Friday, 19 July 2013

Grandma and Milk

"Grandma, what color is your hair? White. Just like milk!

I was moved by my grandson’s observation who, at age two, likes “white milk”.
The primordial nutrient, that brings with it comfort, tenderness, growth and nutrition.
Milk is good!
My grandson didn’t tell me that my hair was white as snow, which is cold and burns, and he wasn’t talking about saudade”.
In his childhood wisdom, he was going against the foul words spoken by a Social Democratic deputy who, in a moment of parliamentary theatricality, said that “our fatherland was contaminated by the gray plague” (sic).
In order to speak against the systematic violence against the elderly, now also perpetrated in our country’s highest Chamber, I did some research on the accomplishments of said gray haired guys: the “plague”. Here are but a few: 
·        Morse developed the Morse Code at age 47;
·        Edgar Rice Burroughs, creator of Tarzan, was a War correspondent at age 67;
·        Bell was still inventing at age 75 and Edison produced the telephone at age 84;
·        Golda Meir was Prime Minister at age 70 and Winston Churchill both at 66 and 77 years old, and Adenauer at age 88.
·        Both Charles de Gaulle and Ronald Reagan were presidents at age 69.
·        Benjamin Franklin gave his contribution to the US Constitution at age 81.
·        Goethe finished “Faustus” at age 81, Tolstoi wrote “I cannot be silent” at 82, Somerset Maugham wrote “Viewpoints” at age 84, and Bernard Shaw wrote the “Farfetched Fables” at age 93;
·        Claude Monet still painted in his 70’s – 80’s, Michelangelo in his 80’s and Picasso in his 90’s.
·        Albert Schweizer still worked on the operating table at age 89;
·        Elizabeth Arden and Coco Chanel both took care of their respective companies until they were over 85 years old.
·        Rubinstein played in his 90’s and Pablo Casals while over 96 years of age;
·        Tesichi Igarishi climbed Mount Fuji on foot in his 100th birthday;
·        Manoel de Oliveira directed twenty films after his 82nd birthday and released his film “Gebo and the Shadow” while he was 104 years old.

One might argue that these are only a few and successful people, while there is an enormous amount of useless and ill elderly that make society spend an enormous quantity of money. The foolish inverted pyramid!
While they don’t decide to retake the old Sparta’s habit of throwing the elderly into the sea, perhaps in Sagres or Cape Espichel, I would like to name but a few elderly who anonymously and without  glamour, continue to prove their usefulness every single day:
·        There are mothers in their 80’s that must once again take care of their unemployed sons;
·        There are grandparents taking care of the household members suddenly unemployed or divorced;
·        There are husbands or wives taking care of their now demented partners;
·        There are many elderly all over the country, taking care of their plantation or villages, and so maintaining our secular identities.
·        There are many elderly still working and making a living;
·        There are many elderly stubbornly living alone.There are many elderly who are unique deposits of our cultural knowledge and of our collective memories;
·        There are many gray heads ruling over Europe’s destiny;
·        There is a national solidarity network of people and institutions, organized beside the current state of affairs, that maintains untouched and alive churches, homes and other social institutions;
·        In Europe, it is mainly gray haired people who silently perpetrate in each church our Lord Jesus’ memento: “Do this in my name”.

The Scriptures teach us that age brings wisdom. Thus, the biblical patriarchs, Abraham, Isaac and Jacob were elderly, and the most stable institutions in History, such as the Religious Churches, Universities or the Armed Forces, have been governed by gray haired people.
Our deputy surely did not have the pleasure of being in his grandmother’s lap, nor does he have parents with gray hair.
Since my hair is white as milk, I am really sorry for you. I’m sorry for you and for all those who can’t see anything in their lives beyond money, power and possessions.
I’m sorry for those who, as Pope Francis says, are contaminated by indifference’s globalization.
I’m sorry for those who don’t include any sort of transcendence in their daily lives.
And therefore, especially for you, Mr. Deputy, and for whoever feels like reading it, I leave a psalm for an eventual meditation.

Psalm 92:12-14

The justs will flourish like a palm tree and will grow as Lebanon’s cedar trees; planted in the Lord’s Home they will flourish in Our Lord’s court. They will still bear fruit in their elder age and will remain fresh and verdant. 

Professor Teresa Paiva
Lisbon, July 19th 2013

Friday, 12 July 2013

Guardian Angels

It happened on July 2nd around 9:30 am.
It was a noise, so loud and unknown, that no one could identify what it was.
One had to run…to run from something unnamed and terrible.
When I opened my bedroom door, I saw the street and a burned neighbor crying for help.
The stairs were filled with glass, wood and debris. The phone call to 911 was messy: “An explosion, on Conde das Antas Street, in Campolide it’s serious.” “We already know!”
Everything was black, and the fire was starting, wrapped in an even darker smoke. Terrifying.
What about the grandson, who I had heard in the backyard just before? He was alright, Anabela cried. “I heard a noise, a candle fell on my nose, and I cried”. To take him away from the fire was imperative; friends from the office appeared as by miracle in the garden and came towards us; we left, towards the corner to peek at the fire.
Cars burning in the street, one first, then another and another. A jeep burning beneath my window. How to avoid fire? A hose? The house is going to burn…No one can think straight in these circumstances.
A man filled with glass cuts laying on the street. Ambulances arrive. The firefighters arrive and quickly put out the fire.
We are together and each one tells her story. Ana watched a bus stopped because someone had their car blocking its way and opened the window. The explosion threw her underneath another desk and filled her with glasses, she fainted but, Sofia, who had also been hit by glasses, came to her aid, and both were unharmed, other than a small pain resulting from the fall. Ana V. entered the corner where the computers are seconds before the explosion, which meant she saved herself from all debris thrown like bullets. Teresa and Vera had just left, a minute before the explosion and when it happened, they were safe on the next street. Deolinda was in the gym and ran towards the others. They ran to the garden in search of a safe haven. Everybody was alright.
There weren’t any patients in the Office. The one who had just made an exam had just left, the one who had an EEG appointment at 9:30 had canceled, another forgot her consultation. For unexplained reasons, I had canceled that day’s appointments.
I now look back. I was feeling a bit lazy and took longer to get up, and it was those precise seconds that saved me from a rather certain death. We had all escaped by a narrow edge.
This street, where there’s usually a fair amount of traffic was empty, no cars were passing by when the explosion happened. The bus went on his way moments before, taking all its passengers with him.
A neighbor, whose jeep burned, harassed himself for a moment, then looked to his parents’ home completely destroyed an thought: “They went away in vacation just yesterday and are all right. What a relief!”
An elderly grandmother had just gone somewhere with her grandson, took a bit longer than she should have coming back; she was on the corner of the street, away and safe from any danger.
The destruction was monumental, doors, glass and windows had disappeared in three buildings; the fire had ravaged  the street, there were broken glasses in many locations through the surrounding streets.
Many helped us: our neighborhood’s delegate, Dr. André Couto, was flawless, and like him, both his staff, the Police and the civil protection.
I thought how good it was to have a 19th and 20th century house, with such sound foundations, whose structure resisted the impact, and I mentally thanked the Pereira Coutinho family.
Friends called giving comfort and asking “What can I do?” It was good, very good.
I called my daughter and my son-in-law. “It was bad…” They rushed over to give an enormous help and an invaluable support.
But we were alright, protected by forces bigger than ourselves and that, one by one, took care of us. Without a single injury in a sea of debris.
The guardian angels had protected the Practice and had taken care of us.
A deep appreciation; a deeper gratitude, because as we pray in the “Our Father”, “we had been delivered from Evil”.
When I am told “What bad luck!” I think, “No, we were very lucky!”
And this is how, together, we are putting things back up, as a strong and united team.
And today, now that the worse is behind us, I feel the guardian angel’s protection hovering over this house and quietly go to sleep.

Professor Teresa Paiva

Lisbon, July 11 2013

Friday, 21 June 2013

"Marialvas" and Superwomen

In my young days, “Marialvas” dedicated themselves to cars and women, or bullfighting and women, with or without a mixture of fado and copious amounts of alcohol. Handsome or ugly, they wouldn’t be particularly smart or educated, but they carried themselves tirelessly in the aforementioned occupations.
Back in those days, women were either mothers or women, rarely both, since when mothers gained in size and, rounded themselves, they would lose their husband’s interest; or when they were women, they would surround themselves with single aunts and/or maids, worried with dresses and parties they would delegate attention on their children to secondary plans.
Today, everything is different.
Today’s superwomen are everything: mothers, spouses, professionals and maids; and to accomplish such feats they perform acrobatic pirouettes in order to accomplish everything in a proper fashion: they take care of their children, they take care of themselves for their husband, they are perfect in their workplace and still tidy up the house.
This is impossible! You cannot accomplish everything, especially since they do not have the time to be themselves.
Tense and irritable, they organize themselves more and more and then lose themselves in grim consequences: breakdowns, depression, separation and other clumsiness, and many broken dreams despite their hard work and great commitment.
What about men? A wise man doesn’t brag about his female conquests, nor about his cars’ supersonic speeds, nor his wine soaked nights. If he did, he would have feminists to worry about, journalists, and a whole bunch of critics, and who knows even police pursuits.
What do they brag themselves about? I amaze myself with what I hear in the “media”, in a repetitive and successive manner, a sentence with a glint of self-praise: “I don’t sleep much, but…”; “I sleep little time”; “I didn’t sleep”.
They get little sleep? Would someone want a surgeon to operate them, with imprecise hands and sleepy eyes because of lack of sleep? Of course not.
Then why would we want that those who govern important institutions or nations, who deal with day to day affairs or who deal with important economic aspects, who work here and there in the most varied institutions, or – to sum it up – those who need to think, deal with those matters in sleep deprivation?
It is known that sleep deprivation affects the frontal lobe and its executive functions, affecting the abstract reasoning as well, thought flexibility, and creative capacity, memory and learning.
In his book “Sleep Fahring”, Jim Horne questions exactly what effects sleep deprivation has on people in key decision positions.
Indeed, the most important advice Clinton gave Obama was for him to sleep well, since he did some mistakes each time he didn’t sleep enough.
Back to the “old school”, we don’t have a record of Dr. Mário Soares ever bragging about not sleeping enough, and nor did Einstein.

Because … who doesn’t sleep well doesn’t think well and, as Nietzsche said in “Thus spoke Zarathustra”: “All of you, who love frenzied work (...), your labor is the curse and the desire of forgetting who you are.” 

Professor Teresa Paiva
Lisbon, June 21 2013

Friday, 7 June 2013

A healthy mind in a healthy body

With the discovery of electricity, industrial and technological development, control over energy, food production, telecommunications, etc; and with social paradigms turning towards “having” and “success”, international society has changed and developed new habits and new tendencies towards work. Society is now continuous, first 24h per day, and then 7 days per week. Enjoyment changed and extended through the night. In this setting, Sleep became and embarrassment for work, productivity and economic interests.
Therefore, since last century, people have been sleeping less and less, and this deficit extends to all age categories.
Previously, no one questioned how much a baby should sleep, now I am asked if 8 hours are enough?! During my teenage years, we would have dinner early and TV broadcasts ended at midnight with the national anthem, now dinner is had later and later, and TV broadcasts never end. We would go out on a date with a “chaperon” and our parent’s permission, and now sweethearts are together by starting at each other through their cellphones. We would thank God for our “daily bread” and nothing went to waste, nowadays there’s food in abundance inside shopping malls and supermarkets.
We convinced ourselves that we have no limits.
The number of poor is increasing, and millions are beneath the poverty threshold; divorce and single parent families increase; and so do Sleep related illnesses.
The warnings about the risks of this behavior are many, but in global society they do not speak loud enough, choked by the systematic challenges and incentives in the opposite direction
However, the risks and consequences are serious. In all ages and in all continents, not enough sleep or too much sleep increases the risk of obesity, hypertension, type II diabetes, accidents, cancer, depression, insomnia, and early death. Superimposed on all these risks are those that affect the brain, reducing the memory, learning, creativity, problem solving and affecting emotions and emotional stability.
Because during sleep, our brain, released from the focus given to the outside, shifts said focus towards itself and towards our body; and both these dialogues are essential to our health.
During Sleep, the millennia old paradigm “a sound mind in a sound body” reaches its maximum intensity.
Our brain takes care of itself, increasing the intensity of sleep in more stimulated areas while awake (areas related to learning, for example), reconnecting important circuits and bonding quick interconnections between zones that speak with one another, disconnecting circuits in order to rest, deleting irrelevant information and strengthening that which matters.
Since one does not learn what one does not like, a sleeping brain stabilizes emotions; since to learn one must experiment, our brain creates, through dreams, virtual realities where, without risk, one can argue, run, fight, talk or cry; and since one must innovate, dreams are about the impossible, without forgetting the root of that which is real.
In teenagers and children, loss of sleep increases distractibility and irritability, in opposition to adequate sleep which consolidates memory.
On the other hand, sleep deprivation affects memory of neutral and positive stimuli. This effect leads to remembering negative stimuli, and enhances behavioral tendencies towards impulsiveness to negative stimuli, and relating to a lesser degree of expression towards emotional stimuli.
Sleep deprivation also has behavioral consequences such as higher chance of trauma, unintentional accidents in children, adolescents and adults.
The connection between Sleep and Intellect has been indirectly appraised through connections between Sleep Characteristics, having been found certain correlations between sleep zones and IQ.
It is known that a sleep episode following a learning period will enhance said learning. This is said to be true for verbal tasks, motor tasks, special orientation tasks and more specialized performances, such as playing music.
On the other hand, the daytime apprenticeship of a motor task is related and linearly correlated with the increase of Delta activity and Time Zones, in the following sleeping period, in the contralateral motor region.
The effects of sleep in memory consolidation have been described in early 19th and 20th century, but there is presently a significant quotient of papers on the matter, that restates the function and effect of sleep in memory consolidation, procedure consolidation and also in declarative memory. On the other hand, not only does sleep enhance but also protects declarative memory.
It is known since the 1960’s that declarative memory is affected by sleep or by sleep deprivation. A 36h sleep deprivation significantly diminishes the temporal sequence retention, even if aided by heavy doses of caffeine, and also affects the correct perception of said performance.
The idea that sleeps enhances creativity is sprung by tales concerning several scientists and artists who have disclosed having created their masterpieces right after waking up, or after a dream or a hypnagogic stage.
A more detailed disclosure is due to Kekulé, concerning a dream that leads him to the discovery of the Benzene Ring. Others can be also mentioned: Singer’s discovery of the sewing machine gearings, Dali’s paintings, Mr. Jeckyll’s Book by Stevenson, Paul McCartney’s Imagine, Kurosawa’s “Dreams” film, amongst many others.
The effect of sleep is not only to code and consolidate memories or learning, but rather to integrate in into new associative schemes, that through generalization or integration, could show new perspectives or directions, giving reason to the popular saying: “Night brings good counsel”.
Several experiments were conducted towards proving this integration capacity “again”, in adults as well as in pre-lingual children.
Having been taken into account, nocturnal sleep allows, for all age groups, the consolidation of memories, and enhances concepts of information generalization, and the identification of hidden solutions.
Knowledge concerning the effects of sleep on emotions comes from the increase in irritability and bad temper after a sleep deprivation night, characteristics that worsen if said deprivation is repeated. Nonetheless, it is also known that acute deprivation can also have an antidepressant effect, used years prior in the treatment of serious depressions.
On the other hand, it is known that both stress and positive or negative emotions happening during the day both affect sleep.
An increase in positive events contributes to a better subjective sleep, and a good night’s sleep enhances the recognition of images with emotional components. Negative events worsen sleep to many, good or bad, sleepers.
In this perspective, sleep deprivation functions both as a time bomb for irritability outbreaks in normal life and may explain depressive humor in many psychiatric disturbances.
At last, multiple sleep related diseases, or medical diseases, both neurologic and psychiatric that impact sleep in a primordial way, systematically affect memory, attention and executive functions.
Thus, the habit of sleeping less in intellectual workers significantly affects reasoning capabilities (memory, learning, creativity), executive functions and emotional abilities, which are essential to the execution of the intellectual tasks at hand.
Therefore, if body and brain are our tools, to put them in jeopardy equals killing “the hen with the golden eggs” in every professional.
In conclusion: to think right, it’s important to sleep right!

What about our body?
Risks to our body related to sleep deprivation have already been said. Why?
During sleep periods, anabolic hormones are systematically and regularly produced, meaning the growth hormone, prolactin and testosterone, and catabolizing hormones are regulated, particularly cortisol and the thyroidal hormone.
It all happens in a way that you either grow or repair tissues in different organs while you sleep, and reproductive functions are regulated. It all happens so that, in the morning while waking up, cortisol is at an adequate level, in order for the day to start well. But if you do not get enough sleep, anabolic hormones diminish and catabolizing hormones increase, and health risks start to appear.
On the other hand, sleep is essential in energy regulation and in homeostasis, for temperature control, which goes down while we sleep, and for energy control through nourishment, in a balance that diminishes our hunger or increases our hunger. For all this, having not enough sleep leads to fatigue, and increases height gain risk in all age groups.
Sleep as also a narrow and complex relation with immunities, and not sleeping increases the chance for infectious diseases and eventually auto-immune diseases.
While asleep, cell division is controlled, therefore little sleep or out of hours or irregular sleep increase the chance of cancer in both genders.
No limits - The technological age’s grandest illusion.
Not sleeping is in fact risking a roman aphorism: “A healthy mind in a healthy body”.

Professor Teresa Paiva
Lisbon, June 7th 2013

Friday, 31 May 2013

A better sleep? It's possible!

“I go to bed and can’t fall asleep!” “At night, I wake up often!” “When the alarm goes off, I have been awake for a while” “I never have a restful sleep” “I always had bad sleep! Nothing can be done!” “My lack of sleep is killing me!”

These are some of the more despaired and stressful complaints patients often get off their chests while searching, nonetheless, for a specialized assistance from Sleep Medicine to remedy their insomnia related disorders.

However, most of those who suffer its consequences in their daily lives, don’t even know that it’s possible to improve the quality of their sleep. Most of all, they have no idea of how important that is for their physical health, their emotional balance and for their performance in their daily activities.
We live in a 24 hours society, with multiple attractive stimuli, which lead and car
ouse us into prolonged waking periods. Continuous TV shows, convenience stores open 24/7, the overall increase of shift labors or the nightlife sensation lead us into a state of permanent alert, as if the day became the night, disregarding the circadian rhythm that regulates our existence.

We also live in a rushed life, where more time is never enough for all we must or want to do…or should do during the day. It is as a last minute race to catch a train, that often leads to Nowhere, since we want or need so many destinations. Not only our day becomes our night, but it also threatens the diversity and intensity of our daily experiences – tasks, thoughts, emotions, projects, concerns or issues – which leads to activity levels that delay the arrival of drowsiness and disturb its prolonged effect during the night.

Our good or bad sleep can’t be blamed to a single source; but rather to several factors – environmental, behavioral, cognitive, emotional – which become obstacles to the normal workings of our sleep-wake system, which we know (or don’t know) to be involuntary. We are strict when complaining about that a rough night will bring us a bad day.

Underlining the patient’s comments, which I quoted at the beginning of this text, there are many factors related to insomnia, which we will soon deal about in this blog.
For now, there is a message of hope made clear in the title of this text: BETTER SLEEP IS POSSIBLE!
Therefore, if you have a bad sleep, don’t resign yourself to it. And most of all, never give up learning about how to sleep better.

Helena Rebelo Pinto, Psychologist, PhD

Lisbon May 31st 2013 

Friday, 10 May 2013

The "unknown" Narcolepsy

What is it?

Narcolepsy is a chronic, autoimmune sleep disorder, which often begins in childhood or adolescence.
Its primary symptoms are:
Frequent daytime drowsiness, with uncontrollable urges to sleep, relieved by taking short naps;
Cataplexy, which is the sudden loss of strength in the entire body or in specific segments, provoked by strong emotions or scares. No fainting!
Hypnagogic hallucinations, which is seeing unreal  and often scary images while falling asleep;
Sleep Paralysis, which is the inability to move when waking up
Insomnia, or nocturnal sleep difficulties

Which kinds are there?
Narcolepsy with cataplexy or without cataplexy.
How is it diagnosed?
The diagnostic is made by its symptoms and by a Polysomnography, followed by a Multiple Sleep Latency Test.
There are other biologic signs:
A diminution of orexin in the Cephalorachidian Fluid;
 Increased prevalence of HLA subtypes  (HLA DQ B6 01 02)

How to treat?
It depends on the symptoms. The purpose is to treat drowsiness, avoid cataplexy and the hypnagogic hallucinations as well as insomnia. Wakefulness stimulants and hypnotic drugs are implied.
Do not mistake with laziness!
Do not mistake with epilepsy!
Do not mistake with other sleep related disorders!
Do not mistake with chronic sleep deprivation (lack of sleep)!
It’s a rare but serious disease! It must be treated!
If you fall asleep all over the place, get yourself treated!

Professor Teresa Paiva
Lisbon, May 10th 2013 

Friday, 3 May 2013

Forget the evening tea!

- For a better rest, I drink some tea which, I am told, is good for sleeping.
- Before going to sleep, I drink some warm milk and eat a couple of cookies.
- I drink a lot of water during the day, over 2 liters, mostly at tea-time and after dinner.
- What I prefer is hot chocolate, warm enough to cuddle my stomach.
- When I take my medicine, I drink a large mug of water.
- Yes, but I drink at night, I have a bottle at my bedside table and drink as I wake.
Truth be told, these are all things not to be done, especially by older people. Why?
Because excess liquids at the end of the day, after tea-time and dinner, will increase the necessity to urinate during the night.
Waking up to urinate causes two big issues in older people:
-          Increased difficulty in falling back to sleep. This increases as one gets older. Consequence: one spends more time awake, which can determine insomnia or sleep reduction.
-          Getting up to urinate during the night presents large risks for the elderly. Why? Because they might fall down, and fractures in the elderly are particularly dangerous.
What to do? If you’re in need of urinate during the night, lit up a light, and try to keep yourself from getting confused. Remove any slippery carpets and any impediments or obstacles between the bedroom and the bathroom, and ABOVE ALL ELSE, avoid liquids post dinner time, reducing them to a bare minimum. Remember that the risk of falling down for those that take sleeping drugs is higher.
Don’t forget: Past a certain age, keep from drinking at the end of the day so that you don’t urinate by night. 

Professor Teresa Paiva
Lisbon, May 3rd 2013

Friday, 26 April 2013

Walk around or sleepwalking? Unconsciousness or crime?

There is a general assumption that walking during sleep means having somnambulism. It is an erroneous assumption that often leads to diagnostic errors and huge delays towards consulting a physician.
Why? Because walking during sleep may have several causes, and henceforth several possible treatments.
It can be due to somnambulism. Somnambulism is a well-defined illness: it is the most frequent in boys, it is familiar; it begins around 5 – 6 years of age and tends to disappear during adolescence. The occurrences usually appear during the Delta stage of sleep, known as Slow Wave Sleep, about one hour after falling asleep and won’t happen again in the same night. The sleepwalker scarcely remembers – if at all – what happened, walks around the house in an orderly but unconscious manner, which can amount to accidents, like falling through stairs, or through a window, breaking objects, etc. Usually he isn’t aggressive, but can become aggressive if forced or vexed.
Somnambulism can be provoked by certain psychoactive pills, and become worsened by alcohol, drugs, excessive exercise, fever or sleep deprivation.
Knowledge concerning this is very ancient. In Homer’s Odyssey happens to appear the first described case, and alcohol worsened, wherein Elpenor, Trojan war-hero, drunk some wine after a battle and climbed to a roof, where he slept. In the following morning, when he was called for boarding, he woke up, walked around the roof, and fell to his death. The Elpenor Syndrome is based on these events, and on the risks of roaming episodes when you are asleep or when you suddenly wake up in a confusional arousal.
Recently the movie “Side Effects” dealt about this matter, describing a crime perpetrated in a pseudo sleep walking episode, provoked by an antidepressant, and which would have been “perfect” if a psychiatrist had not been investigated through the policeman’s reasoning.
The psychiatrist could have used a more clinical approach, which means that whenever facing a case of nocturnal violence, one must investigate thoroughly and with exemption, performing tests, polysomnography and whatever is required to reproduce the violent episode, in order to achieve clear conclusions: is it a crime, does it result from illness or foul-play.

Violence during Sleep?
Yes, of course. Violence can exist during sleep and is, in that case, particularly dangerous. Why? Because who performs it is unconscious and the intensity of the acts can be enormous.

What are the causes?
Somnambulism, night terrors and the confusional arousals can be the cause of sleep related violence or accidents.
Another case is nocturnal epilepsy. Some epilepsies appear only or mostly during sleep, and manifest themselves through episodes with simple behaviours (limb movement, screams, etc.) or complex behaviours (walking, sitting on the bed, falling from the bed, aggression, striking, etc.). Mistaken for somnambulism, they are not treated. What are the differences? The epilepsies may appear at different hours of the night, or while falling asleep, they may occur repeatedly during the same night, the behavior is stereotyped and there is no recollection on the following day or when waking up. Waking up tends to be arduous, with pain through the body, headaches or confusion. Epilepsies can appear in children, adults, in the elderly, and some of them can even be familiar.

Other cases, while classically appearing mostly in elderly men, are the REM behavior disorder. What is this? It includes episodes that occur in a dream context, during which someone is attacking either the patient or a relative. The patient defends himself and, in that dreamy defense, violently assaults who’s closest, jumps from the bed as if he were flying, etc. When he wakes, with some difficulty, often because someone is screaming or because he injures himself, he stumbles upon what he has caused and shivers: blackened eyes, strangled necks, blood and gore, broken arms, etc. Those who suffer from this usually are peaceful and sane, and isn’t expressing violence in any way, on the contrary: was rather defending himself from it.
What happened? Dreams where he is the victim of violence, and during which he did not have the classical, normal and protective REM atonia, that transiently paralyses us, and he executed exactly what he was dreaming about.
Both epilepsies and REM behavior disorder require an efficient and urgent treatment, by Sleep Medicine specialists or Neurologists. Somnambulism, in most cases, requires protective and prophylactic measures.
Therefore, never mistake one for the others, because most of the times walking around while asleep is not sleepwalking. 

Professor Teresa Paiva,
Lisbon April 26th 2013

Friday, 19 April 2013

The New Bats

Bats are the only mammals capable of flight.
According to the Wikipedia, there are over 11.116 different species representing one quarter of all mammal species in the world. Besides that, they come in various shapes and sizes, they have a fantastic capacity for environmental adaptation, they have one of the most varied diets amongst mammals and have a sophisticated system of echolocation.
I don’t know which of these characteristics is more enviable. Is it their flight? Is it their sonar? Or perhaps their sleep duration of twenty hours per day? In fact despite their prolonged sleeping hours, they have been tranquilly surviving for millions of years.
Is it envy? Yes, I would say so because nowadays I give consultations to patients of all ages with their sleeping habits upside-down. They go to bed after 6am, and get up in the middle of the afternoon!
They sleep by day, to be awake by night, the night long working, playing, chatting, and surfing on the web, producing or creating something, or simply watching television with more or less zapping.
They are young, teenager or young adults, they are middle aged persons, in creative professions – or not, they are retired elderly who let themselves lull by the night.
Social life - It’s not easy. Health - It’s certainly hard, since, and I will say this often, sleeping by day entails to special and serious health concerns.
Why? We are not bats, or mice, or owls. We are human beings and we were made, genetically and physiologically, to live by day, and the presence of electrical light will not convince our body otherwise.
The day-night regulation, called circadian regulation, was precociously acquired during the evolution of life on Earth by blue bacteria, called cyanobacteria, who wanted to avoid the sun induced mutations in their reproduction cycles. This circadian organisation capacity exists throughout all living beings, in both animals and plants.
It is so old, so intrinsic, and so essential, that electric light will not thwart it.
Back to the bats - these fantastic flying animals had a huge impact on many cultures: if they are a symbol of happiness and longevity in Chinese tradition, and in Cinema, Batman is a saviour, in most cultures these extraordinary animals are associated to something grim, to sadness, to vampires and to death; and in Western Africa, some consider them to be the representation of a “torn soul”.
I have an enormous admiration for bats, but I must say that most bat men and women I have encountered had some sort of angst and sadness, as if something in them was actually “torn”. 

Professor Teresa Paiva
Lisbon April 19th 2013


Friday, 12 April 2013

Article by Doctor Luís Portela, President of Bial Foundation

The blog "In Search of Lost Sleep"

Why do we need to sleep? What happens inside the human body while we sleep? How important is Sleep in our daily activities? Why do we dream and what is the meaning of dreams? These questions often leave us wanting to learn more about. These questions become of paramount importance when in today’s society, we can see the quality and quantity of Sleep worsen. 
However, while there is much uncertainty surrounding this particular topic, there is also much certainty. Nowadays, it is believed that reducing the number of sleep hours has consequences over the physical and mental health. Sleeping badly can be associated to an increased risk of hypertension, cardiovascular diseases, diabetes, depression and other pathologies. On the other hand, lack of sleep is also responsible for work and traffic related accidents. 
It is unquestionable that sleep plays an important role in balancing our physical, emotional and social development. So, the creation of this space for awareness, education and sharing of doubts regarding this subject is to be commended. I am sure that the blog “In Search of Lost Sleep” will help us to sleep more, to sleep better and to have sweet dreams. 
My blessings to Professor Teresa Paiva,

Doctor Luís Portela, President of Bial Foundation
Lisbon, April 12th 2013

Friday, 5 April 2013

The Director of Lloyd’s Bank and the President of North Korea

The Director of Lloyd’s bank admitted to having a health problem due sleep deprivation and overwork.
Kim Jong-un, President and Military commander of North Korea, sleeps three hours a day and fasts often.
Horta Osório recognized his situation as a serious one, while Jong-un is believed to be a genius.
In London, it was said that sleep deprivation would reach over 50% of the population. What about in Portugal? There are alarming indicators: 50% of the young adults and teenagers have excessive somnolence. I daily attend patients with sleep deprivation and/or overwork.
They are from all ages, both sexes and all social classes. They are those that rule and those that are ruled. They are executives, officials, salaried and independent workers, merchants and sellers.
They are those that wish to rise in life, and those that are already there. They are rich, poor and remedied. They are those that work in shifts, and those that do not have office hours. They are mothers and fathers, single mothers with dependent children, fathers with two jobs in order to provide for their family. They are those that make it happen in order to pay their debts and those that demand payments. They are those that exercise in powerful positions and those that have little or no power at all. They are many…
At first you work because you have to. You work all night long, going to bed late and getting up early. You hear praises “Well done!” or “What energy!” The good results are obvious: on time replies, the e-mail does not wait, the cellphones always on. Money comes in, or will come in. Success knocks at the door, or will knock at the door.
But… mistakes first start to emerge, fleeting lapses, that word which you cannot remember, that meeting which you forget, the professional error…
Then comes the irritability, then you are on the edge. Then it’s the untimely yawning and the neglect. Memory fades away.
At first, as soon as you get to bed you sleep right away. But latter, you want to sleep and you cannot. Neither by day nor by night. Gaping eyes, head spinning. Sleepless nights, even while on vacations.
Broken sleep, the lost blessing!
Despair, depression, broken memory, sluggish reasoning, bad humor, and “burned out”.
It happens to the best, to those who are best prepared, to the smartest. Genius don’t get little sleep. Some, like Einstein, were considered to be good sleepers. Sleep has guaranteed survival for millions of years. The foremost beneficiary is the brain. Sleep consolidates memory, learning and abstract knowledge, it helps in problem resolution, stimulates creativity and stabilizes emotions.
In order to think and be well, one must sleep!
The body is the other beneficiary. To sleep too much or too little increases the risk of diabetes, obesity, cardiovascular diseases, hypertension, cancer, accidents and reduces life expectancy.
In order to be healthy, one must sleep!
Rules and regularity is required in sleeping, in eating, in resting and in exercising. Beware! Illness results from mistakes in the natural, common sense, rules!
Limits are needed in work, in credit, in expenses, in pleasure, in pain, in everything.
We are not slaves. We need breaks along the day.
We are not as gladiators; instruments to be thrown away when are met with incapacity.
Where did we achieve with so much work, so much unrest, and so much credit, so much everything?
To a country in crisis, a sick society, with sad people and with no future in sight.
Where will Kim Jung-un go, without any control in his warfare strategies, daring and impulsive? What untold suffering will he bring to his people? How much pain, sadness, devastation will spread throughout that region?
Is this the work of a genius brain or rather the end result of a brain suffering from serious decision making issues and impulsive-aggressive tendencies, aggravated by sleep deprivation?

God rested on the seventh day, and we are certainly no gods. 

Professor Teresa Paiva
Lisbon, April 5th 2013

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Friday, 29 March 2013

To sleep with a clear conscience

“I don’t sleep much, but I sleep with a clear conscience.”
I’ve heard our Prime Minister say this sentence regularly, and since today is the Good Friday, we should take this opportunity to meditate on its meaning.
Today, the Christian world remembers, celebrates and worships the passion and death of Jesus Christ; He who said that it would be easier for a camel to pass through the pin of a needle than for a rich man to enter the Kingdom of Heaven.
The Pope took a name that no other before him had taken, reminding me of a Francis that abandoned all richness, criticized opulence, protected the poor and spoke with Nature.
She was needy, dazedly explaining her woes. She was thin, nervous, with restless and uncertain gestures. She came from afar in search for the hope of a solution.
She did not sleep. It began a while earlier but got worse as time went by, especially in the last year. Nothing seemed to make her get well, nor help her get some sleep; it was a nightmare not to sleep and having to get up early in the morning. She got up at 6 am, worked from 7 am to 10 pm and got to bed by midnight.
“You know…Things are bad…we can’t have employees…we had to lay off several employees since it’s just me and my husband. We have an employee that helps in the kitchen, since he cooks and I wait tables, and I don’t want to overburden him…”
If we add up the working hours and the sleeping hours, we amount to truly scary results. “Share with the husband?” It wasn’t possible since he got in a lot earlier, around 4am, to cook the restaurant lunches. “At least he sleeps well, despite his snoring”.
I worried with the lack of solutions and the ensuing complications. Her insomnia and borderline depression, and her husband apnea. I hesitate in a not so convincing rationality.
She’s thin, nervous, with uncertain gestures and a tired demeanor. She adds up to the main issue: “We lost our house, which we built 12 years ago. When the business started slowing down, we stopped paying our loan and the bank took our house, which we both built with the money we had set aside back then.”
“Is there no alternative?”
“No… It´s definitive! The bank took it and we’re going to a loaned apartment. This hurts me the most.”
This insomnia followed the general model of the 3 P, with precipitating, predisposing and perpetuating factors … But which behaviors to change? How to teach rules regarding Sleep Hygiene? How to lessen the effects of the existing life events?
Indeed it was not just about the insomnia, but also about the crisis in our daily lives, about the immorality of dominant and dominating finances, about one class’ misery which, being less knowledgeable, was duped by financial cheap shortcuts, about the dramatic indifference to similar situations happening in a quick succession, about an economy’s fate which, tired of leeching from the poor, is now leeching from the middle class as well, about a shameful society that doesn’t secure the most basic rights of her citizens and doesn’t protect the weak, doesn’t regulate markets nor the anonymous investor’s greed, and doesn’t punish neither the big offenders nor those responsible for the current state of events, aptly named a “crisis”.
A society that widens the gap between the wealthy and the poor and that excels in creating more impoverishment every day that goes by.
According to Pope Francis, a society like this cannot guarantee Human Rights, and thus cannot wash its hands like Pilates, and cannot sleep with a Clear Conscience. 

Professor Teresa Paiva
Lisbon, March 29th 2013


Friday, 22 March 2013

Multitasking? How silly!

We’re in the age of multitasking. To do a lot of different things at the same time, the more the better.
The housewives have been doing it for a while, with one child on the lap while scolding the other, and cooking lunch as well as thinking of a groceries list as they go along. This fashion took, and many practice it.
Housekeepers dusting off with one hand, while answering the mobile phone, do it. The intellectuals with their PC, TV, MP3 and cellphones, while attempting to erase any free space for any reverie, do it. Children switching from toy to toy, not to get bored, do it. Teenagers with their iPad, SMS, Playstations while they study for the following day’s test, do it. Those who believe in the benefits of physical exercise, walk kilometers on the treadmill or on the elliptical machine while watching TV, speaking on the cellphone, read reports or study subjects, do it. The executives with multiple cellphones: the company’s, the home phone, the one for the special clients, plus their iPads, and the notes passed along to their secretaries, do it. The politicians, also with multiple cellphones, their PC and innumerous aides, asking strategic questions, giving news concerning “pressing” affairs, or suggesting schedules for tomorrow’s meetings, do it. Journalists, salesmen, businessmen, doctors, lawyers, veterinarians, pharmaceuticals, policemen…almost everyone does it
So many people buzzing around in this cacophony of tasks, running like tired horses, without knowing or wondering about the purpose of the race. 
I usually say that these systematic oscillations between tasks are like walking in a zigzag, with successive refocusing periods, for every single task, which leads to more effort and inevitable fatigue.  Zigzagging takes longer than going in a straight line. Furthermore, one does not think straight, nor does one actually ponder on each subject. 
Would Da Vinci or Einstein have amounted to anything if they spent the entire day plugged to their mobile phones?
Meditation techniques, ever so popular nowadays, are meant to quiet our minds and focus our thoughts, which means an opposite perspective to multitasking. The issue at hand is that after a systematic bombardment of the brain and senses, people want to have a good night’s sleep because they are tired. 
Don’t fool yourselves; the brain is like a muscle: when the fatigue is too great, it cannot rest and…farewell Sleep! 

Sleep comes with tranquility, silence and comfort. 

Prof. Teresa Paiva
Lisbon, March 22nd 2013


Friday, 15 March 2013

In Search of Lost Sleep

This blog is launched this very day in order to celebrate two events: The World Sleep Day and the 30th anniversary of CENC – Sleep Medicine Center. 
This year’s theme behind the World Sleep Day is “Good Sleep, Healthy Aging”. A fitting theme for a country where the old adults are progressively more common than the young.
With aging, the older adult’s sleep tends to worsen, which doesn’t translate to having a bad sleep when you’re old. A healthy elder sleeps well! 
What happens as one gets older? There are more medical conditions, more sleep related disturbances and sometimes more reasons for sadness, more disability, less interests and more seclusion. Put together, these separate factors will eventually lead to a bad sleep. But it does not have to be this way. A healthy elder sleeps well!
What to do? Diagnose and heal any existing condition, take care with medication, reducing if excessive (beware any sedative and hypnotic drugs taken regularly), maintain active interests and occupations, as well as sensible and regular habits, eat well and fresh, go outside and catch some sunlight, keep your brain occupied, work out a little and keep some company. 

CENC – Sleep Medicine Center’s 30th anniversary. Founded in 1983, CENC, where at first only electroencephalography was performed, has since then diversified, becoming one of the references in Sleep Medicine in Portugal. Prizing its clinical and scientific quality, and keeping the patient’s interests at heart, CENC has improved over the years and at its 30th anniversary renovates itself once more. How? By improving its installations and equipment, and creating new services. In 2013, the new Sleep Consultation for Children and Teenagers began its practice, as well as the Exercise and Pain Consultations. CENC will also renovate its website in April (, will publish new books as well as launching this blog. 
“In search of lost sleep” is a bilingual blog (Portuguese and English), with a weekly publication, and which will have the participation of colleagues, co-workers, friends, healthcare specialists, citizens and patients. Its purpose is to help in the search for the lost pleasure of a good night’s sleep, and in search for the individual and social balance that can be found due to the enormous benefits of healthy sleep habits, alongside a sound mind and body. You may find this blog in

Prof. Teresa Paiva
Lisbon, March 15th 2013.