Showing papers on "Sleep disorder published in 1995"

Sleep complaints among elderly persons: an epidemiologic study of three communities.

Abstract: The frequencies of five common sleep complaints--trouble falling asleep, waking up, awaking too early, needing to nap and not feeling rested--were assessed in over 9,000 participants aged 65 years and older in the National Institute on Aging's multicentered study entitled "Established Populations for Epidemiologic Studies of the Elderly" (EPESE). Less than 20% of the participants in each community rarely or never had any complaints, whereas over half reported at least one of these complaints as occurring most of the time. Between 23% and 34% had symptoms of insomnia, and between 7% and 15% percent rarely or never felt rested after waking up in the morning. In multivariate analyses, sleep complaints were associated with an increasing number of respiratory symptoms, physical disabilities, nonprescription medications, depressive symptoms and poorer self-perceived health. Sleep disturbances, particularly among older persons, oftentimes may be secondary to coexisting diseases. Determining the prevalence of specific sleep disorders, independent of health status, will require the development of more sophisticated and objective measures of sleep disturbances.

Toward a better definition of the restless legs syndrome

Abstract: A large International Restless Legs Syndrome (RLS) Study Group has been formed. As its first task, the group has taken upon itself the role of definig the clinical features of the RLS. As minimal criteria for diagnosis, the group proposes the following four features: (a) desire to move the extremities, often associated with paresthesias/dysesthesias; (b) motor restlessness; (c) worsening of symptoms at rest with at least temporary relief by activity, and (d) worsening of symptoms in the evening or night. Other features commonly seen in RLS include sleep disturbance, periodic limb movements in sleep and similar involuntary movements while awake, a normal neurological examination in the idiopathic from, a tendency for the symptoms to be worse in middle to older age, and, in some cases, a family history suggestive of an autosomal dominant mode of inheritance.

The role of actigraphy in the evaluation of sleep disorders.

Abstract: This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee's parameters for the practice of sleep medicine in North America The growing use of activity-based monitoring (actigraphy) in sleep medicine and sleep research has enriched and challenged traditional sleep-monitoring techniques This review summarizes the empirical data on the validity of actigraphy in assessing sleep-wake patterns and assessing clinical and control groups ranging in age from infancy to elderly An overview of sleep-related actigraphic studies is also included Actigraphy provides useful measures of sleep-wake schedule and sleep quality The data also suggest that actigraphy, despite its limitations, may be a useful, cost-effective method for assessing specific sleep disorders, such as insomnia and schedule disorders, and for monitoring their treatment process Methodological issues such as the proper use of actigraphy and possible artifacts have not been systematically addressed in clinical research and practice

Oral appliances for the treatment of snoring and obstructive sleep apnea: a review.

Abstract: This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee's parameters for the practice of sleep medicine in North America. The 21 publications selected for this review describe 320 patients treated with oral appliances for snoring and obstructive sleep apnea. The appliances modify the upper airway by changing the posture of the mandible and tongue. Despite considerable variation in the design of these appliances, the clinical effects are remarkably consistent. Snoring is improved and often eliminated in almost all patients who use oral appliances. Obstructive sleep apnea improves in the majority of patients; the mean apnea-hypopnea index (AHI) in this group of patients was reduced from 47 to 19. Approximately half of treated patients achieved an AHI of < 10; however, as many as 40% of those treated were left with significantly elevated AHIs. Improvement in sleep quality and sleepiness reflects the effect on breathing. Limited follow-up data indicate that oral discomfort is a common but tolerable side effect, that dental and mandibular complications appear to be uncommon and that long-term compliance varies from 50% to 100% of patients. Comparison of the risk and benefit of oral appliance therapy with the other available treatments suggests that oral appliances present a useful alternative to continuous positive airway pressure (CPAP), especially for patients with simple snoring and patients with obstructive sleep apnea who cannot tolerate CPAP therapy.

Identifying effective psychological treatments for insomnia: A meta-analysis.

Abstract: Insomnia is a debilitating and widespread complaint. Concern over the iatrogenic effects of pharmacological therapies has led to the development of several psychological treatments for insomnia. To clarify the effects of these treatments, 66 outcome studies representing 139 treatment groups were included in a meta-analysis. The results indicated that psychological treatments produce considerable enhancement of both sleep patterns and the subjective experience of sleep. In terms of enhancing sleep onset, active treatments were all superior to placebo therapies but did not differ greatly in efficacy. Greater therapeutic gains were available for participants who were clinically referred and who were not regular users of sedative hypnotics. Future research directions are suggested.

24-Hour metabolic rate in insomniacs and matched normal sleepers.

Abstract: Groups of 10 objectively defined insomniacs and age-, sex- and weight-matched normal sleepers were evaluated on sleep, performance, mood, personality and metabolic measures over a 36-hour sleep laboratory stay. Insomniacs were defined to have increased wake time during the night but also had decreased stage 2 and rapid eye movement sleep. As expected insomniacs reported increased confusion, tension and depression and decreased vigor on the profile of mood states mood scale throughout the evaluation period as compared to the normals. Insomniacs also had decreased memory ability on the short-term memory test and the MAST. These performance and mood differences were not secondary to sleepiness because the insomniacs also had significantly increased multiple sleep latency test (MSLT) values throughout the evaluation period. In conjunction with the consistent mood, performance and MSLT differences during the day and the sleep differences at night, whole body VO2, measured at intervals across the day and throughout one night of sleep, was consistently elevated at all measurement points in the insomniacs as compared to the normals. The nocturnal increase in metabolic rate remained even after metabolic values from periods during the night containing wake time or arousals were eliminated from the data set. It was concluded that patients who report chronic insomnia may suffer from a more general disorder of hyperarousal (as measured here by a 24-hour increase in metabolic rate) that may be responsible for both the daytime symptoms and the nocturnal poor sleep. Future studies need to explore 24-hour insomnia treatment strategies that decrease hyperarousal.

We are chronically sleep deprived

Abstract: Summary: Data from recent laboratory studies indicate that nocturnal sleep periods reduced by as little as 1.3 to 1.5 hours for 1 night result in reduction of daytime alertness by as much as 32% as measured by the Multiple Sleep Latency Test (MSLT). Other data document that 1) 170/0--57% of normal young adults have MSLT latencies of ::;5.5 minutes, whereas ::;50% have MSLT values of ~ 10 minutes and 2) 28°/0--29% of young adults reported normally sleeping ::;6.5 hours on each weeknight. More extensive reduction of daily sleep amount is seen in night­ shift workers. A minimum of 2%-4% of middle-aged adults have hypersomnolence associated with sleep apnea. Together, these data show that significant sleep loss exists in one-third or more of normal adults, that the effects are large and replicable and that similar effects can be produced in just I night in the laboratory. In light of the magnitude of this sleep debt, it is not surprising that fatigue is a factor in 57% of accidents leading to the death of a truck driver and in 10% of fatal car accidents and results in costs of up to 56 billion dollars per year. A recent sleep extension study suggests that the average underlying sleep tendency in young adults is about 8.5 hours per night. By comparison, the average reported sleep length of 7.2-7.4 hours is deficient, and common sleep lengths of ::;6.5 hours can be disastrous. We must recognize the alertness function of sleep and the increasing consequences of sleepiness with the same vigor that we have come to recognize the societal impact of alcohol. Key Words: Sleep deprivation-Sleepiness-Sleep disorders- Work schedule tolerance. Weare in the midst of a golden age of discovery of the intricate interrelationship between our nocturnal sleep process and our level of daytime function. Fueled by the discovery of the tremendous incidence of sleep apnea and periodic leg movements in the population, the relationship between fragmented sleep and residual sleepiness, as well as the increased ability to measure the level of objective sleepiness with an objective test [the Multiple Sleep Latency Test (MSLT)] and in am­ bulatory environments, the pervasive role of excessive sleepiness in our society is becoming apparent. Much literature documents the negative effects of sleep deprivation on a wide range of psychomotor per­ formance tasks and mood variables. For the sake of simplicity, the primary outcome measure reported in this paper will be MSL T. However, the MSL T findings reported are consistent with similar changes in a broad range of abilities, including reaction time, short-term memory, vigilance and mood (1). Many empirical and applied studies have provided evidence for our national sleep debt. The degree of our

A Survey Screen for Prediction of Apnea

Abstract: Questionnaire data from patients presenting at three sleep disorders centers were used to develop and assess a screening tool for sleep apnea based on the reporting of the frequency of various symptoms of sleep apnea and other sleep disorders plus age, body mass index (BMI) and gender. Patients were not specifically referred for suspicion of sleep apnea. Separate factor analyses of survey responses from 658, 193 and 77 respondents from the first, second and third sites, respectively, each yielded four orthogonal factors, one of which accounted for all the questions concerned with the frequency of disordered breathing during sleep. The survey was shown to be reliable in a subset of patients from one of the sites (test-retest correlation = 0.92). Survey data were then compared to a clinical measure of sleep apnea (respiratory disturbance index) obtained from polysomnography. A multivariable apnea risk index including survey responses, age, gender and BMI was estimated using multiple logistic regression in a total sample of 427 respondents from two of the sites. Predictive ability was assessed using receiver operating characteristic (ROC) curves. The area under the ROC curve was 0.79 (p < 0.0001). For BMI alone, it was 0.73, and for an index measuring the self-report of the frequency of apnea symptoms, it was 0.70. The multivariable apnea risk index has potential utility in clinical settings.

Mortality in Sleep Apnea Patients: A Multivariate Analysis of Risk Factors

Abstract: During 1976-1988 we diagnosed sleep apnea syndrome (SAS) in 1,620 adult men and women monitored in the Technion sleep laboratories. Their age at the time of diagnosis ranged between 21 and 79 years. Fifty-seven patients (53 men and 4 women) had died by 1990, 53% due to respiratory-cardiovascular causes. The observed/expected (O/E) mortality rates, calculated for men only, revealed excess mortality of patients under 70 years old. Excess mortality was significant in the fourth and fifth decades (3.33, p < 0.002; 3.23, p < 0.0002, respectively). In patients older than 70 O/E was 0.33 (p < 0.0007). Hierarchical multivariate analysis with four fixed variables [age, body mass index (BMI), hypertension and apnea index] and four additional variables added manually one at a time (heart disease, lung disease, diabetes, apnea duration) was used to determine the predictors of death from all causes, cardiopulmonary causes and from myocardial infarction (MI). All four major variables were found to be significant predictors of mortality from all causes, in addition to lung disease and heart disease. Only age and BMI were significant predictors of cardiopulmonary deaths in addition to lung disease. Age, BMI and hypertension predicted MI deaths in addition to lung disease. These results were interpreted to suggest that SAS affects death indirectly, most probably by being a risk factor for hypertension.

Deficits of cognitive executive functions in patients with sleep apnea syndrome.

Abstract: Impairment of cognitive executive functions previously has been suspected to occur in association with sleep apnea syndrome (SAS), as suggested by some neuropsychological studies. However, such functions have not been assessed directly. In the present study, 17 patients with SAS were evaluated with various focused frontal lobe-related tests in comparison with 17 normal controls. Such tasks explored attention, short-term memory spans, learning abilities, planning and programming capacities, categorizing activities and verbal fluency. Patients were found to have a significantly decreased ability to initiate new mental processes and to inhibit automatic ones, in conjunction with a tendency for preservative errors. They were also affected with deficits of verbal and visual learning abilities and had reduced memory spans. Such defects were further evaluated via logistic regression against two criteria of the severity of the disease: the number of apneas and hypopneas per hour of sleep and the level of nocturnal hypoxemia. Memory deficits were rather related to the former, whereas typical frontal lobe-related abnormalities seemed rather consistent with the latter. These findings are discussed in light of data from the literature concerning cognitive impairments described for patients with isolated daytime sleepiness versus hypoxemia, as illustrated in other pathological or physiological circumstances.

Melatonin Replacement Therapy of Elderly Insomniacs

Abstract: Changes in sleep-wake patterns are among the hallmarks of biological aging. Previously, we reported that impaired melatonin secretion is associated with sleep disorders in old age. In this study we investigated the effects of melatonin replacement therapy on melatonin-deficient elderly insomniacs. The study comprised a running-in, no-treatment period and four experimental periods. During the second, third and fourth periods, subjects were administered tablets for 7 consecutive days, 2 hours before desired bedtime. The tablets were either 2 mg melatonin administered as sustained-release or fast-release formulations, or an identical-looking placebo. The fifth period, which concluded the study, was a 2-month period of daily administration of 1 mg sustained-release melatonin 2 hours before desired bedtime. During each of these five experimental periods, sleep-wake patterns were monitored by wrist-worn actigraphs. Analysis of the first three 1-week periods revealed that a 1-week treatment with 2 mg sustained-release melatonin was effective for sleep maintenance (i.e. sleep efficiency and activity level) of elderly insomniacs, while sleep initiation was improved by the fast-release melatonin treatment. Sleep maintenance and initiation were further improved following the 2-month 1-mg sustained-release melatonin treatment, indicating that tolerance had not developed. After cessation of treatment, sleep quality deteriorated. Our findings suggest that for melatonin-deficient elderly insomniacs, melatonin replacement therapy may be beneficial in the initiation and maintenance of sleep.

Sleep problems and their correlates in a working population

Abstract: OBJECTIVE: To measure the prevalence of sleep problems in a working population and examine their association with health problems, health-related quality-of-life measures, work-related problems, and medical expenditures. Also, to explore the usefulness of a sleep-problems screen for mental health conditions and underlying sleep disorders. DESIGN: Cross-sectional survey administered via voice mail and telephone interview. SETTING: A San Francisco Bay Area telecommunications firm. PARTICIPANTS: Volunteer sample of 588 employees who worked for a minimum of six months at the company and were enrolled in its fee-for-service health plan. MEASUREMENTS AND MAIN RESULTS: Thirty percent of respondents reported currently experiencing sleep problems and were found to have worse functioning and well-being (general health, cognitive functioning, energy), more work-related problems (decreased job performance and lower satisfaction, increased absenteeism), and a greater likelihood of comorbid physical and mental health conditions than were the respondents who did not have sleep problems. They also demonstrated a trend toward higher medical expenditures. CONCLUSIONS: Self-perceived sleep problems were common among the respondents and were associated with poorer health and health-related quality of life. A single question about sleep problems may serve as an effective screen for identifying primary care patients with mental health problems, as well as underlying sleep disorders.

Sleep events among veterans with combat-related posttraumatic stress disorder.

Abstract: Objective: Sleep disturbances are important features of posttraumatic stress disorder (PTSD); however, the published data characterizing PTSD sleep phenomena are limited. The authors report on the phenomenology and physiological correlates ofsymptomatic sleep events in PTSD. Method: The study data included survey results that addressed sleep symptoms during the past month in combat veterans with and without PTSD (N-_58), sleep diary records of awakenings from combat veterans with PTSD hospitalized on an inpatient rehabilitation unit (N=52), and overnight polysomnography recordings obtained from 2 1 medication-free combat veterans with PTSD and eight healthy comparison subjects not exposed to combat. Results: Recurrent awakenings, threatening dreams, thrashing movements during sleep, and awakenings with startle or panic features represented the most prevalently reported sleep-related symptoms. Laboratory findings of longer time awake, micro-awakenings, and a trend for patients to exhibit body and limb movements during sleep are consistent with the subjectively reported symptom profile. Prospectively assessed symptomatic awakenings featured startle or panic symptoms or anxiety related to threatening dreams. Laboratory findings revealed a trend for the symptomatic awakenings (with and without dream recall) to be disproportionately preceded by REM sleep, and the two recorded awakenings with objective physiological arousal were preceded by REM. Conclusions: PTSD features intrusions into sleep of more highly aroused behaviors and states, which appear partially conditioned to REM sleep. (Am J Psychiatry 1995; 152:110-115)

Cigarette Smoking and Sleep Disturbance

Abstract: Background: Individuals with sleep complaints often exhibit unhealthy lifestyles, including obesity, excessive alcohol use, lack of physical exercise, and cigarette smoking. We sought to explore the relationship between cigarette smoking, poor sleep habits, and sleep complaints. Several lines of evidence suggest a relationship between cigarette smoking and sleep disturbance, including the effects of nicotine and nicotine withdrawal on sleep, a tendency for nonsmokers to be more alert in the morning, an association between cigarette smoking and snoring, and a tendency for individuals who engage in one unhealthy behavior also to engage in others. Method: A total of 484 individuals aged 14 to 84 years completed a comprehensive sleep and health questionnaire. There were 99 high school students from grades 9 through 12 (45 boys and 54 girls, of whom 38 [38%] were smokers), who completed an in-class survey. In addition, 385 adults aged 20 to 84 years (122 men and 263 women, of whom 77 [20%] were smokers) from a random sample of 1000 completed a mail survey. The effects of age and smoking status on sleep, health, and daytime function were assessed by multivariate analysis of variance. Results: Cigarette smokers were significantly more likely than nonsmokers to report problems going to sleep, problems staying asleep, daytime sleepiness, minor accidents, depression, and high daily caffeine intake. Conclusion: Individuals with sleep complaints should be queried about tobacco use. Those who are smokers should be advised that there is a relationship between cigarette smoking and sleep disturbance. (Arch Intern Med. 1995;155:734-737)

Sleep-disordered breathing in African-American elderly.

Abstract: Although sleep-disordered breathing (SDB) has been shown to be very prevalent in the elderly, little has been done to examine differences between the elderly of different racial groups. It has been well documented that SDB often results in hypertension and that hypertension is more common in African-Americans than in Caucasians. Therefore, one might suspect that SDB might be more common in African-Americans. Caucasians (n = 346) and African-Americans (n = 54) older than 65 yr of age were studied. African-Americans reported less satisfaction with sleep (p = 0.017), more difficulty falling asleep (p or = 30) independently of age, sex, and body mass index. The mean RDI for those African-Americans with severe SDB was significantly higher than that for Caucasians (72.1 versus 43.3; p = 0.014).

Principles and Practice of Sleep Medicine in the Child

Abstract: Introduction: Pediatric Sleep Disorders. Normal Sleep in Neonates and Children. Sleep in Adolescents. Control of Breathing During Sleep in the Fetus and Neonate. Assessment of Sleep Disorders in the Child. Monitoring of Sleep in Neonates and Young Children. Culture and Family: Influences on Childhood Sleep Practices and Problems. Colic. Sleeplessness in Children. Circadian Rhythm Sleep Disorders in Childhood. Sleepwalking, Confusional Arousals, And Sleep Terrors in the Child. Nocturnal Enuresis in the Child. Non-Arousal Parasomnias in the Child. Narcolepsy, Kleine-Levin Syndrome, And Other Causes of the Sleepiness in Children. Sleep in Children with Neurological Problems. Sleep in Behavioral and Emotional Disorders. Primary Snoring in Children. Obstructurive Sleep Apnea in Infants and Children: Clinical Features and Pathophysiology. Obstructive Sleep Apnea in Infants and Children: Diagnosis and Managment. Sleep and Respiratory Disease in Children. Sudden Infant Death Syndrome.

The sleep/wake rhythm in children with autism

Abstract: The sleep patterns of two groups of children with autism, one with moderate to severe intellectual handicap, and one with mild handicap to normal IQ level, were compared with those of children without autism. Parents completed 14 day sleep diaries and questionnaires. Results suggested that at some stage during childhood, particularly under 8 years of age, the majority of children with autism will experience sleep problems. These problems are likely to be severe in many cases and will generally include one or more of: extreme sleep latencies; lengthy periods of night waking; shortened night sleep; and early morning waking. Such problems may have some specificity for autism as they appear to be rare in non-handicapped children and in children with mild degrees of intellectual handicap. It is likely that sleep problems in early childhood are related to the severe social difficulties present in autism and the consequent inability of these children to use social cues to synchronise their sleep/wake cycle. Continued sleep difficulties at older ages and with higher IQ may also be related to arousal and anxiety factors.

Incidental Lewy body disease in a patient with REM sleep behavior disorder

Abstract: We studied an 84-year-old man with a 20-year history of nocturnal violent behavior during sleep, but no other clinically evident neuropsychiatric disorders. Polysomnographic investigations confirmed that he suffered from REM sleep behavior disorder (RBD). Histopathologic examination revealed he had Lewy body disease with a marked decrease of pigmented neurons in the locus ceruleus and substantia nigra. These histologic findings represent the first documented evidence of a loss of brainstem monoaminergic neurons in clinically idiopathic RBD and suggest that Lewy body disease might provide an explanation for idiopathic RBD in the aged.

A Community Study of Snoring and Sleep-disordered Breathing Prevalence

Abstract: We conducted a study of the prevalence of sleep-disordered breathing in subjects derived from a random sample of the population. A total of 2,202 subjects 35 to 69 yr of age were approached. Four hundred forty-one answered a questionnaire concerning their sleep symptoms, general health, and habits such as alcohol consumption, and they were monitored for sleep-disordered breathing (SDB). The sample was biased in favor of snorers and those with other subjective sleep complaints. Fifty-six percent of the subjects were men. Of the 441 subjects 79 (17.9%) had SDB (more than 15 episodes of apnea or hypopnea per hour: respiratory distress index [RDI] > or = 15), 289 were snorers but had RDI < 15, and 73 were nonsnorers. The prevalence of SDB in this sample was therefore at least 3.6% (79 of 2,204). The minimum prevalence in men was 5.7%, and in women it was 1.2%. Logistic regression identified only male sex as an independent predictor of snoring without SDB (adjusted odds ratio [OR], 3.24; 95% CI, 1.33 to 7.82),...

L-Dopa Therapy of Uremic and Idiopathic Restless Legs Syndrome: A Double-Blind, Crossover Trial

Abstract: We report the effects of a single bedtime dose of L-dopa 100-200 mg on sleep quality, frequency of periodic leg movements (PLM) and daily living in patients with idiopathic and uremic restless legs syndrome (RLS) Seventeen patients with idiopathic and 11 with uremic (on continuous hemodialysis) RLS were evaluated comparatively by polysomnography, actigraphy and subjective ratings in a randomized, controlled and double-blind crossover trial with L-dopa and placebo for 4 weeks each Neurophysiologic assessments showed significant reduction of the number of periodic leg movements (p = 0003) and the PLM-index (p = 0005) most pronounced during the first 4 hours of bedtime after L-dopa (p = 0001) Subjective evaluation confirmed improvement of sleep quality (p = 0002) and showed significantly higher quality of life during daytime (p = 0030) while the patients received L-dopa therapy We conclude that L-dopa 100-200 mg proved to be effective in idiopathic RLS and for the first time under controlled conditions in uremic RLS without any severe side effects

Delayed sleep phase syndrome : a review of its clinical aspects

Abstract: Objective: Delayed sleep phase syndrome is a common but little reported cause of severe insomnia. Since it was first described, few detailed reports of delayed sleep phase syndrome have appeared, and treatment methods have not been reviewed. From the literature, the authors provide diagnostic descriptions and review treatment methods, and from their sleep disorder clinic, they describe the management and outcome of the largest series of patients with delayed sleep phase syndrome thus far reported. Method: The authors reviewed all articles with primary data on delayed sleep phase syndrome published through 1993 and add data from a group of 33 patients at their sleep disorder clinic. Results: Delayed sleep phase syndrome involves undesirably late bedtimes and arising times, early night insomnia, and poor morning alertness but lack of insomnia on vacations. The mean bedtime and arising time for the 33 patients were 4:00 a.m. and 10:38 a.m., respectively. Twenty-five patients were, or had been, depressed. Individual responses to treatments varied widely. Seventeen patients showed little treatment response. Delayed sleep phase syndrome had a worse treatment outcome than other sleep disorders. Conclusions: Delayed sleep phase syndrome presents in a heterogeneous manner. In the sleep disorder clinic population, it was often associated with major depression and was more resistant to treatment than other sleep disorders. Multiple and varied treatments are required

Light Treatment for Sleep Disorders: Consensus Report IV. Sleep Phase and Duration Disturbances

Abstract: Advanced and delayed sleep phase disorders, and the hypersomnia that can accompany winter depression, have been treated successfully by appropriately timed artificial bright light exposure. Under entrainment to the 24-h day-night cycle, the sleep-wake pattern may assume various phase relationships to the circadian pacemaker, as indexed, for example, by abnormally long or short intervals between the onset of melatonin production or the core body temperature minimum and wake-up time. Advanced and delayed sleep phase syndromes and non-24-h sleep-wake syndrome have been variously ascribed to abnormal intrinsic circadian periodicity, deficiency of the entrainment mechanism, or--most simply--patterns of daily light exposure insufficient for adequate phase resetting. The timing of sleep is influenced by underlying circadian phase, but psychosocial constraints also play a major role. Exposure to light early or late in the subjective night has been used therapeutically to produce corrective phase delays or advances, respectively, in both the sleep pattern and circadian rhythms. Supplemental light exposure in fall and winter can reduce the hypersomnia of winter depression, although the therapeutic effect may be less dependent on timing.

Sleep and sleep disorders in older adults.

Abstract: Complaints of sleep disturbance increase with age. Objective sleep assessments using polysomnography reveal sleep impairments (increased wakefulness and arousal from sleep; decreased slow wave sleep) even in healthy seniors. Both polysomnographic sleep and subjective sleep worsen in the presence of health impairments related to drug use, pain, cardiovascular disease, diabetes, depression, or other emotional disorders. In addition to normal aging and chronic disease, sleep complaints can also result from poor sleep habits, specific occult disorders during sleep, or some combination of these factors. Occult disorders include sleep apnea syndrome, periodic leg movements, and restless legs syndrome during sleep. Diagnosis and treatment of these and other sleep disorders is discussed. Both pharmacological and nonpharmacological treatments are considered, with an emphasis on behavioral and educative treatment approaches.

The Distribution And Clinical Significance Of Sleep Time Misperceptions Among Insomniacs.

Abstract: It is well recognized that sleep time misperceptions are common among insomniacs, but little is known about the distribution and clinical significance of these subjective distortions. The current investigation was conducted to examine the distribution of sleep time misperceptions among a large (n = 173), diverse group of insomniacs and to determine if such misperceptions might relate to the patients' clinical characteristics. Consistent with previous studies, our subjects, as a group, produced sleep estimates that were significantly (p < 0.0001) lower than polysomnographically determined sleep times. However, patients' sleep time perceptions were widely distributed across a broad continuum, which ranged between gross underestimates and remarkable overestimates of actual sleep times. Results also showed that subgroups, formed on the basis of presenting complaints and diagnostic criteria (i.e. International Classification of Sleep Disorders nosology), differed in regard to the magnitude and direction of their sleep distortions. Moreover, these differences appeared consistent with the types of objective sleep disturbances these subgroups commonly experience. Hence, the tendency to underestimate actual sleep time is not a generic attribute of all insomniacs. Furthermore, it appears that the accuracy and nature of sleep time perceptions may relate to the type of sleep pathology underlying insomniacs' presenting complaints.

Prevalence of sleep disturbances among young adults in three european countries

Abstract: The aim of this investigation was to study the geographic variation in sleep complaints and to identify risk factors for sleep disturbances in three European countries: Iceland (Reykjavik), Sweden (Uppsala and Goteborg) and Belgium (Antwerp). The study involved a random population of 2,202 subjects (age 20-45 years) who participated in the European Community Respiratory Health Survey. The subjects answered a questionnaire on sleep disturbances. Participants in Iceland and Sweden also estimated their sleep habits and sleep times during a period of 1 week in a sleep diary. Habitual (> or = 3/week) difficulties inducing sleep (DIS) were reported by 6-9% and early morning awakenings by 5-6% of the subjects. The estimated number of awakenings and the prevalence of nightmares was significantly lower in Reykjavik. Participants in Reykjavik went to bed at night and woke in the morning approximately 1 hour later than participants at the Swedish centers (p < 0.001). Symptoms of gastroesophageal reflux (GER) were associated with DIS (odds ratio [OR] = 2.7), nightmares (OR = 4.4), longer sleep latency and frequent nocturnal awakenings. Smoking correlated positively to DIS (OR = 1.8) and estimated sleep latency. We conclude that the prevalence of DIS was fairly similar at these four European centers but that there was a variation in the prevalence of nightmares and nocturnal awakenings. The significant correlation between reported GER and subjective quality of sleep should be followed up in studies using objective measurements.

The effect of sleep apnea on plasma and urinary catecholamines.

Abstract: Numerous studies have suggested an alteration of sympathetic nervous system functioning in sleep apnea However, most of these studies did not control for confounding factors such as diet, obesity, hypertension and anti-hypertensive medications We examined plasma and urinary catecholamines in 43 patients, including hypertensive and normotensive individuals with and without sleep apnea Hypertensive patients were studied at least 3 weeks following tapering of anti-hypertensive medication All patients consumed similar diets and were of similar age and level of obesity Twenty-four-hour urinary norepinephrine levels were significantly higher in apneics (582 ng vs 402 ng in nonapneics, p < 0002) Urinary norepinephrine in apneics was increased during both day and night Plasma norepinephrine levels were not significantly elevated in apneic patients but were elevated in hypertensive patients both during sleep and in the morning (p < 005)

Sleep disturbance and its relationship to psychiatric morbidity after Hurricane Andrew.

Abstract: Objective : Sleep disturbance is an important dimension of posttraumatic stress disorder (PTSD), but most of the limited available data were obtained years after the original traumatic event. This study provides information on sleep disturbance and its relationship to posttraumatic morbidity from evaluations done within a year after the trauma. Method : Sleep and psychiatric symptoms of 54 victims (12 men and 42 women) of Hurricane Andrew who had no psychiatric illness in the 6 months before the hurricane were evaluated. A subset of hurricane victims with active psychiatric morbidity (N=10) and nine comparison subjects who were unaffected by the hurricane were examined in a sleep laboratory. Results : A broad range of sleep-related complaints were rated as being greater after the hurricane, and psychiatric morbidity (which was most commonly PTSD, followed by depression) had a significant effect on most of the subjective sleep measures. In addition, subjects with active morbidity endorsed greater frequencies of bad dreams and general sleep disturbances before the hurricane. Polysomnographic results for the hurricane victims revealed a greater number ofarousals and entries into stage 1 sleep. REM density correlated positively with both the PTSD symptom of reexperiencing trauma and global distress. Conclusions : Subjects affected by Hurricane Andrew reported sleep disturbances, particularly those subjects with psychiatric morbidity. Tendencies to experience bad dreams and interrupted sleep before a trauma appear to mark vulnerability to posttraumatic morbidity. Results ofsleep laboratory evaluations suggested brief shifts toward higher arousal levels during sleep for PTSD subjects and a relationship of REM phasic activity and symptom severity.

Sleep problems of junior high school students in Taipei.

Abstract: The objective of this work was to study the relationship between daily sleep time and characteristics of students, e.g. grade level, gender, and academic program. A sleep habit questionnaire was designed to survey students at two junior high schools, one from northern Taipei and the other from southern Taipei. The impact of shortened duration of sleep on daily function was also evaluated. A total of 965 students and their parents were selected randomly in December 1993 for the questionnaire study. The response rate was 96.4% (930) for students and 88.6% (855) for parents. The self-reported daily sleep time of students declined, and daytime sleepiness and moodiness increased in the higher grades. The girls slept fewer hours than the boys and did not show an increase in daytime sleepiness. Those students not taking the senior high school joint entrance examination slept more hours at night and maintained more alertness in the daytime than those who were taking the examination. The more academic pressures that adolescents faced, the fewer hours they slept. Students not participating in the joint entrance examination seemed to show a healthier sleep pattern. Little sleep at night made the students feel sleepy in the daytime and tired, drowsy, moody and difficult at arising in the morning. The reason why girls slept less than boys needs further investigation.