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

The effect of ageing on the sleep of insomniacs was studied by comparing objective insomnia characteristics from polygraphic recordings made during two successive nights in two groups of different ages : 14 patients aged 19 to 39 years (mean 31 years) and 11 aged 42 to 65 years (mean 50 years). All of them had severe insomnia causing them to request consultation for sleep disorders. Their only clinical symptom was chronic primary insomnia, persisting following withdrawal of hypnotics, no other physical (particularly no sleep apnea) or psychological disorder being present. Parameters studied during the first and the second night were the number and duration of intra-sleep awakenings, and the proportions of the sleep and wakefulness periods.
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PMID:[Nocturnal awakenings as a function of age in insomniacs (author's transl)]. 733 21

A total of 15 patients with sleep disorders were treated by reflexotherapy. These disorders were of the agrypnic type (insomnia), had a polymorphic character and were due to the psychogenic factors (neurosis). Acupunctures were performed with the use of 3 levels of action of acupuncture points (according to the Tabeev method). Under the impact of treatment and in the presence of neurotic symptomatology regress there was a distinct subjective and objective improvement of the night sleep, which was confirmed by polygraphic recording.
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PMID:[Change in the structure of night sleep in agrypnic syndrome patients under the influence of reflexotherapy]. 735 38

A group of 27 elderly patients with complaints of either chronic insomnia or excessive daytime sleepiness were studied in the Sleep Evaluation Center of Western Psychiatric Institute and Clinic during the period January 1977-June 1979. On the basis of anamnestic data from patients and bedroom partners, together with polysomnographic findings, sleep disturbances were classified according to the nosology of the Association of Sleep Disorders Centers. Of the 27 patients, 19 had disorders of initiating or maintaining sleep (DIMS), 7 had disorders of excessive somnolence (DOES), and 1 had parasomnia (episodic nocturnal wandering). Of the 19 DIMS patients, two-thirds had either a primary affective disorder (depression) or a persistent psychophysiologic disturbance. Of the 7 DOES patients, 6 had a primary sleep disorder such as a sleep apnea syndrome or narcolepsy-cataplexy. Additional electroencephalographic sleep data are presented on elderly patients with primary nonpsychotic depression. The latency of rapid eye movements (REM) in the depressed patients was shorter (p less than 0.05) than in patients with a persistent psychophysiologic disturbance. The percentage of REM sleep was significantly elevated (p less than 0.05) in the depressed group, and intermittent wakefulness was decreased (p less than 0.01). The causes of sleep disturbance in the elderly are both heterogeneous and complex. The need for accurate differential diagnosis and a multiaxial approach is stressed.
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PMID:Sleep disturbances in a series of elderly patients: polysomnographic findings. 736 75

During nonentrained sleep--wake conditions in man, healthy adult subjects spontaneously develop "long" biological days (greater than 35 hr) in addition to the normal, approximately 25 hr day. The ratio of sleep to total time remains constant (approximately 0.30), with long sleep episodes occurring approximately 180 degrees out of phase with the short sleep episodes. The timing and amount of REM sleep advance to an earlier time within the sleep episode during free-running, whereas stage 3 + 4 sleep is related to the initiation and course of the sleep process itself. The REM--NREM cycle length does not change, comparing entrained and nonentrained conditions. The study of the chronophysiology of humans under nonentrained conditions may serve as a model of the chronopathology of sleep--wake changes which occur in sleep disorders associated with depression, narcolepsy--cataplexy, sleep--wake dyssomnias, delayed sleep phase insomnia, and aging.
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PMID:Timing of REM and stages 3 + 4 sleep during temporal isolation in man. 740 40

Periodic movements in sleep (PMS) are stereotyped, repetitive, nonepileptiform movements of the lower extremities. A total of 409 sleep disorder patients were studied with all-night polysomnogram recording, and 53 (13%) had PMS. Such movements occurred in a wide variety of sleep-wake disorders in addition to insomnia. The prevalence and magnitude of PMS were not statistically greater in patients with insomniac disorders than in those with syndromes of excessive daytime sleepiness or other sleep-wake disorders. The results suggest that although PMS is responsible for disturbed sleep in relatively few patients, chronic sleep-wake disturbance is associated with PMS and may lead to the development of these movements.
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PMID:Periodic movements in sleep (nocturnal myoclonus): relation to sleep disorders. 743 84

The frequencies of five common sleep complaints--trouble falling asleep, waking up, awaking too early, needing to nap and not feeling rested--were assessed in over 9,000 participants aged 65 years and older in the National Institute on Aging's multicentered study entitled "Established Populations for Epidemiologic Studies of the Elderly" (EPESE). Less than 20% of the participants in each community rarely or never had any complaints, whereas over half reported at least one of these complaints as occurring most of the time. Between 23% and 34% had symptoms of insomnia, and between 7% and 15% percent rarely or never felt rested after waking up in the morning. In multivariate analyses, sleep complaints were associated with an increasing number of respiratory symptoms, physical disabilities, nonprescription medications, depressive symptoms and poorer self-perceived health. Sleep disturbances, particularly among older persons, oftentimes may be secondary to coexisting diseases. Determining the prevalence of specific sleep disorders, independent of health status, will require the development of more sophisticated and objective measures of sleep disturbances.
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PMID:Sleep complaints among elderly persons: an epidemiologic study of three communities. 748 13

To critically assess and summarize the beneficial effects of benzodiazepine therapy for insomnia in community-dwelling elders, a systematic search was undertaken to review all published clinical trials and sleep laboratory studies. The risk of injury for benzodiazepine users was also reviewed. Ten studies met inclusion criteria for assessing benefit. There are no studies regarding the long-term effectiveness of benzodiazepines for the treatment of sleep disorders in the elderly. In the sleep laboratory setting, triazolam 0.125 mg, flurazepam 15 mg, and estazolam 1 mg improved sleep latency by 27 to 30 minutes and increased total sleep time by 47 to 81 minutes for the first 2 to 3 nights of treatment, compared with baseline measurements taken while the patients were receiving placebo. In contrast to these modest short-term benefits, there is an association between the use of benzodiazepines with a long half-life, eg, flurazepam, diazepam, and chlordiazepoxide, and an increased risk of hip fracture in the elderly. Triazolam can cause rebound insomnia as well as anterograde amnesia. Clinicians should discontinue their prescribing of long-acting benzodiazepines for elderly patients with insomnia. More research is needed on the effects of nondrug interventions as well as on short- and intermediate-acting benzodiazepines, such as oxazepam and temazepam, to treat insomnia in community-dwelling elderly.
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PMID:Benzodiazepines for insomnia in community-dwelling elderly: a review of benefit and risk. 759 66

This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee's parameters for the practice of sleep medicine in North America. The growing use of activity-based monitoring (actigraphy) in sleep medicine and sleep research has enriched and challenged traditional sleep-monitoring techniques. This review summarizes the empirical data on the validity of actigraphy in assessing sleep-wake patterns and assessing clinical and control groups ranging in age from infancy to elderly. An overview of sleep-related actigraphic studies is also included. Actigraphy provides useful measures of sleep-wake schedule and sleep quality. The data also suggest that actigraphy, despite its limitations, may be a useful, cost-effective method for assessing specific sleep disorders, such as insomnia and schedule disorders, and for monitoring their treatment process. Methodological issues such as the proper use of actigraphy and possible artifacts have not been systematically addressed in clinical research and practice.
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PMID:The role of actigraphy in the evaluation of sleep disorders. 761 29

There are currently three recognized menstrual-related sleep disorders: premenstrual insomnia, menopausal insomnia and premenstrual hypersomnia. Another category, premenstrual parasomnia (sleep behavior disorder), is now suggested. Case 1, a 17-year-old female, presented with a 6-year history of exclusively premenstrual sleep terrors and injurious sleep-walking that began 1 year after menarche. During the four nights preceding each menses, she would scream and run from her bed. There was no history of premenstrual syndrome. Neurological evaluations had been unrevealing, apart from mild mental retardation and attention deficit disorder; there was no psychiatric history. Polysomnography 3 days before the onset of menses confirmed the diagnosis of sleep-walking. Pharmacotherapies were not satisfactory, but self-hypnosis at bedtime was rapidly effective with benefit sustained at 2.5-year follow-up. Case 2, a 46-year-old woman without psychiatric disorder, presented with a 5-year history of sleep terrors and injurious sleep-walking that initially was not menstrually related, but beginning 8 months prior to referral, she developed an exclusively premenstrual parasomnia that, after polysomnography, was partially controlled with bedtime self-hypnosis and clonazepam, 0.25 mg.
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PMID:Two cases of premenstrual sleep terrors and injurious sleep-walking. 764 Jul 26

Melatonin, produced by the pineal gland at night, has a role in regulation of the sleep-wake cycle. Among elderly people, even those who are healthy, the frequency of sleep disorders is high and there is an association with impairment of melatonin production. We investigated the effect of a controlled-release formulation of melatonin on sleep quality in 12 elderly subjects (aged 76 [SD 8] years) who were receiving various medications for chronic illnesses and who complained of insomnia. In all 12 subjects the peak excretion of the main melatonin metabolite 6-sulphatoxymelatonin during the night was lower than normal and/or delayed in comparison with non-insomniac elderly people. In a randomised, double-blind, crossover study the subjects were treated for 3 weeks with 2 mg per night of controlled-release melatonin and for 3 weeks with placebo, with a week's washout period. Sleep quality was objectively monitored by wrist actigraphy. Sleep efficiency was significantly greater after melatonin than after placebo (83 [SE 4] vs 75 [3]%, p < 0.001) and wake time after sleep onset was significantly shorter (49 [14] vs 73 [13] min, p < 0.001). Sleep latency decreased, but not significantly (19 [5] vs 33 [7] min, p = 0.088). Total sleep time was not affected. The only adverse effects reported were two cases of pruritus, one during melatonin and one during placebo treatment; both resolved spontaneously. Melatonin deficiency may have an important role in the high frequency of insomnia among elderly people. Controlled-release melatonin replacement therapy effectively improves sleep quality in this population.
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PMID:Improvement of sleep quality in elderly people by controlled-release melatonin. 749 Oct 13


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