Sleep Disturbance In People Research Articles

Sleep in dementia and caregiving – assessment and treatment implications: a review

The increasing prevalence of dementia will precipitate a significant burden in terms of the costs of caring for people with dementia over the next 30 years; sleep disturbances in dementia are an important factor contributing to this burden. We reviewed sleep disturbances in people with dementia and their carers and describe the various diagnostic, assessment and treatment strategies available to physicians in the management of this clinically significant problem. Sleep disturbances in people with dementia and their carers (i) are highly prevalent; (ii) impact significantly on quality of life of both people with dementia and their carers; (iii) increase the rate of cognitive decline; and (iv) accelerate the breakdown of community-based care. The training of physicians in the assessment and treatment of sleep disturbances in dementia and caregiving is scant despite a wide range of assessment strategies and treatment approaches, which comprise both pharmacological (including hypnotic/sedative medications) and non-pharmacological approaches (including: environmental; psychobehavioral; exercise and activity; and multi-component interventions). Specific diagnostic criteria for sleep disturbances in people with dementia and their carers remain lacking despite established criteria for general insomnia. Further to this, proposed changes to diagnostic criteria for DSM-V do not include a specific focus for the diagnosis and management of sleep disturbances in people with dementia or their carers. This review suggests that the improved training of physicians to meet the needs of these vulnerable groups of older people is a priority, especially in the context of a rapidly increasing demand for accurate, early diagnosis and efficient management of sleep disturbance in these groups.

Physiotherapy for sleep disturbance in chronic low back pain: a feasibility randomised controlled trial

BackgroundSleep disturbance is becoming increasingly recognised as a clinically important symptom in people with chronic low back pain (CLBP, low back pain >12 weeks), associated with physical inactivity and depression. Current research and international clinical guidelines recommend people with CLBP assume a physically active role in their recovery to prevent chronicity, but the high prevalence of sleep disturbance in this population may be unknowingly limiting their ability to participate in exercise-based rehabilitation programmes and contributing to poor outcomes. There is currently no knowledge concerning the effectiveness of physiotherapy on sleep disturbance in people with chronic low back pain and no evidence of the feasibility of conducting randomized controlled trials that comprehensively evaluate sleep as an outcome measure in this population.Methods/DesignThis study will evaluate the feasibility of a randomised controlled trial (RCT), exploring the effects of three forms of physiotherapy (supervised general exercise programme, individualized walking programme and usual physiotherapy, which will serve as the control group) on sleep quality in people with chronic low back pain. A presenting sample of 60 consenting patients will be recruited in the physiotherapy department of Beaumont Hospital, Dublin, Ireland, and randomly allocated to one of the three groups in a concealed manner. The main outcomes will be sleep quality (self-report and objective measurement), and self-reported functional disability, pain, quality of life, fear avoidance, anxiety and depression, physical activity, and patient satisfaction. Outcome will be evaluated at baseline, 3 months and 6 months. Qualitative telephone interviews will be embedded in the research design to obtain feedback from a sample of participants' about their experiences of sleep monitoring, trial participation and interventions, and to inform the design of a fully powered future RCT. Planned analysis will explore trends in the data, effect sizes and clinically important effects (quantitative data), and thematic analysis (qualitative data).DiscussionThis study will evaluate the feasibility of a randomised controlled trial exploring the effects of three forms of physiotherapy (supervised general exercise programme, individualized walking programme and usual physiotherapy, which will serve as the control group) on sleep quality in people with chronic low back pain.Trial RegistrationCurrent controlled trial ISRCTN54009836

Brief CBT-I for Insomnia Comorbid with Social Phobia: A Case Study

Despite an obvious link between social anxiety and acute state of insomnia, chronic types of sleep disturbances in people with social phobia have so far received limited research/clinical attention. This case report aims to illustrate the possibility of rectifying sleep disturbances comorbid with social phobia, using a brief cognitive behaviour therapy for insomnia (CBT-I). Treatment involved five sessions of CBT-I provided individually on a weekly basis. Major treatment components included psychoeducation, sleep restriction therapy, stimulus control and cognitive restructuring. Treatment effects were assessed using sleep diary and questionnaires over the course of the treatment and at ~9 month follow-up. The results were encouraging with all targeted sleep parameters demonstrating improvements that met dual criteria for clinical significance. The gains were well maintained even at ~9 months after treatment. These improvements in sleep were accompanied by a reduction in sleep-related anxiety and dysfunctional beliefs and attitudes about sleep. Whilst the patient also reported a corresponding improvement in daytime functioning and general anxiety, no gains were observed in depression and social anxiety. These findings highlight the potential benefits of incorporating brief CBT-I into existing treatments for social phobia and encourage further research on the intricate relationship between sleep, mood and social anxiety.

Self-reported Sleep Disturbance of Patients With Heart Failure in Taiwan

Western research studies have found that sleep disturbances reduced quality of life and daily functioning of patients with heart failure; however, information about sleep disturbance is lacking in Taiwanese people with heart failure. The objective of this study was to investigate predictors of self-reported sleep disturbances in Taiwanese people with heart failure. The hypothesis was that health-related quality of life (HRQOL) could have significant effect on sleep disturbances, after controlling for demographics, heart failure characteristics, and health-related characteristics. A cross-sectional, descriptive, correlational design was used. A purposive sample of 125 participants was recruited from the outpatient departments of two hospitals located in southern Taiwan. Participants were interviewed individually to complete the Pittsburgh Sleep Quality Index, Kansas City Cardiomyopathy Questionnaire, Charlson Comorbidity Index, and Perceived Health Scale instruments. Self-reported sleep disturbances were prevalent (74%) among people with heart failure in Taiwan. Five predictors were identified using hierarchical multiple regression analyses with forward methods, accounting for 26.9% of variance in sleep disturbances. They were education, New York Heart Association functional classification, perceived health, HRQOL social functioning, and physical symptoms. After controlling for demographics, heart failure characteristics, and health-related characteristics, the analysis showed that two variables of HRQOL accounted for 9.8% of the variance in sleep disturbances. The importance of ongoing screening for sleep disturbances in people with heart failure is highlighted based on the study findings about the prevalence of sleep disturbances among the participants in this study. Healthcare providers must understand the often multifactorial nature of sleep disturbances to achieve a better and more effective management.

Sleep Disturbance in People With Heart Failure

Heart failure (HF) is associated with high levels of sleep disturbance and sleep disorders, including insomnia, periodic limb movements during sleep, and sleep disordered breathing. Recent studies underscore the importance of disturbances in sleep, a multidimensional biobehavioral phenomenon, to the pathophysiological processes associated with the development of HF, excess morbidity and mortality, and decrements in quality of life and functional performance. Managing disturbed sleep requires specific self-care strategies that must be incorporated into other self-care tasks associated with HF. Decrements in functioning associated with disturbed sleep may also have a negative impact on the self-care capacity and self-care behaviors of people with HF. The purposes of this article are to evaluate the state of the science relative to the nature of sleep disturbance experienced by people with HF and to discuss the implications of sleep, sleep disorders, and sleep-promoting interventions for self-care of people with HF.

Treating Central Sleep Apnea in Heart Failure

A recent enhanced appreciation of sleep–cardiovascular interactions, particularly in patients with congestive heart failure (CHF), has prompted careful consideration of the relevance of sleep-disordered breathing to CHF pathophysiology, progression, and treatment.1 Sleep-disordered breathing may be broadly classified as either obstructive sleep apnea (OSA) or central sleep apnea (CSA).1 The former is characterized by repetitive collapse of the upper airway, whereas in patients with CHF, the latter is most often due to periodic alternation of diminished ventilatory drive and compensatory hyperventilation typical of Cheyne-Stokes respiration (Figure 1). CSA is likely a consequence rather than a cause of CHF. Although the mechanisms that underlie CSA/Cheyne-Stokes respiration in patients with CHF are not well understood, pulmonary congestion with increased lung J-receptor stimulation and greater chemosensitivity may play a role in the genesis of the periodic breathing that characterizes this disorder.1,2 Figure 1. Ventilation during sleep from a patient with CHF and CSA. The ventilatory pattern is characteristic of Cheyne-Stokes respiration: apnea followed by crescendo-decrescendo breathing followed by apnea. The cycle may be repeated throughout sleep. Article p 3173 Of 5 million North Americans with CHF, an estimated 50% may have coexistent sleep apnea. Although the prevalence of OSA is much higher than CSA in the general population,3 it appears that this relationship may be reversed among patients with systolic heart failure. Case series have reported frequencies of CSA exceeding 40% for stable, ambulatory patients with CHF in a ratio >2:1 relative to the frequency of OSA. Indeed, the frequency of OSA in these same series was similar to that observed in the general population, whereas the frequency of CSA was strikingly higher.4,5 Furthermore, in patients with CHF, CSA has been associated with increased morbidity and mortality,5–7 increased neurohormonal activation,1 increased ventricular arrhythmia,8 decreased exercise capacity, …

Sleep disturbances and their management in patients with brain injury.

Sleep disturbances in people with brain injuries, although quite common, remain a problematic management issue for caregivers. This article will review the architecture of sleep, the assessment of insomnia, and discussion of common medications that may exacerbate the problem. Nonpharmacological management techniques, including stimulus control, sleep restriction, and relaxation therapy, will also be discussed. An intensive analysis of pharmacological agents used in treatment, including descriptions of the positive and negative effects of the various classes of drugs (e.g., sedative/hypnotics, antihistamines, dopamine agonists, and stimulants) will be provided. These discussions will hopefully assist in the decision-making processes of caregivers managing this unique group of persons with sleep difficulties.