Topic: Sleep disorder Msg #603710 Section: Tech & Theoretical [11] Forum: Diabetes Date: Sat, Jun 1, 1996, 2:11:09 PM I sleep very badly and have had an eye on sleep disorders. Whilst I originally was simply going to extract the note on hemodialysis I thought much of the release interesting. This week, researchers are presenting more than 575 scientific papers on sleep and sleep-related disorders here at a joint meeting of the American Sleep Disorders Association and the Sleep Research Society. Among yesterday's highlights: HIV-Infected Men Experience Sleep Disturbances... In a study of 11 HIV-infected male patients, Dr. Suzan E. Jaffe of Mount Sinai Medical Center in Miami Beach diagnosed sleep disorders in 10. On evaluation, Dr. Jaffe found that early HIV infection was associated with an increase in the occurrence of total slow-wave sleep and an augmentation of the non-rapid eye movement/rapid eye movement sleep cycle. With progressive deterioration of immune function, Dr. Jaffe observed a progressive decline in the amount of slow-wave sleep during the night. Patients' major subjective sleep complaints - especially difficulty staying asleep and subsequent daytime fatigue - were frequent and pronounced during the terminal stages of HIV disease. Dr. Jaffe said that "...the degree of sleep disruption appears to escalate as immune function deteriorates, as evidenced by decreasing CD4 counts and the development of opportunistic infections." Even in the asymptomatic phase of HIV infection, Dr. Jaffe saw subtle changes in the patients' sleep patterns. Midday Hemodialysis Reduces Daytime Sleepiness... To study whether the timing of hemodialysis could lessen complaints of daytime sleepiness in chronic hemodialysis patients, Dr. Kathy P. Parker of Emory University divided 92 dialysis patients into three groups: shift one (6:00 a.m.-10:00 a.m.); shift two (10:00 a.m.-2:00 p.m.) and shift three (2:00 p.m.-6:00 p.m.). She found that there was a lower rate of daytime sleepiness among the patients in shift two. Dr. Parker said that, in the past, it has been assumed that dialysis patients sleep during the day in response to psychological stress or boredom while undergoing the procedure. But Dr. Parker suspects that dialysis may alter the core body temperature and trigger the production of sleep-enhancing substances such as interleukin-1. "Dialysis may induce its maximal effect on daytime sleepiness near the trough or peak of the body temperature cycle." She is continuing to study the effects of dialysis on sleep using continuous core body temperature measurements. Study Shows Need To Combat Daytime Sleepiness In Medical Personnel... In a study of 15 anesthesiology residents, Dr. Steven K. Howard of Stanford University and his colleagues determined that extending sleep by two hours per day for four successive days was an effective strategy in increasing daytime alertness. Before intervention, Dr. Howard described residents as "...at almost pathological levels of sleepiness throughout the day, both in the baseline and post-call conditions." After allowing the residents to sleep two extra hours a day for four successive days, Dr. Howard said they were more alert and had shorter sleep latency periods. The Stanford investigator believes this is the first demonstration of the effectiveness of the sleep-extension strategy in a non-laboratory work setting. Dr. Howard noted that medical personnel in general, and anesthesiologists in particular ,are required to respond to complicated and changing patient needs in an alert fashion. "If not treated in a timely manner, problems can cascade to patient morbidity and even death," he warned. Researchers Identify New Disorder Of Sexual Behavior In Sleep... Dr. Colin M. Shapiro of the Toronto Hospital described a new sleep disorder that involves engaging in sexual behavior while asleep. Dr. Shapiro, who studied six male patients and one female patient, said that, to his knowledge, this is the first time cases of interactive sexual activity while sleeping have been reported scientifically. He noted that patients with this disorder are at risk of being accused of sexual assault. He has received referrals on several patients for medicolegal reasons, and three were accused of sexual assaults on young children. Dr. Shapiro told conference participants that the patients shared a number of common factors, including a history of alcohol abuse or polysubstance abuse, sleep deprivation and psychological stress. The age of onset appeared to be early adulthood. While the cause of this newly identified sleep disorder is unknown, Dr. Shapiro said its manifestation may "...reveal underlying wishes in a state lacking full consciousness." Clinical management includes avoidance of trigger factors, psychotherapy, treatment with benzodiazepines and treatment of specific problems such as sleep apnea. -Bruce Beale, Heathrow, London, UK.