Sleep Disorders

aytime sleepiness is common in patients with parkinsonism but has little to do with the amount of sleep these patients get and everything to do with dopaminergic dysfunction, according to David B. Rye, MD, PhD, associate professor of neurology at Emory University in Atlanta. "The idea is that if I sleep a lot, I shouldn't be so sleepy the next day, and if I sleep little, I should be very sleepy. This is doesn't hold true for patients with Parkinson disease [PD]. The loss of dopamine disrupts that banking system, or the sleep-wake homeostat," he said during a presentation at the 9th annual meeting of the American Society for Experimental Therapeutics, which met March 8 to 10 in Washington, DC. Addressing dopa- minergic tone during sleep might help ameliorate daytime symptoms of parkinsonism in general.

Once again your patient, an accountant and tax specialist, is complaining about his sleep. More nights than not he awakens at about 2 am. An hour goes by, sometimes 2, before he returns to sleep. You've prescribed 4 different hypnotics. Each gave the same unsatisfactory result. For 2 weeks, your patient got the 8 hours of uninterrupted sleep he-and you-seek, but then the old pattern returned. Following your instructions, he avoids caffeine, doesn't exercise after 6 pm, and confines his activities in bed to sleep, but to no avail. You refer him to a sleep laboratory, and the results there are entirely consistent with what he's been telling you. In the sleep lab he falls asleep at 11 pm, awakens at 2:30 am, returns to sleep at 4 am, and awakens for good at 7:30 am. He does not have sleep apnea, restless legs syndrome, or depression.

Generalized anxiety disorder (GAD) is characterized by excessive or unrealistic anxiety and worries about life circumstances. In the general population, the prevalence of GAD is 2% to 5%. It is the most frequent anxiety disorder seen in primary care, where 22% of patients complain of anxiety problems.1 DSM-IV lists 6 somatic symptoms associated with GAD: restlessness, increased fatigability, difficulty in concentrating, irritability, muscle tension, and sleep disturbance. These symptoms may present with hyperarousal, hypervigilance, and heightened muscle tension; autonomic symptoms are milder than in other anxiety disorders and can be absent.

That depression, anxiety, sleep disorders, and other neuropsychological conditions are often associated with chronic pain isn't news to most neurologists. But physicians who do not specialize in pain management are largely unaware of a growing body of research suggesting that the race (a genetic classification) or ethnicity (a cultural classification) of a patient with chronic pain may determine the patient's risk of neuropsychological symptoms.

ChEIs Beneficially Affect REM Sleep in AD. Cholinesterase inhibitors (ChEIs) do not modify disturbances of sleep-wake rhythm or sleep continuity in patients with either Alzheimer disease (AD) or frontotemporal dementia (FTD), but they may have a beneficial effect on REM sleep, according to investigators from the University of Marburg in Germany.

The degree to which season changes affect mood, energy, sleep, appetite, food preference, or desire to socialize with others has been called "seasonality." Identification of a seasonal pattern can only be made if both the patient and physician actively look for it.

Sleep disorders are very common and are often underrecognized and underreported in children. If left untreated, these disorders can cause serious developmental and physiologic problems.

An unfavorable prognosis may be in store for patients who report severely disrupted sleep patterns accompanied by rapid eye movement (REM).

When assessing a sleep-related problem in a psychiatric patient, investigating all possible causes may be more helpful than assuming the complaint is a result of medication or the underlying condition.

Acknowledging Preindustrial Patterns of Sleep May Revolutionize Approach to Sleep Dysfunction

Sleep-associated movement disorders are common in the general population. When patients complain of sleep disturbance, psychiatrists should consider,and question for, features of nocturnal movement disorder.

sleep apnea

Pediatric neurology, influenza, immunization, light therapy, depression, sleep, multiple sclerosis

Patients with Alzheimer's disease may suffer the same age- and disease-related changes to sleep as their age-matched peers. However, as the dementia progresses, even more severe disturbances develop, with impairments in both nighttime sleep continuity and daytime alertness. This article focuses on long-term, holistic approaches to treatment, including environmental and behavioral interventions to augment sleep medications.

Seasonal affective disorder affects 1% to 3% of the North American population. Evidence exists for the efficacy of high-intensity bright, fluorescent light. Pharmacological management with SSRIs has shown equivalent efficacy to light therapy. How can these two therapies be combined? What other therapies are available?

espite the fact that about 30% of our life is spent sleeping and decades of research have been spent on sleep, we still do not know its real function. What we do know is lack of sleep can have serious implications, such as increased risk of depressive disorders, impaired breathing and heart disease. On the other hand, nighttime sleep disturbance is usually followed by excessive daytime sleepiness that is associated with delayed problems like memory deficits and impaired social and occupational function, and immediate consequences such as car accidents (Kupfer and Reynolds, 1997; Roehrs and Roth, 1995).

Sleep Lab Meditation

As chief of the division of sleep and chronobiology in the department of psychiatry at the University of Pennsylvania School of Medicine, David F. Dinges, Ph.D., focuses on ways sleep and the endogenous circadian pacemaker interact to control wakefulness and waking neurobehavioral functions such as physiological alertness, attention, cognitive performance, fatigue, mood, neuroendocrine profiles, immune responses and health. In an interview with Psychiatric Times, Dinges discussed neurobehavioral consequences of sleep loss, factors that impair sleeping, the pervasiveness of sleepiness and new ways to manage sleepiness.

Insomnia, the subjective sense of having inadequate quantity or quality of sleep, occurs in 20% to 35% of the general population. Not surprisingly, many insomniacs describe a variety of difficulties in their personal and professional lives.

In recent years, melatonin has been touted in the media as a "hot sleeping pill, natural and cheap" and as the drug that "may help ease insomnia, combat jet lag...and extend life." Trials are finally being conducted. Across the United States, some 30 medical centers are studying melatonin as a potential treatment for sleep disturbances.

Today, average young adults report sleeping about seven to seven and one-half hours each night. Compare this to sleep patterns in 1910, before the electric lightbulb, the average person slept nine hours each night. This means that today's population sleeps one to two hours less than people did early in the century.

It was a bad combination, I'll allow that. The call from the emergency room reached me the Saturday morning after I had finished reading Ayn Rand's Atlas Shrugged. I hadn't gotten a lot of sleep, partly because I finally reached page 1,168 around midnight, partly because I couldn't get my mind off John Galt, Hank Rearden, Francisco d'Anconia, Dagny Taggart and the rest of Rand's characters. Before I drifted off, I was already drawing parallels between the current state of psychiatry and Rand's fictional world in which the mind is denigrated, and autonomy and free will nearly stamped out.

Sleep disorders and substance abuse disorders are widespread acrossthe United States, researchers have found. According to the NationalCommission on Sleep Disorders Research, more than 80 million Americanscomplain of sleep difficulties, while Schuckit and Irwin reportedthe lifetime prevalence of alcohol abuse or dependence to be 13percent and nonalcohol drug abuse, 5.9 percent.

Insomnia, the subjective sense of having inadequate quantity orquality of sleep, may result from a variety of causes. In itschronic form, such etiologies may include psychiatric disorderssuch as depression or anxiety, medical illnesses, medications,substance abuse, circadian dysrhythmias and pathophysiologiesintrinsic to sleep such as sleep apnea or periodic movement disorder.When these conditions have been ruled out, however, there remaintwo very interesting groups that at this time are best understoodin psychophysiological terms.

Sleep apnea, a medical disorder with significant health and behavioraleffects, is of particular interest to psychiatrists for its capacityto mimic or exacerbate symptoms of psychiatric disturbances suchas depression, anxiety and panic disorder.