Sleep Quality

A measure used to assess sleep quality, usually determined by means of polysomnography. A parameter such as wake after sleep onset (WASO) is often used to describe sleep continuity. 

Determinations of the quality of sleep can either be made based on patient report (i.e. perceived sleep quality), using standardised questionnaires, or by more... 

Oberndorfer, S., Saletu-Zyhlarz, G. Saletu, B. (2000). Effects of selective serotonin reuptake inhibitors on objective and subjective sleep quality. Neuropsychobiology 42, 69 81. 

Wurtman, R. J. Zhdanova, I. (1995). Improvement of sleep quality by melatonin. Lancet 346, 1491. 

Copinschi, G., Leproult, R., Van, O. A. et al. (1997). Prolonged oral treatment with MK-677, a novel growth hormone secretagogue, improves sleep quality in man. Neuroendocrinology 66, 278-86. 

Disturbances of sleep are typical of mood disorders, and belong to the core symptoms of major depression. More than 90% of depressed patients complain of impaired sleep quality [60], Typically, patients suffer from difficulties in falling asleep, frequent nocturnal awakenings, and early morning awakening. Not only is insomnia a typical symptom of depression but, studies suggest, conversely, insomnia may be an independent risk factor for depression. In bipolar disorders sleep loss may also be a risk factor for the development of mania. Hypersomnia is less typical for depression [61] and, in contrast to insomnia, may be related to certain subtypes of depression, such as seasonal affective disorder (SAD). 

Patients with short-term or chronic insomnia should be evaluated after 1 week of therapy to assess for drug effectiveness, adverse events, and compliance with nonpharmacologic recommendations. Patients should be instructed to maintain a sleep diary, including a daily recording of awakenings, medications taken, naps, and an index of sleep quality. 

The Medical Outcomes Study 36-Item Short Form Health Survey and the Rhinoconjunctivitis Quality of Life Questionnaire measure not only improvement in symptoms but also parameters such as sleep quality, nonallergic symptoms (e.g., fatigue, poor concentration), emotions, and participation in a variety of activities. 

The effects of valerian in poor sleepers was studied comparing it to placebo controls (Schulz et al. 1994). Valerian showed an increase in slow-wave and a decrease in stage 1 sleep. K-complex density was increased, but REM was unaltered, and no effects were reported on subjective sleep quality. 

Leathwood PD, Chauffard F, Heck E, Munoz-Box R. (1982). Aqueous extract of valerian root (Valeriana officinalis L.) improves sleep quality in man. Pharmacol Biochem Behav. 17(1) 65-71. Lebot V, Merlin M, Lindstrom L. (1997). Kava—the Pacific Elixir The Definitive Guide to Its Ethnobotany, History, and Chemistry. Rochester, VT Healing Arts Press. [Originally published New Haven Yale University Press, 1992.]... 

Sometimes, a medical illness prodnces insomnia in a more immediate fashion. Pain, shormess of breath, congh, and the nrge to nrinate or defecate are just a few of the medical symptoms that can interfere with sleep. Fibromyalgia and several neurological conditions can directly interfere with sleep quality (see Table 9.3). 

Valerian root, an over-the-counter herbal supplement, has also been used for insomnia. Thought to act, like the benzodiazepines, by increasing the activity of the neurotransmitter GABA, preliminary studies indicate that 400 mg of valerian root decreases sleep latency and enhances sleep quality. 

Eszopiclone has been approved for the treatment of patients who experience difficulty falling asleep, poor sleep maintenance, and for long-term treatment of insomnia. Clinical trials have shown that eszopiclone improved sleep onset, sleep maintenance, total sleep time, sleep quality, and daytime functioning compared with placebo. Improved wake time alertness, concentration, and sense of well-being were reported. Eszopiclone was well tolerated, with only mild adverse events reported. There was no evidence of dmg-drug interactions, tolerance, residual drowsiness or treatment-related rebound insomnia. The recommended dose to improve sleep onset and maintenance is generally between 1 and 3 mg. 

Indiplon is rapidly absorbed (1-2 h) and eliminated (ti/2 =1.3 h). In-vitro studies on indiplon show two major metabolites A-demethylation due to CYP3A4/5 and Ai-deacetylation by carboxylesterases. Its short half-hfe has enabled the development of two dosing paradigms with different formulations (1) an immediate release formulation to improve sleep initiation and for dosing in the middle of the night, and (2) a modified release formulation, which provides for immediate release and sustained release of the drug to help with sleep initiation, duration, maintenance, and sleep quality (Neubauer,... 

Mechanism of Action A nonbenzodiazepine that enhances the action oftheinhibitory neurotransmitter gamma-aminobutyric acid. Therapeutic Effect Induces sleep and improves sleep quality. 

As with studies of many other herbs and nutritional supplements, interpretation of clinical trials of valerian is hampered by small sample sizes, suboptimal study design, lack of specified inclusion and exclusion criteria, and unknown composition of valerian extract (Plushner, 2000). Furthermore, none of the trials have included children or teenagers. Nevertheless, several studies have showed a mild hypnotic action in persons with insomnia and in normal sleepers, as well as a mild sedative effect (Leathwood and Chauffard, 1983, 1985 Balderer and Borbely, 1985). One report has described an anxiolytic effect (Kohnen and Oswald, 1988). There are suggestions that valerian may have beneficial effects on sleep latency, frequency of waking, nighttime motor activity, and overall sleep quality. 

Garfinkel et al. (168) conducted an investigation of melatonin s effects on sleep quality in 12 elderly subjects with insomnia [seven men, five women mean age, 76 years (range, 68 to 93 years standard deviation (SD), 8 years)]. These authors used a randomized, double-blind, crossover design with 2 mg controlled-release melatonin or a placebo taken 2 hours before desired bedtime every night for 3 weeks. After a 1-week washout, the subjects then received 3 weeks treatment with the other preparation. Compared with placebo, the controlled-release melatonin improved the sleep quality of these elderly subjects and was well tolerated. Further, 2 months treatment with 2 mg of controlled-release melatonin in these relatively healthy elderly subjects was much more effective than 1 week of treatment ( 168). 

Garfinkel D, Laudon M, Nof D, et al. Improvement of sleep quality in elderly people by controlled-release melatonin. Lancet 1995 346 541-554. 

Clinical studies in patients with sleep disorders have shown that oral melatonin supplementation may alter sleep architecture. Subjective improvements in sleep quality and improvements in sleep onset and sleep duration have been reported. However, the significance of these findings is impaired by many study limitations. 

Kava (Piper methysticum) The roots of kava contain molecules called dihydropyrones that help promote muscle relaxation and increased sleep quality. Kava is often incorporated into drinks such as teas or can be taken in capsule form. However, it should be noted that combining kava with alcohol may cause sedation that can cloud thinking and impair the ability to drive a car. 

Valerian is used in the short-term treatment of insomnia characterized by difficulty in falling asleep and poor sleep quality. Valeriana officinalis L. inhibits reuptake of and stimulates the release of y-aminobutyric acid (GABA), contributing to its sedative properties. 

Valerian root (Valerian officinalis) has also been a popular sleep aid. It is believed to work by stimulating the release of the neurotransmitter GABA. Several trials have shown a 400 mg dose to significantly reduce sleep latency (the time it takes to fall asleep) and improve subjective sleep quality. Some commercial preparations of valerian root also contain hops (Flores humuli) as a synergistic ingredient. 

As outlined earlier, many of the anti-Parkinson s medications concurrently produce insomnia or sleep disturbance while relieving other symptoms of the disease—e.g., L-dopa, combination L-dopa/carbidopa, MAO-B inhibitors, anticholinergic agents, and COMT inhibitors. Since much of the sleep disturbance may be attributed to the anti-Parkinsonian medications, adjustment of dosing regimens may provide some improvements in sleep. A balance between the alleviation of daytime symptoms and increased sleep quality is ultimately desirable, but not always achievable. 

For chronic disorders, the use of soporific or hypnotic compounds is not recommended for the treatment of comorbid sleep disturbance, just as these compounds are not recommended for the treatment of chronic insomnia. Alleviation of the pain associated with many disorders, including fibromyalgia and arthritis, results in a lessening of symptoms and improvement of sleep. Similar to how reduced sleep quality can amplify the symptoms of these disorders, and augment pain, which in turn produces reduced sleep quality and consolidation, improvement in sleep can improve the symptoms, which in turn helps maintain the increased sleep quality. 

Agargun MY, Tekeoglu I, Gunes A, Adak. B, Kara H, Ercan M. Sleep quality and pain threshold in patients with fibromyalgia. Comprehensi Psychiatry 1999 40 226-228. 

Myers BL, Badia P. Changes in circadian rhythms and sleep quality with aging mechanisms and interventions. Neurosci Biobehav Rev 1995 19 553-571. 

Moeller AA, Oechsner M, Backmund HC, Popescu M, Emminger C, Holsboer F. Self-reported sleep quality in HIV infection correlation to the stage of infection and zidovudine therapy. J AIDS 1991 4 1000-1003. 

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