Search

Intraindividual variability is an often understudied aspect of health outcomes research that may provide additional, complementary information to average values. The current paper aims to further our understanding of intraindividual variability in health research by presenting the results of a daily diary study of sleep and pre-sleep arousal. Pre-sleep arousal is often implicated in poor sleep outcomes, although the arousal–sleep association is not uniform across age groups. The examination of intraindividual variability in different age groups may provide a more complete understanding of these constructs, which, in turn, can inform future research. The overall objectives of the current study are to quantify the amount of intraindividual variability in pre-sleep arousal and sleep and to examine age differences in this variability. A sample of older (n=50) and younger (n=50) adults recruited from North Central Florida and online completed 14-consecutive-day diaries assessing pre-sleep arousal and sleep outcomes. Significant age differences were found for sleep and pre-sleep arousal; older adults displayed poorer, more variable sleep for the majority of sleep outcomes, and higher levels of pre-sleep arousal than younger adults. The high amount of intraindividual variability has implications for the assessment of pre-sleep arousal and sleep across age groups.

Human sleep begins in stage 1 and progresses into stages 2 and 3 of Non-Rapid-Eye-Movement (NREM) sleep. These stages were defined using several arbitrarily-defined thresholds for subdivision of albeit continuous process of sleep deepening. Since recent studies indicate that stage 3 (slow wave sleep) has unique vital functions, more accurate measurement of this stage duration and continuity might be required for both research and practical purposes. However, the true neurophysiological boundary between stages 2 and 3 remains unknown. In a search for non-arbitrary threshold criteria for distinguishing the boundaries between NREM sleep stages, scores on the principal components of the electroencephalographic (EEG) spectrum were analyzed in relation to stage onsets. Eighteen young men made 12–20-minute attempts to nap during 24-hour wakefulness. Single-minute intervals of the nap EEG records were assigned relative to the minute of onsets of polysomnographically determined stages 1, 2, and 3. The analysis of within-nap time courses of principal components scores revealed that, unlike any conventional spectral EEG index, score on the 4th principal component exhibited a rather rapid rise on the boundary between stages 2 and 3. This was mostly a change from negative to positive score. Therefore, it might serve as yes-or-no criterion of stage 3 onset. Additionally, similarly rapid changes in sign of scores were exhibited by the 1st and 2nd principal components on the boundary of stages 2 and 1 and on the boundary between stage 1 and wakefulness, respectively.

Streptococcal infections are suggested as a risk factor for narcolepsy. This hypothesis is supported by the presence of anti-streptolysin antibodies in 65% of patients with narcolepsy. These infections are associated with the activation of general immunity and concomitant increased permeability of blood–brain barrier after T cell activation during inflammation and fever.It has also been shown a significant association between birth order and narcolepsy in genetically susceptible patients, with positivity for HLA-DQB1⁎0602 allele. Watson and colleagues showed a significant association between birth order and narcolepsy in genetically susceptible patients, with positivity for HLA-DQB1⁎0602 allele. In that study, the disease was predominant in young children cases compared to controls.We report here the case of a child diagnosed with narcolepsy with cataplexy, positivity for the HLA-DQB1⁎0602 and previous history of streptococcal infection.

This issue of Sleep Science contains an article by Yeh and Schenck about behavioral dyscontrol during sleep emerging with sporadic (non-familial) nocturnal frontal lobe epilepsy (NFLE) [1]. A series of eight cases was reported, with video-polysomnography (vPSG) and sleep EEG documentation, and successful treatment outcome [1]. The sporadic form of NFLE is not as frequently reported and not as well understood compared to familial, autosomal dominant NFLE. Two notable findings in this case series are that (i) the spectrum of clinical features of sporadic NFLE, including its therapy, closely match the well-known clinical features and therapy of familial NFLE; and that (ii) the spectrum of clinical features of sporadic NFLE, including its therapy, in this first published series in Asian patients (from Taiwan), closely match the extensive published findings in Caucasian patients with NFLE, as cited in the article. The challenging issue of distinguishing NFLE from nocturnal temporal lobe epilepsy (NTLE), and from NREM sleep parasomnias is also addressed in this article, with the pertinent literature cited. There are overlapping features of behavioral dyscontrol in sleep with these three conditions, which very likely reflect overlapping activations of central (motor) pattern generators (CPGs) in the brainstem [2]. Sleep related nocturnal dissociative disorder (Noc DD) also shares behavioral features with these conditions, and activation of CPGs was strongly suggested in one reported case in which a 19 y.o. male engaged in prolonged (for several minutes) constant leg pedaling, both at home and in the sleep laboratory, with both episodes captured on video [3]. It is now known that abnormal ambulation during sleep can be a manifestation of sleepwalking (SW), NFLE, NTLE, REM sleep behavior disorder (RBD), or Noc DD [3–5]. Likewise, screaming during sleep can be a manifestation of these same conditions [6]. So in regards to similar abnormal complex sleep behaviors, there is a broad range of causes and usually separate therapies, which places a premium on establishing the proper diagnosis, which can then direct appropriate therapy. To this end, the validated Frontal Lobe Epilepsy Parasomnias (FLEP) scale, developed by Derry et al. [7], has been particularly useful in distinguishing NFLE from NREM sleep parasomnias, as utilized in the Yeh and Schenck report [1]. Nevertheless, controversial points are still being debated, as the recognized difficulties “in distinguishing nocturnal epileptic seizures from parasomnias reflect just one aspect of the intriguing issue of the pathophysiological relationships between all types of paroxysmal motor behaviors during sleep” [8]. The complexity of these pathophysiological relationships is highlighted by a study finding a greatly increased rate of NREM sleep arousal parasomnias in families of patients with NFLE [9]. Research on the cyclic alternating pattern (CAP), an EEG marker of arousal fluctuations during sleep, calls attention to the unifying role of pathological arousals, originating in thalamocortical circuits, across epileptic, parasomnia and other abnormal motor events during sleep [10]. A recent study found different CAP characteristics in patients with NREM sleep arousal parasomnias compared to patients with frontal and temporal lobe epilepsies [11], which encourages further research on identifying different CAP profiles across patient populations with behavioral disturbances during sleep.

Objective: The aim of this study was to identify chronotypes of medical students at the Federal University of Paraíba (UFPB) and its relationship to quality of sleep, daytime sleepiness, age, sex and season of birth. Methods: The final sample consisted of 221 students, assessed by four questionnaires: demographic questionnaire, Morningness–Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality lndex (PSQI) and Epworth Sleepiness Scale (ESS). Results: There was a statistically significant difference between groups with respect to chronotypes and PSQI score (p

Objectives: Excessive daytime sleepiness (EDS) and sudden sleep onset (SOS) episodes are frequent in Parkinson׳s disease (PD). The objectives are to identify clinical characteristics and factors associated with EDS and SOS episodes. Methods: Clinical demographic data were recorded (N=100, mean age=65.0±10.4). EDS was identified by the Epworth Sleepiness Scale (ESS>10) and SOS episodes were registered. Disease severity was evaluated by the Unified Parkinson׳s Disease Rating Scale (UPDRS, I, II, and III), sleep disturbances by the Parkinson׳s Disease Sleep Scale (PDSS10) and rapid eye movement (REM) sleep behavior disorder (RBD) by the REM sleep behavior scale. Levodopa equivalent dose was measured. Results: PD patients with EDS (67%) were predominately male (73.1%) and had worse disease severity (UPDRS II and III p= 0.005); SOS episodes (39%) were associated with disease duration, diabetes, sleep disturbances (PDSS Scale), disease severity (UPDRS I, II, III) and RBD symptoms (p

In 1998, a group of phenotypically distinct neurons were discovered in the postero-lateral hypothalamus which contained the neuropeptides hypocretin 1 and hypocretin 2 (also called orexin A and orexin B), which are excitatory neuromodulators. Hypocretinergic neurons project throughout the central nervous system and have been involved in the generation and maintenance of wakefulness. The sleep disorder narcolepsy, characterized by hypersomnia and cataplexy, is produced by degeneration of these neurons.The hypocretinergic neurons are active during wakefulness in conjunction with the presence of motor activity that occurs during survival-related behaviors. These neurons decrease their firing rate during non-REM sleep; however there is still controversy upon the activity and role of these neurons during REM sleep. Hence, in the present report we conducted a critical review of the literature of the hypocretinergic system during REM sleep, and hypothesize a possible role of this system in the generation of REM sleep.

Sleep medicine in general and psychology in particular have recently developed cognitive behavioral treatment for narcolepsy (CBT-N). Despite a growing interest in this topic, most studies since 2007 have reviewed CBT applications for other sleep disorders. Currently, 6 reviews have been published on narcolepsy, with an expert consensus being reached that CBT represented an important adjunctive treatment for the disease. The current paper reviews the need for CBT applications for narcolepsy by generalizing the application of multicomponent treatments and performing studies that extrapolate the results obtained from multicenter studies. Nineteen studies were found in which the need-for-treatment guidelines identified the use of CBT for narcolepsy. Three additional studies were identified that evaluated the effectiveness of cognitive behavioral measures and multicomponent treatments for which treatment protocols have been proposed.

Background and objective: Among substances that have a significant effect on sleep are stimulants, including amphetamines. As there are few studies assessing sleep quality in methamphetamine withdrawal this study aims to evaluate changes in sleep quality of methamphetamine dependent patients during early remission period by controlling depression and anxiety as confounding variables. Methods: This study was conducted in Mashhad, Iran. Ninety amphetamine dependent patients, who were admitted in residential centers during 2012–2014 and met our inclusion criteria, were chosen by purposive nonprobability sampling method. Sleep quality was assessed by Pittsburg sleep questionnaire, in the first, second, and after the fourth week of abstinence. Additionally all participants were assessed by Beck Depression Inventory-2 and Beck Anxiety Inventory for controlling depressive and anxiety symptoms. Results: The prevalence of improper quality of sleep was very high (97.8%) within the first week of withdrawal, but it reduced considerably four weeks after abstinence (52.2%), which was statistically significant (P=0.00). The variations of depression and anxiety levels within four weeks after quitting methamphetamine, have low impact on variation of patients' sleep quality (adjusted R2

To date, shift workers represent between 15% and 25% of the modern day workforce. Work time poses a great challenge to workers as it requires that they balance productivity and sleep time between shifts. As a result, these workers experience chronic sleep deprivation with increased fatigue and drowsiness due to this sleep deprivation. The impact of this kind of work on the immune system is not yet known. We conducted a literature review with the aim of evaluating articles on this specific type of work's effects on sleep and immunity.

Background Chronic insomnia is associated with consequential experience that may affect quality of life. Understanding such experience can be helpful in planning effective interventions for patients with chronic insomnia. Objective The study aimed to describe and illuminate the experience of living with chronic insomnia. Method The study was conducted using a descriptive phenomenology approach. Participants were selected purposefully from patients with chronic insomnia who had been referred to the sleep disorders research center at Kermanshah University of Medical Sciences in Iran in 2014. Data were gathered through in-depth unstructured interviews and analyzed according to the Colaizzi method by means of Husserlian phenomenology. Results Two main themes were found in this study, from which five sub themes were constructed: first, an upset mind, with the subthemes of insomnia as an unpleasant experience and insomnia as a worrying experience; and second, an unwanted new lifestyle with treatment seeking behavior, a boring new daily routine and being overshadowed by depressed mood as the subthemes. Conclusion The study identified the experience of living with chronic insomnia as a painful one with both mental and practical aspects. The experience also explains how mental engagement and practical outcomes of chronic insomnia may interfere with well-being and quality of life in sufferers. It is recommended that patients' experiences would be considered in assessment and treatment of chronic insomnia. Therefore, therapeutic interventions should pay attention to this area.

Sleep-related health disorders are increasing worldwide; diagnosis and treatment of such sleep diseases are commonly invasive and sometimes unpractical or expensive. Actigraphy has been recently introduced as a tool for the study of sleep and circadian disorders; however, there are several devices that claim to be useful for research and have not been thoroughly tested. This comparative study provides activity, sleep and temperature information regarding several of the most commonly used actigraphers: Micro-Mini Motion Logger; Act Trust; Misfit Flash; Fitbit Flex & Thermochron. Twenty-two healthy young subjects were assessed with five different commercial actigraphs (Micro-Mini Motionlogger Watch, Condor Act Trust, MisFit Flash and Fitbit Flex) and a temperature recorder (Thermochron), and also completed a sleep diary for a week. There were not significant differences in the analysis of rest-activity pattern between devices. Temperature rhythm comparison between the Act Trust and the Thermochron showed significant differences in rhythm percentage (p

We report an unusual case of a Duchenne Muscular Dystrophy(DMD) patient who initiated a restless leg syndrome after the use of amytriptiline. The prescription and use of this medication for patients with persistent neuropathic pain is relatively common, especially for patients with DMD. Normally, this medication is well tolerated, however, we now report the occurrence of an induction or intensification of a restless leg syndrome case in a young patient with DMD, treated with amytriptiline for his chronic pain.

Objective: To present a male patient who performed arm banging on his face during sleep every night since 7 months of age. Methods: Clinical course of this patient with electroencephalographic recording with video recording at 23 months of age was shown. Results: His arm banging began at the age of 7 months and showed no complete remission at the age of 57 months of age, although clonazepam revealed mild effects on its intensity and frequency. Discussion: We diagnosed him as having arm banging type of sleep related rhythmic movement disorder. To our knowledge, no precise description on this type of sleep related rhythmic movement disorder has been found. In addition, this patient seemed to be the youngest case of sleep related rhythmic movement disorder showing arm banging.

Narcolepsy is a disease in which there is diurnal excessive sleepiness with sleep attacks and a prevalence in the general population of 1/4000 individuals. Classically, it is characterized by cataplexy, sleep paralysis, hypnagogic hallucinations and fragmented sleep. The use of modafinil in the treatment of narcolepsy is the first option of treatment for diurnal excessive sleepiness.Although considered a safe drug for use in patients with narcolepsy, being utilized for more than 20 years, modafinil possesses a series of side effects, some of them still not fully researched or described.Side effects such as headache, nausea, anxiety, insomnia, lumbago, diarrhea, dyspepsia, rhinitis and vertigo are the most frequent. However, the clinical follow-up of patients under treatment with modafinil must be intensive and the side effects ought to be noted and evaluated. The under-response to treatment or the unexpected side effects must always be directed to differential diagnostics.The objective of this article is to describe an unexpected side effect of the use of modafinil in a patient with incorrect diagnosis of narcolepsy.