alex Christodoulou's List: Sleep

• • use this article to figure out what kind of sleep disorder I have
• Primary sleep disorders result from an endogenous disturbance in sleep-wake generating or timing mechanisms, often complicated by behavioral conditioning. Primary sleep disorders are subdivided into parasomnias and dyssomnias. Parasomnias are unusual experiences or behaviors during sleep and include sleep terror disorder and sleepwalking (which occur during Stage 4 sleep) and nightmare disorder (which occurs during REM sleep). Dyssomnias are characterized by abnormalities in the amount, quality, or timing of sleep. These include primary insomnia and hypersomnia, narcolepsy, breathing-related sleep disorder (ie, sleep apnea), and circadian rhythm sleep disorder.
• At times, assessing if anxiety and depression are causing sleep problems or if the anxiety and depression are secondary to a primary sleep problem is difficult.
• Primary insomnia is the general term for difficulty in initiating or maintaining sleep. Because sleep requirements vary from individual to individual, insomnia is considered clinically significant when a patient perceives the loss of sleep as a problem
• Sleep is divided into 2 categories, rapid eye movement (REM) and nonrapid eye movement (NREM). Each of these sleep states is associated with distinct central nervous system activity.
• NREM sleep is further divided into 4 progressive categories, termed stages 1-4 sleep. The arousal threshold rises with each stage of sleep, with stage 4 (delta) being the sleep state from which a person is least able to be aroused, characterized by high-amplitude slow waves.
• REM sleep is characterized by muscle atonia, episodic REMs, and low-amplitude fast waves on electroencephalogram (EEG) readings. Dreaming occurs mainly during REM sleep.
• Multiple neurotransmitters are thought to play a role in sleep. These include serotonin from the dorsal raphe nucleus, norepinephrine contained in neurons with cell bodies in the locus ceruleus, and acetylcholine from the pontine reticular formation. Dopamine, on the other hand, is associated with wakefulness.
• Approximately one third of all Americans have sleep disorders at some point in their lives.
• Chronic insomnia is associated with an increased risk of depression and accompanying danger of suicide, anxiety, excess disability, reduced quality of life, and increased use of health care resources.
• cognitive dysfunction, depression, and decrements in daytime work performance owing to fatigue or sleepiness.
• Primary insomnia is more common in women, with a female-to-male ratio of 3:2.
• Obstructive sleep apnea is more common in men (4%) than in women (2.5%).
• Initial insomnia is characterized by difficulty falling asleep, with increased sleep latency (time between going to bed and falling asleep). Initial insomnia is frequently related to anxiety disorders.
• Hypersomnia, or excessive daytime sleepiness, is often attributable to ongoing sleep deprivation or poor quality sleep for reasons ranging from sleep apnea to substance abuse or medical problems.
• • In delayed sleep phase syndrome, the patient is unable to fall asleep until very early morning. As time progresses, the onset of sleep becomes progressively delayed.
• • Drowsiness
  • Poor concentration
  • Slowed reaction time
  • Weight gain
• Depression may cause alterations in REM sleep. As many as 40% of people with depression have insomnia.
• Anxiety disorders predispose to insomnia. The most common of these are generalized anxiety disorder, panic disorder, and anxiety disorders not otherwise specified.
• Thought disorders and misperception of sleep state are other potential states that cause insomnia.
• Psychotropic medications, such as antidepressants, may interfere with normal REM sleep patterns.

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• • Melatonin reduces sleep onset time in patients with primary sleep disorders but not in normal sleepers or insomniacs
• There was evidence of possible publication bias in the selection of studies that were analyzed; we found a greater number of studies reporting positive results compared to negative results.

  • I like the idea of discussing publication bias. I should look into that in my research area
• Melatonin decreased sleep onset latency
• clinically insignificant.
• Melatonin decreased sleep onset latency in people with a primary sleep disorder
• clinically significant.
• The effects of melatonin did not vary with dose or duration of treatment.
• Our literature review indicated that melatonin reduced sleep onset latency to a greater extent in people with delayed sleep phase syndrome than in people with insomnia.
• This finding may indicate that the effects of melatonin on people with primary sleep disorders are mediated by a direct re-setting of the endogenous circadian pacemaker rather than via a direct action on somnogenic structures of the brain, given that individuals with delayed sleep phase syndrome are distinguished from individuals with insomnia by the presence of a circadian abnormality.
• in people with primary sleep disorders supports the hypothesis that melatonin exerts its effects on this population by acting as a phase re-setter rather than as a hypnotic.
• The results of the current review suggest that melatonin does not affect either sleep onset latency or sleep efficiency in jet lag sufferers or people suffering from shift-work disorder.

• However, the safety of exogenous melatonin when used in the long-term, over months and years, remains unclear.

    

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• Since it is principally blue light that suppresses melatonin,^[23] wearing glasses that block blue light^[24] in the hours before bedtime may avoid melatonin loss. Use of blue-blocking goggles the last hours before bedtime has also been advised for people who need to adjust to an earlier bedtime, as melatonin promotes sleepiness.
• but over-illumination can create significant reduction in melatonin production.
• Even low light levels inhibit melatonin production to some extent
• Many supplemental melatonin users have reported an increase in vivid dreaming.
• Extremely high doses of melatonin (50mg) dramatically increased REM sleep time and dream activity in both narcoleptics and those without narcolepsy.
• However, one factor that may influence this perception is that many over-the-counter melatonin tablets also include Vitamin B6 (pyroxidine), which is also known to be capable of producing vivid dreams
• Exogenous melatonin, used as a chronobiotic and usually taken orally in the afternoon and/or evening, is, together with light therapy upon awakening, the standard treatment for delayed sleep phase syndrome and non-24-hour sleep-wake syndrome.
• Research shows that after melatonin is administered to ADHD patients, the time needed to fall asleep is significantly reduced. Furthermore, the effects of the melatonin after three months showed no change from its effects after one week of use.
• Studies from Massachusetts Institute of Technology have said that melatonin pills sold as supplements contain three to ten times the amount needed to produce the desirable physiologic nocturnal blood melatonin level for enhancement of sleep. Dosages are designed to raise melatonin levels for several hours to enhance quality of sleep, but some studies suggest that smaller doses (for example 0.3 mg as opposed to 3 mg) are just as effective at improving sleep quality.^[63]
• If taken several hours before bedtime according to the phase response curve (PRC) for melatonin, it merely advances the phase of melatonin production. If taken 30 to 90 minutes before bedtime, it advances the period of melatonin's presence in the blood.
• When taken several hours before bedtime in accordance with the PRC for melatonin in humans, the dosage should be so tiny as to not cause tiredness/sleepiness

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