There is an effort on several fronts for newer effective therapy for obstructive sleep apnea. This is because, till now the two main modalities of therapy, continuous positive airway pressure therapy or use of various oral appliances are fraught with problems of poor acceptance and long time adherence. Though numerous modalities have been tried which are discussed in the review, there are few novel approaches which hold great promise as probable effective modalities for the future. In children, the simplest cost effective treatment undoubtedly remains a well timed adeno-tonsillectomy which could as well be curative. However, a high flow open nasal cannula based positive airway pressure therapy has been found to be effective in mild and moderately obese children. In adults, oral pressure therapy using an external suction apparatus connected to an intra oral device, that increases the retropharyngeal space and prevents the tongue from falling back, has been found to be effective in initial studies. Stimulation of the genioglossus by hypoglossal nerve pacing with the use of a pulse generator placed in the infraclavicular region is another promising modality. Various new surgical techniques specially the maxilla mandibular advancement procedures and computerized surgical planning methods hold great promise. Lastly, the multimodality approach using the new knowledge on the pathophysiology of sleep apnea is likely to be the therapy for the future.
Insomnia is one of the most prevalent sleep disorders. Patients with insomnia tend to have altered quality of life, impaired daytime functioning and increased risk of road traffic accidents. Insomnia is commonly associated with chronic medical conditions and psychiatric illness like depression and anxiety. However, it is now being recognized as an independent disorder. All patients of Insomnia should receive therapy for any medical illness, psychiatric disorders, substance abuse or sleep disorders that might precipitate insomnia. In this review, we discuss the current pharmacotherapeutic options for treatment of insomnia. Research for newer therapeutics for insomnia is often complicated by multifactorial etiology. of insomnia. Understanding the molecular and receptor mechanisms involved in promoting sleep may provide further approaches tothe development of newer drugs.
Normal human sleep comprises of two states rapid eye movement (REM) and Non-REM (NREM), which alternates cyclically across a sleep episode. REM sleep was identified by its most typical behavior rapid eye movements during sleep. Electroencephalogram (EEG) of neocortex of most mammals exhibit desynchronized,low-amplitude, and high frequency fast character previously seen in waking, but behavioral sleep persists. This state of sleep called as paradoxical sleep or activated sleep or activated brain in a paralyzed state. Hippocampus has regular high voltage theta waves throughout REM sleep. Multiple neuro-scientific and physiological studies were done to understand the mechanism and genesis of REM sleep. Results of different studies analyze that REM sleep is executed by widely distributed network, rather than single REM sleep center. A number of studies have been attempted to identify pedunculopontine tegmentum (PPT) cholinergic cells present in brainstem, which when activated causes generation and modulation of REM sleep when compared with either NREM or waking. REM sleep sign generator remains in Turned-off condition when aminergic and cholinergic neurotransmitter ratio is1:1 and generator is turned-on to express REM sleep signs when the ratio is 0:0.65. REM-on cells use the neurotransmitter GABA, Ach, glutamate, and glycine, whereas REM-off cells use nor-epinephrine,serotonin, and histamine. c-AMP-PKA intracellular signaling pathway is critically involved in cholinergic cell compartment of the PPT for regulation of cholinergic tone in REM sleep-sign-generators. This review reflects the recent updates on cellular and molecular mechanisms in regulation of REM sleep.
Behavioral treatments focus exclusively on modifying environmental contexts/contingencies and patterns of behavior that presumably exacerbate symptoms and functional impairment. Cognitive-behavioral treatments (CBTs), by comparison, include a focus on behavior modification and an emphasis on modifying maladaptive patterns of thinking. There are central elements of CBT and self-management, which cut across treatment for specific psychiatric disorders and headache disorders. In many cases, insomnia occurs when there is another problem, such as stress, pain, or a medical condition. In these cases, treatment of the underlying problem may help to improve sleep. In other cases, the causative factor of insomnia is unclear or the insomnia does not improveeven after the treatment of the coexisting problem. Hence, the insomnia itself requires to be particularlytreated.
DOI: 10.5958/0974-0155.2015.00021.2 |
Open Access |
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How to cite this article:
Behari M, Shukla G, Goyal V, Gupta A, Poornima S, Srivastava A. Dysfunctional thought-behavior evaluation: effectiveness in differentiating psychophysiological insomnia from co-morbid insomnia. Indian Sleep Med 2015; 10 (4):154-158.
Background: Dysfunctional thinking has been seen as one of the major factors in the maintenance of insomnia; however, there is no literature to elaborate on the differences in thought processes in different insomnia subtypes. The aim of the present study was to assess if we could differentiate psychophysiological insomnia from co-morbid insomnia by noting specific pre-sleep issues relating to dysfunctional thought and behavior.
Methods: Dysfunctional thought was noted for insomnia patients seen in Comprehensive Sleep Disorders Clinic at AIIMS, using a structured telephonic interview questionnaire. Later they were divided into two groups - patients with psychophysiological insomnia and patients with co-morbid insomnia. Responses were then analyzed using Fisher Exact test in STATA 11.0.
Results: There was no significant difference found between the two groups, for most of the dysfunctional statements given in the questionnaire. However, a significant difference was found in response for one of the statements concerned with the effect on next day's behavior of the patient as a result of dysfunctional thinking.
Conclusion: In this preliminary research, we found that patients with psychophysiological and co-morbid insomnia are similar in thoughts and behavior that are attributed to the maintenance of insomnia. However, the only difference noted was that patients with comorbid insomnia had significantly greater ‘worry about next day's functioning’ as a result of poor sleep and hence, affecting their behavior for the next day with regard to social and occupational functioning.
Objectives/Background: Snoring is a hallmark of Sleep Disordered Breathing (SDB) and is seen more often in pregnancy. This study was conducted to determine the frequency of snoring in pregnancy-induced hypertension and to observe its impact on feto-maternal outcomes.
Participants/Methods: Sixty-five women with preeclampsia and gestational hypertension comprised the study group, whereas 85 normotensive, age, and gestation matched women were the controls. All the subjects were questioned about habitual snoring and they were followed to study their feto-maternal outcomes.
Results and Conclusions: Snoring was seen more frequently in the cases (OR 16.9, 95% CI 6.8-41.7) as compared to controls even after controlling for BMI. The severity of hypertension was more in snorers (p=0.021). The adverse pregnancy outcomes were more severe in the snorers in the cases as well as the controls. The fetal outcomes were more severely affected by snoring.
Conclusions: Snoring is more prevalent among women with pregnancy-induced hypertension and is associated with more severe hypertension and adverse outcomes.
OBJECTIVES: A high percentage of professional drivers (PDs) often report feeling fatigue during their work, and falling asleep at the wheel (FAW) is a major contributing factor to the occurrence of near-miss or actual accidents.The aim of this study is to evaluate the prevalence of FAW among Italian PDs and the effect of fatigue on this occurrence (corrected for the main predictive factors already known).
MATERIAL AND METHODS: We performed a crosssectional questionnaire survey. Data from PDs (N = 497)
were used for analyses. Logistic regression analyses were performed to assess the association of reported suddenonset sleep at the wheel with working conditions and general lifestyle factors.
RESULTS: Forty-one percent of the interviewees experienced at least 1 episode per month of suddenonset sleep at the wheel (4.7% per week). Predictive factors of self-reported FAW were: age > 55 years old (odds ratio (OR) = 4.91, confidence interval (CI): 1.79-13.50, p < 0.01), traveling more than 40 thousand miles per year (OR = 1.86, 95% CI: 1.08-3.22, p < 0.05),body mass index e” 30 (OR = 2.16,95% CI: 1.01-4.64,p < 0.05) and Chalder Fatigue Questionnaire score > 22 (OR = 3.93, 95% CI: 1.90-8.14, p < 0.01).
CONCLUSIONS: There are different work and human factors underlying FAW among PDs.The Chalder Fatigue Questionnaire might be useful in measuring fatigue in this group and in detecting PDs at high risk of experiencing FAW.