Sleep Arousal Disorders
Parasomnias
Clitoris
Arousal
Sexual Dysfunctions, Psychological
Sleep
Sleep, REM
Sleep Disorders
Sleep arousal after lower abdominal surgery and relation to recovery from respiratory obstruction. (1/16)
BACKGROUND: Hypoxemic episodes occur during sleep after abdominal surgery, possibly caused by airway obstruction. The authors found arousals from sleep more often than respiratory disturbances, so they related changes in sleep state (short arousals from sleep and longer periods of wakening) to the sudden increase in respiratory flow that indicates relief from complete or partial respiratory obstruction. METHODS: Sleep state and nasal flow were studied in 16 patients receiving patient-controlled morphine and oxygen by facemask on the night after routine gynecologic surgery. Traces were analyzed separately for sleep events and for sudden increases in respiratory flow. The authors noted sleep events (arousals from sleep and transition from sleep to wake) that occurred within 12 s of relief of obstruction. RESULTS: Sleep quality was poor, with only stage 2 sleep in most patients. Median sleep duration was 70% of the study period, with 15 arousals and 6 awakenings per hour of sleep. Only 30% of arousals and awakenings were associated with relief of obstruction. Relief of obstruction also occurred without arousal from sleep, with a median frequency of 38 (30-62) in each night. Relief of obstruction was more frequently associated with arousal from sleep after benzodiazepine premedication (33% vs. 28%; P = 0.012), but this allocation was not randomized. CONCLUSIONS: Arousals from sleep are frequent after abdominal surgery and mostly not related to respiratory disturbance. Relief of respiratory obstruction can occur during sleep without sleep arousal and during wakefulness. (+info)Sleep . 8: paediatric obstructive sleep apnoea. (2/16)
In the past 25 years there has been increasing recognition of obstructive sleep apnoea (OSA) as a common condition of childhood. Morbidity includes impairment of growth, cardiovascular complications, learning impairment, and behavioural problems. Diagnosis and treatment of this condition in children differs in many respects from that in adults. We review here the key features of paediatric OSA, highlighting differences from adult OSA, and suggest future directions for research. (+info)Sleep bruxism is associated to micro-arousals and an increase in cardiac sympathetic activity. (3/16)
Sleep bruxism (SB) subjects show a higher incidence of rhythmic masticatory muscle activity (RMMA) than control subjects. RMMA is associated with sleep micro-arousals. This study aims to: (i) assess RMMA/SB episodes in relation to sleep cycles; (ii) establish if RMMA/SB and micro-arousals occur in relation to the slow wave activity (SWA) dynamics; (iii) analyze the association between RMMA/SB and autonomic cardiac activity across sleep cycles. Two nights of polygraphic recordings were made in three study groups (20 subjects each): moderate to high SB, low SB and control. RMMA episodes were considered to occur in clusters when several groups of RMMA or non-specific oromotor episodes were separated by less than 100 s. Correlations between sleep, RMMA/SB index and heart rate variability variables were assessed for the first four sleep cycles of each study group. Statistical analyses were done with SYSTAT and SPSS. It was observed that 75.8% of all RMMA/SB episodes occurred in clusters. Micro-arousal and SB indexes were highest during sleep cycles 2 and 3 (P < 0.001). Within each cycle, micro-arousal and RMMA/SB indexes showed an increase before each REM sleep (PAdult obstructive sleep apnea: pathophysiology and diagnosis. (4/16)
Obstructive sleep apnea (OSA) is a highly prevalent disease characterized by recurrent episodes of upper airway obstruction that result in recurrent arousals and episodic oxyhemoglobin desaturations during sleep. Significant clinical consequences of the disorder cover a wide spectrum, including daytime hypersomnolence, neurocognitive dysfunction, cardiovascular disease, metabolic dysfunction, and cor pulmonale. The major risk factors for the disorder include obesity, male gender, and age. Current understanding of the pathophysiologic basis of the disorder suggests that a balance of anatomically imposed mechanical loads and compensatory neuromuscular responses are important in maintaining upper airway patency during sleep. OSA develops in the presence of both elevated mechanical loads on the upper airway and defects in compensatory neuromuscular responses. A sleep history and physical examination is important in identification of patients and appropriate referral for polysomnography. Understanding nuances in the spectrum of presenting complaints and polysomnography correlates are important for diagnostic and therapeutic approaches. Knowledge of common patterns of OSA may help to identify patients and guide therapy. (+info)Disorders of arousal from sleep and violent behavior: the role of physical contact and proximity. (5/16)
STUDY OBJECTIVES: To review medical and legal case reports to determine how many appear to support the belief that violence against other individuals that occurs during Disorders of Arousal - sleepwalking, confusional arousal, and sleep terrors - is triggered by direct physical contact or close proximity to that individual and does not occur randomly or spontaneously. DESIGN: Historical review of case reports in the medical and legal literature. MEASUREMENTS AND RESULTS: A total of 32 cases drawn from medical and legal literature were reviewed. Each case contained a record of violence associated with Disorders of Arousal; in each, details of the violent behavior were available. Violent behaviors associated with provocations and/or close proximity were found to be present in 100% of confusional arousal patients and 81% of sleep terror patients. Violent behaviors were associated with provocation or close proximity in 40%-90% of sleepwalking cases, depending on whether the legal verdict and other factors were taken into account. Often the provocation was quite minor and the response greatly exaggerated. The specific manner in which the violence was triggered differed among sleepwalking, confusional arousals, and sleep terrors. CONCLUSIONS: In the cases reviewed, violent behavior directed against other individuals associated with Disorders of Arousal most frequently appeared to follow direct provocation by, or close proximity to, another individual. Sleepwalkers most often did not seek out victims, but rather the victims sought out or encountered the sleepwalker. These conclusions are tempered by several limitations: the selection of cases was not random and may not represent an accurate sample of violent behaviors associated with Disorders of Arousal. Also, final verdicts by juries in reported legal cases should not be confused with scientific proof of the presence or absence of sleepwalking. The pathophysiology of Disorders of Arousal with and without violent behavior could be associated with normally occurring deactivation of the frontal lobes during slow wave sleep (SWS) connected via atypically active thalamocortical pathways to the limbic areas. It is not known if the violent sleepwalker, confusional arousal patient, or sleep terror patient differs from other patients with these disorders. The conclusions of this case series await confirmation by the results of future sleep laboratory based studies. (+info)Kids that go bump in the night. (6/16)
BACKGROUND: Incomplete arousal from deep sleep in children causes night time disruption and can present as confusional arousals, sleep walking or night terrors. These nocturnal events are common in childhood but can be extremely concerning to parents and disruptive to families. OBJECTIVE: This article provides a framework for the initial assessment of children's nocturnal events. DISCUSSION: Occasionally night time disturbances are seizures. A framework discussing the clinical features of typical benign childhood events and how to differentiate them from seizure disorders is presented. Generally, sleep walking and night terrors are self limiting and children grow out of them. However, in some cases there are ongoing precipitants that are important to identify and treat. (+info)Nocturnal enuresis and overweight are associated with obstructive sleep apnea. (7/16)
(+info)NREM arousal parasomnias and their distinction from nocturnal frontal lobe epilepsy: a video EEG analysis. (8/16)
STUDY OBJECTIVES: To describe the semiological features of NREM arousal parasomnias in detail and identify features that can be used to reliably distinguish parasomnias from nocturnal frontal lobe epilepsy (NFLE). DESIGN: Systematic semiologial evaluation of parasomnias and NFLE seizures recorded on video-EEG monitoring. PATIENTS: 120 events (57 parasomnias, 63 NFLE seizures) from 44 subjects (14 males). Interventions. The presence or absence of 68 elemental clinical features was determined in parasomnias and NFLE seizures. Qualitative analysis of behavior patterns and ictal EEG was undertaken. Statistical analysis was undertaken using established techniques. RESULTS: Elemental clinical features strongly favoring parasomnias included: interactive behavior, failure to wake after event, and indistinct offset (all P < 0.001). Cluster analysis confirmed differences in both the frequency and combination of elemental features in parasomnias and NFLE. A diagnostic decision tree generated from these data correctly classified 94% of events. While sleep stage at onset was discriminatory (82% of seizures occurred during stage 1 or 2 sleep, with 100% of parasomnias occurring from stage 3 or 4 sleep), ictal EEG features were less useful. Video analysis of parasomnias identified three principal behavioral patterns: arousal behavior (92% of events); non-agitated motor behavior (72%); distressed emotional behavior (51%). CONCLUSIONS: Our results broadly support the concept of confusion arousals, somnambulism and night terrors as prototypical behavior patterns of NREM parasomnias, but as a hierarchical continuum rather than distinct entities. Our observations provide an evidence base to assist in the clinical diagnosis of NREM parasomnias, and their distinction from NFLE seizures, on semiological grounds. (+info)Sleep arousal disorders are a category of sleep disorders that involve the partial or complete awakening from sleep, often accompanied by confusion and disorientation. These disorders are characterized by an abnormal arousal process during sleep, which can result in brief periods of wakefulness or full awakenings. The most common types of sleep arousal disorders include sleepwalking (somnambulism), sleep talking (somniloquy), and night terrors (pavor nocturnus).
In sleepwalking, the individual may get out of bed and walk around while still asleep, often with a blank stare and without any memory of the event. Sleep talking can occur in various levels of sleep and may range from simple sounds to complex conversations. Night terrors are episodes of intense fear and agitation during sleep, often accompanied by screams or cries for help, rapid heart rate, and sweating.
These disorders can be caused by a variety of factors, including stress, anxiety, fever, certain medications, alcohol consumption, and underlying medical conditions such as sleep apnea or restless leg syndrome. They can also occur as a result of genetic predisposition. Sleep arousal disorders can have significant impacts on an individual's quality of life, leading to fatigue, daytime sleepiness, impaired cognitive function, and decreased overall well-being. Treatment options may include behavioral therapy, medication, or addressing any underlying medical conditions.
Parasomnias are a category of sleep disorders that involve unwanted physical events or experiences that occur while falling asleep, sleeping, or waking up. These behaviors can include abnormal movements, talk, emotions, perceptions, or dreams. Parasomnias can be caused by various factors such as stress, alcohol, certain medications, or underlying medical conditions. Some examples of parasomnias are sleepwalking, night terrors, sleep talking, and REM sleep behavior disorder. These disorders can disrupt sleep and cause distress to the individual and their bed partner.
The clitoris is an important female sex organ that is primarily responsible for sexual arousal and pleasure. It is a small, highly sensitive piece of tissue located at the front of the vulva, where the labia minora meet. The clitoris is made up of two parts: the visible part, known as the glans clitoris, and the hidden part, called the corpora cavernosa and crura.
The glans clitoris is a small knob-like structure that is covered by a hood, or prepuce, and is located at the top of the vulva. It contains a high concentration of nerve endings, making it highly sensitive to touch and stimulation. The corpora cavernosa and crura are the internal parts of the clitoris, which are made up of sponge-like erectile tissue that becomes engorged with blood during sexual arousal, leading to clitoral erection.
The clitoris plays a crucial role in female sexual response and pleasure. During sexual arousal, the clitoris swells and becomes more sensitive to touch, which can lead to orgasm. The clitoris is also an important source of sexual pleasure during masturbation and partnered sexual activity. Despite its importance in female sexuality, the clitoris has historically been overlooked or stigmatized in many cultures, leading to a lack of understanding and education about this vital organ.
In a medical or physiological context, "arousal" refers to the state of being awake and responsive to stimuli. It involves the activation of the nervous system, particularly the autonomic nervous system, which prepares the body for action. Arousal levels can vary from low (such as during sleep) to high (such as during states of excitement or stress). In clinical settings, changes in arousal may be assessed to help diagnose conditions such as coma, brain injury, or sleep disorders. It is also used in the context of sexual response, where it refers to the level of physical and mental awareness and readiness for sexual activity.
Sexual dysfunctions, psychological, refer to disorders that affect a person's ability to engage in sexual activity due to psychological factors. These factors can include stress, anxiety, depression, relationship issues, past traumatic experiences, and negative attitudes towards sex.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) identifies several types of sexual dysfunctions that can be caused by psychological factors:
1. Sexual Interest/Arousal Disorder - characterized by a lack of interest in sexual activity or an inability to become sexually aroused.
2. Male Hypoactive Sexual Desire Disorder - characterized by a persistent or recurrent lack of desire for sexual activity in men.
3. Female Sexual Arousal Disorder - characterized by an inability to become physically aroused during sexual activity.
4. Male Erectile Disorder - characterized by the inability to achieve or maintain an erection.
5. Female Orgasmic Disorder - characterized by a delay in or absence of orgasm despite adequate stimulation.
6. Male Orgasmic Disorder - characterized by a delay in or absence of orgasm after sufficient sexual stimulation and desire.
7. Premature (Early) Ejaculation - characterized by ejaculation that occurs before the person wishes it to, leading to distress or frustration.
8. Genito-Pelvic Pain/Penetration Disorder - characterized by pain or discomfort during vaginal penetration.
These disorders can cause significant distress and impact a person's quality of life, relationships, and overall well-being. Treatment for psychological sexual dysfunctions typically involves psychotherapy, counseling, and education to address the underlying psychological factors contributing to the disorder.
Sleep is a complex physiological process characterized by altered consciousness, relatively inhibited sensory activity, reduced voluntary muscle activity, and decreased interaction with the environment. It's typically associated with specific stages that can be identified through electroencephalography (EEG) patterns. These stages include rapid eye movement (REM) sleep, associated with dreaming, and non-rapid eye movement (NREM) sleep, which is further divided into three stages.
Sleep serves a variety of functions, including restoration and strengthening of the immune system, support for growth and development in children and adolescents, consolidation of memory, learning, and emotional regulation. The lack of sufficient sleep or poor quality sleep can lead to significant health problems, such as obesity, diabetes, cardiovascular disease, and even cognitive decline.
The American Academy of Sleep Medicine (AASM) defines sleep as "a period of daily recurring natural rest during which consciousness is suspended and metabolic processes are reduced." However, it's important to note that the exact mechanisms and purposes of sleep are still being researched and debated among scientists.
REM sleep, or Rapid Eye Movement sleep, is a stage of sleep characterized by rapid eye movements, low muscle tone, and active brain activity. It is one of the two main types of sleep along with non-REM sleep and is marked by vivid dreaming, increased brain metabolism, and altered brain wave patterns. REM sleep is often referred to as "paradoxical sleep" because of the seemingly contradictory nature of its characteristics - an active brain in a state of relaxation. It is thought to play a role in memory consolidation, learning, and mood regulation. A typical night's sleep cycle includes several episodes of REM sleep, with each episode becoming longer as the night progresses.
Sleep disorders are a group of conditions that affect the ability to sleep well on a regular basis. They can include problems with falling asleep, staying asleep, or waking up too early in the morning. These disorders can be caused by various factors such as stress, anxiety, depression, medical conditions, or substance abuse.
The American Academy of Sleep Medicine (AASM) recognizes over 80 distinct sleep disorders, which are categorized into the following major groups:
1. Insomnia - difficulty falling asleep or staying asleep.
2. Sleep-related breathing disorders - abnormal breathing during sleep such as obstructive sleep apnea.
3. Central disorders of hypersomnolence - excessive daytime sleepiness, including narcolepsy.
4. Circadian rhythm sleep-wake disorders - disruption of the internal body clock that regulates the sleep-wake cycle.
5. Parasomnias - abnormal behaviors during sleep such as sleepwalking or night terrors.
6. Sleep-related movement disorders - repetitive movements during sleep such as restless legs syndrome.
7. Isolated symptoms and normal variants - brief and occasional symptoms that do not warrant a specific diagnosis.
Sleep disorders can have significant impacts on an individual's quality of life, productivity, and overall health. If you suspect that you may have a sleep disorder, it is recommended to consult with a healthcare professional or a sleep specialist for proper evaluation and treatment.