Daytime noise stress and subsequent night sleep: interference with sleep patterns, endocrine and neurocrine functions.

The effects of strong daytime noise stress on subsequent undisturbed night sleep were studied in six male volunteers. They slept for seven consecutive nights in the laboratory, two nights being preceded by an 8 h exposure to 83 dB (A) pink noise. Continuously during all nights EEG, EOG, EMG, ECG and respiration were recorded. Additionally, during five nights, blood samples were taken every 30 min by an indwelling venous catheter for the determination of ACTH, hGH, PRL, TRP, 5-HT and 5-HIAA. After daytime noise load, increased sleep stage 4 stability, partly elevated hGH and PRL levels and decreased levels of the metabolites of the serotonergic system were found. This result may be explained by the assumption that high daytime noise stress is an additional load for the CNS which demands an intensification of recovery processes during the sleep of the subsequent night.

Bad tidings and the hospitalized patient.

The physician in hospital practice may be faced with a situation in which a patient under his care suffers a bereavement or some other unexpected tragedy but is unaware of the fact. Three such cases encountered in the context of our psychiatric sonsultation service are presented. Factors influencing the decision as to whether, when and how the patient should be informed are considered. The complex psychodynamic situation which arises and involves the patient, his family and the medical staff is described. Stress is laid on the role played by archaic fears of being the bearer of evil tidings. The situation is seen as being ideally handled by the direct treating physician in conjunction with the family, the extent of psychiatric intervention being dictated by the needs of each of the parties concerned. Ideally the patient should be told as soon as his physical and mental condition are seen as conducive and preferably before he leave hospital.