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PubMed2006

Do patients with sleep maintenance insomnia have a problem with sleep maintenance?

Do patients with primary insomnia differ from good sleepers with respect to the number or duration of awakenings or to the stages from which awakenings occur? To address this question, polysomnography (PSG) records were evaluated in 10 good sleepers (GS) and 10 primary insomnia patients (PI). PSG records were evaluated for occurrence and duration of awakenings and for the stage immediately preceding each awakening. PIs woke more frequently and for longer durations than did GSs. PIs' awakenings tended to occur from Stages 1 or 2; GSs' occurred from epochs scored as movement times. The data from this study represent the first attempt to characterize the stages from which awakenings occur in sleep maintenance insomnia.

Adult↗
PubMed1996

Sleep characteristics in healthy children from birth to 6 years of age in the urban area of Rome.

The current survey is an attempt to evaluate age-specific sleep characteristics and to identify the presence of sleep problems in Italian normally developing preschool-aged children. A cross-sectional survey by parental interview on sleep behavior was carried out on 2,889 children (from birth to 6 years). Groups were formed based on age level. Results showed a developmental trend of some sleep characteristics, regarding mainly the length of sleep and rating of night wakings. Comparison with other studies showed that the children in this study had a later sleep onset time and slept less than children of the same age living in some other countries. These dissimilarities may be due to sociocultural and climate differences. Sleep problems (sleep latency longer than 30 minutes or disruptive night wakings) were found in 35% of children less than 2 years old, in 23% of 2-3-year-olds and in 14% of 4-6-year-olds. Children with sleep problems slept significantly less (on average 30-40 minutes across all age levels, required parental presence at time of sleep onset and shared their parents' bed more frequently than those without sleeping problems.

Age Factors↗
PubMed2004

[The relationship between attention deficit hyperactivity disorder and sleep-alertness problems].

Several studies have reported a relationship between Attention Deficit Hyperactivity Disorder (ADHD) and sleep problems. Parents of children with ADHD report on decreased nocturnal sleep efficiency and sleep fragmentation compared to controls. On the other hand, objective measurements often show that these children sleep longer, and there is even a theory that suggests that daytime somnolence is the primary cause of the inattention problems seen in the disorder. Experimental sleep restriction, which leads to daytime somnolence, has been shown to be associated with ADHD-like behavior and poor cognitive achievements. In a study that we have recently performed, we found that children with ADHD had high prevalence of primary sleep disorders and objective daytime somnolence. This finding can explain why Ritalin, which is a stimulant medication, improves symptoms in these children. Sleep problems, primarily treatable such as Obstructive Sleep Apnea (OSA) or Periodic Limb Movements Disorder in Sleep (PLMD), should be investigated in the assessment of these children.

Adrenergic Uptake Inhibitors↗
PubMed2000

Sleep habits and sleep disturbance in elementary school-aged children.

Relatively little is known about sleep habits, sleep disturbances, and the consequences of disordered sleep in school-aged children. This descriptive study examined a variety of common sleep behaviors in a group of 494 elementary school children, grades kindergarten through fourth, using a battery of sleep questionnaires that included parent, teacher, and self-report surveys. The prevalence of parent-defined sleep problems ranged from 3.7% (Sleep-Disordered Breathing) to 15.1% (Bedtime Resistance), with 37% of the overall sample described as having significant sleep problems in at least one sleep domain. Younger children were more likely than older children to have sleep problems noted by parents (particularly bedtime struggles and night wakings), as well as by teacher and self-report. Children tended to identify more sleep problems by self-report, particularly sleep-onset delay and night wakings, than did their parents. Overall, approximately 10% of the sample was identified by all three measures as having significant problems with daytime sleepiness. The results of this study emphasize the importance of screening for sleep disorders in this age group in the clinical setting. The need for consensus regarding the use of sleep screening instruments and the definition of "problem" sleep in school-aged children is also discussed.

Child↗
PubMed2006

Co-sleeping and clinical correlates in children seen at a child guidance clinic.

INTRODUCTION: Co-sleeping or bed-sharing is a common practice that has been little researched. While often viewed as being "cultural" in nature, there is a suggestion that it may be a parental response to sleep problems. Some studies link co-sleeping with behavioural and temperamental difficulties. The objectives of the current study were to determine the prevalence of co-sleeping and how they relate to sleeping problems among a cohort of children and adolescents seen in a child guidance clinic. METHODS: Parents or guardians of all new patients seen at the child guidance clinic were asked to complete a questionnaire upon their consent to participate in the study. The questionnaire included socio-demographical data and frequency of sleep problems in the past six months. A list of nine common sleep problems was included. RESULTS: The prevalence of co-sleeping was found to be 72.7 percent. The children who co-sleep were significantly younger and there was a decrease in the practice with increasing age. Sleep starts and nightmares were significantly more among those sleeping alone. CONCLUSION: Co-sleeping was not associated with significant sleep problems in our cohort. Co-sleeping may have been initiated in response to an existing sleep problem but eventually resolved the problem. If co-sleeping is not permitted, the sleep problem could be compounded, giving rise to a higher prevalence of sleep starts and nightmares among those in our cohort who slept alone.

Adolescent↗
PubMed2001

Prevalence of insomnia in the adult Norwegian population.

A representative adult sample (18 years and above) of the Norwegian population, comprising 2001 subjects, participated in telephone interviews, focusing on the one-month point prevalence of insomnia and use of prescribed hypnotics. Employment of DSM-IV inclusion criteria of insomnia yielded a prevalence rate of 11.7%. Logistic regression analysis performed on the different insomnia symptoms revealed that somatic and psychiatric health were the strongest predictors of insomnia, whereas gender, age, and socioeconomic status showed a more inconsistent relationship. Use of prescribed hypnotic drugs was reported by 6.9% and was related to being female, elderly, and having somatic and emotional problems. Sleep onset problems and daytime impairment were more common during winter compared to summer. Use of hypnotics was more common in the southern (rather than the northern) regions of Norway. For sleep onset problems a Season x Region interaction was found, indicating that the prevalence of sleep onset problems increased in southern Norway from summer to winter, while the opposite pattern was found in the northern regions. The importance of clinically adequate criteria and seasonal variation in the evaluation of insomnia is briefly discussed.

Adolescent↗
PubMed2006

Multidimensional scaling of pediatric sleep breathing problems and bio-behavioral correlates.

STUDY OBJECTIVES: Complex relationships exist between pediatric sleep disorders and daytime behavior. Using a multidimensional scaling model, we investigated these relationships in 126 children with sleep breathing disorders (SBD). METHOD: Validated questionnaires on nighttime behavior, daytime behavior, and respiratory health were administered to a large number of school children in Belgium. Children who met the criterion of having at least one sleep-related breathing problem (three or more times per week during the past six months) were selected for further analyses. A total of 26 indicators were defined and modeled, including sleep problems, sleep efficiency, sleep environment, sleep enuresis, internalised and externalised behavioral problems, respiratory health of the child and relatives, smoking exposure, and caffeine consumption. RESULTS: From 3,045 questionnaire responses 4.1% of the children were reported to have a SBD symptom. SBD children differed on sleep and health domains from non-SBD children. Furthermore, through scaling of the (dis)similarities among the 26 indicators the SBD child was able to be modeled. By way of an internal analysis of the data-matrix the following indicators were eliminated: sleep correlates, health of the family, and behavior rated by teachers, followed by caffeine intake, drugs, and behavior rated by the parents. This revealed a two-dimensional model, consisting of primary SBD and secondary SBD. CONCLUSION: Children with SBD differ on many domains from children without such disorders and an underlying two-fold SBD concept was found. Firstly, the SBD-indicator positioned in between investigated correlates with disorders of initiating and maintaining sleep and sleep hyperhydrosis on one hand and with respiratory-related illnesses on the other; this was labeled primary SBD. Secondly, the SDB-indicator not closely associated with any of the investigated correlates can be interpreted as secondary SBD.

Child↗
PubMed1997

A survey of sleep habits and sleeping difficulties in an elderly Swedish population.

A random sample of 876 subjects aged 65-79 years were investigated by means of a questionnaire concerning sleep and related factors. Sleep problems were reported by 23.8% of females and 13.3% of males. Moderate or major complaints of maintaining sleep were reported by 43.5% of subjects, early morning awakening 33.4% and difficulties falling asleep 31.4%. Daytime sleepiness was more common among males, and a relationship between daytime sleepiness and perceived poor sleep was found. Daytime napping was common, but not related to poor sleep. The prevalence of regular sleeping pill users was 7.6% for females and 3.0% for males and a relationship between sleep problems, sleeping pill usage and psychiatric symptoms was established. Among the regular sleeping pill users 39.1% had possible depression (PD) and 63.0% had possible anxiety disorder (PA). Among respondents with sleep complaints 29.8% had PD and 48.7% had PA. Sleep problems were also related to impaired physical health. Various medical illnesses contributed to sleep complaints among males, and depression affected sleep the most among females.

Aged↗
PubMed1994

Use of dihydroergotamine in patients with postconcussion syndrome.

The experience with 34 patients who came to the Shreveport Headache Clinic for treatment of postconcussion headache is reviewed. All had been suffering from postconcussion (posttraumatic) syndrome for periods ranging from one day to more than three years, and all displayed, in addition to headache, at least three other symptoms characteristic of the syndrome, eg, memory problems, impaired concentration, sleep problems, dizziness, and anxiety. After initial evaluation at the clinic, the patients were admitted to Willis Knighton Medical Center and treated with repetitive administration of intravenous dihydroergotamine (DHE) and metoclopramide. A good to excellent overall response to DHE therapy was achieved by 88% (29) of the patients. The percentages and numbers of patients obtaining good to excellent relief of selected key symptoms were: 85% (28) - headache, 91% (30) - memory problems, 94% (31) - sleep problems, and 88% (29) - dizziness. DHE was well-tolerated, and no serious or unexpected adverse reactions were reported. The most frequently reported adverse reactions were mild nausea and brief worsening of headache.

Adult↗
PubMed1999

Sleep alterations in cancer patients.

This multi-institutional sleep study involved two phases aimed at investigating sleep alterations in patients with any stage of breast and lung cancer. The first phase of this study used an 82-item, 20-minute telephone survey to elicit information regarding the impact of sleep disturbances on a convenience sample of 150 patients. Of these patients, 44% reported a sleep problem during the month before the interview. Significant relations included these: report of sleep problems prediagnosis over the past month (x = 5.82; p = 0.02), duration of sleep medication use and frequency of sleep problem (r = 0.58; p = 0.05), age and severity of sleep problems (r = 0.38; p = 0.05), and frequency and severity of the sleep problem over the past month (r = 0.21; p < 0.10). Communication with health care providers occurred in 16.6% of patients reporting a sleep disturbance. The second phase of this study explored the type, frequency, and severity of sleep problems and perceptions of causation, support, and methods of coping with the sleep problem. A qualitative approach to the problem was used in this phase. A one-time telephone interview of 42 patients, derived from a convenience sample, revealed a 45% prevalence of sleep problems a month before the interview. A qualitative analysis of the responses suggested that sleep problems are related to experiences of other symptoms and perceptions of cancer and treatment. Content analysis of the responses identified the following categories: figuring out the reason, seeking help, seeking support and relation to the overall cancer experience.

Baltimore↗
PubMed2001

Alcohol's effects on sleep in alcoholics.

Sleep problems, which can have significant clinical and economic consequences, are more common among alcoholics than among nonalcoholics. During both drinking periods and withdrawal, alcoholics commonly experience problems falling asleep and decreased total sleep time. Other measures of sleep are also disturbed. Even alcoholics who have been abstinent for short periods of time (i.e., several weeks) or extended periods of time (i.e., several years) may experience persistent sleep abnormalities. Researchers also found that alcoholics are more likely to suffer from certain sleep disorders, such as sleep apnea. Conversely, sleep problems may predispose some people to developing alcohol problems. Furthermore, sleep problems may increase the risk of relapse among abstinent alcoholics.

Alcohol Drinking↗
PubMed2005

A systematic review of patient-reported outcome instruments measuring sleep dysfunction in adults.

Sleep dysfunction can manifest in several ways, ranging from insomnia to somnolence, and from disrupted sleep to lack of restful sleep. Measuring sleep dysfunction is an area of active research and there exist a number of patient-reported outcome instruments that measure various aspects of sleep dysfunction. However, these instruments have not been evaluated systematically. We used a conceptual model of sleep that included four physical domains of general interest to patients and investigators, and cover the breadth of this disorder: sleep initiation; sleep maintenance; sleep adequacy; and somnolence. We next considered the additional health-related quality-of-life (HR-QOL) domains of psychological and social functioning, progressing along the continuum to include health perceptions and opportunity. We then conducted a literature review to identify instruments and, using criteria developed by the Medical Outcomes Trust Scientific Advisory Committee, evaluated these instruments for their potential use in measuring sleep dysfunction. Twenty-two instruments were identified. Six instruments were found to include the four physical domains defined a priori (Basic Nordic Sleep Questionnaire, Leeds Sleep Evaluation Questionnaire, Medical Outcomes Study - Sleep Problems Measures, Pittsburgh Sleep Diary, Pittsburgh Sleep Quality Index, Self-Rated Sleep Questionnaire and the Sleep Dissatisfaction Questionnaire). Several additional instruments addressed at least some of the domains and thus may be useful for specific purposes. A few instruments addressed overall HR-QOL, but did not include all four domains of interest (Functional Outcomes of Sleep Questionnaire, Quality of Life in Insomniacs and the Sleep-Wake Activity Inventory). Two instruments had undergone extensive psychometric evaluation (Medical Outcomes Study - Sleep Problems Measures and Pittsburgh Sleep Quality Index), with only the latter reporting information about interpretability. Our review indicates that measuring sleep dysfunction in adults is an area of active research and that much work still needs to be completed, specifically the study of interpretability and the application of patient preferences or item response theory. The specific research focus should dictate instrument selection.

Adult↗
PubMed2005

Sleep disturbances in midlife unrelated to 32-year diabetes incidence: the prospective population study of women in Gothenburg.

OBJECTIVE: To study the relation between diabetes incidence and sleep problems in a population-based sample of women followed for 32 years. RESEARCH DESIGN AND METHODS: The researchers conducted a prospective population study initiated in 1968-1969, with follow-ups in 1974-1975, 1980-1981, 1992-1993, and 2000-2001 in Gothenburg, Sweden. A total of 1,462 women born in 1908, 1914, 1918, 1922, and 1930, representative of women of the same ages in the general population, initially participated (90% participation rate). Reported sleep duration, sleep problems, and use of sleeping medication were related to incident diabetes from 1968 to 2000. Associations between sleep problems and diabetes were corrected for waist-to-hip ratio (WHR), BMI, subscapular skinfold, fasting blood glucose and serum lipid concentrations, blood pressure, heart rate, smoking, physical activity, education, and socioeconomic status. Additionally, associations between BMI, WHR, and sleep problems were examined. RESULTS: Over 32 years, 126 women (8.7%) developed diabetes. Associations between diabetes and initial sleep problems were tested in a Cox regression analysis, taking into consideration factors associated (P < 0.1) with diabetes. Sleep problems in 1968 did not increase risk of developing diabetes during the following 32 years. Obesity, particularly centralized, was associated with sleep problems. CONCLUSIONS: No association between sleep problems and developing diabetes was seen in this 32-year follow-up of middle-aged women. Obesity, on the other hand, known to cause increased risk of diabetes, was associated with current sleep problems.

Adult↗
PubMedDate not supplied

Characterizing sleep disorders in chronic hemodialysis patients.

Forty-eight chronic hemodialysis (HD) patients (pts) completed questionnaires that used linear analogue scales (LAS), yes/no responses, and demographic data collection to characterize sleep disorders. Twenty-five pts (52%) reported problems sleeping. These pts graded sleep problems significantly higher than those without sleep problems (6.5 +/- 3 vs. 1.8 +/- 2, p less than 0.001 by LAS). Those with sleep disorders were more likely to smoke cigarettes (13/25 vs. 6/23, p less than 0.05) and have bone pain (14/25 vs. 6/23, p less than 0.05). No differences among pts with and without sleep problems were seen in age, gender, time on dialysis, caffeine intake, pruritus, feelings of sadness, worry, or anxiety, or Kt/V values (1.5 +/- 0.2 vs. 1.4 +/- 0.2, p less than 0.13). Restless legs (84%), onset insomnia (76%), and nighttime (76%) and early A.M. waking (72%) characterized the sleep disorders; symptoms suggesting nocturnal myoclonus were less common (20%). We conclude that sleep disorders are common in HD pts and may be exacerbated by tobacco use, bone pain, and restless legs. Kt/V does not correlate with sleep disorders. Further examination of this problem, including formal sleep studies, is needed.

Adult↗
PubMed2003

Comprehensive assessment of insomnia in recovering alcoholics using daily sleep diaries and ambulatory monitoring.

BACKGROUND: Many alcoholics continue to experience disrupted sleep after quitting drinking. Previous studies with recovering alcoholics have relied on retrospective questionnaires and a single night of polysomnography to document sleep problems. In the present study, sleep was assessed at home over the course of a week using both subjective and objective sleep measures. METHODS: A mixed gender group of alcoholics in recovery (n = 63) experiencing insomnia underwent a multimodal sleep assessment including a structured interview, daily sleep diaries, questionnaires, and ambulatory sleep monitoring. Alcoholics with short-term (<12 months) and long-term (>12 months) abstinence had their sleep monitored prospectively and were compared. RESULTS: Over half of the participants reported sleep problems that predated the onset of alcohol dependence. Alcoholics with short- and long-term abstinence had similarly disturbed sleep. Overall, problems with getting to sleep were worse than sleep maintenance difficulties. Severity of insomnia was unrelated to drinking history and modestly correlated with the current level of depressive symptoms. Poor sleep hygiene was evident in the sample. CONCLUSIONS: Alcoholics can experience sleep problems for many months after quitting drinking. Implications for sleep interventions with this population are discussed.

Adult↗
PubMed2004

Pediatric sleep disorders: exploratory modulation of their relationships.

STUDY OBJECTIVES: This study explores relationships between clinically encountered sleep problems in children. DESIGN: The Sleep Disturbance Scale for Children (SDSC) (Bruni et al 1996), which screens 26 sleep problems and results in 6 sleep disorder-subscales, was used as core in a larger health-behavior questionnaire (HBQ). PARTICIPANTS: Caregivers of 3045 6- to 12-year-olds filled out the HBQ. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: 21 SDSC-items plus 15 new sleep items were selected. Via structural equation modelling we explored (1) relations within and between disorder-subscales, (2) relations between the disorder-subscales with 3 indexes added (i.e., sleep efficiency index, sleep environment index, and sleep enuresis) and (3) relations of the disorder-subscales to their categorization: dyssomnia and parasomnia, without and with the indexes. CONCLUSIONS: The final model had a satisfying fit and approximates the Association of Sleep Disorders Centers' classification. Each disorder-subscale can be applied individually. However, some items are statistically of low value. For that reason, the use as the inference of relations between such items should be cautious. Adding the 3 indexes improved the fit of the model. The complexity of 'sleep enuresis' was especially revealed. For the practicing care provider, as for researchers, the statistical model proposed could be a valuable directive in the diagnostic classification process of pediatric sleep problems.

Adolescent↗
PubMed1997

The morbidity of insomnia uncomplicated by psychiatric disorders.

The morbidity of sleep problems has been well documented; however, they are frequently associated with and are symptomatic of several psychiatric disorders. It is unclear how much of the morbidity can be accounted for by the associated psychiatric and substance abuse disorders and medical problems, and how much by the sleep problems per se. Sleep problems may also be an early sign of a psychiatric problem. This paper reports data from an epidemiologic community survey of over 10,000 adults living in three U.S. communities. A structured diagnostic assessment of psychiatric disorders as well as assessment of the presence of insomnia not due to medical conditions, medication, drug or alcohol abuse, and a 1-year follow-up were completed. Persons with insomnia in the past year without any psychiatric disorders ever (uncomplicated insomnia); with a psychiatric disorder in the past year (complicated insomnia); and with neither insomnia nor psychiatric disorders ever were compared on treatment utilization and the first onset of a psychiatric disorder in the subsequent year. Eight percent of those with uncomplicated as compared with 14.9% with complicated insomnia and 2.5% with neither had sought treatment from the general medical sector for emotional problems in the 6 months prior to the interview. The rates of treatment sought from the psychiatric specialty sector were 3.8%, 9.4%, and 1.2%, respectively. These differences were significant after controlling for sociodemographic characteristics and were sustained when the persons were interviewed 1 year later. Uncomplicated insomnia was also associated with an increase in risk for first onset of major depression, panic disorder, and alcohol abuse over the following year. Insomnia, even in the absence of psychiatric disorders, is associated with increased use of general medical and mental health treatment for emotional problems and for the subsequent first onset in the following year of some psychiatric disorders. Early diagnosis and treatment of uncomplicated insomnia may be useful.

Adult↗