L-Histidine: failure to affect the sleep-waking cycle in man

L-Histidine was administered to three patients with intractable narcolepsy (20 g/day for 2 weeks), to 4 normal volunteers (32.4 g/day for 5 days), and to a patient with progressive systemic sclerosis (48.6 g/day for 16 days). No effect was observed on noctural EEG sleep patterns in any of the subjects or on the symptoms of the patients with narcolepsy. These results fail to support the hypothesis that histamine is a waking factor.

Narcolepsy

NARCOLEPSY IS A DISORDER OF SLEEP CONTROL CHARACTERIZED BY A TETRAD OF SYMPTOMS: sleep attacks, cataplexy, sleep paralysis and hypnagogic hallucinations. A diagnosis is made from a careful history. The incidence is estimated as high as 0.3% of the population. Unfortunately patients go for many years before the diagnosis is made and often have experienced disruption of their employment, social and family life, and may have experienced a number of car accidents because of falling asleep at the wheel. An unknown number of narcoleptics kill themselves on the highways before the diagnosis is ever made. Sleep attacks can usually be controlled by methylphenidate, and if the other symptoms persist they can often be effectively managed by imipramine.

Levo(-) amphetamine and dextro(+) amphetamine in the treatment of narcolepsy

The narcoleptic syndrome is a life-long and sometimes familial disorder in which there is a disturbance of the rapid eye movement phase of sleep. Patients with periodic sleep in the daytime but no other symptoms seldom develop the narcoleptic syndrome and have a separate unrelated disorder. Twelve patients with the narcoleptic syndrome were treated separately with l(-) amphetamine and d(+) amphetamine. Both drugs abolished narcolepsy, d(+) amphetamine being slightly more potent than l(-) amphetamine. In equipotent doses, unwanted effects of nervousness and insomnia were equal in frequency. No tolerance to either preparation developed during a six month period. Cataplexy was not affected by amphetamine treatment, but was abolished in two patients when clomipramine was given together with either amphetamine.

Metabolic effects of chronic caffeine administration in a patient with diabetes mellitus

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Medical-psychological implications of recent sleep research

Recent sleep research has shown that the conventional concept of sleep as a period of inactivity for recovery from fatigue is outmoded. Active neurophysiological mechanisms regulate the sleep cycle in a manner similar to other circadian rhythms. The slow wave (NREM) part of the sleep cycle appears to be involved in recovery from muscular fatigue; the dreaming (REM) part appears to be involved in psychological adaptation to life events. Since most hypnotic drugs suppress REM sleep, they should be used after careful consideration of the possible psychological effects. For example, some depressions may be alleviated by agents which suppress dreaming at the cost of isolating the patient from his inner emotional life. Chloral hydrate, chlordiazepoxide, and diazepam avoid this problem because they do not affect REM sleep. Some sleep disorders like severe nightmares may be treated by suppressing deep NREM sleep. Other disorders like enuresis and narcolepsy appear to be psychosomatic conditions and require a medical psychological-approach. There is some evidence that methods which increase or substitute for REM sleep may eventually be useful in facilitating emotional adjustment.