When Neuropathy Deprives You Of Sleep

Today's post from neuropathyjournal.org (see link below) talks about the much-underestimated problem of fatigue associated with neuropathy. Let's assume that your neuropathy was caused by another condition, or you are suffering from another condition anyway - the chances are that fatigue will play a part in those symptoms anyway. Add to that your nerve damage and muscular weakness and you have serious tiredness on a daily basis. It's not fair folks and other people may look at you as if you're malingering but it's the way it is and one of Lt.Col. Richardson's best pieces of advice in this article is to ignore them; accept the state of your body as being what it is and...go take a nap if you need it.
It may also be worth mentioning that we're entering holiday periods across the world and the strains on your body and mind can be considerably greater. Listen to your body and rest when it all gets a bit too much - you'll thank yourself later and others may also benefit from a rested you too😉

Fatigue in Peripheral Neuropathy
By LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM

Unfortunately fatigue is a central part of many neuropathies and especially the immune mediated neuropathies. It is central to many other chronic illnesses that affect the body’s immune system. The causes are often complex and many.

Dr. Scott Berman, in his book Coping with Chronic Neuropathy notes in chapter VIII “Dealing with Fatigue and Insomnia” that this symptom is one of the most difficult and challenging for the neuropathy patient. Dr. Berman is a Psychiatrist, a member of the Board of Directors of the NSN and a Medical Advisor. Scott lives with untreatable CIDP.

He notes:

…that in one study looking at fatigue in autoimmune neuropathy 80% of 113 patients had severe fatigue. The fatigue was independent of motor or sensory symptoms and was rated as one of the top three most disabling symptoms. (“Fatigue in Immune-Mediated Polyneuropathies,” Neurology 53: 8 November 1999, I.S.J. Merkies, et al).


For decades in living with untreated Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Autonomic Neuropathy (AN) and Progressive Polyneuropathy due to exposure to Agent Orange in Vietnam, I can attest to the facts noted above. While other major symptoms respond to treatment with Immune Globulin (IVIg), the symptom of severe fatigue continues as one of the symptoms that responds only temporarily to the infusions followed by several days of total fatigue following infusion and then with some lessening until the next infusion.

Dr. Norman Latov in his book “Coping with Peripheral Neuropathy”, states what I have heard other neurologists share, that the fatigue we feel, first appearing as weakness, increases as the weakness (or damage) of motor nerves expands. At this point with only a few muscles doing the whole job of lifting a leg or arm or carrying on autonomic functions, the body becomes weak and eventually extreme fatigue occurs. Think of a young child who tires easily because the muscles and nerves are not fully developed and only a few underdeveloped nerves or muscles are doing the job of moving!

On the other hand, to state the obvious, pain in some neuropathies does not help us sleep. Neuropathy patients must seek medical help in finding medications or other options which works for them. The medical practitioners have increased their knowledge in recognizing the reality of neuropathic pain. These strange symptoms from damaged peripheral nerves are present in sensory neuropathies. It is become less common for these patients to be told that it is all in their ‘head’ and are finally getting the help they need.

UPDATE ON FATIGUE IF YOU ARE ON IVIG (September 28, 2016):

Learned something else with my infusion yesterday. I got talked into getting 50 or 60 grams and could not figure out why I had such increase in fatigue, both physical and mental , when I was getting this dosage as they told me that was the dose for my weight. I forgot my line that ‘my body has not read your book” and discovered it was the excess IVIg! Yesterday I had my doctor reduce my dosage to the 40 grams which I was getting previously, and wow…. less fatigue etc…. even the day after. I have had the fatigue explained away in a number of ways, and fatigue is common in chronic illness, but then yesterday I read the brochure again that came from Gammagard. Guess what is NOW listed at top of the reactions? Fatigue and malaise!!!! I am considered going down to 30grams and see if that is even better. The point here is that each of our bodies are different an the brands of IVIg are different! Fatigue is a complex subject and deserves more research and attention as this as many have stated is one of the worst symptoms of many Peripheral Neuropathies.

Impact on family and friends:

Families and friends, as we all have learned, may not understand this reality since we “look so good” and may even believe/suggest that you are just lazy or unmotivated or worse. The best thing you can do for them is to have them watch the DVD Coping with Chronic Neuropathy which will be an education about the impact of any neuropathy on our lives.

Educating yourself about neuropathy:

At any rate, fatigue is something we struggle with every day and often regulates/determines our daily activities.

While fatigue in neuropathy and other chronic illnesses is not fully understood by the experts, from a practical standpoint, here is what I have learned to do or not do in coping with fatigue. If you have found other things that help, send us a message and we will add it to the list.

1. DO NOT think negatively about fatigue, thus feeling guilty about your fatigue. Go take a nap! (See DVD “Coping with Chronic Neuropathy”).

2. Learn when your “fatigue” periods occur, as these often establish a pattern at certain times of the day. Then go lay down and stop moaning about it, as it is what it is until it isn’t.

3. I have learned that you do not even have to actually “sleep”, but just allowing your body to rest/stop for an hour takes care of the exhaustion as the body recovers. But whatever works for you, do it without guilt or apology.

4. For nighttime, have a standard bedtime routine in preparing for sleep that tells your body that it is time to sleep.

5. Do not eat a large meal just before bedtime or take a stimulant that keeps you awake or might interfere with sound sleep (i.e. caffeine, for some alcohol).

6. Do consider drinking a glass of milk as for many this encourages the body to sleep.

7. Do consider one of those special recordings of quiet music or rain falling or similar if it helps.

8. Do consider using a ticking clock if that helps. As a child in the 40s I got my best sleep on the floor in front of the big radio in the living room listening to Dragnet or was it the Lone Ranger, maybe the Big Story. Today most TV programs have the same effect, sleep! Pun intended.

9. Muscle spasms and/or restless leg can make sleeping difficult and rob you of needed sleep. Speak to your doctor and have tests done for calcium, salt, potassium levels and other deficiencies which can make it difficult for muscles to work properly. This is especially true if you are on a diuretic which can empty your body of needed minerals. Getting up and having a glass of orange juice worked for my mother and works for me. If the lack of something is not the problem, have the doctor find out what may be causing these muscle problems. There are also medications to help prevent these muscle spasms and cramps for they are very common in neuropathy.

10. I have found that if I wake up with my mind creating solutions to an issue or writing poetry (happens) and not able to sleep, I go to another room or go do some work on my computer (write out the solution or poetry) until I begin to feel sleepy again. It works for me.

11. For some insomnia is a real curse. There are medications that one can use as Dr. Scott Berman mentions in his book, so speak to your doctor. Frankly, I would work on natural solutions first and be creative to see what works for you. But if ALL else fails these medications may help and be a heaven sent blessing.

12. My Nurse told me that many patients with this effect of a chronic illness, take Folic Acid and it is known to help. So you many want to speak to your doctor in this regard.

13. Dr. Erika Schwartz, M.D. (national leading expert on wellness) suggests that patients with extreme fatigue have the physician check your basal metabolic rate and your thyroid function. Low thyroid is a common cause of fatigue. So speak to your doctor in this regard.

14. So what do you do or not do that helps? Send it to us and we will enter it here!

DISCLAIMER: The information in this article and on the website or the links or in the guidance provided is intended to be educational and informative and not medically prescriptive or diagnostic. All patients are encouraged to consult with their own medical doctor when considering any this information.

Copyright – 2014-2015 Network for Neuropathy Support, Inc., 501c3, dba as Neuropathy Support Network. This article or its contents may be reprinted or published for educational purposes as long as the printing or publishing is not for profit and acknowledgement is granted the author.

https://www.neuropathyjournal.org/fatigue-in-peripheral-neuropathy/

Sleep Deprivation And Neuropathy

Today's post from beating-diabetes.com (see link below) is aimed at diabetics with neuropathy but applies to all of us living with nerve problems. It talks about a problem that millions of people with neuropathic symptoms have and that is sleep deprivation. You don't need telling how important a good night's rest is for your general health and feeling of well-being and if the symptoms of neuropathy regularly disrupt your sleep it can affect your whole life, leading to all sorts of problems during the waking hours. This article gives some very helpful advice as to how to tackle the problem. The solution doesn't always lie with prescription sleeping pills; there may be other ways of improving what can seem an insurmountable problem. Lack of sleep is a vastly underrated aspect of living with neuropathy and all good advice is welcome.
 

Diabetic Neuropathy and Sleep
Written By: Paul - May• 11•14

Diabetic neuropathy can develop into a nagging intrusiveness that will undermine you ability to enjoy a good night’s sleep. And lack of sleep will exacerbate the painful symptoms of neuropathy. What can you do about it?

Peripheral neuropathy is damage to the nerves in the feet and legs. When it is caused by long-term diabetes it is called diabetic neuropathy.

This nerve damage can cause a loss of feeling in the feet or symptoms such as tingling, numbness, burning, and pain. These symptoms come and go and can be quite intensive and disturbing from time to time.

It is permanent, so once it’s happened you cannot improve it by controlling your diabetes better. However, you can allay the symptoms (and prevent the damage getting worse) through a change in diet and exercise.
Sleep disturbances

As it can be very intrusive, neuropathy can disturb your sleep in a number of ways.

The pain and weird sensations (especially in the legs) of neuropathy can make it hard to fall asleep.

Many people find themselves focusing on their pain during the evening when daytime distractions are at a minimum which makes it more difficult to get to asleep. The pain can also kick in during the night and wake you up.

Neuropathy has been linked with sleep apnoea syndrome, ie pauses in breathing during sleep.

A meta-analysis published online in late 2013 by three Japanese researchers indicates that patients with diabetic neuropathy are twice as likely to have apnoea compared to diabetic patients who do not have neuropathy. This, however, does not mean that neuropathy is a cause of sleep apnoea.

The relationship between neuropathy and sleep is a two-way street. While neuropathy can cause your sleep to be disturbed, sleep that is disturbed (for other reasons) can make the symptoms of neuropathy worse.

In addition, being deprived of sleep can lower your pain threshold and your ability to tolerate pain, which makes your neuropathic pain feel worse.
Overcoming the effects of neuropathy on sleep

There are several things you can do to overcome the intrusiveness of neuropathy:

[1] You can use medicines, both over-the-counter and prescription medications. However these can cause drowsiness during the day, as well as other side affects and can cause dependency.

[2] You can try non-pharmacological treatments such as cognitive behavioural therapy, relaxation techniques, stress management, and acupuncture.

[3] You can follow the tips below for getting a good night’s sleep. This is probably the best thing you can do.
Getting a good night’s sleep despite your neuropathy

There are several things you can do to get a good night’s sleep. You may find some or all of the following useful: 

Keep your blood glucose under control using diet and, if necessary, medications.

Get some exercise every day.

Go to bed at about the same time each night so you adhere to a regular sleep/wake schedule.

Make sure your bed is large and comfortable with a good mattress and supportive pillows.

Elevate the bed sheets so that they are not in direct contact with your legs and feet. You can do this using wire frames to create a tunnel for your feet under the blankets.

Ensure your room is cool (18 degrees Centigrade) and well ventilated.
Sleep in the dark in a noise free room (or use a blindfold and/or ear plugs).

Develop a bedtime ritual (eg, taking a warm bath, reading light material).

Limit or eliminate caffeine four to six hours before bed and minimize daytime use.

Avoid smoking, especially near bedtime or if you awake in the middle of the night.

Avoid alcohol and heavy meals before going to bed.

Turn off your TV, smartphone, iPad, and computer a few hours before your bedtime.

Adopt relaxation techniques to help induce sleep such as setting an hour aside before bedtime to relax and unwind. Try meditation or deep breathing exercise.

http://beating-diabetes.com/index.php/diabetic-neuropathy-and-sleep/

CAN SLEEP LOSS AFFECT YOUR BRAIN SIZE

Sleep difficulties may be linked to faster rates of decline in brain volume, according to a study published in the September 3, 2014, online issue of Neurology, the medical journal of the American Academy of Neurology

Sleep has been proposed to be "the brain's housekeeper," serving to repair and restore the brain.

The study included 147 adults 20 and 84 years old. Researchers examined the link between sleep difficulties, such as having trouble falling asleep or staying asleep at night, and brain volume.

All participants underwent two MRI brain scans, an average of 3.5 years apart, before completing a questionnaire about their sleep habits.

A total of 35 percent of the participants met the criteria for poor sleep quality, scoring an average of 8.5 out of 21 points on the sleep assessment. The assessment looked at how long people slept, how long it took them to fall asleep at night, use of sleeping medications, and other factors.

The study found that sleep difficulties were linked with a more rapid decline in brain volume over the course of the study in widespread brain regions, including within frontal, temporal and parietal areas.

The results were more pronounced in people over 60 years old.

"It is not yet known whether poor sleep quality is a cause or consequence of changes in brain structure," said study author Claire E. Sexton, DPhil, with the University of Oxford in the United Kingdom. "There are effective treatments for sleep problems, so future research needs to test whether improving people's quality of sleep could slow the rate of brain volume loss. If that is the case, improving people's sleep habits could be an important way to improve brain health."

Sleep Deprivation Through Pain Some Non Prescription Supplement Ideas

Today's post from webcache.googleusercontent.com (see link below) comes from the New York Buyers Club, which is a well-known and established supplement company. However, it is also known for its very useful non-biased medical information and can be very useful if you are wondering about the pros and cons of taking supplements. This article talks specifically about sleep deprivation and depression being a vicious circle and suggest which non-prescription supplements may help. You may wonder what this has to do with neuropathy but the fact is that very many neuropathy patients have trouble getting a good nights rest. Their sleep is often disturbed by neuropathic symptoms flaring up at night. This in turn can lead to depression (not a big stretch if you have neuropathy and can't sleep). You may find some of the information and suggestions provided here to be useful in your own situation. Worth a read.

New research on depression, and a new look at supplements for mood and sleep disorders 
Posted  by jarebe This article from the Spring 2014 edition of SUPPLEMENT: Newsletter of the New York Buyers Club

At the end of 2013, there was much buzz about new studies showing that curing insomnia in people with depression might double the chance of a complete recovery from depression. The studies, financed by the National Institute of Mental Health, were welcomed as the most significant advance in treating depression since the introduction of the “selective serotonin re-uptake inhibitor” (SSRI), Prozac, twenty-five years ago. In effect, the new research findings turn conventional wisdom on its head, since they suggest that insomnia can be a main cause of depression, rather than just a symptom or a side effect, as previously assumed. If you can successfully treat a depressed person’s insomnia, according to the new view, you eliminate one of the main factors causing the depressed state.

New research findings turn conventional wisdom on its head
suggesting that insomnia can be a main cause of depression
rather than just a symptom or a side effect as previously assumed

As we followed reports on this breakthrough research on insomnia and depression, we were especially encouraged to read comments like the one from Washington DC psychiatrist James Gordon, who has advocated an integrative approach to treating depression. Here’s his letter to The New York Times:

I welcome a new report’s finding that cognitive behavioral therapy is improving the outcome for depressed people with significant insomnia (“Sleep Therapy Seen as an Aid for Depression,” front page, Nov. 19).

It reminds us that changes in attitude and perspective, and a therapeutic relationship, can right biological imbalances — like disordered sleep — and significantly enhance the lives of troubled people. The study also puts the therapeutic role of antidepressant medication in perspective: the depressed participants who received behavioral therapy did equally well whether or not they were taking the drugs.

I hope that these results will encourage the National Institute of Mental Health, researchers, clinicians and all of us to expand our horizons.

There are a number of other nonpharmacological therapies, including meditation, physical exercise, dietary change and nutritional supplementation, acupuncture and group support, that show promise for improving clinical depression and enhancing brain function.

At NYBC we have long believed that non-prescription therapies, such as supplements, are valuable alternatives for treating mood disorders and sleep disorders When the Centers for Disease Control surveyed use of antidepressant drugs in 2008, it found that one in 10 Americans was taking an antidepressant, and many had taken these drugs for years. Over a period of ten years, antidepressant use in the U.S. had shot up by 400%! So the question arises: how much of this spectacular increase represented real gains in treatment, and how much was over-prescribing? As Dr. Gordon mentions in his letter above, in some cases behavioral therapy for depression has worked just as well whether people were taking antidepressants or not—hardly a strong argument for the value of the prescription drugs.

A well-publicized 2008 report in the New England Journal of Medicine
found that pharmaceutical companies had consistently reported
only the most favorable trial outcomes for their popular antidepressants

A well-publicized 2008 report in the New England Journal of Medicine found that pharmaceutical companies had consistently reported only the most favorable trial outcomes for their popular antidepressants, passing over evidence that suggested a more limited effectiveness. Furthermore, as with many drugs, especially those used over a long period, antidepressants have side effects. Higher bone fracture risk and multiple cardiovascular risks have been identified; sexual side effects are common with antidepressants in both men and women; and withdrawal symptoms for those tapering off antidepressants include a long list of problems, such as panic attacks, insomnia, poor concentration and impaired memory.

Turning to the alternatives, we describe below supplements that NYBC has highlighted over the years for sleep and mood disorders. Note cautions about their use, but also note that some of these products may actually carry added benefits, rather than unwanted side effects.

1. Melatonin is a hormone occurring naturally in the body, but some people who have trouble sleeping have low melatonin levels. Melatonin has been used for jet lag, for adjusting sleep-wake cycles for people doing shift work on varying schedules, and for insomnia, including insomnia due to high blood pressure medications called beta-blockers. It is also used as a sleep aid when discontinuing benzodiazepines (Klonopin, Xanax, etc.) and to reduce side effects when quitting smoking.

2. Fish Oil. Epidemiologists have noted that populations that eat fish regularly have low rates of depression. And research has found that omega-3 fatty acids in fish oil supplements can be of benefit in treating depression and bipolar disorder. Fish oil can also be taken with other anti-depressants as an adjunct therapy. Doses found effective in treating depression are quite high, 3 to 9 grams per day, so be aware of potential problems related to the supplement’s blood-thinning properties. Added benefit: fish oil can help manage cholesterol, and supports cardiovascular health.

3. Deficiencies in the B Vitamins, especially B12 and folate, can result in neurologic symptoms — for example, numbness, tingling and loss of dexterity — and the deterioration of mental function, which causes symptoms such as memory loss, confusion, disorientation, depression, irrational anger and paranoia. A number of studies have shown that vitamin B12 is deficient in a large percentage of people with HIV, and the deficiency can begin early in the disease. Supplementing with a B complex protects against deficiency and supports cognitive health and mental function.

4. Vitamin D deficiency has also been linked to depressed states. Lack of the “sunshine vitamin” may be especially associated with Seasonal Affective Disorder (SAD), the “winter blues.” Vitamin D also supports bone health, and may protect against colds and flus.

5. Theanine, an amino acid found in green tea, acts as a relaxing agent by increasing levels of certain neurotransmitters (=brain chemicals that shape your mood), including serotonin, dopamine, and GABA (gamma amino butyric acid). Human studies have been limited to date, but one small study showed that theanine decreases stress responses such as elevated heart rate. Another investigation compared theanine’s calming effect to that of a standard anti-anxiety prescription drug, and found that theanine performed somewhat better. Note that NYBC stocks Theanine Serene (Source Naturals), a combination supplement that includes theanine and GABA.

6. Probiotics. Very recent research has looked into the communication between the digestive system and the brain, with a goal of understanding how gut health may influence chronic conditions, including mood disorders like depression and anxiety. For example, it has been shown that certain probiotics promote production of the calming, anti-stress neurotransmitter GABA in the body, pointing to a direct influence of probiotics on mood. Other potential links between the gastrointestinal system’s microorganisms and brain function are currently being explored.

7. L-Tryptophan and 5-HTP (5-hydroxy L-tryptophan). These closely related supplements are converted in the body to serotonin and to melatonin. (Take L-tryptophan with carbohydrates to make it effective.) Their use as antidepressants has been studied, and they have also been found to aid sleep and suppress appetite. (To minimize appetite suppression, take the supplement an hour before bedtime.) Although L-Tryptophan and 5-HTP are close relatives, people may respond somewhat differently to them, so it may be worthwhile to try the other if the first doesn’t produce an effect An added benefit: 5-HTP may also decrease symptoms of fibromyalgia and migraine headaches.

8. In research funded by the National Institute of Mental Health, DHEA (dehydroepiandrosterone) was found to be an effective therapy for mild-to-moderate or severe midlife depression, on par with some prescription drugs. Moreover, the research showed that taking DHEA promoted both a significant lifting of depressive symptoms and an improvement in sexual functioning. Note that dosing recommendations vary for men versus women, and DHEA is not recommended for those diagnosed with prostate conditions or cancer.

9. SAMe (S-adenosyl-l-methionine) is produced naturally in the body from the amino acid methionine. Supplementing with SAMe increases concentrations of the neurotransmitters serotonin and dopamine. Several studies show SAMe having an antidepressant effect comparable to that of some prescription drugs. SAMe should be avoided in people with bipolar disorder, and should be used cautiously with other antidepressants, because the combination may push serotonin levels too high. Taking a B-complex vitamin while using SAMe can counter build-up of homocysteine, which has been linked to heart disease SAMe may also support joint health and liver function. Caution: the National Center for Complementary and Alternative Medicine has posted a warning that SAMe may increase likelihood of pneumocystis infection in immune-compromised people. Note: see also Trimethylglycine (TMG), which includes the raw materials that the body uses to manufacture SAMe. TMG is much less expensive than SAMe.

10. St. John’s Wort is a widely used herb with clinically demonstrated (multiple, well-controlled studies, mostly in Europe) anti-depressant effects for mild to moderate depression – generally without the side effects of prescription antidepressants. High doses of the herb may cause a sensitivity to light (phototoxicity), so avoid direct sunlight or sunbathing while using. Do not take St. John’s Wort with 5-HTP, serotonin re-uptake inhibitors (like Prozac), or with protease inhibitors, as it may affect beneficial liver enzymes. St. John’s Wort may also have activity against Epstein-Barr and herpes infections. (St John's Wort should not be used in conjunction with HIV medications Ed:)

11. Finally, we’ll mention another combination supplement that NYBC has stocked: GABA Soothe (Jarrow). The GABA in this supplement is the neurotransmitter that promotes calmness coupled with mental focus. Also included is theanine (see above for a description of its anti-anxiety effects) and an extract of ashwagandha, an herb which has long been used in the Ayurvedic tradition of India to reduce fatigue and tension associated with stress.

http://webcache.googleusercontent.com/search?q=cache:g1tVAtpNWmIJ:nybc.wordpress.com/+&cd=17&hl=en&ct=clnk&gl=nl&client=firefox-a

Sleep Apnea And Nerve Damage

Today's post from mdedge.com (see link below) is a very interesting one, discussing (via a case study), the link between neuropathy and sleep apnea. Many people living with neuropathy also have troubles breathing regularly at night (apnoea) and it has long been suspected that there is a strong link between the two. In this case, the patient eventually responded extremely well to apnea treatment, in that her neuropathy symptoms were also massively reduced. It must be said here, that sleep apnea treatment is no easy option and many patients struggle to adapt to the equipment necessary but the reward re your nerve problems may make it worthwhile sticking it out. Worth a read if you are a smoker, or someone who has sleep apnea problems plus nerve damage.

Peripheral neuropathy linked to obstructive sleep apnea?
J Fam Pract. 2013 October;62(10):577-578 Author(s): Schmidt S, MD, PhD Rodrigues A, MD Lupi Me, MD Wong F, DDS, MS
Siegfried Schmidt, MD, PhD; Anthony Rodrigues, MD; Maria Elisa Lupi, MD; Fong Wong, DDS, MS
Department of Community Health and Family Medicine, College of Medicine (Drs. Schmidt and Lupi), Department of Restorative Dental Sciences, College of Dentistry (Dr. Wong), University of Florida, Gainesville; Department of Child Neurology, Floating Hospital for Children at Tufts Medical Center and Tufts University School of Medicine, Boston, Mass (Dr. Rodrigues)
Fwong@dental.ufl.edu

The authors reported no potential conflict of interest relevant to this article.

OSA may not be the first thing that comes to mind when examining a patient with peripheral neuropathy, but treating the sleep disorder can produce surprising benefits.
 
CASE A 57-year-old white woman presented with symptoms of bilateral “stocking-like numbness” and the sensation of “wearing socks for a few weeks” but denied any injury, previous chemotherapy, or diabetes. Her medical history was positive for untreated obstructive sleep apnea (OSA), obesity (body mass index, 36 kg/m2), osteoarthritis in various joints, impaired fasting glucose with normal glycosylated hemoglobin (HbA1c), hypertension, gastroesophageal reflux disease, hypothyroidism, hypercholesterolemia, and osteoporosis.

Our initial examination revealed decreased sensation to light palpation and pin prick over the distal portion of her lower extremities in a stocking-like fashion. Proprioception was decreased at the distal joint of the big toe. Her deep tendon reflex pattern was symmetric with 2+ at the knees, ankles, and toes. The rest of her lower extremity exam was within normal limits and there were no obvious vascular abnormalities.

Given the suspicion of peripheral neuropathy, the patient underwent laboratory tests and a nerve conduction study. Vitamin B12, vitamin B1, methylmalonic acid (MMA), thyroid function, thyroid peroxidase (TPO), serum protein electrophoresis (SPEP), rapid plasma reagin (RPR), sedimentation rate, vitamin D, complete blood count, and chemistry profile 24 were all negative. The antinuclear antibody test revealed a homogenous 1:80 titer with a negative nuclear deoxyribonucleic acid. Her fasting glucose had been elevated between 107 to 117 mg/dL in the last 5 years but HbA1c was normal (5.8%). The patient had not been diagnosed with diabetes and her latest glucose values had been stable.

However, electromyography and a nerve conduction study were abnormal, with electrophysiological evidence of mild axonal polyneuropathy. During the month prior to her presentation, she had developed burning pain in addition to the numbness/stocking sensation. Pregabalin, gabapentin, duloxetine, celecoxib, hydrocodone, methadone, and other medications were ineffective. Eventually the foot pain became so severe—she described it as “walking on tacks”—that she was unable to walk.

Our team decided to do a nerve block to relieve the pain. Initially she underwent right and later left peroneal and posterior tibial nerve blocks, which gave her immediate relief that lasted about 2 months.

Relief from the pain, but what about the OSA symptoms?

In the meantime, our patient developed increasing OSA symptoms, including snoring, nonrestorative sleep, daytime somnolence, and fatigue. (To learn more about OSA, see “Obstructive sleep apnea: A diagnostic and treatment guide” on page 565.)

Her history of mild-to-moderate OSA dated back 2 years, and included an apnea-hypopnea index (AHI) of 20 events per hour and 133 episodes of oxygen desaturation with a low O2 desaturation of 83%. The patient had never been treated, however, because she felt that she couldn’t tolerate the continuous positive airway pressure (CPAP) mask.

The patient finally agreed to a CPAP titration study. Her AHI improved from 20 to less than 2 events per hour; the oxygen desaturation dropped from 133 to 104 episodes; and the lowest O2 desaturation went from 83% to 85%.

When we initially started CPAP, our patient did not tolerate it very well. However, after consulting with our sleep clinic, she was placed on bilevel positive airway pressure, which she did tolerate. Surprisingly, she also noticed immediate improvement of the neuropathic foot pain; after a few weeks it resolved completely.

Still no foot pain…We continue to follow the patient’s progress and, after 3 years, she remains free of foot pain. Her initial numbness remains, however. She has not After starting CPAP, the patient noticed immediate improvement of the neuropathic foot pain; after a few weeks, it resolved completely. developed diabetes, with similar fasting sugar levels and an HbA1c of 5.4%. She is not taking any medication for neuropathic pain, but remains on methadone for unrelated severe intractable osteoarthritic pain of the lumbar spine, bilateral knee joints, and left hip.

The link between sleep apnea and neuropathy

Our case report suggests that clinicians should consider OSA as a cause of neuropathic pain. A recent review of the literature supports the relationship between the 2 conditions.

The prevalence of neuropathy in the general population is 2.4%, rising to 8% with advancing age.1 Many different types of peripheral neuropathy have been described; they have different symptoms and characteristics, depending on the specific part of the nervous system that is affected.2

The literature reveals a strong association between OSA and peripheral neuropathy and sight-threatening retinopathy.3 One study found that nearly 60% of patients with diabetes and OSA also have peripheral neuropathy.4 Another report found that OSA is an independent risk factor for axonal damage of peripheral nerves.5 Furthermore, a case-control study revealed that the impaired neural function is at least partly reversible with treatment for sleep apnea.4 Finally, Tahrani et al6 have found that “neuropathy prevalence was higher in patients with OSA than those without” (60% vs 27%; P<.001), which supports our case finding.

The specific mechanism linking OSA and neuropathy remains elusive, but the evidence suggests that peripheral nervous tissue is affected by chronic endoneural hypoxia in this patient population.7 In patients with OSA, 2 types of nerve dysfunction are apparent: ischemia-related axonal degeneration and resistance to ischemic nerve failure.8

An approach worth considering. While nerve blocks did provide some relief for our patient, they are not a long-term solution. To our knowledge, this case report is the first one published in the United States describing resolution of neuropathic pain by treatment of OSA. This approach is certainly worth considering in patients who have not responded to more traditional therapy.

Correspondence
Fong Wong, DDS, MS, Associate Professor, Department of Restorative Dental Sciences, College of Dentistry, University of Florida, 1395 Center Drive, PO Box 100435, Gainesville, FL 32610; Fwong@dental.ufl.edu

http://www.mdedge.com/jfponline/article/77872/neurology/peripheral-neuropathy-linked-obstructive-sleep-apnea

Sleep Deprivation Can Lead To More Pain And Weakness

Today's post from brainlessblogger.blogspot.nl (see link below) looks at the effects of impaired sleep patterns on fibromyalgia patients. Fibromyalgia is also a neurological condition closely linked to other forms of neuropathy and many neuropathy patients are well aware that their problems getting quality sleep have an on-going effect on the rest of their lives. The article looks at studies that suggest that short-term sleep deprivation can lead to an increase in adrenalin production and the patient actually feeling better ('running on adrenalin'). However, long-term sleep impairment does lead to an increase in pain due to fatigue and a build up of over-worked neural activity. Neuropathy patients are often kept awake, or wakened, by the pain or tingling itself, leading to a vicious circle of symptoms that reduce the quality of life considerably. The conclusion is that good sleep is essential - no surprise there but if lack of quality sleep is a problem for you, it's worthwhile getting expert advice to achieve as much undisturbed sleep as is possible in your case.

sleep duration and fibromyalgia pain intensity
Tuesday, January 12, 2016

Insomnia, sleep disorders and impaired sleep have always been considered significant factors in regards to fibromyalgia syndrome and even explored as a cause to the syndrome. It is during deep sleep that people produce significant amounts of growth hormone which repair and maintain muscles. Therefore lack of deep sleep and interrupted sleep, which are predominate features with FM, have long been considered factors in pain intensity along with lack of overall time sleeping. Lack of sleep, therefore, must relate to pain levels. A recent study in the Journal of Pain, 2012, suggests this is not necessarily the case.


The Study


74 people with FM were asked to be a part of the University of Florida study and were observed over a 14 day time period. Given the small test group and time frame of the study we have to take these results with a grain of salt. In the study set up FM patients had a sleep diary where they would record how their sleep went and they also were to rate their pain levels every evening.

"For this study, a research team from the University of Florida hypothesized that decreased total sleep time would predict higher clinical pain in a sample of patients with fibromyalgia…Results of the analysis showed that four sleep measures evaluated in the study failed to significantly predict clinical pain. The authors noted that the effects of impaired sleep, such as fatigue and inactivity, may play more significant roles in clinical pain than measures of sleep duration or insomnia. Sciencedaily.com"

Why the results are surprising

These results are surprising because we would expect the opposite. Historically other studies have shown disruptive sleep patterns in people with chronic pain conditions will produce increased pain. Lack of sleep is in fact a factor that can produce pain in healthy people as well. Given the majority of FM patients have disrupted sleep one would expect the results to show decreased duration of sleep would increase pain the next day.

Why we cannot draw firm conclusions

The study is only of 74 people so this is not a large study and we cannot draw any conclusions from one small study. Secondly, the duration of the study itself was short, only over a span of two weeks, which given the nature of chronic pain and sleep disorders is hardly significant. A few days of less sleep can get someone, who regularly gets disrupted sleep, into a sleep deprivation state running on adrenaline. For the short term this will actually make them function fairly well on a pain basis. They will be in 'fight or flight' mode and not feel as much pain, or at least, not right away. However, accumulated sleep deprivation will cause the pain to build up such that we often see with FM the morning muscle pain being severe in the morning and becoming less severe as the day goes on. Ironically, also with short, disrupted sleep someone with FM may feel very alert in the morning because they have not actually gotten much sleep. They do not feel the pain from being in one position for a long period of time so there is no muscle aches from that. The lack of sleep, initially, makes them feel alert, energized and with no morning stiffness and pain. Whereas, longer durations of sleep are often still of poor quality leaving someone with FM still feeling groggy. They will often wake up with morning stiffness and pain from laying in one position for too long if they have managed to be asleep for any length of time. It is not necessarily duration that is a factor but quality. Therefore, it is not necessarily the case that decreasing the total sleep time would increase the pain the next day with someone with FM. Ten hours of poor quality sleep where the person woke up frequently and spent very little time in deep sleep cannot be compared to five solid good hours of sleep. Ten hours of poor quality sleep may leave the person feeling groggy, stiff and sore, while the five hours of restorative sleep may leave them feeling alert and well rested.

Nevertheless, FM patients suffer from poor quality sleep and, at times, other sleep disorders such as restless leg syndrome (RLS) or sleep apnea. Whether the duration of their sleep affects intensity or not certainly lack of sleep affects fatigue, mood and likely even overall health. It is vital with FM to try and maintain healthy sleep habits and a regular sleep cycle. Quality of sleep is just as important as quantity of sleep.

http://brainlessblogger.blogspot.com/2016/01/sleep-duration-and-fibromyalgia-pain.html

Sleep Apnea And Neuropathy Linked

Today's post from jfponline.com (see link below) looks at the relationship between neuropathy and OSN (obstructive sleep apnoea). There have long been suggestions that the two conditions are linked but this article looks at some evidence via case studies. It certainly seems that many people with neuropathy also have sleep apnoea (where you actually stop breathing a number of times during sleep - mostly harmless but can be serious) the moderator of this blog among them. The question is, does either condition cause the other, or play a part in causing it? Interesting read.

Peripheral neuropathy linked to obstructive sleep apnoea? J Fam Pract. 2013 October;62(10):577-578.

OSA may not be the first thing that comes to mind when examining a patient with peripheral neuropathy, but treating the sleep disorder can produce surprising benefits.

Siegfried Schmidt, MD, PhD; Anthony Rodrigues, MD; Maria Elisa Lupi, MD; Fong Wong, DDS, MS

Department of Community Health and Family Medicine, College of Medicine (Drs. Schmidt and Lupi), Department of Restorative Dental Sciences, College of Dentistry (Dr. Wong), University of Florida, Gainesville; Department of Child Neurology, Floating Hospital for Children at Tufts Medical Center and Tufts University School of Medicine, Boston, Mass (Dr. Rodrigues)

Fwong@dental.ufl.edu

The authors reported no potential conflict of interest relevant to this article.

CASE A 57-year-old white woman presented with symptoms of bilateral “stocking-like numbness” and the sensation of “wearing socks for a few weeks” but denied any injury, previous chemotherapy, or diabetes. Her medical history was positive for untreated obstructive sleep apnea (OSA), obesity (body mass index, 36 kg/m2), osteoarthritis in various joints, impaired fasting glucose with normal glycosylated hemoglobin (HbA1c), hypertension, gastroesophageal reflux disease, hypothyroidism, hypercholesterolemia, and osteoporosis.

Our initial examination revealed decreased sensation to light palpation and pin prick over the distal portion of her lower extremities in a stocking-like fashion. Proprioception was decreased at the distal joint of the big toe. Her deep tendon reflex pattern was symmetric with 2+ at the knees, ankles, and toes. The rest of her lower extremity exam was within normal limits and there were no obvious vascular abnormalities.

Given the suspicion of peripheral neuropathy, the patient underwent laboratory tests and a nerve conduction study. Vitamin B12, vitamin B1, methylmalonic acid (MMA), thyroid function, thyroid peroxidase (TPO), serum protein electrophoresis (SPEP), rapid plasma reagin (RPR), sedimentation rate, vitamin D, complete blood count, and chemistry profile 24 were all negative. The antinuclear antibody test revealed a homogenous 1:80 titer with a negative nuclear deoxyribonucleic acid. Her fasting glucose had been elevated between 107 to 117 mg/dL in the last 5 years but HbA1c was normal (5.8%). The patient had not been diagnosed with diabetes and her latest glucose values had been stable.

However, electromyography and a nerve conduction study were abnormal, with electrophysiological evidence of mild axonal polyneuropathy. During the month prior to her presentation, she had developed burning pain in addition to the numbness/stocking sensation. Pregabalin, gabapentin, duloxetine, celecoxib, hydrocodone, methadone, and other medications were ineffective. Eventually the foot pain became so severe—she described it as “walking on tacks”—that she was unable to walk.

Our team decided to do a nerve block to relieve the pain. Initially she underwent right and later left peroneal and posterior tibial nerve blocks, which gave her immediate relief that lasted about 2 months.

Relief from the pain, but what about the OSA symptoms?

In the meantime, our patient developed increasing OSA symptoms, including snoring, nonrestorative sleep, daytime somnolence, and fatigue. (To learn more about OSA, see “Obstructive sleep apnea: A diagnostic and treatment guide” on page 565.)

Her history of mild-to-moderate OSA dated back 2 years, and included an apnea-hypopnea index (AHI) of 20 events per hour and 133 episodes of oxygen desaturation with a low O2 desaturation of 83%. The patient had never been treated, however, because she felt that she couldn’t tolerate the continuous positive airway pressure (CPAP) mask.

The patient finally agreed to a CPAP titration study. Her AHI improved from 20 to less than 2 events per hour; the oxygen desaturation dropped from 133 to 104 episodes; and the lowest O2 desaturation went from 83% to 85%.

When we initially started CPAP, our patient did not tolerate it very well. However, after consulting with our sleep clinic, she was placed on bilevel positive airway pressure, which she did tolerate. Surprisingly, she also noticed immediate improvement of the neuropathic foot pain; after a few weeks it resolved completely.

Still no foot pain…We continue to follow the patient’s progress and, after 3 years, she remains free of foot pain. Her initial numbness remains, however. She has not After starting CPAP, the patient noticed immediate improvement of the neuropathic foot pain; after a few weeks, it resolved completely. developed diabetes, with similar fasting sugar levels and an HbA1c of 5.4%. She is not taking any medication for neuropathic pain, but remains on methadone for unrelated severe intractable osteoarthritic pain of the lumbar spine, bilateral knee joints, and left hip.

The link between sleep apnea and neuropathy

Our case report suggests that clinicians should consider OSA as a cause of neuropathic pain. A recent review of the literature supports the relationship between the 2 conditions.

The prevalence of neuropathy in the general population is 2.4%, rising to 8% with advancing age.1 Many different types of peripheral neuropathy have been described; they have different symptoms and characteristics, depending on the specific part of the nervous system that is affected.2

The literature reveals a strong association between OSA and peripheral neuropathy and sight-threatening retinopathy.3 One study found that nearly 60% of patients with diabetes and OSA also have peripheral neuropathy.4 Another report found that OSA is an independent risk factor for axonal damage of peripheral nerves.5 Furthermore, a case-control study revealed that the impaired neural function is at least partly reversible with treatment for sleep apnea.4 Finally, Tahrani et al6 have found that “neuropathy prevalence was higher in patients with OSA than those without” (60% vs 27%; P is less than .001), which supports our case finding.

The specific mechanism linking OSA and neuropathy remains elusive, but the evidence suggests that peripheral nervous tissue is affected by chronic endoneural hypoxia in this patient population.7 In patients with OSA, 2 types of nerve dysfunction are apparent: ischemia-related axonal degeneration and resistance to ischemic nerve failure.8

An approach worth considering. While nerve blocks did provide some relief for our patient, they are not a long-term solution. To our knowledge, this case report is the first one published in the United States describing resolution of neuropathic pain by treatment of OSA. This approach is certainly worth considering in patients who have not responded to more traditional therapy.

Correspondence

Fong Wong, DDS, MS, Associate Professor, Department of Restorative Dental Sciences, College of Dentistry, University of Florida, 1395 Center Drive, PO Box 100435, Gainesville, FL 32610; Fwong@dental.ufl.edu

 http://www.jfponline.com/topics/neurologic/article/peripheral-neuropathy-linked-to-obstructive-sleep-apnea.html

HOMOEOPTHIC REMEDIES FOR SLEEP APNEA

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly, and you feel tired even after a full night's sleep.

The main types of sleep apnea are:

Obstructive sleep apnea, the more common form that occurs when throat muscles relax.

Central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing.

Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, occurs when someone has both obstructive sleep apnea and central sleep apnea.

·         Symptoms--Loud snoring, which is usually more prominent in obstructive sleep apnea

·         Episodes of breathing cessation during sleep witnessed by another person

·         Abrupt awakenings accompanied by shortness of breath, which more likely indicates central sleep apnea

·         Awakening with a dry mouth or sore throat

·         Morning headache

·         Difficulty staying asleep (insomnia)

·         Excessive daytime sleepiness (hypersomnia)

·         Attention problems

·         Irritability

HOMOEOPATHIC REMEDIES

ARSENICUM ALBUM 30--Arsenicum album is often prescribed for individuals who have breathing difficulties at night,  and is considered for people with a fearful, tense and agitated response to illness. Arsenicum album is derived from arsenious oxide and is a deadly poison when consumed in excess

AMMONIUM CARB 30-Much oppression in breathing. Cough every morning about  three o’ clock with  dyspnea and palpitation

CADMIUM SULPH 30- Stops breathing on going to sleep. Wakes up suffocating. Fears to go to sleep gain.

DIGITALIS PURPUREA 30- Due to heart disease. Sudden sensation as if heart stood still.

KALI CARB 30- Wakes about two o’ clock and cannot sleep again

LACHESIS 200-Lachesis is  prescribed for conditions that worsen at night. It is designed for people who are typically fearful and anxious, but also prone to jealousy and excessive talking

OPIUM 30- Loss of breath on falling asleep

SPONGIA 30--This remedy for croup may help congestive sleep apnea sufferers as it treats respiratory symptoms that worsen when lying down.  It relieves tightness in the chest.  it is prescribed for individuals who are naturally fearful and suffer from anxiety and, in some cases, heart palpitations.

SULPHUR 200—Sulphur is used  for nighttime congestion and sweating.  Sulphur combats a wheezy cough and congested head, both of which are suffered in sleep apnea, Sulphur is noted for its effectiveness with emotionally sheltered individuals who bottle up their feelings.

Sleep and sleeplessness

The wonder of sleep is often praised, after losing it. Sleep is a treasure to human beings, which cannot be achieved all the time, when needed by all. If you wish to sleep, the harder you try and concentrate on going to sleep the more horrible it will be and impossible it becomes. It is just like walking towards the rising sun, which will go up, as you walk towards it and finally it settles on your back and vanishes.
Homeopathy gives much importance to general symptoms of the body i.e. symptoms that affect a person as a whole. For example thirst, appetite, sweat, urine, stool, sleep, menses, etc. Since sleep is one among the general symptoms that affect a person in mind and body as a whole, Homeopathy gives much importance to it.
Before discussing sleeplessness, everyone should know what sleep is? Why do we sleep? What are its advantages? What is the minimum requirement of sleep?…& so on.
What is sleep? The rest taken by the human brain is called sleep. Nature switches on the automatic mode for body functions and provides rest and refreshment for the brain, for doing better work on the next day. The brain’s learning, retrieval and communicating skills get refreshed during this period. Sleep is essential for all and it plays a major role in normal body functions and in development and maintenance of health. To have good health, everyone should eat well, work well and sleep well.
Nature has programmed everything with its own biological clock. It implies that man must work or be active in the daytime and take rest at night. But in this tensed, hurried and greedy world, man overworks day and night with overwork or overtime, disturbing or discarding sleep. Deprivation of sleep results in many psychological and physical complaints. With sleep-deprived money, people buy costly waterbeds or some other costly beds and decorate bedrooms to make a pleasant atmosphere for getting good sleep. But the fact is, even in a queen’s bed, thorns (hands) of the biological clock would make anybody feel uneasy, restless and sleepless. i.e. you can buy a bed, but cannot buy sleep.
Everyone would like to sleep for a long time peacefully, without any disturbance of light, sound or emotion. It is for a relaxed old age that people work overtime during the younger days. Overtime work makes one work hard by avoiding sleep but finally makes him to spend much of the money earned, to get peace and sleep. Overtime workers voluntarily lose sleep and later run behind it.
The general benefits of sleep are:

• It relaxes the mind after a hurried, tense day time
• It relieves tiredness accompanied by relaxed muscles
• It slows and steadies the pulse and blood pressure
• It is more refreshing than anything else
• It is really good for physical health and the mind
• It is the best medicine either for physical or psychological complaints
• All harboured thoughts get released during sleep
• Sleep gives peace

Occurrence – Length and depth of the sleep is an age related phenomena i.e. it varies from childhood to old age. All through life, its rhythm and frequency changes constantly. In the first year of the child, the sleeping period rapidly decreases from 20 hours to 16 hours and after that till the adolescent period, it gets slowly decreased from 16 to 8 hours. Then it gets slowly increased for some period followed or alternated by long waking periods.
In old people, it decreases slowly to frequent naps followed by long waking periods i.e. the classical sleep of the aged. Sometimes the increased sleeping mode in the aged continues and people sleep continuously like a child. The occurrence and time of sleep varies. The minimum requirement of sleep also varies, depending on the age. For an adult it is 6-8 hours. In general

• Children sleep more
• Women sleep more than men

Occasions where sleep is more

• Tiredness
• Alcoholism
• Vitamin deficiency
• Febrile period
• Neurological complaints
• Excessive sexual indulgence
• Sleeping sickness (African trypanosomiaisis – spreads through tsetse flies)

Factors which favour sleep

• Night time
• Light music
• Cool climate
• Hot bath
• Warm milk
• Heavy meal
• Reading

Sedative drugs
How it occurs – Usually a person slips into sleep when he/she is exhausted physically or mentally. As soon as he/she feels sleepy, he/she yawns, voluntary tightening and relaxing the muscles by holding a deep breath. The eyelids feel heavy and droop. These are all responses to the signal of the brain to the body to get ready for sleep. If there is no disturbance, execution of sleep takes place smoothly under the favourable situation. It needs nothing more than shutting the eye window and mind door. Now the brain can take rest comfortably. This process of execution is done with stimulus from the sleep centre in the brain.
Sleep centre – The hypothalamic region in the basal part of the brain, called Reticular Activating System (which consists of upper medulla, pons and mid brain), is the centre of sleep. It is the recipient of highest blood supply in the brain. It regulates the autonomic functions of the body i.e. regulates the body temperature, food intake, thirst, sleep, emotions, gastric acid regulation and sexual behaviour. Sleep is induced or controlled by serotonin, a hormone produced by the Raphe nuclei of this system which regulates the human biological clock. Serotonin secretion is more in the case of a child and gradually decreases as age advances. Hence, due to lack of serotonin, old people suffer from sleeplessness.
When the time of the biological clock is altered, it creates a jet lag situation. This situation often occurs in persons who travel for a long time abroad where there is difference in time. This situation leads to more tiredness, even after long sleep, instead of the person feeling refreshed. This type of unsatisfied sleeps leads to insomnia (sleeplessness). It can also occur due to emotions, depression, deep thoughts, stress, painful disease conditions, and hormonal changes.
Symptoms

During start up

• Fatigue , tiredness & drowsiness
• Deep breaths
• Drooping eyelids
• Yawning (contracts and relaxes the muscles or respiration and abdomen)
• Lack of concentration and learning process is diminished

During sleep

• It provides rest or slow relaxed process for all parts of the body
• Slow contraction and relaxation of the muscles
• Slow pulse rate, heart rate and respiratory rate
• Dreams are like live show; everyone can note the smile of children during sleep
• Bedwetting in deep sleep

For good sleep Do’s

• Do regular exercises or meditation
• Take light diet
• Take warm milk before bedtime
• Go to bed in a relaxed mood
• Wear loose garments
• Keep the light dim
• If your work is sedentary, go for a walk in the evening
• Keep away all your work from the bed or bedroom
• Sleep regularly at a particular time and wake up at a particular time
• Keep the room cool and well aerated

Have soft bed spreads, pillows and bedcovers
Avoid

• Sleeping in the day time or evening
• Eating heavy meal before bedtime
• Loud music
• Emotional or thrilling serials or movies
• Change of place
• Coffee and tea
• External stimuli – smoking, alcohol, lights & loud music
• Fear of any kind or irritability

Types of sleep – Sleep has been under continuous research for centuries. There are two types of sleep patterns depending on EEG changes. They occur usually in an alternate manner.
1) Slow wave sleep – It is the initial period of sleep where there is slow & steady breathing without any eye movement. It is followed by short REM sleep which is again followed by slow wave sleep. During this type of sleep, muscles are relaxed. Disorders of this slow wave sleep are automatic or like sleep talking and sleepwalking. It cannot be recalled or recollected by the sleeper. Self-talking and sleepwalking is common in children and rare in adults. Likewise, after getting alternated with REM sleep on the second or third occasion, in the slow wave sleep – dreaming about terrors, screaming and violent behaviour can occur. The reasons for talking, walking and dreaming is less understood and unexplainable. The length of slow wave sleep is more in aged people.
2) REM (Rapid eye movement) – Active or Paradoxical sleep – This type of sleep usually follows after an hour of slow wave sleep. Then for every 1 to 1½ hours, it recurs alternating with slow wave sleep. These cycles repeat several times throughout the night. The period of rapid eye movements prolongs one after another and leads to waking up. During this period, the brain activity will be fast and irregular, and is accompanied by REM. When the brain gets activated by this sleep, we dream and recollect undone work or deep emotions. Twitching or jerking movements can occur during this stage. Usually, in the case of males, this period of sleep is accompanied by penile erections.
Even though REM looks like shallow sleep due to dreams, the arousal threshold is higher, during this pattern. REM is vital in providing ultimate needs to our mental health and refreshment. Lack of REM will lead to tiredness and irritability. Drug induced sleep is mostly deprived of this type of REM sleep. So it always leads to tiredness, hallucinations, behavioral changes and impaired memory. The length of REM sleep is more in children. The newborn or children smile with peaceful dreams during this sleep. Disorders of REM are nightmares, sleep paralysis and hallucinations – it mostly occurs in the early stage of sleep or while getting up. The dreams of REM can be recollected after waking up.
Investigations of sleep
Sleep laboratories investigate about body position, brain activity, trace for sleep apnoea, snoring, pulse rate, heart rate, respiratory movement of chest and abdomen, from the period of lying for sleep to waking up from sleep.
EEG is a graphical representation of the electrical activity of the brain, by means of waves, namely alpha, beta, delta, theta, lambda, MU, etc. In case of triggers or epilepsy, spike wave pattern occurs in EEG. The sleep bundles usually occur in EEG, during slow wave deep sleep.
Researchers conclude that sleep is the ultimate biological requirement and quote it as unpredictable and unexplainable. Its inadequacy leads to physical and psychological complaints. They further say it can also cause premature ageing.
Then, what is sleeplessness or insomnia?
Sleeplessness – insomnia
Silence is a great treasure. Silent sleep is more than that. Sleeplessness (owl’s night) is a condition where people used to keep awake at night due to difficulty in sleeping. It is called insomnia in medical terminology. t is the condition where sleep is unable to be performed perfectly and peacefully for an expected proper time in a continuous manner. Generally, sleeplessness varies from reduction in sleep time to complete sleeplessness. Mostly, it is accompanied with tiredness, sleepiness and restlessness in the mornings with lack of satisfaction of having slept well.
Initially, these persons find difficulty in falling asleep, followed by restless and difficult sleep and also in continuing or maintaining the sleeping for the required time. Even a single sleepless night, amidst sleepers, will have an impact on the person in the sense the person will feel bad about it.

Sleeplessness indicates…

• You are in trouble, either with your mind or body
• You are hiding secrets
• You are overconscious
• You are a silent sufferer

Incidence – Sleeplessness is more common in old people. Its beginnings are mostly seen after retirement or emotional stress. The most common sufferers are the unemployed, divorcee or widow or a hospitalised person. Usually, women sleep more than men. In the same manner, they are the leaders in suffering from sleeplessness also.
Causes – As a general rule, there is no smoke without fire. Likewise, without any causative factor or precursor, there won’t be sleeplessness. Sleep can be disturbed for everyone due to urination or thirst. But insomniac patients will have any one of the following triggers that drowns them in a sleepless state.

• Habits of overwork or extended sleeping schedule
• Overexcitement or anxiety or depression
• Thoughtful and restless
• Nightmares
• Drugs and smoking
• Excess coffee or tea intake
• Painful and chronic diseases
• Fear of strangers
• Fear of sex, due to failures
• Fear or change of environments due to strange places, loneliness, hospital stay, etc.
• Fear of any other cause

Diseases which often cause sleeplessness

• Nervous disorders – Any nervous stimulation of reticular system will disturb the person and keep him/her awake. Any lesion of mid pontine area which separates lower portions from cortex will prevent going to sleep, causing complete sleeplessness.
• Respiratory disorders – Any breathing difficulty can cause arousal from sleep
• Circulatory disorders – lack of oxygen, due to poor circulation

Symptoms of sleeplessness

• Sufferer feels – time passes very slowly and finds it difficult to face nights
• Restlessness
• Frequent urination
• Thoughtfulness

Effects of sleeplessness
In children, sleeplessness can cause

• Dullness
• Lack of concentration

Behavioural changes
In adults

• Restlessness
• Psychological impairment
• Accidents in case of restless, waking drivers
• Violent behaviour
• Suicidal tendency
• Leads to rewinding the thoughts of the day and finding fault with what has happened and brooding
• Losing health and wealth by spending a lot on medicines and hospitals, sometimes, loss in business too, due to lack of concentration

The complaints that can occur on sudden waking

• Palpitations
• Headache
• Giddiness
• Tiredness

Disturbances in maintaining or getting deep sleep may be due to
In children

• Habit of grinding teeth and rolling in bed
• Deliriousness – sleep talking
• Somnambulism- sleep walking
• Nose block due to adenoids or polyps
• Heavily enlarged tonsils obstructing the airway
• Coughing and wheezing at night or lying posture
• Hyperactivity – being restless, they cannot maintain a position to get sleep
• Nightmares
• Aching muscles and aching bones· Frequent urination due to urinary tract infection or bedwetting

In adults or the aged

• Frequent urination due to diabetes or urinary tract infection
• Snoring or respiratory disorders causing sleep apnoea
• Hunger pain or acid pain of peptic ulcer
• Headache
• Hypertension
• Wheezing
• Painful joints or muscles (cramps)
• Abdomen or digestive disorders
• Prostate enlargement and Priapism (persistent painful erection condition of penis)
• Cholesterol stones of gall bladder which float and obstruct the bile duct in lying posture

To get immersed in good sleep and making sleeping easy
Do’s

• Better take a walk before sleep
• Relieve tension, anxiety, fear and expect tomorrow’s dawn of brightness
• Take a warm bath
• Read mind relaxing books for sometime before sleep
• Take a light meal, if there is any digestive or abdominal disturbances
• Get treated for diseases, if any – nose block, snoring, sleep apnoea, sinuses, diabetes, urinary tract infection, psychological complaints
• Stay in comfortable position and situation to get a good start-up.

Avoid using

• Habit forming sleeping pills
• Stimulants

Sleep promoters
Natural – fruits, nuts, milk & heavy foods usually act as sleep promoters
Artificial – alcohol and drugs (tranquilizer – which calms a person’s brain without clouding consciousness, i.e. diazepam group of drugs)
Diagnosis – Being mostly psychological, diagnosing sleeplessness is very much difficult, unless patient reveals everything to the doctor. To do quality service, in an effective manner, analysis of the cause should be done in every case for removing it or getting cured. To attain easy solutions, analyse the physical and mental state of the patient with the history of the patient, from start-up of the complaints which will mostly guide the case. In case of a child, it is much more difficult to find the cause, unless there is a visual pathology or otherwise the child must be analysed in a sleep lab with EEG changes.


Treatment – In allopathy, sedative treatments (which provide tranquilizers) are given for all types of
insomniac patients. The tranquilizer works very temporarily. Also, most of the hypertensive patients, psychologically disturbed patients and diabetic patients are given sedative drugs with their routine drugs, in order to avoid tension. In the same manner, allopathic medicines used for allergic rhinitis or allergic skin diseases and cough have sedative soothing effects. Sleep disturbances related to physical problems like pain, breathlessness or psychological problems like anxiety, drug withdrawal, nightmares and depression are not analysed in detail, but given habit-forming sedatives to get temporary relief. The effects of these drugs, in due course, will diminish. Then again, to get better sleep, doctor and patient go on adding the dose and frequency of the medicines.
Likewise, all the chronic disease sufferers suffer from sleeplessness, which may be due to diseases or drug-induced. They are also given nothing but sedatives. In case of local pathology-like adenoids, tonsils, painful arthritis and cough, allopaths provide antibiotic and anti-inflammatory drugs, which work only for a week or so. After that, the complaints usually re-start. Sometimes people resort to surgery, to eliminate pathology.
Side-effects of sedative drugs – Sleeping pills always give only artificial, temporary sleep, which will not refresh us fully due to lack of REM sleep. Also, taking merely sleeping pills is just like shutting off the light, instead of removing the cause. If you are going to take sleeping pills, don’t forget your next day is going to be more sleepless than the present-day. Since patients use it as a routine, they are not aware of this symptom. If pills are prescribed for depression or other complaints, the patient can take those drugs only if they are ready to go to sleep even in the daytime, to calm themselves.
Sleepiness and drowsiness are the common side-effects. Also all sleeping pills can cause serious side-effects like tremor, stupor, coma, weakness, dizziness, clumsiness, hallucinations, confusion, depression, rashes, slow heart beat, constipation or diarrhoea and sometimes even death can occur with heavy overdoses. The sleeping pills work in all ways to make the brain dull and sleepy. So, you cannot give those drugs to children or persons whose alertness is important in learning or working (for example – drivers, pilots, etc,). Also, the most distinguishing feature of all sleeping pills is habit forming.
Homeopathic approach on sleeplessness – Sleep arises from the balance of the inhibition and arousal stimuli. First of all, calm your mind and shut all your thoughts, then sleep will not or never get away. Some people go on changing the place and positions, covering the face, legs, ears, hands and eyes, switching off the lights, etc., for getting good sleep. Every tic of the clock will alarm, trigger and wake them up. Sleep is not the matter of all those things, but it is in the calmness of the mind. Removing the actual cause could help.
Usually, in Homeopathy, the remedy is selected on the basis of symptoms of the patient, including physical, mental (emotional states, depression, anxious, etc) and family history. Homeopathy treats the patients, rather than the diseases or its effects. Homeopathy acts neurologically and helps the brain attain calmness. So it can give a permanent solution. It gives psychological support to withstand emotional conditions. Homeopathy, with its dynamic approach, can cure sleeplessness wonderfully. The major credit point with Homeopathy is its nil side-effects and also its effective cure which is permanent without any persistent usage of drugs or dependency or habit-forming.
In Homeopathy, the choice of medicine differs for early awakening, sleeping late, frequent awakening, sleeplessness after midnight or before midnight, sleeplessness at night and sleeping in the morning, etc. The complaints which recur after sudden awakening can also be cured completely. Likewise, Homeopathy considers even dreams for choosing the correct and apt medicine. There are lots and lots of medicines in Homeopathy, particularly fear of snakes, ghosts, strangers, etc., – for every type of dream, the choice of drug differs.
The ultimate secret is no magic prescription can cure all your sleeplessness, unless you reveal everything you feel, including the causative factor and take effort in removing it. So, longing for longer sleep ends here with apt Homeopathy treatment and counselling. One important thing for patients used to tranquilizers – it is better to stop it or withdraw slowly or otherwise there will be a rebound of sickness or more sleeplessness. Likewise, the stimulants should also be withdrawn slowly, under the supervision and advice of the doctor.
The results of Homeopathy treatment are not drowsiness but will be very peaceful refreshment. Homeopathic medicines commonly used in case of sleeplessness are Aconite, Arg Nit, Ars alb, Chamomilla, Gelsemium, Hyosyamus, Ignatia, Kali phos, Nat mur, Nux Vom, Opium, Passiflora, Pulsatilla, Rauwolfia, Staphysagria, Rhus Tox, etc. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath. So, you don’t have to suffer from sleeplessness any more.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)

Laxmi Homeo Clinic

24 E. New Mahalipatti Road

Madurai, TN 625 001

India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)

Fax: +91-452-233-0196

E-mail:  drcheena@yahoo.com

www.drcheena.com / www.drcheena.in

(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)