RESUMEN
The role of melatonin has been extensively investigated in pathophysiological conditions, including autism spectrum disorder (ASD). Reduced melatonin secretion has been reported in ASD and led to many clinical trials using immediate-release and prolonged-release oral formulations of melatonin. However, melatonin's effects in ASD and the choice of formulation type require further study. Therapeutic benefits of melatonin on sleep disorders in ASD were observed, notably on sleep latency and sleep quality. Importantly, melatonin may also have a role in improving autistic behavioral impairments. The objective of this article is to review factors influencing treatment response and possible side effects following melatonin administration. It appears that the effects of exposure to exogenous melatonin are dependent on age, sex, route and time of administration, formulation type, dose, and association with several substances (such as tobacco or contraceptive pills). In addition, no major melatonin-related adverse effect was described in typical development and ASD. In conclusion, melatonin represents currently a well-validated and tolerated treatment for sleep disorders in children and adolescents with ASD. A more thorough consideration of factors influencing melatonin pharmacokinetics could illuminate the best use of melatonin in this population. Future studies are required in ASD to explore further dose-effect relationships of melatonin on sleep problems and autistic behavioral impairments.
Asunto(s)
Trastorno del Espectro Autista/complicaciones , Melatonina/farmacocinética , Trastornos Intrínsecos del Sueño/tratamiento farmacológico , Administración Oral , Adulto , Trastorno del Espectro Autista/metabolismo , Trastorno del Espectro Autista/psicología , Disponibilidad Biológica , Niño , Preescolar , Ritmo Circadiano , Preparaciones de Acción Retardada , Suplementos Dietéticos , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Melatonina/administración & dosificación , Melatonina/análogos & derivados , Melatonina/fisiología , Melatonina/uso terapéutico , Melatonina/orina , Receptores de Melatonina/fisiología , Saliva/química , Estaciones del Año , Serotonina/metabolismo , Trastornos Intrínsecos del Sueño/etiología , Trastornos Intrínsecos del Sueño/fisiopatología , Latencia del Sueño/efectos de los fármacos , Trastorno de la Conducta Social/tratamiento farmacológico , Trastorno de la Conducta Social/etiología , Triptófano/metabolismoRESUMEN
OVERVIEW: Whilst the majority of evidence supports the adjunctive use of eicosapentaenoic acid (EPA) in improving mood, to date no study exists using low-dose docosahexaenoic acid (DHA) alone as an adjunctive treatment in patients with mild to moderate major depressive disorder (MDD). METHODS: A naturalistic 8-week open-label pilot trial of low-dose DHA, (260â mg or 520â mg/day) in 28 patients with MDD who were non-responsive to medication or psychotherapy, with a Hamilton Depression Rating Scale (HAM-D) score of greater than 17, was conducted. Primary outcomes of depression, clinical severity, and daytime sleepiness were measured. RESULTS: After 8 weeks, 54% of patients had a ≥50% reduction on the HAM-D, and 45% were in remission (HAM-D ≤ 7). The eta-squared statistic (0.59) indicated a large effect size for the reduction of depression (equivalent to Cohen's d of 2.4). However confidence in this effect size is tempered due to the lack of a placebo. The mean score for the Clinical Global Impression Severity Scale was significantly improved by 1.28 points (P < 0.05). Despite a significant reduction in the HAM-D score for middle insomnia (P = 0.02), the reduction in excessive daytime somnolence on the total Epworth Sleepiness Scale (ESS) did not reach significance. No significant adverse reactions to DHA were found. CONCLUSION: Within the major limits of this open-label pilot study, the results suggest that DHA may provide additional adjunctive benefits in patients with mild- to -moderate depression.
Asunto(s)
Antidepresivos/uso terapéutico , Antipsicóticos/uso terapéutico , Trastorno Depresivo Mayor/dietoterapia , Trastorno Depresivo Resistente al Tratamiento/dietoterapia , Suplementos Dietéticos , Ácidos Docosahexaenoicos/uso terapéutico , Psicoterapia , Adulto , Antidepresivos/administración & dosificación , Antidepresivos/efectos adversos , Antipsicóticos/efectos adversos , Terapia Combinada/efectos adversos , Depresión/dietoterapia , Depresión/tratamiento farmacológico , Depresión/fisiopatología , Depresión/terapia , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/fisiopatología , Trastorno Depresivo Mayor/terapia , Trastorno Depresivo Resistente al Tratamiento/tratamiento farmacológico , Trastorno Depresivo Resistente al Tratamiento/fisiopatología , Trastorno Depresivo Resistente al Tratamiento/terapia , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Suplementos Dietéticos/efectos adversos , Ácidos Docosahexaenoicos/administración & dosificación , Ácidos Docosahexaenoicos/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Humor/inducido químicamente , Trastornos del Humor/etiología , Trastornos del Humor/prevención & control , Proyectos Piloto , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Trastornos Intrínsecos del Sueño/etiología , Trastornos Intrínsecos del Sueño/prevención & controlRESUMEN
Fibromyalgia has a distinct pathophysiology involving central amplification of peripheral sensory signals. Core symptoms are chronic widespread pain, fatigue, and sleep disturbance. Most patients with fibromyalgia have muscle pain and tenderness, forgetfulness or problems concentrating, and significant functional limitations. Fibromyalgia is diagnosed using an updated set of clinical criteria that no longer depend on tender point examination; laboratory testing may rule out other disorders that commonly present with fatigue, such as anemia and thyroid disease. Patients with fibromyalgia should be evaluated for comorbid functional pain syndromes and mood disorders. Management of fibromyalgia should include patient education, symptom relief, and regular aerobic physical activity. Serotoninnorepinephrine reuptake inhibitors, tricyclic antidepressants, antiepileptics, and muscle relaxants have the strongest evidence of benefit for improving pain, fatigue, sleep symptoms, and quality of life. Multiple complementary and alternative medicine therapies have been used but have limited evidence of effectiveness. Opioids should be used to relieve pain in carefully selected patients only if alternative therapies are ineffective.
Asunto(s)
Fibromialgia/diagnóstico , Fibromialgia/terapia , Analgésicos Opioides/uso terapéutico , Anticonvulsivantes/uso terapéutico , Antidepresivos/uso terapéutico , Terapias Complementarias , Consejo , Medicina Basada en la Evidencia , Ejercicio Físico , Fibromialgia/complicaciones , Humanos , Trastornos del Humor/tratamiento farmacológico , Trastornos del Humor/etiología , Relajantes Musculares Centrales/uso terapéutico , Educación del Paciente como Asunto , Trastornos Intrínsecos del Sueño/tratamiento farmacológico , Trastornos Intrínsecos del Sueño/etiologíaRESUMEN
This is a review of the different complementary techniques that are useful for optimizing home mechanical ventilation (HMV). Airway clearance is very important in patients with HMV and many patients, particularly those with reduced peak cough flow, require airway clearance (manual or assisted) or assisted cough techniques (manual or mechanical) and suctioning procedures, in addition to ventilation. In the case of invasive HMV, good tracheostomy cannula management is essential for success. HMV patients may have sleep disturbances that must be taken into account. Sleep studies including complete polysomnography or respiratory polygraphy are helpful for identifying patient-ventilator asynchrony. Other techniques, such as bronchoscopy or nutritional support, may be required in patients on HMV, particularly if percutaneous gastrostomy is required. Information on treatment efficacy can be obtained from HMV monitoring, using methods such as pulse oximetry, capnography or the internal programs of the ventilators themselves. Finally, the importance of the patient's subjective perception is reviewed, as this may potentially affect the success of the HMV.
Asunto(s)
Terapias Complementarias/métodos , Servicios de Atención de Salud a Domicilio , Respiración Artificial/métodos , Obstrucción de las Vías Aéreas/prevención & control , Terapias Complementarias/psicología , Tos , Técnicas de Diagnóstico del Sistema Respiratorio/instrumentación , Predicción , Humanos , Cifosis/complicaciones , Apoyo Nutricional , Síndrome de Hipoventilación por Obesidad/terapia , Pacientes/psicología , Respiración con Presión Positiva , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/terapia , Calidad de Vida , Respiración Artificial/psicología , Escoliosis/complicaciones , Trastornos Intrínsecos del Sueño/etiología , Trastornos Intrínsecos del Sueño/terapia , Succión , Traqueostomía/instrumentación , Traqueostomía/métodos , Ventiladores MecánicosAsunto(s)
Aminoácidos de Cadena Ramificada/farmacología , Lesiones Encefálicas/complicaciones , Péptidos y Proteínas de Señalización Intracelular/metabolismo , Neuronas/patología , Neuropéptidos/metabolismo , Trastornos Intrínsecos del Sueño/etiología , Trastornos Intrínsecos del Sueño/patología , Aminoácidos de Cadena Ramificada/administración & dosificación , Animales , Suplementos Dietéticos , Ratones , Neuronas/efectos de los fármacos , Neuronas/metabolismo , Orexinas , Trastornos Intrínsecos del Sueño/tratamiento farmacológicoRESUMEN
The purpose of this pilot study was to evaluate the feasibility and effectiveness of a yoga program as an adjunctive therapy for improving post-traumatic stress disorder (PTSD) symptoms in Veterans with military-related PTSD. Veterans (n = 12) participated in a 6 week yoga intervention held twice a week. There was significant improvement in PTSD hyperarousal symptoms and overall sleep quality as well as daytime dysfunction related to sleep. There were no significant improvements in the total PTSD, anger, or quality of life outcome scores. These results suggest that this yoga program may be an effective adjunctive therapy for improving hyperarousal symptoms of PTSD including sleep quality. This study demonstrates that the yoga program is acceptable, feasible, and that there is good adherence in a Veteran population.
Asunto(s)
Trastornos por Estrés Postraumático/terapia , Veteranos/psicología , Yoga/psicología , Ira , Nivel de Alerta , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Proyectos Piloto , Calidad de Vida , Trastornos Intrínsecos del Sueño/etiología , Trastornos Intrínsecos del Sueño/terapia , Trastornos por Estrés Postraumático/complicaciones , Estados UnidosRESUMEN
In this study, the benefits of a program of treatment by laser were evaluated on the improvement of symptoms associated with fibromyalgia. A total of 31 participants took part in the study, all of them women, randomized into two groups: intervention with laser and placebo. The intervention with girlase E11010 consisted of the individual application of six frequencies on seven anatomical zones of the body. The results were statistically significant differences for "weariness" and "difficulty sleeping" variables. In the rest of the variables, we did not find any statistical significance. One of the conclusions from the present study is the need for development of new research to verify the influence of girlase E1.1010 in the improvement of symptoms associated with fibromyalgia.
Asunto(s)
Fibromialgia/radioterapia , Terapia por Luz de Baja Intensidad , Adulto , Fatiga/etiología , Fatiga/radioterapia , Femenino , Fibromialgia/complicaciones , Humanos , Rayos Láser , Persona de Mediana Edad , Dolor/radioterapia , Dimensión del Dolor , Trastornos Intrínsecos del Sueño/etiología , Trastornos Intrínsecos del Sueño/radioterapia , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
Our understanding of the relationship between gastro-oesophageal reflux and respiratory disease has recently undergone important changes. The previous paradigm of airway reflux as synonymous with the classic gastro-oesophageal reflux disease (GORD) causing heartburn has been overturned. Numerous epidemiological studies have shown a highly significant association of the acid, liquid, and gaseous reflux of GORD with conditions such as laryngeal diseases, chronic rhinosinusitis, treatment resistant asthma, COPD and even idiopathic pulmonary fibrosis. However, it has become clear from studies on cough hypersensitivity syndrome that much reflux of importance in the airways has been missed, since it is either non- or weakly acid and gaseous in composition. The evidence for such a relationship relies on the clinical history pointing to symptom associations with known precipitants of reflux. The tools for the diagnosis of extra-oesophageal reflux, in contrast to the oesophageal reflux of GORD, lack sensitivity and reproducibility. Unfortunately, methodology for detecting such reflux is only just becoming available and much additional work is required to properly delineate its role.
Asunto(s)
Reflujo Gastroesofágico/complicaciones , Aspiración Respiratoria/etiología , Enfermedades Respiratorias/etiología , Ácidos y Sales Biliares/análisis , Biomarcadores , Líquido del Lavado Bronquioalveolar/química , Terapia Combinada , Comorbilidad , Agonistas de Dopamina/uso terapéutico , Estudios de Seguimiento , Fundoplicación , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/epidemiología , Reflujo Gastroesofágico/fisiopatología , Reflujo Gastroesofágico/terapia , Pirosis/tratamiento farmacológico , Pirosis/epidemiología , Pirosis/etiología , Humanos , Reflujo Laringofaríngeo/epidemiología , Reflujo Laringofaríngeo/fisiopatología , Laringoscopía , Trasplante de Pulmón , Metaanálisis como Asunto , Modelos Biológicos , Pepsina A/análisis , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Inhibidores de la Bomba de Protones/uso terapéutico , Aspiración Respiratoria/epidemiología , Aspiración Respiratoria/fisiopatología , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/fisiopatología , Índice de Severidad de la Enfermedad , Trastornos Intrínsecos del Sueño/etiologíaRESUMEN
BACKGROUND AND OBJECTIVE: Fibromyalgia is considered as a combination of physical, psychological and social disabilities. The purpose of the present study was to determine the benefits of aerobic exercise program and progressive relaxation techniques on anxiety, quality of sleep, depression and quality of life in patients with fibromyalgia. PATIENTS AND METHOD: An experimental study was performed with a placebo control group. Fifty-six fibromyalgia patients were randomly assigned to intervention (aerobic exercises+progressive relaxation techniques) and placebo (sham treatment with disconnected magnet therapy device) groups. Outcome measures were anxiety (STAI- State Trait Anxiety Inventory), quality of sleep (Pittsburgh sleep quality index), depression (Beck depression inventory) and quality of life (questionnaire SF-36). Measures were performed at baseline and after 10-weeks treatment. RESULTS: After 10 weeks of treatment, the intervention group showed significant reduction (p<0.05) in sleep duration, trait anxiety and quality of life. CONCLUSIONS: The combination of aerobic exercise program and progressive relaxation techniques contribute to improve night rest, trait anxiety and quality of life in patients with fibromyalgia.
Asunto(s)
Ejercicio Físico , Fibromialgia/terapia , Terapia por Relajación , Adulto , Ansiedad/etiología , Ansiedad/terapia , Depresión/etiología , Depresión/terapia , Fibromialgia/complicaciones , Fibromialgia/psicología , Humanos , Persona de Mediana Edad , Calidad de Vida , Índice de Severidad de la Enfermedad , Trastornos Intrínsecos del Sueño/etiología , Trastornos Intrínsecos del Sueño/terapia , Encuestas y Cuestionarios , Resultado del TratamientoAsunto(s)
Anamnesis/estadística & datos numéricos , Médicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Púrpura Trombocitopénica Idiopática/diagnóstico , Adulto , Terapias Complementarias , Utilización de Medicamentos , Educación Médica Continua , Fatiga/diagnóstico , Fatiga/etiología , Hematología , Trastornos Hemorrágicos/diagnóstico , Trastornos Hemorrágicos/etiología , Humanos , Anamnesis/métodos , Oncología Médica , Dolor/diagnóstico , Dolor/etiología , Pediatría , Médicos/psicología , Práctica Profesional/estadística & datos numéricos , Púrpura Trombocitopénica Idiopática/complicaciones , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Púrpura Trombocitopénica Idiopática/psicología , Calidad de Vida , Trastornos Intrínsecos del Sueño/diagnóstico , Trastornos Intrínsecos del Sueño/etiología , Encuestas y CuestionariosRESUMEN
Tinnitus is a symptom caused by the dysfunction of the auditory system associated with hyperactive networks of the central auditory tract. Intimate relationship of the auditory tract with the limbic system may lead to a stress reaction with subsequent sleep disturbances, distress and depression. The target of tinnitus treatment shoud be the annoyance caused by tinnitus, not the sensation itself. Optimally, all tinnitus patients should be treated according to the TRT-principles including careful diagnostics, informational counceling and sound-based therapies. Some patients need sleep therapy as well as anti-depressive therapy.
Asunto(s)
Acúfeno/fisiopatología , Acúfeno/terapia , Estimulación Acústica , Audición/fisiología , Humanos , Trastornos Intrínsecos del Sueño/etiología , Trastornos Intrínsecos del Sueño/terapia , Acúfeno/complicacionesRESUMEN
Two United States Air Force Airmen were injured in a roadside improvised explosive device (IED) blast in Iraq in January 2008. Both airmen suffered concussive injuries and developed irritability, sleep disturbances, headaches, memory difficulties and cognitive difficulties as symptoms of mild traumatic brain injury (mTBI). Six months after injury, repeat Automated Neuropsychological Assessment Metrics (ANAM) testing showed deterioration, when compared to pre-injury baseline ANAM assessment, in all measured areas (simple reaction time, procedural reaction time, code substitution learning, code substitution delayed, mathematical processing, and matching to sample). The airmen were treated with hyperbaric oxygen in treatments of 100% oxygen for one hour at 1.5 atmospheres absolute, resulting in rapid improvement of headaches and sleep disturbances, improvement in all symptoms and resolution of most symptoms. Repeat ANAM testing after completion of the hyperbaric treatments - nine months after initial injury - showed improvement in all areas, with most measures improving to pre-injury baseline levels. The airmen received no other treatment besides medical monitoring. Repeat neuropsychologic testing confirmed the improvement. We conclude that the improvement in symptoms and ANAM performance is most likely attributable to HBO treatment.
Asunto(s)
Traumatismos por Explosión/terapia , Lesiones Encefálicas/terapia , Trastornos del Conocimiento/terapia , Oxigenoterapia Hiperbárica/métodos , Traumatismos por Explosión/complicaciones , Conmoción Encefálica/complicaciones , Conmoción Encefálica/terapia , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/diagnóstico , Trastornos del Conocimiento/etiología , Humanos , Masculino , Personal Militar , Cefalea Postraumática/terapia , Trastornos Intrínsecos del Sueño/etiología , Trastornos Intrínsecos del Sueño/terapia , Adulto JovenRESUMEN
The congenital malformation known as optic nerve hypoplasia (ONH) has been recognized in the past 30 years as an epidemic cause of congenital blindness. It was believed to occur either as an isolated anomaly or as a component of the syndrome of septo-optic dysplasia, which has evolved to include midline brain malformations and hypopituitarism. Evidence now suggests that ONH infrequently occurs in isolation. Most afflicted children will have hypothalamic dysfunction and/or neurodevelopmental impairment, regardless of MRI findings or severity of ONH. Adverse outcomes can often be ameliorated with early intervention. Thus, the syndrome of ONH should be suspected in all infants with signs of hypothalamic dysfunction or vision impairment.
Asunto(s)
Nervio Óptico/anomalías , Displasia Septo-Óptica/congénito , Anciano , Anciano de 80 o más Años , Animales , Axones/patología , Enfermedades de los Perros/genética , Enfermedades de los Perros/patología , Perros , Femenino , Trastornos del Crecimiento/etiología , Humanos , Hipopituitarismo/congénito , Hipopituitarismo/etiología , Hipotálamo/anomalías , Hipotálamo/fisiopatología , Recién Nacido , Masculino , Ratones , Disco Óptico/anomalías , Disco Óptico/patología , Nervio Óptico/patología , Prevalencia , Displasia Septo-Óptica/diagnóstico , Displasia Septo-Óptica/embriología , Displasia Septo-Óptica/epidemiología , Displasia Septo-Óptica/genética , Displasia Septo-Óptica/patología , Displasia Septo-Óptica/veterinaria , Tabique Pelúcido/anomalías , Trastornos Intrínsecos del Sueño/etiología , SíndromeRESUMEN
In Parkinson's disease (PD), waking is frequently punctuated by sleep episodes, including rapid eye movement (REM) (i.e., dream) sleep, and sleep is interrupted by motor activities such as periodic limb movements and REM sleep behavior disorder. Because these pathologic behaviors are unaccounted for by contemporary models, this review summarizes the complex effects of dopamine (DA) on normal and pathological waking-sleeping. Maintenance of wakefulness is probably promoted by mesocorticolimbic DA circuits, and suppression of nocturnal movement appears to be influenced by indirect pathways linking midbrain DA neurons with pre-motor structures in the mesopontine tegmentum and ventromedial medulla. A diencephalospinal DA system may have an additional important role in mediating state-specific sensorimotor activity that is relevant to periodic limb movements and restless legs syndrome.
Asunto(s)
Dopamina/fisiología , Mesencéfalo/fisiología , Sueño/fisiología , Vigilia/fisiología , Nivel de Alerta/fisiología , Estimulantes del Sistema Nervioso Central/farmacología , Ritmo Circadiano/fisiología , Cuerpo Estriado/fisiología , Agonistas de Dopamina/farmacología , Humanos , Neuronas/fisiología , Síndrome de Mioclonía Nocturna/etiología , Síndrome de Mioclonía Nocturna/fisiopatología , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/fisiopatología , Puente/citología , Puente/fisiología , Sueño/efectos de los fármacos , Trastornos Intrínsecos del Sueño/etiología , Trastornos Intrínsecos del Sueño/fisiopatología , Sustancia Negra/fisiología , Tálamo/fisiologíaRESUMEN
Visual hallucinations (VHs) occur frequently in Parkinson's disease (PD). VHs occur more frequently in elderly patients with longer duration of illness, cognitive impairment, and sleep disturbances. The relationship between the use of antiparkinsonian drugs and VHs is complicated, but most drugs used to treat parkinsonian motor symptoms induce VHs and psychosis in some PD patients. The "continuum hypothesis" proposing that medication-induced psychiatric symptoms in PD begin with drug-induced sleep disturbances, followed by vivid dreams, with progression to hallucinatory and delusional experiences has been challenged. In some patients, VHs may represent intrusion of REM sleep-related imagery into wakefulness. Improving REM sleep abnormalities in PD (e.g., stimulants, anticholinesterase inhibitors) is one strategy now being tested to improve VHs in PD.
Asunto(s)
Alucinaciones/etiología , Enfermedad de Parkinson/complicaciones , Trastornos Intrínsecos del Sueño/etiología , Antiparkinsonianos/efectos adversos , Antiparkinsonianos/uso terapéutico , Inhibidores de la Colinesterasa/uso terapéutico , Clozapina/uso terapéutico , Dopaminérgicos/efectos adversos , Dopaminérgicos/uso terapéutico , Sueños/fisiología , Alucinaciones/fisiopatología , Humanos , Enfermedad de Parkinson/tratamiento farmacológico , Enfermedad de Parkinson/fisiopatología , Polisomnografía , Trastornos Psicóticos/tratamiento farmacológico , Trastornos Psicóticos/etiología , Trastornos Psicóticos/fisiopatología , Privación de Sueño/etiología , Privación de Sueño/fisiopatología , Privación de Sueño/psicología , Trastornos Intrínsecos del Sueño/tratamiento farmacológico , Trastornos Intrínsecos del Sueño/fisiopatología , Sueño REM/efectos de los fármacosRESUMEN
In blind individuals, the absence of light cues results in disturbances of sleep and sleep-related neuroendocrine patterns. The Zeitgeber influence of light on the timing of sleep is assumed to be mediated by melatonin, a hormone of the pineal gland, whose secretion is inhibited by light and enhanced during darkness. Here, we investigated whether a single administration of melatonin improves sleep and associated neuroendocrine patterns in blind individuals. In a double-blind crossover study, 12 totally blind subjects received 5 mg melatonin and placebo orally 1 h before bedtime starting at 2300 h. The dose used enhanced blood melatonin concentrations to clearly supraphysiological levels. Melatonin increased total sleep time and sleep efficiency (P < 0.05, respectively) and reduced time awake (P < 0.05). The increment in total sleep time was primarily due to an increase in stage 2 sleep (P < 0.01) and a slight increase in rapid eye movement sleep (P < 0.06). Most important, melatonin normalized in parallel the temporal pattern of ACTH and cortisol plasma concentration. While after placebo, ACTH and cortisol levels did not differ between early and late sleep, melatonin induced the typical suppression of pituitary-adrenal activity during early sleep and a distinct rise during late sleep (P < 0.01, respectively). Cortisol nadir values were also decreased after melatonin (P < 0.05). We conclude from these data that in totally blind individuals the single administration of a clearly pharmacological dose of melatonin can improve sleep function by synchronizing in time the inhibition of pituitary-adrenal activity with central nervous sleep processes.
Asunto(s)
Adyuvantes Inmunológicos/administración & dosificación , Ceguera/complicaciones , Melatonina/administración & dosificación , Trastornos Intrínsecos del Sueño/tratamiento farmacológico , Adolescente , Hormona Adrenocorticotrópica/sangre , Adulto , Ceguera/fisiopatología , Estudios Cruzados , Humanos , Hidrocortisona/sangre , Masculino , Sistemas Neurosecretores/fisiología , Polisomnografía , Trastornos Intrínsecos del Sueño/etiología , Trastornos Intrínsecos del Sueño/fisiopatologíaRESUMEN
Kava and valerian are herbal remedies, claimed to have anxiolytic and sedative properties respectively, without dependence potential or any appreciable side-effects. In this pilot study, 24 patients suffering from stress-induced insomnia were treated for 6 weeks with kava 120 mg daily. This was followed by 2 weeks off treatment and then, 5 having dropped out, 19 received valerian 600 mg daily for another 6 weeks. Stress was measured in three areas: social, personal and life-events; insomnia in three areas also: time to fall asleep, hours slept and waking mood. Total stress severity was significantly relieved by both compounds (p < 0.01) with no significant differences between them; as was also insomnia (p < 0.01). The proportion of patients with no side-effects was 58% with each drug respectively and the 'commonest' effect was vivid dreams with valerian (16%), followed by dizziness with kava (12% ). These compounds may be useful in the treatment of stress and insomnia but further studies are required to determine their relative roles for such indications.