The Neuropharmacology of Sleep Disorders: Better Sleeping Through Chemistry?

2007 ◽  
Vol 20 (2) ◽  
pp. 181-191 ◽  
Author(s):  
Jeremiah Suhl
Keyword(s):  
Sleep Disorders ◽  
Restless Legs Syndrome ◽  
Daytime Sleepiness ◽  
Gaba Receptors ◽  
Behavioral Therapy ◽  
Brain Structures ◽  
Melatonin Receptors ◽  
Restless Legs ◽  
Hygiene Measures ◽  
Idiopathic Hypersomnia

Sleep and wake states involve interaction among many brain centers via multiple neurotransmitters, including dopamine, norepinephrine, hypocretin, acetylcholine, histamine and serotonin (wake promoting), and γ amino butyric acid (GABA) and melatonin (sleep promoting). Most medications for insomnia or hypersomnia act on elements of these neural systems. Initial treatment of insomnia includes sleep hygiene measures. Cognitive-behavioral therapy for insomnia is useful. Medications approved by the Food and Drug Administration for insomnia act on GABA receptors or on melatonin receptors. A frequent cause of insomnia is restless legs syndrome, which is linked to reduced dopaminergic activity in brain structures; idiopathic restless legs syndrome is best treated with dopamine agonists such as ropinerole or pramipexole. Excessive daytime sleepiness is most often due to insufficient sleep hours or sleep apnea but is also caused by medications, illnesses, narcolepsy, or idiopathic hypersomnia. Stimulants generally act through enhanced dopamine action (amphetamines, methylphenidate) or acetylcholine action (caffeine). Modafinil may act through enhanced central histamine, hypocretin, and possibly dopamine action. A newer agent, γ -hydroxybutyrate (GHB), acts on GABA and GHB receptors to consolidate sleep, improving daytime sleepiness in narcolepsy. Improving knowledge of sleep/wake mechanisms should lead to more specific and rational treatments for sleep disorders.

Sleep habits and their association with daytime sleepiness among medical students of Tanta University, Egypt

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Salwa A. Atlam ◽  
Hala M. Elsabagh
Keyword(s):  
Medical Students ◽  
Sleep Disorders ◽  
Sleep Duration ◽  
Daytime Sleepiness ◽  
Sleep Habits ◽  
Restless Legs ◽  
Sleeping Pills ◽  
Life Pattern ◽  
Waking Up ◽  
Malaysian Students

AbstractObjectivesThis study aimed to assess the sleep quality (habits and disorders) and the daytime sleepiness among medical students.MethodsA cross-sectional questionnaire-based study was conducted during September 2018, through November 2018 at the Faculty of Medicine, Tanta University, Egypt. The study recruited undergraduate Egyptian and Malaysian students and applied a modified form of two questionnaires, namely the Sleep Habits and Life Style and the Epworth Sleepiness Scale (ESS)”. Statistical analysis was done using SPSS. The results were expressed as frequency, percentage, and mean ± standard deviation (SD). Chi-square test was used to explore associations between categorical variables. An independent sample t-test was used to detect the mean differences between groups. Ordinal regression analyses were done on the ESS findings in relation to demographics and sleep habits. p-values<0.05 were accepted as statistically significant.ResultsThe study included 899 medical students. Most of the participants were Egyptians (67%), rural residents (57.4%), and in the preclinical stage (79.5%). Males represented 66.0% of the study participants and participants average age (SD) was 21.98 (1.13) years. The average durations (SD) of night sleep were 7.3 (1.6) hours in work days and 8.7 (2.1) hours during the weekends. Both were significantly longer among young (<21 years-old) and preclinical students (p<0.05). Students had on average (SD) 1.33 (0.29) hours duration of napping, but 60% of the participants never or rarely scheduled for napping. Larger proportion of male and Malaysian students sometimes scheduled for napping more significantly than their peers (p<0.05). Only 16.24% of students reported that the cause of daytime napping was no enough sleep at night. The students reported sleep disorders of insomnia in the form of waking up too early, trouble falling asleep, or waking up at night with failure to re-sleep (31, 30, and 26%, respectively). Snoring (22.2%) and restless legs (22.0%) were also reported by the students. High chances of dozing off was reported by 22.02% of the participants, of which 10% used sleeping pills, 41.4% suffered psychological affection, and 34.8% reported life pattern affection. We found an increased chance of daytime sleepiness among males (0.430 times) and Egyptian (2.018 times) students. There was a decreased chance of daytime sleepiness in students from rural areas and those below 21-years-old (0.262 and 0.343 times, respectively). Absence of chronic diseases suffering was significantly associated with 5.573 more chance of daytime sleepiness or dozing off. In addition, enough and average sleep at night significantly decreased the chance of daytime sleepiness by 6.292 and 6.578, respectively, whereas daytime consumption of caffeinated beverages significantly decreased the chance of daytime sleepiness by 0.341.ConclusionThere was unbalanced sleep duration in work days and weekends as well as lack of scheduling for napping among the students. Sleep disorders as insomnia, snoring, and restless legs were associated with excessive daytime sleepiness. Some students who suffered daytime sleepiness also underwent psychological and life pattern affection including taking sleeping pills. Enough and average sleep duration at night as well as daytime consumption of caffeinated beverages decreased the chance of daytime sleepiness.

Restless leg syndrome in adult patients with β-thalassemia major

2021 ◽  
Vol 74 (7-8) ◽  
pp. 266-272
Author(s):  
Ramazan Erdem ◽  
Nazan Şimşek Erdem ◽  
Erdal Kurtoğlu
Keyword(s):  
Sleep Quality ◽  
Restless Legs Syndrome ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Thalassemia Major ◽  
Adult Patients ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Restless Legs

To investigate the quality of sleep and the presence of Restless Legs Syndrome (RLS) in the Turkish population with β-thalassemia major (TM). The second aim was to assess the risk factors of RLS in TM adults. The study sample comprised of 121 patients at least 18 years old with TM. The patients’ socio-demographic information, body mass indexes (BMI), current medications, laboratory data were recorded. The patients were asked if they had a history of chronic kidney disease, diabetes mellitus (DM), and polyneuropathy. Restless legs syndrome was diagnosed according to the International Restless Legs Syndrome Study Group criteria. The sleep quality of the patients was assessed using the Pittsburgh Sleep Quality Index (PSQI) scale. The Epworth Sleepiness Scale (ESS) was used to assess excessive daytime sleepiness in the patients. The median age of the patients was 25 years (range 18-52). The mean BMI was 21.49±2.5 (R 14-26.5) for all patients. The prevalence of RLS was 5% in TM adult patients. The TM patients with RLS had no major complications of TM. The median PSQI global score of all patients was 3. Twenty-two (18.1%) patients had poor sleep quality. The reason for poor sleep quality was RLS symptoms in four patients (18%). There was no significant association between PSQI total score and blood parameters of the patients. Twelve (9.9%) patients had ESS scores greater than 10, which indicates excessive daytime sleepiness. The prevalence of RLS in TM patients was similar to that of the general Turkish adult population. These results indicate that RLS may occur in patients with TM, although they had a high level of serum ferritin.

The effectiveness of short-term cognitive behavioral therapy in the complex treatment of idiopathic restless legs syndrome with chronic insomnia

2021 ◽  
Vol LIII (2) ◽  
pp. 46-56
Author(s):  
Aleksey I. Melekhin
Keyword(s):  
Restless Legs Syndrome ◽  
Behavioral Therapy ◽  
Well Being ◽  
Sleep Hygiene ◽  
Cognitive Behavioral ◽  
Chronic Insomnia ◽  
Short Term ◽  
Restless Legs ◽  
Mental Well Being

Aim. To investigate the effectiveness of the short-term protocol of cognitive behavioral therapy RELEGS M. Hornyak et al. in complex treatment to improve the quality of sleep, reduce the symptoms of depression, anxiety, suicidal thoughts in patients with primary SBN comorbid with chronic insomnia. Methods. Study participants: 68 patients with primary restless legs syndrome with comorbid chronic insomnia. Women 56 (average age 52.110.3 years), men 12 (average age 50.39.4 years). The severity of restless legs syndrome is moderate to severe. The average age of the onset of the disease is 1848 years, the duration of the course of the disease is on average 1415 years. Taking various medications for the management of SBN for an average of 45 years. Study design: a randomized controlled trial, after screening 26 patients were assigned to the main group, underwent combined treatment, took a prolonged form of Pramipexole (Mirapex-PD, 1.5 mg.) and underwent the RELEGS CBT protocol (Restless Legs Skills program, Hornyak, Grossmann, 2018), which integrates the cognitive behavioral insomnia protocol (Morin, 2007) and Mindfulness-Based Stress therapy (Mindfulness-Based Stress Reduction, Bablas, 2016). The control group consisted of 24 people who received only general recommendations on sleep hygiene once. Both groups were treated with dopaminergic agonists under the supervision of a neurologist. Research methods: IRLS, ISI, DBAS-16, sleep diary analysis, actigraphy, BDI, SBQ-R, BAI. Results. The use of the CBT protocol in combination therapy with prolonged-acting dopaminergic agonists in patients with primary restless leg syndrome (mild and moderate severity) with comorbid chronic insomnia, in contrast to simple one-time general recommendations on sleep hygiene, is more effective for reducing dysfunctional behaviors, the spectrum of reinsurance and avoidance behavior both in relation to sleep and symptoms of restless legs. In patients with primary restless legs syndrome who underwent CBT, greater mental well-being was observed, which was expressed in a decrease in the severity of symptoms of insomnia, anxiety, and suicidal behavior after completion and persisted after 3 months of follow-up. Conclusion. As part of a personalized comprehensive approach, along with a drug-based approach and general recommendations for sleep hygiene, the use of short-term CBT (4 sessions, 60 minutes each) can significantly improve mental well-being, improve the quality of sleep of patients with restless legs syndrome with comorbid chronic insomnia.

scholarly journals The prevalence of common sleep disorders in young adults: a descriptive population-based study

SLEEP ◽  
2020 ◽  
Vol 43 (10) ◽  
Author(s):  
Nigel McArdle ◽  
Sarah V Ward ◽  
Romola S Bucks ◽  
Kathleen Maddison ◽  
Anne Smith ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Young Adults ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Restless Legs Syndrome ◽  
Survey Methods ◽  
Apnea Hypopnea Index ◽  
Restless Legs ◽  
Obstructive Sleep

Abstract Sleep disorders in adults are associated with adverse health effects including reduced quality of life and increased mortality. However, there is little information on sleep disorders in young adults. A cross-sectional observational study was undertaken in 1,227 young adults participating in the Western Australian Pregnancy (Raine) Study (2012–2014) to describe the prevalence of common sleep disorders. In-laboratory polysomnography (PSG) and validated survey methods were used, including the Epworth Sleepiness Scale, Pittsburgh Sleep Symptom Questionnaire-Insomnia, and International Restless Legs Syndrome Study Group criteria. A total of 1,146 participants completed a core questionnaire, 1,051 completed a sleep-focused questionnaire and 935 had analyzable PSG data. Participants had a mean age of 22.2 years and female to male ratio of 1.1 to 1. The respective sleep disorder prevalences in females and males were: obstructive sleep apnea (OSA) (apnea-hypopnea index [AHI]: ≥5 events/hour) 14.9% (95% CI: 11.8–18.5) and 26.9% (95% CI: 22.9–31.2); chronic insomnia, 19.3% (95% CI: 16.7–23.9) and 10.6% (95% CI: 8.3–13.9); restless legs syndrome, 3.8% (95% CI: 2.4–5.6) and 1.9% (95% CI: 0.9–3.4); and abnormal periodic leg movements during sleep (&gt;5 movements/hour), 8.6% (95% CI: 6.3–11.5) and 9.6% (95% CI: 7.1–12.7). There were statistically significant differences in prevalence between sexes for OSA and insomnia, which persisted after adjustment for body mass index and education. In those with complete data on all sleep-related assessments (n = 836), at least one sleep disorder was present in 41.0% of females and 42.3% of males. Sleep disorders are very common in young adults. Health practitioners should be aware of these high prevalences, as early identification and treatment can improve quality of life and may reduce later morbidity and mortality.

scholarly journals Lack of Association Between Shape and Volume of Subcortical Brain Structures and Restless Legs Syndrome

2018 ◽  
Vol 9 ◽  
Author(s):  
Marco Hermesdorf ◽  
Benedikt Sundermann ◽  
Rajesh Rawal ◽  
András Szentkirályi ◽  
Udo Dannlowski ◽  
...  
Keyword(s):  
Restless Legs Syndrome ◽  
Brain Structures ◽  
Restless Legs ◽  
Subcortical Brain ◽  
Subcortical Brain Structures

363: Insomnia and Daytime Sleepiness: Risk Attributable to Restless Legs Syndrome, BMI, Smoking, and Alcohol Among VA Outpatients

2005 ◽  
Vol 161 (Supplement_1) ◽  
pp. S91-S91
Author(s):  
C C Bourguet ◽  
R P Steiner ◽  
S K Ober ◽  
K R Baughman ◽  
H D Shapiro
Keyword(s):  
Restless Legs Syndrome ◽  
Daytime Sleepiness ◽  
Restless Legs

scholarly journals Sleep disorders: A review of the interface between restless legs syndrome and iron metabolism

Sleep Science ◽  
2014 ◽  
Vol 7 (4) ◽  
pp. 234-237 ◽  
Author(s):  
Paulo Daubian-Nosé ◽  
Miriam K. Frank ◽  
Andrea Maculano Esteves
Keyword(s):  
Sleep Disorders ◽  
Iron Metabolism ◽  
Restless Legs Syndrome ◽  
Restless Legs

scholarly journals SLEEP IN CHILDREN: FROM PHYSIOLOGY TO PATHOLOGY

2017 ◽  
pp. 97-102
Author(s):  
M. G. POLUEKTOV ◽  
P. V. PCHELINA
Keyword(s):  
Circadian Rhythms ◽  
Sleep Disorders ◽  
Sleep Disturbances ◽  
Behavioral Therapy ◽  
Adult Population ◽  
Brain Structures ◽  
Sleep Hygiene ◽  
Embryonic Period ◽  
Night Terrors ◽  
Light Sedation

Circadian rhythms and the mechanisms of sleep and wakefulness begin to form in the embryonic period and undergo many stages of development before acquire characteristics typical for an adult. Structure of sleep disturbances in children also differs from that in the adult population. Most sleep disorders in children are the result of immaturity of certain brain structures and mechanisms: primary sleep disorders, pediatric behavioral insomnia, sleepwalking, night terrors, enuresis. These disorders are benign, and usually disappear by adulthood. Treatment of benign sleep disorders in children should primarily be based on the methods of behavioral therapy, the rules of sleep hygiene and the purpose of light sedation.

Perceived sleep deficit is a strong predictor of RLS in multisite pain – A population based study in middle aged females

2017 ◽  
Vol 17 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Romana Stehlik ◽  
Jan Ulfberg ◽  
Ding Zou ◽  
Jan Hedner ◽  
Ludger Grote
Keyword(s):  
Sleep Quality ◽  
Restless Legs Syndrome ◽  
Daytime Sleepiness ◽  
Clinical Management ◽  
Sleep Latency ◽  
Psychiatric Disease ◽  
Restless Legs ◽  
Multisite Pain ◽  
Sleep Deficit ◽  
Impaired Sleep

AbstractBackgroundChronic pain conditions as well as Restless Legs Syndrome (RLS) are known to be associated with subjectively and objectively disturbed sleep. RLS has been recently described as highly prevalent in multisite pain and the role of sleep as a modifying factor in this RLS phenotype is unknown. This study aimed to investigate if perceived sleep deficit and other sleep related parameters predict RLS in subjects with multisite pain.Current knowledge/study rationaleWe have recently demonstrated a strong association between Restless Legs Syndrome (RLS) and number of pain locations. In the current analysis we hypothesized that impaired sleep predicts RLS in subjects with multisite pain.MethodQuestionnaire-based data from 2727 randomly selected women aged 18-64 years were used to analyze RLS symptoms, self-reported sleep quality, and the degree of daytime sleepiness (Epworth Sleepiness Scale (ESS)) in relation to type, degree and localization of body pain. Potential confounders including anthropometrics, pain localization, co-morbidities, and medication were adjusted for in the Generalized Linear Models (GLM).ResultsPerceived sleep deficit ≥90 min (OR 2.4 (1.5-3.8), p < 0.001) and frequent nocturnal awakenings (OR 2.3 (1.4-3.6), p <0.001) were the strongest sleep related predictors for RLS in subjects with multisite pain. Additional factors include prolonged sleep latency (≥30 min, OR 1.8 (1.1-2.8), p = 0.01) and daytime symptoms like elevated daytime sleepiness (ESS score ≥9, OR 1.8 (1.2-2.7), p = 0.005). Accordingly, RLS diagnosis was associated with impaired sleep quality (TST (Total Sleep Time) -8.2 min, sleep latency +8.0 min, and number of awakenings from sleep +0.4, p <0.01). ESS score increased with RLS diagnosis (+0.74, p <0.01) and number of pain locations (0.5, 1.7, and 1.8 for 1, 3, and 5 pain areas, p <0.001). In addition, confounders like pain severity, the history of psychiatric disease, and current smoking were associated with impaired sleep quality in this group of females.ConclusionsPerceived sleep deficit and sleep fragmentation are the strongest sleep related predictors of RLS in multisite pain. Potential implication of our results are that clinical management programmes of RLS in subjects with multisite pain need to consider both sleep quality and sleep quantity for individually tailored treatment regimes.Study impactRLS, pain, and sleep disorders are highly interrelated. Our study strongly suggests that clinical management of RLS in patients with multisite pain needs to consider sleep quality as an independent risk factor.

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