Por: Dra. Francis Amendola
Directora del Dpto de Investigación de CMA
Fecha de publicación:23/02/06
El insomnio no puede ser considerado como un problema insignificante, ya que constituye un factor que desencadena
desórdenes físicos y mentales, problemas laborales, deterioro social, así como una importante reducción de la calidad
de vida.
El insomnio puede ser definido como la inhabilidad crónica para obtener la cantidad de sueño necesaria para el
funcionamiento y bienestar óptimos.
Constituye uno de los motivos de consulta médica más comunes, afectando a cualquier sexo. Se presenta más
frecuentemente en la población mayor de 65 años.
La salud de toda persona no está en riesgo cuando se duerme un promedio de 6 a 8 horas diarias, sin embargo, los
requerimientos de sueño son variables. Para algunos es suficiente con 4 horas cada noche, mientras que otros
necesitan de 10 a 11 horas. Los requerimientos de sueño también cambian con la edad. Es recomendable escuchar
las señales de sueño del cuerpo y tratar de dormir la cantidad de horas que resulten reparadoras.
El insomnio puede ser primario cuando no es causado por ninguna condición física ni mental conocida, o secundario
cuando es originado por: abuso de café o alcohol, drogas hipotensoras, betabloqueantes, antidepresivas,
broncodilatadoras, anfetaminas, así como la ansiedad, estrés, depresión u otras enfermedades físicas o mentales.
Las consecuencias que el insomnio puede generar van desde la somnolencia diurna, astenia, incapacidad para sentir
agrado en asuntos usualmente placenteros, trastornos de memoria y concentración, dificultad para el cumplimiento de
las labores diarias, irritabilidad, ansiedad, capacidad disminuida del sistema inmune para combatir infecciones, hasta
sentimientos de baja autoestima, depresión e ideación suicida.
La solución para el insomnio representa un reto para los médicos. El uso de sedantes de acción prolongada o en altas
dosis para tratar el insomnio puede incrementar la somnolencia diurna, empeorando el problema en lugar de
mejorarlo. Los hipnóticos, ansiolíticos, antidepresivos o neurolépticos inducen frecuentemente tolerancia al
medicamento y no proporcionan un sueño tranquilo y reparador. Como resultado, la persona puede sentir más
dependencia del medicamento y concluir que necesita mayor cantidad. Cuanto más medicamento se toma, mayor será
la tolerancia y los efectos secundarios que se pueden desencadenar. Cuando se suspenden estos tranquilizantes, es
común que el insomnio empeore.
La Medicina Sistémica contraria a la indicación de estas nocivas drogas sintéticas, propone una formulación
alternativa que no produce efectos secundarios y que se dirige a la raíz del problema. Esta alternativa se basa en una
combinación de plantas medicinales, que incluye a Rhodiola rosea , Leuzea carthamoides , Valeriana officinalis ,
Panax quinquefolius , calcio y magnesio. La acción conjunta de estas plantas y minerales incrementa los tres
elementos fundamentales de la salud de toda persona, es decir, generan Energía la cual es utilizada por la
Biointeligencia para crear orden y equilibrio en órganos y sistemas, incrementando así el potencial de supervivencia o
nivel de salud en las personas.
Estas plantas, ingeridas de manera regular, corrigen los desequilibrios neuro-endocrinos que acompañan al insomnio,
por lo que la recuperación es mucho más rápida. En otras palabras, ofrecen orden al desorden del sistema, de una
manera sana, natural y mucho más económica.
Performance In Teens
Source: Lifespan
Date: 2005-05-11
Providence, RI -- Adolescents who don't get enough sleep might be jeopardizing their athletic
performance, and high school sports teams on the west coast may be at a disadvantage if they play
east coast rivals, says Mary Carskadon, PhD, of the Bradley Hasbro Children's Research Center.
Carskadon, a leader in the field of sleep research, compared the results of studies that measured
sleep patterns and circadian rhythms in children and adolescents in the May 24 issue of Clinics in
Sports Medicine. While it's widely known that lack of sleep can affect learning, mood and behavior in
teenagers, Carskadon suggests that insufficient sleep can also negatively impact teen athletes in a
number of ways.
"Young people live in nearly a constant state of chronic insufficient sleep," says Carskadon, "and
adolescents who don't get enough sleep on a regular basis are extremely impaired in the morning."
For this reason, she suggests that adolescent travel teams heading westward across time zones
have an advantage over home teams early in the day.
While most adults who routinely travel from coast to coast might be well aware of the difficulty
adjusting to a different time zone, teens are at even more of a disadvantage.
Evidence suggests that the adolescent circadian rhythm, or internal biological clock, is still
adjusting, and their internal day-length is longer than that of adults. This means that teens might not
be ready to fall asleep until later in the evening, or may wake up later in the morning.
"For morning games, the home team might still be in the lowest point of alertness,' while the team
that headed west will have the advantage of having been awake for an hour or so longer, and thus
have more energy."
Additionally, if the eastern team arrives the night before, they would gain an extra hour or two of
sleep, which can improve focus, alertness, and better reaction skills.
Conversely, she warns that athletic teams taking extended training trips (eg. spring break) of a week
or more may experience schedule difficulties on the return home.
"This scenario is most problematic for teams on the east coast that travel west, as student athletes
may return with a significant sleep-phase delay that is difficult to correct," Carskadon says.
Lack of sleep doesn't just affect athletics in teenagers. Studies repeatedly show that reaction time,
vigilance, learning and alertness are impaired by insufficient sleep; so students with short nights
and irregular sleep patterns perform poorly in school and in other aspects of their life and have a
tendency for a depressed mood.
"Circadian and lifestyle changes conspire to place sleep of adolescents at a markedly delayed time
relative to younger children and to adults," says Carskadon.
In fact, studies have shown that teenagers need as much, if not more sleep as younger children (an
average of 9.25 hours per night) but as they mature, their bodies are able to stay alert later into the
night.
She cites part-time jobs, caffeinated beverages, social activities, away-games and long practices as
factors that help contribute to chronic sleep deprivation for young people.
Is there any reprieve? An afternoon nap can help, but only for so long. Carskadon found that a
45-minute nap taken approximately six hours after waking supported alertness and mood for about
eight hours. For a teen who starts his day at 6:30 am, a lunchtime nap could keep him going till 8 or 9
pm.
However, Carskadon warns that afternoon naps don't help morning fatigue the next day.
"In order to help adolescents do their best, parents need to take an active role in helping set a
regular sleep pattern for their teen."
ANN ARBOR, MI -- Several years ago, University of Michigan researchers published some of
the strongest evidence yet that children who snore when they sleep are far more likely to
have attention and hyperactivity problems than their non-snoring peers.
Today, that link takes on a new long-term dimension with the publication in the journal Sleep
of follow-up data from some of the same children who took part in the earlier study.
Indeed, children in the original study who snored regularly, in comparison to those who did
not, were about four times more likely to have developed new hyperactivity by the time the
U-M team contacted their families four years later. In other words, snoring early in life
predicted new or worsened behavior problems four years later.
Similar behavior was seen among children who had had other symptoms of obstructive sleep
apnea, in which repeated pauses in breathing disrupt sleep and can reduce blood oxygen
levels. For example, children with daytime sleepiness in the original study were also more
likely to have developed hyperactivity four years later.
The findings held true even after the researchers took into account which children already
had been identified as hyperactive during the first study, and which ones were taking
prescription behavior medicines during the follow-up survey. In fact says lead author and
U-M sleep researcher Ronald D. Chervin, M.D., M.S., inattention and hyperactivity at
follow-up were usually predicted better by snoring and other sleep apnea symptoms four
years earlier than by those same symptoms at follow-up.
One group, the boys who were under the age of 8 and had the worst sleep-breathing
problems during the first study, were approximately nine times more likely to have developed
new hyperactivity four years later than boys of the same age who hadn't had such sleep
problems.
The results are from a prospective study of 229 children who are now between the ages of 6
and 17. The children were drawn from the group of 866 2- to 13-year-olds whose parents
were originally surveyed in the late 1990s, in the waiting rooms of several community-based
pediatrics clinics. The parents agreed to allow the researchers to mail them a follow-up
survey four years later; 229 returned it. The follow-up group was statistically comparable to
the initial group.
Both at the baseline and at follow-up, the parents completed standardized questionnaires
that measure a child's behavior and sleep characteristics. Children were encouraged to help
their parents complete the questionnaires.
The initial study, published in March 2002 in the journal Pediatrics, found that kids who
snored regularly were twice as likely as non-snorers to have hyperactivity or attention issues
at the same time. Among boys under the age of 8, the rate was four times.
"To our knowledge, this new study is the first long-term, prospective research to show that
regular snoring and other clues to the possible presence of sleep apnea predict future
development of inattention and hyperactivity," says Chervin, M.D., M.S., the director of the
U-M Health System's Michael S. Aldrich Sleep Disorders Laboratory and associate professor
of neurology at the U-M Medical School. "These findings strengthen the hypothesis that
untreated sleep-breathing problems in childhood can contribute to the development of
hyperactivity."
Chervin and other sleep and breathing researchers have built up a large body of evidence on
this issue in recent years. The sleep-behavior link rests on the concept that snoring, sleep
apnea and other breathing problems during sleep diminish the quality of sleep, repeatedly
reduce oxygen levels, and affect daytime behavior.
Data from small groups of children who received treatment for their sleep-breathing problems
-- usually by removal of the tonsils and adenoids -- have indicated that behavior may improve
as sleep improves. Larger studies of pre- and post-treatment sleep and behavior patterns are
now underway; Chervin and his colleagues are currently analyzing data from one performed
at U-M.
But definitive proof that breathing problems during sleep affect daytime behavior is still
elusive, the U-M authors write. And a long-term randomized controlled trial, the gold standard
of medical research, might never be done because it would require researchers to withhold
treatment that has become an accepted standard of care.
The new paper is the first to show that sleep problems come before hyperactive behavior,
and that one predicts the other -- which may help bolster the sleep-behavior theory. "In
research, a prospective study that follows a group over time and assesses them at two or
more time points carries more weight than one that looks for risk factors and possible
outcomes all at the same time," says Chervin. "That's what we set out to achieve, and we
believe we've shown a clear predictive link."
The study combined two different validated survey instruments: one that asked parents
about their children's behavior patterns, and one asking about snoring, sleepiness and
characteristics that may indicate sleep-disordered breathing problems.
The sleep portion of the survey asked about frequency and severity of snoring, as well as
the tendency to struggle to breathe or stop breathing temporarily during the night, to breathe
through the mouth during the day, to wake up feeling unrefreshed, or to have a hard time
waking up. All these can mean a child has sleep-disordered breathing, which can affect the
quality of sleep. Scores for snoring frequency and severity, and for sleepiness and
sleep-disordered breathing, were tallied for each child to allow each tendency to be
considered on its own.
The behavior portion of the survey asked about attention to tasks and schoolwork,
distraction, forgetfulness, fidgeting, inappropriate action and excessive talking, as well as
other symptoms of attention-deficit/hyperactivity disorder. The children were assigned scores
based on the total number of attributes their parents said applied to them, and how often.
Chervin and his colleagues say that a further prospective study is needed to confirm their
results and compensate for some of their study's limitations. The research focused on a mild
to moderate level of hyperactivity, and it's not certain whether the findings would apply to
children with full Attention Deficit/Hyperactivity Disorder. The authors also note that more
precise measures of sleep-breathing problems, and of sleep quality, might reveal even more.
Until such studies can be done, he says, parents should pay attention to their children's
sleep -- and their own.
"Sleep problems in both children and adults are often undiagnosed, even though they can
have a major impact on health, behavior and quality of life," he says. "Getting enough sleep,
adopting good sleep habits, and seeking medical attention for issues such as habitual
snoring, daytime sleepiness and the breathing interruptions of sleep apnea can have a huge
impact on the life of a child or adult." He notes that people interested in more information can
start by contacting the National Sleep Foundation, www.sleepfoundation.org.
