Depression and sleep disorders. The optical isomers of oxaprotiline and their effect on sleep parameters in healthy subjects.

In the context of the questions under discussion here, three findings from this study should be briefly emphasised: Neurophysiological parameters investigated in healthy subjects receiving single doses of the two enantiomers of oxaprotiline in an acute experiment, performed in the sleep laboratory under defined conditions, revealed marked qualitative and quantitative differences between the effects of these enantiomers. Since the two enantiomers are practically devoid of any anticholinergic or antiserotonergic effect and display similar antihistaminic and sedative-antiaggressive activity, it is reasonable to assume that the differences in their effects on the sleep parameters measured are attributable to the difference in their pharmacodynamic profiles with respect to inhibition of noradrenaline uptake. REM sleep parameters correlate significantly with the effect of the d-(+)-enantiomer, i.e. with its selective effect on inhibition of noradrenaline uptake.

[Sleep disorders in patients with chronic renal insufficiency in long-term hemodialysis treatment]. / Schlafstörungen bei Patienten mit chronischer Niereninsuffizienz unter Langzeit-Hämodialysebehandlung.

Of 22 patients on maintenance hemodialysis investigated during a period of 20 days for sleep disturbances by means of a semistructured questionnaire, 14 patients reported sleep disturbances. The patient group was found to be homogeneous with respect to factors influencing sleep behavior, such as age, personality and comedication. The sleep disturbances of the dialyzed patients was characterized by diminished sleep efficiency (time asleep/time in bed) and more fragmented sleep, while time of lying in bed awake was perceived as particularly disturbing. The sleep disturbance could be interpreted as a form of secondary metabolically induced insomnia. A single dialysis caused increased fatigue and diminution of well-being, but also an increase in the first fragment of sleep and of the total duration of sleep, i.e. it induced a modification toward a more physiologic sleep pattern. The retention of "middle molecules" could be of importance for the occurrence of uremic sleep disturbance. Patients who were underdialyzed relative to middle molecules were more numerous in the group with disturbed sleep, but the difference did not reach significance in the small number of subjects studied.

Acute and delayed effects of DSIP (delta sleep-inducing peptide) on human sleep behavior.

A first study of DSIP (= synthetic delta sleep-inducing peptide) application to humans was carried out in six normal volunteers (four males and two females) under extensive psychophysiologic observations and measurements in a double-blind cross-over design. DSIP was applied as slow intravenous infusions at a dosage of 25 nmol/kg in the morning. The subjects immediately reported a feeling of sleep pressure, and sleep increased by 59% (median of total sleep time) within a 130-min interval after the treatment as compared with placebo. Delayed effects on subsequent night sleep were shorter sleep onset, reduced percentage of stage 1, and better sleep efficiency. Nevertheless, sophisticated behavioral and EEG analyses revealed no sedation in the classic pharmacologic way. The results suggest that DSIP in humans is also efficacious by sustaining natural sleep functions. The compound was well-tolerated and no psychologic, physiologic, or biochemical side effects were observed.

Deficient blood pressure regulation in a case of hypersomnia with sleep drunkenness.

In a 43-year-old man suffering from hypersomnia with sleep drunkenness, a polygraphic sleep study with direct measurement of blood pressure was carried out. The main findings were lack of blood pressure activation with arousals during the sleep period and persistence of sleep levels after morning awakening. This indicates that cardio-vascular responses to the needs of active behaviour are insufficient. Taking into account feedback mechanisms of blood pressure on alertness, this could be a cause for sleep drunkenness and daytime sleepiness. The blood pressure sustaining drug etilefrine seems to alleviate these symptoms.

[Psychosomatic insomnia]. / Psychosomatische Insomnie

In presenting a case of extreme hyposomnia, psychosomatic insomnia is elaborated as a special type of primary insomnia. The case study of a 60 years old man is based on psychiatric examinations, an intersive one-week observation including polygraphic sleep recordings, and on reviewing medical data over a period of 35 years. In this case, the insomnia developed during a life situation with social stress and continued over 30 years with a gradual sleep reduction to 2-4 hours. Our sleep recordings confirmed a total sleep time of nearly 3 hours, a marked rhythmicity of sleep and day-time activities, fragmentation of sleep, and psychogenic extrasystoles, all symptoms having been reported by the subject previously. Autonomic functions indicated a good efficiency of NREM sleep, whereas a first night effect with subsequent adaptation revealed a good regulatory function of the sleep-waking-system. In addition to a detailed documentation of this extraordinary case, an interpretation is undertaken in order to explain, how the insomnia developed and continued. Psychodynamic aspects show a set of characteristics which are most typical for psychosomatic syndroms. The authors expect, that the knowledge about psychosomatic insomnia will be helpful in diagnosis and treatment of severe insomnias.

[Education in psychiatry]. / Die Ausbildung in der Psychiatrie

In order to give young doctors a specialist training in psychiatry and psychotherapy and to have the necessary number of available posts, the concept of training presently practised should urgently be revided. To justify this demand, the author points to new developments within psychiatry itself as well as to external circumstances. He mentions firstly the extension of the knowledge itself, the pluralism in therapy, the growing specialization within the specialty, the diffusion of the roles as well as the identity crisis and secondly the disproportion to be expected between the number of young graduated doctors and the number of available posts. So that the readermay for his own opinion, the author refers to the relevant literature. The author's personal opinion and his proposals are discussed.