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PubMed1994

[Incidence and persistence of problems at sleep onset and sleep continuation in the preschool period: results of a prospective study of a representative sample in Bavaria].

The prevalence and persistence of sleeping problems was studied in a prospective investigation of a representative sample of 432 German children at the ages of 5, 20 and 56 months. 21.5% of children had night waking problems at 5 months, 21.8% at 20 months and 13.3% at 56 months. Falling asleep difficulties were diagnosed in 12.1% of 4-5 year olds. One in four of five year-olds slept regularly in the bed with the parents (co-sleeping). Children with night waking problems had a 2.2 to 2.5 fold increased risk to remain nightwakers from one assessment point to the next compared with non-wakers. 7 to 14% of parents were distressed by their children's sleeping behaviour. Parental behaviour often contributed to continued sleeping problems because the children were not supported in acquiring appropriate skills to settle to sleep unaided. A developmental model for the treatment of sleeping problems is discussed.

Child, Preschool↗
PubMed2005

Time estimation in good and poor sleepers.

Time estimation was examined in 148 older good and poor sleepers in analogue and naturalistic sleep settings. On analogue tasks, both "empty" time and time listening to an audiobook were overestimated by both good and poor sleepers. There were no differences between groups. "Empty" time was experienced as "dragging." In the sleep setting, most poor sleepers underestimated nocturnal sleep and overestimated awake times related to their own sleep problem: sleep onset vs. sleep maintenance insomnia. Good sleepers did the opposite. Severity of sleep problem and size of time estimation errors were unrelated. Greater night-to-night wake time variability was experienced by poor than by good sleepers. Psychological adjustment was unrelated to time estimations and to magnification or minimization of sleep problems. The results suggest that for poor sleepers who magnify their sleep problem, self-monitoring can be of benefit by demonstrating that the sleep problem is not as severe as believed.

Adaptation, Psychological↗
PubMed2002

Sleep and quality of life in breast cancer patients.

This study described sleep in a heterogeneous sample of breast cancer patients using the Pittsburgh Sleep Quality Index (PSQI) and examined the relation between sleep disturbance and health-related quality of life as measured by the Rand 36-Item Health Survey. Chemotherapy and radiation therapy were explored as predictors of sleep disturbance in breast cancer patients, and the sleep characteristics of breast cancer patients were compared to the sleep characteristics of a sample of medical patients with general medical conditions. Results showed that 61% of breast cancer patients had significant sleep problems. Sleep was characterized by reduced total sleep time with sleep frequently being disturbed by pain, nocturia, feeling too hot, and coughing or snoring loudly. Despite the frequency of significant sleep disturbance, pharmacological and cognitive-behavioral treatments of sleep problems were observed to be inadequate. Limited evidence was found for the role of chemotherapy and radiation therapy in the sleep disturbance of breast cancer patients, and the general pattern of sleep disturbance in breast cancer patients was not significantly different than that observed in medical patients with general medical conditions. Breast cancer patients having significant sleep problems had greater deficits in many areas of health-related quality of life. The implications of the findings and study limitations are discussed.

Adult↗
PubMed2003

Problems with sleep: what should the doctor do?

Complaints of poor sleep are frequent. The physician's assessment should seek to diagnose the social, medical, and psychiatric etiologies of insomnia and to treat the identified causative conditions. Management must match the specific pathology and type of sleep problem.

Adult↗
PubMed2006

Insomnia: prevalence, impact, pathogenesis, differential diagnosis, and evaluation.

When patients report problems sleeping, a psychiatrist must determine their significance based on frequency, duration, and daytime impairment. Because up to 50% of adults report sleep problems in any year, it is necessary to define when insomnia becomes long-standing, severe, and a complication to daytime function. Psychiatrists must determine if a sleep disturbance reduces mood, motor performance, or cognitive function. If insomnia syndrome is present, major depression, dysthymia, and anxiety disorders commonly are comorbid. To assist in evaluating insomnia, psychiatrists are urged to use the 6 Ps + M of insomnia model to conceptualize the characteristics of the insomnia and coordinate therapeutic intervention.

Chronic Disease↗
PubMed2004

Behavioral profiles in 4-5 year-old children: normal and pathological variants.

Normal and psychopathological patterns of behavior symptoms in pre-school children were described by a classification approach using cluster analysis. The behavior of 406 children, average age 4 years 9 months, from the general population was evaluated at home visits. Seven clusters were identified based on empirically defined dimensions: attention, hyperactivity, aggressiveness, social relationship problems, sleeping problems, eating problems, depression and anxiety. Clusters scoring high in inattention, hyperactivity, aggressiveness, and social relationship problems but low in depression and anxiety were found and could indicate early onset conduct disorder. The approach of analysing patterns of symptoms expands the basis on which normal and psychopathological patterns are distinguished.

Aggression↗
PubMed1999

Pathophysiology and management of insomnia during depression.

Depressed patients often report problems sleeping, and epidemiologic evidence suggests that insomnia may precede the onset of depression. Insomnia is associated with marked impairment in quality of life and ability to function effectively. Many studies have indicated that patients with chronic sleep problems have impaired mood and that effective management of insomnia in depressed patients can markedly improve their depression. Diagnosis of insomnia is challenging because there can be many different causes and the clinical picture can be blurred by the presence of other psychiatric illnesses. Pharmacotherapy provides reliable and rapid relief from insomnia, whereas behavioral therapies help produce long-term improvement. For many years, benzodiazepines have been the mainstay of drug treatment for insomnia. However, these drugs have significant side effects, and tolerance and dependence have discouraged use. Many doctors use sedating antidepressants in low doses to treat chronic insomnia. However, there is little evidence supporting the efficacy of these agents, and many have adverse side effects, including impairment of sleep. The newer selective hypnotic drugs, including the imidazopyridines, may offer patients a better short-term alternative to benzodiazepines or sedating antidepressants.

Anti-Anxiety Agents↗
PubMed1999

Introduction of a recorded health information line into a pediatric practice.

OBJECTIVE: To examine the utilization, satisfaction, and parental health-seeking behavior associated with the introduction of the Parent Advice Line (PAL), a collection of 278 recorded health-related messages accessible by telephone, into a private practice. DESIGN: Booklets listing PAL topics were mailed to eligible families, and utilization data were collected for all incoming PAL calls from June to August 1996. Satisfaction and effect on health-seeking behavior were assessed using a recorded questionnaire appended to each call (n = 561) and a randomized telephone questionnaire (n = 821). SETTING: A suburban, 7-pediatrician practice in Colorado. PATIENTS: Families with children younger than 12 years seen in the practice within 2 years (N = 8365). RESULTS: Of families who reported receiving the mailed PAL booklet, 32% used PAL. Sixty percent of PAL calls were placed during office hours, 21% from 5 PM to 9 PM, and 8% after midnight; call volume was higher on weekdays than on weekend days (25 calls per day vs 10 calls per day, respectively; P<.05 by chi2 test). The 5 most commonly requested topic categories were toilet training, sexual development, discipline problems, sleep problems, and teenage behavior. Preventive care topics predominated in infants, behavioral topics in preschool children, and acute illness topics in school-aged children. Of users, 88% were satisfied or very satisfied and 98% said that they would use PAL again. Respondents to the 2 questionnaires reported that use of PAL made a call or visit to their child's physician unnecessary 58% to 69% and 61% to 70% of the time, respectively. CONCLUSIONS: The PAL was used primarily to access information about behavioral and developmental issues during office hours. Its use was associated with high rates of satisfaction and, by parental report, decreased calls or visits to a physician.

Adult↗
PubMed1988

The preschool child: developmental themes and clinical issues.

The preschool years are a remarkable period of dramatic growth in the areas of physical, affective, and cognitive development. Physical development is characterized by a slow but steady rate of somatic growth and the mastery of motor skills that facilitate the child's achievement of autonomy and independence. Major themes in affective development include the achievement of autonomy and independence from family, a lessening of attachment to parents and the alleviation of separation anxiety, and the acquisition of impulse control and socialization skills. Cognitive development during the so-called preoperational period is best characterized by the mastery of language. The remarkable developmental gains achieved during this dynamic period culminate in a child who can function independently and competently and begin the major occupation of childhood--attending school. Health maintenance issues during the preschool years directly reflect the child's developmental stage. For example, nutritional issues reflect not only physical growth and motor skills, but also negativism and the child's struggle to achieve autonomy. Similarly, safety and injury prevention related to the "motor-minded" behavior so characteristic of children at this age, as well as the illogical, egocentric thought that predominates during this period of cognitive development. Examples of other stage-related issues addressed during health maintenance visits include discipline and behavior problems, sleep problems and night awakening, and toilet training. The unique aspects of development during the preschool years also have implications for other components of child health maintenance, including developmental screening, procedures and immunizations, and physical assessment. A number of clinical issues are of special significance during the preschool years. For example, the most common causes of children's short stature, constitutional delay in growth and familial short stature, may result in major parental concerns at this time. Recurrent otitis media is an important problem during this period of language acquisition. Among preschool children with urinary tract infections, the risk of an underlying structural anomaly of the urinary tract and the danger of irreversible renal damage is greater than for older children.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗
PubMed2004

Sleep and quantitative EEG in neurodegenerative disorders.

This paper reviews current knowledge on sleep problems, sleep architecture changes and quantitative EEG alteration brought on by various neurodegenerative diseases, such as Alzheimer's disease (AD), progressive supranuclear palsy (PSP), REM sleep behavior disorder (RBD), Parkinson's disease (PD), dementia with Lewy bodies (DLB), multiple system atrophy MSA, Huntington's disease and Creutzfeldt-Jakob disease, in comparison to normal aging. The study of sleep variables and that of the spectral composition of the EEG can provide valuable information for understanding the pathophysiology and for assisting the diagnosis of neurodegenerative diseases.

Aged↗
PubMed2001

Diagnoses and interactive patterns of infants referred to a community-based infant mental health clinic.

OBJECTIVES: To describe the distribution of symptoms and diagnoses in a community-based infant mental health clinic and to compare play and feeding interactions of referred and nonreferred infants. METHOD: The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC 0-3) was used to diagnose 113 referred infants (60% were boys). Thirty additional dyads were matched with 30 nonreferred dyads. Feeding, play interactions, and home environment were compared. RESULTS: Two peaks of referral were found: 0 to 6 and 12 to 18 months. The main reasons for referral were eating problems, sleep problems, aggressive behavior, irritability, and maternal depression. The most common DC 0-3 diagnosis was a combination of primary infant disorder, parent-child relationship disorder, and parental psychopathology. Mothers of referred children provided lower levels of sensitivity, support, and structuring of the interaction, and less optimal home environment. The dyadic relationship showed a lower degree of mutuality and higher negative exchanges. Feeding interactions elicited more negative interactions than play. CONCLUSIONS: Infants referred by community health workers showed less optimal mother-infant interactions and had less optimal environment, compared with nonreferred dyads. Symptoms of emotional distress in infancy are best apprehended when assessed in multi-institutional contexts and formulated in a multiaxial approach.

Affective Symptoms↗