Sleep Disorders

Nightmares, night terrors, sleepwalking, sleep talking, head banging, wetting the bed and grinding your teeth are kinds of sleep problems called parasomnias. There are treatments for most sleep disorders. Sometimes just having regular sleep habits can help.

Insomnia (in-SOM-ne-ah) is a common sleep disorder. People who have insomnia have trouble falling asleep, staying asleep, or both. As a result, they may get too little sleep or have poor-quality sleep. They may not feel refreshed when they wake up.

Insomnia can cause daytime sleepiness and a lack of energy. It also can make you feel anxious, depressed, or irritable. You may have trouble focusing on tasks, paying attention, learning, and remembering. These problems can prevent you from doing your best at work or school.

Insomnia also can cause other serious problems. For example, you may feel drowsy while driving, which could lead to an accident.

One type of insomnia is sleep apnea, impaired ability to sleep breathe while sleeping. People with sleep apnea have breathless periods of a minute or so from which they awaken gasping for breath. Sleep apnea results from several causes, including genetics, hormones, and old-age deterioration of the brain mechanisms that regulate breathing. Another cause is obesity, especially in middle-aged men. 

Narcolepsy is a sleep disorder that causes excessive sleepiness and frequent daytime sleep attacks. Narcolepsy is a nervous system disorder. The exact cause is unknown. In some patients, narcolepsy is linked to reduced amounts of a protein called hypocretin, which is made in the brain. What causes the brain to produce less of this protein is unclear. There is a possibility that narcolepsy is an autoimmune disorder. An autoimmune disorder is when the body's immune system mistakenly attacks healthy tissue. Narcolepsy tends to run in families. Certain genes are linked to narcolepsy. Narcolepsy has four main symptoms; (1) gradual or sudden attacks of sleepiness during the day, (2) occasional cataplexy, (3) sleep paralysis, and (4) hypnagogic hallucinations. 

Currently, the most common treatment for Narcolepsy is stimulant drugs, such as methylphenidate (Ritalin), which enhance dopamine and norepinephrine activity. 

Another sleep disorder is periodic limb movement disorder, characterized by repeated involuntary movement of the legs and sometimes arms. Frequent or especially vigorous leg movements may awaken the person or his/her partner. In some cases, tranquilizers help suppress the movements. 

A night terror is a sleep disruption that seems similar to a nightmare, but with a far more dramatic presentation. Though night terrors can be alarming for parents who witness them, they're not usually cause for concern or a sign of a deeper medical issue. During a typical night, sleep occurs in several stages. Each is associated with particular brain activity, and it's during the rapid eye movement (REM) stage that most dreaming occurs. Night terrors happen during deep non-REM sleep. Unlike nightmares (which occur during REM sleep), a night terror is not technically a dream, but more like a sudden reaction of fear that happens during the transition from one sleep phase to another.

During a night terror, a child might suddenly sit upright in bed and shout out or scream in distress. The child's breathing and heartbeat might be faster, he or she might sweat, thrash around, and act upset and scared. After a few minutes, or sometimes longer, a child simply calms down and returns to sleep.

Here are some steps recommended by the Mayo Clinic in order to sleep better 

No. 1: Stick to a sleep schedule

Go to bed and get up at the same time every day, even on weekends, holidays and days off. Being consistent reinforces your body's sleep-wake cycle and helps promote better sleep at night. There's a caveat, though. If you don't fall asleep within about 15 minutes, get up and do something relaxing. Go back to bed when you're tired. If you agonize over falling asleep, you might find it even tougher to nod off.

No. 2: Pay attention to what you eat and drink

Don't go to bed either hungry or stuffed. Your discomfort might keep you up. Also limit how much you drink before bed, to prevent disruptive middle-of-the-night trips to the toilet.

Nicotine, caffeine and alcohol deserve caution, too. The stimulating effects of nicotine and caffeine — which take hours to wear off — can wreak havoc with quality sleep. And even though alcohol might make you feel sleepy at first, it can disrupt sleep later in the night.

No. 3: Create a bedtime ritual

Do the same things each night to tell your body it's time to wind down. This might include taking a warm bath or shower, reading a book, or listening to soothing music — preferably with the lights dimmed. Relaxing activities can promote better sleep by easing the transition between wakefulness and drowsiness.

Be wary of using the TV or other electronic devices as part of your bedtime ritual. Some research suggests that screen time or other media use before bedtime interferes with sleep.

No. 4: Get comfortable

Create a room that's ideal for sleeping. Often, this means cool, dark and quiet. Consider using room-darkening shades, earplugs, a fan or other devices to create an environment that suits your needs.

Your mattress and pillow can contribute to better sleep, too. Since the features of good bedding are subjective, choose what feels most comfortable to you. If you share your bed, make sure there's enough room for two. If you have children or pets, set limits on how often they sleep with you — or insist on separate sleeping quarters.

No. 5: Limit daytime naps

Long daytime naps can interfere with nighttime sleep — especially if you're struggling with insomnia or poor sleep quality at night. If you choose to nap during the day, limit yourself to about 10 to 30 minutes and make it during the mid-afternoon.

If you work nights, you'll need to make an exception to the rules about daytime sleeping. In this case, keep your window coverings closed so that sunlight — which adjusts your internal clock — doesn't interrupt your daytime sleep.

No. 6: Include physical activity in your daily routine

Regular physical activity can promote better sleep, helping you to fall asleep faster and to enjoy deeper sleep. Timing is important, though. If you exercise too close to bedtime, you might be too energized to fall asleep. If this seems to be an issue for you, exercise earlier in the day.

No. 7: Manage stress

When you have too much to do — and too much to think about — your sleep is likely to suffer. To help restore peace to your life, consider healthy ways to manage stress. Start with the basics, such as getting organized, setting priorities and delegating tasks. Give yourself permission to take a break when you need one. Share a good laugh with an old friend. Before bed, jot down what's on your mind and then set it aside for tomorrow.

Know when to contact your doctor

Social Pain

Social pain is the experience of pain as a result of interpersonal rejection or loss, such as rejection from a social group, bullying, or the loss of a loved one. Research now shows that social pain results from the activation of certain components in physical pain systems. Although social, clinical, health, and developmental psychologists have each explored aspects of social pain, recent work from the neurosciences provides a coherent, unifying framework for integrative research.

Most doctors don’t recommend Tylenol for a broken heart or a supportive friend for a headache. But an article published by Janet Taylor Spence Award recipient Naomi I. Eisenberger in the February 2012 edition of Current Directions in Psychological Science shows there is a growing body of evidence that social pain shares some of the neural circuitry that underlies physical pain.

Eisenberg explains that physical pain has two components — sensory and affective — each of which is associated with different parts of the brain. Psychological scientists who study social pain have shown that the dorsal anterior cingulated cortex (dACC) and anterior insula, which are crucial to the affective or unpleasant component of pain, are also involved in the experience of social pain. One recent study even indicated that separate regions of the brain associated with the sensory experience of pain were also activated when participants were asked to remember a difficult breakup.

Other studies have suggested that these overlaps in brain activity can affect how people experience social or physical pain. For example, when Eisenberg and her colleagues asked female study participants to rate the pain caused by heat stimuli, the women reported less pain when they were looking at pictures of their romantic partners or holding their romantic partners’ hands. In another experiment, Eisenberg’s team asked participants to take a pill daily and self-report their “hurt feeling” every evening for three weeks. Participants who took acetaminophen (aka Tylenol) daily experienced a decrease in hurt feelings that was not duplicated in the control group, which received a placebo.

There may be an evolutionary explanation for the painful sting of social rejection. Just like physical pain teaches us to avoid dangerous situations, Eisenberg suggests that “over the course of evolutionary history, social pain may have helped us to avoid social rejection, increasing our connections with others, our inclusion in the social group, and ultimately our chances of survival.”

In conclusion, they say, accumulating evidence is revealing that physical and social pain are similar in experience, function, and underlying neural structure. Continuing to explore the commonalities between physical and social pain may provide us with new ways of treating physical pain and new techniques for managing social pain. Having a better understanding of the physical-social pain overlap may help to grant social pain the same status that physical pain has achieved in the medical and clinical communities, as evidenced by the amount of time and attention dedicated to its treatment and prevention.

Alzheimer's Disease

Alzheimer's Disease

Alzheimer's disease is a progressive, degenerative disorder that attacks the brain's nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and behavioral changes. 


           

These neurons, which produce the brain chemical, or neurotransmitter,

acetylcholine, break connections with other nerve cells and ultimately die.

For example, short-term memory fails when Alzheimer's disease first

destroys nerve cells in the hippocampus, and language skills and judgment

decline when neurons die in the cerebral cortex. 


           

Two types of abnormal lesions clog the brains of individuals with 

Alzheimer's disease: Beta-amyloid plaques—sticky clumps of protein fragments and cellular material that form outside and around neurons; and neurofibrillary tangles—insoluble twisted fibers composed largely of the protein tau that build up inside nerve cells. Although these structures are hallmarks of the disease, scientists are unclear whether they cause it or a byproduct of it. 


           

Alzheimer's disease is the most common cause of dementia, or loss of intellectual function, among people aged 65 and older. Alzheimer's disease is not a normal part of aging. 


           

Origin of the term Alzheimer's disease dates back to 1906 when Dr. Alois Alzheimer, a German physician, presented a case history before a medical meeting of a 51-year-old woman who suffered from a rare brain disorder. A brain autopsy identified the plaques and tangles that today characterize Alzheimer's disease. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles).

Plaques and tangles in the brain are two of the main features of Alzheimer’s disease. The third is the loss of connections between nerve cells (neurons) in the brain.

Although we still don’t know how the Alzheimer’s disease process begins, it seems likely that damage to the brain starts a decade or more before problems become evident. During the preclinical stage of Alzheimer’s disease, people are free of symptoms but toxic changes are taking place in the brain. Abnormal deposits of proteins form amyloid plaques and tau tangles throughout the brain, and once-healthy neurons begin to work less efficiently.

Over time, neurons lose their ability to function and communicate with each other, and eventually they die. Before long, the damage spreads to a nearby structure in the brain called the hippocampus, which is essential in forming memories. As more neurons die, affected brain regions begin to shrink. By the final stage of Alzheimer’s, damage is widespread, and brain tissue has shrunk significantly.

Scientists don’t yet fully understand what causes Alzheimer’s disease, but it has become increasingly clear that it develops because of a complex series of events that take place in the brain over a long period of time. It is likely that the causes include some mix of genetic, environmental, and lifestyle factors. Because people differ in their genetic make-up and lifestyle, the importance of any one of these factors in increasing or decreasing the risk of developing Alzheimer’s may differ from person to person.

Most people with Alzheimer’s disease have “late-onset” Alzheimer’s, which usually develops after age 60. Many studies have linked the apolipoprotein E (APOE) gene to late-onset Alzheimer’s. This gene has several forms. One of them, APOE ε4, seems to increase a person’s risk of getting the disease. However, carrying the APOE ε4 form of the gene does not necessarily mean that a person will develop Alzheimer’s disease, and people carrying no APOE ε4 can also develop the disease.

Research suggests that a host of factors beyond basic genetics may play a role in the development and course of Alzheimer’s disease. There is a great deal of interest, for example, in associations between cognitive decline and vascular and metabolic conditions such as heart disease, stroke, high blood pressure, diabetes, and obesity. Understanding these relationships and testing them in clinical trials will help us understand whether reducing risk factors for these conditions may help with Alzheimer’s as well.

Further, a nutritious diet, physical activity, social engagement, and mentally stimulating pursuits can all help people stay healthy as they age. New research suggests the possibility that these and other factors also might help to reduce the risk of cognitive decline and Alzheimer’s disease.

Corpus Callosum Disorders

Disorders of the corpus callosum are conditions in which the corpus callosum does not develop in a typical manner. Since these are disorders of brain structure, they can only be diagnosed by brain scan, including:

• Pre/postnatal sonogram (ultrasound)


• Computerized Axial Tomography (CT-scan or CAT scan)


• Magnetic Resonance Imaging (MRI)

The disruptions to the development of the corpus callosum occur during the 5th to 16th week of pregnancy. There is no single cause and many different factors can interfere with this development, including:

• Prenatal infections or viruses (for example, rubella)


• Chromosomal (genetic) abnormalities (for example, trisomy 8 and 18, Andermann syndrome, and Aicardi syndrome)


• Toxic metabolic conditions (for example, Fetal Alcohol Syndrome)


• Blockage of the growth of the corpus callosum (for example, cysts)

Disorders of the corpus callosum are not illnesses or diseases, but abnormalities of brain structure. Many people with these conditions are healthy. However, other individuals with disorders of the corpus callosum do require medical intervention due to seizures and/or other medical problems they have in addition to the disorder of the corpus callosum.

Estimates of the frequency of corpus callosum disorders vary greatly. Some suggest as many as 7 in 1000 children may have DCC, while others believe it may be as rare as 5 in a million. The rate of diagnosis of these disorders is likely to increase with greater access to the brain scanning technology listed above.

Physically, it is a condition that does not change. It will not get worse. Since the corpus callosum is already absent, it cannot regenerate or degenerate. Likewise, in partial ACC and hypoplasia, once the infant’s brain is developed, no new callosal fibers will emerge.

In that sense, disorders of the corpus callosum are conditions one must “learn to live with” rather than “hope to recover from.” Long-term challenges are associated with malformation of the corpus callosum, but this in no way suggests that individuals with DCC cannot lead productive and meaningful lives.


Behaviorally individuals with DCC may fall behind their peers in social and problem solving skills in elementary school or as they approach adolescence. In typical development, the fibers of the corpus callosum become more efficient as children approach adolescence. At that point children with an intact corpus callosum show rapid gains in abstract reasoning, problem solving, and social comprehension. Although a child with DCC may have kept up with his or her peers until this age, as the peer-group begins to make use of an increasingly efficient corpus callosum, the child with DCC falls behind in mental and social functioning. In this way, the behavioral challenges for individuals with DCC may become more evident as they grow into adolescence and young adulthood.

This is an overview of the behavioral characteristics, which are often evident in individuals with DCC.

•   Delays in attaining developmental milestones (for example, walking, talking, reading). Delays may range from very subtle to highly significant.

•   Clumsiness and poor motor coordination, particularly on skills that require coordination of left and right hands and feet (for example, swimming, bike riding, tying shoes, driving).

•   Atypical sensitivity to particular sensory cues (for example, food textures, certain types of touch) but often with a high tolerance to pain.

•   Difficulties on multidimensional tasks, such as using language in social situations (for example, jokes, metaphors), appropriate motor responses to visual information (for example, stepping on others’ toes, handwriting runs off the page), and the use of complex reasoning, creativity and problem solving (for example, coping with math and science requirements in middle school and high school, budgeting).

•   Challenges with social interactions due to difficulty imagining potential consequences of behavior, being insensitive to the thoughts and feelings of others, and misunderstanding social cues (for example, being vulnerable to suggestion, gullible, and not recognizing emotions communicated by tone of voice).

•   Mental and social processing problems become more apparent with age, with problems particularly evident from junior high school into adulthood.

•   Limited insight into their own behavior, social problems, and mental challenges.

These symptoms occur in various combinations and severity. In many cases, they are attributed incorrectly to one or more of the following: personality traits, poor parenting, ADHD, Asperger’s Syndrome, Nonverbal Learning Disability, specific learning disabilities, or psychiatric disorders. It is critical to note that these alternative conditions are diagnosed through behavioral observation.

In contrast, DCC is a definite structural abnormality of the brain diagnosed by an MRI. These alternative behavioral diagnoses may, in some cases, represent a reasonable description of the behavior of a person with DCC. However, they misrepresent the cause of the behavior.