We report the case of a 22-year-old female victim of childhood sexual abuse with dissociative identity disorder and hypersomnia who remitted from both clinical conditions with the use of modafinil 400 mg/day.We review the literature supporting the sleep-dissociation theory, where trauma-related memories induce a labile sleep-wake cycle allowing dreamlike mentation to intrude into waking consciousness and precipitate dissociative symptoms.The studies examined here found high correlations between dissociation and unusual sleep experiences.This may explain why in our case report modafinil, a medication with wake-promoting properties, improved both excessive daytime sleepiness and dissociation.Future studies are needed to determine which alterations in the sleep-wake cycle are most associated with dissociative disorders.We suggest a new perspective on the use of medications for comorbid hypersomnia, such as modafinil, in the treatment of dissociation.
This article reviews the role of evocative communication in psychotherapy and hypnosis.In hypnosis, the goal is to elicit a change in the client's state.Hypnosis is defined in a relational context and does not require conscious awareness to have an impact.Therapists can extend their understanding of hypnotic processes to psychotherapy to elicit conceptual realizations that empower changes in states and identities.Metaphor and signification, two examples of evocative communication, are widely used in the arts to create emotional impact.The therapist's "palette of colors" includes words, gestures, tone, tempo and locus of voice, and posture.The authors contend that: a) effective hypnotherapy and psychotherapy are anchored in evocative communication; b) communication techniques can be taught and studied; c) evocative communication spurs the activation of the subconscious; and d) the subconscious can effect changes in state that can result in solutions to psychological problems.
Background: Sleep is a state of reduced consciousness and responsiveness from which an individual can be aroused by external stimulus. In humans, is also associated with reduced movement. It enables to restore energy in the body and initiate neural plasticity for learning and memory. Several studies in the world identified poor sleep quality among nurses and tried to explore associated factors. But there is no any study in Ethiopia on sleep quality and associated factors among nurses. Objectives: the main aim of this study was to determine the prevalence of sleep quality and associated factors among nurses in Jimma zone public hospitals. Methods: An institution based cross-sectional study was conducted on 550 nurses from June 1 to July 1, 2018. Data was collected using self-administered questionnaire; sleep quality was measured using PSQI which is standard validated tool. Collected data was checked for completeness, entered Epi data version 3.1 and exported to SPSS Version 20.0. Frequencies, means and percentages were used for the descriptive analysis of data. Bivariate analysis was done to select candidate variables. Variables having p< 0.05 was considered statistically significant. Results: A total of 528 nurses were included in the study with a response rate of 96%. The mean age was 31.73 7.36 years and 54.7% of nurses were females. Prevalence of poor sleep quality among nurses was 70.6%. According to the multiple logistic regression analysis current khat chewing, BMI in overweight individual, BMI in Obese individual, medium job related stress, high job related stress , and Shift working were significantly associated with poor sleep quality. Conclusion: The magnitude of poor quality of sleep among nurses working in hospitals, Jimma Zone was very high. Independent predictors of poor sleep quality as identified by this study were current khat chewing, overweight, obesity, job related stress, and shift work.
Working time is the period of time that a person spends at paid labour.For every shift our body needs to adopt to the external changes.This may cause dreadful disruption of circadian rhythm which maintains all the biological responses including sleep-wake cycle, hormone inductioninhibition, hunger, growth and other cellular processes.Hence preventing the disruption of the circadian rhythm can prevent the disturbances in biological responses.The specific objectives include numerating the working pattern of general and shifting workers.To compare food habits, incidence of various health effects such as Cardiovascular risks, Sleep wake disorders, Endocrinological disorders (Diabetes, Cholesterol), Obesity, BMI, Blood Pressure among general and shift workers.An observational prospective study was carried out by approaching the workers, by a standard questionnaire which was designed to collect the data of the employees from the company and data was analyzed using statistical software.The observed values have shown that out of 302 workers general workers were 112 and shift workers were 190 and P-value <0.001 which is found to be significant.This study shows that the diabetic status, sleep disorders, appetite and GERD disturbances of the workers are dependent on the shift pattern being followed by them.There was a significant difference between shift and general workers in terms of Glucose levels, Blood Pressure, Total Cholesterol levels and GIT disturbances.Conclusion of our study revealed that prople working in shifts tend to have higher risk of prevalence of disorders such as Hypertension (Blood Pressure compared), Diabetes (Random Blood Sugar compared), Sleep and GIT disturbances.Body Mass Index, Total cholesterol levels of both general and shift workers did not show any high significance when compared.The risk of metabolic disorders was higher among those working in shift work rather than in the general workers.
Patients with anorexia nervosa (AN) frequently complain of insomnia and poor sleep quality. Some studies report changes in sleep self-reports and in several polysomnography parameters. These studies suggest that patients with AN and concomitant sleep disturbances have a poorer quality of life, are more predisposed to the appearance of comorbidities and have a poor prognosis of AN. The presence of sleep problems appears to influence the course and prognosis of AN. This article intends to briefly discuss the possible impact of sleep disturbances in AN and describe potential pathophysiological mechanisms involved.
During pregnancy, women experience changes in sleep patterns and poor sleep quality is a common complaint as pregnancy progresses. The aim of this study was to investigate the effect of foot reflexology on sleep quality in high risk pregnant women. In this randomized controlled trial, 72 women with high risk pregnancy were recruited and were assigned to reflexology and control group (n=36 in each group). The intervention group received 30 Minute foot reflexology twice a week, for four weeks. The control group received routine prenatal care. Before and after the intervention, the Sleep Condition Indicator Scale was used to assess sleep quality. After implementation of intervention independent t-test showed significant differences between the intervention and the control group in quality of sleep. The results of paired t-test revealed Significant improvement of sleep quality in the intervention group (p<0.05). In the control group, sleep quality significantly decreased (p <0.05).The results of present study may suggest that foot reflexology as a noninvasive and non-pharmacological nursing intervention can improve sleep quality in high risk pregnant women.
Human spend one quarter of life in sleep. However, not everyone gets adequate sleep as there are factors that can disturb sleep that can lead to insomnia. One of the behavioural factors that can influence sleep is the consumption of caffeinated drinks. The purpose of the present study was to identify the lifestyle factor for insomnia such as consumption of caffeinated drink (tea and coffee). The participants were 500 working adults aged 20-60 years in Georgetown, Penang who were relatively healthy. The participants were recruited through convenience sampling at various working places. Athen’s Insomnia Scale (AIS) was administered to screen on insomnia symptoms. 135 respondents who had insomnia symptoms were assessed on consumption of caffeinated drink in daytime and close to bedtime through descriptive questions. Interestingly, our finding showed insomnia did not increase with age, younger adults experienced more insomnia also the caffeine consumption among these adults were higher. The results revealed that consumption of caffeine in daytime and close to bedtime among young age-group significantly predicted insomnia. This finding may help to increase the awareness that sleep among young individuals can be disturbed by unhealthy lifestyle, thus it is imperative to take preventive measure against insomnia.
Previous research introduced the Nightmare Proneness Scale (NPS) as a measurement for nightmare proneness, the trait-like disposition to experience frequent nightmares.However, outside predicting nightmares, little is known about the structure of the scale or relationships of its facets with nightmares.The factor structure of the NPS and the scale's statistical independence from psychological distress and negative affect were examined among a sample of 306 university students.The NPS predicted frequent distressing nightmares independent from psychological distress and negative affect.Three NPS facets were found representing general psychical dysregulation, depressiveness, and somatization.The NPS facet representing general dysregulation was the strongest predictor of nightmares and the only NPS facet to independently predict nightmares outside of distress and negative affect.The results, limitations, and directions for future research are noted.
The association between napping and consolidation of emotional face memory is still not well understood. In the present study, subjects of a nap and wake condition (each n = 20) were presented pictures of facial expressions in a declarative memory task and word learning was used as a control task, whereby emotional valence in both tasks was varied. Hypothesized was better memory performance for negative than neutral stimuli after a 1 h nap as well as a positive association between negative stimuli and non-rapid eye movement (NREM) sleep. Memory performance was evaluated via face recognition (old/new discrimination) and free recall of words. No enhancement of face recognition and word recall by sleep was found. However, while recall of negative words positively correlated with NREM sleep (i.e., total sleep time), the positive and linear association for recognition of negative faces was limited to the sleep stage N3 (rich in slow-wave sleep). Selective enhancement of negative facial processing by slow-wave sleep can be concluded.
The aim of this study was to evaluate preschool children’s sleep habits, determine parental behaviours that affect these sleep habits, and examine the potential factors that cause sleep problems. 400 children aged 5-6 and their mothers participated in the study. A Child Information Form and Sleep Habits Questionnaire were applied to the mothers. In this way, the children’s resistance to bedtime, delay in falling asleep, sleep duration, sleep anxiety, waking during the night, parasomnias, sleep-disordered breathing, and daytime sleepiness were evaluated. The results of the study revealed that six-year-old children’s scores in the sleep habits and problems scale were higher than those of five-year-olds, and that sleep duration decreased in six-year-olds. In the study, when varieties of sleep problems were examined, it was found that children sleeping in the same bed as their parents had more sleep problems, and that as length of time spent sleeping together increased, sleep problems also increased.
In a sample of 444 university students, the subjective quality of sleep was analyzed and compared between smokers and non-smokers. Nicotine dependence was assessed using the Fagerström Test for Nicotine Dependence and the subjective quality of sleep was measured using the Pittsburgh Sleep Quality Index. Of the sample, 41.2% admitted to smoking daily. Poor sleep quality was reported by 45.7% of the sample (scores of > 5 on the PSQI). Smokers presented a risk of poor sleep quality that was greater than that of non-smokers with an Odds Ratio (OR) = 1.42 (95% CI [.990-2.074]). Smokers appear to have an increased risk of long sleep latencies with an OR = 1.50 (95% CI [1.018-2.213]). Moreover, smokers have a greater risk of showing high sleep disturbance with an OR = 2.45 (95% CI [1.391-4.304]). It is necessary to extend the studies that link sleep with cigarette smoking, and to explore the factors that modulate these causal relationships.
To assess the association of sleep quality with reaction time and aiming accuracy in young healthy individuals, we performed a one-group crosssectional study in an outpatient clinic of the Department of Physical Medicine and Rehabilitation at a University Hospital. Overall, 32 young men at the age range of 18 to 24 years were recruited from the university students. All participants were healthy people with no important physical or psychological problems. Quality of sleep was assessed using the Pittsburgh Sleep Quality questionnaire. Reaction time and aiming accuracy were measured with electrical reaction timer and tremometer, respectively. Quality of sleep was significantly correlated with reaction time and aiming accuracy (all p values < 0.001). In reaction time Pearson’s correlation coefficients were 0.882, 0.868, 0.824, and 0.894 for the association of sleep quality with simple auditory stimuli, simple visual stimuli, choice, and the number of errors, respectively. In aiming accuracy the coefficients were 0.823, 0.828, and 0.853 for total time, error time, and number of errors, respectively. To our knowledge, there has been no research published in the literature for the effect of sleep quality on aiming accuracy. Our results showed that the quality of sleep is obviously correlated with reaction time and aiming accuracy. The relations are positive and highly significant. Healthy young men with a higher quality of sleep respond faster to external stimuli and have greater concentration and aiming accuracy. Improving the quality of sleep enhances cognitive performance.
Background: Sleep quality is a complex construct to evaluate empirically, and yet the Pittsburg Sleep Quality Index (PSQI) is commonly used in studies as their only measure of sleep quality.Furthermore, the PSQI may not be the best sleep quality measure for older adults post coronary artery bypass graft (CABG), due to its reliance on the cognitive capacity to reflect on the past month.Purpose: The present study was conducted to compare the PSQI's predictive validity as a subjective measure of sleep quality with an objective sleep quality (as measured by actigraphy).Methods: 80 male participants aged 45-65years-who underwent coronary artery bypass graft CABG since 6 weeks -were randomized to two groups: aerobic group (AG), and combined aerobic and resistance group (ARG).Training lasted ten consecutive weeks with 30 uninterrupted sessions.The actigraph together with Pittsburg sleep quality index (PSQI) were used in sleep quality assessment.The actigraph (Actiwatch Minimitter Company, Incorporated (INC) -Sunriver, OR, USA) was placed on the non-dominant wrist and activities were monitored continuously while being recorded at one minute intervals.The participants kept the device for a period of 96 hours, filled PSQI, and did 6MWT before the first and last training sessions.Pearson's correlation was used to assess the relationship between the data obtained from these 2 assessment methods.Results: Our results suggest perceived sleep quality is quite different from objective reality, at least for this group.Previous studies have shown the PSQI to be a valuable tool for assessing subjective sleep quality; however, our findings indicate for middle aged adults who did CABG the PSQI should not be used as a substitute for actigraphy, or vice versa.Conclusion: The best practice is to include both subjective and objective measures when examining sleep quality in older adults (i.e., the PSQI,and actigraphy).
Hypnosis researchers need to provide effect size measures, and that they need to calculate reliability indices for their data. In addition, hypnosis researchers need to think meta-analytically, and not to apply mindlessly statistics and measurement (Fidler, Cumming, Thomason, Pannuzzo, Smith, Fyffe, et al 2005). Moreover, confidence intervals are needed within hypnosis research. Finally, this article described applications of reliability, validity, effect sizes, and confidence intervals to hypnosis research.
This study examined the effects of the sleep quality of chronic stroke outpatients on their patterns of activity performance and quality of life.This study was conducted on 49 patients with chronic stroke who received outpatient care in hospitals in South Korea.The Pittsburgh Sleep Quality Index (PSQI) was used to examine sleep quality, the Occupational Questionnaire (OQ) was used to assess frequency of occupational participation; while the World Health Organization Quality of Life-BREF (WHOQOL-BREF)was used to measure quality of life.As the results of the analysis, it was shown that the patient group with higher quality of sleep in the surveyed chronic stroke outpatients were indicated to have the higher activity frequency in the work and daily living work in terms of their activity execution phase, whereas the patient group with higher quality of sleep the higher activity frequency in the field of the rest (p <0.05).In addition, the higher quality of sleep group showed statistically significant higher quality of life (p <0.05).The findings of this study showed that the sleep quality of outpatients with chronic stroke is related with their pattern of activity performance and quality of life, and that bad sleep quality may negatively affect their pattern of activity performance and quality of life.
Insomnia is defined by the DSM-5 (American Psychiatric Association, 2013, p. 362) as a "predominant complaint of dissatisfaction with sleep quantity or quality", especially difficulty initiating or maintaining sleep or earlymorning awakening; insomnia is widespread (prevalence of 5.7% in the German population; Schlack, Hapke, Maske, Busch, & Cohrs, 2013) and tends to persist for years (Morin et al., 2009).This disorder has serious effects on patient's lives; for instance, insomnia is predictive of subsequent depression (Baglioni et al., 2011) and is associated with suicide risk independent of depression (Drapeau & Nadorff, 2017;Etindele Sosso, 2017).Cognitive behavioural therapy is the method of choice for treating patients with chronic insomnia (American Academy of Sleep Medicine, 2017; Qaseem, Kansagara, Forciea, Cooke, & Denberg, 2016).This treatment first focused on behavioural strategies such as sleep restriction, stimulus control and sleep hygiene (cf.Perlis, 2005), which were subsequently supplemented with cognitive models and strategies (Espie, Broomfield, MacMahon, Macphee, & Taylor, 2006;Harvey, 2005;Harvey et al., 2014).These treatments are effective, but most patients experience persistent symptoms (Riemann et al., 2015).Bélanger et al. (2016) reported that a maximum of 80% of the participants were responders and that 73% of the participants were in remission in a study investigating CBT-I, and Morin et al. (2009) reported maximum remission values of 60%.Therefore, new approaches are needed.
Whether it is in traditional or modern context, dreams have a special place in both psychology and psychotherapy studies. ‘The Traditional Interpretive Dream Approach’ model, which we had come across its first remains in Mesopotamia and is also the inspiration for psychoanalysis, is based on the interpretation of the symbols in the dream with the principle of reaching the hidden meaning. However, what is done with this interpretation is to move away frodm the phenomenal subjective reality of the client. Our psychotherapy practice has forced us to see this fact in time: Dreams are also experiences just like the waking experiences and a phenomenal self has its place in the center of these experiences as it has in the waking ones. We modeled the dream studies in which we take dream self in the center and we called this model as ‘Phenomenological Dream Self Model ‘(PDSM). The PDSM proposes a self-centered view and takes its theoretical background from its deepened practice. This practice also brings PDSM closer to the phenomenological view, in principle not based on the unconsciousness but on the consciousness of the dream self. There are four stages of PDSM. In the first stage the dream self-experience and in the second stage the waking selfexperience are examined. These two are compared in the third stage and in the fourth stage, the associations related to dream are examined on the basis of the phenomenology of the dream self.
Background: Twitter and WhatsApp may have the potential to negatively affect quality of sleep. Aim of Study: To assess the impact of using social media (i.e., Twitter and WhatsApp) on sleep quality and to identify risk factors associated with poor sleep quality among medical students in King Khalid University (KKU). Methodology: Following a cross – sectional design, 286 medical students at King Khalid College of Medicine, Abha, Saudi Arabia, were recruited into this study. An anonymous self-administered questionnaire has been designed by the researchers which included sociodemographic data, extent of using the WhatsApp and/or Twitter and the Pittsburgh sleep Quality Index. Results: 76.2% of students use both Twitter and WhatsApp, 21.5% use WhatsApp only, 1% use Twitter only, while 1% do not use any. Most medical students (89.8%) use Twitter/WhatsApp every day. Most medical students use Twitter/WhatsApp for 3-4 or more than 5 hours daily (31.1% for both). Most medical students (88.7%) use Twitter/WhatsApp during night. 29.7% of medical students have poor quality of sleep. Twitter/WhatsApp use was significantly more among female than male medical students (81.7% and 73.1%, respectively, p=0.014). Use of Twitter/WhatsApp by medical students differed significantly according to their scholastic year (p=0.014), with highest use among 6th year medical students (94.1%). Medical students’ quality of sleep differed significantly according to their scholastic year (p=0.02), with highest prevalence of poor quality among those at their 2nd and 6th scholastic years (37.7%) and 37.3%, respectively). Quality of sleep differed significantly according to students’ daily use of Twitter/WhatsApp (p=0.022), with highest prevalence of poor sleep quality among those who spend more than 4 hours daily using Twitter/WhatsApp. Conclusions: The majority of medical students in KKU, especially females and final year students, use Twitter and/or WhatsApp. Almost one third of students have poor sleep quality, especially 2ndand final year medical students and those who use social media for more than two hours daily. This study indicates a strong need for integrating sleep hygiene education for medical studentsand to provide health education to promote correct and effective use of social networks.
