Depression: relationships to sleep paralysis and other sleep disturbances in a community sample

Hypnagogic states are quite common: Self-reported prevalence, modalities, and gender differences

The hypnagogic state refers to the transitional phase between wakefulness and sleep during which vivid experiences occur. In this questionnaire study, we assessed the self-reported prevalence of hypnagogic states considering the frequency of experiences in different modalities. We also assessed the emotional quality and the vividness of the experiences. Moreover, we compared hypnagogic states to other phenomena, such as dreams, sleep paralysis, imagination, and extra-sensory perception in these measures. Hypnagogic states were reported by 80.2 % of 4456 participants and were more prevalent in women than men. Experiences were most often kinaesthetic and visual, and less often auditory, tactile, and olfactory or gustatory. Hypnagogic states were less prevalent than dreams and characterized by different modality profiles. However, they were similar to dreams in their emotional quality, the irritation they caused, and in their vividness. In conclusion, hypnagogic states are quite common.

The hypnagogic state: A brief update

The hypnagogic state refers to a transitional stage between wakefulness and sleep, in which sensory perceptions can be experienced. In this review, we compile and discuss the recent scientific literature on hypnagogia research regarding the future directions proposed by Schacter (1976; Psychological Bulletin, 83, 452). After a short introduction discussing the terminology used in hypnagogia research and the differentiation of hypnagogic states with other related phenomena, we review the reported prevalence of hypnagogic states. Then, we evaluate the six future directions suggested by Schacter and we propose three further future directions. First, a better understanding of the emotional quality of hypnagogic states is needed. Second, a better understanding of why hypnagogic states occur so frequently in the visual and kinaesthetic modalities is needed. Lastly, a better understanding of the purpose of hypnagogic states is needed. In conclusion, research has made great progress in recent years, and we are one step closer to demystifying the hypnagogic state.

Metal mixtures are associated with increased anxiety during pregnancy

BACKGROUND

Exposure to low-dose toxic metals in the environment is ubiquitous. Several murine studies have shown metals induce anxiety-like behaviors, and mechanistic research supports that metals disrupt neurotransmitter signaling systems implicated in the pathophysiology of anxiety. In this study, we extend prior research by examining joint exposure to six metals in relation to maternal anxiety symptoms during pregnancy.

METHODS

The sample includes 380 participants enrolled in the PRogramming of Intergenerational Stress Mechanisms (PRISM) pregnancy cohort. Spot urine was collected during pregnancy (mean ± standard deviation: 31.1 ± 6.1 weeks), and concentrations of six metals (barium [Ba], cadmium [Cd], chromium [Cr], cesium [Cs], lead [Pb], antimony [Sb]) were measured by Inductively Coupled Plasma - Mass Spectrometry. Trait anxiety symptoms were measured during pregnancy using a short version of the Spielberger State Trait Anxiety Inventory (STAI-T) and information on covariates was collected by questionnaire. We used weighted quantile sum (WQS) regression as the primary modeling approach to examine metals, treated as a mixture, in relation to higher (≥20) vs. lower anxiety symptoms while adjusting for urinary creatinine and key sociodemographic variables.

RESULTS

The sample is socioeconomically and racially/ethnically diverse. Urinary metal concentrations were log-normally distributed and 25% of the sample had an STAI-T score ≥20. Joint exposure to metals was associated with elevated anxiety symptoms (OR_WQS = 1.56, 95% CI: 1.24, 1.96); Cd (61.8%), Cr (14.7%), and Cs (12.7%) contributed the greatest weight to the mixture effect.

CONCLUSION

Exposure to metals in the environment may be associated with anxiety symptoms during pregnancy. This is a public health concern, as anxiety disorders are highly prevalent and associated with significant co-morbidities, especially during pregnancy when both the mother and developing fetus are susceptible to adverse health outcomes.

Factors Associated with Depression and Sub-Dimension Symptoms in Adolescent Narcolepsy

OBJECTIVE

We evaluate the association between depression symptoms, clinical features (disease onset-age, disease duration, sleep-related hallucination), sleepiness, and polysomnography parameters in adolescent narcolepsy type 1 patients.

METHODS

Eighty-three adolescent narcolepsy type 1 patients were involved in this cross-sectional study. Patients completed questionnaires evaluating depression symptoms (Center for Epidemiologic Studies Depression Scale) and sleepiness (Epworth Sleepiness Scale). Parameters from polysomnography and multiple sleep latency test were also collected.

RESULTS

Patients with depression symptoms (62.7%) have later disease onset-age. Depression symptoms were associated with sleep-related hallucination (OR = 2.75). Six independent variables were associated with sub-dimensional depression symptoms, including sleep latency, sleep efficiency, sleep-related hallucination, Epworth sleepiness scale, disease duration, and disease onset-age.

CONCLUSION

Sleep-related hallucination is associated with total depression symptoms in adolescent narcolepsy. Subjective sleepiness is associated with depressed affect, somatic symptoms, and interpersonal problems. Lower sleep efficiency is associated with a lack of positive affect.

Biomedical Implications of Plant-Based Principles as Antidepressants: Prospects for Novel Drug Development

BACKGROUND

Depression is a most common mental disorder. The symptoms of depression include loss of energy, changes in appetite, more or less sleep, anxiety, low concentration, uncertainty, restlessness, feelings of worthlessness, guilt, or despair, and thoughts of self-harm or suicide. In order to provide safe, efficient and cost-effective medication, the plants based principles in isolation or in combination with traditional antidepressants are attracting increasing attention for depression therapy.

METHOD

The information regarding the present review and its contents such as collected from published literature materials in different international journals. We have used different search engines such as PubMed, Medline, ResearchGate Google Semantic Scholar and ScienceDirect. For this purpose, the data obtained were properly organized and suitably analyzed to include in this article.

RESULTS

Most of the phytomolecules isolated from the medicinal plants display antidepressant effect through the synaptic regulation of levels of neurotransmitters such as dopamine, serotonin, and noradrenaline in different parts of the brain. The mechanism of action of phytomolecules also involves negative regulation of the activities of monoamine oxidase (MAO) and acetylcholinesterase (AChE) and prevention of hyperactivity of hypothalamic-pituitary-adrenal (HPA) axis. In addition, the strong antioxidative and antiinflamatory potential of these phytochemicals offer synergy to their antidepressant as well as antipsychosomatic functions.

CONCLUSION

The application of phytochemicals has proved it to be a safe, cost effective and efficient therapeutic agent to treat the patients suffering from mild to severe state of depression and other psychiatric disorders. The potential phytochemicals may be further optimized using in silico tools to develop better antidepressants and antisychotic agents in future.

Sleep-Wake Control by Melanin-Concentrating Hormone (MCH) Neurons: a Review of Recent Findings

PURPOSE OF THE REVIEW

Melanin-concentrating hormone (MCH)-expressing neurons located in the lateral hypothalamus are considered as an integral component of sleep-wake circuitry. However, the precise role of MCH neurons in sleep-wake regulation has remained unclear, despite several years of research employing a wide range of techniques. We review recent data on this aspect, which are mostly inconsistent, and propose a novel role for MCH neurons in sleep regulation.

RECENT FINDINGS

While almost all studies using "gain-of-function" approaches show an increase in rapid eye movement sleep (or paradoxical sleep; PS), loss-of-function approaches have not shown reductions in PS. Similarly, the reported changes in wakefulness or non-rapid eye movement sleep (slow-wave sleep; SWS) with manipulation of the MCH system using conditional genetic methods are inconsistent. Currently available data do not support a role for MCH neurons in spontaneous sleep-wake but imply a crucial role for them in orchestrating sleep-wake responses to changes in external and internal environments.

Prevalence and Clinical Picture of Sleep Paralysis in a Polish Student Sample

Sleep paralysis (SP) is a psychobiological phenomenon caused by temporary desynchrony in the architecture of rapid eye movement (REM) sleep. It affects approximately 7.6% of the general population during their lifetime. The aim of this study was to assess (1) the prevalence of SP among Polish students in Lublin (n = 439) using self-reported online surveys, (2) the frequency of SP-related somatic and psychopathologic symptoms, and (3) the factors potentially affecting the occurrence of symptoms among people experiencing SP. We found that the incidence of SP in the Polish student population was slightly higher (32%) than the average prevalence found in other student populations (28.3%). The SP clinical picture was dominated by somatic symptomatology: 94% of respondents reported somatic symptoms (most commonly tachycardia, 76%), 93% reported fear (most commonly fear of death, 46%), and 66% reported hallucinations (most commonly visual hallucinations, 37%). The number of SP episodes was related to sleep duration and supine position during sleep. The severity of somatic symptoms correlated with lifestyle variables and anxiety symptomatology. Our study shows that a significant proportion of students experience recurrent SP and that this phenomenon is associated with fear and physical discomfort. The scale of the phenomenon requires a deeper analysis.

Problematic Internet Use, Mental Health, and Sleep Quality among Medical Students: A Path-Analytic Model

BACKGROUND

There is a close association between problematic Internet use (PIU), sleep quality, and mental health problems. To evaluate which mental health problem is more associated with coexistence of both PIU and poor sleep quality, we hypothesized a model in which PIU influences sleep quality directly and also through the mediation of three different mental health problems.

METHODS

A total of 402 medical students completed the Persian versions of the Internet Addiction Test, 21-item Depression Anxiety Stress Scale, and Pittsburgh Sleep Quality Index. A maximum likelihood structural equation model was used to assess the hypothesis. For assessment of the indirect effects, bootstrapping was conducted.

RESULTS

PIU predicted poor sleep quality through indirect pathways by the mediation of mental health problems (P < 0.001). Poor sleep quality were associated with depressive symptoms (P < 0.001), anxiety (P = 0.035), and stress (P < 0.001); however, the direct pathways from stress and anxiety to poor sleep quality were not statistically significant (P > 0.05).

CONCLUSION

Findings extend our previous knowledge about the interrelationships between PIU, sleep disturbances, and mental health problems by unveiling the key role of depressive symptoms.

Balance Problems, Paralysis, and Angina as Clinical Markers for Severity in Major Depression

Major depressive disorder (MDD) is a heterogeneous disorder. Our hypothesis is that neurological symptoms correlate with the severity of MDD symptoms. One hundred eighty-four outpatients with MDD completed a self-report questionnaire on past and present medical history. Patients were divided into three roughly equal depression severity levels based on scores from the APA Severity Measure for Depression-Adult (n = 66, 58, 60, for low, medium, high severity, respectively). We saw a significant and gradual increase in the frequency of "muscular paralysis" (1.5-5.2-16.7%) and "balance problems" (21.2-36.2-46.6%) from low to medium to high severity groups. We repeated the analysis using only the two most extreme severity categories: low severity (66 samples) vs. high severity (60 samples). High severity patients were also found to experience more "angina" symptoms than low severity patients (27.3 vs. 50%). The three significant clinical variables identified were introduced into a binary logistic regression model as the independent variables with high or low severity as the dependent variable. Both "muscular paralysis" and "balance problems" were significantly associated with increased severity of depression (odds ratio of 13.5 and 2.9, respectively), while "angina" was associated with an increase in severity with an odds ratio of 2.0, albeit not significantly. We show that neurological exam or clinical history could be useful biomarkers for depression severity. Our findings, if replicated, could lead to a simple clinical scale administered regularly for monitoring patients with MDD.

Strained Bedfellows: An Actor-Partner Analysis of Spousal Attachment Insecurity and Sleep Quality

Background

The quality of interpersonal ties-especially closer relationships-appears to be associated with physical health outcomes. Sleep is one pathway through which relationships and health appear to be linked, but this has been inadequately investigated in the context of dyadic attachment.

Purpose

The present study examined links between relationship-specific attachment anxiety (which can involve preoccupation with one's partner, negative relationship cognitions, and fear of abandonment) and avoidance (e.g., low emotional investment or intimacy) and sleep quality.

Methods

Attachment, assessed using the Experience in Close Relationship (ECR), was used to predict Pittsburgh Sleep Quality Inventory (PSQI)-assessed sleep quality in 92 married heterosexual couples via actor-partner interdependence models. Depression was examined as a potential mediator of this association.

Results

Consistent with hypotheses, actors' anxious attachment predicted diminished quality of their own sleep, whereas actors' avoidant attachment was unrelated to their own sleep quality. Results further suggested that couples in which both spouses were higher in attachment anxiety experience better sleep quality (b = -0.74, SE = 0.28, p = .0082, 95% CI [-1.287, -0.196]). Conversely, couples in which both spouses were higher in attachment avoidance showed poorer sleep quality (b = 0.56, SE = 0.23, p = .0188, 95% CI [0.095, 1.016]). These effects were found to be independent of marital satisfaction and depression. Some evidence was also consistent with mediation of links between attachment and sleep quality via depression.

Conclusions

Results suggest adult romantic attachment and sleep are associated in complex ways, highlighting the importance of dyadic approaches to the study of relationships, sleep, and health.

Relationships between sleep paralysis and sleep quality: current insights

Sleep paralysis is the unusual experience of waking up in the night without the ability to move. Currently little is known about the experience, despite the fact that the vast majority of episodes are associated with extreme fear and in a minority of cases can lead to clinically significant levels of distress. The aim of this work was to review the existing literature pertaining to the relationship sleep paralysis has to sleep more generally, measured both with subjective questionnaires and objective laboratory recordings. In terms of subjective sleep variables, worse sleep quality has been found in multiple studies to be associated with increased odds of sleep paralysis occurrence. In addition, insomnia symptoms (but not a diagnosed insomnia disorder) have also been found to predict sleep paralysis. Associations between sleep paralysis and other unusual and/or threatening sleep experiences such as nightmares, exploding head syndrome, and lucid dreaming have been reported. In terms of objective measurements, the limited literature to date shows sleep paralysis to be a "mixed" state of consciousness, combining elements of rapid eye movement sleep with elements of wakefulness. Future research needs to focus on longitudinal designs to disentangle the direction of effects and more typically employ a broader assessment of sleep paralysis that better captures associated features such as hallucinations, fear, and distress.

Sleep Complaints as Risk Factor for Suicidal Behavior in Severely Depressed Children and Adolescents

Objectives

To investigate the association between sleep complaints and suicidal behaviors among severely depressed children and adolescents.

Methods

The sample was 214 youths (56.1% males, mean age 12.5 years) with diagnosis of DSM‐IV major depressive disorder consecutively recruited from a university‐based outpatient clinic specialized in mood disorders. The structured interview for children and adolescents was applied to participants. The Children's Depression Rating Scale—revised version—scored the severity of depression, and the Children's Global Assessment Scale assessed the global functioning. Subgroups of patients were compared for psychopathological association by means of logistic regression, in accordance with presence and absence of sleep complaints and suicidality.

Results

The frequency of sleep complaints and suicidal behaviors was, respectively, 66.4% and 52.3%, and both symptoms were observed in 37.9% of patients. Initial insomnia was the most frequent manifestation (58%), followed by night awakening (36%), daytime sleepiness (31%), and early awakening (29.9%). Significant association between sleep disturbance and suicidal behavior was found (odds ratio range of 2.3–10.8).

Conclusion

Sleep disturbances are potential warning manifestations of suicidal behaviors in depressed youth. Possibly, the severity of the active affective episode likely underlies in both sleep complaints and suicidal behaviors among depressed underage patients.

Terror and bliss? Commonalities and distinctions between sleep paralysis, lucid dreaming, and their associations with waking life experiences

Sleep paralysis and lucid dreaming are both dissociated experiences related to rapid eye movement (REM) sleep. Anecdotal evidence suggests that episodes of sleep paralysis and lucid dreaming are related but different experiences. In this study we test this claim systematically for the first time in an online survey with 1928 participants (age range: 18–82 years; 53% female). Confirming anecdotal evidence, sleep paralysis and lucid dreaming frequency were related positively and this association was most apparent between lucid dreaming and sleep paralysis episodes featuring vestibular‐motor hallucinations. Dissociative experiences were the only common (positive) predictor of both sleep paralysis and lucid dreaming. Both experiences showed different associations with other key variables of interest: sleep paralysis was predicted by sleep quality, anxiety and life stress, whereas lucid dreaming was predicted by a positive constructive daydreaming style and vividness of sensory imagery. Overall, results suggest that dissociative experiences during wakefulness are reflected in dissociative experiences during REM sleep; while sleep paralysis is related primarily to issues of sleep quality and wellbeing, lucid dreaming may reflect a continuation of greater imaginative capacity and positive imagery in waking states.

Isolated sleep paralysis and hypnic hallucinations in schizophrenia

BACKGROUND

Usually remembered in the context of Narcolepsy-Cataplexy syndrome, isolated sleep paralysis (SP) and hypnic hallucination are widely prevalent and because of the overlap of symptoms with schizophrenia, their identification is important but unrecognized.

AIMS

To determine the presence of SP and hypnic hallucinations (HH) in people with schizophrenia and schizoaffective disorder.

STUDY DESIGN

Cross-sectional survey.

METHODS

Participants were patients receiving follow-up care for schizophrenia from Assertive Community Treatment Team. A screening questionnaire was administered during their routine follow-up visits.

RESULTS

Of 71 respondents (49 males, 22 females) only 11 (10 males and 1 female), that is, 15% reported SP, and 12 (7 males and 5 females), that is, 16.9% reported HH, a considerably low prevalence.

CONCLUSION

It is difficult to study the presence of SP and HH in patients with active or residual symptoms of schizophrenia, and more refined studies and appropriate questionnaires are required. The possibility of SP and HH confounding or being misdiagnosed as psychotic symptoms needs to be borne in mind.

Is suvorexant a better choice than alternative hypnotics?

Suvorexant is a novel dual orexin receptor antagonist (DORA) newly introduced in the U.S. as a hypnotic, but no claim of superiority over other hypnotics has been offered.  The manufacturer argued that the 5 and 10 mg starting doses recommended by the FDA might be ineffective.  The manufacturer's main Phase III trials had not even included the 10 mg dosage, and the 5 mg dosage had not been tested at all in registered clinical trials at the time of approval.  Popular alternative hypnotics may be similarly ineffective, since the FDA has also reduced the recommended doses for zolpidem and eszopiclone.  The "not to exceed" suvorexant dosage of 20 mg does slightly increase sleep.  Because of slow absorption, suvorexant has little effect on latency to sleep onset but some small effect in suppressing wakening after sleep onset and in improving sleep efficiency. The FDA would not approve the manufacturer's preferred 40 mg suvorexant dosage, because of concern with daytime somnolence, driving impairment, and possible narcolepsy-like symptoms.  In its immediate benefits-to-risks ratio, suvorexant is unlikely to prove superior to currently available hypnotics—possibly worse—so there is little reason to prefer over the alternatives this likely more expensive hypnotic less-tested in practice.  Associations are being increasingly documented relating hypnotic usage with incident cancer, with dementia risks, and with premature death.  There is some basis to speculate that suvorexant might be safer than alternative hypnotics in terms of cancer, dementia, infections, and mortality.  These safety considerations will remain unproven speculations unless adequate long-term trials can be done that demonstrate suvorexant advantages.

A twin and molecular genetics study of sleep paralysis and associated factors

Sleep paralysis is a relatively common but under-researched phenomenon. In this paper we examine prevalence in a UK sample and associations with candidate risk factors. This is the first study to investigate the heritability of sleep paralysis in a twin sample and to explore genetic associations between sleep paralysis and a number of circadian expressed single nucleotide polymorphisms. Analyses are based on data from the Genesis1219 twin/sibling study, a community sample of twins/siblings from England and Wales. In total, data from 862 participants aged 22-32 years (34% male) were used in the study. This sample consisted of monozygotic and dizygotic twins and siblings. It was found that self-reports of general sleep quality, anxiety symptoms and exposure to threatening events were all associated independently with sleep paralysis. There was moderate genetic influence on sleep paralysis (53%). Polymorphisms in the PER2 gene were associated with sleep paralysis in additive and dominant models of inheritance-although significance was not reached once a Bonferroni correction was applied. It is concluded that factors associated with disrupted sleep cycles appear to be associated with sleep paralysis. In this sample of young adults, sleep paralysis was moderately heritable. Future work should examine specific polymorphisms associated with differences in circadian rhythms and sleep homeostasis further in association with sleep paralysis.

Response to stress in Drosophila is mediated by gender, age and stress paradigm

All living organisms must maintain equilibrium in response to internal and external challenges within their environment. Changes in neural plasticity (alterations in neuronal populations, dendritic remodeling, and synaptic turnover) are critical components of the homeostatic response to stress, which has been strongly implicated in the onset of affective disorders. However, stress is differentially perceived depending on the type of stress and its context, as well as genetic background, age and sex; therefore, an individual's maintenance of neuronal homeostasis must differ depending upon these variables. We established Drosophila as a model to analyze homeostatic responses to stress. Sexually immature and mature females and males from an isogenic wild-type strain raised under controlled environmental conditions were exposed to four reproducible and high-throughput translatable stressors to facilitate the analysis of a large number of animals for direct comparisons. These animals were assessed in an open-field arena, in a light-dark box, and in a forced swim test, as well as for sensitivity to the sedative effects of ethanol. These studies establish that immature and mature females and males represent behaviorally distinct populations under control conditions as well as after exposure to different stressors. Therefore, the neural substrates mediating the stress response must be differentially expressed depending upon the hormonal status of the brain. In addition, an adaptive response to a given stressor in one paradigm was not predictive for outcomes in other paradigms.

Health implications of partner violence against women in Ghana

This article explores the health implications of partner violence against women in Ghana using data from northern Ghana. Face-to-face structured interviews were conducted with a sample of 443 women contacted at health facilities in the northern region. Results indicate that 7 out of 10 women have experienced intimate partner violence (IPV) within the past 12 months; 62% had experienced psychological violence, 29% had experienced physical violence, and 34% had experienced sexual violence. Participants reported health problems associated with violence, including injury, thoughts of suicide, sleep disruption, and fear of partner (FP). Logistic regression analyses showed that women who reported physical, psychological, and sexual violence, respectively, had 3.94 times, 10.50 times, and 2.21 times the odds of reporting thoughts of suicide, whereas the odds that women who reported physical, psychological, and sexual violence would report sleep disruption were 4.82 times higher, 4.44 times higher, and 2.50 times higher, respectively. However, only physical and psychological violence predicted the odds of FP. This study shows that IPV is a health risk factor among women in Ghana. Measures that should be designed to improve the health of women experiencing marital violence are suggested.

Narcolepsy and predictors of positive MSLTs in the Wisconsin Sleep Cohort

STUDY OBJECTIVES

To study whether positive multiple sleep latency tests (MSLTs, mean sleep latency [MSL] ≤ 8 minutes, ≥ 2 sleep onset REM sleep periods [SOREMPs]) and/or nocturnal SOREMP (REM sleep latency ≤ 15 minutes during nocturnal polysomonography [NPSG]) are stable traits and can reflect incipient narcolepsy.

DESIGN AND SETTING

Cross-sectional and longitudinal investigation of the Wisconsin Sleep Cohort Study.

PARTICIPANTS

Adults (44% females, 30-81 years) underwent NPSG (n = 4,866 in 1,518 subjects), and clinical MSLT (n = 1,135), with 823 having a repeat NPSG-MSLT at 4-year intervals, totaling 1725 NPSG with MSLT studies. Data were analyzed using linear mixed-effects models, and the stability of positive MSLTs was explored using κ statistics.

MEASUREMENTS AND RESULTS

Prevalence of a nocturnal SOREMP on a NPSG, of ≥ 2 SOREMPs on the MSLT, of MSL ≤ 8 minutes on the MSLT, and of a positive MSLT (MSL ≤ 8 minutes plus ≥ 2 SOREMPs) were 0.35%, 7.0%, 22%, and 3.4%, respectively. Correlates of a positive MSLT were shift work (OR = 7.8, P = 0.0001) and short sleep (OR = 1.51/h, P = 0.04). Test-retest for these parameters was poor, with κ < 0.2 (n.s.) after excluding shift workers and short sleepers. Excluding shift-work, short sleep, and subjects with negative MSLTs, we found one undiagnosed subject with possible cataplexy (≥ 1/month) and a NPSG SOREMPs; one subject previously diagnosed with narcolepsy without cataplexy with 2 NPSG SOREMPs and a positive MSLT, and two subjects with 2 independently positive MSLTs (66% human leukocyte antigen [HLA] positive). The proportions for narcolepsy with and without cataplexy were 0.07% (95% CI: 0.02-0.37%) and 0.20% (95% CI: 0.07-0.58%), respectively.

CONCLUSIONS

The diagnostic value of multiple sleep latency tests is strongly altered by shift work and to a lesser extent by chronic sleep deprivation. The prevalence of narcolepsy without cataplexy may be 3-fold higher than that of narcolepsy-cataplexy.

Insomnia in adolescents: prevalence, help-seeking behaviors, and types of interventions

BACKGROUND

Little is known about the DSM-IV diagnosis of insomnia among adolescents. Their help-seeking behaviors and self-help strategies for insomnia remain largely unclear.

METHOD

A cross-sectional, interview-based study of 290 Chinese adolescents.

RESULTS

The prevalence of insomnia symptoms was 40%, among which 9.3% had DSM-IV insomnia. Primary insomnia accounted for 7.9%, whereas insomnia associated with psychiatric disorders constituted 1.4%. Adolescents with DSM-IV insomnia had more severe and frequent insomnia, higher GHQ scores, and were more likely to have a history of sleep paralysis than those with insomnia symptoms alone. About 22% of adolescents with insomnia symptoms sought help and 32% attempted various strategies to improve sleep.

CONCLUSIONS

Many adolescents were troubled by insomnia, but they seldom sought help from healthcare professionals or received proper treatments.

Depressive feelings in children with narcolepsy

OBJECTIVES

We aimed to evaluate depressive feelings and their correlations in children and adolescents with narcolepsy collected in national reference centers for narcolepsy.

METHODS

We compared clinical and sleep characteristics of patients with and without depressive symptoms evaluated on the Children's Depression Inventory (CDI).

RESULTS

Our study sample included 88 children (44 boys; 44 de novo patients) with a mean age of 11.9 ± 3.1 years at diagnosis (37.5% were aged ⩽ 10 years). Obesity was found in 59% of the sample and cataplexy was present in 80.7%. The DQB1*0602 allele was positive in 93.5% of our sample. There were 25% of children who had clinically depressive feelings (CDI>16), especially girls older than the age of 10 years. Bivariate associations indicated that depressive feelings were associated with fatigue (48%), hyperactivity (31%), insomnia (16%), and excessive daytime sleepiness (EDS) (14-24%). In the multivariate model adjusted for gender and age, only fatigue explained the variability of the depression score.

CONCLUSION

In our large cohort, high levels of depressive symptoms essentially expressed by fatigue affected 25% of children with narcolepsy. The girls older than 10 years of age were especially vulnerable. The similar prevalence of depressive feelings in treated vs never-treated patients suggests a specific need for diagnosing and managing this symptom in young patients with narcolepsy.

Mental health, sleep quality, drinking motives, and alcohol-related consequences: a path-analytic model

OBJECTIVE

Poor mental health, sleep problems, drinking motivations, and high-risk drinking are prevalent among college students. However, research designed to explicate the interrelationships among these health risk behaviors is lacking. This study was designed to assess the direct and indirect influences of poor mental health (a latent factor consisting of depression, anxiety, and stress) to alcohol use and alcohol-related consequences through the mediators of global sleep quality and drinking motives in a comprehensive model.

METHOD

Participants were 1,044 heavy-drinking college students (66.3% female) who completed online surveys.

RESULTS

A hybrid structural equation model tested hypotheses involving relations leading from poor mental health to drinking motives and poorer global sleep quality to drinking outcomes. Results showed that poor mental health significantly predicted all four subscales of drinking motivations (social, coping, conformity, and enhancement) as well as poor sleep. Most of the drinking motives and poor sleep were found to explain alcohol use and negative alcohol consequences. Poor sleep predicted alcohol consequences, even after controlling for all other variables in the model. The hypothesized mediational pathways were examined with tests of indirect effects.

CONCLUSIONS

This is the first study to assess concomitantly the relationships among three vital health-related domains (mental health, sleep behavior, and alcohol risk) in college students. Findings offer important implications for college personnel and interventionists interested in reducing alcohol risk by focusing on alleviating mental health problems and poor sleep quality.

Case report of adjunctive use of olanzapine with an antidepressant to treat sleep paralysis

Sleep paralysis (SP) is a condition of unknown etiology that usually occurs when falling asleep or when awakening in which the individual remains conscious but is unable to control their voluntary movements. This case report is about a 68-year-old man with a 40-year history of symptoms of SP and associated panic attacks upon awakening. Neurological examination and neuroimaging identified no abnormalities. Five years before the current evaluation he had been diagnosed with depression and treated with various anti-depressants which ameliorated, but did not cure, his SP. However, this 40-year history of SP was abruptly terminated - and did not return over the subsequent two years - after adjunctive treatment with 2.5 mg olanzapine each night was added to his antidepressant.

Is High IQ Protective Against Cognitive Dysfunction in Narcoleptic Patients?

BACKGROUND AND PURPOSE

The aims of this study were to elucidate the cognitive functions of narcoleptics and determine whether intelligence protects against cognitive dysfunction and depressive mood in these patients.

METHODS

Sixty-six subjects (33 narcoleptics, 33 controls) were administered a battery of neuropsychological tests and an individual standardized intelligence test. The cognitive functions of the narcoleptic patients and the healthy controls were compared, as were those of high-IQ and mid-to-low-IQ narcoleptic patients.

RESULTS

Narcoleptics exhibited significantly lower scores in the Corsi Block-Tapping Test forward and backward, and the digit symbol tests, and significantly higher Beck Depression Inventory scores than the controls. However, verbal attention, verbal-visual long-term memory, and executive function task scores did not differ significantly between patients and controls. The mid-to-low-IQ patient group had lower mean digit span backward test, phonemic and semantic fluency Controlled Oral Word Association Test and Korean version of the Boston Naming Test scores, and a higher total score and general depressive symptoms subscales Beck Depression Inventory score than the high-IQ patient group. However, controls exhibited no IQ-related differences in cognitive performance or depressive mood. Patients in the high-IQ group exhibited impaired visual attention and working memory as compared with controls.

CONCLUSIONS

The findings of the present study show that narcolepsy patients have deficits in visual attention and visual working memory, and tend to feel more general depressive symptoms but not somatic symptoms than their control, nonnarcoleptic counterparts. In addition, it appears that higher intelligence protects against cognitive dysfunction and depressive mood.

Hypersomnia and depressive symptoms: methodological and clinical aspects

The associations between depressive symptoms and hypersomnia are complex and often bidirectional. Of the many disorders associated with excessive sleepiness in the general population, the most frequent are mental health disorders, particularly depression. However, most mood disorder studies addressing hypersomnia have assessed daytime sleepiness using a single response, neglecting critical and clinically relevant information about symptom severity, duration and nighttime sleep quality. Only a few studies have used objective tools such as polysomnography to directly measure both daytime and nighttime sleep propensity in depression with normal mean sleep latency and sleep duration. Hypersomnia in mood disorders, rather than a medical condition per se, is more a subjective sleep complaint than an objective finding. Mood symptoms have also been frequently reported in hypersomnia disorders of central origin, especially in narcolepsy. Hypocretin deficiency could be a contributing factor in this condition. Further interventional studies are needed to explore whether management of sleep complaints improves mood symptoms in hypersomnia disorders and, conversely, whether management of mood complaints improves sleep symptoms in mood disorders.

Highly specific role of hypocretin (orexin) neurons: differential activation as a function of diurnal phase, operant reinforcement versus operant avoidance and light level

Hypocretin (Hcrt) cell loss is responsible for narcolepsy, but Hcrt's role in normal behavior is unclear. We found that Hcrt knock-out mice were unable to work for food or water reward during the light phase. However, they were unimpaired relative to wild-type (WT) mice when working for reward during the dark phase or when working to avoid shock in the light or dark phase. In WT mice, expression of Fos in Hcrt neurons occurs only in the light phase when working for positive reinforcement. Expression was seen throughout the mediolateral extent of the Hcrt field. Fos was not expressed when expected or unexpected unearned rewards were presented, when working to avoid negative reinforcement, or when given or expecting shock, even though these conditions elicit maximal electroencephalogram (EEG) arousal. Fos was not expressed in the light phase when light was removed. This may explain the lack of light-induced arousal in narcoleptics and its presence in normal individuals. This is the first demonstration of such specificity of arousal system function and has implications for understanding the motivational and circadian consequences of arousal system dysfunction. The current results also indicate that comparable and complementary specificities must exist in other arousal systems.

Narcolepsy and depression and the neurobiology of gammahydroxybutyrate

A voluminous literature describes the relationship between disturbed sleep and depression. The breakdown of sleep is one of the cardinal features of depression and often also heralds its onset. Frequent arousals, periods of wakefulness and a short sleep onset REM latency are typical polysomnographic features of depression. The short latency to REM sleep has been attributed to the combination of a monoaminergic deficiency and cholinergic supersensitivity and these irregularities have been proposed to form the biological basis of the disorder. A similar imbalance between monoaminergic and cholinergic neurotransmission has been found in narcolepsy, a condition in which frequent awakenings, periods of wakefulness and short sleep onset REM latencies are also characteristic findings during sleep. In many cases of narcolepsy, this imbalance appears to result from a deficiency of hypocretin but once established, whether in depression or narcolepsy, this disequilibrium sets the stage for the dissociation or premature appearance of REM sleep and for the dissociation of the motor inhibitory component of REM sleep or cataplexy. In the presence of this monoaminergic/cholinergic imbalance, gammahydroxybutyrate (GHB) may acutely further reduce the latency of REM sleep and induce cataplexy, in both patients with narcolepsy or depression. On the other hand, the repeated nocturnal application of GHB in patients with narcolepsy improves the continuity of sleep, prolongs the latency to REM sleep and prevents cataplexy. Evidence to date suggests that GHB may restore the normal balance between monoaminergic and cholinergic neurotransmission. As such, the repeated use of GHB at night and the stabilization of sleep over time makes GHB an effective treatment for narcolepsy and a potentially effective treatment for depression.

Poor sleep quality and alcohol use problems among elderly Taiwanese aboriginal women

BACKGROUND

Little is known about sleep quality and alcohol use problems in the elderly minority population. This study aimed to identify a one-month prevalence of poor sleep quality and alcohol use problems among elderly Taiwanese aboriginal women and to examine the association between them.

METHODS

A cross-sectional survey with stratified random sampling was conducted in eight aboriginal communities in Taiwan. The 1261 elderly aboriginal women (response rate 84%) completed all assessments. Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), while the CAGE questionnaire was used to evaluate alcohol use problems.

RESULTS

Of the study participants, 20.54% and 25.59% had poor sleep quality and alcohol use problems, respectively. Controlling for confounding factors, alcohol use problems were a risk factor for poor sleep quality (AOR = 1.44, p = 0.0433). Alcohol use problems were associated with three components of PSQI: sleep disturbances, subjective sleep quality, and daytime dysfunction.

CONCLUSIONS

The elderly Taiwanese aboriginal women with problematic alcohol drinking experienced poorer sleep quality. Development of a program to reduce alcohol use problems might improve sleep quality among elderly Taiwanese aboriginal women.

Melanin-concentrating hormone neurons discharge in a reciprocal manner to orexin neurons across the sleep-wake cycle

Neurons containing melanin-concentrating hormone (MCH) are codistributed with neurons containing orexin (Orx or hypocretin) in the lateral hypothalamus, a peptide and region known to be critical for maintaining wakefulness. Evidence from knockout and c-Fos studies suggests, however, that the MCH neurons might play a different role than Orx neurons in regulating activity and sleep-wake states. To examine this possibility, neurons were recorded across natural sleep-wake states in head-fixed rats and labeled by using the juxtacellular technique for subsequent immunohistochemical identification. Neurons identified as MCH+ did not fire during wake (W); they fired selectively during sleep, occasionally during slow wave sleep (SWS) and maximally during paradoxical sleep (PS). As W-Off/Sleep-On, the MCH neurons discharged in a reciprocal manner to the W-On/Sleep-Off Orx neurons and could accordingly play a complementary role to Orx neurons in sleep-wake state regulation and contribute to the pathophysiology of certain sleep disorders, such as narcolepsy with cataplexy.