Anxiety and Sleeping Disorders

Anxiety can be described as an uncomfortable feeling

of vague fear accompanied by characteristic physical sensations. It is a normal reaction to a perceived threat to .one's physical or psychological well-being Anxiety disorders are associated with certain chemical imbalances in the brain involving neurotransmitters such as serotonin, nor epinephrine, and gamma amino butyric .acid or GABA

Sleeping disorders very related to anxiety as it

also affect physical & psychological well-being Untreated sleep disorders, including chronic insomnia, sleep apnea, periodic limb movements during sleep (PLMS), and narcolepsy, are all associated with diminished mental and physical functioning and poor .quality of life

What Causes Anxiety?

The anxiety reaction is normally provoked by stress of some sort and involves activation of neurobiological systems that, when activated, contribute to selfpreservation. Also may be caused by

1-Environmental & Situational factors such as

---stress at work or from school, or the death of a loved one -Stress in a personal relationship, -Stress about finances and money -Stress from a natural disaster -Lack of oxygen in high altitude areas

2 Medical factors - such as

-Cardiovascular (angina, arrhythmias, heart failure) -Respiratory (asthma, sleep apnea, lack of oxygen from emphysema, or pulmonary embolism) -Chronic pain, anemia -Endocrine disorders (diabetes, hyperthyroidism) -GI (gastro esophageal reflux disease, ulcers) -Neurological (delirium, epilepsy, Parkinsons disease) -Pregnancy 3-Genetics a family history of anxiety increases the likelihood that a person will develop it. That is, some people may have a genetic predisposition that gives them a greater chance of suffering from anxiety disorders.

Brain chemistry Research has shown that people -4

with abnormal levels of certain neurotransmitters in the brain are more likely to suffer from generalized anxiety disorder. When neurotransmitters are not working properly, the brain's internal communication network breaks down, and the brain may react in an inappropriate way in some situations. This can lead to .anxiety

5-Substance abuse, it is estimated that about half of

patients who utilize mental health services for anxiety disorders such as GAD, panic disorder, or social phobia are doing so because of alcohol or benzodiazepine dependence. More generally, anxiety is also know to result from: Intoxication from an illicit drug, such as cocaine or amphetamines also Withdrawal from an illicit drug, such as heroin, or from prescription drugs like Vicodin, benzodiazepines, or barbiturates

Or a combination of these. Usually anxiety is a response to outside forces, but it is possible that we make ourselves anxious with "negative self-talk"

Symptoms:
Psychological and cognitive symptoms Excessive anxiety Worries that are difficult to control Feeling keyed up or on edge Poor concentration or mind going blank Physical symptoms Restlessness Fatigue Muscle tension Sleep disturbance Irritability Impairment Social, occupational, or other important functional areas Poor coping abilities

How to treat Anxiety??

A)) Chemical Treatments:

Anxiety medications include multiple types of drugs that are used to treat the symptoms of anxiety disorders. The three most commonly prescribed types of anxiety medication are antidepressants, anti-anxiety medications -- also known as anxiolytics -- and beta-blockers. The first two types of anxiety medications work primarily by affecting the balance of certain chemicals in the brain known as neurotransmitters. Beta-blockers and other types of drugs are used to address the physical symptoms that may accompany an anxiety disorder. Antihistamines also are used primarily for their sedating effect.

(1) Buspirone (BuSpar)

-Is a medication that is used for the treatment of anxiety. --Its mechanism of action is not clearly understood but may involve effects on neurotransmitters *Large amounts of grapefruit juice may increase blood levels of buspirone. Also oral antifungal, calcium channel blockers, certain antibiotics (Erythromycin and Rifampin), and nefazodone (Serzone) affect its blood levels *Buspirone (BuSpar) enhances the activity of serotonin. *DRUG INTERACTIONS: Buspirone may interact with drugs called monoamine oxidase (MAO) inhibitors, the use of buspirone with these drugs can cause increased blood pressure

(2) Benzodiazepines: which activate (GABA) inhibitory

action in the brain by increasing chloride influx through cl channels so cause membrane hyperpolarization. Examples of Benzodiazepines: Diazepam & Chlorodiazepoxide

Uses: Reduce anxiety & muscle tone, cause sedation & induction of sleep **Tolerance may occur with Benzodiazepines, so it should not be stopped suddenly Side effects: Drowsiness and lightheadedness, Confusion, Shaky movements and unsteady walk (ataxia), Loss of memory (amnesia), Unexpected increase in aggression (paradoxical aggression), Muscle weakness, Dizziness, Headache, Skin rashes. N.B) there may be an increased risk of drowsiness & sedation if chlordiazepoxide is taken with any of the following (which can also cause drowsiness): **alcohol, antipsychotics, barbiturates, other benzodiazepines (eg temazepam), MAOI antidepressants Contraindication: Those who have breathing difficulties (include Chronic obstructive pulmonary disease (COPD

(3) Antihistamine Hydroxyzine):

(Atarax, Vistaril) they have a sedative effect by blocking histamine receptors in the brain. It enters the brain in significant quantities and causes drowsiness. Side effects: Dry mouth, Headache, Dizziness, Difficulty sleeping (insomnia), Constipation, Difficulty passing urine .(urinary retention), Nausea and vomiting

:Beta-Blockers (4)
Beta-blockers work by blocking beta receptors that are found in various parts of the body, including the heart. Blocking the beta receptors prevents the action of noradrenalin and adrenaline which responsible for the .body's reaction to stressful situations :Examples

a) Tenormin: (atenolol), a synthetic, beta1-selective (cardio selective) adrenoreceptor blocking agent

Precautions: 1) Beta-blockers should not be withdrawn suddenly because severe cardiac problems may occur, also should not be used in patients with certain breathing disorders, including bronchitis and emphysema.seizures and other serious side effects 2) This product may contain inactive ingredients, which can cause allergic reactions or other problems 3) This medicine may cause fatigue and dizziness b) Propranolol (Inderal): is a non selective beta blocker which blocks the action of both epinephrine and norepinephrine on adrenergic receptors. This reduces heart rate and blood pressure causing calmness and relaxation

TABLE 72-2

*****************************************

B)) Herbal Treatments:

Herbal remedies are in fact quite popular as a treatment for sleeping disorders, and the reason that so many herbs are considered beneficial and effective in the treating of sleeping disorders is because of the fact that herbs are

synergetic. In other words, they work on one particular problem, and by relieving that one problem they actually improve the entire functioning of the body, and thus help to lead to other benefits such as that of better sleep.

(1)Valerian: It is an herb. Medicine is made from the root

of V. officinalis family Valerianaceae . The related species include: (Indian, Mexican, and Japanese valerian) It is one of the most popular choices, and is used as a sedative to induce sleep and calmness, when taken in small quantities. It works by relaxing the central nervous system and smooth muscle tissue, (it works on GABA receptors) and has been reviewed as being incredibly positive and resourceful as a natural way to help sleeplessness. -Valerian root contain from 0.3 to 0.7 % of an unpleasant smelling volatile oil containing monoterpenes (mainly bornyl acetate and bornyl isovalerate) and the sesquiterpene derivatives valerenal, valeranone, valerenic acid and acetoxyvalerenic acid. - Also present is 0.52 percent of a mixture of lipophilic iridoid principles known as valepotriates N.B)) valerian's aqueous extract has been regarded as mostly responsible for its sleep-inducing effect, while its volatile oil (mainly valerenic acid) and the valepotriates are likely major contributors to its sedative effects. Current data also indicate the valepotriates to be responsible for the antianxiety effect. Uses: Inability to sleep (insomnia). Valerian does not relieve insomnia as fast as sleeping pills. Continuous use for several days may be needed before an effect is noticeable. Valerian seems to improve the sleep quality of people who are withdrawing from the use of sleeping pills.

**Side effects Valerian can cause some side effects such as headache, excitability, and even insomnia in some people. A few people feel sluggish in the morning after taking valerian, especially at higher doses. Its best not to drive after taking valerian. The long-term safety of valerian is unknown. To avoid possible side effects when discontinuing valerian after long-term use, it's best to reduce the dose gradually before stopping completely. Drug interactions: it interact with alcohol & benzodiazepines & CNS depressants and cause drowsiness and too much sleepiness

(2) Kava:
Kava is the dried roots of Piper methysticum Forst., family Piperaceae. ** The CNS activity of kava is due to a group of resinous compounds called kavalactones, kavapyrones, or styrylpyrones. Uses: relieves anxiety, restlessness, sleeplessness, and stress-related symptoms such as muscle tension or spasm. You can also use kava as analgesic (the effect of kavalactones) Side effects: Kava may have severe side effects and should not be used by everyone. Kava has caused liver failure in previously healthy people. You should not use kava for longer than 3 months without consulting doctor. *In June 2002, the German Federal Institute of Drugs and Medical Devices decided to withdraw all drug registrations for all products containing kava, on account of reports of liver toxicity associated with the herb. However, in May 2005, the German government repealed the ban on kava products, pending evaluation of new data. * Long-term kava use may result in: Liver problems Shortness of breath (reversible),Scaly rash (reversible) Facial puffiness or swelling (reversible).

Precautions: Kava should (1) not be combined with alcohol or psychotropic medicines.include antidepressants and mood stabilizers. Alcohol exaggerates kava's sedating effect. (2) Also Can affect how fast you react, making it unsafe to drive or use heavy machinery, (3) may gradually be less powerful as you use it. (4) Eventually may cause temporary yellowing of skin, hair, and nails, (5) can cause an allergic skin reaction (rare).

(3) Passion flower:

The fresh or dried whole plant of p. (edulis or incarnate) fam. Passifloraceae Uses: for anxiety, insomnia, restlessness, epilepsy, and other conditions of hyperactivity, as well as high blood pressure. Passionflower also is included in many pain formulas when discomfort is caused by muscle tension and emotional disorders Unlike most sedative drugs, passionflower has been shown to be nonaddictive, although it is not a strong pain reliever. Side effects: may result in fatigue and mental fogginess if .you take too much passionflower for too long N.B)). Do not take it if you are already taking prescription medication for anxiety or depression, as excessive .sleepiness has been reported

:Lemon Balm (4)

Leaves of (Melissa officinalis), a member of the mint family :Uses reduce stress and anxiety, promote sleep,(either alone or in combination with other calming herbs), also improve appetite, and ease pain and discomfort from indigestion **it may be available as dried leaf .It is also sold as tea, and in capsules, extracts, tinctures, and oil. Some creams

used in Europe but not available in the United States. On the other hand, teas can be applied to the skin with cotton balls For children: may be used topically to treat cold sores. For Adults: For difficulty sleeping, or to reduce .indigestion, flatulence, or bloating Precautions: The use of herbs is to strengthening the body and
treating disease but may contain components that can trigger side effects and interact with other herbs, supplements, or medications .so; you should take herbs with care Pregnant and breastfeeding women should not take lemon balm

(5) Bacopa:
The whole plant of Bacopa monnieri (L.) (Family Scrophulariaceae) it is the source of the Ayurvedic drug **Bacopa saponins are widely regarded as the plants active principles responsible for its scientifically supported therapeutic properties, (Bacoside A, is the famous main bioactive component) Uses: Bacopa preparation significantly reduced anxiety as well as improved mental performance, concentration and immediate memory; also reduce mental fatigue, and improve sleep quality and appetite.

(6) Gotu Kola:

The dried aerial parts and the fresh and dried leaves and stem. Of (Centella. Asiatica) **The active principles are viewed as triterpenoids, mainly asiatic acid, madecassic acid, asiaticoside, and medacassoside.and no caffeine Uses: possess mild tranquilizing, antistress, and antianxiety ability, apparently by enhancing cholinergic mechanisms **ethanolic extract of C. asiatica was found to exhibit significant antistress activity, Antidepressant activity was also indicated and an analgesic effect demonstrated,

along with a reduction in the adrenocortical response. Studies with a hydroalcoholic extract of C. asiatica leaves have confirmed the plants anxiolytic/sedative effect **Only the aqueous extract of whole plant (200 mg/kg for fourteen days) showed an improvement in learning and memory

(7) Lavender:
It has been used either dried or as an essential oil. internally and by olfaction (best route) for centuries as a treatment for anxiety and depression. **Also used as antibacterial, antifungal, carminative and sedative Lavandula angustifolia. is the most common species of lavender utilized for health purposes. The main active constituents of lavender oil are linalool, linalyl acetate, terpinen-4-ol, and camphor MOA): Lavender oil has potentiated expression of GABA-A receptors in cell culture, inhibit glutamate binding in the brain and inhibit acetylcholine release NO contraindications, side effects, or drug interactions for lavender flower but Internal use of lavender oil may cause .nausea and drowsiness after excessive intake The effective dose of lavender oil is suggested to be 20 80 mg per day

How to prevent anxiety & protect ** ??ourselves

Nonpharmacological treatments such as supportive psychotherapy, dynamic psychotherapy, cognitive therapy (identifying negative thoughts and changing them to be more positive), relaxation training, and meditation exercises are often helpful in relieving anxiety and improving coping skills.

Stimulus control procedures 1. Establish regular times to wake up and to go to sleep 2. Go to bed only when sleepy. 3. Perform a relaxing activity (e.g., read, listen to music) until drowsy. 4. Schedule worry time during the day. Do not take your troubles to bed. 5. Exercise routinely

References:
1-American Psychiatric Association. Diagnostic and
Statistical Manual of Mental Disorders, 4th ed., text revision. Washington, DC: American Psychiatric Association, 2000:429484; 2-Baldwin DS, Anderson IM, Nutt DJ, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: 3-Recommendations from the British Society for Psychopharmacology. .J Psychopharmacology 2005; 19:567596 -4 perspectives on generalized anxiety disorder. J Clin Psychiatry 2004 ;( 65 Suppl ;26 20 :(13 Chen J, Reich L, Chung H. Anxiety disorders. West J -6 Med 2002; 176:249253

5- Data from Roy-Byrne PR, Wagner A. Primary care

: -http://www.netdoctor.co.uk 7 8- Taylor & Francis Group, LLC www.WEB MD.com -9

www.umm.edu/altmed/articles/lemon-balm-//: -10 000261.htm#ixzz2NM5Dxmqm

Atanassova-Shopova S, Roussinov KS. On certain central .-11 neurotropic effects of lavender essential oil. Izv Inst .Fiziol. 1970;13;69-77