Recovering from spinal cord surgery

Spinal cord injuries are the result of both accidents and lifestyle habits. We can avoid developing a weak spine by adjusting our lifestyles. Unfortunately, the same cannot be said for accidents. A car accident or slipping over can lead to tremendous long-term discomfort and pain with little we can do to prevent these damages, assuming you're wearing your seatbelt and not running on unstable surfaces. Nonetheless, there are ways we can tackle this issue using advances in medical science. Spine surgery can have incredible effects on your quality of life. Let’s investigate how you can plan your recovery after a surgery. Please note that timestamps are generalized and dependent on your health and recovery plan.

Spine surgery is one of the more common types of surgery, and most are minimally invasive.  Let’s take a look at what spine surgery can do for you.

Firstly, when you’re in the hospital, you may have one of these surgeries depending on what type of damage you have incurred.  

·       Diskectomy – surgery to remove all or part of your disk

·       Foraminotory – surgery to widen the opening in your back where nerve roots leave your spinal column

·       Laminectomy – surgery to remove the lamina, two small bones that make up a vertebra, or bone spurs in your back, to take pressure off your spinal nerves or spinal column

·       Spinal fusion – the fusing of two bones together in your back to correct problems in your spine

Your physician will give you a bespoke plan relating to your damage and recovery plan.

Depending on your surgery, recovery could take anywhere between 3 weeks to 6 months to recover. Other conditions that could affect your recovery is your lifestyle and bodily condition before the surgery.

Your bandages have a lifespan of approximately 9 days.  Check to see if the area has changed colour, swollen, or begins to open up. If this happens, contact your surgeon immediately. If there are no issues, you may begin to shower again. Wait 5 days before showering, and cover the incision with plastic wrap. Do not allow shower from the head to spray the wounded area. You should also want to avoid stairs for the first week or so.

Once a few weeks have passed, and the healing process is underway, you should be attempting to work your way into your previous routine. Before continuing your rehab, please note: do not sit still for extended periods of time, and inform yourself on proper posture by reading this. If you are supported by a brace or corset, you should be wearing it when sitting and walking, however, it would be unnecessary to wear the brace when you are sitting for short periods of time or using the bathroom at night. Finally, do not drive for the first 2 weeks.

Now is the point where, as opposed to what you should avoid, we can start looking at how you can actively help the healing process.

Around the 4 week stage, generally, you should be taking light walks to strengthen surrounding areas. Increase the speed or duration of the walk slowly. This allows the spine to heal itself within an active body and correct itself. A sedentary lifestyle will encourage previous problems to return. Continue to up your exercise slowly as your spine recovers.

Please note, you should contact your surgeon immediately if you experience any of the following:

·        Chills or a fever of 101°F (38.3°C), or higher

·        More pain where you had your surgery

·        Drainage from the wound or the drainage is green or yellow

·        Lose feeling or have a change of feeling in your arms (if you had neck surgery) or your legs and feet (if you had lower back surgery)

·        Chest pain, shortness of breath

·        Swelling

·        Calf pain

·        Your back pain worsens and does not get better with rest and/or pain medicine

·        Difficulty urinating and controlling your bowel movements

If this routine does not help, or you need medical attention, please contact us at Mount Sinai Department of Rehabilitative Medicine. A bespoke plan will be necessary if you suffer from other medical problems. Contact our switchboard on: (212) 241-6321

Laminectomy, The Surgical Response to Sciatica

Laminectomy, the surgical response to sciatica

Sciatica is a symptom of spine damage that can usually be remedied at home. There are a myriad of steps you can take in tending to sciatica without needing surgery. However, in some cases patients need to undergo surgery to alleviate their symptoms. This procedure removes the lamina (a small vertebra in the spine), it may also remove bone spurs in your spine and takes anywhere between 1 and 3 hours. This process has the aim of reducing pressure in your spinal column; in turn lessening the symptoms of sciatica. 

The procedure is often done to treat spinal stenosis. It removes damaged bones or discs. As we explored in last week’s blog, sciatica is a symptom, and not a cause – and the best way to cure sciatica is to tackle the underlying problem. 

It is important to have an x-ray or MRI of your spine before making any decisions to undergo surgery. You must divulge any medication you are taking to your health provider.

Before you leave your home, ensure you leave it prepared for when you return. You must refrain from smoking in the days leading up to your surgery. It is imperative you do not smoke after the surgery is complete. You must speak with your doctor if you have been drinking lots of alcohol, especially if your consumption could be considered alcohol abuse. 

You will likely be asked to not drink or eat anything for 6 – 12 hours before the procedure. With everything prepared, you are ready undergo your Laminectomy. 

Laminectomy opens your spinal column with the aim of giving spinal nerves more space to move. You will be asleep and feel no pain. The procedure begins with you lying face down on the operating table. Once the anaesthetic kicks in, the surgeon makes an incision in your back.

The skin, muscles, and ligaments are moved to the side. Depending on the cause of sciatica, part or all of the lamina bones may be removed on both sides of your spine. Your surgeon may then remove small disc fragments, bone spurs, or other soft tissues. The muscles and other tissues are back in place. The skin is sewn together.

After waking, you will be encouraged to get up and walk around as soon as the anaesthesia wears off. You will be allowed to go home around 1 to 3 days after their surgery.

You will be able to drive within a week and resume light work after around 4 weeks. The surgery should relieve the patient of all symptoms of sciatica due to addressing the root cause of the problem.

As we have stressed in previous blogs, surgical procedure is not recommended as a treatment for sciatica – it should be a last resort and not a go-to when the symptoms of sciatica kick in. Before thinking about surgery, you should consult your physician and discuss options. Alternatively, you can read our blogs on living with sciatica found here.

Sciatica usually goes away on its own if you follow our guidelines. However, if you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

How to Deal With Sciatica, The Do’s and Don’ts

How to deal with sciatica, the do’s and don’ts

This week, we are going to look at ways of managing sciatica. In our previous blog we looked at what sciatica is, and suggested some causes of the problem. To quickly recap, sciatica is the compression of the sciatic nerve – which in turn causes pain down the lower back, through the hamstring all the way to the foot. What is most important to remember when dealing with sciatica, is that is a symptom, and not the underlying problem itself.

The first step when dealing with sciatica is diagnosing the underlying issue. The root of the problem can be anything from a slipped disc in the spine, to a spinal stenosis, or in more serious cases, a tumor. It could even come from a small fracture in the hip. Although we can treat sciatica without dealing with the genesis of the problem, you are more likely to experience a reoccurrence of sciatic pain if we do not.

We recommend that if you suffer from sciatica, get a diagnosis on what caused it. That way we can deal with the pain alongside remedying the original problem, and reduces the chances of it reoccurring.

For now, let’s look at some of Mount Sinai’s recommendations for dealing with sciatica at home.

Conservative (non-surgical) treatment is best in most cases. When you are suffering from sciatica, or begin suffering due to some other cause, apply heat or ice to the painful area. Try the ice first (48-72hrs); then use heat on the pain. Over the counter pain relievers such as ibuprofen or acetaminophen can also help with inflammation and general pain relief.

Surprisingly to a lot of patients, bed rest is not recommended. Although short term bed rest may be needed for patients in extreme pain, staying inactive and reclined for long periods of time weakens the body and extend the life of agonizing symptoms.

Upon first suffering the symptoms of sciatica, it is recommended to tone down your physical activity for the first few days, and gradually work your way back to your daily routine.

You should reduce your activity in the first couple of days – and gradually adjust your body to your usual activities. This will ensure you do not overstress any of the damaged components, and give your body time to adapt.

Patients are recommended to start exercising again after around 2-3 weeks. You should include exercises to strengthen your abdominal muscles and improve flexibility in your spine.

If weightlifting or contact (collision) sports such as American Football are part of your usual exercise routine, you should not return to your sport/hobby for at least 6 weeks since the pain began. Do not lift heavy objects or twist your back. Your physician can help identify good exercises to remedy sciatica.

More serious complications depend on the causes of sciatica, such as slipped discs or spinal stenosis. Call a provider immediately if you have:

·        Unexplained fever with back pain

·        Back pain after a severe blow or fall

·        Redness or swelling on the back or spine

·        Pain traveling down your legs below the knee

·        Weakness or numbness in your buttocks, thigh, leg, or pelvis

·        Burning with urination or blood in your urine

·        Pain that is worse when you lie down, or awakens you at night

·        Severe pain and you cannot get comfortable

·        Loss of control of urine or stool (incontinence)

Also call if:

·        You have been losing weight unintentionally (not on purpose)

·        You use steroids or intravenous drugs

·        You have had back pain before, but this episode is different and feels worse

·        This episode of back pain has lasted longer than 4 weeks

Sciatica usually goes away on its own if you follow our guidelines. However, if you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

Causes and manifestations of sciatica

Sciatica is the name given to any sort of pain caused by irritation or compression of the sciatic nerve. The sciatic nerve stems from the back of your pelvis, and runs through your buttocks, down the legs, and ends at your feet. It is the longest and widest nerve in the human body. It supplies sensation to most of the muscles and ligaments in the lower body – this ranges from the hamstring all the way to the sole of the foot.

When the sciatic nerve is compressed or irritated it can cause pain, numbness, or a tingling sensation that radiates from your lower back and travels down one of your legs to your foot and toes. Some sufferers also report a weakness in the calf muscles or the muscles that move the foot and ankle. Sciatica can range from being extremely painful to a mild annoyance, usually exaggerated by sneezing, coughing – or any involuntary or sudden movements. The pain of sciatica is localised in the lower body region, stemming from the top of your buttock downward, people also report suffering from back pain. Although this is most likely related to the problem, it will not be the sciatic nerve causing the pain.

Most cases of sciatica stem from a slipped disc. Injury or weakness can cause the inner portion of the disk to protrude through the outer ring. This is known as a slipped, herniated, or prolapsed disc. If the slipped disc compresses the sciatic nerve then we have sciatica. Most people with sciatica experience unrelated back pain. But a slipped disc is an injury in its own right; we should see sciatica as a result of this injury. We can summarise this as: Sciatica often occurs from a slipped disc; however, not all cases of sciatica are from slipped discs; and you can get sciatica without having a slipped disc. There are a myriad of ways a disc can slip. 

You can help prevent sciatica by adopting better posture and lifting techniques at work, stretching before and after exercises, and exercising regularly.

Although most cases of sciatica pass within 6 weeks, sciatica can become extremely dangerous. If you are experiencing a tingling or numbness between your legs and around your buttocks, and have recently lost bowel/bladder control, and have sciatica in both your legs – you must contact a physician immediately. Our physicians can confirm a diagnosis of sciatica based on your symptoms and recommend appropriate treatment.

If you are suffering from any of the symptoms listed, please contact us as it is important you speak to your physician as soon as possible. Contact our switchboard on: (212) 241-6321

What Causes Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is the compression – and sometimes squashing – of the median nerve that passes through the wrist. Its symptoms can include numbness, tingling and pain in the thumbs, fingers and wrists, which can travel as far as to the arms and even to the shoulder. Modern medicine has a firm grip on what CTS is; what causes it is quite a different story.

Diagnosing CTS can be done through a relatively simple physical examination. One test is called the ‘flick signal’, for which the patient is asked, ‘what do you do when your symptoms are worse?’ If the patient responds with a hand movement that resembles the shaking of a thermometer, there is good reason to suspect CTS. There are plenty of other tests such as Phalen’s Test and Tinel’s Sign – yet, despite the relative wealth of ways to diagnose CTS, there actually isn’t any kind of test to identify the precise cause CTS, and – except for patients suffering from underlying diseases – the biological mechanisms that create this inflammatory disorder remain unknown. 

It is a common story that CTS is caused through repetitive and often high-stress tasks that involve the wrists and hands – typing, using a computer mouse, manual labour to even playing the piano. While the correlation between CTS and tasks of this nature is undoubted, there is minimal evidence to suggest any clear causality.

In fact, most studies today indicate that CTS’ causes go above and beyond mere so-called ‘workplace factors’ and that they are rather linked to ailments that cause swelling in the wrist (osteoarthritis and rheumatoid arthritis) and others that obstruct blood flow (hypothyroidism and diabetes). We also see CTS pop up in clusters within a family, which suggests that something genetic is at play. Lifestyle also appears to play a significant factor, as those who smoke, drink alcohol excessively, consume excessive salt and who are obese all show increased risk of developing CTS. Women are also three times more likely to develop CTS than men, particularly after childbirth and during menopause.

Despite the range of medical, physical, genetic and life-style related items that are linked to an increased risk in developing CTS, their relationship is that of a correlation and not one of cause and effect. A modicum of clarity might be achieved, however, by overlapping both ends of the spectrum – the ‘workplace effect’ with medical/genetic/lifestyle factors. When somebody is susceptible to CTS – whether it be through genetics, a medical condition or an unhealthy or stressful lifestyle – and they also subject their hands and wrist to frequent, repetitive task, the likelihood of suffering from CTS will be at its greatest.

If you believe you are at risk of developing CTS, we would like to encourage you to seek medical advice on how to prevent it; if you believe you might already be suffering from it, we suggest you speak to one of our specialists for a suitable treatment. The earlier CTS is treated, the more likely – and easier – a full recovery will become.

Bringing Science to the Community – Introducing Dr. David Putrino

This month we introduce to you Dr. David Putrino, Director of Rehabilitation Innovation for the Mount Sinai Health System. Dr. Putrino's medical career began in Australia, where he completed an undergraduate degree in physiotherapy before carrying out a PhD in neuroscience at the University of Western Australia. On completion of his PhD, Dr. Putrino held teaching positions, both at Curtin University of Technology and Edith Cowan University in Perth in Western Australia, teaching neuroanatomy and neuropathology.

After working as a clinician in Australia Dr. Putrino moved to New York to study computational neuroscience at Harvard Medical School, MIT, and NYU. During his time at NYU he worked as a assistant in the School of Medicine, teaching neuroanatomy and clinical neuroscience. Currently he holds a position, not only as the Director of Rehabilitation Innovation, but also as an Assistant Professor of Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai. His work includes developing innovative technology solutions for patients who are in need of better healthcare accessibility. He also lends his technological expertise to the Red Bull High Performance athletics division, consulting with them and using state-of-the-art technologies to monitor, and improve, the performance of athletes.

As well as using his medical training within rehabilitation medicine, and the athletics field, Dr. Putrino believes that it is the responsibility of scientists and medical professionals to add to the education of the community. He believes scientists need to engage the public in science, technological advances, and current research, and to explain why these are such important fields. With this in mind, Dr. Putrino dedicated a portion of his time to co-founding the not-for-profit organization StreetSmart Science. This venture connects scientific mentors with local high schools to get students excited about working in the science sector. The organization currently works with three inner-city high schools in the Bronx and Harlem areas. This passion for community enrichment has also led to Dr. Putrino holding the position of “Chief Mad Scientist” at Not Impossible Labs, an organization that crowd-sources accessible technological solutions for high-impact humanitarian issues.

This interest in community education has brought Dr. Putrino's work into the public eye. He has appeared as a scientific expert on the American Heroes Network as well as having his research featured in a whole range of media, from the ABC, to the LA Times, to the Wall Street Journal, BuzzFeed to name but a few. It is his strong passion for using science to help his community, alongside his extensive background in neuroscience and technology, that have led to Dr Putrino becoming an integral part of the Mount Sinai Rehabilitation Innovation team.

Stroke-Related Language Complications

 Conditions resulting from stroke damage can vary depending on which area of the brain was affected. Certain areas of the brain are responsible for the production, and synthesis, of language information and if these are damaged as a result of a stroke, the consequent communication problems are referred to as aphasia. There are four main types of aphasia – anomic aphasia, Broca's aphasia, Wernicke's aphasia, and global aphasia - each caused by damage to a different area of the brain.

Anomic Aphasia

Anomia is a condition in which a patient suffers a deficit of expressive language and is the most common, and also least severe form, of aphasia. While a patient with anomic aphasia may struggle to find the right word to describe something, especially nouns and verbs, they have no trouble understanding the speech of others and are able to read adequately, though writing may come with more difficulty.

Broca's Aphasia

Also known as expressive aphasia, this form is the result of damage in the frontal area of the left hemisphere of the brain. This area, known as Broca's area, is thought to be involved in the production of speech and damage to it can result in problems with forming full sentences. Though sufferers of expressive aphasia may be able to produce basic words to convey their message they struggle to form full sentences, often missing out important words, such as prepositions. As well as being unable to produce fluid speech they may also struggle to understand the speech of others.

Wernicke's Aphasia

On the other side of possible aphasic manifestations is Wernicke's, or receptive, aphasia. Occurring when the back section of the left brain hemisphere is affected, Wernicke's aphasia is characterized by difficulty understanding the meaning of written or spoken words. Patients still produce fluent, connected sentences, yet they unknowingly use nonsensical, made up words. They may still understand the flow of another person's speech and can work out from the rhythm of it whether they are asking a question or conveying an emotion, but have no understanding of the meaning of the words used. This is because the affected area, known as Wernicke's area, is thought to be the locus of human language comprehension.

Global Aphasia

Both Broca's and Wernicke's aphasias can vary in degree of severity but the most serious form, global aphasia, occurs when there is widespread language impairment. When both language areas of the left brain hemisphere are damaged, patients lose all language abilities, both in terms of comprehension and production and this form of aphasia most commonly occurs immediately after a stroke.

Often global aphasia is caused by swelling around the brain and may improve as this goes down. Similarly, area-specific language problems may decrease during the post-stroke recovery period. However, in instances where full language abilities are not regained speech and language therapies may be use to try and restore speech or, in extreme cases, to develop alternative ways of communicating.

World-Class Care – Introducing Dr. Donald Kastenbaum

This week we introduce one of our senior faculty members in orthopaedic surgery, Physician-In-Chief Dr. Donald Kastenbaum. Having performed over 5,000 primary and revision total hip and total knee replacements Dr. Kastenbaum has certainly earned the position of authority he holds in the field of orthopaedics. An expert in hip and knee surgeries, he has helped to develop several prosthetics for hips and knees that are being used worldwide in replacement surgeries.

Dr. Kastenbaum's journey to his current position of prestige began with studying for a medical degree at the University of Health Sciences – the Chicago Medical School. On completion of this he began an internship in general surgery at the Lenox Hill Hospital, followed by a residency in orthopaedic surgery at the Hospital for Joint Diseases Orthopaedic Institute. His specialisation into the field of hip and knee surgeries was further honed with a fellowship in Sports Medicine at New York University Hospital Medical Center before crossing the pond to complete another in Total Hip and Knee Replacement Surgery/ Arthritis at the London Hospital Medical Center.

His medical work on an international scale continued after his British fellowship, and over the past decade he has both lectured and worked worldwide. Having trained over 30 Chinese orthopaedic fellows, Dr. Kastenbaum returns to China every quarter in order to carry out, and teach, advanced surgical techniques, including minimally invasive and revision hip and knee surgery. Closer to home, he created Mount Sinai's first Comprehensive Arthritis Center, a facility designed to provide complete orthopaedic and rheumatological care, and physical therapy services. Dr. Kastenbaum holds positions within this institution as both Co-Director and Surgeon-In-Chief.

That, however, does not complete his list of medical contributions. In 2002 he was invited to be a part of the Insall Scott Kelly Institute for Orthopaedic and Sports Medicine, and was given the position of Associate Chairman of the Department of Orthopaedic Surgery, before becoming the Vice President in 2005. To add to his already-full career Dr. Kastenbaum also holds the position of President of the Mount Sinai Beth Israel Medical Board and Chairman of the Surgical Chairs. He is renowned as an expert in Hospital Perioperative Management, Safety/ Efficiency/ Outcome Analysis and aids hospitals across the world in developing their models of “best practice”.

All of Dr. Kastenbaum's involvements in different institutions are predicated on his great knowledge and expertise in the field of orthopaedic surgery. For more information on the medical procedures this world-class doctor can provide call 212-241-6335 to book a consultation.

Our Tips for Healthy Bones and Reducing Joint Pain

 It is estimated that between one third and one half of the population of the United Stated aged 20 and over suffers from some form of joint pain. This can be caused by a variety of factors, from genetic predispositions to natural wear and tear of bones as we get older. While there may be no definite cure for chronic joint issues, there are ways that pain can be reduced so that it does not restrict everyday activities.

One tried-and-tested technique for reducing pain and inflammation around affected joints is to use temperature therapy. Cryotherapy, or ice therapy, is suggested as colder temperatures reduce the blood flow to the problem area and thus lessen swelling in the surrounding tissue. It is recommended that, on the first day pain is experienced, you should ice the area every hour for 15 minutes, reducing this to four or five times the next day, and each successive day that the pain remains. If the pain is caused by stiffness rather than inflammation, heat therapy can be used to relax the muscles and to warm up the joints so that they move more smoothly. Hydrotherapy with warm water will ease

pressure on the joints, and immersing the affected area while massaging it will stimulate blood flow to the area.

Often chronic joint pain is caused by the breakdown of protective cartilage over time. This can be counteracted to a certain extent by increasing intake of vitamin D, which is needed to help the body absorb calcium to strengthen bones. Increasing vitamin C levels can also be beneficial as it is a key component in making the cartilage that cushion the bones, and as such may reverse some of the damage. Diet plays a large role in join pain, and reducing sugar intake is an effective step to maintaining healthy joints as, if too much sugar is consumed it can begin to bond to proteins in a process known as glycation and can cause further weakening of the bones and joints.

Temporary relief from joint pain can be obtained with pain killers, however, there is also a whole range of more natural home remedies that have been suggested as having pain-alleviating properties. For reducing inflammation around the affected joints, turmeric and ginger tea may prove an effective solution. Turmeric contains an antioxidant called curcumin while ginger is high in compounds known as gingerols. Both of these active substances are known to be anti-inflammatory and as such can reduce painful joint swelling. For pain relief try taking a magnesium supplement or soaking the painful area in Epsom salts, which contain magnesium sulfate. These are effective natural pain relievers as magnesium relaxes muscles and nerve endings while also helping bones to mineralize, making them stronger.

To a certain extent bone deterioration and resulting joint pain is unavoidable, as natural processes weaken them with age. Nonetheless, there are steps that can be taken to keep bones as strong as possible, reducing joint pain to a minimum.  

How does insomnia affect the body?

 Anyone who has had a sleepless night can attest to the fact that they don't feel 100% the next day. However, could lack of sleep be having more effect on the body than just leaving a feeling of tiredness?

The brain is the part of the body that is more dramatically affected by insomnia, and many of its everyday functions are inhibited by insufficient rest. While tests have shown that short-term memory on the whole is unaffected by insomnia, those who suffer from it may have a less active working memory, the part of short-term memory involved with processing and storing information and applying it to a task. fMRI scans showed that those with insomnia had lower activity levels in brain regions involved with this working memory compared with control subjects. As well as impacting everyday thinking, lack of sleep can also result in a slowing of mental processes, reduced concentration and, in cases of extreme sleep deprivation, can restrict the transformation of short-term term memories into long-term memory. As well as reducing the efficienct of the brain, a state of prolonged wakefulness means that activity levels of the emotion-processing part of the brain, the amygdala, rise. This increased activity can cause insomniacs to experience higher levels of frustration and anger throughout the day

Over time sleep deprivation can begin to affect hormonal processes, which can further impact sleep quality. Secretions of the stress hormone cortisol rise, resulting in higher levels of anxiety and a faster heart rate. During normal sleep, a hormone is secreted which suppresses feelings of hunger. When sleep is reduced there is more time for the body to produce ghrelin, the hunger hormone, meaning insomnia patients experience heightened appetite. In order to quickly boost energy levels, the body craves foods with a high sugar or salt content, resulting in an observed link between insomnia and obesity.

As sleep cycles become irregular the body's circadian rhythm is affected, meaning that those suffering from too little sleep are likely to experience more erratic peaks and troughs in their energy levels. It is normal to experience a period of lethargy during the day, however, for insomniacs this period is prolonged, making it harder for them to stay awake in the afternoon. At the other extreme, insomniacs may experience stretches of feeling excessively alert, as they become focussed on the pressures of the day and heart rate and adrenaline levels are maintained at a high level.

In the long term, long periods of limited sleep can have drastic effects on the body and a person's performance during activities. If insomnia persists it is important to see a doctor, who can provide advice or medicinal aid for returning to a normal sleeping pattern, giving the body time to repair and relax.

Sleep Science – The Mechanisms Behind Insomnia

 Everyone is prone to a sleepless night or two, brought on by excitement or stress. However, for some, lack of sleep can last for weeks, sometimes months. Sustained sleep-deprivation is something that is estimated to affect between 20% and 50% of adults. Much work has gone into researching not only how to cure insomnia but also what the mechanisms are that cause it.

The 3 P's of Insomnia

A popular explanation for this sleep disorder looks at three key factors – predisposition, precipitation, and perpetuation. Advocates of the 3-P Model believe that insomniacs have certain characteristics, such as being naturally anxious or being perfectionists, that make them more susceptible to sleep problems. This predisposition, combined with a precipitating event, such as a death of a loved one or job stress, can affect sleep resulting in a period of acute insomnia (short-term sleep loss). The third facet of this model is that anxiety about, and poor attitudes towards, sleep will perpetuate the symptoms of insomnia. This is because, the more uneasiness a sufferer feels about falling asleep, the more active their brain will be, resulting in them actually staying awake for longer.

The Cognitive Processes of Sleeplessness

This idea of perceptions of how one will sleep feeds into the Cognitive Model of insomnia, an idea put forward over ten years ago. The simple concept is that those suffering from insomnia worry about their sleep and what will happen if they don't get enough. These thoughts actually trigger emotional stress and brain activity which causes the individual to search themselves and their surroundings for factors that could interrupt their sleep, such as noise, light, or discomfort. In the process of focussing on these things they actually bring themselves back into a state of full wakefulness, as the brain isn't allowed to wind down. By actively focussing on the act of falling sleep, insomniacs delay it, by maintaining the brain in a state of awareness.

The Brain Chemistry of Insomniacs

Related to the Cognitive Model, but taking a more in depth stance, the Neurocognitive Model of sleep deprivation explores how brain activity may differ between those with regular sleeping patterns and those without. Scientists have observed that those suffering from acute insomnia actually have higher levels of electrical activity in the brain than those who don't suffer sleep problems. The result of this could be that insomnia sufferers may have higher sensory or information processing activity during times when those with regular sleeping patterns don't. This could have drastic effects on a person's ability to fall asleep, as they are more aware of what is happening around them.

The role physiological factors has been more thoroughly researched, as it has come to be believed that insomniacs may have innate characteristics that affect how easily their sleep is disrupted by both external and psychological factors. Elevated levels of brain metabolism have been observed in studies of insomniacs, making it harder for them to switch off at night. Furthermore, it has been seen that patients with insomnia secrete less melatonin at night, the hormone responsible for making us feel tired. This, combined with the observed increased levels of norepinephrine, a hormone similar to adrenaline, in insomniacs have the debilitating effect of making it much harder to fall asleep.

Thankfully, as insomnia becomes better understood, more techniques and medical interventions are being developed to cure it.