Increase In Sleep Latency Research Articles

Modafinil for the treatment of idiopathic hypersomnia – results of a randomized, double-blind, placebo controlled study

The European Medicines Agency withdrew modafinil for the indications idiopathic hypersomnia (IH) and narcolepsy in children due to the lack of sufficient evidence based literature. The literature provides mainly retrospective data. Lavault et al. (Sleep Medicine 2011) found modafinil to be the medication of first choice in 96% of IH patients resulting in a reduction of ESS of 2.6–3 points. The purpose of our study was to study the effects of modafinil on ESS and sleep latency in the MWT (primary variables) of IH patients. In this investigator initiated study only drug naïve IH patients without long sleep according to ICSD2 criteria were included. Disease onset had to be before the age of 30 years. Patients were consecutively recruited from 3 German Sleep Centers and randomized to placebo or 200 mg modafinil once daily in the morning. Visit 1 on day 1 (drug naïve) included vital signs, ESS, medical history, physical investigation and laboratory tests. Throughout the 28 days patients filled in evening morning protocols. Patients were on medication from days 8–21. On days 7, 14 and 21 MWT, ESS and CGI were performed. 14 IH were randomized to modafinil (10 m, 4f, mean age 38.4 ± 12.7 years), 17 (9 m, 8f, mean age 34.8 ± 13.5 years) to placebo. One patient was excluded due to protocol violation. In the intention to treat analysis ESS was significantly reduced in the modafinil group by 5.4 points, compared to 1.9 points in the placebo group ( p < 0.023, effect size 0.64), sleep latency in the MWT was not significantly prolonged (4.9 vs. 1.5 min.), CGI was significantly improved (−01.4 vs. −0.36, p < 0.028, effect size 0.61). Manovas showed no interaction of gender and ESS, but the differences were smaller for men than for women. There was no age effect. Modafinil 200 mg improves ESS and CGI significantly when compared to placebo. The increase of sleep latency in the MWT is not significant. There is no interaction with age and gender. Modafinil is an effective medication in adult patients with idiopathic hypersomnia without long sleep. This investigator initiated study was financed by Cephalon Germany.

P.3.f.018 Aminotransferase levels as a predictor for the development of metabolic syndrome in patients with schizophrenia

Insomnia is a common feature in schizophrenia, and is characterized by an increase of sleep latency (SL), as well as reductions in total sleep time (TST) and sleep efficiency (SE). Regarding sleep architecture, non-rapid-eye-movement (NREM) sleep, slow wave sleep (SWS) and rapid-eye-movement (REM) sleep latency are decreased, whereas REM sleep tends to remain unchanged. According to polysomnographic studies, clozapine, olanzapine, quetiapine and ziprasidone administration increased TST and/or SE in healthy subjects. Additionally, olanzapine and ziprasidone augmented SWS, while changes corresponding to REM sleep were inconsistent. Furthermore, administration of clozapine, olanzapine and paliperidone to patients with schizophrenia was followed in most instances by a significant reduction of SL and an increase of TST and SE. In addition, olanzapine and paliperidone augmented SWS and REM sleep. By contrast, quetiapine administration further disrupted sleep as judged by the increase of SL, wake time after sleep onset (WASO) and REM sleep latency, and the reduction of SWS and REM sleep. No consistent effects on sleep variables were obtained during treatment with risperidone. To date, no polysomnographic studies have been published on the effects of aripiprazole, asenapine, iloperidone and lurasidone on sleep in either healthy subjects or patients with schizophrenia. Taken together, this evidence supports the conclusion that second generation antipsychotics (SGAs) including clozapine, olanzapine and paliperidone may ameliorate insomnia in patients with schizophrenia.

Sleep, Mood, and Quality of Life in Patients Receiving Treatment for Lung Cancer

To distinguish relationships among subjective and objective characteristics of sleep, mood, and quality of life (QOL) in patients receiving treatment for lung cancer. Descriptive, correlational study. Two ambulatory oncology clinics. 35 patients with lung cancer. The following instruments were used to measure the variables of interest: Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Treatment-Lung (FACT-L), a sleep diary, and a motionlogger actigraph. Sleep, mood, and QOL. Significant differences were found between sleep diary and actigraph measures of sleep efficiency (p = 0.002), sleep latency (p = 0.014), sleep duration (p < 0.001), and wake after sleep onset (p < 0.001). Poor sleepers (PSQI score greater than 5) were significantly different from good sleepers (PSQI score of 5 or lower) on sleep diary measures of sleep efficiency and sleep latency and the FACT-L lung cancer symptom subscale, but not on mood or actigraphy sleep measures. Although patients with lung cancer may report an overall acceptable sleep quality when assessed by a single question, those same patients may still have markedly increased sleep latencies or reduced total sleep time. The findings indicate the complexity of sleep disturbances in patients with lung cancer. Lung cancer symptoms had a stronger association with sleep than mood. Research using prospective methods will help to elucidate their clinical significance. Patients receiving treatment for lung cancer are at an increased risk for sleep disturbances and would benefit from routine sleep assessment and management. In addition, assessment and management of common symptoms may improve sleep and, ultimately, QOL. A high frequency of sleep disturbances in patients receiving treatment for lung cancer was evident, and poor sleepers had lower QOL. Sleep disturbances may be more related to lung cancer symptoms than anxiety or depression. Improving lung cancer symptoms such as dyspnea may improve sleep.

Sleep parameters in rhesus monkeys by using actigraphy

Dear Editor; Andersen et al. (2013) reported the effect of methamphetamine on sleep parameters in rhesus monkeys by using actigraphy, named Actiwatch®. They quoted some references (Mann et al. 2005; Andersen et al. 2010; Andersen et al. 2012) to establish the validity of their study. Sleep efficiency, sleep latency, and sleep fragmentation were selected as sleep parameters, which were calculated by using Actiware software program. As a conclusion, methamphetamine (0.03 mg/kg) disrupted sleep by producing an increase in sleep latency and sleep fragmentation, in combination with a decrease in sleep efficiency. After concluding the drug experiment, the effect disappeared. I have two concerns on their study. First, actigraphy cannot become a substitute for sleep polysomnography. Actigraphy is based on an accelerometer for movement, and it does not directly reflect brain activity. They quoted one validation study with Actiwatch® (Terrill et al. 2010), but Terrill et al. mentioned that the sensitivity of detecting wakefulness during time in bed was poor. There is a cutoff value of Actiwatch® sensitivity for arriving at sleep/wake differentiation, which is initially set at 40 counts per minute. This value was originally determined for human subjects, and the cutoff value should be set according to each test situation. Second, they prepared two concentrations of methamphetamine and the effect of methamphetamine treatment was evaluated. As an additional analysis, they calculated correlation coefficients between the intake of methamphetamine and three sleep parameters. Although statistical significance was observed in each relationship, the explanation rates were 0.27 or smaller. As the authors mentioned, further studies are needed to confirm the relationship. I agree with the simplicity of actigraphy to monitor sleep, but much more trials are needed to establish validation for the application of actigraphy to small nonhuman primates. Activity monitoring and sleep monitoring are different concepts, and special caution should be paid when inferring sleep based on actigraphy (Terrill et al. 2010).

Do Circadian Preferences Influence the Sleep Patterns of Night Shift Drivers?

Objective: The objective of this study was to analyze the effect of individual circadian preferences of drivers with fixed night work schedules on sleep patterns. Subjects and Methods: A total of 123 professional drivers, 32 indifferent preference drivers and 91 morning preference drivers of an intermunicipality and interstate bus transportation company were evaluated. All drivers underwent polysomnographic recordings after their shifts. Furthermore, they filled out a questionnaire that contained sociodemographic and health questions. The Horne and Östberg questionnaire was used to assess the subjects' morningness-eveningness preference. Results: The mean age was 42.54 ± 6.98 years and 82 (66.66%) of the drivers had worked for ≥15 years. A significant effect on rapid eye movement (REM) was observed in the morning preference drivers. They showed an increased sleep latency and an REM sleep percentage of 5% of the total REM time. This reveals a significant effect on sleep architecture associated with work time. Conclusion: The drivers reported that morning preference had a significant effect on their sleep pattern indicating less REM sleep and longer REM sleep latency in the morning preference group. Thus, it is important to evaluate interactions between individual aspects of health and other parameters, such as sleep quality and work organizational factors, to promote night shift workers' health and well-being.

Sleep and Sleepiness in Children with Nocturnal Enuresis

To assess if sleep patterns and sleepiness are compromised in children with nocturnal enuresis (NE), in comparison with normal control subjects, and to evaluate the role of enuresis-related events during sleep. Assessment of natural sleep patterns at home in a sample of children referred to enuresis clinics and controls. Children's homes. Thirty-two children (19 boys and 13 girls aged 5.1 to 9.1 years) who suffer from primary NE and 94 healthy control subjects (49 boys and 45 girls aged 5 to 8.58 years). N/A. Sleep measures were derived from 3 to 5 nights of actigraphy and daily logs. Additional information on events related to enuresis and daytime sleepiness was collected using daily reports. Children with NE slept significantly worse than did the control subjects. Their compromised sleep patterns were reflected in a higher number of actigraphic nighttime awakenings, the reduced percentages of motionless sleep, the higher number of reported nighttime awakening, and the increased sleep latency. Children with NE also reported higher levels of sleepiness in the morning and in the evening. Compared with the sleep of control subjects, the natural sleep of children with NE is significantly more fragmented, and the children with NE experience higher levels of daytime sleepiness. This phenomenology is associated with bedwetting episodes and attempts to keep the child dry during the night. These findings may suggest that children with NE suffer from sleep fragmentation, which may explain their higher arousal threshold. These findings have clinical implications for enuresis management.

Hypobaric hypoxia modulates brain biogenic amines and disturbs sleep architecture

Sojourners to high altitude experience poor-quality of sleep due to hypobaric hypoxia (HH). Brain neurotransmitters are the key regulators of sleep wakefulness. Scientific literature has limited information on the role of brain neurotransmitters involved in sleep disturbance in HH. The present study aimed to investigate the time dependent changes in neurotransmitter levels and enzymes involved in the biosynthesis of brain neurotransmitters in frontal cortex, brain stem, cerebellum, pons and medulla and the effect of these alterations on sleep architecture in HH. Thirty adult Sprague–Dawley rats, body weight of 230–250 g were exposed to simulated altitude ∼7620 m, 282 mm Hg, partial pressure of O 2 59 mm Hg for 7 and 14 days continuously in an animal decompression chamber. After 7 and 14 days of HH, brain nor-epinephrine and dopamine levels were significantly increased in frontal cortex, brain stem, cerebellum and pons and medulla whereas serotonin level was significantly reduced in frontal cortex and pons and medulla after 14 days of HH. Tyrosine hydroxylase level in locus coeruleus (LC) was significantly increased whereas Choline Acetyl Transferase and Glutamic Acid Decarboxylase (GAD) levels were significantly reduced in laterodorsal-tegmentum and pedunculopontine-tegmentum after 7 days of HH. GAD was also reduced in LC after 7 days HH. Alteration in these neurotransmitters and enzyme levels was accompanied with reduction in quality and quantity of sleep. There was a significant increase in sleep latency, rapid eye movement (REM) latency, duration of active awake, quiet awake, quiet sleep and a significant decrease in duration of REM sleep and deep sleep on day 7 and 14 of HH. It was concluded that HH alters the expression of enzymes linked to sleep neurotransmitter synthesis pathway and subsequent loss of homeostasis at neurotransmitter level disrupts the sleep pattern in hypobaric hypoxia.

P.3.c.003 A randomized, controlled study to evaluate quetiapine fumarate in improving sleep quality of schizophrenia

Insomnia is a common feature in schizophrenia, and is characterized by an increase of sleep latency (SL), as well as reductions in total sleep time (TST) and sleep efficiency (SE). Regarding sleep architecture, non-rapid-eye-movement (NREM) sleep, slow wave sleep (SWS) and rapid-eye-movement (REM) sleep latency are decreased, whereas REM sleep tends to remain unchanged. According to polysomnographic studies, clozapine, olanzapine, quetiapine and ziprasidone administration increased TST and/or SE in healthy subjects. Additionally, olanzapine and ziprasidone augmented SWS, while changes corresponding to REM sleep were inconsistent. Furthermore, administration of clozapine, olanzapine and paliperidone to patients with schizophrenia was followed in most instances by a significant reduction of SL and an increase of TST and SE. In addition, olanzapine and paliperidone augmented SWS and REM sleep. By contrast, quetiapine administration further disrupted sleep as judged by the increase of SL, wake time after sleep onset (WASO) and REM sleep latency, and the reduction of SWS and REM sleep. No consistent effects on sleep variables were obtained during treatment with risperidone. To date, no polysomnographic studies have been published on the effects of aripiprazole, asenapine, iloperidone and lurasidone on sleep in either healthy subjects or patients with schizophrenia. Taken together, this evidence supports the conclusion that second generation antipsychotics (SGAs) including clozapine, olanzapine and paliperidone may ameliorate insomnia in patients with schizophrenia.

Falling asleep: the determinants of sleep latency

Background:Difficulty falling asleep (prolonged sleep latency) is a frequently reported problem in school-aged children.Aims:This study aimed to describe the distribution of sleep latency and factors that influence its duration.Methods:871 children...

Effects of Some Antipsychotics and a Benzodiazepine Hypnotic on the Sleep-Wake Pattern in an Animal Model of Schizophrenia

We studied the effects of antipsychotics and a hypnotic on sleep disturbance in schizophrenia using an animal model of the disease. Electrodes for the electroencephalogram (EEG) and electromyogram (EMG) were chronically implanted into the cortex and the dorsal neck muscle of rats. EEG and EMG were recorded with an electroencephalograph for 6 h (10:00 – 16:00). SleepSign ver. 2.0 was used for EEG and EMG analysis. Haloperidol and olanzapine had an antagonizing effect on the increases in sleep latency and total awake time and the decrease in total non-rapid eye movement (NREM) sleep time induced by MK-801. Olanzapine also antagonized the decrease in total rapid eye movement (REM) sleep time induced by MK-801. Aripiprazole antagonized only the increase in sleep latency induced by MK-801, whereas, risperidone, quetiapine, and flunitrazepam had no effect in the changes of sleep-wake pattern induced by MK-801. Olanzapine increased delta activity and decreased beta activity during NREM sleep. In contrast, flunitrazepam had an opposite effect. It was clarified that haloperidol and olanzapine were effective for decrease of sleep time in this animal model of schizophrenia. In addition, aripiprazole showed a sleep-inducing effect in schizophrenia model rat. On the other hand, flunitrazepam showed no beneficial effect on sleep disturbance in schizophrenia model rat.

Restless legs syndrome associated with cardiac failure and aggravated after valvular replacement: Vesper's curse?

The restless legs syndrome (RLS) is a neurological disorder characterized by symptoms of discomfort (usually paresthesias) in the limbs, predominating in the afternoon, present mainly at rest and alleviated by movement. The symptoms usually appear in the late afternoon or at night, which may bring on a significant increase in sleep latency and contribute to poor sleep quality1 […] Restless legs syndrome associated with cardiac failure and aggravated after valvular replacement: Vesper’s curse?

Somatostatin analog treatment is associated with an increased sleep latency in patients with long-term biochemical remission of acromegaly

Background Somatostatin analogs induce alterations in sleep in healthy adults. Presently, it is unknown whether somatostatin analog treatment affects sleep parameters in patients with acromegaly. Design Case-control study. Patients and measurements We assessed sleepiness and sleep patterns in 62 adult patients (32 men, age 61 years (33–88 years) controlled by surgery alone or postoperative radiotherapy (69%), and/or somatostatin analogs (31%). We used two validated sleep questionnaires (Epworth sleepiness score and Münchener chronotype questionnaire). Patient outcomes were compared to controls. Results Sleep duration and timing of sleep were not different in patients compared to controls. However, sleepiness score was increased in all patients compared to controls: 6 (1–20) vs. 4 (0–14), P = 0.014 (median (range)), reflecting increased daytime sleepiness. Snoring was reported in 68% of both patients and controls ( P = 0.996), observed apnoea’s and restless legs in 23% and 37% of patients compared to 12% and 21% of controls ( P = 0.062 and P = 0.031, resp.). In addition, sleep latency was increased in patients treated by somatostatin analogs compared to patients cured by surgery and/ or radiotherapy (52 ± 48 min vs. 26 ± 40 min, P = 0.005), resulting in a delayed sleep onset (24:08 ± 1:26 h vs. 23:25 ± 0:43 h, P = 0.053). Sleep duration was unaffected. Conclusions Daytime sleepiness is increased in a homogeneous cohort of patients in long-term remission from acromegaly. In addition, somatostatin analog treatment increases sleep latency and delays sleep onset in patients with long-term biochemical control of growth hormone overproduction without altering total sleep duration.

C.17.03 Can we reduce discontinuation rates in the treatment of schizophrenia?

Insomnia is a common feature in schizophrenia, and is characterized by an increase of sleep latency (SL), as well as reductions in total sleep time (TST) and sleep efficiency (SE). Regarding sleep architecture, non-rapid-eye-movement (NREM) sleep, slow wave sleep (SWS) and rapid-eye-movement (REM) sleep latency are decreased, whereas REM sleep tends to remain unchanged. According to polysomnographic studies, clozapine, olanzapine, quetiapine and ziprasidone administration increased TST and/or SE in healthy subjects. Additionally, olanzapine and ziprasidone augmented SWS, while changes corresponding to REM sleep were inconsistent. Furthermore, administration of clozapine, olanzapine and paliperidone to patients with schizophrenia was followed in most instances by a significant reduction of SL and an increase of TST and SE. In addition, olanzapine and paliperidone augmented SWS and REM sleep. By contrast, quetiapine administration further disrupted sleep as judged by the increase of SL, wake time after sleep onset (WASO) and REM sleep latency, and the reduction of SWS and REM sleep. No consistent effects on sleep variables were obtained during treatment with risperidone. To date, no polysomnographic studies have been published on the effects of aripiprazole, asenapine, iloperidone and lurasidone on sleep in either healthy subjects or patients with schizophrenia. Taken together, this evidence supports the conclusion that second generation antipsychotics (SGAs) including clozapine, olanzapine and paliperidone may ameliorate insomnia in patients with schizophrenia.

Effects of chlorogenic acid and its metabolites on the sleep–wakefulness cycle in rats

The effect of chlorogenic acid on the sleep–wakefulness cycle in rats was investigated in comparison with those of caffeic acid (the metabolite of chlorogenic acid) and dihydrocaffeic acid (the metabolite of caffeic acid). A significant prolongation of sleep latency was observed with chlorogenic acid and caffeic acid at a dose of 500 and 200 mg/kg, respectively. On the other hand, no remarkable effects were observed with dihydrocaffeic acid even at a dose of 500 mg/kg. Caffeine caused a significant increase in sleep latency and waking time and decrease in non-rapid eye movement sleep time at a dose of 10 mg/kg. In contrast, chlorogenic acid and its metabolites had no significant effects on each sleep state. From these results, it may be concluded that chrologenic acid caused a mild arousal effect compared with that of caffeine, and the effect of chlorogenic acid may have occurred through its metabolite caffeic acid.

Effect of age on MSLT results in patients with narcolepsy-cataplexy.

To measure the effect of age on Multiple Sleep Latency Test (MSLT)characteristics, sleep latency, and number of sleep-onset REM periods (SOREMP) in two large populations of narcoleptic patients with similar genetic backgrounds. Clinical and polygraphic information on the severity of the condition was obtained on 236 well-defined narcolepsy-cataplexy-human leukocyte antigen DR2-positive patients from Montpellier (France) and on 147 similar patients from Montreal (Canada). The results show a progressive decrease in the number of SOREMP with age and a progressive increase in the mean sleep latency on the MSLT as a function of age. This finding is also related to the severity of cataplexy as assessed from the clinical history with a progressive decrease in the frequency of cataplexy attacks with age. These results may reflect the progressive increase in sleep latency seen in normal aging and suggest that clinical improvement might be due to changes in the neural mechanisms responsible for SOREMP, which may weaken with age. The progressive decrease in the number of SOREMP and increase in the mean sleep latency on the MSLT as a function of age suggest that the current criteria used for diagnosis may be too stringent in older patients. The major influence of age on MSLT results should therefore be taken into account when diagnosing a narcoleptic patient.

Daytime sleepiness during Ramadan intermittent fasting: polysomnographic and quantitative waking EEG study.

During the lunar month of Ramadan, Muslims abstain from eating, drinking and smoking from sunrise to sunset. We reported previously that Ramadan provokes a shortening in nocturnal total sleep time by 40 min, an increase in sleep latency, and a decrease in slow-wave sleep (SWS) and rapid eye movement (REM) sleep duration during Ramadan. During the same study, the effects of Ramadan intermittent fasting on daytime sleepiness were also investigated in eight healthy young male subjects using a quantitative waking electroencephalograph (EEG) analysis following the multiple sleep latency test (MSLT) procedure. This procedure was combined with subjective alertness and mood ratings and was conducted during four successive experimental sessions: (1) baseline (BL) 15 days before Ramadan, (2) beginning of Ramadan (R11) on the 11th day of Ramadan, (3) end of Ramadan (R25) on the 25th day of Ramadan, (4) recovery 2 weeks after Ramadan (AR). During each session, four 20-min nap opportunities (MSLTs) were given at 10:00, 12:00, 14:00 and 16:00 h and were preceded by rectal temperature readings. Nocturnal sleep was recorded before each daytime session. Subjective daytime alertness did not change in R25 but decreased in R11 at 12:00 h, and subjective mood decreased at 16:00 h, both in R11 and R25. During the MSLT, mean sleep latency decreased by an average of 2 min in R11 (especially at 10:00 and 16:00 h) and 6 min in R25 (especially at 10:00 and 12:00 h) compared with BL. There was an increase in the daily mean of waking EEG absolute power in the theta (5.5-8.5 Hz) frequency band. Significant correlations were found between sleep latency during the MSLT and the waking EEG absolute power of the fast alpha (10.5-12.5 Hz), sigma (11.5-15.5 Hz) and beta (12.5-30 Hz) frequency bands. Sleep latency was also related to rectal temperature. In conclusion, Ramadan diurnal fasting induced an increase in subjective and objective daytime sleepiness associated with changes in diurnal rectal temperature.

Sleep during Ramadan intermittent fasting

During the month of Ramadan intermittent fasting, Muslims eat exclusively between sunset and sunrise, which may affect nocturnal sleep. The effects of Ramadan on sleep and rectal temperature (Tre) were examined in eight healthy young male subjects who reported at the laboratory on four occasions: (i) baseline 15 days before Ramadan (BL); (ii) on the eleventh day of Ramadan (beginning of Ramadan, BR); (iii) on the twenty-fifth day of Ramadan (end of Ramadan, ER); and (iv) 2 weeks after Ramadan (AR). Although each session was preceded by an adaptation night, data from the first night were discarded. Polysomnography was taken on ambulatory 8-channel Oxford Medilog MR-9000 II recorders. Standard electroencephalogram (EEG), electro-oculogram (EOG) and electromyogram (EMG) recordings were scored visually with the PhiTools ERA. The main finding of the study was that during Ramadan sleep latency is increased and sleep architecture modified. Sleep period time and total sleep time decreased in BR and ER. The proportion of non-rapid eye movement (NREM) sleep increased during Ramadan and its structure changed, with an increase in stage 2 proportion and a decrease in slow wave sleep (SWS) duration. Rapid eye movement (REM) sleep duration and proportion decreased during Ramadan. These changes in sleep parameters were associated with a delay in the occurrence of the acrophase of Tre and an increase in nocturnal Tre during Ramadan. However, the 24-h mean value (mesor) of Tre did not vary. The nocturnal elevation of Tre was related to a 2-3-h delay in the acrophase of the circadian rhythm. The amplitude of the circadian rhythm of Tre was decreased during Ramadan. The effects of Ramadan fasting on nocturnal sleep, with an increase in sleep latency and a decrease in SWS and REM sleep, and changes in Tre, were attributed to the inversion of drinking and meal schedule, rather than to an altered energy intake which was preserved in this study.

Insomnio en ancianos: afectación cognitiva y actitudes terapéuticas

Sleep is an important biological function, which greatly affects the quality of life at all ages. Sleep influences the alertness and stress levels, psychosomatic diseases and health in general. The predisposition to insomnia increases with age, illnesses such as heart disease, breathing disorders, cancer, strokes, pain and polyuria often disturb sleep patterns. In addition, the aging process, which directly alters sleep-wake cycles and other cerebral functions, affects the elderly. All the above points can lead to an increase in sleep latency, less total sleep time, increases in early awakening and a greater frequency of daytime naps. In an attempt to improve sleep in the elderly, and thus their quality of life, we can try to prevent stress and psychiatric symptoms by altering life-styles and improve the patients' awareness of the problem. Hypnotic drugs are useful for short periods but for longer ones we prefer techniques which attempt to modify behavior. In chronic patients who need treatment with hypnotic drugs for a long time, therapy must be individualized.

Sleep Disturbance in Patients with Chronic Fatigue Syndrome and Chronic Fatigue

AbstractTo examine whether the identification of patients with Chronic Fatigue Syndrome can be made using more objective criteria than presently available (1), we compared 14 patients with Chronic Fatigue Syndrome and 12 patients with chronic fatigue (but who did not meet the criteria for Chronic Fatigue Syndrome) on sleep architecture, continuity, and sleep abnormalities from polysomnography recordings. No differences in sleep continuity or architecture were found between the two groups, except that patients with Chronic Fatigue Syndrome recorded significantly increased sleep latencies. There were no differences in the frequency of sleep disorders. Results indicated that apart from sleep latency, other sleep variables do not adequately differentiate patients with CFS from those with chronic fatigue and that other variables should be examined, which may validly diagnose patients with CFS.

Activity, Arousal, and the MSLT in Patients with Insomnia

It has recently been shown that physiological arousal following walking increased sleep latencies during daytime naps as compared to sleep latencies following TV viewing. Patients with insomnia have been shown to have increased physiological arousal and to also have longer MSLT latencies. It was hypothesized that insomnia patients, who are at a higher state of physiological arousal, would be unable to relax while lying in bed and watching TV and therefore would have relatively longer sleep latencies in naps following TV watching (due to inability to relax) as compared to walking. Twelve patients with psychophysiological insomnia took Multiple Sleep Latency Tests after either watching television for 15 minutes or after a 5-minute walk following baseline, sleep deprivation, and recovery sleep conditions. Sleep Laboratory Twelve patients with psychophysiological insomnia Manipulation of state arousal and sleep deprivation Sleep latencies were significantly longer following the walk as compared to watching TV (11.9 vs. 6.9 min. respectively). Sleep latencies were 13.4 and 3.8 min. following baseline and sleep deprivation conditions. Heart period, used as a measure of physiological arousal, was significantly elevated throughout naps following the walk as compared to naps following TV viewing. Heart period was also significantly correlated with nap sleep latency. The insomnia patients in this study had significantly increased arousal, as measured by heart rate, and significantly longer sleep latencies after walking as compared to resting. The magnitude of these changes was similar to that seen in normal subjects in a previous study. These data, in concert with previous work, support the contention that measured sleep tendency is a combination of sleep drive and level of central nervous system arousal, where arousal has both state and trait components.