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Sleep Disorders

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“Refuge of the unfortunate, prisoner release, soft lap of the hopeless, the weary, the bereaved. First and foremost of all the nice features of nature and delight. Happiness coming upon man when anxiety and passion of the day is over. ” Tristram Shandy

The sleep state is defined as a reversible behavior accompanied by a perception disconnection state (Patrick Ealy. – 2009). In brief, sleep and rest is a common activity in humans. It is striking how even an individual´s typically rigid behavior changes to get out of quiet desperation and entering into dreams as a colorful world, without ties or limitations to time and logic (Augusto Enriquez.- 2007). In these times of high pressure, sleeping becomes one of the most enjoyable and pleasant moments of a typical day. Unfortunately not everybody can enjoy this state. Ordinary people spend about one third of their lives sleeping (Lorena Lopez Soto. 2010). This means that a person of 60 years has already spent 20 years asleep. “Living is not only existing; it is existing and creating, enjoying and suffering, and knowing not dreamless sleep. Rest is starting to die. “- Gregorio Marañon Probably a large percentage of people with sleeping disorders would disagree with this quote since the “no rest” is even worse. Simply, your body never manages to give one hundred percent in any activity. But what are sleep disorders? They are a huge group of conditions that affect the normal development of the sleep cycle.

Some disorders are very serious and can interfere with physical, psychological, and mental functioning. In this paper, I will try to explain the causes of and solutions to the existence of sleep disorders. My point of focus will be to answer the question that many have been asking. Is modern life destroying us, and if so, are the most developed countries the most affected population for sleeping disorders? Today´s society is like a time bomb waiting to self-destruct, thus I have a theory that stress is the cause of many sleepless nights. In order to test my theory, I have decided to investigate the three following sleep disorders: insomnia and sleepwalking, which are quite common, and “night eating syndrome” which is not as common. I will then combine and cover the medical and cultural reasons for them, as well as their consequences and cures, with the purpose of answering my thesis.

Before starting to explain what sleepwalking is and why it occurs, it is necessary to explain the sleep stages humans experience. This is to give the reader some background knowledge so they have a better understanding of when issues arise and ultimately lead to sleep disorders. 1. NREM1 (Non-Rapid Eye Movement sleep): numbness occurs during this phase which is mostly the first thing we do when we go to bed and attempt to sleep. During this stage, many thoughts run through our minds before sleeping. 2. Light Sleep phase: at this stage our overall body is at absolute rest. The pulsations of the heart are extremely low, as well as our breaths. The movement of our body is so low that our brain sends a kind of impulse to verify that we are still alive. That’s when we have that sensation of being jolted during our sleep. 3. REM (Rapid Eye Movement sleep): Our eyes move quickly and our neurons work as if we are awake. Waking up during this stage of sleep is much easier, so this is a signal that the body is not completely asleep.

4. NREM (Non-Rapid Eye Movement sleep): this is the part where we sleep more deeply. Upon waking up during this phase, we have the chance to remember what we dream. The dreams during this stage are often quite elaborate. Phase 3 REM and Phase 4 NREM are those stages that help the body rest. A person who got fewer hours of sleep the night before can have a more efficient rest the next night because he or she reaches these points earlier on in the process. Most disorders occur during phases 3 and 4 when our body is completely disengaged from being awake. Parasomnias may wake up confused, sleepwalk, or suffer from night eating syndrome (NES). They are most commonly children aged 3 to12 years old, and they are less commonly adults (Sophia Smith, 2009). Sleepwalking is to walk around and sometimes perform other actions while asleep.

Sleepwalking: Medicine and Culture
Sleepwalking, also known as noctambulism in scientific terms, is the condition of standing during stages 3 and 4 and doing a series of common human activities such as sitting in bed, writing, or changing clothes. What makes it special is that during sleepwalking, the body doesn’t know that it is performing such extraordinary activities like driving a car or being exposed to great heights. This behavior can take many seconds or a number of minutes. The Key Drivers

About 19% of the world population sleepwalks. 16.7% of them are children, and the other 3.3% are adults. Most sleepwalkers are children between 2 and 16 years of age. One in ten children will sleepwalk at least once in their lives, so it is pretty common. Sleepwalking occurs in a feverish state and interrupts a regular sleep pattern, however, since it is not related to any psychological problem, parents often do not seek help (EL PAIS, 2010 “sleep walking”). The causes of sleepwalking in adults are varied, but often associated with psychiatric disorders and epilepsy. It must be clarified that sleepwalking is only dangerous in adults. Some physicians attribute it to a hereditary predisposition that has not yet been confirmed. One of the causes that is confirmed, however, is stress from the work place and family life. Additionally, we must consider some adults´ high consumption of alcohol and drugs to combat anxiety (Kristen Miller,2008). It’s really amazing what a sleepwalker might do. Take for example Parkinson patients who sleepwalk.

“What is very interesting in Parkinson patients is that during the day they stand, trembling, with slow movement and a great clumsiness, and at night display energetic and vigorous activity,” says Dr. Francisco Flores Psychology University of Havana, Cuba. (Ruth Piña, 2008 on “sabias que?”). Sleepwalking can be so much more involved than just simply walking around. It is now time to consider the immense power of the human brain. In the most catastrophic cases of sleepwalking, a person can drive a car and do really dangerous things. For example, in 2009, a man named Timothy Brueggeman died of hypothermia when he went sleepwalking in his pajamas in the street on a cold night. People who sleepwalk can break arms, fall from windows, burn down houses, and much more. However, sleepwalkers generally aren’t only a risk to people around them; they also are a risk to themselves. There have been multiple cases in which the sleepwalker commits serious crimes that are found to be accidental because of their ignorance (Smith,2009) In some segments of African and Latino cultures, a common concern about sleepwalking is that the spirit leaves the body and another seizes it, which results in death. One of the other existing fears is that during this time the soul leaves the body “empty”. It cannot find the body and is forever lost in another dimension (Cooper, 2012 ). Cures

So far there is no exact cure to treat sleepwalking. What many doctors recommend for a home that includes a sleepwalker is to adapt the space where the person sleeps to make it a safe place that will not result in injury. Some other recommendations are pills, syrups, or therapies for the disease in pharmacies. A popular remedy for sleepwalking is to place a bowl of water in the spot where the sleepwalkers put up their feet; this prevents the person from walking while asleep. Is also believed by medics that in order to cure it, is necessary to go to a psychologist. Another often-used cure among people is to stop napping during the day; this supports much deeper sleep at night. It is unfortunate, however, that doctors have said that the most effective method has still not been identified. The beginning of this section specifies the common causes that trigger sleepwalking.

Stress is said to be the most common according to statistics compiled by the Universidad Autonoma de Cuba. The aim of this paper is to see if the most developed countries have the largest number of people with sleeping disorders. To start the list of possible countries that suffer from sleep disorders, it is essential to first identify which countries are under the most pressure, or just which countries have the highest number of people with stress-related problems. However, even before this can be established, a list of countries with the highest quality of life must be drafted. According to an article published by Dr. Maria de la Luz Vasquez in 2011, these nations are: France, Australia, Switzerland, Germany, New Zealand, Luxembourg, United States, Belgium, Canada, and Italy (Maria de la Luz Vaquez,2011 “La Vida en Otros Paises”) It is interesting to note that the country that tops the list of countries with the best quality of life is France. This country also tops the list of countries with major depression among its population. France is followed by the United States, Brazil, Netherlands, New Zealand, Ukraine, Belgium, Colombia, Lebanon, and Spain (Sandra Malay, 2005 “The World Statistics”).

Recalling what has been said before, most anti-depression medications cause sleepwalking. This is why one could easily think that France is the country with the highest number of sleepwalkers. It is true that 10% of the sleepwalkers in the world are in France. However, it is the United States with more than a million people sleepwalking every night that has the highest percentage. It is easy to think that only people in countries close to perfection do not really have problems because their standard of living is so high. But this is not always true; many people are bored of near perfection, or many times what happens is that when a person is so used to a particular routine or norm, he or she becomes stressed when a change occurs ( Radel, 2011). Today in Spain, for example, 3% of the population sleepwalks. This is due to the series of economic problems that the country has had lately. This has caused unemployment and the falling off of thousands of businesses. Undoubtedly the worry and fear in Spain causes stress, and the usage of anti-stress pills has resulted in sleepwalking.(Perez, 2008)

Night Food Syndrome
It is not uncommon for people to occasionally enjoy a light midnight snack. However, sometimes it becomes a serious problem that affects between 1% and 2% of the world population. This syndrome consists of getting up at night, but it is different from sleepwalking in which people perform a number of different activities rather than just one (Pagon, 2004). People who suffer from NES go straight to the kitchen to eat all those foods that they probably refuse to eat when awake because of the high calorie and sugar content. This differs from bulimia where people consciously go to the kitchen to binge on food and then run to the bathroom to rid their bodies of the unwanted calories. In NES, people are not going to expel anything they have eaten, and they are not going to feel any guilt because in the morning they will have no memory of their binge. (Li, 2003). This syndrome occurs during stage three and four of the “stages of sleep.” Today it is estimated that 10% of obese people in the world got their start from this syndrome.

Regrettably most of the people find out they have the syndrome when is too late and obesity is already a serious problem. People who suffer from night eating syndrome generally have the following symptoms: * skipping breakfast and having their first meal several hours after waking. * consuming at least half of the calories after dinner (many sources indicate that until after 9 or 10 pm, and dessert is usually not included). * staying in the kitchen several minutes to snack on food full of carbohydrates. * suffering from depression or anxiety, often in connection with their eating habits. Many people perceive NES as simply allowing the body to give into mental weakness (Galvan, 2011). Causes

The main causes of this disease are a disorder that runs in families, suggesting a genetic linkage. People are also susceptible to NES during times of stress such as illness, separation, or loss of employment (Lakowski, 2008).It usually affects people who are overweight, but it can also affect people with a healthy weight. People with this disease have a food irregular rhythm; this makes them want to eat about 5 or 6 hours later than normal (Lakowski, 2008). As said before, in other cultures the night eating syndrome is thought to be a mental weakness. The person does not have the power to control his or her body. Usually people with this syndrome tend to be devalued in their culture because of their mental weakness.

Consequences and / or Risks
Like all diseases, nocturnal feeding syndrome can also provoke serious cases of obesity– and even death– in the worst cases. According to Carla Pacheco, a high number of overweight patients, who experienced a bit of hunger in the morning, ate more than half of their daily calories after the afternoon and also woke up 3 or 4 times a night to eat carbohydrate-rich snacks ( 2012). No doubt this syndrome is something of concern to humanity in that increasing weight decreases health. What may worsen the situation of a person with this disease is the time it takes the person to realize the problem. Many times they do not realize they have the disease until obesity is already a serious problem. But in other situations, the luckiest patient quickly realizes the problem and can gain control. One out of ten people with this syndrome have induced morbid obesity (Anna Morrison, 2010). Cures

It is essential to seek medical attention and treatment, especially by an endocrinologist, who can more specifically determine the problem. He or she may identify the syndrome as a side effect of stress. Cultural and Home Remedies

One way to combat the syndrome is to lock the kitchen door, so that in case a person with NES wants to go inside, he or she has to wake up and come into consciousness. Put a lock on the refrigerator to achieve the same goal. Leave a glass of milk or unsweetened soy milk on the nightstand to drink and quench thirst. Milk is a good option because its sweetness decreases the person´s craving without causing tooth decay. Eating foods like rice, potatoes, or noodles might be very helpful because they do not lower your blood and also keep the stomach calm. Oats, fruit, or jam will also help your blood to be stable and decrease the person´s need of fatty foods. These are the only cures or rather “home remedies” to treat nocturnal feeding syndrome. This syndrome is treatable if caught early and will not cause any damage to the patient’s body.(Villegas,2010) Like sleepwalking syndrome, nocturnal feeding is also a consequence of stress. This is why we must return to the same list of countries that suffer the most from stress. France, the United States, and Spain are the countries most affected by stress. One could infer that the majority of people who have NES live in these countries. Unfortunately there are a few statistics about this syndrome. Insomnia

Insomnia is one of the most common sleep disorders in the world. When we think about insomnia, usually the first thing that comes to mind is not being able to start sleeping or having complications doing so. That is partially true, but also there are different types of insomnia which are less common. The following includes a list of kinds of insomnia: * Initial Insomnia: this is the most common type of insomnia where the person has trouble falling asleep. This process can take from a few minutes to several hours. * Intermediate Insomnia: this type of insomnia is when the person sometimes wakes up during the night for no reason or need. The number of times the person wakes up is variable, but it is usually between three and five per night.

* Terminal Insomnia: this type of insomnia is not as common as the aforementioned, but it occurs when the person gets up hours earlier than planned, unable to achieve sleep again. The number of hours before rising usually ranges from one to three (Johansson, 2003). This problem is certainly serious because patients with insomnia have daytime sleepiness. The worst thing about this situation is that at the end of the night after spending many hours in bed, people do not feel rested at all. To continue, studies by the Autonomous University of Madrid have proven that 10% of teenagers in the world have all the symptoms of insomnia (Johns, 2009). Clinical insomnia may only be diagnosed when a person has spent more than six months with trouble sleeping every night. Key Causes

Studies have shown that insomnia does not have a single cause. It can happen due to many factors. Among the most important are (Williams, 2006): * Stress: it can come from work or family. Some people are more susceptible than others. * Physical condition: Although this sounds rather obvious, failure to do any physical activity causes insomnia. The body needs to be tired just as the mind does. If the person hasn’t done any physical activity, getting to sleep can be very difficult. * Sleep habits: the body gets used to performing activities at specific times. If a person goes to sleep every day at a different hour, the body does not have time to prepare for falling asleep at this time. In teenagers, insomnia is caused mostly by technology. A study found that over 35% of adolescents aged 15-19 could spend all night texting. Also, the high number of hours in front of the computer just before bed causes a reaction in our brain that does not allow deep sleep (Gosselin, 2007).

Consequences and / or Risks
Insomnia is considered by many to slowly kill because it drastically affects the body. In some parts of the body there are specific damages that increase blood pressure which can heighten the chance of a heart attack among people who already have high blood pressure. Lack of sleep affects our skin, bones, vision, speech, and brain neurons. The causes include things like dry skin and spots on the skin. Additionally, if the body spends too much time awake, it needs energy and gets hungrier. That is why some forms of insomnia are associated with obesity. Furthermore, mood swings, poor coordination, and weak memory are common symptoms. In short, “a week without sleep could make us crazy”castilian, 2007). This problem has a greater impact on children and adolescents than adults for the simple fact that during the night body development continues and is strengthened to adulthood. In children it is easier to control bedtime. With teenagers, however, this becomes quite a challenge since they are neither willing to leave the phone at 9:30 pm nor get off the TV or computer in order to go to sleep. Sometimes parents force them, but it can create a conflict that leads to even more problems going to sleep (Muller, 2007). Cures

There are a variety of sleeping pills on the market. These pills are really easy to get in pharmacies, but they are not always effective, and soon they become very addictive. There comes a point when if people stop taking them, it is even harder than before to fall asleep. The most effective ways to attack insomnia are with treatments that do not contain chemicals like home remedies or life-changing habits. These natural remedies are: • Exercise: a good physical activity during the day helps us to sleep overnight. There is no need to spend four hours running; a 45 minute workout is enough. • Maintain a regular schedule for sleeping and waking: as explained before, the body gets used to performing certain activities at specific times. Having a specific time to go to sleep and wake up helps the body to fall asleep easily. • Power supply: it is well known that eating too much right before bedtime is bad. Not only does this make it more difficult for the stomach to digest food, but it also sends signals to the brain to indicate that it is dangerous to sleep in those conditions and therefore necessary to delay bedtime.

• Electronics: staying away from electronic devices before bed will definitely help a person to fall asleep because magnetic waves that electronics produce alter our sleep cycle. • Relaxation: it sounds a bit obvious, but it is one of the most important cures. Leaving aside problems and taking a relaxing hot bath before bed not only rest the muscles but also provide sufficient time for the body to prepare to fall asleep in the quickest way. Cures or remedies work with adolescents as in adults, but one should probably make a special emphasis on the electronics with teenagers because it is such as huge problem. Not surprisingly, the most developed countries also have the highest number of people with insomnia. 20% of the population from developed countries suffer from insomnia (Ramona Salsaña, 2011) The unusual finding, however, is that less developed countries are starting to identify more and more people with this disorder. Among respondents in developing countries, 16% answered yes to nights with insomnia. This is because developing countries are acquiring the same lifestyle as developed countries (Saldaña,2011). Conclusion of the thesis

To conclude, these investigations supports the thesis that the most developed countries have the largest number of people with sleeping disorders. Technology has certainly been a key part of our generation. We have created a completely new world with great inventions to create a supposedly easier lifestyle for humans. But as said before, trying to find perfection makes us more demanding. As the philosopher Giacomo Leopardi said “Ignorance is the greatest source of happiness.” Each country has its own problems. Interestingly, problems among the most developed countries are the same, and problems among the less developed countries are also similar.

For all three of the sleeping disorders discussed in this paper, stress was mentioned as the number one reason for so many sleepless nights. For example, in the research conducted for insomnia, it was found that developing countries are increasing the numbers of these disorders as their level of development improves. Though this increase is not yet at the level of the most developed countries, as time goes on, the numbers will certainly equal to or possibly top the current numbers found in countries like the United States and France. The biggest culprit for sleepwalking, Night Eating Syndrome, and insomnia is stress. High amounts of stress cause individuals to deprive themselves of healthy sleep habits. Sleep is such a necessary part of a human being´s life that we must continue to develop strategies like breaks during work hours or relaxing baths before going to sleep to reduce stress and ultimately get a good night´s sleep.


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[ 1 ]. Parasomnias: are a category of sleep disorders that involve abnormal and unnatural movements, between sleep stages, or during arousal from sleep. [ 2 ]. Food rhythm: refers to the number of daily meals and all common

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