grand Hyatt
Hotels. Another version is ‘My Bed’ from Sofitel. In all such examples, and to
their credit, the hotel groups have invested fortunes in testing beds, covers and
other accoutrements, and each is convinced that a good night’s sleep for a
guest, possibly better than they get at home, is a guaranteed builder of
customer loyalty.
practical responses
Not every conference organiser, however, is going to select an internationallyacclaimed
hotel, and besides, the comfort of the bed is only part of the issue.
Instead, what practical responses are open to them to consider?
A list of sleep tips might be presented to each delegate, and for example, among
those recommended by the London Sleep Centre are taking a late bath, avoiding
stimulants (so forget the Scotch!), sticking to your normal time of turning-in and
applying relaxing therapies such as yoga or deep-breathing. Face-masks and
earplugs have a role, as can a late-night snack featuring cheese and milk that is
recommended by Hilton because it releases the amino acid tryptophan that
promotes sleepiness.
Encouraging delegates to exercise (though not too close to bed-time) is also a
proven aid to better sleep. Event planners can also advise chefs to prepare a
more sleep-friendly evening meal – more carbohydrates, less fats – and, with
difficulty, encourage bartenders to limit each person’s intake of alcohol.
wimpish disorder
It would also make sense to ‘out’ the poor sleepers (otherwise perhaps too
embarrassed to admit to such a wimpish and ‘neurotic’ disorder), in order to
tackle delegate sleep deprivation more strategically. Is it so daft, in the context
of a conference costing £10-£20,000 say, to allow for short after-lunch snoozes?
Is it really out of the question to identify the characteristic circadian body clock
of each and every delegate, or in other words, those (probably) inherited biorhythms
that render us either early morning types, or ‘larks’, as opposed to those
through-the-nighters, otherwise known as ‘owls? Indeed, dare an organiser risk
starting a conference with a keynote speech at 9am when half the audience
could in theory still be half-asleep? Similarly, given the likelihood of the troubled
‘first night effect’ that is experienced in a strange bedroom, should anything too
important be discussed or decided upon on the first morning following arrival at
the hotel? Such arguments certainly appeal to conference agents, for example,
Ron Sweeney (ITC World) who specifically plans for the fact that people ‘spark at
different times’, with the result that he suggests that influential speakers need
‘slotting in very carefully’.
It may be concluded that many in the meetings industry are likely to be taking
sleep for granted. Organisers may not have considered that the temporary
insomnia of business people can be a draining influence on event ROI. In turn,
many hoteliers may be paying only lip service to the idea of guaranteeing
quietness, and instead might be better advised to test each of their rooms
personally for noise, and then spend whatever it takes (insulation, doubleglazing,
renewed machinery etc.) to tackle the identified problem(s). Sleep
deprivation is not going to be solved simply with a new kind of mattress!
We left Nottingham and the Business Tourism Conference with just a glint of
hope that the questions being raised here are indeed being addressed. At one of
the city’s middle-range but older hotels, a sign on the exterior of the lift
(obviously prone to whinings and clankings) stated that in the interests of all
guests it would not be operating between the hours of 11pm and 7am. Now that
decision really does represent an investment in positive guest relations, and in
delegate productivity, and yet it cost literally nothing to implement ….
Conference News Article – Chris Martins

Restless legs syndrome

Restless legs syndrome


Restless legs syndrome is characterised by uncomfortable sensations in the legs, which are worse during periods of inactivity or rest or while sitting or lying down.

Summary
  • Restless legs syndrome is characterised by uncomfortable sensations in the legs.
  • It gets worse during periods of inactivity or rest or while sitting or lying down.
  • There is often a positive family history of the disorder.
  • The sensations are described as: pulling, drawing, crawling, wormy, boring, tingling, pins and needles and prickly.
  • It is a life-long condition for which there is no cure.

Description
Restless legs syndrome is characterised by uncomfortable sensations in the legs, which are worse during periods of inactivity or rest or while sitting or lying down. There is often a positive family history of the disorder.
Individuals affected with the disorder describe the sensations as pulling, drawing, crawling, wormy, boring, tingling, pins and needles, prickly, and sometimes painful sensations that are usually accompanied by an overwhelming urge to move the legs.

Sudden muscle jerks may also occur. Movement provides temporary relief from the discomfort. In rare cases, the arms may also be affected.

Symptoms may interfere with sleep onset (sleep onset insomnia). Research suggests that restless legs syndrome is related to periodic limb movement disorder (PLMD), another more common motor disorder, which causes interrupted sleep.

The symptoms often exhibit circadian rhythmicity in their peak occurrence during awakening hours.

Prognosis
Symptoms may gradually worsen with age, and their most disabling feature is the sleep onset insomnia they cause, which can be severe.

Treatment
  • Treatment is symptomatic.
  • Massage and application of cold compresses may provide temporary relief.
  • Certain medications are effective in relieving the symptoms.
  • Research suggests correction of iron deficiency may improve symptoms for some patients.

Reviewed by Dr Kevin Rosman, neurologist in sleep disorders, June 2010

Tuesday, May 19, 2009

To sleep, perchance... By Juliet Pitman

To sleep, perchance...

Sleep disorders leave one feeling exhausted and frustrated. We look at the many facets of this condition and how to treat them.
By Juliet Pitman

Narcolepsy, insomnia, sleep apnoea, restless leg syndrome. Apart from all having peculiar-sounding names, these conditions are all sleep disorders and, in a variety of different ways prevent their sufferers from feeling well-rested. If you’ve ever felt exhausted and in desperate need of sleep, imagine not being able to get to sleep, falling asleep unexpectedly or having severely disturbed sleep and you’ll have some idea of what it’s like to have a sleep disorder.

For sufferers, the road to treatment can be a long and frustrating one – but it’s a journey that starts with understanding the basics of sleep.
 
What is sleep?
The Morningside Sleep Centre in Johannesburg provides diagnosis and treatment for people with sleep and neurological disorders, and conducts research into sleep and neurological conditions. Lead by neurologist Dr Kevin Rosman, who has been Chairman of the Sleep Society of South Africa since 2002, the Centre’s literature describes sleep as “an active highly organised sequence of events and psychological conditions.”

Furthermore, sleep can be divided into two separate and distinctly different stages – non-rapid eye movement (NREM) sleep, which is further divided into four phases (1, 2, 3, 4) and rapid eye movement (REM) sleep. Your body cycles about 4 to 5 times during the night through NREM and REM sleep. The physiological differences of each stage are listed below



1. NREM Sleep: Around 75% of the time you are asleep is spent in the NREM state.
  • Stage 1: this is the transitional phase just after you fall asleep during which time you can be easily awakened. It’s a short period.
  • Stage 2: this phase accounts for almost half (45%) of NREM sleep and is characterized by a lack of eye movement and two kinds of brain waves called sleep spindles and K-complexes.
  • Stage 3: this involves a deeper state of sleep and during this time the person will be difficult to wake. Around 12% of NREM sleep is made up of stage 3 sleep.
  • Stage 4: this is very deep sleep and the final phase of NREM sleep. If you wake up during this time you may feel disorientated or very sleepy.
 
2. REM Sleep: most dreaming takes place in REM sleep, a period during which the brain blocks signals to the muscles to prevent you from being able to physically ‘act out’ your dreams. REM accounts for around 20 – 25% of your sleep.
Each of these phases is important but deep sleep possibly offers the most benefits. Studies of sleep deprived people show that the brain naturally attempts to recover deep sleep first and sleep experts know that the worst effects of sleep deprivation occur when people are deprived of deep sleep.
REM sleep is also important because it’s the period during which our brains process emotions, memories and stress. Although its function is not fully understood, it is believed to influence many things, from our ability to learn and develop new skills, to our ability to make proteins. If REM sleep is disrupted one night, your body will go through more REM the next to ‘catch up’.
 
How much is enough?
Your mother may have told you that a good night’s sleep was eight hours long, but the fact is that different people need different amounts of sleep. This may be because their body can operate on less sleep, or that they sleep more ‘effectively’ and are able to get maximum rest from less time spent sleeping. There is a misconception that older people need less sleep but this is not true; they often get less sleep but this is not because their body no longer needs as much. Children, on the other hand, definitely need more sleep than adults. If you were to look at averages, most adults need around 6 - 8 hours to function at their best. Experts suggest that the best way to determine how much sleep you naturally need.
     
When to sleep
Many things influence when we need to sleep and when we feel alert and awake. You may have heard of circadian rhythms. Dr Alison Bentley, head of the Wits Dial-a-Bed Sleep Laboratory describes what these are and how they influence sleep cycles in an article published in Science in Africa magazine: “These are our 24-hour body rhythms including changes in body temperature, plasma levels of various hormones and variables such as heart rate and blood pressure. These increase and decrease during the day and night.” She goes on to explain how simply changing the time you go to bed – for example going to bed in the morning and staying awake at night if you are a shift worker – does not mean your body will be ready to sleep or be wakeful when you want it to be. This also applies to travellers who are going to different time zones e.g. Australia which is nine hours ahead of us. “All the other rhythms need to be changed as well and that can take up to seven days to occur,” she explains.
The point is that sleep is complex, which is perhaps why sleep disorders are so difficult to understand and to treat.
 
Narcolepsy
Narcolepsy is probably one of the strangest sleep disorders. A chronic disorder caused by the brain’s inability to regulate sleep-wake cycles normally, it causes sufferers to experience urges to sleep, and in many cases to actually fall asleep, at various periods throughout the day. They typically remain asleep for a few seconds up to a few minutes, but in some cases can even be asleep for an hour or more.
In addition to falling asleep in this way during the day, people with narcolepsy can experience vivid hallucinations as well as brief periods of total paralysis during the onset of sleep or when they wake up. The cause of the disorder is unknown and at this time there no cure for it. In addition to antidepressant drug therapies, narcoleptics are treated using various behaviour strategies, such as taking short, regular naps during the day and improving the quality of sleep at night.
 
Restless legs syndrome
As its name suggests, Restless Legs Syndrome (RLS) is characterised by unpleasant sensations in the legs and an uncontrollable urge to move them when they are at rest in an effort to relieve these feelings. RLS sensations are often described by people as burning, creeping, tugging, or like insects crawling inside the legs.
RLS is most noticeable in the evening and at night, and can severely disrupt sleep. Although its precise cause is not known, it is associated with low iron levels, end-stage kidney disease in people who are on dialysis and damage to the peripheral neurosystem. Pregnant women also often report experiencing RLS and certain medications, such as anti-nausea, anti-seizure and antipsychotic drugs, as well as some cold and allergy medications, may aggravate symptoms
Again, there is no cure for RLS, but there are drugs that can help to alleviate the symptoms. They include sedatives, pain relievers, anticonvulsants and dopaminergic drugs. In addition, the Restless Legs Syndrome Foundation suggests that sufferers have their iron and vitamin levels checked, remove alcohol and caffeine from their diet, change any medication that may be the cause and identify and try to avoid habits and activities that seem to make RLS symptoms worse.
 
Obstructive sleep apnoea
Described by the Morningside Sleep Centre as “a serious, potentially life-threatening condition that is far more common than is generally understood”, Obstructive Sleep Apnoea (OSA) is characterised by brief interruptions of breathing during sleep. It owes its name to the Greek word, apnoea, meaning “without breath”. The interruptions themselves are known as apnoeas and can last for 10 or more seconds. During this time the soft tissue at the back of the throat collapses, closing the airway. Breathing stops which in turn causes the brain to react by waking the person so that the airways can open again and breathing can resume.
Although sufferers are usually unaware of the process, they can be experiencing it hundreds of times a night, which makes restful sleep impossible. The excessive tiredness (even after what the person thought was a full night’s sleep) is one of the first signs of OSA. Loud snoring, followed by a gasp and then loud snoring again, is another common symptom. Experts at the Morningside Sleep Centre say, “Although the typical OSA patient is overweight, male, and over the age of 40, sleep apnoea affects both males and females of all ages and those of ideal weight.”
 
Insomnia
At some period in their lives, most people have experienced insomnia, or the inability to fall or stay asleep. The condition is so common that it affects one third of the population each year, and around 10% of adults are regular insomniacs. It can last for days, months or even years and sufferers experience extreme fatigue, lethargy, concentration difficulties, poor memory, irritability and a depressed mood as a result.
The causes of insomnia vary widely and include psychological factors such as stress and depression, the use of stimulants such as alcohol and caffeine, keeping erratic hours and environmental factors such as too much noise or light. Many people find that once they’ve experienced a bout of insomnia, they become hyper-vigilant and are unable to fall asleep precisely because they are focusing on the fact that they won’t.
Treatment for insomnia takes many forms. If the problem is acute, your doctor may prescribe sleeping tablets, but many of these are potentially habit-forming and don’t offer a sustainable long-term solution. Natural non habit-forming over-the-counter remedies can provide relief. They include herbal remedies such as chamomile, valerian root, kava kava, lemon balm, passionflower, lavender, and St. John’s Wort. Some people have found essential aromatherapy oils to be of benefit. The ones most commonly used include lavender, jasmine, clary sage, and chamomile. Your homeopath might recommend you try Belladonna, Nux vomica, Hyoscyamus or Chamomilla, depending on your condition and the reasons underlying your insomnia. Relaxation techniques such as yoga and meditation can also be very helpful.