---
A Brief Note on Sleep
Dr.K.N.Pai  B.H.M.S

Sleep is the natural state of bodily rest observed in all animals including human beings. It is distinguished from quiet wakefulness by decreased ability to react to stimuli. Regular sleep is essential for survival. A person spends 6-8 hours per day in sleep and in one’s lifetime it amounts to be about one third of lifespan. In spite of it being for such a long duration, it is still a million dollar question as to why we sleep?  

Sleep is divided into two broad types- Rapid eye movement sleep (REM) and Non-rapid eye movement sleep (NREM) Each type has a distinct set of associated physiological, neurological and psychological feature. NREM sleep is again divided into three stages-N1,N2 & N3.Usually sleep proceeds in cycles of REM & NREM. There is greater amount of deep sleep (N3) early in the night, while the proportion of REM sleep increases later in the night and just before natural awakening. 

Sleep stages and other characteristics of sleep are assessed by measurements like elctroencephalography, elctrooculography and electromyography done in specialized sleep laboratory.

REM sleep accounts for 20-25% of total time in normal human adult. In REM sleep , the brain is quiet active, but its activity is not channelised in proper direction. Most memorable dreaming occurs in this stage.It occurs in episodes during sleep.

NREM sleep consists of three stages .Most sleep during each night is of the slow wave variety (NREM). This is the deep, restful sleep one experiences during first hour of sleep. The first stage, N1, refers to drowsy stage. The person loses some muscle tone and most conscious awareness of external environment. In N2 stage conscious awareness of environment disappears. This stage occupies 40-50% of total sleep in adults. In N3 stage parasomnias like nightmares,  bedwetting, sleepwalking and sleep-talking occurs.

Timing of sleep is controlled by circadian rhythm, sleep-awake homeostasis and partly willed behaviour. Circadian rhythm is influenced by melatonin concentration which is released from the pineal gland in the base of brain. Activity of pineal gland decreases with age , by deposition of brain sand .Hence sleep decreases in old age.

Quality of sleep depends on duration of sleep, sleep latency, number of arousals and depth & restfulness of sleep.

Physiological effects of lack of sleep includes aching in muscles, irritability, yawning, tantrums in children, ADHD etc. It may also lead to diabetes, brain dysfunction obesity, etc. It has effect on healing process and growth.

Lack of sleep will result in many disorders. Most common disorders is insomnia-primary or secondary. Primary insomnia is without any specific cause. There is difficulty in falling asleep or frequent wakes up. Secondary insomnia is due to medical or psychiatric causes. Medical causes include physical pain, asthma arthritis, hyperthyroidism hunger, excess use of caffeine, drugs such as aminophylline & steroids. Psychiatric causes are depression, anxiety, mania, etc.

In hypersomnia there is excessive sleep. Narcolepsy is a disabling sleep disorder characterized by excessive day sleeping.

Obstructive sleep apnoea is an important sleep disorder. There is cessation of respiration for 10 seconds which compel the patient to arousal. There is oxygen desaturation. It occurs mainly in obese persons with short neck. There will be associated thyroid dysfunction. These persons are prone to CVS dysfunction, diabetes, hypertension, arrhythmia and later stroke.

It is better to follow sleep hygiene for good sleep and thereby good health. One should be punctual to bed and must have regular waking time. Food also plays an important role. It is better not to take food 4-5 hours before going to sleep. Regular exercise results in good sleep pattern. Following some stress relieving procedures yield better sleep.  Good sleeping environment is as important as other factors.

Dr. K.N. Pai BHMS
Top | Back to Sample Articles

Concomitant Symptom - A Critical Study
Dr. N. Harihar Iyer.

‘Concomitant symptoms are the symptoms that always accompany the main symptom but have no pathological relation to the chief ailment’.  This is the customary view on concomitant symptom mainly sketched by Dr. H. A. Roberts.  But on closely scrutinizing the article by Dr. Boenninghausen ‘A contribution to the judgment concerning the characteristic value  of symptoms’ in his lesser writings, we can perceive wider dimensions and clarity on these auxiliiary symptoms. We all  know the parameters set by Boenninghausen for identifying characteristic symptoms in a case  as well as in a drug.  They being The individuality of the patient, Disease individualization, Seat of disease, Prima causa morbi, Concomitance, Modality and Time modality. Out of this prime importance was given to Quibus Auxiliis – refers to accompanying symptoms. He openly admits that the above parameters originally owned to the hexameter of theologic scholastic dates back in the twelfth century, which was used at that time to judge the peculiarity and grievousness of moral disease.

He was fully aware of the fact that accompanying symptoms has got only  a diagnostic value as they are the common symptoms of the disease.  But Boennighausen’s inquisitive mind intelligently converted it into symptoms of high significance - concomitant symptom - by setting three prescribed qualifications.  But unfortunately only one qualification has got prominence and is frequently used by the practitioners.  The group of concomitance has a significant role in the construction of totality. That is why H.A Roberts said ‘what concomitance to the totality is modality to a single symptom’ It simply means the differentiating factor of totality is concomitant symptom and that of a single symptom is modality.

Here it will be better to discuss the concept of totality of symptoms of Dr. Hahnemann and Dr. Boennighausen.    In aphorism 6 and 25 of Organon we can see that Hahnemann is talking about the number of symptoms or numerical totality and is aph 153, in the practical part Hahnemann deals with characteristic totality. In the foot note to aphorism 153 Hahnemann praise Boenninghausen for his meritorious work on setting criteria’s for characteristic symptoms and hence can be amply relied.

Boenninghausen reiterates that concomitant symptoms are just coexisting symptoms of a disease under consideration but distinguished by a rare peculiarity and can be elevated to the rank of a characteristic symptom.  The three standards are

1. Rarely appear in connection with the leading disease, and are, therefore, also found rarely among the provings.

If in a case of fever the patient prefers to drink only in the stage of chilliness, it in a rare peculiarity and Apis comes in the scene.  The other being symmetrical distribution of eruption of Arnica, Prosopalgia associated with nasal discharge of same side of Spigelia, Diarrhea without prostration of Acid phos etc.

2. Those which belongs  to another sphere of the disease than the chief ailment.

This criteria was usually highlighted by many and elaborated with the prefix that there should be no pathological relation to the chief ailment.

The common examples are Headache > by profuse urination of Gelsemium, Coryza associated with polyurea of Cal carb, Pain with chilliness of puls, Prolapse and uterine affection which is > ted by crossing legs but with empty all gone sinking feeling in abdomen and less sexual desire of Sepia etc.

3. ‘Those which have  more  or less of a characteristic signs of one of the medicines, even in case they have not before been noticed in the present juxtaposition’.

In a case of erysipelas with vesicles, the patient complains of the characteristic  burning during micturition, tenesmus and with bloody urine points towards cantharis or is a case of uterine prolapse with a desire to give hard pressure on the parts and increased sexual desire will make one think of Lit. tig are the instances satisfying the above qualification though urinary symptoms and increased sexual desire are not the usual accompaniments of the former and latter diseases respectively.

Dr. Kent says symptoms which make you hesitate and force you to ask why are the characteristic symptoms.

So in short the symptoms which exists together with the main symptoms and shows some striking peculiarity have a prominent place and the totality of these (not a single symptom but a totality) unreasonable attendants chiefly though not exclusively helps in the selection of similar remedy. The remark is that concomitant symptoms gives more certainty and surety and build confidence to the physician in clinical practice.

On the basis of the qualifications made by Boenninghausen I made a simple attempt to study some remedies which acts specifically on heart.

We know that the, common symptoms of heart complaints are Cyanosis, Vertigo/syncope, Dyspnoea orthopnoea, Oedema, Palpitation Weakness, General < by  exertion etc.  In homoeopathic proving  also all most all drugs have some symptoms in common. They are sadness, anxiety about heart, dry cough especially at night, dreams of falling, hot upper part and cold lower part, < lying down especially on left side.         

In case of CACTUS the main causa morbi is either the suppression of rheumatism or natural progress of rheumatism to heart. So there will be a past history of rheumatic complaints. The drug will be characterized by  peculiar pain  as if heart is constricted with an iron hand. Concomitant symptom is vertigo on taking deep breath or holding breath. The characteristic modality is breathing possible only by lying down with shoulders elevated. Oedema is more on upper extremity of left side.  When heart disease progress kidney will be affected first.  Anal fistula and palpitation are associated.

In DIGITALIS, an awful deathly sinking feeling in the abdomen especially in the epigastric region is associated with the characteristic slow, weak, intermittent pulse.  On standing, liver will be affected with pale white stool, and jaundice. There is marked Cyanosis.

NAJA along with the characteristic nature of pain as if a hot iron  is pressed on heart, there is chocking in throat and larynx with hoarseness in heart affection.  One organ affected with heart is ovary as if  heart and ovary are drawn together.  Cardiac cough will be associated with sweat of palms. Cardiac asthma starts with Coryza and > ted by sneezing and lying on right side.                    

Hypertrophy of heart in young persons who exposed to strenuous manual labor before the age of puberty and in gymnastic persons is the key aetiology in CRETAEGUS.  They are more irritable and the accompanying symptom is flurred feeling with rapid irregular pulse due to rapid action of heart.

LAUROCERASUS is a known remedy for want of animal heat, but external heat in intolerable. The associated symptom with vertigo and dyspnoea, with an intense desire to sleep and sleep and lying down will relieve this complaints which is usually a contradictory modality. Associated with this there is retention of urine.   Along with the suffocative spells there is diarrhea of green mucus.

Dr. N. Harihar Iyer.
Tutor, Dept. of Organon,
Dr. Padiar Memorial Homoeopathic Medical College, Ernakulam.
Now doing P.G. in GHMC, Calicut.
Top | Back to Sample Articles