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At least 19 recordsLinked to original sources
PubMedDate not supplied

Sleep breathing and sleep movement disorders masquerading as insomnia in sexual-assault survivors.

A descriptive, hypothesis-generating study was performed with 156 female sexual-assault survivors who suffered from insomnia, nightmares, and posttraumatic stress disorder (PTSD). They completed 2 self-report sleep questionnaires to assess the potential presence of intrinsic sleep disorders. Seventy-seven percent of the sample (120 of 156) endorsed additional sleep complaints, besides their insomnia symptoms, that indicate the potential presence of sleep-disordered breathing ([SDB] 81 of 156, 52%) and sleep-related movement disorders ([SMD] 94 of 156, 60%). The potential for SDB was strongly correlated with the body mass index (BMI), an increase in arousal symptoms, and greater total PTSD severity. In some sexual-assault survivors, the relationship between sleeplessness and posttraumatic stress may be caused or exacerbated by intrinsic sleep disorders, and not be solely a function of psychophysiological insomnia--the traditional diagnostic term usually offered to explain the sleep problems associated with PTSD. Prevalence studies that use objective diagnostic evaluations such as polysomnography (PSG) are needed to test these hypotheses.

Adolescent↗
PubMed1999

Etiology and treatment of intrinsic circadian rhythm sleep disorders.

Some individuals experience an acute or chronic sleep disturbance, associated with a misalignment between the timing of their sleep and the sleep-wake cycle that is desired, or considered normal by society. It is estimated that 5-10% of insomniacs seeking treatment have this type of disorder, collectively called circadian rhythm sleep disorders. This paper reviews circadian rhythm sleep disorders of the intrinsic type, which include delayed sleep phase syndrome, advanced sleep phase syndrome, non-24-hour sleep-wake syndrome, and irregular sleep-wake pattern. For each disorder, we present data addressing its pathophysiology and potential treatments, including the use of behavioral measures and chronotherapy, bright light treatment and pharmacological treatments such as melatonin. We conclude by addressing some of the limitations and drawbacks of the various treatments.

Journal Article↗
PubMed2004

Assessment and treatment of disturbed sleep in attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder affects 3-5% of children in the USA, and is commonly accompanied by disrupted sleep in the form of insomnia, restless sleep or excessive daytime tiredness. In addition, daytime inattention and hyperactivity which mimicks attention deficit hyperactivity disorder can result from intrinsic sleep disorders such as obstructive sleep apnea or periodic limb movement disorder. In most cases, the correct clinical evaluation permits appropriate diagnosis and management. Current research investigating the relationship between attention deficit hyperactivity disorder and sleep, as well as general precepts of clinical assessment and treatment are reviewed.

Attention Deficit Disorder with Hyperactivity↗
PubMed2002

Molecular genetics of timing in intrinsic circadian rhythm sleep disorders.

Recent advances in circadian biology are identifying key genes and the molecular clockworks they command. These biochemical systems provide new tools for evaluating clinically observed, intrinsic circadian rhythm sleep disorders. A striking example was last year's discovery of a point mutation in a human clock gene that produces a sleep phase syndrome. This finding suggested that other intrinsic sleep disorders may have genetic underpinnings, and that less debilitating variations in sleep/wake behavior may be revealed by molecular screening of known clock genes in broader human populations.

Animals↗
PubMed2005

Symptoms of sleep disturbance in persons with Alzheimer's disease and normal elderly.

We retrospectively analyzed sleep time and sleep disturbance symptoms in 399 healthy, non-demented elderly (NDE) and 263 persons with a diagnosis of possible (n = 53) or probable (n = 210) Alzheimer's disease (AD). Our primary objective was to determine differences in subjective sleep disturbance between these samples. Secondary objectives were to determine if subjects with time in bed (TIB) < or =6 h per night reported more sleep disturbance and whether sleep complaints were associated with more severe cognitive and/or functional impairment. The prevalence of 'sleep problems' (a single item) was significantly lower in NDE (18.3%) than AD (27.6%), and the proportions of each cohort reporting TIB < or =6 h per night were very low (NDE: 6.0%; AD: 3.5%) and not significantly different. Less TIB was correlated with better cognitive function for AD (P < 0.01), and cognition and function were significantly worse for AD subjects with estimates of >6 h of TIB compared with those with estimates of < or =6 h (P < 0.05). Greater sleep disturbance was correlated with greater functional impairment in both cohorts; but only in AD did greater estimated TIB also correlate with greater functional impairment (all P < 0.05). In general, estimated TIB was not associated with mood in either cohort; however, in both cohorts depression was significantly associated with sleep disturbance symptoms and was significantly worse in those who reported having 'sleep problems'. There was no association between subjective perception of 'sleep problems', the number and frequency of sleep disturbance symptoms, and estimated TIB in either group.

Activities of Daily Living↗
PubMed2002

Reduction of periodic leg movement in individuals with paraplegia following aerobic physical exercise.

PURPOSE: According to the American Association of Sleep Disorders, periodic leg movements (PLM) are classified into the group of intrinsic sleep disorders. Studies on PLM in individuals with spinal cord injury are very recent. The objective of the present study was to assess the efficacy of aerobic training in reducing the index/score of PLM in individuals with complete spinal cord injury. METHODS: Twelve male volunteers with complete spinal cord injury between T7 and T12 were submitted to six polysonographies (PSG Oxford Medilog SAC system; EEG, EMG and EOG: (1) basal night, (2) 12 h after a maximum effort test, (3) 36 h after a maximum effort test, (4) after 44 days of aerobic physical training, (5) 12 h after the last training session, and (6) 36 h after the last training session. All volunteers participated in a physical training program for 44 days using an arm crank ergometer. Data were analyzed statistically by the Wilcoxon test, with the level of significance set at alpha5%. RESULTS: The results demonstrated a statistically significant reduction (P < or = 0.05) in the comparison of first evaluation (35.1 PLM/h) with fifth (12.70 PLM/h) and sixth evaluation (18.5 PLM/h). CONCLUSION: This study suggests that a program of regular and systematized physical activity promotes an effective reduction of PLM in individuals with spinal cord injury.

Adult↗
PubMed2001

Kava and valerian in the treatment of stress-induced insomnia.

Kava and valerian are herbal remedies, claimed to have anxiolytic and sedative properties respectively, without dependence potential or any appreciable side-effects. In this pilot study, 24 patients suffering from stress-induced insomnia were treated for 6 weeks with kava 120 mg daily. This was followed by 2 weeks off treatment and then, 5 having dropped out, 19 received valerian 600 mg daily for another 6 weeks. Stress was measured in three areas: social, personal and life-events; insomnia in three areas also: time to fall asleep, hours slept and waking mood. Total stress severity was significantly relieved by both compounds (p < 0.01) with no significant differences between them; as was also insomnia (p < 0.01). The proportion of patients with no side-effects was 58% with each drug respectively and the 'commonest' effect was vivid dreams with valerian (16%), followed by dizziness with kava (12% ). These compounds may be useful in the treatment of stress and insomnia but further studies are required to determine their relative roles for such indications.

Adult↗
PubMed2000

Prevalence of sleep disturbances in chinese patients with end-stage renal failure on continuous ambulatory peritoneal dialysis.

Patients with end-stage renal failure (ESRF) are reported to have a high prevalence of sleep disorders, such as daytime sleepiness, insomnia, restless legs syndrome (RLS), and obstructive sleep apnea syndrome (OSAS). However, there are few published data from Southeast Asia. A sleep questionnaire was administered to 201 patients (103 men) at the continuous ambulatory peritoneal dialysis (CAPD) outpatient clinic to assess sleep problems. Patients had a mean age of 56.7 +/- 12 (SD) years, with a mean body mass index (BMI) of 23.6 +/- 3.5 kg/m(2). Daytime sleepiness was the most frequent symptom (77.1%), and frequent awakening occurred in 69% of the patients. Sleep-onset insomnia and sleep-maintenance insomnia occurred in 73% and 60% of the patients, respectively. Sixty-two percent of the patients reported symptoms of RLS, which significantly correlated with sleep-onset insomnia (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.5 to 5.5; P = 0.001) and sleep-maintenance insomnia (OR, 2.1; 95% CI, 1.2 to 3.8; P = 0.014). The prevalence of OSAS was estimated by the frequency of the following symptoms: extremely loud snoring, 7 patients (3.5%); observed choking, 21 patients (10.5%); witnessed apnea, 11 patients (5.6%); snoring and witnessed apnea, 6 patients (3%); disruptive snoring, 29 patients (14.4%); and disruptive snoring and witnessed apnea, 3 patients (1.5%). This questionnaire survey confirmed a high prevalence of daytime sleepiness, insomnia, and RLS in patients with ESRF undergoing CAPD but showed a relatively low prevalence of OSAS of up to 14.4%, which may be related to the low BMI of these patients with ESRF compared with other populations. Whether this contributes to the overall better survival observed in some Asian patients with ESRF undergoing dialysis needs further investigation.

Adolescent↗
PubMed2003

Medication for sleep-wake disorders.

Medication is indicated for only a limited number of children's sleep disorders. However, correctly chosen and supervised, pharmacological treatment may be justified and helpful. For a given sleep problem it is important to identify the underlying cause (or sleep disorder) which often calls for treatment of a non-medication type. Where medication is appropriate, cautious use and careful review of the child's physical and psychological state is essential in view of the limited information available on effectiveness and possible short and long term effects. It follows that much further research is required to establish the part medication can play in the care of children with sleep disorders, and also to define the possible effects on sleep and wakefulness of other drugs used in clinical practice.

Child↗
PubMed2004

Restless legs syndrome and pregnancy.

OBJECTIVE: To perform a large and detailed epidemiologic study on restless legs syndrome (RLS) during pregnancy and the puerperium. METHODS: A structured clinical interview, assessing symptoms since the beginning of pregnancy, was performed to a population of 642 pregnant women at the time of delivery and at follow-up evaluation (1, 3, and 6 months after delivery). Main hematologic tests were also evaluated. A woman was considered affected if she met the International RLS Study Group criteria for RLS diagnosis. RESULTS: Twenty-six percent of women were affected by RLS during their pregnancy. The disease was strongly related to the third trimester of pregnancy and tended to disappear reaching the time of delivery. Affected women presented lower values of hemoglobin and mean corpuscular volume compared with healthy subjects (both groups received the same supplemental iron and folate therapy). CONCLUSIONS: Pregnancy is associated with transient restless legs syndrome.

Adult↗
PubMed2004

Sleep disorders in the elderly.

Geriatric patients often complain about sleep disorders, but many of the typical sleep disturbances in the elderly are thought to be normal consequences of old age and go underdiagnosed and undertreated. Sleep disorders are estimated to affect nearly 50% of older persons. Most frequently the elderly suffer from Sleep Disordered Breathing (SDB), Periodic Limb Movements in Sleep (PLMS), Restless Legs Syndrome (RLS), morning headaches, circadian rhythm disorders, excessive daytime sleepiness, Obstructive Sleep Apnea Syndrome (OSAS), and insomnia. This review describes all these common sleep problems in the older population and their possible treatment.

Age of Onset↗
PubMed1991

Appropriate use of benzodiazepines in insomnia: clinical update.

Insomnia and anxiety are frequently experienced not only by healthy persons, but in their more intense expressions, by patients suffering from a variety of medical and psychiatric disorders. The International Classification of Sleep Disorders (1990) lists 88 types of sleep disorders. Thirty-three of these are related to insomnia and belong to the categories of intrinsic sleep disorders, extrinsic sleep disorders, circadian rhythm sleep disorders, and sleep disorders associated with medical or psychiatric disorders. Benzodiazepines are frequently used for the treatment of insomnia. For optimal treatment of insomnia, exact diagnosis, correct understanding of the biology, and appropriate use of the drugs are essential.

Benzodiazepines↗
PubMed1993

Insomnia. Use of a 'decision tree' to assess and treat.

Insomnia, a remarkably common disturbance in a basic biologic function, arises from multiple psychological, physiologic, and environmental factors. Transient insomnia usually resolves spontaneously. Short-term insomnia is usually normalized by coping with acute changes in a medical condition or a relationship. In patients with insomnia caused by stressful life events, a short (ie, 10 days or less) course of a short- or intermediate-acting benzodiazepine hypnotic may be indicated. Long-term insomnia deserves comprehensive evaluation. Psychiatric disorders are common in patients with long-term insomnia. In patients over age 50, intrinsic sleep disorders are more prevalent. Behavioral therapy, including improved sleep hygiene, stimulus-control techniques, and sleep-restriction therapy, is preferred in the management of long-term insomnia. Pharmacotherapy (eg, low-dose antidepressant or benzodiazepine) is best used as an adjunct.

Decision Trees↗
PubMed2001

Sleepiness in a population of Italian shiftwork policemen.

The aim of this study was to evaluate the effects of shiftwork on sleepiness, sleep disorders and sleep related accidents in a population of policemen. Data concerning age and physical characteristics, working conditions, sleep problems and accidents were collected by a questionnaire. Sleepiness was evaluated by the Epworth Sleepiness Scale (ESS) while the presence of sleep disorders was evaluated by a score (SD-score) drawn from indicators of insomnia, breathing disorders, periodic limb movements-restless leg syndrome and hypersomnia. The effects of age, gender, body mass index, working condition and seniority on ESS, SD-score and accidents were analysed by linear and logistic regression. Participants were 1280 policemen: 611 shiftworkers and 669 non-shiftworkers. The ESS scores were not higher in shiftworkers than in non-shiftworkers, but the SD-score was found to be significantly influenced by shiftwork condition and seniority. The occurrence of sleep-related accidents was found to have been significantly increased for shiftworkers and related to the presence of indicators of sleep disorders. The sleepiness could be underestimated or even overcome by the influence of stressing conditions. However our data should alert occupational health physicians for the diagnosis and prevention of possible lurking intrinsic sleep disorders likely to influence health problems and risk of accidents in shiftworkers.

Accidents, Occupational↗
PubMed2002

Sleepiness and sleep disorders in shift workers: a study on a group of italian police officers.

STUDY OBJECTIVES: evaluation of shift-work effect on sleepiness, sleep disorders, and sleep-related accidents in a population of police officers. DESIGN: Aquestionnaire-based survey was used to gather information on age and physical characteristics, working conditions, sleep problems, and accidents. Sleepiness was measured by the Epworth Sleepiness Scale (ESS) while the presence of sleep disorders was evaluated by a score (SDS) drawn from indicators of insomnia, breathing disorders, periodic limb movements and restless legs syndrome, and hypersomnia. The effects of age, gender, body mass index, working conditions, and seniority on ESS, SD score, and accidents were analyzed by linear and logistic regression. SETTING: The self-administered questionnaires were filled in by police officers in the district of Genoa (Italy). PARTICIPANTS: 1,280 police officers: 611 shift workers (SW) and 669 non-shift workers (NSW). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The ESS score was not higher in SW than in NSW, while the SDS was significantly influenced by shift-work conditions and seniority in shift work. The occurrence of sleep-ascribed accidents was significantly increased in the SW group and related to the presence of indicators of sleep disorders. There was evidence for sleep disorders in 35.7% of SW and in 26.3% of NSW. CONCLUSIONS: Shift-work conditions and seniority may enhance sleep disorders and may favor sleep-related accidents, but they do not influence ESS score. Stressful conditions could cause sleepiness to be underestimated, or else they might overcome sleepiness. However, our data should alert occupational health physicians for the diagnosis and prevention of possible undetected intrinsic sleep disorders, which could possibly worsen shift workers' health and increase the risk of accidents.

Adult↗
PubMed1996

[Electrical status epilepticus during sleep].

INTRODUCTION: Sleep electrical status epilepticus (SESE) is a rare entity whose diagnosis depends or showing spike and wave complexes on the EEG during more than 85% of the duration of NoREM sleep. Typically it presents in children, most of whom have subjacent epilepsy. It is currently accepted that SESE is asymptomatic, although its persistence may give rise to severe neuropsychological sequelae. There are no references to sleep disorders in these patients. We present the case of a seven year old girl with SESE, hypersomnia and secondary nocturnal enuresis. CLINICAL CASE: The seven year old patient had a past history of simple partial crises with motor symptoms. There was progressive hypersomnia and nocturnal enuresis. The polysomnogram showed SESE. The Test for Multiple Latencies in Sleep (TMLS) showed pathological diurnal somnolence. HLA DR2 typing was negative. Neuropsychological study showed severe alterations in the language area, with a normal intelligence quotient. CONCLUSIONS: The new findings presented suggested that SESE is an intrinsic sleep disorder and not merely an EEG pattern. Since it occurs in children, sometimes with neuropsychological deficits, systematic TMLS should be done. The association of hypersomnia, changes in immediate visual memory and autistic regression suggest involvement of the limbic system.

Brain↗
PubMed2006

Autonomic changes during wake-sleep transition: a heart rate variability based approach.

Autonomic function during sleep and wakefulness has been extensively investigated, however information concerning autonomic changes during the wake to sleep transition is scarce. The objective of the present study was to non-invasively characterize autonomic function and additional physiologic changes during sleep onset in normal and abnormal sleep. The estimation of autonomic function was based on time-frequency analysis of the RR interval series, using the power components in the very-low-frequency range (0.005-0.04 Hz), low-frequency (0.04-0.15 Hz), and high-frequency range (0.15-0.5 Hz). The ratio of low to high frequency power represented the sympathovagal balance. Thirty-four subjects who underwent whole night polysomnography were divided into 3 groups according to their complaints and study results: normal subjects, apneic patients (OSAS), and subjects with various sleep disorders (VSD). The results indicated a significant increase in RR interval during sleep onset, although its variability decreased; respiratory rate did not change, yet respiration became more stable; EMG amplitude and its variability decreased with sleep onset. Very-low-frequency power started to decrease significantly 2 min before sleep onset in all groups; low-frequency power decreased and high-frequency power did not change significantly in all groups, accordingly their ratio decreased and reflected a shift towards parasympathetic predominance. Although autonomic function displayed similar behavior in all subjects, OSAS and VSD patients presented a higher sympathovagal balance reflecting enhanced sympathetic predominance in those groups compared to normal subjects, both before and after sleep onset. All parameters reached a nadir at a defined time point during the process of falling asleep. We conclude that the wake-sleep transition period represents a transitional process between two physiologically different states; this transition starts with a decrease in the very slow oscillations in heart rate that anticipates a step-change resetting of autonomic function, followed by a decrease in sympathovagal balance towards the end of the process.

Adolescent↗