Good night's sleep elusive for many women. Why we may not be getting enough sleep and what we can do about it.
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Aging↗
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Neurophysiological investigations in restless legs syndrome and other disorders of movement during sleep.
Besides polysomnographic techniques, other neurophysiological methods have been utilized in order to understand the pathophysiology of restless legs and periodic limb movement syndromes. By using electromyography with nerve conduction velocity (EMG-CV) and somatosensory evoked potentials (SEPs) it has been possible to determine how frequently each muscle was involved in periodic limb movements, how frequently EMG activity started in a given muscle and the time delay and pattern of activation between the first and the other activated muscles. The etiology of symptoms does not involve structural lesions since brainstem and spinal pathways are intact. Recent evidence from paired transcranial magnetic stimulation suggests that the pathophysiological key in sleep motor disorders is a modified global excitability of corticospinal pathways. The next neurophysiological goal will be to localize the unresolved anatomical level of sleep disorder movement generators and to describe their mechanism.
Electromyography↗
Sleep disorders in regional sleep centers: a national cooperative study. Coleman II Study Investigators.
STUDY OBJECTIVE: In the last two decades there has been an increase in the awareness of and professional expertise in sleep disorders. The objective of this study was to determine the spectrum of sleep-related disorders diagnosed in regional sleep centers and compare this to a previous survey published in 1982. DESIGN: A two-month prospective point-prevalence survey SETTING: Nineteen accredited regional sleep centers in the United States. PARTICIPANTS: Patients evaluated at regional sleep centers during a two-month period. INTERVENTIONS: NA. RESULTS: Obstructive sleep apnea, narcolepsy, and restless legs syndrome were the top three reported primary diagnoses with a prevalence of 67.8%, 4.9%, and 3.2%, respectively. The entire range of sleep disorders, however, was represented in the study sample. Nearly a third of patients had either a primary or secondary diagnosis of a non-respiratory sleep disorder. Referral physicians were most likely to be from internal medicine, pulmonary medicine, and otolaryngology. Compared to the previous survey from 1982, there has been an absolute increase in patient referrals/center with a two- to four-fold increase in the number of patients/center with a final diagnosis of a non-respiratory sleep-related problem. Moreover, there has been a greater than twenty-fold increase in the diagnosis of obstructive sleep apnea. CONCLUSION: Regional sleep centers are encountering increasing patient referrals and a broad range of sleep-related disorders. The predominant reasons for referral are related to obstructive sleep apnea, narcolepsy, and restless legs syndrome.
Adult↗
Sleep laboratory and clinical studies of the effects of triazolam, flunitrazepam and flurazepam in insomniac patients.
Polysomnographic recordings allow the recognition of three normal sleep stages: wakefulness, NREM and REM sleep. There are quantitative changes in these stages from childhood to old age. Most characteristic are progressive decreases in total sleep time, stage 4 NREM sleep and REM sleep. Insomnia can be defined as an alteration of both the quantity and quality of sleep. It can be associated with psychophysiological factors, psychiatric disorders, use of drugs and alcohol, sleep apnea, sleep-related myoclonus and restless legs, medical, toxic and environmental conditions, or REM sleep interruptions. At present, the benzodiazepines are the most frequently prescribed hypnotics. Their efficacy has been evaluated in the sleep laboratory and by means of sleep questionnaires (clinical studies). Their derivatives are grouped according to their pharmacokinetic profiles as short acting (triazolam), intermediate acting (flunitrazepam) and long acting (flurazepam). At the EEG level these compounds induce an increase in fast frequencies and in the number of sleep spindles. Slow wave activity is markedly decreased. All of the derivatives effectively and significantly induce and maintain sleep. Total sleep time increase is related to an imcrement of stage 2 sleep while REM sleep and stages 3 + 4 sleep are consistently reduced. Triazolam withdrawal is followed by a rebound insomnia. In contrast, under the same circumstances, flurazepam has a carry-over effect.
Adolescent↗
Primary care assessment and management of sleep disorders.
PURPOSE: To review the functions of sleep and describe an appropriate sleep assessment for the identification of sleep disorders for nurse practitioners (NP) in primary care. Guidelines for management and referral are included. DATA SOURCES: Selected and the author's experience. CONCLUSIONS: The incidence of sleep deprivation in the United States is generally unacknowledge by the public as well as health care professional. Unfortunately, the castastrophic and debilitating consequences that result from alterations in sleep are usually noted after significant physical and emotional damage have occurred. IMPLICATIONS FOR PRACTICE: An assessment of sleep hygiene and the physical, emotional, or lifestyle changes that alter sleep patterns should be a part of the NP's routine encounter with patients. Referral is indicated for suspicion of obstructive sleep apnea, narcolepsy, restless leg syndrome, complex motor activity, or if the condition fails to respond to therapeutic management.
Humans↗
Sleep movements and associated autonomic nervous activities in patients with Parkinson's disease.
Nine parkinsonian patients were studied during one night using the static charge sensitive bed (SCSB) method for the monitoring of respiration, ballistocardiogram (BCG) and body movements. The parkinsonian sleep was more restless than that of the controls. As the SCSB-defined levels of autonomic nervous activity were concerned, the amount of motor active wakefulness (MAW) was significantly (P less than 0.05) increased in parkinsonian patients, who also had less quiet sleep (P less than 0.05) than the controls. Parkinsonian tremor was present during 29.8 +/- 15.8% of the time in bed. Usually it was observed during wakefulness; it disappeared when the patient fell asleep. The frequency of turning-over events in bed was smaller in the parkinsonian patients than in the controls (P less than 0.05). When the heart rate changes associated with sleep movements were studied it was found that the parasympathetic deceleration component in the parkinsonian patients was absent. The motor dysfunction associated with Parkinson's disease is reflected in many ways in the sleep movement activity. Sleep disturbances in PD seem to be secondary in character; i.e. they can be due to impaired motor functions like turning around in the bed, or due to impaired arousal mechanisms during sleep.
Aged↗
Self-evaluations of factors promoting and disturbing sleep: an epidemiological survey in Finland.
The purpose of this epidemiological survey (N = 1600) was to describe the factors which middle-aged urban people in Finland perceived as promoting or disturbing sleep. The response rate was 75%. The results suggested that quality of sleep is determined by numerous factors; social and psychological factors, health status, external sleeping conditions, life style and living habits. Every third respondent felt that exercise had a positive impact on sleep. Second in importance were reading and listening to music. Furthermore, sauna, shower and bath, stability in life, psychological factors, positive experience in work, satisfactory sexual life and good and quiet sleeping environment were reported to have positive effects on sleep. Men considered work-related pressure and fatigue (20%) as the most important factor disturbing falling asleep or quality of sleep. In women's ranking work problems appeared no sooner than in the third place. Women reported worries, interpersonal problems, and marital and family discord as the most disturbing factors to sleep (37%). Coffee in the evening had a negative effect on falling asleep. Although a 'nightcap' was considered to improve relaxation on falling sleep, men ranked alcohol as the fourth disturbing factor. Other disturbing factors were stress, irregularities in everyday life because of social events, travelling or atypical catnaps. Eating and exercising too heavily or too late in the evening were found to disturb sleep. On the other hand, temporary lack of exercise seemed to impair the quality of sleep. As external factors disturbing sleep the subjects considered noise light, too high room temperature, tight clothing, unfamiliar sleeping environment and restless children.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[The diagnostic approach to and clinical study of 23 children with an obstructive sleep apnea syndrome].
23 children, aging from 3 to 13 years, affected by chronic upper airway obstruction, were studied. The clinical suspicion was "obstructive sleep apnea" (O.S.A.). In this study was found a significantly different frequency, in O.S.A. group, if compared with controls, of the following symptoms: nocturnal snoring (100%), mouth breathing when awake (69%), and during sleep (91%), abnormal restless movements (69%), behavioral disturbances (60%). Clinical evaluation revealed: pectus excavatum (82%), enlarged tonsils and adenoids (82%), failure to thrive (39%). Chest index was 0.72 +/- 0.07 significantly higher (p < 0.001) than controls. The authors also carried out in all patients and controls pCO2 venous blood determination during sleep, to screen subjects with high risk of cardiopulmonary dysfunction. Data obtained showed that threshold value of pCO2 was 45.6 mmHg.
Adolescent↗
Epilepsy and sleep.
A sleep history should be taken routinely in patients with epilepsy. Treatment of sleep disorders and improvement in sleep hygiene may improve seizure control, daytime cognitive functioning, and quality of life. Patients with recurrent sleepiness interfering with daily activities or an Epworth Sleepiness Scale score more than 10 should be considered for additional evaluation by a sleep specialist. Treatment options for insomnia include improvements in sleep hygiene, cognitive behavior therapies, and sedative or hypnotic drugs. Alterations in the timing or type of antiepileptic drugs (AEDs) may be helpful (for example, using sedating medications before bedtime and avoiding evening use of drugs that may exacerbate insomnia ). Improvements in sleep hygiene alone are less effective than cognitive behavioral therapy or pharmacologic therapy. Cognitive behavioral therapy is more efficacious and its effects longer lasting than pharmacologic treatments. Sedative and hypnotic drugs may exacerbate AED cognitive adverse effects during the day and should be used only after other therapies have failed. Excessive daytime sleepiness (EDS) in patients with epilepsy may be secondary to AEDs, nocturnal seizures, or a concomitant sleep disorder such as sleep apnea or restless leg syndrome. Sedating AEDs should be minimized during the day, and activating AEDs should be used as appropriate. Video electroencephalogram polysomnography should be performed when EDS interferes with daily activities and the etiology of sleepiness is unclear. AEDs that are associated with weight gain should be avoided in patients with sleep apnea. AEDs that may promote weight loss should be considered for obese patients with sleep apnea. Continuous positive airway pressure is the treatment of choice for sleep apnea.
Journal Article↗
Prevalence of sleep disturbances in chinese patients with end-stage renal failure on continuous ambulatory peritoneal dialysis.
Patients with end-stage renal failure (ESRF) are reported to have a high prevalence of sleep disorders, such as daytime sleepiness, insomnia, restless legs syndrome (RLS), and obstructive sleep apnea syndrome (OSAS). However, there are few published data from Southeast Asia. A sleep questionnaire was administered to 201 patients (103 men) at the continuous ambulatory peritoneal dialysis (CAPD) outpatient clinic to assess sleep problems. Patients had a mean age of 56.7 +/- 12 (SD) years, with a mean body mass index (BMI) of 23.6 +/- 3.5 kg/m(2). Daytime sleepiness was the most frequent symptom (77.1%), and frequent awakening occurred in 69% of the patients. Sleep-onset insomnia and sleep-maintenance insomnia occurred in 73% and 60% of the patients, respectively. Sixty-two percent of the patients reported symptoms of RLS, which significantly correlated with sleep-onset insomnia (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.5 to 5.5; P = 0.001) and sleep-maintenance insomnia (OR, 2.1; 95% CI, 1.2 to 3.8; P = 0.014). The prevalence of OSAS was estimated by the frequency of the following symptoms: extremely loud snoring, 7 patients (3.5%); observed choking, 21 patients (10.5%); witnessed apnea, 11 patients (5.6%); snoring and witnessed apnea, 6 patients (3%); disruptive snoring, 29 patients (14.4%); and disruptive snoring and witnessed apnea, 3 patients (1.5%). This questionnaire survey confirmed a high prevalence of daytime sleepiness, insomnia, and RLS in patients with ESRF undergoing CAPD but showed a relatively low prevalence of OSAS of up to 14.4%, which may be related to the low BMI of these patients with ESRF compared with other populations. Whether this contributes to the overall better survival observed in some Asian patients with ESRF undergoing dialysis needs further investigation.
Adolescent↗
Motor pattern of periodic limb movements during sleep.
BACKGROUND: The pathophysiology of periodic limb movements in sleep (PLMS) in restless legs syndrome (RLS) is unclear. OBJECTIVE: The authors neurophysiologically investigated PLMS in patients with idiopathic RLS in order to obtain information on the origin and pathophysiology of the movements. METHODS: Ten patients with idiopathic RLS underwent electromyography with nerve conduction velocity (EMG-CV), somatosensory evoked potentials (SEPs), transcranial magnetic stimulation (TMS), nocturnal videopolysomnography, and multiple sleep latency test. The authors analyzed 100 consecutive PLMS for each patient to determine how frequently each muscle was involved in the PLMS; how frequently EMG activity started in a given muscle; and the time delay and pattern of activation between the first and the other activated muscles. RESULTS: EMG-CV, SEPs, and TMS findings were all normal; in PLMS, leg muscles were those more frequently involved, often with alternation of side. Axial muscles were rarely and upper limb muscles sometimes involved. The tibialis anterior was the most frequent starting muscle. There was no constant recruitment pattern from one PLMS episode to another, even in the same patient. There was no ordinate caudal or rostral spread of the EMG activity. CONCLUSION: The recruitment pattern indicates the engagement of different, independent, and sometimes unsynchronized generators for each PLMS. The authors hypothesize an abnormal hyperexcitability along the entire spinal cord, especially its lumbosacral and cervical segments, as the primary cause of PLMS, triggered by sleep-related factors located at a supraspinal but still unresolved level.
Aged↗
Heart rate and spectral EEG changes accompanying periodic and non-periodic leg movements during sleep.
OBJECTIVE: To evaluate the changes in heart rate (HR) and EEG spectra accompanying periodic (PLM) and non-periodic leg movements (NPLM) during sleep in patients with restless legs syndrome (RLS). METHODS: Sixteen patients with RLS underwent one polysomnographic night recording; leg movements (LMs) during sleep were detected and classified as PLM or NPLM; up to 10 PLM and NPLM were chosen from NREM and REM sleep, for each patient and for each type (mono- or bilateral). EEG spectral analysis and HR were evaluated for 20s preceding and 30s following the onset of each LM. RESULTS: EEG activation preceded LMs, particularly in the delta band which increased before the other frequency bands, in NREM sleep but not in REM sleep for PLM, and in both stages for NPLM. A similar difference was seen between mono- and bilateral LMs. CONCLUSIONS: Sleep EEG, HR, and leg motor activity seems to be modulated by a complex dynamically interacting system of cortical and subcortical mechanisms, which influence each other. SIGNIFICANCE: Future studies on the clinical significance of leg motor events during sleep need to take into account events classifiable as "isolated" and to integrate the autonomic and EEG changes accompanying them.
Autonomic Nervous System↗
Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey.
OBJECTIVE: To assess the association between sleep problems and chronic disease in older adults. METHODS: Self-reported standardized questionnaire data from 1506 community-dwelling men and women aged 55-84 years in the continental United States who completed a 20-min telephone interview when contacted from lists of randomly selected telephone numbers. RESULTS: A majority of the participants (83%) reported one or more of 11 medical conditions and nearly one in four elderly respondents (age 65-84 years) had major comorbidity (i.e. four or more conditions). Depression, heart disease, bodily pain and memory problems were associated with more prevalent symptoms of insomnia. Other conditions such as obesity, arthritis, diabetes, lung diseases, stroke and osteoporosis were associated with other sleep-related problems such as breathing pauses, snoring, daytime sleepiness, restless legs or insufficient sleep (<6 h nightly). CONCLUSIONS: Poll findings are consistent with epidemiological studies of sleep, aging and chronic disease. These results suggest that the sleep complaints common in older adults are often secondary to their comorbidities and not to aging per se. These types of studies may be useful in promoting sleep awareness among health professionals and among older adults, especially those with heart disease, depression, chronic bodily pain or major comorbidity.
Aged↗
[Sleep-wake complaints in Parkinson's disease].
We analyzed the questionnaires concerning sleep-wake complaints in 1,575 Parkinsonian patients and 2,509 controls of 945 office workers and 1564 seniors living at home. The questionnaire included 20 contents. The Parkinsonian patients complained of sleep-wake disturbances more frequently than the controls in initiation disturbance, frequent awakenings in night, early morning awakening, day time sleepiness, usage of sleep pills, parasomnias, restless legs symptoms, nocturnal myoclonus, snoring, apnea episodes and dyspnea in night (chi-square method). The incidences of restless legs symptoms and nocturnal myoclonus increased significantly with worsening of physical symptoms in the Parkinsonian patients (p less than 0.01).
Aged↗
Pharmacologic treatment of fibromyalgia.
Fibromyalgia is a chronic syndrome characterized by widespread pain, unrefreshed sleep, disturbed mood, and fatigue. Until such time as we have a clearer understanding of the trigger and/or pathophysiologic mechanisms producing these symptoms, pharmacologic treatment should be aimed at individual symptoms. Such treatment should ideally be offered as part of a multidisciplinary treatment program using both pharmacologic and nonpharmacologic treatment modalities. Critical components of any successful fibromyalgia treatment program include addressing physical fitness, work and other functional activities, and mental health, in addition to symptom-specific therapies. The main symptoms that should be addressed include pain, sleep disturbances including restless leg syndrome, mood disturbances, and fatigue. Pharmacologic therapy should also be considered for syndromes commonly associated with fibromyalgia including irritable bowel syndrome, interstitial cystitis, migraine headaches, temporomandibular joint dysfunction, dysequilibrium including neurally mediated hypotension, sicca syndrome, and growth hormone deficiency. This article provides general guidelines in initiating a successful pharmacologic treatment program for fibromyalgia.
Analgesics↗
Outcome of restless legs severity after continuous positive air pressure (CPAP) treatment in patients affected by the association of RLS and obstructive sleep apneas.
BACKGROUND AND PURPOSE: The association of obstructive sleep apnea syndrome (OSAS) and restless legs syndrome (RLS) has been reported in the literature for many years. Nevertheless, this pathological association has not yet been extensively studied and many questions remain unanswered. The primary concern of this study is to evaluate the influence of nasal continuous positive airway pressure (n-CPAP) therapy on daytime sleepiness and fatigue as well as the presence of a possible long-term beneficial effect on RLS severity and, secondarily, to ascertain the clinical, neurophysiological and polysomnographic characteristics of a group of patients with both OSAS and RLS. PATIENTS AND METHODS: All patients had a diagnostic polysomnography (PSG) and a second polysomnography for titration of n-CPAP. Laboratory tests (blood glucose, serum ferritin), body mass index (BMI) calculation and a neurophysiological evaluation (auditory P300 and electroneuromyography) were done. The Epworth Sleepiness Scale (ESS) and the Pichot's questionnaire of fatigue/depression (PIC) were applied to all patients before and after three months of n-CPAP treatment. The International Restless Legs Syndrome Study Group rating scale (IRLS) was applied before and after n-CPAP. Results were compared. RESULTS: The ESS scores decreased from 10.64+/-4.83 at baseline to 7.41+/-3.5 (P<0.05). PIC scores decreased from 16.65+/-7.27 to 10.12+/-6.40 (P<0.01). IRLS scores decreased from 17.60+/-7.11 before to 12.52+/-9.25 after n-CPAP (P<0.05). CONCLUSIONS: Our findings suggest that not only fatigue and sleepiness but also the severity of RLS show a favorable response to n-CPAP in the group of patients with OSAS and RLS.
Adult↗
[Sleep disorders in the elderly].
Insomnia dominates the sleep disorders of the elderly. Sleep apnea, the restless legs syndrome and nocturnal agitation represent other facets. After eliminating the possibility of painful or degenerative organic disease, iatrogenic cause and mode of life, other symptoms should be sought, namely mental and personality-related. Investigation requires polysomnogram recording, supported by careful history-taking, including objective and subjective factors. Treatment includes notions of diet, biological rhythm and desynchronisation. It should take into consideration the deleterious effects of prolonged use of certain psychotherapeutic agents.
Aged↗
Facilitating sleep for patients with end stage renal disease.
Patients with end-stage renal disease (ESRD) are confronted with many changes and problems; a lack of sleep may be one of the most prevailing difficulties they endure. Poor sleep is often the result of restless leg syndrome (RLS), periodic leg movements during sleep (PLMS), sleep apnea syndrome (SAS), or depression. Nurses who provide health care to these patients can use timely interventions to assist the patients to achieve better sleep.
Causality↗