Poor sleepers who do not complain of insomnia: myths and realities about psychological and lifestyle characteristics of older good and poor sleepers

Psychological adjustment, lifestyle, and sleep parameters were investigated in 634 older community residents. Participants were divided into three categories: good sleepers, poor sleepers experiencing high distress, and poor sleepers experiencing minimal distress. Results indicate that (1) highly distressed poor sleepers manifested an anxious, depressed, negative cognitive-affective set; (2) many coped well with age related changes in sleep quality--they resembled good sleepers in the relative absence of psychological maladjustment they displayed; (3) the three groups had similar lifestyles, but they differed in the cognitive-affective evaluation of their activities, (4) the insomnia complaint is itself multifaceted and is comprised of three distinct elements--difficulty sleeping, distress, and daytime fatigue; (5) sleep practices (e.g., naps, bedtimes) are not implicated in chronic poor sleep; and (6) many commonly held assumptions about sleep disruptions in older individuals are myth rather than reality. Implications for better understanding and treating insomnia in older individuals are discussed.

Children from alcoholic families--a population at risk

This article focuses on children of alcoholics as a population at risk, and discusses strategies for assessment and intervention by school nurses. Information about alcohol abuse and the effects of problem drinking on children is provided. Case history examples will offer additional illustration, with resiliency being highlighted.

Reproducibility and relation to mean heart rate of heart rate variability in normal subjects and in patients with congestive heart failure secondary to coronary artery disease

Before heart rate (HR) variability can be used for predictive purposes in the clinical setting, day-to-day variation and reproducibility need to be defined as do relations to mean HR. HR variability and mean HR were therefore determined in 2 successive 24-hour ambulatory electrocardiograms obtained from 33 normal subjects (age 34 +/- 7 years, group I), and 22 patients with coronary disease and stable congestive heart failure (CHF) (age 59 +/- 7 years, group II). Three measures were used: (1) SDANN (standard deviation of all mean 5-minute normal sinus RR intervals in successive 5-minute recording periods over 24 hours); (2) SD (the mean of the standard deviation of all normal sinus RR intervals in successive 5-minute recording periods over 24 hours); and (3) CV (coefficient of variation of the SD measure), a new measure that compensates for HR effects. Group mean HR was higher and HR variability lower in group II than in group I (80 +/- 10 vs 74 +/- 9 beats/min, p less than 0.04). Mean group values for HR and HR variability showed good correlations between days 1 and 2 (mean RR, r = 0.89, 0.97; SDANN, r = 0.87, 0.87; SD, r = 0.93, 0.97; CV, r = 0.95, 0.97 in groups I and II, respectively). In contrast, considerable individual day-to-day variation occurred (group I, 0 to 46%; group II, 0 to 51%). Low HR variability values were more consistent than high values. SDANN and SD correlated moderately with HR in both groups (r = 0.50 to 0.64). The CV measure minimizes HR effects on HR variability.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of the sexual consequences of surgery: retrospective and prospective strategies

To assess the impact of a stressor, it is desirable to evaluate affected individuals' status both prior to and following a stressful event. Because of the difficulties inherent in prospective designs, investigators often ask people who have experienced an aversive event to evaluate their prestressor adjustment retrospectively. Do such retrospective evaluations provide a reasonable alternative to prospective assessment? To answer this question we compared retrospective and prospective data gathering procedures in the evaluation of sexual adjustment after prostate surgery. One hundred fifty-two married males who had undergone prostatectomy for benign prostatic enlargement completed a battery of measures which evaluated pre- and postsurgical sexual adjustment either prospectively (i.e., before and after surgery) or retrospectively (i.e., ratings made after surgery of both pre- and postsurgical adjustment). Retrospective assessment indicated considerable sexual deterioration pre- to postsurgery. In subjects tested prospectively, however, the results showed that surgery had little impact on sexual adjustment. Moreover, direct comparisons of retrospective and prospective methodologies reveal that discrepancies are due to differences in evaluations of presurgery status, with retrospective evaluation yielding more favorable ratings than prospective assessment. The results highlight a variety of biases which may affect self-ratings of pre- and post-stressor adaptation and show that discrepancies associated with the two methodologies have important implications for understanding the impact of a stressor on adjustment.

Transurethral prostatectomy: differential effects of age category and presurgery sexual functioning on postprostatectomy sexual adjustment

Sexual functioning and adjustment of 72 aging married males who had undergone transurethral prostatectomy were examined retrospectively according to their pre- and postsurgery status. Results indicate that although transurethral prostatectomy was generally associated with deterioration in various aspects of sexual expression, grouping subjects according to age and presurgery sexual adjustment qualified these general findings dramatically. For example, more younger than older males retained or attained good sexual adjustment after surgery. Furthermore, while older males with good presurgery sexual adjustment maintained good couple sexual functioning, they manifested greater loss of sexual self-confidence and individual sexual capacity than did their younger counterparts. In addition, the findings suggest that the question "Does transurethral prostatectomy affect sexual function?" must be rephrased to take into account changes in the cognitive, capacity, and affective domains as well as in the couple behavior and adjustment dimensions of sexual expression.