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Sleep Disorders

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Sleep disorders / insomnia / insomnia


Sleep is vital for humans, since most biological and psychological regeneration processes are directly dependent on it [1] . Long-term storage of memory contents also appears to take place during sleep [2] . Lack of sleep not only leads to daytime tiredness, but also damages the ability to concentrate, predestined for infections (decrease in leukocytes / NK activity) [3] and leads to a significantly higher mortality [4] .


If someone is kept from sleep for 24 hours (sleep deprivation), the metabolic activity in the brain drops (PET examinations) by up to 11% [5] , the release of growth hormones decreases and the heart rate variability (HRV) deteriorates [6] . Already 1.3 - 1.5 hours less sleep than necessary reduces the attention span by 32%. It is therefore not surprising that fatigue causes 57% of all fatal truck accidents and 10% of all fatal car accidents in the United States and costs of $ 56 billion a year (1995) [7] .


For example, the processing speed for solving mathematical tasks drops even with a night's sleep of 7 hours. 5 hours of sleep / at night have an impact on the precision of a draft or the driving behavior after just 1 week [8] . Likewise, the willingness to take risks increases or the consequences of higher costs or a possible loss are increasingly ignored [9] .


Prevalence and cost

The prevalence, i.e. frequency of insomnia, is 10 to 30% worldwide [10] , [11] . In China, for example, it appears to be 15.0% lower than in the western industrialized countries [12] . The economic damage is immense. In a Canadian study, it is estimated to be around 1% of the country's gross national product.


Sleep rhythm

Sleep is divided into deep sleep and dream phases. The dream phases can be recognized by rapid eye movements and hot REM sleep, whereby REM stands for Rapid Eye Movement. Consequently, deep sleep is referred to as NREM, i.e. non-rapid eye movement.

Sleep stages

A sleep cycle lasts between 60 - 110 minutes and consists of the sleep phase, a light and a deep sleep (non-REM) and an REM phase. A healthy sleeper will go through this cycle 4-7 times a night. The duration of the nightly sleep period is very stable intraindividually, but very variable compared to others. Deep sleep dominates at the beginning of sleep, then dream sleep later, with deep sleep being much easier for adults than for children.


Above all, anabolic processes are driven in deep sleep. As a result, the release of growth hormone is promoted especially in deep sleep [13] - which is shown in a maximum blood level about 1 hour after falling asleep - regardless of when you fell asleep.

Protein synthesis

The general assumption that sleep is primarily for recreation is partially questioned by an investigation that protein synthesis (even after physical exertion) should decrease at night. It is therefore speculated that sleep actually serves to save energy. Although the energy consumption during sleep actually decreases by around 10% and the body temperature also drops, this is contradicted by previous studies because an increase in protein synthesis can be observed [14] . These differing results are probably related to the fact that an increased nightly protein synthesis after physical training depends on the availability of amino acids or an evening protein intake [15] .

Melatonin myth

With a bestseller [16] , published in 1995, about the pineal gland hormone melatonin, which was supposed to work true miracles, a myth built up that continues to this day. The authors had implanted the pinealis (pineal gland / epiphysis) of young mice in old mice and, in return, transplanted the pinealis of old mice to young mice [17] . The old mice with the young Pinealis then showed clear signs of rejuvenation and lived 12% longer than their peers. The young mice, however, aged prematurely and died earlier. The fact that the mice used for the studies had a well-known genetic defect and that their pineal gland could not produce melatonin was not mentioned in any way at all [18] , [19] .


In the wake of this hype, the well-known sleep-promoting effects of melatonin again suddenly became the focus of public attention and desire. A fatigue-causing effect had already been discovered in a self-experiment (100 mg melatonin) in 1958 [20] . It later turned out that light suppresses the body's own melatonin production [21] and mainly influences the circadian rhythms of humans when it gets dark, which only strengthens the natural willingness to sleep, but is not to be seen as a sleep aid [22] , [23] .


Melatonin works particularly well in the prophylaxis and minimization of jet lag syndrome - mainly flight direction west to east [24] . However, this is largely ineffective if a stressful schedule with irregular light exposure is expected after arrival [25] . The overvaluation of melatonin can also be seen in the age-dependent synthesis rate [26] .


Viewed from another perspective, sleep is not God-given, but has to originate from somewhere. After all states of consciousness such as wakefulness, relaxation, dream or deep sleep are accompanied by rhythmic discharges or brain waves, it can be assumed that they are also their originators. However, there is no less relevant information on any physiological question than on the location of brain waves.


Derived from the active model, so-called brain machines, which are supposed to improve the willingness to learn (alpha waves) and ability to concentrate via sound signals or light rhythms, the actual control center for brain waves is located in the thalamus. This part of the midbrain upstream of the cerebral cortex controls and filters all sensory stimuli from the periphery before forwarding them to the cortex (cerebral cortex) - where we then become aware of them.


Accordingly, if the thalamus selects external stimuli and can “tune in” to this rhythm (eg marching music, musical rhythms), it also appears to be the driving force behind the brain waves that can be measured in the EEG. At least this has already been seen as a "reaction" to a corresponding stimulus input for beta waves (15 - 29 Hz), which stand for attention, vigilance, but also frightening [27] . With the restriction that the waves may start in the neocortex after they are triggered by signals from the thalamus (+ basal ganglia). At least the latter seems to apply to the extremely slow brain waves (delta waves 1 Hz), which start from the neocortex [28] , [29] . For alpha waves (8 - 13 Hz), the thalamus seems to be the central stimulus [30] , [31] . And this also applies to theta waves [32] .


So while our waking consciousness mainly takes place in the beta wave range (15-29 Hz) or at rest or in a relaxed mood in the alpha range (8-13 Hz), dreaming is only between 3 - 7 Hz or a deep sleep or an "unconsciousness" is only possible at 1-2 Hz. The question therefore arises whether the thalamus, the pineal gland or a completely different sleep initiator is responsible for an insomnia. Vegetativum is a possible candidate here.


Influencing factor vegetative nervous system

The vegetative nervous system is an autonomously acting nerve network that, for example, leads to (permanent) activation of the sympathetic nervous system in the event of stress. Its main task is to stimulate vigilance, cognition, concentration and alertness and to provide the body with the necessary resources (energy and logistics) to achieve set goals or avert danger. This is supported by the hormones adrenaline, noradrenaline and cortisol. Stress is essentially determined by cognitive evaluation processes [33] , [34] , which can also be experienced as fear or depression by the person concerned. It is particularly important here whether an event or a situation is perceived subjectively as stress.


So it is not so much a question of the number or severity of stressful events, but of whether a person feels impaired ("stressed") by certain factors of everyday life [35] . A study with insomnia patients ("insomniacs") showed that insomniacs and "good sleepers" could have the same number of stressful situations. The stress assessment or the feeling that the situation could not be processed or mastered was much more pronounced among the insominiacs than among the healthy individuals [36] .


Conversely, the "Insomniac characters" were more concerned about sleep, feared more negative consequences of insomnia, and were more afraid of not being able to control their sleep than other people. The author concluded that the actual stress does not keep her awake. Rather, it is the assessment of the situation and “perceived loss of control over stressful events”, their disturbed belief and attitude to sleep (DBAS = Dysfunctional Beliefs and Attitudes about sleep).


The thought of stressful events such as speaking in public [37] or meals [38] is often enough to trigger a maximum increase in the HNA axis and thus also in cortisol. This means that lunch creates the same stress level as an arithmetic problem [39] .


This psychosomatic or psychopathological disease model has a practical therapeutic relevance, because with this basic pattern it should be difficult to provide real help solely through drug or medical technology interventions. Regardless of this, the cortisol level naturally plays an important role. This is significantly higher in insomniac and insomniac characters (also known as psychophysiologic type / PP type) than in the normal population [40] . However, high levels of cortisol are also measured in a primary insomnia [41] , which in turn suggests that insomnia should also be treated by lowering the cortisol level or dampening the HPA axis (see document Vegetativum).


Study location

Double-blind, placebo-controlled study. 101 patients with sleep disorders (difficulty falling asleep, staying asleep and nightmares) are treated with the QRS system over 4 weeks. The parameters sleep time, number of sleep interruptions, sleepiness after getting up, daytime tiredness, difficulty concentrating and daytime headache were checked.


The result: 70% of the QRS group indicated a substantial or even complete improvement in their sleep problems. 24% reported a clear improvement and 6% a slight improvement. In contrast, only 2% of the placebo patients had a clear improvement in sleep, 49% reported a slight or clear improvement and 49% had no placebo treatment [42] .

Explanation of circadian rhythm

The circadian rhythm is the ability of an organism to synchronize physiological processes (including sleep) over a period of around 24 hours. The synchronization happens mainly through certain photoreceptors in the retina of the eye. The most important circadian rhythm is the sleep-wake rhythm. Circadian rhythm disorders result from an active shift in the normal sleep-wake and light-dark cycle. Affected people then usually suffer from insomnia and excessive daytime sleepiness.

Explanation memory formation

Contrary to the earlier belief that memory consolidation mainly takes place in REM sleep, current studies suggest that non-REM sleep dominates here [43] , [44] . In any case, this applies to declarative memory, i.e. the ability to remember facts. On the other hand, emotional experiences ("child murder, serious accident, tragedies") are better established in dream than in REM sleep.

Insight "Mindmachines"

Despite the lack of study evidence, case histories suggest that extremely low frequency PEMF produce a sleep-promoting effect. This seems to indicate a synchronization of the thalamic activity, for example with "Mind- or Brainmachines", the brain wave pattern can obviously be shifted into the alpha range by means of optical-acoustic stimuli ("10 Hz") - whereby this effect seems to be much stronger than is possible through relaxation exercises [45] .


It was already proven in 1949 that the brain wave activity of subjects followed or settled to the predetermined frequency, for example by photostimulation [46] . Later there was a merging of auditory [47] and visual stimulation [48] in order to use them for the purpose of relaxation and learning [49] . The synthesis of auditory and visual stimulation promised a more effective effect than in a separate application [50] . Results from Stanford University on optical-acoustic stimulation, for example, generated such strong relaxation effects that the idea arose to even use this type of brain wave influence for anesthesia [51] .

Explanation of frequency response

The swinging in of the thalamus or the shifting of the brain waves into an externally predetermined cycle range corresponds to the principle of a “frequency-response”. This means that if the brain or its control center for external stimuli (thalamus) is stimulated with certain optical and / or acoustic stimuli over a certain period of time, it synchronizes with them and adapts to the specified stimulation frequencies [52] , [53] .


One can perhaps imagine that audiovisual stimuli lead to neuronal excitement. This spreads in a wave shape via action potentials and excites other nerve cells, which also start to fire synchronously [54] . If the stimulation takes place at periodic intervals, for example in the alpha rhythm (8-12 Hz), the neural neighbors are also stimulated to fire synchronously in the same rhythm. This is also called evoked potential in neurology.

So if audiovisual stimuli lead to a change in the structure of the brain wave and thus changed states of consciousness (vigilance, relaxation, dream, deep sleep), it can be assumed that pulsating electromagnetic fields applied from outside also have the same potential. This is simply because mammals have a chemical magnetic field receptor (cryptochrome) [55] . Cryptochrome is actually a light-sensitive protein that affects the processes of circadian rhythm in plants and many fungi, flies and mammals. In mammals, cryptochrome is a photosensitive pigment in the retina. In other tissues, however, it can also function independently of light [56] . This could also explain why PEMF effects are often light-dependent.


It has already been experimentally proven that the application of short electromagnetic pulses (7 - 14 Hz / 15 - 29 Hz) led to an almost instantaneous increase in the amplitude (doubling) of corresponding alpha or beta waves. Amazingly, frequencies below 8.6 Hz were blocked again and again after 250 ms, so whether the neurons tried to "defend" their own rhythm [57] . This may have something to do with the fact that any light, sound or even electromagnetic stimuli can put your life at risk if you initiate sleep. The thalamus should have appropriate filters to sort out frequent stimuli. System errors could then be reflected in accident reports, in which one wonders why accidents are accumulating on a straight road [58] .


Low frequency bands should therefore be responsible for the sleep-promoting effects of PEMF. Frequently, frequencies in the theta and delta range are more difficult to accept than alpha and beta vibrations.

Discussion vegetative

As already described in the chapter “Influencing factor vegetative nervous system”, sympathetic dominance is associated with both difficulty falling asleep and restless sleep. For example, the level of cortisol levels correlates with waking phases or sleep disorders [59] . A raised HPA axis shortens especially the deep sleep phases and worsens declarative memory formation [60] , while the REM (dream) phases tend to intensify [61] .


Sleep disorders caused by a raised HPA axis then lead in a kind of "vicious cycle" to increased cortisol levels the next evening [62] , ie the cortisol level also indirectly depends on the quality of sleep [63] . Even mild stress predestines sleep disorders and in turn influences brain wave activity in the sense that beta, i.e. vigilance, rhythms appear more often during non-REM (deep) sleep - especially in the elderly, who also experience an accompanying increase in cortisis increases the inflammatory mediator IL-1beta [64] .


If there are more awake phases during sleep, the deep sleep phases are automatically reduced so that less growth hormone is formed [65] . The result is reduced performance and daytime tiredness.


The results are promising in Prof. Pelka's double-blind sleep study with 101 test persons over 4 weeks. Despite the contradictions to the melatonin theory. 70% of the verum group reported a substantial or even complete improvement in their sleep problems. 24% reported a clear improvement and 6% a slight improvement.


It can be concluded that “breaking open” of a disturbed vegetative regulation or readjusting a stuck sympathetic dominance by means of PEMF indirectly serves to promote sleep. In relation to vegetative interference, PEMF therefore do not directly promote sleep. Rather, an improvement in the sleep architecture should only ever be the result of a large number of PEMF applications that promote natural regulation by activating both vegetative axis (sympathetic-parasympathetic) in the same direction. There are limits where the psychopathological personality structure of a so-called "insomniac" counteracts the PEMF influence.


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