1/8. Long-term rectal temperature measurements in a patient with menstrual-associated sleep disorder.The international classification of sleep disorders has proposed menstrual-associated sleep disorder. However, few studies have investigated its pathophysiological mechanism. A 34-year-old woman complaining of insomnia in the late luteal phase underwent continuous rectal temperature measurements and simultaneous actigraphic monitoring for 146 days. The acrophase of rectal temperature rhythm was delayed in the luteal phase, compared with that in the follicular phase. Her bedtime and risetime did not differ across the menstrual cycle. These results suggest that her insomnia in the luteal phase may have been a consequence of desynchronization between her temperature rhythm and sleep phase in the luteal phase.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
2/8. Treatment of persistent sleep-wake schedule disorders in adolescents with methylcobalamin (vitamin B12).Two adolescent patients suffering from persistent sleep-wake schedule disorders appear to have responded to treatment with vitamin B12 (methylcobalamin). A 15-year-old girl with delayed sleep phase syndrome (DSPS) and a 17-year-old boy with hypernychthemeral syndrome complained of not being able to attend school despite many trials of medication. The improvement of the sleep-wake rhythm disorders appeared immediately after the administration of high doses (3,000 micrograms/day) of methylcobalamin. Neither patient showed any laboratory or clinical evidence of vitamin B12 deficiency or hypothyroidism (which can cause B12 deficiency). serum concentrations of vitamin B12 during treatment were in the high range of normal or above normal. The duration of the sleep period of the DSPS patient decreased gradually from 10 hours to 7 hours, and the time of sleep onset advanced from 2 a.m. to midnight. The period of the sleep-wake cycle of the hypernychthemeral patient was 24.6 hours before treatment and 24.0 hours after treatment. The relationship between the circadian basis of these disorders and vitamin B12 and its metabolites is discussed.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
3/8. Bedtime fading in the treatment of pediatric insomnia.In this paper, the sleep-wake cycles of two children with severe sleep problems were regulated by delaying bedtimes, thus increasing the probability of short latency to sleep onset. A fading procedure was then utilized to advance the bedtimes and gradually increase duration of sleep. Several treatments had previously been attempted with both of these patients without success. The advantages of this treatment over other interventions for pediatric sleep disorders are discussed.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
4/8. Vitamin B12 treatment for sleep-wake rhythm disorders.Vitamin B12 (VB12) was administered to two patients suffering for many years from different sleep-wake rhythm disorders. One patient was a 15-year-old blind girl suffering from a free-running sleep-wake rhythm (hypernychthemeral syndrome) with a period of about 25 h. In spite of repeated trials to entrain her sleep-wake cycle to the environmental 24-h rhythm, her free-running rhythm persisted for about 13 years. When she was 14 years old, administration of VB12 per os was started at the daily dose of 1.5 mg t.i.d. Shortly thereafter, her sleep-wake rhythm was entrained to the environmental 24-h rhythm, and her 24-h sleep-wake rhythm was maintained while she was on the medication. Within 2 months of the withholding of VB12, her free-running sleep-wake rhythm reappeared. The VB12 level in the serum was within the normal range both before and after treatment. The other patient was a 55-year-old man suffering from delayed sleep phase syndrome since 18 years of age. After administration of VB12 at the daily doses of 1.5 mg, his sleep-wake rhythm disorder was improved. The good therapeutic effect lasted for more than 6 months while he was on the medication.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
5/8. A treatment trial of delayed sleep phase syndrome with triazolam.triazolam causes a phase-shift of the circadian rhythm of locomotor activity in golden hamsters. We attempted to treat two patients with delayed sleep phase syndrome (DSPS) with triazolam. In one male patient we administered triazolam when the sleep phase began to delay after chronotherapy. triazolam combined with chronotherapy enabled him to normalize and stabilize his sleep-wake cycle. But in the other female patient despite normalization of her sleep-wake cycle, she became depressive and did not continue taking the drug. In some cases triazolam is useful for the treatment of DSPS, but in others, triazolam induces a depressive state.- - - - - - - - - - ranking = 2keywords = cycle (Clic here for more details about this article) |
6/8. melatonin replacement corrects sleep disturbances in a child with pineal tumor.A child with a germ cell tumor involving the pineal region had marked suppression of melatonin secretion associated with severe insomnia. Exogenous melatonin (3 mg in the evening) for 2 weeks restored sleep continuity, as demonstrated by objective monitoring of rest-activity cycles. This case report provides direct evidence of the essential role of melatonin in normal sleep.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
7/8. Zolpidem for dementia-related insomnia and nighttime wandering.OBJECTIVE: To describe two elderly patients with dementia and severe nighttime wandering in whom zolpidem restored normal sleep patterns. CASE SUMMARIES: A 90-year-old African-American woman (case 1) and an 87-year-old African-American man (case 2) presented with nighttime wandering associated with the progression of Alzheimer-like dementia. Both patients had previously not responded to bedtime regimens of benzodiazepines, trazodone (an antidepressant used for its sedative properties), and neuroleptics. Both patients averaged 2-3 hours of sleep each night. Low-dose zolpidem (5 mg hs) was initiated with only partial response. The dosage was titrated in 5-mg increments until the optimum dosage was reached for case 1 (15 mg hs) and case 2 (10 mg hs). These dosages have proven to be effective over a period of 3 months, with both patients averaging 7-8 hours of sleep each night with no apparent adverse effects. DISCUSSION: dementia produces inversion of the circadian sleep/ wake cycle, leading to daytime sedation and nighttime wandering. Zolpidem, a nonbenzodiazepine hypnotic with proven safety and efficacy in older patients with insomnia, was well tolerated and improved sleep patterns in two patients with dementia and severe nighttime wandering. CONCLUSIONS: Zolpidem appears to be useful for restoring normal sleep patterns in elderly patients with dementia and nighttime wandering.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
8/8. Treatment of rapidly cycling bipolar patient by using extended bed rest and darkness to stabilize the timing and duration of sleep.BACKGROUND: The modern practice of using artificial light to extend waking activities into the nighttime hours might be expected to precipitate or exacerbate bipolar illness, because it has been shown that modifying the timing and duration of sleep can induce mania in susceptible individuals. With this possibility in mind, we treated a patient with rapidly cycling bipolar illness by creating an environment that was likely to increase and to stabilize the number of hours that he slept each night. methods: We asked the patient to remain at bed rest in the dark for 14 hours each night (later this was gradually reduced to 10 hours). Over a period of several years, his clinical state was assessed with twice-daily self-ratings, once-weekly observer ratings, and continuous wrist motor activity recordings. Times of sleeping and waking were recorded with sleep logs, polygraphic recordings, and computer-based event recordings. RESULTS: The patient cycled rapidly between depression and mania and experienced marked fluctuations in the timing and duration of sleep when he slept according to his usual routine, but his sleep and mood stabilized when he adhered to a regimen of long nightly periods of enforced bed rest in the dark. CONCLUSIONS: Fostering sleep and stabilizing its timing by scheduling regular nightly periods of enforced bed rest in the dark may help to prevent mania and rapid cycling in bipolar patients.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |