What is Pickwickian Syndrome?

Charles Dickens is best known for his characters Tiny Tim, Ebenezer Scrooge, the Artful Dodger, Nicholas Nickleby and David Copperfield. But perhaps his most influential character was Joe the “fat boy” in Dickens’s first novel The Posthumous Papers of the Pickwick Club.

You say you’ve never heard of Joe or the novel? You’re not alone because it doesn’t get read every year at the holidays nor is it a regular part of school curriculum. However, the reason why Joe is an influential Dickens character is that the author’s description of his physical attributes prompted researchers to name a medical condition after him.

Take a Deep Breath

Dickens paints Joe the “fat boy” as a young man who is quite large and continually falls asleep regardless of where he is, what’s happening around him or even what he’s doing. It’s this combination of being severely overweight and having a propensity to doze off that led experts to identify the pickwickian syndrome, a variation of sleep apnea.

More commonly referred to today as obesity hypoventilation syndrome (OHS), the condition affects extremely obese individuals who exceed the medically recommended weight per height by 20 or more percent. Carrying that weight carries a lot of health complications, including heart disease, diabetes, and sleep apnea, which are interruptions in breathing while asleep. And when you do not sleep well night after night, the cumulative effects can further complicate your health.

OHS is more involved than just a few seconds of not breathing. Rather, one’s breathing becomes chronically compromised, with respiration falling below normal levels. In serious OHS cases, blood oxygen levels begin dropping and that can trigger the small vessels that feed oxygen into the lungs to constrict. This then increases pressure, which eventually can place stress on the heart.

Another consequence of chronically decreasing breathing ability is an gradual increase of carbon dioxide in the blood because your body is less capable of expelling it from the lungs efficiently.

CPAPOther OHS and sleep apnea side effects include:

• sleepwalking

• anxiety

• irritability

• lower sex drive

• memory loss

Feeling Better

Probably the most effective treatment for OHS is to lose weight so your body mass index (BMI) hits within the recommended ranges, and to manage that healthy weight for the long term. As the pounds drop off, your body should become more efficient at distributing oxygen and expelling carbon dioxide.

Or your physician may recommend you wear a continuous positive airway pressure (CPAP) device while you sleep. This machine uses forced air to keep your airways open and prevent breathing interruptions.

In extreme cases, surgery may be prescribed. Children diagnosed with pediatric obesity hypoventilation syndrome may undergo adenotonsillectomy to remove tonsils and adenoids. Adults may be advised to pursue bariatric surgery to aid the weight-loss process.

Professional Guidance

Dickens may have created Joe the “fat boy” as an unexpected farce to keep readers interested, but there’s nothing farcical about breathing disorders induced by obesity. If you have concerns regarding your health, always consult your physician.

What is Sleep Hypnosis?

Hypnosis, often called hypnotherapy, is a natural treatment that can have benefits for those suffering with a sleep disorder.  There are millions of Americans who have some form of a sleep disorder every year and the use of sleep hypnosis is showing signs of potentially being a benefit to them.


Of all the sleep disorders, insomnia is the most common, with around 30-40% of people thought to suffer from it at some stage each year.  There are two main types; temporary or transient and permanent or chronic.

Temporary insomnia usually lasts anywhere from one night to three or four weeks.  There is a variety of different triggers such as jet lag, stress, change of working conditions, alteration of sleeping patterns, noises such as snoring, room temperature or what you eat or drink before bed.  If the condition returns over a number of months for periods of time, it is classified as intermittent.

Chronic insomnia lasts for at least one month and occurs nearly every night.  It can be brought on by medical conditions such as arthritis, Parkinson’s disease, asthma and even allergies.  It can also be caused by the pain created by a medical condition or as a side effect of the drugs to treat them.  Other causes include depression, stress, anxiety and changes in the body’s hormones.

How it works

hypnotist-29832_1280Hypnosis is a state similar to a trance when the individual is deeply relaxed, their attention focused and they are more open to suggestion.  Due to this suggestibility, hypnosis is often used to help alter behaviours and reactions that may be causing chronic health problems such as insomnia and sleep disorders.

While treatment by a hypnotherapist is common, there are also self-hypnosis techniques that are often used by insomniacs.  It is suggested that it may be helpful in reducing anxiety by moving the mind away from the source of the anxiety and bringing about relaxation.

Sleep hypnosis as a treatment is often paired with sleep hygiene instructions for the best impact.  Researchers have also found that the treatment may work well for people suffering with nightmares, sleep terrors, sleep walking and even bed-wetting.


One example was someone suffering from insomnia where anxiety was acting as a barrier to her sleeping.  When she was anxious, her adrenaline levels were high and this meant she couldn’t fall asleep.  Visual imagery and the sense of touch were used by hypnotherapists to help her learn techniques to create a comfort zone and triggering good feelings.  This taught her to relax and was then able to fall asleep, while during the day the same technique helped her remained focused and alert in what she was doing.

One hypnotherapist described the process as like being at the cinema – you become involved in the movie and enjoy the story, even jumping at the scary bits no matter how predictable.  You don’t over think the matter and start thinking about the actors and the quality of the sound crew, you simply involve yourself in the film.  Hypnotism can work a little like this – you are in a susceptible state where you can change the patterns in yourself instead of over thinking about things.  You can stop something making you anxious instead of dwelling over what it is.

What is a Home Sleep Study?

If a medical professional thinks you may be suffering from a sleep disorder such as sleep apnea then they will often suggest a sleep study to diagnose exactly what the problem is.  Sometimes this can be done in a sleep lab when a device called a polysomnograph (PSG) records information but it can also be done at home and this is what a home sleep study is.

Why stay at home?

There are some clear benefits as to why a home sleep study may be more beneficial and give better results than one in a lab.  First is the most obvious; people respond better in their own home and their own bed whereas when staying somewhere unfamiliar, this can alter sleep patterns and skew the test results.

Home sleep studies are also ideal for people who are house bound, elderly or have other chronic illnesses that mean they need the care of a family member or a nurse.  It is also ideal for people who work unusual shift patterns that means attending a sleep lab is difficult.

It also works out much cheaper to do the study at home without having any effect on the results of the test.

What happens in the study

The main areas that are studied are the oxygen saturation, heart rate, airflow and effort as well as snoring and sleeping positions.  The only things that are done extra in a lab is monitoring brain waves and leg movements.

Usually you can simply collect the device from a scheduled location rather than someone needing to visit the home and is a light and easy to carry device.  The common form of the device works by putting a belt around your midsection and attaching a clip on your finger.  An airflow sensor goes under your nose and you are ready to turn the machine on.

What kind of conditions are diagnosed?

Sleep apneaOne of the most common conditions that is diagnosed by this type of study is sleep apnea.  It is diagnosed across three levels of severity, which are

  • Mild – 5-14 episodes in an hour
  • Moderate – 15-30 episodes in an hour
  • Severe – more than 30 episodes in an hour

Sleep apnea is a disorder where patients have pauses in breathing or episodes of shallow or infrequent breathing.  Every time breathing pauses, this is called an apnea and can last anywhere from ten seconds to several minutes and can occur from five to 30 times an hour.  A shallow breathing event is called a hypopnea.

There are two main types of sleep apnea; central and obstructive, though people can have a combination of the two.  In CSA, breathing is interrupted due to a lack of respiratory effort while in OSA, this is because of a physical block to airflow despite respiratory effort and snoring is common in these cases.  It is thought that around 12 million Americans have OSA and there may be many more cases where people don’t realise they have the condition and it goes unreported.

What is Hypopnea?

Hypopnea is a sleep disorder that is similar to apnoea but involves periods of overly shallow breathing or an abnormally low respiratory rate whereas apnoea is where breathing stops altogether.  Therefore hypopnea is less severe a condition than apnoea but can nevertheless be frightening for sufferers.  It can be that you have the condition and get a full night’s sleep but don’t feel rested because you didn’t get the right kind of sleep.


There are various causes of hypopnea including:

  • Physical problem such as nasal septum deformation or a congenital narrowness of the nasal meatus (nose canal)  and the gullet
  • Severe cases of tonsillitis and/or adenoiditis
  • Being overweight
  • Any neuromuscular disease or condition that means the respiratory muscles are weakened
  • Using sedatives or sleeping pills
  • Alcohol abuse
  • Smoking
  • The ageing process

Nasal septum deviation is where the nasal septum becomes displaced and around 80% of people that have this condition never realise it.  It can occur from an impact accident or a blow to the face or it can be something that happened as a child or during childbirth.  In itself, it causes difficulty in breathing and infections around the sinuses as well as hypopnea and apnoea.  As well as the poor sleep, people often experience repeated sneezing, nosebleeds and pain in the face along with an impaired ability to smell.


SleepinessThe most common symptom of hypopnea is that people are excessively sleepy due to the lack of proper sleep.  People with the condition also tend to have a loud, heavy snore that is broken up by choking sounds or loud snorts then short periods of silence when the air cannot get through to the lungs.  This period can be around 20 seconds or longer and can happen as often as every hour.

Other symptoms due to the condition can be depression, mood changes, forgetfulness, loss of concentration, lack of energy and nervousness.  However, these are not always found by suffers and not all people with these conditions have hypopnea.


The most direct consequence of sleep hypopnea is that the carbon dioxide in the blood increases and the oxygen levels decrease, relative to how serious the airway is obstructed.  Generally, this means that people have a disrupted sleep pattern leading to fatigue, lethargy, lack of concentration, being irritable and headaches in the morning.  Or in other words, they act like someone who is really tired.

There are two main types of hypopnea; central or obstructive.  With obstructive hypopnea, the airway is only partial closed but it is closed enough to cause the physical effects.

There is a hypopnea index (HI) used to decide the severity of the condition whereby the number of events during a sleep period are divided by the number of hours slept.  Another method to diagnose severity can be the Respiratory Disturbance Index, which is also used for sleep apnoea and other conditions, but take into account events that do not disturb sleep but may be part of the condition.


One of the main treatment for the condition is called continuous positive airway pressure (CPAP).  This is where the patient wears a mask that covers their nose and/or mouth and an air blower pushes air through the upper airway.  The amount of pressure used can be altered so that it maintains the oxygen levels in the blood.

Another treatment used is an oral appliance.  This is the preferred method of the American Academy of Sleep Medicine especially for those with mild to moderate versions of the condition.  It is also used where people cannot manage to have the mask fitted in the CPAP treatment.  Oral appliances are custom made by a dentist who has been trained in dental sleep medicine.

Mild versions of the condition can be treated on some occasions by lifestyle changes such as avoiding alcohol or stopping smoking.  Also, learning to avoid sleeping on your back can sometimes have a beneficial effect, as can losing weight if you are overweight.  The use of sedative has been found to help some people, as have hypnotics.

Finally, surgery is a last-resort treatment and is only used when the person has a problem in the upper airway.  It can involve removing an obstruction such as tonsils, adenoids or the uvula so is not a solution for everyone who suffers with the condition.

Delayed Sleep Phase Syndrome

Do you often have trouble getting to sleep at night?  Do you find yourself not able to fall asleep until the early hours of the morning?  Do you find yourself tired throughout the day and frustrated that you can’t get enough sleep?  If so, it’s possible you have Delayed Sleep Phase Syndrome.  But don’t fear, as treatment is possible.

Circadian rhythm

Sleep disorderA Circadian rhythm is a natural biological process that sets the body’s functions on a 24-hour cycle.  These rhythms are driven by one’s circadian clock.  Circadian rhythm sleep disorders are family of sleep disorders characterized by the disrupting of normal sleep patterns and the circadian clock.  Those suffering from circadian rhythm sleep disorders are unable to function in a sleep pattern conducive to work and normal life.  Most unusually, most are able to get a good and uninterrupted sleep once they actually fall asleep.  These disorders are extremely harmful to those who suffer from them, affecting them biologically and also socially.  There are two different types of circadian sleep disorders: extrinsic and intrinsic.  One of the more common intrinsic circadian rhythm sleep disorders is Delayed Sleep Phase Syndrome.

Just what is Delayed Sleep Phase Syndrome?  Delayed Sleep Phase Syndrome is a circadian rhythm sleep disorder characterized in its most simple terms as the inability to fall asleep in a timely manner.  People who suffer from DSPS will often find themselves not falling asleep until early in the morning, and then having a hard time waking up in time for work or school.  Delayed Sleep Phase Syndrome affects almost .13% of the adult population.  For teenagers the numbers are much worse, with DSPS affecting almost 7% of teenagers.  DSPS especially affects people who are attempting to maintain a normal schedule.  Students or adults who work a 9 to 5 job will be most affected by DSPS as it inhibits them from blending into the normal daily routine.


What causes Delayed Sleep Phase Syndrome is not well known.  Because of its prevalence in adolescents, it is theorized that it may be an exaggerated form of the internal clock change that young people experience when undergoing puberty.  What we do know for certain about DSPS are the symptoms of it.  Symptoms of DSPS include the inability to wake up at the desired time, difficulty falling asleep until the desired time, a deep sleep once falling asleep, depression, and erratic behavior.  Because of these, the only way to properly diagnose DSPS is to analyze the subject’s sleep habits.  Because of its dramatic symptoms and similarity to other sleep disorders, it is often misdiagnosed.  An overnight sleep study, or a polysomnogram, will help eliminate the possibility of it being another sleep disorder.


Once DSPS is diagnosed, there are a few ways to treat the disorder.  The best and most simple way to fight back against DSPS is to start and maintain good sleep habits.  Maintaining a steady sleep schedule can be the best preventative against DSPS.  This may involve changing the current cycle of sleep, by moving back or forward they time one goes to bed.  A new method of treating DSPS is bright light therapy.  Bright light therapy consists of exposing the subject to a bright light for thirty minutes in the morning.  This helps reset the body’s internal clock.

There are also a variety of pharmaceutical treatments as well.  Consuming sleep medication may be a way to force oneself into sleep to create a sleep cycle.  Melatonin may be prescribed for this reason.  However, the problem with Melatonin is it has the potential to have drastic side effects that may outweigh the benefits of taking the drug in the first place.  Modafinil is a drug that is commonly prescribed for shift work sleep disorder, but can also be used for treating DSPS as well.

Finally, one of the least talked about treatments of DSPS is structuring one’s life around the disorder in a way that one can cope with the disorder.  This can involve taking on careers with late hours, or working at home in a way that allows one to work at their peak periods of energy.  It’s important to remember that it is never worth giving up, despite how much harder it may be for you.

Top 5 Sleep Apnea Symptoms

Do you often experience drowsiness throughout the day, but get more than enough sleep at night?  You may have sleep apnea disorder.  Sleep apnea disorder affects over 18 million Americans, making it just as big of a problem as type 2 diabetes.  In this article we will discuss just what sleep apnea is, treatment options for sleep apnea, and the top 5 most common sleep apnea symptoms that affect Americans today.

What is Sleep Apnea?

Obstructive Sleep Apnea
Obstructive Sleep Apnea

Sleep apnea is a sleeping disorder that affects your breathing rate during sleep.  When affected by sleep apnea, your body will take pauses in breathing.  During these pauses, carbon dioxide builds up in the bloodstream.  In order to equalize the amount carbon dioxide in the bloodstream, the body will take breaths and wake the body up.   There are three different forms of sleep apnea.  Central sleep apnea, or CSA, is characterized with difficulty breathing due to a lack of respiratory effort.  Obstructive sleep apnea, or OSA, is characterized by the airway being blocked.  Complex or mixed sleep apnea is a mixture of these two problems.

Self-diagnosing sleep apnea can be tricky business.  There are a few symptoms you can be on the lookout for if you suspect that you or someone you know has sleep apnea.  If one or more of these symptoms are present, it’s a good idea to see a doctor to know for sure.  Excessive daytime sleepiness, known as hypersomnia, is a common symptom.  If you find yourself drowsy throughout the day, it could be a sign that sleep apnea is waking you up at night.  Loud snoring is another common sign, usually indicating that you have OSA.  Waking up abruptly short of breath is a common sign of CSA.  Morning headaches and general attention problems throughout the day can be a common sign.  And conversely, difficulty falling asleep can be a big sign.  Different conditions put you at risk for developing sleep apnea.  Being male, overweight, or over the age of 40 puts you in the demographic most likely for developing sleep apnea.  People with larger neck diameters tend to be in the group for those at risk, as are those with large tonsils and large tongues.

What to do

If you experience any of these symptoms, the next step is to see a doctor.  A doctor can diagnose your symptoms with much more expertise, and can lead you to treatment.  There are a variety of different ways of treating sleep apnea, all of which should be discussed with your physician.  The biggest treatment most people will undergo is a simple lifestyle change.  Alcohol and sleep medication is the first to go, as these often make it hard to keep your airway open during sleep.  Weightless is a common problem solver, as obesity can be a trigger for sleep apnea.  Also, quitting smoking is not only a drastically healthy lifestyle choice, but it also will help fight sleep apnea as well.

After lifestyle changes, many doctors will turn to traditional treatment to combat sleep apnea.  Custom-fitted mouthpieces are often used to keep the airway open during sleep, allowing the body to get a good airflow.  Breathing devices are also a common treatment option.  Breathing devices fit over your mouth and nose, and gently pump air into your lungs keeping a consistent breathing rate.  In drastic circumstances, surgery will be an option on the table.  This usually means widening the breathing passages, or resetting the lower jaw to allow for improved airflow.  Sometimes it means tonsil removal as well.  While this may seem like a scary route, it’s often the best route to curing your apnea, which will finally allow for an easy and good night’s sleep.

How Long Can You Go Without Sleep?

Just how long can you go without sleep?  Many famous historical figures claimed to go without sleep for long periods of time.  Inventor Nikola Tesla claimed to only sleep for two hours a night, certainly giving a record for most accomplishments on the least amount of sleep.

But how long can you go without sleeping at all?  Sleep deprivation is a long and well studied topic with a lot of research going into it.  Despite this however, there is no clear consensus on how long one can go without sleep.  While detrimental effects have been studied and proven from not getting enough sleep, the typical belief that not getting enough sleep will outright kill you is not exactly true.

Sleep Deprivation

There are two different categories of sleep deprivation: chronic and acute.  Chronic sleep deprivation means a periodic and common lack of sleep.  This can be characterized as sleep disorders like sleep apnea, or just genrally not getting enough shuteye at night.  Acute sleep deprivation is a complete absence of sleep over a long period of time.  The effects of acute sleep deprivation are a hotly studied topic in the scientific community, with no clear consensus on the effects of it.

The longest period of time anyone has ever gone without sleeping is up for debate as many have claimed different times but few have been veritified.  The official record for the longest period of time without sleep is by Randy Gardner, who successfully stayed awake for a period of 264 hours, or 11 days and 24 minutes.  Gardner suffered no ill effects from his stunt.  While Gardner was able to successfully stay awake for this period of time and suffered no ill effects, the jury of whether he was really “awake” is still out.

SleepWhen staying awake for long periods, the body will make attempts to preserve itself by going through “microsleeps,” or short bursts of sleep with may last from one to thirty seconds.  These “microsleeps” are commonly seen as the cause of traffic or air accidents resulting from a lack of sleep.  Gardner’s body subjected himself to these sleeps, resulting in his ability to stay “awake” for the period.  Lab rats that have been subjected to sleep deprivation tests have not been so lucky.  Lab rats subjected to two weeks without sleep or more have not been so lucky.  Lab rats deprived of sleep usually die after two weeks.  For obvious reasons, this has never been tested in humans.


Because of the lack of research of consensus on the effects of acute sleep deprivation, there are many interesting frontiers in which the sleep deprivation is being studied.  There are a few different disorders which prevent the victums from sleeping, all lending to interesting results.  Morvan’s fibrillary chorea or Morvan’s syndrome is a disorder that among many symptoms, causes severe loss of sleep.  In many cases of patients with this disorder, they would suffer severe hallucinations for a period of 20 to 60 minutes a night, but would otherwise be unaffected from the lack of sleep.  Another disorder, Fatal Familial Insomnia, is a disease that also causes an acute lack of sleep.  Among other things, this disease is usually fatal after six to thirty months.  While death isn’t brought about directly from a lack of sleep, it is brought about by multiple organ failure.

While there’s no definitive answer out on how long you can go without sleeping, it’s probably best to leave it a question unanswered for now.  While not sleeping won’t necessarily kill you, it for sure has detrimental effects: the least of which miscrosleeps.  Get a full nights sleep each night, or at least get a little sleep!


What is Insomnia?

Insomnia is a sleep disorder that can affect people in one or both of two ways – either they have trouble falling asleep or staying asleep.  Either way it means they don’t get enough good quality sleep and don’t feel refreshed when they get up in the morning.


InsomniaInsomnia is generally said to be either acute or chronic, the first being a short-term condition while the second is an ongoing condition.  Acute insomnia can be caused by things such as stress, family or work pressure or a traumatic event.  It typically lasts from days to weeks.

Chronic insomnia lasts at least a month or longer.  Many times, it is a secondary condition, meaning it is a symptom or a side effect of something else.  Some medical conditions or medicines can cause insomnia.

When insomnia is the primary condition, it isn’t because of a medical problem but tends to be triggered by a life event.  This can be long-lasting stress or emotional issues though the complete causes are uncertain.


Insomnia causes daytime sleepiness as well as a lack of energy.  It can bring on feelings of anxiety and depression and make people irritable.  Focusing on tasks can become difficult and attention span, ability to learn things and to remember things can all be effected.  This means it can have a serious effect on work or school life.

Insomnia can also lead to other serious problems.  For example, the lack of concentration can effect ability to drive leading to an accident.  Or operating machinery when suffering from daytime sleepiness could lead to an injury.


The first step to treating insomnia is to identify the underlying cause of the problem if it is a secondary condition.  It may be something as simple as caffeine before bedtime causing you to be unable to fall asleep so by cutting out caffeine around three to four hours before bedtime, this can be alleviated.

Some of the main medication conditions that see insomnia as a secondary effect can include:

  • Conditions that cause chronic, ongoing pain including arthritis and headache problems
  • Respiratory conditions such as asthma
  • Overactive thyroid
  • Gastrointestinal disorders including heartburn
  • Stroke or heart failure
  • Menopause including hot flashes
  • Other sleep disorders including restless leg syndrome and sleep-related respiratory problems

Emotional disorders are another likely cause of insomnia with conditions such as depression, anxiety and PTSD being major issues.  Alzheimer’s and Parkinson’s disease have both been shown to have insomnia as a secondary condition.

Certain medicines have been shown to cause insomnia including asthma medicines such as theophylline and also cold and allergy medicines.  Beta-blockers cause insomnia also.


Doctors use a range of tools to diagnose insomnia and find any underlying causes.  The primary way they understand the condition is by asking about your sleep history.  This can include information about:

  • how often you have trouble sleeping
  • how long it takes to fall asleep or how often you wake during the night
  • whether you snore loudly or wake with feelings of gasping
  • how refreshed you feel when you wake
  • if you doze off during the day or have trouble doing tasks because you are not properly awake

Doctors will often ask you to keep a sleep diary for a week or two detailing when you go to sleep, naps taken and when you wake up.  If you think you have problems, it can be worth starting this immediately.


Obviously, treatment is wholly dependent on what type of insomnia you have and any underlying causes that are uncovered.  Treatment can be as simple as changes to lifestyle such as the caffeine tip mentioned earlier, changing sleep routines or the make-up of your bedroom.

Another method used is CNT – Cognitive-Behavioural Therapy.  This is designed to target thoughts and actions that disrupt sleep and alter them in a positive way.

Sometimes over the counter medicines can help the conditions and herbal remedies such as some teas can be beneficial.  As a last resort, doctors will sometimes prescribe medication for short or long-term use to get you sleeping once more.