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Effects of abstinence from tobacco smoking on physiological and psychological arousal levels in habitual smokers.

Effects of abstaining temporarily from tobacco smoking were studied in a group of habitual smokers during a 15-day period, during which they smoked normally for the forst 5 days, refrained from smoking the next 5 days, and smoked again during the last 5 days. Results were evaluated against values obtained in a nonabstaining group of smokers. Adrenaline and noradrenaline excretion decreased, skin temperature increased, and hand steadiness was improved when the subjects stopped smoking. Submaximal, physical work tests were performed once each period. No changes occurred in perceived exertion for abstainers during work, in spite of a reduced heart rate. There were only minor differences between abstaining and smoking subjects with regard to performance in the cognitive tests. Irritation, depression, lack of concentration, sleep disturbances, anxiety, tension, and restlessness were frequently reported as abstinence symptoms. The results indicate a decrease in arousal level during abstinence.

Adult↗

Natural history of nicotine withdrawal.

AIMS: To examine the natural history of nicotine withdrawal and individual differences associated with withdrawal duration and severity. DESIGN AND SETTING: Prospective study of withdrawal symptoms among smokers who quit for at least 24 hours. Participants used Ecological Momentary Assessment to monitor symptoms in their natural environment using an Electronic Diary (ED). PARTICIPANTS: A total of 214 cigarette smokers (59% female, 92% Caucasian). INTERVENTION: All participants received a clinic-based, behavioral, group cessation intervention. Severity and duration of withdrawal was not addressed explicitly in treatment. MEASUREMENTS: Participants were 'beeped' by the ED approximately five times/day to complete affect assessments (negative affect, arousal, attention disturbance, restlessness), and daily assessments of sleep disturbance (at waking) and of cognitive performance (each evening) for a week prior to quitting and for up to 21 days after quitting. Withdrawal was considered resolved when withdrawal scores returned to baseline levels for at least 2 consecutive days. FINDINGS: All symptoms returned to baseline levels within 10 days of quitting. All variables except arousal and sleep disturbance showed change over time. No robust predictors of individual differences in withdrawal responses emerged. CONCLUSIONS: The time-course of withdrawal may be shorter than previously reported. The natural history of nicotine withdrawal may have implications for theories of withdrawal and smoking relapse and for smoking cessation treatment.

Adult↗

Relation of somatic symptoms to degree of paternal-role preparation of first-time expectant fathers.

This study was conducted to determine the association between the presence of somatic symptoms (couvade syndrome) and the amount of paternal-role preparation attained by 64 expectant fathers. Thirty-five men in the sample identified more than two symptoms; most frequently, restlessness, increased appetite, and difficulty sleeping. Men experiencing symptoms scored higher on scales measuring paternal-role preparation than men not experiencing symptoms.

Adult↗

[Contraindications and complications in vaccinations].

By immunizations many infectious diseases and their associated severe complications can be prevented. The high importance of vaccinations must be emphasized by the paediatricians. But it is also very important to know the contraindications and especially the rare complications and also adverse reactions following some immunizations e.g. against pertussis, tuberculosis, measles, rubella, diphtheria, tetanus and polio, which must be carefully investigated. The contraindications to immunizations must be paid attention, but they should not be dramatized. Slight adverse reactions following some immunizations some hours or days later may not be considered as complications (e.g. some children develop fever, become restless or have a broken sleep in the following night; reddening at the place of injection, a transitory exanthem and others). Incomplete knowledges and informations in side of some physicians must be removed by permanent graduate medical education.

Bacterial Vaccines↗

Sleep enhanced and irritability reduced in preterm infants: differential efficacy of three types of waterbeds.

The purpose of this study was to determine whether waterbeds enhance preterm infants' sleep and reduce irritability, and whether plain, continuously, or intermittently oscillating waterbeds are differentially effective in producing these effects. The baseline states and motility of 52 stable preterm infants were assessed on two consecutive days for 100 minutes each. The infants then were randomly assigned to four groups: a control group who remained on the incubator mattress, or to one of the three experimental groups, each using a different waterbed. On days 3 and 4 in the assigned test condition, the infants' states and motility were again assessed for 100 minutes each day. The results indicate that, compared with infants in the control group, infants assigned to any of the waterbed groups slept significantly more and better, had significantly fewer unsmooth movements, state changes, and transitional states, and were significantly less irritable. Differential treatment effects were found, with infants on continuously oscillating waterbeds showing the most marked reductions in irritability, restlessness, state changes, and unsmooth movements. Thus, to enhance restful sleep and to reduce irritability and/or restlessness, it would be clinically advantageous to use waterbeds in the care of preterm infants. Since even the simple, nonoscillating waterbed improved sleep and reduced restlessness, the use of these beds would be the least costly to achieve these effects.

Arousal↗

Sleep disturbances in Parkinson's disease.

Disorders of sleep and daytime alertness are frequent in Parkinson's disease patients and arise from a number of diverse factors. The most common complaint of night-time sleep disturbance in Parkinson's disease is sleep fragmentation. Sleep fragmentation can be associated with recurrent parkinsonian symptoms, the effect of medications, concomitant medical disorders such as nocturia, or psychiatric disorders such as depression or anxiety. Likewise, nocturnal sleep disturbance may arise from sleep apnea, periodic limb movements of sleep, or rapid eye movement (REM) sleep behavior disorder. Nocturnal sleep deprivation may lead to excessive daytime sleepiness. Other potential sources of daytime sleepiness include the effects of medications or disruption of central sleep mechanisms due to the pathologic processes of Parkinson's disease itself. Diagnosis of sleep disturbances and daytime sleepiness requires a direct interview of the patient and the caregiver, and may involve consultation with the sleep specialist or medical physician. Treatment is aimed toward improving night-time sleep and daytime drowsiness by addressing the causative factors.

Antiparkinson Agents↗

Depression and anxiety complaints; relations with sleep disturbances.

Objectives were to assess the relations of various sleep complaints with depressive and anxiety complaints in a non-clinical population. Four-hundred-and-two randomly approached adults received three questionnaires. Results showed a high interrelatedness between sleep and depressive/anxiety complaints. Both assessment and treatment of depressive and anxiety complaints should address sleep problems.

Anxiety↗

Nocturnal problems occurring in Parkinson's disease.

A large number of patients with Parkinson's disease (PD) experience nocturnal problems that impair their sleep quality. Among them, motor disorders such as tremor, rigidity, akinesia, akathisia, periodic leg movements, painful dystonia, dyskinesias, restless legs syndrome, and rapid eye movement sleep behavior disorder are common. This article reviews the clinical characteristics of some nocturnal motor problems that often induce sleep disruption in PD patients.

Blepharospasm↗

Insomnia in somatoform pain disorder: sleep laboratory studies on differences to controls and acute effects of trazodone, evaluated by the Somnolyzer 24 x 7 and the Siesta database.

Patients with chronic pain often suffer from sleep disturbances, specifically decreased deep sleep, and thus may get into a vicious circle which maintains their pain condition. Utilizing polysomnography and psychometry, objective and subjective sleep and awakening quality was investigated in 11 patients with nonorganic insomnia (F51.0) related to somatoform pain disorder (SPD; F45.4) as compared with age- and sex-matched healthy controls of the Siesta normative database. Patients demonstrated a markedly deteriorated Pittsburgh Sleep Quality Index, a decreased Quality of Life Index, slightly increased self-reported anxiety (Zung SAS) and depression scores (Zung SDS), as well as an increased Epworth Sleepiness Scale and International Restless Legs Syndrome Scale score. Subjective sleep and awakening quality was markedly reduced, while somatic complaints were increased. Polysomnographic evaluation by a recently developed automatic sleep classifier (Somnolyzer 24 x 7) based on the rules of Rechtschaffen and Kales demonstrated reduced slow-wave sleep (SWS), the target variable in the present study, a decreased stage shift index, increased SWS latency and stage 4 sleep (S4) latency and an increased frequency of shifts from S2 to wakefulness (W) in patients as compared with controls. Minimal oxygen saturation was found decreased, periodic leg movements (PLMs) were increased. In the morning, patients showed deteriorated well-being, drive, mood and wakefulness. There were no significant noopsychic or psychophysiological differences between patients and controls (except for a reduced numerical memory and a slightly increased morning diastolic blood pressure in patients). Subsequent evaluation of the acute effects of 100 mg of a controlled-release formulation of trazodone (Trittico retard) in the patients demonstrated an increase in the target variable SWS, accompanied by a reduction in the number of awakenings and stage shifts. It normalized the frequency of shifts from S2 to W and reduced the frequency of shifts from W to S1, from S1 to S2, as well as from any stage to S1 and S2. Trazodone, however, also significantly reduced the total sleep period and S2 and increased the latency to S1. Moreover, the drug increased the reduced minimal O(2 )saturation, reduced the arousal index and the PLMs-in-wake index and normalized the increased morning diastolic blood pressure. In conclusion, our study demonstrated that SPD induced significant changes in subjective and objective sleep and awakening quality, which were partially mitigated by trazodone therapy. The data on the target variable SWS support our hypothesis of a key-lock principle in the diagnosis and drug treatment of sleep disorders. Our study provided the first evidence on the usefulness of the Somnolyzer 24 x 7 and the Siesta database in clinical practice.

Adolescent↗

Cognitive and behavioral anomalies among insomnia patients with mixed restless legs and periodic limb movement disorder.

This study examined whether patients who have periodic limb movement disorder (PLMD), with or without comorbid restless legs syndrome (RLS), display the sleep-disruptive cognitive and behavioral anomalies found among primary insomnia sufferers. Archival data from a Sleep History Questionnaire, home-based polysomnography, and a sleep log were obtained for matched RLS/PLMD, primary insomnia, and noncomplaining volunteer samples. Statistical comparisons showed that the RLS/PLMD and primary insomnia samples differed significantly from the normal sleepers in regard to their propensities for certain sleep disruptive habits, perceived difficulties controlling pre-sleep cognitive activity, and their subjective sleep appraisals. These findings suggest RLS/PLMD patients display many of the cognitive and behavioral anomalies thought to perpetuate primary insomnia. Hence, behavioral interventions may be warranted for RLS/PLMD patients.

Adult↗

Medication effects on sleep.

Each person spends one third of his or her life asleep. It is not surprising that such a complex and pervasive cognitive state should be affected by drugs in many different ways. A philosophy that remains cogent for the CNS is that new research almost always shows this system to be more complex than previously thought. Only a few years ago, if patients complained of difficulty sleeping, they were given pills, often dangerous and addictive pills, to induce sleep no matter what the basis of the complaint might be. Sleeping pills may be safer now, and the understanding of the sleep state itself has increased rapidly. Diagnoses are still diffuse, however, and treatments are often poorly directed. Depression is the offspring of the phlegmatic disposition and the melancholia of another era. Clinically, diagnosis is based on a global assessment of symptoms. It is likely that a diagnosis of depression may include a spectrum of underlying diseases that cannot now be clinically differentiated. Medications have multiple effects on sleep and have many side effects. Progress has, however, been made beyond mother's little pills. Insomnia is no longer a diagnosis but a complaint to be addressed--a symptom of 1 of 60 potential sleep disorders. Each of these disorders has specific and appropriate treatments.

Awareness↗

[Sleep fragmentation as the cause of daytime sleepiness and reduced performance].

Studies in healthy young adults revealed that periodic arousals during the night result in increasing sleepiness as a function of the interval of time between arousals. When arousals are frequent, deficits similar to those seen after total sleep deprivation have been found. Observed decrements appear to be specifically related to EEG arousals and do not require complete awakening. In patients with fragmenting sleep disorders such as periodic leg movements and central sleep apnea, improved nocturnal sleep is related to increased alertness and daytime performance.

Adult↗

Antidepressants and periodic leg movements of sleep.

BACKGROUND: Frequent electroencephalographic arousals or awakenings associated with periodic leg movements (PLM) might be responsible in part for the complaints of sleep disturbances made by patients treated with antidepressants. Past studies, however, have determined the effects of only certain limited antidepressants, generally in small numbers of subjects, and never in a head-to-head study. METHODS: A total of 274 consecutive patients taking antidepressants and 69 control subjects not taking antidepressants met criteria among patients referred for overnight diagnostic polysomnography. Periodic leg movements were visually counted and the PLM index (PLMI) was calculated. RESULTS: The venlafaxine and selective serotonin reuptake inhibitor (SSRI) groups had significantly higher mean PLMIs than control and bupropion groups. Periodic leg movement indexes at thresholds considered to be of potential clinical significance were more statistically prevalent in the SSRI and venlafaxine groups compared with the control and bupropion groups. The odds ratio of having a PLMI greater than 20 was 5.15 for the SSRI group and 5.24 for the venlafaxine group compared with the control group. CONCLUSIONS: Venlafaxine and SSRI-induced PLM are likely to be the result of enhanced serotonergic availability and secondarily decreased dopaminergic effects. The results of this study might assist in the selection of antidepressants, especially in patients with pronounced sleep complaints.

Adolescent↗

Nonpharmacologic treatment of periodic leg movements in sleep.

The effects of a 30-minute stimulation of the dorsiflexors of the feet and toes before bedtime were investigated in eight patients with periodic leg movements in sleep (PLMS). None were taking medications at the time of the investigation. All subjects were treated with the EMS-250 Neuromuscular Stimulator, which has a maximum output per channel of 1.5mA and a frequency of 47Hz. Stimuli were delivered via a pulse train (on for 1.5sec and off for 1.8sec). A single all-night polysomnogram after this stimulation showed that all patients responded to stimulation, with reduction of leg movements from an average pretreatment PLMS index of 44.6 per hour to a posttreatment PLMS index of 14 per hour (p less than .01). Nocturnal leg movements were primarily reduced during the non-REM sleep. Multiple indices of sleep continuity did not change significantly, although there was a trend toward better sleep consolidation.

Adult↗

Actigraphic and parent reports of sleep patterns and sleep disorders in children with subtypes of attention-deficit hyperactivity disorder.

STUDY OBJECTIVE: To describe parent-reported and actigraphically assessed sleep patterns and sleep disorders in stimulant-medication-free children with attention-deficit/hyperactivity disorder (ADHD), divided according to ADHD subtype. PARTICIPANTS: Seventy-one stimulant-medication-free children with a clinical diagnosis of ADHD (8 girls; mean 8.8 years (SD 2.6), range 3-15 years) recruited from child psychiatry clinics. MEASUREMENTS: ADHD: ADHD Rating Scale DSM IV- Home Version to subdivide children into those with predominantly attention deficit, mainly hyperactivity, and those with both aspects equally. Sleep: Parent-completed sleep diary, clinical history, and 5 nights of actigraphy. RESULTS: Parents reported a wide range of frequently occurring sleep disturbances in their children. However, the objective sleep patterns were not abnormal and did not differ between the ADHD subtypes, and objective sleep patterns did not predict ADHD severity. There was poor correspondence between parent report and actigraphy. Careful clinical consideration of each case suggested that sleep disorders may be widespread in this group of children; only 8 of the 71 children had no discernable likely sleep disorder. Symptoms of sleep-disordered breathing, sleeplessness and reports of restless legs featured prominently. CONCLUSIONS: Parents of children with ADHD may not be accurate reporters of their children's sleep pattern and/or the sleep disturbances that come to parents' attention are not best detected by actigraphy. Results highlight the prominence of parent-reported sleep disturbance in children with ADHD and the need for clinicians to routinely screen for the presence of sleep disorders and assess detailed sleep physiology where indicated.

Adolescent↗

Sleep problems in the elderly.

Sleep problems in older adults are so common that nearly half of all hypnotic prescriptions written are for persons over 65 years old. Although normal aging affects sleep, the practitioner should evaluate the many factors that cause insomnia: medical illness, psychiatric illness, dementia, alcohol and/or polypharmacy, restless legs syndrome, periodic leg movements, and sleep apnea syndrome. Nonpharmacologic treatment of sleep disorders is preferred. The nurse practitioner can assess and manage elderly patients with sleep disorders, but they need to refer those who can benefit from evaluation to a sleep disorder center.

Aged↗