Sleep patterns of sheltered battered women

PURPOSE

To describe sheltered battered women's sleep patterns and resulting daytime fatigue. The model for symptom management framed this study to describe one component of the model--symptom experience. Beginning evidence suggests that sheltered battered women experience disturbed sleep and fatigue that can interfere with vital activities.

DESIGN

Descriptive using a convenience sample of 50 ethnically diverse women residing at least 21 days in battered women's shelters located in one western U.S. city. The study was done in 1997.

METHODS

The Pittsburgh Sleep Quality Index (PSQI), the Mini Motionlogger Actigraph, a sleep diary, the Visual Analogue Scale for Fatigue, and an open-ended interview were used to collect data. Descriptive and inferential statistics were used to analyze the quantitative data. Qualitative data were analyzed to determine patterns and themes.

FINDINGS

Seventy percent of the women had global PSQI scores of greater than five indicating poor sleep and 17 (34%) had a sleep efficiency index of 80% or less. Fourteen (28%) of the women went to bed very fatigued (> 66 mm) and 20 (40%) woke up very fatigued (> 33 mm).

CONCLUSIONS

The majority of sheltered battered women experienced disturbed sleep and daytime fatigue. Both personal and environmental variables were found to significantly affect sleep patterns. Sheltered battered women can benefit from information about sleep disturbances and sleep enhancing self-care strategies.

Sleep disturbances in the Vietnam generation: findings from a nationally representative sample of male Vietnam veterans

OBJECTIVE

This study analyzed questionnaire items that address complaints about sleep from the National Vietnam Veterans Readjustment Study, a nationally representative sample of the 3.1 million men and women who served in Vietnam. This study compared the frequency of nightmares and difficulties with sleep onset and sleep maintenance in male Vietnam theater veterans with male Vietnam era veteran and male civilian comparison subjects. It focused on the role of combat exposure, nonsleep posttraumatic stress disorder (PTSD) symptoms, comorbid psychiatric and medical disorder, and substance abuse in accounting for different domains of sleep disturbance.

METHOD

The authors undertook an archival analysis of the National Vietnam Veterans Readjustment Study database using correlations and linear statistical models.

RESULTS

Frequent nightmares were found exclusively in subjects diagnosed with current PTSD at the time of the survey (15.0%). In the sample of veterans who served in Vietnam (N = 1,167), combat exposure was strongly correlated with frequency of nightmares, moderately correlated with sleep onset insomnia, and weakly correlated with disrupted sleep maintenance. A hierarchical multiple regression analysis showed that in Vietnam theater veterans, 57% of the variance in the frequency of nightmares was accounted for by war zone exposure and non-sleep-related PTSD symptoms. Alcohol abuse, chronic medical illnesses, panic disorder, major depression, and mania did not predict the frequency of nightmares after control for nonsleep PTSD symptoms.

CONCLUSIONS

Frequent nightmares appear to be virtually specific for PTSD. The nightmare is the domain of sleep disturbance most related to exposure to war zone traumatic stress.

Treatment of sleep disturbances in depressed patients

Sleep is disturbed in 90% of patients with major depression. Disordered sleep physiology may persist after clinical remission of depression, suggesting either that sleep disruption is a trait characteristic of recurrent depression or that depressed patients acquire new habits that perpetuate sleep-related problems. This article reviews the data suggesting a common pathophysiology between sleep and depression. It then focuses on a strategy for evaluating and treating sleep disruption in depressed patients. Treatment must have a conservative goal of restoring sleep quality to the pre-episode level. The treatment of sleep disruption relies primarily on optimal treatment of the depression itself. This includes evaluation and treatment of comorbid medical disorders, substance use (e.g., caffeine, alcohol), and sleep disorders (e.g., nocturnal myoclonus, sleep apnea). The effects of the different classes of antidepressant medications on sleep architecture are presented. Nonpharmacologic strategies for improving sleep, such as behavior modification, relaxation, and phototherapy, are discussed. Finally, the risks and benefits of hypnotic use in the depressed patient and a treatment algorithm for the acute and chronic use of hypnotics are considered.

Delta sleep-inducing-peptide-like immunoreactivity (DSIP-LI) and delta sleep in schizophrenic volunteers

Delta sleep-inducing-peptide (DSIP) has been reported to increase sleep in subjects with insomnia. The authors studied cerebrospinal fluid (CSF) DSIP-like immunoreactivity (DSIP-LI) in 15 drug-free male subjects with a DSM-IIIR diagnosis of schizophrenia. The subjects underwent a lumbar puncture and three nights of polysomnography. CSF DSIP-LI was significantly correlated with polysomnography the night before the LP: with stage 3 sleep (p = 0.05), stage 3 and delta (stages 3 + 4) sleep during the first nonrapid eye movement NREM period (p = 0.02 and p = 0.05, respectively) and the ratio of the first and second NREM period (p < 0.05), and negatively with stage 2% sleep (p < 0.05). Whether this first report of a potential relationship between CSF DSIP-LI and slow-wave sleep in man might be generalized to sleep in nonpsychiatric subjects awaits further study.

Sleep in schizophrenic patients on and off haloperidol therapy. Clinically stable vs relapsed patients

We examined the state-dependent contribution of neuroleptic withdrawal and psychotic relapse in influencing sleep measures. Eighteen clinically stable male schizophrenic patients taking haloperidol were studied with 3 nights of polysomnography for baseline measures and again after neuroleptic withdrawal. Sleep measures were also obtained at the point of relapse (n = 9) or after a 6-week drug-free period if the patient remained clinically stable (n = 9). Neuroleptic withdrawal led to a global deterioration of rapid eye movement and non-rapid eye movement sleep and a reduction of rapid eye movement latency in both groups. Relapsers differed from nonrelapsers in that they had a larger decrease in total sleep time, sleep efficiency, total non-rapid eye movement sleep, and stage 2 sleep. The level of psychosis was inversely correlated with sleep efficiency, total sleep time, and stage 4 sleep in the drug-free patients. Our data suggest that clinical state needs to be identified in sleep studies of drug-free patients.

CSF chromogranin A-like immunoreactivity in schizophrenia: relationships with REM latency and slow wave sleep

Chromogranin A (CgA) is a calcium binding protein and a precursor of modulatory peptides in the brain. We measured CgA-like immunoreactivity (CgA-LI) in cerebrospinal fluid (CSF) in 15 male schizophrenic patients (diagnosed by DSM-III-R criteria) after 3 nights of polysomnography. Patients had been drug free for at least 33 days. Our earlier report that CSF CgA-LI in schizophrenic patients correlated significantly with negative symptoms and ventricle-brain ratios, which have been related to slow wave sleep, raised the possibility that CgA-LI might relate to slow wave sleep. CSF CgA-LI was significantly correlated with stage 4 sleep and rapid eye movement latency. Whether these positive relationships between CSF CgA-LI and electroencephalographic sleep measures are specific for schizophrenia awaits further study.

Illness beliefs of leprosy patients: use of medical anthropology in clinical practice

Illness beliefs of 61 patients identified as having leprosy were assessed by Kleinman's Explanatory Model Format. Our patients used a wide variety of etiologic theories which were grouped in categories such as venereal disease, heredity, dangerous food, sin, karma, and humoral disorders. Despite efforts at patient education, very few patients adopted the concept of bacterial infection to explain their illness. The patients identified their illness with a variety of different labels, some of which had associations with particular symptoms. Leprosy was perceived and experienced more as a series of acute disorders not necessarily related to one another. The various theories of illness were instrumental in directing treatment choices which included a number of indigenous healing practices. Such information may be useful in improving patient care and compliance by providing practitioners with interpretive strategies for communicating with their patients.