• Sleep Medicine and Psychophysiology
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• v.2 no.1
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• pp.13-22
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• 1995

To provide the physician with adequate information to diagnose and treat sleepwalking and sleep terrors, the author reviewed clinical features, epidemiology, causative and precipitating factors, polysomnography, diagnosis, differential diagnosis, and treatment for these disorders. Sleepwalking and sleep terrors have been defined as disorders of arousal that occur early in the night and have their onset during stage 3 or 4 sleep. In both disorders, patients are difficult to arouse, and complete amnesia or minimal recall of the episode is frequent. Genetic, developmental, and psychological factors have been identified as causes of both sleepwalking and sleep terrors. Sleepwalking and sleep terrors typically begin in childhood or early adolescence and are usually outgrown by the end of adolescence. When sleepwalking or sleep terrors have a post-pubertal onset or continue to adulthood, psychopathology is a more significant causative factors. The behavior that occur from deep slow-wave sleep can be painful or dangerous to the individual and/or disturbing to those close to that individual. The assessment of patients suspected of having these conditions requires a thorough medical and sleep history. The most important consideration in managing patients with sleepwalking or sleep terrors episodes is protection from injury.

• Proceedings of the KOSOMBE Conference
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• v.1996 no.05
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• pp.60-64
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• 1996

This paper describes the development of portable arousal measurement and analysis system. Skin impedance change which responds the change of arousal level was detected by the three electrode constant current method and separated into two components (SIR, SIL). Relationship between Nz, IRI and arousal level was studied and Criteria of arousal level control was decided by the sleep study.

• Proceedings of the IEEK Conference
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• 2006.06a
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• pp.819-820
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• 2006

The purpose of this study is to develop an automatic algorithm to detect the arousal events. The proposed method is based on time-frequency analysis and the support vector machine classifier using single channel electroencephalogram. To extract features, first we computed 6 indices to find out the information of sleep states. Next powers of each of 4 frequency bands were computed using spectrogram of arousal region. And finally we computed variations of power of EEG frequency to detect arousals. The performance has been assessed using polysomnographic recordings of twenty patients with sleep apnea, snoring and excessive daytime sleepiness. We have shown that proposed method was effective for detecting the arousal events.

• Annals of Occupational and Environmental Medicine
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• v.35
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• pp.47.1-47.14
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• 2023

Background: This study aimed to examine the impact of chronotype on depressive symptoms and explore the mediating effects of sleep quality, pre-sleep cognitive arousal, and social jetlag in a sample of wage earners. Methods: A total of 3,917 waged workers were surveyed online in July 2022. Logistic regression and mediation analysis were used to assess the relationship between chronotype (morningness, intermediate, and eveningness) and depressive symptoms (Patient Health Questionnaire ≥ 5), and the mediating effects of Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Pre-Sleep Arousal Scale (PSAS). All analyses were adjusted for age, education level, income level, marital status, coffee consumption, alcohol consumption, physical activity, occupation, employment status, and working hours to calculate odds ratios (ORs). Results: The chronotypes of all the participants were divided into morningness (4.7%), intermediate (93.5%), and eveningness (1.8%). Multiple logistic regression analysis showed an increased risk of depression in the eveningness chronotype (OR: 2.96; 95% confidence interval [CI]: 1.51, 5.86). Regarding the mediation analysis, ISI mediated 28.44% (95% CI: 16.39-40.5), PSQI for 31.25% (95% CI: 19.36, 43.15), and PSAS-Cognitive Score (PSAS-C) for 23.58% (95% CI: 10.66, 36.50) of the association between chronotype and depressive symptoms. However, social jetlag did not significantly mediate this relationship. (percentage mediated = 0.75%, 95% CI: -3.88, 5.39) Conclusions: Evening chronotypes exhibit an increased risk of depressive symptoms, which ISI, PSQI, and PSAS-C partially mediated. This suggests that interventions to improve sleep quality and maintain adequate sleep habits may effectively prevent and treat depression in employees with an eveningness chronotype.

• Sleep Medicine and Psychophysiology
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• v.7 no.2
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• pp.115-119
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• 2000

Objectives Summary: A 20-year-old man was presented with a history of difficult waking for 10 years. He suffered from morning headache, chronic fatigue and mild daytime sleepiness but had no history of irresistible sleep attack, cataplexy, hypnagogic hallucination or sleep paralysis. Methods: Night polysomnography (PSG), multiple sleep latency test (MSLT) and HLA-typing were carried out. Results: The PSG showed short sleep latency (4.0 min) and REM latency (2.5 min), increased arousal index (15.7/hour), periodic limb movements during sleep (PLMS index=8.1/hr) with movement arousal index 2.1/hr and normal sleep efficiency (97.5%). The MSLT revealed normal sleep latency (15 min 21 sec) and 4 times sleep-onset REM (SOREM). HLA-typing showed DQ6- positive, that corresponded at the genomic level to the subregion DQB1*0601, which was different from the usual locus in narcolepsy patients (DQB1*0602 and DQA1*0102). Conclusion: Differential diagnosis should be made with circadian rhythm disorder and other causes of primary waking disorder. The possibility of a variant type of narcolepsy could be suggested with an unusual clinical manifestation and a new genetic marker.

• Childhood Kidney Diseases
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• v.16 no.1
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• pp.9-14
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• 2012

The relationship between central nervous system (CNS) and enuresis has not been sufficiently elucidated despite the presence of several circumstantial evidences. Contrary to common belief, polysomnographic sleep analysis revealed that the disturbance of arousal rather than deep sleep was responsible for enuresis. Subsequent studies confirmed depressed sympathetic tone and retarded brainstem reflex indicating abnormal arousal threshold in enuretics. In accordance with the bladder-brain dialogue, chronic stimulation of bladder may modify the brainstem function elevating arousal threshold. Epidemiological studies have suggested the association between enuresis and various psychosomatic disorders like attention deficit hyperactivity disorder (ADHD), which has shown the abnormal brainstem reflex similar to enuresis. Taken together, CNS is assumed to play a crucial role in the pathogenesis of enuresis. Psychological assessment is vital to understand the psychodynamic effect of enuresis. Studies have shown that the prevalence of psychological problems was higher in enuretic children and externalization of the symptoms was usually found. Several explanations have been brought up regarding the development of enuresis and psychological problems. Enuresis may cause psychological problems and vice versa. Otherwise, both may be associated with other variables, such as socioeconomic status (SES).

• Sleep Medicine and Psychophysiology
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• v.1 no.1
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• pp.3-8
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• 1994

With the recent development of sleep medicine, insomnia has been perceived as a disease from a simple symptom. As there are various causes in a disease, proper treatment according to each cause is necessary for a more effective treatment In general, insomnia is classified into five categrories of physical, physiological, psychological, psychiatric and pharmacological aspects. However, such categorizations are often insufficient in treating insomnia. Furthermore understanding of the developmental mechanisms of insomnia is required. The function of sleep is developed and maintained through the balance of the reciprocal forces of sleep and arousal. These forces are contantly regulated by what is called a circadian rhythm. Sleep is induced by this rhythm which is affected by factors such as awakening time in the morning, amount of intellectual function, amount and time length of physical exercise and sunlight Insomnia could develop when this rhythm is delayed and leads to a "forbidden zone" which is a very difficult period for inducing sleep about two to four hours before the routine bedtime. Whereas sleep gradually develops in line with the circardian rhythm, arousal can occur very abruptly by any cause triggered by emotional discomfort or anxiety. Such characteristic and emotional factors as perfectionism, separation anxiety, secondary gain, insecurity, and negative cognition may provoke the inner anxiety and fear for insomnia, which can lead acute insomnia to a chronic one. As chronic insomnia is developed by multiple causes and factors, integrated approaches through analysis of above mentioned factors will be more effective in the treatment of insomnia than a simple administration of hypnotics.

• Journal of Korean Academy of Nursing
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• v.27 no.4
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• pp.820-830
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• 1997

Sleep is an essential component for health and the quality of life of individuals, and is affected by multiple factors. Thereby, sleep impairment is known to be frequent even in healthy subjects. The purpose of the study is to compare sleep patterns and related factors between healthy young and old adults and to identify aging effects upon sleep in a cross-sectional way. The survey questionnaire was developed by translation and modification of two well-known sleep questionnaires which were originally developed by Monroe(1967) and Ellis, et al. (1982). Discussion with experts and pilot study were completed to finalize the contents of the questionnaire that was used in this study. Results are as follows : 1. Sleep complaints were lower in older adults. 2. The most frequent variables that explain sleep satisfaction were feeling rested in the morning in the older adults and feeling rested and failing asleep within five minutes in the young adults. 3. Regarding sleep-disturbing factors, physical factors were more frequently reported in the older adults and environmental factors are reported more frequently in the young adults, and there was no difference related to the emotional factors between the two groups. 4. Young adults were practiced strategies for better sleep more often than the older adults, and they were mainly in-home activities just before sleep. 5. Sleep patterns which change with aging were as follows : going to bed and waking up earlier : not staying in the bed long after waking up ; getting harder to fall asleep ; frequent arousal after sleep onset ; getting harder to go back to sleep after arousal during night sleep. From the results of this study, it can be concluded that sleep and related factors of the young and the older adults are different. Also, sleep patterns change with aging and those changes seem to be negative for sleep in the elderly. Repeated studies are needed to establish more concrete information regarding sleep patterns. In addition, further research is needed to develop more reliable, valid, and feasible sleep measure tools, and to develop and evaluate nursing interventions.

• Perspectives in Nursing Science
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• v.2 no.1
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• pp.37-47
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• 2005

Biobehavioral nursing research is focused on generating knowledge that examines relations among biological, behavioral, and social dimensions of health to improve outcomes. In this paper we review the findings of a biobehavioral nursing study of individuals with fibromyalgia (FM) that was framed from the perspective of an individual human response model, the FM literature, and our previous studies in midlife women. We were particularly interested in the studying the role of 'arousal' secondary to pain or to dysregulated hypothalamic-pituitary-adrenal (HPA) axis hormones during sleep and the impact on symptom expression. Unexpectedly, we did not find evidence of, arousal' or abnormal amounts of HPA axis hormones but we did find reduced amounts of growth hormone (GH) and prolactin (PRL) and of sleep spindle activity, a biomarker of sleep maintenance. We discuss these new findings and how our thinking was re-shaped to better understand the role that disturbed sleep plays in symptom expression in FM. It is argued that disturbed sleep maintenance mechanisms coupled with dysregulated somatotrophic-growth hormone axis and sleep-related PRL render individuals vulnerable to the development of or exacerbations of FM symptoms.

• The Korea Journal of Herbology
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• v.35 no.6
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• pp.29-34
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• 2020

Objectives : Gyejigamchoyonggolmoryeo-tang (GT, Guizhigancaolonggumulitang in Chinese) is a herbal medicine to be prescribed for insomnia caused by anxiety induced by Heart-Heat and elevated Liver-Yang. In the present study, the onset time (sleep latency) and the duration time of sleep were measured to find out the sleep inducing effects of GT. The expression of c-fos immunohistochemistry was also measured at the ventrolateral preoptic area (VLPO) and tuberomammillary nucleus (TMN) site in brain. Methods : The onset time (sleep latency) and the duration time of sleep were measured 30 minutes after thiopental sodium injection. Thereafter, brain tissue was obtained and c-fos immunohistochemistry was performed on the VLPO and TMN sites. Results : GT statistically significantly reduced the sleep latency required to enter sleep, and significantly increased sleep duration time. GT significantly increased the number of c-fos immunohistochemical staining-positive cells in the sleep-inducing center (VLPO), whereas GT significantly decreased the number of c-fos immunohistochemical staining-positive cells in the arousal center (TMN). Conclusions : It could be concluded that the GT shortened the sleep latency and increased the duration time for sleep induced by thiopental sodium. And it was confirmed that the mechanism was to stimulate the sleep-inducing center (VLPO) and suppress the arousal center (TMN) in the brain. The results of this study are considered to be useful as scientific evidence that can be used clinically for the treatment of insomnia caused by anxiety.