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Monday 3 April 2017

SLEEP DISORDERS AND HOMEOPATHY

                        SLEEP DISORDERS AND HOMEOPATHY 

    Nearly one-third of human life is spent in sleep an easily reversible state of relative unresponsiveness and serenity which occurs more or less regularly and repetitively each day.
The EEG recordings show typical features of sleep which are broadly divided into two broadly different phases. 
1. D-sleep(desynchronised or dreaming sleep) also called as REM-sleep (rapid eye movement sleep) active sleep or paradoxical sleep. 
2. S-sleep(synchronised sleep) also called as NREM-sleep(non-Rem sleep) quiet sleep or orthodox sleep. S-sleep or NREM-sleep is further divided into four stages ranging from stages 1 to 4. As the person falls asleep the person first passes through these stages of NREM- sleep. 
   Definition:  A condition of body and mind which typically recurs for several hours every night in which the nervous system is inactive the eyes closed the postural muscles relaxed and consciousness practically suspended. 
    Sleep is a biological process and is required to maintain a normal health. However, normally it varies widely from person to person. Excessive sleep is called hypersomnia and less or on sleep is called insomnia. The cause of these two extreme aspects of sleep vary widely. However, a chronic recurrent form of hypersomnia is seen Narcolepsy. This is usually seen in teenagers where there is irresistible or uncontrollable sleep. It may be associated with
1. Sleep attacks associated with REM(Rapid eye movement)
2. Cataplexy or sudden development of muscular hypotonicity developing after emotion or surprise.
3. Sleep paralysis when the individual though conscious and realizing all about him cannot move his limbs or speaks and
4. Hypnagogic hallucination which is a dream-like an experience midway between wakefulness and sleep. 

   Narcolepsy is inherited as an autosomal dominant trait. MAO inhibitors or amphetamine may give relief. Sometimes hypersomnia may be associated with polyphagia and is periodic in nature occurring in teenagers or young boys. This is called Klein-levin syndrome. This condition readily improves during the adult stage. Sometimes clonazepam may be helpful. Nocturnal myoclonus is also seen in hypersomnia. During sleep, there will be periodic lower leg movement associated with daytime sleepiness
anxiety, depression on, and cognitive defect. Sleep apnoea is another type of hypersomnia. Here there will be a cessation of breathing for about 10 seconds to 2 minutes or more during sleep. There are two types of sleep apnoea-obstructive and central. Obese middle-aged and older individuals with hypertension and CCG usually develop sleep apnoea. Symptoms are snoring, restlessness during sleep, daytime sleepiness, headache, loss of memory, depression, cardiac arrhythmia, loss of judgment and blood gas abnormality. During apnoea, sleep becomes lighter or the patient takes a deep breath and awakens. Daytime sleepiness and excessive snoring during sleep are present. In this disorder usually, there may be an upper respiratory defect or a central defect causing absence of diaphragmatic movement. Usually, there is a history of moderate alcohol consumption at bedtime. Moderate weight reduction, air administration under pressure in nasopharynx and acetazolamide or tricyclic antidepressants may be of help. Medical treatment is not of much help. If there is upper respiratory obstruction surgical correction may be done. Oxygen or hypnotic drugs are risky. There are also various drugs are risky. There are also various other types of sleep disorders called parasomnias or abnormal behavior during sleep. Some of these are nocturnal enuresis, nightmares, night terror, sleep talking and sleep walking. All these are usually seen in childhood to adult life. As age advances these problems usually disappear. For nocturnal enuresis imipramine in a dose of 25-50 mg at bedtime or ADH, preparations are very much effective.

Sleep disorders: 
 The various sleep disorders are divided into 2 subtypes: 
1. Dyssomnias
a. Insomnia
b. Hypersomnia c. Disorders of sleep-wake schedule.
2. Parasomnias
a. Stage 4 sleep disorders
b. Other sleep disorders

Dyssomnias: Are sleep disorders that are characterized by disturbances in the amount quality or timing of sleep. These are the commonest disorders of sleep. 
Insomnia: Insomnia is also known as the disorder of initiation and Maintenance of sleep(DIMS). Insomnia means one or more of the following: 
1. Difficulty in initiating sleep(Going off to sleep).
2.Difficulty in maintaining sleep(remaining asleep).
This can include both: a. Frequent awakenings during the night, and b. Early morning awakening.
3. Non-restorative sleep where despite an adequate duration of sleep, there is a feeling of not having rested fully(poor quality sleep). 
Insomnia is very common with nearly 15-30% of general population complaining of a period of insomnia per year requiring treatment. It is required for diagnosis that sleep disturbance occurs at least three times a week for at least 1 month and that it causes either marked distress or interferes with social and occupational functioning. 
Common Causes of Insomnia
1. Medical illness, 2. Any painful or uncomfortable condition,3. Respiratory diseases, 4. Rheumatic and musculoskeletal disease, 5.Old age, 6. Brain stem or hypothalamic lesions, 7. Delirium, 8. PMS(Periodic movements in sleep)
2. Alcohol and drug use
1. Drug or alcohol withdrawal syndrome, 2.Delirium treatments, 3. Amphetamine or other stimulants e.g. caffeine, 4. Psychiatric disorders. 
3. Current medication e.g. steroids 
4. Psychiatric disorders. 1. Mania. 2.Major depression 3.Dysthymia, 4. Anxiety disorder, 5. Stressful life situation
5. Idiopathic insomnia.

Hypersomnia: Hypersomnia is also known as disorder of excessive more of the following: (1) Excessive daytime sleepiness.2.Sleep attacks during daytime(falling asleep unintentionally). (3)Sleep drunkenness(person needs much more time to awaken, and during this period is confused or disoriented)
Medical illnesses
1.Narcolepsy. 2. sleep apnoea. 3. kleine-Levin syndrome. 4.Menstrual-associated somnolence. 5. Sleep deprivation. 
Alcohol and drug use:
1. Stimulant withdrawal. 2.Alcohol intoxication. 3.Use of CNS depressant medications. 

Disorders of sleep-wake schedule: These are characterized by a disturbance in the timing of sleep. The person with this disorder is not able to sleep when he wishes to although at other times he is able to sleep adequately. 
Etiology: Jet lag or rapid change of time zone. This typically occurs during international flights crossing many time zones. At the new place, the person's internal time of sleep and the sleep time of surroundings are different.
2. Work shift from day to night or vice versa
3. Unusual sleep phases: some persons are unable to sleep early.They typically sleep late at night and get up late in the morning. They are called as OWLS. 

Parasomnias: Parasomnias are dysfunctions or episodic nocturnal events occurring with sleep. Sleep stages or partial arousals. Most parasomnias are common in childhood though they may persist into adulthood. 
  Stage 4 sleep disorders: 1. sleepwalking (somnambulism): The patient carries out automatic motor activities that range from simple to complex. 2. Sleep terrors or night terrors(Pavor nocturnus): The patient suddenly gets up screaming with autonomic arousal.
3. Sleep-related enuresis(Bedwetting)
4. Bruxism(Teeth-grinding): The patients has an Involuntary and forceful grinding of teeth during sleep.Though the bed partner reports loud sounds produced by grinding of teeth and destruction of the tooth enamel is obvious.
5.  Sleep-talking(somniloquy): The patient talks during stages 3 to 4 of sleep but does not remember anything about it in the morning on awakening.
Other sleep disorders: Nightmares(Dream anxiety disorder) occur during the REM-sleep. They are characterized by fearful dreams occurring most commonly in the last one-third of night sleep. The person wakes up very frightened and remembers the dream vividly. Other sleep disorders include nocturnal angina nocturnal asthma nocturnal seizures, paroxysm small nocturnal haemoglobinuria nocturnal head banging and familial sleep paralysis. 
Sleep Hygiene
Some basic components of sleep hygiene are:
1. Regular, daily physical exercises (preferably not in
the evening).
2. Minimize daytime napping.
3. Avoid fluid intake and heavy meals just before bedtime.
4. Avoid caffeine intake (e.g. tea, coffee, cola drinks)
before sleeping hours.
5. Avoid regular use of alcohol (especially avoid the use of
alcohol as a hypnotic for promoting sleep).
6. Avoid reading or watching television while in bed.
7. Sleep in a dark, quiet, and comfortable environment.
8. Regular times for going to sleep and waking-up

9. Try relaxation techniques

Homeopathic remedies for sleep

    Belladonna: The sleeplessness conditions calling for belladonna are due to congestion sleep is extremely restless as a rule it is interrupted by talking, starting muscular jerkings and spasmodic motions, frightful images appear on closing the eyes and the patient there for dreads sleep. Children awake from sleep frightened. Oftentimes there is a violent throbbing in the brain which prevents sleep. The dreams found under belladonna are frightful ones and they constantly awaken the patient. 
    Nux vomica: The great characteristic of this remedy is that the patient is very sleepy in the evening cannot keep awake moreover the sleep is not sound or restful and the patient is awakened at night by anxiety and frightful dreams. He awakens at about four or five O'clock in the morning feeling somewhat refreshed but soon restless and awakens at the usual time feeling worse than ever. It is especially the remedy for those who drink too much those who abuse coffee and tea those who are subject to abdominal disorders and a sluggish portal circulation. Sleeplessness from mental overwork from a too close study, especially at night. The morning sleep aggravates all the affections.Pulsatilla is sleepless in the evening falling asleep very late; the sleep is restless with frequent awakening and troubled dreams. Sleeplessness after quinine, iron, strychnine, tea, or chloral. Cocculus has sleeplessness from mental activity. Sulphur.Cat naps; the slightest noise awakens and it is difficult to get to sleep again, sleepy in daytime. 
   Hyoscyamus: Sleeplessness from nervous excitement; the brain is full of bewildering ideas and images.After the long illness and the brain cells are ill-nourished this remedy is very useful. It is especially indicated in sleeplessness in children, who twitch, cry out frightened and tremble. Sleeplessness from overworked minds and without apparent cause may be benefited by Hyoscyamus."The patient is jolly and wakeful.Hyoscyamus lacks the anxiety of aconite the violence of belladonna the pessimism of nux vomica, and the stupidity of gelsemium.   
   Coffea. Cruda: In cases where there is excessive agitation of body and mind and where ideas force themselves on the mind Coffea is the remedy and its use as a beverage withheld. It will be found that this acts better in the higher potencies. The patient is wide awake, without the slightest inclination to sleep and all the senses are extremely acute.It is the remedy when excitement or good news joys or night watching cause the INSOMNIA. It is well suited to sleeplessness in teething children while opium is better suited to adults. Sleeplessness from the bad effects of too good news. Platina has sleeplessness from extreme nervous irritability. 
   Chamomilla: For sleeplessness in children due to severe pain, chamomilla is a sovereign remedy. It quiets the irritability and the emotional excitement and the patient sleeps. It is also adapted to weak nervous women. The sleep is tormented by dreams which are fanciful vivid and anxious the patient is hot and thirsty. Moaning in sleep. This is also a remedy acting better in the higher potencies.
   Gelsemium: For the insomnia of brain workers, Gelsemium is a remedy. It is indicated in businessmen who pass restless nights awaken early in the morning and worry over their business affairs. It also is most useful in a state of alternate excitement and depression.It also is most useful in a state of alternate excitement and depression. Bryonia is useful where the business cares of the day keep him awake. Gelsemium has also sleeplessness emotional disturbances and after evening company. 
   Sulphur: Sleeplessness from nervous excitement cutaneous irritation and external heat. The patient is drowsy all day and sleepless at night. Sleep in cat naps wakes frequently. Arsenicum is a useful remedy for the sleeplessness of malnutrition where there is general degeneration of the blood and exhaustion of the nervous system. Restlessness pf anaemic irritability.
    Cannabis Indica: In obstinate and intractable forms of insomnia cannabis is one of the best remedies we have to induce sleep. An irregular sleep is more of an indication than absolute insomnia. It produces a tranquil slumber relieves the nervousness and neuralgic pains. 
    Passiflora incarnata: Passiflora incarnata in mother tincture form in doses of from 30 to 60 drops, and repeated if necessary, will induce sleep when mental irritation or pain is the cause of the wakefulness. Camphora mono-bromate is useful for sleeplessness due to the continued use of tea. 
     Scleranthus: Scleranthus the grasshopper mind, various thoughts coming in from all angles, bits of this and that never quite finishing with one thought before another pops in. Scleranthus allows the mind to be more directed focussed centered and clear. 
    Honeysuckle: Honeysuckle is the remedy for those who suffer dreams, nightmares, flashbacks or any recurring thoughts from the past. Honeysuckle will bring you into the present time so the thoughts and images from the past have no need to be there. 
    Vervain: Verain is the remedy for a very busy mind, who is always planning, organizing, over-enthusiastic, intense, over busy. Vervain allows your mind to relax. 

Rubrics from different repertories: 
Kent repertory: 
Sleep: COMATOSE: 3. Aant-t, arg-n, bapt, bell, croc, nux-m,                                     op,Veret. 2. aeth, agar, agn, apis, arn, ars, asaf. 
SLEEP: DISTURBED: 3. Graph, Sulph 2. apis, ars, Calc-p, laur, 
SLEEP: Dreams, absurd: 2 glon, sulph, 1 apis, chin, coloc, ferr-m,                                          mygal, pip-m,rumx, thuj.
SLEEP: DREAMS: accidents: 3Ars, Graph, 2. Nux-v, 1 iod, iodof,                                         jab, kali-c.
SLEEP: DREAMS: amorous: 3.Am-m, lach, nat-c, nux-v, op, ph-                                    ac, staph, viol-t. 
SLEEP: RESTLESS: 3: Acon, ars, bar-c, bell, calc-ar, chin, cina,                                       cocc, cupr, graph, kali-ar, lyc, op, puls, rhus-t,                              sil, sulph. 
SLEEP: SLEEPINESS: 3. Alum, ant-c, ant-t, apis, ars, bapt, bell,                            cann-i, carb-s, carb-v, casut, chel, chin, croc, graph,              kali-ar, lach, merc-c, nux-v, op, ph-ac, phos, pic-ac, podo,                 puls, sulph, thuj. 
SLEEP: SLEEPLESSNESS: 3. Arg-n, ars, bell, bry, cact, calc,                                   cham, chin, cit-v, coff, cycl, hep, hyos, kali-ar, kali-                       c, lach, merc, merc-c, nux-v, op, phos, plb, puls, rhus-                    t, sep, sil, stann, staph, sulph, thuj. 
sleep all day, sleepless all night, body aches all over: 3staph. 

Respiration: SNORING: 3. Lach, Op. 2. brom, camph, carl, cham,                                         chin, cic, cupr, hep, ign, nux-v, rhus-t,                                         sulph. 
SLEEP: UNREFRESHING: 3. Lach, Mag-c, Mag-m, Nit-ac, Phos.                             2alum, am-c, arg-n, ars, bar-c, bell, carl, chel,                                      chin, clem, cob, cocc, cycl, dig, guaj, lec, lyc,                       nat-m, nux-v, op, petr, podo, puls, sep, sil, spig, sulph,                   zinc. 

Schuessler Tissue Salts:

    Take the following remedies for the various disorders, ten tablets each twice per day until condition improves.
For insomnia: 
Natrum muriaticum 30X 
Kali phosphorica 12X 
For oversleeping: 
Natrum sulphorica 12X 
For nightmares: 
Natrum sulphorica 12X 
For awake screaming: 
Kali phosphorica 12X 
For crying out in sleep: 
Calcarea phosphorica 12X 
For tiredness in the morning: 
Natrum muriaticum 12X 
Calcarea phosphorica 12X 
For those hard to wake in the morning: 
Calcarea phosphorica 12X 
For constant desire to sleep in the morning: 
Natrum muriaticum 30X
For sleep that does not refresh: 
Natrum muriaticum 12X 
For great drowsiness in old persons: 
Silica 30X 
For jerking of limbs during sleep: 
Silica 30X 
Natrum muriaticum 20X 
For anxious dreams: 
Natrum muriaticum 12X
For vivid dreams: 
Kali sulphorica 12X









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