Evaluating and managing premenstrual syndrome.

Premenstrual syndrome (PMS), a common disorder in women, refers to physical and/or mood symptoms that appear predictably during the latter half of the menstrual cycle, last until menses begin, and are absent during the early part of the menstrual cycle. A diagnosis of PMS requires that the symptoms be severe enough to affect a woman's ability to function at home or in the workplace or in her relationships with others. Diagnostic assessment entails a thorough medical and psychiatric history and prospective daily ratings. Disorders such as major depression, anxiety, hypothyroidism, and diabetes must be excluded before a diagnosis of PMS can be considered. Treatment strategies include either eliminating the hormonal cycle associated with ovulation or treating the symptom(s) causing the most distress to the patient. Medical therapies are available for both treatment approaches but should be initiated only after behavioral measures have failed; the physician must also carefully weigh the severity of symptoms against the potential for adverse effects of treatment.

Comparison of a frequency-based analysis of electroencephalograms (Z-ratio) and visual scoring on the multiple sleep latency test.

In a sample of multiple sleep latency test naps following nocturnal polysomnograms from a group of 13 patients of varying ages and diagnoses, we compared a computer-derived electroencephalographic (EEG) measure (z-ratio) with standard visual sleep stage scoring. In this clinical population, z-ratio scoring agreed with human scorers approximately 80% of the time when determining sleep versus wake in 30-second epochs. These results show that a single, objectively quantifiable value derived from a single channel of EEG can distinguish between sleep and wakefulness (as defined by Rechtschaffen and Kales) with at least a moderate degree of precision. When refined, the z-ratio method might be of use as the basis for a new sleep scoring system, particularly where an accurate determination of sleep onset is required.

Pediatricians and sleep disorders: training and practice.

OBJECTIVE: A series of studies were conducted to investigate pediatricians' training, knowledge, and practices regarding sleep and sleep disorders in children and adolescents. METHOD AND RESULTS: Study 1, a national survey of 156 pediatric residency programs, found that pediatricians receive a mean of 4.8 hours of instruction on sleep and sleep disorders, although the mode and median hours of instruction is 0 hours. In study 2, 88 pediatricians completing a questionnaire concerning general knowledge about sleep disorders in children and adolescents received a mean score of 71.8% (range, 40% to 93%). Pediatricians appear to know the most about developmental issues and sleep hygiene and the least about specific disorders such as narcolepsy and parasomnias. In the third study, 183 pediatricians were surveyed about their actual beliefs and practices regarding young children's sleep problems. Together, those surveyed reported that approximately 25% of their patients experience some type of sleep problem. Most pediatricians recommend behavioral interventions, although 14.8% of pediatricians report prescribing pharmacological treatments, and 48.9% inform parents that their child is likely to outgrow the problem. CONCLUSIONS: The results of these studies support the need for more education in sleep and sleep disorders in children and adolescents within medical schools, pediatric residency programs, and the practicing pediatric community.

Age-related differences in recovery from simulated jet lag.

Six healthy young men and eight early middle-aged men were isolated from environmental time cues for 15 days. For the first 6-7 days (one or two nights adaptation, four nights baseline), their sleep and meals were scheduled to approximate their habitual patterns. Their daily routines were then shifted 6 hours earlier by terminating the sixth or seventh sleep episode 6 hours early. The new schedules were followed for the next 8 or 9 days. Important age-related differences in adjustment to this single 6-hour schedule shift were found. For the first 4-day interval after the shift, middle-aged subjects had larger increases of waking time during the sleep period and earlier termination of sleep than young subjects. They also reported larger decreases in alertness and well-being and larger increases in sleepiness, weariness and effort required to perform daily functions. The rate of adjustment of the circadian core temperature rhythm to the new schedule did not differ between groups. These results suggest that the symptoms reported by the middle-aged subjects may be due mainly to difficulty maintaining sleep at early times of the circadian day. The compensatory response to sleep deprivation may also be less robust in middle-aged individuals traveling eastbound.