Thoracic and Sleep Group Queensland People caring for how you breathe and sleep

March 30, 2017

Parasomnia in Arts

Filed under: Blog — Tags: , , , , — Erika Mateus @ 4:59 am

Parasomnia in arts

In the middle of the night, she woke up dreaming of huge white heads like turnips that came trailing after her, at the end of interminable necks, and with vast black eyes. But being a sensible woman, she subdued her terrors and turned over and went to sleep again. H. G Wells. The invisible Man

 

Sleep and dreams have had a mystical connotation and big influence in our lives. Many artists have included this in their paintings and literature masterpieces.  Some artists have shown interest in sleep disorders such as somnambulism, insomnia and nightmares. One could argue that these artists may have suffered from these conditions themselves.

The word parasomnia represents all the atypical things that can occur to people while they are sleeping. Parasomnias are known by undesirable physical or verbal behaviours, such as walking, talking during sleep, nightmares, sleep paralysis, REM sleep behaviour disorder and other movement disorders (sleep aggression, sleep sex – sexsomnia). Some of these disorders can be frightening for those sleeping and for those around them.

By way of example, in Literature, Shakespeare describes sleepwalking and sleep talking of Lady Macbeth. In Macbeth the gentlewoman says: “Since his majesty went into the field, I have seen her rise from her bed, throw her night-gown upon her, unlock her closet, take forth paper, fold it, write upon‘t, read it, afterwards seal it, and again return to bed; yet all this while in a most fast sleep.” Furthermore, the gentlewoman shows the doctor the actual act of Lady Macbeth sleepwalking: “Lo you, here she comes! This is her very guise, and, upon my life, fast asleep.” The Doctor comments, “You see, her eyes are open.” And the gentle-woman answers, “Ay, but their sense is shut”.

Kryger et al. have described how some famous paintings depict sleep in diverse ways, in mythology, in religion and often showing the relationship between sleep and dreams or danger and death. Kryger et al. discuss some of these masterpieces and explore their depiction of nightmares and sleep paralysis. For example, Francisco Goya, in The Sleep of Reason Brings Monsters (ca. 1799) (Fig. 1), shows that dreams can be distressing, with the attack of “monsters” while the man is dreaming. Heinrich Füssli and his painting The Nightmare (ca. 1781) has become a symbol for the phenomenon of sleep paralysis (Fig. 2). In the picture, the girl has visions of a devil-like creature on her abdomen and a horse’s head peering at her from the left, but she cannot move.

Nightmares

sleep paralysis

Sleep is such an important part of our lives and can be quite fascinating at times. I am sure most of us have had a strange dream at some point, or have heard of someone’s strange behaviour during sleep. So it is not all that surprising that that writers and painters have also been fascinated by sleep.

 

It is thought that perhaps the description of these disorders by artists actually may have led to the first detection of these disorders in medicine. Today, some people may be reluctant to declare their parasomnias, even in clinical environments. Let’s hope that the “art of sleep” can help normalise sleep disorders as precisely that, a sleep disorder.

 

George R. R Martin “Sleep is good, and books are better.”

 

References:

  • Depiction of parasomnia in the arts. Available from: https://www.researchgate.net/publication/284094689_Depiction_of_parasomnia_in_the_arts [accessed Mar 29, 2017].
  • Kryger M, Avidan A, Berry R. Atlas of Clinical Sleep Medicine, 2nd Edition, Elsevier, 2014.
  • Kryger M, Sleep in Art and Literature. The Huffington Post. Available from: http://www.huffingtonpost.com/entry/sleep-in-art-and-literature_us_5767f19be4b0fbbc8beae074
  • Alex Iranzo, Joan Santamaria, Martín de Riquer. Sleep and sleep disorders in Don Quixote. Sleep Medicine, Volume 5, Issue 1, January 2004, Pages 97-100

March 28, 2017

March 27, 2017

Easter Road Safety

Filed under: Blog — Mark Russell-Pavier @ 10:36 pm

Easter is a joyous occasion celebrated the world-over and a time of year that families travel far and wide to spend the long weekend together. However, the stark reality is that this holiday is accompanied by an increase in road fatalities which, in some cases, may be avoided by planning and preparation. Below are some simple, yet effective tips to get you to your destination safely.

Get a good night’s sleep

Driver fatigue is a major contributing factor to road accidents. With many people covering vast distances during the holidays it is critical to be well rested and refreshed prior to starting your journey. Whilst it may be seem like a good idea to get a jump on the traffic by leaving during the midnight-to-morning hours, the reality is this will greatly disturb your sleep cycle leaving you drowsy later in the day. Stick to your normal sleep cycle in order to be alert behind the wheel.

Take a break

Stop every 2 hours for a 15 minute break. You can find rest stops on your route at www.driverreviver.com.au/ . A microsleep is a short episode of sleep that can last anywhere from 1 second to 30 seconds. They occur during times of sleepiness, generally without warning. It’s a very light sleep. Often the person having the microsleep won’t even be aware they had just nodded off. Perhaps the most troubling aspect of microsleep episodes is that they’re common at the wheel, and they can lead to accidents. In fact, microsleep has been said to be the most common cause of falling asleep behind the wheel.

Slow Down

Be aware of speed limits on unknown roads. Remember, it is double demerit points all Easter weekend.

Remember that everyone is in the same position as you. Don’t get frustrated is you are stuck behind a caravan. Be patient and wait until you reach dual lanes or only overtake when it is 100% safe to do so.

Prepare your vehicle

Conduct a 5 point safety check on tyres, brakes, suspension, lights and restraints.

Check your tyre pressure when your tyres are cold, as under inflation of tyres can cause excessive tyre wear and tear. Correctly inflated tyres will also improve your fuel economy.

Make sure your lights are working for any night time driving you may do over the long weekend. It’s also a good time to clean the lenses for maximum visibility.

Check your battery strength- a dead battery is not what you want when you’re due at the in-laws place for the traditional family egg hunt.

Remember, not everything is open over this long weekend, so make sure you have all your supplies, from spare tyres to extra oil.

Plan your trip

Plan a safe route on well-lit roads and work out your rest stops and overnight stays beforehand.

Have your GPS set. For those who haven’t graduated to GPS technology yet, get out that trusty map!

Don’t waste fuel and time driving around looking for your destination.

Share the driving

If there is more than one driver in the car, share the load. This gives everyone the chance to have a nap and recharge their batteries if you are driving a long distance.

If you are a lone driver, remember to take a break. Rather add extra time to your trip due to rest breaks then drive tired and risk injuring yourself and others.

Keep safe on the roads this long weekend and have a fun, happy and relaxing Easter!

MATRx and Mandibular Advancement Splints; changes to sleep studies coming?

Filed under: Blog — Tags: , , , , — Phil Teuwen @ 3:47 am

Mandibular Advancement Splints are a common treatment for Obstructive Sleep Apnoea (OSA). These look much like the mouthguards that your favourite football stars wear on the weekend. These work by having two plates, these plates (or mouth guards) sit over your teeth (top and bottom) and connect help keep your lower jaw forward. It is thought that by stabilising and/or protruding the lower jaw forward, the MAS devices prevent the soft tissue of the upper airway from collapsing and thus treating OSA.

MAS – the pro’s:

  • Patient compliance is generally pretty good. The devices are easy to wear and can be a comfortable sleep therapy

MAS – the con’s:

  • These don’t always work for every patient, i.e. the efficacy of therapy is lower than other OSA treatment
  • Can have side effects on the jaw, bite and dentition

MAS – the summery:

  • What these devices may lose in efficacy they may gain in compliance
  • Its hard to know if the MAS will work prior to having the device made, can be a $2000 treatment that may or may not treat OSA
  • A fully fitted MAS device can cost a similar amount to CPAP (CPAP = gold standard treatment for OSA

 

MATRx

 

Recently Sutherland et al tested a device called MATRx at the Royal North Shore Hospital in Sydney. What this device does, is it allows a MAS to be adjusted remotely, i.e. by a sleep technician while a patient is asleep in the sleep unit. They found that by adjusting the device overnight during a sleep study, they could actually give a good indication of whether or not the MAS would be suitable or not.

 

Why is this important? Well, if a disposable MAS could be made cheaply and used during a sleep study, we could potentially identify those patients who may be suitable for a MAS device. More importantly, we could identify those who are NOT suitable candidates for MAS. These patients otherwise need to pay for the device up front, then have a sleep study to see if it works. Hopefully, in time, patients may be able to have a trial device made, and have the sleep study to assess its effectiveness before having to spend the money to have the device made.

 

Go here for the original article: http://www.aasmnet.org/JCSM/ViewAbstract.aspx?pid=30965

Sleepwalking: An Overview

Filed under: Blog — Tags: , — Trent Segal @ 1:32 am

Sleepwalking is a relatively rare sleep disorder that has been reported in ancient medicine from as far back as 2,500 years ago. In modern medicine, it is not seen as anything dangerous: a random, occasional thing that can happen to anyone with no ill effect.

Sleepwalking (somnoambulism or noctambulism) is a non-REM parasomnia, meaning it occurs during one of the stages of sleep that is not during dreaming or REM sleep (typically occurring in stage 3 or slow wave sleep).

Typical symptoms include:

  • Open eyes but with a staring or blank expression.
  • Slow nonsensical or no response to questions.
  • Typical movements: sitting up, walking, running,
  • Unusual movements: urinating, climbing, getting dressed, more complex motor tasks
  • No memory of having sleepwalked.

There is no known physical or psychiatric cause and many think it is acting out of dreams or indulging in secret desires such as eating.  However as sleepwalking does not occur during dream sleep or REM (rapid eye movement) sleep.  Instead it occurs during slow wave sleep (stage 3) which is the part of the sleep cycle where brain waves are slowest and the conscious brain is quiet and inactive.  During this time the nervous system can sometimes be responsible for activation of the motor cortex producing movements, which are independent of active thinking (I-Fuction).

Many things can contribute to the likelihood of sleepwalking however such as:

  • Being sleep deprived
  • Having another sleep disorder
  • Illness such as fever, or during allergic reactions
  • Certain medications such as psychoactive drugs, and alcohol
  • Genetic pre-disposition
  • Children are most likely to sleepwalk between ages 4-8.

Sleepwalking itself is not dangerous and has not been linked with any underlying psychological issues.  In some instances though people may put themselves into harm’s way if leaving the house, driving or climbing or there may also be a more serious sleep disorder present.

Treatment is often performed to try and remove stresses and treating lack of sleep or adjusting medications depending on the sleepwalker’s circumstances.   Hypnotism has been shown to be effective as well.  Understanding other potential underlying psychological or medical causes can be important to effective treatment so if frequent or violent sleepwalking has become problematic ensure you consult a sleep specialist.

Some self-administered techniques which may assist:

  • Ensure enough time for 6-8hrs sleep each night to prevent sleep deprivation.
  • Cease TV, computer and mobile phone usage before bedtime to remove excessive stimulus.
  • Try relaxation or calming exercises.
  • Ensure the environment is safe by locking windows or doors, and removing potentially harmful objects from the area.

 

http://www.sleepeducation.org/sleep-disorders-by-category/parasomnias/sleepwalking/overview-facts

https://www.soundsleephealth.com/blog/sleepwalking-causes-reasons-risks-and-treatments?utm_content=51157358&utm_medium=social&utm_source=linkedin

http://serendip.brynmawr.edu/bb/neuro/neuro03/web2/tlitvine.html

March 23, 2017

Sleep as a vital sign

Filed under: Blog — Tags: , , , — Erika Mateus @ 6:46 am

For years sleep disorders have been underestimated and sometimes undiagnosed. Some patients are not aware about the symptomatology of sleep problems. While other patients are mindful of these issues,  but they do not think their concerns are relevant for reporting under a medical examination.

The Sleep Health Journal, two important authors in the field of sleep medicine wrote an article called Sleep as a vital sign: why medical practitioners need to routinely ask their patients about sleep[1]. They looked to address the question of whether sleep should be assessed as part of routine medical evaluation. The importance of this topic is to recognise that sleep problems can predispose individuals to many medical conditions, and, conversely, medical disorders can lead to sleep disturbance.

Malhotra and Grander argue that sleep is a critical marker or indicator of disease and recovery, and that changes in sleep are relevant for common disorders and presentations across many medical subspecialties. Physicians routinely asking their patients about sleep may find benefit from the detection and successful treatment of sleep disorders and the associated comorbidities.

Perhaps these clinical questions may help improve the relationship between the healthcare professionals and their patients. Sometimes a simple, seemingly trivial question about a patients’ sleep may in fact, lead to a greater level of confidence in that health professional taking the patient’s problems seriously. Like blood pressure, blood glucose and body temperate, sleep is a vital sign, that sadly often gets overlooked.

 

[1] Sleep as a vital sign: why medical practitioners need to routinely ask their patients about sleep

Authors: Grandner, Michael A. Malhotra, Atul.

Sleep Health: Journal of the National Sleep Foundation, Volume 1, Issue 1, 11 – 12

Available online: http://www.sleephealthjournal.org/article/S2352-7218(15)00026-1/fulltext

 

Obesity, Sleep Apnoea, and Heart Surgery

Filed under: Blog — Tags: , , , , , , , , — Mark Russell-Pavier @ 1:25 am

A study recently published in Chest investigated obesity, sleep disordered breathing and complications after cardiac surgery. Atrial fibrillation, the complication being investigated, is an abnormal heart rhythm characterised by rapid and irregular beating; a disruption in the electrical system of your heart.

The study took large group of 190 people. Each person had done a sleep study, and then had cardiac surgery within three years. The investigation aimed to use that data to determine whether sleep apnoea is a risk factor for post-cardiac surgery atrial fibrillation. Whilst the study concluded that there was no association between the two, the methodology may be flawed.

The study took the AHI of the patients, and adjusted it for obesity, and then compared that to atrial fibrillation numbers. By doing this they may have eliminated a great deal of the variation in AHI, thereby making it difficult to form a statistical association. Perhaps a better way of investigating the relationship would be to split the group of patients into three; one with sleep apnoea and no obesity, one with obesity, and one with sleep apnoea and obesity. The difference between the three groups might have investigated the relationship more conclusively.

Kaw, Roop et al. “Obesity As An Effect Modifier In Sleep Disordered Breathing And Post-Cardiac Surgery Atrial Fibrillation”. Chest (2017): n. pag. Web. 23 Mar. 2017.

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