Sleep Wake Transition

Survey results shed light on the effects of insomnia and obstacles to effective treatment.

Insomnia-a sleep disorder that can pose impairments far more debilitating than than problems with cognition (eg, difficulty processing, unclear thinking).

Sleep-disordered breathing is common in patients with mood and anxiety disorders. This article explores the implication for practicing psychiatrists whose patients have sleep disorders.

Melatonin has a role in psychiatric illness and the treatment of circadian rhythm sleep disorders, insomnia, and comorbid depressive disorders.

Although the purpose of sleep continues to be the subject of much debate, few would argue that a well-functioning sleep-wake cycle is essential for good health.

Sleep changes associated with psychotropic drugs are common enough to justify routinely obtaining a baseline sleep diary before beginning treatment, even when the initial screening for sleep disorders indicates that no further investigation is needed.

Sleep disorders - most commonly sleep apnea - are often comorbid with psychiatric disorders. Treatment of disordered sleep can result in a significant improvement in the psychiatric disorder.

Can you name an important part of good sleep hygiene? The use of which short-acting sedative-hypnotics to treat sleep disturbances in patients is associated with Alzheimer disease? These questions and more.

What do we know about circadian rhythms and melatonin? And what further lessons do we need about circadian rhythms, light exposure, and melatonin to help our patients with disturbed sleep/wake cycles?

Simple but powerful suggestions to get a better night's sleep.

As we begin this brief review of the neurobiology of major depressive disorder (MDD), we face these fundamental questions

The National Comorbidity Survey estimates that approximately 50% of the population in the United States is exposed to traumatic events and that the lifetime prevalence of posttraumatic stress disorder (PTSD) is approximately 7.8%.

A number of studies have found decreased scores on quality-of-life scales in persons with insomnia, which is associated with a wide assortment of daytime impairments, some intuitive and some startling.

A variety of conditions may account for the sleep difficulties experienced by many older adults, including specific sleep disorders, circadian rhythm disturbances, and medical and psychiatric comorbidities.

Insights Into Neuropathology Elucidated Through the Science of Sleep

It is a widely known fact that Fyodor Dostoevsky, the famous 19th-century Russian novelist, suffered from epilepsy for most of his life. However, not too many persons are aware that Dostoevsky also had a sleep disorder called delayed sleep phase syndrome, which may have contributed to his seizures.1 Although no one knows for certain, it is quite conceivable that Dostoevsky's sleep disorder worsened his epilepsy, according to Carl Bazil, MD, PhD, director of Clinical Anticonvulsant Drug Trials and director of the Neurology Division, Columbia Comprehensive Sleep Center, Columbia University, New York.

Patients who experience seizure 24 hours after stroke onset may be at increased risk for death, according to Angela Rackley, MD, a clinical neurophysiology fellow in epilepsy, and coresearchers at the University of Cincinnati. Rackley presented an abstract on the incidence of seizures within 24 hours after acute stroke at the annual meeting of the American Epilepsy Society in San Diego this past December. She and colleagues found a higher 30- day mortality rate among patients who had a seizure within hours of stroke compared with patients who did not experience poststroke seizure.

aytime sleepiness is common in patients with parkinsonism but has little to do with the amount of sleep these patients get and everything to do with dopaminergic dysfunction, according to David B. Rye, MD, PhD, associate professor of neurology at Emory University in Atlanta. "The idea is that if I sleep a lot, I shouldn't be so sleepy the next day, and if I sleep little, I should be very sleepy. This is doesn't hold true for patients with Parkinson disease [PD]. The loss of dopamine disrupts that banking system, or the sleep-wake homeostat," he said during a presentation at the 9th annual meeting of the American Society for Experimental Therapeutics, which met March 8 to 10 in Washington, DC. Addressing dopa- minergic tone during sleep might help ameliorate daytime symptoms of parkinsonism in general.

Once again your patient, an accountant and tax specialist, is complaining about his sleep. More nights than not he awakens at about 2 am. An hour goes by, sometimes 2, before he returns to sleep. You've prescribed 4 different hypnotics. Each gave the same unsatisfactory result. For 2 weeks, your patient got the 8 hours of uninterrupted sleep he-and you-seek, but then the old pattern returned. Following your instructions, he avoids caffeine, doesn't exercise after 6 pm, and confines his activities in bed to sleep, but to no avail. You refer him to a sleep laboratory, and the results there are entirely consistent with what he's been telling you. In the sleep lab he falls asleep at 11 pm, awakens at 2:30 am, returns to sleep at 4 am, and awakens for good at 7:30 am. He does not have sleep apnea, restless legs syndrome, or depression.

Sleep disorders are very common and are often underrecognized and underreported in children. If left untreated, these disorders can cause serious developmental and physiologic problems.

An unfavorable prognosis may be in store for patients who report severely disrupted sleep patterns accompanied by rapid eye movement (REM).

When assessing a sleep-related problem in a psychiatric patient, investigating all possible causes may be more helpful than assuming the complaint is a result of medication or the underlying condition.

Acknowledging Preindustrial Patterns of Sleep May Revolutionize Approach to Sleep Dysfunction

Sleep-associated movement disorders are common in the general population. When patients complain of sleep disturbance, psychiatrists should consider,and question for, features of nocturnal movement disorder.

sleep apnea

Pediatric neurology, influenza, immunization, light therapy, depression, sleep, multiple sclerosis

Patients with Alzheimer's disease may suffer the same age- and disease-related changes to sleep as their age-matched peers. However, as the dementia progresses, even more severe disturbances develop, with impairments in both nighttime sleep continuity and daytime alertness. This article focuses on long-term, holistic approaches to treatment, including environmental and behavioral interventions to augment sleep medications.

One more mouth rimmed in charcoal after an OD screams for release: to probe the night for the man who left her. No one pretends an interest: at 4 a.m. it's too late to care.

Sleep Lab Meditation

As chief of the division of sleep and chronobiology in the department of psychiatry at the University of Pennsylvania School of Medicine, David F. Dinges, Ph.D., focuses on ways sleep and the endogenous circadian pacemaker interact to control wakefulness and waking neurobehavioral functions such as physiological alertness, attention, cognitive performance, fatigue, mood, neuroendocrine profiles, immune responses and health. In an interview with Psychiatric Times, Dinges discussed neurobehavioral consequences of sleep loss, factors that impair sleeping, the pervasiveness of sleepiness and new ways to manage sleepiness.