Michał Skalski

Prevalence and consequences of insomnia in pediatric population.

Insomnia presents an increasing and significant health issue in paediatric population. As the problem had grown over past decade, it became recognised by the specialists dealing with children and adolescents. In a recent study American Academy of Child and Adolescent Psychiatry members were asked about their experience with patients complaining about sleep disturbances. Doctors reported that sleep was a problem for 1/3 of their patients out of which 1/4 required pharmacotherapy [1]. Multiple studies concerning adults confirmed significance of healthy sleep in optimal cognitive, emotional, social and biological functioning. Adequate sleep is important in prophylaxis of many chronic diseases such as obesity, diabetes, hypertension, myocardial infarction, stroke [2]. Due to increasing prevalence of insomnia in children and adolescents growing attention is paid to its short and long term consequences in this group. This review summarises available data on chronic insomnia prevalence and its consequences in population under 18 years old.

Treatment guidelines for Circadian Rhythm Sleep – Wake Disorders of the Polish Sleep Research Society and the Section of Biological Psychiatry of the Polish Psychiatric Association, part I: Physiology, assessment, and therapeutic methods.

Majority of the physiological processes in the human organism are rhythmic. The most common are the diurnal changes that repeat roughly every 24 hours, called circadian rhythms. Circadian rhythms disorders have negative influence on human functioning. The aim of this article is to present the current understanding of the circadian rhythms physiological role, with particular emphasis on the circadian rhythm sleep-wake disorders (CRSWD), principles of their diagnosis and chronobiological therapy. The guidelines are based on the review of recommendations from the scientific societies involved in sleep medicine and the clinical experiences of the authors. Researchers participating in the preparation of guidelines were invited by the Polish Sleep Research Society and the Section of Biological Psychiatry of the Polish Psychiatric Association, based on their significant contributions in circadian rhythm research and/or clinical experience in the treatment of such disorders. Finally, the guidelines were adjusted to the questions and comments given by the members of both Societies. CRSWD have a significant negative impact on human health and functioning. Standard methods used to assess CRSWD are sleep diaries and sleep logs, while the actigraphy, when available, should be also used. The most effective methods of CRSWD treatment are melatonin administration and light therapy. Behavioral interventions are also recommended. Afourteen-day period of sleep-wake rhythm assessment in CRSWD enables accurate diagnosis, adequate selection of chronobiological interventions, and planning adequate diurnal timing of their application. This type of assessment is quite easy, low-cost, and provides valuable indications how to adjust the therapeutic approach to the circadian phase of the particular patient.

Treatment of behavioral sleep problems in children and adolescents - literature review.

AIM To collect data on treatment of behavioural sleep disorders in children and adolescents. MATERIALS AND METHODS A literature review based on the PUBMED database. RESULTS Based on the analysed materials three basic complementary procedures were identified - implementation of sleep hygiene, behavioural interventions and pharmacological treatment. The rules of sleep hygiene proven to be effective include: regular sleep schedule, adequately prepared place to sleep (a dark, quiet bedroom without multimedia), bedtime routine, avoiding caffeinated beverages. The following issues require further studies to confirm their effectiveness: falling asleep independently without parents assistance, bedtime reading, physical activity, reducing daytime multimedia use, tryptophan rich breakfasts. Behavioural interventions and pharmacological treatment may in some cases be temporarily implemented to complement the sleep hygiene. CONCLUSIONS The implementation of sleep hygiene is a primary, fully acceptable to the child and parents, way to improve the baby sleep. In case of ineffectiveness of the proposed rules, those can be complemented with behavioural methods that are highly effective but some parents do not accept them or make mistakes in their introduction. Pharmacotherapy can be used as a temporary support for families with severe behavioural problems as an aid in the implementation of sleep hygiene and behavioural methods.

Treatment guidelines for Circadian Rhythm Sleep – Wake Disorders of the Polish Sleep Research Society and the Section of Biological Psychiatry of the Polish Psychiatric Association, part II: Diagnosis and treatment

AIM Circadian rhythm sleep-wake disorders (CRSWD) are a group of disorders, in which the timing of sleep and wakefulness significantly differs from a patients expectations or socially acceptable times. The aimof the article is to present the current principles for the diagnosis and treatment of CRSWD in adults and children. METHOD Guidelines proposed as CRSWD treatment standard are based on the recommendations from the scientific societies involved in the sleep research and medicine. Researchers participating in the guidelines preparation were invited by the Polish Sleep Research Society and the Section of Biological Psychiatry of the Polish Psychiatric Association based on their significant contribution to the circadian rhythm research and/or clinical experience in the treatment of these disorders. Finally, the guidelines were adjusted to the questions and comments given by the members of both Societies. RESULTS Patients with endogenous CRSWD are often misdiagnosed and treated for insomnia or hypersomnia. Therefore, each patient reporting sleep-wake disorders should be interviewed about the quality of sleep and its timing during free days (e.g. weekends, holidays). Avalid CRSWD diagnosis can be also established by using sleep diaries/logs and actigraphy. The treatment of choice for CRSWD is chronotherapy, which involves melatonin application, light therapy, and behavioral interventions. Sleep disorders associated with shift work and time zone changes are a growing health problem. Interventions for these disorders should primarily focus on prevention. CONCLUSIONS The main problem in the treatment of CRSWD is an invalid diagnosis. Hypnotics and/or psychostimulants are often used instead of chronotherapeutic interventions, what can alleviate symptoms but is not an effective treatment.