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Results for “Restless sleep”

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At least 541 records · Page 30Linked to original sources

PubMed1996

Sleep in multiple pregnancy: breathing patterns, oxygenation, and periodic leg movements.

OBJECTIVES: Our goal was to study whether multiple pregnancy at the third trimester predisposes to breathing disturbances and arterial oxyhemoglobin desaturation during sleep. STUDY DESIGN: Nocturnal breathing, oxygenation, and movement activity were studied in 10 mothers: 8 with twins, 1 with triplets, and 1 with quadruplets. RESULTS: No obstructive and few central sleep apnea episodes were observed. Four subjects had episodes of increased respiratory resistance, but only one, the mother with quadruplets, was significantly affected. Arterial oxyhemoglobin saturation was always maintained above 90%. Periodic leg movements were present in all mothers, with a frequency range of 3.7 to 49.7 movements per hour. CONCLUSIONS: In spite of the large uterus in multiple pregnancy, nocturnal breathing and oxygenation are well maintained. Increased motor activity and frequent awakenings suggest poor sleep quality, which may be further compromised by intensive periodic leg movements.

Adult↗

PubMed1985

Sleep apnea disorders. Introduction to sleep and sleep disorders.

This overview of normal and disordered sleep introduces techniques for recording and classifying sleep stages, physiological and temporal characteristics of sleep, age-related changes in sleep, consequences of sleep deprivation, theories on the function of sleep, and neurophysiological and biochemical mechanisms regulating sleep. Various categories of sleep disorders are briefly surveyed, with special emphasis on differential diagnosis of sleep apnea syndromes and other disorders characterized by symptoms of excessive daytime somnolence.

Adolescent↗

PubMed1991

Triazolam diminishes daytime sleepiness and sleep fragmentation in patients with periodic leg movements in sleep.

Fifteen subjects (9 men and 6 women) exhibiting objective evidence of excessive daytime somnolence and periodic leg movements in sleep underwent 4-7 days of treatment with triazolam (0.25 or 0.50 mg) and placebo in a double-blind crossover design. One night of polysomnography followed by daytime multiple sleep latency testing were conducted on the first and last days of each treatment block. By the last day of treatment, the mean multiple sleep latency test score after triazolam (9.0 minutes) was significantly greater than that after placebo (5.7 minutes). Thus, triazolam treatment led to a decrease in daytime somnolence. Triazolam also improved sleep architecture and continuity; it increased total sleep time, decreased the number of awakenings and arousals, and decreased stage 1 and increased stage 2 percentages. Although the frequency of periodic electromyographic bursts remained unchanged, the frequency of associated arousals decreased after treatment. Short-term treatment with triazolam is thus effective in diminishing daytime sleepiness and in improving sleep architecture, continuity and duration in patients with periodic leg movements in sleep. These effects do not seem to be mediated through a decrease in periodic leg movement activity.

Adult↗

PubMed1991

Polysomnography at a sleep disorders unit in Melbourne.

OBJECTIVE: To outline the procedure of polysomnography as carried out in a sleep disorders unit in Melbourne and to describe the patients undergoing polysomnography in terms of their age and sex and the sleep disorder diagnosed. DESIGN: A retrospective survey of consecutive patients who required diagnostic polysomnography. SETTING: The Sleep Disorders Unit at Epworth Hospital, a large private hospital in Melbourne. PATIENTS: Two hundred consecutive patients who underwent polysomnography over a seven-month period. Their ages ranged from 19 to 77 years. INTERVENTIONS: All patients had diagnostic polysomnography for one night in the sleep laboratory. This involved 12 to 14 physiological variables being monitored continuously overnight by means of a new digital recording and sleep analysis system. MAIN OUTCOME MEASURES: Patients were categorised according to their main sleep disorder or primary diagnosis. Additional sleep disorders in some patients were categorised as secondary diagnoses. RESULTS: The commonest age group among both male and female patients was 40-49 years. Overall, men outnumbered women three to one. Almost two-thirds of all patients had as their primary diagnosis some degree of obstructive sleep apnoea syndrome or simple snoring. The next most common diagnosis was periodic limb movement disorder. The remaining diagnoses included a variety of sleep disorders, from narcolepsy to sleep terrors. CONCLUSIONS: Despite its complexity and time-consuming nature, polysomnography is an essential procedure for the diagnosis and treatment of a wide range of sleep disorders. More sleep laboratories and a greater emphasis on the multidisciplinary teaching of sleep disorders medicine will be required in Australia.

Adult↗

PubMed1999

EEG and cardiac activation during periodic leg movements in sleep: support for a hierarchy of arousal responses.

OBJECTIVE: To investigate other physiologic changes that occur with periodic leg movements during sleep (PLMS) that might be considered to be more sensitive indices of sleep fragmentation. BACKGROUND: Although PLMS are associated with recurrent microarousals (MA), the frequency of PLMS with MA does not correlate with objective daytime sleepiness. It is postulated that the lack of correlation results from the low sensitivity of the standard criteria used to score MA. METHODS: Ten drug-free patients with a polygraphic and clinical diagnosis of restless legs syndrome (RLS) and PLMS were examined. The EEG correlates of PLMS were analyzed by visual scoring and spectral analysis during PLMS that ended in a visible microarousal (PLMS with MA) or not (PLMS without MA). The R-R interval in the EKG signal was also examined. RESULTS: A total of 34% of PLMS were associated with MA lasting >3 seconds, and 3% of PLMS were associated with MA lasting <3 seconds. Although PLMS with MA were associated with an increase in alpha activity, for PLMS without MA a significant increase in delta and theta activity was present. Both types of PLMS induced a shortening of the R-R interval; this was particularly more marked for PLMS with MA. CONCLUSIONS: First, visual scoring of MA that include a duration of less than 3 seconds has little effect on the detection of PLMS with MA. Second, EEG activation and tachycardia are present during both types of PLMS. Third, a hierarchy in the arousal response is present-going from autonomic activation to bursts of delta activity to alpha activity to a full awakening.

Analysis of Variance↗

PubMed1986

Nocturnal myoclonus: treatment efficacy of clonazepam and temazepam.

Clonazepam (1 mg h.s.) and temazepam (30 mg h.s.) were studied in 10 patients diagnosed as having insomnia with nocturnal myoclonus. Each subject underwent two nocturnal polysomnographic recordings while drug-free, two during treatment with clonazepam, and two during treatment with temazepam. Treatment sessions were 7 days long, and recordings were done on nights 6 and 7 of the treatment sessions. A 14-day washout period separated the treatment sessions. The order of drugs used in the first and second treatment sessions was randomized. Objective and subjective sleep laboratory data showed that both drugs improved the sleep of patients with insomnia in association with nocturnal myoclonus. Neither drug significantly reduced the number of nocturnal myoclonic events. Sleep changes were consistent with those produced by sedative benzodiazepines in general. Thus, the data support clinical reports that clonazepam, a benzodiazepine marketed for the indication of seizure, is useful in improving sleep disturbances associated with nocturnal myoclonus. Temazepam, a benzodiazepine marketed for the indication of insomnia, was found to be a suitable alternative to clonazepam in the treatment of insomnia associated with nocturnal myoclonus. The present data and other studies suggest the need for a model that explains why leg movements and sleep disturbances may wax and wane independently.

Adult↗

PubMed1995

Sleep disorders in patients on continuous ambulatory peritoneal dialysis.

Sleep complaints, habits, and medical history were surveyed in 81 patients chronically receiving continuous ambulatory peritoneal dialysis. Seventy-three percent of the sample reported insomnia, and 52% reported unintentional napping during the day. Behavioral factors (such as caffeine or alcohol use) or the severity of concurrent medical disease did not account for the sleep problems. Eighteen of these patients subsequently underwent polysomnography and objective measurement of daytime sleepiness. Clinically significant sleep apnea syndrome was present in 11. The presence of sleep apnea was associated with increased levels of psychological distress and daytime sleepiness. Periodic leg movements during sleep were also frequently observed but had minimal effect on sleep quality. Implications of these findings for clinical practice are discussed.

Adult↗

PubMed1986

Evaluation of insomnia.

The effective treatment of patients with a complaint of insomnia requires an appreciation of the range of etiologic factors underlying the symptom of insomnia, as well as sound clinical judgment and appropriate application of available therapeutics. Systematic inquiry regarding nocturnal and daytime aspects of a patient's life is helpful in narrowing the range of diagnostic possibilities. Specialized evaluation at a sleep disorders center may be useful in cases of chronic insomnia that remain refractory to initial interventions.

Adolescent↗

PubMed2004

Sleep disturbances in elderly: a subjective evaluation over 65.

Sleep in elderly people shows progressive changes caused by general aging processes. Several alterations are described in medical literature: changes of sleep/wake rhythm and modifications both in sleep duration and in sleep architecture. The aim of our study was to evaluate sleep disturbances in elderly people, with and without cognitive impairment,through a sleep questionnaire. Our population included 1000 subjects, over 65 years of age, stratified by sex and age. The first 600 interviews were included in this report. All patients underwent a mini mental state examination (MMSE) and a questionnaire concerning excessive daytime sleepiness. In our total sample, we found a high prevalence of excessive daytime sleepiness, insomnia, nighttime awakenings, snoring, restlessness and periodic leg movements during sleep. Patients with cognitive dysfunctions showed less difficulty in falling asleep and fewer nighttime awakenings; they snored less frequently and were the only ones to present enuresis and to fall off the bed. Moreover, patients with cognitive impairment presented excessive daytime sleepiness with variable intensity and frequency. In conclusion, our results indicate significant differences in sleep disorders between healthy subjects and patients cognitively impaired. Besides, our subjective evaluation seems to be a useful method to perform an assessment of sleep disturbances in elderly people.

Aged↗

PubMed2000

Assessing ambulatory geriatric sleep complaints.

Sleep disturbances afflict more than 50% of adults age 65 and older. Sleep apnea and periodic limb movements of sleep are the primary sleep disorders in the elderly. Patient assessment tools, a thorough physical examination, and appropriate tests can simplify the diagnostic process; sleep center referral is not always warranted. Ultimately, accurate sleep disorder diagnoses can result in decreased geriatric morbidity and mortality, and increased patient quality of life.

Aged↗

PubMed1999

Sleep problems in the elderly.

Refreshing sleep requires both sufficient total sleep time as well as sleep that is in synchrony with the individual's circadian rhythm. Problems with sleep organization in elderly patients typically include difficulty falling asleep, less time spent in the deeper stages of sleep, early-morning awakening and less total sleep time. Poor sleep habits such as irregular sleep-wake times and daytime napping may contribute to insomnia. Caffeine, alcohol and some medications can also interfere with sleep. Primary sleep disorders are more common in the elderly than in younger persons. Restless legs syndrome and periodic limb movement disorder can disrupt sleep and may respond to low doses of antiparkinsonian agents as well as other drugs. Sleep apnea can lead to excessive daytime sleepiness. Evaluation of sleep problems in the elderly includes careful screening for poor sleep habits and other factors that may be contributing to the sleep problem. Formal sleep studies may be needed when a primary sleep disorder is suspected or marked daytime dysfunction is noted. Therapy with a benzodiazepine receptor agonist may be indicated after careful evaluation.

Aged↗

PubMed2001

High levels of nocturnal activity in children with attention-deficit hyperactivity disorder: a video analysis.

Sleep disturbances can lead to symptoms of attention-deficit hyperactivity disorder (ADHD) in children. In the present study, we compared the sleep patterns of 30 children with ADHD, with those of 19 controls matched for age (5-10 years) and sex. Sleep patterns were recorded during one night, using polysomnography (PSG) and a video system in the sleep laboratory. Both ADHD children and controls were medication free and showed no clinical signs of sleep and alertness problems. An infrared camera was used to record all types of movement, which were scored and analyzed using specific software (Observer(R) 3.0; Noldus International, The Netherlands). No significant differences in sleep variables were found between ADHD children and controls. Polysomnography data showed no significant difference between the two groups. Attention-deficit hyperactivity disorder children moved more often than controls (upper limbs, P < 0.04; lower limbs, P < 0.03; all types, P < 0.003). The duration of movements was significantly longer in ADHD children (upper limbs, P < 0.03; all types, P < 0.02). The results of the video analysis were consistent with previous findings that ADHD children have higher levels of nocturnal activity than controls. This activity concerned mostly upper and lower limb movements. Futher studies are required to determine why noctural activity does not affect sleep continuity in a more significant way and whether it should be treated specifically.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Incidence of sleep disorders in children with presumed normal variant short stature.

OBJECTIVE: To determine whether unrecognized obstructive sleep apnoea (OSA) is present in some children diagnosed with normal variant short stature. METHODS: One hundred and fifty-eight children aged less than 15 years and previously diagnosed with familial short stature or constitutional delay of growth were identified from the endocrine clinic database. A validated, standardized questionnaire designed to screen for symptoms of sleep disorders in children was mailed to the parents of eligible children. RESULTS: Fifty-three questionnaires were returned. Fifteen of these had an abnormal score (greater than the mean + three standard deviations in 1157 normal control children). Of these, 10 agreed to a sleep study. Overnight polysomnography showed no evidence of OSA or other sleep/breathing disorders. However, five (half) children showed frequent periodic leg movements of 6.3, 9.2, 9.4, 10.2 and 15.4 per h (adult normal <5 per h). CONCLUSIONS: We did not find OSA among a group of children with normal variant short stature. However, we found frequent periodic limb movements during sleep in a large proportion of the subjects, the significance of which remains to be determined.

Adolescent↗

PubMed2002

State dependent excitability changes of spinal flexor reflex in patients with restless legs syndrome secondary to chronic renal failure.

OBJECTIVE: Periodic limb movement in sleep (PLMS) is a common dysfunction of motor control during sleep, occurring either in isolation or associated with a variety of neurological disorders including restless legs syndrome (RLS). Although the PLMS generators have not been established, their occurrence in patients with spinal cord injury and their clinical resemblance to the spinal cord flexor withdrawal reflex (FR) suggest that PLMS may originate in the circuitry that mediates the FR. The significantly increased spinal cord excitability noted in primary RLS/PLMS patients may play an important role in the pathophysiology of primary RLS. The aim of this study is to establish whether the enhanced spinal cord excitability, which is represented by a lower threshold and/or greater spatial spread of the FR, is also true for the RLS/PLMS patients whose RLS is secondary to chronic renal failure (CRF). METHODS: Twenty patients with RLS/PLMS secondary to CRF have been compared with matched controls according to the state dependent changes in FR excitability. All patients met the diagnostic criteria for RLS and PLMS. They had CRF for 5.2+/-3.5 years, and were under the hemodialysis treatment. Twenty healthy, age and sex matched subjects were tested as controls. The electrophysiological testing of the FR was performed during wakefulness (9:30-10:30 p.m.) and sleep (beginning of stage II, the first sleep cycle). RESULTS: A significant increase in FR excitability was found in RLS/PLMS patients with CRF. This abnormality was prominent during sleep, which was also true for the primary RLS. CONCLUSIONS: Our results suggest that similar neuronal pathways are involved in primary and secondary RLS/PLMS patients. Our results also support that RLS/PLMS and FR share a common spinal mechanism.

Journal Article↗

PubMed1998

Sleep disorders presenting as psychiatric disorders.

In summary, disordered sleep can present in a complex and atypical fashion in which the primary sleep-related component may not be immediately apparent. A high index of suspicion serves the clinician well in these cases. A careful and systematic evaluation of sleep often proves to be rewarding in terms of diagnostic accuracy and improved treatment outcome.

Adolescent↗

PubMed1994

Patterns of sleep disorders and sedative hypnotic use in seniors.

Adequate sleep is required for good physical and psychological health. Sleep disturbance is common and its prevalence increases with advancing age. Physiologically, sleep in elderly adults differs from that in younger adults, both in terms of quantity and quality. Sleep disturbance in old age may be associated with many physical and psychological conditions, and less commonly can occur as a primary disturbance. It must be distinguished from the understandable but unrealistic expectations of many elderly people that they will sleep for as long and as soundly as when they were younger. The evaluation of a patient with a sleep disorder requires full medical psychiatric and social histories, mental state and physical examinations and appropriate investigations. If present, an underlying condition should be treated. Management strategies for sleep disorders include attention to sleep hygiene, behavioural treatment and hypnotics. Ideally, a hypnotic should be prescribed for a limited period and then in the smallest effective dose.

Aged↗

PubMed1999

Periodic limb movements and obstructive sleep apneas before and after continuous positive airway pressure treatment.

Periodic limb movements during sleep (PLMS) and obstructive sleep apnea syndrome (OSAS) are two common sleep disorders. The similarity in periodicity of periodic limb movements (PLMs) and obstructive sleep apneas (OSAs) led us to hypothesize the existence of a common central generator responsible for the periodicity of both OSAs and PLMs. In order to test this hypothesis, we compared apnea periodicity before continuous positive airway pressure (CPAP) treatment with PLMs periodicity during CPAP treatment in 26 OSA patients, consecutively recorded and treated in our sleep laboratory. The investigation on CPAP was performed twice, once during the initial evaluation and once during a follow-up evaluation after 3 months of home treatment with CPAP. Our results showed that, in this sample, 16 patients out of 26 had an association of OSAS and PLMS, defined as the occurrence of at least 5 PLMs per hour of sleep. The mean apnea interval - measured as the time between the beginning of two successive apneas - was 43.1 s (+/-15.2, SD) and the mean PLM interval - calculated in the same way - was 29.6 s (+/-15.2) during the baseline night, 28.5 s (+/-15.7) during the first CPAP night, and 29.8 s (+/-14.8) during the second CPAP night. Thus, the periodicity of the two phenomena (apneas and PLMs) was different, both before and after CPAP treatment (P< 0.05). When considering the interval between the end of an event (apnea or PLM) and the beginning of the next one the mean apnea interval was 19.5 s (+/-11. 6), and the mean PLM interval was 28.1 s (+/-15.3) during the untreated night, 26.6 s (+/-16) during the first CPAP night and 27.9 s (+/-15) during the second CPAP night. The shortening of apnea intervals with this method of measuring intervals reflects the longer duration of apneas as compared to PLMs. Again the intervals between PLMs were not different between each other but the intervals between apneas were different from the intervals between PLMs (P< 0. 05) These results show that the periodicity of PLMs is different from that of OSAs, suggesting that sleep apneas and PLMs are not generated by a common central generator.

Adult↗

PubMed1992

Sleep disorders with aging: evaluation and treatment.

Sleep disorders are especially common among elderly patients and may be the result of psychiatric illness, a medical problem, poor sleep habits, or a primary sleep disorder. Because a sleep complaint (especially insomnia) is only a symptom, the physician must undertake a careful evaluation in an attempt to identify a specific treatable cause. Although some patients may require referral to a psychiatrist or sleep disorders clinic, many patients may benefit from behavioral strategies, such as improved sleep hygiene. In general, hypnotics should be prescribed for only a limited period of time and should be combined with other therapeutic approaches in patients with chronic insomnia.

Aged↗