Search Results

This chapter examines epidemiological evidence on associations between sleep and death in adults. It includes coverage of associations between sleep duration and mortality. Additional sections document evidence on associations with premature death for seven of the eight categories of sleep disorders included in the International Classification of Sleep Disorders: insomnia, parasomnia, hypersomnia, sleep-related breathing disorder, sleep-related movement disorder, circadian rhythm sleep disorder, and other sleep disorders. The chapter concludes with a brief discussion of the implications of these findings for health policy and health promotion. Consistent evidence suggests an increased risk of mortality at both the short and long ends of the sleep duration distribution, with evidence accumulating that the highest risk is among the long sleepers. However, debate remains with regard to the ‘independent’ contribution of sleep itself to premature death. In population health terms fatal accidents resulting from excessive daytime sleepiness or fatigue are probably the most serious sleep-related public health problems.

The impact of poor sleep in the developing child is tremendously underrated and virtually unexplored. Furthermore, it remains crucial to realize that relations between sleep duration and cognition, affect, and health are all multidirectional, and that sleep plays an important role. This chapter discusses the latest findings on such interrelations and highlights the risks associated with disrupted, shortened, or insufficient sleep. Studies have shown that children in our society are very unlikely to obtain sufficient sleep on a stable and regular schedule. Therefore, each healthcare provider should monitor periodically any condition that may affect sleep in a developing child. Since a child engages in sleeping activities more than in any other during the 24-hour cycle, the most forgotten, overlooked, or even actively ignored behaviour of this century is undoubtedly childhood sleep. If we aim for a successful society and economy where individual productivity is fostered and encouraged, then we need to preserve and promote sleep, so that dreams can be fulfilled.

This chapter provides a case study to show the desired skills, attitudes, and knowledge required to diagnose and manage sleep disorders in palliative patients. It addresses a number of questions such as: How common are sleep disorders? Why should we pay close attention to the patient's disrupted sleep? How to diagnosis a patient's sleep disorder? What other medical conditions are associated with sleep disorders?

This chapter reviews literature pertaining to clinical sleep disorders and nonclinical aspects of sleep patterns among children and adolescents in relation to socioeconomic status (SES) and race/ethnicity. Sleep duration, quality, and/or scheduling are compared in individuals of various SES and ethnic/racial backgrounds. First, initial epidemiologic studies assessing sleep parameters among members of these groups are reviewed. Following this initial summary, more recent studies are summarized, and these investigations are separated into those conducted with participants in three age groups: young children (ages two through eight years), preadolescents (ages eight to thirteen years), and adolescents. Then, the literature comparing individuals of various SES levels and racial/ethnic backgrounds on symptoms and diagnoses of sleep disordered breathing (SDB) are considered. SDB is discussed because of the significant daytime consequences associated with this illness and because of recent studies showing disparities in SDB associated with SES and race/ethnicity. Finally, conclusions, limitations, and future directions will be highlighted.

This chapter discusses sleep-disordered breathing in heart failure (HF). The association between HF and sleep disturbance can be divided into two major categories: the symptoms of HF which result in direct disruption of sleep and insomnia; and sleep apnoea syndromes (central sleep apnoea syndrome (CSAS), which is usually a consequence of worsening HF; and obstructive sleep apnoea syndrome, which may be a precursor of cardiac diseases leading to the development of chronic HF). The diagnosis and treatment options for these categories are shown. The prognosis of patients with chronic HF seems to be significantly worse if CSAS is present. Treatment options include continuous positive airway pressure (CPAP) and supplemental oxygen. Adequately powered prospective randomized controlled trials with survival and health status as endpoints are needed to establish whether the correction of sleep-related abnormalities of breathing in patients with HF really does improve outcome.

This chapter makes the case for a connection between sleep and school performance in children from socioeconomically disadvantaged as well as ethnic minority families. Research relevant to this topic has been conducted with children who have no known clinical sleep disorders, with children who do have disorders such as sleep apnea, and with children who have been diagnosed learning and behavior problems; all of which are reviewed. School performance is defined as academic achievement and behavioral adjustment necessary for that achievement. Academic achievement is also presumed to relate to cognitive functioning, defined generally as the ability to acquire and retain information.

The classification of sleep disorders have evolved over the last 45 years and currently are aggregated into six categories based on convergence of the functional changes. Sleep disorders adversely impact health, as well as intellectual, emotional and physical performance. In this chapter I will provide an overview of the classification of sleep disorders, and the epidemiology of the more common disorders to highlight their socio-economic impact. I will focus on two of the more prevalent sleep disorders, namely insomnia and obstructive sleep apnea (OSA) for which sleepiness is often a symptom, to describe the consequences of sleep disruption on work.

Sleeping and waking mechanisms operate together as a homogeneous functional unit, the final output of which determines the level of arousal. Thus, disorders of one mechanism inevitably tend to affect others: anxiety is accompanied by insomnia; poor night-time sleep is associated with daytime sleepiness. However, for convenience the disorders are divided here into those which are mainly manifested in the waking state (for example anxiety syndromes) and those whose main characteristic is sleep disturbance (for example insomnia and hypersomnia).

Pregnancy is characterized by profound metabolic and physiological alterations involving virtually every organ system. Among apparently healthy women, the metabolic challenges, or “stress test” of pregnancy may contribute to adverse perinatal and neonatal outcomes, and may also unmask susceptibility for maternal chronic disorders. Available clinical and epidemiologic data are supportive of the hypothesis that common medical complications of pregnancy including gestational diabetes mellitus, and hypertensive disorders of pregnancy may represent, at least for some women, their underlying risk for developing related chronic medical conditions as they age. This chapter first provides a brief overview of maternal metabolic, physiological, and anatomical changes during pregnancy. These are followed by a review of selected maternal pre-gestational chronic medical conditions and those arising during pregnancy. The chapter closes with a discussion of the influence of other factors, including intimate partner violence, on maternal physical and mental well-being.

Pediatric sleep disorders have been gaining awareness among practitioners due to their potential for cognitive, behavioral, and somatic effects (Gozal 2008; Moore et al. 2006). Sleep-disordered breathing (SDB) is commonly seen in children and encompasses a range of disorders, in primary snoring to obstructive sleep apnea (Marcus 2000). Sleep-disordered breathing is characterized by partial or complete upper airway obstruction during sleep due to collapse or narrowing of the pharynx. This can result in sleep fragmentation due to brief arousals during the night, as well as disruption or cessation of airflow (Blunden and Beebe 2006; Halbower and Mahone 2006). This chapter describes the neuropsychological and behavioral consequences of SDB, comorbid disorders, and effects of treatment. Sleep-disordered breathing is considered a spectrum of airflow limitation, from mild to severe. For instance, primary snoring (PS), defined as snoring without oxygen desaturation or sleep arousals, is at the mild end of the spectrum. Upper airway resistance syndrome (UARS), in the middle of the spectrum, is characterized by increased negative intrathoracic pressure with sleep arousals and sleep fragmentation but no oxygen desaturations (Bao and Guilleminault 2004; Garetz 2008; Lumeng and Chervin 2008). In obstructive sleep apnea (OSA), at the severe end of the spectrum, there are repeated episodes of blockage of the airway with changes in oxygenation. Obstructive sleep apnea results from a combination of factors, including anatomical obstruction from adenoids, tonsils, or a narrow pharynx, and decreased neuromuscular tone required to maintain airway patency (Arens and Marcus 2004). An overnight polysomnogram (PSG) completed in a sleep laboratory and measuring sleep–wake states, respiration, movement, blood levels of oxygen and carbon dioxide, and cardiac activity, is considered the “gold standard” for the diagnosis of OSA (American Academy of Pediatrics 2002). The PSG is used to diagnose respiratory events, cardiac changes, and arousals from different sleep states. Respiratory events include obstructive apneas and hypopneas. Obstructive apnea events are episodes of complete airway obstruction, while hypopneas are partial obstructions or airflow limitations (Garetz 2008; Redline et al. 2007).

Pregnancy is the time during which one or more offspring develops inside a woman. This chapter focuses on sleep quality and emergence of sleep disorders in pregnancy, which has implications for both the fetus as well as the mother. An overview of empirical evidence of the association between disturbed sleep in pregnancy and pregnancy-related outcomes is provided along with a ion of The chapter also reviews common sleep disturbances in pregnancy, such as sleep-disordered breathing, insufficient sleep, poor sleep quality, and restless legs syndrome, and synthesizes current knowledge of the impact of poor sleep on pregnancy outcomes, with a particular emphasis on fetal well-being. Evidence is also presented on the potential for maternal sleep to influence fetal origins of chronic disease.

This chapter finds that Parkinson’s disease (PD) manifests itself in the agentic self impairments, which emerge due to weak cognitive processes and lack of coordination in neural networks. The impaired agentic self gives rise to anxiety and restlessness, resulting in problematic sleeping or sleep behavior disorder (SBD) in PD patients. Patients suffering from SBD are unable to sleep peacefully and reach the rapid eye movement stage, which helps in consolidating neural activities and memory. Sleep disorders result in obstructions in normal memory and learning functions, and reduce the ability to focus or remain attentive during a task when awake. Disruptions in such cognitive activities lead to psychiatric disorders, which play a key role in the onset of PD. Disturbed sleep also has a significant adverse impact on the moods of the patients, resulting in unstable mood swings and irritation.

Over 70 described sleep disorders disrupt the sleep of an estimated 50–70 million Americans. The disorders present with a broad array of symptoms but result in the individual not getting the health, cognitive, and restorative benefits of a good night’s sleep. The disorders have been categorized into the following categories: insomnia, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep–wake disorders, parasomnias, and sleep-related movement disorders. This chapter reviews each category and provides details on the symptoms, pathophysiology, and treatment of the most common disorder in each category, including insomnia, obstructive sleep apnoea, narcolepsy, restless legs syndrome, and REM sleep behaviour disorder. The presenting complaint is the key to diagnosis, directing subsequent evaluation.

The arousal and sleep systems interact with other functional systems and generate patterns of neural activity which may at times have an asymmetric hemispherical distribution. They utilize many transmitters and employ multiple redundant back-up systems. They are subject to malfunction, as manifested in anxiety states and sleep disorders, and they are very sensitive to centrally-acting drugs. This chapter describes the neurological organization of these systems.

As Americans live longer, growth in the number of older adults is unprecedented. In 2014, 14.5% (46.3 million) of the U.S. population was aged 65 or older, and this is projected to reach 23.5% (98 million) by 2060. This chapter focuses on sleep among older adults, defined as at least 65 years old, and includes a discussion on sleep and retirement. The chapter especially discusses variation of sleep and sleep disorders in this age group and associations with frailty and disease and provides a social determinants perspective. Social/environmental factors that impact sleep in older adults include the impact of retirement, caregiving, institutionalization, and other key life transitions. Important sex and gender differences among older adults are also discussed.

The chapter discusses the methodological background assumptions of scientific dream research. These are laboratory studies of sleep and dreaming; neuroimaging of sleep; the analysis of dream reports and home dream diaries; the study of sleep behavior in disorders of dreaming; lucid dreams; selective changes and the loss of dreaming in neurological syndromes; and the possibility of using neuroimaging of REM sleep to move beyond dream reports in the study of dreaming. The chapter complements chapter 1 by confronting philosophical skepticism about the trustworthiness of dream reports with a metatheoretical critique of the methods of contemporary scientific dream research. This helps clarify a number of theoretical issues and leads to a more precise definition of dream reporting as well as an analysis of the relationship between dream reports, polysomnographic and neuroimaging data, and behavior during sleep, including signal-verified lucid dreams.

Sleep is a universal phenomenon that occurs in every species studied so far. A normal sleep period fluctuates in a regular cycle of two basic forms: slow wave sleep (SWS) and rapid eye movement (REM) sleep. The sleep–wake cycle is modulated by diverse brain circuits and neuromodulators as well as by several endogenous and exogenous molecules, including cannabinoids. This chapter describes the effects of certain cannabis-derived and synthetic cannabinoids on sleep. Additionally, it provides an overview of current knowledge about potential uses of natural or synthetic cannabinoids for the treatment of sleep disorders.

This chapter starts by advising how to reduce the impact of stress. When stress becomes long term, the immune system becomes less sensitive to cortisol, and since inflammation is partly regulated by this hormone, this decreased sensitivity heightens the inflammatory response and allows inflammation to get out of control, increasing our risk of many diseases. You can reduce your stress yourself through a variety of methods, including physical activity and mindfulness-based stress reduction. Adequate sleep is also a major factor that can improve cognitive abilities and reduce the risk of dementia, and this chapter outlines what we need to know about sleep cycles, insomnia, and sleep disordered breathing, and how to sleep more and sleep better. The chapter then covers how to protect your brain from over medication (polypharmacy). It finishes by discussing how to maintain and indeed increase your levels of physical activity, and how increasing physical activity has both direct and indirect effects on the brain.