Italian guidance on Dementia Day Care Centres: A position paper.

Dementia Day Care Centres (DDCCs) are defined as services providing care and rehabilitation to people with dementia associated with behavioural and psychological symptoms (BPSD) in a semi-residential setting. According to available evidence, DDCCs may decrease BPSD, depressive symptoms and caregiver burden. The present position paper reports a consensus of Italian experts of different disciplines regarding DDCCs and includes recommendations about architectural features, requirements of personnel, psychosocial interventions, management of psychoactive drug treatment, prevention and care of geriatric syndromes, and support to family caregivers. DDCCs architectural features should follow specific criteria and address specific needs of people with dementia, supporting independence, safety, and comfort. Staffing should be adequate in size and competence and should be able to implement psychosocial interventions, especially focused on BPSD. Individualized care plan should include prevention and treatment of geriatric syndromes, a targeted vaccination plan for infectious diseases including COVID-19, and adjustment of psychotropic drug treatment, all in cooperation with the general practitioner. Informal caregivers should be involved in the focus of intervention, with the aim of reducing assistance burden and promoting the adaptation to the ever-changing relationship with the patient.

Daytime course of sleepiness in de novo Parkinson's disease patients.

Normal subjects show an increase of sleepiness in the morning, early afternoon and before sleep. In the advanced stages of Parkinson's disease (PD) the mean level of sleepiness is quite high, while with respect to healthy subjects it seems to be unchanged in the early stages. The aim of this study was to evaluate the time-course of the sleepiness level during the wakefulness period in untreated patients with early-stage Parkinson's disease. Eighteen Parkinson's disease patients who had never been treated before with dopaminergic drugs (male = 9, female = 9, age: 68.39 ± 1.89, mean ± standard error) and 18 healthy subjects (male = 9, female = 9, age: 67.22 ± 1.98) were recruited for this study. All subjects underwent continuous actigraphic recording for three consecutive days, during which they also completed the Karolinska Sleepiness Scale (KSS) once an hour throughout wakefulness. Our results showed a higher level of sleepiness in the patients than the controls in the hours following awakening and in the early afternoon, specifically at 08:00 and 14:00 hours (08:00 hours, PD patients, KSS: 3 ± 0.3 versus healthy subjects, KSS: 2 ± 0.2, P < 0.05; 14:00 hours, PD patients, KSS: 4.4 ± 0.5 versus healthy subjects, KSS: 3 ± 0.3, P < 0.05). We suggest that some daytime hours are sensitive windows showing the first increase of sleepiness which will spread later to the whole daytime.

Good and Bad Sleep in Childhood: A Questionnaire Survey amongst School Children in Southern Italy.

Despite its clinical importance, the issue of subjective sleep quality in children remains unexplored. Here we investigate, in school-aged children, the prevalence of bad sleep perception and its relationships with sleep habits and daytime functioning, to provide hints on its possible determinants. Subjective sleep perception, sleep habits, and daytime functioning were studied through a questionnaire survey in a sample of 482 children (6-12 yrs.). Being "bad sleeper" was reported by 6.9% of the sample. Compared to the "good sleepers", these subjects displayed shorter sleep duration on schooldays, longer sleep latencies, and a more pronounced evening preference, beyond more frequent insufficient sleep. Though no differences emerged in sleepiness, bad sleepers showed higher impairments in daytime functioning, indicated by more frequent depressed mood and impulsivity. These distinctive features might be very important to precociously detect those children who are possibly more vulnerable to sleep disturbances and whose sleep-wake rhythms evolution should be paid particular attention thereafter. "The good people sleep much better at night than the bad people.Of course, the bad people enjoy the waking hours much more"Woody Allen.

Factors involved in sleep satisfaction in the elderly.

BACKGROUND: In healthy aged subjects, subjective complaints of poor sleep are not as frequent as one would expect from the notable objective age-related sleep impairments. This discrepancy could depend on the sleep characteristics they require to feel satisfied about their sleep, which could be different from younger subjects. In order to verify this hypothesis, our study aims to identify changes in sleep satisfaction predictors as a function of age. METHODS: Sleep features, both quantitative (sleep latency, sleep duration, frequency and duration of night-time awakenings) and qualitative (calmness of sleep, ease of falling asleep, satisfaction with sleep, ease of awakening, freshness after awakening and sufficient sleep), as well as afternoon nap habits were investigated throughout a pre-arranged interview in healthy individuals: 117 elderly subjects (47 men, 70 women, 65-99 years) and 120 young adults (48 men, 72 women, 19-28 years). RESULTS: Quantitative sleep features worsen with age, whereas qualitative ones are equivalent or even improved in the aged group; only "calmness of sleep" decreases with age. Afternoon nap habits increase in elderly subjects, but they do not appear to be linked to sleep satisfaction. Predictors of sleep satisfaction differ between age groups: freshness after awakening but not frequency of night-time awakenings were relevant for elderly subjects, whereas the opposite was observed in young adults. CONCLUSIONS: These findings point out that sleep satisfaction is preserved in healthy elderly individuals despite the worsening of quantitative night-time sleep features, reflected by the increase of afternoon naps. This discrepancy could be explained by changes in sleep satisfaction determinants, towards which a spontaneous adaptive adjustment is likely to occur in aged subjects. In contrast with young adults, elderly subjects heed the freshness perceived after the awakening and pay little attention to frequent night-time awakenings.

Yawning and subjective sleepiness in the elderly.

Yawning is related to sleep/wake transitions and time of day, probably reflecting the time course of sleepiness. As aging modifies sleep-wake and sleepiness rhythms, we suppose that yawning frequency and its time course vary as a function of age. Thirteen aged healthy subjects (77.15 +/- 4.09 years) and 12 young adults (24.41 +/- 3.31 years) were instructed to keep their habitual sleep schedules for three consecutive work-days, during which they were required to signal every yawning occurrence and to evaluate hourly their sleepiness level. Results showed that aged subjects yawn less frequently than young adults, particularly during morning and mid-afternoon hours. The time course of yawning was different between the two age groups: aged subjects showed earlier morning peak and evening rise compared with young adults; in addition, aged subjects showed two minor peaks in-between. Differences as a function of age in the time course of yawning were associated with differences in the time course of sleepiness. The only exception pertained to the early morning yawning peak, which was close to the awakening but it was not associated with high sleepiness in aged subjects. Our study discloses that aging modifies yawning frequency and its time course. Furthermore, as in the elderly yawning after the awakening is not associated with high sleepiness level as in young adult, we put forward that sleepiness level and the proximity of sleep/wake transitions could separately affect yawning.

Yawning in morning and evening types.

Yawning occurs more frequently in the early morning and in the late evening, close to sleep onset and after the awakening, and it might be linked to sleep propensity. We aimed to study yawning and its temporal distribution in morning and evening subjects who display different sleep-wake and sleepiness rhythms. Sixteen healthy young adults (8 evening-types and 8 morning-types, matched for age and gender) have been selected and instructed to keep their habitual sleep schedules and to signal every yawning occurrence for three consecutive days. Results show that evening-types yawn more frequently than morning-types, particularly during morning hours. Yawning frequency decreases across daytime in evening-types reaching its lowest level in the early evening and increases thereafter. Instead, in morning-types, yawning frequency remains quite low during daytime and increases in the evening. Moreover, both morning and evening types show a progressive increase of yawning frequency in the hours preceding sleep onset, whereas they differ after the awakening. Evening-types show a higher yawning frequency that remains quite stable in the hours following the awakening, while morning-types display a decline in yawning frequency. Our findings show that the temporal distribution of yawning frequency differs between chronotypes, supporting the hypothesis that differences in sleep-wake rhythm affect yawning, which could represent a behavioural sign of sleep propensity.

Music in dreams.

Music in dreams is rarely reported in scientific literature, while the presence of musical themes in dreams of famous musicians is anecdotally reported. We did a systematic investigation to evaluate whether the occurrence of musical dreams could be related to musical competence and practice, and to explore specific features of dreamt pieces. Thirty-five professional musicians and thirty non-musicians filled out a questionnaire about the characteristics of their musical activity and a structured dream log on the awakening for 30 consecutive days. Musicians dream of music more than twice with respect to non-musicians; musical dreams frequency is related to the age of commencement of musical instruction, but not to the daily load of musical activity. Nearly half of the recalled music was non-standard, suggesting that original music can be created in dreams.