Disorders Of Initiating And Maintaining Sleep Research Articles

Modification of a parent-report sleep scale for individuals with CDKL5 deficiency disorder: a psychometric study.

Sleep difficulties are common in CDKL5 deficiency disorder (CDD), a developmental and epileptic encephalopathy (DEE). This study evaluated the factor structure of the Disorders of Initiating and Maintaining Sleep (DIMS), Disorders of Excessive Daytime Somnolence (DOES) and Sleep Breathing Disorders (SBD) domains of the Sleep Disturbance Scale for Children (SDSC) for CDD. A cross-sectional psychometric study design was used. Data were collected for 125 individuals aged 3 years or older who attended a US Centers of Excellence clinic or registered with the International CDKL5 Disorder Database. The median age was 10.3 years (range 3.2 - 40.7 years) and 105 (84%) were female. Two of the three SBD items related were not observed by most respondents and analysis was restricted to the DIMS and DOES domains. Using all items in the initial confirmatory factor analysis, two items in the DIMS domain and one item in the DOES domain loaded poorly. After deleting these items and repeating the analysis, item loading (0.524-0.814) and internal consistency (DIMS: 0.78, DOES: 0.76) statistics were good. The square of the inter-domain correlation coefficient was 0.17, less than Average Variance Extracted values for both domains and indicating good discriminant validity. The Tucker-Lewis and Comparative Fit indices were slightly lower than the threshold of >0.9 for establishing goodness of fit. The modified DIMS and DOES domains from the SDSC could be suitable clinical outcome assessments of insomnia and related impairments in CDD and potentially other DEE conditions.

Sleep disturbance in children with attention-deficit hyperactivity disorder: relationship with melatonin and behavior

ABSTRACT Aim To evaluate the prevalence and types of sleep problems and their correlations with melatonin content and behavior in Attention-Deficit Hyperactivity Disorder (ADHD) children. Method Sleep in ADHD children and typically developing children (TD) aged 6–14 was assessed by the Sleep Disorders Scale for Children (SDSC) and actigraphy, salivary melatonin quantified by ELISA, and behavior was analyzed using the Strengths and Difficulties Questionnaire. Results ADHD children showed a higher frequency of sleep disturbances, higher sleep latency, and lower sleep efficiency than in the TD group. The ADHD group presented lower melatonin nocturnal content compared to the TD group. Disorders of Initiating and Maintaining Sleep (DIMS) was moderately associated with nocturnal melatonin. The total behavior difficulties were correlated with Disorders of Initiating and Maintaining Sleep (DIMS), Sleep/Wake Transition Disorders (SWTD), Disorders of Excessive Somnolence (DES), Sleep Hyperhidrosis (SHY) and Total SDSC Score. The behavior was the only determinant of the total SDSC score (R2 = 0.499; p < 0.002). Conclusion This study provides, for the first time, evidence that among the frequent sleep disturbances in ADHD, the disorders in initiating and maintaining sleep are associated with the low levels of melatonin found in this population. Additionally, these, along with other sleep disturbances, are linked to behavioral problems in ADHD.

Atopic Dermatitis, Sleep, and the COVID-19 Pandemic

Abstract Objective To investigate sleep disorders among children with atopic dermatitis (AD), before and during the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods The present longitudinal, prospective study included 26 patients with AD, and the Sleep Disturbance Scale for Children (SDSC) questionnaire and questions about sleep hygiene were used. The severity of AD was determined by the Patient-Oriented Eczema Measure (POEM). The first evaluation was conducted before the pandemic (in 2019) and the second, during the pandemic, from September to December 2020. Results Sleep disorder was present in 17 (65.38%) patients in the 1st evaluation, and in 11 (42.30%) in the 2nd (p = 0.04). In the 1st evaluation, disorders of initiating and maintaining sleep (DIMSs) were more frequent in patients with moderate-to-severe AD (83.33%). During the pandemic, 6 patients (23.07%) reported improvement in sleep quality. Conclusion Sleep quality was negatively influenced by the severity of AD. During the COVID-19 pandemic, there was improvement in sleep quality, despite the absence of changes in disease severity.

Sleep disturbances in children and adolescents after kidney transplantation.

Disturbances of sleep are prevalent among children with chronic kidney disease. However, the aetiology of sleep disorders in children particularly after kidney transplantation is not clear. We sought to ascertain the prevalence and type of sleep disturbances in paediatric kidney transplant recipients and to identify predictors of sleep disturbances in this population. Caregivers of kidney transplant recipients completed online questionnaires about their child's sleep. The questionnaires utilised were the Sleep Disturbance Scale for Children (SDSC), the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), questions about sleep hygiene, and questions about restless leg syndrome. Demographic and clinical details were collected from medical records. Thirty-five children were included in the study, with a median (IQR) age of 14.1years (9.5-16.1) and median years (IQR) since transplant of 3.7 (0.7-8.7) years, and 72.0% were identified to have at least one category of sleep disturbance according to scores on the SDSC. The most common sleep disturbances reported were disorders of initiating and maintaining sleep (DIMS) (40.0%) and disorders of excessive somnolence (DOES) (31.4%). Statistically significant predictors of sleep disturbances include low estimated glomerular filtration rate and increased age. Among children who screened positive for DIMS and DOES, the majority indicated use of electronic devices in 1h before bed. A high prevalence of sleep disturbances has been identified in children after kidney transplants, and some risk factors may be modifiable. Further studies are required to understand whether there are other readily modifiable predictors of sleep disturbances.

Study of the sleep in Egyptian children with Juvenile SLE and it's effect on their scholastic achievement

The clinical spectrum of neuropsychiatric manifestations of juvenile systemic lupus erythematosus (JSLE) can be quite variable and sleep problems have been reported as being one of the under-recognized needs of SLE patients.Aim Determination of sleep abnormalities among lupus children and their effects on children's scholastic achievements.Subjects This study was carried out on 38 children with systemic lupus erythematosus and thirty healthy children, whom their guardians agreed to volunteer in the study .Methods In the current cross sectional study all children were subjected to full clinical examination, MRI brain of the patients, sleep history, Epworth sleepiness scale and the Sleep disturbances scale for childrenResults 52.6% of the studied children had different sleep patterns, as follows:13.2% disorders of initiating and maintaining sleep (DIMS), 2.6% with Sleep breathing disorders (SBD), 10.5% with disorders of arousal (DA), 5.3% with sleep-wake transition disorders (SWTD), 2.6% with disorders of excessive somnolence (DOES), 7.9% with Sleep Hyperhidrosis (SHY), 7.9% with pathological total sleep disturbances score.5.3% of children had excessive daytime sleepiness and 21% had moderate daytime sleepiness and 73.7% had normal daytime sleepiness.Children with positive findings in brain MRI had different sleep disorders demonstrated as follows, 33.3% had disorders of initiating and maintaining sleep (DIMS). 16.7% had Sleep Hyperhidrosis (SHY).16.7% had pathological total sleep disturbances score.

The relationship between gross motor function impairment in cerebral palsy and sleeping issues of children and caregivers

AimTo investigate, among children and adolescents with cerebral palsy (CP), the relationship between impairment of the gross motor function and: (i) child sleep disorders; (ii) the need for nocturnal support; and (iii) the quality of sleep of their caregivers. MethodsFor children, we considered their scores on the gross motor function measure (GMFM-88) and on the sleep disturbance scale for children (SDSC), besides analyzing qualitative features about their sleep. For caregivers, we considered their scores in the Pittsburgh sleep quality index (PSQI). ResultsOur sample was comprised of 87 participants with mean age of 11.4 years old (±3.4). We observed correlations between GMFM-88 and disorders of initiating and maintaining sleep (DIMS) (r = −0.22; p = 0.039), sleep–wake transition disorders (SWTD) (r = 0.26; p = 0.017) and disorders of arousal (DA) (r = 0.23; p = 0.033). Children receiving nocturnal support presented lower scores in the GMFM-88 (p = 0.001) and higher scores in the SDSC (p = 0.029). For the caregivers, we found no correlation between GMFM-88 and PSQI. Nonetheless, their PSQI scores correlated with the SDSC scores (r = 0.24; p = 0.027). ConclusionImpairment of the gross motor function correlated with DIMS and the need for nocturnal support but might not have an impact on the caregivers’ sleep, which in turn correlated with child sleep disorders.

Sleep Disorders in Patients with Juvenile Idiopathic Arthritis as Characterised by Sleep Disturbance Scale for Children

Introduction: Sleep disorders negatively impact a child’s quality of life, behaviour and cognitive function. Sleep disturbances have not been widely studied in patients with Juvenile Idiopathic Arthritis (JIA) especially using the Sleep Disturbance Scale for Children (SDSC). Aim: To characterise sleep disorders in JIA patients by using SDSC and determine its correlation with pain and disease activity. Materials and Methods: In this cohort study, 30 patients each of active JIA and age and sex matched controls (age 6-15 years) were administered SDSC at enrollment and after six months of treatment (in JIA patients). The study duration was from November 2017 to March 2019. Pain severity and disease activity were assessed at baseline and after six month by Visual Analogue Scale (VAS) for pain and Juvenile Arthritis Disease Activity Score-27 (JADAS-27). Data at baseline between patients and controls were compared by unpaired t-test and between six months and baseline by paired t-test. Categorical variables were analysed by Chi-square test or Fisher’s-exact test and correlation by Spearman correlation. Results: Total SDSC score was higher in JIA patients at baseline (45.67±9.13 vs. 28.5±1.17) and decreased significantly after six months (29.73±3.17). Disorders of Initiating and Maintaining Sleep (DIMS), excessive somnolence, hyperhidrosis, arousal and sleep-wake transition were observed in 29, 18, 4, 1 and 2 patients, respectively. After six months excessive somnolence and hyperhidrosis were found in one patient each. Significant positive correlation was observed between total SDSC score, VAS for pain and JADAS-27 score. Conclusion: SDSC scores revealed significant sleep disturbances in patients with JIA and a positive correlation with pain severity and disease activity.

Sleep disturbances in Rett syndrome: Impact and management including use of sleep hygiene practices.

Sleep disturbances are debilitating for individuals with Rett syndrome (RTT) and their families yet the evidence base for management is poor. We investigated management strategies and their relationships with sleep problems. Data were provided by 364/461 (79%) families with a child with RTT and registered with the International RTT Phenotype Database. Logistic regression models were used to investigate relationships between impacts of sleep problems on the child and family with age group, mutation type, medication type, and sleep hygiene score. Linear regression models were used to estimate the association of disorders of initiating and maintaining sleep (DIMS) with age group, mutation type, medication type, and sleep hygiene. Among those who ever had difficulty falling asleep or night waking, use of any medication was associated with higher odds of moderate/major impact sleep problems (relative to minor/no impact) for the affected child and the family, as well as higher DIMS scores, when compared with the no treatment/nonmedication group accounting for the effects of age, mutation type, and sleep hygiene score. Better use of sleep hygiene practices was associated with lower odds of moderate/major impact on the family (odds ratio 0.60, 95% confidence intervals [CIs] 0.37, 0.98) and lower DIMS scores (geometric mean ratio 0.86, 95%CI 0.80, 0.92) compared with poorer use after adjusting for covariates. Attention to sleep hygiene remains an important management strategy for sleep problems in RTT. Further prospective research is required to investigate efficacy of pharmaceutical treatments.

Sleep disorders in children with cerebral palsy and its correlation with sleep disturbance in primary caregivers and other associated factors.

Aims:To observe prevalence of sleep disturbance (SD) in cerebral palsy (CP) children in a specific age-group and its correlation with SD in primary caregivers and other associated factors.Materials and Methods:This was a prospective cross-sectional study. SD assessed using Sleep Disturbance Scale for Children (SDSC) in CP children and Pittsburgh Sleep Quality Index (PSQI) in caregivers. Fifty cases of clinically diagnosed CP [27 females, mean age: 107.9 ΁ 29.5 months (range: 78-180 months)] fulfilling criteria were included.Results:Eighteen (36%) children had pathological sleep total score (TS) and Disorders of Initiating and Maintaining Sleep (DIMS) was the commonest SD (n = 25, 50%). All primary caregivers were mothers. Twenty-five (50%) mothers had SD on PSQI scale. DIMS, Disorders of Excessive Somnolence (DES), and TS had significant correlation with PSQI (P < 0.05). Disorders of Arousal (DA) and TS had significant correlation with seizures (P < 0.05) in CP children. Bed-sharing had significant correlation with SD in caregivers (P < 0.001) but not with CP children. No significant correlation was observed between SD in CP and gross motor function (Gross Motor Function Classification System), use of orthoses, and dental caries.Interpretation:Children with CP have underreported significant SD, which negatively impacts caregiver's sleep also. Seizure disorders and medications contribute significantly to SD.

Sleep disorders in boys with Duchenne muscular dystrophy

Determine the frequency and predictors of sleep disorders in boys with Duchenne Muscular Dystrophy (DMD). Cross-sectional study by postal questionnaire. Sleep disturbances were assessed using the Sleep Disturbance Scale for Children (validated on 1157 healthy children). A total sleep score and six sleep disturbance factors representing the most common sleep disorders were computed. Potential associations between pathological scores and personal, medical and environmental factors were assessed. Sixteen of 63 boys (25.4%) had a pathological total sleep score compared with 3% in the general population. The most prevalent sleep disorders were disorders of initiating and maintaining sleep (DIMS) 29.7%, sleep-related breathing disorders 15.6% and sleep hyperhydrosis 14.3%. On multivariate analysis, pathological total sleep scores were associated with the need to be moved by a carer (OR = 9.4; 95%CI: 2.2-40.7; p = 0.003) and being the child of a single-parent family (OR =7.2; 95%CI: 1.5-35.1; p = 0.015) and DIMS with the need to be moved by a carer (OR = 18.0; 95%CI: 2.9-110.6; p = 0.002), steroid treatment (OR = 7.7; 95%CI: 1.4-44.0; p = 0.021) and being the child of a single-parent family (OR = 7.0; 95%CI: 1.3-38.4; p = 0.025). Sleep disturbances are frequent in boys with DMD and are strongly associated with immobility. Sleep should be systematically assessed in DMD to implement appropriate interventions.

Association between PM10 exposure and sleep of Egyptian school children

This study aims to investigate the potential association between exposure to particulate matter with an aerodynamic diameter <10 μm (PM10) and sleep disturbances among Egyptian school children. In this cross-sectional study, parents of school children from four elementary schools in areas with different PM10 exposures filled out the Sleep Disturbance Scale for Children questionnaire in Arabic. Air pollution data were obtained from the Egyptian Environmental Affairs Agency. The sample consisted of 276 children, 121 (44 %) of them were boys with a mean age of 9.26 ± 1.96 years. Disorders of initiating and maintaining sleep (DIMS), disorders of excessive somnolence, and the total score were reported in the clinical range (T score > 70) in 19.9, 24.3, and 24.3 % of the sample, respectively. A generalized additive model with adjustment for potential confounding factors was used to examine the association between PM10 exposure and sleep disturbances. There were statistically significant associations between PM10 exposure and DIMS and sleep hyperhidrosis (P < 0.05). Air pollution exposure has a negative impact on children's sleep with significant association between exposure to PM10 and sleep disturbances.

Sleep disorders in patients with juvenile idiopathic arthritis as assessed by the sleep disturbance scale for children

Methods Out of 35 patients with JIA, enrolled after parental consent, 31 (23 males and 8 females) completed the study. Mean age of the patients was 9.8 years (Range 6.114.5 years). The patients were enrolled when they demonstrated active disease at presentation or during relapse, as ‘active disease group’ and followed up regularly at 6-8 weekly intervals, till they improved with treatment. Disease activity of JIA was assessed by ACR PEDI criteria. Sleep was studied using SDSC which is a validated screening tool (for the age interval studied), that categorizes sleep disturbances into six different categories: Disorders of initiating and maintaining sleep (DIMS), Sleep disordered breathing (SDB), Disorders of arousal (DA), Sleep wake transition disorders (SWTD), Disorders of excessive somnolence (DOES) & Sleep hyperhydrosis (SHY). The SDSC questionnaire was filled by the parent / patient in the waiting room at each follow up visit. When the patients showed maximum improvement in JIA, they were included in the ‘post treatment’ group. For quantifying sleep disorders, we compared the scores of the subjects with scores derived from a sample of normal population in a similar age band from our city. Differences between the active and post treatment groups were analyzed by non parametric Wilcoxson test for paired data and non parametric Mann-Whitney U test for unpaired data

The Tayside children's sleep questionnaire: a simple tool to evaluate sleep problems in young children

Behavioural sleep problems in young children are relatively common with between 20% and 40% of those aged 1 to 5 years being affected. This paper describes the development of a simple questionnaire to assess disorders of initiating and maintaining sleep (DIMS) in children aged between 1 and 5 years for use as a selection tool for research purposes or as a screening instrument in primary care. A subsection of the Sleep Disturbance Scale for Children was adapted and piloted with a small sample of children in two inner city GP practices (n = 81). Face and content validity were initially established by expert review. Discriminant validity was assessed qualitatively using interviews with mothers of identified cases and non-cases. The validity of the cut-off score was assessed by blinded case note reviews off known cases; inter-rater reliability was also calculated. Following modifications, the final questionnaire was posted to a representative sample of parents across the region with children in the appropriate age band (n = 1023). Internal reliability was assessed using Cronbach's alpha and factor analysis was undertaken to identify significant factors within the questionnaire. The response rate to the population questionnaire was 61.5% (n = 628) with 218 of the children having sleep scores that were indicative of DIMS (35%), echoing other figures reported in the literature. There was good internal consistency for the items (Cronbach's alpha = 0.85) with two main factors accounting for 58% of the variance. The Tayside Children's Sleep Questionnaire (TCSQ) is an easy-to-read and reliable tool that could be used both as a clinical and research instrument to assess the severity and prevalence of DIMS in young children.

Factors affecting sleep disturbances in children and adolescents

Objective: To determine factors affecting sleep disturbances in children. Background: Factors affecting sleep disturbances have been studied extensively in adults, but relatively few studies have been done in children. Methods: As part of the twelfth survey of the Tucson Epidemiologic Study of Obstructive Airways Disease (TESOAD, 1991–1992), children, ages 3–14, of adult cohort members were administered a health questionnaire which contained items related to sleep problems as well as items related to respiratory diseases and symptoms. Participants were classified as having sleep disturbances if they reported disorders of initiating and maintaining sleep (DIMS), excessive daytime sleepiness (EDS) or snoring. Potential factors affecting sleep included age, gender, obesity, asthma, other bronchial problems, cough and sputum production, wheezing and rhinitis. Results: The overall prevalence rates were 16.8, 4 and 22.9% for DIMS, EDS, and snoring, respectively. We found a significantly higher prevalence of DIMS in 11–14-year-old girls (30.4%) and snoring (32.3%) in 3–6-year-old boys. Certain respiratory factors were more prevalent in children with sleep disturbances. Multivariate analysis revealed that risk factors for DIMS included female gender, age 11–14 and wheezing. The risk for EDS was increased in those children with cough and sputum production. Cough and sputum production also were risk factors for snoring as was rhinitis and age 3–6. Conclusions: We conclude that in children as in adults, respiratory symptoms are associated with sleep disturbances. Further, the increased insomnia seen in adult women may begin in early adolescence.

Behaviour Therapy for DIMS: Comparison of Three Treatment Procedures with Follow-up

Forty patients suffering from persistent psychophysiological Disorders of Initiating and Maintaining Sleep (DIMS) were assigned to one of the following groups: (1) EMG-biofeedback training; (2) cognitive modification treatment, combining paradoxical instructions, cognitive restructuring and thought stopping; (3) stimulus control and progressive relaxation treatment; (4) waiting list (control). Each active treatment consisted of six sessions over a period of 2 weeks.After treatment, the patients in the three treatment groups showed shorter sleep onset latency (37%), shorter wake time after sleep onset (50%), and more positive evaluations of sleep quality and restedness on awakening in the morning. The waiting-list group did not show any changes. Benefits were maintained and further increased during the 1 and 3 year follow-ups. Results did not suggest substantial differences, among the three treatments, in amount and/or stability of benefits. The 3 year follow-up revealed seven failures, as against 23 successes. The initial variables differentiating the failures were shorter sleep time and higher scores on the P scale of the Eysenck Personality Questionnaire.

Do diagnostic patterns exist in the sleep behaviors of normal children?

We investigated the factor structure of the Children's Sleep Behavior Scale in an unselected sample of children (N = 838), ages 6 to 12.5 years, drawn from an elementary school population. Although no factor emerged that corresponded exactly to the parasomnias, as described by the Association of Sleep Disorders Centers (1979), all of the variables that loaded on Factor 1 were behaviors characteristic of the parasomnias, with the exception of recalled nightmares. Variables that were expected to load on this factor, but did not, were sleeptalking, teeth grinding, and enuresis. Enuresis was not related to any of the sleep behaviors assessed, and teeth grinding shared less than 9% of the variance with any of the other variables. Many of the variables loaded on more than one factor. The second factor, which was labeled bedtime resistance, was the only clearly unambiguous factor. Of the five factors that emerged, the third reflected positive affect, the fourth was a motor factor, and the fifth was an anxiety factor. Nightmares loaded on the anxiety factor as well as the first factor. The results of the study offered no support for the category of Disorders of Initiating and Maintaining sleep (DIMS), which has a childhood onset.

Polysomnographic Assessment of DIMS: Empirical Evaluation of Its Diagnostic Value

This investigation examined the diagnostic value of polysomnography (PSG) for evaluating disorders of initiating and maintaining sleep (DIMS). The sample consisted of 100 outpatients who presented to the Duke Sleep Disorders Center with a complaint of chronic insomnia. All patients were given comprehensive medical, psychiatric, behavioral, and ambulatory PSG evaluations. Sleep disorder diagnoses were assigned using the criteria of the Association of Sleep Disorders Centers. Overall, PSG yielded important diagnostic information in 65% of the sample: 34% were given a primary sleep disorder diagnosis that was heavily dependent on PSG data [periodic movements of sleep (PMS) = 25%, apnea = 3%, and subjective insomnia = 6%]; 15% were given a secondary diagnosis of one of these three disorders; and PSG ruled out suspected PMS in 9% and sleep apnea in 7% of the sample. Patients greater than 40 years of age had a significantly higher rate of positive PSG findings than younger patients. Using only the clinical exam, two experienced sleep clinicians were able to predict only 14 of 25 PMS cases and one of three cases of sleep apnea. Based on these data, we suggest using PSG routinely with older insomniacs and with younger patients who fail initial treatment.

Prevalence of Reported Sleep Disturbances in a General Adult Population and their Relationship to Obstructive Airways Diseases

In order to determine the prevalence of reported sleep disturbances in a general adult population and the relationship of these complaints to age, gender and coexistent obstructive airways disease, 2,187 subjects in the Tucson Epidemiologic Study of Obstructive Airways Disease were surveyed in 1985 regarding their sleep symptoms. At least one symptom of disturbed sleep was present in 41.4 percent of all subjects. Women generally reported a significantly higher prevalence of both disorders of initiating and maintaining sleep (DIMS) and nightmares (NM)(p less than .001). Before age 64 years, the prevalence of complaints of excessive daytime sleepiness (EDS) among men and women were similar. However, the frequency of EDS was significantly higher in men than women after age 64 years. Prevalence of at least one sleep symptom and DIMS increased with advancing age. The prevalence of nightmares appeared to be age-related only among women, who displayed a declining prevalence with advancing age. EDS increased only after age 64 years. There was a significant relationship between DIMS and EDS with coexistent chronic bronchitis, concomitant asthma and chronic bronchitis, and emphysema, but not asthma as a solitary diagnosis. Nightmares were reported with much greater frequency among subjects with asthma, asthma and chronic bronchitis, and emphysema but not in subjects with chronic bronchitis alone. The presence of coexistent asthma and chronic bronchitis was associated with particularly high prevalence of complaints of DIMS, EDS and nightmares. We conclude that, in the general adult population, sleep disorder symptoms increase with age and usually are greater in women. Furthermore, there is an increased prevalence of sleep symptoms among adults with chronic airways obstructive disease, especially those with coexistent asthma and chronic bronchitis.

Behavioral self-control procedures for Disorders of Initiating and Maintaining Sleep (DIMS)

Behavioral self-control procedures have been demonstrated to be efficacious for certain types of Disorders of Initiating and Maintaining Sleep (DIMS). Controlled experiments have shown progressive relaxation, biofeedback-assisted relaxation, and stimulus control to be effective. Paradoxical intention produces benefit for some insomniacs, but is less reliable than the other procedures. The present review defines each procedure, describes the treatment plan for each, and reviews the evidence for efficacy. Future research will focus on refining the diagnostic process. It will include EEG assessment and a test of the efficacy of self-control procedures with secondary DIMS disorders associated with the side effects of chemotherapy for cancer, chronic pain, and the concomitant effects of aging.

Daytime alertness in subjective and objective insomnia: Some preliminary findings

Daytime performance and alertness were examined in two groups of patients with disorders of initiating and maintaining sleep (DIMS) and a control group of self-described good sleepers. Individuals complaining of disturbed sleep that was verified by polysomnographic indices (objective DIMS) and a group with complaints of disturbed sleep in the absence of objective findings (subjective DIMS) were compared with normal sleepers. Nocturnal polysomnographic recordings documented increased sleep latencies and decreased sleep efficiencies for the objective DIMS group and essentially normal sleep for the subjective DIMS group. However, the subjective DIMS group showed impaired daytime vigilance compared with both the objective DIMS and control groups. Additionally, the subjective DIMS group demonstrated an atypical daytime alertness and a tendency toward lowered arousal during vigilance task performance. Insomniacs without clear objective findings of disturbed sleep, therefore, showed decrements commonly seen following sleep loss or sleep disturbance, whereas insomniacs with evidence of disturbed nocturnal sleep did not differ from the control group in terms of waking function.