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PubMed1978

Insomnia and the physiology of sleep.

Sleep is a vital human physiologic process. Insomnia can be caused by obsession and depression states, pain, or worry over everyday problems. Because of their pharmacologic action, alcohol and high doses of soporifics used as remedies may produce REM-deficit sleep and actually prolong insomnia. If the true cause of sleeplessness is not recognized and properly treated, insomnia may develop into a severe sleep problem. Since benzodiazepines and chloral hydrate do not suppress REM sleep, they are the medications of choice in the therapy for insomnia.

Depression↗
PubMed1994

[REM sleep parasomnia].

The parasomnias consist of a heterogenous group of sleep behaviour disorders with different etiologies and various symptomatologies. By employing polysomnography and the simultaneous video recording of behaviour during sleep, it is possible to associate behavioral disturbances during sleep with specific sleep stages. In the present case study, a patient with a REM (rapid eye movement) sleep behaviour disorder is discussed. This rare form of parasomnia is characterized by motor enactment of vivid and striking dreams. Underlying disease in the present case involved bilateral lacunar ischemic infarcts in the brain stem. Under the combined psychotropic medication of carbamazepine and amitriptyline, the behaviour disorder during REM sleep remitted markedly.

Amitriptyline↗
PubMed1996

Asymmetry of rapid eye movements in chronic unilateral neglect does not change with behavioral improvement induced by rehabilitation treatment.

A strong reduction of leftward rapid eye movements (REMs) during REM sleep was recently documented in patients with severe and chronic left unilateral neglect. The aim of the present research was to study the stability of the unilateral suppression of REMs before and after a rehabilitative treatment for neglect disorders. Six right-brain-damaged patients were tested for neglect at the beginning and at the end of a 2 month cognitive rehabilitation treatment. REMs were recorded during 1 night of undisturbed sleep before and after the training. Five out of 6 patients improved considerably their ability to attend the previously neglected left hemispace; in all patients REM asymmetry remained unchanged. The lack of relationship between the improvement of the neglect disorder and the persistence of REM asymmetry suggests that the sensorimotor mechanisms activated by rehabilitation are different from those involved in the production of REMs. It is proposed that: (a) the directional vectors of REMs are computed on the basis of the exclusive or predominant endogenous activation of the central attentional mechanisms related to vestibular input; (b) the presence of rightward and leftward saccades and the positive effects of the rehabilitation treatment are functionally linked to attentional oculomotor mechanisms that are not active in REM sleep.

Aged↗
PubMed1979

Sleep patterns in Kleine-Levin syndrome.

Diurnal and nocturnal sleep records were obtained from a male and a female with Kleine-Levin syndrome, during excessive daytime sleep attacks and while they were asymptomatic. A common pattern of abnormal sleep was seen in both patients even during the asymptomatic period. The female, aflicted with a severe form of periodic hypersomnia, showed nocturnal and diurnal sleep onset REM periods. The different pattern of sleep abnormality in the female could be an expression of the severity of her symptoms or might indicate a variant of sleep abnormality present only in females with Kleine-Levin syndrome.

Adolescent↗
PubMed2002

[Comorbidity in narcoleptic patients].

BACKGROUND AND OBJECTIVE: Narcolepsy is a rare disease which remains undiagnosed in 90 %. The international literature so far has paid little attention to comorbid disorders. PATIENTS AND METHODS: In preparation for a German Narcolepsy Register this pilot study evaluated data from hospital records of 106 narcolepsy patients (60 men, 46 women, 8-83 years, mean 45.1 years) retrospectively emphasising comorbid diseases. RESULTS: The parasomnias sleepwalking and nightmares were 6 times as frequent as in the general population. With respect to the HLA findings the extremely high frequency of REM behavior disorder contributes to the assumption of a common pathomechanism. Obstructive sleep apnea and periodic limb movement disorder (PLMD) occurred much less than described in literature, while the results on obesity, headache and depression are in line with published findings. CONCLUSION: Diagnosis of one of these comorbid disorders should always be followed by thorough investigation for symptoms of narcolepsy i. e. excessive daytime sleepiness, sleep attacks and cataplexy.

Adolescent↗
PubMedDate not supplied

[Narcolepsy in children].

INTRODUCTION: Narcolepsy is a neurological disorder characterized by excessive somnolence during the daytime, with recurrent, irresistible episodes of sleepiness. The complete forms are associated with cataplexy, hypnagogic hallucinations and sleep paralysis. The incidence reported in adults is 4 10/10,000. A considerable proportion of adults consider their disorder to have started before the age of 15 years. It is essential to have neurophysiological confirmation of the short period of the onset of REM sleep for diagnosis. CLINICAL CASE: An 11 year old boy with diurnal hypersomnolence, behavior disorder and weight gain. He was evaluated in the Sleep Disorder Unit by polysomnography and the multiple latency test, which confirmed the suspicion of narcolepsy. CONCLUSIONS: Narcolepsy is a disorder which starts during childhood and usually goes unnoticed or is erroneously diagnosed and treated. At the present time there are valid criteria for the identification and diagnosis of children with this disorder. Treatment of these patients should be orientated towards adaptation of the environment to the child and prevention of the psychosocial problems which may be caused by this disorder, in view of the poor response to the drugs used.

Central Nervous System Stimulants↗
PubMed1978

Kleine-Levin syndrome associated with fire setting.

Kleine-Levin syndrome is characterized by periodic hypersomnia associated with megaphagia and striking behavioral and psychiatric symptoms; it occurs primarily in adolescent boys. We treated a 17-year-old boy who had typical recurring somnolent episodes. His bizarre behavior included fire setting and stealing, both of which may have represented compulsions. His EEG during a sleepy episode was diffusely abnormal with generalized slowing of background activity; as he awoke and improved clinically, his EEG returned to normal. Between episodes, his EEG was normal. The relationship between Kleine-Levin syndrome and other sleep disorders is discussed. The neurochemistry and neurocircuitry that may provide the requisite substrate for this complex and fascinating neuropsychiatric disorder are briefly reviewed.

Adolescent↗
PubMed1986

Anatomy of Rett syndrome.

Rett syndrome is a clinical entity with a distinct set of signs and symptoms. Its etiology is unknown. We review here our observations in this disorder based upon clinical and polysomnographic examinations which are consistent with a developmental disorder of the monoaminergic neural system. These studies argue for a disorder of the noradrenergic, serotonergic and dopaminergic system arising in the locus ceruleus, raphe nuclei and substantia nigra, respectively. Because events of rapid eye movement sleep appear not disturbed, except for body movements, cholinergic neurons are probably not affected. Disordered physiologic states appear in a characteristic sequence with advancing age. Clinical symptoms associated with the aberrant caudally located neurons appear early and those rostrally located become manifested later. This caudalorostral developmental process attributable to early lesion of monoaminergic neurons may explain the age-related sequence of symptoms of Rett syndrome.

Adolescent↗
PubMed1985

Rett syndrome--an early catecholamine and indolamine deficient disorder?

The results of clinical and polysomnographical examinations on 11 Japanese Rett syndrome cases were summarized to substantiate further our previous results regarding the pathophysiology of the disease. It was concluded that the disease starts early in infancy and takes a progressive course. Each characteristic symptom appears in an orderly sequence which is thought to reflect the sequential systemic involvement of certain neuronal systems. Based on the characteristic symptoms and signs, and polysomnographical studies, we speculated that the initial lesion was the locus coeruleus with a hypoactive noradrenergic system combined with other hypoactive monoaminergic systems, including those of serotonin and dopamine, occurring along with the early developmental course. In later stages, hyperfunction possibly due to postsynaptic supersensitivity of the dopamine system causes the characteristic symptoms of the Rett syndrome.

5-Hydroxytryptophan↗
PubMed2001

Sleep and suicide in psychiatric patients.

Suicidal patients often report problems with their sleep. Although sleep-related complaints and EEG (electroencephalographic) changes have been seen widely across the spectrum of psychiatric disorders, sleep complaints such as insomnia, hypersomnia, nightmares, and sleep panic attacks are more common in suicidal patients. The subjective quality of sleep as measured by self-rated questionnaires also appears to be more disturbed in suicidal depressive patients. Sleep studies have reported various polysomnographic findings including increased REM (rapid eye movement) time and REM activity in suicidal patients with depression, schizoaffective disorder, and schizophrenia. One mechanism responsible for this possible association between suicide and sleep could be the role of serotonin (5HT). Serotonergic function has been found to be low in patients who attempted and/or completed suicide, particularly those who used violent methods. Aggression dyscontrol appears to be an intervening factor between serotonin and suicide. Additionally, agents that enhance serotonergic transmission decrease suicidal behavior. Serotonin has also been documented to play an important role in onset and maintenance of slow wave sleep and in REM sleep. CSF 5-HIAA levels have been correlated with slow wave sleep in patients with depression as well as schizophrenia. Moreover, 5HT2 receptor antagonists have improved slow wave sleep. Further studies are needed to investigate the possible role of sleep disturbance in suicidal behavior.

Electroencephalography↗
PubMed2003

Sleep and posttraumatic stress disorder: a review.

Research seeking to establish the relationship between sleep and posttraumatic stress disorder (PTSD) is in its infancy. An empirically supported theory of the relationship is yet to emerge. The aims of the present paper are threefold: to summarise the literature on the prevalence and treatment of sleep disturbance characteristic of acute stress disorder (ASD) and PTSD, to critically review this literature, and to draw together the disparate theoretical perspectives that have been proposed to account for the empirical findings. After a brief overview of normal human sleep, the literature specifying the relation between sleep disturbance and PTSD is summarized. This includes studies of the prevalence of sleep disturbance and nightmares, content of nightmares, abnormalities in rapid eye movement (REM) sleep, arousal threshold during sleep, body movement during sleep, and breathing-related sleep disorders. In addition, studies of the treatment of sleep disturbance in individuals with PTSD are reviewed. We conclude that the role of sleep in PTSD is complex, but that it is an important area for further elucidating the nature and treatment of PTSD. Areas for future research are specified. In particular, a priority is to improve the methodology of the research conducted.

Cognitive Behavioral Therapy↗
PubMed2003

REM behavior disorder and excessive daytime somnolence in Machado-Joseph disease (SCA-3).

We reported previously that behavior suggestive of rapid eye movement sleep behavior disorder (RBD) was markedly increased in a small population of SCA-3 patients. We, therefore, asked patients and nonpatient attendees at an SCA-3 annual clinic to complete a questionnaire soliciting RBD-like behavior. Our results support the previous observation that RBD-like behaviors are significantly increased in SCA-3.

Adult↗
PubMed2004

Pharmacologic treatment expectations in the management of dementia with Lewy bodies.

Recently recognized as an entity separate from Alzheimer's disease (AD) and Parkinson's disease with dementia, dementia with Lewy bodies (DLB) is a frequent cause of dementia. It is characterized by progressive cognitive decline and attention deficits, but in contrast to AD, the cognitive changes typically fluctuate over time. Patients with DLB often experience Parkinson-like spontaneous motor features as well as recurrent visual hallucinations. Another frequent finding in DLB is rapid eye movement (REM) sleep disorder. Ideally, each of the major symptom domains associated with DLB (behavioral, motor, and cognitive) would be treated, but drug interactions in these patients are a serious concern. In addition, many patients with DLB are hypersensitive to neuroleptics, which can induce severe extrapyramidal and other symptoms--sometimes ending in death. Compared with conventional neuroleptics, the newer atypical antipsychotic agents may be associated with lower rates of extrapyramidal side effects. Cholinergic deficits in DLB are even more severe than in AD, whereas the extent of cerebral atrophy and neuronal damage may be less. These observations and emerging clinical data support the treatment of DLB with acetylcholinesterase inhibitors. Encouraging results have been obtained from studies of DLB patients treated with rivastigmine, donepezil, and galantamine, but large-scale, controlled trials are needed to confirm the efficacy and safety of acetylcholinesterase inhibitors in patients with DLB.

Aged↗
PubMed2005

The neuropsychiatry of Parkinson's disease.

The neuropsychiatry of Parkinson's disease (PD) and its correlates are reviewed. Dementia occurs in up to 30% and can be treated with cholinesterase inhibitors. Cognitive impairments involve executive, visuospatial, attentional, and memory dysfunctions. Apathy may respond to dopamine agonists or cholines-terase inhibitors. Cognitive impairment, psychosis, and depression predict quality of life. Visual hallucinations and paranoia are common, and respond to low dose clozapine. Depression is common and predicts caregiver burden and depression. The best data suggest the efficacy of nortriptyline and the safety of SSRIs. Anxiety disorders occur in 40% of patients, especially off-period panic attacks and specific phobias. Bromazepam has proven useful for anxiety in PD, but buspirone has only diminished drug-induced dyskinesias to date. Sleep disorders occur in up to 94% of patients. Insomnia is common and is treated by dopaminergic agent dose reduction, nocturnal dosing, treatment of depression, or use of short half-lived hypnotics, depending on etiology. Parasomnias include REM behavior disorder and vivid dreams and nightmares. Excessive daytime somnolence occurs in at least 15% of patients. Sleep attacks are common and patients should be warned about driving when taking dopamine agonists. Sexual disorders occur in most patients. Paraphilias are associated with dopamine agonists, and clozapine may be useful in their treatment. Surgical therapies are associated with a wide variety of neuropsychiatric features, and vigilance for suicide attempts with subthalamic nucleus stimulation seems warranted. Neuropsychiatric disorders are important determinants of quality of life and caregiver burden in PD. More clinical research is needed to establish effective treatments.

Anxiety↗
PubMedDate not supplied

The adrenergic-cholinergic imbalance hypothesis of depression: a review and a perspective.

The catecholamine deficiency hypothesis of depression was essentially based on the incidental detection of iproniazide and imipramine. However, current findings favor noradrenergic overactivity, at least in the periphery. The incidental observation of acute behavioral inhibition by centrally active cholinomimetics like physostigmine suggested a cholinergic-adrenergic balance involved in the regulation of drive and mood. Indeed, cholinomimetics seem to have acute depressiogenic and antimanic properties and, conversely, anticholinergics some acute euphoriant activity. However, time course and dose-response relationships of drugs influencing mood and drive do not favor simple concepts of too much or too little activity of one or the other transmitter system. Cholinomimetics and psychostimulants show an acute mutual antagonism, the mechanism of which is obscure. In healthy volunteers clonidine and the putative antidepressant brofaromine did not influence the effects of physostigmine. Patients with mood disorders respond supersensitively to a cholinergic challenge in terms of behavior, neuroendocrine regulation and REM sleep induction. Thus, the anticholinergic properties of tricyclics might be relevant to their antidepressant activity. However, adjunctive treatment with the cholinolytic biperiden as compared to placebo did not enhance the antidepressant efficacy of mianserin or viloxazine. This is incompatible with cholinergic overactivity contributing to the depressive state. Physostigmine induces autonomous and endocrine responses reminiscent of stress reactions. Findings in healthy volunteers suggest relationships between the sensitivity to physostigmine and personality traits like irritability and emotional lability and passive stress coping strategies. Thus, the cholinergic supersensitivity in mood disorders might be related to some personality dimension like stress intolerance rather than the depressive state itself.

Acetylcholine↗
PubMed2003

Parasomnias.

Parasomnias are common in the benign forms such as sleepwalking and sleep talking. The more dramatic forms such as sleep terrors and confusional awakenings occur frequently in childhood, but attenuate in the teen years. REM behavior disorder, seen in the elderly, is an uncommon entity. Generally diagnosis is based upon clinical history with sleep studies reserved for unusual presentation. The focus of treatment is attention to sleep hygiene with medication(s) reserved for more severe and repetitive cases.

Humans↗