Sleep Onset Insomnia Research Articles

한방병원에 내원한 소아청소년기 수면 장애 환자에 대한 임상적 연구

The subjects were composed of 308 children who visited the department of pediatrics, <TEX>${\bigcirc}{\bigcirc}$</TEX> korean medicine hospital from January 2010 to May 2013. Results 1. Among 308 patients, there were 188 boys and 120 girls; their ratio was 1.57:1. The age distribution showed that 38.3% were in the age less than 1 years, 38.0% in 1 years, 7.8% in 2 years, 5.2% in 3 years, 3.3% in 4~5 years, 4.5% in 6~10 years, 2.9% in 19~21 years. 2. It was found that 36.7% of the sleep disorder was caused without motivation, 17.2% caused by negligent accidents, 13.9% by traffic accidents, 10.4% by the unfamiliar environment, 8.1% by separation from parents, 7.5% after suffering disease, and 6.2% by irritating sound. 3. The sleep onset insomnia accounts for 17.2% of sleep disorder, sleep maintenance insomnia for 67.5%, poor sleep quality 24.4%, and daytime sleep disorder takes 19.8%. The ratio of sleep onset insomnia in adolescence comprises larger proportion (44.4%) than it of any other age groups. 4. The symptoms complicated with sleep disorder are the respiratory infection which takes 25.3%, being easily startled 18.2%, anorexia 14.6%, soft stools frequency 13.0%, greenish stools 10.7%, and skin rash 10.7%. Conclusions The causes of sleep disorders, changes of sleeping patterns, and complicated diseases show diversity in children and adolescence. Further study of sleep disorders in children and adolescence should be progressed as well.

Intensified Hypnic Jerks

To analyze the nature and propagation of muscle bursts in patients presenting with intensified hypnic jerks and sleep onset insomnia. We obtained polymyographic recordings from cranially and spinally innervated muscles during polysomnographic study in 10 subjects presenting with repeated jerking movements at sleep onset, anxiety and sleep onset insomnia. One subject also had daytime polymyography during relaxed wakefulness and drowsiness as well as back-averaging of the EEG preceding the muscle bursts. We observed 4 patterns of muscle propagation: synchronous and symmetrical patterned muscle bursts between the two sides and agonist-antagonist muscles similar to those noted in audiogenic startle reflex, reticular reflex myoclonus, dystonic myoclonus, and pyramidal myoclonus with rostrocaudal propagation of muscle bursts. Hypnic jerks are physiological phenomena which may be accentuated and repeated and may be of several physiological subtypes.

Sleep patterns and insomnia among adolescents: a population‐based study

The aim of the current study was to examine sleep patterns and rates of insomnia in a population-based study of adolescents aged 16-19 years. Gender differences in sleep patterns and insomnia, as well as a comparison of insomnia rates according to DSM-IV, DSM-V and quantitative criteria for insomnia (Behav. Res. Ther., 41, 2003, 427), were explored. We used a large population-based study in Hordaland county in Norway, conducted in 2012. The sample included 10,220 adolescents aged 16-18 years (54% girls). Self-reported sleep measurements included bedtime, rise time, time in bed, sleep duration, sleep efficiency, sleep onset latency, wake after sleep onset, rate and frequency and duration of difficulties initiating and maintaining sleep and rate and frequency of tiredness and sleepiness. The adolescents reported short sleep duration on weekdays (mean 6:25 hours), resulting in a sleep deficiency of about 2 h. A majority of the adolescents (65%) reported sleep onset latency exceeding 30 min. Girls reported longer sleep onset latency and a higher rate of insomnia than boys, while boys reported later bedtimes and a larger weekday-weekend discrepancy on several sleep parameters. Insomnia prevalence rates ranged from a total prevalence of 23.8 (DSM-IV criteria), 18.5 (DSM-V criteria) and 13.6% (quantitative criteria for insomnia). We conclude that short sleep duration, long sleep onset latency and insomnia were prevalent in adolescents. This warrants attention as a public health concern in this age group.

Improved Neurobehavioral Performance during the Wake Maintenance Zone

Although impairment of daytime functioning is a symptom of many sleep disorders, there are limited data on their nature for some patient groups. The role of the circadian system on impaired functioning, specifically the wake maintenance zone (WMZ)-a ∼3-h window of reduced sleep propensity that occurs shortly before the onset of melatonin synthesis-has received little attention. The study examined the influence of the WMZ on neurobehavioral performance under normal conditions and following sleep deprivation. Thirty-one adults (8 F; 18-29 y) completed an in-patient protocol including a baseline day (8-h sleep:16-h wake) and a ∼50-h constant routine (CR), including regular assessment of plasma melatonin and neurobehavioral performance (i.e., auditory and visual psychomotor vigilance tests [aPVT, vPVT], Digit Symbol Substitution Test [DSST], and subjective sleepiness). Performance in the 3 hours before the onset of melatonin secretion (i.e., the expected WMZ) was significantly improved compared to performance during a 3-hour block earlier in the biological day, despite a longer time awake. The improvement during WMZ was most prominent after extended wakefulness (i.e., day 2 of the CR). These results suggest that alignment of circa-dian phase with respect to sleep-wake timing may affect cognitive performance, particularly when homeostatic sleep pressure is high, and especially when performance is assessed in the evening, near the predicted WMZ. The potential contribution of the WMZ to sleep-onset insomnia complaints should be assessed further, using objective neurobehavioral testing and simultaneous circadian phase measurement.

Neuroflexibility and Sleep Onset Insomnia Among College Students: Implications for Neurotherapy

This study was designed to assess a neuroflexibility model of sleep onset insomnia among college students. Neuroflexibility refers to the ability to adjust cortical activation consistent with environmental demands. It was anticipated that good sleepers would demonstrate better feedback contingent alpha control, defined as the ability to both enhance alpha and suppress alpha, than poor sleepers. Ten good and 10 poor sleepers participated in two sessions of bidirectional alpha feedback. As predicted, good sleepers demonstrated better alpha control compared to poor sleepers, although this pattern was only partially replicated in a second session. This study provides a degree of empirical support for interventions designed to enhance neuroflexibility in the treatment of some people with sleep onset insomnia.

Probable rapid eye movement sleep behavior disorder, nocturnal disturbances and quality of life in patients with Parkinson’s disease: a case-controlled study using the rapid eye movement sleep behavior disorder screening questionnaire

BackgroundIncreasing evidence provides a clear association between rapid eye movement sleep behavior disorders (RBD) and Parkinson’s disease (PD), but the clinical features that determine the co-morbidity of RBD and PD are not yet fully understood.MethodsWe evaluated the characteristics of nocturnal disturbances and other motor and non-motor features related to RBD in patients with PD and the impact of RBD on their quality of life. Probable RBD (pRBD) was evaluated using the Japanese version of the RBD screening questionnaire (RBDSQ-J).ResultsA significantly higher frequency of pRBD was observed in PD patients than in the controls (RBDSQ-J ≥ 5 or ≥ 6: 29.0% vs. 8.6%; 17.2% vs. 2.2%, respectively). After excluding restless legs syndrome and snorers in the PD patients, the pRBD group (RBDSQ-J≥5) showed higher scores compared with the non-pRBD group on the Parkinson’s disease sleep scale-2 (PDSS-2) total and three-domain scores. Early morning dystonia was more frequent in the pRBD group. The Parkinson’s Disease Questionnaire (PDQ-39) domain scores for cognition and emotional well-being were higher in the patients with pRBD than in the patients without pRBD. There were no differences between these two groups with respect to the clinical subtype, disease severity or motor function. When using a cut-off of RBDSQ-J = 6, a similar trend was observed for the PDSS-2 and PDQ-39 scores. Patients with PD and pRBD had frequent sleep onset insomnia, distressing dreams and hallucinations. The stepwise linear regression analysis showed that the PDSS-2 domain “motor symptoms at night”, particularly the PDSS sub-item 6 “distressing dreams”, was the only predictor of RBDSQ-J in PD.ConclusionOur results indicate a significant impact of RBD co-morbidity on night-time disturbances and quality of life in PD, particularly on cognition and emotional well-being. RBDSQ may be a useful tool for not only screening RBD in PD patients but also predicting diffuse and complex clinical PD phenotypes associated with RBD, cognitive impairment and hallucinations.

Sleep and non-motor symptoms in Parkinson’s disease

Beyond the cardinal motor symptoms, bradykinesia, rigidity, tremor and postural instability, defining the diagnosis of Parkinson’s disease, there is a big spectrum of non-motor features that patients may suffer from and that may reduce their quality of life. Non-motor symptoms are not only frequent but also often under-reported by patients and caregivers. As they are frequently under-recognized by clinicians, they remain consequently under-treated. This review wants to give a short overview of the importance of non-motor symptoms on patients’ quality of life and helpful assessment tools that might facilitate recognition of non-motor features during clinical setting. Given the wide range of non-motor symptoms in Parkinson’s disease, we concentrate on common issues such as depression and sleep disorders like sleep-onset insomnia or sleep maintenance insomnia and restless legs syndrome. Thereby, we present some recent studies that have investigated the efficacy of dopaminergic drugs, especially dopamine agonists, revealing possible treatment strategies and thus improving disease management.

Sleep and circadian rhythm dysregulation in schizophrenia

Sleep-onset and maintenance insomnia is a common symptom in schizophrenic patients regardless of either their medication status (drug-naive or previously treated) or the phase of the clinical course (acute or chronic). Regarding sleep architecture, the majority of studies indicate that non-rapid eye movement (NREM), N3 sleep and REM sleep onset latency are reduced in schizophrenia, whereas REM sleep duration tends to remain unchanged. Many of these sleep disturbances in schizophrenia appear to be caused by abnormalities of the circadian system as indicated by misalignments of the endogenous circadian cycle and the sleep-wake cycle. Circadian disruption, sleep onset insomnia and difficulties in maintaining sleep in schizophrenic patients could be partly related to a presumed hyperactivity of the dopaminergic system and dysfunction of the GABAergic system, both associated with core features of schizophrenia and with signaling in sleep and wake promoting brain regions. Since multiple neurotransmitter systems within the CNS can be implicated in sleep disturbances in schizophrenia, the characterization of the neurotransmitter systems involved remains a challenging dilemma.

Anxiety and Its Related Factors at Bedtime Are Associated with Difficulty in Falling Asleep

Insomnia is a sleep disorder that is marked by difficulty in falling asleep, difficulty in maintaining sleep, and/or early morning awakening. Difficulty in falling asleep is particularly common in young adults, and sleep onset is affected by psychological factors. The purpose of the present study was to identify the physical and mental factors related to the subjective evaluation of falling asleep among Japanese university students. The participants were 366 students, including 197 (53.8%) females, with a mean age of 20.6 ± 1.7 years. The questionnaire battery mainly covered items about sleep onset, sleep quality, trait anxiety, and general mental state. Sleep onset was categorized as "easy to achieve" for 121 (33.1%) subjects, "difficult" for 38 (10.4%), and "intermediate" for 207 (56.6%). For example, "difficult" was defined as taking a longer time to fall asleep. The subjects with difficult sleep onset reported significantly higher awareness of the smell and noises in the bedroom, body sensations such as a heavy stomach feeling and frequent rolling over, mental agitation and excitement, unstable mental state, negative state, and strain. The subjects with difficult sleep onset also showed less sleep comfort and less recovery from fatigue. A multinominal logistic regression analysis revealed that each of body sensation, sleep comfort, unstable mental state, and fatigue influenced whether an individual had the difficult type. Anxiety-related factors at bedtime, in particular, may delay the sleep onset. The results of the present study indicate that many university students may be at risk of sleep-onset insomnia.

1A1-N07 個人適合した刺激による入眠促進手法に関する基礎検討(インテリジェント・ロボティクス・スペース(IT,RTとETの融合))

In modern society, insomnia which is the lack of sleep is becoming a serious problem. In this paper, sleep-promoting robot is proposed as an aid to sleep-onset insomnia which is one of the most typical insomnia. The basic concept of the robot is to shorten the sleep-onset time by giving the personal adapted stimulation effective in relaxing. Now, as one of the fundamental researches, we inspected the availability of personal adaption in sleep experiment. As a result, it was uncertain whether subjects were sleep-promoted. One of the main reason was that the target condition differed drastically. Therefore an appropriate evaluation with fixed target condition should be regained in the future work.

Can a community pharmacy sleep assessment tool aid the identification of patients at risk of sleep disorders in the community: a pilot study

Background: When experiencing sleep problems for the first time, consumers may often approach community pharmacists for advice as they are easily accessible health care professionals in the community. In Australian community pharmacies there are no specific tools available for use by pharmacists to assist with the assessment and handling of consumers with sleep enquiries. Objective: To assess the feasibility of improving the detection of sleep disorders within the community through the pilot of a newly developed Community Pharmacy Sleep Assessment Tool (COP-SAT). Method: The COP-SAT was designed to incorporate elements from a number of existing, standardized, and validated clinical screening measures. The COP-SAT was trialed in four Australian community pharmacies over a 4-week period. Key findings: A total of 241 community pharmacy consumers were assessed using the COP-SAT. A total of 74 (30.7%) were assessed as being at risk of insomnia, 26 (10.7%) were at risk of daytime sleepiness, 19 (7.9%) were at risk of obstructive sleep apnea, and 121 (50.2%) were regular snorers. A total of 116 (48.1%) participants indicated that they consume caffeine before bedtime, of which 55 (47%) had associated symptoms of sleep onset insomnia. Moreover, 85 (35%) consumed alcohol before bedtime, of which 50 (58%) experienced fragmented sleep, 50 (58%) were regular snorers, and nine (10.6%) had apnea symptoms. The COP-SAT was feasible in the community pharmacy setting. The prevalence of sleep disorders in the sampled population was high, but generally consistent with previous studies on the general population. Conclusion: A large proportion of participants reported sleep disorder symptoms, and a link was found between the consumption of alcohol and caffeine substances at bedtime and associated symptoms. While larger studies are needed to assess the clinical properties of the tool, the results of this feasibility study have demonstrated that the COP-SAT may be a practical tool for the identification of patients at risk of developing sleep disorders in the community.

Gabapentin Shows Promise in Treating Refractory Insomnia in Children

Insomnia is prevalent in pediatrics, particularly in those with neurodevelopmental disorders. Gabapentin has shown promise in treating insomnia in adults. The purpose of our study was to review our experience with using gabapentin to treat insomnia in children. We identified 23 children, seen by the authors in our Pediatric Sleep Clinic from January 2009 to March 2012. The mean age was 7.2 years and 70% were male. The majority (87%) had been given diagnoses of neurodevelopmental or neuropsychiatric disorders. All parents received education in sleep behavioral interventions. The majority of children (70%) had both sleep-onset and sleep maintenance insomnia. The average starting dose of gabapentin was 5 mg/kg every bedtime and the maximal dose was 15 mg/kg every bedtime. At follow-up, improved sleep was noted in 78% of children. Adverse effects were noted in 6 children.

A More Creative Version of Counting Sheep to Get to Sleep

Sleep-onset insomnia continues to be a widespread problem. Cognitive-behavioral approaches such as stimulus control therapy and more recently developed

Does exercise improve self-reported sleep quality in non-remitted major depressive disorder?

Sleep disturbances are persistent residual symptoms following remission of major depressive disorder (MDD) and are associated with an increased risk of MDD recurrence. The purpose of the current study was to examine the effect of exercise augmentation on self-reported sleep quality in participants with non-remitted MDD. Method Participants were randomized to receive selective serotonin reuptake inhibitor (SSRI) augmentation with one of two doses of exercise: 16 kilocalories per kilogram of body weight per week (KKW) or 4 KKW for 12 weeks. Depressive symptoms were assessed using the clinician-rated Inventory of Depressive Symptomatology (IDS-C). The four sleep-related items on the IDS-C (Sleep Onset Insomnia, Mid-Nocturnal Insomnia, Early Morning Insomnia, and Hypersomnia) were used to assess self-reported sleep quality. Significant decreases in total insomnia (p < 0.0001) were observed, along with decreases in sleep onset, mid-nocturnal and early-morning insomnia (p's <0.002). Hypersomnia did not change significantly (p = 0.38). Changes in total, mid-nocturnal and early-morning insomnia were independent of changes in depressive symptoms. Higher baseline hypersomnia predicted a greater decrease in depression severity following exercise treatment (p = 0.0057). No significant moderating effect of any baseline sleep on change in depression severity was observed. There were no significant differences between exercise treatment groups on total insomnia or any individual sleep item. Exercise augmentation resulted in improvements in self-reported sleep quality in patients with non-remitted MDD. Given the prevalence of insomnia as a residual symptom following MDD treatment and the associated risk of MDD recurrence, exercise augmentation may have an important role in the treatment of MDD.

Several Strategies Fight Insomnia in Mood-Disorder Patients

Sleep medicine experts are enthusiastic about a variation of cognitive-behavioral therapy and advances in light technology as they seek better insomnia treatments.

Sleep-Related Arousal Versus General Cognitive Arousal in Primary Insomnia

The present study aimed at further investigating trait aspects of sleep-related cognitive arousal and general cognitive arousal and their association with both objective and subjective sleep parameters in primary insomnia patients. A clinical sample of 182 primary insomnia patients and 54 healthy controls was investigated using 2 nights of polysomnography, subjective sleep variables, and a questionnaire on sleep-related and general cognitive arousal. Compared to healthy controls, primary insomnia patients showed both more sleep-related and general cognitive arousal. Furthermore, sleep-related cognitive arousal was closely associated with measures of sleep-onset and sleep-maintenance problems, while general cognitive arousal was not. Cognitive-behavioral treatment for insomnia might benefit from dedicating more effort to psychological interventions that are able to reduce sleep-related cognitive arousal.

Methylphenidate Modifies the Motion of the Circadian Clock

People with attention-deficit/hyperactivity disorder (ADHD) often experience sleep problems, and these are frequently exacerbated by the methylphenidate they take to manage their ADHD symptoms. Many of the changes to sleep are consistent with a change in the underlying circadian clock. The present study was designed to determine if methylphenidate alone could alter properties of the circadian clock. Young male mice were examined in light-dark cycles and in constant darkness and recordings were performed on behavioral activity, sleep, and electrical activity in the suprachiasmatic nucleus (SCN) of freely moving mice. Methylphenidate in the drinking water (0.08%) significantly increased activity in the mid-to-late night, and led to a delay in the onset of activity and sleep relative to the light-dark cycle. While locomotor levels returned to baseline after treatment ended, the phase angle of entrainment required at least a week to return to baseline levels. In constant darkness, the free-running period of both wheel-running and general locomotor rhythms was lengthened by methylphenidate. When the treatment ended, the free-running period either remained stable or only partially reverted to baseline levels. Methylphenidate also altered the electrical firing rate rhythms in the SCN. It induced a delay in the trough of the rhythm, an increment in rhythm amplitude, and a reduction in rhythm variability. These observations suggest that methylphenidate alters the underlying circadian clock. The observed changes are consistent with clock alterations that would promote sleep-onset insomnia.

Reduced Cerebral Perfusion of Putamen and Insular Cortex in Patients with Idiopathic Restless Leg Syndrome

Address for correspondence Seung Bong Hong, MD, PhD Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: +82-2-3410-3592 Fax: +82-2-3410-0052 E-mail: sbhong@skku.edu Objectives: To evaluate the cerebral perfusion pattern of idiopathic restless leg syndrome (RLS). Methods: We performed Tc-ethyl cysteinate dimer brain single-photon emission computed tomography (SPECT) in 36 drug-naive patients with RLS patients and 30 age-and gender matched normal cotrols during wakefulness. Their SPECT images underwent statistical parametric mapping analysis. Results: Mean age of patients and normal controls was 48.3 years and 80% of them were women. Most patients reported the sleep onset and maintenance insomnia due to RLS symtoms. Average duration of RLS was 10.5 years. Mean score of international RLS was 26.6, suggesting moderate to severe severity. They did not report daytime sleepiness (mean Epworth sleepiness scale, 7.0). All subjects underwent polysomnography, showing no definite obstructive sleep apnea syndrome. Seventeen of them (56.6%) had periodic leg movement during sleep (PLMS). Sleep quality was more deteriorated in patients than that in normal controls (increased sleep latency and arousal index, which resulted in reduced sleep efficiency). In RLS pateints, cerebral blood flow was decreased in the right putamen and insular cortex compared to normal controls (uncorrected p<0.005). There was no brain region showing increased cerebral perfusion in patients. Regional cerebral perfusion was not correlated to any sleep parameter including PLMS index or movement arousal index. Conclusions: Reduced cerebral perfusion in putamen and insular cortex in RLS suggested functional abnormalities in motor circuit and sensori-motor modulation, which may be related to pathophysiology of idiopathic RLS. J Korean Sleep Res Soc 2012;9:10-14

Controlled‐release melatonin, singly and combined with cognitive behavioural therapy, for persistent insomnia in children with autism spectrum disorders: a randomized placebo‐controlled trial

Although melatonin and cognitive-behavioural therapy have shown efficacy in treating sleep disorders in children with autism spectrum disorders, little is known about their relative or combined efficacy. One hundred and sixty children with autism spectrum disorders, aged 4-10 years, suffering from sleep onset insomnia and impaired sleep maintenance, were assigned randomly to either (1) combination of controlled-release melatonin and cognitive-behavioural therapy; (2) controlled-release melatonin; (3) four sessions of cognitive-behavioural therapy; or (4) placebo drug treatment condition for 12 weeks in a 1 : 1 : 1 : 1 ratio. Children were studied at baseline and after 12 weeks of treatment. Treatment response was assessed with 1-week actigraphic monitoring, sleep diary and sleep questionnaire. Main outcome measures, derived actigraphically, were sleep latency, total sleep time, wake after sleep onset and number of awakenings. The active treatment groups all resulted in improvements across all outcome measures, with moderate-to-large effect sizes from baseline to a 12-week assessment. Melatonin treatment was mainly effective in reducing insomnia symptoms, while cognitive-behavioural therapy had a light positive impact mainly on sleep latency, suggesting that some behavioural aspects might play a role in determining initial insomnia. The combination treatment group showed a trend to outperform other active treatment groups, with fewer dropouts and a greater proportion of treatment responders achieving clinically significant changes (63.38% normative sleep efficiency criterion of >85% and 84.62%, sleep onset latency <30 min). This study demonstrates that adding behavioural intervention to melatonin treatment seems to result in a better treatment response, at least in the short term.

Place des thérapies comportementales dans la prise en charge des insomnies

Insomnia is among the most common health complaints in medical practice and the most prevalent of all sleep disorders. Generally, hypnotics and sedative drugs are widespread used, despite new knowledge in medical literature. Chronic insomnia can be a symptom, a syndrome and co morbid disorder. Its diagnostic relies on subjective reports from patient and sleep diary. Different subtypes of insomnia are defined: prolonged sleep latency (sleep onset insomnia), difficulties in maintaining sleep (sleep maintenance insomnia), early insomnia or a mix of different sleep complaints (mixed insomnia). Beside nights complaints, diurnal consequences are reported, include fatigue, mood disruption impaired attention… First, identification and treatment of primary psychiatric disorders or medical conditions or specific sleep disorders (apnea syndrome or periodic limb movement) are essential and associated with sleep hygiene (therapeutic education). If this first step is not sufficient, behavioral therapy (BT) (stimulus control and sleep restriction) or cognitive-behavioral therapy (CBT) of insomnia have demonstrated considerable efficacy within randomized clinical trials. Other techniques exist: relaxation, biofeedback… But CBT or BT is gold standard. Nevertheless, treatment of insomnia is an individual course of care.