The symptoms of restless legs syndrome usually involve legs, but can extend to other body parts. However, isolated body parts other than the leg are rarely involved. A 36-year-old woman presented for evaluation with a tingling and burning sensation in the both hands for one year. These abnormal sensations appeared in the evening and night, resulting in difficulty in falling asleep. The symptoms were relieved by shaking and bending of hands and wrists. Pramipexole was increased to 0.375 mg, and 75 mg of pregabalin was added, but her abnormal nocturnal sensation was not improved. Overt hyperthyroidism was revealed by thyroid function test: free thyroxin 2.99 ng/dL and thyroid-stimulating hormone 0.009 µIU/mL. One month later, her symptom showed much improvement after taking methimazole 5 mg twice a day. We report a case of abnormal nocturnal sensation of hands in the patient with hyperthyroidism who responded with methimazole.
Accidental Falls ; Adult ; Burns ; Female ; Hand* ; Human Body ; Humans ; Hyperthyroidism* ; Leg ; Methimazole ; Pregabalin ; Restless Legs Syndrome ; Sensation* ; Thyroid Function Tests ; Thyrotropin ; Thyroxine ; Wrist

Sleep-related laryngospasm is a rare cause of sleep-related breathing disturbance which produce stridor or interruption of airflow associated with a distinct polysomnography arousal pattern. We report a case of a sixty-five-year-old woman who was referred for awakenings with abrupt respiratory distress and fear of suffocation. A polysomnography showed a total or near-total cessation of airflow, followed by choking and stridor for several minutes with a rapid increase in heart rate. Temporary hoarseness was seen. The esophageal pH monitoring indicated acid reflux, which confirmed gastroesophageal reflux disease. The protonpump inhibitor eliminated the sleep-related laryngospasm.
Airway Obstruction ; Arousal ; Asphyxia ; Esophageal pH Monitoring ; Female ; Gastroesophageal Reflux* ; Heart Rate ; Hoarseness ; Humans ; Laryngismus* ; Polysomnography ; Respiration ; Respiratory Sounds

OBJECTIVES: The current study aimed to investigate individuals with night eating syndrome tendency in 115 female undergraduate sample based on night eating syndrome criteria, and analyze its association between mood, sleep, and alcohol use. METHODS: Subjects were divided into high and low tendency group of night eating syndrome based on the night eating questionnaire. All participants completed the Hospital Anxiety and Depression Scale, Insomnia Severity Index, Munich Chronotype Questionnaire, and Alcohol-Use Disorders Identification Test. Data was collected at two time points which were 3 months apart. All analyses were conducted using repeated measure ANOVA. RESULTS: Results indicated a significant difference between night eating syndrome tendency groups for anxiety and depression [F(1,113)=12.35, p=0.001 and F(1,113)=9.59, p=0.002, respectively]. Depression also had a significant time effect [F(1,113)=11.15, p=0.001]. Additionally, the high night eating syndrome tendency group had higher levels of insomnia severity [F(1,113)=24.34, p<0.001], eveningness [F(1,113)=15.09, p<0.001], and alcohol use [F(1,113)=6.73, p=0.011], and lower sleep efficiency [F(1,113)=6.30, p=0.014] compared to the low night eating syndrome tendency group. CONCLUSIONS: The high night eating syndrome tendency group had higher negative mood, sleep disturbance, and alcohol use compared to the low night eating syndrome tendency group. In summary, intervention for night eating syndrome may be important to consider in undergraduate students.
Alcohol Drinking ; Anxiety ; Circadian Rhythm ; Depression ; Eating* ; Feeding and Eating Disorders ; Female* ; Humans ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: We conducted this study to evaluate the utility of the McGill oximetry score (MOS) to rule out moderate to severe obstructive sleep apnea syndrome (OSAS) in Korean children. METHODS: We performed a cross-sectional study by using medical and polysomnography (PSG) records from our sleep disorder center. We assessed 58 PSG records conducted from September 2011 to December 2015. MOS was calculated from the overnight oximetry tests performed as part of PSG. We also investigated age, gender, height z-score, weight z-score, body mass index z-score, obesity, underweight, and pediatric daytime sleepiness scale. RESULTS: MOS revealed inconclusive (score 1) in 50 (68.2%), and abnormal (2-4) in 8 (13.8%) of PSG results. And moderate to severe OSAS were diagnosed in 20 (34.5%) records according to the apnea-hyponea index (≥5). In a multivariate logistic regression analysis, age [adjust odds ratio (OR) 0.8; p-value=0.013] and abnormal MOS (adjust OR 39.5; p-value=0.007) showed statistical significance between normal/mild OSAS group and moderate/severe OSAS group. MOS had a positive predictive value of 88%, a negative predictive value of 74%, a sensitivity of 35% and a specificity of 97% for detecting moderate/severe OSAS. CONCLUSIONS: In our small group study, MOS cannot exclude moderate to severe OSAS. Further prospective studies are needed.
Body Mass Index ; Child* ; Cross-Sectional Studies ; Humans ; Logistic Models ; Obesity ; Odds Ratio ; Oximetry* ; Polysomnography ; Prospective Studies ; Sensitivity and Specificity ; Sleep Apnea, Obstructive* ; Sleep Wake Disorders ; Thinness

OBJECTIVES: Shift workers are at risk for various sleep and health-related problems. To investigate light exposure and sleep-wake pattern according to shift schedules in shift workers. METHODS: We enrolled 12 full-time, rapidly rotating three-shift female nurses (age 26.4±4.01 years). They completed sleep logs and actigraphy monitoring of sleep-wake parameters, light exposure, and activity levels for over 14 days (mean numbers of night shifts 2.5). RESULTS: Before beginning shift work, participants were healthy and had no history of hypnotics. One third of participants (33.3%) had clinically significant insomnia-related symptoms (insomnia severity index ≥15, mean 14.0). Reported health problems were irregular menstruation cycles (75%), nightmares (25%), and irritable bowel syndrome (16.7%). Mean sleep time was less than 6 h regardless of the shift periods and wakefulness after sleep onset was prolonged more than 30 min. Light exposure in night-shift periods was the lowest during working hours and the highest during non-working hours. Activity levels were not different during working hours throughout the schedules. CONCLUSIONS: Fast-rotating shift nurses sleep less and unsatisfactorily. Health-related problems were frequent in shift nurses. Rapidly rotating shift schedules and related inappropriate light exposure may be detrimental to sleep and health in shift workers.
Actigraphy ; Appointments and Schedules ; Dreams ; Female ; Humans ; Hypnotics and Sedatives ; Irritable Bowel Syndrome ; Menstruation ; Wakefulness

The Cognitive-Behavioral Therapy for Insomnia (CBT-I) is an important and effective treatment for insomnia patients. However, it is not easy for most general practitioners to learn and practice CBT-I, and it is popular to prescribe sleeping pills to insomnia patients in clinical practice. In the case, we need to consider the factors which can influence the effect of sleeping pills to prescribe sleeping pills appropriately and safely with the lowest dosage. Age, gender, medical or psychiatric comorbid disease, workplace, or sleep environment may affect the patients' satisfaction with their sleeping pills. Physician should know about the mechanism of action of each sleeping pill and which type of sleeping pills needs to be prescribed to patients in each situation. Physician also needs to ask patients what time they took their sleeping pills and check whether patients followed physician's sleeping pills administration instruction or not. In this review, we want to discuss about optimizing the sleeping pills prescription to insomnia patients.
Drug Therapy ; General Practitioners ; Humans ; Hypnotics and Sedatives ; Prescriptions ; Sleep Initiation and Maintenance Disorders*

Although a nasal mask is a standard interface for continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA), severe mouth breathing during sleep often leads to the use of a full face mask which covers the nose and mouth. Herein, we present a case of a patient with uncontrolled severe OSA with CPAP and a full face mask, who subsequently shows dramatic improvement of OSA with a nasal mask and lower CPAP pressure.
Continuous Positive Airway Pressure* ; Humans ; Masks* ; Mouth ; Mouth Breathing ; Nose ; Sleep Apnea, Obstructive ; Treatment Failure*

OBJECTIVES: Gamma-aminobutyric acid (GABA) has potential benefits in counteracting the sleep disruption and potential therapeutic effects on blood pressure, stress, cancer, and inflammatory diseases. Recently, High-dose GABA can be extracted from fermented rice germ using lactic acid bacteria. This study aimed to evaluate the effects of GABA natural extracts from fermented rice-germ on sleep latency, subjective sleep quality and insomnia symptoms. METHODS: This was a prospective randomized double-blind placebo-controlled trial performed at Kyung-Hee University hospital at Gangdong from June 2013 to October 2013. Adult (age≥30) patients who was diagnosed of insomnia according to DSM-IV criteria was enrolled. They were randomized into three groups: high dose treatment group 300 mg; low-dose treatment group, 100 mg; and placebo group. Questionnaires including Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), WHO-5 Well-Being Index were performed, and 1-week actigraphy was recorded before and 1 week after the treatment. RESULTS: Total of 114 patients were randomized into 3 groups: high-dose treatment (n=37), low-dose treatment (n=38), and placebo treatment group (n=39). At 1 week after the treatment, PSQI total score and C2 (sleep latency) score significantly decreased in low-dose and high-dose treatment group than the placebo groups [Repeated measures analysis of variance (ANOVA), p=0.017, 0.004 respectively]. ISI score also decreased in the two groups in dose-dependent manner (Repeated measures ANOVA, p=0.037). There were five (4.4%) patients who reported medication adverse events. CONCLUSIONS: This study suggests that treatment of low and high-dose GABA from unpolished rice-germ decreases sleep latency and improve insomnia severity without severe adverse events.
Actigraphy ; Adult ; Bacteria ; Blood Pressure ; Diagnostic and Statistical Manual of Mental Disorders ; gamma-Aminobutyric Acid* ; Humans ; Lactic Acid ; Prospective Studies ; Sleep Initiation and Maintenance Disorders ; Therapeutic Uses

OBJECTIVES: The current study aimed to explore the difference of dream themes, emotional intensity, and sleep parameters between nightmares and bad dreams in nightmare sufferers. METHODS: Twenty-four nightmare sufferers who endorsed clinical levels of nightmares (Disturbing Dream and Nightmare Severity Index Scores ≥10) recorded daily information about their dream themes using a modified version of the Typical Dreams Questionnaire, emotional intensity about their nightmares and bad dreams, and sleep for two weeks on a mobile device. RESULTS: Evil presence (35%) was reported with higher frequency in nightmares, whereas interpersonal conflicts (31%) were predominantly reported in bad dreams. Nightmares were rated substantially more emotionally intense than bad dreams. Especially, fear (Z=-2.118, p=0.034) was rated as being significantly higher in nightmares than bad dreams. There were differences on time in bed, wake after sleep onset, sleep efficiency on the days with nightmares or bad dreams compared to other days; however, there were no differences in sleep parameters between nightmares and bad dreams. CONCLUSIONS: The results suggest that nightmares may be qualitatively and quantitatively different from bad dreams in nightmare sufferers.
Dreams*

OBJECTIVES: Narcolepsy with cataplexy is a rare chronic sleep disorder characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations. The aims of the present study were comparing the health-related quality of life (HR-QOL) of patients with type I and type II narcolepy patients, and determining the factors that influence the HR-QOL in narcolepsy patients. METHODS: All patients performed night polysomnography (PSG) and multiple sleep latency test (MSLT). HR-QOL and the severity of subjective symptoms were evaluated using various questionnaires, including the Korean versions of the Medical Outcome Study Short Form-36, the Pittsburg Sleep Quality Index-Korean version, the Korean version Epworth Sleepiness Scale, and the Korean version Beck Depression Inventory-2. RESULTS: We enrolled 21 type I narcolepsy patients and 27 type II patients. Type I patients had short rapid eye movement (REM) latency on night PSG and more sleep onset REM periods on MSLT. The total score of HR-QOL was worse in patients with type I narcolepsy than in the type II narcolepsy patients. There was association between the severities of excessive daytime sleepiness, depression and the degree of worsening of QOL. CSF hypocretin level had no correlation with the scores of HR-QOL. CONCLUSIONS: These findings demonstrate that type I narcolepsy patients are sleepier, depressive, and have more burden on the HR-QOL. And the impairment in QOL of narcolepsy patients is related to the degree of excessive daytime and depressive mood.
Cataplexy ; Depression ; Hallucinations ; Humans ; Narcolepsy* ; Outcome Assessment (Health Care) ; Polysomnography ; Quality of Life* ; Sleep Paralysis ; Sleep Wake Disorders ; Sleep, REM