«Spasmophilia» is not a simple anxiety of psychological cause, it is a feeling of imminent danger with the meaning of an alarm sign in a context of tiredness and "hypo-sleep"
The concept of unefficient sleep ("hypo-sleep") allows to understand spasmophilia better and, thus, to control its mechanisms.
What is spasmophilia ?; Why ?;
But I do sleep a lot, though !; That’s true, I’m tired ;
So, it isn’t bad ?; But how stop the attack ?
«Sleep and general medicine» defends, here, the thesis of the «hypo-sleep syndrome» which places sleep at the center of the understanding of that disease which is considered like a simple anxiety of psychological cause by a great part of the medical profession.
We advise the readers to refer, too, to the links at the bottom of the page for an excellent presentation of the current medical definition: "Spasmophilia, Tetany and psychogenic hyperventilation" (in French).
The distance that is still to be covered so that spasmophilia can be considered like a sleep disorder, which we think it is, can be measured.
Do not hesitate to use the forum.
The concept of «spasmophilia» is not often taught in the faculties of medicine. The reality of the disease is sometimes even officially refuted.
It is mentioned like an «acute behavior desorder linked to a fear and maintained by a reflex of hyperventilation».
The attacks are perfectly well described (the diagnosis is quite easy) and their caretaking seems to be codified well.
Yet, the sick people do not seem very satisfied by that approach and, according to our experience, like Professor A. Pelissolo wrote so well : "risk to turn away from the health professionals who are likely to provide them an efficient help". (Cf. doc at the bottom of the page).
In our opinion, that failure is linked to the fact that sleep is not mentioned enough during the diagnosis investigation.
For the spectators of the attack and for many doctors (who often face it in the context of emergency visits), it is a form of "depression"...
For the general public, it is a pathology that is often mentioned by the medical profession which often carries out that diagnosis in situations of "felt emergency".
The search engines on the Internet sometimes put forwards a "disorder of the acid-base balance related to a respiratory alkalosis induced by an hyperventilation of psychological cause due to an irrational fear of dying".
Elsewhere, a ground of "neuromuscular hyperexcitability" or "neurovegetative dystonia", meaning a dysfunction of the automatic nervous system (which is more accurate) is mentioned.
Many commercial websites take a stand to praise the virtues of this or that food supplement, diet or other panacea.
A special grade for the "directors of conscience" who make of it a problem of "serenity"...with the purpose of selling something...
The expression «panic attack» matches an international psychiatric definition in the chapter of the anxiety disorders (of the DSM-IV - Diagnostic and statistical manual of mental disorders, 4th edition) which comprises phobias, GADs (generalized anxiety disorders) and OCDs (obsessive compulsive disorders). (Refer to the doc at the bottom of the page (French).
In fact, the attack of spasmophilia can be summarized in the sensation of an imminent danger, it is the onset of an "alarm system". The subject experiences a dysfunction of a presumed vital organ. It is the feeling that something bad is happening at the level of the heart (infarctus), the brain (paralysis), or breathing (choking), the belly (to be surgically operated), and so on...
That sort of crisis is the cause of the majority of the direct calls to the emergency services and causes a lot of hospitalizations in emergency room.
The visible normality of the numerous and repeated checkups contrasts with the apparent seriousness of the attack, to a point that these "true sick persons" end up wondering about the skills of the medical profession which, from its side, often sees them like false sick people. (See the article about the "True False-sick")
As we will see, that misunderstanding is shared by the people who suffer from fibromyalgia, from Chronic Fatigue or simply from chronic functional disorders like migraine or irritable bowel syndrome.
But in our opinion, tiredness and its causes are always neglected and another alarm, just as worrying, will not be long to return.
None of these approaches can be really satisfying for these true sick people which multiply the consultations (or change doctors all the time in their lives).
The recent knowledges in sleep pathology concerning fibromyalgia offer a more pragmatic alternative based on the rules of sleep hygiene.
Yet, generally, patients who are interviewed about their sleep often claim to sleep a lot because (as well here as in fibromyalgia and chronic fatigue) it is the quality of sleep that is concerned, not the amount.
Do people consider that a food deprived subject eats a lot because he is very hungry?
The quality of sleep cannot only be measured with the facility to fall asleep (sleepiness) or with duration...
Sleep is evaluated when one gets up and it seems obvious that the sleep of subjects with spasmophilia does not fill its role because it is when the person wakes up that the tiredness is most intense.
Nb. A good marker of the functional disorganization of sleep is the frequence of the need to urinate during the night. In our experience, that abnormal sign is present in nearly 100 of the cases.
Beyond the illness, sleep would seem correct if it wasn’t for the need to get up to drink or urinate several times during the night.
That increase of the nocturnal diuresis. is the consequence of the collapse of an "antidiuretic" system which is normally very active during the phases of deep sleep.
It all looks like if nature had foreseen the need to respect the sleep of the good sleepers by adapting the diuresis to the size of the bladder.
In case of a bad sleep the kidneys produce more urine than the vesical content cas accept over the duration of sleep.
That "nocturnal pollakiuria" is also very visible in pathological snorers where it is an "appealing sign" well known by the somnologists.
IUntil very recently, a prostatic hypertrophy in men or an "unstable" or "too little" bladder in women were made responsible for that disorder...
One of the first official definitions of "spasmophilia" goes back to 1992, when the French public welfare system decided to consider that there was not enough reasons to keep monitoring magnesium, in order to lower the useless expenses, while France was the only country to do it, amongst others in the case of a "complete checkup for tiredness".
The first row of Opposable Medical References (RMO) asserted «spasmophilia» justified the measurement of magnesium
The text thus defined that illness, still not in the medical dictionaries, as a clinical chart combining three symptoms : "tiredness", "neurodystonia" and "anxiety".
In our analysis, the chart could be completed with a fourth sign : the volunteer personnality of the sick people (that tough character allows them to fight very long alone against their illness). A recurrent sign witnesses for it : the flat refusal of being stopped from work as soon as the attack is over.
(That often altruist and hyperactive personnality is sometimes called "Sister Theresa"...)
For us, the attack is the first sign of decompensation of sleep on a ground of functional insufficiency of sleep.
If the unefficiency of sleep is not pointed at, the sick person will return at the occasion of another attack which may take a very different clinical form
The patient who goes to emergency room in a situation of panic tries to express his/her feeling through quite characteristic words :
- "I know that I have spasmophilia (because I lack magnesium, or I don’t "fix" it) ", - " But this time, it is different, it isn’t that, it’s something else, it’s serious, it’s urgent...!"
For an emergency practician «spasmophilia (or tetany)» is not a true emergency and it is relatively easy to review it on the phone : no vital danger, level of gravity zero
Three consequences of the absence of caretaking can be faced yet :
The attack of spasmophilia represents, in our opinion, an appealing point for the hyposleep syndrome.
The sick person is at risk to see the steps of the "train of the hyposleep syndrome" follow each other.
Unfortunately there are only very few epidemiological studies about spasmophilia because (like in other equivalent syndromes) the reality of that illness is still called into question by those who consider it a psychiatric illness.
According to the current classifications (the famous "DSM4", american classification of mental diseases), spasmophilia is a form of pathological anxiety.
We think that it would rather be pathological not to panic when danger seems imminent (The alarm systems are there for that purpose).
When the alarms indicate a "danger", the solution is not to get away from it (in running to emergency room for example) because it is the alarm system in itself that is the problem.
In practice, the attack stops as soon as a sedative is powerful enough to "cut the sound off" (the best use, in emergency, of BZs.)
The remarkable efficiency of benzodiazepines in that situation (in a sole and sufficient dosis) confirms the "neurodystonia" characteristic of the faintness.
In our opinion, every attack stands for a sign of decompensated "hyposleep", and if the cause (the efficiency of sleep) is not taken care of, the attack can return "without warning" with every occasion.
The preventive treatment of spasmophilia essentially relies on sleep hygiene and the understanding of the notions of chronobiology.
Smg° offers you here an interactive questionnaire of sleep disorder screening : "clic on the items for which you feel concerned" ... ... "your answers match with the following problem(s) ... you should discuss these questions with your doctor".
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