Sleep deprivation therapy to reset the circadian pacemaker in a non-24-hour sleep-wake disorder: a case report

A model for the timing of human sleep is presented. It is based on a sleep-regulating variable (S)--possibly, but not necessarily, associated with a neurochemical substance--which increases during wakefulness and decreases during sleep. Sleep onset is triggered when S approaches an upper threshold (H); awakening occurs when S reaches a lower threshold (L). The thresholds show a circadian rhythm controlled by a single circadian pacemaker. Time constants of the S process were derived from rates of change of electroencephalographic (EEG) power density during regular sleep and during recovery from sleep deprivation. The waveform of the circadian threshold fluctuations was derived from spontaneous wake-up times after partial sleep deprivation. The model allows computer simulations of the main phenomena of human sleep timing, such as 1) internal desynchronization in the absence of time cues, 2) sleep fragmentation during continuous bed rest, and 3) circadian phase dependence of sleep duration during isolation from time cues, recovery from sleep deprivation, and shift work. The model shows that the experimental data are consistent with the concept of a single circadian pacemaker in humans. It has implications for the understanding of sleep as a restorative process and its timing with respect to day and night.

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The Impact of Sleep Deprivation on Work Performance towards Night-shift Healthcare Workers: An Evidence-based Case Report

Acta Medica Philippina ◽

10.47895/amp.v55i6.3157 ◽

2021 ◽

Vol 55 (6) ◽

Author(s):

Muhammad Habiburrahman ◽

Elvira Lesmana ◽

Fadhilah Harmen ◽

Nadya Gratia ◽

Listya Tresnanti Mirtha

Keyword(s):

Case Report ◽

Physical Fitness ◽

Sleep Deprivation ◽

Healthcare Workers ◽

Work Performance ◽

Night Shift ◽

Worker Safety ◽

Work Behavior ◽

Evidence Based ◽

The Impact

Background. Poor sleep and excessive fatigue among workers can reduce well-being and physical fitness. However, not many studies have mentioned how sleeping deprivation among night-shift healthcare workers impacted their work performance in multiple aspects. Method. We conducted an evidence-based case report (EBCR) of a night shift nurse who was worried about the impact of her sleep deprivation on her work performance in the future due to prior history of needle-stick injuries. We aimed to determine whether sleeping deprivation caused by regular night shifts leads to decreased work performance among night-shift healthcare workers by formulating a clinical question. Evidence was searched systematically using five major journal databases (Proquest, EBSCO-Host, PubMed, ScienceDirect, and Cochrane) and was assessed thoroughly using inclusion and exclusion criteria. Results. Eleven eligible studies were obtained with a medium level of evidence (III-IV), three systematic reviews with meta-analyses (SR-MA), three SR without MA, and five observational studies. All of them were analyzed and critically appraised using Oxford Evidence-Based Medicine and Joanna Briggs Institute tools. We found that reduced quantity and quality of sleep impacted all dimensions of work performance among healthcare professionals, be it in task performance (e.g., skill proficiency), contextual performance (e.g., communication skill and mental health issues), and patient and health worker safety (accident and medication error). It could also encourage counterproductive work behavior, such as absenteeism. Furthermore, sleep deprivation changes circadian rhythms, causing decreased information processing and affective recognition functions in some vital brain areas, ultimately affecting several work dimensions. Conclusion. In conclusion, stakeholders need to adjust proper shift scheduling for health care workers, practice sleep hygiene, maintain physical fitness, and consume nutritional food, positively correlated to health and productivity.

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Switch to hypomania induced by repetitive transcranial magnetic stimulation and partial sleep deprivation added to antidepressant: A case report

Vojnosanitetski pregled ◽

10.2298/vsp1402207k ◽

2014 ◽

Vol 71 (2) ◽

pp. 207-210 ◽

Cited By ~ 4

Author(s):

Jelena Krstic ◽

Tihomir Ilic

Keyword(s):

Case Report ◽

Sleep Deprivation ◽

Slow Rate ◽

Magnetic Stimulation ◽

Bipolar Depression ◽

Repetitive Transcranial Magnetic Stimulation ◽

Bipolar Affective Disorder ◽

Treatment Resistance ◽

Fixed Dose ◽

Partial Sleep Deprivation

Introduction. Bipolar depression is often unrecognized and difficult to treat because of two opposite problems: treatment resistance and risk of manic switch. Case report. A 53-year-old female was suffering from unipolar depressive disorder since the age of 36. During a recent major depressive episode pervasive feelings of sadness, lost of interest in activities, severe insomnia and highly expressed somatic anxiety dominated 7 months. After unsuccessful tries with two different antidepressants of adequate doses and duration, slow rate repetitive trascranial magnetic stimulation (rTMS) was started, but the patient stayed at the fixed dose of antidepressant. Partial sleep deprivation (PSD) was additionally applied twice during these 2 weeks with the idea to boost up, or enhance rTMS treatment response. At the last two rTMS sessions depression obviously meliorated, but the patient also expressed symptoms of hypomania. The therapy of rTMS was stopped, hypomanic symptoms gradually vanished and two weeks after the rTMS treatment the patient was euthymic. Antidepressant was kept on. In a follow-up period of 2 years the diagnose of bipolar affective disorder was definitely established. Conclusion. This case report shows that a combination of slow rate rTMS and partial sleep deprivation in the patient at the fixed dose of antidepressants, have strong synergistic effect even with potential to induce hypomanic switch, that is the first description in the literature to our knowledge.

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Circadian regulation of sleep propensity, sleep structure and alertness: A symphony of paradoxes

Acta Neuropsychiatrica ◽

10.1017/s0924270800037467 ◽

1995 ◽

Vol 7 (2) ◽

pp. 24-26 ◽

Cited By ~ 3

Author(s):

D.J. Dijk

Keyword(s):

Sleep Deprivation ◽

Circadian Regulation ◽

Circadian Pacemaker ◽

Sleep Structure ◽

Adult Human ◽

Relative Contribution ◽

History Of ◽

Sleep Propensity

The adult human typically exhibits a monophasic sleep-wake cycle, i.e., remains awake and alert for approximately 16 hours and then sleeps for 8 hours. Recent experiments have provided new insights in the role of the endogenous circadian pacemaker in this consolidation of sleep and wakefulness.Sleep deprivation studies had shown previously that sleepiness and alertness are co-determined by a process which keeps track of the history of sleep and wakefulness and the circadian pacemaker, which keeps track of time. During every day life and during sleep deprivation both processes change simultaneously and their relative contribution to alertness and sleep propensity cannot be assessed under these conditions.

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Relapse of Mania due to Sleep Deprivation: A Case Report

Indian Journal of Sleep Medicine ◽

10.5005/jp-journals-10069-0047 ◽

2020 ◽

Vol 15 (1) ◽

pp. 15-16

Author(s):

Vineet Jalota ◽

Swarna B Nayok ◽

T Sathyanarayana Malleswaram ◽

HS Akshatha

Keyword(s):

Case Report ◽

Sleep Deprivation

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Misophonia: An Evidence-Based Case Report

American Journal of Audiology ◽

10.1044/2020_aja-19-00111 ◽

2020 ◽

Vol 29 (4) ◽

pp. 685-690

Author(s):

C. S. Vanaja ◽

Miriam Soni Abigail

Keyword(s):

Quality Of Life ◽

Case Report ◽

Case History ◽

Pure Tone ◽

Physiological Responses ◽

Evidence Based ◽

Management Option ◽

Pure Tone Audiogram

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

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