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At least 415 records · Page 23Linked to original sources

PubMed2003

Managing insomnia in the elderly - what prevents us using non-drug options?

OBJECTIVE: To identify strategies needed to increase use of non-drug interventions in the management of insomnia in the elderly. METHODS: A questionnaire was mailed to 425 general practitioners (GPs) in the South Australian Southern Division of General Practice. To provide a consumer perspective, 16 older persons attended focus groups. RESULTS: Responses from 209 GPs showed the role of non-drug strategies in insomnia management was widely known, however access to and the usefulness of these strategies was less well known. GPs' perceptions of patients' expectations regarding medication were the greatest barrier. Patient inquiries about other options, patients' willingness to consider alternatives, printed information for patients on non-drug options, and step-by-step procedures to follow during consultations were considered enabling factors. Most consumers reported problems with sleeping but thought the GP could not help them with their sleep problems. In contrast to GPs' perceptions, consumers expressed interest in alternative treatments and willingness to participate in education sessions. CONCLUSIONS: Strategies to increase the use of non-drug alternatives need to provide GPs with information on access to, and the usefulness of, non-drug strategies. Consumers need concurrent education to inform them that GPs can help manage insomnia, and that they need to express willingness to trial non-drug strategies. Effective communication between GPs and consumers is paramount.

Aged↗

PubMedDate not supplied

Do maritime crew members have sleep disturbances?

Data obtained from surveys of two samples of maritime crew members were studied for differences in self-reported sleep lengths and sleep problems. The data addressed both on- and off-duty variables. Statistical analysis of the data found that on-duty sleep length was shorter than off-duty sleep length for both groups. The two groups' responses to various sleep-problem items were significantly different. Most responses were below the scale mid-point. The differences between on- and off-duty sleep-problem items were not significant. Following a factor analysis, selected sleep-problem items were combined to form a composite Sleep Disturbance Scale. Using this composite measure, the correlation between the composite and sleep length was not significant. Overall, the results indicate that caution should be exercised before labeling shift workers as having "disturbed sleep" or suffering from "sleep disorders." The results do confirm the previous findings that shiftwork reduces sleep length on workdays.

Adult↗

PubMed2000

Psychological distress two years after diagnosis of breast cancer: frequency and prediction.

The present prospective study aimed at (1) investigating the frequency of high levels of psychological distress in women with early-stage breast cancer almost two years after diagnosis and (2) identifying characteristics associated with long-term distress. One hundred and seventy women participated on two occasions. Two months after surgery, patients completed questionnaires measuring psychosocial variables (e.g., stressful life-events, health complaints, sleep problems, social support, subjective distress, personality factors), demographic and biomedical variables (e.g., TNM status, type of surgery). At the second measurement, subjective distress was assessed for a second time by means of the Impact of Events Scale (IES). Almost two years after diagnosis, 16% of the women reported a high level of psychological distress as measured by the Intrusion scale (IES). Best predictors of a high level of distress were: intrusive thoughts about the disease, trait-anxiety, health complaints and problems with sleeping. No significant association was found between previous life-events, social support or biomedical variables and levels of distress.

Adult↗

PubMed1992

A cognitive-behavioral therapy for sleep-maintenance insomnia in older adults.

Older adults (3 men, 4 women, aged 55 to 68 years) with chronic sleep-maintenance insomnia were treated sequentially with relaxation therapy (RT) and then with a cognitive-behavioral therapy (CBT) specifically designed for alleviating sleep maintenance problems. Sleep diaries and an objective measure of sleep, the sleep assessment device, showed only modest improvements in measures of wake time after sleep onset, sleep efficiency, and night-to-night sleep variability following RT. However, significant improvements in these measures were observed following CBT and at a 3-month follow-up. These findings, considered in conjunction with previous reports, suggest that CBT specifically addresses factors that sustain sleep maintenance complaints. Additional trials of CBT with larger samples are warranted.

Aged↗

PubMed2006

Consequences of youth tobacco use: a review of prospective behavioural studies.

BACKGROUND: Cigarette smoking represents a significant health problem and tobacco has been identified as causing more preventable diseases and premature deaths than any other drug. Although health consequences from smoking have been documented, there has been a surprising lack of research into behavioural consequences. AIMS: To review what is known of the long-term relationship between patterns of tobacco use prior to age 18 years and behavioural consequences in adulthood. METHOD: A literature search of electronic abstraction services from 1980 to September 2005 was conducted. To be included in the review, studies had to have large, representative samples, be longitudinal studies with baseline age under 18 years and follow-up age 18 years or older and clarify effects due to attrition, leaving 16 articles that met the inclusion criteria. Two reviewers evaluated each paper. FINDINGS: Adolescent tobacco use predicts a range of early adult social and health problems. Surprisingly few studies met the inclusion criteria. The limited evidence available suggests that adolescent tobacco smoking increases the likelihood of early adult tobacco use and the initiation of alcohol use or the development of alcohol-related problems. The link between adolescent tobacco use and subsequent cannabis use was not resolved convincingly from the studies summarized. The effects of tobacco use on later illicit drug use tended to fall away when adjusting for underlying risk factors. Existing studies of the effects of tobacco use on later mental health have many limitations. Nevertheless, a finding that youth tobacco use may predict subsequent mental health problems deserves further investigation. The possible effects of tobacco use on academic/social problems and sleep problems also warrant further investigation. CONCLUSION: This review highlights links between youth tobacco use and subsequent behavioural and mental health problems. It provides health care professionals with evidence of the possible harmful effects of youth tobacco smoking on later social, emotional, and behavioural well-being.

Adolescent↗

PubMed2005

Use of the 'BEARS' sleep screening tool in a pediatric residents' continuity clinic: a pilot study.

OBJECTIVE: To assess the effectiveness of a simple, 5-item pediatric sleep screening instrument, the BEARS (B=Bedtime Issues, E=Excessive Daytime Sleepiness, A=Night Awakenings, R=Regularity and Duration of Sleep, S=Snoring) in obtaining sleep-related information and identifying sleep problems in the primary care setting. SETTING: Pediatric residents' continuity clinic in a tertiary care children's hospital. METHODS: BEARS forms were placed in the medical records of a convenience sample of 2 to 12 year old children presenting for well child visits over the 5 month study period. Sleep-related information recorded in the BEARS visit and in the pre-BEARS visit, which was the subject's most recent previous well child check (WCC), was coded with respect to whether or not a sleep problem was indicated, and whether sleep issues were addressed. RESULTS: A total of 195 children had both a documented pre-BEARS and BEARS WCC visit. BEARS visits were significantly more likely than the pre-BEARS visits to have any sleep information recorded (98.5% vs. 87.7%, p<0.001), and to have information recorded about bedtime issues (93.3% vs. 7.7%, p<0.001), excessive daytime sleepiness (93.9% vs. 5.6%, p<0.001), snoring (92.8% vs. 7.2%, p<0.001), nighttime awakenings (91.3% vs. 29.2%, p<0.001), and regularity and duration of sleep (65.3% vs. 31.5%, p<0.001). Significantly more sleep problems were identified during the BEARS visits in the domains of bedtime issues (16.3% vs. 4.1%, p<0.001), nighttime awakenings (18.4% vs. 6.8%, p<0.001) and snoring (10.7% vs. 4.6%, p=0.012). Finally, almost twice as many BEARS charts had sleep mentioned in the Impression and Plan (13.1% vs. 7.3%), which approached significance (p=0.07). CONCLUSIONS: The BEARS appears to be a user-friendly pediatric sleep screening tool which significantly increases the amount of sleep information recorded as well as the likelihood of identifying sleep problems in the primary care setting.

Ambulatory Care Facilities↗

PubMed2005

Prevalence and consequences of insomnia in New Zealand: disparities between Maori and non-Maori.

OBJECTIVE: To investigate the prevalence of self-reported insomnia symptoms among Maori (Indigenous people) and non-Maori adults in the general population of New Zealand. To explore the consequences for health and quality of life experienced by those who report common insomnia complaints and sleeping problems. METHODS: In 2001, a two-page questionnaire was mailed to a stratified random sample of 4,000 adults aged 20-59 years nationwide. Participants were selected from the New Zealand electoral roll. The sample design aimed for equal numbers of Maori and non-Maori participants, men and women, and participants in each decade of age (72.5% response rate). RESULTS: Population prevalence estimates indicate that self-reported insomnia symptoms and sleeping problems are higher among Maori than non-Maori. Multiple logistic regression analyses showed that self-reported insomnia symptoms and/or sleeping problems are significantly associated with reporting poor or fair health and quality of life outcomes. CONCLUSIONS: Approximately one-quarter of adults in New Zealand may suffer from a chronic sleep problem, highlighting insomnia as a major public health issue in New Zealand. IMPLICATIONS: Significant differences in the prevalence of insomnia symptoms and current sleeping problems with respect to ethnicity have implications in the purchase and development of treatment services, with greater need for these services among Maori than non-Maori.

Adult↗

PubMed2002

Sleep patterns of children with pervasive developmental disorders.

Data on sleep behavior were gathered on 100 children with pervasive developmental disorders (PDD), ages 2-11 years, using sleep diaries, the Children's Sleep Habits Questionnaire (CSHQ), and the Parenting Events Questionnaire. Two time periods were sampled to assess short-term stability of sleep-wake patterns. Before data collection, slightly more than half of the parents, when queried, reported a sleep problem in their child. Subsequent diary and CSHQ reports confirmed more fragmented sleep in those children who were described by their parents as having a sleep problem compared to those without a designated problem. Interestingly, regardless of parental perception of problematic sleep, all children with PDD exhibited longer sleep onset times and greater fragmentation of sleep than that reported for age-matched community norms. The results demonstrate that sleep problems identified by the parent, as well as fragmentation of sleep patterns obtained from sleep diary and CSHQ data, exist in a significant proportion of children with PDD.

Child↗

PubMed1999

Predictors and timing of adverse experiences during trandsdermal nicotine therapy.

OBJECTIVES: Difficulty sleeping is a recognised tobacco withdrawal symptom, but sleep problems, like application site reactions, are commonly reported as adverse reactions to transdermal nicotine therapy. However, no studies have examined potential predictive factors associated with the occurrence of expected adverse experiences during transdermal nicotine therapy. The subject of skin tolerability among patients with a history of eczema, psoriasis or other skin disorders is of particular interest, as are the relationships between plasma concentrations of nicotine, concurrent smoking, sleep problems and nausea. METHODS: The cohort study involving 1392 participants was designed to assess the timing, severity and predictive factors of adverse experiences reported during 24-hour transdermal nicotine therapy. Data were collected on patients aged 18 to 70 years old who were smokers and who had expressed a strong desire to stop smoking. The intervention consisted of brief behavioural counselling, a booklet containing smoking cessation advice and instructions for use of the patches, and a 12-week course of decreasing transdermal nicotine doses. RESULTS: Follow-up was available on 1392 out of 1481 study participants. The majority of adverse experiences were mild. Sleep problems occurred in 669 out of 1392 (48%) participants and most often commenced on the day of smoking cessation. Application site reactions occurred in 478 out of 1392 (34%) participants and most often occurred after 6 days of therapy. No predictor had an adjusted hazard ratio above 2. Statistically significant (p < 0.05) predictors of sleep problems were successfully quitting smoking and female gender. Predictors of application site reactions were psoriasis or eczema, other skin conditions, age <40 years, female gender, place of birth outside Australasia, and trade or university education level. Substantially increased nicotine intake during therapy compared with baseline smoking occurred in 8% of participants who smoked concurrently, and 4% of participants who did not (p = 0.1). Increased nicotine intake was associated with a modest increase in the overall rate of adverse experiences (89% vs 63%, p = 0.04) and dizziness/lightheadedness (17% vs 3%, p = 0.03), but not with sleep problems or cardiovascular events. CONCLUSIONS: Transdermal nicotine therapy appears to be well tolerated, even if the user smokes concurrently. Sleep disturbance during therapy appeared to be primarily associated with tobacco withdrawal rather than with nicotine excess from treatment with transdermal nicotine. Study participants with pre-existing skin disorders were somewhat more likely to report mild application site reactions than other participants.

Administration, Cutaneous↗

PubMed2001

Effects of age and alcoholism on sleep: a controlled study.

OBJECTIVE: Sleep problems are common, costly and potentially fatal in older adults. Sleep problems are also commonly associated with alcoholism. Yet few studies have examined the combined effects of alcoholism and aging on sleep. The purpose of this study was to investigate the main and interactive effects on sleep of diagnostic group and age group. METHOD: Alcohol dependent patients (n = 139; 118 men) and nonalcoholic controls (n = 87; 57 men) completed full-montage polysomnography, structured psychiatric diagnostic interviews, validated rating scales and alcohol histories at the University of Michigan between 1989 and 1996. The sample was divided for analytic purposes into older (aged 55+ years) and younger (aged <55 years) subgroups. RESULTS: After controlling for gender, race, body mass index and psychiatric-related sleep symptoms, alcoholics and older adults had significantly decreased total sleep time, and increased Stage 1 sleep percentage, respiratory distress and periodic limb movements. Older adults also had decreased delta sleep percentage and shorter rapid eye movement sleep latencies. Significant interactions were found between alcoholism and age group for Stage 1 sleep percentage, sleep-disordered breathing and periodic limb movements, with older alcoholics having the most disturbances. Older alcoholics had the highest mean values for sleep latency and the lowest mean values for sleep efficiency and delta sleep percentage when compared with the other three groups. CONCLUSIONS: Older alcoholics have increased sleep disturbances when compared with younger alcoholics and with nonalcoholics of both age groups. Care providers should screen for sleep problems among older adults with alcohol problems.

Adult↗

PubMedDate not supplied

Distressing emotions in female caregivers of people with AIDS, age-related dementias, and advanced-stage cancers.

PURPOSE: To describe and compare the depressive mood, anxiety, anger, and sleep problems of informal female caregivers of people with AIDS, age-related dementias (ARD), and cancer (CA). METHODS: Caregivers recruited from clinics serving people with AIDS, ARD, and CA were interviewed using structured instruments measuring depressive symptoms, anxiety, anger, and sleep problems. Data analysis compared these emotions in the caregivers and related aspects of the caregiving situation to these emotions within each group. FINDINGS: Caregivers did not differ significantly in depressive mood, but did differ in anxiety and anger and sleep problems. Individual items on each scale were compared to provide more descriptive detail. In each group, distressing emotions were significantly related to each other and to sleep problems. CONCLUSIONS: Caregivers of people with AIDS, ARD, and CA experience distressing emotions that may affect their mental and physical health. A comprehensive approach to mental health nursing therapy will best meet the needs of caregivers in relieving their distress.

Acquired Immunodeficiency Syndrome↗

PubMed2006

The natural history of headache: predictors of onset and recovery.

The objective of this study was to determine predictors of onset of new headache episodes and recovery from headache over one year. A population-based cohort study was conducted, comprising a baseline postal survey to a random sample of adults aged>or=18 years, with follow-up survey after 1 year. Risk factor data at baseline were compared with headache status at follow-up in two groups: (i) those free of recent headache at baseline and (ii) those with a recent headache at baseline. In respondents free of recent headache at baseline, previous headache [risk ratio (RR) 4.15], the presence of other pain at baseline (RR 1.43), severe sleep problems (RR 1.67) and drinking caffeine (RR 1.99) increased the risk of a new headache episode during the follow-up year. In respondents with recent headache at baseline, less severe headaches at baseline predicted recovery during the follow-up year, as did the absence of anxiety [recovery ratio (ReR) 2.84] and of sleep problems (ReR 2.77). Risks for increased headache-related disability reflected those for onset of a new episode and these risks increased in strength for large increases in disability. Sleep problems and caffeine consumption increase the risk of developing headache and thus provide targets for prevention. Low levels of anxiety, sleep problems and the absence of other pain improve the likelihood of recovering and remaining free from headache.

Adolescent↗

PubMed2001

Characteristics of patients referred to an insomnia clinic.

AIM: To study the socio-demographic profile, symptomatology, prior treatment and treatment response of patients seen in an Insomnia Clinic. METHOD: Information was gathered by case-note review from eighty-five consecutive cases referred to the clinic. FINDINGS: There were almost equal numbers of males and females and they were predominantly Chinese, married and almost equally distributed in the 31 to 60 years age range. More than half (54.2%) had sleep problems for more than a year and almost three quarters (74.1%) had prior treatment for sleep problems. The main presenting complaints were of difficulty initiating sleep (92.9%). About 60.7% reported that their sleep problems were transient episodes and 39.3% reported it as persistent. 92.9% of the cases received pharmacotherapy. All patients received psychological treatment. For those treated with pharmacotherapy, 44.7% received benzodiazepines and 37.6% received non-benzodiazepine hypnotics. The majority, 77.5% were on treatment for less than six months. 48.2% improved and ended treatment themselves. CONCLUSIONS: The patients in this sample sought treatment or were referred for treatment much earlier compared to other samples studied. Importantly, 29.5% of the patients referred had an undiagnosed psychiatric condition.

Adult↗

PubMed2006

Sleep disturbances and correlates of children with autism spectrum disorders.

This study examined sleep patterns, sleep problems, and their correlates in children with autism spectrum disorders (ASD). Subjects consisted of 167 ASD children, including 108 with autistic disorder, 27 with Asperger's syndrome, and 32 with other diagnoses of ASD. Mean age was 8.8 years (SD = 4.2), 86% were boys. Parents completed a self-administered child sleep questionnaire. Results showed that average night sleep duration was 8.9 h (SD = 1.8), 16% of children shared a bed with parent. About 86% of children had at least one sleep problem almost every day, including 54% with bedtime resistance, 56% with insomnia, 53% with parasomnias, 25% with sleep disordered breathing, 45% with morning rise problems, and 31% with daytime sleepiness. Multivariate logistic regression analyses indicated that younger age, hypersensitivity, co-sleeping, epilepsy, attention-deficit/hyperactivity disorder (ADHD), asthma, bedtime ritual, medication use, and family history of sleep problems were related to sleep problems. Comorbid epilepsy, insomnia, and parasomnias were associated with increased risk for daytime sleepiness. Results suggest that both dyssomnias and parasomnias are very prevalent in children with ASD. Although multiple child and family factors are associated with sleep problems, other comorbid disorders of autism may play a major role.

Asperger Syndrome↗

PubMed1999

Cosleeping in context: sleep practices and problems in young children in Japan and the United States.

OBJECTIVE: To determine the relationship between cosleeping and sleep problems in cultures with very different sleep practices. DESIGN: Interview study. SETTING: Families in urban Japan and the United States identified through pediatric and other professional contacts. PARTICIPANTS: Parents of healthy 6- to 48-month-old children (56 Japanese parents and 61 white US parents). All children had been breast-fed and lived in 2-parent, middleclass households. INTERVENTION: None. MAIN OUTCOME MEASURE: Sleep practices and sleep problems. RESULTS: More Japanese than US children coslept 3 or more times per week (59% vs. 15%, P<.001). All cosleeping Japanese children regularly slept all night with their parents (vs. 11% of US cosleepers, P<.001). Japanese and US children did not differ in part-night cosleeping (7% vs. 13%, P = .37). Most Japanese children had adult company and body contact as they fell asleep, and fathers slept separately in 23% of families. A greater proportion of US children had regular bedtime struggles and night waking. Within the US sample, cosleeping was associated with more bedtime struggles (P<.001), night waking (P<.01), and overall stressful sleep problems (P<.01). In the Japanese sample, cosleeping was associated only with night waking (P<.05); however, the proportion of cosleeping Japanese children with frequent night waking was at the level reported for US children who slept alone (30% vs 23%, P = .47). CONCLUSIONS: Cultural differences seem to influence the relationship between sleep practices and sleep problems. The experience of the Japanese families indicates that cosleeping per se is not associated with increased sleep problems in early childhood.

Adult↗

PubMed2005

Sleep disturbances in adolescents and young adults with autism and Asperger syndrome.

Sleep problems are commonly reported in children with autistic disorders. Most studies are based on sleep questionnaires and sleep diaries, but polysomnographic and actigraphic data have also been used. In this study we investigated sleep in older individuals (aged 15-25 years) with autism and Asperger syndrome, using sleep questionnaires, sleep diaries and actigraphy. Although the sleep questionnaires completed by parents and caretakers revealed only a moderate degree of sleep problems, greater sleep disturbance was recorded with actigraphy. Using the latter method, low sleep efficiency (below 85 percent) or long sleep latency (more than 30 minutes) were found in 80 percent of the individuals. There was no early morning awakening, contrary to some earlier reports. This study suggests that even though subjective complaints of sleep disturbances are less common in adolescents and young adults with autism, this may be due to an adaptation process rather than an actual reduction in sleep disturbances.

Adolescent↗

PubMed2006

A review of pediatric nonrespiratory sleep disorders.

Sleep problems are extremely common during childhood, from infancy to adolescence. Despite the prevalence of sleep problems, childhood sleep disorders are often underrecognized and undiagnosed, despite being either preventable or treatable. Sleep impacts almost all aspects of a child's functioning, and thus the increased recognition and treatment of sleep disorders will positively affect a child's well-being. Children experience the same broad range of sleep disturbances encountered in adults, including sleep apnea, insomnia, parasomnia, delayed sleep phase, narcolepsy, and restless legs, but their clinical presentation, evaluation, and management may differ. Although snoring and sleep apnea may be the most common indication for an overnight sleep study in a child, one quarter of children presenting to a sleep clinic for evaluation will have a second sleep diagnosis, which is often nonrespiratory in nature. Especially in children, ruling out sleep apnea is rarely the end point of the sleep evaluation. Clinicians involved in sleep medicine must be prepared to recognize, evaluate, and manage plans for sleep disorders across the lifespan of the patient. This article will provide an updated review of nonrespiratory pediatric sleep disorders within a developmental framework.

Adolescent↗

PubMed2004

Occupation-specific screening for future sickness absence: criterion validity of the trucker strain monitor (TSM).

BACKGROUND: Monitoring psychological job strain may help occupational physicians to take preventive action at the appropriate time. For this purpose, the 10-item trucker strain monitor (TSM) assessing work-related fatigue and sleeping problems in truck drivers was developed. OBJECTIVES: This study examined (1) test-retest reliability, (2) criterion validity of the TSM with respect to future sickness absence due to psychological health complaints and (3) usefulness of the TSM two-scales structure. METHODS: The TSM and self-administered questionnaires, providing information about stressful working conditions (job control and job demands) and sickness absence, were sent to a random sample of 2000 drivers in 1998. Of the 1123 responders, 820 returned a completed questionnaire 2 years later (response: 72%). RESULTS: The TSM work-related fatigue scale, the TSM sleeping problems scale and the TSM composite scale showed satisfactory 2-year test-retest reliability (coefficient r=0.62, 0.66 and 0.67, respectively). The work-related fatigue, sleeping problems scale and composite scale had sensitivities of 61, 65 and 61%, respectively in identifying drivers with future sickness absence due to psychological health complaints. The specificity and positive predictive value of the TSM composite scale were 77 and 11%, respectively. The work-related fatigue scale and the sleeping problems scale were moderately strong correlated (r=0.62). However, stressful working conditions were differentially associated with the two scales. CONCLUSIONS: The results support the test-retest reliability, criterion validity and two-factor structure of the TSM. In general, the results suggest that the use of occupation-specific psychological job strain questionnaires is fruitful.

Adult↗