ABSTRACT
Circadian rhythm sleep disorder, free-running type (CRSD, FRT) is a disorder in which the intrinsic circadian rhythm is no longer entrained to the 24-hour schedule. A unique case of CRSD, FRT in a 67-year-old sighted male is presented. The patient had a progressively delayed time in bed (TIB) each night, so that he would cycle around the 24-h clock approximately every 30 days. This was meticulously documented each night by the patient over the course of 22 years. The patient's CRSD, FRT was associated with severe depression, anxiety, and agoraphobia. The agoraphobia may have exacerbated the CRSD, FRT. Entrainment and stabilization of his circadian rhythm was accomplished after treatment that included melatonin, light therapy, and increased sleep structure.
Subject(s)
Agoraphobia/complications , Anxiety Disorders/complications , Depressive Disorder/complications , Sleep Disorders, Circadian Rhythm/complications , Sleep Disorders, Circadian Rhythm/diagnosis , Aged , Agoraphobia/diagnosis , Agoraphobia/therapy , Anxiety Disorders/diagnosis , Anxiety Disorders/therapy , Combined Modality Therapy , Depressive Disorder/diagnosis , Depressive Disorder/therapy , Disease Progression , Drug Administration Schedule , Follow-Up Studies , Humans , Male , Melatonin/therapeutic use , Phototherapy/methods , Risk Assessment , Severity of Illness Index , Sleep Disorders, Circadian Rhythm/therapy , Time Factors , Treatment OutcomeABSTRACT
PURPOSE: The purpose of this study was to describe a case of central serous chorioretinopathy (CSC) associated with narcolepsy. METHODS: Case report. RESULTS: A 34-year-old man was followed for persistent CSC in his left eye for more than 11 months. He did not have any known risk factors for CSC, including obstructive sleep apnea. However, he experienced disrupted sleep because of narcolepsy, which was inadequately treated. After 2 weeks of adequate treatment for his narcolepsy, fundus examination and optic coherence tomography demonstrated complete resolution of his CSC. CONCLUSION: As this case report suggests, overactivation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, seen with disrupted and poor quality sleep, may contribute to the development of CSC. Risk factors for CSC should include sleep disorders that can lead to chronic sleep deprivation.
Subject(s)
Complementary Therapies/statistics & numerical data , Health Knowledge, Attitudes, Practice , Patient Satisfaction/statistics & numerical data , Sleep Apnea Syndromes/epidemiology , Sleep Apnea Syndromes/therapy , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Polysomnography , Prevalence , Treatment Outcome , United States/epidemiologyABSTRACT
Sleep difficulty is one of the hallmarks of menopause. Following recent studies showing no cardiac benefit and increased breast cancer, the question of indications for hormonal therapy has become even more pertinent. Three sets of sleep disorders are associated with menopause: insomnia/depression, sleep disordered breathing and fibromyalgia. The primary predictor of disturbed sleep architecture is the presence of vasomotor symptoms. This subset of women has lower sleep efficiency and more sleep complaints. The same group is at higher risk of insomnia and depression. The "domino theory" of sleep disruption leading to insomnia followed by depression has the most scientific support. Estrogen itself may also have an antidepressant as well as a direct sleep effect. Treatment of insomnia in responsive individuals may be a major remaining indication for hormone therapy. Sleep disordered breathing (SDB) increases markedly at menopause for reasons that include both weight gain and unclear hormonal mechanisms. Due to the general under-recognition of SDB, health care providers should not assume sleep complaints are due to vasomotor related insomnia/depression without considering SDB. Fibromyalgia has gender, age and probably hormonal associations. Sleep complaints are almost universal in FM. There are associated polysomnogram (PSG) findings. FM patients have increased central nervous system levels of the nociceptive neuropeptide substance P (SP) and lower serotonin levels resulting in a lower pain threshold to normal stimuli. High SP and low serotonin have significant potential to affect sleep and mood. Treatment of sleep itself seems to improve, if not resolve FM. Menopausal sleep disruption can exacerbate other pre-existing sleep disorders including RLS and circadian disorders.
