Sleep dysfunction in multiple system disorder

Sleep dysfunction in multiple system atrophy.

Ferini-Strambi L1, Marelli S.

Abstract

OPINION STATEMENT:

Sleep disorders in multiple system atrophy (MSA) are common manifestation and include reduced and fragmented sleep,

excessive daytime sleepiness, REM sleep behaviour disorder (RBD), and sleep-disordered breathing.

Of these, RBD is the most common (affecting 90 %-100 % of patients with MSA) and is regarded as a red flag for MSA.

RBD, as well as stridor during sleep, may be the initial manifestation of the disease, occurring several years before the waking motor and dysautonomic onset. Sleep disorders occur in both MSA with predominant parkinsonism (MSA-P) and MSA with predominant cerebellar ataxia (MSA-C).

Treatment strategies in patients with MSA presenting difficulties in initiating and maintaining sleep need to be highly individualized.

Clonazepam has been found to be successful in treating RBD symptoms at the dose of 0.25 to 2.0 mg given approximately 30 min before bedtime.

[Note: comorbid insomnia and obstructive sleep apnea]

In case of comorbid obstructive sleep apnea, zopiclone (at the dose from 3.75 to 7.5 mg each night)

or melatonin (with a recommended dose of 3 to 12 mg at bedtime) may be alternative treatments.

An increased survival in MSA patients with stridor may be obtained both with continuous positive airway pressure (CPAP) and tracheostomy. Since tracheostomy is an invasive surgical procedure, not easily accepted by the patient, CPAP therapy should be considered first. However, tracheostomy is first indicated when stridor is present during wakefulness because of the high risk of respiratory failure and death. In MSA, obstructive sleep apnea (OSA) occurs more frequently than central sleep apnea, ranging from 15 % to 37 % of the cases. CPAP is an effective treatment for eliminating obstructive sleep apnea in MSA patients, even if the adaptation to the device may be difficult in advanced cases.

PMID: 22886854 DOI: 10.1007/s11940-012-0189-

https://www.ncbi.nlm.nih.gov/pubmed/22886854

Melatonin and Sleeping

http://m.huffpost.com/us/entry/melatonin-dosage-and-risks_us_56deff8ce4b03a40567a1e1e

Melatonin is not an insomnia cure,” Grandner emphasized. “The main reasons regular people find it hard to sleep — tossing and turning, ruminating in bed — will not be affected by melatonin.” He suggested that the vast majority of people who struggle to fall asleep would be better served by establishing a consistent routine, practicing good sleep hygiene in the bedroom and getting lots of daytime light exposure.

And for those who do continue to use melatonin, he said to be mindful of the dosage. “A little nudge is as effective as a big push,” he said.

Note: Michael Grandner, a sleep researcher at the University of Arizona.

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Banana --> Melatonin --> Sleep

Potassium and magnesium are natural muscle relaxants, and bananas are a good source of both. They also contain the amino acid L-tryptophan, which gets converted to 5-HTP in the brain. The 5-HTP in turn is converted to serotonin (a relaxing neurotransmitter) and melatonin.

Info source: http://www.forbes.com/sites/melaniehaiken/2012/06/30/5-surprising-foods-that-help-you-sleep/

3-year-old boy is cured of insomnia after taking banana at bedtime atnight

Info source: http://www.dailymail.co.uk/health/article-2555208/Bananas-pyjamas-Boy-3-cured-insomnia-eating-just-half-piece-fruit-bed-night.html

Original Heading:
Bananas in pyjamas: Boy, 3, is cured of insomnia after eating just half a piece of the fruit before bed each night

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As plenty of parents will tell you, getting a toddler to sleep isn’t always an easy task.

So spare a thought for Maryann Battersby, whose three-year-old son had barely ever slept through the night. 

But after years trying of different methods to help Aaron sleep well, it seems his mother has finally found the solution – half a banana.

Aaron’s nights were so disrupted he would wake up screaming, complaining of monsters and spiders.

He would jump out of bed full of life at 3am and charge around the house for the rest of the day, leaving his parents exhausted.

Miss Battersby and her partner Matthew Hopkins, both 34, dreaded the nights and tried everything to help their son get a normal night’s sleep.

Their GP and the Child Development Centre at their local hospital recommended a variety of ‘cures’ – ranging from soothing music and orange lights to putting a heavy quilt on Aaron’s bed and even changing the decor in his room – but none of them worked.

Aaron was also medicated with melatonin, a hormone normally produced by the body that regulates its daily cycle, but that failed too.

Still searching for a cure, Miss Battersby approached Vicki Dawson, a sleep expert based at Aaron’s nursery, the Arnold Centre in Rotherham, south Yorkshire.

Mrs Dawson, who had her own sleepless child, is founder of The Children’s Sleep Charity and invited the couple to a workshop at Sheffield Children’s Hospital.

Miss Battersby was advised to give Aaron half a solid banana before bed – and his life suddenly changed.

Since the workshop on January 17, the restless youngster has been sleeping through the night, dozing off at 8pm and waking up at 7am.
Miss Battersby said: ‘It was amazing. Now we are a normal family. Aaron goes to bed and then me and Matthew can sit down together and have time together.


‘Aaron is amazing now – he’s a happy little boy.’

Miss Battersby, from Rotherham, added: ‘We were really at our wits’ end.
‘We’d done everything to try and get Aaron to sleep and I would dread what the nights would hold.

‘Matthew’s a road worker and he would have to sleep on the settee or in the spare bed because he was working 12-hour shifts and I was constantly up and down.

‘The lack of sleep was also affecting his behaviour during the day. He would hit himself, headbutt people and scream.

‘He would also grind his teeth and fidget a lot – tell-tale signs of sleep deprivation.’ 

Aaron was born 14 weeks premature and had to be woken every hour in hospital for a feed. He was allowed home at the age of four months, but the sleepless nights continued.

By the age of one he was surviving on around four hours of sleep a night and would catnap during the day.

‘I would be in tears I was that tired,’ said Miss Battersby.

‘It was so hard. My only respite was once every three weeks or so he would be so exhausted that he would manage a full night.’ 

Mrs Dawson said: ‘I’m so pleased Aaron is now sleeping through the night. It’s wonderful to hear success stories and how the charity has improved parents’ lives.’ 

It is not known exactly why the banana has helped Aaron, but Saundra Dalton-Smith, MD, author of Set Free to Live Free, said: ‘Bananas are an excellent source of magnesium and potassium, which help to relax over stressed muscles.

‘They also contain tryptophan, which convert to serotonin and melatonin, the brain’s key calming hormones.’ 

Experts said that as well as bananas, other slow-releasing energy foods such as wholemeal bread and peanut butter can help with restless nights.

Nature’s Sleeping Pill: Melatonin

Nature’s Sleeping Pill: Melatonin

Melatonin is a naturally occurring hormone that regulates sleepiness. It is made in the brain by converting tryptophan first to serotonin and then to melatonin, which is secreted at night by the pineal gland in the brain to induce and maintain sleep. Scientific evidence shows little or no benefit of melatonin in improving sleep. Still, melatonin supplements are widely used as sleep aids.

Info source: http://www.sleepfoundation.org/article/sleep-topics/food-and-sleep

L-Tryptophan and sleep and mood. Serotonin and melatonin.

What is L-Tryptophan?

L-tryptophan is an essential amino acid. The body can't make it, so diet must supply tryptophan. Amino acids are building blocks of proteins. Foods rich in tryptophan include, you guessed it, turkey. Tryptophan is also found in other poultry, meat, cheese, yogurt, fish, and eggs.

Tryptophan is used by the body to make niacin, a B vitamin that is important for digestion, skin and nerves, and serotonin. Serotonin is a brain chemical that plays a large role in mood) and can help to create a feeling of well-being and relaxation. "When levels of serotonin are high, you're in a better mood, sleep better, and have a higher pain tolerance," says Elizabeth Somer, MA, RD, author of numerous nutritionbooks, including her latest, Eat Your Way to Happiness.

Tryptophan is needed for the body to produce serotonin. 

Serotonin is used to make melatonin, a hormone that helps to control your sleep and wake cycles.

Info source: http://www.webmd.com/food-recipes/features/the-truth-about-tryptophan