Archive for the ‘Live & Learn’ Category

February 28, 2010

www.Lightworkers.org



Come join me at www.Lightworkers.org just look for “Kimmie”


posted by kimmie under Lifestyles Live & Learn Self Improvement Spells & The Craft Spirituality & Mysticism Twilight & Vampirism 0 comments

January 5, 2010

Old Farmers Advice…


1.      Your fences need to be horse-high, pig-tight and bull-strong. 

2.      Keep skunks and bankers at a distance.

3.      Life is simpler when you plow around the stump.

4.      A bumble bee is considerably faster than a John Deere tractor.

5.      Words that soak into your ears are whispered…not yelled.

6.      Meanness don’t jes’ happen overnight

7.      Forgive your enemies; it messes up their heads.

8.      Do not corner something that you know is meaner than you.

9.      It don’t take a very big person to carry a grudge.

10.  You cannot unsay a cruel word.

11.  Every path has a few puddles.

12.  When you wallow with pigs, expect to get dirty.

13.  The best sermons are lived, not preached.

14.  Most of the stuff people worry about ain’t never gonna happen anyway.

15.  Don’t judge folks by their relatives.

16.  Remember that silence is sometimes the best answer.

17.  Live a good, honorable life.  Then when you get older and think back, you’ll enjoy it a second time.

18.  Don’t interfere with somethin’ that ain’t bothering you none.

19.  Timing has a lot to do with the outcome of a Rain dance.

20.  If you find yourself in a hole, the first thing to do is stop diggin’.

21.  Sometimes you get, and sometimes you get got.

22.  The biggest troublemaker you’ll probably ever have to deal with, watches you from the mirror every mornin’.

23.  Always drink upstream from the herd.

24.  Good judgment comes from experience, and a lotta that comes from bad judgment.

25.  Lettin’ the cat outta the bag is a whole lot easier than puttin’ it back in.

26.  If you get to thinkin’ you’re a person of some influence, try orderin’ somebody else’s dog around.

27.  Don’t pick a fight with an old man.  If he is too old to fight, he’ll just kill you.

28.  Live simply.  Love generously.  Care deeply.  Speak kindly.  Leave the rest to God.


posted by kimmie under Lifestyles Live & Learn 0 comments

August 15, 2009

SCORE!!! U.S. 1 - Nigeria 0


As some readers of my blog may be aware, I occasionally respond to Nigerian 419 e-mail scams. The idea is to have some fun and hopefully waste a little of their time, making it time they can’t use scamming.

I had a particularly enjoyable exchange with a 419 scammer recently and decided to publish it here.

Warning: The following is arguably the crudest piece ever published in this newsletter. No, seriously. I’m not kidding.

For those who don’t know, Nigerian 419 fraud named after the applicable Nigerian legal code is a scam where someone claims to have millions of dollars they’d like to get out of a country, usually Nigeria, but needs assistance doing so. The scammers offer would-be dupes a large percentage of the transaction if they’ll let the money pass through their account.

Once someone takes the bait, they are told some advance fees are required to process paperwork or bribe government officials. When 419 fraud works, the scammer will keep coming up with new fees and the scammee will keep paying in an effort not to lose money already spent.

Two weeks ago, I received a e-mail from a Mr. Peter Lee claiming to be an executive at Hang Seng Bank with $25.6 million in an account owned by a client who died with no next of kin.

According to Mr. Lee, all I had to do was pose as this persons next of kin to get 30% of the account. So I created a special e-mail account just for this discussion, ShuvittInyurass@yahoo.com, and answered him:

Dear Mr. Lee:

Thank you for contacting me. I am interested in your proposal. But I must make sure I can trust you. In my family, there has been a history of bad luck and unfortunate business dealings. My name is Shuvitt Inyurass. I have traced my last name to pre-communist Russia where the Inyurasses were affluent peasants, or kulaks, as their class was known. After the Communist revolution, the kulaks were declared enemies of the people and most of the Inyurasses were sent to the Russian gulag system never to be seen again.

However, my great grandfather Puhttitt Inyurass escaped to the west by train and then immigrated to America. Somehow, he had enough money to found the Inyurass Ointment Company. Family lore has it that Great Grandpa Puhttitt fell in with the Goscruyerself Russian crime family, and thats how he got the money.

In any case, Great Grandpa Puhttitt wrote his son, my grandfather, Yurhedis Inyurass out of his will after Yurhedis left the family to start the Inyurass Hair Removal Company. The Inyurass Hair Removal Company is very successful, but my father, Lance D. Boyle Inyurass, who took over the business from Granddad Yurhedis, has let it be known that he is passing the entire business to my brother Rahmitt Inyurass.

I also have an uncle named Pierce D. Boyle Inyurass, aka Pop, but, alas, he is untrustworthy. Last I heard, Uncle Pop D. Boyle Inyurass married a young hussy named Hemma Royd. Aunt Hemma I cant believe I’m calling her that; she’s younger than I am and Uncle Pop had a daughter and named her Lihtta Pharty Inyurass. But their marriage went sour after Uncle Pop had an affair and began spending all his money on gambling and drink.

So you see, my family history is one broken trust after another. I have a great deal of trouble believing people, even members of my own family. I have a good feeling about you, though. The tone of your letter is very kind. But still, I am wary. How do I know I can trust you? Would you please supply some more details on the transaction you propose?

Sincerely:

Shuvitt Inyurass

Mr. Lee responded with what looked to be a form letter asking for some personal information including my age and occupation. The idea behind stringing along 419 scammers is to try and get personal letters from them so they spend some of their would-be scamming time not scamming.

So I responded again:

Dear Mr. Lee Peter [Yes, I screwed up and transposed his first and last names here]:

Thank you for your note. In answer to your question, I am 47 years old and work in a jacket factory owned by my sister, Pympell Inyurass. The company is called the Inyurass Wind Breaker Company. It is quite successful, but my sister is very hard to work for.

Hopefully you can free me from the hell that is my life right now. But still you’ve given me no proof that I can trust you. How do I know I can trust you? This is an awful lot of money you’re talking about. You know all about me. Tell me about yourself.

Sincerely, and I really mean it:

Shuvitt Inyurass

This time Mr. Lee responded with a personal note:

Dear Shuvitt Inyurass,

Many thanks to you e-mail and explanations. I am happy you are of age to handle this transaction. But for your information, age has nothing to do with Maturity. I want to believe that you are matured enough to work with me. I am glad you wish to free yourself from the hell you are facing with your sister and start a life of your own, I hope that is what you meant in your e-mail.

I have worked with Hang Seng bank for years now and this is a one time opportunity to own my personal business and start life just as most influential men did. Life is all about making use of the opportunity at hand. Shuvitt Inyurass, It is your choice to work with me or not. I will do everything legally required to ensure that this project goes smoothly, it shall pass through all international Banking law.

Having resolved to entrust this transaction unto your hands, I want to remind you that, it needs your commitment and diligent follow up. If we work seriously the entire transaction should be over in a couple of days. I need you to send me a copy of your identification (I.D, Driver’s license or International passport), your contact address and valid telephone number along with the filled funds release form. You will be receiving other details from me including a copy of my identification and other relevant information. All I need is your seriousness and commitment. With a short period, your sister will not recognize you again I assure you.

Regards,

Peter Lee JP

Dear Mr. Lee Peter: [Again, I screwed up his name, but I hadn’t yet noticed and neither, apparently, had he.]

Thank you for responding. I am sincerely ready to work with you and get away from my annoying, somewhat painful sister Pympell Inyurass and her Wind Breaker Company. Working there really stinks.

It looks as if you are in Hong Kong. I have two cousins there, Aylianprobe Inyurass and Itchyrash Inyurass. Do you know either of them?

Aylianprobe Inyurass is quite nice and very rich, though he tends to make people uncomfortable. And many people who claim to have dealt with him are clearly crazy. For some reason, they all want to go to Nevada. I communicate with Aylianprobe often. He has always told me if I ever need any financial help to call him. I have been hesitant to do so, though. Maybe we can get him to help us in our dealings.

My other cousin, Itchyrash Inyurass, is a girl and I think she’s a bit loose. It seems everyone has had an Itchyrash at one time or another. It’s a very uncommon name, no?

In any case, when do you need a copy of my driver’s license? My license has been suspended. I was pulled over by a police officer recently. I rolled down the window. He asked my name. I said, I thought innocently enough, Shuvitt Inyurass. Well, he became very agitated at this. Then he asked who was with me. I said: My wife. He said, Who? I thought he didn’t hear me so I spoke up: My wife! Crammit Inyurass!!

With that, the officer got really mad, hauled me out of the car and off to the police station.

Now, I ask you Mr. Lee Peter: Would you get mad if I said Crammit Inyurass loudly to you? I hope not. I would like to think you’re a more reasonable man than that.

I think I get my driver’s license back next week. Is that too late?

Sincerely, and I hope you take this literally:

Shuvitt Inyurass.

To my surprise, Mr. Lee responded with another personal note:

Dear Shuvitt Inyurass,

Many thanks to your e-mail and letting me know you are ready and willing to work with me on this transaction. Yes I am in Hong Kong but might be travelling for a board meeting to Seoul, Korea tomorrow.

Now, you mentioned your cousin Aylianprobe Inyurass is a very rich but tends to make people uncomfortable, that is already a negative introduction of him. To be honest with you, I want you to keep this transaction confidential knowing fully well the amount involved. For now we do not need your cousin or your family members. In fact, I want you to surprise them after the funds has been transferred. You will be as rich as they are and they will respect the name Shuvitt Inyurass for once; mark my words.

I have told you in my last e-mail that I need your commitment and willingness, so I do not need your cousin or any other third party, not even my wife know about this transaction, so I have shown you the limit to wish I wish to expose our dealings. It has to be between both of us.

Sure, I will not be mad at you when you mention your wife’s name to me, although people have their own way of reasoning; well try and get your license back. You can send your work ID to me now along side the form (I am attaching another copy to you).

I also scan and attach a copy of my work ID, certificate of deposit of the deceased, this is to let you know how serious I am and how far have brought this transaction. As such I will need you to be serious and leave your family out of this and lets get down to business.

If you can fill out the form now, I will be very glad. My regards to your wife and kids. I await your e-mail.

Regards

Peter Lee

It was then that I realized I had been addressing Mr. Lee backwards. Time for an apology:

Dear Mr. Peter Lee:

Sorry I mixed up your first and last name in my last e-mail. You know us ignorant Americans: All those Asian names sound alike to us!

People sometimes mistakenly spell and pronounce my name in its original English form: Shuvitt Inyerarse. I never get mad though. People make mistakes, right? Nothing to get upset about.

In any case, I’m not sure how to proceed. The form you want filled out isn’t clear to me.

Would you explain it to me, please?

Sincerely, and I can’t remember having ever meant anything more strongly:

Shuvitt Inyurass, or Inyerarse if you prefer.

A day later, I received another personal note from Mr. Lee. He was not pleased:

Dear Shuvitt Inyurass

This is in response to your e-mail. In your first e-mail, you claimed to be a Russian and now you are claiming American. Now you need to confirm you actual country and facial identity.

Look Shuvitt Inyurass, I am not here for time waste or a child’s play discussion. If you are ready to work on this transaction, then find attached again, the form. It is clear and concise nothing to explain. Just download, print, fill out, scan and send back to me. There is absolutely nothing to more required.

I thought that by sending you my work ID, certificate of deposit and other explanations, you will understand my seriousness. I will appreciate, if you rather become serious and send the filled out form alongside work ID, so we can proceed. If not state clearly your intentions not to proceed further, so I can know my fate in you.

Finally, I will not entertain anymore family issues or irrelevant discussion outside this subject matter. We have some business aims to actualize so, act like a matured and ready person. I hope you understand my state of conversation.

Thank you

Peter Lee

Uh oh. I irritated him. Time for another apology:

Dear Mr. Lee:

Geez. I am so sorry. I thought we were becoming friends.

Just to clarify, in my first letter I did not claim to be Russian. I said my ancestors were Russian. If you’ll recall, I said my great grandfather Puhttitt Inyurass escaped from Russia to the west by train and then immigrated to America to found the Inyurass Ointment Company.

My family has been American ever since. I’m sure if you check our correspondence you’ll see I never claimed to be Russian.

And when you say you want no more discussions of my family members, I take it you would not like to hear of my second cousin, once removed Twobyfour Inyurass. He is really quite interesting, but not as interesting as his brother Tenfootpole Inyurass, though. Like my other family members Twobyfour and Tenfootpole can be quite annoying.

Do you know what it’s like to deal with a Twobyfour or Tenfootpole Inyurass? Let me tell you, it can be excruciating. As for the documents you sent. Anyone could forge those so I’m not sure they’re real. This relationship must be about trust, Mr. Lee. So I really need proof I can trust you.

I think I would be able to trust you if you sent me $100. That would certainly cement the deal. So how about it, Mr. Lee? Just send me $100 and I’ll fill out the form.

Sincerely, I beseech you:

Shuvitt Inyurass

Mr. Lees response arrived the next day:

Dear Shuvitt Inyurass

I am really pleased with your last e-mail. Well, Yes we are friends and cannot recall telling you that we are not friends or trying to become friends. I only needed seriousness from you. But with your last e-mail, I am now convinced that you cannot handle this transaction. You demanding for $100, just to gain trust, that is a very high sense of immaturity, do not feel insulted please, but I must confess you are not ready to make use of this opportunity.

For your information, the certificate of deposit alone is enough for a proof along side my work ID. That certificate you have with you is worth millions of dollars and all you demand is a $100, I cannot believe you actually typed your last mail.

Sorry, sending you a $100 does not guarantee you my trust; that is rather a very cheap means of buying trust and that is not good enough for this transaction; you have shown a low esteem on my plans for you.

I do not feel insulted by your e-mail anyway, I feel much more relieved now. Thank you Shuvitt Inyurass and I hope someday you understand.

Peter

Wow. Now he decides I’m immature. Obviously, Mr. Lee is trying to goad me into dropping my demand for money by wounding my pride, but I think this is a perfect place to finish.

Farewell, Mr. Lee. For those who enjoy reading about 419 scammers being strung along, check out 419eater.com. The folks who contribute to that site are hilarious. I don’t even pretend to be in their league.


posted by kimmie under Humor Live & Learn 0 comments

June 13, 2009

Joke of the Day


For  those of you who watch what you eat, here’s the final  word on nutrition and health.
It’s a relief to know the  truth after all those conflicting nutritional  studies. 

1. The Japanese eat  very little fat
       and suffer  fewer heart attacks than  Americans.

2. The Mexicans  eat a lot of  fat
       and suffer fewer heart attacks than  Americans.

3. The Chinese  drink very little  red wine
       and  suffer fewer heart attacks than  Americans.

4. The  Italians drink a lot of red  wine
       and suffer fewer heart attacks than  Americans. 

5. The Germans  drink a lot of beers and eat lots of  sausages and fats 
       and suffer fewer heart attacks than   Americans.

CONCLUSION

Eat and drink what you like.
Speaking  English is apparently what kills  you.


posted by kimmie under Humor Lifestyles Live & Learn 0 comments

May 12, 2009

Dreams & Sleep


~Dreams occur during all stages of sleep. Nightmares are common. They can be associated with poor sleep and diminished daytime performance. Frequent nightmares are not related to underlying psychopathology in most children and in some “creative” adults. However, recurrent nightmares are the most defining symptom of post-traumatic stress disorder and may be associated with other psychiatric illnesses. Night terrors are arousal disorders that occur most often in children and usually occur early in the sleep period. Patients with rapid-eye-movement behavior disorder often present with nocturnal injury resulting from the acting out of dreams. Dream disorders may respond to medication, but behavioral treatment approaches have shown excellent results, particularly in patients with post-traumatic stress disorder and recurrent nightmares.

A dream is the recall of mental activity that has occurred during sleep. Using polysomnography, sleep can be divided into stage 1 (sleep onset), stage 2 (light sleep) and stages 3 and 4 (deep sleep)–the non­rapid-eye-movement (REM) stages. REM sleep occurs cyclically every 90 minutes during the night in association with high brain activity, rapid spontaneous eye movements and suppressed voluntary motor activity. Dreaming occurs in all stages of sleep. It is reported by 80 percent of persons who are awakened during REM sleep and sleep onset (stages 1 and 2), and 40 percent of persons who are awakened from a deep sleep.

Patient reports about the content of their dreams vary based on the sleep stage from which they are awakened. Patient reports of dreams experienced during REM sleep tend to be bizarre and detailed, with storyline plot associations. In contrast, dreams experienced in deep sleep are more diffuse (e.g., dreams about a color or an emotion). The dreams of stages 1 and 2 are simpler, shorter and have fewer associations than the dreams of REM sleep. The ability to recall dreams may reflect the dream’s accessibility or distance from awake thought; the highest recall seems to occur during sleep stages with electroencephalographic patterns that are most like those in the waking state.

Some researchers believe that dreams have no function. Others think that dreams are the nocturnal continuation of conscious thought processing during the day or a reprogramming of the central nervous system for the next day’s conscious functioning. Evidence suggests that dreaming, like most other physiologic events, is important for learning and memory processing, gives cognitive feedback about a person’s mental functioning and helps a person adapt to emotional and physical stress.

Frightening Dreams 

 


Type of dream

Incidence

Symptoms

Sleep stage

Associatedfactors 

 

Frequent
nightmares in children
20 to
30%,
declines with age

Frightening,
detailed plots. Difficult return to sleep
REMsleep,
usually late insleep period (i.e.,
4 to 6
a.m.)

 

Usually
reflects
no pathology
Frequentnightmares in adults 

 

5 to 8% Increasedawakenings Daytime memory impairment and anxiety 

 

REM
sleep


“Thin-boundary”

personality/creative personality. May have associated psychopathology


Post-traumaticstress disorder 

 

Variable
8 to 68% of war veterans.At least 25% of trauma victims 

 


Stereotypic dreams of the trauma.Intense rage, fear or grief 

 

REM
sleep and sleep onset

Significant trauma.Daytime hyperarousability and anxiety 

 

REM
sleep behavior disorder

Most
common inlate middle age and in men 

 

Acting
out of dreams.Nocturnal injuries 

 

REM


sleep
Increased

REM
sleep EMG tone on polysomnogram

 


Degenerativeneurologic illness in 50% of affected persons 

 

Night
terrors
1 to 4%
of children. Declines with age. Rare in adults

Blood-curdling screams.Autonomic discharge. Limited recall 

 

Deep
sleep, early in sleep period (i.e., 1 to 3 a.m.).Stages 3 and 4 arousals on polysomnogram 

 

No
pathology in children.Psychiatric and neurologic disorders in adults 

 

REM = rapid eye
movement;
EMG
= electromyography.
       

Frightening Dreams: The
Nightmare

Nightmares are vivid and terrifying nocturnal episodes in which the dreamer is abruptly awakened from sleep. Typically, the dreamer wakes from REM sleep and is able to describe a detailed, associative, often bizarre dream plot. Usually, the dreamer has difficulty returning to sleep. Nightmares are also common. In a two-week prospective study of college students, 47 percent described having at least one nightmare. Results of a general population study of 1,049 persons with insomnia revealed that 18.3 percent had nightmares. In this study, nightmares were more common in women and were associated with increases in nocturnal awakenings, sleep onset insomnia, and daytime memory impairment and anxiety following poor nocturnal sleep. Studies of the general population reveal that 5 to 8 percent of the adult population report a current problem with nightmares.

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Medications Known to Cause Nightmares


 


Medications that alter
central nervous system neurotransmitter levels
AntidepressantsTricyclic

Monoamine oxidase inhibitors

Selective serotonin reuptake inhibitors

Centrally acting antihypertensives

Beta blockers

Rauwolfia alkaloids

Alpha agonists

Antiparkinsonian agents

Levodopa (Larodopa)

Selegiline (Eldepryl)


Miscellaneous
medications known to cause nightmares

Flutamide (Eulexin)

Procarbazine (Matulane)

Ketamine (Ketalar)

Short-acting barbiturates

 

Medication
withdrawal associated with nightmares

Ethanol

Barbiturates

Benzodiazepines

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Nightmares affect 20 to 39 percent of children between five and 12 years of age. Contrary to popular belief, frequent nightmares in children do not suggest underlying psychopathology. Nightmares are often described by creative persons who demonstrate “thin boundaries” on psychologic tests. Persons with thin boundaries are less likely than others to define the world around them in concrete terms. They rarely define issues as being black and white, but instead see themselves and the world in shades of gray.

Nightmares are also associated with the use of medication, primarily those medications that affect neurotransmitter levels of the central nervous system, such as antidepressants, narcotics or barbiturates. Intense, frightening dreams may occur during the withdrawal of drugs that cause REM sleep rebound, such as ethanol, barbiturates and benzodiazepines).

Nightmares and Post-traumatic Stress Disorder

Nightmares are a defining symptom in post-traumatic stress disorder (PTSD). The latter is not a new disorder. In 1667, after the great fire of London, Samuel Pepys wrote, “To this very day I cannot sleep a-night without great terrors of the fire.” Nightmares related to PTSD occur after an intensely frightening or highly emotional experience. These nightmares are often associated with disturbed sleep and altered daytime behavior, which is best described as hyperarousability.

The occurrence of PTSD following trauma varies. Thirty percent of veterans of the Vietnam War were affected by PTSD, as were 68 percent of veterans who were in the Arab-Israeli conflict of 1973 and 8 percent of veterans of the Gulf War. Among the civilian population, PTSD affects approximately 25 percent of persons who have experienced emotional and physical trauma or have suffered a severe medical illness. However, among some groups of patients, such as immigrant psychiatric patients, the incidence of PTSD approaches 40 percent.

The frequency of PTSD increases with severity of trauma, hostility, depression, poor health habits and poor coping skills. Persons with PTSD generally report awakening from dreams that involve reliving the trauma. In these dreams, they experience strong emotions, such as rage, intense fear or grief, that would have been appropriate reactions to the original traumatic event. Nightmares related to PTSD generally happen during REM sleep but also occur at sleep onset, which can interfere with the initiation of sleep. Polysomnographic studies in these patients have shown that they have poor sleep maintenance, increased eye movement density, decreased percentage of REM sleep and an increased tendency to have REM sleep at sleep onset (REM pressure). This phenomenon is similar to that occurring in patients with narcolepsy.

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Recurrent
nightmares are the most defining symptom of post-traumatic stress
disorder.

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Symptoms of PTSD can persist for decades after the traumatic experience; however, the occurrence of PTSD after trauma is the exception rather than the rule. Patients who experience PTSD are divided into two groups based on the presence or absence of impaired psychologic functioning before the trauma.

Nightmares and
Psychiatric Illness

Nightmares can occur in patients with psychiatric illness. Depression is sometimes associated with themes of masochism and poor self-image in dreams. Patients with schizophrenia and dissociative disorders may have intense dreams during a relapse of the illness. Panic attacks can occur during REM sleep in patients who have panic disorders and depression, and in patients who have asthma and breathing disorders of sleep. The REM sleep rebound related to withdrawal from alcohol and sedative-hypnotics, which chronically suppress REM sleep, may present as disturbing nightmares.

REM-Sleep­Associated
Disorders

 


REM Sleep Parasomnias and Arousal Disorders


 


Arousal disorders
(usually associated with deep sleep)
Confusional arousalsSleepwalking

Sleep terrors


Parasomnias (usually
associated with

REM
sleep)

Nightmares

Sleep paralysis

Impaired sleep-related penile erections

Sleep-related painful erections

REM-sleep­related sinus arrest

REM sleep behavior disorder

 

 


 

REM = rapid eye
movement.

Information from The international classification of sleep disorders,
revised: diagnostic and coding manual. Rochester, Minn.: American Sleep
Disorders Association, 1997.

 

 

A strong association exists between REM sleep and dreaming. Most frightening dreams occur during REM sleep, and most REM-altering disorders and medications affect dreaming. A variety of REM-associated parasomnias can alter dreaming. Symptoms of underlying illness can also occur during REM sleep. It often happens that persons awakening from REM sleep, a state that is  electrophysiologically near waking, recall the mentation and physical symptoms associated with the state of REM sleep.

REM Behavior Disorder

REM behavior disorder most commonly affects middle-aged men. Patients with this disorder often present with a history of sleep-associated injuries to themselves or a sleeping partner. REM behavior disorder is characterized by vivid, action-filled, violent dreams that the dreamer acts out, sometimes resulting in injury to the dreamer or the sleeping partner. On polysomnography, these patients show elevated submental and limb electromyographic tone, which may be phasic or tonic and that is associated with prominent jerking of the limb or truncal areas.

REM behavior disorder often occurs without concomittant pathophysiology, but can be associated with neurodegenerative neurologic disorders. The most common of these disorders are Parkinson’s disease, primary dementia and narcolepsy. Computed tomography or magnetic resonance imaging brain scans of affected patients may show diffuse hemispheric lesions, bilateral thalamic abnormalities or brain stem lesions.

Night Terrors

Night terrors are nocturnal episodes of extreme terror and panic that usually occur early in the sleep period. They are similar to other arousal disorders that occur during deep sleep, such as somnambulism (sleepwalking) and confusional arousals. Night terrors are associated with autonomic discharge, confusion and vocalizations, often a “blood-curdling” scream. Persons with night terrors are often difficult to arouse and have limited recall of their dream content. Night terrors can occur in association with the other arousal disorders that are associated with deep sleep. Night terrors are most common in children between four and 12 years of age and affect 1 to 4 percent of the population. Polysomnographic studies in these patients generally show increased arousals from deep sleep.

Adults who have night terrors are more likely than children to have psychopathology, mainly substance abuse and affective disorders. As with other parasomnias that affect adults, night terrors are more likely to occur in association with other sleep pathology, such as periodic limb movements and obstructive sleep apnea.

Diagnostic Testing

 


Medical Symptoms Associated with REM Sleep


 


Angina (e.g., coronary artery disease)

REM-sleep­associated apnea (e.g., chronic obstructive pulmonary disease)

Abdominal pain (e.g., peptic ulcer disease, gastrointestinal reflux)

Headache (e.g., migraine, cluster headache, chronic paroxysmal
hemicrania)


 

REM = rapid eye
movement.

Information from The international classification of sleep disorders,
revised: diagnostic and coding manual. Rochester, Minn.: American Sleep
Disorders Association, 1997.

 

 

Often, nightmares and night terrors can be diagnosed on the basis of the patient’s history. In persons who have a history of nocturnal injuries, polysomnography is required to diagnose REM behavior disorder or nocturnal seizures. To diagnose REM behavior disorder, the use of additional electromyographic arm leads is required. In up to 25 percent of patients with epilepsy, the condition may present only as nocturnal seizures. A diagnosis of nocturnal seizure may be suggested by family history, stereotypic nocturnal behaviors and incontinence. Nocturnal seizures can be grand mal, petit mal, partial-complex, vegetative or paroxysmal nocturnal dystonias.

All parasomnias more commonly affect persons who have breathing disorders during sleep. Polysomnography is appropriate for any patient with symptoms or signs of obstructive sleep apnea, such as daytime hypersomnolence, nocturnal hypoxia, loud snoring and increased neck circumference. REM behavior disorder often occurs concomitantly with degenerative neurologic illnesses that may require further evaluation. In adults, the onset of arousal disorders such as somnambulism and night terrors may reflect underlying neurologic disease. Thus, neurologic evaluation, including imaging of the central nervous system, may be indicated.

Treatment

Nightmares and Night Terrors in Children

Nightmares and night terrors in children are usually disturbing to parents and family members; therefore, proper diagnosis and education of family members are important components of management. It is essential to control the environment by removing dangerous objects and providing barriers to prevent escape from a safe sleeping environment. Reassurance and support are often the only therapy required because these disorders rarely, if ever, reflect underlying illness and usually disappear with maturity. Pharmacologic intervention is not usually indicated; in fact, it should be discouraged because it may contribute to further sleep disruption. Behavioral methods for treatment of frequent nightmares are effective in older children.

REM Behavior Disorder

Clonazepam (Klonopin), in a dosage of 0.5 to 1.0 mg at bedtime, is generally effective in the treatment of REM behavior disorder. Long-term efficacy and safety have been reported, along with relapse when the medication is discontinued. Response to other medications (primarily antidepressants) has been reported with postulated effects secondary to diminished REM sleep. Many parasomnias in adults, including night terrors, respond to this pharmacologic approach.

Post-Traumatic Stress Disorder

PTSD can be a short-term, limited problem or a lifelong, chronic illness that results in recurrent hospitalizations, impaired social relationships and aggressive or self-destructive behavior. Although many different approaches to treatment have had limited success, psychotherapy, individually or in a group setting, is generally indicated and can help with resocialization. Cognitive restructuring, eye movement desensitization and reprocessing therapy,  rolonged exposure (flooding) therapy and nightmare imagery techniques can decrease symptoms in patients with PTSD for months after therapy. Fluoxetine (Prozac) is an effective agent in the treatment of symptoms of PTSD. This condition is often associated with anxiety and mood disturbance, which may also require pharmacotherapy.

Recurrent Nightmares

Nightmares that occur after the patient has experienced trauma or stress may lead to an interpersonal integration of the event. On the other hand, long-term persistence (the habitual pattern of recurrent nightmares not associated with recent trauma) can cause a decline in daytime functioning without apparent benefit.

Behavioral approaches in the treatment of nightmares have been successful and can result in short- and long-term reduction of nightmare frequency in more than 70 percent of patients. Such therapy requires only a few group or individual sessions with a psychologist or in a sleep medicine center.

 


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