A review of common sleep disorders

What should clinicians know about sleep disorders? This article briefly introduces the reader to sleep medicine and succinctly reviews common sleep disorders. First, the authors describe the diagnostic tools unique to sleep medicine: the over-night polysomnogram and the multiple sleep latency test. Next, the authors review essential features of a subset of the sleep, described in the International Classification of Sleep Disorders-Revised, that sleep disorder specialists commonly evaluate, diagnose, and treat. The disorders reviewed include the intrinsic and circadian rhythm subsets of the dyssomnias group and the parasomnia group of sleep disorders. The authors identify the core signs and symptoms, polysomnogram findings, multiple sleep latency test findings, and treatment of these disorders.     

Psychoendocrinological aspects of affective disorders.

Psychoendocrinological studies have opened a new approach to understanding affective disorders. In this study, the links of affective illnesses to changes in endocrine secretions--particularly adrenal, gonadal, growth, pineal, thyroidal, and prolactin--were reviewed with the object of adding to the number of depressed whose symptoms can be relieved.     

Cognitive aspects of mental activity during sleep.

Upon nighttime experimental awakening of 27 subjects in four sleep conditions (sleep onset early; sleep onset late; Stage 2; and rapid eye movement, REM, sleep), 108 dream reports and their association reports were collected. Dream reports were analyzed for length (temporal units) and content categories (continuity; implausibility; presence of the dreamer [i.e., "the self"], a setting, characters). Associations were classified as episodic, abstract self-referred, and semantic memories. The two sets of results tend to show a basic homogeneity among mentation reports in the four sleep conditions considered. These findings are interpreted as supporting the hypothesis that the same cognitive mechanisms operate, at different levels of engagement, in dream generation rather than the hypothesis of multiple dream-generation systems dependent upon the physiological characteristics of the various sleep stages.     

Neurocognitive dysfunction in children with sleep disorders

It is well known that adults with sleep disturbances frequently exhibit a wide range of neurocognitive decrements, and that these deficits are potentially reversible with effective treatment. However, the consequences of respiratory sleep disturbances on neurocognitive function in children have only recently been evaluated, and suggest a strong causal association between the episodic hypoxia and sleep fragmentation that characterize the disease and the emergence of reduced memory, attention and intelligence as well as a link to problematic and hyperactive behaviours and mood disturbances. This article takes a critical look at the current literature on these issues, reviews the major findings and discusses such findings in conjunction with those derived from pertinent animal models.     

Some aspects of sleep disturbance in coronary patients.

Of 42 coronary care patients studied during 10 hr. of polygraphically recorded sleep, 28 were in an open-ward coronary care unit and 14 were in a semi-private telemetry unit. The observed sleep disturbances were not a function of type of unit, length of hospitalization, sex, or medications. Sleep was significantly less fragmented in those patients judged less severe in pathology. These results indicate that alterations in normal sleep patterns occur routinely within coronary care environments, even in the absence of disturbing environmental stimuli and suggest that a closer analysis be made of sleep in these settings in light of the known relationships between sleep and cardiac function.     

Epidemiologic study of sleep disorders in Kuwaiti adolescents.

A sample of 2,574 volunteer Kuwaiti boys (n = 1,309) and girls (n = 1,265) in secondary schools were recruited. Their ages ranged from 14 to 18 years. 13 items were used to assess prevalence of insomnia, hypersomnia, nightmares, sleepwalking, sleep terror, and narcolepsy. Participants were requested to respond according to the past month on a 5-point scale. The summation of responses in the last two options, i.e., "Much" and "Very much" was considered as the point prevalence rates. Girls had significantly higher mean ratings than boys on the following items: difficulty initiating sleep, fitful and disturbed sleep, waking up several times, nightmares, and sleep terror, while boys had significantly higher mean ratings on sleepwalking and "watching TV causes naps or sleep." The point prevalence on all the items for boys ranged from 4.6% to 35.2%, and that for girls ranged between 1.0% and 37.5%. One should keep in mind that the present sample was not a clinical one.     

Some biochemical and behavioural aspects of the paradoxical sleep window

It has recently been proposed that there is a vulnerable period of time following successful learning when paradoxical sleep (PS) is necessary for learning. This vulnerable time period has been called the PS window. In Experiment 1, the protein synthesis inhibitor anisomycin (ANI) was administered following shuttle avoidance training in the Sprauge-Dawley rat to coincide with the onset of an established PS window. Control groups received either saline or ANI either 3 hours before or 3 hours after the beginning of the PS window. Three hours after the injection, each group was retested. Then animals were immediately sacrificed, and whole brain biochemical analyses were done on levels of acetylcholine (ACh) and activity of acetylcholinesterase (AChE). Only the rats given ANI timed to coincide with the beginning of the PS window showed learning deficits. All ANI-treated groups had less ACh and AChE activity. In Experiment 2, the ACh antagonist scopolamine (SCOP) was injected at the same times as in Experiment 1, and each of these groups had a corresponding saline control group as before. Retesting was done 1 day later; once again, the only group to show learning deficits was the group receiving SCOP timed to coincide with the PS window. Results suggested that the transmitter ACh plays an important role in learning/memory processes at the PS window.     

Habitual sleep duration and eating disorders in college students

To measure the relationship between habitual sleep duration and eating disorders, the responses of groups of 34 short- and 43 longer-sleeping college students to the EAT-26 Test were compared. The short-sleepers scored twice as high and were five times more likely to exhibit abnormal eating patterns than the longer-sleeping group.     

Melatonin rhythm abnormalities and sleep disorders in the elderly

Biological aging is often associated with sleep problems and daytime napping. Complaints of difficulty in initiating and maintaining sleep, as well as daytime drowsiness, are more common in the elderly than in any other age group. This report reviews evidence that impaired melatonin secretion is associated with sleep disorders in old age. Circulating melatonin levels have been found to be significantly lower and onset and peak times have been delayed in elderly insomniacs as compared to age-matched control subjects. In view of these findings, we investigated the effects of melatonin treatment on melatonin-deficient insomnia in the elderly. From the results of our study, it seems likely that melatonin replacement therapy may be beneficial in the initiation and maintenance of sleep in this population.     

Neuropsychological aspects of disorders of higher functions of the cerebral cortex in children with speech disorders

A complex and multiaspects study of the high cerebral function--speech, gnosis, praxis, gesture and mimics has been coducted on 98 children with proved speech defects--alalia, dyslalia, dysgraphia, dyslexia and stammering. In high percentage of the children various focal neurological signs have been established (so called soft neurological symptoms). Very high was the percentage of the children with visual-space defects. Rhythm gnosis and praxis suffered mostly in children with motor alalia. The tests for gesture and mimics prevailed. The unified mechanism of the disturbed development of the speech and the other high cerebral functions were discussed.     

Clinical and theoretical aspects of enactment

Enactment as a concept can serve analytic discourse through its established meaning of an act intended strongly to influence, persuade, or force another to react. We might agree to use the term in two complementary ways: Broadly, enactment can designate all behaviors of both parties in the analytic relationship, even verbal, in consequence of the intensification of the action intent of our words created by the constraints and regressive push induced by the analytic rules and frame. Patient and analyst are vulnerable to falling back on behaviors that actualize their intentions, doing so in ways motivated by and reflecting transference hopes, fears, and compromises shaped in their developmental past. Specifically, enactment can then be defined as those regressive (defensive) interactions between the pair experienced by either as a consequence of the behavior of the other. While nominally an interpersonal perspective, this concept of enactment facilitates more balanced attention to the involvement of both parties and to the intrapsychic dynamics in both that specifically shape their interactions. A clinical vignette illustrates the analyst's contributions to enactment, especially those reflecting his reactivated conflicts and their relation to his theoretical and technical preferences.     

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.