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PubMed1998

[Sleep-wake transition disorders].

The term sleep-wake transition disorders refers to a group of parasomnias that occur during the transition from wakefulness to sleep or from one sleep stage to another. Rhythmic movement disorder, sleep starts, sleep talking, and nocturnal leg cramps--these four disorders belong to sleep-wake transition disorders in the International Classification of Sleep Disorders. Although these are common disorders, little attention is given to them and their mechanisms are remain unclear. The majority of patients are not so severe as to require any treatment. Their prognosis are usually well. This article describes sleep-wake transition disorders concerning the clinical features, differential diagnosis, treatment, etc.

Diagnosis, Differential↗
PubMed1992

Update on disorders of sleep and the sleep--wake cycle.

Wakefulness and sleep are antagonistic states competing for the domain of brain activity. Non-REM sleep and REM sleep are different states of being, sustained by activity in brainstem nuclei, hypothalamus, basal forebrain, and thalamus. Such complex phenomenology is subject to many alterations grouped in the new International Classification of Sleep Disorders. The insomnias are the result of interacting psychosocial, psychophysiologic, neurodevelopmental, and medical factors. Proper perspective of each factor provides the clinical strategies to approach medically the symptom-complex of insomnia. The most common cause of daytime hypersomnia is chronic sleep deprivation. Obstructive sleep apnea responds to nasal CPAP, but the failure rate approaches 30%. In intolerant patients BiPAP and surgical remedies should be considered. Motor and behavioral abnormalities of sleep may be linked to REM sleep as in the REM sleep behavior disorder. Paroxysmal nocturnal dystonia and nocturnal wanderings may be associated with epilepsy. Intrusions of one state of being (wakefulness, non-REM sleep, and REM sleep) into another result in mixed, poorly defined, or only partially developed states. Dissociation of states may be responsible for confusional arousals, hallucinations, and cateplexy. Senile degeneration of the suprachiasmatic nuclei may underlie the circadian rhythm changes in old age and the "sundown" syndrome in demented patients. Misalignment of the hypothalamic pacemaker causes dysregulation of sleep-related physiologic and behavioral variables. Exposure to bright light retrains the pacemaker in night-shift workers, transmeridian travelers, and in patients with seasonal affective syndrome. Benzodiazepine compounds are very effective hypnotics, but should be used sparingly in the elderly to avoid falls, memory lapses, and aggravation of a preexisting sleep apnea syndrome. Sleep laboratory evaluations are indicated in patients with hypersomnia, suspected sleep apnea syndrome, motor-behavioral disorders of sleep, and in many individuals complaining of insomnia.

Age Factors↗
PubMed1977

[Disorders of the sleep-wakefulness function].

Disorders of sleep belong to the most frequent troubles. A lot of different factors may contribute to the pathogenesis of sleep disorders. Modern sleep research has opened important views into the structure of sleep and the pathophysiology of sleep disorders. In a narrower sense sleep disorders mean a deficiency of sleep (hyposomnia). This may concern the induction of sleep or its maintenance. Sleep disorders without underlying disease may be differentiated from those caused by different diseases. Hypersomnia may occur as a symptom of various cerebral dysfunctions and processes, as an episodic disorder (Kleine-Levin-syndrome) or as a part of the Pickwick-syndrome. In narcolepsy characteristic symptoms are sleep attacks, kataplexy (emotionally induced loss of muscle tone) and transient pareses during awakening. Disturbances linked with sleep are snoring, somnambulism, speaking and grinding of the teeth during sleep and nocturnal enuresis. They may constitute idiopathic disorders. On the other hand, there may be similarities between epileptic phenomena and these disorders. Some epilepsies demonstrate relations to the rhythm of sleep and wakefulness which become evident in the manifestation of seizures and epileptiform EEG activity at certain stages of vigilance.

Anxiety↗
PubMed1994

Long-term follow-up study of 10 adolescent patients with sleep-wake schedule disorders.

Therapeutic trials for sleep-wake schedule disorders have been described, but a long-term follow-up of adolescents with such disorders have not previously been reported. We investigated 10 adolescents with sleep-wake schedule disorders who had formerly received intensive treatment. The investigation was carried out with detailed questionnaires about current sleep conditions and social state. The follow-ups were obtained from 1.2 to 11.2 years after the initial treatment. Three cases have remitted, and six have improved in illness severity. All patients showed improvement in social adaptation. Improvement in the social adaptation level was greater than improvement in the illness severity level. More cases should be studied to learn what factors influence the prognosis of these disorders.

Adolescent↗
PubMed2006

Genetics of the sleep-wake cycle and its disorders.

The sleep-wake cycle is under the control of the circadian clock. Recent advances in rhythm biology have identified molecular clocks and their key regulating genes. Circadian clock genes (Clock, Per) were first isolated in Drosophila, and their homologous counterparts have been found in mammals. Some of the circadian master genes have been shown to influence sleeping behavior. For instance, a point mutation in a human clock gene (Per2) was shown to produce the rare advanced sleep phase syndrome, whereas a functional polymorphism in Per3 is associated with the more frequent delayed sleep phase syndrome. Furthermore, a study examining the association between Clock gene polymorphisms and insomnia revealed a higher recurrence of initial, middle, and terminal insomnia in patients homozygous for the Clock genotype. Other genes have been shown to contribute to sleep pathologies. A point mutation in the prion protein gene appears to be the cause of fatal familial insomnia. A missense mutation has been found in the gene encoding the GABA-A beta 3 subunit in a patient with chronic insomnia. In both animal models and humans, a deficiency in the hypocretin/orexin system was proposed to be responsible for narcolepsy. Selective destruction of hypocretin neurons is the most probable culprit in humans. These findings suggest that the genetic contribution to sleep disorders and wake determinants is more important than originally thought. Beyond sleep, light/dark cycles and sleep deprivation appear also to be associated with eating habits, and epidemics of obesity have to be evaluated in the context of shortened sleep duration.

Animals↗
PubMed2003

Sleep disorders.

Humans spend approximately one third of their lives asleep. Although the same medical disorders that occur during wakefulness persist into sleep, there are many disorders that occur exclusively during sleep or are manifestations of a disturbance of normal sleep-wake physiology. The most common reason for referral to a sleep laboratory is OSA, whereas the most common sleep disorder is insomnia. Effective treatments now exist for many sleep disorders, such as OSA and RLS, and a major breakthrough in the treatment of narcolepsy seems imminent. Because all disease processes are adversely affected by insufficient sleep, it is essential that the practicing physician understand the causes and treatments of the common sleep disorders.

Adult↗
PubMed2005

Gastroesophageal reflux disease and sleep disorders: a wake-up call for physicians and their patients.

Sleep's implications to the physiology and pathogenesis of a number of diseases have been ignored until recently. With the evolution of studies conducted in sleep laboratories, the relationship between various gastrointestinal diseases, in particular gastroesophageal reflux disease (GERD), and sleep disorders is being recognized. This article discusses the personal and societal impact of GERD-related sleep disorders, including quality of life issues and work and leisure impairment. A review of intervention studies indicates that GERD-related sleep disorders respond effectively to acid-suppressive medical therapy. Clinicians are advised to take a proactive stance in evaluating patients with GERD for unrecognized sleep disorders and ascertaining whether patients with sleep disorders have GERD symptoms as well.

Anti-Ulcer Agents↗
PubMed1995

[Sleep-wake rhythm disorders in the framework of a Diogenes syndrome. Improvement in sleep architecture using supportive treatment with zolpidem].

In a 72-year-old man suffering from the Diogenes syndrome, but with no other pathologies (no dementia, no underlying depression), marked disorders in the sleep-wake rhythm developed. Treatment with zolpidem brought about an improvement in the sleep architecture. Psychotherapy, largely behavioral treatment, resulted in partial reintegration of the patient.

Aged↗
PubMed1998

[Alertness disorders and parasomnias of the wakefulness-sleep transition].

INTRODUCTION: Disorders of arousal and parasomnias of sleep-wake transition are revisited. Disorders of arousal are: Sleepwalking (SW), confusional arousals (CA) and sleep terrors (ST). SW, CA and ST are different clinical manifestations of the same disorder being ST the most severe and SW the mildest manifestation. Disorders of arousal are typical parasomnias of NREM sleep, mainly slow wave sleep. Pathophysiological mechanism of these disorders is the state's dissociation of wakefulness and sleep. The conjunction of the constitutional factors (genetic, age, sleep privation, drugs, psychological, etc.), and precipitant factors (light, sound, temperature, touch, apnea, gastroesophageal reflux, seizure, fever, psychological, etc.) permit three possible arousal behavioral response: A full awakening, a shift stage of sleep or a partial arousal. Clinical significance of arousal parasomnias depend on the age. In children are caused by developmental and genetic factors and usually are autolimited. In adults usually are caused by psychopathology. In the elderly are often caused by organic brain syndromes. Parasomnias of sleep-wake transition are: Rhythmic movements of sleep, sleeptalking, starts and the nocturnal cramp. Most of them are mild disorders, almost physiological phenomena that usually don't need any treatment.

Adult↗
PubMed2005

Behavioral and psychiatric consequences of sleep-wake schedule disorders.

Circadian rhythm sleep disorders (CRSDs) arise when an individual's sleep-wake rhythm mismatches the environmental 24-h schedule. Physiological data and genetic studies in patients with CRSDs suggest that these disorders result from abnormal functioning of the circadian timing system. Diagnosis involves recognition of the characteristics of CRSDs, which can be achieved by clinical interview and actigraphic monitoring of rest-activity patterns. Bright-light therapy and melatonin administration have proved to be the most effective treatment modalities of CRSDs. In psychiatric practice, CRSDs can be encountered on various occasions. Some evidence indicates that a deviant sleep-wake schedule might be a predisposing factor to personality disorders. CRSDs can emerge as an iatrogenic effect of certain psychoactive drugs, such as haloperidol and fluvoxamine. It is not uncommon that the daytime functional difficulties that accompany CRSDs are misinterpreted as symptoms of psychopathology. Recognition and awareness of these disorders should prevent years of erroneous diagnosis and treatment in these patients.

Circadian Rhythm↗
PubMed1996

Cardiac autonomic activity during wakefulness and sleep in REM sleep behavior disorder.

In REM sleep behavior disorder (RBD) it has been reported that tachycardia may not accompany the impressive movements associated with dream mentation. Up to now there are no data concerning the cardiac autonomic activity during wakefulness as well as during sleep out of nocturnal dream-enacting behaviors, in RBD. We evaluated 14 RBD patients. Our study shows that only 36% of patients had normal results in all traditional autonomic tests during wakefulness. Moreover, RBD patients had a reduced tonic and phasic heart rate variability during sleep. Autonomic evaluation during sleep may show impairment earlier than the traditional tests during wakefulness. No difference was found between idiopathic RBD patients and symptomatic ones.

Aged↗
PubMed1996

[Sleep-wakefulness rhythm disorders].

The circadian system is synchronized on 24-hour by the light-dark synchronizer and by the social time cue. The circadian rhythm sleep disorders share a common underlying chronobiological basis. These disorders may be due to either jet-lag, shift-work or to lesions of the peripheral visual pathway. The delayed sleep phase syndrome, the advanced sleep phase syndrome, the non 24-hour syndrome as well as the irregular sleep-wake patterns are described. Therapeutic approaches, in particular with melatonin and (or) bright light, are presented.

Circadian Rhythm↗