best java barcode library These disorders are fairly common in children and less so in adults in Objective-C

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These disorders are fairly common in children and less so in adults
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B Narcolepsy
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Narcolepsy consists of a tetrad of symptoms: (1) Sudden, brief (about 15 minutes) sleep attacks that may occur during any type of activity; (2) cataplexy sudden loss of muscle tone involving specific small muscle groups or generalized muscle weakness that may cause the person to slump to the floor, unable to move, often associated with emotional reactions and sometimes confused with seizure disorder; (3) sleep paralysis a generalized flaccidity of muscles with full consciousness in the transition zone between sleep and waking; and (4) hypnagogic hallucinations, visual or auditory, which may precede sleep or occur during the sleep attack The attacks are characterized by an abrupt transition into REM sleep a necessary criterion for diagnosis The disorder begins in early adult life, affects both sexes equally, and usually levels off in severity at about 30 years of age REM sleep behavior disorder, characterized by motor dyscontrol and often violent dreams during REM sleep, may be related to narcolepsy
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Classification & Clinical Findings
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A Sleep Terror
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Sleep terror (pavor nocturnus) is an abrupt, terrifying arousal from sleep, usually in preadolescent boys although it may occur in adults as well It is distinct from sleep panic attacks Symptoms are fear, sweating, tachycardia, and confusion for several minutes, with amnesia for the event
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B Nightmares
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Nightmares occur during REM sleep; sleep terrors in stage 3 or stage 4 sleep
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C Sleepwalking
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Sleepwalking (somnambulism) includes ambulation or other intricate behaviors while still asleep, with amnesia for the event It affects mostly children aged 6 12 years, and episodes occur during stage 3 or stage 4 sleep in the first third of the night and in REM sleep in the later sleep hours Sleepwalking in elderly people may be a feature of dementia Idiosyncratic reactions to drugs (eg, marijuana, alcohol) and medical conditions (eg, partial complex seizures) may be causative factors in adults
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C Kleine-Levin Syndrome
This syndrome, which occurs mostly in young men, is characterized by hypersomnic attacks three or four times a year lasting up to 2 days, with hyperphagia, hypersexuality, irritability, and confusion on awakening It has often been associated with antecedent neurologic insults It usually remits after age 40
D Enuresis
Enuresis is involuntary micturition during sleep in a person who usually has voluntary control Like other parasomnias, it is more common in children, usually in the 3 4 hours after bedtime, but is not limited to a specific stage of sleep Confusion during the episode and amnesia for the event are common
D Nocturnal Myoclonus
Periodic lower leg movements occur during sleep with subsequent daytime sleepiness, anxiety, depression, and cognitive impairment
Treatment
Narcolepsy can be managed by daily administration of a stimulant such as dextroamphetamine sulfate, 10 mg in the morning, with increased dosage as necessary Modafinil is a schedule IV medication FDA-approved for treating the excessive daytime fatigue of narcolepsy Usual dosing is 200 mg each morning Its mechanism of action is unknown, yet it is thought to be less of an abuse risk than stimulants that are primarily dopaminergic Common side effects include head-
Treatment
Treatment for sleep terrors is with benzodiazepines (eg, diazepam, 5 20 mg at bedtime), since it will suppress stage 3 and stage 4 sleep Somnambulism responds to the same treatment for the same reason, but simple safety measures should not be neglected Enuresis may respond to imipramine, 50 100 mg at bedtime, although desmopressin nasal spray (an ADH preparation) has increasingly become the treatment of choice for nocturnal enuresis Behavioral approaches (eg, bells that ring when the pad gets wet) have also been successful
CMDT 2008
Jindal RD et al Maintenance treatment of insomnia: what can we learn from the depression literature Am J Psychiatry 2004 Jan;161(1):19 24 [PMID: 14702243] Johnson MW et al Ramelteon: a novel hypnotic lacking abuse liability and sedative adverse affects Arch Gen Psychiatry 2006 Oct;63(10):1149 57 [PMID: 17015817] Parmet S et al JAMA patient page Insomnia JAMA 2006 Jun 28;295(24):2952 [PMID: 16804158] Siversten B et al Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial JAMA 2006 Jun 28;295(24): 2851 8 [PMID: 16804151]
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