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A combination of valerian and lemon balm is effective in the treatment of restlessness and dyssomnia in children.

Efficacy and tolerability of a combined valerian/lemon balm preparation were investigated in an open, multicentre study in children less than 12 years suffering from restlessness and nervous dyskoimesis. Patients were dosed individually by the investigators. In total, 918 children were evaluated for therapeutic efficacy and tolerability. A distinct and convincing reduction in severity was found for all symptoms in the investigators' and parents' ratings. The core symptoms dyssomnia and restlessness were reduced from "moderate/severe" to "mild" or "absent" in most of the patients. In total, 80.9% of the patients who suffered from dyssomnia experienced an improvement for this symptom and 70.4% of the patients with restlessness improved clearly. For the other listed symptoms the total improvement was 37.8% on average. Both, parents and investigators assessed efficacy as to be "very good" or "good" (60.5% and 67.7%, respectively). The tolerability of Euvegal forte was considered as "good" (in 96.7% of the patients it was judged to be "very good" or "good"). No study medication-related adverse events occurred. In conclusion, Euvegal forte was effective in the treatment of younger children with restlessness and dyssomnia and it was very well tolerated.

Administration, Oral↗

Case series: evaluation of a behavioral sleep intervention for three children with attention-deficit/hyperactivity disorder and dyssomnia.

OBJECTIVE: The authors conducted a preliminary evaluation of a behavioral sleep intervention for children with attention-deficit/hyperactivity disorder (ADHD) and dyssomnia delivered via distance treatment. METHOD: Three children (1 male, 2 females; aged 6-10 years) with ADHD and dyssomnia participated in a 5-week manualized intervention. Using a non-concurrent multiple baseline design, the children were randomly assigned to a 1-, 2-, or 3-week baseline and then received the 5-week intervention. Sleep problems were assessed daily by both objective and subjective measures. Measures of problematic nighttime behaviors and daytime ADHD symptoms were also obtained weekly. RESULTS: After 5 weeks, a clinically significant decrease was found in the severity of the children's dyssomnia. No changes in ADHD symptoms were noted. Gains were generally maintained at the 3-month follow-up. Parents perceived the intervention as being "helpful" to "very helpful." CONCLUSION: Based on the initial data, this intervention shows promise as an effective and feasible treatment.

Attention Deficit Disorder with Hyperactivity↗

[Clinical observation on governor vessel Daoqi method for treatment of dyssomnia in the patient of depression].

OBJECTIVE: To explore clinical therapeutic effects of Governor Vessel Daoqi needling method combined with antidepressants on dyssomnia in the patient of depression. METHODS: depression with dyssomnia were randomly divided into a treatment group (n=23) and a control group (n=22). The treatment group were treated with Governor Vessel Daoqi needling method and oral administration of antidepressants, with Shenting (GV 24), Baihui (GV 20), Dazhui (GV 14), Shendao (GV 11) and Zhiyang (GV 9) selected as main acupoints; and the control group with simple antidepressants. They were treated for 4 weeks. Changes of scores for Hamilton Depression Rating Scale (HAMD) and Pittsburgh Sleep Quality Index (PSQI) were investigated in the two groups. RESULTS: Significant differences before and after treatment in the scores for HAMD (P < 0.01) in both the two groups, and a significant difference before and after treatment in the score for PSQI only in the treatment group (P < 0.01) were found; after treatment, there were significant differences between the two groups in the scores of HAMD and PSQI (P < 0.01). CONCLUSION: The combined therapy of Governor Vessel Daoqi needling method and antidepressants can significantly improve dyssomnia in the patient of depression.

Acupuncture Therapy↗

TCM treatment for 63 cases of senile dyssomnia.

In order to study the therapeutic effects of the TCM drugs on senile dyssomnia, 121 such patients were randomly divided into a treatment group of 63 cases (given the TCM drugs) and a control group of 58 cases (given estazolam). The changes shown in the SDRS and HAMA scores and the other indexes were observed in both of the two groups to evaluate the therapeutic effects. The results showed that the effective rate was 76.3% in the treatment group, and it was 69.1% in the control group; and that the TCM drugs had better effects in improving such symptoms as lethargy, dry mouth, and rebound of insomnia. Therefore, it can be concluded that the effect of the TCM drugs isbetter for senile dyssomnia than that of the Western drug estazolam.

Aged↗

Dyssomnia in children diagnosed with attention deficit hyperactivity disorder: a critical review.

OBJECTIVE: Studies prior to 1999 reported prevalent sleep disturbances in children diagnosed with attention deficit hyperactivity disorder (ADHD). However, these reports were largely inconclusive and inconsistent in their findings, hence the current review based on studies published thereafter. METHOD: An online research of the National Library of Medicine and the Cochrane Library was conducted using the terms 'attention deficit hyperactivity disorder', 'sleep', 'human', and 'English language'. RESULTS: Sixteen articles met the search criteria with 10 reporting objective measures of sleep characteristics (i.e. polysomnography, actigraphy, and/or video recording). These studies confirm an increase of rapid eye movement (REM) sleep latency and a proportional decrease of REM sleep in children diagnosed with ADHD. Stimulant treatment appears to have little effect on sleep quality while parent's reports of poor sleep in their ADHD-diagnosed offspring was largely inconsistent with the objective measures. CONCLUSIONS: The review demonstrated a link between disturbances in sleep architecture and ADHD. Whether this is of an intrinsic or extrinsic cause remains debateable, as both behavioural (parental reporting) and physiological (objective differences in sleep architecture) factors are indicated. The effect of stimulant medication on sleep also requires further research, as current evidence is limited by study design.

Attention Deficit Disorder with Hyperactivity↗

Treatment of non specific dyssomnia with simple stimulus control procedures in a child with Down's syndrome.

Nonaversive behavioural interventions were used successfully to treat a disrupted sleep pattern in a child with Down's syndrome. A quasi-experimental single-case design was employed to evaluate the treatment efficacy. During the first phase of treatment, the mother implemented a structured bedtime routine and the child was no longer allowed to engage in activities while in bed. During the second phase, a stimulus control paradigm was employed in which a nearly life-sized rag doll was substituted for the mother in bed. Finally, the mother gradually withdrew from the child's bed and room. During baseline, the child spent an average of only six percent of the night sleeping alone. By the second phase, this rose to a mean of 26%. By the end of treatment this was increased to a mean of 78.2%. The increase was accompanied by collateral decreases in crying and distress. Improvements were maintained at follow-up.

Arousal↗

Psychiatric diagnoses of patients visiting a sleep disorder clinic due to dyssomnias.

This study analyzed the demographic characteristics and psychiatric diagnoses of 90 consecutive patients who visited a sleep disorder clinic in Taiwan with complaints of insomnia (difficulty initiating or maintaining sleep, or nonrestorative sleep) or hypersomnia (excessive sleepiness as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily). All subjects were interviewed using a sleep disturbance questionnaire and the structured Mini-International Neuropsychiatric Interview supplemented by the DSM-IV criteria for psychiatric diagnoses. Among 90 patients, 79 were classified as having insomnia and 11 had hypersomnia. 53 patients also had psychiatric diagnoses other than sleep disorders. Patients with insomnia had a significantly higher rate of comorbidities with other psychiatric diagnoses (65.8%) than did subjects with hypersomnia (9.1%). These results emphasize the importance of psychiatric evaluation of patients with complaints of sleep disturbance.

Adolescent↗

Dyssomnias, parasomnias, and sleep disorders associated with medical and psychiatric diseases.

Sleep disorders can be intrinsic, as are insomnia or narcolepsy, or can be accounted for by external factors, such as noise, altitude, drug or alcohol abuse, or shift work. The arousal disorders, common in children, are usually benign and disappear by puberty. Sleep-wake transition disorders such as sleep starts are benign as well, and may occur at any age. The parasomnias comprise different entities such as nightmares, REM-sleep behavior disorder, sleep enuresis, and bruxism. Diagnosis and treatment often require a multidisciplinary approach. Virtually every psychiatric, neurologic, or medical disease, when of sufficient severity, leaves its specific fingerprint on sleep; some disorders, such as peptic ulcer disease, gastroesophageal reflux, or epilepsy, tend to be exacerbated during sleep. Fortunately, most sleep disorders are amenable to therapy, which can include counseling, sleep hygiene, withholding of an offending agent, behavioral therapy, light therapy, or cautious drug therapy.

Humans↗

Comparability of sleep disorders diagnoses using DSM-IV and ICSD classifications with adolescents.

STUDY OBJECTIVES: The use of diagnostic classifications to define sleep disorders is still unusual in epidemiological studies assessing the prevalence of sleep disorders in an adolescent population. DESIGN: Cross-sectional study. Representative samples of general populations in United Kingdom, Germany and Italy were selected and interviewed by telephone about their sleep habits, sleep and mental disorder diagnoses. Overall, 724 adolescents ages 15-18 years and 1447 young adults ages 19 to 24 years were interviewed. ICSD-90 and DSM-IV diagnoses provided by the Sleep-EVAL expert system were used for the comparisons. SETTING: N/A. PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: 8% of the adolescents and 12.6% of the young adults had ICSD dyssomnia or sleep disturbances associated with a mental disorder. According to the DSM-IV classification, 5.7% of the adolescents and 8.1% of the young adults had a dyssomnia diagnosis. The comparison between the two classifications show that 73.2% of adolescents and young adults with a DSM-IV dyssomnia diagnosis also had similar ICSD diagnosis. The reverse comparison, ICSD vs. DSM-IV, shows that 39.8% of the subjects with an ICSD diagnosis had a DSM-IV diagnosis. DSM-IV primary insomnia was the most frequent diagnosis. Subjects with such a diagnosis were found in about 10 different ICSD diagnoses, mainly inadequate sleep hygiene, psychophysiological or idiopathic insomnia and insufficient sleep syndrome. CONCLUSIONS: ICSD-90 classification provided higher prevalence of sleep disorder diagnoses than the DSM-IV classification. In adolescents and young adults, DSM-IV primary insomnia is two times more often associated with ICSD inadequate sleep hygiene than with ICSD psychophysiological or idiopathic insomnia.

Adolescent↗

[Zolpidem (ivadal) treatment of sleep disorders].

The results of the multicenter study of zolpidem activity, being carried out in inpatient- and out-patient clinics of 20 cities in Russia, are reported. One thousand seventeen patients with transitory, short time and chronic dyssomnia have been included in the trial. Zolpidem (ivadal, "Sanofi-Syntelabo", France) has been prescribed once a day in a dose of 10 mg (one tablet) before going to sleep in a period of two weeks. The efficiency has been assessed by evaluating dyssomnia symptoms according to "Sleep assessment questionnaire" of "Sanofi-Syntelabo" completed by the patients and "Clinical Global Impression Scale" completed by investigators. Safety has been assessed by analyzing a frequency of side effect appearance and changes in vital parameters: blood pressure, heart and breath rate. Zolpidem has been found to reveal high clinical efficiency and safety. By the end of the treatment, 59.5% of the patients experienced no difficulties in falling asleep, in 28.6% of the patients the latter being significantly reduced. On the whole the improvement was in 89.4% patients. No side effects have been observed. Zolpidem is a highly effective and safe medication for different type dyssomnia treatment that can be recommended for application in general clinical practice.

Adolescent↗

Sleep problems in primary school children: comparison between mainstream and special school children.

This paper reports on a study of the prevalence and social correlates of dyssomnias, features associated with obstructive sleep apnoea, and parasomnias in primary school children aged 4-12. Head teachers of schools selected randomly from lists of local primary and special schools were contacted by telephone and asked to distribute a questionnaire package to the parents of all pupils aged 4-12 years. In all, 890 parents of children from mainstream schools and 300 from special schools were approached. The response rates were 64.7% and 60%, respectively. The results showed that significantly higher proportions of children in special schools than in mainstream schools presented four of the five dyssomnias investigated and all of the features associated with obstructive sleep apnoea. In contrast, only two of the seven parasomnias were presented by higher proportions of the children in special schools. Age and gender differences for the two groups of children are presented. Finally, multiple correlations were computed between a range of child, family, and environmental characteristics and the three problems most frequently reported: frequency of settling problems; sleeping in the parents' bed; and night waking. The findings are discussed with reference to other studies of children's sleep problems, and the implications for treatment are considered.

Child↗

Sleep problems in children with attention-deficit/hyperactivity disorder: impact of subtype, comorbidity, and stimulant medication.

OBJECTIVE: To determine the relationship of sleep problems to attention-deficit/hyperactivity disorder (ADHD), diagnostic subtype, comorbid disorders, and the effects of stimulant treatment. METHOD: On the basis of clinical diagnostic interviews, children aged 6 to 12 years were assigned to 4 groups: unmedicated ADHD (n = 79), medicated ADHD (n = 22), clinical comparison (n = 35), and healthy nonclinical comparison (n = 36). These groups were compared on 2 sleep questionnaires completed by the parents that assessed current sleep problems and factors associated with sleep difficulties (i.e., sleep routines, sleep practices, child and family sleep history). RESULTS: Factor analysis revealed 3 sleep problem categories: dyssomnias, parasomnias, and sleep-related involuntary movements. Linear regression analyses showed that (1) dyssomnias were related to confounding factors (i.e., comorbid oppositional defiant disorder and stimulant medication) rather than ADHD; (2) parasomnias were similar in clinical and nonclinical children; and (3) the DSM-IV combined subtype of ADHD was associated with sleep-related involuntary movements. However, sleep-related involuntary movements were more highly associated with separation anxiety. CONCLUSIONS: The results suggest that the relationship between sleep problems and ADHD is complex and depends on the type of sleep problem assessed as well as confounding factors such as comorbid clinical disorders and treatment with stimulant medication.

Attention Deficit Disorder with Hyperactivity↗

Sleep disorders in children.

Many children experience some type of sleep problem. Often, these are transient problems with no long-lasting sequelae. But in certain cases, sleep problems may significantly impact on functioning and well-being. Sleep disorders in children can be classified into two major categories. Dyssomnias include those disorders that result in difficulty either initiating or maintaining sleep or involve excessive sleepiness. Parasomnias are disorders that disrupt sleep after it has been initiated but do not result in complaints of insomnia or excessive sleepiness. Even though sleep disorders in children are common, not enough is known. This article reviews the dyssomnias and parasomnias experienced by children, discusses methodological limitations of the studies reviewed, and presents future directions for research in this field.

Adolescent↗

Chronic insomnia: outcome of hypnotherapeutic intervention in six cases.

Chronic dyssomnia is highly prevalent and has multiple etiologies. Hypnotherapy has been reported as beneficial for insomnia, but the description of the subject populations has been limited. A group of patients was evaluated at a sleep disorders center for a dyssomnia that occurred on at least 3 nights per week for 6 months or more. Six patients accepted hypnotherapy for their persistent psychophysiological insomnia and other sleep disorder diagnoses. Three patients responded to two sessions of structured hypnotherapy. The three responders remained improved at 16-month follow-up. Factors that seemed to contribute to long-term response in this small group of patients included a report of sleeping at least half of the time while in bed, increased hypnotic susceptibility, no history of major depression, and a lack of secondary gain.

Adult↗

Prevalence of sleep problems and their association with inattention/hyperactivity among children aged 6-15 in Taiwan.

This study investigated the 6-month prevalence rates of sleep-related problems and their association with daytime inadvertent napping, inattention, hyperactivity/impulsivity, and oppositional symptoms in children and adolescents. A representative school-based sample of 2463 first to ninth graders was recruited using a multistage sampling method. The instruments included the Sleep Habits Questionnaire (including dyssomnia, parasomnia, sleep schedules, and sleep-disordered breathing), the Chinese Health Questionnaire, and the Chinese versions of the Conners' Parent and Teacher Rating Scales-Revised: Short forms. The informants were mothers and teachers. The linear and nonlinear mixed models were used for statistical analyses and sex and age were controlled in the model. Results showed that the rates of middle insomnia, disturbed circadian rhythm, mouth breathing, and daytime inadvertent napping increased with age; whereas those of bedwetting, bruxism, sleep terrors decreased with age. Dyssomnia, sleep-disordered breathing problems, daytime inadvertent napping, and sleep schedules were related to attention-deficit/hyperactivity disorder (ADHD)-related symptoms as assessed by mothers' and teachers' ratings. Parasomnia was associated with ADHD-related symptoms as assessed by mothers' ratings. Our findings suggest an age trend of sleep problems similar to those found in the literature and the association of daytime inadvertent napping, inattention, hyperactivity/impulsivity, and oppositional symptoms with sleep-related problems.

Adolescent↗