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Actigraphy in irregular sleep–wake rhythm
Sleep Medicine 8 (2007) 184–185 www.elsevier.com/locate/sleep
Images in Sleep Medicine
Actigraphy in irregular sleep–wake rhythm Jana Steinig a, Gerhard Klo¨sch b, Cornelia Sauter b, Josef Zeitlhofer b, Svenja Happe a
a,*
Department of Clinical Neurophysiology, Klinikum Bremen-Ost/University of Go¨ttingen, Germany b Department of Clinical Neurology, University Hospital of Neurology, Vienna, Austria Received 25 June 2006; received in revised form 4 August 2006; accepted 11 August 2006 Available online 1 February 2007
1. Introduction to the case A 43-year-old female patient presented with complaints of a heavily disturbed sleep–wake cycle during the last seven years. She reported sleeping at unusual times, with problems initiating and maintaining sleep and being tired during times of wakefulness. Medical history was unremarkable except a mild depressive disorder. The lack of a clearly defined circadian rhythm, the chaotic sleep–wake pattern and the symptoms of insomnia and excessive sleepiness suggested a circadian rhythm sleep disorder of the irregular sleep–wake type [1]. Four weeks of continuous actigraphy monitoring, sleep diary and body temperature measurement also failed to show any regular sleep–wake profile. She was instructed to follow the rules of sleep hygiene, stimulus control, and to stay on a defined sleep window from about 1 pm to 8 am. For the first four weeks, 5 mg of zolpidem at bedtime was allowed. Actigraphy, sleep diary and body temperature measurement showed a clear improvement of the sleep–wake pattern and an almost regular sleep profile. Subjective symptoms of daytime sleepiness and insomnia also improved.
profile with shorter and longer sleep periods at different times of the day can be seen. Fig. 2 shows the actigram of five weeks after initiating behavioral treatment as mentioned above to synchronize the sleep–wake pattern to the usual social sleep–wake times of a 24-h rhythm. Now an almost normal sleep– wake profile with sleep times between 12 pm and 8 am can be seen. 3. Discussion Actigraphy is a helpful tool to study sleep–wake patterns and circadian rhythms [2], and thus is a good
2. Image analysis Fig. 1 shows the actigram of four weeks before treatment (from Mi = Wednesday to Wednesday; from noon to noon of the following day). An irregular sleep–wake *
Corresponding author. Tel.: +49 421 408 2370; fax: +49 421 408 2375. E-mail address: [email protected] (S. Happe). 1389-9457/$ - see front matter Ó 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.sleep.2006.08.008
Fig. 1. Actigram before therapy showing an irregular sleep–wake profile. Mi, wednesday; Do, thursday; Fr, friday; Sa, saturday; So, sunday; Mo, monday, Di, tuesday.
J. Steinig et al. / Sleep Medicine 8 (2007) 184–185
185
adjunct to diagnose circadian rhythm disorders and control sleep rhythm and its resynchronization. Behavioral training with external control and initial treatment with hypnotics such as zolpidem seems to be a sufficient tool to improve symptoms of patients with a circadian sleep rhythm disorder, and its result can be visualized by actigraphy. However, it must be kept in mind that hypnotics might lead to a pseudo-normalization of phase. References
Fig. 2. Actigram after therapy showing an almost regular sleep–wake profile. Mi, wednesday; Do, thursday; Fr, friday; Sa, saturday; So, sunday; Mo, monday, Di, tuesday.
[1] American Academy of Sleep Medicine, ICSD-2 – International Classification of Sleep Disorders, 2nd ed., Diagnostic and coding manual, Westchester, Illinois: American Academy of Sleep Medicine, 2005. [2] Littner M, Kushida CA, Anderson WM, Bailey D, Berry RB, Davila DG, et al., Standards of Practice Committee of the American Academy of Sleep Medicine (2005). Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: an update for 2002. Sleep 28:1017–18 (comment on Sleep 2003; 26: 337–41).
Images in Sleep Medicine
Actigraphy in irregular sleep–wake rhythm Jana Steinig a, Gerhard Klo¨sch b, Cornelia Sauter b, Josef Zeitlhofer b, Svenja Happe a
a,*
Department of Clinical Neurophysiology, Klinikum Bremen-Ost/University of Go¨ttingen, Germany b Department of Clinical Neurology, University Hospital of Neurology, Vienna, Austria Received 25 June 2006; received in revised form 4 August 2006; accepted 11 August 2006 Available online 1 February 2007
1. Introduction to the case A 43-year-old female patient presented with complaints of a heavily disturbed sleep–wake cycle during the last seven years. She reported sleeping at unusual times, with problems initiating and maintaining sleep and being tired during times of wakefulness. Medical history was unremarkable except a mild depressive disorder. The lack of a clearly defined circadian rhythm, the chaotic sleep–wake pattern and the symptoms of insomnia and excessive sleepiness suggested a circadian rhythm sleep disorder of the irregular sleep–wake type [1]. Four weeks of continuous actigraphy monitoring, sleep diary and body temperature measurement also failed to show any regular sleep–wake profile. She was instructed to follow the rules of sleep hygiene, stimulus control, and to stay on a defined sleep window from about 1 pm to 8 am. For the first four weeks, 5 mg of zolpidem at bedtime was allowed. Actigraphy, sleep diary and body temperature measurement showed a clear improvement of the sleep–wake pattern and an almost regular sleep profile. Subjective symptoms of daytime sleepiness and insomnia also improved.
profile with shorter and longer sleep periods at different times of the day can be seen. Fig. 2 shows the actigram of five weeks after initiating behavioral treatment as mentioned above to synchronize the sleep–wake pattern to the usual social sleep–wake times of a 24-h rhythm. Now an almost normal sleep– wake profile with sleep times between 12 pm and 8 am can be seen. 3. Discussion Actigraphy is a helpful tool to study sleep–wake patterns and circadian rhythms [2], and thus is a good
2. Image analysis Fig. 1 shows the actigram of four weeks before treatment (from Mi = Wednesday to Wednesday; from noon to noon of the following day). An irregular sleep–wake *
Corresponding author. Tel.: +49 421 408 2370; fax: +49 421 408 2375. E-mail address: [email protected] (S. Happe). 1389-9457/$ - see front matter Ó 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.sleep.2006.08.008
Fig. 1. Actigram before therapy showing an irregular sleep–wake profile. Mi, wednesday; Do, thursday; Fr, friday; Sa, saturday; So, sunday; Mo, monday, Di, tuesday.
J. Steinig et al. / Sleep Medicine 8 (2007) 184–185
185
adjunct to diagnose circadian rhythm disorders and control sleep rhythm and its resynchronization. Behavioral training with external control and initial treatment with hypnotics such as zolpidem seems to be a sufficient tool to improve symptoms of patients with a circadian sleep rhythm disorder, and its result can be visualized by actigraphy. However, it must be kept in mind that hypnotics might lead to a pseudo-normalization of phase. References
Fig. 2. Actigram after therapy showing an almost regular sleep–wake profile. Mi, wednesday; Do, thursday; Fr, friday; Sa, saturday; So, sunday; Mo, monday, Di, tuesday.
[1] American Academy of Sleep Medicine, ICSD-2 – International Classification of Sleep Disorders, 2nd ed., Diagnostic and coding manual, Westchester, Illinois: American Academy of Sleep Medicine, 2005. [2] Littner M, Kushida CA, Anderson WM, Bailey D, Berry RB, Davila DG, et al., Standards of Practice Committee of the American Academy of Sleep Medicine (2005). Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: an update for 2002. Sleep 28:1017–18 (comment on Sleep 2003; 26: 337–41).