Length of a Human DNA Molecule

The chromosomes in the nucleus of a cell contain all the information a cell needs to carry on its life processes. They are made up of a complex chemical (a nucleic acid) called deoxyribonucleic acid, or DNA for short. Scientist's decoding of the chemical structure of DNA has led to a simple conceptual understanding of genetic processes. DNA is the hereditary material of all cells. It is a double-stranded helical macromolecule consisting of nucleotide monomers with deoxyribose sugar and the nitrogenous bases adenine (A), cytosine (C), guanine (G), and thymine (T). In the chromosomes of a cell, DNA occurs as fine, spirally coiled threads that in turn coils around another, like a twisted ladder.

The DNA molecule is threaded so fine that it is only possible to see it under high powerful electron microscopes. To get a sense of exactly how long an uncoiled DNA molecule is compared to a typical cell, a cell is magnified 1000 times. At this scale, the total length of all the DNA in the cell's nucleus would be 3 km -- the equivalent distance of the Lincoln Memorial to the capital in Washington, DC.

The human genome comprises the information contained in one set of human chromosomes which themselves contain about 3 billion base pairs (bp) of DNA in 46 chromosomes (22 autosome pairs + 2 sex chromosomes). The total length of DNA present in one adult human is calculated by the multiplication of

(length of 1 bp)(number of bp per cell)(number of cells in the body)

(0.34 × 10-9 m)(6 × 109)(1013)

2.0 × 1013 meters

That is the equivalent of nearly 70 trips from the earth to the sun and back.

2.0 × 1013 meters = 133.691627 astronomical units
133.691627 / 2 = 66.8458135 round trips to the sun

On the average, a single human chromosome consists of DNA Molecule that is almost 5 centimeters.

Stop Smoking Recovery Timetable

Stop Smoking Recovery  •  20 minutes	Your blood pressure, pulse rate and the temperature of your hands and feet have returned to normal.
•  8 hours	Remaining nicotine in your bloodstream will have fallen to 6.25% of normal peak daily levels, a 93.75% reduction.
•  12 hours	Your blood oxygen level will have increased to normal and carbon monoxide levels will have dropped to normal.
•  24 hours	Anxieties have peaked in intensity and within two weeks should return to near pre-cessation levels.
•  48 hours	Damaged nerve endings have started to regrow and your sense of smell and taste are beginning to return to normal. Cessation anger and irritability will have peaked.
•  72 hours	Your entire body will test 100% nicotine-free and over 90% of all nicotine metabolites (the chemicals it breaks down into) will now have passed from your body via your urine.  Symptoms of chemical withdrawal have peaked in intensity, including restlessness. The number of cue induced crave episodes experienced during any quitting day will peak for the "average" ex-user. Lung bronchial tubes leading to air sacs (alveoli) are beginning to relax in recovering smokers. Breathing is becoming easier and the lung's functional abilities are starting to increase.
•  5 - 8 days	The "average" ex-smoker will encounter an "average" of three cue induced crave episodes per day. Although we may not be "average" and although serious cessation time distortion can make minutes feel like hours, it is unlikely that any single episode will last longer than 3 minutes. Keep a clock handy and time them.
•  10 days	10 days - The "average" ex-user is down to encountering less than two crave episodes per day, each less than 3 minutes.
•  10 days to 2 weeks	Recovery has likely progressed to the point where your addiction is no longer doing the talking. Blood circulation in your gums and teeth are now similar to that of a non-user.
•  2 to 4 weeks	Cessation related anger, anxiety, difficulty concentrating, impatience, insomnia, restlessness and depression have ended. If still experiencing any of these symptoms get seen and evaluated by your physician.
•  21 days	Brain acetylcholine receptor counts that were up-regulated in response to nicotine's presence have now down-regulated and receptor binding has returned to levels seen in the brains of non-smokers.
•  2 weeks to 3 months	Your heart attack risk has started to drop. Your lung function is beginning to improve.
•  3 weeks to 3 months	Your circulation has substantially improved. Walking has become easier. Your chronic cough, if any, has likely disappeared. If not, get seen by a doctor, and sooner if at all concerned, as a chronic cough can be a sign of lung cancer.
•  8 weeks	Insulin resistance in smokers has normalized despite average weight gain of 2.7 kg.
•  1 to 9 months	Any smoking related sinus congestion, fatigue or shortness of breath have decreased. Cilia have regrown in your lungs, thereby increasing their ability to handle mucus, keep your lungs clean and reduce infections. Your body's overall energy has increased.
•  1 year	Your excess risk of coronary heart disease, heart attack and stroke have dropped to less than half that of a smoker.
•  5 years	Your risk of a subarachnoid haemorrhage has declined to 59% of your risk while still smoking . If a female ex-smoker, your risk of developing diabetes is now that of a non-smoker
•  5 to 15 years	Your risk of stroke has declined to that of a non-smoker.
•  10 years	Your risk of being diagnosed with lung cancer is between 30% and 50% of that for a continuing smoker .Risk of death from lung cancer has declined by almost half if you were an average smoker (one pack per day).  Risk of cancer of the mouth, throat, esophagus and pancreas have declined. Risk of developing diabetes for both men and women is now similar to that of a never-smoker.
•  13 years	The average smoker able to live to age 75 has 5.8 fewer teeth than a non-smoker. But by year 13 after quitting, your risk of smoking induced tooth loss has declined to that of a never-smoker.
•  15 years	Your risk of coronary heart disease is now that of a person who has never smoked. Your risk of pancreatic cancer has declined to that of a never-smoker - but note 2nd pancreatic making identical finding at 20 years).
•  20 years	Female excess risk of death from all smoking related causes, including lung disease and cancer, has now reduced to that of a never-smoker. Risk of pancreatic cancer reduced to that of a never-smoker

Smoking - effects on your body

Smoking - effects on your body

Nicotine is the addictive drug in tobacco smoke that causes smokers to continue to smoke. Addicted smokers need enough nicotine over a day to ‘feel normal’ – to satisfy cravings or control their mood. How much nicotine a smoker needs determines how much smoke they are likely to inhale, no matter what type of cigarette they smoke.

Along with nicotine, smokers also inhale about 7,000 other chemicals in cigarette smoke. Many of these chemicals come from burning tobacco leaf. Some of these compounds are chemically active and trigger profound and damaging changes in the body.

There are over 60 known cancer-causing chemicals in tobacco smoke. Smoking harms nearly every organ in the body, causing many diseases and reducing health in general.

In Victoria, it is illegal to smoke in cars carrying children under 18 years of age.

Tobacco smoke contains dangerous chemicals

The most damaging compounds in tobacco smoke include:

Tar – this is the collective term for all the various particles suspended in tobacco smoke. The particles contain chemicals including several cancer-causing substances. Tar is sticky and brown, and stains teeth, fingernails and lung tissue. Tar contains the carcinogen benzo(a)pyrene that is known to trigger tumour development (cancer).

Carbon monoxide – this odourless gas is fatal in large doses because it takes the place of oxygen in the blood. Each red blood cell contains a protein called haemoglobin – oxygen molecules are transported around the body by binding to, or hanging onto, this protein. However, carbon monoxide binds to haemoglobin better than oxygen. This means that less oxygen reaches the brain, heart, muscles and other organs.

Hydrogen cyanide – the lungs contain tiny hairs (cilia) that help to clean the lungs by moving foreign substances out. Hydrogen cyanide stops this lung clearance system from working properly, which means the poisonous chemicals in tobacco smoke can build up inside the lungs. Other chemicals in smoke that damage the lungs include hydrocarbons, nitrous oxides, organic acids, phenols and oxidising agents.

Free radicals – these highly reactive chemicals can damage the heart muscles and blood vessels. They react with cholesterol, leading to the build-up of fatty material on artery walls. Their actions lead to heart disease, stroke and blood vessel disease.

Metals – tobacco smoke contains dangerous metals including arsenic, cadmium and lead. Several of these metals are carcinogenic.

Effects of smoking on the respiratory system

Effects of smoking on the respiratory system

                 
The effects of tobacco smoke on the respiratory system include:

• Irritation of the trachea (windpipe) and larynx (voice box)
• Reduced lung function and breathlessness due to swelling and narrowing of the lung airways and excess mucus in the lung passages
• Impairment of the lungs’ clearance system, leading to the build-up of poisonous substances, which results in lung irritation and damage
• Increased risk of lung infection and symptoms such as coughing and wheezing
• Permanent damage to the air sacs of the lungs.
• Effects of smoking on the circulatory system

The effects of tobacco smoke on the circulatory system include:

• Raised blood pressure and heart rate
• Constriction (tightening) of blood vessels in the skin, resulting in a drop in skin temperature
• Less oxygen carried by the blood
• Stickier blood, which is more prone to clotting
• Damage to the lining of the arteries, which is thought to be a contributing factor to atherosclerosis (the build-up of fatty deposits on the artery walls)
• Reduced blood flow to extremities like fingers and toes
• Increased risk of stroke and heart attack due to blockages of the blood supply.
• Effects of smoking on the immune system

The effects of tobacco smoke on the immune system include:

• The immune system doesn’t work as well
• The person is more prone to infections such as pneumonia and influenza
• Illnesses are more severe and it takes longer to get over them.
• Lower levels of protective antioxidants (such as Vitamin C), in the blood.
• Effects of smoking on the musculoskeletal system

The effects of tobacco smoke on the musculoskeletal system include:

• Tightening of certain muscles
• Reduced bone density.
• Other effects of smoking on the body

Other effects of tobacco smoke on the body include:

• Irritation and inflammation of the stomach and intestines
• Increased risk of painful ulcers along the digestive tract
• Reduced ability to smell and taste
• Premature wrinkling of the skin
• Higher risk of blindness
• Gum disease (periodontitis).
• Effects of smoking on the male body

The specific effects of tobacco smoke on the male body include:

• Lower sperm count
• Higher percentage of deformed sperm
• Genetic damage to sperm
• Impotence, which may be due to the effects of smoking on blood flow and damage to the blood vessels of the penis.
• Effects of smoking on the female body

The specific effects of tobacco smoke on the female body include:

• Reduced fertility
• Menstrual cycle irregularities or absence of menstruation
• Menopause reached one or two years earlier
• Increased risk of cancer of the cervix
• Greatly increased risk of stroke and heart attack if the smoker is aged over 35 years and taking the oral contraceptive pill.
• Effects of smoking on the unborn baby

The effects of maternal smoking on an unborn baby include:

• Increased risk of miscarriage, stillbirth and premature birth
• Low birth weight, which may have a lasting effect of the growth and development of children. Low birth weight is associated with an increased risk for heart disease, stroke, high blood pressure, being overweight and diabetes in adulthood
• Increased risk of cleft palate and cleft lip
• Paternal smoking can also harm the fetus if the non-smoking mother is exposed to second-hand smoke.
• If the mother or father continues to smoke during their baby’s first year of life, the child has an increased risk of ear infections, respiratory illnesses such as pneumonia and bronchitis, sudden infant death syndrome (SIDS) and meningococcal disease.

Diseases caused by long-term smoking

• A lifetime smoker is at high risk of developing a range of potentially lethal diseases, including:
• Cancer of the lung, mouth, nose, voice box, tongue, nasal sinus, oesophagus, throat, pancreas, bone marrow (myeloid leukaemia), kidney, cervix, ovary, ureter, liver, bladder, bowel and stomach
• Lung diseases such as chronic obstructive pulmonary disease, which includes chronic bronchitis and emphysema
• Coronary artery disease, heart disease, heart attack and stroke
• Ulcers of the digestive system
• Osteoporosis and hip fracture
• Poor blood circulation in feet and hands, which can lead to pain and, in severe cases, gangrene and amputation.

DNA

What is DNA?

The answer lies in a molecule called deoxyribonucleic acid (DNA), which contains the biological instructions that make each species unique. DNA, along with the instructions it contains, is passed from adult organisms to their offspring during reproduction.

                              

Where is DNA found?

DNA is found inside a special area of the cell called the nucleus. Because the cell is very small, and because organisms have many DNA molecules per cell, each DNA molecule must be tightly packaged. This packaged form of the DNA is called a chromosome.
During DNA replication, DNA unwinds so it can be copied. At other times in the cell cycle, DNA also unwinds so that its instructions can be used to make proteins and for other biological processes. But during cell division, DNA is in its compact chromosome form to enable transfer to new cells.
Researchers refer to DNA found in the cell's nucleus as nuclear DNA. An organism's complete set of nuclear DNA is called its genome.
Besides the DNA located in the nucleus, humans and other complex organisms also have a small amount of DNA in cell structures known as mitochondria. Mitochondria generate the energy the cell needs to function properly.
In sexual reproduction, organisms inherit half of their nuclear DNA from the male parent and half from the female parent. However, organisms inherit all of their mitochondrial DNA from the female parent. This occurs because only egg cells, and not sperm cells, keep their mitochondria during fertilization.

What is DNA made of?

DNA is made of chemical building blocks called nucleotides. These building blocks are made of three parts: a phosphate group, a sugar group and one of four types of nitrogen bases. To form a strand of DNA, nucleotides are linked into chains, with the phosphate and sugar groups alternating.
The four types of nitrogen bases found in nucleotides are: adenine (A), , thymine (T), guanine (G) and cytosine (C). The order, or sequence, of these bases determines what biological instructions are contained in a strand of DNA. For example, the sequence ATCGTT might instruct for blue eyes, while ATCGCT might instruct for brown.
Each DNA sequence that contains instructions to make a protein is known as a gene. The size of a gene may vary greatly, ranging from about 1,000 bases to 1 million bases in humans.
The complete DNA instruction book, or genome, for a human contains about 3 billion bases and about 20,000 genes on 23 pairs of chromosomes.

What does DNA do?

DNA contains the instructions needed for an organism to develop, survive and reproduce. To carry out these functions, DNA sequences must be converted into messages that can be used to produce proteins, which are the complex molecules that do most of the work in our bodies.

How are DNA sequences used to make proteins?

DNA's instructions are used to make proteins in a two-step process. First, enzymes read the information in a DNA molecule and transcribe it into an intermediary molecule called messenger ribonucleic acid, or mRNA.
Next, the information contained in the mRNA molecule is translated into the "language" of amino acids, which are the building blocks of proteins. This language tells the cell's protein-making machinery the precise order in which to link the amino acids to produce a specific protein. This is a major task because there are 20 types of amino acids, which can be placed in many different orders to form a wide variety of proteins.

Who discovered DNA?

The German biochemist Frederich Miescher first observed DNA in the late 1800s. But nearly a century passed from that discovery until researchers unraveled the structure of the DNA molecule and realized its central importance to biology.
For many years, scientists debated which molecule carried life's biological instructions. Most thought that DNA was too simple a molecule to play such a critical role. Instead, they argued that proteins were more likely to carry out this vital function because of their greater complexity and wider variety of forms.
The importance of DNA became clear in 1953 thanks to the work of James Watson, Francis Crick, Maurice Wilkins and Rosalind Franklin. By studying X-ray diffraction patterns and building models, the scientists figured out the double helix structure of DNA - a structure that enables it to carry biological information from one generation to the next.

What is the DNA double helix?

Scientist use the term "double helix" to describe DNA's winding, two-stranded chemical structure. This shape - which looks much like a twisted ladder - gives DNA the power to pass along biological instructions with great precision.
To understand DNA's double helix from a chemical standpoint, picture the sides of the ladder as strands of alternating sugar and phosphate groups - strands that run in opposite directions. Each "rung" of the ladder is made up of two nitrogen bases, paired together by hydrogen bonds. Because of the highly specific nature of this type of chemical pairing, base A always pairs with base T, and likewise C with G. So, if you know the sequence of the bases on one strand of a DNA double helix, it is a simple matter to figure out the sequence of bases on the other strand.
DNA's unique structure enables the molecule to copy itself during cell division. When a cell prepares to divide, the DNA helix splits down the middle and becomes two single strands. These single strands serve as templates for building two new, double-stranded DNA molecules - each a replica of the original DNA molecule. In this process, an A base is added wherever there is a T, a C where there is a G, and so on until all of the bases once again have partners.
In addition, when proteins are being made, the double helix unwinds to allow a single strand of DNA to serve as a template. This template strand is then transcribed into mRNA, which is a molecule that conveys vital instructions to the cell's protein-making machinery.

Treatments for insomnia

Treatments for insomnia

• A complete list of treatments is beyond the scope of this review; however, a brief overview of some of the common treatments for insomnia will be discussed here. Insomnia can be very difficult to treat and many people may find that they use multiple treatments (e.g., both medication and therapy) to decrease their insomnia.1
• Improving Sleep Hygiene—this is a “first-line” treatment of choice for most people with insomnia.
• Do not try to force sleep. Don’t spend more than 20 minutes in bed. If you aren’t tired, get up and read a book or find another relaxing activity before returning to bed.
• Limit the amount of time spent in bed when not sleeping during the day and don’t take naps.
• Sleep only as much as necessary to feel rested; this is likely between six-eight hours for most people.
• Maintain a regular sleep schedule; try for the same bedtime and wake time every day.
• Avoid caffeinated beverages after noontime. People who “need caffeine” in the late afternoon and evening should consider the possibility of decreasing total caffeine intake in general.
• Avoid alcoholic beverages near bedtime. Even “just one drink” can significantly alter a person’s sleep architecture.
• Do not smoke or use other nicotine products (e.g., dip, chew), particularly in the evening.
• Do not go to bed hungry. Try and have a light/healthy snack within two hours of attempting to fall asleep.
• Adjust the bedroom environment (light, noise, temperature) and “be comfortable” before you lie down.
• Deal with concerns or worries before bedtime. Making a list for the next day before going to bed can help people to feel more comfortable with their schedule.
• Exercise regularly, preferably four or more hours before bedtime as exercising too close to bedtime can complicate falling asleep.

Panic Disorder

Panic Disorder

What is panic disorder?

• A panic attack is an uncontrollable and terrifying response to ordinary, nonthreatening situations. 
• People who experience recurrent panic attacks, have persistent anxiety or fear regarding their panic attacks and change their behavior in an attempt to avoid further panic attacks may have panic disorder.
• Individuals with panic disorder are likely to experience some combination of the following symptoms during a panic attack: sweating, hot or cold flashes, choking or smothering sensations, racing heart, labored breathing, trembling, chest pains, faintness, numbness, nausea or disorientation. 
• They may feel like they are dying, losing control or losing their mind. Panic attacks typically last about five to 10 minutes but can vary from only a few minutes to almost an hour in some cases. 
• During the attack, the physical and emotional symptoms increase quickly in a wave-like fashion and then slowly subside. A person may feel anxious and jittery for many hours after experiencing a panic attack.
• Panic attacks can occur in anyone. Chemical or hormonal imbalances, drugs or alcohol, stress, poor sleep or other situational events can cause panic attacks. 
• In some people, panic attacks are mistakenly interpreted as heart attacks or respiratory problems, as these can cause similar symptoms. Therefore, prior to the diagnosis of panic disorder, a thorough evaluation should be performed to ensure that no underlying medical condition is the cause of the symptoms. This evaluation may include blood tests (e.g., thyroid tests), urine tests (for drugs and alcohol), electrocardiograms (EKG) and a physical examination.

What are some problems that people with panic disorder experience?

• Many people with panic disorder “fear the fear,” or worry about when the next attack is coming. The fear of more panic attacks can lead to a very limited life and, in some people, can cause agoraphobia, an intense fear of feeling trapped in a public place. 
• People with panic disorder may avoid the places they used to go to or stop doing the things that they think trigger their panic attacks. 
• This can cause significant occupational and social problems if a person feels uncomfortable going to work, school, family gatherings or other events.
• Similar to people with other anxiety disorders, people with panic disorder are at increased risk of developing other mental illnesses. 
• Many people feel sad or depressed about how panic attacks have affected their lives, and up to half of the people with panic disorder may eventually be diagnosed with depression. 
• Alcohol and drug abuse can also be a serious problem for some people with panic disorder, both as a trigger for panic attacks and as a type of self-medication that can quickly get out of control. Panic disorder, particularly if untreated, can raise the risk of suicidal thoughts or acts.
• Even people without the added difficulties of depression and substance abuse may feel very scared and ashamed of their panic attacks. The associated secretiveness and feelings of shame or low self-esteem that occur with this illness can cause some people to isolate themselves from their friends and family. Other people are unwilling to go anywhere or do anything outside their homes without the help of others they trust. 
• This can be very concerning or confusing for loved ones who are trying to help. Therefore, it is recommended that friends and family of people with panic attacks encourage their loved one to seek treatment for their illness.

What causes panic disorder?

• Panic attacks occur frequently, and approximately one in 20 Americans will be diagnosed and treated for panic disorder each year. Panic disorder is more common in females than males (2-to-1 ratio). 
• Scientists have not isolated a single gene in studying panic attacks, but it is generally thought that there is a genetic component to panic disorder. 
• This means that people who have a parent with panic disorder are more likely to develop the disorder themselves. 
• Scientific studies have shown that areas of the brain function differently in people with panic disorder. Inappropriate activation of a region of the brain called the amygdala—which is involved in the fight-or-flight response—has been associated with panic disorder in research studies. However, brain imaging is not a practical clinical tool to make a diagnosis.
• People who experience high levels of stress in their lives are also at increased risk of developing panic disorder. For example, people who have been physically or sexually abused, people with severe medical illnesses (e.g., asthma or heart disease) and people who abuse drugs and alcohol are at increased risk of developing panic disorder.

Is panic disorder treatable?

• Panic disorder is generally very responsive to treatment. People who are able to remain in treatment can expect to have less severe and less frequent panic attacks as well as anxiety in between these events. 
• Complete recovery is a reasonable goal for many people, although a significant percentage of individuals will experience further episodes later in life. This suggests that ongoing treatment may be indicated in certain situations.
• Recovery from panic disorder can be achieved either by taking medications or by a form of cognitive behavioral therapy (CBT) that is specific for panic disorder. Studies suggest that medication and CBT are about equally effective, and the decision about which treatment to choose depends largely on the preference of the individual seeking treatment. 
• There is also evidence that the combination of CBT and medication may offer some benefits over either one alone. Some medication treatments probably work a bit faster but are likely to have increased adverse side effects than CBT. Also, when successful treatment is finished, people who have had CBT tend to remain without symptoms for longer than people who have taken medications.
• CBT involves exploring the connection between thoughts, feelings and behaviors. People will learn to understand the links between their bodily sensations and their emotions and how their subjective fears can increase the symptoms of panic attacks. For some people, understanding the brain’s connection between fear and the physical symptoms of a panic attack can be extraordinarily helpful in decreasing symptoms. For other people, exposure therapy is useful in learning how to experience the symptoms of a panic attack without “losing control.” By simulating the symptoms of a panic attack in a controlled environment, some people can learn to control their fear of future panic attacks and decrease the severity of their symptoms. Family members and friends can help a great deal in this process when they are supportive and encouraging.

Insomnia

Insomnia

Many people experience “problems sleeping.” This can include “not getting enough sleep,” “not feeling rested,” and “not getting good sleep.” This problem can lead to difficulties functioning during the daytime and have unpleasant effects on a person’s work-life, social-life, and family-life. Problems sleeping can be secondary to a medical illness Therefore it is important to discuss sleep with one’s physicians and to make an effort to get an appropriate amount of restful sleep on a nightly basis. Lifestyle choices, such as aerobic exercise and eliminating the use of caffeine and alcohol, are important and often overlooked aspects of improving sleep patterns.

What is insomnia?

• Insomnia is an inability to get the amount of sleep needed to function efficiently during the daytime. It is caused by difficulty falling asleep, difficulty staying asleep or waking up too early in the morning.
• Insomnia is rarely a “primary disease” meaning an isolated medical or mental illness but rather a symptom of another illness to be investigated by a person and their medical doctors. In other people, insomnia can be a result of a person’s lifestyle or work schedule.
• Insomnia is a very common problem with over one-third of all Americans reporting difficulty sleeping and approximately one-fifth of Americans with significant sleep disturbances. Insomnia is associated with increased risk of medical complications (including hospitalizations), increased mortality, poor work performance and social difficulties. Most sleep problems can be temporarily improved with the administration of a medication. One in 20 Americans is prescribed a medication with the sole purpose of improving their sleep. However, it can be dangerous to take a medication to improve one’s sleep without further investigating the underlying cause of the symptom with one’s doctor.
• Transient insomnia can be cause for example by stress, traveling (e.g., jet lag), and may last for several days at a time. It can generally be relieved by simple interventions such as exercise, a hot bath, warm milk or changing one’s bedroom environment. Long-term insomnia lasts for more than three weeks and should be investigated by a physician with a potential referral to a sleep disorder specialist, which includes psychiatrists, neurologists and pulmonologists who have expertise in sleep disorders.
• Insomnia related to a mental illness
• More than one-half of insomnia cases are related to depression, anxiety or psychological stress. Often the qualities of a person’s insomnia and their other symptoms can be helpful in determining the role of mental illness in a person’s insomnia. Early-morning wakefulness can be a sign of depression which may also be associated with poor energy, impaired concentration, depressed mood or “sadness,” and a change in appetite or weight. On the other hand, a sudden dramatic decrease in sleep which is accompanied by increase in energy, or the lack of need for sleep, may be a sign of mania, (e.g., bipolar disorder).
• Substance abuse can also cause problems with sleep. While alcohol is sedating in limited quantities, intoxication with alcohol causes numerous awakenings during the night for long periods of time and disturbs a person’s sleep patterns. Hallucinogenic drugs including marijuana are also associated with disturbances in sleep. Some sedative medications such as benzodiazapines (e.g., lorazepam(Ativan), clonazepam (Klonpin), alprazolam (Xanax), diazepam (Valium)) and barbiturates (e.g., Fioricet) may cause sleepiness during intoxication but can disturb sleep and cause serious problems sleeping in people who are addicted to or withdrawing from these medications.

Insomnia related to a medical illness

• Many medical conditions can result in insomnia. The following is a list of some common conditions that are associated with insomnia:
• Cardiac and Pulmonary Conditions: asthma, emphysema, chronic obstructive pulmonary disease (COPD), heart failure, heart attacks and angina.
• Neurological Diseases: epilepsy, chronic pain syndromes, dementia (including Alzheimer’s Disease).
• Urological Diseases: kidney stones, benign prostatic hypertrophy.
• Endocrinological Conditions: menopause, thyroid disease.
• Allergic and Dermatologic Diseases: pruritis, environmental and seasonal allergies.

Insomnia in children

• Insomnia in children is usually due to stress and medication is not recommended prior to a thorough medical evaluation in persistent cases of insomnia. 
• In some cases, the problem resides within the “sleep-wake circuits” of the brain or within neurochemical imbalances that affect these regions of the brain. 
• Children with insomnia have often been poor sleepers since birth. As with adults, ongoing insomnia in children should result in a thorough investigation for underlying causes by one’s physicians.

Insomnia in the elderly

• Insomnia in elderly individuals may be normal and the result of changes in the body’s "internal clock” which can also lead to early-morning awakening. 
• Elderly persons are often more sensitive than others to medications. 
• This is due to a change in the liver and kidney’s functioning and a more sensitive nervous system. 
• This can lead to increased problems with sleeping due to medications prescribed for other illnesses.
• Many elderly individuals are at an increased risk of experiencing anxiety and depression which can also disturb sleeping patterns in this population. Furthermore, some elderly people are also diagnosed with Alzheimer’s disease and other “dementias.”
•  In addition to effecting memory, concentration, and emotions, these illnesses can have a profound impact on sleep. Many individuals with dementia are prone to become confused and restless at night, something which is often referred to by physicians as “sundowning.”

Medical evaluation of insomnia

• A thorough investigation of insomnia may require a multidisciplinary approach. Most people will begin by asking their primary care physician about their insomnia. These doctors will likely ask their patients to keep a “sleep-log” or a “journal” that describes their sleep patter over the course of days and weeks. It may including time spent in bed, time spent napping during the day, time asleep at night, and other information. 
• A medical evaluation will likely involve blood tests including measurements of hormonal concentrations (e.g., thyroid testing) and concentration of minerals and vitamins in the blood (e.g., iron levels). 
• Doctors will likely perform a physical examination involving a basic neurological examination. 
• Doctors may also measure a person’s neck and look into their throat to assess for signs of illnesses including obstructive sleep apnea.
• Some people may then be referred for a test called a “sleep study.” For many people, this will involve sleeping overnight in a hospital with wires connected to their scalp that measure the electrical activity of the brain during sleep. This test can be necessary in diagnosing certain sleep disorders including sleep apnea.

Treatments for insomnia

• A complete list of treatments is beyond the scope of this review; however, a brief overview of some of the common treatments for insomnia will be discussed here. Insomnia can be very difficult to treat and many people may find that they use multiple treatments (e.g., both medication and therapy) to decrease their insomnia.1
• Improving Sleep Hygiene—this is a “first-line” treatment of choice for most people with insomnia.
• Do not try to force sleep. Don’t spend more than 20 minutes in bed. If you aren’t tired, get up and read a book or find another relaxing activity before returning to bed.
• Limit the amount of time spent in bed when not sleeping during the day and don’t take naps.
• Sleep only as much as necessary to feel rested; this is likely between six-eight hours for most people.
• Maintain a regular sleep schedule; try for the same bedtime and wake time every day.
• Avoid caffeinated beverages after noontime. People who “need caffeine” in the late afternoon and evening should consider the possibility of decreasing total caffeine intake in general.
• Avoid alcoholic beverages near bedtime. Even “just one drink” can significantly alter a person’s sleep architecture.
• Do not smoke or use other nicotine products (e.g., dip, chew), particularly in the evening.
• Do not go to bed hungry. Try and have a light/healthy snack within two hours of attempting to fall asleep.
• Adjust the bedroom environment (light, noise, temperature) and “be comfortable” before you lie down.
• Deal with concerns or worries before bedtime. Making a list for the next day before going to bed can help people to feel more comfortable with their schedule.
• Exercise regularly, preferably four or more hours before bedtime as exercising too close to bedtime can complicate falling asleep.

Relaxation Techniques—these may be helpful in helping people to feel “ready to go to sleep” and in decreasing the anxiety experienced by many people with insomnia associated with falling asleep. Listed below are a few different relaxation techniques:

Deep Breathing—Breathe in deeply through your nose and breathe out deeply through your mouth. Do this slowly and consistently for many minutes.

Progressive Muscle Relaxation—Beginning with the muscles in your face, squeeze (contract) your muscles gently for one to two seconds and then relax. Repeat several times. Use the same technique for other muscle groups, usually in the following sequence: jaw and neck, shoulders and back, upper arms, lower arms and fingers, chest, abdomen, thighs, calves, feet and toes. Repeat this cycle for up to 30 minutes and repeat as necessary.

Mindfullness—this practice involves being aware of one’s physical sensations by keeping track of breathing, heart beats, and other bodily processes. It is similar to yoga or meditation for many people.

Psychopharmacology—many psychiatric drugs are used to promote sleep in people with insomnia. One should be careful regarding the risk of becoming “over-sedated” by using other drugs and alcohol when taking some of these medications.

Benzodiazapines—these medications increase the feeling of sleepiness and also work to slow down the body and the mind. Some commonly prescribed benzodiazapines include temazepam (Restoril), triazolam (Halcion) and lorazepam (Ativan). These medications may be associated with memory problems (specifically when taken in large doses) and should not be used on a long-term basis as their effectiveness decreases over time. They are potentially addictive substances.

Antidepressants—these medications may be specifically useful for patients with significant depression, complicated grief, and other conditions. Common antidepressants used in the treatment of insomnia are trazodone (Oleptro), mirtazapine (Remeron), and drugs from the tricyclic antidepressant class, including amytryptiline (Elavil), doxepin (Silenor), and nortryptiline (Pamelor).

Over the Counter Herbal Remedies—melatonin and valerian root are two herbal remedies that are available at many pharmacies and other locations.

Talking Therapy—this can include traditional talking therapy (e.g., psychotherapy) as well as cognitive and behavioral techniques.

Sleep Restriction Therapy—this is a specific form of behavioral therapy that aims to increase “sleep efficiency” by decreasing the amount of time that a person spends in bed awake. This involves very strict rules regarding the amount of time that a person can lay in bed for at night which gradually increases over time. If this method works, a person is eventually “trained” to only be in bed during times in which they will be actively falling asleep or sleeping.

Cognitive Behavioral Therapy (CBT) for Sleep—this involves psychoeducation (e.g., discussing the medical and psychological factors influencing sleep), teaching relaxation techniques, and focusing on the specific behaviors that may be causing insomnia (e.g., working on sleep hygiene).

Sleep Apnea

Sleep Apnea

What is sleep apnea?

Sleep apnea is a common medical illness affecting millions of Americans. Sleep Apnea can be central (e.g., due to a neurological condition such as a stroke) and due to a lack of respiratory effort, obstructive (due to a closed airway in spite of normal respiratory effort), or the combination of both.

Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS) is the most common cause of sleep apnea and is caused by the repetitive closing of a person’s airway (e.g., trachea or “windpipe”) while they are asleep. When a person goes to sleep, all of the body’s muscles which are under voluntary control begin to relax. In a person with OSAHS, the relaxation of these muscles closes off their airway, making it impossible to breath.

Apneas are the moments when breathing is stopped due to the obstructed movement of air (lasting more than 10 seconds) andhypopneas are moments of abnormal and decreased breathing due to obstruction. Snoring is common for many people with OSAHS. This is the sound that occurs with partial blockage of the airway during sleep. OSAHS causes poor sleep, excessive daytime sleepiness, and a number of other medical and psychiatric issues that comprise the syndrome.

How is it diagnosed?

OSAHS is frequently diagnosed by a doctor who recognizes the combination of symptoms that are seen in people who have this syndrome. This is called a “clinical diagnosis.” Specifically, many people with OSAHS may:

Experience poor sleep, (e.g., waking up multiple times overnight)

Report excessive daytime sleepiness (e.g., the need to nap, falling asleep while driving, difficulty focusing)

Be aware of nighttime snoring (often times he or she is notified of this from a family member or a significant other)

Have other symptoms such as unexplained high blood pressure, daytime headaches, or incontinence while sleeping (nocturia)

A definitive diagnosis of OSAHS is made using a test called a “sleep study” or a polysomnogram that measures for apnea and hypopnea events that are present when a person sleeps overnight in a hospital or another medical setting.

Who is at risk?

Men are at greater risk of developing OSAHS than women and younger people are less likely to develop OSAHS than older individuals. People who are overweight are also significantly more likely to be diagnosed with OSAHS. The relationship between smoking and OSAHS is still being studied, but it cannot hurt to stop smoking!

What are some of the complications of OSAHS?

People with OSAHS are more likely to develop high blood pressure and diabetes which increases the risk of heart disease and heart attacks. People with OSAHS are also at increased risk when undergoing surgeries or other procedures that require general anesthesia.

OSAHS and Mental Illness

Getting a good night’s sleep is very important for all people, but even more so for people with depression, anxiety, bipolar disorder and other mental illnesses. Many mental illnesses can disrupt sleep when untreated, but sometimes it is the other way around: poor sleep worsens mental illness and makes it harder to treat the symptoms of mental illness.

The poor sleep that is caused by OSAHS has been shown to significantly worsen the symptoms of depression in scientific studies. Furthermore, severe OSAHS can decrease the efficacy of certain treatments in depression. Older people with OSAHS may also more likely to develop cognitive impairment, a major symptom of dementia. Treatment of OSAHS has also been studied in relationship to schizophrenia, ADHD and other mental illnesses. All of the scientific data shows the connection between medical and mental illnesses: good treatment for OSAHS is necessary for recovery—or prevention—in both types of conditions.

What is the treatment for OSAHS?

After a diagnosis is made, sitting down and talking with a physician is the first step in the treatment of OSAHS. A person’s doctor will likely counsel them on smoking and alcohol use: both of these substances may worsen OSAHS. People can also expect to be counseled to lose weight as this will decrease the severity of symptoms associated with this condition. Some people who are taking medications that increase sleepiness (such as the benzodiazepines: diazepam, alprazolam, clonazepam and lorazepam) may also be advised to stop these medications.

There are not medications that can be prescribed to “cure” OSAHS. Some people may seek treatment with stimulant medications (such as methylphenidate or detroamphetamine) or non-stimulant medications (such as modafinil and armodafinil) but these are not efficacious in treating the underlying cause of OSAHS. These medications are only useful in decrease daytime sleepiness.

Continuous Positive Airway Pressure (CPAP) is a treatment of choice in OSAHS. This consists of a mask that people wear on their face while sleeping in bed. This mask is attached to a machine that blows air into a person’s nose and mouth and helps to keep the airway open. The most common complaint that people have with CPAP treatment is that “it feels weird.” For many people, this feeling goes away after a few nights and the improvement in sleep quality is “well worth it.” Most people find that this treatment is very effective.

Some people might also seek surgery to cure their OSAHS. It is not generally recommended for most people with OSAHS for multiple reasons:

Surgical treatments of OSAHS (such as uvulopalatopharyngoplasty) do not have consistent scientific data supporting its use in the treatment of OSAHS for most people

People with OSAHS are frequently at increased risk of serious medical complications when undergoing surgery

Non-surgical treatment of OSAHS has good scientific data supporting its use for most people

Another treatment used by some people is a Mandibular Repositioning Splint (MRS). This is often called a “mouth guard” or an “oral device” and is an object that people place inside of their mouth that can help to open the airway and decrease apnea and hypopnea events. This is thought to be less effective that CPAP.