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This chapter will discuss the relationship between a select group of anxiety disorders [nocturnal panic/panic disorder (PD), posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD)] and sleep disturbance. Of particular interest will be the outcome measure quality of life (QOL). QOL scales are well suited to investigate treatment outcome for some sleep disorders because often subjective measures of sleep are not sensitive enough to uncover disturbance. Therefore, global measures such as QOL may be more suitable. In both PTSD and GAD, studies that show the impact of sleep disorder treatment on improving anxiety symptoms will be discussed. Hyperarousal is a major underlying theme for various sleep and anxiety disorders; therefore, it will also be addressed. [ABSTRACT FROM AUTHOR]

Insomnia is a common complaint in people living with HIV and AIDS. It contributes to fatigue, functional impairment, and an overall reduction in the quality of life; yet, there remains considerable uncertainty about its cause and significance. Early reports of sleep-specific EEG changes related to HIV infection, in particular an increase in slow wave sleep, have not been confirmed in later controlled studies. Sleep disturbance is reported at all stages of HIV infection, but the presence of cognitive impairment or an AIDS-defining illness is a significant risk factor. Antiretroviral medications have not demonstrated a class effect, but plasma levels of the non-nucleoside reverse transcriptase inhibitor, efavirenz, do correlate with insomnia. Amongst the recognized risk factors, the most notable is psychological morbidity which has shown a consistent and strong association with insomnia in seropositive patients. Insomnia in HIV infection is associated with a reduced quality of life, but in this population, it remains both under-recognized and under-treated. This may in part be a reflection of uncertainty about approaches to management, as there is little data on treatment of insomnia in this population. Insomnia in HIV presents a considerable challenge for the clinician and requires careful evaluation, in particular screening for anxiety and depression, and a familiarity with non-pharmacological interventions as well as drug treatments for sleep disturbance. [ABSTRACT FROM AUTHOR]

Sleep fragmentation and disruption during the normal physiological changes of pregnancy are as significant as some medical diseases. Sleep disorders during pregnancy are an even further complication. These changes, which persist not only over the course of the pregnancy, but also into the postpartum period, are significant enough to affect quality of life. Measures specific to the quality of life associated with sleep disorders are limited in pregnancy. Sleep disruption affects quality of life in a significant way. Those with insomnia suffer significant distress during that period, and those with poor sleep suffer the daytime consequences such as excessive daytime sleepiness. The literature regarding sleep and quality of life during pregnancy is limited. This review outlines the sleep characteristics typical of a normal pregnancy, including physical and emotional changes, and then the quality of life implications. We present some preliminary data that have been collected on quality of life in a study of normal pregnancy, and how sleep disruption may have an impact. Then, we explore sleep disorders such as restless legs syndrome and sleep-disordered breathing in pregnancy and assess how they may impact quality of life. Finally, we discuss sleep changes in the postpartum period, and how they may impact quality of life. The implications for perinatal depression may be particularly important. It becomes clear that for such a significant change in life, physically and emotionally, further studies exploring the impact of sleep on quality of life in pregnancy are required. The potential treatment of sleep disorders in pregnancy could lead to significant quality of life improvements during this time. [ABSTRACT FROM AUTHOR]

This chapter explores the interface among sleep patterns, psychological trauma, and quality of life. This chapter is written with the conceptual model, health-related quality of life (HRQL), as the backdrop for understanding the relationships between sleep, psychological trauma, and HRQL. It incorporates an understanding of the interrelationship of health, biological, social, and psychological markers as it relates to a person's HRQL. Under this framework, sleep acts as a biological variable that intersects with psychological trauma causing alterations in HRQL. In this chapter, we 1) review the current literature on the characteristics and uniqueness of sleep disturbances that are associated with a psychological trauma, 2) examine the relationship among: sleep, psychological trauma, and quality of life among select groups, and 3) focus on empirical gaps present in our knowledge related to trauma, sleep, and quality of life. [ABSTRACT FROM AUTHOR]

Health-related quality of life does not appear to be substantially worsened during menopause. Although women increasingly report difficulty sleeping during this period, laboratory physiological studies do not bear this out. Rather, women who report higher levels of anxiety also report difficulty sleeping. The prevalence of insomnia in the general population is highly dependent upon the definition employed and may account for the reports obtained in menopausal women. [ABSTRACT FROM AUTHOR]

What is the relationship between obstructive sleep apnea (OSA) and head and neck neoplasms (HNN)? For relevant articles identified through MEDLINE, thirty-three were about neoplasms (often benign) presenting first as OSA, and five were about head and neck cancer (HNC) treatment causing OSA. Three of these articles gave incidences for HNC treatment causing OSA, but these incidences varied widely, as they went from 8 to 92%. A few, older case studies described individual patients treated for HNC who developed OSA, particularly after extensive radiotherapy. However, those case studies did not stimulate much further investigation. Handling of OSA caused by HNN fits the classic, medical pattern of a symptom that is traced to a disease for which treating the disease removes the symptom (the treatment typically is to remove the HNN). OSA secondary to treatment for HNC may be missed, in part, because patients have many, permanent, adverse effects, such as xerostomia, from HNC treatment, and those adverse effects camouflage the OSA symptoms. OSA that has been caused by the treatment for HNC has been managed by tracheostomy or Continuous Positive Airway Pressure (CPAP), although patient complications may require additional steps. Quality of life surveys confirm that patients with HNC have sleep problems. Xerostomia may contribute to these sleep problems, and the role of salivary mucins deserves consideration. HNN and their treatments create special situations for studying the causes of OSA and for caring for patients. [ABSTRACT FROM AUTHOR]

Current clinical practice and research in cancer patients has focused on supportive care needs as well as tumor control. Sleep disorders are commonly observed in cancer patients but they are under-reported by the patients, and infrequently elicited by their physicians. The prevalence of sleep disorders ranges from 30 to 60% in cancer patients and of insomnia from 18 to >50%. In the oncology population, insomnia often forms part of a symptom cluster consisting of pain, depression,anxiety, and most importantly fatigue. The pathophysiological basis of sleep disorders in cancer has not been fully elucidated but includes circadian rhythm disturbances and alterations in cortisol, melatonin, and cytokine secretion. Risk factors for sleep disorders can be categorized as predisposing, precipitating, and perpetuating factors, some of which are related to personal traits of the patients, and others which are related to the disease, its treatment, or reactions to it. Measurement of sleeprelated problems has varied from objective observation to a variety of sleep-specific questionnaires, to quality of life (QOL) instruments, the latter usually containing very few items regarding sleep. The most accepted and efficacious treatment for sleep difficulties in cancer patients is cognitive behavioral therapy. However, in some subgroups (e.g., palliative care patients) medications may be preferred. A combined pharmacological and behavioral approach may be necessary for some patients.Methodological problems are frequent in the literature on sleep and QOL in cancer patients. There is a need for consensus on definitions, instruments for measurement, and high-quality trials to assess the efficacy of therapies. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is one of the most common chronic medical conditions. It affects all age groups, has a variety of presentations, a range of complications, and numerous therapeutic interventions. Its impact on patients' quality of life is dependent on factors such as demographics, the level of glycemic control, and the presence of co-morbidities and diabetic complications. Some of these complications, such as painful diabetic peripheral neuropathy and nocturia, can cause sleep onset and sleep maintenance problems resulting in poor sleep quality, daytime fatigue, and somnolence. Co-morbidities, such as depression, are common in diabetes and may affect sleep and quality of life. Sleep complaints and sleep disorders, such as restless legs syndrome and sleep-related breathing disorders, are very common among adult diabetics. Their impact on the health-related quality of life (HRQoL) of the diabetics, however, has not been extensively studied. Even though there is a multitude of validated quality of life measures that have been used in the diabetic population, few generic and disease-specific questionnaires include sleep-related items. The results of the studies using instruments that incorporate sleep-related questions indicate that sleep complaints contribute significantly to the overall impairment of quality of life in this population. This chapter will review the literature on the relationship between diabetes, some of its complications, HRQoL and sleep quality. It will focus on the most common sleep disorders and describe their impact on quality of life. Finally, it will provide suggestions for further research in this area. [ABSTRACT FROM AUTHOR]

It is well established that a close relationship exists between sleep and hormones of the hypothalamic-pituitary axis. Sleep has an electrophysiological component and an endocrine component, i.e., the distinct patterns of hormone secretion. Both the electrophysiological and the hormonal component interact bi-directional. Sleep-endocrine rhythms are closely interrelated, and sleep is an important regulator of (neuro)endocrine function. The secretion of growth hormone (GH), prolactin (PRL), and thyrotropin (TSH) is markedly increased during sleep, whereas the secretion of adrenocorticotrophic hormone (ACTH) and cortisol is inhibited. Sleep deprivation is associated with decreased GH and PRL secretion, and increased cortisol and TSH secretion. The decrease of GH secretion, which occurs with advancing age, is strongly associated with impaired quality of sleep. Increasing age is associated with increased levels of cortisol, which is significant after age 50 years when sleep is more fragmented and REM sleep declines. GH deficiency in adults (AGHD) is a well-recognized clinical syndrome, which is characterized by abnormal body composition and most notably, impairment of quality of life (QoL). Recent studies on long-term treatment of adult GH-deficient patients have convincingly shown that GH replacement therapy improves QoL in association with a reduction in healthcare utilization. Chronic excess of glucocorticoids, Cushing's syndrome, is associated with sleep disturbances, mood alterations, depression, and impaired QoL. Patients with thyroid disease have sleep disturbances and a significantly reduced health-related QoL. [ABSTRACT FROM AUTHOR]

Obesity is a global problem now affecting more than 60% of the US population. It is associated with a wide range of co-morbidities including depression, diabetes, cardiovascular, hepatic, and rheumatologic conditions. Sleep disturbances are also common and include breathing disorders such as obstructive sleep apnea, obesity hypoventilation, upper airway resistance syndrome, and REM-specific sleep-disordered breathing. Obesity may account for more than 50% of sleep apnea cases. Although sleep apnea is an important and common complication of obesity, other sleep diagnoses have been associated with obesity. These include insomnia, hypersomnia, sleep fragmentation, and non-restorative sleep. The overlap of obesity, medical co-morbidities, and sleep disturbances results in a significant reduction in quality of life as measured by various self-report scales. The benefits of weight loss are also discussed as there can be a significant improvement of both obesity and associated health problems. [ABSTRACT FROM AUTHOR]

It has become increasingly evident that sleep problems are common in patients with systemic lupus erythematosus (SLE). Approximately 56-60% of patients with SLE report poor sleep quality, characterized mainly by difficulties initiating and/or maintaining sleep. Emerging data also indicate that sleep respiratory and movement disorders are prevalent in patients with SLE. Despite their prevalence and potential to negatively impact health and quality of life, sleep problems remain underrecognized, undertreated and understudied in this patient population. Only a handful of studies have been conducted to investigate determinants of sleep problems in SLE. The findings to date suggest that disease expression (activity, pain), behavioural and psychosocial factors including physical inactivity and depressed mood contribute to sleep problems in SLE. More studies, integrating a biopsychosocial approach, are needed to clarify the specific factors and underlying mechanisms that trigger and maintain sleep problems in SLE. The course of sleep problems in SLE remains unknown as studies have been cross-sectional. Directions for future research are discussed herein. Routine assessment and management of sleep problems in SLE should be part of the comprehensive care of patients with SLE. While effective pharmacological and nonpharmacological treatments are available to manage sleep problems, there are currently no studies which have specifically evaluated these strategies for patients with SLE. Given the complex interplay of factors contributing to sleep problems in SLE, a multimodal treatment approach combining several nonpharmacological strategies and possibly medication for more chronic and difficult cases, should be utilized for the management of sleep difficulties in SLE. [ABSTRACT FROM AUTHOR]

Cystic fibrosis (CF) is a progressive disorder. Patients face rigorous daily treatments and fears of an uncertain future, both of which can impact on the physical, social and psychological aspects of their lives. In addition, with ongoing lung damage and airway obstruction, hypoxemia and hypercapnia during sleep can develop, contributing to daytime physiological and neurocognitive deficits. Health-related quality of life (HRQoL) in CF has become increasingly important as patient survival has increased. As a result, CF-specific measures of HRQoL have been developed. Quality of life research suggests that, despite chronic symptoms of dyspnoea and cough, reduced functional capacity, and the burden of repeated respiratory infections and hospitalization, people with CF generally report a good HRQoL in the psychosocial domain. However, scores for most physical domains are lower than those seen in matched healthy controls. Many patients with CF perceive their quality of sleep to be poor, with those individuals with more severely impaired lung function and worse gas exchange more likely to report poorer subjective sleep quality. Sleep disturbance appears to be a major factor in the poor overall sleep quality that patients with CF report. Although hypoxia and hypercapnia might contribute to sleep disruption and impaired daytime function in the presence of severe lung damage, other mechanisms likely to contribute include cough, airway inflammation, sinusitis and gastrointestinal disturbances. Pulmonary exacerbations also adversely affect sleep quality, quality of life and cognitive function, but no cause-and-effect relationship between exacerbation-related sleep disturbance and quality of life and cognitive changes has been demonstrated. Although treatments such as oxygen and NIV can improve nocturnal gas exchange, little evidence of a long-term benefit on either quantity or quality of life in CF has yet been demonstrated. As survival increases, there will be increasing focus on issues such as sleep quality, its effects on daytime function and management of respiratory failure. Improving the impact of the illness and its treatments on quality of life will become an increasingly important goal for interventions in this patient group. [ABSTRACT FROM AUTHOR]

Nocturia, waking up at night to void, is a highly prevalent disorder in the elderly, with a profound impact on life expectancy, health, and quality of life (QoL). Elderly persons with nocturia are troubled by sleep impairment because of involuntary awakenings, increased nightmares, and a general feeling of insufficient and non-restorative sleep. Consequently, their daytime performance is impaired and they are more inclined to daytime sleepiness and napping than the elderly in general. Particularly, waking up three or more times a night to void is related to a steep increase in sleep disturbances. Giddiness both at night and during the daytime is another common consequence, since in three cases of four nocturia is due to nocturnal urine overproduction, causing a negative fluid balance. Nocturia may be attributable to nocturnal polyuria (nocturnal urine overproduction), a diminished nocturnal bladder capacity, or a combination of the two. In some elderly people, a disorder of the vasopressin system, with very low or undetectable levels of vasopressin at night and in some cases throughout the entire 24-h period may cause an increase in nocturnal urine output, which in most extreme cases will account for 85% of the 24-h diuresis. The increased urine output can be treated with desmopressin orally at bedtime, in generally low doses. Nocturia is also more prevalent in association with reduced bladder capacity. Antimuscarinic drugs may be administered to depress involuntary bladder contractions. This chapter emphasizes the importance of correctly diagnosing and treating nocturia in order to improve the patients' sleep and, in turn, to reduce the risk of fall injuries and their detrimental consequences and to improve health and QoL. [ABSTRACT FROM AUTHOR]

There has been an increasing interest in sleep problems of patients after organ transplantation. Despite the high prevalence of sleep disorders and the potential impact on both health-related quality of life and on morbidity and mortality, there is still a paucity of published data in the transplanted population. We aim to review here the few studies that address these issues in the kidney-transplanted population. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) leading to renal insufficiency and failure is a growing health care problem. It is well established that patients with end-stage renal disease (ESRD) have a diminished quality of life (QOL), as well as increased sleep complaints. Much less is known about individuals with early-stage CKD who do not require dialysis. Sleep disturbance appears to be part of the uremic syndrome, and manifests as excessive daytime sleepiness, changes in sleep architecture, sleep-disordered breathing/sleep apnea, and periodic limb movements (PLMs)/restless legs syndrome. Numerous studies in patients with ESRD have associated sleep disturbances with poor QOL, but very limited data exist on pre-dialysis CKD patients. There is increasing evidence that correction of uremia by intensification of dialysis or renal transplantation can improve sleep disturbances, as well as perceived QOL. These and other treatments for sleep disorders used in the general population require further research to demonstrate efficacy and the impact on QOL in patients with all stages of CKD. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is a common inflammatory illness that affects over 10% of the world's population. Among patients with AR, difficulties with falling asleep and maintaining sleep often result in decreased daytime energy, easy fatigability, decreased cognitive and psychomotor function, and reduced quality of life. Two models have been proposed to explain sleep-related symptoms associated with AR. One model focuses on the role of nasal congestion and ventilation during sleep, resulting in obstructive arousals and awakening. An alternate model involves the direct role of systemic inflammatory mediators on the regulation of sleep and nocturnal events, resulting in daytime symptoms and decreased quality of life. The present chapter explores the interaction of nasal obstruction and systemic inflammatory mediators using these two models to evaluate their role on sleep quality and resultant symptomatic and functional effects. It also examines pharmacologic and nonpharmacologic therapies that are commonly used to treat AR, and how these agents can have both beneficial and adverse effects. [ABSTRACT FROM AUTHOR]

Cardiac surgical procedures, especially coronary artery bypass surgery used to treat coronary artery disease (CAD), is most frequently utilized in the USA, but utilization of this procedure is increasing in countries that have not in the past used such high-technology health care interventions. Most people experience improvements in multiple dimensions of quality of life, especially those associated with mobility and physical activity. Sleep disturbance is common pre-operatively and extends through the recovery period, but appears to improve over the long term and may contribute to various dimensions of quality of life. The purposes of this chapter are to review the literature on dimensions of quality of life and sleep and the relationships between sleep and quality of life among cardiac surgical patients and to propose implications for future research. [ABSTRACT FROM AUTHOR]

Congestive heart failure (CHF) because of left ventricular systolic dysfunction is a prevalent syndrome and associated with morbidity, mortality, and huge economic cost. Hallmarks of CHF are exercise intolerance, poor prognosis, and poor quality of life (QoL). According to reports from several laboratories, a large number of patients with heart failure also have sleep apnea (SA). SAs cause arousals and sleep disruption, alter blood gases, and increase sympathetic activity. SA has a major impact on QoL, and disturbed sleep itself significantly contributes to depressive syndromes in patients with stable CHF. The correlation of the apnea/hypopnea index (AHI) with most of the QoL measures and depressive syndromes indicates that patients with AHI indices estimated their impaired physical and emotional health status lower as opposed to patients without sleep-related breathing disorder. Fatigue leads to reduced QoL after stroke. Sleep-disordered breathing precedes stroke and may contribute to the development of stroke. It is an independent prognostic factor related to mortality in stroke and associated with fatigue and impaired QoL. Obstructive events seem to be a condition before the neurological disease whereas central events and Cheyne-Stokes respiration (CSR) could be its consequence. In this article, the impact of sleep-disordered breathing on patients with heart failure and stroke and its influence on QoL are discussed. [ABSTRACT FROM AUTHOR]

Hypertension and coronary heart disease are leading global causes of death, disability, and decrements in health-related quality of life. Sleep disorders are also intimately associated with health-related quality of life, appear to be factors influencing the progression of cardiovascular disease, and are more common among people with these disorders than the general population of middle-aged and older adults. Factors that contribute to sleep quality and sleep disorders appear to be multifactorial in this setting and may include demographic, clinical, and treatment-related characteristics. The purposes of this chapter are to evaluate the nature of sleep and sleep disorders and quality of life in adults with cardiovascular disease, as well as those who may be at-risk for cardiovascular disease; to critically review research findings addressing the relationships between sleep, sleep disorders and quality of life; and to propose directions for future research. [ABSTRACT FROM AUTHOR]

Attempting to treat patients who are actively using addictive drugs is unlikely to be helpful and is potentially harmful. Actively using patients should be referred for detoxification before treatment for insomnia is implemented. All drugs of abuse cause insomnia. Although insomnia is most severe during withdrawal, it may be a long-lasting complication of addiction. Cocaine has been shown to provoke "occult" insomnia: degraded sleep accompanied by deteriorated cognitive functioning without the sensation of lack of sleep. This is thought to be caused by a decreased drive for sleep. Insomnia during methadone maintenance is the rule. Because of methadone-provoked central sleep apnea and because of the common lethality of benzodiazepines added to methadone, benzodiazepines are contraindicated during methadone maintenance. Physicians should be sure to include non-medication approaches for insomnia such as sleep hygiene, and if available, acupuncture. If medications are indicated for insomnia, trazodone, low-dose mirtazapine, quetiapine, clonidine, and valproic acid are good choices. Drug dreams are probably provoked by the same mechanism as drug craving: up-regulation of the ventral tegmental dopaminergic seeking system. Attention to drug-seeking during dreams may facilitate recovery. [ABSTRACT FROM AUTHOR]

Alcohol disrupts sleep even in healthy individuals, and when consumed in excessive amounts for long periods, the sleep disturbance remains even after prolonged abstinence. Disturbed sleep is an important factor contributing to poor quality of life (QoL) in clinical samples of alcohol-dependent subjects as well as in population-based samples. Relapse to alcoholism, which clearly lessens QoL, is associated with disturbed sleep in both prospective treatment and population-based studies. However, these alcohol, sleep, and QoL associations found in treatment and population studies are confounded by other risky health behaviors and co-morbid medical and psychiatric diseases. Controlled laboratory studies have documented the sleep-disruptive effects of alcohol and its impairing effects on functioning the following day. The exacerbating effects of alcohol on sleep-related breathing disorders and an increased association of periodic leg movements with alcoholism have also been well documented. And each of these primary sleep disorders are known for their own impairing effects on daytime function. Finally, and most importantly from a public health perspective, studies have demonstrated that reduced sleep and increased daytime sleepiness, not due to alcohol consumption, will enhance the impairing effects of alcohol. [ABSTRACT FROM AUTHOR]

Caffeine is regarded as a mild stimulant acting on the central nervous system that is responsible for a significant portion of the behavioural and physiological effects of coffee and tea. Motives why people take caffeine are reflected in consumption patterns. Early in the morning caffeine might help to wake up, whereas during the day it is an aid to stay awake or counteract fatigue. The intake of caffeine shortly before sleep might affect sleep characteristics, especially if high doses of caffeine are used. Moreover, these disturbances of sleep might result in tiredness in the morning. Caffeine is frequently used as a countermeasure for fatigue and sleepiness. During sub-optimal circumstances such as working night shifts and sleep deprivation it maintains performance and wakefulness at satisfying levels. These effects of caffeine depend largely on its antagonistic actions on the A_2A adenosine receptor. Simple task performance seems in particular sensitive to caffeine. Part of the caffeine effects might be due to withdrawal reversal, although caffeine is stimulating in non-withdrawn subjects, as well. In addition, in habitual users, there is no complete tolerance to the effects of caffeine. [ABSTRACT FROM AUTHOR]

Patients with schizophrenia have severe and persistent sleep disturbance. Multiple mechanisms contribute to poor sleep in patients with schizophrenia, including high brain dopamine levels, high anxiety, and medication side effects. Persons with psychoses generally rate their QOL worse than both the general population and physically ill patients. Although patients with schizophrenia can self-rate their QOL, the most complete picture of QOL includes assessment by family members and professionals. Negative symptoms, depressed mood, anxiety, medication side effects, and stigma correlate with low QOL in patients with schizophrenia. Positive mood, high self esteem, good social support, a sense of personal control and empowerment, and an extroverted, agreeable personality promote QOL. Sleep deprivation may foster poor functioning and high levels of thought disorder, hostility, and excitement. Improving sleep in patients with schizophrenia is likely to improve their psychiatric symptoms. [ABSTRACT FROM AUTHOR]

Patients suffering from obsessive-compulsive disorder (OCD) scarcely complain primarily of insomnia. However, sleep disturbance is very common in this population as shown by epidemiological and polysomnographic studies. Clinical psychiatrists have to check for sleep disruptions through a careful medical history of the patient. Special attention will be paid to patients with checking of washing rituals who can delay their sleep during endless compulsive activities. To what extent these sleep problems are related to the pathophysiology of OCD or simply a consequence of the obsessive-compulsive symptoms remains to be addressed in future studies. In OCD, despite initial confusing findings, there is no specific alteration of the sleep structure. However, impaired sleep continuity, intrusion of wake during sleep, and reduction of sleep duration are constantly observed. Endocrine functions are also strongly modified during sleep of OCD sufferers. Adrenocorticotrophic hormone (ACTH) and cortisol are significantly elevated whereas sleep onset-related GH secretion is blunted in patients compared with healthy controls. Clinical experience suggests that the improvement of OCD is strongly linked to the decrease of sleep alterations but the specific impact of insomnia on the course of the illness and the quality of life (QOL) of patients has not been investigated precisely. Neurobiology shows that sleep regulation and OCD pathophysiology share common serotoninergic mechanisms, suggesting that their relationship is not fortuitous. Prescription of serotonin-acting antidepressant for OCD has to be reassessed to prevent further alteration of sleep structure. Actually, antidepressants active on OCD stimulate vigilance and could disrupt sleep continuity. From a therapeutic point of view, we need to determine the reciprocal effects of specific treatments (ODC or sleep focused) on the evolution of the other variables. It is likely that sleep care should facilitate OCD treatment and reciprocally. [ABSTRACT FROM AUTHOR]

Anorexia nervosa (AN) and bulimia nervosa (BN) are well-recognized eating disorders clinically. Night eating syndrome (NES) and binge eating disorder (BED) are also of considerable importance and are increasingly recognized in the clinic, because of the distress they cause and their links with obesity. Each of these four eating disorders has the capacity to disturb sleep and in that respect additionally impair quality of life and the ability to function for sufferers supplementary to the characteristic eating disorder symptoms, per se. Sleep disturbance in the form of subjective impairments in sleep quality, initial- and mid-phase insomnia, changes in Rapid Eye Movement (REM) duration and density, and reduced sleep efficiency appear to be most marked in AN and NES. The NES produces the most clinically overt disturbance in sleep with frequent awakenings to ingest food and marked reductions in sleep efficiency being cardinal diagnostic features. It can be distinguished from the parasomnia, sleep-related eating disorder (SRED) by the presence of awareness during and the lack of amnesia for nocturnal eating episodes. Treatment of eating disorders is associated with improvements in quality of life measures. Sleep dysfunction is also ameliorated by successful treatment of the associated eating disorder. Although improvements in functioning and quality of life must no doubt to a large degree ensue from controlling of distressing eating disorder symptoms such as restricting, purging, and bingeing, it is also plausible that improvements in sleep quality and duration also contribute. Further research is needed to assess further links between sleep disturbance in eating disorders and quality of life. [ABSTRACT FROM AUTHOR]

Attention-deficit hyperactivity disorder (ADHD) is a highly prevalent neuropsychiatric disorder characterized by symptoms of inattention, impulsivity, and hyperactivity. From early childhood to late adulthood, patients with ADHD (or their parents) complain about poor sleep quality and insufficient sleep quantity. As a result, ADHD patients experience excessive daytime sleepiness (EDS). Because EDS has been found to result in behavioral problems and cognitive impairments that mimic ADHD symptoms, sleep problems (e.g., due to a primary sleep disorder) may be misdiagnosed as ADHD. Alternatively, ADHD may actually cause sleep disturbances, e.g., due to dysfunctions in shared dopaminergic or noradrenergic neural systems. Here, we review studies on sleep and ADHD. Studies using subjective measures, such as questionnaires and diaries, have indicated a wide variety of sleep problems, a high prevalence of sleep disorders, and EDS. Studies using objective measures have only partly been able to confirm these findings. Studies using the Multiple Sleep Latency Test (MSLT) have clearly demonstrated EDS in ADHD. Actigraphic studies have inconsistently suggested an increase in nocturnal activity levels, whereas polysomnographic studies have mostly indicated deviations in REM activity and the presence of periodic limb movement disorder (PLMD). Intervention studies yielded mixed results. Sleep problems have been claimed to reduce, increase, and be unaffected by methylphenidate (MPH), the drug of choice for ADHD treatment. The large inconsistencies across studies are likely due to numerous confounding variables, such as small sample sizes, the heterogeneity of ADHD samples, the presence of comorbid conditions, differences in medication status and treatment regiments, differences in pubertal status, gender and the lack of methodological guidelines (e.g., the use of validated questionnaires and the inclusion of adaptation nights). Implications for future research are discussed. [ABSTRACT FROM AUTHOR]

Major depression is a common disorder; nearly 10% of the population suffers from a depressive illness in any given year. There is a strong association between sleep disturbances and depression. The most common sleep disturbance associated with major depressive disorder is insomnia. The relationship between insomnia and depression is bidirectional in that insomnia is one of the symptoms of depression and chronic insomnia can be a risk factor for depression. Depression causes changes in sleep patterns and sleep quality. Depressed patients showed prolonged sleep latency, increased wakefulness during sleep, early morning awakening, decreased sleep efficiency, decreased amounts of slow wave sleep and rapid eye movement (REM) sleep abnormalities. Depression is currently one of the leading causes of disability in the world. There is a direct association between the severity of depression and the level of disability. Depression has a big impact on quality of life of patients. Studies have showed that patients with major depressive disorder have poorer quality of life than persons from the general population. Effects of depression on quality of life are equal to or greater than those of patients with chronic medical conditions. Untreated depression usually does not go away by itself and often gets worse with time and increases a person's risk of suicide; it is a fact that up to 15% of those who are clinically depressed die through suicide. Clinical depression is treatable with counseling and medication. The majority of people with depressive disorders improve when they receive appropriate treatment. Improvement in depressive symptoms during the treatment is related to improvement in the quality of life. Antidepressants are shown to improve quality of life. There are some tools for evaluating quality of life in depressive patients, today. These tools help us to assess improvement in depressive patients beyond the extent to which depression rating scales do. In clinical settings, quality of life instruments can show us when patients begin to feel benefits of antidepressant therapy. [ABSTRACT FROM AUTHOR]

The fatigue in chronic fatigue syndrome (CFS) appears to be more severe, more functionally impairing, and less likely to be alleviated by rest than fatigue commonly experienced by healthy individuals. The words used by individuals with CFS to describe their fatigue are characterized by terms that deal with functional limitations, frustration, loss of control, permanence, depression, and pervasiveness—language that clearly reflects their diminished quality of life (QOL). With respect to etiology, CFS has been conceptualized among a spectrum of stress-related, functional disorders characterized by profound fatigue and, frequently, pain. In terms of sleep characteristics, individuals with CFS display the characteristic signs of poor overall sleep efficiency that is typically seen in persons with insomnia. They frequently experience nonrestorative sleep, and their daytime functioning is also seriously compromised. QOL scores reflect findings which show that symptoms of CFS significantly undermine many facets of these individuals' lives and significantly impair physical and social functioning as well as participation in activities of daily living. Physicians have little to offer their patients who have CFS. Friends and family, also unable to help, often tell people who have CFS to "just get on with your life," "pull yourself together," and "stop moping around." By dismissing and invalidating the lived experience of individuals with CFS, they contribute to an already poor QOL. Despite recent progress in understanding the biological mechanisms of the illness, more work needs to be done to find effective clinical treatments. Healthcare professionals and disability insurance carriers need to be informed that CFS is a real and disabling physical illness. [ABSTRACT FROM AUTHOR]

Disordered sleep affects daytime health and behavioral functioning in a variety of neurologic and psychiatric conditions. Sleep disorders lead to a multitude of secondary behavioral effects that affect both the individual and the family (1). Daytime sleepiness resulting from disrupted sleep often manifests itself in typically developing children as hyperactivity, inattention, and aggression (2). Those with autism, a spectrum of neurodevelopmental disorders characterized by difficulties in language and social communication with restricted and repetitive behaviors, may be at even higher risk for sleep disorders given the overlap of autism with sleep. In turn, behaviors inherent to autism, such as impairments in communication and stereotypies, may be exacerbated by sleepiness and interfere with the child's ability to function optimally, thereby affecting quality of life in autism. Aggression and hyperactivity, two problematic behaviors frequently associated with autism, may be further exacerbated by lack of sleep in the child with autism. This chapter will review our current understanding of the neurobiology of autism, especially in reference to sleep-related aspects of this disorder. Sleep disorders in autism, including prevalence, etiology, evaluation, and treatment, will then be characterized. The impact of sleep disorders on daytime behavior and on quality of life in individuals affected with autism and their families will then be discussed. Our chapter will conclude with future research directions for advancing our knowledge in this field. [ABSTRACT FROM AUTHOR]

Respiratory muscle weakness is a common feature of many neuromuscular disorders contributing to the development of daytime respiratory failure. However sleep-related breathing abnormalities and sleep disturbance can occur months or years before the emergence of daytime hypercapnia. Although obstructive events are commonly seen in the early stages of many disorders with age and disease progression central events and nocturnal hypoventilation occur. Patients may complain of unrefreshing sleep daytime sleepiness and impaired concentration although these symptoms can develop insidiously and be overlooked or mistaken as features of primary disease process. As management of neuromuscular disorders is primarily supportive not curative therapeutic intervention must be directed towards managing symptoms and maintaining quality of life. Non-invasive ventilation (NIV) has been convincingly shown to improve physiologic parameters and extend survival in patients with a wide variety of neuromuscular disorders. Although an improvement in symptoms once therapy is commenced is frequently reported the impact on sleep quality and health-related quality of life (HRQOL) has received far less attention. Assessing quality of life is essential to evaluate the financial and human costs and benefits of therapy. Health professionals frequently underestimate the quality of life in patients with neuromuscular disorders and significant disability and this can affect the type of therapeutic options that are offered to patients. As sleep quality has been shown to be a major determinant of global quality of life in patients with chronic respiratory failure evaluating sleepiness specific sleep-related quality of life issues and neuropsychological function should be undertaken routinely before the institution of home ventilation and during follow up. [ABSTRACT FROM AUTHOR]

In multiple sclerosis (MS), an autoimmune inflammatory disease of the central nervous system (CNS), the myelin sheet insulating the axons is destroyed. This diminishes the electric conduction within the CNS. The exact pathologic mechanism responsible for the development of demyelinating plaques and axonal damage is still unclear. MS is probably a heterogeneous disease where different pathogenetic mechanisms are of importance (1, 2). We know from clinical evidence that demyelinization is mediated by autoreactive T-cells, and furthermore, certain hereditary and environmental factors seem to make certain individuals more susceptible to MS than others. In the MS population, sleep disturbances are three times more common as compared to the general population and MS patients are twice as likely to have reduced sleep quality (3, 4). MS-related sleep disorders can be subdivided into primary sleep disorders and secondary sleep disorders. The most common primary sleep disorders seen in patients with MS are insomnia, nocturnal movement disorders, sleep-disordered breathing, narcolepsy, and rapid eye movement behavior disorder (5-7). Secondary sleep disturbances can result from a clinical variety of symptoms seen in MS. Sleep disturbances, depression, and fatigue are often co-existing in MS and thereby influence and intensify each other. Identification of them is very important, because appropriate treatment will improve the symptoms itself, improve quality of sleep, and diminish fatigue. Altogether this reduces disability and will provide patients with a better quality of life (QOL). MS has a substantial negative effect on QOL, even when compared with other chronically ill patients (8). This is probably due to its unpredictable and most often progressive disease course. As a healthcare provider for MS patients, it is important to aid patients in maintaining social activity, employment, and regular exercise. All these factors are important for the improvement of patients' well-being. As attitudes toward MS and ways of coping with this unpredictable disease are vital to the experienced QOL, psychological support toward the acceptance of having MS is essential. Through maintaining a reasonable QOL institutionalization of those with MS may be delayed. [ABSTRACT FROM AUTHOR]

Assessment of quality of life (QOL) is important in evaluating the well-being of patients suffering from chronically painful conditions. In addition to identifying the degree of psychosocial distress experienced by these patients, QOL assessments allow quantification of how pain specifically impacts daily functioning, and it serves as a treatment outcome in clinical research. The effect of pain on QOL depends on several characteristics of pain, such as the extent to which pain affects the anatomy, the duration of pain, the intensity of pain, the personal meaning of pain, and to some extent how pain may be a marker of, and directly impacts, an underlying disease state. However, pain is not a unique predictor of poor QOL. Sleep quality has been shown to be an important mediating factor in pain-related disability by influencing pain intensity and emotional distress. Chronic pain and sleep disturbances each independently and synergistically have profound detrimental effects on QOL, and psychosocial mediators have been identified. [ABSTRACT FROM AUTHOR]

Sleep disturbances in Parkinson's disease (PD) are both widespread and wide-ranging. Emerging early in the disease process, sometimes prior to the onset of motor symptoms, sleep disruption results from the degeneration of the basal ganglia that is the hallmark of the disease, as well as changes in brain stem sleep centres. Accordingly, sleep problems consist of motor symptoms such as stiffness, difficulty turning and dystonia as well as disruption to the normal sleep-wake cycle, arousal and alertness. Sleep disruption has been associated with reduced quality of life (QOL) and increased depression and anxiety in PD patients and their caregivers alike, and may be severe enough to impair everyday functioning. It is also likely that presence of certain sleep symptoms such as REM behaviour disorder (RBD) and sleep-disordered breathing (SDB) are the harbingers of a poor prognosis. Although no studies have yet investigated the effect of sleep problems on institutionalization in PD, chronic disruption to the sleep of caregivers may well lead to a breakdown in the caregiving relationship and care arrangements. The following article reviews the prevalence, phenomenology, pathophysiology and impact of sleep disturbances on QOL for individuals with PD and their caregivers. Clinical management strategies are discussed. [ABSTRACT FROM AUTHOR]

Headache and sleep disorders are prevalent, comorbid conditions that challenge physical as well as psychosocial well-being. Headache is the most common pain-related complaint and the seventh leading ailment seen in medical practice, accounting for 18 million physician visits annually in the USA alone (1). Though historically headache often has been trivialized (perhaps because pain is not easily quantified and headache does not generally compromise life expectancy), headache is in a major quality of life (QOL) concern. In fact, migraine headache is among the 20 leading causes of "years lived with disability" according the World Health Report (2). The burden of headache is increasingly appreciated in psychological, family and interpersonal, vocational, and economic realms. Headache, particularly in its more chronic and severe forms, has been linked to sleep disorders. Interestingly, the sleep disorders associated with headache are varied in nature, including obstructive sleep apnea, periodic limb movement disorder, circadian rhythm disorder, insomnia, and hypersomnia. General symptom patterns, particularly morning headache and chronic daily headache, are suggestive of and aid in recognition of a sleep disorder. Management of the sleep disorder may improve or resolve the headache; sleep-disordered breathing is the most empirically supported example of this relationship. Although pure sleep-related headaches, such as hypoxemia-related headache, are less prevalent and more easily recognized, primary headaches as well are often impacted to some degree by sleep. Irrespective of sleep disorders, variation in the sleep/wake schedule is one of the most common acute headache precipitants while sleeping is one of the most common palliative responses to headache. Insomnia is the sleep disorder most often cited by clinical headache populations. Despite an emerging literature supporting the interdependence of sleep and headache, our understanding of the underlying mechanisms remains speculative. Few well-controlled studies are available, and it is difficult to generalize results across sleep and headache literatures due to inconsistencies in diagnostic nosologies, lack of standardized outcome measures, and varied populations. Future research with improved methods is needed to identify mediating factors between sleep and headache. This chapter reviews the co-morbidity of headache and sleep disorders, prevalence, diagnostic considerations, societal and individual burden of headache, clinical implications, and considerations for future directions. [ABSTRACT FROM AUTHOR]

Sleep changes are inherent to dementia but difficult to define or measure. As the sleep changes in dementia are probably related to neuronal changes in the brain, the location and severity of these changes, manifested as different clinical dementias, affects the presentation of sleep pathology. In the case of most dementias, including Alzheimer's dementia, the sleep problems affect both the patient and the caregiver. Treatment involves a multifaceted approach, including identification of treatable medical problems, correction of sleep hygiene, and identification and treatment of the particular form of dementia. Cholinesterase inhibitors seem to be emerging as the drug of choice for sleep problems in dementia. [ABSTRACT FROM AUTHOR]

Sleep disorders in traumatic brain injury include insomnia, disruption of sleep architecture, excessive daytime sleepiness (EDS), and disorders of biological rhythms. Insomnia is common and is an important impediment to successful rehabilitation. Risk factors for insomnia in traumatic brain injury (TBI) include female gender, lesser degrees of injury, depression, and pain. EDS usually appears later in the course of illness than does insomnia. Circadian rhythm disturbances, particularly delayed sleep-phase syndrome, may present as insomnia. A number of reports have described behavioral aberrations in Guillain-Barré syndrome, a condition that targets mainly the peripheral nervous system. Hallucinations and oneiric experiences are among the behaviors seen in Guillain-Barré syndrome (GBS). These phenomena may be associated with reduced hypocretin-1 in the cerebrospinal fluid (csf) and with narcoleptic-like changes on polysomnography (PSG), suggesting the possibility of hypothalamic involvement in GBS. [ABSTRACT FROM AUTHOR]

Sleep disorders are known to have a dramatic effect on the quality of life of children. They may present very differently from infancy through adolescence, which makes diagnosis and treatment of these conditions both challenging and complex. Pediatric sleep disorders constitute a variety of conditions including central apnea, acute life-threatening events (ALTEs), sudden infant death syndrome (SIDS), and narcolepsy. However, the most common diagnosis is sleep-disordered breathing (SDB). SDB is associated with adenotonsillar hypertrophy and usually resolves after adenotonsillectomy. Children with SDB have scores on a global quality of life measure that are worse than those of children with asthma or juvenile rheumatoid arthritis. Fortunately, dramatic improvements in quality of life scores for SDB have been shown in a number of studies after adenotonsillectomy. The improvements are comprehensive and include all domains of quality of life. Caregivers report improvements in sleep disturbance, physical suffering, emotional distress, and daytime problems in their children. These improvements in quality of life are maintained up to 18 months after surgery and are dramatic regardless of the severity of SDB. The prevalence of SDB in children with obesity, neuromuscular or craniofacial disorders, Down syndrome or mucopolysaccharidoses is higher than in the general pediatric population and is widely underestimated. Unfortunately, few studies on quality of life have included these "high-risk" children or children with sleep disorders other than SDB. In future studies of quality of life and sleep disorders in children there is a need to quantify the diagnosis of the sleep disorder on the basis of data from polysomnography so that selection criteria might be standardized, to include appropriate control groups in the study design, and to assess the impact of co-morbidities. [ABSTRACT FROM AUTHOR]

Sleep disturbance is common with advancing age due to age-related changes in sleep and an increased prevalence of certain sleep disorders, in addition to health conditions, psychosocial issues, medication effects and a variety of other factors that impact sleep. The evidence that insomnia and other sleep problems have negative effects on health and quality of life (QOL) across the lifespan is convincing, and data suggest that this relationship is even stronger as people age. Several population-based studies have demonstrated an association between impaired sleep and worse performance on global measures and specific individual domains of QOL in the older adult. In addition, among older people, excessive daytime sleeping may be associated with an increased risk in mortality and morbidity and increased risk of falls. With advanced age, sleep disturbance is also associated with declines in functional status and social functioning, in addition to memory and other cognitive impairments. There is also evidence that sleeping problems can interfere with an older person's ability to carry out healthy and stable relationships with their spouse, other family and friends, which likely further impairs their QOL. In general, people with sleep disturbances have poor health-related self-perception, which may be related to inability to cope with daily activities. Taken together, research evidence is convincing among older adults that the cumulative effects of sleep disturbance can significantly impair their well-being and QOL. [ABSTRACT FROM AUTHOR]

Undesirable behaviors occurring during non-rapid eye movement (NREM) sleep have been reported to be associated with injuries to self and others ranging from bruises and lacerations to paralysis to death. During sleepwalking, confusional arousals and sleep terrors complex motor behaviors may occur while cognitive functions that usually control or modify our actions are limited or absent. Dangerous behaviors such as falling down, jumping out of windows, and sleep driving have been reported. [ABSTRACT FROM AUTHOR]

Parasomnias are abnormal behavioral or physiological events that intrude into the sleep process disrupting its continuity. Parasomnia associated to REM sleep include REM sleep behavior disorder, nightmare disorders, recurrent isolated sleep paralysis (SP), and sleep-related painful erections. The quality of life of patients suffering from parasomnias may vary according to the disorder. REM sleep behavior disorder patients experience recurrent vivid and violent dreams and frequent sleep-related injuries for themselves or bed partners, with possible impacts on personal, couple, and social life. Despite the possible awakening from REM sleep, sleep architecture is usually preserved in RBD. Idiopathic RBD may often precede a neurodegenerative disease, and its diagnosis might imply a psychological burden for patients and their family. The increased risk for neurodegenerative illnesses poses the ethical dilemma whether the patient should or should not be told about, especially in view of the current lack of effective neuroprotective strategies and the lack of knowledge about the precise extent of this risk. Nightmares are intensely disturbing dreams involving a variety of dysphoric emotions, most often fear and anxiety. Nightmares have been correlated to various measures of psychopathology, namely neuroticism, anxiety, depression, but not all studies support this relationship. Personality factors, such as nightmare frequency, nightmare distress (ND), and coping style, appear to be important in modulating the clinical severity of nightmare disorder. Parasomnias, especially nightmare and SP, can lead to postawakening anxiety with difficulty returning to sleep, sleep avoidance, and sleep deprivation, with subsequent insomnia, daytime sleepiness, and intensification of the parasomnia REM-rebound related. [ABSTRACT FROM AUTHOR]

The ability to be aware of and to interact with the external environment is a basic evolutionary requirement of all higher organisms requiring intact alertness. Hypersomnia and excessive daytime sleepiness (EDS) relate to the inability to maintain an alert state during the major waking periods of the day. Up until recently, somnolence arising due to sleep pathology was misunderstood as a sign of laziness or even malingering by many medical practitioners and society-at-large. The discovery of the orexin/hypocretin receptor system as a key mediator in abnormal daytime sleepiness as well as growing interest in the daytime cognitive impact of common sleep disorders have played important roles in improving scientific and public awareness of hypersomnia as a clinical entity. Hypersomnia, EDS and fatigue are among the most common manifestations of sleep disorders affecting quality of life (QOL) and productivity. In an increasingly interconnected global economy where workload and productivity have shifted towards cognitive as opposed to physical labour, research is now focusing more than ever on the impact of disorders causing somnolence during desired wake time. Similarly, scholastic/academic motivation and performance deficits are being noted in children and adolescents, in part due to the increased 24/7 availability of technology and entertainment options, usually at the expense of sufficient sleep. Other important implications of somnolence include the direct and indirect consequences of transport and occupational accidents, as well as disruption of family and social relationships. Clinical conditions causing this condition include obstructive sleep apnea (OSA), narcolepsy, idiopathic hypersomnia (IH), circadian disturbances and most commonly, self-imposed insufficient sleep syndrome. In conditions such as insomnia, restless legs syndrome (RLS) and periodic limb movements in sleep (PLMS), the association with frank daytime somnolence is more controversial although patients do complain of impaired daytime cognitive function. As the ‘baby-boom' generation approaches old age, senescence-related deterioration of sleep quality and quantity is increasingly recognized as an important factor impacting QOL by affecting memory, cognitive function and vitality in activities of daily living (ADLs) including driving. Somnolence can be a serious and even life-threatening impairment. Often there is a gap between the subjective complaints of patients regarding the impact of hypersomnia/EDS on QOL and the ability to reliably measure this dysfunction. An important area of current research involves clarifying the nosology of daytime EDS symptoms, ranging from somnolence to fatigue or neurocognitive impairment. Improvements in diagnostic instruments assessing daytime function and ergonomic activities in relation to both healthy and pathological sleep processes will aid in better delineating these subjective and objective parameters. [ABSTRACT FROM AUTHOR]

Restless legs syndrome (RLS) is a sensory-motor disorder characterized by uncomfortable and disagreeable sensations at lower limbs, urge to move them and peaking during rest periods and at evening/night, with impact on sleep, causing insomnia and sleep fragmentation. Both severity of the sensory symptoms and periodic legs movements during sleep (PLMS) contribute to sleep impairment and, consequently, to a reduced quality of life (QoL). Measurement of RLS impact on QoL is made, both in clinical and epidemiological studies, by means of a Short Form-36 (SF-36) of health survey questionnaire and by validated and disease-specific QoL scales (RLSQoL and Hopkins RLSQoL). Both types of measures indicated a significant impact of RLS on QoL in different clinical and prevalence studies and showed good reliability, reproducibility and responsiveness. Moreover, QoL significantly improved, both in short-term studies and in recently published long-term protocols, with dopaminergic treatment in comparison to placebo. In what measure RLS per se, some disease-specific symptoms as restlessness and bad sleep or other co-morbidity factors, contribute to the impairment of QoL remain to be further investigated. [ABSTRACT FROM AUTHOR]

With an increase in the older segment of the population and a concurrent increase in the prevalence of chronic illnesses, interest in quality of life (QOL) has gained increasing significance. This presentation discusses the significance and theoretical constructs in the definition and measurement of QOL. Furthermore, a review of studies shows that narcolepsy has a profound negative social, psychological, and economic impact on the lives of affected individuals. New management strategies comprising comprehensive, multidisciplinary patient management approach including psychosocial treatment and social support are needed to improve patients' functional status. Educational programs about the wide ramifications of having narcolepsy are needed. Also, the operational definition of the symptoms of narcolepsy and indicators of health-related quality of life (HRQOL) are often not consistent and need standardization to make comparison of studies on the impact of narcolepsy more meaningful. [ABSTRACT FROM AUTHOR]

Health-related quality of life (HRQOL) is increasingly recognized as an important parameter in the assessment of the morbidity associated with obstructive sleep apnea (OSA). Generic and sleep disorder-specific instruments consistently demonstrate impairment in multiple domains of HRQOL in OSA, particularly in the domains of sleep, energy, fatigue, and vigilance. Sleep disorder-specific tools are potentially more sensitive than generic tools in describing HRQOL impairment in untreated OSA and treatment effects of continuous positive airway pressure (CPAP) and are increasingly being employed in clinical trials of OSA treatment. Severe OSA is generally associated with severe HRQOL impairment; however, studies do not consistently demonstrate a linear relationship between physiologic measures of OSA severity and measures of severity of HRQOL impairment. Excessive sleepiness, cognitive dysfunction, and psychological impairment are common measurable components of HRQOL impairment in OSA, particularly severe OSA, but the interactions among these and quality of life impairments measured by standard HRQOL instruments are not well studied. Therapeutic CPAP appears to broadly improve HRQOL domains in OSA, but substantial placebo effect has been demonstrated, suggesting that HRQOL impairment in OSA may be mediated by aspects of the disorder other than the physiologic effects of the OSA. Further randomized controlled trials should better elucidate the associations between physiologic impairment in OSA and HRQOL measures of interest to clinicians and researchers in this field. [ABSTRACT FROM AUTHOR]

There is substantial evidence that fragmented sleep, delayed sleep phase syndrome (DSPS), insomnia, and impaired daytime alertness are the result of disorders in brain functioning that are closely linked to disruptions in the regulation of circadian rhythms. In children suffering from neurodevelopmental disabilities, such as attention deficit hyperactivity disorder (ADHD) and epilepsy, sleep disturbance and behavioral problems are significant correlated symptoms. There is also evidence that by addressing these problems directly, significant improvements can be made in the quality of life (QOL) experienced by the affected individuals. Children with ADHD exhibit impairments in the circadian pacemaker as shown by studies confirming an associated delay in the peak melatonin output under dim light conditions. Therapy involving melatonin administration to these children not only improves their sleep onset and efficiency but also improves their health status and QOL. The QOL of young adults who suffer from DSPS is significantly impaired by the resulting symptoms of insomnia and tiredness. Treatment of DSPS patients with melatonin has been reported to improve QOL dimensions such as physical functioning, mental health, and emotional well-being, as well as social functioning and general health. In patients suffering from chronic fatigue syndrome, melatonin improved QOL by enhancing vitality and energy and by reducing pain perception and fatigue. Melatonin has also been demonstrated to improve the quality of sleep of elderly insomniacs. Strategically timed administration of melatonin is useful for reducing the symptoms of jet-lag in intercontinental travelers. Additionally, melatonin has been found to enhance the nighttime alertness of shift workers and to improve their sleep during the daytime. Melatonin has a promising role in cancer patients not only as an oncostatic drug but also in promoting their general physical health and well-being. Meditation, besides improving QOL, coincidentally enhances the secretion of melatonin from the pineal gland, thus suggesting that melatonin may be an important physical mediator of the meditation experience. [ABSTRACT FROM AUTHOR]

This chapter provides an overview of the effects of hypnotics on sleep and quality of life (QOL). In the 1970s it was accepted that a consequence of taking longer acting benzodiazepine hypnotics was a residual hangover next day, producing feelings of sedation and impaired performance. The realization during the 1980s that insomnia was not just a subjective complaint of poor sleep, but in itself resulted in impaired functioning with increased accident risk, led to studies evaluating the effects of sleep medication on both sleep and waking function including QOL. The potentially impairing effects of hypnotic treatment therefore need to be weighed up against the costs and consequences of untreated insomnia. The emergence of the newer benzodiazepine receptor agonists (BzRAs) zopiclone, zolpidem and zaleplon (Z drugs) with their shorter half-lives and reduced levels of residual impairment, tolerance and dependency, particularly for zolpidem and zaleplon, shift the balance in favour of safer hypnotic treatment, so that insomnia should no longer go unrecognized and untreated in so many. Guidelines for limiting hypnotic prescriptions to a few weeks resulted from the association of long-term benzodiazepine use with tolerance and therefore lack of treatment benefit, as well as the associated risks of dependence occurring with some compounds. These guidelines are at odds with the significant number of chronic insomniacs, often elderly patients, who require long-term treatments. There is now limited evidence that newer formulations and different treatment schedules, including intermittent use, can sustain hypnotic efficacy with the Z drugs over longer periods, enhancing QOL and waking function, and without rebound insomnia following withdrawal. Similarly, behavioural and psychological approaches may be beneficial in the long term for some, though possible treatment limitations amongst different types of patients have still to be defined. [ABSTRACT FROM AUTHOR]

Purpose: Insomnia is highly prevalent in the general population, and most of the insomniacs complain of daily consequences the day following a poor night. However, it is very difficult to assess objectively this daytime impact. Quality of life (QOL) may be the most accurate way to understand the consequences of insomnia on the daily lives of patients. Subjects and Methods: Based on two keywords, insomnia and quality of life in Medline Pubmed, we reviewed articles on the subject from 1989 to 2006 and we retained those specifically focussed on QOL of insomniacs and some devoted to the impact of poor sleep on the QOL of subjects with other chronic illness. Results: We found very few studies focussed on the QOL of insomniacs. Many surveys were oriented on the QOL and sleep of patients with cancer or other chronic diseases. Conclusion: Insomnia is commonly linked to a worse quality of life status. QOL instruments may be powerful in showing the impact of poor sleep on the daily lives of patients by itself or during other associated chronic diseases. Specific QOL focussed on insomnia has to be developed to better assess the impact of insomnia on daytime functioning and to appreciate the efficacy of sleep treatments. [ABSTRACT FROM AUTHOR]

This chapter introduces the reader to the different classifications of sleep disorders. This chapter comprises nine general sections of main sleep disorders encountered in the general population: insomnia, sleep apnea, narcolepsy, hypersomnias, periodic limb movement disorder, restless leg syndrome, REM-related parasomnias, non-REM-related parasomnias, and circadian rhythm disorders. Each section provides a general definition/description of the disorder, diagnosis pointers, main consequences associated with the disorder as well as some treatment options. When available, prevalence and incidence data are provided. Two short clinical vignettes illustrate main complaints of insomnia and apnea. These vignettes also report some daily consequences of the unrefreshing and disturbed sleep experienced by the sleepers. Although most sleep disorders are diagnosed and treated, the present chapter also highlights that some of them nonetheless may go unnoticed to the suffering individuals but not to his/her bed partner/significant other. Furthermore, daily consequences associated with sleep disorders are various, and a thorough examination of all side effects shall be taken into consideration during evaluation and when treatment is initiated. Sleep medicine is a growing field and the common goal of all clinicians and researchers is by far to alleviate sleep disorders' sometimes disastrous consequences and increase the quality of life of suffering individuals. [ABSTRACT FROM AUTHOR]

The Rechtschaffen and Kales system for scoring sleep states distinguishes a waking state, nonrapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep. From the polysomnographic point of view, four stages are conventionally distinguished during NREM sleep. The young adult spends 20-28 of a night's sleep in REM sleep, 4-5 in stage 1, 46-50 in stage 2, 6-8 in stage 3, and 10-16 in stage 4. A range of differences in average sleep length has been established in young adults. In this respect, subjects have been characterized who sleep significantly less (short sleepers) or more (long sleepers) relative to a group norm. Short sleepers spend less time in stages 1, 2, and 3 sleep, whereas long sleepers spend more time in stage 2 sleep and REM sleep. On the basis of behavioral and polysomnographic aspects, three sleep states have been defined in the newborn infant: quiet sleep (the precursor of adult NREM sleep), active-REM sleep (the precursor of adult REM sleep), and indeterminate sleep. Total sleep time attains its highest levels in neonates and young infants (16-17 h). The fastest decrease in sleep length is observed in the 6-month-old infant (13-14 h) and is mainly related to the diminution of REM sleep during daytime. Compared to the infancy, changes of sleep duration during early childhood occur at a slower pace. The total amount of sleep decreases to 12 h by 4 years and to 8-10 h by 10 years. A series of neural structures involved in the occurrence of waking, NREM sleep, and REM sleep have been characterized in the central nervous system (CNS). In addition, a number of neurotransmitters have been described that function to promote waking (acetylcholine, noradrenaline, dopamine, serotonin, histamine, glutamate, and orexin), NREM sleep (Γ-aminobutyric acid, gallanin, and adenosine), and REM sleep (acetylcholine). [ABSTRACT FROM AUTHOR]

Selecting the best health-related quality of life (HRQL) measures for sleep/wake research requires evaluation of congruity between each measure's conceptual framework and the proposed research study's hypotheses, design, and sample. As a first step, the study team works to identify the most salient HRQL concepts, often with the help of focus groups and patient interviews. Next, a brief review of anthologies and electronic resources may be sufficient to find candidate measures addressing the relevant concepts. Judging the relative merits of the candidate HRQL measures requires careful analysis. A comprehensive and systematic approach for comparing the quality and suitability of candidate HRQL measures based on literature is recommended. Considerations and criteria for assessing the psychometric evidence of measurement quality, including validity, reliability, responsiveness to change, and sensitivity to group differences, are presented. Also discussed are useful attributes such as population norms and precedents for determining the minimally important difference (MID). To insure successful implementation, pilot testing of the chosen measures with the target population is encouraged. This chapter also provides an overview of a new and exciting methodology, item response theory (IRT), that is leading to the refinement of HRQL measures. IRT also enables computer-adaptive testing (CAT), where concept indicators (e.g., individual questions about a concept such as daytime sleepiness) are successively selected from an item bank and shown to each patient in an order tailored to that of patient's previous response choices. The results rapidly and accurately estimate that patient's true score while yielding scores that can be grouped across patients or followed over time. This chapter ends with a list of practical issues like the patient burden, costs, and copyright that impact the choice of HRQL tools, along with a list of resources for locating measures. [ABSTRACT FROM AUTHOR]