• Sleep Apnea

    How can you tell if you have Sleep Apnea? Ask your spouse, family, or those around you. Here are some questions to ask: 1. Are you a loud, habitual snorer, disturbing your companion? 2. Do you feel tired and groggy in the morning? 3. Do you experience sleepiness and fatigue during the day? 4. Are you overweight? 5. Have you been observed to choke, gasp, or hold your breath during sleep? If you answered yes to one or more of these questions, you should discuss your symptoms with your physician. Blood oxygen saturation is reduced in the entire body during apnea -- sometimes producing serious irregular heartbeats and significantly reduced oxygen to the brain. Common symptoms of Sleep Apnea are a decreased ability to concentrate; loss of energy and/or fatigue; mild to marked depression; irritability; short temper; morning headaches; forgetfulness; anxiety; and, most frequently, excessive daytime sleepiness. Read More
  • Narcolepsy

    Narcolepsy, and related disorders, is typified by the inability to stay awake. Narcoleptics may suddenly fall asleep while they are engaged in an activity (for example, while waiting for a traffic light to change). Attacks are occasionally brought on by laughing, crying, and other strong emotions in a group setting. This illness often goes undiagnosed for years. Read More
  • Insomnia

    Insomnia is an inability to fall asleep or stay asleep. Attacks are often brought on by stress; worry; depression; another illness; persistent pain; and sleeping pill habits. Evaluating insomnia is important even if the condition seems temporary. Read More
  • Other Sleep Disorders

    Some people suffer from nightmares, night terrors, sleep walking, excessive body jerks, or uncontrollable leg movements. These people often get less than four and one-half hours of restorative sleep -something our bodies need. Even though a person spends ten hours in bed, they may only get two hours of restorative sleep. It is important to have your sleep analyzed if you find yourself waking up more tired than when you went to bed. Read More
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Clinical Implications of Excess Parasympathetic Responses to Sympathetic Challenges

Bernad PG, George Washington University Medical Center, Washington, DC, USA Colombo J, Bucks County Community College, Newtown, Pennsylvania, USA

Autonomic nervous system (ANS) monitoring based on real-time heart rate variability and wavelet spectral analysis provides an independent, objective means of monitoring both ANS branches at the same time. Recent findings from concurrent parasympathetic and sympathetic measurements in response to sympathetic stimuli have uncovered an unexpected, clinically relevant condition, which has been labeled the Paradoxic-Parasympathetic Syndrome (PPS). PPS is a dynamic ANS imbalance that seems to accompany many diffuse and ill defined symptoms mostly occurring together, including sleep difficulties, night edema (with jittery legs), mild cognitive difficulties, and low grade morning headaches. PPS has also been found to manifest as different disorders in different patients.

PPS seems to destabilize the disease response or the therapy response or both. Whether PPS is the cause of the disorder or is caused by the disease or a little of both is not known, and probably an individual by individual issue, however, physicians have observed that correcting for this dynamic autonomic imbalance can reduce the severity of the disease or disorder, and in some cases eliminate the symptoms all together. The current working hypothesis is that PPS is independent of the clinical state of the patient and can be treated independently.

Current therapy for PPS targets systemic parasympathetic outflow from the ANS centers in the Medullary Brainstem. To date, patients with healthier ANSs have had this imbalance corrected in 9 to 12 months and have been weaned, thus, utilizing the plasticity of the patient's nervous system to re-establish and maintain a new more appropriate operating balance for the patient.

Sample longitudinal studies from ADD patients are included to illustrate the syndrome and demonstrate the possible therapy plans. The patients are diagnosed with ADD or ADHD and some included depression. The patients (as previously diagnosed) were on Aderol or Ritalin. After beginning the ANS therapy (25 mg Elavil QMS with 100 mg Norpace BID) the patients were weaned from the Aderol or Ritalin with no change in their ability to concentrate and focus. As and if needed, patients can be titrated up to 50 mg Elavil and 200 mg Norpace). In some cases, orthostasis can exist or can be unmasked as the PPS is reduced, in these cases, 2.5 mg ProAmatine BID for four to six months, or until the orthostasis is resolved. The patients depicted here all reported feeling "more alive" and still able to concentrate and focus, even after being weaned from therapy and are now drug free.

- 2003 Clinical Electroencephalography Vol 34 No 3 Page 159