Is time elapsed between cannabis use and sleep start time associated with sleep continuity? An experience sampling method.

BACKGROUND: A substantial proportion of people using cannabis report using it to improve sleep. Yet, little research exists on the associations between the timing of cannabis use and sleep. This study examines the time elapsed between cannabis use and sleep start time and its association with two of the main indicators of sleep continuity: (1) sleep onset latency (SOL) and (2) number of awakenings (NOA) throughout the night. METHODS: Each morning, for 7 consecutive days, daily cannabis users (n = 54) reported on the timing of previous night's cannabis use and sleep indicators on their smartphones. Mixed effects models examined the relations of within- and between-subjects' time elapsed between previous night cannabis use and sleep start time, with (1) SOL and (2) NOA. RESULTS: Within subjects, shorter time elapsed between cannabis use and sleep start time was associated with shorter SOL (ß = 0.519, p = 0.010), but not NOA (ß = -0.030, p = 0.535). Furthermore, between individuals, the time gap between the previous night cannabis use and sleep start time was not associated with SOL or NOA (p > 0.05). CONCLUSIONS: It is possible that cannabis use proximal to bedtime is associated with shorted sleep onset latency but not nighttime awakenings. Cannabis users should be informed about both the potential sleep aid effects of cannabis and its limitations. Pending further evidence of the effects of cannabis on sleep, cannabis users experiencing sleep problems should be provided with evidence-based alternatives to improve sleep, e.g., pharmacological and behavioral treatments.

Quality of life and contact with healthcare systems among patients with psoriasis and psoriatic arthritis: results from the NORdic PAtient survey of Psoriasis and Psoriatic arthritis (NORPAPP).

Psoriasis (skin psoriasis, PsO) is a chronic inflammatory condition. In about one-third of cases, the joints are affected (psoriatic arthritis, PsA). Both conditions, especially PsA, profoundly impact patients' health-related quality of life (HRQoL). To describe the impact of psoriasis on HRQoL and patients' contact with the healthcare system in Sweden, Denmark, and Norway, the NORdic PAtient survey of Psoriasis and Psoriatic arthritis (NORPAPP) asked 22,050 adults randomly selected in Sweden, Denmark and Norway if they had psoriasis. 1264 individuals who reported physician-diagnosed PsO/PsA were invited to the full survey; 1221 responded (74.6% diagnosed with PsO alone; 25.4% with PsA ± PsO). Respondents with PsA most frequently consulted a rheumatologist; however, 14.3% had never seen a rheumatologist. Respondents with PsO alone most frequently consulted a general practitioner and 10.7% had never seen a dermatologist (although those with severe symptoms visited dermatologists more often). Negative impacts on HRQoL were reported by 38.1% of respondents with PsO [mostly limitations on clothing (22.6%), sleep disorders (16%), and depression/anxiety (16%)] and by 73% of respondents with PsA [mostly limitations on clothing (41.8%), sports/leisure (44.0%), or daily routine (45.1%) and sleeping disorders]. Absence from work/education was more common with PsA ± PsO (51.9%) than PsO alone (15.1%). In this survey in Sweden, Denmark, and Norway, the impact of psoriasis on the respondents' HRQoL was profound and was greater for PsA than for PsO, as was sickness absence. Sleeping disorders and depression were common and should not be overlooked.

Sleep of Māori and non-Māori of Advanced Age.

AIM: To estimate prevalence and identify predictors and outcomes of reporting sleep problems in Māori and non-Māori of advanced age. METHOD: Participants were 251 Māori, and 398 non-Māori adults (79-90 years) from Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu. Life and Living in Advanced Age: A Cohort Study in New Zealand. Multiple logistic regression identified predictors of reporting a current sleep problem and investigated relationships between current sleep problems and physical and mental health. RESULTS: 26.3% of Māori and 31.7% of non-Māori reported a current sleep problem. Reporting a current sleep problem was associated with ethnicity (non-Māori, adjusted OR=0.52, 95% CI=0.30-0.90), and reporting a past sleep problem (adjusted OR=2.67, 95% CI=1.25-5.72). Sleep problems were related to poorer physical and mental health, and falling. CONCLUSION: Sleep problems are commonly reported and associated with poorer health. Early recognition and management of sleep problems could improve physical and mental health.

Bed Partner "Gas-Lighting" as a Cause of Fictitious Sleep-Talking.

A case report highlighting a rare and striking, but perhaps under-recognized, cause of reported sleep-talking to a specialist sleep clinic, involving "gas-lighting" by the bed partner.

Noise and stress effects on preschool personnel.

The aim of the study was to analyze the presence of stress-related health problems among preschool employees and the way in which these reactions are related to noise and other work parameters. The investigation included 101 employees at 17 preschools in Umeå County, located in northern Sweden. Individual noise recordings and recordings in dining rooms and play halls were made at two departments from each preschool. The adverse effects on the employees were analyzed by use of different validated questionnaires and by saliva cortisol samples. Stress and energy output were pronounced among the employees, and about 30% of the staff experienced strong burnout syndromes. Mental recovery after work was low, indicated by remaining high levels of stress after work. The burnout symptoms were associated with reduced sleep quality and morning sleepiness. Cortisol levels supported the conclusion about pronounced daily stress levels of the preschool employees.

An unusual clinical phenomenon: a case of bedtime ritual with apparent sexual overtones.

A 6-year-old boy attended a psychology clinic with a history of separation anxiety, delayed bedtime and problematic daytime behaviour. In addition, his mother described that at bedtime he would rock over a particular soft toy (teddy bear) on the floor of his bedroom with the bear straddled between his legs in what appeared to be a sexualized ritual. Clinical history taking and a psychological assessment led to a diagnosis of Separation Anxiety and sleep related Rhythmic Movement Disorder (RMD). Systematic desensitization, token-reward systems and play therapy were used to reduce separation anxiety. Alternative bedtime rocking routines without sexual overtones were developed and resulted in reduced time for sleep initiation, increased total sleep time and improved daytime behaviour. This case study demonstrates a case of severe RMD used as a self-soothing and anxiety-reduction strategy which was initially misinterpreted as a sexualized activity. Caution should be exercised in misinterpreting similar case presentations. Correct diagnosis was increased in this case with a psychologist with expertise in sleep and therefore presents a potentially unmet clinical need for sleep psychologists.

Maternal separation anxiety as a regulator of infants' sleep.

BACKGROUND: The regulation of infants' sleep is determined not only by biological factors but by relational aspects too. This study focused on maternal separation anxiety and examined its association with sleep-wake regulation at 10 months of age. METHOD: In a community sample comprising 52 infants and their mothers, sleep was measured objectively with an activity monitor, as well as through questionnaires. The mothers reported on their own separation anxiety and on the child's perceived distress. RESULTS: The main finding was that maternal separation anxiety was linked to settling to sleep routines and to night-waking. The contribution of the mothers' own separation anxiety to their infants' night-waking remained significant after controlling for the child's fussiness. CONCLUSIONS: Consistent with the transactional perspective, the current research documented an interplay between maternal separation anxiety and aspects of the child's sleep-wake transitions.

Rhythmic movement disorder in sleep persisting into childhood and adulthood.

STUDY OBJECTIVES: To evaluate the type, duration, and distribution of rhythmic movements in sleep stages in school-aged children and young adults; to find out if cases of rhythmic movement disorder persisting beyond infancy are associated with any daytime symptoms or psychopathology. DESIGN: All participants underwent neurologic examination, biochemical screening, electroencephalography, neuroimaging, overnight videopolysomnography, and psychologic examination. SETTING: Department of Neurology and Sleep Laboratory, 1st Medical Faculty, Charles University, Prague. PATIENTS OR PARTICIPANTS: Ten subjects referred to the sleep disorders center because of rhythmic movement disorder. Five males, 5 females; age range, 7-24 years; mean age 14.7 +/- 5.69 years. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Biochemical screening, electroencephalogram, and neuroimaging were unremarkable in all cases. According to duration, 2 types of rhythmic movements were observed on polysomnography: longer episodes appeared in wakefulness and in non-rapid eye movement stage 1 sleep, while shorter episodes (2-80 seconds) occurred during non-rapid eye movement stage 2, non-rapid eye movement stage 3-4, and rapid eye movement sleep. According to sleep-stage distribution, we defined (a) rhythmic movements prevailing in the first half of the night and in the morning hours, usually associated with wakefulness or superficial sleep; (b) rhythmic movements occurring throughout the night in all sleep stages; (c) rhythmic movements prevailing in the second half of the night and mainly associated with rapid eye movement sleep. Psychologic examination showed symptoms of the attention-deficit/hyperactivity disorder in 6 cases. CONCLUSIONS: According to our study, rhythmic movement disorder persisting beyond infancy may be connected with various daytime symptoms; a strong association between rhythmic movement disorder and attention-deficit/hyperactivity disorder was found in school-aged children. We speculate that pathogenetic mechanisms similar to those in attention-deficit/hyperactivity disorder are involved in rhythmic movement disorder or that symptoms of attention-deficit/hyperactivity disorder may be secondary to rhythmic movement disorder.

[Sleep disorders and mental disorders]. / Søvnforstyrrelser og psykiske lidelser.

BACKGROUND: Recent research has revealed a lot of the secrets of sleep and how sleep influences our daily life and mental functioning. MATERIAL AND METHODS: Current knowledge on the interaction between sleep disturbances and mental disorders is reviewed. The review is based on relevant literature identified by search in Medline and PsycInfo. RESULTS: Research shows that sleep as a psychobiological phenomenon interacts with the processes of mental disorders. The best evidence for interactions between sleep disturbances and mental problems is found in depression, and sleep disturbances over some weeks have been found to be a predictor for depressive disorders. INTERPRETATION: Clinicians must distinguish between primary chronic sleep disorders of functional origin and secondary sleep disorders as part of a psychiatric condition. The former category should be treated by non-pharmacological interventions, while the latter should be adequately treated in a biopsychosocial model.

Antecedent control of sleep-awakening disruption.

The sleep-awakening disruption of an adolescent with developmental disabilities was treated using an antecedent control intervention that identified his consistent time of wake-up, provided the presence of a preferred staff in his bedroom, and prompted social interaction from staff before challenging behaviors occurred. Positive findings were documented using a combined reversal and multiple baseline across settings design, with results maintained through a 9-month follow-up. A partial component analysis of the intervention plan suggested that the presence of preferred staff was the influential antecedent variable.