The 28th session of eighth round of the physician legion was held in Taleghani Park on March 11, 2016 at 8 a.m. under the mastery of Mr. dezhakam, and with the secretary of Ms. Azam, and Mr. Jahanfar as the guest speaker. The agenda was: The Importance of night sleep and waking early.
I am Jahanfar Vahidy, graduated as a general practitioner in 1992 and got PhD in psychiatry in 1999. I graduated in 2012 and since then I have been practicing medicine in Razi Hospital. In 2012 I passed the fellowship training in Psychosomatic Medicine (PM) in Shahid Beheshti University. I am also one of the shareholders of Iranian Hospital and I am practicing medicine there. I founded a recovery addiction center in Shahriar in 2012. In many books, sleep has been vastly examined from psychological and neurophysiological perspectives. It is of such significant importance that a great part of instructions in congress 60 has been dedicated to it. I listened to the CD and learned good points that had been said in a simple and comprehensive way. As we have physicians and psychiatrists here, I try to get into the topic from a deeper view.
Sleeping is an unknown subject. As you know human brain is an electric and chemical device; i.e. neurons create electric current using anions and cations and consequently body system is regulated by the electric current. There is a center in hypothalamus, in brain base, called sleep center. It is located in suprachiasmatic, in hypophysis. There are 5000 neurocells forming sleep center. There is also another center called reticular which causes one to wake up. This center gives out waves and creates electric current in brain. The interaction between these two centers makes sleep-wake cycle.
Human body has a 24-hour rhythm of sleep and this cycle is repeated all the time. Environmental stimuli such as light make the sleep-wake cycle normal. Light itself makes an opium-like substance in brain called melatonin. It is made by a pineal gland in brain and is so much essential for individuals to fall into sleep. Sleep function has not been clear yet. Some say it is good for memory. Some others say it can alleviate fatigue and in fact people can be charged with sleeping.
Sleep disorders include several types: insomnia, narcolepsy, and so on. They are also called parasomnia. The commonest is insomnia and as it is said in congress 60 a large number of addicts and those who quit addiction via Free-Fall (suddenly quitting drugs) suffer from it. One of its reasons is extra stimulation of central nervous system. It means when a person is mentally sad, stressed out and anxious and having a bad day, all these negative thoughts and feelings are evoked at night and make him/her to concentrate on the issues, and consequently s/he becomes sleepless. Thus vicissitudes of life during the day influence one’s sleeping and move his/her bed-time and awakening forward. This is technically called phase advance. (For example, sleep would extend from 11 pm to 2 or 3 a.m). An important point said in the CD is that sleep can return to its natural state if its duration is limited. It is necessary for the person to wake up early and by staying awake during the day, s/he can control and regulate his/her sleeping.
One of the great progress that has been made regarding sleeping is a device called polysomnography. It records the brain waves during the sleep time. It is said in the CD by the master that the brain waves need to slow down little by little when we want to sleep. In fact when going to bed, as the first stage of our sleep starts, the brain waves slow down. This continues until the brainwaves, called delta or theta, reach to 3 or 4 cycles per second. Afterwards we enter another phase of sleeping that is called “Rem Sleep” (Rapid Eye Movement). The electric waves of our brain fluctuate and are followed by our rapid eye movements. At this point if someone opens our eyes he can see them move rapidly.
Most of our dreams and sleep happen in the REM sleep and it is repeated every 90 to 120 minutes. It means that we experience the REM sleep 7-8 times in 24 hours, 20%-30% of our sleep happens in the third and fourth and 40%-%50 in the first and second stage. We achieve deeper and more restful sleep in the third and fourth stage. This makes us become refreshed and energetic in the morning. And as it is said in the CD we must do something for our brainwaves to appear more slowly.
If we have problems in each stage of sleeping, we will experience sleeping disorders including the obstructive and central sleep apnea. Statistics show that 8%-10% of adults older than 40 years old suffer from obstructive sleep apnea and this figure is high. Their breathing repeatedly stops for 2 seconds and starts again during sleeping. Consequently the brain is deprived of adequate oxygen supply and the result is hypoxia. Therefore the body shows reactions including faster heart rate and increasing of the amount of nurepinefrin. This makes them suddenly wake up. The issue causes frequent sleeping and waking during night and brings them a feeling of fatigue in the morning. Experiencing this state repeatedly can lead to substance abuse to be more energetic and refreshed.
This sleeping disorder is much observed in drug abusers. Drug abusing has physiological effects on sleep center and causes narcolepsy. It also makes central apnea, which means stopping in breathing. Another reason for sleeping disorders is mental health problems. As it is said in the CD, addicts are in a stage of darkness. They have anxiety, tension and stress which cause anxiety disorders and panic attacks. All these lead to sleep deprivation at night. It takes a long time for them to fall asleep and since their REM sleep is longer, they experience more nightmares.
Some physical illnesses such as arthritis, cancer and rheumatism can result in sleeping disorders. Restless leg syndrome and frequent muscle spasms are two other types of sleep disorders from which People with diabetes and anemia usually suffer more than others.
The last point that is referred to in the CD is that the direction we sleep is important. It is recommended that people sleep in the East-West position to have a better sleep.
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Dr. Masoud
Good morning everybody. I hope you have a nice new year Ensha’allah. Although I myself didn’t experience the substance dependence phase, I was always afraid to lose my face when abusing drugs. I developed the unwelcome feelings like anxiety, fear and inferiority. I took medicines for a period of time and then found that the amount of the medicines was increasing. I had problems whether I used them or not. Therefore I can understand those who have the drug-dependence feeling. I suffered from insomnia for a long time and in this case my life was badly disrupted.
Many people attending congress 60 have these problems, too. There are as many as 200 archers in Takhti stadium and many travelers and companions play darts here. These sports extraordinarily help people to re-concentrate. We should remember that congress 60 gives us peace. What goes through the individuals’ mind is that: “I was abusing drugs or sleeping once upon a time, but now I am doing exercise, no matter if I win or lose. I have a restful sleep, wake up completely refreshed and full of energy, and I owe all these to congress 60’s thoughts and method. Mr. Dezhakam definitely asks the travelers who come to him on their liberation day: “Do you have a good night sleep?” This suggests that one third of our lifetime which is spent on sleeping is of significant importance.
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Dr. Azam
I have a question. Sleeping time differs in different age groups. Is daily afternoon sleep harmful, as it is said in the CD? Does sleeping have a certain schedule? There are so many contradictory statements about it.
Dr. Samad
The agenda is so important that a traveler should travel (start his/her treatment from the beginning) again from the beginning if s/he has sleep disorders. Because night sleep helps human body to be restored and repaired. It is necessary for individuals to sleep before midnight. There are certain hours at which the body tries to detoxify the organs like the liver, the kidney and the digestive system. Disrupted sleep can cause hormonal imbalance during the day. Hormones’ secreting from glands is done in the early morning therefore those who wake up late have the hormonal imbalance. Melatonin production happens in darkness and is essential for a good night sleep. It means that light is an obstacle for melatonin production. Thus a good and restful sleep helps one’s body to be repaired gradually. This is associated with the proverb saying “the early bird catches the worm”.
Dr. Fereshta
As it is said in the CD, it is a fact that we need to balance our sleeping from morning. We should organize our programs so that we can be more active in the morning. The individual who wants to control his/ her sleep-wake time should be said to wake up at a certain hour in the morning. In fact we adjust his/her physiological clock. Night sleep is in fact a period in which the body is repaired. The person who is supposed to take an entrance university exam must have good sleep several nights before the exam so that his/her memory is regulated well. One, who doesn’t sleep well at night, doesn’t feel well in the morning. Nighttime is for sleeping and daytime for doing daily affairs.
Dr. Reza
Sleeping is an important part of man’s life and is influenced by his/her lifestyle. It has many unknown complications. We have considered sleeping as a cause, just like addiction, while sleep disorder is an effect. Thus the causes behind it should be known. Modern medicine tends to prescribe drugs for sleep disorders. Benzodiazepines and some other drugs disrupt the sleep-wake cycle and it is too difficult for an individual to return to the natural cycle again.
It is necessary for us to revise our procedures related to sleep disorders in our clinics and dedicate more time to the subject. Mr. Dezhakam mentioned that a normal person must sleep like a stone (the dead). Most of our anxiety and sleep disorders are due to our routine life and daily agitation. We cannot return to the previous balance unless we have a complete night sleep. I have a question, too. Is REM sleep deeper than the first, second, third and fourth stage of sleep or lighter?
Dr. Mohammad Hossein
The question Mr. Dezhakam asks on a traveler’s liberation day implies the significance of the night sleep in addiction treatment. There are several factors that lead to relapse into addiction including depression, having pain, restlessness, feeling faint and sleep disorders. Most of us posed the question but I want to ask the master of the ceremony and guest speaker to tell us what to do. We encounter the addicts who suffer from sleep disorders and we cannot serve them with the same services provided in congress 60 for 11 months.
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Dr. Mohammad
An addiction treatment program is now carried out in prisons of our country. Methadone is given to the prisoners at 8 to 10 a.m. We were informed that in some prisons methadone was given to them at 7-8 p.m. This led to their sleep deprivation and MMT was questioned in the field of addiction treatment. Insomnia is a reason by itself for relapsing into addiction. The problem is less encountered when the medicine is prescribed to be taken 3 times per day.
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Ms. Elham, a psychologist
Sleep disruption usually leave trails in all other disorders. Changes in lifestyles during the last two decades have affected sleep disorders. We observe the disorders in elementary students because of TV, satellite and social apps. Some of them stay awake till the midnight and their parents don’t take it seriously. Sleeping follows a habit pattern. As a behavioral habit takes 25 days to happen, controlling the sleep-wake cycle doesn’t occur in a short time.
Mr. Mohsen, a psychologist
I read an article in which taking a nap during the day was suggested. It means that taking a nap for 10-20 minutes can help an individual to promote his/her own output. Japanese researchers have proved the subject and so employees can take a short nap in nap rooms when they are on the job. Sleeping is a sign, it means that a chain of good things should be present untill sleeping occurs. What are the good things? Having good social relationships, intimacy and love, a good family, a good job, proper spiritual beliefs and finally self-relationship are 5 factors which help people to have a proper sleep. That’s the point happening during the treatment.
Dr. Jahanfar
To answer Dr. Azam’s question, I should say people’s sleep needs differ and they need to sleep between 6-9 hours a day. The best bedtime is from 11 p.m to 7 a.m. Taking a nap during the day is a controversial topic but it is recommended for some people.
Regarding the deep sleep, the third and fourth stage of sleep are the deepest stages in which brain waves reach to their highest frequencies. If someone is awakened in this stage, s/he feels dizzy and has no adaptation with the environment. This state is called night terror syndrome in which the person is frightened and has no remembrances. REM sleep’s physiological role has not been realized yet bur as I said dreams occur in this stage and is closely associated with the daily stresses.
REM sleep is disrupted in some brain diseases like Parkinson, Alzheimer and Strokes. As you know during REM sleep the body shuts down the muscles’ activity. This state is useful for the individual to dream. For example, although s/he is struggling or falling or… during sleeping, s/he shows no reactions because of her/his frozen body. Fluoxetine consumers lose the state of freezing during their sleep and sometimes they kick and punch the ones sleeping beside them.
Methadone causes hyperarousal or drug-induced pleasure. Every drug that creates pleasure, increases the brain arousal, and consequently alpha waves don’t turn into thetas because the brain has been stimulated. High doses of methadone, like meth, can stimulate the brain. Thus the drug dose adjustment is of significant importance. Anyway, one can learn how much methadone to be taken in order for him/her to fall into sleep. We should be more flexible in methadone treatment. We need to speak with the patient and ask him/her to adjust the methadone dose so that s/he doesn’t have any sleep disorders.
The policy is based on the fact that no benzodiazepine should be prescribed for addicts. Since they have been addicted to drugs before, have more chance to increase these drug doses and be dependent on another drug again. The best thing for sleep disorder treatment is to get a proper diagnosis, that is speaking with the patient first, taking her/his psychological background, medical history, employment and addiction status. Afterwards we must diagnose. One of the diagnosis methods is polysomnography. Otherwise, clinical diagnosis also helps a lot.
Afterwards the first step for sleep disorder treatment is “the sleep health” which includes 7 tips.
1- Go to sleep at a certain time
2- Avoid stimuli and events that cause fear like horror movies
3- Lighten up on evening meals
4- Keep the lights down
5- Practice some meditation and relaxation exercises
6- Listen to calming music
7- Improve your sleeping environment
Mr. Dezhakam
One said to a man,” Being in love is so much painful.” The man replied,” You’ve never gone hungry to forget to be in love.” That’s the same for insomnia. One of the commonest tortures around the world is to deprive someone of sleep. S/he may endure till 48 hours but it is the worst form of torture to be tolerated. Once I worked in a factory and stayed awake for two nights. I drove from Qazvin to Tehran and it took 11 hours for me to reach to Tehran. I felt sleepy once every few kilometers and I had to park my car and napped for a few minutes and again continued driving.
We can make people anesthetized but not force them to sleep. We can wake them up whether they are heavy sleepers or not. Therefore, in congress 60 we don’t focus on the bedtime but we put emphasis on the wake-up time. The morning dosage of OT should be taken at 5, 6 or 7 a.m. This has a great impact on the wake-up time. S/he may say, “I am not awake at that time”, but we tell him/her to set the alarm and take the OT at the right time and then sleep again. Little by little the OT-induced pleasure wakes them up and they can stay awake after using the OT.
As Dr. Jahanfar mentioned there are several important factors for sleeping. The first is a proper time since human body is used to sleep at a certain time. I myself must go to sleep at 9:30-10 p.m and wake up at 4:30-5 a.m. If this time changes into 10:30, I cannot sleep anymore. I must roll in my bed for 3-4 hours to sleep again. Thus I concluded that a system is activated in my body and releases serotonin, adrenaline, melatonin, acetylcholine and so on at this time. Addicts have sleep disorders because their bed times are not fixed and vary from night to night. Unfortunately nowadays some people come back from work at 11 p.m. In the past people went to bed at the sunset and they woke up before the sunrise.
Good sleeping needs a system (as we call it X system) to work properly. It also needs proper thoughts and proper place. If we make a person to stay awake for a few hours, s/he decidedly falls into sleep after a period of time. Sleep rushes after a certain time. Body is a smart system which tries to repair its organs. Liver, kidneys digestive system, …. all need to be rehabilitated and this process needs time. Body itself tries hard to make the person sleep.
In order to regulate night sleep we have developed two morning sessions. One in Laleh Park at 6:30 a.m and another in Shiroodi pool at 6 a.m. About 170 people attend Shiroodi Pool at 6 a.m on Wednesdays. We learned in congress 60 that we cannot force people to sleep but we can wake them up. We concluded that if a person doesn’t have sleep disorders, s/he has no other problems. If people have proper sleep, the will never get cancer. Healthy physiology is characterized by proper and good sleep. Those who don’t get good and enough sleep have puffy eyes, pale skin and feel faint.
This is the last session in the solar year 1394. The first session after Nowrouz holidays will be held on 8 April, 2016 and the agenda will be “the seventh valley”.
Mr. W. White is one of the influential figures in addiction treatment in the United States of America. He has been working in this field for 50 years and he was the first director of NIDA 20 years ago. I sent him the Arbor Week report of physician legion and he said, “I have never seen such cooperation between physicians and NGOs except in congress 60.” We are proud of this interaction and exchanging our experiences and knowledge. May God ever-increasingly bless you! I congratulate you on Nowruz in advance.
Legion members congratulated each other on Nowruz in advance and ended the last session of the solar year 1394 by taking memorable photos.
prepared by: Amin Hamladari
translated by: Marjan Moradi
March 4, 2016