Regular Sleep Habits Research Articles

Regular sleep habits in toddlers are associated with social development and brain coherence

ObjectiveAlthough sleep habits are associated with the development of toddlers, factors affecting social development and brain function remain unclear. We aimed to elucidate the relationship between sleep habits and social development as well as brain coherence in toddlers. MethodsWe used the data set at 1.5-2 years old, in the longitudinal study until 6 years old. We evaluated sleep parameters, such as average wake-up time, bedtime, nighttime sleep duration, total sleep duration, and the standard deviation (SD) of sleep habits. We also examined the development, including the social stimuli fixation percentage using Gazefinder® and electroencephalography (EEG) coherence between brain regions. ResultsSeventy-two children (37 boys and 35 girls) were included. The fixation percentage for the human face was negatively correlated with the SD of the total sleep duration, nighttime sleep duration, nap duration, and bedtime (r=-0.516, p=0.000; r=-0.331, p=0.005; r=-0.330, p=0.005; and r=-0.324, p=0.005, respectively). The EEG analysis indicated that α-band coherence in the right centro-parietal area was negatively correlated with the total sleep duration (r=-0.283, p=0.016). The path diagram demonstrated a direct significant effect of sleep duration irregularity on development including social communication and fixation percentage for human faces. Additionally, total sleep duration exhibited a direct effect on α cortical coherence in the right centro-parietal area. ConclusionsIn this study, we found an association between sleep irregularity and the development of social communication, preference for humans, and brain coherence in toddlers. We suggest that regular sleep plays an important role in promoting the development of social communication.

191 - Appropriate bedtime and regular sleep habits reduce nocturnal urine volume per hour and prolong hours to undisturbed sleep.

191 - Appropriate bedtime and regular sleep habits reduce nocturnal urine volume per hour and prolong hours to undisturbed sleep.

A randomized controlled trial to assess if changing sleep timing can improve glucose metabolism in people with prediabetes and type 2 diabetes

BackgroundSocial jetlag is a chronic disruption of sleep timing that is characterized by different sleep timing during workdays and free days. Social jetlag has been associated with disturbed glucose metabolism, insulin resistance, and increased risk of metabolic syndrome and type 2 diabetes. In this study, we aim to investigate whether a combination of bright light therapy in the morning, bright light reduction in the evening and sleep advance instructions for 3 weeks reduces social jetlag and if this results in improvement of glycemic and metabolic control, sleep, mood and quality of life after 3 and 12 weeks in people with prediabetes and type 2 diabetes and to assess possible mediators, compared to regular sleep habits.MethodsIn this randomized controlled trial, 60 people with prediabetes or type 2 diabetes with > 1 h social jetlag will be recruited. The intervention consists of bright light therapy (5000 lx) emitted by Vitamine-L (Lumie, UK) for 30 min each morning, combined with the advice to follow sleep advance instructions and to wear bright light-dimming goggles every evening for a period of 3 weeks. The control group adheres to their regular sleep habits and conditions. The primary outcome is glycated hemoglobin (HbA1c) after 12 weeks comparing the intervention and control in an intention-to-treat analysis. Secondary outcomes at 3 and 12 weeks are (1) social jetlag; (2) insulin sensitivity, fasting blood glucose, glucose-lowering medication use, and frequency of perceived hypoglycemia; (3) metabolic outcomes, including body mass index (BMI), waist circumference, body fat percentage, and blood pressure; (4) mood, including depression, fatigue and anxiety (measured with questionnaires); and (5) quality of life measured using EQ5D questionnaire. To assess other factors that might play a role as possible mediators, we will measure (para)sympathetic nervous system activity assessed with ECGs and electrochemical skin conductance tests, sleep quality and sleep phase distribution assessed with a sleep measuring headband (ZMax), the Dim Light Melatonin Onset in saliva samples (in a subgroup) at 3 and 12 weeks, the feeling of satiety and satiation with a 10-cm visual analog scale (VAS), diet using a food frequency questionnaire, and physical activity using an accelerometer (ActiGraph).DiscussionSocial jetlag can contribute to poorer glycemic control and metabolic control in those with type 2 diabetes. With this intervention, we aim to reduce social jetlag and thereby improve glycemic and metabolic control. This could offer a way to improve overall population health and to reduce the disease burden of type 2 diabetes.Trial registrationISRCTN registry ISRCTN11967109. Registered on 9 May 2024.

Pharmacological Treatment for Restless Legs Syndrome

Restless legs syndrome (RLS) is a neurological disorder that causes insomnia and daytime functional disability due to an urge to move the legs usually accompanied by uncomfortable sensations. Non-pharmacologic treatment includes regular sleep habits and exercise. Iron supplementation is indicated for patients with low serum ferritin levels. Antidepressants, antihistaminergics, and dopamine antagonists should be reduced or discontinued because they induce RLS symptoms. Dopamine agonists and alpha 2-delta ligands are the first-line pharmacological treatments for RLS.

Prevalence of Bedtime Procrastination in University Students and Reexamination of the Bedtime Procrastination Scale.

Objective: To determine the prevalence of bedtime procrastination (BtP) among Indian university students and to evaluate the performance of the Bedtime Procrastination Scale (BPS).Methods: The BPS (scoring range, 9-45), with separate, additional questions related to sleep and influences thereon, was administered to all on-campus graduate and postgraduate students attending Navrachana University, Gujarat, India. The variable of regular sleep habits was defined as a BPS total score of 9-18 and BtP as a BPS total of 36-45. The BPS was examined using factor analysis. The study was conducted from November 2021 to December 2021.Results: Completed forms were received from 560 of 567 eligible students. The mean BPS total score was 29.1. BPS total scores did not differ significantly between males and females. Few students (n = 54, 9.6%) had study-defined regular sleep habits. One-fifth of the sample (20.2%) had study-defined BtP. Higher BtP total scores showed a small but statistically significant correlation with daytime tiredness (r = 0.26). Factor analysis of the BPS yielded a 2-factor solution that explained 49.3% of the variance in the data. The latent variables appeared to represent "Going to bed late" and "Going to bed on time." Potential problems, not previously discussed in the literature, were identified based on the manner in which BPS items were presented and scored.Conclusions: Few university students have regular sleep habits. BtP is present in a sufficiently large enough proportion of students to be of health concern. The BPS is likely to require modifications for future use.

Forming the development of a value relationship to a healthy lifestyle among future primary school teachers based on healthcare technology

The aim of this study is to obtain the opinions of prospective teachers in order to create the development of the value relationship between the healthy lifestyle and the value of future primary school teachers based on health technology. This research was created in accordance with the qualitative research method. The study group of the research consists of 25 teacher candidates studying in primary school teaching departments in various universities in Kazakhstan. The data collection tool for the research is the semi-structured interview form developed by the researchers. As a result of the research, future primary school teachers stated that they had a healthy lifestyle, balanced and healthy nutrition, regular exercise, avoided harmful habits like alcohol and smoking, avoided stress, protected mental and emotional health and acquired regular sleep habits. They stated that technological devices are used in the field of health, health technology shortens the healing process, facilitates health practices, saves time, requires professional application and use and increases awareness. Moreover, the majority of future primary school teachers stated that they strongly support the development of the value relationship with a healthy lifestyle based on health technology.
 Keywords: Healthy life, health technology, primary school teachers of the future;

Sleep duration, risk of obesity, and parental perceptions of residential neighborhood environments in 6-9years-old children.

The present study aimed to analyze the association between healthy sleep duration of children and the parental perception of the social/built environment. A cross-sectional study was done and a sample of 8273 children (4183 females) aged 6-9 years was observed. Height (cm) and weight (Kg) were measured, and the body mass index (BMI) was calculated. Participants were classified as normal weight or overweight/obese. Sleep habits, sedentary behaviors (i.e., TV viewing) and environmental variables were assessed by questionnaire. Logistic regressions were used, with adjustments for age, sex, BMI, and sedentary time. Children whose parents reported a positive perception of the built environment in the residential area were 1.21 times more likely to have regular sleep habits during weekdays. Furthermore, children whose parents reported a negative perception of the social environment and safety were 81% more likely to have irregular sleep habits during the weekdays. The present study revealed a positive association between regular sleep during the weekdays and the parental perception of the social/built environment (land use and urban design).

Validation study of the Italian version of the Sleep Hygiene Index

Sleep hygiene rules are a set of behavioural and environmental recommendations that promote healthy and good quality sleep, playing a role in insomnia disorder. The Sleep Hygiene Index (SHI) is a self-report questionnaire developed to evaluate the practice of sleep hygiene behaviours with adequate psychometric properties in different samples. The present study aimed to translate the original version of the SHI into the Italian language and evaluate the psychometric properties of this instrument in the Italian adult population. After the translation of the SHI from the original English version into the Italian version, factorial structure, internal consistency, as well as convergent and discriminant validity were estimated. The principal component analysis showed a four-factor solution for the SHI, accounting for 52.03% of the total sample variance (F1=25.65%, F2=10.00%, F3=8.48% and F4=7.90%). Factor 1 comprised items regarding arousal; Factor 2 comprised items regarding regular sleep habits; Factor 3 comprised items about sleep environment; and Factor 4 comprised items on sleep-disrupted behaviours. The Italian version of the SHI can be regarded as a reliable tool with adequate concurrent and predictive validity for assessing sleep hygiene in Italian adults with or without insomnia symptoms.

088 Irregular Sleep Patterns Predict Worse Sleep Quality and Poorer Psychosocial and Academic Outcomes

Abstract Introduction While the consequences of short sleep duration are well understood, relatively little is known about how irregular sleep durations are related to daily functioning. We utilized actigraphy and self-report methods to investigate the correlates of intraindividual sleep variability in two populations. Methods In Study 1, N=699 adults (mean age=38.04, SD=11.65; 44.78% female) completed online questionnaires on sleep, work status, and time management. In Study 2, N=100 college students (mean age=19.08, SD=1.26; 50% female; 50% underrepresented minorities) wore actiwatches for two one-week sessions (1 month apart) and reported sleep, psychosocial functions, and academic outcomes. In both studies, variability of sleep duration was defined as the individual standard deviation (ISD) of sleep durations. Results In Study 1, after controlling for mean sleep duration, greater variability in sleep duration was related to shiftwork (F=8.68, p=.003), younger age (r=-.15, p<.001), male gender (F=4.43, p=.036), and greater vulnerability to stress (r=.15, p=.001). Beyond mean sleep duration, variability in sleep duration also predicted poorer sleep quality (r=.25, p<.001), greater sleepiness during the day (r=.10, p=.014), poorer time management (r=-.09, p=.031), lower work efficiency (r=-.14, p=.002), and more procrastination (r=.11, p=.009). In Study 2, variability in actigraphy-defined sleep duration increased as the semester progressed (ISD=1.25±0.55 hours at T1; ISD=1.57±0.80 hours at T2, t=4.64, p<.001). After controlling for mean sleep duration, sleep variability was associated with greater perceived stress (r=.31, p=.002 at T1), poorer sleep quality (r=.39, p<.001 at T1; r=.30, p=.003 at T2), and lower expected grades (r=-.27, p=.01 at T2). Sleep variability was unrelated to depression or perceptions of one’s overall health. Conclusion Keeping regular sleep habits appear just as important as average sleep duration to psychosocial, work, and academic outcomes. Sleep interventions should incorporate specific guidelines on how to promote regular sleep and employers should institute work schedules that promote regularity. Support (if any) This work is supported by the National Science Foundation, Psi Chi Honor Society, and the American Psychological Association.

Insomnia among Active Patients with COVID-19: A Cross-Sectional Study

Objective Coronavirus disease (COVID-19) pandemic has become a source of abrupt disruptions in regular sleep habits (circadian rhythms) secondary to the associated severe physical and mental health issues. However, there are no studies, to the best of our knowledge, providing evidence based information on sleep-related disorders among patients with COVID-19 from India till date. In the present cross sectional studies, we explored the prevalence of insomnia and its correlations in a COVID-19 patient population in South India. Methods A cross-sectional study was conducted among patients admitted with COVID-19 in a designated COVID-19 treatment centre. Sociodemographic and clinical details were collected according to a structured performa. Medical records were reviewed to collect information about medical background, overall medical parameters of COVID-19, laboratory values and treatment details. The insomnia was evaluated using the Insomnia Severity Index. Results The mean age of the participants was 51.59 years, and 73 (53.7%) participants were females. Twenty-three (16.9%) participants had subthreshold insomnia, and 3 (2.2%) participants had clinical insomnia. The white blood cell count was higher in the insomnia group (8.5×109/L) than in the non-insomnia group (6.4×109/L) (p=0.003). The lymphocyte count was significantly lower in the insomnia group (24.13%WB) compared with the non-insomnia group (31.41%WB) (p=0.008). The ALT, AST, and serum creatinine levels were significantly higher among the insomnia group. Conclusion Insomnia may occur among active patients with COVID-19 infection. It is important to keep in mind that there is a hidden danger of the transformation of acute insomnia into chronic insomnia among COVID-19 patients. It is important to disseminate sleep health education and sleep hygiene behavior interventions to the COVID-19 patient population while they are admitted in the hospital. Keywords: Insomnia; COVID-19; Inpatients; India

Night-to-night variability in obstructive sleep apnea using peripheral arterial tonometry: a case for multiple night testing.

Night-to-night variability of obstructive sleep apnea severity is considerable and may depend on the diagnostic modality used. We investigated the night-to-night variability using peripheral arterial tonometry (PAT). Home sleep apnea testing was performed in 51 patients during 3 consecutive nights using PAT. Patients referred to our sleep clinic were screened and prospectively recruited for this study. All recordings were automatically and manually scored according to the PAT scoring guidelines. No systematic differences in PAT-derived apnea-hypopnea index (pAHI) were found between the nights. The night-to-night variability was comparable between manually and automatically scored data. pAHI varied in 35% of patients more than 10 events/h between the nights. The obstructive sleep apnea severity of 24% of patients was misclassified when using 1 night compared to the average of all nights. On average, pAHI varied by 57% from night to night. The variability of pAHI could partially be explained by the variability of time spent in the supine position with more time supine leading to a higher pAHI. On measuring a subsequent night, 12-14% of patients spontaneously fulfilled the commonly accepted criteria for treatment success without any intervention. With repeated recordings of PAT, we found no first night effect. However, there is considerable night-to-night variability similar to values found for polysomnography, which can partially be explained by the variability of time spent in the supine position. Obstructive sleep apnea severity was frequently misclassified due to the night-to-night variability. Our findings make a strong case for multiple testing in the diagnostic work-up of obstructive sleep apnea patients. Tschopp S, Wimmer W, Caversaccio M, Borner U, Tschopp K. Night-to-night variability in obstructive sleep apnea using peripheral arterial tonometry: a case for multiple night testing. J Clin Sleep Med. 2021;17(9):1751-1758.

Irregular sleep habits, regional grey matter volumes, and psychological functioning in adolescents.

Changing sleep rhythms in adolescents often lead to sleep deficits and a delay in sleep timing between weekdays and weekends. The adolescent brain, and in particular the rapidly developing structures involved in emotional control, are vulnerable to external and internal factors. In our previous study in adolescents at age 14, we observed a strong relationship between weekend sleep schedules and regional medial prefrontal cortex grey matter volumes. Here, we aimed to assess whether this relationship remained in this group of adolescents of the general population at the age of 16 (n = 101; mean age 16.8 years; 55% girls). We further examined grey matter volumes in the hippocampi and the amygdalae, calculated with voxel-based morphometry. In addition, we investigated the relationships between sleep habits, assessed with self-reports, and regional grey matter volumes, and psychological functioning, assessed with the Strengths and Difficulties Questionnaire and tests on working memory and impulsivity. Later weekend wake-up times were associated with smaller grey matter volumes in the medial prefrontal cortex and the amygdalae, and greater weekend delays in wake-up time were associated with smaller grey matter volumes in the right hippocampus and amygdala. The medial prefrontal cortex region mediated the correlation between weekend wake up time and externalising symptoms. Paying attention to regular sleep habits during adolescence could act as a protective factor against the emergence of psychopathology via enabling favourable brain development.

Relationship between screen time and sleep among Finnish preschool children: results from the DAGIS study

Study objectivesTo examine the associations between screen time, the time spent on different screen devices, and sleep in a sample of Finnish preschool children. MethodsThe current study analyzed cross-sectional data from the DAGIS study carried out in Finland in 2015–2016 on 736 children aged 3–6 years. Parents reported in a 7-day diary the durations the child used screen devices daily, with separate details about watching TV or DVDs, using tablets or smartphones, and using computers. In addition, parents reported children's bedtimes and wake-up times, which were further used in calculating sleep duration. Parents answered questions regarding their child's sleep consistency. Statistical analyses included adjusted general linear modeling. ResultsAn hourly increase in total screen time was associated with 11 min later bedtime (p < 0.001) and 10 min shorter sleep duration (p < 0.001). More TV/DVD watching was associated with later bedtimes (p = 0.016) and a shorter sleep duration (p = 0.001). More smartphone/tablet use was associated with later bedtimes (p = 0.005), later wake-up times (p = 0.038), and weaker sleep consistency (p = 0.024). More computer use was associated with later bedtimes (p = 0.046). Results did not differ between genders. ConclusionsIncreased screen time was associated with later bedtimes and shorter sleep duration among preschool children. Adverse associations with sleep outcomes were found for each screen device. Attention should be paid to promoting balanced use of screens and regular sleep habits in young children.

The Relation between Students’ Writing Anxiety with Writing Disposition

Yazma, birden fazla fiziksel, bilişsel ve duyuşsal becerilerin aynı anda kullanılmasını gerektiren yapısıyla kaygı ve eğilimi etkileyen problemlerin ortaya çıkma oranını artırmaktadır. Yazma kaygısının yükselmesi ve yazma eğiliminin azalması, yazma eğitiminin temel hedefi olan yazma alışkanlığının kazandırılmasına engel oluşturmaktadır. Bu araştırmanın amacı; ortaokul öğrencilerinin yazma kaygı ve eğilimleri arasındaki ilişkiyi belirlemektir. Araştırma; nicel desende ilişkisel tarama modelinde, Elazığ il merkezinde aşamalı ve tabakalı örnekleme yöntemiyle belirlenen 1325 ortaokul öğrencisi ile gerçekleştirilmiştir. Verilerin analizinde parametrik olan Anova ve t-testleri kullanılmış, yazma kaygısı ile yazma eğilimi arasındaki ilişkiyi belirlemede Pearson korelasyon katsayısı, çoklu doğrusal regresyon ve düzenleyici değişkenler özelinde basit doğrusal regresyon analizleri gerçekleştirilmiştir. Araştırmanın sonucunda öğrencilerin yazma kaygılarının yazma eğilimlerini büyük düzeyde (%51) yordadığı; katılımcıların cinsiyetleri, sınıf düzeyleri, ilgilendikleri hobi alanları, daha çok hangi ortamda oyun oynadıkları, düzenli uyku alışkanlığına sahip olma durumlarına göre yazma kaygı ve eğilimlerinin farklılaştığı, yazma kaygı ve eğilimi arasında anlamlı negatif ilişkiler olduğu bulunmuştur.

Social Jet Lag Associates Negatively with the Adherence to the Mediterranean Diet and Body Mass Index among Young Adults.

Obesity and unhealthy eating habits have been associated with irregular sleep–wake patterns during the week, also known as social jet lag. The Mediterranean diet is a healthy pattern related with a better health and sleep quality. However, potential associations with social jet lag remain unexplored. The aim of this study was to examine whether higher social jet lag is linked to lower adherence to the Mediterranean diet and whether it is associated with BMI (Body Mass Index). This cross-sectional study included 534 young adults (18–25 years). Anthropometric parameters, adherence to the Mediterranean diet, chronotype and social jet lag were studied. Our results revealed that individuals with greater social jet lag showed lower adherence to the Mediterranean diet and had a higher BMI. Among the habits that characterized the Mediterranean dietary pattern, we observed that higher social jet lag was significantly associated with a lower intake of fruits and vegetables, as well as skipping breakfast. Hence, the promotion of regular sleep habits together with healthy dietary patterns should be considered for obesity prevention, especially among young adults.

Prevalence of attention-deficit/hyperactivity disorder symptoms and their associations with sleep schedules and sleep-related problems among preschoolers in mainland China

BackgroundAttention-deficit/hyperactivity disorder (ADHD) among children is an increasing public health concern. The identification of behavioral risk factors, including sleep quality, has important public health implications for prioritizing behavioral intervention strategies for ADHD. Herein, this study aimed to investigate the prevalence of high levels of ADHD symptoms and to explore the association between sleep schedules, sleep-related problems and ADHD symptoms among preschoolers aged 3 to 6 years in mainland China.MethodsA cross-sectional study was conducted, comprising a large sample of 15,291 preschoolers in Ma’anshan city of Anhui Province in China. ADHD symptoms were assessed by the 10-item Chinese version of the Conners Abbreviated Symptom Questionnaire (C-ASQ). Sleep-related variables included caregivers’ responses to specific questions addressing children’s daytime and nighttime sleep schedules, as well as sleep-related behaviors. Data on other factors were also collected, such as socio-demographic characteristics, TV viewing duration on weekdays and weekends, and outdoor activities. Logistic regression models were used to analyze the relationships between sleep schedules, sleep-related problems and ADHD symptoms.ResultsApproximately 8.6% of the total sample of preschoolers had high levels of ADHD symptoms, with boys having higher levels than girls (9.9% vs. 7.2%). In the logistic regression analysis, after adjusting for TV viewing duration, outdoor activities, and socio-demographic characteristics, delayed bedtime was significantly associated with a risk of high levels of ADHD symptoms, with odds ratios (OR) of 2.50 [95% confidence interval (CI): 2.09 ~ 3.00] and 2.04 (95% CI: 1.72 ~ 2.42) for weekdays and weekends, respectively. Longer time falling asleep (≥ 31 min) (OR = 1.76, 95% CI: 1.47 ~ 2.11), no naps (OR = 1.57, 95% CI: 1.34 ~ 1.84) and frequent sleep-related problems (OR = 4.57, 95% CI: 3.86 ~ 5.41) were also significantly associated with an increased risk of high levels of ADHD symptoms, while longer sleep duration (> 8.5 h) was associated with a decreased risk of high levels of ADHD symptoms (OR = 0.76, 95% CI: 0.67~ 0.87).ConclusionsADHD symptoms are prevalent in preschoolers in Ma’anshan region, China. Undesirable sleep schedules and sleep-related problems among preschoolers confer a risk of ADHD symptoms, highlighting the finding that beneficial and regular sleep habits potentially attenuate ADHD symptoms among preschoolers.

Poor toddler-age sleep schedules predict school-age behavioral disorders in a longitudinal survey.

Behavioral problems are often associated with poor sleep habits in children. We investigated whether undesirable toddler-age sleep schedules may be related to school-age behavioral problems. We analyzed the data of a nationwide longitudinal survey with available results from 2001 to 2011. The participants were 41,890 children. The predictors were waking time and bedtime at 2years of age, and the outcomes were assessed by determining the presence or absence of three attention problems and four aggressiveness problems at 8years of age. In logistic regression models with adjustments for confounding factors, we estimated odds ratios (ORs) and confidence intervals (CIs) for the association between toddler sleep schedules and behavior during primary-school age years. The outcomes of attention problems and aggressiveness problems were observed in 1.7% and 1.2% of children, respectively, at 8years of age. The OR of an irregular or late morning waking time at 2years of age with the outcome of aggressiveness problems was 1.52 (95% CI, 1.04-2.22) in comparison to an early waking time. The OR of an irregular or late bedtime with attention problems was 1.62 (95% CI, 1.12-2.36), and the OR of an irregular or late bedtime with aggressiveness problems was 1.81 (95% CI, 1.19-2.77) in comparison to an early bedtime. Poor toddler-age sleep schedules were found to predict behavioral problems during primary-school age years. Thus, good and regular sleep habits appear to be important for young children's healthy development.

Sleep paralysis in Chinese adolescents: A representative survey

Sleep paralysis has been studied in different countries and regions, but it has rarely been investigated in mainland China. The aim of the present study was to estimate the prevalence of sleep paralysis and examine features of and factors associated with sleep paralysis (SP) among Chinese adolescents. A cross-sectional study was performed by using self-administrated questionnaires distributed to junior and senior high school students. The prevalence of sleep paralysis was determined from 11 754 completed questionnaires (overall response rate: 95.1%). The relationship of sleep paralysis to personal (age, gender), lifestyle (smoking, drinking alcohol), and community (rural or urban) characteristics and sleep status (sleep duration, nap time, bedtime, subjective sleep quality) were analyzed, and the features of sleep paralysis were investigated. We found that the prevalence of sleep paralysis in this population was 6.77%. The prevalence of sleep paralysis increased significantly from junior to senior high school regardless of sleep duration, naptime, bedtime, or mental health status. Logistic regression analysis revealed that risk factors for sleep paralysis included female sex, drinking alcohol, low subjective sleep quality, and living in a rural area. Major features of sleep paralysis included the inability to move (92%) and a sense of weight on chest/difficulty breathing (43%). The results of this study suggest that in order to reduce the incidence of SP, health education should be used to promote the importance of regular sleep habits for adolescents.

Increased cerebral blood flow in the right frontal lobe area during sleep precedes self-awakening in humans.

BackgroundSome people can subconsciously wake up naturally (self-awakening) at a desired/planned time without external time stimuli. However, the underlying mechanism regulating this ability remains to be elucidated. This study sought to examine the relationship between hemodynamic changes in oxyhemoglobin (oxy-Hb) level in the prefrontal cortex and sleep structures during sleep in subjects instructed to self-awaken.ResultsFifteen healthy right-handed male volunteers with regular sleep habits participated in a consecutive two-night crossover study. The subjects were instructed to wake up at a specified time (“request” condition) or instructed to sleep until the morning but forced to wake up at 03:00 without prior notice (“surprise” condition). Those who awoke within ± 30 min of the planned waking time were defined as those who succeeded in self-awakening (“success” group). Seven subjects succeeded in self-awakening and eight failed.No significant differences were observed in the amounts of sleep in each stage between conditions or between groups. On the “request” night, an increase in oxy-Hb level in the right prefrontal cortex and a decrease in δ power were observed in the “success” group around 30 min before self-awakening, whereas no such changes were observed in the “failure” group. On the “surprise” night, no significant changes were observed in oxy-Hb level or δ power in either group.ConclusionsThese findings demonstrate a correlation between self-awakening and a pre-awakening increase in hemodynamic activation in the right prefrontal cortex, suggesting the structure’s contribution to time estimation ability.

Guidelines for the Management of Cognitive and Behavioral Problems in Dementia

Family physicians play a crucial role in the management and ongoing care of patients with Alzheimer disease (AD). This article reviews the effects of nonpharmacologic and pharmacologic interventions on the functional abilities and behavior of patients with dementia and how these can be implemented into clinical practice. Nonpharmacologic interventions are recommended as the initial strategy for managing problematic behaviors. Strategies for improving behavior include ensuring that the patient's environment is safe, calm, and predictable; removing environmental stressors; and identifying and avoiding situations that agitate or frighten the patient. Simple interventions include redirecting and refocusing the patient, increasing social interaction, establishing regular sleep habits, eliminating sources of conflict and frustration, and establishing rewards for successes. The effectiveness of long-term behavioral management is largely dependent on the caregiver; as such, it is important to assess the role and needs of the caregiver. Because currently available therapies cannot reverse the pathologic processes of AD, the primary objective of pharmacotherapy is to preserve cognitive and functional ability, minimize behavioral disturbances, and slow disease progression. Cholinesterase inhibitors represent first-line therapy for patients with mild to moderate AD, whereas a glutamate N-methyl D-aspartate antagonist is used in the treatment of moderate to severe AD. Looking forward, there are a number of therapies in development aimed at modifying the disease course; these include amyloid-lowering drugs, τ-based and neuroprotective approaches, acetylcholine agonists, and mitochondrial inhibitors.