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Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Restless legs syndrome (RLS) is a common neurosensorimotor disorder that presents with paresthesias, sleep disturbances and, in most cases, periodic limb movements of sleep (PLMS). Although many treatments have been described, interest has recently been focused on dopaminergic mechanisms of etiology and treatment. The dopamine agonists L-dopa/carbidopa, bromocriptine mesylate or both were initiated in 49 patients with RLS/PLMS who sought consultation at a sleep disorders center. This retrospective study describes the symptoms, time course of response and complications in 36 men and 13 women with a mean age of 53.9 years. Only 47 of the patients were available for extended follow-up. The most common presenting complaints were the sensation of restless legs and sleep maintenance insomnia lasting over 20 years. In the extended follow-up group of 47, four failed to respond to L-dopa or bromocriptine, five discontinued treatment because of side effects and two reported loss of therapeutic effect within the first month. Between month one and six, only three additional subjects discontinued treatment. At a mean follow-up of 283 days (SD 316), 33 patients continued on L-dopa/carbidopa at a mean bedtime dose of 160 mg L-dopa (SD 300). Treatment-emergent morning leg restlessness developed in eight patients, seven of whom required daytime medication for relief. Other side effects, generally nausea, occurred in only eight of 43 patients. Psychiatric side effects of dyskinesia were not seen. The > 70% long-term response is comparable to other studies in the literature.
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PMID:Dopaminergic agents in restless legs syndrome and periodic limb movements of sleep: response and complications of extended treatment in 49 cases. 790 74

A 67-year-old man with SIADH complicated by slowly progressing autonomic failure was described. The patient noticed constipation at the age of 57. In the following years, he suffered from urinary incontinence, depletion of sweating, impotence, sleeplessness with snore, and dizziness while walking. Physical examination revealed a masked oily face with slight cerebellar disturbance. Abnormality of autonomic function tests was recognized and he was diagnosed as Shy-Drager syndrome with gradually progressing, diffuse autonomic failure accompanied by slight cerebellar ataxia and Parkinsonism. Both serum sodium level and plasma osmotic pressure were reduced, whereas daily sodium excretion was more than 100mEq and urinary osmolality was about 500mOsm/kgH2O. His renal function was intact, and the adrenocortical and thyroid hormone levels were normal, then criteria of SIADH was fulfilled. SIADH was thought to have occurred on the basis of Shy-Drager syndrome. Water load test showed failure of adequate water diuresis, but intravenous phenytoin administration following the water load test ameliorated the diuresis to normal. The relationship between plasma osmolality and the ADH response indicates that ADH was adequately secreted in response to the increase in plasma osmolality but not suppressed in response to the decrease in plasma osmolality below 280mOsm/kgH2O. These results suggest that ADH synthesis in the hypothalamus and its secretion from the pituitary gland were both intact. The response of ADH secretion to the orthostatic hypotension induced by head-up tilt was quite blunted, being compatible with Shy-Drager Syndrome. Sleep disturbance was studied by polysomnography and laryngoscopy, and was revealed to be based upon severe sleep apnea due to incomplete paralysis of the bilateral vocal cords. Sleep apnea due to vocal cord paralysis is sometimes found to be complicated in patients with multiple system atrophy (MSA) including Shy-Drager syndrome, and is known as Gerhardt syndrome. This is the first report on a case of Shy-Drager syndrome complicated with SIADH and bilateral vocal cord paralysis. In this case, SIADH is caused by impaired afferent pathways from baroreceptors to the hypothalamus, which transfer inhibitory stimuli on ADH secretion. It is suggested that Shy-Drager syndrome should be considered one of the causes of SIADH.
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PMID:[A case of Shy-Drager syndrome complicated with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and incomplete paralysis of bilateral vocal cords]. 795 87

One of the most controversial issue concerning chronic insomnia is its association with psychopathology. Many patients tend to present their sleep disturbances as isolated, whereas others admit that they have difficulties in other sectors of their life too. If psychopathology exists in chronic insomnia, it should manifest itself in the form of defensive mechanisms which can be clinically observed. In order to have information concerning this problem, the initial interview of patients with chronic insomnia has been analysed in every details, in order to detect behavioural features and characteristics of verbal expression, indicating that defense mechanisms are working. A group of 100 patients from the specialized consultation for sleep disorders has been studied They were referred by their physicians. The patients with a somatic disease or a psychiatric condition corresponding to a diagnostic on axis I of DSM III-R were not included. The patients with a form of insomnia corresponding to psychophysiological insomnia, idiopathic insomnia or sleep state misperception of the international classification were included in this sample. For all patients except 2 of them, the initial interview was audiovisually recorded. This interview aimed at establishing the clinical features of the disturbance, the psychiatric and somatic condition as well as the history of the trouble and the treatment taken at the time or attempted in the past. After an initial open query: "what seems to be the problem?", a semi-structured interview was conducted to obtain information about nocturnal sleep, daytime condition, dream and parasomnia, the history of the disturbance and the treatment. Anxiety and depression, as well as other psychiatric conditions were systematically investigated. Under these conditions, the patients showed from the very beginning of the interview, noticeable characteristics in their behaviour and verbal expression. Therefore, it is essentially the first 10 minutes of the interview that have been analysed. One exception was regressive weepiness, which usually appeared later in the interview. The audio-visual recording was analysed two times, two months apart, and a number of individual traits have been scored for presence or absence. Only the most obvious traits have been scored. In the behavioural presentation of the patient, detachment, eye avoidance and distant attitude were most commonly observed. Many patients also showed some signs of tension and anxiety. The other traits were smile, immobility of the body posture, incessant movements and tics, bored attitude, mannerism, difficulties to concentrate, retardation or weepiness. The formal characteristics on verbal expression can indicate logorrhea, or in contrast very parcimonious expression, precipitated elocution which makes the patient difficult to understand, or montonous voice. From the point of view of verbal content, the speech is often vague, hesitant, dispersed or superficial, the patient going rapidly from one line to the next one. Some patients have problems to focus on what they want to explain.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Initial contact in clinical interview with patients suffering from chronic insomnia]. 798 4

We report the ontogeny and persistence of sleep and arousal disorders in amygdala-kindled kittens. We also identify procedural differences that may explain discrepancies in the literature on postkindling sleep disorders. The study population consisted of 12 preadolescent kittens kindled between 2.5 and 6.5 months of age, 8 of which were followed to adulthood (> or = 1 year), and 8 unkindled implanted control animals. Sleep and seizure patterns were monitored on 12-24-h polygraphic or split-screen video recordings of EEG and behavioral activity. Kindled kittens displayed spontaneous seizure and interictal sleep anomalies that persisted to adulthood, as follows. As compared with neurosurgical controls, kindled kittens exhibited slow-wave sleep (SWS) and REM sleep insomnia at least 1 year after kindling and 1-5 months after convulsions, regardless of postictal recording delay. Sleep and arousal defects in kindled kittens were similar to but more pronounced than those in kindled adult cats, possibly because kittens spontaneously became epileptic. Detection of postkindling SWS insomnia could be masked by brief scoring epochs (less than the preferred 1-min epoch for cats); recurrent behavioral arousals after kindling frequently aborted 1-min SWS epochs but often did not interrupt 30-s SWS epochs (based on 1-min vs. 30-s minimum duration scoring criteria). Detection of postkindling REM sleep insomnia could be masked in kittens with alternating patterns of REM loss and REM rebound; all these kittens showed periodic bouts of REM onset from waking after kindling. Different data collection and analysis procedures influence detection of sleep and arousal disorders in amygdala-kindled cats when replication of findings is attempted. We conclude that these differences explain some controversies regarding the nature and prevalence of sleep disturbances in the kindling literature in temporal lobe epilepsy (TLE).
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PMID:Ontogeny of feline temporal lobe epilepsy. III: Spontaneous sleep and arousal disorders in amygdala-kindled kittens. 798 23

Recent research has pointed to the importance of cognitive activity in interfering with sleep, and suggested a close relationship between worry and insomnia. To explore the relationship between worry and insomnia in more detail, a sample was studied in which worry and insomnia were combined in a 2 x 2 design. The content of sleep-interfering cognitions was explored both with a previously developed Sleep Disturbance Questionnaire and a newly developed checklist of the content of thoughts that arose if people could not sleep. Both supported the importance of a distinction between sleep-related and other thoughts. Whereas worried insomniacs show a broad range of sleep-interfering thoughts, the thoughts of non-worried insomniacs focused mainly on sleep itself.
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PMID:The contribution of worry to insomnia. 803 40

The sleep-wake cycle is the most important circadian rhythm in man and thus constitutes an excellent indicator of internal equilibrium and of health. Sleep disorders, and particularly insomnia, affect a great percentage of the population. In daily practice, an inappropriate treatment may transform a bad sleeper into an insomniac dependent on pharmaceuticals for life. It is therefore necessary to give priority to non-chemical treatments in the management of insomnia. Acupuncture, which offers a personalized treatment, is particularly indicated for reharmonizing a disturbed sleep-wake cycle. Furthermore, there is an interesting similarity between the 5000-year-old theoretical basis of Chinese medicine and the recent scientific discoveries about man's internal rhythms. Clinical and statistical studies of the effects of acupuncture on insomnia are rare and evaluate only the subjective appreciation of sleep. Objective analysis of sleep by polysomnography permits evaluation of sleep architecture and visualizes the site and depth of action of the therapeutic method. Such studies have only been conducted in relation to pharmaceutical treatments. No such study has been carried out for acupuncture. A scientific and objective evaluation of the effects of acupuncture on insomnia by polysomnography could be not only of academic but mainly of great practical interest. If the efficiency of acupuncture is thus verified, this method could be integrated and proposed along with other classical therapeutic technics.
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PMID:[The effect of acupuncture in the treatment of insomnia. Clinical study of subjective and objective evaluation]. 807 40

The objective of the study was to evaluate the relation between every-night (habitual) snoring, sleep apnea and cognitive complaints (concentration and memory problems) in an adult population-based sample. In the Dan-MONICA (MONItoring trends in CArdiovascular diseases) 1,504 males and females aged 30, 40, 50 and 60 years were classified according to their snoring habits. Nocturnal respiration was measured in 748 participants. The following measures were regarded as potential confounders: age, gender, unintended sleepiness, insomnia, depression, hypnotic use, alcohol and tobacco consumption by questionnaire, body mass index (BMI) and blood pressure. Concentration and memory problems were both related to depression, insomnia and unintended sleepiness. Snoring and sleep apnea (defined as a respiratory distress index - RDI > or = 5), were associated with concentration problems and unintended sleepiness. The odds ratios (95% confidence intervals) between snoring, concentration and memory problems, calculated by logistic regression analysis after adjustments of the above confounders, were 1.90 (1.23-2.91, p < 0.01) and 1.38 (0.97-1.99, NS). For those with sleep apnea, the odds ratios were 3.53 (1.42-8.73, p < 0.001) and 1.51 (0.81-2.14, NS) for concentration and memory problems, respectively. The main conclusion drawn from this study is that cognitive complaints show a high correlation to mood, insomnia, and hypersomnia. Habitual snoring and sleep apnea show a correlation to concentration problems, but not to memory complaints. This suggests that part of the association between snoring, sleep apnea and cognitive dysfunction is related to the presence of sleep disturbances and daytime sleepiness.
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PMID:Self-assessed cognitive function in snorers and sleep apneics. An epidemiological study of 1,504 females and males aged 30-60 years: the Dan-MONICA II Study. 808 78

Small ischemic vascular lesions or hemorrhages provide a pathological model useful for the study of sleep disturbances in human due to lesions in the pontine tegmentum. We present 7 patients, 4 men and 3 women, with severe insomnia and hallucinations due to small vascular lesions of the pontine tegmentum. Nocturnal-sleep and/or 24-h polygraphic studies were done on all patients, as were neurophysiological and image studies; pathological studies were performed in one patient. Insomnia affected both non-REM and REM sleep, appeared in the acute phase and tended to improve with time. The patients tolerated insomnia with no serious effects on general health. Insomnia was not affected by administration of L-tryptophan with or without carbidopa. Hallucinations were mainly visual, but were also auditory in 2 cases; they were unrelated to the occurrence of normal or dissociated REM sleep. Imaging studies, and autopsy in 1 case, revealed damage to the pontis centralis caudalis and pontis centralis oralis nuclei, which appeared to be responsible for insomnia. The relationship between visual and/or auditory hallucinations and sleep disturbances remain speculative.
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PMID:[Insomnia and hallucinations caused by vascular lesions of the pontine]. 781

The effects of 20 mg zolipidem were studied in an open, polysomnographically-monitored 179 day trial in 14 elderly psychiatric patients suffering from severe insomnia. After a placebo run-in of 7 days, zolpidem was given for 179 days followed by a 30-day wash-out period. Polysomnographic recordings (PSG) were performed just before active treatment; 30, 90 and 179 days into the treatment period; and at the end of the wash-out period. Statistically significant improvements in total sleep time, sleep efficiency and percentage of rapid eye movement sleep were observed after 30 days, all of which were maintained at 179 days. Sleep stages 1-4 all changed, with a significant decrease in percentage of stage 1, and a significant increase in both percentages of stage 2 and 3, and duration of stages 3 and 4 at the end of active treatment. After a 90-day follow-up period, only stage 3 sleep and sleep efficiency were no longer significantly changed compared to baseline, all other criteria showing maintenance of efficacy. Slow-wave sleep, which was increased during active treatment, decreased in the follow-up period. No serious adverse events were observed. These results suggest that, contrary to other hypnotics, zolpidem, after long-term administration, improves objective sleep parameters and may normalize a disturbed sleep architecture.
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PMID:Long-term polysomnographic study of the efficacy and safety of zolpidem in elderly psychiatric in-patients with insomnia. 811 75

Abnormal sleep can be insufficient, which constitutes insomnia; it can be excessive or inappropriate, which is hypersomnia, it can be misplaced with respect to the normal sleep-wakefulness rhythm, or it can be accompanied by various phenomena which do not belong to sleep itself (i.e. parasomnia). This is the format of most traditional classifications of sleep disorders. A modern classification has been introduced in 1990 and contains the description of 88 different sleep disturbances. They are classified in the main categories of dyssomnia, parasomnia and sleep disorders associated with psychiatric, neurological or somatic conditions. This classification is an excellent tool for the practice of sleep medicine and for the study of sleep disorders.
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PMID:[Classification of sleep disorders]. 815 2


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