During the months of July and August, I always wish that I could just slope off to laze away the hazy days of summer but instead, with staff holidays upon us, I am thrust increasingly into the fray.  Still, this does not stop my mind from drifting off occasionally.

The other day, whilst gently mulling the domestic donkey’s (Equus asinus) clue to cultural changes...People domesticated donkeys in north-east Africa on two separate occasions, according to a genetic comparison of donkeys from fifty-two countries across the old world with wild asses.  The domestication of the donkey, like that of the horse (Equus caballus), marks a milestone in human history - a cultural shift away from sedentary, agrarian lifestyles toward more extensive movement and trade...the phone cruelly disrupted my pondering.  My mind still in disarray, I grabbed the handset. Where’s my Aromastone?

My reverie disturbed, I shuffled quickly my disparate thoughts - about the domestication of the donkey as a response by pastoral societies in north-east Africa to the desertification of the Sahara and a drug from the saliva of the Gila monster (Heloderma suspectum), a poisonous lizard that lives in the Arizona desert and eats just four times a year, which may assist Type 2 diabetes - to concentrate upon an electrified lump of glazed clay.

Amylin, Nubian or Asian? I mumbled. The earpiece spluttered with incomprehension.  No wonder, because what I had meant to say was: Aromastone, blue or oatmeal? Amylin, a tiny biotechnology company, is the inventor of the injectable drug exenatide, derived from the Gila’s saliva, which has been shown to lower blood sugar in clinical trials, and the domestic donkey is descended from Nubian and Somali wild asses rather than Asian wild populations. Am I completely losing it?!

However, all that aside, the slow delivery of Aromastones has caused much angst, for which I apologise most sincerely.  Never the best time of year to guarantee deliveries, the arrival of Aromastones has been promised for months but they have still not all arrived! Be it colour, voltage, wiring, or shipping, Murphy’s Law (the maxim that anything that can go wrong will go wrong) continues to prevail. Nonetheless I shall continue to hope, because.....After all, tomorrow is another day. 

A £25 Essentially Oils Gift Voucher to the first person who can tell me who expressed this sentiment first, and where.

Sorting me out!

Meanwhile very many thanks to all those who proffered advice about the treatment of my ganglion and eczematous rash.

The family Bible featured large in the minds of many to rid me of my lump. Used like a mallet, I was assured by several that one firm thump would do the trick. I, however, was not so sure having weighed our tome - a hefty 5 kilos - and had disturbing visions of ending up with my arm in a sling, not to mention my ganglion skidding off like a croquet ball: I returned the Bible to the shelf.

A far more appealing remedy came from Roberta Spencer, who owned Food for Thought in London’s Covent Garden and Manna Restaurant in Regents Park both of which were macro based so that sick people on special diets could go out to eat, but I was in two minds whether to apply it or devour it!     

Take one organic fist-sized potato, washed and grated, 1 tea cup of organic wholemeal flour, a tablespoon of grated fresh ginger, a tablespoon of sea salt, and mix together as a dough. If the potato juice is not enough, add a very small amount of cold water.  Form a flat pancake, and heat dry in frying pan.  Place between soft cotton cloth and apply to affected area. Reheat as and when required, and apply at least three times. Good for ganglia and cysts. Laid on the stomach, it can ease period pain.

This was a remedy used for exterior treatment by the late Dr. Yoshio Kawahara, with whom Roberta worked for two years.

Ian Barber kindly dropped in a tub of his cream concoction: This is not a cure, but it does clear the bulk of skin problems.  He’s not wrong, because the smallest dab erased almost immediately a slight rash that had appeared beneath my arm. A blend of Roman Chamomile, Lavender, Melissa, Neroli, Palmarosa and Ravensara in Aloe Cream, this sweetly-scented soother has been quite a hit.

However I could not dismiss lightly the somewhat sybaritic solution for stress suggested by Jasmine Mas......warm bath, essential oils of choice, candles, Chardonnay and a copy of F1 Racing magazine!  Am I that much of an open book?!

Long overdue.

I was delighted to receive recently Understanding Hydrolats: The Specific Hydrosols for Aromatherapy by Len and Shirley Price, because it goes a long way to filling a significant gap in my knowledge. Although there is no published scientific evidence to say that hydrolats are dangerous in any way, equally, there is none to say that they are not.

This comprehensive book gives a clear understanding of hydrolats and explains why they are therapeutic in many ways, although little has been written in the past to make clear their properties and clinical applications.  It details the nature, properties (where known) and nomenclature of hydrosols, and gathers in one source the sure and sensible facts about these distilled waters.  Already used by aromatherapists interested in extending their therapeutic range, this book will provide all professional health therapists with the confidence to practise safely with a sure understanding of their value.

It is not intended to be a definitive work on the subject, but it does attempt to gather together a wide range of both anecdotal and scientific information in order to provide an informative survey of the current state of our knowledge, and so make it easier for others to build on this knowledge, and to expand and improve on it.

Serious stress.

I am not an aromatherapist, but I always read the newsletter with interest.  I was especially interested to read of your stress remedies and your reference to the Xian faith. Chronic illnesses, redundancy, death, marital issues, etc. have been pounding at our door these last few years. In addition to eczema, I have huge problems sleeping.  Much of this is hormonal, but undoubtedly exacerbated by stress. It’s been going on for some years and the only way I can cope is by having 5mg Temazepam occasionally during the week to give me three or four hours rest. Is there a combination of oils that you would recommend that I could burn which might help ease things a little more?

Although I do not feel myself competent to answer such a painful question, I did rush off one or two suggestions from Gabriel Mojay’s Aromatherapy for healing the spirit, in which he explores the profound psychological benefits of essential oils. Building the link between fragrance and mood, this stimulating book explains how to use aromatherapy to alleviate tension, anxiety and depression. However, like all psychological problems, states of nervous tension are best approached with an eye to the individual concerned, taking into account the unique cause and characteristics of their particular disharmony.  Nevertheless, although a blanket approach will fail probably to yield the same results, I should welcome very much any suggestions.

Doggy dreams.

My dog Mungu is a real layabout, grabbing any opportunity to snooze off, and occasionally can be quite snappy if his slumber is interrupted, which is most uncharacteristic.  I thought that I would investigate further.

Sound sleep is therapeutic for dogs. While eight hours a night is about right for most people, dogs need 12 hours of sleep each day.  Sleep consists of Rapid Eye Movement (REM) sleep, when dreams occur, and Non-REM (NREM) or deep sleep.  Deprived of sleep a dog becomes confused and forgets its training. Aha! It is often after I have been away for a few days, and he left with others, that he becomes a trifle grumpy. Apparently he never really relaxes until I return and, therefore, perhaps enjoys only fitful sleep whilst I am absent.

During dreamless (NREM) sleep, a dog’s body repairs and regenerates itself and the immune system strengthens and revitalizes. Puppies have more need of NREM sleep than adults because this is when they build their muscles and bones.  With advancing years the need for NREM sleep diminishes.     

During dream (REM) sleep a dog’s eyes move behind the lids, its feet twitch, the whiskers on its face quiver, and sometimes it makes yelping sounds. About 20% of a dog’s sleep is REM sleep, but I think that Mung enjoys somewhat more because every day our bed, which he chooses as his lounger whilst we are at work, is reduced to a dishevelled heap of scattered pillows, sheet and duvet. No one knows the exact purpose of sleep and dreams but both appear to be vital for dogs, and both activities should always be allowed to proceed without needless interruption.  In which case, now that I understand more clearly the needs of my canine chum, I shall delay my call for “Walkies” until he is fully awake!

Sparrow napping.

Every year many songbird species migrate for thousands of miles between their summer and winter habitats, apparently flying all night but remaining active during the day.  How - and indeed whether - the birds manage to sleep during these lengthy journeys is one of the mysteries of ornithology.  Do they somehow sleep (or achieve a sleeplike state) while flying long distances? Or have they evolved to cope with severe seasonal sleep deprivation?

Recent research by Ruth Benca and colleagues at the University of Wisconsin, who monitored the behaviour and brain patterns of captive white-crowned sparrows, which normally migrate 4,000km between Alaska and southern California, suggests that migratory birds have a seasonal sleep cycle that enables them to survive on brief but intense periods of sleep while resting during migrations.

In the laboratory, during the migratory seasons, the caged sparrows became restless, hopping around and flapping their wings a lot. They slept only one-third as much as during the rest of the year, very rapidly entering the REM state.  Understanding this mechanism may eventually help to treat human sleep disorders. 

Investigating insomnia.

I am always a little surprised how many ask me how to cope with insomnia, because I have never suffered myself, and am rather horrified by the number who resort to tranquillizers and the like. Sleeping pills and tranquillizers induce sleep that falls short of the body’s needs.  The way the body reacts to the stress of the chemistry of a pill prevents our reaching that deepest level of sleep. We remain unconscious but not rested, and it is the need for rest that drives us to the pill in the first place.

Insomnia and its management have been the subject of many reviews and discussions [e.g., Ashton, C.H. Management of insomnia. Prescribers’ J. 1997; 37: 1-10]. Insomnia is the inability to achieve or maintain sleep and is the most common of sleep disorders. It often leaves sufferers feeling unrefreshed by sleep and may lead to impaired daytime performance. It is a symptom of various conditions and may be transient (lasting 2 to 3 days), short-term (lasting up to 3 weeks), or long-term (lasting longer than 3 weeks).  Transient insomnia may occur in those who normally sleep well and may be due to an alteration in the conditions that surround sleep, for example noise, or to an unusual pattern of rest as in shift work or travelling between time zones. It may also be associated with acute disorders. Short-term insomnia is often related to an emotional problem or more serious medical illness such as acute pain and may recur.  Chronic insomnia may be attributed to an underlying psychiatric disorder, especially depression, to alcohol or drug abuse, to excessive caffeine intake, or to cat napping, or physical causes such as pain, pruritis, or dyspnoea.

Management of insomnia requires resolution of any stressful precipitant or identification and treatment of any underlying causes with an emphasis on non-pharmacological measures.  Such measures may involve counselling, behavioural therapy, development of relaxation techniques, and avoidance of stimulant substances.

Hypnotic drugs should ideally be reserved for short courses in the acutely distressed patient; they should be avoided in the elderly, and their use is rarely justified in children. Generally hypnotics should be given at the lowest effective dose for as short a period as possible.  In transient insomnia one or two doses of a short-acting hypnotic may be indicated whereas in short-term insomnia intermittent doses of a short-acting hypnotic given for no more than 3 weeks may be appropriate. Routine use of hypnotics is undesirable. Tolerance can develop rapidly with continuous use and withdrawal following long-term use can lead to rebound insomnia and a withdrawal syndrome.

Benzodiazepines are generally regarded as the hypnotics of choice. They all hasten sleep onset, decrease nocturnal awakenings, increase total sleeping time, and often impart a sense of deep and refreshing sleep. Anxiolytic and muscle relaxant actions add to the hypnotic effect.  Slow-wave sleep and REM sleep are, however, reduced and the extra sleeping time is largely made up of relatively light sleep.

Tolerance to the hypnotic effect develops rapidly, sleep latency and pattern returning to pretreatment levels within a few weeks of starting treatment.  Long-acting benzodiazepines accumulate in the body to a greater extent than ones with a shorter half-life. Although this might be expected to increase the frequency of daytime sedation and impairment of performance (so-called hangover effects) after a hypnotic dose, such a straightforward  relationship has not always been observed in practice [Greenblatt, D.J. et al. Neurochemical and pharmacokinetic correlates of the clinical action of benzodiazepine hypnotic drugs. Am. J. Med. 1990; 88 (suppl. 3 A): 18S-24S].

Rebound insomnia, that is worsening of sleep disturbance beyond pretreatment levels on drug discontinuation, is more likely with short- and intermediate-acting benzodiazepines than with longer-acting ones.  It is not always easy to distinguish between rebound and withdrawal symptoms. Broken sleep with vivid dreams and increased REM sleep may persist for some weeks after benzodiazepine withdrawal.  Rebound and withdrawal symptoms develop particularly rapidly with the very short-acting drug triazolam ; patients have reported early-morning waking and daytime anxiety while receiving treatment. Anterograde amnesia (loss of memory for recent events) is also more common with short-acting drugs such as triazolam; ‘traveller’s amnesia’ has been used to describe amnesia in persons taking benzodiazepines for sleep disturbances resulting from jet lag [Meyboom, R.H.B. Benzodiazepines and pilot error. Br. Med. J. 1991; 302: 1274-5].

Forty odd years ago there was great excitement when scientists thought they had found a substance which did not have the problems of existing sedatives. This was to become the group of drugs known as the benzodiazepines. They were said to be virtually free from side-effects and to be non-addictive. We now know this not to be so - they are highly addictive drugs and the side-effects are numerous.  In fact, some would say that these drugs are responsible for one of the worst medical blunders of the century.  Millions of people worldwide taking no more than normal therapeutic doses are suffering physically and emotionally from the effects of treatment and withdrawal.

In 1988, because of the recognition of the hazard of dependence with benzodiazepines, the UK Committee on the Safety of Medicines (CSM) recommended that they be used to treat insomnia only when it is severe, disabling, or subjecting the individual to extreme distress [Committee on Safety of Medicines. Benzodiazepines, dependence and withdrawal symptoms. Current Problems 21 1988]. They should be given in the lowest dose which controls symptoms (if possible, intermittently), should not be continued beyond 4 weeks, and should be withdrawn by gradual tapering of the dose to zero.

Subsequently the EU Committee on Proprietary Medicinal Products (EU CPMP) has recommended that the treatment period should be limited to 2 weeks when brotizolam, midazolam, or triazolam are used [Anonymous. Short-acting hypnotics: a comparative assessment. WHO Drug Inf. 1993; 7: 125-6]. 

Nonetheless, in Britain alone, during the year 1992-3, 540 million days’ supply of benzodiazepines were dispensed [Richard Thompson. The Brain, a Neuroscience Primer. 1993. p. 121].

Alternative ways to treat insomnia?

In her well-adjusted account of kicking the benzodiazepine habit, Coming Off Tranquillizers & Sleeping Pills, Shirley Trickett answers the question Who takes tranquillizers?........

Everyone: you, me, the lawyer, the doctor, the taxi driver, the isolated young man, the frightened young policeman, the menopausal woman, the harassed executive.  The list is endless. In the light of more recent information [she was writing in March 1990], however, things will change. There will be fewer prescriptions issued, people will be a lot more wary about what they are taking, and will be willing to learn other ways of coping with stress.

Judging from my mailbag, I am not convinced that things have changed that much but I would not deny that there are many willing to learn other ways.

A National Institutes of Health (NIH) conference concluded that behavioral interventions such as relaxation training and biofeedback may produce improvement in some aspects of sleep [National Institutes of Health. Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. JAMA 276: 313, 1996].  However, some questions regarding whether the magnitude of improvement in sleep onset and total sleep time were clinically significant were raised.  The Complementary & Alternative Medicine (CAM) literature is replete with reports on the treatment of insomnia, but extremely limited with conclusive evidence of therapeutic effectiveness.

Practitioners of Traditional Chinese Medicine (TCM) have used acupuncture for thousands of years to treat insomnia.  Yi [Yi, R. Eighty-six cases of insomnia treated by double point needling. J. Tradit. Chin. Med. 5: 22, 1985] reported on 86 cases of insomnia treated by double-point needle insertion. He reported “fairly satisfactory results in the treatment of insomnia” in all 86 patients.  However, clinical data were limited primarily to a discussion of the needle insertion technique. Also, any large trial that reports an improvement in 100% of the study subjects must be viewed with some level of scepticism.

Nan and Qingming [Nan, L., Qingming, Y. Insomnia treated by auricular pressing therapy. J. Tradit. Chin. Med. 10: 174, 1990] compared auricular pressing (AP) therapy to a Western medicine control group, with both groups consisting of 80 subjects. Western control subjects were administered 10mg diazepam orally before sleep for 30 days.  Of the AP group, 30 were cured, 35 improved, and 15 were considered ineffective.  Of the Western (diazepam) group, 11 improved, and 69 were designated “ineffective”.  The authors concluded the AP group was “better than the Western medicine group”. However, they did report that diazepam was more effective initially but lost effectiveness over time, whereas AP improved with time.

Cranial electrostimulation (CES) is a therapeutic technique that uses low-level electrical signals applied to the eyelids and mastoid process to induce calming and ultimately sleep.  In 1953, Gilyarovski et al. [Gilyarovski, V.A. et al. A’s Electroson. Medguaz 6: 10, 1953] coined the term “electrosleep” and applied the technique for the treatment of insomnia. The procedure was used almost exclusively in eastern Europe until the first International Symposium for Electrosleep was held in 1966. Despite numerous reports of clinical effectiveness, inadequacies in research design have resulted in scepticism in the West.

Nevertheless, four prominent U.S. studies did conclude that electrosleep improved sleep and anxiety [e.g. Feighner, J.P. et al. Electrosleep treatment: double-blind study. J. Nerv. Ment. Dis. 157: 121, 1973].

Low-energy emission therapy (LEET), developed as a treatment for chronic insomnia, consists of low-amplitude-modulated electromagnetic fields delivered by means of a mouthpiece in direct contact with the oral mucosa. LEET was reported as safe, well tolerated, and effective in improving sleep in patients with chronic insomnia [Pasche, B. et al. Effects of low energy emission therapy in chronic psychophysiological insomnia. Sleep 19: 327, 1996].  This large, well-designed study clearly demonstrated a reduction of insomnia.

Valerian (Valeriana officinalis L.) is an ancient herbal remedy used to treat anxiety and insomnia. Lindahl and Lindwall [Lindahl, O., Lindwall, L. Double blind study of a valerian preparation. Pharmacol. Biochem. Behav. 32: 1065, 1988] reported that valerian was safe and effective in treating insomnia in 21 of 27 study subjects.  The authors noted their results could not be extrapolated to long-term use but believed that long-term follow-up trials were justified.

Can aromatherapy help?

Conclusive research-based evidence to support the use of aromatherapy to treat insomnia is scant. However, the aromatherapy literature suggests that any of the following essential oils can be used singly or in combinations:

Lavender (Lavandula angustifolia Mill.), Mandarin (Citrus reticulata Blanco), Clary Sage (Salvia sclarea L.), Marjoram (Origanum majorana L.), Valerian (Valeriana officinalis L.), Hops (Humulus lupulus L.), Vetiver (Vetiveria zizanoides (L.) Stapf.), Roman Chamomile (Chamaemelum nobile (L.) All.), Sandalwood (Santalum album L.), Lemon (Citrus limon (L.) Burm. f.), Cypress (Cupressus sempervirens L.), and Basil (Ocimum basilicum ssp. linalol).

Use 10 drops in a warm bath before bed.  Gently diffuse the essential oils in the room, or place the essential oils on a tissue or cotton wool ball and place under the pillow.

Lavender, generally expected to be Lavandula angustifolia, is the usual essential oil of choice, but hospital pharmacists often supply the more camphoraceous Spike Lavender (Lavandula latifolia Medik) [Buckle, J. Which lavender oil? Nursing Times 88(22): 54-55, 1992] and Pierre Franchomme and Daniel Penoel [L’aromatherapie exactement. 1990] indicate the variety of Lavandin closest to true lavender - Lavandula x intermedia ‘Super’ Emeric ex. Loisel - which, interestingly, also contains more camphor.

Finally......

Anyone reluctant to turn to tranquillizers, antibiotics or other pills to help them alleviate seemingly minor problems as diverse as nervousness, insomnia, headaches, influenza and swollen joints, will find aromatherapy invaluable. It provides the means to treat such ailments before they turn into much more serious kinds of illness. [Daniele Ryman, 1984]

charles@essentiallyoils.com
 

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