Ian Oswald

Mono-amine oxidase inhibitors, sleep and mood

Abstract Electrophysiological evidence from the sleeping human is presented to support the clinical impression that the dose of the anti-depressant drug phenelzine must exceed a critical minimum and that it must be administered for longer than a minimum duration if its desired actions are to be obtained. After 5–22 days of phenelzine, 60–90 mg daily in the adult, signs of REM (paradoxical) sleep were abolished. Time of abolition in three depressed patients coincided with the start of mood improvement. Up to 52 successive nights without REM sleep had no adverse effects. “Rebound” increase of REM sleep followed withdrawal and also followed phenelzine overdose. Phenelzine tended to reduce restlessness in sleep and cause insomnia on withdrawal. Effects on REM sleep were not observed with nialamide 75 mg for 17 days, or with 500 mg by injection. Brain monoamines are thought to be implicated in the chemistry of sleep as well as in the regulation of mood.

Eye movements during active and passive dreams.

Independent confirmation is offered that the amount of rapid eye movement during dreaming is associated with the dream content.

Sleep as restorative process: human clues.

Publisher Summary This chapter examines the proposition that sleep is for growth and tissue restoration, and that sleep provides optimal conditions for protein synthesis. Protein synthesis and degradation proceed all the time, but they are not always equal. The metabolic conditions of wakefulness allow degradation to have priority, as indeed would be essential to cope with emergencies. In sleep it would seem that the balance between degradation and synthesis can shift in favor of synthesis. The proposition that sleep is associated with tissue restoration does not deny that sleep as a behavior may be advantageous in its own right. It would be expected that in evolution, species would so evolve that their sleep habits would be optimal for survival. Species that are constantly liable to being killed by other animals will survive better if they stay awake more. The belief that sleep is associated with tissue restoration does not rest upon assumptions about the length of time needed to be spent in sleep either by the individual or the species. It would merely be expected that there would be a broad relationship of longer or more intensely restorative sleep to counter-balance greater waking degradation.

Anxiety caused by a short-life hypnotic.

SIR,-Dr G MacGregor responds to a query on idiopathic oedema (26 June, p 1937) with recommendations about the management of a patient whose oedema is related to the use of diuretics. Many cases of idiopathic oedema, however, do not fall into this category. In this practice in the last six months I have identified 10 patients, all women (age range 19 to 55 years), suffering from idiopathic oedema. Only one patient seems to fit into the diureticuse class, while the other nine were consistent in having a long history of inflammatory disease of the urinary tract with renal pain and tenderness. Three of these patients had been given diuretics for symptomatic treatment. Despite their chronic and troublesome urinary symptoms, they did not usually have significant bacteriuria. Indeed, this group of nine patients had had 45 recorded urinalyses between them, and only two showed significant bacteriuria. If your inquirers patient falls into this class of idiopathic oedema, I would suggest that a full urological examination should be undertaken, with the hope that a remediable surgical condition might be brought to light. Urethral stenosis should be specifically looked for. Even in the absence of significant bacteriuria, it is worthwhile trying in succession the usual urinary antibacterials in usual doses and then if necessary low-dose long-term cotrimoxazole or nitrofurantoin. The degree of oedema and other symptoms in these cases is closely related to ones success in controlling the renal symptoms.

The eec, eye-movements and dreams of the blind

It was found that characteristic frontal EEG waves significantly often precede the rapid eye movements of dreaming. The rapid eye movements were absent during dream periods of three men with life-long blindness, and of two men, 30 and 40 years blind respectively, but were present during dream periods in three men blind only 3, 10 and 15 years respectively.

Hyperthyroidism, sleep and growth hormone ☆

Abstract The electrophysiological features of sleep in four hyperthyroid patients were sampled for 9–22 months. The patients showed a great excess of sleep stages 3 and 4, characterized by high voltage EEG slow waves, and evidence of raised nocturnal plasma growth hormone levels. These abnormalities parallel those in other states of heavy metabolic demand, but the EEG abnormalities returned only very slowly towards normal after the patients became euthyroid.

The function of sleep

Evidence is reviewed that points to sleep as a time during which synthetic processes for growth and repair are enhanced. REM (paradoxical) sleep seems especially related to increased synthetic processes in the brain.

SCRATCHING DURING SLEEP

Abstract Four patients with atopic eczema were studied throughout the night, while sleep was monitored for electrophysiological variables. Scratching occurred during all stages of sleep, often without change of stage. The pattern of scratching varied in the different stages. The frequency and length of the bouts of scratching during sleep offer objective measures of skin itchiness. The technique described may be suitable for use in trials of systemic antipruritic agents.

Drugs of Dependence Though Not of Abuse: Fenfluramine and Imipramine

Measures of subjective feeling used by five patients indicated that depression of mood occurred about four days after fenfluramine withdrawal. An experiment in which another 11 patients took fenfluramine 80 mg for 28 days confirmed the depression, maximal on the fourth withdrawal day. It also indicated that in the first week of administration there was some mood elevation, but with feelings of impaired ability to concentrate. The drug reduced appetite and weight. A comparison is drawn with imipramine, which was found to induce initial and withdrawal changes of subjective experience (of dreaming) in six volunteers. It is suggested that certain mood-influencing drugs may not be drugs of abuse because of some unpleasant initial effects, though they can be drugs of dependence.

Chronic fenfluramine administration: some cerebral effects.

Human cerebral function was monitored electrophysiologically during sleep over a period of months before, during, and after the intake of fenfluramine, 40-120 mg/day. Effects included dose-related reduction of paradoxical sleep, increase of intra-sleep restlessness, and changes in E.E.G. slow-wave sleep. It is hypothesized that weight loss may be associated with increase of the last. Grinding of teeth (bruxism) also was noted. Long-term studies make it possible to demonstrate changing central effects with time, including tolerance phenomena. Withdrawal abnormalities are related to the time taken for the drug to be eliminated—in the present case reaching a maximum four days after withdrawal.