The two-factor structure of sleep complaints and its relation to depression and anxiety.

Although sleep complaints are common in depression and anxiety, there is little agreement as to how they should be organized and assessed. It is also unclear whether sleep complaints show specificity with certain disorders or whether they are nonspecific symptoms. The authors examined the structure of sleep complaints and the relations of these complaints to depression and anxiety in 3 samples: college students, older adults, and psychiatric patients. Exploratory and confirmatory factor analyses indicated that sleep complaints consistently defined 2 distinct dimensions: Insomnia and Lassitude. The Insomnia factor included indicators of early, middle, and late insomnia, as well as poor sleep quality. The Lassitude factor included measures of hypersomnia, fatigue, and sleepiness. Both factors were significantly related to symptoms and diagnoses of depression and anxiety. However, Lassitude was more strongly related to symptoms of depression and anxiety than was Insomnia. In addition, Lassitude showed specificity to measures and diagnoses of depression compared with anxiety disorders. This specificity can be explained by Lassitude's relation with negative and positive emotionality, both of which are components of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Glycine receptor reduction within segmental gray matter in a rat model in neuropathic pain

OBJECTIVES: To determine the prevalence rates of self-reported sleep complaints and their association with health-related factors. DESIGN: A cross-sectional study. SETTING: People living in the community. PARTICIPANTS: A total of 2398 noninstitutionalized individuals, aged 65 years and older, residing in the Veneto region, northeast Italy. MEASUREMENTS: Odds ratios for the association of sleep complaints with potential risk factors. RESULTS: The prevalence of insomnia was 36% in men and 54% in women, with increased risks for women (odds ratio (OR) = 1.69, 95% CI: 1.3-2.1), depression (OR = 1.93, 95% CI, 1.5-2.5), and regular users of sleep medications (OR = 5.58, 95% CI, 4.3-7.3). About 26% of men and 21% of women reported no sleep complaints. Night awakening, reported by about two-thirds of the participants, was the most common sleep disturbance. Women and regular users of sleep medications had significantly increased odds for insomnia and for not feeling rested upon awakening in the morning. Depressive symptomatology was more strongly associated with insomnia and night awakening than with awakening not rested, whereas physical disability was more strongly associated with awakening not rested than with the other two sleep disturbances. CONCLUSION: Our findings show that sleep complaints, highly common among older Italians, are associated with a wide range of medical conditions and with the use of sleep medications. Further longitudinal studies are needed to investigate the causes and the negative health consequences of sleep disturbances to improve both the diagnosis and treatment.     

Sleep patterns and aging: Comparison of older adults with and without insomnia complaints.

The nature of geriatric insomnia was studied by comparing older adults with (n?=?42) and without (n?=?30) insomnia complaints on measures of sleep, mood, life-style, health, and sleep-requirement expectations. Elderly persons with insomnia complaints reported longer sleep latency and more frequent and longer awakenings and used sleeping aids more often than those without insomnia complaints. Nocturnal sleep time was not a reliable discriminator. Poor sleepers showed greater discrepancies between their current sleep patterns and sleep-requirement expectations than did good sleepers. Elderly insomniacs acknowledged greater symptomatology of depression and anxiety than did good sleepers. Daytime napping and physical exercise were equivalent in both groups. Medical disorders, pain conditions, and drug usage (other than sleep aids) did not distinguish the two groups. Clinical implications for the treatment of geriatric insomnia are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sleepiness and sleep disorders. Causes and consequences

Sleepiness and sleep disorders are prevalent in our society. Symptoms of sleepiness and complaints referable to sleep disorders have generally--and incorrectly--been discounted as being of minor importance and are often thought to be manifestations of psychological problems or character defects. It is now apparent that the cost to the American public--both to individuals and the larger society--is substantial. Sleep medicine has become established as an independent field, and knowledge of sleep, sleepiness, and sleep disorders has grown dramatically. This knowledge, when applied to individuals, will enhance the lives of patients with sleep disorders, and when applied to society as a whole, will have important socioeconomic implications.     

Compulsory collegial guidance. What do candidates in general practice think about training of practical procedures?

Sleep disorders are common and well documented in patients with Parkinson's disease (PD). However, most data on sleep in patients with PD are derived from selected patient populations. This community-based survey evaluated the prevalence of and risk factors for sleep disturbances in an unselected group of 245 patients with PD and two control groups of similar age and sex distribution: 100 patients with another chronic disease (diabetes mellitus) and 100 healthy elderly persons. Nearly two thirds of the patients with PD reported sleep disorders, significantly more than among patients with diabetes (46%) and healthy control subjects (33%). About a third of the patients with PD rated their overall nighttime problem as moderate to severe. The most common sleep disorders reported by the patients with PD were frequent awakening (sleep fragmentation) and early awakening. Sleep initiation showed no significant difference compared with the control groups. Pain and cramps were not more prevalent among the patients with PD, but they were more likely to report sleep disturbed by myoclonic jerks. Use of sedatives was common in all three groups but significantly higher in the PD group than in the healthy elderly. Symptoms of depression and duration of levodopa treatment showed a significant correlation with sleep disorders in the PD group. This community-based study confirms that sleep disorders are common and distressing in patients with PD. The strong correlation between depression and sleep disorders in patients with PD underlines the importance of identifying and treating both conditions in these patients.     

Catecholaminergic nerve fibres in normal and alkali-burned rabbit cornea

Increased lifestyle demands and reduced sleep are reported to result in daytime sleepiness and impaired functioning for teenagers. A sample of 612 freshman urban high school students completed a questionnaire describing their sleep patterns and problems, along with sociodemographic information, daily activities, pubertal development, depressive mood, and morning-evening preference. About 63% of the respondents felt they needed more sleep on weeknights (MS group), experienced sleepiness that interfered with their schoolwork, and had problems with sleeping. The other group reported they got sufficient sleep on weeknights (SS group) and did not experience sleepiness problems to the same degree. However, both had similar weeknight sleep and daily activity patterns. The MS group reported an ideal sleep time of 9.2 h, about 2 h more than they were getting and 1 h more than the SS group ideal, and had a higher preference for later bed and waking times. In our sample, individual differences in biologic sleep need and quality of sleep may be emerging as early as 14 years of age.     

Sleep of sleep research personnel--results of the Munster Congress survey

Due to different knowledge of sleep and sleep disorders (i.e. focussing) sleep quality of sleep-researchers may be better or worse than the sleep of other scientists. On the Münster Congress for Sleep-research and Sleep medicine in March 1994 we investigated this question using the Pittsburger Sleep Quality Index (PSQI). 46 sleep researchers, 52 practitioners and 103 scientists of other disciplines from the Münster University filled out the questionnaire. Results show no difference in overall sleep quality between the three groups, but only sleep quality in the group of sleep researchers shows a bimodal distribution suggesting a subpopulation with more serious sleep problems. 10 to 15% of the total academic population can be regarded as "poor" sleepers. Especially the group of practitioners, in which we found the highest values of daytime sleepiness, seems to be a risk-population for sleep disorders.     

Periodic leg movements during sleep and sleep disturbances in elders

BACKGROUND: Periodic limb movements in sleep (PLMS) are an increasingly pervasive disturbance for aging adults. The aims of this experiment were: (a) to describe the index of periodic limb movements in sleep (myoclonus index [MI] in elderly subjects with complaints of poor sleep or depression (N = 22; 68 +/- 5.5 SD years); and (b) to correlate MI with sleep history, depression scores, and objective and subjective indices of sleep. METHOD: Sleep and leg movements were assessed for 5 consecutive nights. Between-subjects, nonparametric correlations were examined between mean MI and sleep history, depression scores, and objective and subjective sleep characteristics. Associations among within-subject night-to-night variabilities of MI, objective, and subjective variables were examined with repeated measures ANCOVA, entering MI as a covariate. RESULTS: A remarkably high level of MI was found (median 25.8 events per hour; 86% of subjects > 5). Nevertheless, no associations were found between MI and sleep disturbance measures. CONCLUSION: These results extend previous reports that PLMS are remarkably persuasive in elderly volunteers and support other reports questioning whether there is a distinct PLMS syndrome.     

Companionable sleep: Social regulation of sleep and cosleeping in egyptian families.

This exploratory study examined family sleep patterns and quality in a setting of normative napping and cosleeping. Participants were 78 members of 16 families from 2 locales in Egypt (Cairo and a village). Each family member provided a history of sleeping arrangements, 1 week of continuous activity records, and details of each sleep event. Sleep records documented late-onset and dispersed sleep patterns with extensive cosleeping. Of recorded sleep events, 69% involved cosleeping, 24% included more than 1 cosleeper, and only 21% were solitary. Mid-late afternoon napping occurred on 31% of days, and night sleep onsets averaged after midnight. Age and gender structured sleep arrangements and, together with locale, extensively explained sleep behavior (onset, duration, total) and quality. Cosleepers had fewer night arousals, shorter and less variable night sleep duration, and less total sleep. Increased solitary sleep in adolescents and young adults was associated with increased sleep dysregulation, including exaggerated phase shifts in males and more nighttime arousals in females. Where normative, cosleeping may provide psychosensory stimuli that moderate arousal and stabilize sleep. Such moderating features may address important self-regulatory developmental needs during adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Study on quality of sleep and mental health in patients with hyperthyroidism

Sleep quality and psychical health were investigated with Pittsburgh Sleeping Quality Index (PSQI) and SCL-90 in 128 patients with hyperthyroidism. The results showed that: 1. The PSQI scores of the patients with ages over 35 years old were higher than that less than 35 years old (P < 0.05). 2. Sleep problems occurred in 87.55% of the patients. Sleep quality of 9.38% of patients were worse. The sleep quality of the female patients were better than the male (P < 0.05). 3. Apart from interpersonal sensitivity, paranoid ideation and psychoticism, scores of the rest were higher than the general people (P < 0.05). 10.2% of the patients with hyperthyroidism had psychical problems. 4. Apart from sleep time and using sleep pill, there was a high correlation between the scores of SCL-90 and PSQI (P < 0.05-P < 0.001). The results showed that sleep problems of the patients with hyperthyroidism affected their psychical health. Lower sleep quality was a main dangerous factor which affected psychical health of the patients with hyperthyroidism.     

Sleep apnoea in patients with quadriplegia

BACKGROUND: This study was undertaken to establish the prevalence of, and the factors contributing towards, sleep disordered breathing in patients with quadriplegia. METHODS: Forty representative quadriplegic patients (time since injury > 6 months, injury level C8 and above, Frankel category A, B, or C; mean (SE) age 35.0 (1.7) years) had home sleep studies in which EEG, EOG, submental EMG, body movement, nasal airflow, respiratory effort, and pulse oximetry (SpO2) were measured. Patients reporting post traumatic amnesia of > 24 hours, drug or alcohol abuse or other major medical illness were excluded from the study. A questionnaire on medications and sleep was administered and supine blood pressure, awake SpO2, spirometric values, height, and neck circumference were measured. RESULTS: A pattern of sustained hypoventilation was not observed in any of the patients. Sleep apnoeas and hypopnoeas were, however, common. Eleven patients (27.5%) had a respiratory disturbance index (RDI, apnoeas plus hypopnoeas per hour of sleep) of > or = 15, with nadir SpO2 ranging from 49% to 95%. Twelve of the 40 (30%) had an apnoea index (AI) of > or = 5 and, of these, nine (75%) had predominantly obstructive apnoeas-that is, > 80% of apnoeas were obstructive or mixed. This represents a prevalence of sleep disordered breathing more than twice that observed in normal populations. For the study population RDI correlated with systolic and diastolic blood pressure and neck circumference. RDI was higher in patients who slept supine compared with those in other postures. Daytime sleepiness was a common complaint in the study population and sleep architecture was considerably disturbed with decreased REM sleep and increased stage 1 non-REM sleep. CONCLUSIONS: Sleep disordered breathing is common in quadriplegic patients and sleep disturbance is significant. The predominant type of apnoea is obstructive. As with non-quadriplegic patients with sleep apnoea, sleep disordered breathing in quadriplegics is associated with increased neck circumference and the supine sleep posture.     

Effect of anatomical and physiological factors on the indirect blood pressure measurement: identification of nurses'' knowledge

Sleep disorders are major syndromes that can interfere with falling to sleep or maintaining sleep, or produce excessive daytime sleepiness. Sleep disorders are rarely diagnosed in the elderly due to age-related changes in sleep patterns. Gerontological nurses can assist the elderly client to achieve improved sleep through increased awareness of sleep disorders, related assessment tools, and interventions.     

Association of physical activity and human sleep disorders

BACKGROUND: It is generally believed that exercise exerts a beneficial effect on the quality of sleep. However, most studies regarding exercise and sleep have been concerned with the influence of exercise on sleep architecture and efficiency, and not on its effects in the prevention and treatment of sleep disorders. Moreover, epidemiological evidence of the benefits of exercise on sleep are limited. OBJECTIVE: To investigate the influence of moderate exercise or physical activity on self-reported sleep disorders among a randomly selected population of adults. SUBJECTS AND METHODS: Study subjects were participants in the Tucson Epidemiological Study of Obstructive Airways Disease who in the 12th survey completed health questionnaires that included several questions on physical exercise and sleep disorders. Sleep disorders were classified as disorders in maintaining sleep, excessive daily sleepiness, nightmares, and any sleep disorder. Six questions regarding exercise and physical activity were asked. Analyses were performed using multivariate logistic regression models with selected measures of sleep disorders as dependent variables and measures of exercise and physical activity as the independent or predictor variables. RESULTS: There were 319 men and 403 women included in the analyses. The results showed that more women than men reported participating in a regular exercise program and having sleep symptoms of disorders in maintaining sleep and nightmares and that more men than women did regular vigorous activity and walking at a brisk pace for more than 6 blocks per day. Both men and women had significantly reduced risk of disorders in maintaining sleep associated with regular activity at least once a week, participating regularly in an exercise program, and walking at a normal pace for more than 6 blocks per day. Reduced risk of any sleep disorder was associated with regular activity at least once a week, and for men, walking at a brisk pace for more than 6 blocks. Among women increases in age also reduced the risk of nightmares. CONCLUSIONS: These data provide additional evidence that a program of regular exercise may be a useful therapeutic modality in the treatment of patients with sleep disorders.     

Sommeil, insomnie et psychopathologie.

Sleep plays a critical role in psychological well-being and adaptation. Not surprisingly, sleep disturbance is a frequent problem among individuals facing situational psychological difficulties as well as among those with more chronic psychopathology. This article examines the relationship among sleep, insomnia, and psychopathology. In the first section, we address the issue of comorbidity by examining prevalence rates of sleep disturbances in the general population and among subgroups of individuals with selected psychopathologies and, conversely, rates of psychological symptoms/syndromes among individuals with and without sleep disturbances. The data indicate high rates of psychological syndromes (40%) associated with insomnia among community-based samples, and even higher rates (80%) of sleep disturbances among selected samples of patients with psychopathology. Comorbidity is particularly high among patients with insomnia, major depression, and generalized anxiety disorder. Although insomnia is often a symptom of an underlying psychopathology, longitudinal studies show that it can also be an important risk factor for a new onset major depressive disorder. The second section of this article summarizes the main subjective and EEG sleep impairments in selected anxiety disorders, mood disorders, and schizophrenia. Insomnia is a common clinical feature or even a diagnostic criterion of several of those disorders. Other related symptoms such as fatigue, low energy and poor concentration are shared across insomnia, major depression, and generalized anxiety disorder, suggesting some common mechanisms among those conditions. In addition to subjective sleep complaints, there is also evidence of EEG sleep abnormalities, such as impairment of sleep continuity, reduced slow wave sleep, and altered REM sleep patterns, with the latter two features being more specific to mood disorders. The third section of this article examines the effects of insomnia treatment on co-existing psychological symptoms or disorders and, conversely, the effects of treatment of selected anxiety and mood disorders on sleep. These results indicate that treatments of depression and anxiety may produce some sleep improvements but, in many cases, residual sleep disturbances persist and may actually increase the risk of subsequent relapse. The main implication is that treatment should directly target both co-existing conditions. Additional implications for the treatment and prevention of comorbid sleep disturbances and psychopathology and for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sleep disorders in neurology. Hypersomnia

Hypersomnia (excessive sleepiness) accompanies many diseases. 14% of the total Austrian population regularly have problems staying awake during the day or are prone to taking spontaneous naps. Hypersomnia is a symptom of the sleep apnea syndrome, which is a risk factor for cerebrovascular disorders. Daytime sleepiness is also a characteristic symptom of narcolepsy, idiopathic hypersomnia, episodic hypersomnia, and many more neurological or psychiatric disorders; it can also be drug induced. Involvement of brain structures which are essential for the regulation of the sleep wake cycle as a result of neurological disorders can likewise lead to hypersomnia. Symptomatic treatment is necessary when treatment of the causal factors is not possible or no improvement has been achieved.     

Sleep patterns and sleep disruptions in school-age children.

This study assessed the sleep patterns, sleep disruptions, and sleepiness of school-age children. Sleep patterns of 140 children (72 boys and 68 girls; 2nd-, 4th-, and 6th-grade students) were evaluated with activity monitors (actigraphs). In addition, the children and their parents completed complementary sleep questionnaires and daily reports. The findings reflected significant age differences, indicating that older children have more delayed sleep onset times and increased reported daytime sleepiness. Girls were found to spend more time in sleep and to have an increased percentage of motionless sleep. Fragmented sleep was found in 18% of the children. No age differences were found in any of the sleep quality measures. Scores on objective sleep measures were associated with subjective reports of sleepiness. Family stress, parental age, and parental education were related to the child's sleep–wake measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obstructive sleep apnea. Warding off the sometimes dire consequences

Obstructive sleep apnea (occlusion of the upper airway despite continued respiratory muscle activity) is accompanied by increased morbidity and mortality from cardiovascular and cerebrovascular disease. Daytime sleepiness due to the disorder may also be a factor in a higher incidence of automobile accidents in these patients. An overnight polysomnogram is used to confirm the diagnosis and assess severity of physiologic disturbances. Initially, simple measures, such as avoidance of alcohol and sedatives before bedtime and sleeping on the side rather than the back, may be tried. Nasal continuous positive airway pressure is considered first-line therapy, and compliance can be improved by education and counseling of the patient. Uvulopalatopharyngoplasty is beneficial in only 50% of patients. Tracheostomy gives the most consistent long-term benefit but is accompanied by significant emotional morbidity.     

The diagnosis and clinical manifestations of activated protein C resistance: a case report and review of the literature

A survey of musculoskeletal problems among visual display unit (VDU) users was carried out in a bank using a self-administered questionnaire. The prevalence of complaints in various body parts were: neck--31.4%, back 30.6%, shoulder--16.5%, hand and wrist--14.9% and arm--6.6%. Frequent users of VDU had significantly more musculoskeletal problems in the neck and shoulder regions than infrequent users. Individual musculoskeltal complaints were associated with various risk factors including personal attributes, working posture, repetitive movements and work station design. Back, neck and shoulder problems were more related to unfavourable working postures, white arm, hand and wrist problems were more affected by repetitive movements. Some risk factors for musculoskeletal problems were specifically related to the nature or design of VDU work. Modification of the workstation design and improvement in work organization should be able to reduce the prevalence of these disorders.     

The Epworth Sleepiness Scale may not reflect objective measures of sleepiness or sleep apnea

OBJECTIVE: To assess the validity of the Epworth Sleepiness Scale score (ES) as a measure of sleepiness among patients suspected or confirmed to have obstructive sleep apnea syndrome. BACKGROUND: The ES is used with increasing frequency as a measure of excessive daytime sleepiness in part because several studies suggested that the ES correlates with mean sleep latency (MSL) on the Multiple Sleep Latency Test and with severity of sleep apnea among patients with that disorder. However, associations identified between the ES and other measures were not strong or consistent. METHODS: The authors used regression models and retrospective data from a relatively large series of 237 patients to restudy how ES relates to MSL, to a simple self-rating of problem sleepiness (available for 141 patients), and to two polysomnographic measures of sleep apnea severity: the number of apneas or hypopneas per hour of sleep and the minimum recorded oxygen saturation. RESULTS: The ES had a statistically significant association with self-rated problem sleepiness but not with MSL or measures of sleep apnea severity. Male gender, adjusted for potential confounding variables, had considerably more influence on the ES than did MSL or measures of sleep apnea severity. CONCLUSIONS: Our data suggest that the subjectively derived ES cannot be used as a surrogate for the objectively determined MSL.     

Differential effect of codeine on thermal nociceptive sensitivity in sleepy versus nonsleepy healthy subjects.

Basal sleepiness–alertness modulates drug effects. Sleepiness produced by sleep restriction leads to increased nociceptive sensitivity, suggesting opioid analgesia may also be modulated by sleepiness–alertness. This study compared thermal nociceptive sensitivity in sleepy versus nonsleepy participants after codeine or placebo. Twelve healthy normal adults, 18 to 35 years of age, had an 8-hr nocturnal polysomnogram (NPSG) followed by a Multiple Sleep Latency Test (MSLT; Carskadon and Dement, 1987). All had sleep efficiencies > 80% on their NPSG; 6 had average MSLT ≥ 8 min (nonsleepy group) and 6 had latencies