Sleeping routines

Children with other chronic medical conditions, such as asthma [37] or atopy [38] and cystic fibrosis, can be prone to sleep disruption either from medication used to treat the underlying condition, or as a result of poor symptom control. In addition, other factors such as the psychological response to illness, family dynamics, hospitalization-related disruption of normal sleep routines, and related secondary symptoms, such as pain, can significantly impact sleep in these children. Medical conditions which may place children particularly at risk for sleep problems also include severe burns, sickle cell anemia, rheumatological disorders, and chronic headaches. 

A routine EEG can be helpful if epileptiform discharges are seen. However, the EEG may be normal between seizures, and most routine EEGs are not performed during a seizure. Maneuvers such as sleep deprivation, photic stimulation, hyperventilation, or prolonged monitoring can help reveal EEG changes consistent with epilepsy. 

Trazodone routinely causes sedation, which is why it is used far more often as an adjunct with other antidepressants for sleep than as a primary agent for the treatment of depression. Priapism is a rare but serious adverse effect in males who take trazodone. In addition, orthostatic hypotension and dizziness are more common with trazodone than with nefazodone because the latter agent has a weaker effect at a-adrenergic receptors and also has a balancing of adrenergic effects owing... 

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. 

Routinely assess acromegaly complications, including blood pressure, glucose tolerance, fasting lipid profile, cardiac evaluations (if clinically indicated), colonoscopy, dual-energy x-ray absorptiometry (DEXA) scan (hypogonadal only), evaluation of residual pituitary function, and evaluation of sleep apnea. 

To reduce nocturia, patients should be instructed to stop drinking fluids several hours before going to bed, and then voiding before going to sleep. During the day, patients should avoid excessive caffeine intake, as this may cause urinary frequency. In addition, toilet mapping (knowing the location of toilets on the way to and from various destinations) may help reassure the patient that he can still continue with many of his routine daily activities. 

These disorders should concern all physicians and mental health professionals for several reasons. First, mood disorders are very common and will be encountered on a daily basis in most clinical settings (see Table 3.1). Second, they disrupt life in numerous ways. During an episode of depression or mania, sleep patterns change, appetite and eating are affected, family life is disrupted, work efficiency suffers, substance abuse rates soar, and physical illness is exacerbated. Thus, comprehensive treatment of mood disorders routinely requires the work of nutritionists, social workers, family therapists, vocational rehabilitation counselors, substance abuse counselors and 12 step groups, primary care physicians, and others. 

Sleep is another concern during maintenance therapy. As we noted in the discussion of acute phase treatment, sleep deprivation can destabilize mood and is often the first sign of an impending episode of illness. Therefore, it remains imperative that the patient sleeps well. It is common practice for patients to keep a small supply of a hypnotic agent such as zolpidem or a benzodiazepine to use as needed in the event of sleep disturbance. Furthermore, patients should routinely be advised to notify their physician should they have two or more consecutive nights of poor sleep so that more aggressive measures can be taken to circumvent the possible development of an illness episode. 

Trazodone has been used therapeutically, but because of low potency and marked sedative effects, its use has been mostly restricted to a sleeping aid in doses of 50-100 mg at bedtime. It has been routinely used in adults on SSRIs, who develop sleep problems. The concern about priapism even at low doses may reduce enthusiasm for its use in male children and adolescents. 

The visualization method of spreading colored dust might seem difficult at first, but I routinely practice visualization methods as I go to sleep, such as rotating objects like horses in my mind or sinking in a black pool of liquid while looking up at the water surface until it becomes a bright white slit miles above me. 

Sedatives and hypnotics as a group, and BZDs in particular, are frequently implicated in drug-related hospital admissions in the elderly ( 333, 334). This group is at particular risk for abrupt drug discontinuation when hospitalized, with resulting withdrawal symptoms that may be unrecognized as such and attributed to other health problems (313, 335, 336 and 337). BZD hypnotics should not be routinely prescribed in the hospital unless the patient has a demonstrated sleep disorder ( 338). Even then, reassurance that restless sleep is normal in such a situation may obviate the need for a hypnotic ( 330). 

Bedtime Routine and Sleep Hygiene. Sleep-Deprivation.com. Available online at http //www.sleep-deprivation.com/html/sleep-basics.php3. 

Fortunately, even if you have neglected your health, you can start now to plan a lifestyle that takes you into a healthier retirement. How well you ve taken care of yourself determines how much change may be required in your daily routine. This includes such things as proper eating habits, exercise, sleep, smoking, drinking, and the amount of stress you experience. Complete the following exercise to evaluate your current health practices. 

Exercise. Unless you have a daily workout routine, you may not be meeting your body s need for exercise. Our bodies appreciate a good aerobic workout every day. Exercise helps you sleep more soundly and feel more relaxed throughout the day. Vigorous exercise is a great way to combat anxiety because it releases endorphins—the body s natural feel-good chemical. 

The MSLT is routinely performed at 2-hr intervals, beginning 1.5-3 hr after awakening from nocturnal sleep, and consists of 4-6 naps. Subjects should be in bed 5 min before the scheduled start of the test, to allow for calibrations of the... 

Carskadon MA, Dement WC. Multiple sleep latency tests during the constant routine. Sleepl992 15(5) 396-399. 

The results from the studies described above indicate that the MSLT provides a robust measure of sleepiness that is sensitive to sleep restriction in children and adolescents (112). Patterns of sleep latency from repeated naps during constant routine protocols or forced desynchrony protocols in older children and adolescents also illustrate the influences of both homeostatic and circadian processes on sleepiness/alertness and provide evidence for the hypothesis that... 

Many patients also have a high risk for traffic accidents and do not necessarily address this problem with their physicians. When exploring sleepy patients, the routine investigation should include questions about sleepiness at the wheel, the need to stop driving because of sleepiness, and whether the patient has been a victim of a sleep-related accident. 

In summary, resident physicians, particularly those at more junior levels of training and those in the surgical specialties, routinely experience significant levels of sleep deprivation in the work setting, and are frequently required to function at work under conditions that are likely to lead to compromised levels of... 

MSLT data for young adults have also identified the period near 15 30 as a time of increased sleepiness (64). Furthermore, the endogenous circadian rhythm of sleep propensity as derived from a laboratory-controlled, constant-routine procedure confirmed the timing of the afternoon sleepy period to be 13 40 in a midtwenties, full-time-employed sample (56) and about 15 30 in a young-adult student sample (65). 

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