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