Differential effects of sleep deprivation on sleepwalking: Role of demographic and clinical profiles.

BACKGROUND: Although sleepwalking is one of the most prevalent and potentially injurious of the NREM parasomnias, it is still diagnosed primarily based on the patient's clinical history. Early pilot work suggested that sleep deprivation protocols could help obtain a polysomnographically-based (PSG) diagnosis of sleepwalking, but larger studies remain lacking. METHODS: We compared baseline PSG recordings with those obtained after 25hrs of sleep deprivation in a cohort of 124 consecutively assessed adult sleepwalkers. RESULTS: When compared to baseline recordings, post-sleep deprivation PSG assessments resulted in nearly twice as many somnambulistic episodes being recorded in the laboratory and significantly increased the proportion of patients (from 48 % to 63 %) experiencing at least one lab-based episode. Moreover, while 17 % of patients experienced a sleepwalking event exclusively during recovery sleep, only 2 % of patients did so solely at baseline. Sleep deprivation had similar facilitating effects on patents' somnambulistic events regardless of age of onset and positive versus negative family history for sleepwalking. Younger age and higher home episode frequency both predicted a positive response to sleep deprivation. A separate group of 17 patients with comorbid sleep disorders showed a similar increase in their proportion experiencing at least one episode during recovery sleep. CONCLUSION: The results from this large series of sleepwalkers provide strong support for the use of sleep deprivation in facilitating the occurrence of somnambulistic events in the sleep laboratory.

Prevalence and correlates of disturbed dreaming in children.

Relatively little is known about nightmares and other forms of disturbed dreaming in children. This article reviews the literature on the prevalence and correlates of nightmares in children and highlights key methodological issues in the field. Results show that regardless of how they are defined and measured, nightmares affect a significant proportion of children of all ages and there is some evidence to suggest that nightmare frequency may peak around the age of 10. Gender differences in nightmare frequency, with girls reporting more nightmares than do boys, tend to appear between the ages of 10 and 15. Although nightmares are associated with a range of psychosocial difficulties (e.g., stress, behavioural problems), elevated anxiety and concomitant sleep-related disorders (e.g., sleepwalking) are among the most robust correlates of nightmares. Very few studies have examined nightmare treatment in children, but promising results have been obtained with imagery rehearsal therapy. Overall, research in the field has been hampered by inconsistent definitions for nightmares, by extensive variability in questionnaire items used to measure nightmare frequency, and by a lack of awareness of how using parents versus children as respondents may impact results. Longitudinal studies are needed to better understand how nightmares and their correlates evolve during childhood and adolescence, to delineate their clinical significance, and to develop effective and age-appropriate treatment strategies.

Dynamics of slow-wave activity during the NREM sleep of sleepwalkers and control subjects.

STUDY OBJECTIVE: To compare the number and distribution of awakenings from slow-wave sleep (SWS) and both the power and dynamics of EEG slow-wave activity (SWA) in sleepwalkers and controls. Somnambulism is considered to be a disorder of arousal from NREM sleep and related to anomalous SWS and SWA. Power spectral analyses have never been used to quantify patients' SWA across sleep cycles. DESIGN: N/A SETTING: N/A PATIENTS: A polysomnographic study was performed on 15 adult sleepwalkers and 15 age- and sex-matched controls. INTERVENTIONS: N/A MEASUREMENTS & RESULTS: Sleepwalkers had a significantly greater number of awakenings from SWS than did control subjects. Controls showed a greater decrease in SWA across NREM cycles. Sleepwalkers had a significantly lower level of SWA during the first NREM period, where most awakenings take place. CONCLUSION: Sleepwalkers appear to suffer from an abnormality in the neural mechanisms responsible for the regulation of SWS.

Nightmares and bad dreams: their prevalence and relationship to well-being.

This study, for the first time, distinguishes between nightmares and bad dreams, measures the frequency of each using dream logs, and separately assesses the relation between nightmares, bad dreams, and well-being. Eighty-nine participants completed 7 measures of well-being and recorded their dreams for 4 consecutive weeks. The dream logs yielded estimated mean annual nightmare and bad-dream frequencies that were significantly (ps < .01) greater than the mean 12-month and 1-month retrospective estimates. Nightmare frequency had more significant correlations than bad-dream frequency with well-being, suggesting that nightmares are a more severe expression of the same basic phenomenon. The findings confirm and extend evidence that nightmares are more prevalent than was previously believed and underscore the need to differentiate nightmares from bad dreams.

Prevalence of auditory, olfactory, and gustatory experiences in home dreams.

Although numerous studies have investigated the content of laboratory and home dream reports, surprisingly little is known about the prevalence of various sensory modes in dreams. 49 men and 115 women completed a battery of questionnaires and kept a home dream diary for two to three consecutive weeks. Retrospective responses to the questionnaire indicate that approximately 33% of men and 40% of women recalled having experienced sensations of smell or taste in their dreams. A total of 3372 dream reports were collected and scored for unambiguous references to auditory, olfactory, and gustatory experiences. Auditory experiences were reported in approximately 53% of all dream reports. Olfactory and gustatory sensations occurred in approximately 1% of all dream reports. A significantly greater percentage of women than men reported one or more dreams containing references to olfactory sensations. The results lend support to previous studies which have shown that a variety of sensory experiences, although relatively rare, can occur in dreams.

Lucid dreaming as a treatment for recurrent nightmares.

BACKGROUND: Lucid dreams occur when a person becomes aware that he or she is dreaming while still in the dream state. Previous reports on the use of lucid dreaming in the treatment of nightmares do not contain adequate baseline data, follow-up data, or both. METHODS: A treatment of recurrent nightmares incorporating progressive muscle relaxation, guided imagery, and lucid dream induction is presented for 2 case studies. Three other cases were treated with lucid dream induction alone. The duration of the nightmares ranged from once every few days to once every few months. RESULTS: The procedures were effective in all 5 cases. A 1-year follow-up showed that 4 of the subjects no longer had nightmares and that 1 subject experienced a decrease in the intensity and frequency of her nightmares. CONCLUSIONS: The alleviation of recurrent nightmares in these 5 cases parallels the results reported by other authors who have used training in lucid dreaming to treat nightmares. Our results support the idea that treatments based on lucid dream induction can be of therapeutic value. Based on these and other case studies, it remains unclear whether the principal factor responsible for the alleviation of nightmares is lucidity itself, or the ability to alter some aspect of the dream.

Pain in dreams.

Little is known about pain in dreams. Some studies indicate that it is rare and that it may be beyond the representational capability of dreaming. However, the present study describes experiences of dreamed pain that were reported incidentally in experiments on the effects of somatosensory stimulation administered during rapid eye movement (REM) sleep. Dreams were selected from five subjects who had reported at least one instance of dreamed pain in these studies. The subjects had undergone 42 stimulation trials over 20 nights and had reported a total of 13 dreams (31%) with one or more references to pain. Most often, these references appeared to be direct, untransformed incorporations of real sensations produced by stimulation. Pain was the principal motivating agent in a majority of these dreams and was in many cases associated with strong emotion--typically anger. Dreams often depicted the subjects' attempts to obtain relief from pain, in some cases by repetition of actions, in others by metaphoric renditions of the goal. The results indicate that although pain is rare in dreams, it is nevertheless compatible with the representational code of dreaming. Further, the association of pain with dream content may implicate brainstem and limbic centers in the regulation of painful stimuli during REM sleep.

[Complications in surgical management of pelvic fractures]. / Komplikationen der operativen Versorgung von Beckenfrakturen.

In the care of pelvic injuries complications arise because of organizational and technical factors, some of which are described here. The following measures are important: autotransfusion, emptying the bladder and catheterization, checking and protection of the colon, correct management of the operation table, and prophylactic measures to avoid thrombosis. From an operational/technical point of view, it is most important that a larger with good exposure route be chosen that takes the anatomical structures into account. Of 123 cases, 20% were not ideally reduced. Twice massive bleeding occurred from the A. glutea superior, once the sacral dura was opened without any adverse effects, infection occurred 8 times and 10 times peroneal paralysis was observed.