Eszopiclone in the treatment of insomnia

2020 ◽  
Vol 36 (1) ◽  
pp. 9-21
Author(s):  
Marek Jarema ◽  
Adam Wichniak
Keyword(s):  
Sleep Latency ◽  
Total Sleep Time ◽  
Subjective Evaluation ◽  
Sleep Onset ◽  
The Elderly ◽  
Pharmacological Action ◽  
Sleep Time ◽  
Medical Problem ◽  
Quality Of Sleep

Insomnia is an important medical problem; its treatment requires both nonpharmacological methods (education and psychotherapy) and the use of hypnotic agents. The benzodiazepine derivatives may be used as hypnotic agents but their use is substantially limited. The alter­native treatment includes so-called z-drugs, which means nonbenzodiazepine hypnotic agents. Their mechanism of pharmacological action is a GABA-receptor agonism. In general, these drugs improve the quality of sleep (sleep latency, wake after sleep onset, number and duration of awakenings, total sleep time). Contrary to the benzo­diazepines they do not possess anti-anxiety, myorelaxant, and anti-seizure properties, and are better tolerated. Eszopiclone for the treatment of insomnia was not available in Poland. It is not only effective in the treatment of insomnia in comparison to placebo but is also well tolerated. It may be used for a longer time than the benzodiazepines – not only a couple of weeks but per several months. Eszopiclone shortens the sleep latency, decreases the number of wakes after sleep onset and increases total sleep time. It improves the subjective evaluation of sleep by the patients, the quality of sleep and functioning during the day. Its efficacy in the treatment of insomnia in the elderly has also been proved. It is quite well-tolerated and the most frequent side-effect of eszopiclone in the unpleasant taste.

Sleep disturbance and quality of life in Rheumatoid Arthritis: a prospective mobile health study (Preprint)

2021 ◽  
Author(s):  
John McBeth ◽  
William G Dixon ◽  
Susan Mary Moore ◽  
Bruce Hellman ◽  
Ben James ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Sleep Disturbance ◽  
Mobile Health ◽  
Sleep Disturbances ◽  
Total Sleep Time ◽  
Sleep Onset ◽  
Sleep Time ◽  
Domain Scores

BACKGROUND Sleep disturbance and poor health related quality of life (HRQoL) are common in people with rheumatoid arthritis (RA). Sleep disturbances, such as less total sleep time, more waking periods after sleep onset, and higher levels of non-restorative sleep, may be a driver of HRQoL. However, understanding if these sleep disturbances reduce HRQoL has, to date, been challenging due to the need to collect complex time-varying data in high resolution. Such data collection has now been made possible by the widespread availability and use of mobile health (mHealth) technologies. OBJECTIVE In a mobile health (mHealth) study we tested whether sleep disturbance (both absolute values and variability) caused poor HRQoL. METHODS The Quality of life, sleep and rheumatoid arthritis (QUASAR) study was a prospective mHealth study of adults with RA. Participants completed a baseline questionnaire, and for 30 days wore a triaxial accelerometer to objectively assess sleep, and provided daily reports via a smartphone app of sleep (Consensus Sleep Diary (CSD)), pain, fatigue, mood, and other symptoms. Participants completed the World Health Organization Quality of Life-Brief (WHOQoL-BREF) questionnaire every 10 days. Multi-level modelling tested the relationship between sleep variables and WHOQoL-BREF domains (physical, psychological, environment and social). RESULTS Of 268 recruited participants, 254 were included in this analysis. Across all WHOQoL-BREF domains, participant’s scores were lower than the population average. CSD sleep parameters predicted WHOQoL-BREF domain scores. For example, for each hour increase in the total time asleep physical domain scores increased by 1.11 points (β = 1.11 (0.07, 2.15)) and social domain scores increased by 1.65 points. These associations were not explained by sociodemographic and lifestyle factors, disease activity, medication use, levels of anxiety, sleep quality, or clinical sleep disorders. They were, however, attenuated and no longer significant when pain, fatigue and mood were included in the model. Increased variability in the total time asleep, was associated with poorer physical and psychological domain scores independently of all covariates. There were no patterns of association between actigraphy measured sleep and WHOQoL-BREF. CONCLUSIONS Optimising total sleep time, increasing sleep efficiency, decreasing sleep onset latency, and reducing the variability in total sleep time could improve HRQoL in people with RA.

Sleep Patterns During Afternoon Naps in the Young and Elderly

1969 ◽  
Vol 115 (518) ◽  
pp. 107-108 ◽  
Author(s):  
S. A. Lewis
Keyword(s):  
Young Adults ◽  
Elderly People ◽  
Total Sleep Time ◽  
Sleep Onset ◽  
The Elderly ◽  
Sleep Time ◽  
Rapid Eye Movement Sleep ◽  
Nocturnal Sleep ◽  
Disturbed Sleep ◽  
Moderate Reduction

Recently there has been interest in the nocturnal sleep of the elderly. The studies by McGhie and Russel (1962), Weiss et al. (1962), Kales et al. (1967) demonstrated that, compared with young adults, elderly people have a reduced total sleep time, more awakenings following sleep onset and a moderate reduction in REM (rapid eye movement) sleep. In other words, elderly people have a more disturbed sleep. While this group have a shortened night's sleep, they are given to taking afternoon naps, and it may be that through these they can compensate for their insomnia at night.

scholarly journals P003 The impact of forced wake from overnight polysomnography on multiple sleep latency test results

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A22-A23
Author(s):  
A Amaranayake ◽  
S Frenkel ◽  
P Lyell ◽  
A Southcott
Keyword(s):  
Diagnostic Accuracy ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Sleep Onset ◽  
Sleep Time ◽  
Multiple Sleep Latency Test ◽  
Test Results ◽  
The Impact ◽  
Multiple Sleep Latency ◽  
Overnight Polysomnography

Abstract Introduction The multiple sleep latency test (MSLT) is used to diagnose disorders of hypersomnolence. Although internationally-recognised protocols do not stipulate whether patients should be woken from the preceding overnight polysomnography (PSG), many labs wake their patients for logistic reasons. This study analyses the impact on PSG and MSLT parameters of forced wake (FW) from the overnight PSG compared with unrestricted sleep (US). Methods 400 consecutive patients (FW=200; US=200) undergoing PSG/MSLT were included and the following parameters were compared: Epworth Sleepiness Scale (ESS), Morningness-Eveningness Questionnaire score (MEQ), PSG total sleep time (TST), wake-up time from the PSG, overall MSLT sleep latency (MSL), individual nap latencies (SLNap 1–4), number of MSLT naps with sleep-onset REM periods (#SOREMP), and percentage of MSLTs with overall MSL<8 minutes (%MSLT<8). Results The 2 groups were well-matched for ESS and MEQ. The FW group had more males (49% vs 39%). When compared to FW, patients with US had longer TST (+38 minutes; p=<0.0001), later wake-up time (+52 minutes; p<0.0001), longer MSL (+1.9 minutes; p=0.0049), 50% fewer #SOREMP (p=0.0224), and 16% fewer %MSLT<8 (p=0.0018). SLNap1 increased by 1.5 minutes (p=0.0623), SLNap2 increased by 2.0 minutes (p=0.0067), SLNap3 increased by 0.75minutes (p=0.0533) and SLNap4 increased by 2.5 minutes (p=0.0059). Discussion Allowing patients to have unrestricted sleep on the night prior to the MSLT resulted in significantly longer TST, longer sleep latencies during the MSLT, fewer SOREMP and fewer tests with MSL<8 minutes. International protocols should stipulate unrestricted sleep on the PSG prior to the MSLT to improve diagnostic accuracy.

scholarly journals Sleep Organisation in Depression and Schizophrenia: Index of Endogenous Periodicity of Sleep as a State Marker [Retracted]

2013 ◽  
Vol 1 (1) ◽  
pp. 70-75
Author(s):  
Andrej Ilankovic ◽  
Aleksandar Damjanovic ◽  
Vera Ilankovic ◽  
Srdjan Milovanovic ◽  
Dusan Petrovic ◽  
...  
Keyword(s):  
Major Depression ◽  
Eye Movement ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Psychiatric Patients ◽  
Sleep Onset ◽  
Sleep Time ◽  
Rapid Eye Movement Sleep ◽  
Control Subjects ◽  
Healthy Control

Background: Sleep disorders are frequent symptoms described in psychiatric patients with major depression or schizophrenia. These patients also exhibit changes in the sleep architecture measured by polysomnography (PSG) during sleep. The aim of the present study was to identify potential biomarkers that would facilitate the diagnosis based on polysomnography (PSG) measurements.Subjects and Methods: 30 patients with schizophrenia, 30 patients with major depression and 30 healthy control subjects were investigated in the present study. The mean age in the group with schizophrenia was 36.73 (SD 6.43), in the group of patients with depression 40.77 (SD 7.66), in the healthy controls group 34.40 (SD 5.70). The gender distribution was as follows: 18 male, 12 female in the group with schizophrenia; in the group of patients with depression 11 male, 19 female; in the control group 16 male and 14 female. All subjects underwent polysomnography (PSG) for a minimum time of 8 hours according to the criteria of Rechtschaffen & Kales (1968). The following polysomnographic (PSG) parameters were analyzed: sleep latency (SL), total sleep time (TST), waking time after sleep onset (WTASO), number of awakenings (NAW), slow wave sleep (SWS), rapid eye movement sleep (REM), rapid eye movement sleep latency (REML), first REM period (REM 1), and first NREM period (NREM 1). We tested the potential of multiple sleep variables to predict diagnosis in different groups by using linear discriminate analysis (LDA).Results: There were significant differences in polysomnography (PSG) variables between healthy control subjects and psychiatric patients (total sleep time, sleep latency, number of awakenings, time of awakening after sleep onset, REM 1 latency, REM 1 and index of endogenous periodicity). Importantly, LDA was able to predict the correct diagnosis in 88% of all cases.Conclusions: The presented analysis showed commonalities and differences in polysomnography (PSG) changes in patients with major depressive disorder and in patients with schizophrenia. Our results underline the potential of polysomnography (PSG) measurements to facilitate diagnostic processes.

scholarly journals Comparative analysis of multiple sleep latency tests (MSLT) parameters and occurrence of dreaming in patients with daytime sleepiness of narcoleptic and non-narcoleptic origin

2006 ◽  
Vol 64 (4) ◽  
pp. 958-962 ◽  
Author(s):  
Eduardo Siqueira Waihrich ◽  
Raimundo Nonato Delgado Rodrigues ◽  
Henrique Aragão Silveira ◽  
Fernando da Fonseca Melo Fróes ◽  
Guilherme Henrique da Silva Rocha
Keyword(s):  
Comparative Analysis ◽  
Rem Sleep ◽  
Daytime Sleepiness ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Onset Latency ◽  
Onset Latency ◽  
Multiple Sleep Latency

OBJECTIVE: To compare MSLT parameters in two groups of patients with daytime sleepiness, correlated to the occurrence and onset of dreams. METHOD: Patients were submitted to the MSLT between January/1999 and June/2002. Sleep onset latency, REM sleep latency and total sleep time were determined. The occurrence of dreams was inquired following each MSLT series. Patients were classified as narcoleptic (N) or non-narcoleptic (NN). RESULTS: Thirty patients were studied, 12 were classified as narcoleptics (N group; 40%), while the remaining 18 as non-narcoleptic (NN group; 60%). Thirty MSLT were performed, resulting in 146 series. Sleep was detected in 126 series (86%) and dreams in 56 series (44.44%). Mean sleep time in the N group was 16.0±6.3 min, while 10.5±7.5 min in the NN group (p<0.0001). Mean sleep latency was 2.0±2.2 min and 7.2±6.0 min in the N and NN group, respectively (p<0.001). Mean REM sleep latency in the N group was 3.2±3.1min and 6.9±3.7 min in the NN group (p=0.021). Dreams occurred in 56.9% of the N group series and 28.4% in that of the NN group (p=0.0009). Dream frequency was detected in 29.8% and 75% of the NREM series of the N and NN groups, respectively (p=0.0001). CONCLUSION: Patients from the N group, compared to the NN group, slept longer and earlier, demonstrated a shorter REM sleep onset and greater dream frequency. NN patients had a greater dream frequency in NREM series. Thus, the occurrence of dreams during NREM in the MSLT may contribute to differentially diagnose narcolepsy and daytime sleepiness.

scholarly journals 0758 Quantification of Late REM Periods in Patients With Prolonged Sleep Duration

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A288-A288
Author(s):  
M S Blattner ◽  
J August ◽  
S Chopra ◽  
L Dalal ◽  
S Luthra ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Rem Sleep ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Sleep Onset ◽  
Onset Time ◽  
Sleep Time ◽  
Sleep Studies ◽  
Long Sleep ◽  
Idiopathic Hypersomnia

Abstract Introduction Evaluation of hypersomnia includes polysomnography followed by mean sleep latency testing (MSLT). As consistent with guidelines as applied in most centers, the overnight portion of the study will be terminated to begin sleep latency testing. For patients with prolonged sleep duration, this interruption could result in REM sleep on nap testing that reflects continuation of their biological night, rather than abnormalities in REM sleep pressure/regulation. Methods We reviewed 42 consecutive extended (unrestricted) sleep studies for patients with a total sleep time greater than 600 minutes. For studies with sleep onset before midnight, we evaluated for REM period onset after 6AM, the number of REM periods after 6AM and 8AM, and the time of the final REM period onset. Results 42 hypnograms were reviewed for patients undergoing evaluation of hypersomnia, median age 32 years (range 19-92) with a median total sleep time of 663 minutes (range 602-832), of these 28/42 (67%) had sleep onset before midnight (12 AM) and were included in the analysis. 27/28 (96%) of hypnograms reviewed had REM sleep after 6 AM, 24/28 (86%) had REM sleep after 8 AM, with the onset of the final REM period ranging from 4:46 AM-12:30 PM for patients with sleep onset time before midnight (12 AM). Conclusion These data suggest that termination of overnight polysomnography to complete mean sleep latency testing, as is standard in most sleep labs, may influence the presence of REM sleep on MSLT for patients with prolonged total sleep duration. These results may have implications for the interpretation of MSLT for patients with long sleep duration, and may explain why a given individual may test as type II narcolepsy or idiopathic hypersomnia unpredictably on repeat testing. Support Sleep Medicine Fellowship at BIDMC

511 Pathological sleep prolongation and sleep onset REM period

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A201-A201
Author(s):  
Makoto Honda ◽  
Shinya Kimura ◽  
Kaori Sasaki ◽  
Masataka Wada ◽  
Wakako Ito
Keyword(s):  
Clinical Symptoms ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Studies ◽  
Long Sleep ◽  
The Status ◽  
Idiopathic Hypersomnia ◽  
Sleep Propensity

Abstract Introduction ICSD-3 employs two definitions of pathological sleepiness: sleep prolongation with 24-hour total sleep time (24hrPSG TST) ≥660 and high sleep propensity with mean sleep latency(mSL) ≤8 min on MSLT. Multiple SOREMPs on MSLT reflects the pathophysiology (sleep instability) of narcolepsy, but it is not clear whether the lack of SOREMPs is associated with the pathophysiology of idiopathic hypersomnia. We performed 24hr PSG and PSG-MSLT sequentially to understand the meaning of SOREMP in those with pathological sleep prolongation. Methods Fifty-six consecutive patients visiting Seiwa Hospital or Koishikawa Tokyo Hospital affiliated to Institute of Neuropsychiatry with suspected idiopathic hypersomnia with habitually long sleep time were evaluated by 3-day sleep studies: unattended 24hr PSG followed by PSG and MSLT from January 2017 to November 2020. After excluding inadequate recordings or other sleep pathologies, we analyzed 52 data and found that 39 patients (23 females, 21.8 ± 7.9 years old, BMI 20.4 ± 2.5 kg/m2) exhibited pathological sleep prolongation. Results We divided 39 patients with pathological sleep prolongation into those with at least one SOREMP(n=9) and those without SOREMP(n=30) and explored differences in clinical symptoms and PSG variables. There were no differences in conventional sleep variables except for PSG sleep latency, shorter in those with SOREMP (20.8min vs 43.8min, p=0.032). Also 24hr PSG sleep variables showed no differences except for the number of NREM-REM cycles, more in those with SOREMP (10.4 vs 8.1, p=0.037). Frequency of clinical symptoms such as REM related phenomena and various symptoms characteristic for idiopathic hypersomnia did not differ between groups except for less frequency of general malaise p=0.003 and orthostatic hypotension p=0.049 in those with SOREMP. We had similar results when we compared 5 patients with multiple SOREMPs and 30 patients without SOREMP. Conclusion Our results indicated that sleep variables and clinical characteristics of idiopathic hypersomnia in those with pathological sleep prolongation were mostly the same regardless of the status of SOREMP on MSLT, suggesting that the absence of SOREMPs on MSLT were not fundamentally related to the pathophysiology of those with pathological sleep prolongation (idiopathic hypersomnia with long sleep time). Support (if any):

scholarly journals Actigraphy versus Polysomnography to Identify Changes in the Sleep Patterns of Adults with Insomnia

2020 ◽  
Vol 28 ◽  
pp. 1-25
Author(s):  
Andrea dos Santos Garcia ◽  
Juliana Durães das Neves ◽  
Solange Campos Vicentini ◽  
Glycia de Almeida Nogueira ◽  
Juliana Mendes Marques ◽  
...  
Keyword(s):  
Sleep Latency ◽  
Total Sleep Time ◽  
Meta Analysis ◽  
Sleep Time ◽  
Cochrane Library ◽  
Sleep Patterns ◽  
Inverse Variance ◽  
The Cochrane Library ◽  
Grade Approach

Introduction. Insomnia is the most common sleep-wake disorder worldwide. Polysomnography is the complementary exam considered the gold standard for the identification of sleep disorders. However, Actigraphy – a method easily applicable for several consecutive days –, has emerged as an alternative tool. Objective. To evaluate the effectivity of actigraphy in comparison with polysomnography, in determining the sleep patterns of adults with insomnia. Method. Integrative review with meta-analysis, on which randomized observational and clinical studies were searched in the Cochrane Library, on MEDLINE through the PUBMED Portal, in the Google Scholar and on the TRIP DATABASE meta-search engine, from November 2019. The GRADE approach was used to evaluate the quality of the evidence. The meta-analysis was performed using the Inverse-variance weighting, considering the 95% confidence interval (95% CI). Results. Six studies were included, representing 399 patients. The studies examine the effectivity of actigraphy in identifying the total sleep time, the latency, the Wake After Sleep and the sleep efficiency. It was noticed that the Actigraphy was close to polysomnography only when verifying sleep latency, with a small average difference of -1.46 (95% CI: -9.61 to 6.70 min.). The other outcomes evaluated had their values underestimated by actigraphy. The quality of the evidence was moderate and low. Conclusion. The evidence to evaluate the effectivity of actigraphy is still limited – especially when it is intended to compare it with polysomnography, since the studies found shown methodological limitations, mainly in the measurement of results.

scholarly journals Automatic detection of sleep onset in healthy adults

2017 ◽  
Vol 20 (K3) ◽  
pp. 18-24
Author(s):  
Khai Quoc Le ◽  
Anh Thi Ngoc Dinh ◽  
Bao Hoang Tran ◽  
Linh Quang Huynh
Keyword(s):  
Sleep Latency ◽  
Sleep Onset ◽  
Sleep Medicine ◽  
Quality Of Sleep ◽  
Micro Structure ◽  
Using Data ◽  
External Stimuli ◽  
First Time ◽  
Timely Warning

Sleep is very important for the health. Analyzing the polysomnography (PSG) helps us get valuable information to assess the quality of sleep. In this work, we develop a program to automatically detect the transition from wakefulness to sleep in adults. The accurate detection of the point of sleep onset occurs in the first time is useful for assessing the micro-structure of sleep. The proposed method is analyzed polysomnography of 30 healthy volunteers, using data of one channel Electroencephalography, Electrooculography and chin Electromyography. The algorithm automatically analyzes every second according to American Academy of Sleep Medicine (AASM) standards with the latest version. The results obtained under two levels: identify and list the epoch occurred the transition, and exact the time of the shift occurred. With more than 85% in accuracy, the study shows the feasibility to provide timely warning. This approach opens up developing a system in real-time warning: doze off in student, drowsiness, sleepiness when driving or working. It helps us to examine the brain's response to external stimuli to reduce the time of sleep latency.

scholarly journals Evaluating Sleep Characteristics in Intensive Care Unit and Non-Intensive Care Unit Physicians

2011 ◽  
Vol 39 (6) ◽  
pp. 1071-1075 ◽  
Author(s):  
G. Ok ◽  
H. Yilmaz ◽  
D. Tok ◽  
K. Erbüyün ◽  
S. Çoban ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Shift Work ◽  
Pittsburgh Sleep Quality Index ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Total Activity ◽  
Sleep Time ◽  
Sleep Parameters ◽  
Icu Physicians

Healthcare workers’ cognitive performances and alertness are highly vulnerable to sleep loss and circadian rhythms. The purpose of this study was to investigate the changes in sleep characteristics of intensive care unit (ICU) and non-ICU physicians. Actigraphic sleep parameters, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Hamilton Depression Rating Scale were evaluated for ICU and non-ICU physicians on the day before shift-work and on three consecutive days after shift-work. Total sleep time, sleep latency, wakefulness after sleep onset, total activity score, movement fragmentation index, sleep efficiency, daytime naps and total nap duration were also calculated by actigraph. In the ICU physicians, the mean Pittsburgh Sleep Quality Index score was significantly higher than the non-ICU physicians (P=0.001), however mean Epworth Sleepiness Scale scores were not found significantly different between the two groups. None of the scores for objective sleep parameters were statistically different between the groups when evaluated before and after shift-work (P >0.05). However in both ICU and non-ICU physicians, sleep latency was observed to be decreased within the three consecutive-day period after shift-work with respect to basal values (P <0.001). Total sleep time, total activity score and sleep efficiency scores prior to shift-work were significantly different from shift-work and the three consecutive-days after shift-work, in both groups. Working in the ICU does not have an impact on objective sleep characteristics of physicians in this study. Large cohort studies are required to determine long-term health concerns of shift-working physicians.

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