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Biomedical subjects

A J Spielman

Publications and source records attributed to A J Spielman.

13 recordsLinked to original sources
PubMed1990

Sleepiness and REM sleep recurrence: the effects of stage 2 and REM sleep awakenings.

Determinants of daytime sleepiness include sleep length, sleep continuity, and circadian factors. Sleep stage composition has not been seen as influencing subsequent daytime functioning; however, earlier studies did not focus explicitly on sleepiness. The present experiment studied the effects of selective sleep-stage restriction on an objective measure of sleep tendency, and explored the relationship between sleepiness and subsequent REM recurrence during REM deprivation. Daytime sleep latency was measured by a modified Multiple Sleep Latency Test prior to and following two nights of awakenings from either REM or Stage 2 sleep in 16 normal young adults. Sleep latency following these awakenings was also measured. REM sleep and Stage 2 awakenings produced comparable levels of sleepiness, both during the Awakening Nights and subsequent daytime Multiple Sleep Latency Testing. Pooling the groups, daytime and nocturnal sleepiness measures were correlated within individuals. In the REM-Awakening Group, Pre-Awakening daytime sleepiness was associated with the tendency for REM sleep to recur following experimental awakenings. Comparable levels of sleepiness may result from nonspecific processes such as sleep curtailment and fragmentation, or alternatively from separate REM and Stage 2 mechanisms. The relationship between REM sleep and sleepiness is discussed in the context of both state and trait models.

Adult↗
PubMed1988

Delayed sleep phase syndrome in adolescents.

The delayed sleep phase syndrome is characterized by difficulty in falling asleep at a socially acceptable time of night and an inability to be easily aroused in the morning. Most commonly encountered in adolescents, this condition can produce daytime sleepiness and poor school performance, and it can lead to behavioral problems. The clinical features of the syndrome are described in 22 adolescents. Nine subjects participated in a protocol of polysomnographic recordings to simulate habitual "weekday" and "weekend" sleep patterns. There was a significant increase in total sleep time (p less than 0.005) and REM sleep (p less than 0.001) during the "weekend" sleep period. A multiple sleep latency test was performed between the two nights to assess daytime sleep tendency. Daytime sleepiness was maximal in the morning, with a tendency for greater alertness as the day progressed. The reduced amount of REM sleep during the "weekdays" plus the tendency for sleepiness in the mornings may contribute to the behavioral and educational difficulties seen in these patients. Recognition of this syndrome enables a specific sleep schedule change to be made that effectively treats the problem.

Adolescent↗
PubMed1987

A behavioral perspective on insomnia treatment.

The major behavioral treatments of insomnia--progressive relaxation, biofeedback, cognitive approaches, stimulus control instructions, chronotherapy, and sleep restriction therapy--are described. The basis of these interventions are conceptualized as issuing from the interdependence of sleep and wakefulness, the temporal organization of sleep-wake processes, cognitive effects on arousal, the role of perpetuating factors in chronic insomnia, and conditioning. A pilot study of the conditioning of rapid sleep onset with the aid of a hypnotic provides a preliminary demonstration of the application of conditioning to the pharmacotherapy of sleep. It is predicted that the commonly accepted view of sleep latency as solely reflecting physiological sleep tendency, will require modification to include the effects of conditioning. The current pattern of hypnotic usage, an issue of widespread concern, is subjected to a behavioral analysis based on a new model of conditioned tolerance. The intermittent administration of placebo within a hypnotic regimen is predicted to be especially beneficial in sustaining hypnotic efficacy.

Behavior Therapy↗
PubMed1987

Treatment of chronic insomnia by restriction of time in bed.

A treatment of chronic insomnia is described that is based on the recognition that excessive time spent in bed is one of the important factors that perpetuates insomnia. Thirty-five patients, with a mean age of 46 years and a mean history of insomnia of 15.4 years, were treated initially by marked restriction of time available for sleep, followed by an extension of time in bed contingent upon improved sleep efficiency. At the end of the 8-week treatment program, patients reported an increase in total sleep time (p less than 0.05) as well as improvement in sleep latency, total wake time, sleep efficiency, and subjective assessment of their insomnia (all p less than 0.0001). Improvement remained significant for all sleep parameters at a mean of 36 weeks after treatment in 23 subjects participating in a follow-up assessment. Although compliance with the restricted schedule is difficult for some patients, sleep restriction therapy is an effective treatment for common forms of chronic insomnia.

Analysis of Variance↗
PubMed1986

Dynamics of REM sleep in narcolepsy.

The discovery of sleep onset REM periods (SOREMPs) in narcolepsy first suggested the important role of REM sleep in the disorder. We have conducted a series of studies exploring factors that affect the onset and termination of REM sleep in narcolepsy. Following a preliminary study of REM sleep deprivation, we compared the sleep onset response of narcoleptic and normal subjects to awakenings at REM sleep onsets and awakenings during NREM sleep. In addition, we have investigated the relationship of these awakenings to daytime sleepiness. We have demonstrated that an index of the REM sleep process predicts the sleepiness of both normal and narcoleptic subjects. The finding of increased frequency of SOREMPs following both REM and NREM sleep awakenings in the narcoleptic patient suggests that accelerated triggering and inertia of the REM sleep process are pathophysiological mechanisms of the disorder.

Activity Cycles↗
PubMed1985

Predictive value of Müller maneuver in selection of patients for uvulopalatopharyngoplasty.

Uvulopalatopharyngoplasty (UPPP) is an effective treatment for some patients with obstructive sleep apnea syndrome (OSAS). A major difficulty has been to select those patients who will have a good response to UPPP. Fiberoptic nasopharyngoscopy with Müller Maneuver (FNMM) was applied in preoperative evaluation of patients with OSAS to identify those in whom greatest pharyngeal collapse was in the region of the tonsillar fossae and soft palate. Those with pharyngeal changes on FNMM who were considered most likely to respond to surgery underwent UPPP. Comparison of pre and postoperative polysomnography reveals significant (p less than .001) improvement in indices of severity of OSAS The mean apnea index (apneas per hour) was diminished by 72%. Eighty-seven percent of patients had greater than 50% reduction in apnea index. Preoperative selection of OSAS patients by FNMM increases the likelihood of success of UPPP.

Adult↗
PubMed1984

Patterns of daytime sleepiness in narcoleptics and normals: a pupillometric study.

Pupil diameter was measured in light and dark conditions every half hour for 6.5-10 h in 3 normal controls and 3 narcoleptics. Mean pupillary diameter was significantly smaller in the narcoleptic group than in the normal group. Pupil activity was correlated with pupil diameter only in the dark condition in narcoleptics. Pupil diameter varied with a circa 90 min periodicity in the narcoleptics but not in the normal controls. These results indicate firstly, that one-time assessment of pupil size is insufficient; and secondly, that the appearance of these rhythms may be the result of a defect in arousal mechanisms of narcoleptics which usually play an inhibitory role.

Adult↗
PubMed1978

Long-term ambulatory temperature monitoring in a subject with a hypernychthemeral sleep--wake cycle disturbance.

A portable temperature data logger was used for prolonged rectal temperature monitoring in an ambulatory subject with a longer than 24 hr (hypernychthemeral) sleep-wake cycle. The mean period of the sleep-wake and circadian temperature cycles was 24.8 hr. However, the period of the sleep-wake cycle fluctuated considerably, being less than 24.8 hr when he slept during the socially desirable sleep hours and more than 24.8 hr when he slept during the day. In the first instance, the daily temperature fall occurred later than, and in the second earlier than, sleep onset. During the times of desynchronization of the two cycles, he complained of insomnia, fatigue, and reduced performance. We postulate that his hypernychthemeral cycles were the result of either a primary defect in the mechanism of entrainment or "weakened" social zeitgebers due to a personality disorder. These concepts are supported by a sleep-wake pattern resembling that of relative coordination. We therefore raise the possibility that 24 hr was beyond the range of entrainment of the subject's circadian temperature cycle during the study.

Adult↗