Thursday, December 18, 2014

Sleep Hygiene

So we know that sleep consists of two physiological states : 75% of rapid eye movement (REM) and 25% of nonrapid eye movement (NREM). It takes about 15-20 minutes to fall asleep. When we go to sleep, we will first experience NREM sleep, comprising of four stages. Stage I and Stage II occurs in the next 45 minutes. Stage II makes up 45% of our sleep. This is the time when you feel drowsy, and people can wake you up easily. But when it gets to Stage III and IV, this is the deep sleep. Largest stimulus is needed to arouse one in these stages. It is also the time when you experience sleepwalking or night terror. These stages last 45 minutes. After NREM, we will have REM sleep. We can say that average REM latency (from the time of sleep onset to REM onset) is 90 minutes. When we go into REM state, we DREAM

The characteristics of REM sleep aka paradoxical sleep: 
1. Rapid eye movements
2. Dreaming
3. Autonomic instability (increase heart rate, blood pressure and respiratory rate, increase variability of HR, BP and RR from minute to minute, appears similar to an awake person on EEG)
4. Tonic inhibition of skeletal muscle tone (paralysis)
5. Reduced in hypercapnic respiratory drive, no increase in tidal volume as partial pressure of carbon dioxide decreases
6. Relative poikilothermia (cold-bloodedness)
7. Penile tumescence or vaginal lubrication
8. Reduced sensistivity to sounds

So, throughout the night when we sleep, we will go through four stages of NREM sleep followed by REM sleep. However, as the night progresses, each REM period becomes longer, and stages III and IV disappear. Hence, further into the night, we will sleep more lightly and dream more. Here are some figures to help you understand further:

You can see that initially a person will experience stages I-IV, then REM but as the night progresses, stage III and IV disappear. REM sleep becomes longer. Taken from this website.

Stages of sleep defined by brain wave patterns taken from this website.

Summary taken from this website.

Now let's talk about SLEEP DISORDERS. It can be divided into primary (not caused by another mental disorder) and secondary (can be caused by major depressive disorder, panic disorder, schizophrenia etc. that lasts for at least 1 month).

Two main primary sleep disorders consist of DYSSOMNIAS (abnormalities in the quality, amount or timing of sleep) and PARASOMNIAS (unusual or undesirable phenomena during sleep or on the threshold of sleep).

Dyssomnias can be further divided into:
1. Primary insomnia (difficulty in initiating or maintaining sleep) MOST COMMON TYPE
2. Primary hypersomnia (excessive daytime sleepiness or excessive daytime sleep)
3. Narcolepsy (characterized by excessive daytime sleep attacks, brief muscle weakness, sleep paralysis, dreamlike experience during transition from wakefulness to sleep and vice versa with hallucination or illusion, short sleep latency)
4. Breathing-related sleep disorders (apneas, hypoapneas and oxygen desaturations)
5. Circadian rhythm sleep disorders (misalignment between desired and actual sleep periods divided into delayed sleep phase, jet lag, shift work and unspecified)
6. Dyssomnias not otherwise specified (periodic leg movement disorder aka nocturnal myoclonus, restless leg syndrome aka Ekbom syndrome, Kleine-Levin syndrome, menstruation-associated syndrome, insufficient sleep, sleep drunkenness, altitude insomnia)

Parasomnias can be further divided into:
1. Nightmare disorder
2. Sleep terror disorder
3. Sleepwalking disorder aka somnambulism
4. Parasomnia not otherwise specified (sleep bruxism aka tooth grinding, REM sleep behavior disorder, sleep talking aka somniloquy, rhythmic movement disorder aka jactatio capitis nocturna, sleep paralysis not associated with narcolepsy and others) 

Let's say if a patient has sleep disorder, do you prescribe medication straightaway?

The answer is NO. Why?

Because, the first thing you have to advise patient is to practise SLEEP HYGIENE.

What is sleep hygiene? It is nonspecific measures to induce sleep.

You can advise patient to do these:
1. Arise at the same time daily
2. Limit daily in-bed time to the usual amount before the sleep disturbance
3. Discontinue CNS-acting drugs such as caffeine, nicotine, alcohol or stimulants
4. Avoid daytime naps, except when sleep chart shows they induce better night sleep
5. Establish physical fitness by means of a graded program of vigorous exercise early in day
6. Avoid evening stimulation, substitute radio or relaxed reading for television
7. Try very hot, 20-minute, body temperature-raising bath soaks near bedtime
8. Eat at regular times daily, avoid large meals near bedtime
9. Practice evening relaxation routines such as progressive muscle relaxation or meditation
10. Maintain comfortable sleeping conditions

Source: Kaplan and Sadock's Pocket Handbook of Clinical Psychiatry Fifth Edition

I think I have to start practising sleep hygiene myself. My bed is sooo comfortable that I feel like sleeping all day longg. Hahahha.

Okie dokie. Enough lecture on sleep, now I have to go to bedd. But the problem is, now I don't feel like sleeping, because I just woke up from a 2-hour sleep! I have no one to blame but myself. Grr.

I'll watch a movie then! Oh oh have you seen How to Train Your Dragon 2? The movie is awesome, rightt! I wish I can have my own pet dragon, a cute and fluffy one, a PINK one!

And and have you watched The Expendables 3? Side Effects? Teenage Mutant Ninja Turtles? The Maze Runner? The Guardians of the Galaxy?

I am soo going to practise sleep hygiene after this LOL

You...have a good night sleep! And regulate your sleeping pattern okehh :D

Goodnightttt

Saturday, December 13, 2014

Bukit Panorama...Again.

This early morning, my sister, her friends and I went to Bukit Panorama. My third time, but it's their first. We departed from home at 530am. By 6.30am, we arrived at the mosque. After prayer, we started climbing.

If you want to use GPS to go there, search for Masjid Jamek Sungai Lembing. Bukit Panorama is just nearby, you can ask people around for the direction.

Sunrise! :O


Four of us

;
Posingg hehe 

One more one more

The sun is going up!

Wahhh so beautiful!


Enjoying the scenery

In memory

Sisterss :)  

Gediks.

Proper one.


SMILEE :D


Last picture on top of the hill

Come let's go backk

Hahahha nak jugakk

Walk walk

Almost there?

The journey.

We ate our breakfast at Medan Selera there. Mee Jawa and Laici Kang. We arrived home around 930am. I parked the car beside Adlin's little car. Here:

Adlin's Honda at the parking area LOL


Now I have to finish my work, because after this, at 140pm, Farah and I will go study at Coffee Library! Ops. The Library Coffee Bar!! :D


I am using my dad's laptop because I lost my mini notebook. And my Vaio laptop is being fixed. Luckily I saved all my work in my email.

Anywayy, you...have a good dayy!! :)

Toodles.

Wednesday, December 10, 2014

Upset. Angry.

My dad, my mom, my little sister and I were having dinner at the table. My mom commented on how lazy I had been for these past few months. She was thinking of how good it would be if I spend more time in the kitchen, do more cooking and baking - like I always did before.

I told her that since I am already in my final year, I am thinking of focusing more on my studies. My dad agreed with me, saying that my mom should be more understanding, and that I have other important things to do. I was so happy and hugged my dad, just to irritate my mom hahaha

My mom said that you can't always be studying 24 hours a day, you have to have time to relax and do other work. And then, she looked at my dad, saying that next time when we are having this conversation, my dad should agree with her opinion. There can't be any different views between them on dealing with children. My dad and I laughed.

My dad then pretended to scold me, telling me to go cook in the kitchen, don't always study bla bla bla. Then my mom said that guys (referring to my dad) cannot be trusted to handle the children and the house, what if my mom dies some days, who is going to take care of us all? And then my dad replied, I can always find another woman to take care of that. Ouch.

Then my mom said, then I can also marry other guy if you die later. My dad answered back, yes you can do that. The difference is that I can still marry other woman even if you are alive. I have three more (referring to polygamy).

Oh boy. Although my dad was talking casually and smiling, I could tell that my mom was hurt by that statement. She was silent.

I then quickly started a conversation with my little sister, asking her about cats and stuff. After a while, my dad went out for prayer, and my mom joined us talking. She was smiling and laughing again.

Towards the end, she mentioned that she likes to be silent when she feels upset when dealing with my dad. When my dad gets home later, she will then pinch him on his butt, and tell him that she is mad at him. Hahahahhaa I love my mom.

She always gives us advice, reminding us the dos and don'ts and all things proper. She is strict at times, but we all know it's for good reason. She is the one who keeps our family together. She is so patient. I was thinking, what if I were to be in that situation, and my husband jokingly mentions that he wants to get married again, what would I do? Start a fight? Or sulk all day long?

For me, polygamy is a sensitive issue. You can't just talk about it lightly. Yes, it is true that Islam allows polygamy. I am not against it. I just don't like it. Just like I don't like spiders. Or people who smoke.

Speaking of it, I remember this one time when a friend of mine lighted up his cigarette when we were walking down the street. I never ever approve of smoking. But in his case, I had to act like I didn't care because he was helping me out with something. He thought that smoking is not harmful to health. He compared it with air pollution and smoke from vehicles. He said things like he is a fit guy, always go to the gym, his lungs are of good condition and he did not think that smoking is haram.

It was up to the point that I said, okay fine do whatever you want it's your life if you want to keep smoking then do it. I bit my lips from talking because I was worried that I might say things that I would come to regret later, or that I might offend him. But mainly because I was upset. Really upset.

Even our prophet Muhammad pbuh said that if we feel angry at someone, keep our silence. Walk away from him. If we are standing, sit down. If we are sitting, lie down. If that doesn't work, go take ablution and pray.

Random photo from Mr.Google.

Moral of the story : Keep calm and be happy. Okay?

Wahh it's late! This is what happens when you haven't been writing for a while. Hahahaha

Have a good dayy people! :D