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DIFFICULTY FALLING OR STAYING ASLEEP: BREATHING DISORDERS

admin — Tue, 26 Apr 2011 14:46:50 +0000

Respiratory ailments such as sleep apnea are notorious for their role in disturbing sleep. There are two primary types of sleep apnea: obstructive, in which the airways become blocked for one of a number of reasons, and central, in which the physiological mechanisms controlling breathing are disrupted. Sometimes the apnea is a result of both types, and is thus known as mixed apnea. At this point I will briefly discuss those breathing disorders that are specifically associated with DIMS; for the most part these fall into the central sleep apnea category (CSA). However, I want to point out that obstructive sleep apnea (OSA) is a more common problem. Like CSA, OSA can occasionally result in the disorders of maintaining sleep that are the focus of this chapter; more often, however, OSA is manifested as a disorder of excessive sleepiness (DOES).

Relatively little is known about central sleep apnea. In CSA something—perhaps disruptions in circadian cycles, perhaps some facet of the sleep process itself—causes perturbations in the basic system that drives your breathing cycle. As a result you may cease to breathe temporarily, or your breathing may become too infrequent or too shallow to provide adequate oxygenation of the blood and tissues. As described earlier, your brain will then alert you to awaken in order to overcome the problem. Normally we awaken several times a night anyway, usually at the end of a REM period. With central apnea, however, the arousals are frequent and prevent you from enjoying a good night’s sleep.

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SURGERY, DERMATOLOGIC TREATMENT, AND OTHER NONPSYCHIATRIC MEDICAL TREATMENT FOR BDD: WHAT ABOUT PEOPLE WITH BDD

admin — Wed, 22 Dec 2010 10:58:07 +0000

WHO DON’T GO TO A PSYCHIATRIST BUT ONLY SEE A SURGEON, A DERMATOLOGIST, OR A DENTIST? What about people with BDD who don’t go to a psychiatrist but only see a surgeon, a dermatologist, or a dentist? You may recall that 6%-20% of people who receive cosmetic surgery, and 9%-12% of people who receive dermatologic treatment, appear to have BDD. Are they any happier with the outcome of these treatments than people who eventually see a psychiatrist? Or are they even less happy? Although little systematic research has been done on BDD in dermatologic, surgical, and other medical settings, these patients have been well described in the professional medical literature. In the dermatology literature, BDD has been referred to as “dermatologic hypochondriasis,” “hypochondriacal preoccupation with trivial lesions,” and “dermato-logical non-disease.” Skin picking associated with BDD is subsumed by the term “neurotic excoriations.” In some reports the term “monosymptomatic hypochondriacal psychosis” is used, which refers to delusional BDD.

BDD is even less precisely identified in the surgery scientific literature. Scientific papers discuss patients with characteristics that overlap with BDD, such as “insatiable” surgery patients, “polysurgical addicts,” and patients with “psychological problems” or “minimal deformity.” The problem is that these terms aren’t clearly defined, and can’t be assumed to pertain to BDD because it isn’t clear which patients in these studies, if any, had BDD.

One study from Japan was an exception in that the patients were identified as having BDD. This was a study of 274 patients with BDD who went to a surgery clinic requesting cosmetic surgery. A review of the patients’ medical researchers concluded that surgery in people with BDD is risky because they often have unrealistic expectations, are often unhappy with the outcome, and may be angry with the surgeon about the outcome, even though it looks fine to other people. These surgeons therefore tended to avoid operating on people with BDD. Other articles in surgery journals have also cautioned surgeons against performing surgery on people with BDD because of poor outcomes that include patient dissatisfaction with the procedure or even violence toward the surgeon. There are several well-known cases of surgeons who were murdered by people who appeared to have BDD. A review of BDD in a German surgery journal concluded that such patients should not be treated with surgery.

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SURGERY, DERMATOLOGIC TREATMENT, AND OTHER NONPSYCHIATRIC MEDICAL TREATMENT FOR BDD: WHAT ABOUT PEOPLE WITH BDD WHO DON’T GO TO A PSYCHIATRIST BUT ONLY SEE A SURGEON, A DERMATOLOGIST, OR A DENTIST? What about people with BDD who don’t go to a psychiatrist but only see a surgeon, a dermatologist, or a dentist? You may recall that 6%-20% of people who receive cosmetic surgery, and 9%-12% of people who receive dermatologic treatment, appear to have BDD. Are they any happier with the outcome of these treatments than people who eventually see a psychiatrist? Or are they even less happy? Although little systematic research has been done on BDD in dermatologic, surgical, and other medical settings, these patients have been well described in the professional medical literature. In the dermatology literature, BDD has been referred to as “dermatologic hypochondriasis,” “hypochondriacal preoccupation with trivial lesions,” and “dermato-logical non-disease.” Skin picking associated with BDD is subsumed by the term “neurotic excoriations.” In some reports the term “monosymptomatic hypochondriacal psychosis” is used, which refers to delusional BDD.BDD is even less precisely identified in the surgery scientific literature. Scientific papers discuss patients with characteristics that overlap with BDD, such as “insatiable” surgery patients, “polysurgical addicts,” and patients with “psychological problems” or “minimal deformity.” The problem is that these terms aren’t clearly defined, and can’t be assumed to pertain to BDD because it isn’t clear which patients in these studies, if any, had BDD.One study from Japan was an exception in that the patients were identified as having BDD. This was a study of 274 patients with BDD who went to a surgery clinic requesting cosmetic surgery. A review of the patients’ medical researchers concluded that surgery in people with BDD is risky because they often have unrealistic expectations, are often unhappy with the outcome, and may be angry with the surgeon about the outcome, even though it looks fine to other people. These surgeons therefore tended to avoid operating on people with BDD. Other articles in surgery journals have also cautioned surgeons against performing surgery on people with BDD because of poor outcomes that include patient dissatisfaction with the procedure or even violence toward the surgeon. There are several well-known cases of surgeons who were murdered by people who appeared to have BDD. A review of BDD in a German surgery journal concluded that such patients should not be treated with surgery.*350\204\8*

HOW TO STOP TAKING SLEEPING PILLS?

admin — Fri, 08 May 2009 09:40:36 +0000

The myth of sleeping pills needs to be destroyed here. Sleeping pills are useful for two weeks only; after that the body develops a tolerance to the pills and they become less and less effective in inducing sleep. The reason why most people continue to take them beyond two weeks is to avoid rebound insomnia. Rebound insomnia is a withdrawal symptom experienced after sleeping pills are stopped. Rebound insomnia should be distinguished from true insomnia. When the sleeping pills are stopped, rebound insomnia follows immediately, and one must be prepared for not sleeping well for the next few nights. Natural sleep should commence after the rebound insomnia passes. Hence it is most important to stop taking the sleeping pills gradually. The tragedy is that most people stop taking the sleeping pills suddenly, and consequently they cannot sleep because they experience rebound insomnia. They then believe they have lost the innate ability to sleep, and they immediately start taking the sleeping pills again.

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PAIN AND GUILT: PAIN AND PUNISHMENT

admin — Wed, 29 Apr 2009 10:30:07 +0000

The word “pain” comes from the Latin word poena which also means punishment. So there is nothing new in the association of these two ideas. The child is educated to a complicated system of values and behaviour which allows him to take his place in society. This is achieved primarily by the process of reward and punishment. Love and physical rewards are given for being good; and hostility and physical punishment for being bad. This is the learning process in its simplest form, and as a means of leading the child to acceptable behaviour it is very effective. However, the constant association of pain with punishment conditions us to lose sight of the biological

purpose of pain as a simple and helpful warning against injury. The child is constantly reminded of this association so that it persists into adult life. If in fact corporal punishment is not inflicted, the threat of it is usually still there, and even if it is not actually threatened it is referred to obliquely, “If you had been properly punished when you were younger, this would not have happened.” This is the child’s ordinary experience, so the two ideas, pain and punishment, become fused together in his mind.

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BOREDOM AT WORK AS REASON OF STRESS

admin — Thu, 23 Apr 2009 08:20:53 +0000

«The job. How can you complain about not having enough to do? It seems too stupid for words. But that’s what it is. Just plain bored. Sounds silly. Instead of just sitting and doing nothing, I get irritable. Irritable with myself. Irritable with the people around me. Irritable with a society that lands me in a job like this. Worse than all that, I bring the irritability home with me to my wife and kids. Snap at them. Then I feel guilty. Then more on edge than ever. »

They laugh about the civil service. Joke about it. But there is often that glimmer of truth in the things we laugh about most readily.

Man. As a species we have survived. We have survived because we have learned to assert ourselves against an inhospitable environment. If we graduate into a changed environment of continuing calm and ease, we are left without the normal challenges of life to which we have become accustomed over countless generations. It demands that we adjust to a new way of living in which our innate assertiveness has no external outlet. We seem to be lost. Our brain is alerted, but there is no outlet for mental or physical activity. And we experience this deprivation as boredom.

Other interests and hobbies are a help. Not much to do at work and our mind can run on enjoying the challenge of our hobby. The same applies when our work is mainly repetitive, requiring little mental effort on our part.

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