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Diagnostic Confusion of Nocturnal Paroxysmal Motor Activity.

Journal of Sleep Medicine.2016;13(2):77-80. doi:10.13078/jsm.16015

It is a significant challenge for the clinician to make distinction between nocturnal epilepsy form non-epileptic sleep disorders. Although in some patients, diagnosis is easy to achieve but sometimes not. At times even with help of polysomnogram and electroencephalogram, diagnostic confusion remains. We present two cases of nocturnal paroaxysmal events, which still need elucidate diagnosis.
Diagnosis ; Electroencephalography ; Epilepsy ; Humans ; Motor Activity* ; Parasomnias ; Polysomnography ; Seizures ; Sleep Wake Disorders

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Periodic Limb Movements During Sleep Associated with Human T-Lymphotropic Virus Type I-Associated Myelopathy.

Jung Hwan OH ; Jun Soon KIM ; Sa Yoon KANG ; Jung Joon SUNG

Journal of Sleep Medicine.2016;13(2):74-76. doi:10.13078/jsm.16014

Periodic limb movements during sleep (PLMS) are frequently observed in the general population, although such movements may be associated with a variety of medical and neurological disorders. Human T-lymphotropic virus type I-associated myelopathy (HAM) is a rare progressive disease in which abnormalities are rarely observed on spinal images. We present the case of a 55-year-old woman with PLMS who was later diag-nosed with HAM. The current case indicates that HAM can be considered a possible cause of PLMS.
Extremities* ; Female ; Human T-lymphotropic virus 1 ; Humans* ; Middle Aged ; Nervous System Diseases ; Nocturnal Myoclonus Syndrome ; Spinal Cord Diseases*

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Two Cases of Sleep-Related Painful Erection.

Kyoo Ho CHO ; Hye Ihn KIM ; Kyoung HEO ; Yang Je CHO

Journal of Sleep Medicine.2016;13(2):70-73. doi:10.13078/jsm.16013

Sleep-related painful erection (SRPE) is characterized by deep penile pain accompanied with erection occurring rapid eye movement (REM) movement period. Two (47-year-old and 40-year-old, respectively) male visited with the complaint of painful penile erection occurring during sleep. They had no problems with erection during daytime sexual activities except for mild premature ejaculation in one patient. Urologic inspections revealed no focal abnormalities. Polysomnography with simultaneous penile erection monitoring showed several episodes of awakening with painful erection which are time-locked to onset of REM sleep periods. According to the diagnostic criteria in international classification of sleep disorders, each patient was diagnosed to have chronic, severe SRPE. Despite of a low prevalence of SRPE, this condition should be considered in a patient who presents with nocturnal penile. A polysomnography accompanied with penile erection recording may help confirm diagnosis.
Adult ; Classification ; Diagnosis ; Humans ; Male ; Penile Erection ; Polysomnography ; Premature Ejaculation ; Prevalence ; REM Sleep Parasomnias* ; Sexual Behavior ; Sleep Wake Disorders ; Sleep, REM

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Treatment Failure of Continuous Positive Airway Pressure with a Full Face Mask, Reversed with a Nasal Mask.

Jee Hyun KIM ; Jae Wook CHO

Journal of Sleep Medicine.2016;13(2):67-69. doi:10.13078/jsm.16012

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*

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Effect of Low and High-Dose GABA from Unpolished Rice-Germ on Timing and Quality of Sleep: A Randomized Double-Blind Placebo-Controlled Trial.

Yu Yong SHIN ; Jung Ick BYUN ; Sung Eun CHUNG ; Min Ji SEONG ; Han Ah CHO ; Hyun Keuk CHA ; Won Chul SHIN

Journal of Sleep Medicine.2016;13(2):60-66. doi:10.13078/jsm.16011

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

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Comparison of Dream Themes, Emotions and Sleep Parameters between Nightmares and Bad Dreams in Nightmare Sufferers.

Ruda LEE ; Sooyeon SUH

Journal of Sleep Medicine.2016;13(2):53-59. doi:10.13078/jsm.16010

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*

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Comparison of Health Related Quality of Life between Type I and Type II Narcolepsy Patients.

Jae Wook CHO ; Dae Jin KIM ; Kyoung Ha NOH ; Junhee HAN ; Dae Soo JUNG

Journal of Sleep Medicine.2016;13(2):46-52. doi:10.13078/jsm.16009

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

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Subjective Sleep Disturbances of Factory Workers in Relation to Shift Work Schedule and Chronotype.

Pamela SONG ; Su Jung CHOI ; Eun Yeon JOO

Journal of Sleep Medicine.2016;13(2):40-45. doi:10.13078/jsm.16008

OBJECTIVES: Shift work in Korea is most prevalent in automobile system manufacturing industries. The subjective sleep complaints and individual chronotypes of shift worker was evaluated. METHODS: A cross-sectional study was conducted among single automobile system manufacturing industries in Korea. All participants completed questionnaires about the work schedule, duration of sustained employment and various division of work. And sleep questionnaires including: Epworth Sleepiness Scale, Insomnia Severity Index, Hospital Anxiety and Depression Scale, and Morningness-Eveningness Questionnaire. RESULTS: This study enrolled 208 participants [shift workers (SWs)=142, day workers (DWs)=66]. Insomnia symptoms were significantly worse in the SW group (p<0.001). Excessive daytime sleepiness was not significantly different between groups. The evening chronotype in DWs was related to both excessive daytime sleepiness (EDS) (p=0.008) and insomnia (p=0.034). On the other hand, chronotypes in SWs were not significantly different in terms of EDS and insomnia. CONCLUSIONS: Insomnia symptoms were significant in SWs compare to DWs. In DWs the evening types were sleepier and had more insomnia symptoms than other chronotypes. The sleep symptoms are prevalent in automobile industries workers, and in part it is related to work schedule and individual chronotype.
Anxiety ; Appointments and Schedules* ; Automobiles ; Cross-Sectional Studies ; Depression ; Employment ; Hand ; Korea ; Sleep Initiation and Maintenance Disorders

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Current Status and Proposal of Drowsy Driving.

Keun Tae KIM ; Ki Young JUNG

Journal of Sleep Medicine.2016;13(2):35-39. doi:10.13078/jsm.16007

Drowsy driving is a major cause of automobile crashes which can lead to more serious injuries than other causes of traffic accidents. Here, we review the accumulated scientific evidences and legal decisions of drowsy driving in various countries. Also, we highlight recent institutional strategies and developing technologies for prevention of drowsy driving. To prevent drowsy driving, raising public awareness as well as collaboration of professionals in various fields are requisites.
Accidents, Traffic ; Automobiles ; Cooperative Behavior ; Sleep Deprivation ; Sleep Wake Disorders

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A Case of Hypersomnolence with Subclinical Hypothyroidism Treated with Levothyroxine.

Minkyeong KIM ; Song Hwa CHAE ; Eun Hye OH ; Baik Kyun KIM ; Dae Jin KIM ; Jae Wook CHO

Journal of Sleep Medicine.2015;12(1):23-25. doi:10.13078/jsm.15005

We present a patient who complained of excessive daytime sleepiness (EDS), which started three years ago. She had no other medical, neurological, and psychiatric disorders. Nocturnal polysomnography did not indicate any sleep disorders, which might cause daytime EDS, such as obstructive sleep apnea. The following multiple sleep latency test was not compatible for narcolepsy. Her laboratory findings were remarkable for subclinical hypothyroidism, although free T4 and T3 were within reference rage, she had elevated thyroid stimulating hormone. After four weeks of levothyroxine treatment, her EDS resolved. The hypersomnolence, as a presenting symptom of subclinical hypothyroidism, was optimally treated after thyroid hormone replacement.
Disorders of Excessive Somnolence* ; Humans ; Hypothyroidism* ; Narcolepsy ; Polysomnography ; Rage ; Sleep Apnea, Obstructive ; Sleep Wake Disorders ; Thyroid Gland ; Thyrotropin ; Thyroxine*

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