DOCSLIB.ORG

Sleep Disorders Dirckx

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Sleep Disorders Dirckx Wake Me When It’s Over: Sleep and Its Disorders by John H. Dirckx, M.D. he phenomenon of sleep is hardly less complex and minutes, each stage being characterized by waves of lower fre- inscrutable than those of cognition, respiration, diges- quency and higher voltage than the preceding one. After about Ttion, and reproduction. Sleep is not just a temporary sus- 30 minutes in stage 4, the sleeper gradually passes back through pension of consciousness, but an intricate process, consisting of stage 3 to stage 2. A full night’s sleep typically includes five to cyclical changes in many aspects of body chemistry and func- seven such cycles, but only the first one or two of these may tion, that must occur periodically to restore and maintain neu- reach stage 4. rologic health. Numerous disorders of this process have been During stage 1 sleep, the EEG shows theta waves, which identified, from nightmares, jet lag, and insomnia, which we all have a frequency of 4-7 Hz (hertz, or cycles per second). sometimes experience, to less common but more serious ones In stage 2, so-called sleep spindles occur—brief intermittent such as obstructive sleep apnea, narcolepsy, and sudden infant bursts of faster (12-14 Hz) activity. The very slow (1-2 Hz) death syndrome. This article surveys the physiology of normal high-voltage waves of stages 3 and 4 are called delta waves. sleep and discusses the nature, diagnosis, and treatment of some The deeper the stage of sleep, the more difficult it is for the of its more important disorders. sleeper to be aroused by external stimuli. About 50% of nor- mal sleep is spent in stage 2. The Physiology of Sleep During the four stages of sleep thus far described, the para- Until the 1950s, neurophysiologists considered sleep a sympathetic division of the autonomic nervous system is domi- largely passive state, in which the reduction or withdrawal of nant. Pulse, blood pressure, and respiratory rates gradually external and internal stimuli allowed for an idling or suspension decline, and gastrointestinal motility is increased. Voluntary of many neural functions. During the past 50 years, intensive muscles are relaxed but not inhibited; a normal sleeper changes study of sleep by means of electroencephalography (EEG), ani- position every 5-20 minutes. mal experimentation, and more recently positron-emission Upon the return to stage 2 after an interval at deeper tomography (PET), along with observation of the effects of stages, a series of striking alterations occur. The sleeper central nervous system (CNS) depressants and stimulants, has passes into an entirely different state, in which many of the fea- yielded a concept of sleep as an active process characterized by tures characterizing stages 1-4 are sharply reversed. The EEG a regular succession of psychophysiologic events. now shows low-voltage, high-frequency activity, as in the wak- Normal sleep is a cyclically recurring phenomenon, the ing state. Cerebral blood flow and oxygen consumption are length of the cycle determined by one of many internal rhythms increased, and the sympathetic division of the autonomic ner- or “biological clocks.” The sleep-wake cycle parallels, but is vous system becomes activated, with increases in pulse, blood not inherently tied to, other circadian rhythms such as those that pressure, and respiratory rate, and inhibition of gastrointestinal determine fluctuations in body temperature and cortisol secre- motility. tion. In persons isolated for many weeks and given no sensory A profound loss of tone, amounting almost to paralysis, clues as to the time of day, the period of each sleep-wake cycle affects all the voluntary muscles except those controlling eye gradually increases to 25-30 hours, or even longer. Individual movements. While the rest of the sleeper’s body lies immobile variations in sleep biorhythms account for the difference and inert, the eyes undergo spells of rapid, irregular movement. between “morning persons” and “night owls” (more about this Hence this phase of sleep is called rapid-eye-movement (REM) later). sleep. In contrast, the four stages previously described are said Four stages or levels of normal sleep have been identified to pertain to non-REM or NREM sleep. REM sleep was first on the basis of EEG changes. In the waking state, the EEG reported by Aserinsky and Kleitman in 1953. typically shows low-voltage waves of moderate frequency Periods of REM sleep typically occur with each return to (alpha waves) or high frequency (beta waves). In contrast, the stage 2—hence five to seven times during a full night’s sleep— EEG during most of the time spent in sleep is characterized and they make up about 25% of the total period of sleep. The by slower waves of higher voltage. The normal sleep latency longer one sleeps, the more frequently periods of REM sleep (the interval between going to bed and falling asleep) varies occur, and the longer they last. During REM sleep, the subject from 15 seconds to 15 minutes. After falling asleep, one passes is even less susceptible to arousal by external stimuli than in gradually from stage 1 to stage 4 over a period of about 45 stage 4 sleep, but is more likely to awaken spontaneously. 28 • PERSPECTIVES, Spring 2000 Alcohol and barbiturates suppress REM sleep, while reser- pine and lysergic acid diethylamide (LSD) increase it. After Insomnia is not a single disorder, but selective deprivation of REM sleep, experimental subjects expe- rather a symptom with numerous possible rience a rebound period of increased REM sleep, which may causes. Various patterns of sleep disturbance persist for more than one night. REM sleep cycles also increase occur. in frequency and duration during withdrawal from barbiturates, amphetamines, and narcotics. Virtually everyone dreams nightly. However, it has been shown experimentally that dreams are remembered for only umerous disorders of sleep, some potentially fatal, have 8-15 minutes. Hence, unless one awakens during this brief been identified and studied. These include insomnia, period, all possibility of later recall of the dream is probably Nsleepwalking, bedwetting, nightmares, restless legs syn- lost. Most dreaming occurs during REM sleep, but some men- drome, narcolepsy, and sleep apnea syndrome. During the past tal activity (less vivid, more structured, and more plausible than decade, a number of sleep clinics, either free-standing or asso- dreaming) may occur during NREM sleep, and most night- ciated with other healthcare programs or facilities, have been mares occur during stages 3 and 4 of NREM sleep. established for the diagnosis and treatment of sleep disorders. The sleep requirements of the human brain decline with Experimental observations of normal and abnormal sleep, age. While the newborn may sleep 16-20 hours a day, an elder- and diagnostic studies of persons with sleep disorders, are car- ly adult may get along on 4-5 hours of sleep in each 24-hour ried out in a sleep laboratory by polysomnography. While the period. For most healthy adults, the sleep requirement remains subject lies in a comfortable bed in a dark, quiet room and fairly stable at 7-9 hours during the middle decades. In later sleeps or tries to sleep, a multichannel monitor continuously life, sleep patterns change: more time is spent in REM sleep, measures and records pulse, respirations, limb movements, and less time in delta-wave sleep. After age 60, descent to stage 4 eye movements simultaneously with the EEG. In some cases sleep may no longer occur. Elderly sleepers are subject to more other measurements may be made as well. frequent arousal, often related to psychological or medical fac- tors (depression, joint pain, nocturia due to bladder or prostate Insomnia problems). Insomnia has been defined as the inability to sleep long The sleep pattern of infants is biphasic (a longer period of enough or deeply enough at night to maintain optimum CNS sleep at night, a nap in the afternoon), and in advanced age this health and function during the day. Since sleep requirements pattern may return. Traces of the biphasic cycle may persist vary markedly from person to person, no quantitative definition throughout the middle years. Many persons experience drowsi- (so many minutes or hours in such-and-such a stage of sleep) is ness in the afternoon and attribute it to the effects of eating feasible. Moreover, the diagnosis of insomnia is generally lunch. The digestive process, however, actually tends to inhibit based on the patient’s own observations, and extensive studies sleep, as will be discussed later. The tendency to doze in the have shown that these observations are often unreliable. One early afternoon is culturally reinforced in tropical countries researcher studied a large group of self-professed insomniacs in where the siesta is customary. a sleep laboratory and found that they had an average sleep As mentioned earlier, sleep used to be considered a nega- latency of 15 minutes and an average duration of nighttime tive or idling process in which a postulated arousal or activat- sleep of 7 hours. In exasperation, he postulated that many per- ing system was temporarily shut down. We now know that the sons who claim that they suffer from insomnia actually sleep onset of sleep is an active process, initiated in the brainstem, well, but dream that they are awake! possibly in more than one neural center. During REM sleep, Be that as it may, insomnia is regarded as a significant and voluntary muscle tone is actively inhibited by a zone in the widespread public health problem. The prevalence of chronic locus ceruleus of the pons. Hence sleep is radically different insomnia (defined as inadequate sleep at least three nights a from coma, which does indeed represent a breakdown or week for at least one month) may be as high as 15% in the gen- failure of cortical activation and responsiveness due to CNS eral population.
Load more

Recommended publications
  • The Significant Other: a Literary History of Elves
    1616796596 The Significant Other: a Literary History of Elves By Jenni Bergman Thesis submitted for the degree of Doctor of Philosophy Cardiff School of English, Communication and Philosophy Cardiff University 2011 UMI Number: U516593 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U516593 Published by ProQuest LLC 2013. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 DECLARATION This work has not previously been accepted in substance for any degree and is not concurrently submitted on candidature for any degree. Signed .(candidate) Date. STATEMENT 1 This thesis is being submitted in partial fulfilment of the requirements for the degree of PhD. (candidate) Date. STATEMENT 2 This thesis is the result of my own independent work/investigation, except where otherwise stated. Other sources are acknowledged by explicit references. Signed. (candidate) Date. 3/A W/ STATEMENT 3 I hereby give consent for my thesis, if accepted, to be available for photocopying and for inter-library loan, and for the title and summary to be made available to outside organisations. Signed (candidate) Date. STATEMENT 4 - BAR ON ACCESS APPROVED I hereby give consent for my thesis, if accepted, to be available for photocopying and for inter-library loan after expiry of a bar on accessapproved bv the Graduate Development Committee.
    [Show full text]
  • Encyclopedia of CELTIC MYTHOLOGY and FOLKLORE
    the encyclopedia of CELTIC MYTHOLOGY AND FOLKLORE Patricia Monaghan The Encyclopedia of Celtic Mythology and Folklore Copyright © 2004 by Patricia Monaghan All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage or retrieval systems, without permission in writing from the publisher. For information contact: Facts On File, Inc. 132 West 31st Street New York NY 10001 Library of Congress Cataloging-in-Publication Data Monaghan, Patricia. The encyclopedia of Celtic mythology and folklore / Patricia Monaghan. p. cm. Includes bibliographical references and index. ISBN 0-8160-4524-0 (alk. paper) 1. Mythology, Celtic—Encyclopedias. 2. Celts—Folklore—Encyclopedias. 3. Legends—Europe—Encyclopedias. I. Title. BL900.M66 2003 299'.16—dc21 2003044944 Facts On File books are available at special discounts when purchased in bulk quantities for businesses, associations, institutions, or sales promotions. Please call our Special Sales Department in New York at (212) 967-8800 or (800) 322-8755. You can find Facts On File on the World Wide Web at http://www.factsonfile.com Text design by Erika K. Arroyo Cover design by Cathy Rincon Printed in the United States of America VB Hermitage 10 9 8 7 6 5 4 3 2 1 This book is printed on acid-free paper. CONTENTS 6 INTRODUCTION iv A TO Z ENTRIES 1 BIBLIOGRAPHY 479 INDEX 486 INTRODUCTION 6 Who Were the Celts? tribal names, used by other Europeans as a The terms Celt and Celtic seem familiar today— generic term for the whole people.
    [Show full text]
  • Hmong Sudden Deaths
    Sm. Sri. Med.Vol. 40, No. 12,Pp. 1623-1629,1995 Copyright0 1995Elsevier Science Ltd Pergamon 0277-9536(94)00347-5 Printedin GreatBritain. All rightsreserved 0277-9536/95 S9.50f0.00 REFUGEE STRESS AND FOLK BELIEF: HMONG SUDDEN DEATHS SHELLEY R. ADLER Division of Medical Anthropology, Department of Epidemiology and Biostatistics, University of California, San Francisco, 1350 Seventh Avenue, CSBS-317,San Francisco, CA 94143-0850.U.S.A. Abstract-Since the first reported death in 1977, scoresof seeminglyhealthy Hmong refugeeshave died mysteriously and without warning from what has come to be known as Sudden Unexpected Nocturnal Death Syndrome (SUNDS). To date medical research has provided no adequate explanation for these sudden deaths. This study is an investigation into the changing impact of traditional beliefs as they manifest during the stressof traumatic relocation. In Stockton, California, I18 Hmong men and women were interviewed regarding their awarenessof and personal experiencewith a traditional nocturnal spirit encounter. An analysis of this data reveals that the supranonnal attack acts as a trigger for Hmong SUNDS. Key words-refugee stress. sudden death, ethnomedical pathogenesis With the fall of the capital city of Vientiane in 1975, for themselvesand their children, a clear idea of who they thousands of Hmong fled their native Laos and- are, of their identity as Hmong, of their place in history and in the cosmic realm of spirits, ancestors’ souls and human often after extended delays in Thai refugee camps- societies(41. began arriving in the United States. The Hmong are more widely known in the West than other Laotian The Hmong who have fled Laos leave behind them ethnic groups because of their efforts on behalf of a homeland ravaged by war, but in their transition to the United States during the war in Viet Nam, the West they are met with new and unique problems.
    [Show full text]
  • Norse Mythology: Legends of Gods and Heroes
    Norse Mythology Legends of Gods and Heroes by Peter Andreas Munch In the revision of Magnus Olsen Translated from Norwegian by Sigurd Bernhard Hustvedt New York The American-Scandinavian Foundation 1926 vii CONTENTS PAGES Translator’s Preface xi Introduction xiii I. MYTHS OF THE GODS The Creation of the World — The Giants — The Æsir — Men and Women — Dwarfs — Vanir — Elves ……………………… 1 The Plains of Ida — Valhalla — Yggdrasil …………………….. 5 Odin ………………………………………………………………... 7 Thor ………………………………………………………………... 10 Balder ……………………………………………………………… 12 Njord ……………………………………………………………….. 13 Frey ………………………………………………………………... 15 Tyr ………………………………………………………………..... 16 Heimdal ………………………………………………………….... 17 Bragi ……………………………………………………………….. 18 Forseti ……………………………………………………………... 18 Hod — Vali — Vidar — Ull ………………………………………. 18 Hœnir — Lodur …………………………………………………… 19 Loki and His Children ……………………………………………. 21 Hermod — Skirnir ………………………………………………… 25 The Goddesses — Frigg — Jord — Freyja .…………………... 25 Saga — Eir — Gefjon — Var — Vor — Syn — Snotra ………. 28 Idun — Nanna — Sif ...…………………………………………... 29 The Norns …………………………………………………………. 30 Familiar Spirits — Attendant Spirits ……………………………. 31 The Valkyries ……………………………………………………... 32 Thorgerd Hœlgabrud and Irpa ………………………………….. 34 The Forces of Nature — Ægir …………………………………... 34 Night — Day ………………………………………………………. 37 viii Hel …………………………………………………………………. 37 The Giants ………………………………………………………… 39 The Dwarfs ………………………………………………………... 41 The Vettir ………………………………………………………….. 42 The Heroes and Life in Valhalla ………………………………… 48 Corruption
    [Show full text]
  • Encyclopedia of Vampire Mythology This Page Intentionally Left Blank Encyclopedia of Vampire Mythology
    Encyclopedia of Vampire Mythology This page intentionally left blank Encyclopedia of Vampire Mythology THERESA BANE McFarland & Company, Inc., Publishers Jefferson, North Carolina, and London LIBRARY OF CONGRESS CATALOGUING-IN-PUBLICATION DATA Bane, Theresa, ¡969– Encyclopedia of vampire mythology / Theresa Bane. p. cm. Includes bibliographical references and index. ISBN 978-0-7864-4452-6 illustrated case binding : 50# alkaline paper ¡. Vampires—Encyclopedias. I. Title. GR830.V3B34 2010 398.21'003—dc22 2010015576 British Library cataloguing data are available ©2010 Theresa Bane. All rights reserved No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying or recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cover illustration by Joseph Maclise, from his Surgical Anatomy, 1859 Manufactured in the United States of America McFarland & Company, Inc., Publishers Box 6¡¡, Je›erson, North Carolina 28640 www.mcfarlandpub.com To my father, Amedeo C. Falcone, Noli nothi permittere te terere. This page intentionally left blank Table of Contents Preface 1 Introduction 7 THE ENCYCLOPEDIA 13 Bibliography 155 Index 183 vii This page intentionally left blank Preface I am a vampirologist—a mythologist who specializes in cross- cultural vampire studies. There are many people who claim to be experts on vampire lore and legend who will say that they know all about Vlad Tepes and Count Dracula or that they can name several different types of vampiric species. I can do that, too, but that is not how I came to be a known vam- pirologist. Knowing the “who, what and where” is one thing, but knowing and more impor- tantly understanding the “why” is another.
    [Show full text]
  • Germanic Mythology in Richard Wagnsr's 'Der Ring'
    GERMANIC MYTHOLOGY IN RICHARD WAGNSR'S 'DER RING' Emile Berger Department of German Studies McGill University, Montreal March 2002 A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of MASTER OF ART~ © Emile Berger, 2002 National Library Bibliothèque nationale 1+1 of Canada du Canada Acquisitions and Acquisitions et Bibliographie Services services bibliographiques 395 Wellington Street 395. rue Wellington Ottawa ON K1A ON4 Ottawa ON K1 A ON4 canada canada The author bas granted a non­ L'auteur a accordé une licence non exclusive licence allowing the exclusive permettant à la National Library ofCanada to Bibliothèque nationale du Canada de reproduce, loan, distribute or sell reproduire, prêter, distribuer ou copies ofthis thesis in microform, vendre des copies de cette thèse sous paper or electronic formats. la forme de microfiche/film, de reproduction sur papier ou sur fonnat électronique. The author retains ownership ofthe L'auteur conserve la propriété du copyright in this thesis. Neither the droit d'auteur qui protège cette thèse. thesis nor substantial extracts frOID it Ni la thèse ni des extraits substantiels may be printed or otherwise de celle-ci ne doivent être imprimés reproduced without the author's ou autrement reproduits sans son pemnSSlOn. autorisation. 0-612-78989-6 Canada Il ABSTRACT Richard Wagner, in writing the text which would become the libretto of his fo~r operas comprising the Ring was influenced greatly by German Mythology as weil as old Norse writings. His main sources are the Voisungensaga, ttile Thidreksaga and the Nibelungenlied. Certain portions of the Ring follow closely the events described in some of the sagas, other portions have been chang~d and elaborated to achieve theatrical effect.
    [Show full text]
  • By Wolfgang Baur, Dan Dillon, Richard Green, James Haeck, Chris
    by Wolfgang Baur, Dan Dillon, Richard Green, James Haeck, Chris Harris, James Introcaso, Chris Lockey, Shawn Merwin, and Jon Sawatsky Developed and Edited by SampleMeagan Maricle file CREATURE CODEX CREDITS Designers: Wolfgang Baur, Dan Dillon, Richard Green, Chris Art Director: Marc Radle Harris, Jeremy Hochhalter, Chris Lockey, James Haeck, James : Craig J. Spearing Introcaso, Shawn Merwin, Jon Sawatsky, and Brian Suskind Cover Artist Additional Design: David Zaine Aarons, Kirby Atwood, Interior Artists: Gabriel Cassata, Michele Giorgi, Leesha Jonathan Breese, Charlie Brooks, Matt Burriss, Joseph Hannigan, Frank Hessefort, Michael Jaecks, Robert Jenkins, Cirino, Daniel Colby, Matt Cochran, Nathan Crouch, Paul Rob Jenx, Russell Jones, Marcel Mercado, Julia Metzger, A. Catalano, Jr., C.N. Constantin, Nicolas Courtemanche, Georgi Minkov, Allen Morris, William O’Brien, Beatrice Benjamin L. Eastman, Summer Fenwick, Andrew Harshman, Pelagatti, Roberto Pitturru, Claudio H Pozas, Florian Stitz, Jim Heston, Tyrel Hoopman, Zachary Host, Kei Imamura, Bryan Syme, Takashi Tan, Egil Thompson, Simon Tjong, and Andrew Johannes, Dylan Lloyd, Alex Kanous, Adam Eva Widermann Letherbarrow, Eugene Katz, Robert Morehead, Magneto Layout and Graphic Design: Marc Radle Morgan & Kasey Brockelsby, Kenneth Nero & Winifred Chiang, Ross Paton, Luke Pickles, Eric Robbins, Corry Logo: Doug Wohlfeil Rogerson, Sebastian Rombach, Joel Russ, Graham Ruston, Limited Edition Graphics: Addison Rankin George Sager, Artem Serebrennikov, Andrew Shockney, Joshua Simpson & Bailey
    [Show full text]
  • Charms Against the Nightmare and the Mythology of Dreams
    https://doi.org/10.7592/Incantatio2017_6_Milne THE TERRORS OF THE NIGHT: CHARMS AGAINST THE NIGHTMARE AND THE MYTHOLOGY OF DREAMS Louise S. Milne School of Art, University of Edinburgh School of Arts and Creative Industries, Edinburgh Napier Universit [email protected], [email protected] This article takes a semiotic and structuralist approach to understanding the characteristic nightmare package of imagery, or image-constellation, which ap- pears also in charms, curses and lullabies to do with disturbed sleep. Elements of the nightmare package – its mythos – is related to a spectrum of charms and related belief-narratives. Charms against the nightmare are investigated, as are sleep charms as representative of the nightmare narrative of threat coming close to fruition. Detail is provided on spiritual beings believed to attack the sleeper, as well as on charms as methods to ward off such attacks. Psychological explanations are considered, such as the nightmare antagonist being a disguised avatar of the self. Keywords: body, dreams, dream imagery, lullabies, mara, metaphor, nightmare, sleep, spells INTRODUCTION: THE NIGHTMARE AND CHARMS “Let’s use a charm ... Quiet sleep, or thou shalt see / The horrid hags of Tartary ... And Cerberus shall bark at thee ... And all the Furies ... lash thee ... And therefore sleep thou peacefully” Thomas Randolph, The Jealous Lovers, III. v (1632) “No one hears the words spoken in dreams” Dogon saying (Calame-Griaule 1965: 146) 78 www.folklore.ee/incantatio Charms Against The Nightmare and the Mythology of Dreams The experience of nightmare has for centuries been mediated through and ex- pressed by a characteristic package of imagery, which appears also in charms, curses and lullabies to do with disturbed sleep.
    [Show full text]