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Sleep-wake habits of schoolchildren according to grade.

Five hundred and twelve students aged from 6 to 18 years were administered the morningness-eveningness questionnaire and a sleep log. The mean morningness-eveningness score decreased with grade; this decrease was significant around the seventh grade. The habitual waking time showed no difference among grades but the habitual bedtime became later with grade; thus, the sleep length on weekdays decreased with grade. The percentage of students falling asleep during school lessons significantly increased from the eighth to 12th grade. We found that a delay of sleep phase, reduction of sleep length, increased daytime sleep, and transition to evening type occurred at around the seventh grade.

Adolescent↗

The time course of slow wave sleep and REM sleep in habitual long and short sleepers: effect of prior wakefulness.

Three groups of young good sleepers were selected according to their habitual sleep length as short (SS), regular (RS), or long (LS) sleepers. Their sleep was recorded in three situations: reference nights, a recovery sleep night after 36 h of sleep deprivation, and a sleep night after a morning sleep recovery from sleep deprivation (12 h waking time). Total and cycle-by-cycle amounts of slow wave sleep (SWS) and REM sleep were studied both as a function of experimental conditions and of the group of subjects. In all three conditions, LS had less SWS than other sleepers while the differences in SWS amounts between groups were mainly due to different amounts in the second and third cycles, differences between conditions essentially due to variations of SWS within sleep cycle 1 (SWS1). SWS1 appeared to reflect some physiological process whose level increases during waking and declines during sleep. REM sleep proved to be proportional to sleep length.

Adult↗

Intrinsic dreams are not produced without REM sleep mechanisms: evidence through elicitation of sleep onset REM periods.

The hypothesis that there is a strict relationship between dreams and a specific rapid eye movement (REM) sleep mechanism is controversial. Many researchers have recently denied this relationship, yet none of their studies have simultaneously controlled both sleep length and depth prior to non-REM (NREM) and REM sleep awakenings, due to the natural rigid order of the NREM--REM sleep cycle. The failure to control sleep length and depth prior to arousal has confounded interpretations of the REM-dreams relationship. We have hypothesised that different physiological mechanisms underlie dreaming during REM and NREM sleep, based on recent findings concerning the specificity of REM sleep for cognitive function. Using the Sleep Interruption Technique, we elicited sleep onset REM periods (SOREMP) from 13 normal subjects to collect SOREMP and sleep onset NREM (NREMP) dreams without the confounds described above. Regression analyses showed that SOREMP dream occurrences were significantly related to the amount of REM sleep, while NREMP dream occurrences were related to arousals from NREM sleep. Dream properties evaluated using the Dream Property Scale showed qualitative differences between SOREMP and NREMP dream reports. These results support our hypothesis and we have concluded that although 'dreaming' may occur during both REM and NREM periods as previous researchers have suggested, the dreams obtained from these distinct periods differ significantly in their quantitative and qualitative aspects and are likely to be produced by different mechanisms.

Adolescent↗

Sleep and circadian rhythms of temperature and urinary excretion on a 22.8 hr "day".

Two groups of subjects (total N = 6) were studied in an isolation chamber for a period of 3 weeks whilst living on a 22.8 hr "day". Regular samples of urine were taken when the subjects were awake, deep body temperature was recorded continuously and polygraphic EEG recordings were made of alternate sleeps. The excretion in the urine of potassium, sodium, phosphate, calcium and a metabolite of melatonin were estimated. Measurements of the quantity and quality of sleep were made together with assessments of the temperature profiles associated with sleep. In addition, cosinor analysis of circadian rhythmicity in urinary variables and temperature was performed. The 22.8 hr "days" affected variables and subjects differently. These differences were interpreted as indicating that the endogenous component of half the subjects adjusted to the 22.8 hr "days" but that, for the other three, adjustment did not occur. When the behaviour of different variables was considered then some (including urinary potassium and melatonin, sleep length and REM sleep) appeared to possess a larger endogenous component than others (for example, urinary sodium, phosphate and calcium), with rectal temperature behaving in an intermediate manner. In addition, a comparison between different rhythms in any subject enabled inferences to be drawn regarding any links (or lack of them) that might exist between the rhythms. In this respect also, there was a considerable range in the results and no links between any of the rhythms appeared to exist in the group of subjects as a whole. Two further groups (total N = 8) were treated similarly except that the chamber clock ran at the correct rate. In these subjects, circadian rhythms of urinary excretion and deep body temperature (sleep stages and urinary melatonin were not measured) gave no evidence for deterioration. We conclude, therefore, that the results on the 22.8 hr "day" were directly due to the abnormal "day" length rather than to a prolonged stay in the isolation chamber.

Adolescent↗

Sleep patterns of shiftworkers.

Work hours affect sleep because the sleep behavior of people on nonworkdays differs from that on workdays. For most workers, workday sleep is shorter than nonworkday sleep. On nonworkdays most workers sleep at night. Work schedule interacts with the effects of work hours on workday sleep. On workdays, people on the nightshift sleep the least, people on the afternoon/evening shift sleep the most, and people on the dayshift sleep less than those on the afternoon/evening shift but more than those on the nightshift. Thus, the infradian sleep strategy elected by a shiftworker is ordinarily related to the schedule worked. Despite historical preconceptions that nightshift work disturbs sleep, the primary problem appears to be a workday reduction in sleep length, which most workers do not usually compensate for by getting more sleep on their nonworkdays. Polysomnographic studies of workers on the nightshift show ultradian sleep-stage sequencing similar to that of people who have chronically reduced their usual sleep duration. This chronic reduction in sleep length is evident in data from experienced night shiftworkers, including those who most prefer to work nights. Experienced night shiftworkers also manifest decrements in performance of the sort expected of people suffering from chronic sleep deprivation. It seems reasonable to suggest that chronic sleep deprivation of night shiftworkers may often be a productivity, safety, or health hazard. Sleep disorders may be a secondary problem also facing night shiftworkers. In general, shiftworkers who do night shiftwork report difficulty falling asleep or staying asleep at rates higher than workers who do not work nights. Data suggest that this may be due to the regular practice of inappropriate infradian sleep strategies or to chronic napping habits. At this point in our study of shiftworker sleep behavior, there is as yet no clear evidence that night shiftworkers suffer from clinical sleep disorders at a higher rate than other workers. It is reasonable to suggest that occupational health professionals can make initial assessments of the sleep complaints made by night shiftworkers. Subjective measurements can be used for these assessments if care is taken to use appropriate methods. It is recommended that this data be collected by asking workers quite literal and concrete questions about the time of day they usually elect to go to sleep and get up. A sleep survey of this sort should gather main sleep period and napping times for both workdays and nonworkdays, so that the infradian sleep strategy of the worker can be identified.(ABSTRACT TRUNCATED AT 400 WORDS)

Circadian Rhythm↗

Clinical analyses of sighted patients with non-24-hour sleep-wake syndrome: a study of 57 consecutively diagnosed cases.

STUDY OBJECTIVES: The objective of this study was to clarify the clinical features of sighted patients with non-24-hour sleep-wake syndrome. DESIGN: Clinical analyses of consecutive patients suffering from non-24-hour sleep-wake syndrome. SETTING: The sleep disorders clinic at Kohnodai Hospital, National Center of Neurology and Psychiatry, Japan. PATIENTS: Fifty-seven patients who were diagnosed consecutively as having non-24-hour sleep-wake syndrome between 1991 and 2001 were included in the study. MEASUREMENTS AND RESULTS: The clinical features and sleep characteristics of the patients were analyzed. A semistructured psychiatric interview that included the criteria for Axis I or II disorders of Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised was conducted, and relationships between psychiatric problems and non-24-hour sleep-wake syndrome were analyzed. The patient cohort included 41 (72%) men and 16 (28%) women. The onset of non-24-hour sleep-wake syndrome had occurred during the teenage years in 63% of the cohort, and the mean ( +/-SD) period of the sleep-wake cycle was 24.9 +/- 0.4 hours (range 24.4-26.5 hours). The mean sleep length of the patients was 9.3 +/- 1.3 hours, and 44% of them had a sleep length of between 9 and 10 hours. Psychiatric disorders had preceded the onset of non-24-hour sleep-wake syndrome in 16 patients (28%); of the remaining 41 patients, 14 (34%) developed major depression after the onset of non-24-hour sleep-wake syndrome. CONCLUSIONS: These results represent the first detailed clinical review of a relatively large number of sighted patients with non-24-hour sleep-wake syndrome.

Adult↗

Automatic scoring of polygraphic sleep recordings: midazolam in insomniacs.

Midazolam in doses of 0.21-0.46 mg/kg was given to four insomniacs for 27 days, and to a fifth insomniac for an additional 124 days, to assess its short, intermediate, long-term and long-standing efficacy. Automatic analysis of the polygraphic sleep recordings was carried out employing real-time signal processing (based on linear prediction), and an off-line sequential fuzzy clustering. Total sleep length did not vary significantly during medication, whereas other efficacy parameters such as sleep onset latency, wake time after sleep onset and number of nightly awakenings decreased significantly throughout the period of active medication. In one patient, midazolam was still effective after 151 days of administration. The ultrashort action (probably 3-4 h) of midazolam could be demonstrated by the distribution of the efficacy parameters, dividing the night into 2-h periods, by the unchanged total sleep length during medication compared with baseline and by the lack of any subjective clinical symptoms of hangover. The quantitative analysis of the signals showed that, although a decrease in the total amount of slow-wave sleep during long-term medication and withdrawal was detected, the total relative power in the delta band increased during drug administration. This was interpreted as redistribution of the delta activity during active medication. A lengthening of REM sleep was found during active medication probably attributable to intranight rebound. This was not followed by any clinical symptom of clinical REM rebound.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Fatigue and the shiftworker: firefighters working on a rotating shift schedule.

Fatigue has often been viewed as a simple variable that is positively correlated with time on task in the workplace and is produced mainly by physical activity. However, shiftwork researchers have demonstrated time-of-day differences for variables including sleepiness and mood, thereby challenging this notion of fatigue. Using a within-subjects design, the present study advances this research by searching for differences in time-of-day interactions in firefighters' sleep length, sleepiness, and mood ratings as a function of shift. We examined reductions in sleep length associated with shiftwork and used sleepiness and mood scales to assess the effects of these reductions. Participants completed surveys throughout a complete cycle of their shift schedule. The study showed that firefighters working on a rotating 8-h shift schedule will sleep less and will report lower positive mood scores, higher negative mood scores, and greater sleepiness ratings on the night shift. Additionally, it was shown that over the course of a shift (two weeks), firefighters were unable to adapt to changes in their sleep schedule. Finally, the significant interactions that were observed challenge the historical, singular notion of fatigue.

Adult↗

Age and gender difference in habitual sleep-wake rhythm.

We analysed the effects of age and gender on the habitual sleep-wake rhythm in 2252 randomly selected subjects living in Shimonoseki, Japan. Subjects were divided into 21 age groups with a matching number of males and females for each. During the period from primary school to adolescence, the bedtime became delayed and sleep length decreased with age. After that period, with increasing age, bedtime became earlier and sleep length increased. The number of awakenings and the length of daytime naps increased markedly with epoch after 50 years and 70 years of age, respectively. Gender differences were considered to be due to the women's social and domestic customs in Japan.

Adolescent↗

The effect of sleep/wake state on nocturnal melatonin excretion.

Twenty-four hour patterns of urinary 6-sulphatoxymelatonin excretion were monitored in eight healthy adult subjects in two bed rest constant routines, one with normal nocturnal sleep and one with continuous wakefulness. The implementation of dim light "constant routines" enabled the effect of the sleep wake/state on melatonin to be tested without the confounding effects of body activity and normal room lighting. In both conditions 6-sulphatoxymelatonin excretion was significantly higher during the nighttime hours (2200-1000) than during the daytime hours (1000-2200) producing averages of 80% and 78.5% of the total 24 hour output in the sleep and wakeful conditions, respectively. The large differences between subjects in nocturnal melatonin excretion (38 to 150 nmol) were highly consistent between the two conditions. There were no differences between the nocturnal wakeful and sleep conditions in total nighttime melatonin excretion nor in the nighttime percentage of the 24 hour total melatonin excretions. Therefore, the sleep/wake state alone had no effect on nocturnal melatonin excretion. On the other hand, a significant correlation between the nighttime melatonin percentage and sleep length suggested the need to investigate further the relation between the amplitude of the melatonin circadian rhythm and sleep length and quality.

Adult↗

Effects of alternating 8- and 12-hour shifts on sleep, sleepiness, physical effort and performance.

OBJECTIVES: The aim of the present study was to compare 12-hour shifts during weekends with 8-hour shifts during weekdays with respect to sleep, sleepiness, physical effort, and performance. METHODS: Thirty-one subjects at a power plant participated. Sleep, sleepiness, and physical effort were measured with a diary. About half of the subjects carried out a reaction-time test during both 8- and 12-hour morning and night shifts. The remaining subjects carried out a vigilance task. RESULTS: Sleepiness was higher and physical effort lower on the 12-hour night shift than on the 8-hour night shift. However, the subjects who had the same level of physical effort on 8- and 12-hour night shifts did not differ with respect to sleepiness. During the 12-hour morning shift, sleepiness was lower and the sleep length was longer than on the 8-h morning shift. The subjects who had the same amount of sleep for 8- and 12-hour morning shifts showed no difference in sleepiness. Sleep did not differ between 8- and 12-hour night shifts. There was no difference between 8- and 12-hour shifts with respect to performance. CONCLUSIONS: It was suggested that the difference in sleepiness between 8- and 12-hour shifts is related to differences in sleep length for the morning shift, and to differences in physical effort for the night shift, rather than to shift duration. Thus the most likely conclusion is that 12-hour shifts do not cause increased sleepiness or impaired performance or disturbed sleep.

Adult↗

Ageing, physical fitness and shiftwork tolerance.

The effects of ageing and physical fitness on shiftwork tolerance are reviewed. Ageing is one of the most cited factors decreasing the health of shiftworkers. Although long-term prospective studies on ageing are few, shiftworkers over 40-45 years of age seem to sleep worse after night, but not after morning shifts. Sleepiness after successive night shifts is also decreased by age although older shiftworkers' ability to resist acute sleep loss seems to be even better. The reasons for the altered sleep and wakefulness of older shiftworkers are probably related to changes in circadian rhythms, especially higher 'morningness'. Sleep need may also decrease with age which could explain some of the differences found in sleep length. Physical fitness as a factor increasing tolerance to shiftwork is a recent finding. Although the effects of physical activity on sleep have been studied in detail, the relationship of physical fitness to sleep is still a controversial issue. In shiftworkers, moderate physical training has been shown to increase sleep length and night-time alertness. It has not been shown, however, that exercise would quicken the circadian adjustment to night work. It is recommended that work time arrangements should take account of the older workers' changing personal references. Continuous night work should be voluntary after 40 years of age. Moderate physical exercise a few hours before the main sleep period is recommended.

Journal Article↗

Sleep stage characteristics of long and short sleepers.

The possibility of different sleep stage characteristics being associated with different sleep lengths was explored by comparing two groups of high school seniors, who characteristically slept 6(1/2) hours or less or who slept 8(1/2) hours or more, with an age-matched control group not selected on the basis of sleep length. All-night electroencephalography was used to examine the sleep stage characteristics of these groups. Compared with the unselected age-matched group, the short sleepers showed no significant diminution in their stage 4 (deep) or rapid eye movement (dream) sleep. The long sleepers were observed to obtain significantly more rapid eye movement sleep than did the other groups.

Adolescent↗

Sleep characteristics of adolescents: a longitudinal study.

The aim of the present research was to study sleep/wake cycle parameters of adolescents and to examine biologic and social influences on their changing sleep patterns. This was a longitudinal study of sleep characteristics of a group of 66 adolescents (mean age, 13 years and 6 months). The adolescents underwent a physical examination, had their pubertal development classified according to Tanner stages, and answered a sleep questionnaire on three timepoints at 6-month intervals. Sleep onset occurred about 1.0 hr later, wake-up time about 3.0 hr later, and sleep length was 1.0-1.5 hr longer on weekends when compared with weekdays. About 60% of the adolescents reported daytime sleepiness, mainly from 8:00 a.m. to 10:00 a.m. and from 2:00 p.m. to 4:00 p.m. on school days. Morning sleepiness on school days occurred at a time of the day that corresponded to sleep on non-school days. Additionally, there was a displacement toward later hours of the wake-up time and a sleep-length increase during weekends from the first to the third timepoint. Social factors such as home conditions and scheduling of school and non-school activities did not change throughout the period of pubertal development studied. Changes of sleep patterns detected may therefore represent an ontogenetic trend along puberty.

Adolescent↗

[Changes in the length of sleep cycles during administration of flurazepam and lopirazepam].

The influence of narcotics on the duration of the ultradian NREM/REM cycle can be clearly recognized only when the first, particularly instable cycle is also included in the evaluation. A study with Lopirazepame and Flurazepame showed that compared to placebo Lopirazepame prolonged the first cycle particularly. In contrast with Flurazepame the first, but mainly the second cycle was shortened, and not until the third NREM/REM cycle the duration was compatible with that of placebo and Lopirazepame. The result is, that in nights of the same length Flurazepame shows a half or one cycle more compared to Lopirazepame.

Adolescent↗

Transient total sleep loss in cerebral Whipple's disease: a longitudinal study.

A case with transient, almost complete sleep loss caused by cerebral manifestation of Whipple's disease (WD) is presented. Cerebral WD is rare and in most cases occurs after gastrointestinal infection. In our case, a progressive and finally almost complete sleep loss was the initial and predominant symptom. Polysomnographic studies in several consecutive nights and over 24 h showed a total abolition of the sleep-wake cycle with nocturnal sleep duration of less than 15 min. Endocrine tests revealed hypothalamic dysfunction with flattening of circadian rhythmicity of cortisol, TSH, growth hormone and melatonin. Cerebrospinal fluid (CSF) hypocretin was reduced. [18F]Deoxyglucose positron emission tomography (FDG-PET) revealed hypermetabolic areas in cortical and subcortical areas including the brainstem, which might explain sleep pathology and vertical gaze palsy. In the course of treatment with antibiotics and additional carbamazepine for 1 year, insomnia slowly and gradually improved. Endocrine investigations at 1-year follow-up showed persistent flattening of circadian rhythmicity. The FDG-PET indicated normalized metabolism in distinct regions of the brain stem which paralleled restoration of sleep length. The extent of sleep disruption in this case of organic insomnia was similar to cases of familial fatal insomnia, but was at least partially reversible with treatment.

Adult↗

Sleep and sleepiness among Brazilian shift-working bus drivers.

The aim of this study was to evaluate daytime and nighttime sleep, as well as daytime and nighttime sleepiness of professional shift-working bus drivers. Thirty-two licensed bus drivers were assessed by nocturnal and diurnal polysomnography (PSG) recording and multiple sleep latency testing (MSLT) sessions. Sleep length was shorter and sleep efficiency reduced during daytime sleep compared with nighttime sleep. Thirty-eight percent of the drivers had indices of obstructive apnea and hypopnea syndrome (>5/h sleep) during nighttime and daytime sleep; more drivers snored during daytime than nighttime sleep (50% vs. 35%, p < 0.05), and 38% of the drivers evidenced periodic leg movements. The MSLT revealed that 42 and 38% of the bus drivers met the criteria for sleepiness when the test was conducted during the day and night, respectively. The daytime as compared to nighttime sleep of shift-working bus drivers was shorter and more fragmented and was associated in many with evidence of excessive sleepiness. Respiratory disorder was a common finding among the professional shift-working bus drivers. All these sleep deficiencies may adversely affect on the job driving performance.

Adult↗