Health news blog

When a person is sleeping in a sleep laboratory he is hooked up to a number of machines that measure a number of bodily functions. These include the EEG and EOG. A further recording is made by an EMG or electromyogram which is attached to the chin to determine muscle tension. In some situations in men, the circumference of the penis is also monitored. It has been discovered that during REM sleep there are a lot of physiological changes, including male erection—more about that in chapter 8 on Sex and Dreams.

The Sleep Disorder Unit at Epworth Hospital, Melbourne has the most advanced equipment and, in addition to the above measurements, the patient is monitored for many other important bodily functions also. These include air flow through the mouth and nose, the movement of the chest during respiration, blood oxygen saturation (by means of an oximeter in the finger), snoring (by recording the noise level in the room), the condition of the heart (electrocardiogram), and individual leg movement. All these activities are computed at real time and organized on a video screen. The amount and frequency of the brain waves are analysed by computer and displayed in different colours on a separate screen which gives a clear indication of which stage of sleep the patient is in. The patient is also observed from the control room with an infra-red camera and is continuously recorded on video.

This kind of multiple recording in the sleep laboratory is called a polysomnogram, and operates as long as the person is asleep. The recordings can then be analyzed the next day and the results

used in the diagnosis and treatment of impotence, sleep apnoea, and other sleep disorders. There are now as many as 50 sleep disorders identified, thanks to the sleep laboratory.

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The perfectionist unconsciously tries to ward off his inner tension by having everything just right. If everything is in order there is nothing to worry about. His efforts to be perfectly neat, scrupulously conscientious, and meticulously clean soon bring worries of their own, and at the same time fail to ward off his inner anxieties. The result is that the perfectionist comes to live a rigid and rather constricted way of life with a constantly high level of mental tension.

These difficulties are so much the more accentuated if the perfectionist is married to, or works with, a person who is freer and less restricted than himself. Then he is constantly ill at ease, wanting to clean up after his less orderly companion so that he can once again establish the pattern of having everything just right.

A patient who sought relief from inner tension fits this picture of the perfectionist. He was a jeweller, a modest and rather humble man, and extremely conscientious and fussy about his job, so that the work he produced was of exceptionally high quality. He had three apprentices working under him. In actual fact they did good work, and no one had ever found fault with it. But he was always worrying, fearing that it might not be quite perfect and wanting to check over the work of the apprentices just as he did his own.

With the relaxing mental exercises he was able to reduce his tension, so that he could carry on in relative ease, although he still remained very conscientious and a perfectionistic workman.

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It is not uncommon for an anti-depressant that works initially to stop working after a period, which may range from weeks to years. St John’s Wort is no exception in this regard and depressive symptoms may recur after an initial response. A relapse of this kind may be due to a worsening of the depression, which is sometimes the result of a definable cause such as a personal loss, a new stress or the onset of winter. Wherever possible, the first-line response to such a setback is to deal with the underlying cause, for example to obtain extra support from friends and family, adopt strategies to help deal with the stress or increase the amount of environmental light.

If the trigger for relapse cannot be identified or if the steps to correct it by making environmental changes are unsuccessful, medication adjustments can be made, including increasing the dosage of St John’s Wort or adding another anti-depressant. Sometimes a person develops what is known as tolerance to an antidepressant, which means that certain chemical changes in the brain override the beneficial effects of the medication. In this case it can pay to switch to another medication or to add a medication specifically designed to potentiate the effects of the anti-depressant. Drugs such as lithium carbonate and synthetic thyroid hormone have been reported to be effective potentiators of conventional anti-depressants and may be of value when added to St John’s Wort as well. If the medication situation is complicated enough to warrant potentiation of an anti-depressant, it is certainly necessary for a highly skilled doctor to be involved in treatment decisions. The purpose of providing you with this information is so that you can understand some of the steps your doctor is likely to consider in dealing with the delayed development of unresponsiveness to an anti-depressant.

One possible reason why St John’s Wort may stop working is that the composition of active ingredients may vary from one batch of St John’s Wort to another. You might suspect this to be the case if you purchased a new batch of St John’s Wort just before noticing the change in anti-depressant effect. Reliability of quality control is one reason why I recommend the brand of St John’s Wort with the best documented and most reliable track record, namely Kira™, so as to minimize the likelihood of relapses due to inconsistencies between batches.

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