When awake, most people exhibit the brain wave patterns that can be classified into two types of waves, beta and alpha. Beta waves are those associated with day to day wakefulness. These waves are the highest in frequency and lowest in amplitude, and also more desynchronous than other waves. That is, the waves are not very consistent in their pattern. This desynchrony makes sense given that day to day mental activity consists of many cognitive, sensory, and motor activities and experiences, and, thus, when awake, we are mentally desynchronous as well. During periods of relaxation, while still awake, our brain waves become slower, increase in amplitude and become more synchronous. These types of waves are called alpha waves. For example, such brain waves are often associated with states of relaxation and peacefulness during meditation and biofeedback.

The first stage of sleep is characterized by theta waves, which are even slower in frequency and greater in amplitude than alpha waves. The difference between relaxation and stage 1 sleep is gradual and subtle. As the sleeper moves to stage 2 sleep theta wave activity continues, interspersed with two unusual wave phenomena. These phenomena, which occur periodically every minute or so, and are defining characteristics of stage 2 sleep, are termed sleep spindles and K complexes. The former is a sudden increase in wave frequency, and the latter is a sudden increase in wave amplitude. Stages 1 and 2 are relatively “light” stages of sleep. In fact, if someone is awoken during one of these stages, he or she will often report no being asleep at all.

Stage 1 is light sleep where you drift in and out of sleep and can be awakened easily. In this stage, the eyes move slowly and muscle activity slows. During this stage, many people experience sudden muscle contractions preceded by a sensation of falling. The first stage of sleep is characterized by theta waves, which are even slower in frequency and greater in amplitude than alpha waves. The difference between relaxation and stage 1 sleep is gradual and subtle. As the sleeper moves to stage 2 sleep theta wave activity continues, interspersed with two unusual wave phenomena. These phenomena, which occur periodically every minute or so, and are defining characteristics of stage 2 sleep, are termed sleep spindles and K complexes. The former is a sudden increase in wave frequency, and the latter is a sudden increase in wave amplitude. Stages 1 and 2 are relatively “light” stages of sleep. In fact, if someone is awoken during one of these stages, he or she will often report not being asleep at all.

In stage 2, eye movement stops and brain waves become slower with only an occasional burst of rapid brain waves.

When a person enters stage 3, extremely slow brain waves called delta waves are interspersed with smaller, faster waves.

In stage 4, the brain produces delta waves almost exclusively.

Stages 3 and 4 are referred to as deep sleep or delta sleep, and it is very difficult to wake someone from them. In deep sleep, there is no eye movement or muscle activity. This is when some children experience bedwetting, sleepwalking or night terrors. In 2008 the sleep profession in the US eliminated the use of stage 4. Stages 3 and 4 are now considered stage 3 by them.

Slow wave sleep comes mostly in the first half of the night, REM in the second half.  Waking may occur after REM.  If the waking period is long enough, the person may remember it the next morning.  Short awakenings may disappear with amnesia.

In the REM period, breathing becomes more rapid, irregular and shallow, eyes jerk rapidly and limb muscles are temporarily paralyzed. Brain waves during this stage increase to levels experienced when a person is awake. Also, heart rate increases, blood pressure rises, males develop erections and the body loses some of the ability to regulate its temperature. This is the time when most dreams occur, and, if awoken during REM sleep, a person can remember the dreams. Most people experience three to five intervals of REM sleep each night.

Infants spend almost 50% of their time in REM sleep. Adults spend nearly half of sleep time in stage 2, about 20% in REM and the other 30% is divided between the other three stages. Older adults spend progressively less time in REM sleep.

Turn in tomorrow to the topic covering light sleepers vs heavy sleepers.

“It may surprise you to learn that chronic sleep deprivation, for whatever reason, significantly affects your health, performance, safety, and pocketbook.”

WEB MD

“Personally I have no bones to pick with a dead man”.

Samuel Beckett  (April 1906 – 22 December 1989) regarded as among the most influential writers of the 20th century.

There are two basic conditions that produce violent tendencies in human beings. One condition is that the person has been hurt (mentally or physically).  The accumulation of minor hurts (stress) can lead to violent behavior as well.

Aletha Solter, Ph.D. (The M.D. who wrote Tears and Tantrums.)

There are a few main population groups who have a higher risk for sciatica than the rest of us. At highest risk are people between the ages of 30 and 50 years old. These people may be very active, which increases the possibility of injury. But they are also beginning to age, and that can mean degenerative changes in the spine.

Sciatica is pain, tingling, or numbness produced by an irritation of the sciatic nerve including the roots that start from the beginning of the sciatica nerve which can go all the way down the leg depending on the individual’s damage. The sciatic nerve is formed by the nerve roots coming out of the spinal cord into the lower back. It goes down through the buttock, then its branches extend down the back of the leg to the ankle and foot. When something presses on the sciatica nerve, like a herniated disc, it presses on that nerve which causes the pain from the buttock that can radiate all the way down to the foot. The intensity of the pressure on the nerve and where its pressed decides if it goes to the foot or less. Other causes of sciatica nerve damage:

The most common cause -a bulging or ruptured disc in the spine pressing against the nerve roots that lead to the sciatic nerve.

-Sciatica Nerve Damage can be a symptom of other conditions that affect

*Narrowing of the spinal canal due to spinal stenosis. This spinal canal narrowing pinches on the sciatica nerve.

*Bone spurs-they are growths that are small forming along joints caused by arthritis.

*Simply injury (like a car accident or fall) causing nerve root compression=again the same result-pinching the sciatica nerve.

*Pregnancy-not as common as a cause as the others listed.

*Rarely but also tumors could cause the problem also.

What are the symptoms?

Symptoms of sciatica include pain that begins in your back or buttock and moves down your leg and may move into your foot.

*Weakness, tingling, or numbness in the leg may also occur.

*At times a inconsistent stabbing feeling or pricking feeling in the ankle or foot

*Sitting, standing for a long time, and movements that cause the spine to flex (such asexercises using the knee to chest) which may make symptoms worse.

*Walking, lying down, and movements that extend the spine (such as press-ups) may relieve symptoms.

How is sciatica diagnosed?

Sciatica is diagnosed with a medical history and physical exam. Sometimes x-rays and other tests such as magnetic resonance imaging (MRI) are done to help find the cause of the sciatica.

What are the Complications?

Although most people recover fully from sciatica, often without any specific treatment, sciatica can potentially cause permanent nerve damage. Seek immediate medical attention if you experience:

-Loss of feeling in the affected leg                                                                                               -Weakness in the affected leg

-Loss of bowel or bladder function

How is it treated?

In many cases, sciatica will improve and go away with time. Initial treatment usually focuses on medicines and exercises to relieve pain. You can help relieve pain by:

*Avoiding sitting (unless it is more comfortable than standing).

*Alternating lying down with short walks. Increase your walking distance as you are able to, without pain.  

* Takingacetaminophen (tylenol) or Motrin (Ibuporfen) or Advil or Aleve (Naproxen). All are nonsteroidal anti-inflammatory drugs which decrease the swelling of the inflammation around the area or injury to the back which will decrease the pain. More inflammation=more pinching on the nerve.

*Using a heating pad on a low or medium setting for 15 to 20 minutes every 2 or 3 hours. Try a warm shower in place of one session with the heating pad. You can also buy single-use heat wraps that last up to 8 hours. You can also try an ice pack for 10 to 15 minutes every 2 to 3 hours. There is not strong evidence that either heat or ice will help, but you can try them to see if they help you.

*Additional treatment for sciatica depends on what is causing the nerve irritation. If your symptoms do not improve, your doctor may suggest physical therapy, injections of medicines such as steroids, stronger medicines such as muscle relaxants or opiates.                                                                                                                                                

*Physical Therapy or chiropracter therapy or some form of therapy for 6 to 8 weeks.

* If the therapy is uneffective than the last resort in most cases is surgery that ranges from:

– laser surgery

– scrapping of the vertebrae pinching the nerve with leaving the rest of the vertebrae spacing the spinal cord in place or removing the vertebrae pinching the nerve and replacing it with cement (not cement we use for sidewalks that we know of).   It’s natural to want to return to your regular activities as soon as possible after surgery, but a lot depends on the type of operation you get.

In two common methods, vertebroplasty and kyphoplasty, your surgeon makes a small cut in your back, which lets you recover faster. If you get spinal fusion surgery, the cut is larger, and it will take a longer time to heal.

-small endoscopic surgery that is microsurgery removing pieces of the vertebraepinching which has a test called a discogram (injecting a dye right into the injured disc and than a ultrasound of the area is done to show the surgeon the exact route he has to follow to cure the problem. The surgeon numbs the area that he will repair with the pt wide awake; he makes a incision about 2/10 of an inch, using the cat scan as a guide for his eyes inserting a scope inserting a grabber that goes in the scope removing disc fragments that are pressing on the nerves causing the pain. It takes about 30 minutes for this procedure with only a small bandage covering the incision followed with the patient leaving the hosp–ital in less than a few hours

*Other self-care treatments that may be helpful include:

-Cold packs. Initially, you may get relief from a cold pack placed on the painful        area for up 20 minutes several times a day. Use an ice pack or a package of frozen peas wrapped in a clean towel.

-Hot packs. After two to three days, apply heat to the areas that hurt. Use hot packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs.

-Stretching. Stretching exercises for your low back can help you feel better and may help    relieve nerve root compression. Avoid jerking, bouncing or twisting during the stretch and try to hold the stretch at least 30 seconds.

-Over-the-counter medications. Pain relievers such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve) are sometimes helpful for sciatica.

References:

National Cancer Society

Web MD

Mayo Clinic

Dr. Bruce Hensel M.D. (chief medical editor channel 4)

Dr. David Ditsworth Surgeon – does back scoping

Robert Forrest Physical Therapy in Santa Monica, California.In this article

“A stent is a tiny, metal mesh tube that is placed with a catheter and permanently embedded within the artery wall to prop open and prevent it from collapsing.”

You & Your Stent” is provided compliments of Daiichi Sankyo/Eli Lilly in Partnership with SCAI. Copyright © 2013 Daiichi Sankyo, Inc. and Lilly

“Cardiac arrest is reversible in most victims if treated within a few minutes. It’s critical to recognize the symptoms and act quickly.”

The American Heart Association

Sodium plays a key role in your body. It helps maintain normal blood pressure, supports the work of your nerves and muscles, and regulates your body’s fluid balance.

MAYO CLINIC