The Sleep Clinic Package
I INTRODUCTION TO SLEEPSleep, normal, regular state of rest of an organism. In contrast to the waking state, sleep is characterized by relative quiescence of physiological functions (blood pressure, breathing, heartbeat) and a relatively low response to external stimuli.
II TYPICAL SLEEP CYCLE
III PHYSIOLOGY AND CHEMISTRY OF SLEEPA tremendous amount of knowledge has been accumulated about the central and peripheral mechanisms controlling and involving sleep. Basically, certain areas in the brain stem—the most primitive part of the brain and the part that controls such basic functions as breathing and heart rate—are involved in the control of the two sleep states. Considerable controversy still exists as to exactly which brain-stem regions are involved and how they interact, but it is known that several brain chemicals called biogenic amines—dopamine, norepinephrine, and serotonin—act as neurotransmitters and neuromodulators in regulating discharge of brain cells. The evidence is clearest for the involvement of serotonin. Serotonin is necessary for normal sleep to occur, although it is only one of many elements and is not sufficient in itself. The roles that norepinephrine and dopamine have in sleep are less certain.
Recent research demonstrates that the human nervous system controls the body's functions differently during the sleep states than during waking. The details are complex, but breathing mechanisms, temperature mechanisms, and musculature all function differently during sleep. Especially dramatic are the changes during D-sleep, in which core-body temperature is hardly controlled at all, so that mammals, including humans, become poikilothermic (cold-blooded). Differences in control mechanisms are becoming important in helping to characterize and understand a whole series of sleep-related diseases; for instance, in sleep apnea, breathing repeatedly stops or becomes very shallow during sleep.
A Functions of Sleep and Sleep Requirements
Probably the most important and difficult question is that of the functions of sleep. This question has not been completely answered, and differences of opinion exist. Some scientists believe that sleep has no biological function and is simply a sort of habit. The predominance of evidence, however, suggests a biological function for sleep—in fact, most probably two functions, related to the two states of sleep. S-sleep tends to increase after exercise, after starvation, and at other times of increased metabolic need. Thus, S-sleep probably plays a role in the restoration of the body and brain, perhaps facilitating the synthesis of large molecules such as proteins and ribonucleic acids. D-sleep may play a more complex role in providing restoration for brain processes—especially some higher-level brain processes involved in focusing attention, waking ego mechanisms, performing subtle cognitive and social tasks, and so on.
The numerous investigations leading to these conclusions include studies of total sleep deprivation and of differential deprivation of different sorts of sleep, as well as studies of persons who always sleep 9 or more hours (long sleepers) and those who always sleep less than 6 hours (short sleepers). As the latter point indicates, a tremendous variation occurs in sleep requirements. Some persons function well on five hours of sleep a night, whereas others require ten hours; yet they are all physically and mentally normal. A person functioning with no sleep or almost none is occasionally heard of, but such reports have not been substantiated; apparently some sleep, at least four or five hours, is needed by everyone.
B Sleep Disorders
A new field of clinical medicine is developing, related to psychiatry and neurology but not identical to either one. Called sleep medicine, it deals with sleep disorders, of which many kinds can be identified. Sleep problems are usually divided into three kinds: the insomnias, a group of problems producing difficulty in falling asleep or difficulty in staying asleep (see Insomnia); hypersomnolence, characterized by too much sleep, or sleepiness when a person does not want to sleep and episodic nocturnal events, consisting of disorders such as night terrors, nightmares, and sleepwalking .
Insomnia and hypersomnolence are only symptoms and may have many different causes. For example, insomnia can be caused by such conditions as painful arthritis; by endocrine disturbances; by the use of certain chemical substances or by the withdrawal from others (including alcohol); by psychological problems, such as anxiety and depression; and by disturbances in biorhythm such as jet lag (see Biological Clocks). In terms of treatment, therefore, insomnia is not an illness that can be cured by a sleeping pill. Rather, the physician must determine and treat the insomnia's underlying cause.
Ernest Louis Hartmann
These statements have not been evaluated by the Food & Drug Administration although most of the following information was found on The National Institute of Health (NIH) web site.. These products are not intended to diagnose, cure, treat or prevent any disease. If pregnant or lactating, consult a physician before using.
Alluna™ is a clinically tested formulation that promotes natural sleep.* Its natural properties help promote calm and relaxation, so you can fall asleep naturally and rest through the night.* Alluna™ helps your body maintain its own natural sleep pattern so you wake up refreshed.* Alluna™ is safe to take over time. Unlike with many drugs, you should not experience lingering effects with this product after you wake up. Alluna™ is a special formulation of herbs that have been used for centuries. This formulation meets our modern, strict standards for safety and quality. Imported from Switzerland.
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
This randomized, double-blind, controlled clinical trial in parallel group design demonstrated equivalent efficacy and tolerability of a hop-valerian preparation compared with a benzodiazepine preparation in patients suffering from sleep disorders-- according to DSM-IV criteria. Sleep quality, fitness and quality of life were determined by psychometric tests, psychopathologic scales and sleep-questionnaires at the beginning of the therapy, end of therapy (duration 2 weeks) and then 1 week after cessation of therapy. Patients' state of health (4-point scale) and medication tolerability (occurrence of adverse events) were documented. Using the following as parameters "Alphabetischer Durchstreichtest, Feinmotoriktest, Befindlichkeitsskala, Beschwerdeliste, Schlaffragebogen A and B" the differences between beginning and the end of the therapy were analyzed by simultaneous testing of the equality or superiority of the test preparation. The equivalence of both therapies according to sleep quality, fitness and quality of life was proven by a Mann-Whitney-Statistic of 0.50 with a lower boundary of the 95% confidence interval of 0.46. The patients' state of health improved during therapy while showing a deterioration after cessation with both preparations. Withdrawal symptoms, however, were documented with benzodiazepine. Only one adverse drug reaction was reported during this study, namely stomach complaints from both the test and reference medication. This study shows that the investigated hop-valerian preparation in the appropriate dose is a sensible alternative to benzodiazepine for the treatment of nonchronic and non-psychiatric sleep disorders.8
Seda-Kneipp a compound preparation of valerian and hops was given to sleep disturbed subjects during the second or third of three consecutive nights disturbed by heavy traffic noise. Prior drug administration reduced the noise induced disturbance of sleep stage patterns: slow-wave sleep and stage REM increased. It is recommended that the initial treatment of severe insomnia by "strong" sleeping pills should be followed by a period during which "weak" sleeping pills are given before the drug administration finally is discontinued.9
Melatonin is a hormone produced mainly by the pineal gland and secreted primarily at night, when it reaches levels 10 times higher than those present in the daytime. The highest melatonin levels are found in children younger than 4yr; thereafter melatonin levels begin to decline with age. As a chronobiotic, melatonin acts on sleep by phase-advancing or delaying the sleep-wake cycle so that sleep onset occurs earlier or later than usual. Beneficial effects of melatonin have been observed in delayed and advanced sleep phase syndromes. These effects depend on the time that the hormone is administered. Melatonin is also used for jet lag and has been tried in shift workers and night workers to re-entrain their desynchronized rhythms. Melatonin also has free radical-scavenging properties that have primarily been observed in vitro at pharmacological concentrations.4
Melatonin is remarkably effective in preventing or reducing jet-lag, and occasional short-term use appears to be safe. It should be recommended to adult travellers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet-lag on previous journeys. Travellers crossing 2-4 time zones can also use it if need be. The pharmacology and toxicology of melatonin needs systematic study, and routine pharmaceutical quality control of melatonin products must be established. The effects of melatonin in people with epilepsy, and a possible interaction with warfarin, need investigation.6
Melatonin may have a promising future for the treatment of insomnia. The lack of standardized criteria for diagnosing sleep disorders and the lack of structured psychiatric interviews for ruling out psychiatric pathology are clear obstacles in generalizing these results.7
The sedative effect of Passion flower has made it popular for treating a variety of ailments, including nervousness and insomnia. Research has indicated that passion flower has a complex activity on the central nervous system (CNS), which is responsible for its overall tranquilizing effects. Also, it apparently has an antispasmodic effect on smooth muscles within the body, including the digestive system, promoting digestion.
Progesterone has been shown to exert benzodiazepine-like (Valium et al) effects on sleep, which suggests that they are mediated by an agonistic modulation of GABA(A) receptor functioning.1,2
Another study suggests that medroxyprogesterone acetate and micronized progesterone are both effective for treating menopausal symptoms but that the latter might better improve the quality of sleep in postmenopausal women taking estrogen.5
Projuvine (pro-ju-ven-a') is a replenishing/regenerating skin cream, which contains natural pharmaceutical grade (USP) progesterone and liposomal antioxidants in a patented surfactant free European emulsion system.Healthy levels of progesterone have also been shown to promote better sleep.
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1.The GABA(A) receptor antagonist picrotoxin attenuates most sleep changes induced by progesterone.
Lancel M, Faulhaber J, Holsboer F, Rupprecht R.Department of Neuroendocrinology, Max-Planck Institute of Psychiatry, Munich, Germany.
2. Allopregnanolone affects sleep in a benzodiazepine-like
3. Dehydroepiandrosterone and diseases of aging. Watson RR,
Huls A, Araghinikuam M, Chung S.
4. Human aging and melatonin. Clinical relevance. Touitou
Y.Department of Biochemistry, Faculty of Medicine
5. Sleep in menopause: differential effects of two forms
of hormone replacement therapy.Montplaisir J, Lorrain J, Denesle R, Petit D.
6.Melatonin for preventing and treating jet lag (Cochrane
Review). Herxheimer A, Petrie KJ.
7. [Efficiency of melatonin in the treatment of
insomnia].[Article in Spanish] Morera AL, Henry M, Villaverde-Ruiz ML, Gracia-Marco
8.[Comparative study for assessing quality of life of patients with exogenous sleep disorders (temporary sleep onset and sleep interruption disorders) treated with a hops-valarian preparation and a benzodiazepine drug]. [Article in German] Schmitz M, Jackel M.Institut fur Psychosomatik, Wien. Schmitz@ins.at
9. [Experimental studies of the effects of Seda-Kneipp on the sleep of sleep disturbed subjects; implications for the treatment of different sleep disturbances (author's transl)]. [Article in German] Muller-Limmroth W, Ehrenstein W.
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