Sleep schedules

Interpersonal, family, or group therapy with a licensed psychiatric nurse practitioner/clinical nurse specialist, psychologist, social worker, or counselor assists individuals with bipolar disorder to establish and maintain a daily routine and sleep schedule and to improve interpersonal relationships.3,20 These therapies may help treat and protect against manic episodes. 

The sleep disorders fall into four main categories (1) insomnia, (2) hypersomnia, (3) parasomnias, and (4) sleep schedule disorders. Insomnia is the most common sleep problem. It is simply defined as poor sleep and can be manifested by difficulty falling asleep, difficulty staying asleep, waking up too early, or waking up in the morning without feeling refreshed. 

Hartley LR. A comparison of continuous and distributed sleep schedules. Q J Exp Psychol 1974 26 8-14. 

Balkin T, Thome D, Sing H, Thomas M, Redmond D, Wesensten N, Williams J, Hall S, Belenky G. Effects of Sleep Schedules on Commercial Motor Vehicle Driver Performance. FMCSA Report No. DOT-MC-00-133, May, 2000. 

Similarly, persistent sleep problems have also been associated with learning difficulties throughout the elementary-high-school years (116). Studies of excessive sleepiness in children and adolescents due to DSPS, narcolepsy, or sleep apnea have also reported negative effects on learning, school performance, and behavior (117-119). Students who get more sleep and maintain more consistent school/weekend sleep schedules may obtain better grades because of their ability to remain alert and to pay greater attention in class and on homework. 

As we have shown earlier, survey studies and studies of clinical samples have provided a large body of evidence relating inadequate or disturbed sleep to various measures of functioning. Very few studies, however, have employed experimental designs to study consequences of inadequate or restricted sleep. Parents are often reluctant for their children to lose sleep or to stay overnight in a laboratory. In addition, preparing laboratory and staff for the needs of children adds another layer of complexity to laboratory studies. The few experimental studies have provided mixed results and much more research is required. New evidence that school-age children can comply with imposed sleep schedules at home for days and weeks may facilitate additional studies (137). 

Fallone G, Seifer R, Acebo C, Carskadon MA. How well do school-aged children comply with imposed sleep schedules at home Sleep 2002 25 739-745. 

Wolfson AR, Carskadon MA. Sleep schedules and daytime functioning in adolescents. Child Dev 1998 69 875-887. 

P. Philip JT, D. Leger, K. Diefenbach, T. Akerstedt, B. Bioulac, C. Guilleminault. Work and rest sleep schedules of 227 European truck drivers. Sleep Med 2003 In press. 

One other area of recent debate in workers compensation cases involves shift-work-maladaption syndrome. These cases usually involve workers who are unable to adapt to working a third shift. Workers asserting these claims usually complain of being unable to adapt their personal sleeping schedules to the late shift, and suffer from continued sleep deprivation. American courts have rejected shift-work-maladaption syndrome as a compensable injury under the workers compensation definitions of injury, and generally hold that harm occasioned by the mere scheduling of hours is not enough to state a claim (53). A worker must show that a specific injury has been caused by a specific workplace condition or job function. 

Signal and Gander (43) concluded that stage 1 sleep significantly contributed to nap benefits. In a review of polyphasic sleep schedules, Stampi (54) proposed that every time the organism falls asleep some process related to the recuperation might be activated, which may be independent from sleep episode duration, and therefore, that overall beneficial effects are related to the number of times the sleep system is activated (within reasonable limits) (p. 172)... 

Taken together, these findings suggest that multiple naps may be effective in offsetting performance impairments during prolonged periods of wakefulness. Furthermore, while monophasic sleep may be superior to polyphasic sleep under conditions of prolonged wakefulness (69), polyphasic sleep schedules may be more effective under conditions of extreme sleep deprivation (54). For a comprehensive review of polyphasic sleep schedules, refer to Ref. 54. 

Stampi C, Mullington J, Rivers M, Campos JP, Broughton R. Ultrashort sleep schedules sleep architecture and recuperative value of 80-, 50- and 20-min naps. In Horne J, ed. Sleep 90. Bochum Pontenagel Press, 1990 71-74. 

Stampi C. The effects of polyphasic and ultrashort sleep schedules. In Stampi C, ed. W W N Evolution, Chronobiology, and Functions of Polyphasic and Ultrashort Sleep. Boston Birkhauser, 1992 137-179. 

Seidel WF, Roth T, Roehrs T, Zorick F, Dement WC. Treatment of a 12-hour shift of sleep schedule with benzodiazepines. Science 1984 224 1262-1264. 

Walsh JK, Tepas DI, Moss PD. The EEG sleep of night and rotating shiftworkers. In Johnson LC, Tepas DI, Colquhoun WP, Colligan MJ, eds. The 24-Hour Workday A Symposium on Variations in Work-Sleep Schedules. Cincinnati, National Institute for Occupational Safety and Health, 1981 451 —466. 

Federal Motor Carrier Safety Administration. Effects of Sleep Schedules on Commercial Motor Vehicle Driver Performance. Report No. DOT-MC-00-133. 2000. 

---