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PubMed2006

Arm pain and daytime sleepiness among nursing home employees.

We investigated the relationship between musculoskeletal disorders and sleep problems among 98 employees (79 women) at three nursing homes. Self-reported data were collected regarding pain in the neck, shoulders, arms, legs, and low back, sleep disturbances, daytime sleepiness (Epworth Sleepiness Scale), and the level of workload on the hands, legs, and low back by type of care. Pain in the arms was significantly associated with less difficulty initiating sleep, fewer symptoms of insomnia, and a higher level of daytime sleepiness. After adjusting for age and gender, only the association between arm pain and daytime sleepiness remained significant (Odds Ratio 6.70, 95% Confidence Interval 1.40-31.97). Participants with both arm pain and daytime sleepiness showed significantly greater levels of workload in some kinds of care in a systemic manner than counterparts without either complaint. These findings suggest that arm pain is associated with elevated sleep propensity/fatigue in nursing home work.

Adult↗

PubMed2000

Workup and indications for polysomnography in patients with sleep-related complaints.

A significant proportion of the population has chronic sleep problems necessitating an increasing involvement by the primary care physician. Also, the general patient population is becoming more familiar with these disorders and is seeking assistance. Because sleep studies are expensive and time consuming, adhering to the recognized indications for testing reduces the number of inappropriate studies. Under most circumstances, individuals with excessive daytime sleepiness and symptoms suggestive of obstructive sleep apnea are candidates for polysomnography. Other individuals with parasomnias or difficult-to-treat insomnia are also candidates for testing. In some circumstances, procedures designed to assess sleepiness may also need to be used to ascertain the impact of the disorder on daytime functioning and may be part of evaluations involving the transportation industry. Only after taking a thorough history and doing a physical examination can the physician make an accurate determination of the appropriate study type.

Diagnosis, Differential↗

PubMed1993

Sleep, psychological distress, and somatic symptoms in perimenopausal women.

OBJECTIVE: Self-report and somnographic data from 135 volunteer, disease-free, women (37-59 years) were used to determine the prevalence of perceived poor sleep and to compare women with and without "poor" sleep on menopausal status, somnographic sleep, psychological distress, and somatic symptom cluster frequencies. METHODS: Data from identical measures done on two groups of perimenopausal-age women, one recruited for menopausal age and the other for same age but sleep problems plus controls, were tested using a two-way analysis of variance for the main effects of recruitment group and the presence or absence of "poor" sleep as well as the joint effects of both. RESULTS: "Poor" sleep was reported by more than one-third of the women, but menopausal status and perceived sleep quality were not statistically related. Women with "poor" sleep took longer to fall asleep, spent longer in bed, and had higher scores for psychological distress and for four out of five somatic symptom clusters (p < or = 0.03), compared to women with "good" sleep. CONCLUSION: In sum, midlife women reporting poor sleep are likely to have trouble falling asleep and to have higher psychological distress and somatic symptoms, especially musculoskeletal discomfort and fatigue, coinciding with their perceived poor sleep.

Adult↗

PubMed1992

Sleep disturbance, depression, and lesion site in patients with multiple sclerosis.

We examined the prevalence of sleep problems in a sample of patients with mild but clinically definite multiple sclerosis (n = 143) and sought to determine whether there was a relationship between the presence of sleep complaints and the level of depression. As magnetic resonance imaging scans were available for a subsample of the patients with multiple sclerosis (n = 117), we also wanted to determine whether there was a relationship between the site of the lesion and the presence of sleep difficulties. The prevalence of sleep difficulties was three times higher in the patients with multiple sclerosis than the control group (25.2% vs 8.2%). Moreover, the presence of sleep complaints was associated with higher levels of depression. Three lesion sites that subserve supplemental motor areas were significantly related to the presence of sleep complaints. These findings suggest that, for some patients with MS, sleep disturbance and accompanying increases in depression may be a function of the lesion site resulting in nocturnal spasms.

Adult↗

PubMed2001

Circadian rhythm sleep disorders as a possible side effect of fluvoxamine.

Sleep problems, day somnolence, and fatigue as a result of psychotropic drugs are very common. Psychiatrists usually consider these effects a result of insomnia and treat them by prescribing sleeping pills or other benzodiazepine agents. We describe here 10 cases of circadian rhythm sleep disorders (CRSD)--and not merely insomnia--as a possible side effect of fluvoxamine (FVA). Two other serotonin reuptake inhibitors, fluoxetine and clomipramine, did not induce CRSD in any of these 10 patients. We speculate that FVA-induced CRSD is caused by the effect of FVA on serotonin and melatonin levels in the central nervous system. CRSD as a side effect of FVA can be treated by replacing the suspected FVA or adding melatonin to a beneficial FVA treatment. Thus, it is important to be aware of possible iatrogenic CRSD in order to treat appropriately. Prospective studies are needed to confirm our observation and to study the influence of other psychotropic drugs on sleep-wake schedule.

Journal Article↗

PubMed1993

Behaviour and emotional problems in three-year-old children of Asian parentage.

Three-year-old Asian children in inner Birmingham were found to have a similar prevalence of behaviour and emotional disturbance to white English children. The Asian children had fewer sleep problems than the white and their mothers had less difficulty in controlling them. There was a difference in parental attitude to difficult behaviour between the two groups and also several differences in associated social variables. In both groups there was a high level of psychological distress in the mothers of the children with behaviour problems and to a lesser extent the fathers. Implications for service provision are discussed.

Child Behavior Disorders↗

PubMed2003

Hormonal changes in satisfied and dissatisfied shift workers across a shift cycle.

Although the literature claims that shift work is harmful, it overlooks the fact that that many shift workers are satisfied and stay healthy. There is little knowledge of the biological mechanisms mediating the differences in susceptibility. The present study compared satisfied and dissatisfied shift workers with respect to major anabolic and catabolic hormones. Forty-two male shift workers, with an extremely rapidly rotating shift schedule, were divided into two groups according to their ratings of satisfaction with their work hours. Morning blood samples were taken during the first and last morning shift in the shift cycle. Serum was analyzed with respect to testosterone, cortisol, and prolactin. Dissatisfied shift workers had lower morning testosterone than satisfied ones, but they did not significantly differ with respect to cortisol or prolactin. Low testosterone levels were, in addition, associated with a greater sleep need, disturbed sleep/wakefulness, and an increased need for recovery after the work period, the latter being the best predictor of testosterone levels. The only change across the shift cycle concerned a significant decrease of morning cortisol at the end of the shift cycle. High morning cortisol was related to having a morning personality and fewer sleep problems before the morning shift. Dissatisfaction with the shift system seems related to lower testosterone levels, which in turn are related to disturbed sleep/wakefulness and increased need for sleep and recovery. Furthermore, morning cortisol was reduced across a shift cycle. It is suggested that reduced testosterone levels may be part of a mechanism of shift work maladjustment.

Adult↗

PubMed1994

Sleep management. Evaluating advice booklets for parents.

Health professionals are increasingly using information booklets to disseminate important health messages to a wider population. However, such booklets are rarely evaluated from the consumer's point of view. Robert Deller and Jo Walker describe an evaluation by parents of a series of booklets giving parents advice about dealing with sleep problems in young children.

Child Behavior Disorders↗

PubMedDate not supplied

Hypnotic activity of diphenhydramine, methapyrilene, and placebo.

In a double-blind controlled study, an oral dose of diphenhydramine hydrochloride (12.5, 25, or 50 mg), methapyrilene fumarate (36, 72, or 144 mg), or placebo was administered to 1295 post-partum patients if they complained of, or anticipated, a sleep problem. Hypnotic activity was assessed clinically by subjective and objective techniques. Methapyrilene and diphenhydramine, at all doses, were found to be effective hypnotics in comparison to placebo, based on sleep latency, sleep duration, awakening in the night, global evaluation, and morning alertness. Increasing the dose of these drugs, in the range studied, produced a minimal increase in effectiveness.

Aminopyridines↗

PubMed2005

[Attitude toward insomnia: survey of 6043 French general practitioners].

AIM: To describe the attitudes of French general practitioners (GPs) about insomnia and its effect on patients' physical health and work. METHOD: A questionnaire about patients with insomnia and its diagnosis, treatment, and consequences was distributed to a representative sample of 8000 GPs. RESULTS: 6,043 GPs completed and returned the questionnaires. They estimated the prevalence of insomnia in their patients at 18.1%. They identified the principal causes of insomnia as anxiety (58.8%) and work issues (54%). Nearly 45% reported that they always raise the subject of sleep with their patients. For 62.4% sleep problems reflect another disorder rather than being a primary syndrome. Nearly two-thirds (60.2%) do not prescribe medication at the first complaint. When prescribing hypnotics, 81.3% also recommended sleep hygiene measures. Most (68.5%) agreed that insomnia affects concentration, memory, and attention. Almost all employed patients with insomnia complained of work-related effects, such as loss of productivity and absenteeism. CONCLUSION: Insomnia and its management are topics of strong interest for GPs.

Attitude of Health Personnel↗

PubMed1993

Is caffeine a factor in subjective insomnia of elderly people?

Subjective insomnia is more prevalent in elderly than in young populations. In order to examine the relationship between caffeine and sleep quality we studied 181 community-dwelling subjects over a wide age range and 53 elderly patients receiving continuing hospital care. Subjects completed a sleep questionnaire and data concerning smoking, alcohol, use of hypnotics and caffeine-containing substances were recorded. Late afternoon plasma caffeine concentrations were measured in a sub-group of 87 of the community-dwelling subjects and in the hospitalized patients. For the group as a whole, there was a significant negative correlation between age and coffee but not tea consumption (p < 0.001). A global score of sleep quality was significantly inversely related to age (p < 0.001). For the community-dwelling population, the median plasma caffeine concentration was 1.71 micrograms/ml (range 0.10-6.74) and showed a significant correlation with sleep quality (p < 0.05). In contrast, for the hospital dwelling population, median caffeine concentration was higher in patients reporting sleep problems than in those without (p < 0.05). Self-reported consumption of coffee and tea did not correlate with plasma caffeine concentrations. It is possible that people with poor sleep quality, residing in the community, are aware of the stimulatory effects of caffeine and lower their intake accordingly, whereas hospitalized elderly patients, who have less control over their environment, do not.

Adult↗

PubMedDate not supplied

A comparison of wound treatments in nasopharyngeal cancer patients receiving radiation therapy.

The purpose of this study was to compare the effectiveness of gentian violet and nonadherent absorbent dressing in the healing of postirradiation wounds in nasopharyngeal carcinoma patients. This was a randomized controlled trial. A sample of 146 nasopharyngeal carcinoma patients who had developed postirradiation wounds was assessed. Comparisons were made regarding parameters related to wound healing, including healing time, presence of infection, and wound pain, and also regarding the impact of wound on the patient, including mood changes, restriction of neck movement, social isolation, sleep problem, and disturbance in body image. The results showed that patients in the 2 groups did not have any significant difference on wound-healing time, disturbance in mood, sleep, social interaction, appearance, and neck mobility. However, there was a trend of higher wound pain score, not reaching statistical significance, in the gentian violet group.

Administration, Cutaneous↗

PubMed1992

Sleep disorders in early childhood: association with insecure maternal attachment.

Psychological, family, and social characteristics relating to attachment relationships were measured in mothers of 20 sleep-disordered toddlers, comparing them with 21 mothers of toddlers without sleep problems. The groups were matched on measures of socioeconomic status, child and maternal age, maternal education, marital status, and family size. Results showed that 100% of mothers of sleep-disordered children were classified as insecure with respect to attachment, as assessed by the Adult Attachment Interview, compared with 57% of control group mothers (p less than 0.002). There were no group differences on measures of maternal defensiveness, self-esteem, marital satisfaction, and social support. These results suggest that maternal current perspectives on their relationship history, rather than general psychosocial adjustment, are crucial contributors to the onset and perpetuation of sleep disorders in early childhood.

Child, Preschool↗

PubMed1989

Sleep deprivation and the effect on exercise performance.

Sleep deprivation or partial sleep loss are common in work conditions as rotating shifts and prolonged work hours, in sustained military operations and in athletes competing in events after crossing several time zones or engaged in ultramarathon or triathlon events. Although it is well established that sleep loss has negative effects on mental performance, its effects on physical performance are equivocal. This review examines the latter question in light of recent studies published on this problem. Sleep deprivation of 30 to 72 hours does not affect cardiovascular and respiratory responses to exercise of varying intensity, or the aerobic and anaerobic performance capability of individuals. Muscle strength and electromechanical responses are also not affected. Time to exhaustion, however, is decreased by sleep deprivation. Although ratings of perceived exertion always increased during exercise in sleep-deprived (30 to 60 hours) subjects compared with normal sleep, this is not a reliable assessment of a subject's ability to perform physical work as the ratings of perceived exertion are dissociated from any cardiovascular changes in sleep deprivation. Examination of the various hormonal and metabolic parameters which have been measured in the studies reviewed reveals that the major metabolic perturbations accompanying sleep deprivation in humans are an increase in insulin resistance and a decrease in glucose tolerance. This may explain the reduction in observed time to exhaustion in sleep-deprived subjects. The role of growth hormone in mediating altered carbohydrate metabolism may be of particular relevance as to how sleep deprivation alters the supply of energy substrate to the muscle.

Exercise↗

PubMed2000

Importance of sleep restoration in co-morbid disease: effect of anticonvulsants.

Over the past two to three decades, sleep medicine has emerged as an important discipline as it strives to meet the challenges of some of the most prevalent disorders among humans. Among the 110 disorders listed in the International Classification of Sleep Disorders, two of the most prevalent and treatable have only recently begun to receive significant attention: sleep apnea and restless legs syndrome with sleep-related periodic limb movements disorder. It is becoming clear that the sleep disruption caused by such disorders has ramifications beyond the usually associated daytime sleepiness, and may include: exacerbation of seizures, headaches, short-term memory deficits, and other cognitive problems. Sleep apnea has also been correlated with hypertension and cardiovascular/cerebrovascular disease. Animal studies have taken this one step further by demonstrating that total sleep deprivation is consistently fatal, usually within 1 month, although the precise mechanism remains to be discovered. The most compelling finding in the animal studies is that "rescuing" the animals with sleep, before the irreversible stage, is associated with rebound amounts of deep sleep and rapid eye movement (REM) sleep ("dream sleep"). This same response is seen after initiating treatment of sleep apnea with nasal continuous positive airway pressure (CPAP), and can also occur in patients with other sleep disorders in response to particular medications, such as valproate or gabapentin.

Anticonvulsants↗

PubMed1987

Sleep disorders in the elderly: rationale for clinical awareness.

Complaints about sleep are extremely common in the elderly, leading to an impression that aging-related sleep problems are virtually normal and benign. However, studies have shown that such complaints as habitual snoring, frequent awakening, nocturnal sweating, and awakening with anxiety, may be signs of genuine sleep disorders. The most prevalent and most serious aging-related sleep disorder is sleep apnea. There is recent evidence of an association between sleep apnea and circulatory disorders, including hypertension, stroke, and angina pectoris, and with reduced life expectancy. The older sleep apnea victim may not complain of daytime sleepiness, the usual symptom in younger patients. Sleep apnea, and several other sleep disorders of the elderly are treatable, once an accurate diagnosis is made. Physicians are urged to make questions about sleep as routine as the taking of blood pressure.

Aged↗

PubMed2005

Self-reported heart symptoms are strongly linked to past and present poverty in Russia: evidence from the 1998 Taganrog interview survey.

BACKGROUND: In this Russian-Swedish collaborative study the question of how symptoms of heart disease are linked to poverty in Russia was addressed. METHOD: A random sample household survey was conducted in Taganrog, southern Russia. It covered questions about living circumstances, poverty and health. Health questions included both symptoms of heart problems, such as chest pain and high blood pressure, psychological problems such as depression and anxiety, as well as health-related behaviours such as alcohol drinking. Answers from 1972 women and men aged 18-70 are analysed here. RESULTS: The poorest fifth of the population were more than twice as likely as others to report heart symptoms. Problems in affording vegetables, meat or fish, clothes and footwear were linked to heart symptoms more closely than other economic indicators, such as car ownership or ownership of consumer durables. Psychological symptoms, sleeping problems and alcohol drinking were all related to self-reported heart symptoms, but explained little of the excess risks attributable to present poverty. Childhood poverty was also linked to present heart symptoms. CONCLUSION: Life-time accumulated experience of economic hardship contributes to present levels of heart disease symptomology in Russia.

Adolescent↗

PubMed2006

Factors associated with receiving help and risk factors for disaster-related distress among Connecticut adults 5-15 months after the September 11th terrorist incidents.

BACKGROUND: To obtain prevalence estimates and identify factors associated with psychological problems and receipt of help by a geographically proximate population in which some persons had direct exposure but the overall prevalence of direct exposure was low, 5-15 months after the September 11th, 2001 terrorist incidents. METHOD: Telephone survey data from the Behavioral Risk Factor Surveillance System (BRFSS) (Connecticut Module) with a randomly selected cohort of 2741 women and 1899 men aged 18 and older were examined using bivariate Chi Square and multivariate logistic regression analyses of weighted data. RESULTS: One in three respondents reported 9/11-related psychological problems, 26% of whom reported receiving formal services or peer support. Risk factors for reporting psychological problems included being surveyed earlier, female gender, age 64 or younger, Hispanic ethnicity, disability, recent depression, and reporting one day or more in the past 30 of poor mental health, sleep problems or worry. Poor mental health was associated with receipt of formal services, and increased alcohol use was associated with receipt of peer support. CONCLUSION: In the post-impact recovery period following mass trauma, psychological problems by persons with ongoing mental health conditions or increased alcohol use warrant continuing public and professional attention. Women, Hispanics, and disabled adults also may be under-served.

Adolescent↗