• Journal of Oriental Neuropsychiatry
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• v.31 no.4
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• pp.329-336
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• 2020

Objectives: This case report intended to examine how herbal medicine treatment for breathingrelated sleep disorders applied with polysomnography affected the structure of sleep. Methods: From January to November 2019, we retrospectively reviewed the progress records and polysomnography reports of patients who visited Korean medical hospitals in Daejeon and Cheonan. Results: In case 1, the patient complained of daytime sleepiness and snoring and was diagnosed with obstructive sleep apnea disorder and treated with Ukgan-san-gami. There were significant changes in the polysomnographic parameters, such as sleep efficiency, waking after sleep onset, sleep latency, the total arousal index, and the apnea-hypopnea index after herbal treatment. In case 2, the patient complained of frequent waking after sleep onset, daytime sleepiness, and snoring, and was diagnosed with obstructive sleep apnea disorder and treated with Yeoldahanso-tang-gami. There were significant changes in the polysomnographic parameters, such as the total arousal index and the apnea-hypopnea index after herbal treatment. In case 3, the patient complained of daytime sleepiness and was diagnosed with obstructive sleep apnea disorder and treated with Bangpungtongsung-san. There was no significant change in the polysomnographic parameters after herbal treatment. Conclusions: It is meaningful to note that objectively identifying the outcome of treatment for breathing-related sleep disorders is necessary in the clinical practice of Korean medicine.

• Sleep Medicine and Psychophysiology
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• v.10 no.1
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• pp.12-19
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• 2003

Sleepiness, or hypersomnia, is a relatively common complaint and one of the main problems of modern society. Accurate evaluation and diagnosis of sleepiness are important. The methods used for evaluating sleepiness are subjective measures or self-evaluations, performance decrease measures, sleep propensity measures, and arousal decrease measures. A clear and detailed history is important in differential diagnosis of sleepiness because symptoms of sleepiness may be expressed in terms of 'tiredness' or 'fatigue' that do not directly denote sleepiness. Comprehensive diagnostic evaluation is also invaluable because these symptoms may result from a variety of causes ranging from medical disorders to insufficient nocturnal sleep.

• Korean Journal of Cognitive Science
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• v.18 no.1
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• pp.57-68
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• 2007

This study explores children's categories of emotion understanding from facial expressions onto two dimensional structure of emotion. Children of 89 from 3 to 5 years old were required to those facial expressions related the fourteen emotion terms. Facial expressions applied for experiment are used the photographs rated the degree of expression in each of the two dimensions (pleasure-displeasure dimension and arousal-sleep dimension) on a nine-point scale from 54 university students. The experimental results showed that children indicated the greater stability in arousal dimension than stability in pleasure-displeasure dimension. Emotions about sadness, sleepiness, anger and surprise onto two dimensions was understand very well, but emotions about fear, boredom were showed instability in pleasure-displeasure dimension. Specifically, 3 years old children indicated highly the perception in a degree of arousal-sleep than perception of pleasure-displeasure.

• Journal of Physiology & Pathology in Korean Medicine
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• v.35 no.1
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• pp.8-14
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• 2021

Shihogayonggolmoryo-tang (ST) is a Korean medical herb cocktail which has been used to treat anxiety induced insomnia. In this study, we will examine sleep-promoting and anti-anxiety effects of ST, and investigate its mechanism. ICR mice were divided into three groups for the first examination : control group (n=11), ST50 group (50 mg/kg, po, n=11), ST200 group (200 mg/kg, po, n=11). Sleep-promoting effect was confirmed by measuring the sleeping duration time and sleeping onset time after thiopental sodium treatment (50 mg/kg, ip). ICR mice were divided into five groups for the second examination : control group (n=11), ST200 group (200 mg/kg, po, n=11), ST200+Flumazenil group (ST 200 mg/kg, po, flumazenil 0.3 mg/kg, ip, n=11), diazepam group (1 mg/kg, ip, n=11), diazepam+flumazenil group (diazepam 1 mg/kg, ip, Flumazenil 0.3 mg/kg, ip, n=11). Anxiety behavior and sleep-promoting effect was confirmed by open field test and measuring the sleeping duration time and sleeping onset time. Expression levels of c-fos in tuberomammillary nucleus (TMN) and ventrolateral preoptic nucleus (VLPO) were analyzed by immunohistochemistry. ST treated group showed significantly decreased anxiety behavior and enhanced sleeping duration time and sleeping onset time concentration dependently. The expression of c-fos was significantly upregulated in VLPO as sleep-inducing center and TMN as downregulated in arousal center by ST treatment. In addition, all effects of ST were reversed by flumazenil. Our results suggest that ST has sleep-promoting and anti-anxiety effects through regulating arousal center (TMN) and sleep-inducing center (VLPO).

• Safety and Health at Work
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• v.13 no.2
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• pp.148-154
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• 2022

Background: Bus driving is a mentally demanding activity that requires prolonged attention to ensure safety. The aim of the study was to assess mental fatigue caused by driving a public bus and to find a profile of workers at higher risk. Methods: We evaluated changes of critical flicker fusion (CFF) (index of central arousal) and heart rate variability (HRV) (index of autonomic balance) in a 6-hour driving shift on a real route, in 31 professional bus drivers, and we tested the influence of personal factors such as sleep quality, BMI, and age. Paired t-test was used to test differences of CFF and HRV between both initial and final phase of driving, while multiple linear regression tested the influence of personal variables on the indexes of mental fatigue. Results: Results showed that CFF significantly decreased after 6 hours of bus driving (41.91 Hz, sd 3.31 vs. 41.15 Hz, sd 3.15; p = 0.041), and heart rate significantly decreased in the final phase of driving, with respect to the initial phase (85 vs. 78 bpm, p = 0.027). Increasing age (beta = -0.729, p = 0.022), risk of obstructive sleep apnea syndrome (beta = -0.530, p = 0.04), and diurnal sleepiness (beta = -0.406, p = 0.017) showed a significant effect on influencing mental fatigue. Conclusion: Elderly drivers at higher risk of sleep disorders are more prone to mental fatigue, when exposed to driving activity. Monitoring indexes of central arousal and autonomic balance, coupled with the use of structured questionnaires can represent a useful strategy to detect profile of workers at higher risk of mental fatigue in such duty.

• Sleep Medicine and Psychophysiology
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• v.7 no.1
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• pp.5-9
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• 2000

Several nonpharmacological treatment methods of insomnia and their effects were reviewed. A long-term use of most hypnotics may produce tolerance, dependence, cognitive and psychomotor impairments at daytime, shallow sleep, and rebound insomnia on drug withdrawal. To reduce hypnotic abuse, nonpharmacological strategies have been developed to correct disordered behavioral and cognitive factors. These treatments aim at modifying maladaptive sleep habits, lowering physiological and cognitive arousal levels, and correcting dysfuctional beliefs and attitudes about sleep. These non-pharmacological or cognitive behavior treatments include stimulus control, sleep restriction, relaxation training, sleep hygiene education, cognitive therapy, and light therapy. Among them the stimulus control therapy has been demonstrated most effective as a single treatment or in combination with other treatments. Through nonpharmacological treatments, sleep latency was most significantly reduced and wake time after sleep onset was also reduced. About 50% of insomniacs reported clinical improvements in terms of nearly normalized sleep latency, awakening time, sleep efficiency, and reduction of hypnotic use. Compared to the hypnotic therapy, nonpharmacological treatments are more cost-effective and more readily accepted by patients, and their effects last longer.

• Journal of Sleep Medicine
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• v.15 no.2
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• pp.55-61
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• 2018

Objectives: Despite the accumulating evidence of the effectiveness of positive airway pressure (PAP) therapy in obstructive sleep apnea (OSA) syndrome, adherence to PAP therapy is not high. Several factors reportedly affect PAP adherence; however, it remains unclear whether patients' symptoms were detrimental to adherence rate. This study is aimed at investigating the relationship between insomnia symptoms and adherence. Methods: Retrospective analyses were performed in 359 patients with OSA (mean age $58.4{\pm}13.2$ years; females, n=80). Logistic regression analyses were performed between PAP adherence with clinical factors and questionnaires, such as Epworth Sleepiness Scale, Insomnia Severity Index, and Beck Depression Inventory (BDI). Results: PAP adherence was defined as the use of PAP for ${\geq}4h$ per night on 70% of nights during 30 consecutive days. The median follow-up time was 55 days (interquartile range, 30-119 days), and 54.3% showed poor adherence. Non-adherent patients showed more severe sleep onset insomnia, higher BDI, and higher nadir oxygen saturation ($SaO_2$). Patients with good adherence had higher apnea-hypopnea index, oxygen desaturation index, and respiratory arousal to total arousal ratio. Sleep onset insomnia [odds ratio (OR)=1.792, p=0.012], BDI (OR = 1.055, p=0.026), and nadir $SaO_2$ (OR=1.043, p=0.040) were independently associated with PAP non-adherence. Conclusions: Not the severity of insomnia but sleep onset insomnia was associated with PAP adherence, as well as depressive mood. It suggests that different interventions for reducing insomnia and depressive mood are needed to increase PAP adherence in patients with OSA.

• Sleep Medicine and Psychophysiology
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• v.27 no.2
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• pp.41-50
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• 2020

Napping is a natural and universal phenomenon. There are some differences depending on the age, but they are common throughout life. As research on naps in sleep medicine has recently increased, negative perceptions about naps are gradually decreasing with development of new and positive perspectives. First, naps relieve fatigue and sleepiness and increase arousal, improving cognitive abilities. Even in the process of memory consolidation, which allows retention of learned memory content, a period of short daytime sleep shows the same results as nocturnal sleep. In addition, evidence of the contribution of sleep to emotional regulation is increasing. The role of the nap has been extended recently to areas associated with immunity and pain. However, naps can disturb sleep at night. There are also concerns that habitual naps in old age are linked to cardiovascular risk and increased mortality. Various aspects and values of naps are being gradually unveiled. However, compared to that of night sleep, research on naps is insufficient, and more research on naps is required.

• Sleep Medicine and Psychophysiology
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• v.4 no.1
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• pp.49-56
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• 1997

Nocturnal panic involves sudden awakening from sleep in a state of panic characterized by various somatic sensation of sympathetic arousal and intense fear. Many(18-71%) of the spontaneous panic attacks tend to occur from a sleeping state unrelated to the situational and cognitive context. Nocturnal panickers experienced daytime panics and general somatic sensation more frequently than other panickers. Despite frequent distressing symptoms, these patients tend to exhibit little social or occupational impairment and minimal agoraphobia and have a high lifetime incidence of major depression and a good response to tricyclic antidepressants. Sleep panic attacks arise from non-REM sleep, late stage 2 or early stage 3. The pathophysiology and the similarity of nocturnal panic to sleep apnea, dream-induced anxiety attacks, night terrors, sleep paralysis, and temporal lobe epilepsy are discussed.

• Sleep Medicine and Psychophysiology
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• v.15 no.1
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• pp.17-24
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• 2008

Periodic leg movements during sleep (PLMS) are best described as repetitive stereotypical movements of the lower extremities characterized by dorsiflexion of the ankle, dorsiflexion of the toes and a partial flexion of the knee and sometimes the hip. The prevalence of PLMS is about 5-11% in adults and is predicted much higher than previously surveyed. They are also frequently found in various sleep disorders, several disorders not primarily affecting sleep, and patients taking psychiatric medications. Although they are rarely found in children, they are common findings in children referred to a pediatric sleep laboratory. The pathophysiology is strongly associated with decline of central dopaminergic function and closely related to arousal system during sleep. Benzodiazepines, levodopa, dopamine agonists and opioids are generally recommended for treatment but more controlled studies on the effectiveness are needed.