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Thoracic Medicine

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Sleep Medicine

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In what may be the largest study of sleep problems among individuals with multiple sclerosis (MS), researchers at UC Davis have found that widely undiagnosed sleep disorders may be at the root of the most common and disabling symptom of the disease: fatigue. Study paticipant reports of sleep disorder frequency, sleep patterns and complaints of excessive daytime sleepiness suggest that sleep problems may be a hidden epidemic in the MS population.

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A sleep-promoting circuit located deep in the primitive brainstem has revealed how we fall into deep sleep. Discovered by researchers at Harvard School of Medicine and the University of Buffalo School of Medicine and Biomedical Sciences, this is only the second "sleep node" identified in the mammalian brain whose activity appears to be both necessary and sufficient to produce deep sleep.  Using designer genes, researchers were able to 'turn on' specific neurons in the brainstem that result in deep sleep.

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Insomnia can cause chronic inflammation, which can lead to weight gain, hypertension, diabetes, heart disease, and earlier death. This study finds that curing the insomnia reduces the inflammation and hopefully reduces disease. It also found the best way to cure lack of sleep is through the use of a common psychotherapy treatment - cognitive behavioural therapy.

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Getting enough sleep is important to people of any age, but it is especially so for teenagers, with insufficient sleep possibly being linked to obesity as an adult.

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A study is shining new light on a sleep disorder called “sleep drunkenness.” The disorder may be as prevalent as affecting one in every seven people. Sleep drunkenness disorder involves confusion or inappropriate behaviour, such as answering the phone instead of turning off the alarm, during or following arousals from sleep, either during the first part of the night or in the morning. An episode, often triggered by a forced awakening, may even cause violent behaviour during sleep or amnesia of the episode.

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Ever wondered about the effects of binge sleeping? Are naps bad or how long should you nap for? For all these myths debunked follow the link

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Sarcoidosis

WHAT IS Sarcoidosis?

Sarcoidosis causes small inflammatory masses or nodules (known as granulomas) to form mainly in the lungs and chest lymph glands but can affect the eyes, liver, heart and brain as well. Granulomas are groups of immune cells, which are normally part of the body’s defence system.  These granulomas might alter the structure or function of the organs involved.  Often there are no symptoms, however some people may have a cough or chest discomfort, tiredness, breathlessness, dry mouth, sore eyes and skin rashes.  Some patients develop tender, red lumps on their shins or ankles called erythema nodosum.

Sarcoidosis and the lungs

The lungs are affected in about 9 out of every 10 sarcoidosis patients – however still not all will show symptoms.  It is thought that Sarcoidosis of the lungs starts with inflammation of the alveoli – the tiny gas exchanging units of the lungs.   Alveolitis either clears up naturally or leads to granuloma formation.  Eventually fibrosis can form causing the lung to stiffen – making breathing even more difficult.   About 20-30% of people with Sarcoidosis will develop some kind of permanent lung damage.

 WHAT causes SARCOIDOSIS?

The cause of Sarcoidosis is not yet known – despite extensive world-wide research.   Occasionally Sarcoidosis runs in families and most commonly affects people between the ages of 20-40, however much younger and older people have been known to have the disease.  How Sarcoidosis spreads from one part of the body to another is also currently being studied.  Sarcoidosis can appear suddenly and/or severely and subside after a short amount of time.  Sometimes symptoms can come on slowly and subtly and last or recur over a long time span.

how is SARCOIDOSIS diagnosed?

Sarcoidosis is usually diagnosed through biopsy of the affected organ; however it can sometimes be diagnosed by x-rays, blood tests and a detailed patient history.  The following are the main tools your doctor will use to diagnose you:

  • Chest x-ray – look for cloudiness (pulmonary infiltrates) or swollen lymph glands
  • CT scan – provides an even more detailed look at the lungs and lymph glands than an x-ray
  • Breathing test – measures how well your lungs are functioning
  • Bronchoscopy – involves passing a tube down the airways to provide a better look at what is happening inside your lungs.   The doctor can also take a small biopsy to check for granulomas and rule out other infection.

how is sarcoidosis treated?

Most cases of Sarcoidosis get better over 1-3 years, and may not need any treatment at all.  The granulomas can go away by themselves. Most people with Sarcoidosis can lead a normal, active life.

Treatment, when needed generally falls under 2 categories – maintenance of good health and drug treatment.  Maintenance of good health involves:
  • Getting regular check-ups with your doctor
  • Eating a well-balanced diet
  • Getting 6-8 hours of sleep per night
  • Exercising regularly and maintaining your weight
  • Quitting smoking
  • Avoiding dust, gases and harsh chemicals that can irritate your airways
  • Occasionally people with Sarcoidosis will have high blood or urine levels of calcium – if your doctor has told you this relates to you, it may help to avoid excess calcium in your diet and avoid excessive sunlight (i.e. daily sunbathing). 

Drug treatments are used to relieve symptoms, reduce the inflammation of affected tissues, reduce the impact of granuloma development and possibly prevent the development of lung fibrosis and other irreversible organ damage.  Drug treatments include prednisolone and corticosteriods – both of which have side effects if used for an extended period of time, however often the benefits outweigh the risks. 

Other drug combination treatments may be available, speak to your doctor to find out what treatment is right for you. Unfortunately there are no treatments able to reverse the fibrotic damage Sarcoidosis may cause on the lungs.

 

 

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