Insomnia


Stanford Sleep Epidemio J, 2010, II, 1

NIGHTTIME AND DAYTIME CORRELATES OF DIFFICULTY MAINTAINING SLEEP VS DIFFICULTY FALLING ASLEEP IN A YOUNG ADULT SAMPLEPDF icon

Antonio Vela-Bueno, MD
Autonomous University
Madrid, Spain

  • The complaint of DIS is associated with the nighttime and daytime clinical characteristics of insufficient sleep and insomnia.
  • The complaint of DMS is associated with those of insomnia.
  • Key measures: Sleepiness; Fatigue; Napping; Sleep quality.

In the majority of cases, DIS could be explained by an "insufficient sleep model", in which the joint effect of a delayed sleep pattern and attending a morning college schedule might lead to DIS and short sleep duration (i.e. sleep debt) and the ensuing EDS (i.e. ESS scores, inability to concentrate, missing classes due to tiredness, napping). In some individuals, the complaint of DIS could be also explained by an "insomnia model". A model that was revealed by the correlates of DMS. The clear-cut presence of markers of hyperarousal (i.e. non-napping, fatigue, restlessness, negative affect, and reports of inadequate sleep quality vs.sleep quantity) suggest that this mechanism could be viewed as the main causative factor of the complaint of DMS and its daytime correlates.



Implications Of Habitual Snoring And Sleep Habits In ChildrenPDF icon

David Gozal, MD
University of Chicago
Chicago, IL, USA

Habitual snoring in children is a frequent condition that affects 10-12 % of non-obese, otherwise healthy children. In recent years, increased awareness to sleep apnea and changes in the frequency of obesity among pediatric populations has contributed to significant changes in the prevalence of habitual snoring and in its clinical presentation.

Several surveys have indicated that the total amount of reported sleep obtained by children is on the decline; however, the implications of such reductions in sleep duration have thus far received little attention.

This paper reviews some of the evidence linking habitual snoring to cognitive, behavioral, and cardiovascular morbidity. The potential associations between the home literacy environment and sleep hygiene of the child and learning abilities will also be reviewed.



On The Usefulness Of Polygraphic Recordings In The Diagnosis Of Insomnia

Christian Guilleminault, MD
Sleep Disorders Clinic
Stanford University

There has been questions on the usefulness of polygraphic recordings in the diagnosis of insomnia.

Everybody agrees that actigraphy is very useful as it can be performed for 10 to 15 days at home.. One night of polysomnography has also been recognized as useful. It has the advantage to indicate presence/absence of health problems inducing sleep disturbances and it simultaneously allows to calibrate the actigraph used at home: correlation between activity level during sleep on actigraphy and PSG renders the accuracy of actigraphy better.

Also it has been well demonstrated that "what wakes up someone is not what maintain some one up" Conditioning, even in sleep onset insomnia, is an important element, and has been related to health problems that may start as early as childhood, much before the insomnia complaint emerge. It is then important to establish the cause of the initial conditioning. Many studies have shown that it is currently impossible based on interviews and questionnaires to establish presence absence of PLM or upper airway resistance, or presence of some types of movement or mild pain syndromes, including GE reflux during sleep. PSG is thus critical in chronic insomnia to eliminate the possible causes of conditioning.

One night of PSG is useless to obtain information on such variables as sleep latency, total sleep time or % NREM or REM sleep, the first night effect is a well known handicap, but protocols with 3 successive night of recordings have been shown to bring valid information on these variables, pharmacological companies have known this fact for a long time and have requested such protocol in many of their hypnotic drugs studies.



Sleep Deprivation And Fragmentation Enhances PainPDF icon

Timothy Roehrs, PhD
Henry Ford Hospital
SDetroit, MI, USA

Sleep and pain are two vital functions that interact in complex ways to ultimately compromise the biological and behavioral capacity of the individual.

Disturbed sleep in acute and chronic pain conditions has been demonstrated. But, the reciprocal nature of the sleep-pain relation (i.e., how sleep disturbance enhances pain) and the mediators of this relation are just now be investigated.

This paper discuss research showing deprivation and fragmentation of sleep enhances pain, while treatments, both behavioral and pharmacological, that improve sleep also reduce pain.



Prevalence Of Chronic Sleep Complaints And Insomnia And Their Relationships To Medical Conditions In The VITAL Study Cohort Of 77,000 Older Adults

Michael V. Vitiello, PhD
Sleep Research Group
University of Washington

Study Objectives: Report the prevalence of sleep-related complaints and possible diagnosis of insomnia in association with age, gender, and medical conditions in a large cohort of community-dwelling adults.

Design: Cross-sectional mailed questionnaire. Setting: Western Washington State. Participants: 39,792 women and 36,868 men, aged 50-76 years. Measurements: Three nighttime and two daytime sleep problems occurring at least half the days of the past year. Study-defined chronic insomnia diagnosis required the presence of both a nighttime and daytime complaint.

Results: Overall, 51 percent of the cohort reported at least one nighttime complaint and 31% a daytime complaint. Significantly more women (24%) than men (18%) met criteria for chronic insomnia. Among both men and women, reports of daytime complaints declined significantly with increasing age compared to small increases in reports of nighttime complaints. Consequently, the prevalence of insomnia declined from 25% among those 50 to 54 years of age to 18% among those 65 to 76 years of age. Number of medical conditions was strongly associated with daytime complaints, moderately associated with nighttime complaints, and strongly with prevalence of insomnia (37% for those with 3 or more medical conditions vs. 10% for those with none).

Conclusions: This study affirms the strong association between prevalent insomnia and co-morbidity among aging adults. Medical burden was most strongly associated with daytime complaints, strongly with insomnia and less so with nighttime complaints. In contrast to prior studies, increasing age was associated with decreased prevalence of both daytime complaints and of insomnia.