Symptoms of Shift Work Sleep Disorder:

• Headaches
• Fatigue
• Difficulty concentrating at work
• Irritability

Dealing with Shift Work Sleep Disorder:
If you suspect that you have shift work disorder, here are a few tips to deal with it:

• Avoid exposure to bright light after coming back from work. Light signals your body to stay awake and can keep you from sleeping
• Avoid working overtime
• Avoid working in rotating shifts
• Try to get enough sleep every day, about 7 to 8 hours of sleep necessary on a daily basis
• Have a regular sleeping schedule, even if you are sleeping during the day. This will help your body to adjust to the new sleep cycle
• Keep your bedroom dark, noise-free, and of comfortable temperature
  Ask your family members or friends at your place to minimize the noise or sounds. For example, you can ask them to use headphones while watching television

Shift work sleep disorder can cause accidents, work-related errors, and mood disorders. Not all people working in shifts have this disorder; few of them adjust to the new sleep timings easily. However, if you experience problems due to the new sleeping schedule, do speak to your doctor for advice and treatment.

These seizures are usually tonic-clonic seizures, where the patient may fall into a deep sleep or lose consciousness immediately after their seizure.

Symptoms:

• The seizures might occur just after a person has fallen asleep, just before waking, during daytime sleep, or while in a state of drowsiness.
• People who experience nocturnal seizures may find it difficult to wake up or to stay awake.
• After getting up from the sleep they may arise with a headache, have temper tantrums, or other destructive behavior throughout the day.
• There may be some unusual differences such as having wet the bed, having bit the tongue, a bone or joint injury or light-headedness.

Diagnosis:

Electroencephalogram test or scalp EEG is the premiere test given in order to diagnose epilepsy. Other techniques used to differential diagnose nocturnal epilepsy include MRI (Magnetic Resonance Imaging) of the brain, PET (Positron Emission Tomography), SPECT (Single-Photon Emission Computed Tomography) and MRS (Magnetic resonance spectroscopy).

Treatment:

Anticonvulsant therapy should be initiated once the diagnosis of epilepsy is established. Many nocturnal episodes of epilepsies are treated well carbamazepine.

Patients with medically intractable nocturnal epilepsy are considered for resective epilepsy surgery. In this surgery, the surgeon removes the area of the brain that causes the patient’s seizures. Here it is the temporal lobectomy, in which part of the temporal lobe of the brain is removed.

If resective surgery is not possible, other surgical options include corpus callosotomy, multiple subpial transections, or the vagal nerve stimulator.

Parasomnias may be classified into primary and secondary.

Primary parasomnias are the disorders of sleep states and are concerned only to the sleep phenomena of the individuals. They can be further classified according to the sleep state of origin, rapid eye movement (REM), or non-rapid eye movement (NREM)

Secondary parasomnias are the disorders of other organ systems that may manifest during sleep. For example arrhythmias, seizures, respiratory dyskinesias, and gastroesophageal reflux.

NREM parasomnias are primary parasomnias that cause sudden arousal of the patient during the stages 3 and 4 of NREM sleep. They are also known as slow wave sleep (SWS) parasomnias. Here there is physiological activation in which the patient’s brain exits from SWS and is caught in between a sleep and waking state. In particular, these disorders involve activation of the autonomic nervous system, motor system, or cognitive processes, during sleep or sleep-wake transitions.

Some of the causes of NREM are alcohol, sleep deprivation, physical activity, emotional stress, depression, medications, or a fevered illness. Some of the disorders that can be put in this category are confusional arousals, somnambulism and night terrors. Other specific disorders include sleepeating, sleep sex, teeth grinding, rhythmic movement disorder, restless legs syndrome, and somniloquy.

REM parasomnias are the behavior related disorders that occur during the REM stage of sleep. Here the subject enacts the dream that includes talking, yelling, punching, kicking, sitting, jumping out of bed, arm flailing, and grabbing.

Other Dramatic Parasomnias:

Following other conditions that should be considered as possible explanations for dramatic behavior at night in children and adults: True nightmares, nocturnal asthmatic attacks, ‘awakenings’ associated with obstructive sleep apnea, nocturnal panic attacks, sleep paralysis, pseudoparasomnias and overlap parasomnias.

Diagnosis and Differential Diagnosis:

Polysomnography, Electroencephalography (EEG) – Postarousal EEG, Electro Myography (EMG), Muscle twitch studies and Actigraphy are the common methods of diagnose and differential diagnose parasomnias.

Melatonin supplements can be helpful. For dealing with circadian rhythm abnormalities you have to work out with your sleep wake cycle for at least a week before the flight. Try to adjust the your sleep and wake timing to the time zones of the place you are going to so that you don’t face much jet lag. No-jet-lag is one of the safe and effective homeopathy remedy for counteracting jet lag.

Symptoms of Jet Lag:

Jet lag is experienced when your internal clock goes haywire and throws your body off balance. It is a disruption that can affect how and when you sleep, how and when you eat, and when to be mentally alert. It is scientifically called Circadian Dischronism. Some of the symptoms include:

• Broken sleep or insomnia for few days
• Disorientation and lack of concentration
• Fuzziness and fatigue or tiredness
• Becoming irrational or unreasonable
• Dehydration which can cause headaches, dry skin and nasal irritation
• Discomfort of legs and feet. There may be some swelling in the limbs while flying and can be very uncomfortable.

Remedies:

Before You Fly: Get plenty of rest and be calm till you board the plane. Have thorough physical and mental check up with your doctor. Be well hydrated. Avoid the things that dehydrate you ex caffeine, coffees, tea. Plan to wear comfortable clothing that allows you to move freely.

While You Fly: Drink at least 8-12 oz. of water each hour that you are on the plan. Make sure that you drink clean mineral water suitable to your body. Avoid drinking alcohol and caffeine as it may dehydrate you. You may apply a lotion to minimize the dehydration of your skin. Be sure to set your watch to the new time zone upon departure to help prepare your mind for your new time zone. You can walk around the cabin of the plane and can do mild stretch exercises. Sleep on the plane if you are scheduled to arrive in the morning. Stay awake on the plane if you are scheduled to arrive in the evening. Keep yourself busy with an activity, reading, needlework, or conversation. Avoid taking Sleeping Pills.

After You Fly: As soon as you get off the plane stand in direct sunlight for 10-20 minutes without glasses. Start moving e.g., use the stairs and avoid the elevators, escalators and moving sidewalks. At your destination, walk barefoot on the ground, if possible, and/or swim in the ocean or soak in an Epsom salt bath. This will help ground your electromagnetic system. Keep your mind off of the time difference. Don’t think about what time it is at home. Get some outdoor exercises. Keep drinking plenty of water. Take a shower or bathe to help re-hydrate and refresh your body.

The MSLT charts brain waves and heartbeat and records eye and chin movements. The study also measures how quickly and how often one enters the rapid-eye-movement (REM) stage of sleep. The test usually begins about two hours after awakening in the morning and continues to late afternoon or early evening. The test is painless and the diagnosis takes about seven hours to complete.

Procedure:

The patient is taken to the screening procedure and all the drugs used by the patient are noted down. The patient submits the sleep diary for at least one week before the MLST. The patient should not smoke for at least 30 minutes before each nap trial. The patient is advised not to have alcohol or caffeine during the procedure.

Generally MSLT is performed immediately following polysomnography recording on the previous night. This helps to access the causes of excessive sleeping during the day. A cool, dark and quiet place is selected where the patient is allowed to rest during testing. Sensors are placed on the head, face, chin and chest of the patient which are in turn connected to a computer for recording.

The patient is asked to lie quietly in bed and try to go to sleep. The test will measure how long it takes the subject to fall asleep. After sleeping for 15 minutes the patient is awakened. Each trial will end if the patient does not fall asleep within 20 minutes and about 5 such trials are recorded at two-hour interval each. Between the nap trials, the patient is asked to stay out of bed so that he remains awake. After the last nap trial, the sensors are removed and the patient is free to go.

The MLST Record:

MLST records the data from the nap study and the chart gives sleep wake times and sleep stages. The technologist looks for and counts the number of times the patient entered REM sleep. MLST report includes the start and end times of each nap or nap opportunity, latency from lights out to the first epoch of sleep, mean sleep latency (arithmetic mean of all naps or nap opportunities), and number of sleep-onset REM periods (defined as greater than 15 sec of REM sleep in a 30-sec epoch).

In this article you will find how to get rid of these sleep-enemies:

• Bed bugs are persistent and getting rid of them requires persistence. You have to start the treatment of getting rid of bed bugs from the day you find them under your bed. Bed bugs multiply soon. So you should be smart enough to subdue them before it is too late.
• Wash all your bedding in very hot water. Soft toys and other things that cannot be washed should be sealed in plastic bags for a couple of weeks.
• If you hire an exterminator strip down your bedroom to its barest so that the bed bugs are exposed, as they tend to hide out in small cracks and crevices. Take the cushions off of couches and strip down mattresses and prevent bed bugs from having the opportunity to hide out and escape the mass killing.
• Next step is to vacuum everything including mattress, upholstered furniture, the drapes, bed frames, the baseboards, and any furniture near the bed. Although by vacuuming you may not catch every single bug and egg, it will help get rid of some of the infestation before treatment with pesticides. When you have done with that; place the vacuum cleaner contents in a sealed bag.
• One way of preventing bed bugs in your bed room is to use a plastic mattress cover. Bed bugs will not be able to hide on the cover.
• In extreme cases you can use pesticides recommended by pest control unit in your locality. Pesticides contain permethrins and pyrethrins which effectively kill bed bugs but they can be harmful to humans and pets. You must careful not to expose your eyes and skin while using such products. Avoid using these pesticides for the long time as they may have other complications.
• One of the natural ways is ‘Bug Patrol.’ It is an all-natural product that is very effective. It is supplied in both spray and dust that, when used together, eliminate bed bugs and keep them from coming back. It is easy to use and doesn’t cause the harmful side effects as those of pesticides.

Dosage: Temazepam is produced as a gel-filled capsule, designed to be taken orally. A normal therapeutic dose of temazepam would be 10mg-30mg for adults. For elderly and debilitated patients the initial dose before retiring should not exceed 15 mg. The dose should be short-term i.e. only for 7-10 consecutive days. Use for more than 2-3 consecutive weeks requires complete re-evaluation of the patient.

Contraindications:

• Temazepam is contraindicated if the person is allergic to temazepam or to other benzodiazepines drugs.
• This medicine should not be taken if the person suffers from myasthenia gravis, sleep apnea syndrome, asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems.
• Temazepam is not recommended for a person having previous paradoxical reactions to alcohol and/or sedative medications.
• This medication can cause birth defects in an unborn baby, or withdrawal symptoms in a newborn. Pregnant women and nursing mothers should not take this medicine. This medicine is contraindicated for anyone under 18 years old.

Side Effects:

Some of the common side effects include: Dizziness, fatigue, lethargy, drowsiness, headache, confusion, euphoria, staggering, ataxia, falling and infrequent paradoxical reactions (e.g. excitement, stimulation, hyperactivity, hallucinations).

Drug Interactions:

Temazepam interacts with certain other drugs, including cimetidine (an antihistamine); disulfiram (a drug given to help patients control cravings for alcohol); or clozapine (an antipsychotic medication). It should be co-administered with other CNS depressants such as barbiturates, alcohol, opiates and tricyclic antidepressants as temazepam is itself a CNS depressant.

Construction and Working:
A CPAP device includes a mask, tubes and a fan. The main component of a CPAP device is a small, portable compartment that quietly compresses and releases air. The device works by releasing a continuous, slightly pressurized stream of air directly into a person’s nose, which allows for unobstructed breathing.

There is often a digital or analog display screen on the compartment which indicates that the CPAP device is operating and the amount of air pressure that it is generating. Medical professionals can determine, preset, and adjust air pressurization levels based on an individual’s specific condition and needs. People who experience excessive nasal dryness can obtain CPAP models that are equipped with small humidifiers.

Since it is unnecessary to continuously apply pressure to the airway even when the patient is not having an apnea, the researchers are devising CPAP that pushes air in only when the patient has apnea. Pulse oximeter is also used in latest CPAP devices to achieve this but it needs more research in this subject.

Types of CPAP devices:

Modern CPAP devices have four types of masks: Triangular masks, Oral masks, Nasal pillow masks and Hybrid masks.

There are four different types of CPAP machines:

• Traditional CPAP: This is obviously the most common type of CPAP machine. It will provide you with a steady pressure while you sleep to assist with your sleep apnea.
• BiPAP: With this type of machine, you will have one pressure for when you exhale at night and one (stronger) pressure for when you inhale.
• Automatic: For people with sleep apnea who don’t want to have to worry about the pressure of their machine, the automatic is the best choice. It reads your body and regulates how much pressure you need while you’re sleeping.
• Travel CPAP: You may get this one in addition to one of the others if you travel a lot. You may also choose to get only this one because it is smaller and more convenient than the others.

Problems associated and Side Effects of CPAP Devices:

• Nasal stiffness or congestion
• Nasal irritation or drying
• Dryness of the mouth
• Mask air leaks
• Noise made by the PAP machine
• Sore, dry or red eyes
• Skin irritation from the mask and/or straps
• Abdominal bloating
• Too much air
• Headaches

Actigraph: It a small instrument generally watch-shaped and worn on the wrist of the non-dominant arm. It is also called actigraph unit, actimetry sensor, acti-watch or sleep actigraph.

Procedure: A small actigraph unit is worn by a patient to measure gross motor activity. Motor activity often under test is that of the wrist, measured by an actigraph in a wrist-watch-like package. The unit continually records the movements it undergoes. The data is later read to a computer where it can be analyzed.

The patient is asked to keep a sleep diary over a week and fill few questionnaires about sleep quality, daytime sleepiness, fatigue and mood. This additional information will facilitate in the assessment of sleep wake cycles.

Recommendations and Assessment:

• Actigraphy is useful for assessing daytime sleepiness in situations where a laboratory sleep latency test is not appropriate. It is used to clinically evaluate insomnia, circadian rhythm sleep disorders, excessive sleepiness and restless legs syndrome. It is also used in assessing the effectiveness of pharmacologic, behavioural, phototherapeutic or chronotherapeutic treatments for such disorders.
• Actigraphy is indicated to assist in evaluating patients for Advanced Sleep Phase Syndrome (ASPS), Delayed Sleep Phase Syndrome (DSPS), and shift-work sleep disorder as well as circadian rhythm disorders, including jet lag and non–24-hour sleep-wake syndrome (including that associated with blindness).
• When polysomnography is not available, actigraphy is indicated to estimate total sleep time in patients with obstructive sleep apnea syndrome. Compared with using time in bed, use of actigraphy combined with a validated method to monitor respiratory events may improve accuracy in determining the severity of obstructive sleep apnea.
• In patients with insomnia, including insomnia associated with depression, actigraphy is indicated as a method to characterize circadian rhythm patterns or sleep disturbances.
• In patients with complaints of hypersomnia, actigraphy is indicated as a method to determine circadian pattern and estimate average daily sleep time.
• Actigraphy is indicated to determine sleep patterns and to document treatment responses in healthy infants and children, in whom traditional sleep monitoring using polysomnography can be difficult to perform and/or interpret, as well as in special pediatric populations.

Description:
There are 19 self-rated questions and 5 questions rated by a bed partner or roommate in PSQI. Among 19 questions there are 15 multiple-choice questions and 4 write-in questions. Multiple choice questions inquire about frequency of sleep disturbances and subjective sleep quality and write-in questions inquire about typical bedtime, wake-up time, sleep latency, and sleep duration. The 5 bed partner questions are multiple-choice ratings of sleep disturbance.

All items are brief and easy for most adolescents and adults to understand. The items have also been adapted so that they can be administered by a clinician or research assistant. The PSQI can be used for both initial assessment and ongoing comparative measurements with older adults across all health care settings.

Ratings:
The client self-rates each of these seven areas of sleep. Scoring of answers is based on a 0 (no difficulty) to 3 (severe difficulty) scale. The component scores are summed to produce a global score (range of 0–21). A PSQI global score >5 is considered to be suggestive of significant sleep disturbance. Cut off scores are not available for component scales.

Clinical Studies:
The sum of scores for these seven components yields one global score. Clinical and clinometric properties of the PSQI were assessed over an 18-month period with “good” sleepers (healthy subjects, n = 52) and “poor” sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. Numerous other studies using the PSQI have supported high validity and reliability.

Limitations of PSQI:
The PSQI is a subjective measure of sleep. Self-reporting by clients can empower the client, but can reflect inaccurate information if the client has difficulty understanding what is written, or can not see or physically write out responses. Moreover, the scale is presented in English. The scale can be adapted to enable clients to respond verbally to items on the scale by having the nurse read the statements to the client.