Understanding sleep

Sleep is a multi-system brain/body cascade effect.  It may be best understood in deep sleep with Rapid Eye Movement associated with dreaming.  The wave patterns are smooth and rhythmic. Dreaming happens during this time.  A sufficient amount of coordination between sections of the brain/body are required to achieve deep sleep.  Two of the brain sections I know about related to sleep are the frontal lobe and the limbic system.  The lack of coordination between these two sections seems to be at the root of sleep problems with many of the patients I have had with anxiety problems.

One type of medicine prescribed to help sleep is Benzodiazapines.  The psychoactive component of these drugs is a frontal lobe suppressant.  When taken at an effective dose, this dampening of activity in the frontal lobe can help the observing part of the brain not react to stimuli generated from the limbic system.  Anxious people have an exaggerated sense of endangerment, which sends an exaggerate signal to the frontal lobe.  For optimum healthy sleep anxious people need to include the frontal lobe inhibitory effect on the limbic system.  90% of the function of the tissue in the pre-frontal cortex is designed to inhibit impulses coming from the brain stem.  Including the frontal lobe is easier said than done.  When sleep gets compromised frontal lobe activity is challenged to stay coordinated; therefore, inhibiting fear impulses is not as effective.  When fear impulses aren't modulated the frontal lobe can get more active.  The tireder the system gets the more this coordination can be impaired.

Benzodiazapine can allow at least some level of sleep and dreaming.  This can be a tremendous benefit to breaking long-standing sleep deficits.  The trouble with this is Benzodiazapines compromise the very part of the brain we need to influence to lower brain/body fear impulses that are interfering with sleep.

Quality of life and continued improvement in sleep hygiene are how to make decisions about using medicine for sleep.  Many of the patients I have worked with have two choices; 1) Do not take Benzodiazapines and have a continually decreasing ability to get refreshing sleep, or 2) Use Benzodiazapines and strengthen their frontal lobe abilities to modulate impulses in their waking life.  Either way enhancing the ability to see fear stimuli and soothe the multi-systems needs to be the target.  These medicines will soothe the frontal lobe and maybe enough to not need ever increasing doses.  I don't view Benzodiazapines as physically very addicting, however it is easy to become dependent on them in ways that aren't useful.  Close coordination with a competent medical person is mandatory.  Having someone like me who has a lay understanding of these processes can help make decisions more likely to be useful.