Biomedical subjects

P B Glovinsky

Publications and source records attributed to P B Glovinsky.

6 recordsLinked to original sources

PubMed1996

Insomnia.

The series of cases presented here should illustrate that the complaint "I can't sleep" is deceptively simple. The clinician must be prepared to gather information from many disparate aspects of the patient's history and present circumstances. Diagnostic considerations are complicated further by the significant night-to-night variation in the manifestations of the insomnia. Too often, the result of this hidden complexity is a tendency either to prescribe hypnotic drugs as a first intervention or to give signals to patients with insomnia that not much can be done and that difficulty sleeping is simply a fact of life. The sleep log can help to bring order to the jumble of insomniac experiences. It leads both the clinician and patient away from assigning too much weight to a specific instance, instead allowing more general patterns to be discerned. As order is created out of the factors contributing to the insomnia, a treatment plan can be designed that goes beyond mere symptomatic treatment.

Adult↗

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

Parasomnias.

This article presents four examples of parasomnia activity. Sleepwalking, sleep terror, and rhythmic movement disorder all occur more commonly in children; however, they can persist into adulthood. REM behavior disorder frequently occurs in elderly patients with neurologic lesions. The sleep stage associations of the different disorders differ. Two of the disorders, sleepwalking and sleep terrors, have a clear association with stage 3/4 sleep, and REM behavior disorder occurs in REM sleep. Rhythmic movement disorder episodes can present solely in REM sleep but more typically occur in light non-REM sleep, and there are usually voluntary episodes during wakefulness.

Adolescent↗

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↗