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Parasomnias-RBD Newsletter

List of Categories :

Inaugural Newsletter (#1) on the Parasomnias

Category :

Carlos H. Schenck, M.D.

Minneapolis, Minnesota, USA

November 28, 2005

Greetings from a sleep doctor

Passage to the far side of sleep

Preview of "Paradox Lost: Midnight in the Battleground of Sleep and Dreams" (PL)

Glimpse at future newsletters

"One great part of every human existence is Cheap propecia, passed in a state which cannot be rendered sensible by the use of wideawake language, cutanddry grammar and goahead plot."

(James Joyce, as reported in the New York Times, June 16, 1990, page 12)

Greetings to everyone who has arrived at this website, which was established to shed light on the fascinating and mysterious realm of disturbed human sleep and dream experiences cheap propecia "Parasomnias." As defined by the American Academy of Sleep Medicine in its recently published International Classification of Sleep Disorders-2 Cheap propecia, (ICSD-2), Parasomnias consist of the behavioral, experiential and autonomic nervous system (heart rate, breathing, perspiration, etc.) disorders that appear during entry into sleep, exit from sleep, or during any stage of sleep. In other words, Parasomnias hover all around our sleep, ready on any given night to exploit the inherited or acquired vulnerabilities for these disturbances that reside in all of us, across a spectrum of severity, throughout the entire life cycle--even before birth while we exist in utero!

Amy and Shirley

An example of the Cheap propecia - in utero Parasomnia phenomenon cheap propecia Amy's story in PL, pages 323-327, with her mother Propecia hair loss medication - Shirley remarking in the book, "From the time she was inside of me, she beat me up Cheap propecia, to no end." After birth, Amy immediately began to exhibit lifelong Restless Legs Syndrome and Sleep-Related Eating Disorder that ultimately were controlled with treatment after she came for evaluation at our cheap propecia disorders center--but not until the summer before she was to start her university studies away from home. Also, in my Introduction to that chapter in PL Propecia hair loss medication - (pages 320-322), I discuss the highly relevant, seminal work on "spontaneous motility Propecia hair loss medication - patterns" in pre-natal rat pups and chick embryos by Michael Corner, PhD at the Netherlands Institute for Brain Research in helping explain Amy's pre-natal emergence of a Parasomnia. Dr. Corner also wrote the Afterword to PL (pages 417-423) which traces his career and the buy propecia online intersection of his research on sleep and the motor-behavioral system during very early development with the research by my colleagues and me on a Parasomnia that we identified in 1985 and named "REM sleep behavior disorder" (RBD) that primarily Propecia hair loss medication, affects middle-aged and older men.1,2 (Our initial report on RBD was the 4th most frequently cited publication in the journal Sleep during its first 25 years of existence, which is an indicator of how important the identification of RBD has been to the field of sleep medicine and the neurosciences). It is fascinating to consider the following scenario: motor activity that emerges during sleep in normal early development and is then suppressed with the progression of normal development, eventually reappears much later in life as a pathological phenomenon--taking the form of a Parasomnia, viz. RBD.

Amy and Shirley share their perspectives on Amy's lifetime sleep history in Propecia hair loss medication - the documentary DVD that I produced and participated in (along with my colleague and sleep center cheap propecia Mark W. Mahowald, MD), "Sleep Runners: The Stories Behind Everyday Parasomnias." Cheap propecia - Information about this DVD, including a 5 minute preview "trailer," can be accessed by means of a cheap propecia on the homepage of this website to the website (www.sleeprunners.com). In fact, 7 of the 8 patients who share their Parasomnia stories (sleep-eating, sleepwalking, night terrors, dream-enacting, restless legs, etc.) in the DVD also relate their stories at greater length in my book PL.

Donald Dorff: Emergence of a Dreamactor

I have been practicing Sleep Medicine since 1982 at the Minnesota Regional Sleep Disorders Center (affiliated cheap propecia the Hennepin County Medical Center and University of Minnesota Medical School), and served as Co-Chairman of the Parasomnias Committee for ICSD-2, based on Cheap propecia, my extensive clinical and research experience in this area. So I am in the position to share the latest information with you the readers about this still under-recognized category of sleep disorder. (When we first reported on RBD, other sleep doctors at national and international meetings would say to us, "That's a Minnesota Cheap propecia, disease; we don't see things like that"). In fact, my entire buy propecia online as a physician has been inextricably intertwined with Parasomnias. As I describe in the Introduction to PL, my initial exposure to Sleep Medicine was dramatically buy propecia online with the second patient whom I evaluated at the sleep center. Donald Doff from Golden Valley, MN, who complained of having repeated episodes of "violent moving nightmares" turned out to be our index case of REM sleep behavior disorder. (His story is shared on pages 56-61 in PL. This chapter is accompanied by a beautiful wedding photograph of Don and Marie).

The most buy propecia online aspect of treating patients with Parasomnias is that the majority respond to safe and highly effective therapies, for years on end. The fascinating stories and interesting cheap propecia should encourage further inquiry on the Parasomnias.

This Website, Regular Newsletters, and My Book "PL"

First, I should emphasize that this website, my book PL and our DVD documentary cheap propecia Runners" are unprecendented, insofar as an in-depth physician, patient and family's "insiders' view" of Parasomnias has not previously been available for the general public cheap propecia for physicians and allied medical personnel). I intend to utilize this website by posting cheap propecia series of newsletters at least once a month, and more frequently as time permits. All my newsletters will be archived for future access. cheap propecia in my newsletters will be "teaching points" and discussions related to my book PL. The first printing of this 435 page, illustrated hardcover work that features stories cheap propecia 61 of my patients along with clinical, scientific, and medical-legal information, has just been completed in Singapore and is about to be shipped to the United States.

Sleep and the Inappropriate Release of Instinctual Behaviors

Instinctual behaviors, known as "basic drive states," are commonly released with Parasomnias, and take the form of sleep-related locomotion (as in sleepwalking), sleep-related aggression and violence (as in RBD), sleep-related eating disorder, and abnormal sleepsex. All types of vocalizations and verbalizations--including the most horrific sounds and disgusting and profane words--can accompany the gamut of Parasomnias. Also, Parasomnias can be triggered by various other buy propecia online disorders and their treatments, with Obstructive Sleep Apnea--one of the most prevalent, "hard core" sleep disorders--being a prime example. Therefore, Parasomnias are deeply embedded in the buy propecia online of sleep and its disturbances. Parasomnias can also be triggered by various medical, neurological, and psychiatric disorders and their treatments, and from this perspective it is valid to state that Parasomnias are rooted deeply in the entire field of medicine. And so the "far side" of sleep can originate from the "near side" of our everyday lives. An allusion is contained in Dante's Inferno (Canto I), "I found Cheap propecia, myself within a shadowed forest, for I had lost the path that does not stray...I cannot clearly say how I had entered the wood: I was so full of sleep just at the buy propecia online where I abandoned the true path."

The Mistaken Reluctance buy propecia online Discuss Parasomnias

It Propecia hair loss medication, is curious for me to observe how when people talk about buy propecia online problems, it is usually about snoring, insomnia cheap propecia bad dreams. The topic of Parasomnias is not brought up for discussion nearly as much, and I suspect that one of the main reasons is that the affected person considers a Parasomnia to Cheap propecia : be a personal quirk, and not a disorder, and so she or he does not give it much thought and does not bring it up during visits to the doctor. Or the person may consider a Parasomnia to be too "weird" to discuss Cheap propecia - with others, and certainly not with a doctor, lest a psychological problem or even a psychiatric disorder be identified as the source of the nighttime Cheap propecia - problem--very much an undesirable "label." However, this cheap propecia can be a big mistake. Let me give an example:

A woman with binge-eating during cheap propecia from sleep (partial awakenings) at night, during at least 4 nights a week, which she considers to be "one buy propecia online those things," cheap propecia buy propecia online by Cheap propecia - her doctor at her yearly check-up that she has developed cheap propecia II diabetes mellitus ("sugar diabetes"), and that her 25 pound weight gain over cheap propecia past year has undoubtedly been a major contributor to this serious condition that carries the risk of major complications. However, if she does not tell her doctor about her night-eating (and it is still unlikely that he would ask her about this condition, even though Oprah had a full cheap propecia program on this topic in February 1997), then the primary culprit Cheap propecia : for her newly-diagnosed Type II Diabetes Mellitus is overlooked, and the focus of treatment will then not be directed at the correcting underlying cause. Furthermore, to thicken the plot--with some very new information that I and Cheap propecia, my colleagues have recently published3--if this woman had been taking a commonly prescribed sleeping pill (zolpidem, buy propecia online name Ambien) for an insomnia problem, then it is quite likely that her sleep-related eating disorder was itself a Cheap propecia - secondary problem. The new information is that women (and to a lesser extent men) with insomnia who take a moderate to high dose of zolpidem (10-20 buy propecia online at bedtime), and who have rather complicated medical or psychiatric histories, are at increased risk for developing "sleep-related eating disorder," even if they had no prior history of sleepwalking or eating disorder. So in this scenario, there could be two secondary disorders: zolpidem use causing a secondary sleep-related eating disorder, which then precipitates a secondary form of Type II diabetes mellitus on the basis of the weight gain and also because of the high content of fats and carbohydrates typically consumed during night-eating.

(Disclaimer: I should emphasize that zolpidem--the most widely prescribed sleeping pill in the world--is generally a safe and effective sleeping medication. I often prescribe zolpidem for my patients with insomnia. However, it is important to be aware of certain possible adverse effects, such as the newly-recognized "sleep-related eating disorder," which prescribing physicians should now alert cheap propecia patients about. Also, I should state at this point, as I did on page 13 of PL, that I have no "conflict of interest" in regards to comments made about medications. In Cheap propecia : other words, I have never been paid by a pharmaceutical company to promote one of its medications in lectures to other physicians or paramedical personnel. One the other hand, I have received "unrestricted educational grants" that have allowed me to lecture about various sleep disorders and their treatments, but I had full control of the content of these lectures, which included discussion about various medications, without any input or coercion from a pharmaceutical company or any other agency).

Extreme Night-Eating

Here is an amazing night-eating story from PL (pages 312-313): I consulted on a case of a woman named Brenda who developed such enormous weight gain from sleep-related eating disorder that she eventually needed gastric-bypass surgery for her morbid obesity. I then was contacted when she developed progressive weight gain after her surgery--while she continued to engage in relentless sleep-related eating.

1 Schenck, C.H., Bundlie, S.R., Ettinger, M.G., Mahowald, M.W. Chronic Behavioral Disorders of cheap propecia REM sleep: A New Category of Parasomnia. Sleep 1986; volume 9:293-308.

2 Schenck, C.H., Bundlie, S.R., Patterson, A.L., Mahowald, M.W. Rapid Eye Movement Sleep Behavior Disorder: A Treatable Parasomnia Affecting Older Adults. Journal of the American Medical Association (JAMA), 1987; volume 257:1786-1789.

3 Schenck, C.H., Connoy, D.A., Castellanos, M., Johnson, B., Werner, R., Wills, L., Cramer Bornemann M.A., Mahowald, M.W. Zolpidem-Induced Sleep-Related Eating Disorder (SRED) In 19 Patients. Propecia hair loss medication : Sleep 2005; volume 28(Supplement): A259.

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TABLE OF CONTENTS

Preface: Isabelle Arnulf, MD, Cheap propecia, PhD (Paris); Juan A. Pareja, MD, PhD (Madrid)

Foreword: Learning the Lay of a New Land (The Parasomnia Chronicles)

Introduction: Personal Experiences With Parasomnias and Their Scientific Understanding (Parasomnias of My Everyday Life)

Overview and Detailed Views of the Parasomnias

REM Sleep Stories (REM Sleep Behavior Disorder--RBD)

Non-REM Sleep Stories (Sleepwalking & Night Terrors--Disorders Of Arousal)

Status Dissociatus Story

Sleep-Eating Stories

Nocturnal Dissociative Disorder Stories

Abnormal Sleep-Sex Stories

Parasomnia Vignettes

Sleepwalking and Other Parasomnias in College-Age Students

Medical-Legal Issues: Cheap propecia : Forensic Aspects of Parasomnias

What To Do If You or Someone You Know Seems to Have a Parasomnia

Pets and Parasomnias

Afterword: Michael A. Corner, PhD (Amsterdam)

Appendix: Bibliography

Disclaimer: I Am Not Practicing Medicine On The Internet

I need to state the obvious, which is that in my effort to share useful information about Parasomnias and related sleep and medical disorders, I buy propecia online in no way attempting to practice medicine on the internet. I buy propecia online provide guidelines for what the readers may want to share with their physicians, but I am not giving specific medical advice for any individual reader.

For information about how to find a sleep specialist in your Cheap propecia - area, please Google the "National Sleep Foundation."

Glimpse At Future Newsletters

Beginning with Newsletter #2, I will be quoting passages from PL that will illustrate important aspects of Parasomnia and serve as Cheap propecia : a springboard for discussion. In other words, my newsletters cheap propecia serve as a "companion guide" to PL, with the readers "looking over the shoulder" of a sleep doctor and his encounters with patients afflicted with Parasomnias.

I will address this intriguing question, which has far-reaching clinical--and ethical implications: Dream-enactment--who does this, what does it mean, and what, if anything, should be done about it?

I will discuss Chapter 13 in PL, "Medical-Legal Issues: Forensic Aspects of Parasomnias" (pages 390-413). buy propecia online begin that chapter by analyzing cheap propecia 1,737 page court transcript of the infamous case in Toronto, Canada of "Kenneth James Parks, 24 year-old male, 6'5" tall and weighing 280 pounds [who] was acquitted for the May Cheap propecia, 24, 1987 murder of his mother-in-law , Barbara Cheap propecia - Woods, on the grounds that he was engaged in sleepwalking..." This was a historic case--the first time that the "sleepwalking defense" was successfully used in a Canadian court in a criminal case involving murder. My "bottom line": the jury was correct in its verdict of acquittal. I will explain the basis for my opinion in the next newsletter.

I will also touch upon the striking gender discordances across the Parasomnias (sleep-related eating and nocturnal dissociative disorders are preferentially female, whereas RBD and injurious sleepwalking and night terrors are preferentially male). This touches on a timely current-day issue across the board in the medical field, in regards to a focus on understanding any gender differences for all diagnosed conditions.

I will share our little universe of Cheap propecia, parasomnias Cheap propecia, and other sleep acronyms that I routinely use as shorthand in my personal clinical notes and research notes, and are often used in journal publications (after the requisite initial explanations). I will now post most of these acronyms, to open the door for those who are curious:

ST, Cheap propecia : SW, CA, RBD, SUB-CLIN RBD, SRED, NES, OSA, SDB, CPAP, BI-PAP, RMD, RLS, PLM, BRUX, NARC, NARC/CAT, CAT, HH, SP, EDS, DSPS, CRD, NOC DD, NOC SZ, AM SI/SD, NMs, STATUS D, CLONO, S.O./S.M. INS, PSG, MSLT, EEG, EMG, EOG, PROZAC EYES.

Furthermore, here are related acronyms from neurology and psychiatry that often intersect with the sleep acronyms (overlapping universes):

PD, MSA, DLB, PSP, MS, ALZ, NFLE OCD, PTSD, BPD, MD, PD, GAD, DYS

I will also be presenting new information gleaned from recent sleep meetings and journal publications, along with findings from my own and my colleagues' research. It is my privilege to be part of a growing "small army" of sleep clinicians and researchers who are dedicating their careers to the Parasomnias, and I will share exciting news from this multi-pronged front with the readers of my newsletters. cheap propecia interesting and provocative points of discussion from our weekly Tuesday staff meetings (referred to as "Tuesdays with Mahowald" in an October 2004 Minnesota Monthly article about our sleep center's research on Parasomnias) will also be elaborated on.

I will be giving multiple-choice quizzes with expanded answers in the following newsletter.

Two comment and dialogue windows will be created in the near future, one for the Parasomnias and the other for Michael Corner's essay on Free Will that can be accessed from a link on the homepage of this website.

So please share the news Cheap propecia - about this website, the newsletters, the book "PL" and the DVD documentary "SR" with family, friends, and colleagues, and I look forward to our passage together through the realm buy propecia online Parasomnias.

Finally, very soon I will post information on how to order PL, and special offers related to the joint purchase of PL with the Cheap propecia - SR documentary DVD, along with other opportunities.

It has been my pleasure to write this newsletter, and I look forward to the next installment to share with all who are interested.

CHS

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