[Sleep: the basis of a healthy lifestyle]. / Slaap: de basis voor een gezonde leefstijl.

BACKGROUND: The use of sleep as modifiable lifestyle factor is not yet self-evident in psychiatry.
AIM: To increase knowledge about sleep as health-affecting factor.
METHOD: Description of normal sleep, effects of disturbed sleep and lifestyle advice to promote healthy sleep.
RESULTS: Disturbed sleep negatively impacts physical and mental health. Targeted lifestyle advice can improve sleep and bring about positive effects in multiple areas.
CONCLUSION: From preventive and treatment perspectives, interventions optimizing sleep in psychiatric care seem promising.

Sleep misperception, EEG characteristics and autonomic nervous system activity in primary insomnia: a retrospective study on polysomnographic data.

Misperception of Sleep Onset Latency, often found in Primary Insomnia, has been cited to be influenced by hyperarousal, reflected in EEG- and ECG-related indices. The aim of this retrospective study was to examine the association between Central Nervous System (i.e. EEG) and Autonomic Nervous System activity in the Sleep Onset Period and the first NREM sleep cycle in Primary Insomnia (n=17) and healthy controls (n=11). Furthermore, the study examined the influence of elevated EEG and Autonomic Nervous System activity on Stage2 sleep-protective mechanisms (K-complexes and sleep spindles). Confirming previous findings, the Primary Insomnia-group overestimated Sleep Onset Latency and this overestimation was correlated with elevated EEG activity. A higher amount of beta EEG activity during the Sleep Onset Period was correlated with the appearance of K-complexes immediately followed by a sleep spindle in the Primary Insomnia-group. This can be interpreted as an extra attempt to protect sleep continuity or as a failure of the sleep-protective role of the K-complex by fast EEG frequencies following within one second. The strong association found between K-alpha (K-complex within one second followed by 8-12 Hz EEG activity) in Stage2 sleep and a lower parasympathetic Autonomic Nervous System dominance (less high frequency HR) in Slow-wave sleep, further assumes a state of hyperarousal continuing through sleep in Primary Insomnia.

Acquired progressive hypotonia in infancy: consider compressive cervical myelopathy.

UNLABELLED: This case report presents a rare cause of progressive hypotonia due to a congenital bony defect of the atlas in a 2-month-old girl. The patient was initially referred to the paediatric department with feeding problems. Within days after admission she developed progressive hypotonia and showed decreased reflexes of the upper extremities. Magnetic resonance imaging showed compressive myelopathy at the level of vertebra C1. After laminectomy of the C1-vertebra the neurological symptoms resolved. CONCLUSION: Most anomalies of the vertebras are asymptomatic. Only symptomatic anomalies with compression and neurological symptoms need surgery.

The use of actigraphy revised: the value for clinical practice in insomnia.

In the last years, actigraphy has been used more often for clinical research and research evaluation of sleep disorders. Compared to polysomnography, actigraphy is cheap and less time-consuming. Actigraphy provides more objective information about sleep than sleep logs. Although the algorithms to score sleep and wake based on motions measured by actigraphy are still being improved, we believe that the role of actigraphy in the clinical evaluation of sleep in insomnia is limited. Instead of using actigraphy to distinguish a wakeful state from sleep in insomnia, we might better use the activity plots which the actigraph provides to get more insight into the physiological hyperarousal or restfulness of insomnia patients.

Evaluation of short-term nonpharmacological treatment of insomnia in a clinical setting.

Of the 86 chronic insomnia patients we treated with nonpharmacological means, 74 improved considerably. The subjective improvement was confirmed by the outcome of the sleep logs registered after 4 weeks of treatment (decrease in sleep-onset latency, wake after sleep onset, and an increase of sleep efficiency). Of the 49 patients who had used hypnotics at intake, 18 discontinued their medication and 19 considerably reduced theirs after therapy. The investigated population was characterized by high scores for anxiety, depression, and somaticization; the depression and anxiety scores were significantly higher for the hypnotics users. The percentage of nonresponders (patients who were unaffected by the treatment) was highest for the group of homemakers and for the group of patients with a low level of education. Significantly less of the nonresponders had received cognitive therapy compared with responders. The value of nonpharmacological treatment lies in the fact that it leads to a subjective improvement of sleep and to increased control over the sleep problem that the patient was experiencing. Helping the patients to obtain control over their sleep problems was our main therapeutic goal.

Comparative flow cytometric analysis of the human sperm acrosome reaction using CD46 antibody and lectins.

PURPOSE: Our purpose was to determine the most suitable marker for the human sperm acrosome reaction, based on detection of CD46 antibody binding compared with lectin binding. METHODS: Flow cytometric analysis of CD46 antibody versus lectins (PNA, PSA, and Con A) was used to quantify the acrosome reaction of human sperm. RESULTS: Neither PSA nor Con A was able to detect significant changes in the spontaneous and ionophore-induced acrosome reactions compared to CD46 antibody. However, PNA was found to exhibit a binding pattern similar to that observed with CD46 and could be used to quantify measurable changes in acrosomal response to ionophore, albeit of a lower magnitude than the responses detected by CD46. CONCLUSIONS: We conclude that PNA binds to the inner acrosomal membrane of acrosome-reacted sperm and is suitable for use as a marker of the acrosome reaction by flow cytometry. Data are presented which clarify the assessment of the acrosome reaction when CD46 and lectins are used.

Shifts and awakenings: valuable indicators of the quality of sleep: do these parameters react differently to hypnotics?

In order to test the assumption that the sleep stability increases as the number of shifts and awakenings decreases, all-night sleep recordings (registered at home) were reanalyzed. The registrations belong to 10 young good sleepers, 10 adult good sleepers, 10 insomnia patients without treatment, 10 treated with a benzodiazepine and 10 treated with a nonbenzodiazepine hypnotic, 10 patients with proven narcolepsy, and 10 with obstructive sleep apnea syndrome (OSAS). For each of the categories NREM-1-2, NREM 3-4, and REM sleep, indices were defined as the number of shifts and awakenings that occurred per hour. Our results show that the indices of awakenings for the good as well for the bad sleepers were similar, whereas the indices of awakenings were very group dependent. We interpreted these results as showing that awakenings are valuable indicators for studying the quality of sleep, whereas shifts are not.