The Puzzle of Paradoxical Insomnia
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Slow-Wave Sleep, Diabetes, and the Sympathetic Nervous System
COMMENTARY Slow-wave sleep, diabetes, and the sympathetic nervous system Derk-Jan Dijk* Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XP, United Kingdom leep oscillates between two dif- of SWS that has accumulated. The latter less provides supportive evidence for the ferent states: non-rapid eye conclusion was derived from SWS depri- notion that SWS is restorative also for movement (NREM) sleep and vation experiments in which stimuli, usu- the body and that negative effects asso- rapid-eye movement (REM) ally acoustic stimuli [although early on ciated with disruption of this state may Ssleep. Slow-wave sleep (SWS) is a sub- in the history of SWS deprivation, mild extend to the body. state of NREM sleep, and its identifica- electric shocks were used (5)], are deliv- Many other physiological variables are tion is based primarily on the presence ered in response to the ongoing EEG. affected by the behavioral-state sleep, of slow waves, i.e., low-frequency, high- The drive to enter SWS is strong and is the NREM–REM cycle, and SWS. amplitude oscillations in the EEG. Upon the transition from wakefulness to Quantification of SWS is accomplished sleep, heart rate slows down. During by visual inspection of EEG records or Short habitual sleep sleep, the balance of sympathetic and computerized methods such as spectral parasympathetic tone oscillates in syn- analysis based on the fast Fourier trans- has been associated chrony with the NREM–REM cycle. form (FFT). Slow-wave activity (SWA; Analysis of autonomic control of the also referred to as delta power) is a with increased risk variability of heart rate demonstrates quantitative measure of the contribution that, within each NREM episode, as of both the amplitude and prevalence of for diabetes. -
Chronic Insomnia Disorder in Australia
Chronic Insomnia Disorder in Australia A REPORT TO THE SLEEP HEALTH FOUNDATION 1,2 1. Appleton Institute, CQUniversity Australia 44 Greenhill Amy C Reynolds Road, Wayville SA 5034 3,4 Sarah L Appleton 2. School of Health, Medical and Applied Sciences, CQUniversity Australia 4,5 Tiffany K Gill 3. Adelaide Institute for Sleep Health: A Flinders Centre of Robert J Adams 3,4 Research Excellence, Flinders University, Bedford Park, SA. 4. The Health Observatory, Adelaide Medical School, The University of Adelaide, SA. 5. South Australian Health and Medical Research Institute, Adelaide, Australia Chronic Insomnia Disorder in Australia A Report to the Sleep Health Foundation Amy C Reynolds1,2, Sarah L Appleton3,4, Tiffany K Gill4,5 & Robert J Adams3,4 1. Appleton Institute, CQUniversity Australia 44 Greenhill Road, Wayville SA 5034 2. School of Health, Medical and Applied Sciences, CQUniversity Australia 3. Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Flinders University, Bedford Park, SA. 4. The Health Observatory, Adelaide Medical School, The University of Adelaide, SA. 5. South Australian Health and Medical Research Institute, Adelaide, Australia This work was supported by the Sleep Health Foundation, an Australian not‑for‑profit organisation devoted to improving sleep health, and an unrestricted grant from Merck Sharp & Dohme (Australia) Pty Limited which had no part in conception, planning, execution or write‑up of it. Publication and graphic design by Flux Visual Communication www.designbyflux.com.au July 2019 2 Chronic Insomnia Disorder in Australia EXECUTIVE SUMMARY Sleep problems are common and costly to the Australian community. One common sleep condition is insomnia. -
Sleep & Dreams & Dsm-5
PAL Conference - Green River, WY - May 2015 SLEEP & DREAMS & DSM-5: ASSESSMENT AND TREATMENT OF PEDIATRIC INSOMNIA James Peacey, MD PAL Conference Green River, WY Disclosure Statement No relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this CME activity. I will reference off-label or investigational use of medications in this presentation. PAL Conference - Green River, WY - May 2015 Goals and Objectives Learn how to identify and categorize pediatric insomnia. Increase knowledge of common behavioral and pharmacologic sleep treatments. Increase understanding of sleep issues in particular patient populations (Autism, ADHD, depression and anxiety) and appropriate strategies to optimize treatment. PAL Conference - Green River, WY - May 2015 Sleep Stage Development PAL Conference - Green River, WY - May 2015 Homeostatic and Circadian Processes D. J. Dijk and D. M. Edgar, Regulation of Sleep and Wakefulness, 1999 PAL Conference - Green River, WY - May 2015 Homeostatic and Circadian Processes PAL Conference - Green River, WY - May 2015 Alerting Systems PAL Conference - Green River, WY - May 2015 Normal Sleep Requirements Babcock, Pediatr Clin N Am 58 (2011) 543–554PAL Conference - Green River, WY - May 2015 Percentiles for total sleep duration per 24 hours from infancy to adolescence. Iglowstein I et al. Pediatrics 2003;111:302-307 PAL Conference - Green River, WY - May 2015 ©2003 by American Academy of Pediatrics Insomnia “significant difficulty initiating -
Sleep Disorders and Deprivation Causes and Effects on College Students Reham Karana Biology, Bachelors of Science to the Honors
Sleep Disorders and Deprivation Causes and Effects on College Students Reham Karana Biology, Bachelors of Science To The Honors College Oakland University In partial fulfillment of the requirement to graduate from The Honors College Mentor: Jessica Koppen, Professor of Chemistry Department of Chemistry Oakland University (February 15, 2018) Introduction When told to picture a college student, a picture of a student in a library frantically studying for their next exam will most likely come to mind. Others might picture college students in a social environment among their peers, participating in a sorority, or even at a raucous party. What most will not picture a college student doing is simply sleeping. A growing and unattended problem among college students is their common day-time sleepiness and increased sleep disorders. A student’s sleep is no longer driven by the light and dark cycle but rather but their school schedule, academic load, and socialization. To maximize success in college, an obstacle most students have now endured is a lack of sleep and potential sleep disorders. What most do not know is this could actually do the opposite and hurt academic performance (Allan, 2015). Current research has shown that fifty percent of college students report daytime sleepiness and seventy percent experience insufficient sleep (Hershner, 2014). This can adversely affect one’s academic performance due to sleep having vital biological effects on the human body (Gaultney, 2010). According to The American Academy of Sleep Medicine, students that maintain a sufficient amount of sleep per night performed better on memory and motor tasks than students deprived of sleep (“College Students”, 2015). -
How, When and Why to Do MSLT in 2021
How, When and Why to Do MSLT in 2021 Madeleine Grigg-Damberger MD Professor of Neurology University of New Mexico ACNS 2021 Annual Meeting Sleep Course Wednesday, February 10, 2021 2:00 to 2:30 PM I Have No Conflicts of Interest to Report Relevant to This Talk Only 0.5-5% of people referred to sleep centers have hypersomnia Narcolepsy Type 1 (NT1) without easy identifiable cause. Narcolepsy Type 2 (NT2) Idiopathic hypersomnia (IH) Central Hypersomnias Central Kleine-Levin syndrome (KLS) Excessive daytime sleepiness (EDS) in people Symptomatic narcolepsies referred to sleep centers is most often due medical/psychiatric disorders, insufficient sleep and/or substances. Multiple Sleep Latency Test (MSLT) • Most widely accepted objective polygraphic test to confirm: a) Pathologic daytime sleepiness; b) Inappropriate early appearance of REM sleep after sleep onset. • Measures of physiological tendency to fall asleep in absence of alerting factors; • Considered a valid, reliable, objective measure of excessive daytime sleepiness (EDS). REFs: 1) Sleep 1986;9:519-524. 2) Sleep 1982;5:S67-S72; 3) Practice parameters for clinical use of MSLT and MWT. SLEEP 2005;28(1):113-21. MSLT Requires Proper Patient Selection, Planning and Preparation to Be Reliable 1) Sleep Medicine Consult before test scheduled: 2) Best to confirm sleep history and sleep/wake schedule (1 to 2-weeks sleep diary and actigraphy) → F/U visit to review before order “MSLT testing”. 3) Standardize sleep/wake schedule > 7 hours bed each night and document by actigraphy and sleep log; 4) Wean off wake-promoting or REM suppressing drugs > 15 days (or > 5 half-lives of drug and its longer acting metabolite) Recent study showed 7 days of actigraphy sufficient vs. -
Differences in Polysomnographic, Nocturnal Penile Tumescence and Penile Doppler Ultrasound Findings in Men with Stuttering Priap
IJIR: Your Sexual Medicine Journal www.nature.com/ijir ARTICLE OPEN Differences in polysomnographic, nocturnal penile tumescence and penile doppler ultrasound findings in men with stuttering priapism and sleep-related painful erections 1 1 1 1 1 1 1 Mark Johnson , Venkata McNeillis ✉, Julia Gutbier , Andy Eaton , Robert Royston , Thomas Johnson , Giovanni Chiriaco , Miles Walkden1 and David Ralph 1 © The Author(s) 2021 Men with Stuttering Priapism (SP) and sleep-related painful erections (SRPE) experience bothersome nocturnal painful erections resulting in poor sleep. The aim of this study is to observe common features and differences between men with SP and SRPE based on polysomnography, nocturnal penile tumescence (NPT), and penile doppler ultrasound (PDU). This is a prospective cohort study of 20 participants divided into two groups (Group 1 = SP [n = 12]; Group 2 = SRPE [n = 8]) with bothersome painful nocturnal erections. All participants were referred to the sleep disorder clinic to be assessed and consented for overnight polysomnography with simultaneous NPT recording and to complete validated sleep, sexual dysfunction and health-related quality of life questionnaires. Unstimulated PDU was also performed. Abnormal Polysomnographic findings (reduced sleep efficiency, total sleep time, and awake after sleep onset) were identified in both groups suggesting poor sleep. Men with SP had significantly longer erections (60.0 vs 18.5; p = 0.002) and took longer to detumesce once awake (25.7 vs 5.4 min; p = 0.001) than men with SRPE. They also had significantly higher peak systolic and end diastolic velocities on unstimulated PDU with an abnormal low resistance waveform identified. No sleep pathology was identified in men with SP. -
Parasomnias Fact Sheet
Fact Sheet Parasomnias Overview Parasomnias are unusual things we do or experience while asleep or while partially asleep. Almost everyone has a nightmare from time to time. When someone has nightmares frequently, and they are very distressed about them, they may have Nightmare Disorder. Nightmare Disorder is considered a parasomnia since it is an unpleasant event that occurs while asleep. The term parasomnia is much broader than nightmares, and a person with Nightmare Disorder has more than just the occasional nightmare event. In addition to Nightmare Disorder, other common parasomnia events include: REM Behavior Disorder (RBD) Sleep paralysis Sleepwalking Confusional arousals What are common parasomnias? Typically parasomnias are classified by whether they occur during the rapid eye movement (REM) sleep or Non- REM sleep. People with an REM parasomnia are more likely to recall their unusual sleep behaviors (for example, nightmare) than those with a Non-REM parasomnia (for example, sleepwalking). REM Behavior Disorder (RBD) Most dreaming occurs in REM sleep. During REM sleep, most of our body muscles are paralyzed to prevent us from acting out our dreams. In REM Behavior Disorder (RBD), a person does not have this protective paralysis during REM sleep. Therefore, they might “act out” their dream. Since dreams may involve violence and protecting oneself, a person acting out their dream may injure themselves or their bed partner. The person will usually recall the dream, but not realize that they were actually moving while asleep. Sleep Paralysis and Sleep Hallucinations During REM sleep our muscles are paralyzed to keep us from acting out our dreams. -
Normal and Delayed Sleep Phases
1 Overview • Introduction • Circadian Rhythm Sleep Disorders – DSPS – Non-24 • Diagnosis • Treatment • Research Issues • Circadian Sleep Disorders Network © 2014 Circadian Sleep Disorders Network 2 Circadian Rhythms • 24 hours 10 minutes on average • Entrained to 24 hours (zeitgebers) • Suprachiasmatic nucleus (SCN) – the master clock • ipRGC cells (intrinsically photosensitive Retinal Ganglion Cells) © 2014 Circadian Sleep Disorders Network 3 Circadian Rhythm Sleep Disorders • Definition – A circadian rhythm sleep disorder is an abnormality of the body’s internal clock, in which a person is unable to fall asleep at a normal evening bedtime, although he is able to sleep reasonably well at other times dictated by his internal rhythm. • Complaints – Insomnia – Excessive daytime sleepiness • Inflexibility • Coordination with other circadian rhythms © 2014 Circadian Sleep Disorders Network 4 Circadian Sleep Disorder Subtypes* • Delayed Sleep-Phase Syndrome (G47.21**) • Non-24-Hour Sleep-Wake Disorder (G47.24) • Advanced Sleep-Phase Syndrome (G47.22) • Irregular Sleep-Wake Pattern (G47.23) • Shift Work Sleep Disorder (G47.26) • Jet Lag Syndrome * From The International Classification of Sleep Disorders, Revised (ICSD-R) ** ICD-10-CM diagnostic codes in parentheses © 2014 Circadian Sleep Disorders Network 5 Definition of DSPS from The International Classification of Sleep Disorders, Revised (ICSD-R): • Sleep-onset and wake times that are intractably later than desired • Actual sleep-onset times at nearly the same daily clock hour • Little or no reported difficulty in maintaining sleep once sleep has begun • Extreme difficulty awakening at the desired time in the morning, and • A relatively severe to absolute inability to advance the sleep phase to earlier hours by enforcing conventional sleep and wake times. -
Clinical Characteristics of Primary Insomniacs with Sleep-State Misperception
JCN Open Access ORIGINAL ARTICLE pISSN 1738-6586 / eISSN 2005-5013 / J Clin Neurol 2015;11(4):358-363 / http://dx.doi.org/10.3988/jcn.2015.11.4.358 Clinical Characteristics of Primary Insomniacs with Sleep-State Misperception Hye-Jin Moona b Background and PurposezzThe aims of this study were to determine the prevalence of Mei Ling Song a sleep-state misperception and to identify any differences in the clinical characteristics of pri- Yong Won Cho mary insomniacs with and without misperception. a Department of Neurology and MethodszzIn total, 250 adult primary insomniacs were enrolled whose objective total sleep b Nursing Graduate School, time (TST) was more than 120 min, as assessed by full-night polysomnography. Sleep state Dongsan Medical Center, misperception was defined objectively as a TST of at least 6.5 h and an objective sleep effi- Keimyung University School of Medicine, Daegu, Korea ciency (SE) of at least 85%. ResultszzThe prevalence of sleep-state misperception in primary insomniacs was 26.4%. The (low) quality of sleep and psychiatric parameters were similar in the two groups, al- though the objective sleep architecture was relatively normal for the misperception group. Multivariate analysis revealed that both SE and sleep quality were significant factors associat- ed with subjective TST in the misperception group, while only SE was significant in those without misperception. Subjective TST was a significant effect factor with respect to sleep quality in the misperception group, while the Beck Depression Inventory-2 score and age were significant factors in those without misperception. ConclusionszzThe clinical characteristics of patients with sleep-state misperception differed from those without this condition. -
A Cognitive Behavioral Exposure Treatment Package for Night Terrors: a Case Study
Send Orders of Reprints at [email protected] 8 The Open Sleep Journal, 2013, 6, 8-11 Open Access A Cognitive Behavioral Exposure Treatment Package for Night Terrors: A Case Study Steven J. Linton* Center for Health and Medical Psychology, School of Law, Psychology and Social Work, Örebro University, Sweden Abstract: Night terror is a rare problem in adults characterized by nighttime episodes similar to panic attacks except that sufferers are not aware of the content. There is no current treatment, but exposure is a treatment of choice for panic. The purpose of this case study was therefore to develop and describe a novel treatment. The client had a 22-year history of night terror attacks with verbalization causing sleep difficulties and daytime fatigue. A cognitive-behavioral package featuring exposure (listening to audio recordings of the episodes) and re-conceptualization was provided over 13 sessions. Results indicated a large decrease in the ratings of the intensity of the night terror episodes. Moreover, sleep onset latency decreased while sleep quality and duration improved substantially. The client reported important increases in daytime activities and resumed working. Although caution is necessary because this is a case study, the results suggest that this technique warrants further study for people suffering from night terrors. Keywords: Night terrors, adults, exposure therapy, cognitive behavioral treatment. INTRODUCTION insomnia [7, 8] and panic disorders [9, 10]. Indeed, exposure is a treatment of choice for panic attacks and theoretical Night terrors are rare among adults, but when they do should be effective for night terrors as well [11, 12]. -
Simultaneous Stimulation of Slow-Wave Sleep and Growth Hormone Secretion by Gamma-Hydroxybutyrate in Normal Young Men
Simultaneous Stimulation of Slow-wave Sleep and Growth Hormone Secretion by Gamma-hydroxybutyrate in Normal Young Men Eve Van Cauter,* Laurence Plat,*§ Martin B. Scharf,‡ Rachel Leproult,* Sonya Cespedes,* Mireille L’Hermite-Balériaux,§ and Georges Copinschi§ *Department of Medicine, University of Chicago, Illinois 60637; ‡Center for Research in Sleep Disorders, Cincinnati, Ohio 45246; and §Center for the Study of Biological Rhythms (CERB), Laboratory of Experimental Medicine and Department of Endocrinology, Erasme Hospital, Université Libre de Bruxelles, B-1070 Brussels, Belgium Abstract first episode of slow-wave (SW) sleep (2, 3). A study with blood sampling at 30-s intervals has shown that maximal GH release The aim of this study was to investigate, in normal young occurs within minutes of the onset of SW sleep (4). Available ev- men, whether gamma-hydroxybutyrate (GHB), a reliable idence suggests that nocturnal GH secretion is controlled prima- stimulant of slow-wave (SW) sleep in normal subjects, would rily by growth hormone–releasing hormone (GHRH) release simultaneously enhance sleep related growth hormone (GH) (5). Because GH secretion is also under inhibitory control by so- secretion. Eight healthy young men participated each in matostastin, variability of somatostatinergic tone may underlie four experiments involving bedtime oral administration of dissociations between SW sleep and nocturnal GH release (6–9). placebo, 2.5, 3.0, and 3.5 g of GHB. Polygraphic sleep re- While such dissociations are observed frequently during late cordings were performed every night, and blood samples sleep, a large pulse of GH secretion occurs during the first SW were obtained at 15-min intervals from 2000 to 0800. -
Chapter 2 – Normal Human Sleep : an Overview Mary A
Carskadon, M.A., & Dement, W.C. (2011). Monitoring and staging human sleep. In M.H. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and practice of sleep medicine, 5th edition, (pp 16-26). St. Louis: Elsevier Saunders. Chapter 2 – Normal Human Sleep : An Overview Mary A. Carskadon, William C. Dement Abstract Normal human sleep comprises two states—rapid eye movement (REM) and non–REM (NREM) sleep— that alternate cyclically across a sleep episode. State characteristics are well defined: NREM sleep includes a variably synchronous cortical electroencephalogram (EEG; including sleep spindles, K- complexes, and slow waves) associated with low muscle tonus and minimal psychological activity; the REM sleep EEG is desynchronized, muscles are atonic, and dreaming is typical. A nightly pattern of sleep in mature humans sleeping on a regular schedule includes several reliable characteristics: Sleep begins in NREM and progresses through deeper NREM stages (stages 2, 3, and 4 using the classic definitions, or stages N2 and N3 using the updated definitions) before the first episode of REM sleep occurs approximately 80 to 100 minutes later. Thereafter, NREM sleep and REM sleep cycle with a period of approximately 90 minutes. NREM stages 3 and 4 (or stage N3) concentrate in the early NREM cycles, and REM sleep episodes lengthen across the night. Age-related changes are also predictable: Newborn humans enter REM sleep (called active sleep) before NREM (called quiet sleep) and have a shorter sleep cycle (approximately 50 minutes); coherent sleep stages emerge as the brain matures during the first year. At birth, active sleep is approximately 50% of total sleep and declines over the first 2 years to approximately 20% to 25%.