Reviewing notes & drug charts for 6 months duration (Jan to June 2010) for all the inpatients (74) on the 6 Forensic wards at the Littlemore Hospital

Findings:

1. - 3 patients were found (Zopiclone 7.5)

2. - PRN basis

3. - Insomnia: recorded on charts only

4. - Non pharmacologic measures: 1

5. - Documentation: 1

6. - Max duration: No

7. - Revision: No

1. - Hypnotics are rarely used in Forensic units

2. - Only used for couple of days

3. - Zopiclone mainly used

4. - No switching

5. - Documentation: rare

Recommendations:

1. - Non pharmacological (sleep hygiene)

2. - Document entry in notes (medical+ nursing)

3. - Max duration 2 weeks (NICE)

4. - Larger scale (General wards)

1. - Forensic patients:HDAT & RT

2. - Standards followed by Trust

3. - Forensic patients supervised at all times

4. - On call doctor??

5. - Sleep Hygiene encouragement

Acupuncture, as complementary medicine, has been used since many years ago in china and many researches have proved its effect separately or combined with other treatment methods.

To compare therapeutic effects of Acupuncture plus estazolam and Cognitive - Behavioral Therapies plus estazolam on insomnia.

To determine the efficacy of acupuncture as complementary medicine in treating insomnia.

64 insomnia patients were randomly divided into an acupuncture group and a behavioral group, 30 cases in acupuncture group and 18 cases in behavioral group completed research. The acupuncture group was treated by administration oral estazolam before sleeping each day and needling, three times a week, the behavioral group received Stimulus control as Cognitive - Behavioral Therapy plus oral estazolam before sleeping each day. Treatment course was 3 weeks. The insomnia severity index (ISI) scores before and after treatment were observed in the both groups.

The total effective rate was 86.7% in the acupuncture group and 50% in the behavioral group with statistically significant difference (P < 0.05). The cured rate of 30% in the acupuncture group was significantly higher than 16.7% in the behavioral group (both P < 0.05).

The therapeutic effect of Acupuncture as a complementary medicine on insomnia is better than stimulus therapy as a Cognitive - Behavioral Therapy.

The Insomnia Severity Index ISI is a Questionnaire to screen insomnia in clinics; so, it has been translated to many languages.

To determine the Reliability and validity of the Chinese Translation of Insomnia Severity Index(C-ISI) in patients with Insomnia and compare it with Chinese version of Pittsburgh Sleep Quality Index (C-PSQI).

To show the Reliability and validity of C-ISI for using it in chinese speakers.

English version ISI was translated into Chinese base on standard guidelines then Chinese version was filled in 83 patients with insomnia as a clinical group and 45 persons without sleep complain as the control group by themselves in Neuropsychiatery Department of DongzhiMen hospital. For finding Test-Retest reliability they refilled ISI questionnaire 2 weeks later.

Cronbach-α coefficient of C-ISI for the clinical group, control group and both of them was 0.72, 0.75 and 0.91 respectively. The C-ISI component and total scores in test were significantly correlated with their related components and total scores in re-test (P < 0.05). Mean Ranks for All C-ISI components, total score were significantly higher in clinical group than control group that presents low sleep quality in clinical group. There are Significant correlations between C-ISI component and total scores and C-PSQI components and Total scores in related Items.

Insomnia is one of the most common sleep complications which are defined as a problem in the beginning of sleep or its permanence.

The aim of this study was the effects of herbal medicine (Valeriana officinalis) and homeopathic remedy (Coffea cruda) on insomnia.

This is a single blind clinical trial study, conducted on 90 students who suffered on insomnia. They were chosen by volunteer sampling and randomly allocated in two groups. One group received homeopathic remedy Coffea cruda drop and placebo capsule and other ones used allopathic medicine Valeriana officinalis capsule and placebo drop. Both groups used one capsule one hour before sleep every night and one drop every 8 hours for one month. The ethical committee of the university approved the study. Data were collected through 3 questionnaires: Demographic, Petersburg sleep quality index and Standard Insomnia Severity Index (ISI). Content validity and test-retest methods were used for validity and reliability. Data analysis using descriptive and inferential statistics.

Before usage, the quality and severity average of Sleep in Valeriana officinalis group was mean =11.78and15/14 before and 7.56and8/6 after a period of 1 months. The quality and severity average of Sleep in Coffea curada group was mean =11/51 and14/53 before usage and 5.51and 6/05 after a period of 1 months. We have obtained a significant difference between 2 groups 1 month after the start of consumption (P < 0/05).

The results of this study suggested, Cafea cruda, is more and low side effect methods than herbal medicine.

Short nocturnal sleep impairs morning glucose tolerance, and this effect is thought to involve the lack of slow-wave sleep (SWS).

So far, it has not been examined in humans whether the influence of poor sleep on morning glucose tolerance may emerge when non-SWS sleep is lacking.

To compare the influence of one night of slow-wave sleep suppression (SWSS) with that of one night of non-SWS suppression (NSWSS) on morning glucose tolerance in humans.

16 normal-weight students [age 20–30 years] participated in a counterbalanced fashion in three experimental conditions: regular sleep, SWSS, and NSWSS. The suppression of sleep was performed by means of an acoustic tone (562 Hz) with gradually rising intensity. Glucoregulatory parameters were measured upon an oral glucose tolerance test (OGTT) the next morning.

Following the oral glucose load, the serum insulin and plasma glucose responses were significantly greater after the nocturnal suppression of SWS, as compared with those after NSWSS and regular sleep, respectively (P < 0.03). In contrast, such effects did not emerge when comparing the NSWSS and regular sleep conditions (P > 0.27).

One night of SWSS is linked to an impaired glucoregulatory response to an oral glucose load. Since NSWSS, compared to regular sleep, did not influence the postprandial serum insulin and plasma glucose response, our data suggest that lacking slow wave sleep may be the driving force that underlies the association between poor sleep and impaired daytime glucose tolerance.

In the present study, 37 chemical veterans with injury magnitude of moderate and severe based on the standards of Foundation of Martyrs and Veterans Affairs were selected from Mazandaran province. In addition, the spouses of 31 of them were selected and 15 of their close relatives were also enrolled in the study as the control group. The three groups were evaluated by GHQ for their mental health and Pittsburg Sleep Quality Index (PSQI) for their sleep quality. .

The mean score of mental health in veterans, their spouses and close relatives were 44.13 ± 14.4, 34.19 ± 15.2 and 21.73 ± 17.32, respectively, and the mean scores of PSQI test in veterans, their spouses, and their close relatives were 10.94 ± 5.6, 8.7 ± 5.5 and 4.27 ± 1 showing a statistically significant difference between the three groups (P ≤ 0.0001). There was a positive relationship between mental health and sleep quality in veterans and their spouses, that is, (r = 0.4▮P = 0.02) and (r = 0.83, P < 0.0001), respectively. However, no relationship was found between mental health and sleep quality in their close relatives: r = 0.01, P = 0.96).

It could be claimed that poor sleep quality in chemical veterans, compared to their spouses and close relatives, could be due to mental health, rather than chemical effects and chronic lung disease; therefore, treatment of mental health might be an important step in improving the sleep quality of veterans.

Circadian rhythms were reported for sleep and cardiac activities. Moreover, chronotropic cells were found in brain stems implied in sleep and cardiac regulations. In healthy men, modifications in cardiac vagal activity appeared before those in delta power band.

We tested if the delay between modifications in cardiac vagal activity and delta power band was maintained across nocturnal sleep and, whether dominance between vagal and delta activities was preserved before spontaneous awake in the morning.

Circadian rhythms between heart and sleep could explain evening sleep and morning awakening.

Thirteen healthy men without sleep, somatic or psychiatric disorders were recorded across three successive nights. Sleep architecture was composed by five NREM-REM cycles at least. Sleep stages, spectral components of heart rate variability (HRV) and sleep, coherence analysis between cardiac vagal component of HRV and each sleep power band were performed and compared between two periods: the first and the last three NREM-REM cycles.

NREM, REM and awake durations were similar between both night periods. Heart rate was shortened during first cycles and NREM sleep. Cardiac sympatho-vagal balance did not demonstrate major changes between periods and sleep stages. At the end of the night, phase shift between changes in HRV and sleep power bands were more variable. Interaction between cardiac vagal influence and sigma power was increased as well for alpha power, and dominated all other interactions.

Circadian rhythms influence the link between cardiac and sleep activities to allow sleep during night and awake in morning.

Numerous cardiovascular events are related to sleep apnea-hypopnea syndrome (SAHS). Several studies reported, in SAHS patients, increased cardiac sympathic influence and altered link between cardiac vagal activity and delta sleep EEG. Nevertheless, short-term nasal CPAP (nCPAP) treatment regulates cardiac sympatho-vagal balance and sleep architecture.

We tested that long-term nCPAP treatment improves the link between cardiac vagal influence and delta sleep EEG across the night.

Long-term nCPAP treatment could improve the link between heart rate variability (HRV) and sleep to prevent occurrence of cardiovascular events.

Cardiac activity and sleep of 8 middle-aged men suffering from SAHS were recorded before and after at least 6 months of nCPAP treatment. They were matched for sex, age, caffeine, nicotine and alcohol consumption with 14 healthy men. All subjects were free of somatic and psychiatric disorders as well as medication. Sleep architecture, spectral components of HRV and delta power band were calculated across the first three NREM-REM cycles as well as a coherence analysis between cardiac vagal influence and delta sleep EEG.

AHI was 63.5 ± 22.9 vs 5.5 ± 4.4 events/hour after 47 ± 34 months of nCPAP treatment (mean± standard deviation). Awake, NREM and REM sleep durations were similar between groups as well as spectral HRV components. Coherence analysis revealed decreased gain value for untreated patients in comparison to controls while difference disappeared with nCPAP treatment.

Long-term nCPAP treatment improves the link between cardiac vagal influence and delta sleep even in the absence of altered HRV.

Several studies reported increased cardiac sympathic activity in ADHD patients and increased mortality with treatment. In contrast, others did not find differences for heart rate variability (HRV) in comparison to healthy controls. Sleep disorders were often associated to ADHD.

We tested whether HRV components and the link between cardiac vagal activity and delta sleep EEG were altered in patients suffering from ADHD but without sleep disorders.

ADHD without sleep disorders did not affect cardiac vagal activity.

10 men, diagnosed ADHD by a psychiatrist and using Conners and Wender-Utah rating scales, were matched for age and BMI with healthy men. All subjects were medication-free and did not suffer from somatic or psychiatric conditions. Sleep was recorded across three successive nights. ECG and EEG of the three first NREM-REM cycles were computed to obtain spectral components of HRV and sleep delta power. Coherence analysis was applied to measure the link between cardiac vagal activity and delta.

Patients demonstrated lower sleep efficiency and larger REM duration. During the first 3 cycles, NREM, REM and awake durations were similar between groups. RR-Intervals decreased from NREM to REM and awake for controls and from NREM to awake for patients. The spectral cardiac vagal components of HRV were similar between groups and decreased from NREM to REM and awake. ADHD patients did not demonstrate differences for coherence analysis in comparison to controls.

Patients suffering from ADHD without sleep disorder did not show altered cardiac sympatho-vagal influence across the night.

Sleep complaints are common in patients with major depressive disorder (MDD).Venlafaxine is an antidepressant of the serotonin -norepinephrine reuptake inhibitor class. Mirtazapine is a tetracyclic antidepressant (TeCA) used primarily in the treatment of depression. This study compares the effects of venlafaxine and mirtazapine on sleep continuity measures in DSM-IV MDD patients with insomnia.

Patients (N = 37) received initial baseline polysomnography evaluations over 2 consecutive nights.Subjects were randomly assigned to either venlafaxine (75–150 mg/day) or mirtazapine (15–45mg/day)treatment for an 8 week,double -blind,double -dummy treatment trial.Single-night polysomnograms were conducted at weeks 1,2,and 8, with depression ratings assessed at baseline and weeks 1,2, 3,4, 6,and 8.

Patients receiving mirtazapine (N = 20) had significant improvement in objective sleep physiology measures at 8 weeks.Improvement in sleep latency,sleep efficiency,and wake after sleep onset were significant after only 2 weeks of mirtazapine treatment.No significant changes in sleep continuity measures were observed in the venlafaxine group (N = 17).Both groups improved clinicaly in mood and subjective sleep measures from baseline, with no differences between groups.

These date demonstrate the differential effects of mirtazapine and venlafaxine with significant improvement in favor of mirtazapine ,on objective sleep parameters in MDD patients with insomnia.

Chronic sleep restriction results from a number of factors; medical condition and social demands, and has adverse effects on daytime function, such as cognitive function and driving performance. We demonstrated that the acute sleep restriction (time in bed < 4 h/night) impaired cortical oxygenation response during word fluency task.

We examined the chronic effect of insufficient sleep on cerebral blood flow and cognitive function.

Ten healthy adults (mean age 19.0 years, mean BMI 22.5 kg/m2) were enrolled in this study. All participants spent > or = 8 h/night in bed prior to study day (sufficient sleep), followed by < 4 h/night in bed for 3 days (insufficient sleep1, 2 and 3). The oxyhemoglobin (oxyHb) level by a word fluency task was measured with a near-infrared spectroscopy recorder on the morning following sufficient and insufficient sleep 1 and 3. Wisconsin card sorting test (WCST), continuous performance test -identical pairs version (CPT-IP) and 2-back test were evaluated on the same day.

The peak oxyHb during the word fluency task was significantly reduced after insufficient sleep 1 and 3 than that after sufficient sleep. The percentage of correct responses on CPT-IP and 2- back test after insufficient sleep 3 were lower than those after sufficient sleep, though there were no significant differences on those. WCST did not significantly differ among insufficient sleep 1 and 3 and sufficient sleep.

The chronic sleep restriction reduced cortical oxygenation response, and might result in cognitive performance impairment.

The association of epileptic seizures with sleep has been recognized since antiquity. Sleep disturbance in patients with epilepsy may be related with the underlying seizure disorder itself, its therapy, or the presence of a sleep disorder such as obstructive sleep apnea. On the other hand, in some patients, seizures may be the underlying cause of symptoms that initially suggested a primary sleep disturbance.

The authors’ aim is to report a case of a 26-year-old male who presented to the hospital with symptoms suggestive of a mood disorder and a sleep disturbance, and was diagnosed with nocturnal complex partial seizures. A literature's review about the psychiatric manifestations of epilepsy was also made.

The patient is a 26-year-old single male who was referred to the psychiatric yard when he was 19 years-old because he exhibited depressed mood, social inhibition and complained of sleep disturbance. He explained that episodically he made rhythmic head movements to fall asleep, since he was a child. Laboratory tests with thyroid function were normal. Cranial tomography showed mild plagiocephaly with a slight deformation of the right parietal region. Magnetic resonance imaging was normal. Diurnal and nocturnal electroencephalogram (EEG) documented left frontotemporal paroxysmal activity with a tendency to generalize.Video-EEG polysomnogram revealed rhythmic head movements during REM sleep, without paroxysmal activity preceding the events, and reduced REM sleep.

Psychiatric conditions occur frequently in epilepsy and their manifestations are diverse. Clinicians should be aware of atypical presentations.

Motor Vehicle Accidents(MVA) are the main attendees of accident emergency unit in UMMC. Assessment by doctor found that some ot them used alcohol/substance prior to MVA event. They also found to have abnormal sleep pattern and “emotional problems” that contribute to MVA and injuries. Yet, limited study available in Malaysia that explore the relationship between sleep disorders, substance use, psychiatric morbidity and MVA events.

To investigate the prevalence and associations of sleep disoders, substance use and psychiatric comorbidity among attendees in accident emergency unit, UMMC.

This is a cross-sectional hospital based study that examine all MVA attendees age 18 and above with written consent in accident emergency unit UMMC from 30 September to 30 November 2011. We exclude those patients with Glasgow Coma Sale(GCS) less than 10, intoxication and refused consent. We measure sleep disorders using Epsworth Sleep Scale(ESS), Psychiatric morbidity using Hospital Anxiety Depresion Scale(HADS) and substance use with Drug abuse screening tool(DAST). We also do rapid urine test kits for opiates, canabis, amphetamine type stimulants(ATS) and benzodiazepines. Chi square test will be analyses for the variable asssociations using SPSS 16.

We expect that the prevalence of sleep disorders, subsatnce use and other psychiaric comorbidity are higher among MVA attendees. There are some association in between those factors that contributes to the MVA events.

MVA attendees probably need further assesment as routine e.g. sleep study, psychiatric morbidity and drug screening in order to better manage them and prevent further MVA in the future.

The purpose of this study was to test the impact of foot reflexology (FR) on sleep architecture in patients suffering from sleeping disorders.

Try to improve sleep quality in patients with sleep disorders using the foot reflexology.

A controlled interventional study in which volunteers (n = 10) were their own control. Each subject received one 20 min FR session during their three nights in the sleep laboratory. Randomly, FR was performed during night 2 or night 3. A polygraph was used to measure these changes in sleep architecture throughout the night and a visual analogue scale (VAS) completed the measurements, in the morning, to subjectively determine the sleep quality.

The sleep architecture measured by polygraphy showed no statistically significant difference in percentage between nights with and without FR. However, a tendency to increase sleep latency and duration of nocturnal awakening was recorded insignificantly. The VAS sleep quality increased highly significantly with FR (p = 0.0059).

According to the patients′ feelings, FR induced an improved sleep quality, while the polygraph measures showed no change. This suggests that FR stimulates endogenous factors causing a feeling of well-being and comfort in those patients.

Poor sleep hygiene is a risk factor for poor sleep quality and chronic insomnia and its improvement is one of the main components in the cognitive-behavioural therapy for insomnia.

To measure the knowledge on healthy/unhealthy sleep behaviours and the self-reported sleep quality in individuals suspected of chronic insomnia compared to those that report a healthy sleep.

To assess whether knowledge of sleep behaviours is linked with sleep quality.

Adults were recruited via online adverts and invited to fill in a battery of tests consisting in the Romanian translations of the Sleep Condition Indicator, Sleep Disorders Questionnaire and Sleep Beliefs Scale. The survey was hosted on Surveygizmo and analysis was performed with MyStat.

To date, one hundred and sixty one participants enlisted (71% females, N = 115, mean age 38 ± 13). While better sleep knowledge did not mean better sleep quality in individuals suffering from chronic insomnia, those with sound sleep revealed better healthy sleep behaviours awareness, though without reaching the significance level. Sleep knowledge was significantly better in women and did not vary by education or age group.

Better sleep knowledge does not seem to improve the quality of sleep in chronic insomniacs, but does so in those without sleep complaints.

Insomnia as a disorder is rather common in general population. By definition, it causes distress and impairment in several areas, such as attention. Insomnia can present itself as an isolated condition or as a co-morbid phenomenon of various somatic and neuropsychiatric disorders; an example is adult attention-deficit/hyperactivity disorder (ADHD), characterized by the triad of inattention, hyperactivity and impulsivity.

To identify individuals likely to suffer from chronic insomnia and/or adult ADHD, as well as to measure the impairment caused by these conditions.

To assess whether young adults complaining of insomnia are undiagnosed patients suffering from ADHD.

Adults recruited from the general community and students from two Romanian universities were invited to fill in a battery of scales consisting in the Romanian translations of the Sleep Disorders Questionnaire, Sleep Condition Indicator, Adult ADHD Self-Report Scale and Barkley Adult ADHD Rating Scale.

To date, three hundred twenty five participants enlisted: 208 young adults, aged 23 ± 3 (78% women) and 117 older adults aged 44 ± 11 (73% women). Chronic insomnia was suspected in 5% of the young adults and 15% of the older ones (9% overall). Adult ADHD was likely in 19% of the younger participants and in 9% of the older ones (16% overall). Half of the young likely to suffer from chronic insomnia were likely to suffer from ADHD, too, compared to only 12% of the older (p = 0.03).

Young adults suspected of chronic insomnia were significantly more likely to suffer from adult ADHD, too.

To determine the prevalence of somatisation, depression, anxiety and stress, investigate the socio-demographic characteristics and determine the diagnostic overlap of somatisation, depression, anxiety and stress.

A cross-sectional study.

Primary Health Care (PHC) Center.

Representative sample of 2150 patients were approached and 1762 patients agreed to participate (81.9%) March to October, 2011.

General Health Questionnaire (GHQ-12) was used to identify the probable cases. Anxiety was assessed with Generalized Anxiety Disorder Scale (GAD-7). Depression was assessed with depression module (PHQ-8). Somatisation was measured with somatic symptom module of the PHQ -15. The Perceived Stress Scale (PSS) instrument was used to identify the stress cases.

The prevalence rate of somatisation, depression, anxiety and stress were 11.7%, 10.6%, 8.3% and 18.6% respectively. More than half of the sufferers with somatisation (58.3%), depression (54.3%), anxiety (50.7%) and stress (56.4%) were men in the age group 45–54 years. Half of the subjects with somatisation (51.4%), depression (50.8%), anxiety (53.4%) and stress (50.7%) were with low education. low economic status among the somatic (35.9%), depressive (35.7%), anxious (35.6%) and stress (34.5%) patients. For somatisation, the most common symptom experienced by men (68.3%) and women (66.3%) was back pain. There was considerable overlap between these four mental disorders.

Stress and somatisation were the most frequent observed among patients compared to depression and anxiety. Patients with low education and low economic status were more affected with these four mental disorders and patients were not able to cope up daily activities.