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PubMed1984

Diagnosis and management of insomnia.

The symptom of insomnia concerns not only psychiatrists, but other physicians as well. Most cases of insomnia resolve with the passage of time or when the underlying medical or psychiatric condition is treated. For situational insomnias or psychophysiologic insomnias, consider nonpharmacologic interventions before prescribing a sedative-hypnotic. When a sedative-hypnotic is indicated, the BZs are the drugs of choice because of their better margin of safety and lower potential for abuse. In most cases, limit the use of a sedative-hypnotic to several days to a few weeks.

Aging↗
PubMed1978

Restless legs, anxiety and caffeinism.

This clinical study of 62 patients with restless legs syndrome and associated anxious-depressed and other clinical states seems to indicate that caffeine is the major etiological factor in the causation of the restless legs syndrome. Anxiety, while modifying the subjective experience of the dysphoric sensation of restless legs, is not a causative factor. Caffeine is responsible for the increased nervous system arousal as well as for the direct peripheral contractile effect on the striated muscle. This arousal is often reflected psychologically in anxiety and sometimes depressive manifestations, insomnia, heightened proprioceptive awareness and physiologically in the toxic sensory experience of restless legs associated with increased neuromuscular reactivity which may include myoclonus and myokomia.

Adolescent↗
PubMed2003

[Indications for sleep laboratory studies in psychiatrically symptomatic children and adolescents].

Many mental and behavioural disorders during childhood and adolescence are associated with sleep difficulties. A polysomnography is seldom needed but indicated in following cases: In a general view when there is suspected obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness or suspected nocturnal seizures. Specific mental disorders with indication of polysomnography are: Diagnostic unclear and dangerous parasomnias, emotional disorders in case of differing sleep perception, Attention-deficit Hyperactivity Disorder (ADHD) and Tourette Syndrome with suspected (additional) OSAS, Restless Legs Syndrome (RLS) or Periodic Limb Movement Disorder (PLMD). Further indications are -therapy-resistant insomnia and sleep-wake-rhythm-disorders.

Adolescent↗
PubMed1998

When does estrogen replacement therapy improve sleep quality?

OBJECTIVE: Our purpose was to evaluate the effect of estrogen replacement therapy on sleep complaints by postmenopausal women and to assess the predictive factors involved. STUDY DESIGN: Sixty-three postmenopausal women entered a 7-month prospective, randomized, double-blind, crossover study consisting of two 3-month treatments with estrogen and placebo with a 1-month washout period between. Eight Visual Analogic Scale statements about different sleep complaints, the Basic Nordic Sleep Questionnaire, scoring of climacteric symptoms, The Beck Depression Inventory, and serum estradiol and follicle-stimulating hormone level controls were the main outcome measures. RESULTS: Estrogen replacement therapy improved sleep quality, facilitated falling asleep, and decreased nocturnal restlessness and awakenings (p < 0.001). The subjects were less tired in the mornings and in the daytime (p < 0.001) when taking estrogen replacement therapy. Estrogen-induced sleep improvement was associated with alleviation of vasomotor symptoms (r range 0.27 to 0.55), alleviation of somatic symptoms (palpitations and muscular pain, r range 0.26 to 0.36), and alleviation of mood symptoms (r range 0.28 to 0.37) on estrogen replacement therapy. The severity of initial insomnia predicted only one estrogen-induced sleep improvement effect: the more the subjects experienced insomnia, the better the estrogen replacement therapy facilitated falling asleep (r = 0.26, p = 0.040). Estrogen-induced sleep improvement was also reported by the 15 climacterically asymptomatic subjects. In these subjects initial insomnia scores strongly predicted estrogen-induced sleep improvement (r range 0.50 to 0.75). CONCLUSIONS: Estrogen replacement therapy significantly diminished sleep complaints among postmenopausal women. Alleviation of climacteric symptoms was the most important predictive factor for the beneficial effect of estrogen replacement therapy on sleep complaints. The use of estrogen replacement therapy in women without self-reported climacteric symptoms could also be considered because women do not always recognize their climacteric symptoms or they ignore them.

Climacteric↗
PubMed2000

A randomized, double-blind placebo-controlled trial of iron in restless legs syndrome.

BACKGROUND: Previous open-label trials have shown iron to be efficacious in the treatment of restless legs syndrome. We performed a randomized, double-blind, placebo-controlled trial of iron sulfate. METHODS: Twenty-eight patients were randomized to receive either ferrous sulfate 325 mg b.i.d. or placebo for 12 weeks. The primary outcome measure was the dichotomous variable of improvement or no improvement in average quality of sleep as recorded by a visual analog scale nightly over a 2-week period, comparing a pretreatment 2-week baseline to weeks 13-14. Secondary outcome measures included a comparison of the quality of sleep as measured by a visual analog scale, effect of restless legs syndrome on life as a whole as measured by a different visual analog scale, and the percentage of nights patients were symptomatic. RESULTS: No significant differences were noted between iron and placebo groups for both primary and secondary outcome measures. Responders taking iron did have a significant increase in their iron saturation compared to nonresponders taking iron. CONCLUSIONS: Iron sulfate does not appear to be an effective empiric treatment for restless legs syndrome.

Adult↗
PubMed1987

Are periodic movements in sleep a basal ganglia dysfunction?

Muscle activity during sleep is a new area of interest in sleep research. No precise brain structures are known to be involved in sleep movement. The etiology of periodic movements during sleep is unknown. The present study was dedicated to evaluate involvement of basal ganglia in periodic movements of the legs during sleep (PMS) in Parkinson's diseased patients. Sleep was monitored in 3 patients suffering from Parkinson's disease and PMS (PMS/PD) and in 3 patients suffering from restless legs syndrome and PMS (PMS/non PD). Following treatment, the six patients were monitored again during sleep. It was found that only the PMS/PD group of patients had improved significantly with appropriate treatment. Improved motor function in PD patients is associated with decreased PMS, regardless of wether the patients are treated with dopaminergic or anticholinergic agents. This is consistent with our previous data. It may be suggested that the striopallidal system is involved in periodic sleep movements of Parkinson's diseased patients.

Aged↗
PubMed1999

A controlled study of additional sr-L-dopa in L-dopa-responsive restless legs syndrome with late-night symptoms.

OBJECTIVE: To investigate whether a combination treatment of regular-release levodopa (rr-L-dopa) and sustained-release levodopa (sr-L-dopa) compared with monotherapy of rr-L-dopa improves sleep quality and reduces periodic limb movements (PLM) in patients with restless legs syndrome (RLS) and problems with maintaining sleep. BACKGROUND: Reappearance of RLS symptoms during the second half of the night while being treated with rr-L-dopa is a common problem in the treatment of sleep disturbances caused by RLS. METHODS: A randomized, controlled, double-blind crossover trial was undertaken. Eligible patients fulfilled the diagnostic criteria of the International RLS Study Group, and met an actigraphically confirmed higher number of PLM per hour time in bed (PLM index) during the second half compared with the first half of the night under treatment with rr-L-dopa. During the crossover periods the patients received 100 to 200 mg rr-L-dopa plus either placebo or 100 to 200 mg sr-L-dopa at bedtime for 4 weeks each period. RESULTS: Thirty patients with RLS (11 men and 19 women) were assessed by actigraphy and subjective sleep quality, and showed a significant improvement in PLM index (p < 0.0001), in "time in bed without movements" (p < 0.0001), and in subjective sleep quality (p < 0.001). Eight of 30 patients reported an altered pattern of RLS symptoms, characterized by a time shift of RLS symptoms into the afternoon or evening, five of these during monotherapy with rr-L-dopa. CONCLUSIONS: A combination therapy of rr-L-dopa and sr-L-dopa is better than monotherapy with rr-L-dopa in reducing the frequency of PLM and problems maintaining sleep, even in patients who are severely affected.

Adult↗
PubMed1995

Sleep complaints are common in a dialysis unit.

Sleep disturbance among uremic patients is reported to be high, but data on the actual prevalence, clinical significance, and causative factors is limited. A sleep questionnaire was distributed to an entire hemodialysis unit of 64 patients. Of the 54 patients who completed the survey, 83.3% had sleep-wake complaints. Disturbed sleep was reported by 28 patients (51.8%), and causes were secondary to delayed sleep onset in 25 patients (46.3%), frequent awakening in 19 patients (35.2%), restless legs syndrome (RLS) in 18 patients (33.3%), and generalized restlessness in six patients (11.1%). Daytime sleepiness was the most frequent complaint, reported by 36 patients (66.7%), and RLS was the second most frequent specific complaint, reported by 31 patients (57.4%). Symptoms of sleep apnea were described by seven patients (13.0%). Male gender, age more than 60 years, RLS, and caffeine intake were associated with more sleep-wake complaints (P = 0.009, P = 0.002, P = 0.028, and P = 0.008, respectively). Urea and creatinine levels were higher in patients with RLS (P = 0.04 and P = 0.08, respectively); otherwise, no other metabolic or demographic variable was associated with specific sleep disorders or disturbance. Sleep problems are very common in dialysis patients and likely contribute to the impaired quality of life experienced by many of these patients.

Adult↗
PubMed2002

Assessment of spontaneously occurring periodic limb movements in sleep in the rat.

OBJECTIVE: Periodic limb movements in sleep (PLMS) are often associated with the restless legs syndrome (RLS). Although the dopaminergic system seems to be involved, the pathophysiology of PLMS and RLS is still obscure. The objective of this study is to explore whether a PLMS-like phenomenon can be observed in rodents in order to elucidate the underlying mechanisms. METHODS: In a group of young and old rats (1.4-1.6 and 16.2-20.5 months, respectively), sleep-wake behavior was recorded and hindlimb movements were detected by means of a magneto-inductive device during two 12-h light periods. Furthermore, in the old rats, recordings were made after administration of the dopamine antagonist haloperidol (HAL) on three consecutive days. Periodic hindlimb movements (PHLM) during nonrapid eye movement sleep (NREM) were identified according to modified human criteria. RESULTS: In the young animals, no PHLM were observed, whereas, 4 out of 10 old rats showed PHLM, two of them have more than 5 PHLM/h. Haloperidol affects neither the sleep pattern nor the number of PHLM. Interestingly, the percentage of old rats spontaneously displaying PHLM resembles the prevalence of PLMS in the elderly. CONCLUSIONS: Our study demonstrates for the first time that periodic hindlimb movements (PHLM) in sleep can occur spontaneously in rats. A clear effect of age on this phenomenon was seen, with only old animals displaying PHLM. To validate whether the observed PHLM constitute a good model for human PLMS or even RLS, their pharmacological properties need to be characterized in a large number of PHLM positive animals.

Aging↗
PubMed1987

Central nervous system effects of beta-adrenergic-blocking drugs: the role of ancillary properties.

Among the side effects commonly reported with the use of beta-blockers are symptoms related to the central nervous system (CNS). In this study we compared the effects of four beta-blockers with different ancillary properties (atenolol, metoprolol, propranolol, and pindolol) and placebo on objective and subjective measures of CNS function in 30 healthy male subjects. All subjects were randomly assigned to a double-blind, placebo controlled, Latin-square design study in which five 1 week periods of drug or placebo administration were separated by 2 week washout periods. Laboratory evaluations were conducted at the end of each treatment period, and included multistage exercise stress testing; questionnaire assessments of mood state, sexual function, and sleep habits; tests of psychomotor function; and overnight polysomnographic measures of sleep. Significant effects on sleep continuity were observed for each of the lipophilic drugs, as reflected in the number of awakenings (pindolol = 6.4 +/- 5.0; propranolol = 6.3 +/- 3.2; metoprolol = 7.2 +/- 4.7; atenolol = 3.6 +/- 2.9; placebo = 3.9 +/- 2.7) and time of wakefulness (pindolol = 20.6 +/- 27.0 min; propranolol = 15.5 +/- 23.0 min; metoprolol = 19.5 +/- 24.3 min; atenolol = 10.2 +/- 11.6 min; placebo = 9.2 +/- 74.5 min). Only pindolol significantly affected rapid eye movement (REM) sleep time (pindolol = 54.5 +/- 21.9 min; placebo = 74.5 +/- 74.5 min) and REM latency (pindolol = 175.0 +/- 60.7 min; placebo = 95.4 +/- 43.8 min). Subjective reports of sleep similarly indicated increased wakefulness and greater restlessness with lipophilic beta-blockers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed2005

Patients with attention-deficit/hyperactivity disorder without observed apneic episodes in sleep or daytime sleepiness have normal sleep on polysomnography.

STUDY OBJECTIVE: There is continuing speculation about the relationship between attention-deficit/hyperactivity disorder (ADHD) and obstructive sleep apnea (OSA) or periodic limb movement disorder (PLMD)/restless legs syndrome. The objective was to determine if a significant portion of children with ADHD diagnosed using DSM-IV criteria have OSA or PLMD. SETTING: Sleep disorders centers in a private practice setting and a hospital setting. PARTICIPANTS: Children aged 6 to 14 years with ADHD were enrolled. Patients with snoring were not excluded. Although patients with snoring plus either observed apneic episodes in sleep or excessive daytime sleepiness were to be excluded, as were patients with restless legs at night, only 1 subject actually had to be excluded because of these criteria. MEASUREMENTS AND RESULTS: Forty children were evaluated with a polysomnogram. A respiratory disturbance index cut-off of more than 5 per hour of sleep was used to diagnose OSA, and a periodic limb movement (with arousal) index cut-off of 5 or more per hour of sleep was used to diagnose PLMD. The Attention-Deficit/Hyperactivity Disorder Rating Scale-IV-Parent Version: Investigator Administered and Scored was used to determine severity of inattentive, hyperactive, and total ADHD symptoms. Except for a somewhat longer rapid eye movement sleep latency and decreased percentage of rapid eye movement sleep, polysomnography was essentially normal. No patient had OSA or PLMD on polysomnography. CONCLUSIONS: OSA or PLMD is not a common underlying disorder or etiologic factor in patients who meet the criteria for ADHD. In the absence of symptoms suggesting a primary sleep disorder, such as snoring with observed apneic episodes in sleep or daytime sleepiness or restless legs, polysomnographic evaluation does not seem indicated in patients with ADHD.

Adolescent↗