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

Six patients between the ages of 25 and 59, with chronic, primary insomnia received the new, non-benzodiazepine, hypnotic zopiclone continuously for 17 weeks after a drug free interval of 12 nights. To qualify for the study, sleep efficiency, determined by a sleep study on two, consecutive, placebo-controlled nights, had to be less than 75%. Patients evaluated their sleep by questionnaire and had sleep studies completed throughout active treatment. Zopiclone (7.5 mg) increased sleep efficiency by decreasing sleep latency, wakefulness after sleep onset and increasing total sleep time. Sleep architecture was minimally affected by zopiclone treatment; no significant changes in delta or REM sleep were observed. The commonest side effect was a bitter or metallic taste. No significant changes in biological functioning were noted throughout the study period. These findings indicate that zopiclone is a safe and effective hypnotic medication which maintains its effectiveness with protracted use.
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PMID:A sleep laboratory evaluation of the long-term efficacy of zopiclone. 336 34

The purpose of this work was to investigate the sequence of modifications of sleep and pain parameters in a condition of persistent nociceptive stimulation. In freely moving cats carrying implanted electrodes, continuous polygraphic and behavioral recordings were collected 24 h a day for several consecutive days before and after treatment. Injection of formalin (2 ml, 37%) elicited continuous wakefulness (1-6 h) associated with behavioral manifestations of pain. This insomnia was followed by the delayed appearance of LS (light, slow wave sleep) DS (deep slow wave sleep) and REM (rapid eye movement sleep). On days 1 and 2 after injection, pain manifestations displayed a gradual decrease, while total sleep time (LS + DS + REM) slowly returned to normal levels. On day 1, the amount of LS was not modified, but DS and REM were greatly decreased. For 12 h after the first REM episode, REM was decreased while DS was already at the basal levels. Formalin elicited a long-lasting increase in EMG activity of the tibialis anterior muscle which was suppressed during REM and returned to higher levels afterwards. Prolonged wakefulness and delay in sleep stage appearance were also recorded when a 24-h sleep deprivation preceded formalin injection. In this condition, LS, DS and REM amount were at basal levels from their first reappearance, and a rebound in total sleep time and DS occurred on day 2 after the injection. After injection of smaller doses of formalin (0.5 ml, 8%), the amount of LS, DS and REM was at control levels since day 1. The results suggest that (1) the amount of sleep depends on sleep debt and on the level of pain intensity and (2) sleep stages are differentially sensitive to persistent pain.
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PMID:Differential effects of persistent nociceptive stimulation on sleep stages. 342 91

Sleep rhythm can be influenced by narcotics and exogenous disturbances causing persistent insomnia, exhaustion and moodiness. In this study the influence of anesthesia on the patients' sleep during the first postoperative night was investigated. It was attempted to differentiate between the influences due to anesthesia, namely to surgery, and due to intensive care. In 10 patients with halothane narcosis, 12 patients with neuroleptanalgesia, 12 young patients and 12 patients more than 70 years of age with halothane/fentanyl anesthesia a sleep study was performed during the first postoperative night. Electrodes were placed according to the criteria of Rechtschaffen and Kales [US Department of Health, Education and Welfare, Public Health Service, Bethesda 1968]. The group of controls consisted of 10 healthy female volunteers, who had to sleep under identical conditions. The sleep stages were visually evaluated by criteria of Rechtschaffen and Kales [US Department of Health, Education and Welfare Public Health Service, Bethesda 1968]. The disturbances by nurses did not, on the whole, interfere with the sleep rhythms of the 10 healthy volunteers: 4-5 REM phases and stage IV sleep were seen regularly. The patients had a maximum of 1 REM phase. Stage II sleep was reached after falling asleep and maintained for several hours. Stage III and IV were hardly seen in all patient groups. Geriatric patients showed the most obvious changes in their sleep. They were sleepless during 41.1% of the monitored period. Stage II was slightly reduced. Night sleep of patients after anesthesia is disturbed not only by intensive care unit conditions, but also by direct effects of narcotics and surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:General anesthesia and postnarcotic sleep disorders. 344 24

Many changes occur in sleep as a function of aging, but it is not known whether these changes result in sleep being less restorative. To examine the sleep restorative process, groups of 12 normal young adults and 12 normal and 12 insomniac male subjects, age 55-71, were totally sleep deprived for 64 hours and then allowed recovery sleep. Response speed, immediate recall, sleepiness, and body temperature were tested at approximately 2300, 0115, 0330, 0530 and 0800 during baseline, sleep loss, and recovery nights. Significant group (age or insomnia) by sleep loss condition interactions were found for reaction time and immediate recall performance measures. Similar significant interactions were found for oral temperature and all EEG sleep variables except total time in bed, percent stage 1, and percent REM. It was concluded that performance recovery following sleep loss was no slower in older subjects than in younger subjects despite very different recovery sleep stage parameters. This implied that aging effects on sleep are developmental rather than degenerative.
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PMID:Sleep and performance in young adults and older normals and insomniacs during acute sleep loss and recovery. 350 53

The effects of an ultra-rapidly eliminated hypnotic (midazolam 7.5-15.0 mg; mean elimination half-life approximately 2 h) and a rapidly eliminated hypnotic (brotizolam 0.125-0.25 mg; mean elimination half-life approximately 5 h) were studied on transient insomnia induced by sleeping in a reclining seat. Rest in the seat did not lead to delay in sleep onset, but there was increased wakefulness and drowsy sleep and less REM sleep. There were no differences in wakefulness or drowsiness between sleep with drugs in the seat and with placebo in bed, but with midazolam, though not with brotizolam, there was a reduction in REM sleep less than or equal to 300 min after sleep onset. Ultra-rapidly and rapidly eliminated compounds used in the management of transient insomnia should be given in doses that are as free as possible from central nervous system depression as indicated by suppression of REM sleep during the early part of the night. Low doses of ultra-rapidly eliminated drugs are indicated for sleep-onset insomnia and for short periods of sleep, while rapidly eliminated hypnotics with elimination half-lives of approximately 5 h have the potential to sustain sleep free of residual effects.
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PMID:Transient insomnia and rapidly eliminated hypnotics. 350 31

The effects of 8-chloro-6-(2-fluorophenyl)-1-methyl-4H-imidazo[1,5-a] [1,4]benzodiazepine (midazolam, Ro 21-3981, Dormicum) in oral formulation of 15 and 30 mg on the sleep cycle of patients suffering from insomnia were assessed by means of polysomnographic recordings using a double-blind cross-over design. Both doses of midazolam were effective in improving sleep on short-term administration. In addition, significantly larger decrements of non-REM (NREM) sleep latency and of wake time through the 3rd third of night and nonsignificant trends toward smaller number of awakenings as well as shorter total wake time and longer NREM sleep time were induced by the 30 mg dose. Irrespective of the dosage sleep was almost exclusively increased at the expense of NREM sleep. Following 3 days treatment there was no rebound insomnia. These preliminary results suggest that the 15 mg dose could be appropriate in patients with difficulties in falling asleep, while the 30 mg dose would be more appropriate for patients who also experience difficulties in staying asleep.
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PMID:Short-term sleep laboratory evaluation of midazolam in chronic insomniacs. Preliminary results. 355 70

The treatment of sleep disorders in depressives depends basically on the nature of the underlying affective disorder (endogenous, organic, psychogenic or constitutional depression). Therapeutic approaches may be categorized in: psychological, somatic and pharmacological ones. The former include psychotherapies and behavioral treatments which are useful in psychogenic and constitutional depressions with sleep-onset insomnia but may also be supportive in endogenous depressions. The basic therapeutic factor common to all is anxiety reduction. Somatic therapies, such as ECT, total, partial and REM-sleep deprivation, sleep schedule shifts and bright light (EL) are utilized mostly in endogenous depressions. Sleep laboratory findings and different hypotheses concerning the mode of action of these alternative treatment methods are reviewed. Somnopolygraphic, psychometric, and neuroendocrinological data of our comparative trial with BL and partial sleep deprivation in normals and patients are discussed. The similarity of changes after BL, antidepressants and lithium points to a chronobiological factor in the pathogenesis and treatment of affective disorders. Electrosleep is still controversial, hydro-, ergo- and physical therapy are supportive therapies and as such indicated in all depressions. Exercise, fatigue and nutritional factors may influence sleep. Psychopharmacological treatment has to be regarded as the most important therapeutic approach for sleep disorders in depressives. Antidepressants are the drugs of choice for most patients. Based on their effects on sleep-induction, -maintenance, and -architecture and REM measures, one may differentiate at least two subtypes: sedative antidepressants of the amitriptyline type and nonsedative antidepressants of the desipramine type. Bedtime infusions of antidepressants may have sleep promoting properties, which was objectivated by an EEG spectral analysis during infusion and subsequently by all night sleep studies. Measures indicative of therapeutic outcome are still controversial. Tranquilizers, hypnotics, neuroleptics and serotonin precursors are utilized if the antidepressants alone do not ameliorate insomnia. However, as evidence of a shared diathesis of origin of depressive and anxiety disorders is building up, benzodiazepines are increasingly prescribed as monotherapy too. Finally, sleep laboratory data concerning the hypnotic properties of a pharmacological 80 mg doses of melatonin are demonstrated.
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PMID:Therapy for sleep disorders in depressives. 355 6

In most research dealing with biological abnormalities in depression, the clinical diagnosis of depression is made and the occurrence of a biological abnormality, for example, reduced REM latency, is documented. In this study, that design was reversed; REM latency was used as a grouping variable to assess empirically the "biological" priority of Research Diagnostic Criteria endogenous symptoms. We found that terminal insomnia, pervasive anhedonia, unreactive mood, and appetite loss were most likely to discriminate among "reduced" and "nonreduced" REM latency depressions at various threshold values. Contrary to expectation, diurnal mood variation was found equivalently in all categories of REM latency studied. Implications for clinical decision making based on endogenous symptoms are discussed.
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PMID:Which endogenous depressive symptoms relate to REM latency reduction? 369 37

On the basis of sleep-polygraphic examinations of twelve alcoholics over a period of six days is given on the sleep behaviour during alcohol withdrawal. The study showed the withdrawal symptoms described in the literature, such as withdrawal insomnia, REM rebound and persisting shortening of the deep sleep time, in ten patients whereas in two cases the examinations had to be interrupted in the third night because of a withdrawal delirium. In these cases, however, an almost 100 per cent REM occurrence was seen from the first night. The significance of these findings with respect to an early prediction of the outbreak of the delirium and for the pathogenesis of the delirium in general is discussed.
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PMID:[Sleep polygraphic studies in the preliminary stages of delirium tremens]. 372 69

Periodic movements during sleep (PMS) are frequent, involuntary movements, usually of the lower extremities, that disrupt sleep. Twelve patients (nine men and three women, mean age 53.9 years) with a complaint of persistent insomnia (DIMS) were compared with 11 patients (eight men and three women, mean age 53.0 years) complaining of excessive daytime sleepiness (DOES). DIMS patients had more PMS (both absolute and relative), a longer delay to sleep onset and to REM onset, more wakefulness after sleep onset, and less total sleep time. Although the fragmentation of physiological sleep was more severe in the DIMS patients, those individuals with DOES reported cognitive intrusions during their sleep. While DOES patients may be regarded as "sleeping through" the brief arousals associated with leg activity during sleep, there appears to be sufficient cognitive awareness of the nocturnal interruption to precipitate a complaint of daytime sleepiness. Insomnia patients, however, appear to experience longer and more frequent awakenings, which are proportional to increased fragmentation of sleep.
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PMID:Periodic movements in sleep and sleep-wake complaint. 388 Jan 71


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