ALL YOU NEED TO KNOW ABOUT  INSOMNIA...

INSONMIA and OTHER SLEEP DISORDERS.

Of the sleep disorders, insomnia is the most common ailments. It is defined as a dream that does not produce adequate energy recovery that the body needs to continue with daily activities of the day (it does not matter how many hours you sleep, but their quality). According to the presentation, consists of:
Conciliation Insomnia: The difficulties in launching the dream.  Maintenance Insomnia: Begin the dream is easy, but keep it stable during the night is very difficult overnight frequent awakenings occur, leaving the next day feeling tired. Terminal insomnia: the person has difficulties in initiating sleep, but will rise later in the night, and can not go to sleep. Cause: According to its origin is said that insomnia is:

Primary type when its source is a transitory event generated by acute stress (personal, family). Psychiatric type when the cause is an emotional disorder such as depression, mania, etc.. Caused by organic disease that causes trouble sleeping, and pain in arthritis, or gastric or duodenal ulcer, and difficulty breathing in emphysema, etc.. As a side effect of chemicals that affect mood: alcohol, caffeine, tea, cola, stimulant drugs, etc.. Caused by a disturbance in the rhythm of breathing at night: patient temporarily stops breathing (apnea) and then wakes up, causing an awakening tired, we note that the patient is unaware of this respiratory disorder, and therefore denies nocturnal awakenings. By involuntary movement of the legs (myoclonus), especially present in the elderly. It consists of uncontrolled, repetitive movements of the legs, of which the patient is not aware and which disturb the depth and thus the quality of sleep. Others who are aware of them say it is an irresistible desire to move the legs.

Treatment: The first thing the doctor tells the patient are measures to restore sleep hygiene:
Sleep only enough for a wake rested.  Establish schedules for sleeping and follow them strictly. Use the bed only for sleep, especially recommended that in elderly people who frequently go to bed to watch TV, read, listen to the radio, etc..  Do not go to sleep even have real desire to sleep. Controlling the sounds outside the room, enough gloom and room temperature are suitable for sleeping.  Do not lie down after eating or drinking to excess, nor hungry or thirsty. Avoid consuming coffee, tea, cola, alcohol and not smoking before bedtime. Avoid taking naps longer than 20 minutes. Certain medications such as influenza and cough suppressants may alter quality of sleep, so they must be considered in patients with insomnia.

The drug treatment is offered when it has become clear that management is appropriate habits and insomnia persists. Hypnotics are used short-acting benzodiazepines such as triazolam, brotizolam, midazolam, esteazolam or intermediate half-life as flunitrazepam. There are non-benzodiazepine drugs such as zopiclone and zolpidem. Also used the drugs known as sedative antidepressants such as amitriptyline, trimipramine, and trazodone. Also there are medicines that are used for allergy episodes but tend, as a side effect, produce drowsiness as hydroxyzine and diphenhydramine.

What causes insomnia?  Insomnia is a manifestation of the body that something is wrong. Insomnia can be caused by several reasons - stress, too much caffeine, depression, change in working hours, and pain from medical problems such as arthritis.  Many people suffer from insomnia. People suffering from insomnia might not be able to fall asleep. Or maybe you wake up during the night and can not go back to sleep, or perhaps wake up too early in the morning.

And the insomnia is a serious problem? Not really, but it can make you feel tired, depressed and irritated, and may make it difficult to concentrate during the day.  How many hours sleep you need one? Most adults need between 7 and 8 hours of sleep each night. You know you're getting enough sleep if you feel tired during the day. The amount of sleep you need stays the same during the adult stage. However, sleep patterns may change with age. For example, older people may sleep less at night and take naps during the day.

What can I do to improve my sleep habits?

Here are some tips to help you sleep better:


Go to bed and rise at the same time every day, even if not enough sleep. This will help your body be trained to sleep well at night. Develop a routine at bedtime. Do the same activities before bedtime to help your body prepare for sleep. For example, take a hot bath and read for 10 minutes every night before going to bed. Soon, your body will connect these things with sleep, and help your body feel sleepy when done. Use your bedroom for sleep. Do not eat, talk on the phone or watch television while in bed.  Make sure your room is a dark and quiet. If the noise is a problem, use a fan to cover the noise and wear earplugs. If you must sleep during the day, use thick curtains that darken either the fourth or a mask for your eyes.  If still awake after trying to fall asleep for 30 minutes, get up and go to another room. Sit quietly for 20 minutes before returning to bed. Do this as often as necessary, until you fall asleep.

How to obtain a HABIT.  Helping your child to set up a habit because we perform a function associated with some external elements. For example we associate eating a number of elements such as the bib, chair, plate, spoon, fork, and repeat this association of "external elements" until the child learns to be successful. In the dream there is a similar mechanism. The child must learn to initiate sleep alone, associating the act of sleeping with some "external factors" such as your bed, the teddy bear, pacifier and other decorative elements of your room. The attitude of parents is crucial because they provide security to the child communicate.

Parents when a child is sitting first in the table does not expect the child knows how to properly use utensils, spoon, fork, etc.. and always think that children should "learn" to eat correctly. There are distressed and the next day try again the same way. This attitude of security is giving the child confidence that after repeating the same action multiple times just performed correctly. Usually the dream is usually in the same way. Parents should know that children should "learn" to sleep alone and should not communicate uncertainty

There are two types of insomnia:

Transient: is one that lasts less than 3 weeks, is due to episodes of sudden stress, temporary illness, schedule changes for travel or sleep deprivation temporarily. It manifests as difficulty going to sleep, difficulty staying asleep, or waking up prematurely in the morning, may even have trouble sleeping during the day. Anxiety is one of the most common causes, the normal sleep patterns usually recover in two to three weeks.

Chronic: if the insomnia has lasted more than three weeks should be considered as chronic insomnia. Among the most common causes include: pain, difficulty breathing, ulcers, asthma, parkinsonism. Problems endogenous depressive type, characterized by difficulty maintaining sleep to wake prematurely. These patients are fatigued, irritable, tense and depressed. There is a group of patients with these manifestations, with insomnia that has lasted since childhood and also have a family history of the problem, without any internal or external factors associated, this condition is considered as primary insomnia. Chronic insomnia can be the result of other sleep disorders like sleep apnea and narcolepsy.

Insomnia.  Treatment for Chronic Insomnia. Sleep medications
There are several medications to help sleep. The main concern of people about these products is the ability to acquire dependence or addiction to them. This means that if you start taking them your body will get used to them and can never suspend. However, this does not happen if you follow your doctor's recommendations. Usually are prescribed for a short period, which must not exceed four to eight weeks. During that period are corrected the causes that may precipitate insomnia and are introduced measures of sleep hygiene.

Tips:  The insomnia is always a cause, try to find it yourself or with help from your doctor.

Never take medication for insomnia own initiative. It is best to consult with the doctor who will recommend the best alternative for you.
Follow a regular routine of sleep hygiene.
The excessive daytime sleepiness is a warning sign that indicates a significant sleep disorder.

The active mechanism of the MR brake is located in the raphe nuclei of the pons. They are in the midline of the brainstem (RAFE means, in Greek, seam, sewing the two halves of the brain). There occurs seretonina monoamine projecting to the hypothalamus and cortex to produce sleep. The proceeds from seretonina tryptophan diet (dairy) mostly, and some pineocytes (pineal gland), is secreted throughout the day and builds up to produce the final day of slow-wave sleep. The metabolism of this substance occurs in paradoxical sleep, it seems as if the orthodox were just a dream preparation paradoxical. If there is a paradoxical sleep deprivation, there is a recovery period in which the proportion of this to return to normal levels of that substance.

The dream SOL develops in stages:

PHASE I

It is a transitional state between drowsy and relaxed after sleep orthodox. It is characterized by slow eye movements and short very vivid dreams, where images are in color and in great detail. This is called state HIPNAGÓJICO (meaning "entering the dream"). The alpha rhythm voltage decreases and disappears. This state lasts from 1 to 7 minutes and comprises approximately 5% of total sleep time.

PHASE II

It is a true dream, characterized by an electroencephalographic pattern itself, the "sleep spindles" spikes of alpha waves that last about 5 seconds, three or four times per minute, and "K complexes" negative wave followed by a slow positive component , lasting about 5 seconds and repeat every 3 minutes.
It occupies over 50% of sleep time in adults. Mental activity at this point is sparse, and worldly thoughts.

PHASE III and IV

Some twenty or thirty minutes after going to sleep, one enters a deeper sleep sleep DELTA, high voltage waves, often one to two cycles per second. It is a synchronous activity of millions of neurons in each wave. The delta rhythm comes from the thalamic reticular nuclei, isolated from all afference which oscillate as a pacemaker. Its neurons GABA, induce in cortical neurons hyperpolarized (the neocortex is an extension thalamic). Cortex is prevented from carrying out the cognitive processes that require a fast thalamocortical activity, such as wakefulness or paradoxical sleep. A blockage of sensory messages and loss of consciousness.

This dream is not dream, it's very relaxing, accompanied by a decrease in peripheral vascular tone and also most of the other vegetative functions.
There is a decrease from 10 to 30% of blood pressure, breathing rate and metabolism. During slow wave sleep, growth hormone is secreted for the body to replenish its wear (anabolism). At this stage of sleep occurring phenomena such as myoclonus (jerking of limbs accompanied by sensation of falling, it is actually small seizures but that's not serious, orgasms are also somehow), bedwetting, sleepwalking , nightmares (feeling of impending doom without just dreaming nightmares are not tied to a fantasy of persecution for example), the production of RNA (ribonucleic acid) linked to memory.

There is another system responsible for sleep homeostatic regulation orthodox reactive

Excessive fatigue or change the internal digestion, blood. The aorta sends the signals to the vagus nerve. The nerve passes near the nucleus of the solitary tract of the medulla (SR) and then projects to the preoptic region, which secretes serotonin and inhibitory sends a message to the posterior hypothalamus (sympathetic system) and n.caudado (orienting reaction ). This mechanism explains the extra sleeping hours after excessive tiredness (reactive homeostatic regulation).

Dreamless sleep or delta sleep is taken into account in some Eastern mystical traditions. He believes in them that is the state in which we make contact with our deepest consciousness. According to Swami Rama ( "Yoga and Psychotherapy" Honesdale, Pa.: Himalayan Institute, 1976): "... It is when the inner world can be bathed in the light of the highest universal consciousness. The ego of the waking consciousness vanishes. Furthermore, the personal aspects of the mind are temporarily abandoned. The memories, the problems, restless dream images are left behind. All the limitations of the personal unconscious are swamped by the light of higher consciousness. "

PART REM

There are three mechanisms of REM sleep:

The pacemaker PGO REM sleep is triggered by the gating every 90 minutes (ultradian rhythm) from a pacemaker located in the dorsal part of the high ridge in a small area whose name is the locus ceruleus, in blue. There are different types of neurons, the cholinergic and adrenergic. The cholinergic (acetylcholine) give the order to begin REM sleep. This is manifested in the EEG by a "PGO spikes" of high voltage, isolated or in groups, go to the protuberance occipital visual cortex. These points make their appearance one minute of REM sleep.  The Blue Place cholinergic neurons also slow down or inhibit the secretion of raphe serotonin, norepinephrine Thus regularly impersonates the regulatory role of serotonin.

DREAMS, BIG BRAIN STORM

Some neurons (type II) of the pons and medulla that are active only in REM sleep, secrete norepinephrine and are projected to the thalamus, posterior hypothalamus and hippocampus, on their way to the cortex. This produces the paradoxical sleep cortical activation is intense excitement in most brain neurons, including motor, comparable to the most intense activity that may occur while awake. That storm brain are dreams. This is the stage of sleep catecholaminergic (norepinephrine and epinephrine are catecholamines). Norepinephrine is the fuel of the SR. The Blue Place also accumulate enzymes responsible for the destruction of catecholamines.

The first REM sleep usually occurs at night from 80 to 100 minutes after going to sleep. When the person is very tired, the duration of paradoxical sleep discharge is very short, and may not even arise. Moreover, when a person has relied paradoxical sleep duration significantly increased. It seems as if the body needs to rest first then perform its main task, dreams.

In REM sleep activates the sympathetic system (prepares the body for acts of defense, attack and sexual activity). The heart and breathing is often irregular. Erections in men and vaginal vasodilation in women.

The electroencephalogram shows a sync rate of high-voltage beta waves, 40 cycles per second, similar to what occurs during wakefulness. Where dreams activates the hippocampus produces theta electroencephalographic pattern of 5 Hertz

Place the blue out three issues:

- The dorsal noradrenergic innervation involved in all the SR: midbrain, thalamus and cortex, using very large terminals fine. It has been estimated that a neuron could get to connect with hundreds of thousands of neurons. It is the light bulb suddenly lights up the stage.

- The other issue is the intermediary catecolaminérjico leaving the nucleus subcerúleo.

It supplies the diencephalon, hippocampus and cortex through terminals thicker than the dorsal cord. This fascicle crossing the Limbic System linking sleep with emotions and memories.

- From the bottom, waxy leaves a complex issue down as discussed below.


BLOCKADE OF MUSCLE Muscle tone throughout the body is very depressed. The Blue Place is projected into the medullary gigantocellular nucleus, which in turn is projected onto spinal motor neurons, releasing Glycina that inhibits. This leads to paralysis. A person is most difficult to wake during slow wave sleep or light, so is also called deep sleep to REM sleep. Despite the extensive inhibition of the peripheral muscles, irregular muscle movements occur, especially rapid eye movement (REM). Motor neurons are the only eye that develop muscular activity in response to PGO activity. However motor neurons (pyramidal and extrapyramidal) can not escape the strong influence PGO excitatory pacemaker, as demonstrated by intense brain activity important points contained in the motor pathways. It is only at the spinal level where the nerve impulse is slowed muscle.

This paralysis is necessary so that the sleeper is not damaged by living a dream hallucination. There are neurons in blue, the cholinergic, which remain active during wakefulness. The 90-minute ultradian rhythms are maintained and day and night. They originate and excitability periods varying throughout the day. So now it is very likely that we can consider the following paradoxical sleep rhythm reticular system itself.  There cortical activity of 40 cycles per second which is characteristic of consciousness both in waking and in REM sleep, and greatly reduced in the dream SOL. This oscillation is reset by sensory stimuli during the day when there is a reflection of orientation, ie when we ask "What is this?". Probably also find this update in REM sleep if you experiment with lucid dreaming (lucid dream is one in which the dreamer knows he is dreaming).

BREATHING DURING SLEEP  Ventilation is controlled by the Central Respiratory Pattern Generator, which is located in nuclei at the bulb and the bulge. This center receives impulses from both upper levels of the central nervous system from peripheral receptors and generates an appropriate ventilatory response directed to the respiratory muscles and pharyngeal muscles by stimulating inspiration and dilatation of the pharynx. During sleep changes in control mechanisms of breathing, which determine that the ventilation is different and increase the possibility of developing obstructions in the upper airway and alveolar hypoventilation, thus: You lose the influence of higher centers on both cortical and subcortical level the respiratory center in the brainstem. Lowers the pitch of the pharyngeal muscles, which determines the pharyngeal lumen diameter decreases during sleep. This is further complicated during the period of REM sleep, which is associated with a generalized relaxation of skeletal muscles, further decreasing the tone of the pharyngeal muscles.

The responses of the chemoreceptors also altered during sleep. The ventilatory response to CO2 decreases. During non-REM sleep, has documented a decrease of approximately 50% of the ventilatory response to CO2 in wakefulness. This decrease appears to be greater in men than in women, but occurs in both sexes. During REM sleep reduced the CO2 response is even more marked, Douglas and colleagues found that the ventilatory response to CO2 drops to 28%. The ventilatory response to hypoxia during sleep is normal in women, however, is decreased in men. It is unclear why this difference between the sexes. As with CO2, the declining response to hypoxemia is greater during REM sleep. During sleep there is a suppression of the cough reflex, even with inhaled irritants, the response reappears only after awakening.  Awakening. The interrupt sleep respiratory disturbances variably: hypoxia is a poor stimulus for awakening, staying asleep even subjects with loadings as low as 70%, with no difference between REM and non-REM sleep.
Hypercapnia awake patients to varying degrees, but most of the subjects awake when CO2 has risen about 15 millimeters above the level of CO2 during wakefulness.  Breathing obstruction or increased resistance to inspiration is an important stimulus to awaken. The increased inspiratory resistance occurs at a frequency similar awakenings in all stages of sleep. Studies Glisan and staff found that the inspiratory effort is the most important factor in the awakening of patients with Sleep Apnea Syndrome.

OTHER SLEEP DISORDERS: APNEA

Some people with a daily insidente unable to sleep or sleeping in a satisfactory manner throughout the night. However, there are others who succeed with the same event but then sleep during the day are dominated by a sense of insecurity, drowsiness and malaise. This means that we sleep poorly. If this happens (not achieving a satisfactory sleep) is because they suffer from various sleep disorders. Sleep disorders are many and diverse, these are some of the most common and experienced by the population:  Respiratory: "Syndrome Obstructive Sleep Apnea"  "Central sleep apnea"  Resistance syndrome increased airway  Insomnia Time Changes "The Syndrome of Obstructive Sleep Apnea It is characterized by an interruption of airflow during sleep despite continued inspiratory efforts, which are increasing in response to this obstruction. The obstruction is secondary to a collapse of the pharynx. These patients have alterations that decrease pharyngeal light such as obesity, micrognactia, retrognactia, macroglossia, hypertrophic tonsils, throat tumors, nasal abnormalities, diseases such as hypothyroidism and acromegaly.

On sleeping, relaxation of pharyngeal muscles, normal during sleep, allowing the collapse of the pharyngeal light with consequent obstruction to airflow.
These obstructions are repeated continuously during sleep and cause frequent awakenings, usually without awareness thereof in substantially altering sleep architecture. During periods of apnea is a drop in oxygen saturation, increased CO2 partial pressure and increased inspiratory effort in a progressive manner, the latter to reach a threshold induces wakefulness, the pharyngeal muscles contract opening New air flow and to restore normal ventilation. Breathing is normally until the patient begins to relax and sleep again to repeat the cycle. In addition to respiratory disorders, there is an adrenergic response during these periods of apnea characterized by bradycardia, tachycardia and hypertension, which put significant overhead to the heart and alter the characteristics of the normal circulation in the central nervous system. Patients with obstructive sleep apnea complain of daytime hypersomnolence, difficulty concentrating, decreased performance, lack of strength, fatigability, memory problems, decreased libido. Their partners describe episodes of irregular and heavy snoring that alter the peace of the night associated with restless sleep and cessation of breathing.

Changes in blood pressure or arrhythmias may be associated with the syndrome of obstructive sleep apnea as an independent or concomitant factor. Physical examination may show: overweight, thick necks, micrognactia or retrognathia, abnormal pharynx such as long soft palate, tonsillar hypertrophy, reduction in light of the pharynx, nasal abnormalities (polyps, obstructive hypertrophic turbinates, nasal septum abnormalities ). "The Central Apnea Syndrome" It is characterized by the absence of airflow associated with an absence of ventilatory effort. This phenomenon is much less common than obstructive sleep apnea, are probably not more than 10% of the ventilatory changes seen in sleep centers. It is more common in men and its prevalence increases with advancing age, snoring, obesity and abnormalities of the pharynx are not commonly associated with this disorder. This syndrome is reported in relation to central nervous system disorders that can affect the respiratory center and heart failure.

During the day, these patients hipersomnoliencia, fatigue and lack of strength. Overnight, patients complain of insomnia, nocturnal choking, fear and difficulty falling asleep. Occasionally patients have no symptoms and are referred to studies by their bed partners who observe prolonged episodes of apnea. Mixed apneas It is characterized by start as a central apnea, respiratory effort when it reappears, not restored by airflow obstruction at pharyngeal behave as an obstructive apnea until the patient is awake.

-Resistance Syndrome increased airway. These are patients with symptoms of sleep apnea in which during the sleep studies is an absence of episodes of apnea, but with a higher arousal index with no other pathology to explain them (restless leg syndrome). When evaluating pleural pressure, shows that these awakenings are associated with increased inspiratory effort probably related to increased resistance to the level of the upper airway and this effort is that triggers the awakening without being an apnea. The quality of life of these patients is very upset by the disruption of sleep architecture. (Arch. of sleep: sleep homogeneous distribution) These patients are referred to sleep laboratories for studies hipersomnoliencia day, snoring very strong that disrupt the sleep of their bed partners.


Glossary. Benzodiazepines: drugs that act on the nervous system. They are used to treat anxiety, insomnia and some forms of epilepsy.  Hypnotic: medicine used to induce sleep.  Insomnia: inability to falling or staying asleep. Feeling little refreshing break.