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Normal Sleep
Published in Ravi Gupta, S. R. Pandi Perumal, Ahmed S. BaHammam, Clinical Atlas of Polysomnography, 2018
Ravi Gupta, S. R. Pandi Perumal, Ahmed S. BaHammam
To fall asleep, it is important that both the homeostatic and circadian processes are in the same phase. If they are not synchronized, then we may feel difficulty in falling asleep or staying awake. Such a condition leads to the generation of circadian rhythm sleep disorders (Figure 1.3).
Botanicals and Dietary Supplements
Published in Hilary McClafferty, Integrative Pediatrics, 2017
The best evidence to date for melatonin use in children is in insomnia caused by circadian rhythm sleep disorders. Other conditions such as poor sleep hygiene, depression, anxiety, or other mental health or social issues should not be treated with melatonin as a primary agent. Lack of clear evidence regarding efficacy, dose, and long-term safety remains a relevant concern. Theoretical risk of hypothalamic-gonadal axis suppression and delayed puberty exists, although this was not shown in a follow-up study of 57 Dutch adolescents who had used melatonin for a mean of 3 years (range 1–4.6 years) at a mean dose of 2.69 mg (0.3–10 mg). Recurring headache was reported in 38% of this study population as a primary adverse effect (van Geijlswijk et al. 2011).
Fatigue and Sleep Disturbance following TBI
Published in Tom M. McMillan, Rodger Ll. Wood, Neurobehavioural Disability and Social Handicap following Traumatic Brain Injury, 2017
Similar to fatigue, the aetiology of sleep disturbances following TBI has not been established and is likely multi-factorial. Injury to brain regions, pathways, and neurotransmitter systems associated with sleep regulation, including the suprachiasmatic nucleus, hypothalamus, midbrain and ascending reticular activating system may occur (Baumann et al., 2009). Circadian Rhythm Sleep Disorders and delayed circadian timing have been reported in patients with mild TBI and insomnia (Ayalon, Borodkin, Dishon, Kanety & Dagan, 2007). The timing of sleep is regulated by the circadian (~24-h) pacemaker in the hypothalamic suprachiasmatic nuclei, which generate and maintain circadian rhythms, including pineal melatonin synthesis. Melatonin plays a role in the circadian regulation of sleep-wakefulness. Shekleton et al. (2010) found lower levels of evening melatonin production in individuals with TBI, associated with REM sleep, but not sleep efficiency or night-time awakenings. This finding suggests the circadian regulation of melatonin synthesis may be disrupted following TBI.
Actigraphic and melatonin alignment in older adults with varying dementia risk
Published in Chronobiology International, 2023
Zoe Menczel Schrire, Christopher J Gordon, Jake R Palmer, Jade Murray, Ian Hickie, Naomi L. Rogers, Simon JG Lewis, Zoe Terpening, Jonathon E Pye, Sharon L Naismith, Camilla M Hoyos
While previous findings on the relationship between habitual sleep onset and DLMO are diverse and demonstrate considerable individual variability (Sletten et al. 2010; Wright et al. 2005), the current study provides evidence for the relationship in a sample of older adults with varying risks of dementia. Sleep onset has been shown to be associated with DLMO in young people with a sleep schedule minimally influenced by employment, school and family obligations (Burgess and Eastman 2005; Crowley et al. 2006; Martin and Eastman 2002) and on work-free days in adults in a rural town in Brazil (Ruiz et al. 2020). This association has also been demonstrated in individuals with possible sleep-wake rhythm disorders (Keijzer et al. 2011) and insomnia (Wright et al. 2006). In contrast, desired sleep time and DLMO have been shown to be unrelated to shift workers (Cheng et al. 2020), and one study recommended that the timing of the ingestion of exogenous melatonin for the treatment of circadian rhythm sleep disorders be timed according to DLMO, not habitual sleep onset (Keijzer et al. 2014). Thus, the association between DLMO and sleep time is complex and has been shown to differ between populations. As sleep onset is significantly easier to capture than DLMO time, this relationship could help identify individuals at risk of circadian misalignment who could then be referred on to a DLMO assessment. Based on this assessment, circadian treatment options to reduce dementia risk will be able to be tailored to the individual for optimal efficacy.
Sleep complaints in former and current night shift workers: findings from two cross-sectional studies in Austria
Published in Chronobiology International, 2021
Jakob Weitzer, Isabel Santonja, Jürgen Degenfellner, Lin Yang, Galateja Jordakieva, Richard Crevenna, Stefan Seidel, Gerhard Klösch, Eva Schernhammer, Kyriaki Papantoniou
Chronic insomnia was defined by four criteria, established by the International Classification of Sleep Disorders, 3rd edition (Sateia 2014): 1. Report of difficulty initiating sleep and/or difficulty maintaining sleep and/or waking up earlier than desired without being able to fall back to sleep. 2. Sleep disturbance and associated daytime symptoms (of sleepiness) occurring at least three times/week. 3. Symptoms have been present for at least 3 months. 4. Report of daytime impairment related to nighttime sleep difficulties. Chronic insomnia was present if all four criteria applied (Weitzer et al. 2020). Doctor-diagnosed sleep disorder was defined as a self-report of having been diagnosed with chronic insomnia or a circadian rhythm sleep disorder by a physician. Other diagnoses of sleep problems, for example, sleep apnea, movement disorders, hypersomnia, and parasomnia, were excluded from the case definition in the main analysis. In sensitivity analysis, these diagnoses of other sleep disorders were also excluded from the analysis. Having ever asked for medical help or for treatment for a sleep problem [Yes; No] was also reported. Subjective sleepiness was assessed using the Karolinska Sleepiness Scale (KSS) (Åkerstedt et al. 2014). Participants were classified as sleepy (score ≥7) or alert (score <7). Average sleep duration was calculated based on self-reported sleep duration on workdays and days off. [Average sleep duration = (Sleep duration on workdays*5) + (Sleep duration on days off*2)/7.]
Polysomnographic and psychometric correlates of napping in primary insomnia patients
Published in Nordic Journal of Psychiatry, 2020
Marianna Mazza, Leonardo Lapenta, Anna Losurdo, Giuseppe Marano, Elisa Testani, Luigi Janiri, Salvatore Mazza, Giacomo Della Marca
Definition of nap is a short sleep episode that may be intentionally or unintentionally taken during the major episode of habitual wakefulness. Napping is a widely prevalent phenomenon with transcultural and age-related differences in healthy people. Although it is considered a normal daily routine for babies and young children, the frequency of napping has consistently been reported to increase with advancing age (prevalence of 10% among people aged 55–64 and up to 25% among those75–84 years of age) [6]. Together with older age and a strong association with excessive daytime sleepiness, it has been noticed that factors that independently increase prevalence of napping are depression, bodily pain, and nocturia [6]. Napping in the elderly is positively associated with obsessive-compulsive symptoms and with the symptom of not feeling rested in the morning, so it can be considered partly related to personality characteristics and partly a consequence of night sleep disturbance in this population [7]. With respect to circadian rhythm sleep disorders, in particular the intrinsic types, little attention has been paid to naps and their roles in the context of these sleep complaints, especially with objective measures; moreover, existing studies have mainly been focused on specific populations such as older adults or midlife women [8]. Despite the strong connection between napping and nocturnal sleep [1], apart from narcolepsy, previous works have not determined whether naps could be a therapeutic option for particular sleep disorders.