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Symptoms

Symptoms of Guillain-Barré syndrome usually develop within about 3 to 4 weeks after a viral infection but can develop within a few hours. Symptoms include recurring tingling and numbness and then weakness and paralysis that usually begin in the feet and spread to the legs and later to the trunk and arms. Guillain-Barré syndrome may progress to complete muscle paralysis, affecting the muscles that assist in breathing and swallowing.

Diagnosis

Guillain-Barré syndrome can be difficult to diagnose when the symptoms first begin. Because nerve responses are slow in Guillain-Barré syndrome, a doctor may perform a nerve conduction velocity test, which measures how fast the nerves send messages to the brain. An electromyogram can help determine the severity of the nerve damage. Because the cerebrospinal fluid (the liquid that surrounds the brain and spinal cord) of a person with Guillain-Barré syndrome contains more protein than usual, a doctor may take a sample of the fluid from the person’s spine using a procedure called lumbar puncture (see page 693) to test it for excess protein.

Treatment

Treatment of Guillain-Barré syndrome depends on the symptoms and on how far the disorder has progressed. If the muscles that assist breathing are affected, you will be put on a ventilator; if your ability to swallow is impaired, you may need to be fed intravenously (through a vein) until the symptoms subside. If the nerves that control blood pressure and heart rhythm are affected, you will need a pacemaker (see page 584) to regulate your heartbeat. Plasmapheresis (a procedure that removes antibodies from the blood) or immunoglobulin therapy (treatment in which a doctor injects high doses of immune proteins into a vein) removes or blocks the action of the antibodies that are causing the abnormal immune response, reducing the severity and duration of symptoms.

Sleep Disorders

Sleep is as important to good health as a nutritious diet and regular exercise. When you fail to get enough sleep, your body releases higher than normal levels of the stress hormone cortisol, which can have a harmful effect on body tissues, making you more prone to infections and other diseases. Sleep deprivation or fragmented sleep can also interfere with your daily activities by causing daytime sleepiness, poor concentration, performance and memory problems, delayed responses, and difficulty controlling your emotions. Most people occasionally have trouble falling asleep, and many people routinely fail to get enough sleep because of work and family demands or shift work.

Some medical conditions, such as asthma (see page 640) or heart failure (see page 570) and disorders such as arthritis (see page 996) that cause chronic or occasional pain, can interrupt sleep. Other sleep-disrupting medical problems include heartburn or gastroesophageal reflux disease (GERD; see page 750), osteoporosis (see page 989), Alzheimer’s disease (see page 688), and chronic lung diseases such as emphysema (see page 656) or chronic bronchitis (see page 655). A number of medications, including those used to treat high blood pressure, heart disease, or asthma, can also adversely affect sleep. Alcohol, caffeine, and nicotine can all make it harder to fall asleep and stay asleep. The time changes produced by air travel, especially when traveling west to east, also can interfere with the body’s natural sleep cycle, causing jet lag (see page 705).

Although adults need an average of 8 hours of sleep every day, the amount you require to stay alert during the day may be more or less because the quantity of sleep needed varies from person to person. Additionally, as you age, you may not be able to sleep as long as you once did, although the amount of sleep you need remains the same. Some people have difficulty sleeping because of a medically recognized sleep disorder such as insomnia, restless legs syndrome, or narcolepsy.

Insomnia

People who have insomnia get insufficient sleep or experience poor-quality sleep