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Measuring Sleep Disorders

Until 2002, there were no specific instruments to clinically assess sleep problems of PD in a comprehensive and holistic fashion. Existing sleep scales for other disorders, such as the Pittsburgh Sleep Quality Index (PSQI), Stanford Sleepiness Scale, or the Karolinska Sleepiness Scale, are not specific for PD and have problems related to scale clinimetrics in relation to complexity and face validity when these are used in PD (66, 71-73). For instance, the PSQI, although quantifiable, does not specifically address sleep disturbances of PD, such as restlessness of legs, painful posturing of arms or legs, tremors, or fidgeting. The Stanford Sleepiness Scale and the Karolinska Sleepiness Scale appear too short for a comprehensive assessment of sleep problems. The gold standards for measurement of physiological aspects of sleep architecture are PSG and MSLT. However, these are tests of sleep structure, need specialized sleep laboratories, and can be expensive. In the United Kingdom, for...

Sleep disorders 41 Insomnia

Chronic sleep onset insomnia (SOI) is a frequent finding in ADHD children (Mick et al., 2000 Smedje et al., 2001 Corkum et al., 2001 Owens et al., 2000a O'Brien et al., 2003a) with a prevalence rate of nearly 28 in unmedicated children (Corkum et al., 1999), almost double than the corresponding rate in the normal child population (Owens et al., 2000b Meijer et al., 2000). Its daytime sequelae heavily impact the cognitive domain of children and, specific to this age group, also behavioral attitude and social conduct. Hyperactivity in fact, rather than overt EDS, is the general marker of insufficient sleep in most children, therefore aggravating the typical features of ADHD (Wiggs & Stores, 1999). SOI in ADHD was demonstrated to co-occur with a delayed dim-light melatonin onset and sleep-wake circadian rhythm, whereas sleep continuity proved unaffected (Van der Heijden et al., 2005). These findings suggest a possible disturbance of the circadian pacemaker which, in turn, would be due...

Therapeutic management and options to address comorbid sleep disorders in ADHD

The majority of subjective report studies indicate increased parental complaints of sleep disturbance in medicated versus unmedicated ADHD children, irrespective of stimulant type or regimen (Cohen-Zion & Ancoli-Israel, 2004). However, objective studies, whether actigraphic or PSG, show overall conflicting results as far as sleep measures, continuity and architecture, major differences going in opposite directions with regard, in particular, to REM sleep (Chatoor et al., 1983 Greenhill et al., 1983) no influence, though, on specific sleep disorders such as SDB or PLMD. risperidone (Reyes et al., 2006) might be employed to counteract conduct behavior disorders as aforementioned several melatonin trials have addressed rhythmicity disorders and SOI, whereas levetiracetam, an anti-epileptic drug with antimyoclonic properties has been employed eihter in ADHD-RLS+ children or to treat DOA, seizures and related IEDs in ADHD children.

Effects on Sleep Quality

Sleep disturbance is common among patients with chronic bronchitis and asthma. Sleep disturbance in children with asthma is associated with psychological problems and impairment of memory (59). Among patients with COPD, 41 reported at least one symptom of disturbed sleep (60), possibly contributing to nocturnal oxygen desaturation, the development of pulmonary hypertension, polycythemia, and cardiac arrhythmias (61,62). A randomized double-blinded study involving 36 patients with moderate to severe COPD showed that ipratropium increased total sleep time, decreased the severity of nocturnal desaturation, and improved the patient's perceptions of sleep quality (63).

Developing good sleep habits

In the first few months, it's common for a pattern to evolve in which a baby is fed and falls asleep in a parent's arms. Many parents enjoy the closeness and snuggling of this time. But eventually this may be the only way the baby is able to fall asleep. When the baby wakes up in the middle of the night, he or she can't fall asleep again without being fed and held. To avoid these associations, put your baby in bed while he or she is drowsy but still awake. If babies fall asleep in bed without assistance when they're first laid down, it's more likely that they'll fall asleep easily after waking in the middle of the night.

Self Help Therapies for Insomnia

This chapter provides the reader with a review of self-help approaches for sleep problems. The primary focus will be on self-help for insomnia. The first half of the chapter will overview the scope of insomnia as a problem in the general and clinical populations. This is followed by a review of current empirically supported methods of assessing and treating insomnia with implications for self-help applications. The second half of the chapter will provide readers with an overview of the empirical evidence on self-help treatment of insomnia. Limitations of this evidence will be discussed along with suggestions for future research. Prevalence of Insomnia Sleep disturbances are very common. In the general adult population, the rate of chronic insomnia is estimated as between 9 and 20 (Ancoli-Israel & Roth, 1999 Ohayon, 2002 Partinen & Hublin, 2000). The variability in prevalence rates is due largely to the inconsistent use of strict diagnostic criteria for defining insomnia. Ohayon...

Sweet Dreams Combating Sleep Disorders

Understanding sleep and its importance for people with fibromyalgia Knowing about sleep stages and their relevance to fibromyalgia syndrome Discovering common sleep disorders for those with fibromyalgia Considering lifestyle changes that enhance sleep Treating sleep disorders with medications and alternative remedies All three have been diagnosed with fibromyalgia syndrome (FMS), although the severity of their disease and how they cope with it are very different for each person. They all share one common denominator, though Juanita, Bob, and Darlene have serious sleep problems, each averaging only about four to six hours of sleep nearly every night. The majority of people with fibromyalgia (at least 55 percent) have sleep difficulties, whether they have trouble getting to sleep in the first place or frequently wake up after falling asleep. (Some people have both problems.) Of course, solving sleep disorders doesn't automatically cure your fibromyal-gia. But in many cases, a good...

Understanding the Importance of Sleep Stages

Experience all the different stages of sleep, ranging from light sleep to deep sleep. Some researchers believe that people with fibromyalgia don't spend enough time in the very deep sleep levels. A lack of quality deep sleep may inhibit an adequate production of important protective hormones that are normally made while we sleep, such as growth hormones and prolactin. Prolactin is the same hormone that's released by nursing mothers (although sleep releases much less of it), but scientists aren't sure exactly what function prolactin fulfills in nonlactating people. In 2001, researchers reported on their study of the nighttime hormone levels of women with and without fibromyalgia in the Journal of Clinical Endocrinology & Metabolism. They found that women with fibromyalgia (who agreed to take no medication during the study) had significantly lower levels of both nocturnal growth hormone and prolactin. This result provides even more proof that fibromyalgia is real It also serves as...

Rapid Eye Movement REM sleep behavior disorder

REM sleep is characterized by a paucity of muscle activity with near complete somatic muscular atonia. REM sleep behaviour disorder is characterized by the intermittent loss of REM atonia due to disinhibition of normally inhibitory mid-brain projections to spinal motor neurons. This, in conjunction with an active dream state, results in behavioural release and the apparent acting out of dreams. Abnormal behaviours include sleep talking, yelling, limb movement, and complex motor activities. Patients with REM sleep behaviour disorder arouse from sleep to full alertness often with complete recall of fearful dream content, which may involve being chased or attacked. The motor behaviour exhibited tends to correlate with dream content. REM sleep periods typically occur in the latter half of the night. The most common symptom at time of presentation is injury of the patient or bed partner. As a result of the behaviors, bed partners often simply move to another bed or room. Also, patients and...

Diagnosis for REM sleep behavior disorder

Until recently, the diagnosis of RBD was based on clinical manifestations, namely the presence of limb or body movements associated with dream mentation and at least one of the following (1) harmful or potentially harmful sleep behaviors during sleep (2) dreams that appear to be acted out and (3) sleep behaviors that disrupt sleep continuity. Polysomnographic observations of patients were not necessary for diagnosis according to the International Classification of Sleep Disorders-1 (ICSD-1). Eisensehr et al. and Gagnon et al. pointed out the limitations of these criteria because one half of the cases of RBD with PD would have been undetected based clinical interviews alone (Eisensehr et al., 2001 Gagnon et al., 2002). RBD-like features can occur with other sleep conditions such as obstructive sleep apnea syndrome (OSAS), sleepwalking, night terrors, and sleep-related seizures (see below 4). In the second version of the ICSD (ICSD-2), PSG findings were required to establish the...

Not enough downtime in deep sleep

Even when you finally fall asleep, you may spend the night tossing and turning in the early sleep stages, and experience an insufficient time in the kind of deep, restorative sleep that your body truly needs. In fact, studies indicate that some people with fibromyalgia suffer from a lack of time in deep sleep. The more you relax (which I know is often not easy ), the more likely you are to achieve a deep, restorative sleep state. Research has shown that, for some people, tricyclic antidepressants, such as Elavil, may help to prolong sleep stages 3 and 4. If tricyclic antidepressants don't work, Prozac (generic name fluoxetine), another type of antidepressant, helps some people. (For more on these medications, check out Taking prescriptions for sleepyland, later in this chapter.)

Estimated Therapeutic and Loael Doses of Melatonin

Melatonin is characterized in this book as an immune stimulant (see Table 1.2), but in addition to immune effects it may also have direct cytotoxic effects against TABLE 22.11 ESTIMATED THERAPEUTIC AND LOAEL DOSES FOR MELATONIN* cancer cells. Therefore, it is interesting to compare doses scaled from animal and human experiments to those calculated from pharmacokinetic and in-vitro data. These doses are in agreement. The required mela-tonin dose from the animal experiments is 10 to 50 milligrams per day, the same as the range used in human studies most of these used 10 to 20 milligrams. The anticancer dose based on pharmacokinetic calculations is similar. As discussed, a 10-milligram dose will produce an average nighttime melatonin concentration of about 14 nM, which is reasonably close to the 1-nM optimal concentration. Under normal circumstances, this 1-nM concentration can be reached in vivo with no external administration of melatonin. Thus pharmacoki-netic calculations suggest...

Sleep Benefit and Sleep Hygiene

Sleep benefit is a common phenomenon of variable duration ranging from 30 minutes to 3 hours in PD and implies improvement in mobility and motor state in the morning and after drug intake at night (98). The mechanism of sleep benefit is unknown, and possible causes include (i) recovery of dopaminergic function and storage during sleep, (ii) a circadian rhythm-related phenomenon, or (iii) a pharmacological response to dopaminergic drugs (7,30). Good sleep hygiene is also useful. Activities such as a hot bath a couple of hours before bedtime, maximizing daytime activity, ensuring bright light exposure, having a hot sweet drink or a light snack at bedtime, use of handrails in bed and or satin sheets to enable easier turning in bed, flexible bed times, a reclining armchair for some, and avoiding stimulants such as tea or coffee at bedtime are part of good sleep hygiene (81). Nocturia remains one of the most common causes of sleep disruption in PD and can be reduced by avoiding diuretics,...

Sleep Disorder Areas

A recent survey on sleep disorders in the general population indicated rates of 56 in the US, 31 in Western Europe and 23 in Japan. About 50 of subjects with sleep disorders had never taken any steps to resolve them and the majority of respondents had not spoken to a physician about the problem.29 The implications of insomnia are a reduced quality of life, decreased productivity and increased absenteeism.30,31 These patients experience significantly more limited activity than those without insomnia and are a greater burden on health services overall, annual costs attributable to insomnia in the US have been estimated between 92.5 billion and 107.5 billion.32,33 As particularly the elderly are affected by sleep disorders, accurate screening and appropriate therapy could improve general health and well-being provided pharmacotherapy is used cautiously and conservatively.34 It is therefore possible for a physician to be asked to treat such disorders with non-conventional methods such as...


Melatonin (N- 2-(5-metho y-l H-indol-3-yl)ethyl acctamide, N-acetyl-5-methoxytrypt-aminc molecular weight 232) contains 12 nitrogen. Function Melatonin, a hormone produced by brain, retina, and pineal gland, participates iti the coordination of sleep patterns, thermoregulation, and possibly reproductive cycles to daylight. Deficiency Inadequacies of nutrients needed for endogenous synthesis may sometimes limit production, possibly contributing to insomnia and sexual dysfunction. Excessive intake Many commercial melatonin preparations have been found to contain potentially toxic contaminants similar to those thought to have caused eosinophil - myalgia syndrome in some users of tryptophan supplements. Other consequences of supplemental intakes of melatonin have not been adequately evaluated. Melatonin is synthesized in brain, retina, and pineal gland. This endogenous synthesis proceeds in steps catalyzed by four enzymes and requires L-tryptophan. biopterin. niacin, vitamin B6,...


In clinical practice, lemon balm is often prescribed in combination with other herbs such as valerian in the treatment of insomnia. As a reflection of this, a randomised, double-blind multicentre study investigated the effects of a commercial valerian and lemon balm herbal combination (Songha Night) in 98 healthy subjects (Cerny & Schmid 1999). Treatment was administered over a 30-day period and consisted of 3 tablets taken half an hour before bedtime, providing a total dose of 1-6 g valerian and 1-2 g lemon balm. Herbal treatment was found to significantly improve sleep quality and was well tolerated. Another randomised, double-blind crossover study found that the same combination of valerian and lemon balm taken over 9 nights was as effective as triazolam in the treatment of insomnia (Dressing et al 1992). The dose used was equivalent to 1.4 g dried valerian and 0.9 g dried lemon balm. As with all herbal combination studies, it is difficult to determine the contribution each...

Deep sleep

During deep sleep, your heart slows down and your breathing becomes regular and relaxed. Your body also releases a small amount of growth hormone, which helps rebuild damaged tissue. Other hormones are also released, such as prolactin and melatonin. If you don't have enough sleep and, consequently, don't spend enough time in deep sleep, the biochemical processes that are supposed to occur are aborted or may not happen at all. This is probably a key reason why the pain is worse for an FMS sufferer who's slept very little. If you have trouble sleeping, one tactic that may help is simulating the breathing of a very deep sleep. Doing so may induce your tired body to slip into a sleep state. Try this Lie down in a comfortable and quiet place. Take in a deep breath and let it out very slowly. Repeat several times. Concentrate only on your breathing and on nothing else. Don't worry about falling asleep, about your fibromyalgia, or work or family problems. Just breathe. Breathing is all that...

REM sleep

The body may release Cortisol in this stage (although cortisol can be released anytime during sleep). Cortisol is a hormone released by the adrenal glands. It controls blood pressure, blood sugar, and other key body functions. Some people with FMS may have overly low levels of cortisol in the daytime, leading to excessive fatigue, and overly high levels at night (causing insomnia). Cortisol production peaks early in the morning, shortly before you awake.

Sleep Disorders

Two general categories of sleep disorders are recognized. Dyssomnias are problems with the initiation or maintenance of sleep, or with sleep that is inefficient. These include common sleep timing problems such as frequent night wakings and difficulty falling asleep at night or difficulty waking in the morning. Dyssomnias also include relatively rare problems such as obstructive sleep apnea (associated with enlarged tonsils and adenoids) and narcolepsy (sudden daytime sleep attacks). Parasomnias occur during sleep but are not associated with insomnia or excessive sleepiness. Common parasomnias in children include head banging or rocking (exhibited by about 58 of children) and nightmares (most commonly of being attacked, falling, or dying). Nightmares are not the same as the rarer sleep terrors, a disorder in which a child, although asleep, appears to be awake and terrified. In sleep terrors, the child is screaming and incoherent with a glassy-eyed stare, profuse sweating, and rapid...

Sleep Problems

Sleep problems take various forms depending on the age of the child. Most parents know when their children are having sleep prob-lems particularly when the children have difficulty falling asleep or are getting up at night. Another sign of sleep disturbance is sleeping too much. If your child usually sleeps ten hours at night but suddenly can't get out of bed in the morning and wants to nap right after school, he or she may be clinically depressed. Your child needs professional help if you have tried to address sleep issues without success.

Some basic neurobiological characteristics of sleepwake cycles

A study conducted by Qiu and colleagues in 2010 presented the main overall neurobiological activity of basal ganglia neurons associated with the sleep-wake state. The differences in firing patterns across the basal ganglia suggest multiple input sources, such as the cortex, thalamus, and the dopamine system, as well as some other intra basal ganglia inputs, such as the globus pallidus-subtalamic nucleus, and striatum-globus pallidus interactions. The largest nucleus striatum of the basal ganglia is mostly comprised of y-aminobutiric acid ergic spiny neurons, whose activity is influenced by excitatory glutaminergic projection from the neocortex and thalamus, and dopaminergic projection from the midbrain ventral tegmental area and other known parts. The striatum receiving cortical inputs projects to the globus pallidus, which then projects to the cerebral cortex directly ore by the thalamus (mainly the mediodorsal thalamic nucleus). It was suggested that the lesion of globus pallidus...

Sleep Apnea Syndromes and neuropsychological disorders

In addition to nocturnal Sleep Apnea Syndrome symptoms there are a lot of daytime symptoms. It is assumed that the reduced sleep quality, arising out of deep sleep or REM- It is also assumed that the OSAS accompanying Insomnia and sleepiness influence cognitive functions (Jennum et al. 1993). As reported by Schwarzenberger et al. (1987) that patients with EDS have complaints and problems in situations of physical rest and during prolonged monotonous concentration tasks. A study by Kales (1985) showed that 76 of OSAS patients have cognitive deficits in the areas of thinking, learning ability, memory, communication and the ability to learn new information. Naegele et al. (1995) were able to establish in Sleep Apnea Syndrome patients that they were reduced at executive functions when these tasks involve the acquisition of information to memory processing. Another study by Cassel et al. (1995) showed that Sleep Apnea Syndrome patients have a reduced non-verbal performance and processing...

Epworth Sleepiness Scale ESS

The Epworth Sleepiness Scale (ESS) of Johns (1991) is very often used as a screening method for detecting the global daytime sleepiness and fall asleep in sleep disorders, especially used in hypersomnias. It is asked retrospectively, how high is the probability to fall asleep in eight everyday situations. The scale has a 4-step response format, in which values between 0 and 3 (0 never to 3 strongly agree) must be marked and results are added up a total maximum value of 24.

Maintenance of Wakefulness Test MWT

Chair or on the bed and will be asked to refrain movements (e.g., grimacing, shaking), which may prevent falling asleep to refrain (Hartse et al. 1982, Mitler et al. 1982). Three to four times a day electrophysiological recordings (C3 A2, C4 A1, EOG and EMG) are recorded in 2-hour intervals of 20 minutes. The earliest start of the first test procedure should be scheduled two hours after waking. As with the MSLT test history is filmed with a video camera. Evaluated will be the sleep latency from the moment light off until the onset of the first two epochs of sleep stage 1 or 2.

Vigilance and attention in patients with Sleep Apnea Syndrome 31 State of research

Proposed relationship between sleep quality and sleepiness-related restrictions during the day Divided attention describes the capacity for serial and parallel information processing and the flexibility of selecting to switch back and forth at least two different sources of information (Sturm and Zimmermann 2000). Relevant stimuli can each occur in one or two sources of information to which the person have to respond as quickly as possible. Divided attention can be measured with dual-task activities (e.g. using the subtest Divided attention of the TAP). As with many sleep-related disorders, such as hypersomnias and dyssomnias, the victims suffer from, in addition to their nocturnal symptoms, increased daytime sleepiness and the tendency to fall asleep (B ttner et al. 2004b). These difficulties are in turn associated with attention-related deficits and limitations (including Gerdesmeyer et al. 1997, M ller et al. 1997, Randerath et al. 1997, 1998, Wee 1997, Wee et al. 1998a b,...

Causes of parasomnias

Parasomnias occur due to abnormal transitions between the three primary states of being wake, rapid eye movement (REM) sleep, and non rapid eye movement (NREM) sleep. These different states may overlap or intrude into one another, and it is the overlap of wakefulness and NREM sleep that gives rise to confusional arousals, and the intrusion of REM sleep into waking that produces REM sleep behaviour disorder (Matwiyoff et al, 2010). Parasomnias may have genetic basis, but occurrence is usually triggered by heavy physical activity, febrile illness, sleep deprivation, excessive caffeine drinks, hypnotics, and emotional stress. Intake of alcohol increased occurrence of confusional arousal, night terror, and sleepwalking, while heavy intake of caffeinated drink increased occurrence of sleep walking in a population study (Oluwole, 2010). Parasomnias usually associated with REM sleep Impaired sleep-related penile erections Sleep-related painful erections REM sleep sinus arrest REM sleep...

Nonergotderived dopamine agonists

Ropinirole acts as a dopamine agonist primarily on the D3 as well as D2 & D4 receptors. It was originally studied in the early 1990s for Parkinson's Disease and later found to be beneficial for RLS. Ondo studied 16 RLS patients in an open-label trial of ropinirole. Three patients discontinued ropinirole use. Of the remaining 13 patients, the average duration of use was 3.9 months and there was a 58.7 improvement in symptoms (Ondo W, 1999). Further studies reinforced the safety and efficacy of ropinirole in RLS. The TREAT RLS 1 study (Therapy with ropinirole efficacy and tolerability in RLS 1) was a randomized, double-blinded, placebo-controlled trial of 12 weeks duration. 146 subjects were randomized to the ropinirole group and 138 to the placebo group. The key endpoint was the IRLS severity score which showed significant improvement in the ropinirole group over the placebo group at week 12 (p 0.0036). The researchers concluded that ropinirole improves RLS compared with placebo and...

Other pharmacological treatments for RLS

A number of other therapies have be evaluated for RLS including opioids, gabapentin and pregabalin, clonazepam, and case reports of melatonin, buproprion, and other agents. Overall, there is a long experience with opioids and those drugs have been especially useful in dopaminergic resistant RLS with augmentation problems. Clonazepam has also been widely used but is not particularly efficacious and now has been largely replaced by dopaminergic agents. In April 2011, the FDA approved extended release gabapentin for use in moderate to severe RLS. This anticonvulsant agent has recently been shown to be beneficial in RLS and may be especially useful when dopamine agents provide incomplete resolution of RLS symptoms and or augmentation issues arise. Please remember that the extended release form of gabapentin gives different concentrations of drug than the shorter acting form. Finally, it is important to note that all epilepsy drugs carry a suicide warning label including gabapentin.

The need for screening and screening methods for RBD

PSG is clearly necessary for establishing the diagnosis of RBD, but the procedure requires appropriate monitoring equipment, including time synchronized video recordings, specially trained technologists, bed availability in a sleep laboratory, and clinicians who can interpret the data. The procedure is costly, especially for patients with limited insurance coverage. Subjects must be willing and able to sleep in a sleep laboratory and undergo monitoring. Some patients with coexisting neurologic disorders are too cognitively or physically impaired to tolerate and undergo an adequate study, are too uncooperative to permit all of the monitoring equipment to remain in place, are at risk for falls during the night, or are institutionalized. RBD cannot be accurately assessed in the home. Due to the limited number of sleep disorder centers in many countries, PSG is not possible even when clearly medically warranted. As it is impractical to perform PSG in large numbers of subjects in...

Mayo sleep questionnaire

Boeve et al. also assessed the validity of the MSQ by comparing the responses of patients' bed partners with the findings (REM sleep without atonia) on PSG. The study subjects were 176 individuals (150 males median age 71 years (range 39-90)) with the following clinical diagnoses normal (n 8), mild cognitive impairment (n 44), Alzheimer's disease (n 23), dementia with Lewy bodies (n 74), and other dementia and or parkinsonian syndromes (n 27). Sensitivity and specificity for question 1 on the MSQ for PSG-proven RBD were 98 and 74 , respectively. They concluded that the MSQ has adequate sensitivity and specificity for the diagnosis of RBD among aged subjects with cognitive impairment and or parkinsonism (Boeve et al, 2011).

RLS and other neurologic disorders

227 Charcot-Marie Tooth disease patients compared to 234 controls with a 5.6 prevalence. RLS severity was correlated with worse sleep quality and reduced health-related quality of life measures. Variation in prevalence was not observed between subtypes of Charcot-Marie Tooth disease, but women were more severely affected by RLS than male patients (Boentert M, et al 2010). A series of 28 patients with Friedreich's Ataxia were surveyed for prevalence of RLS with 32 meeting diagnostic criteria (Synofzik M et al, 2011). In a population of 28 chronic inflammatory demyelinating polyneuropathy (CIDP), a prevalence of 39.3 for RLS was found, compared to 7.1 prevalence in age and gender matched control patients. Isolated case reports of RLS symptomatology following development of hyperparathyroidism (Agarwal P et al, 2008), administration of interferon therapy (LaRochelle JS, et al, 2004), development of multifocal motor neuropathy (Lo Coco D, et al, 2009), and Guillain-Barre syndrome have...

Sleepdisordered breathing disorders in neurological diseases

Generation of respiratory movements (neuromuscular disorders). Vascular damage to the respiratory center may lead to central respiratory disturbances. Neurodegenerative disease can damage the respiratory center (Cormican, 2004), as well as demyelinating lesions (Auer, 1996) located within the respiratory center. Damage of the axons projecting from respiratory center to spinal cord a-motoneurons (cervical spine trauma, demyelinating plaques in multiple sclerosis) can cause respiratory disorders. Damage to the a-motor neurons of the spinal cord (amyotrophic lateral sclerosis, post-polio syndrome) leads to respiratory failure (Aboussouan, 2005). Similarly, peripheral nerve conduction abnormalities (Guillian-Barre syndrome and congenital polyneuropathy) may lead to hypoventilation and respiratory failure. Disorders of the neuromuscular transmission (myasthenia gravis, botulinum toxin poisoning) and primary muscle disorders (myopathies, muscular dystrophy) can cause respiratory disorders....

MSLT and MWT criticism

Although MWT and MSLT are often used in practice, since years there is the assumption that its operationalization does not correspond to the tonic activation. Johns (1998) excludes that the MSLT is suitable as a predictor of daytime sleepiness in everyday situations, regardless how strict are implementation and evaluation standards. Although have the sleep latency on both tests satisfactory correlations as Sangal and colleagues (1992, 1997a) showed in subjects with various sleep disorders (r .41, p < .001) and in Narcolepsy patients (r .52, p < .001). However, the tests clarify maximum of 20-25 of common variance, indicating that the test methods measure different constructs of daytime sleepiness. Reasons for the average correlations according to Sangal et al. (1992) are that patients with pathological MSLT values were able to stay awake in the MWT, while others who fell asleep in the MWT were able to stay awake in the MSLT.

Multiple Sleep Latency Test MSLT

For a long time the MSLT has been considered a gold standard for the investigation of daytime sleepiness (Carskadon et al. 1986). The MSLT (as well as the Maintenance of Wakefulness Test (MWT)) is often used to determine the alertness with expert's investigations, e.g. to assess the driving ability (Poceta et al. 1992). Five times a day electrophysiological recordings (C3 A2, C4 A1, EOG, EMG) are performed in 2-hour intervals. The first time of measurement should be from 1.5 to 3 hours after waking. The patient lies in a darkened room and is asked to fall asleep. During the test procedure, the patient is monitored with a video recording. A pathological fall asleep exists, when the medium sleep latency is < 5 minutes (Richardson et al. 1982). The gray area is between 5-10 minutes and > 10-20 minutes is a normal finding. But are also divergent standard values of 5-8 minutes thereby establishing of normal values is equivalent to a kind of rule of thumb (Guilleminault et al. 1994, van...

Neurodegenerative diseases of the central nervous system and SDB 41 Alzheimer disease

Searching for links between Alzheimer's disease and sleep-disordered breathing has already started in the eighties. Cognitive deficits observed in individuals with SDB was seen as a preliminary stage in the development of dementia. Cognitive deficits in individuals with impaired respiratory function were found on both verbal, spatial and executive functions as well as short-term memory (Naegele, 1995 Alchanatis, 2005). A number of pathomechanisms may contribute to cognitive impairment in patients with respiratory disorders. The important part play episodes of hypoxia and subsequent oxidative stress resulting in impaired cholinergic transmission in the central nervous system (Gibson, 1981 Shimada, 1981). Another pathomechanism may be associated with changes in cerebral blood flow, observed during sleep -significant hypoperfusion after an episode of apnea. Studies using magnetic resonance spectroscopy showed a decrease in metabolism in the frontal lobes in people with severe respiratory...

Sleepdisordered breathing SDB in patients with ischemic stroke

2.1 Sleep-disordered breathing (SDB) as a risk factor for ischemic stroke The first studies concerning the sleep-disordered breathing in patients with ischemic stroke, with a quantitative assessment of respiratory dysfunction, were conducted in the 90s. It was shown that among 47 patients with ischemic stroke 72 have breathing problems during sleep (defined as AHI> 10), 53 of patients in this group have had AHI> 30, and 30 of patients have had AHI > 40 (Good 1996). Mohsenin and Valor (1995) showed that, among patients with ischemic stroke SDB (AHI> 10) occur in 80 of patients. Another studies (Bassetti, 1996, 1997, 1999), conducted on 128 patients with ischemic stroke and 28 in the control group, showed the incidence of SDB (AHI> 10) in 62 of patients with ischemic stroke, compared with 12,5 in the control group. It has been also shown that the incidence of apneas is similar and significantly higher in patients with ischemic stroke and TIA than in the control group...

Sleep and pregnancy

Due to the lack of good longitudinal studies there is still little information on what constitutes normal sleep quality and quantity both during pregnancy and in the period following delivery. In a recent study however Signal et al quantified the change and variability in sleep duration and quality across pregnancy and post-partum in 8 healthy nulliparous and 11 healthy multiparous women (Signal et al, 2007). The women wore an actigraph and completed a sleep diary for seven nights during the second trimester, one week prior to delivery, and at one and six weeks post-partum. They observed that compared to multiparous women, nulliparous women generally had less efficient sleep, spent more time in bed and had greater wake after sleep onset in the second trimester, and spent less time in bed and had fewer sleep episodes a day at one week post-partum. The largest change in sleep however occurred during the first week after delivery with the women obtaining 1.5h less sleep than during...


More than 80 of our patients with sleep disorders showed a tendency of a day night reversal life style, especially in the period right after termination of school social life. An overnight EEG study revealed a decrease in deep NREM sleep and delayed latency of the REM sleep phase (unpublished data). Most of them need about 10 hours sleep to keep awake for the rest of the daytime. These data suggest a deteriorated quality of night sleep. Even though sleep disorders are considered to begin in childhood and adolescents, there have been no in depth reports on this problem. We have studied the hormonal circadian secretion rhythm, such as for melatonin, cortisol and P-endorphin. Each of them showed abnormal behavior, that is, a delayed peak secretion time and a decrease in the secreted amount. As to cortisol secretion in the patients, the area under the curve (AUC) was significantly smaller than in normal controls. In addition, the cortisol peak secretion time was significantly delayed.

Sleep architecture

Confounding factors such as the effect of medications, co-morbid neurological and psychiatric conditions and, above all, primary sleep disorders. In fact, ADHD children could be generally subdivided in children without sleep disorders, probably less than 50 according to most estimates, and children with sleep disorders. Kirov et al. (2004), instead, noticed an increased duration of REM sleep and of the number of sleep cycles in ADHD children compared to controls. Also, REM latency resulted shorter in his subjects as already previously reported by Kahn (1982) and Greenhill (1983), as if a forced REM initiation may have produced a longer REM sleep duration along with an increased number of sleep cycles. A decreased dopaminergic activity in ADHD may be responsible for cortical dysinhibition of the motor frontal cortices, which would in turn result in the forced ultradian cycle of ADHD with REM-increased propensity. Later on, the same group reported an increased REM drive with shorter REM...


UARS is defined as daytime sleepiness associated to a sleep disordered breathing and arousals related to respiratory effort (RERA) but without sufficient apneas hypopneas for OSAS. The diagnosis is based on the association of clinical symptoms and polysomnographic findings. RERA is the most important event in UARS patients. In early studies, the definition of UARS included the presence of frequent arousals, indicating an RERA index > 10 h as a diagnostic criteria. Owing to their relation, treating RERA tends to improve excessive daytime sleepiness. This index was established as a treatment criterion. UARS has not found its way into the International Classification of Sleep Disorders Diagnostic and Coding Manual, which is one of the main problems for the acceptance of UARS as a specific entity (AASM 1999 Iber 2007). RERA has been accepted by the American Academy of Sleep Medicine Task Force (AASM, 1999) but it has yet to be standardized. According to the AASM and a number of authors...


Treatment options for UARS include lifestyle changes, Continous Positive Airway Pressure (CPAP), oral appliance therapy and surgery. All patients with UARS should be counseled about the potential benefits of therapy and the risks of going without therapy. Obesity is a modifiable risk factor associated with OSAS so weight loss should be recommended to all overweight or obese. However, patients with UARS are often not obese, so this recommendation has less value in them. As in the treatment of OSAS, within conservative measures are recommended sleep hygiene and avoiding the supine position. Just like in OSA is advisable to multidisciplinary treatment.


Despite the time elapsed since its initial description, UARS remains controversial as it has yet to be accepted as its own entity. However, the literature continues to reflect interest in this disorder. Perhaps SAHS and UARS share the same pathophysiological mechanism, although their clinical expression and pathophysiologic consequences are different. We could say that UARS and OSAS are distinct entities in the spectrum of sleep-disordered breathing. SAHS is one of the most common sleep disorders in clinical practice. It is associated to cardiovascular morbidity, and has become regarded as a public health problem. UARS is an underdiagnosed disorder with low prevalence of sleep units. It has special implications on sleep structure, especially sleepiness and tiredness, and is associated to chronic somatic diseases such as chronic fatigue syndrome, fibromialgia, irritable bowel syndrome, and tension headache. The correct diagnosis of this syndrome is essential to allow the best choice of...

Materials methods

- Sleep behavior was evaluated through semi-structured ad hoc questionnaire exploring the mean latency of sleep onset (more or less of 30 min), the frequency of nights with nocturnal wake-up (< 2 or > 3 nights month) and the subjective perception of sleep quality (satisfied not-satisfied).


The analysis of sleep behavior in different groups showed that migraineurs took more time to fall asleep and awake more frequently during night with a reduced global sleep satisfaction. In conclusion, if compared to controls, migraineurs seem to sleep worse but to breathe better. However, the hypothesis that there is an allostatic function of migraine and allodynia could also be made the presence of these conditions might inhibit deep sleep, and thus avoid prolonged apneas. The observation that allodynic patients complain of a poor subjective satisfaction by sleep with frequent awakenings and difficulties in starting sleep may be the time when an allostatic load (episodic migraine) becomes an allostatic overload (allodynic migraine), or it may correspond to a further allostatic adjustment to maintain an equilibrium migraine is sufficient until the metabolic unbalance is such, that allodynia is needed. Allodynia is more frequently observed among subjects with chronic transformed...

SDB in epilepsy

Synchronization of brain bioelectrical activity, triggered by physiological stages of sleep (Gigli, 1992). The phases of sleep in which there is greatest risk of seizures include the phases associated with a higher probability of awakening - mainly phase I and II NREM sleep type. Phase of sleep associated with EEG desynchronization - REM is characterized by a lower risk of seizures. The probability of awakening during sleep increases the risk of seizure in the case of idiopathic generalized epilepsies (Bonakis, 2009). A similar mechanism was proposed in focal and secondarily generalized seizures (Manni, 2005). Also in these types of epilepsy light sleep phase (I and II NREM) may initiate abnormal synchronous epileptic discharges. The EEG patterns associated with arousal (K complexes) trigger pathological EEG hypersynchrony in the second phase of NREM sleep. Seizure during sleep is associated with the interruption of the continuity of sleep and disorder of its architecture. Seizure,...

State of research

Jenkins & Dallenbach (1924) could show for the first time that learning tasks which are presented before sleep could be keep better than tasks that are presented before wakefulness. This was confirmed in other studies (Hennevin et al. 1995, Smith 1996). The discovery of REM sleep (Dement & Kleitman 1957) was the start for a more specific research program in which certain stages of sleep each were assigned specific roles for the memory processes. As follow on one hand, REM sleep, was attributed partly memory-favouring effects because of its particular physiological changes, on the other hand, as well as the Slow Wave Sleep (SWS) was attributed the same effects (Hobson & McCarley 1977, Crick 1983, Wilson & McNaughton, 1994, Karni et al. 1994, Squire & Alvarez 1995). One of the studies on cognitive deficits in the thinking, memory, communication and the ability to learn new information in OSAS patients comes from Kales (1985). In this study 76 of OSAS patients show...


In the western and eastern industrial countries, the number of sleep disturbed subjects increased over the time. Undiagnosed and untreated, sleep disorders caused on one hand often by subjective suffering among those affected individuals and on the other hand, due to decreased attention and increased daytime fatigue or daytime sleepiness, to an increased risk of accidents in road traffic and workplace (e.g. Peter et al. 1995, Gerdesmeyer et al. 1997, Randerath et al. 1997, 1998, B ttner et al. 2000a b). These performance restrictions or impairments affect the affected subjects, both professionally and in their ability to drive motor vehicles (Findley et al. 1988a b, 1989b, 1990, 1991, 1995, Mitler et al. In 1988, Cassel et al. 1991a b, 1993, 1996 , ATS 1994, Gerdesmeyer et al. 1997, Krieger et al. 1997, Randerath et al. 1997, 1998, 2000, Wee 1997, Wee et al. 1998a b, B ttner et al. 2000a b, B ttner 2001). Consequences of this reduced performance are therefore often accidents or nearly...


Generally parasomnias, particularly those that are associated with non-REM sleep are commoner in childhood, but studies showed that non- REM parasomnias are not uncommon in adults. Parasomnias have been reported in approximately 4 of the adult population (Ohayon et al., 2000). Nightmares are frightening dreams that usually awaken the sleeper from REM sleep. Between 10 and 20 of children experience nightmares that disturb their parents while 50 of adults have occasional nightmares and 1 have one or more nightmares per week. Sleepwalking occurs more frequently in children with an estimated prevalence of up to 40 per cent in this age group. Prevalence among adults is about 4 per cent. Prevalence of RBD is estimated to be about 0.5 per cent13. REM sleep behaviour disorder tends to affect older adults, with a mean age of onset of 50 to 60 years, predominantly affecting males.


It affects mostly children aged 6-12 years, and episodes occur during stage 3 or stage 4 sleep in the first third of the night and in REM sleep in the later sleep hours. Despite widespread prevalence of these disorders and the recognition that they may arise from incomplete arousal, their pathophysiology is not well understood. Evidence for a strong genetic background of sleepwalking was shown in epidemiological surveys as in twin studies. Further evidence for heredity of sleepwalking is documented by the 10-fold increased prevalence of sleepwalking in relatives of patients suffering from sleepwalking. Sleepwalking in elderly people may be a feature of dementia. Idiosyncratic reactions to drugs (eg, marijuana, alcohol) and medical conditions (eg, partial complex seizures) may be causative factors in adults. During an episode of sleepwalking, a person may appear agitated or calm and behaviour may range from simple ambulation with a glassy stare to more complex activities such as...


Nightmares are vivid nocturnal events that cause feelings of fear and terror, with or without feeling anxiety. In most cases, a person having a nightmare will be abruptly awakened from REM sleep and is able to give a detailed account of what he dreamt about. Also, the person having a nightmare has difficulty returning to sleep. Episodes typically occur in the latter half of the night. Following the awakening, the individual becomes fully alert and profoundly anxious. There is vivid recall of the preceding dream as well as difficulty returning to sleep. Compared to sleep terrors, there is less autonomic activation, and tachycardia and tachypnea, if present, are not as severe. Episodes can be precipitated by

Treatment options

Relaxation training and guided imagery may be helpful strategies for some patients, especially those with disorders of arousal or rhythm movement disorders. When the events are frequent or particularly dramatic, medication with a long- or medium-acting benzodiazepine, such as clonazepam, at bedtime is effective therapy in most cases of non-REM disorders of arousal and REM sleep behavior disorder. In non-REM disorders, pharmacologic agents that have been used with some success include paroxetine and trazodone and low-dose benzodiazepines. Typically, medication should be used in combination with nonpharmacologic treatments after such techniques have been tried and found to be ineffective and only when the sleep disorder is affecting daytime function.


Sleep and Pregnancy Sleep Deprivation, Sleep Disturbed Breathing and Sleep Disorders in Pregnancy 1 Sleep Disorders Diagnosis and Management in Children with Attention Deficit Hyperactivity Disorder (ADHD) 31 Elemental Mercury Exposure and Sleep Disorder 47 Sleep-Disordered Breathing in Neurological Diseases 95 Chapter 12 Screening Methods for REM Sleep Behavior Disorder 181 The chapters in this book reflect leading edge ideas, reflections and observations. Even though the modern era of sleep research evolved from Aserinksky's observations of rapid eye movements in the sleep of babies, most work is nonetheless done in adults. There is much less formal work done in youngsters and virtually none in utero and pregnancy itself is virtually unexplored. So, Dr Miller et al's chapter reviewing sleep in pregnancy is particularly welcome as it incorporates current thinking in how disordered sleep impacts other adult pathological processes. Dr Tomoda and Dr Yamakazi's data-driven chapter on...

Other parasomnias

Sleep bruxism is the third most common parasomnia and it can be bothersome to the bed partner. Bruxism is not a dangerous disorder. However, it can cause permanent damage to the teeth and uncomfortable jaw pain, headaches, or ear pain. Approximately 8.2 of people experience it at least once a week. Sleep apnea and anxiety disorders are the most prominent risk factors for bruxism. Bruxism could be a reflex to open the airway after an apneic or hypopneic event. Bruxism may improve with treatment of sleep apnea with continuous positive airway pressure. Sleep bruxism does not have a definite cure. The goals of treatment are to reduce pain, prevent permanent damage to the teeth, and reduce clenching as much as possible. Stress reduction, relaxation, biofeedback, hypnosis and improvement of sleep hygiene have been tried with no persistent or significant improvement. To prevent damage to the teeth, mouth guards or appliances (splints) have been used since the 1930s to treat teeth grinding,...


Although OSAS and UARS share common symptoms, in most cases the clinical manifestations are different (Stoohs 2008). The most common symptoms of SAHS patients include chronic loud snoring, excessive daytime sleepiness, personality changes, depression and deterioration of quality of life (Pichel 2004). Hypersomnolence is the principal daytime manifestation of sleep disordered breathing. Excessive sleepiness resulting from increased breathing effort and sleep disruption is the guide symptom of UARS patients (Guilleminault 1993, 2001a). Drowsiness related to general exhaustion has a negative impact on quality of life. As in OSAS, snoring is a common symptom, predominantly in males, although the absence of snoring has also been described in this syndrome, the so-called silent UARS (Kristo 2005). In recent years, several studies have demonstrated strong associations between UARS and functional somatic syndromes, such as chronic fatigue syndrome, chronic insomnia, chronic pain, irritable...


A lack of sleep is known to affect both our physical and mental health. The few studies that have investigated sleep in pregnancy have found both an increase in total sleep time and an increase in daytime sleepiness in the first trimester whereas the third trimester appears to be associated with a decrease in sleep time and an increase in the number of awakenings. Sleep has an important impact on maternal and foetal health. It has been associated with an increased duration and pain perception in labour, with a higher rate of caesarean delivery and with preterm labour. Some pregnant women develop sleep disorders such as RLS or OSA or insomnia and others develop postpartum depression. Longitudinal studies are required to fully evaluate the effect of sleep deprivation on maternal and foetal outcome.

ADHD and sleep

Items more often referred to by subjective studies on sleep and alertness in ADHD include (Cortese et al., 2006) bedtime resistance, sleep onset insomnia, night awakening, sleep duration, restless sleep, parasomnias, problems with morning awakening, sleep disordered breathing (SDB) excessive daytime sleepiness (EDS). No major differences between adolescents with ADHD and controls were detected (Mick et al., 2000) after excluding confounding factors such as medications and psychiatric comorbidity. As for ADHD children, significantly over reported by comparison with controls were EDS (Marcotte et al., 1998, Owens et al., 2000), whether or not sleep disordered breathing (SDB) related, movements during sleep (Corkum et al., 1999, Owens et al., 2000). Also a longer sleep duration with increased night awakenings and parasomnias were observed upon comparison with controls (Owens et al., 2000). Despite the fact that bedtime resistance and sleep onset insomnia did not come across as...

Sleep nasendoscopy

Drug induced sleep is different from natural physiological sleep but one could argue that the drug used for sedation has the same effect on the different segments of the pharynx thus it would allow us to compare the proportionate obstruction caused at each anatomical level in a similar manner that may exist in natural sleep. early, the muscle relaxation effect of the drug may be over emphasised and if the patient is assessed too late then important anatomical aspect of the obstructive episodes may be missed. Thus the depth of sedation during which the assessment is conducted should be as close to the levels of depth of natural sleep. Evaluation only occurs as a snap shot of a patients whole sleep cycle. However, combining it with BIS values of patients undergoing natural sleep allows a more accurate assessment of sleep disordered breathing. Finally, a couple of studies have compared awake assessment with SNE in the same group of patients and advocate that SNE is superior further...

Plant Part Used Chemical Components

It has been shown that dietary melatonin directly contributes to the circulating level of the hormone. The clinical effects of plant-derived melatonin remains to be investigated (Hardeland & Poeggeler 2003). Baicalin itself is poorly absorbed from the gut, but is hydrolysed to its aglycone, baicalein, by intestinal bacteria and then restored to its original form from the absorbed baicalein in the body (Akao et al 2000).

Your body during weeks 5 to

The second month of pregnancy brings enormous changes for your body. It's the time you're likely to begin experiencing most of the major discomforts and annoyances of early pregnancy, such as nausea, heartburn, fatigue, insomnia and frequent urination. But don't let these get you down. Consider them as signs that your pregnancy is proceeding smoothly. A recent study, in fact, found that women who experience pregnancy-related signs and symptoms by their eighth week were less likely to have a miscarriage.

How your body is changing

Hormone production is continuing to increase this month. This increase is likely resulting in some unpleasant signs and symptoms. You might be experiencing nausea and vomiting, breast soreness, headaches, dizziness, increased urination, insomnia and vivid dreams. Nausea and vomiting may be the most significant hormone-related change you've experienced since last month.

Fightor Flight Response

The hormone melatonin induces sleep, but serotonin is involved in dreaming both are produced in the pineal gland. If the brain has low serotonin levels, dreaming will not occur. Serotonin is also important in learning, memory, and mood. It is deficient in the brains of depressed patients. Serotonin deficiency can result in an inability to fall asleep at night, panic attacks, loss of concentration, and thoughts of suicide or attempted suicide. Melatonin (5-methoxy-N-acetyltryptamine) is produced from tryptophan by the pineal gland, retina, and gastrointestinal tract, and it is bound by melatonin receptors. Nobel Prize laureate Julius Axelrod discovered the role of melatonin and the pineal gland in regulating sleep-wake cycles (circadian rhythms). Production of melatonin by the pineal gland is stimulated by darkness and inhibited by light. Melatonin inhibits secretion of luteinizing hormone and follicle-stimulating hormone from the anterior pituitary gland. of patients who are...

Apparent Life Threatening Events

In addition to the above types of apnea, the cessation of breathing also can occur in connection with Apparent Life-Threatening Events (ALTEs). An ALTE itself is not a sleep disorder but an event that is a combination of apnea, change in color, change in muscle tone, choking, or gagging. Most ALTEs can be frightening to see, but they usually are uncomplicated and do not recur. However, some ALTEs (especially in young infants) are associated with medical conditions such as gastroesophageal reflux (GERD), infections, or neurological disorders. These medical conditions require treatment, so all children who experience an ALTE should be seen by a doctor immediately.

Dosage And Administration

Amobarbital may be given orally, intramuscularly, or intravenously for the treatment of insomnia or anxiety. The adult dosage for sedation is 15 to 50 milligrams but 65 to 200 milligrams for sleep. For treating convulsions, the adult dose is 65 to 200 milligrams, with a maximum dose of 500 milligrams.

Making Lifestyle Changes Pulling Yourself into a Non Fibro World

Improve your sleep to decrease your pain. Don't kid yourself. Five or even six hours of sleep each night aren't enough. So, if insufficient sleep is a problem for you, as it is for many people with fibromyalgia, face up to it. You may need medication (such as a sleep aid or an antidepressant or anti-anxiety medicine), an alternative remedy (such as valerian or melatonin), or another form of treatment to solve this no- or low-sleep problem that you're going through. Read Chapter 14 for some ideas on how to resolve sleep problems and help yourself feel better.

Ephedra Ephedra SiNiCA

No published studies to date exist supporting the use of either ephedra or herbal caffeine individually for weight loss. One study of combination product Metabolife-356 (containing ma huang and guarana) has shown significant effects of a combination of these two herbs on body weight, with a loss of 4.0 kg in the treatment group vs. 0.8 kg in the placebo group (p < 0.001) (34). This study was limited owing to a small sample size, short-term outcomes, and a high dropout rate, primarily secondary to cardiac side effects (e.g., palpitations, hypertension, chest pain). Additionally, Metabolife-356 contans a number of other ingredients (including chromium picolinate), whose effects on weight loss are unclear. Another study by the same principal investigator looked at the effects of a combination of ma huang and kola nut on obese individuals. In this 6-month study, significant improvement in body weight and lipid profiles was seen (35). Blood pressure changes, increased heart rate,...

Early Use In The United States

Amphetamines were initially synthesized in 1887, with methamphetamine being developed approximately thirty years later. The rise in the popularity of the amphetamines parallels that experienced during the introduction of cocaine. Exaggerated publicity and fallacious claims about amphetamines, combined with medical optimism concerning potential uses and a lack of understanding of abuse, contributed to a dramatic increase in public interest in amphetamines. In 1933, Central Nervous System stimulant actions of amphetamines were reported, about the same time that reports of their effectiveness in treating narcolepsy and Parkinson's disease were released. When the American Medical Association (AMA) approved the use of amphetamines for these disorders, a mild warning was added that ''continuous doses higher than recommended'' might cause ''restlessness and sleeplessness,'' but physicians were assured that

Selecting the Instrumentation to Evaluate the QoL in Clients with Dementia

Ultimately, the instruments chosen were the QUALID and the Cornell Scale for Depression in Dementia. QUALID was developed in the Department of Psychiatry at the University of Texas Southwestern Medical Center to assess the effects of treatment on QoL in people with severe dementia. It consists of 11 observable behaviours rated for the previous week on a five-point Likert scale by interview with a caregiver. It also includes two questions for the interviewer to rate the quality of the information. A sum score of responses indicates relative well-being in a range 11-55, with lower scores representing higher QoL. Although relatively new and untested, the scale was appropriate for our use and was well received during the pilot testing. The Cornell Scale for Depression in Dementia is completed by an interviewer and includes both the responses of the client and a relative or care person who knows the client well, and based on the week prior to interview. Responses use a three-point scale...

Recommended Treatment for ADHD

The primary reason, however, that parents oppose the use of medication is because of possible side effects. Some children experience weight loss, lose their appetite, or have difficulty falling asleep. Together, parents and doctors should consider the benefits and concerns when making a decision about medication.

Augmenting Standard CT for Depression

Adapting standard CT for depression with supplemental interventions generally proceeds in one of two directions. First, a therapist might use additional clinical techniques in targeting other problems in a sequential fashion. For example, a clinician working with a patient who presents with comor-bid depression and a substance use disorder might first decide to treat the depression, then the substance use disorder, in a sequential fashion. In deciding upon the order of treatment, the clinician may want to begin with the problem that is most distressing to the patient. Another approach to sequencing of treatment strategies is to begin with the problem that is seen as primary (i.e., occurring prior to other problems) and subsequently moving to secondary problems once the primary problem is successfully treated. For example, if a patient has developed an addiction to a medication prescribed to help with insomnia he she experiences as part of depression, it may be most useful to treat the...

Rapid Eye Movement Behavior Disorder and Restless Legs Syndrome

The treatment of choice for RBD is clonazepam, a benzodiazepine, although the mechanism is unknown and there are no controlled trials (13). Other drugs thought to be helpful for RBD include pramipexole, levodopa, carbamazepine, donepezil, and melatonin (64,89-91). Caution needs to be exercised with the use of clonazepam, as in some cases, RBD may be confused with sleep apnea, which can be worsened by clonazepam. Nighttime dosing with drugs such as selegiline may aggravate RBD. Others have reported a paradoxical worsening of RBD with deep brain stimulation (DBS) of the subthalamic nucleus (STN) (92).

Valerian Valeriana Officinalis

Insomnia is a common sleep problem throughout the world. Many available prescription medications for insomnia are associated with significant side effects including daytime somnolence and dependence. The search for a more natural and safer hypnotic has stimulated many patients to turn to herbal products such as valerian root. Although it has been used for centuries, its mechanism of action, as well as the constituents of the plant responsible for its activity, is not well defined. As with a number of other herbs, comparison of clinical studies is difficult owing to differences in product content, preparations, and sample size. One randomized, double-blind, study of 4-week duration suggested significant improvements in sleep efficacy in patients with insomnia (112). Similar beneficial effects were found in another small study using a different com pound. Sleep latency and quality were noted to be significantly improved with valerian compared to placebo (113). A more recent study...

We Didnt Take Any Preventive Measures

My lungs haven't got back to normal and I still feel tight in the chest. I suffer from a bad insomnia most nights I can only sleep for a couple hours. My muscles are so weak I can hardly lift anything, and my eyes are swollen and red. But the thing that disturbs me the most is my right leg. I can't walk, can't even move the leg without feeling an excruciating pain in my joints. I used to be very active, very physical.6

How can I improve my symptoms of GERD

Immediately after you eat something, your body produces the greatest amount of acid for digestion of that food. Anytime you lie flat stomach acids can reflux into the esophagus. To reduce GERD symptoms, avoid eating late at night or wait at least 2 hours after you eat before you lie down. By coordinating your sleep habits and eating habits, you can allow ample time for the acid and food to pass through the stomach and can minimize reflux.

Effects On The Body And Therapeutic Uses

Barbiturates affect all excitable tissues in the body. However, NEURONS are more sensitive to their effects than other tissues. The depth of central nervous system depression ranges from mild sedation to coma and depends on many factors including which drug is used, its dose, the route of administration, and the level of excitability present just before the barbiturate was taken. The most common uses for the barbiturates are still to promote sleep and to induce anesthesia. Barbiturate-induced sleep resembles normal sleep in many ways, but there are a few important differences. Barbiturates reduce the amount of time spent in rapid eye movement or REM sleep a very important phase

Tolerance Dependence And Abuse

If tolerance develops and the amount of drug taken continues to increase, then PHYSICAL DEPENDENCE can develop. This means that if the drug is suddenly stopped, the tissues' compensatory effects become unbalanced and withdrawal signs appear. In the case of barbiturates, mild signs of withdrawal include apprehension, insomnia, excitability, mild tremors, and loss of appetite. If the dose was very high, more severe signs of withdrawal can occur, such as weakness, vomiting, decrease in blood pressure regulatory mechanisms (so that pressure drops when a person rises from a lying position, called orthostatic hypotension), increased pulse and respiratory rates, and grand mal (epileptic) seizures or convulsions. DELIRIUM with fever, disorientation, and HALLUCINATIONS may also occur. Unlike withdrawal from the opioids, withdrawal from central nervous system depressants such as barbiturates can be life threatening. The proper treatment of a barbiturate-dependent Many barbiturate users become...

Effects on the Central Nervous System

A dose-dependent delay in sleep onset is found as well as a decrease in total sleep time and an impairment of sleep quality characterized by an increased number of spontaneous awakenings and body movements. In premature infants, sleep organization appears to be unaffected by treatment with 5mg kg day caffeine to prevent apnoea.

Benzedrinebenzedrine Inhalers See Amphetamine Epidemics

For the treatment of anxiety and sleep disorders. Members of this class of drug were classified initially as minor tranquilizers although this term has fallen into disfavor. These agents have proven to be safe and effective alternatives to older SEDATIVE-HYPNOTIC agents such as BARBITURATES, CHLORAL HYDRATE, glutethimide, and carbamates. Benzodiazepines are widely prescribed drugs, with 8.3 percent of the U.S. population reporting medical use of these agents in 1990.

Presentday Cultivation And Usage

A concoction of seeds in hot water is used as a carminative, antiseptic, diuretic and digestive, and as a folk remedy for insomnia and constipation (Bisset, 1994). Several therapeutic effects, including for digestive disorders, gynecological problems and dyspnea, as well as anticonvulsant and anti-asthma effects were described for the seeds of Pimpinella anisum L. in ancient medical books (Aboabrahim, 1970). Aniseeds possess expectorant, antispasmodic, carminative, and parasiticidal properties. In traditional medicine, the drug is used internally for bronchial catarrh, pertussis, spasmodic cough, and flatulent colic, and externally for pediculosis and scabies. Furthermore, it is used as an estrogenic agent. It increases milk secretion, and promotes menstruation (Barnes et al., 2002) (Figure 20.2).

Tolerance And Physical Dependence

PHYSICAL Dependence results from adaptive changes in the nervous system that may be related to the development of tolerance. Dependence of this sort can be detected by the appearance of a characteristic abstinence or WITHDRAWAL syndrome when chronic administration of a drug is either abruptly discontinued or after the administration of an antagonist to the drug that has been taken for a prolonged period of time (Ciraulo & Greenblatt, in press). Individuals who are treated chronically with benzodiazepines may exhibit signs and symptoms of withdrawal when the administration of these drugs is discontinued. Minor symptoms of withdrawal include ANXIETY, insomnia, and nightmares. Less common and more serious symptoms include psychosis, death, and generalized seizures. Signs of withdrawal may become evident twenty-four hours after the discontinuation of a benzodi-azepine that is rapidly eliminated from the blood. Peak abstinence symptoms may not appear until two weeks after...

How Much Are They Used

Izers but that a large group of long-term users is accumulating. People starting tranquilizers have at least a 10 percent chance of going on to long-term use, that is for more than 6 months. Some of these chronic users have chronic medical or social problems, and the tranquilizer blunts the unpleasant feelings of tension, anxiety, insomnia and, to a lesser extent, depression.

Side Effects Versus Main Effects

There are more subtle side effects of benzodiaze-pines, effects that interfere in various ways with the treatment of the anxiety or sleep disorder. The ben-zodiazepine lessens the symptom but does not alter the underlying problem say, an unhappy marriage or a precarious job. Indeed, by lessening the symptoms, the individual may lose his or her motivation to identify, confront, and tackle the basic problems. Giving benzodiazepine medicalizes the problem by making the nervous or sad person into a patient, implying that there is something physically wrong. Finally, some events like bereavement need ''working through'' typically by grieving but benzodiazepines can stop this normal process

Longterm Effects Of Benzodiazepines

It is not clear whether benzodiazepines and hypnotics continue to be effective after months or years of daily use. Undoubtedly, many patients believe that they continue to benefit in being less anxious, or in sleeping better. The effect of the drug may be more to stop the anxiety or insomnia that follows withdrawal, however, than to combat any continuing, original anxiety. Most of the side effects lessen over time, a process known as tolerance. Some impairments, however, such as memory disturbances, may persist indefinitely, but patients usually come to terms with this for example, by resorting to written reminders.

Alternative Medicines and Therapies

Alternatives to conventional medical care are increasingly popular in the United States, and their growing use by consumers represents a major trend in Western medicine. Alternative therapies appear to be used most frequently for medical conditions that are chronic, such as back pain, arthritis, sleep disorders, headache, and digestive problems. Surveys of U.S. consumers have shown that more people visit alternative practitioners each year than visit conventional primary-care physicians. Consumers do not necessarily reject conventional medicine, however. Many simply feel that alternative modalities offer complementary approaches that are more in line with their personal health philosophies.

How To Minimize And Manage The Different Types Of Fatigue

Normal fatigue in people with MS can be managed by getting adequate rest at night and by napping at strategic times during the day. If you are experiencing insomnia, talk to your physician about medications that will help you sleep. In addition, training programs are available to help you relax and sleep. Many of these programs are offered through local medical centers and may require a referral from your physician. If sleep deprivation is caused by frequent awakening to urinate (nocturia), bladder management should be pursued with your physician. Bladder management strategies are discussed in Chapter 7 in this book, and will assist those of you experiencing problems with elimination to have adequate rest and sleep. In addition, there has been recent evidence that MS can cause sleep disturbance. Therefore, it is important that you discuss your concerns with your physician for appropriate management.

Your emotions during weeks 29 to 32 Conquering anxiety

The anxiety or even the natural anticipation you're feeling about your baby's arrival may be making it difficult for you to get to sleep or sleep through the night. If you're feeling restless or anxious at night, try some of the relaxation exercises you've learned in childbirth classes. They may help you get some rest, and doing them now will be good practice for the big event.

Early Effects Of The Diagnosis And Initial Treatment On

There is also consensus regarding a third set of findings from this literature on early effects of diagnosis and treatment with regard to the physical realm. These include menstrual changes and menopause, infertility, sleep problems, lymphedema, pain, problems with physical and recreational activities, and weight gain and reduced energy.15,18,30,32-40 Ganz found nearly identical rates of arm problems 2 and 3 years posttreatment related to the initial surgical procedure (numbness, tightness and pulling in the arm, and intermittent mild pain).30 Other early effects are energy reduction, decreases in physical functioning, and symptom distress as found in our early study of Hodgkin's disease.28 Sexual, urinary, and bowel function changes are specific to prostate cancer.29

Autonomic Nervous System Dysfunction

The goal of these two branches is to maintain equilibrium in many instances that range from life-threatening stress to deep sleep. Reactivity in the ANS is sometimes referred to as fight or flight. The actions of the two branches of the ANS are determined by neurotransmitters (body chemicals originating in nerve cells and used to relay signals). Important neurotransmitters include adrenaline (also called norepinephrine, a stress hormone), which is the predominant

What Types of Medications are Used to Treat Bipolar Disorder

Drugs often are classified according to the purpose for which they first got approval for use in the United States. Although many drugs are found to have a variety of uses in addition to this first use, the original name sticks. Because of this, doctors often use drugs classified as antidepressants to treat anxiety and drugs called anxiolytics to treat insomnia. For this reason, it is extremely important for you to know the purpose of a medication, not just its name. It helps to try to have a sense of humor with the well-meaning people who may question your medications because they take these classification terms at face value. For example, a family member may wonder why you are taking a medication for anxiety when you have bipolar disorder. Similar questions about your medication may arise when you pick up your medications at the pharmacy, when you share the names of the medications with your friends or family, or even when you see your primary care physician. When there are...

Lack of Restorative Sleep and the Possible Roles of Substance P and HPA Axis

Scientists theorize that Stage-4 sleep is critical to good nervous system function, because it is during that time the body releases needed neurochemicals. Deep sleep is thought to be critical in resetting levels of the neuropeptide Substance P, which is a key transmitter of pain to the brain. People with FM lack slow-wave sleep and often experience other factors that interfere with Stage-4 sleep such as pain, depression, anxiety, lack of serotonin, and RLS. According to the sleep disturbance hypothesis, a trauma or illness that causes sleep disturbance might trigger FM. Remember that chemical pain processing can be viewed as two opposing forces. The first process involves chemical messages sent to the brain that are interpreted as pain, and the second is a chemical response from the brain that attempts to inhibit the pain message. Pain sensations travel from the periphery to an area of the spinal cord called the dorsal horn, where the release of any chemicals, including Substance P,...

Detection and Assessment

The DSM-IV diagnostic criteria for major depression includes the persistent presence of five of the following nine symptoms anhedonia, depressed mood, diminished ability to think or concentrate, fatigue or loss of energy, feelings of worth-lessness or inappropriate guilt, insomnia or hypersomnia, psychomotor agitation or retardation, recurrent thoughts of death, and significant weight gain or loss (36). However, because several of these symptoms overlap with features of PD, the assessment of depression in patients with PD is not always straightforward. This is highlighted by a study demonstrating that anergy, early morning awakening, and psychomotor retardation are common and similarly frequent in both depressed and nondepressed patients with PD (105).

Pathophysiology of Psychosis and Risk Factors

The presence of dementia, advancing age, impaired vision, depression, sleep disorders, and longer disease duration have all been associated with the development of drug-induced psychosis (15,45-48). Although psychosis has been reported to occur with all of the antiparkinsonian medications (22-25), the dopamine agonists are more likely to cause psychosis than levodopa (49,50). The duration or dose of antiparkinsonian drug therapy, however, has not been found to be associated with an increased risk for psychosis (45,51,52).

Applications To Health Promotion And Disease Prevention

Elettaria cardamomum seed extract is one of the ingredients of the polyherbal formulation for treating the dementia of Alzheimer's disease (Aaishwarya et al., 2005).The extract is also used in herbal combinations utilized in the treatment of anxiety, tension, and insomnia (Prema-latha & Rajgopal, 2005). An in vivo study of an ayurvedic formulation containing cardamom as one of the ingredients shows that the formulation has CNS-depressant and anticonvulsant activity in mice (Achliya et al., 2004). A multi-ingredient herbal formulation with Elettaria cardamomum as one of the ingredients is found to be useful in the treatment of sore throats (Prakash, 2001). Cardamom is one of the ingredients of a Tibetan herbal formulation that was found to inhibit cell proliferation accompanied by the accumulation of CEM-C7H2 cells in subGl phase, fragmentation of poly (ADP-ribose) polymerase (PARP), and nuclear body formation (Jenny et al., 2005). The volatile oils from Elettaria cardamomum are...

Baby Bottle Tooth Decay

This often happens when infants or toddlers fall asleep while sucking on a bottle. Breastfed infants are usually not at risk, unless they feed for extended periods. The carbohydrates in the drink (lactose in milk, or fructose in fruit drinks) mix with the normal bacteria in the mouth. This bacteria is found in the plaque on teeth and gums. When plaque mixes with carbohydrates, acids are formed that dissolve tooth enamel, causing tooth decay and dental caries. To prevent baby bottle tooth decay, a child should not be put in bed with a bottle and the bottle should be taken away as soon as mealtime is over. Further, only formula or water should be put in a bottle juices and sweet drinks should be offered in a cup. see also Infant Nutrition Oral Health.

CT for Residual Symptoms

Cognitive restructuring follows the classic format of Beck et al. (1979 Beck & Emery, 1985) and is based on introduction of the concept of automatic thoughts (Session 2) and of observer's interpretation (Session 3 and subsequent sessions). The problems that may be the object of cognitive restructuring strictly depend on the material offered by the patient. They may encompass insomnia (sleep hygiene instructions are added), hyper-somnia, diminished energy and concentration, residual hopelessness, reentry problems (diminished functioning at work, avoidance and procrastination), lack of assertiveness and self-care, perfectionism, and unrealistic self-expectations.

Anxiolytic Antianxiety Medications

Anxiety is a problem that very frequently accompanies episodes of depression or mania. In addition, sleep problems are common in depression, hypomania, and mania. Within the anxiolytic class, the most anxiety and sleeplessness in bipolar disorder. In addition, the benzodiazepines may be used to help control some of the early symptoms of hypomania. All benzodiazepines have the potential to cause physical and psychological dependence or addiction. The potential for abuse seems to be greatest with drugs that produce a quick effect and that are quickly removed from your blood stream, such as alprazolam (Xanax). The potential for abuse seems to be least with benzodiazepines that have a slower effect and spend a longer time in your blood stream, such as clonazepam (Klonopin).

Lifestyle Modification

One of the aims of therapy is also to make the patient aware of allostatic loads (i.e., chronic and often subtle life stresses that exert harmful consequences on the individual over a certain amount of time). Examples may be excessive work loads, lack of awareness of the longer time that increasing age requires for recovering from demanding days, inability to protect oneself from requests that exceed one's potential, and inappropriate sleeping habits. Such awareness (and the resulting lifestyle implementation) is pursued in all phases of psychotherapy, but particularly with WBT. Patients are given instructions in the diary as to this implementation. For instance, patients are encouraged to modify their work overcommitments, to refuse inappropriate requests from relatives and colleagues, and to dedicate more time to pleasurable activities.

Substance Abuse And Mood Disorders

Nearly all substances of abuse have the potential to alter mood symptoms. Classically, Psychostimulants, such as Amphetamines and COCAINE, may induce an appearance of elevated mood, racing thoughts, increased energy, and sense of well-being. Individuals who have developed tolerance to stimulants will experience, upon their discontinuation, withdrawal. These withdrawal symptoms will overlap characteristic depressive symptoms, including severe dysphoria, insomnia followed by hypersomnia, irritability, and fatigue. OPIATES induce a sense of elevated mood, and increased self-esteem. A sense of decreased anxiety is also frequently reported. Upon withdrawal, depressive symptoms are accompanied by characteristic physical symptoms such as muscle aches, drug CRAVING, lacrimation (secretion of tears), and piloerection (goose flesh).

Cholinesterase Inhibitors

Four cholinesterase inhibitors have been approved by the FDA for the treatment of AD tacrine (1993), donepezil (1995), rivastigmine (2000), and galantamine (2001), but only rivastigmine has been approved for PD dementia (2006). They are all postulated to help correct the cholinergic deficit seen in PD dementia by increasing the amount of acetylcholine (ACh) available for binding to cholinergic receptors in the synaptic cleft. For all the cholinesterase inhibitors, the most common side effects are gastrointestinal distress (nausea, diarrhea, vomiting), fatigue, insomnia, and muscle cramps (157). Rivastigmine tends to also be associated with weight loss and dizziness.

Iiihistory Of G Lucidum As A Medicinal Mushroom

The first book wholly devoted to the description of herbs and their medicinal value is called Shen Nong Ben Cao Jing, written in the Eastern Han dynasty of China (a.d. 25-220). This book is also known as Classic of the Materia Medica or Shen-nong's Herbal Classic and describes botanical, zoological, and mineral substances. It was composed in the second century under the pseudonym of Shen-nong, the Holy Farmer (31). The book, which has been continually updated and extended, describes the beneficial effects of several mushrooms and there is reference to the medicinal mushroom G. lucidum (4,11,31). In the book Shen Nong Ben Cao Jing (''Supplement to Classic of Materia Medica,'' a.d. 502-536) and in the Ben Cao Gang Mu by Li Shin-Zhen, which is considered to be the first pharmacopoeia in China (a.d. 1590, Ming dynasty), the mushroom was attributed with certain medicinal effects, including tonifying effects, enhancing vital energy and strengthening cardiac function, increasing memory, and...

Estimating Allowable Dose Reductions Due to Synergism

Melatonin For simplicity in analyzing dose requirements, we will assume that a maximum of 15 direct-acting compounds will be used in combination. Therefore, the maximum allowable dose reduction for each is 15-fold. As indicated in Table 13.1, a 15-fold dose reduction is more than enough to make essentially all direct-acting compounds seem practical. The first column of numbers in the table indicates how much the target dose would need to be reduced to make each direct-acting compound safe and practical (values taken from discussions in Part III). As shown at the bottom of the column, only a 2.5- to 3fold dose reduction is required on the average. Some direct-acting compounds are not listed in the table because the target dose for these compounds was too uncertain to use as a base for calculations. Also, melatonin is listed, even though it is not categorized as a direct-acting compound, because it can still produce direct effects.

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