Insomnia

Sleep in a physiological activity occurring in the dark at the end of the day. The internal clock of the brain cells circadian rhythm clock sets the sleep wake cycle in conjuction with the night & day. About a third of adults experience some type of sleep disorder during their lifetimes, over half of them do not seek medical advice ay any time. Insomnia is the most common and most widely recognized sleep disorder.

What is Insomnia?

Insomnia is difficulty in initiating or maintaining sleep. It may be transient or persistent. It is the deviation from the normal sleep duration for the particular individual resulting in disturbances in ones life style. The quality of sleep in Insomnia in non-restorative in nature. The more the individual tries to sleep the greater the sense of frustration and distress and the more elusive sleep becomes.

Transient Insomnia is most often associated with anxiety, either as a sequelae to an anxious experience or in anticipation of an anxiety provoking experience, i.e., an examination or an impending job interview. Some others may have transient Insomnia because of grief, change in life style or stress.

Persistent Insomnia in which the individual experience difficulty falling asleep. The difficulty in fairly long in duration before any one realizes that it could be due changes in the sleep patterns rather than occurring due to anxiety and stress.

Due to consumption stimulants like caffeine or caffeine containing beverages like coffee, soft drinks or drugs one may develop persistent Insomnia.

During alcohol oropioid abstience the drug addicts may experience Insomnia. On several other occasions like painful disorders like post surgical state, injuries & arthritis one can develop Insomnia.
Some psychological disorders like depression, psychology anxiety disorders are associated with Insomnia.

Symptoms :

The individual with Insomnia is mostly pre-occupied with the difficulty falling asleep. High levels of arousal during the night time and anxiety with distress further results in delay in onset of sleep.
They may feel sleepy during the day time or may virtually experience sleep attacks. Difficulty in concentrating on tasks during day time, irritation and restlessness at workplace may also be noticed frequently. The lack of feeling of freshness when they get up in the morning is also occasionally described by the individuals suffering from Insomnia.

Total duration of sleep time at night would be reduced significantly and may be associate / at time with multiple awakenings in between.

Feeling of tiresomeness, lack of interest in work, forgetfulness are some other problems faced by individuals with Insomnia.

Dur to psycho physiological disturbances in the life style arising out Insomnia. One may have reduced work efficiency, accidents while driving, injuries at work place while handling machinery may also occur due to Insomnia.

How to treat :

Transient Insomnia can be treated by managing the stress or by getting over the immediate cause of the problem.

Persistent Insomnia requires medication.

The principles of beating Insomnia are :

•	medication shall be prescribed for another period i.e., 2 weeks.
•	Specific medication with proper precaution to the usage of medication like timing, dosage and length of duration of treatment shall be explained to the patients.
•	Awareness about the long term usage of hypnotics to the patient is essential, commonly used drugs for Insomnia are benzodiazepines like alprazolam, lorazepam and chlordiazepoxide. The problem with these drugs are if they are not properly prescribed or explained to the patients they have high addict potential.

New hypnotics drugs like zolpidem and zoleplon are useful and have less addiction potential, it used under supervision

Medication for Insomnia shall be used only after detailed check up by the doctor and under his case find supervision only.

Ones should never attempt to borrow others prescription or buy drugs out the counter at the medical outlets.

Some tips for good night sleep

•	The bedroom should be generally be dark and quiet, no television, sterio or other noise generating sources be allowed in the bed room.
•	Never attempt to read or simply stay in bed without sleeping.
•	If you are not able to fall asleep within 10 minutes get up and do something else until you feel sleepy again.
•	Wake up times should be strictly adhered to relaxation, meditation practices are occasionally helpful to get into sleep.
•	Avoid hot, cafeiene containing beverages and smoking before going to bed.
•	Remember alcohol results in disturbed sleep.

Dr. Tejam,
Consultant Psychiatrist.

source : teluguone

Robotic Heart Surgery

Robotically-assisted heart surgery is a major headway in medical community’s endeavour to minimize the extent and the trauma of cardiac surgery. With this technology, the surgeon manipulates the surgical instruments with the help of a computer.

Robotically-assisted heart surgery technology involves insertion of surgical instruments through pencil sized holes, instead of the conventional way of making a 12 to 15 inch long incision required to split a patient's breast bone. An endoscope and two surgical instruments are passed through tiny incisions in the chest wall. The surgeon views the image provided by the endoscope on a computer screen. Instead of manipulating the surgical instruments directly, the surgeon manipulates them via a computer console - similar to manipulating a computer games console. The computer interprets the surgeon's hand movements and causes the surgical instruments to respond accordingly. This system addresses the major disadvantages of moving the long surgical instruments manually - computer control of the surgical instruments essentially eliminates the tremor effect, and also the non-intuitive feel of maneuvering such instruments.

The Robotic Surgical System enhances a surgeon's hands much like a microscope enhances a surgeon's eyes. This 'enhancement' gives the surgeon the extra precision and dexterity necessary to perform these very delicate procedures without having to crack the patient's chest, wide open.

While it takes special training to become adept at using robotically-assisted instruments, most surgeons who have had such training report that they feel quite comfortable maneuvering surgical instruments via a console instead of directly.

Much of the early work with robotically-assisted heart surgery has been with bypass surgery, limited to single bypass grafts. However, it is predicted that with advances in technology, multiple grafts with robotic assistance will be possible, at virtually any location on the heart.

The chief advantage of such surgery is incisions that are made are tiny, eliminating the large incision and provide the benefits of significantly reduced patient pain and trauma, shorter recovery times and convalescent periods. Rapid recovery from cardiac surgery is not only better for the patient, but it is also less expensive.

The chief disadvantage at this point is that the technology is new, and (despite early encouraging reports) is still evolving. Its efficacy and safety have not yet been proven sufficiently.
Another disadvantage is the cost of the robotic systems. The bottom line: it is likely to be several years before robotic heart surgery is widely available.

However this technology throws open new possibilities, for instance, a surgeon performing a heart operation while sitting at a console 15 feet away from the patient, can also perform with equal efficiency the same operation while sitting 1500 miles away from the patient. In other words patients could be operated upon by only the very best surgeons.
Dr. Vijay Dikshit, MS, MCh
Chief Cardiothoracic Surgeon.

source : teluguone