Case of Ram : Cravings and withdrawals By Dr. Pradnya Ajinkya

Key symptoms : 19 year old male suffering from chronic fatigue, lethargy on not being able to wake up in the morning without close member help. 

Ram: "It started out as having trouble waking up in the morning and feeling tired and sick on waking up for a couple of minutes. I am still feeling sick in the morning on waking up. The tired feeling progressing to extreme fatigue for over an hour on waking up.  I have been a very happy and well looked after child. My mother would wake me up as early as six in the morning for as many as 13 years. All this helped me in the past. However, back in a hostel, I have trouble waking up. It feels like a switch has been turned off and my brain forgot how to wake up early without help. I've always been a heavy sleeper. I would sleep 8 hours at night and could take 3 hours nap. I am concerned that it has been over 2 years and I don't want to cause any damage to my brain, body and future. How can I truly believe that my brain is resistant to waking up without help. Once I am awake I don't yawn or sleep during the day. After an hour on waking, head is not heavy and I do not feel drowsy at any point of time, no chest compression, dry mouth, heart racing. I am not looking for a trial prescription. I want to improve and sincerely hope this doesn't continue. I want to jump out of the bed on my own and want to see this blown out feeling mitigated. But needless to say, I'm very nervous as you know my feelings about the craving for sleep. Otherwise I do not have any kind of stress in my life and I am studying and living in a peaceful area. I eat well, exercise, swim and have a wonderful relationship with my family and friends which I am grateful for."

Primary symptoms:

Lack of confidence

Fear of accomplishment

Fear of goal setting

Mood declined into anxious feelings over excess sleeping

Sinking feeling in the brain on waking up

Therapeutic assessment

1] The average week sleep in hours

2] Figure dropped per week

3] Work for an average of how many sleep hours per week

4] Case: Ram spends half his free time sleeping like:

1] The average time Ram spends in sleeping is how many hours?

2] In a 19 years life span Ram spent how many hours in sleep ?

3] The excess sleep time was enough time to obtain how many achievements by Ram?

4] Ram spend how much time sleeping than spending time with friends, watching television or playing games or reading? 

5] Excess sleeping is more likely to leave Ram passive, tense, and unable to concenterate?

6] Explain craving for sleep can leave Ram in a worse mood.

7] Explain creative thinking, socializing, and individual or group reflection have been replaced by sleep craving. 

8] Explain sleep craving can have a hypnotic and possible addictive effect on the brain.

9] Explain excessive cravings do not necessarily involve physical substances only. 

10] Explain the criteria of sleep dependence.

11] Explain giving up important social, family, or occupational activities for sleep; and reporting withdrawal symptoms when one stops getting it.

12] Explain effects of compulsive sleeping  can be devastating to home life, social relations, and even day-to-day work. 

13] Case study : One 32-year-old IT professional  has a wife, two children, and parents. He rarely goes out any more. He sleeps, sleeps and sleeps.... 

a]  Observations of uncontrolled sleep.

b]  Unsatisfying thirst for more stimulation of sleep.

c] Culture created by sleep provides a fantasy world that makes ordinary life boring. 

d] Relaxation ends when sleep is turned off.

e]  Relaxation occurs as soon as sleep is turned on.

f] Brain changes reinforce this association. 

g] Stress and lowered mood state occur once the sleep is broken, reinforcing the urge to go back to sleep. 

h]  Longer sleep hours, the less satisfaction derived from it.

i] The absence of excess sleep can cause depression, a sense of loss, anxiety, and cravings for more of sleep stimulating effects.

j] Effect of active and passive experience on the brain.

k] Type of learning that takes place while the brain is in a passive state? 

14] Explain many people think that once they are adults and their brains are fully developed their choices don’t affect brain health. 

15] Explain the brain can be shaped by experiences, just as particular muscles respond to particular exercises.

16] Explain it’s true that gross anatomy doesn’t change, but through everyday life, certain neuronal groups are selected to thrive while others die owing to lack of use. If a person is inactive mentally, that individual loses brain cells.

17] Explain sleep craving cannot compete with books, interaction, and real-life experience when it comes to learning. 

18]  Explain through excessive sleep, children may actually fail to develop needed circuitry to master critical-thinking skills.

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