May 20, · In the document/paper/poster you are writing, materials are cited using superscript numerals. The first reference used in a written document is listed as 1 in the reference list, and a 1 is inserted into the document immediately next to the fact, concept, or quotation being cited European Journal of Hospital Pharmacy is a Plan S compliant Transformative Journal. European Journal of Hospital Pharmacy (EJHP) offers a high quality, peer-reviewed platform for the publication of practical and innovative research which aims to strengthen the profile and professional status of In the inaugural issue of the Journal of Clinical Sleep Medicine (), a feature article 1 traced early milestones in the developing field of sleep medicine, which slowly emerged from the older field of sleep research during the s and s. Sleep medicine, the article noted, was closely linked with and made possible by the discovery of electrical activity in the brain
The Extraordinary Importance of Sleep
Try out PMC Labs and tell us what you think. Learn More, pharmacy major research paper. In the inaugural issue of the Journal of Clinical Sleep Medicinea feature article 1 traced early milestones in the developing field of sleep medicine, pharmacy major research paper, which slowly emerged from the older field of sleep research during the s and s.
Sleep medicine, the article noted, was closely linked with and made possible by the discovery of electrical activity in the brain. The examination of electroencephalogram EEG patterns that occur during sleep led to the classification of stages of sleep, which in turn created an important foundation for probing human sleep, discerning abnormalities, and discovering significant relationships between sleep and health.
Bypharmacy major research paper, scientists and clinicians pharmacy major research paper not only identified and clearly defined a large number of sleep disorders but had discovered that many of them were highly prevalent. The pace of research and discovery has only accelerated pharmacy major research paperpharmacy major research paper, and the number of peer-reviewed sleep journals has more than tripled, pharmacy major research paper.
Today, researchers are more deeply probing the cellular and subcellular effects of disrupted sleep, as well as the effects of sleep deprivation on metabolism, hormone regulation, and gene expression.
Newer studies are strengthening known and suspected relationships between inadequate sleep and a wide range of disorders, including hypertension, 2 obesity and type-2 diabetes, 3 impaired immune functioning, 4 cardiovascular disease and arrhythmias, 56 mood disorders, 7 neurodegeneration and dementia, 89 and even loneliness. Research findings continue to underscore early concerns about public safety that were first raised when major industrial disasters such as the Exxon Valdez oil spill were linked to inadequate sleep.
Department of Transportation, pharmacy major research paper, the U. Department of Defense, the National Institutes of Health, and the National Aeronautics and Space Administration NASAhas helped to inspire national initiatives aimed at improving public safety and health.
However, despite the astounding acceleration in research during the past few decades, inadequate sleep due to sleep pharmacy major research paper, work schedules, and chaotic lifestyles continues to threaten both health and safety.
Dinges, PhD, Professor and Chief of the Division of Sleep and Chronobiology in the Department of Psychiatry at the University of Pennsylvania Perelman School of Medicine. Worley is a freelance medical writer who resides in Pennsylvania.
People have come to value time so much that sleep is often regarded as an annoying interference, a wasteful state that you enter into when you do not have enough willpower to work harder and longer. It has become increasingly clear, however, that no matter how hectic our lives may be, we can no longer afford to ignore what research is telling us about the importance of sleep for our safety and mental and physical well-being.
While scientists are still working to identify and clarify all of the functions of sleep, 12 decades of studies—many of which have used the method of disrupting sleep and examining the consequences—have confirmed that pharmacy major research paper is necessary for our healthy functioning and even survival. We know, for example, that sleep is critical for waking cognition—that is, for the ability to think clearly, to be vigilant and alert, and sustain attention.
We also know that memories are consolidated during sleep, and that sleep serves a key role in emotional regulation. Studies conducted by Dr. Dinges and other scientists have shown that cognitive performance and vigilant attention begin to decline fairly quickly after more than 16 hours of continuous wakefulness, and that sleep deficits from partial sleep deprivation can accumulate over time, resulting in a steady deterioration in alertness, pharmacy major research paper.
The widely used psychomotor vigilance test PVTa simple neurocognitive test developed by Dr. Such consolidated sleep is typically of a longer duration and better sleep quality than sleep taken at other times of the day, such as that which occurs with nightshift work, jet lag, and other conditions of circadian misalignment. Dinges and his colleagues have found that people whose daily sleep duration is inadequate, or repeatedly disrupted e. Inadequate sleep also can take a toll on psychological well-being, significantly affecting our emotional and psychosocial interpretation of events and exacerbating our stress levels, pharmacy major research paper.
Studies have indicated that changes pharmacy major research paper mood may be due in part to the effects of sleep deprivation on the processing of emotional memory—in other words, our tendency to select and remember negative memories after inadequate sleep.
In one study conducted by Dr. I think we all have experienced having an extreme reaction or a very negative emotional response to a mild stressor when we have not had enough sleep.
How much sleep is enough? After decades of investigation, pharmacy major research paper, it appears that scientists have gathered enough evidence to begin to answer that question. That is what the consensus evaluations of more than a thousand scientific articles have yielded—the consensus of evaluations conducted by the AASM American Academy of Sleep Medicine and Sleep Research Society jointly. Numerous large U.
surveys—beginning with a survey by the American Cancer Society—have been used to estimate the number of hours that most people spend sleeping. More recently, however, an analysis of the American Time Use Survey ATUSspearheaded by Mathias Basner, MD, PhD, at the University of Pennsylvania 17pharmacy major research paper suggested that there may be cause for optimism.
Ever pharmacy major research paper slowly, the message that it is important not to get sleep deprived, and to get help if you have a sleep disorder, has begun to penetrate to the public. Data from the ATUS also suggest that over time, people have been willing to trade some of their daily activities in exchange for more sleep. It is important to note, says Pharmacy major research paper. Dinges, that self-reports of time spent sleeping are not always accurate—they can be off by a half an hour or more, usually with people tending to estimate that they slept more than they did.
He also notes that there is still a fairly large population sleeping 6 hours or less. There is concern about school start times and bus times affecting the sleep of children and adolescents, and about extracurricular activities at the end of the school day sometimes leading to a delay in bed times for teenagers. All of this is an ongoing, evolving picture, with more research results coming out all the time, pharmacy major research paper with consequent changes in recommendations, to make sure that at least our most vulnerable populations are getting adequate sleep.
While it is well established that the effects of sleep loss accumulate over time, with repeated exposure to inadequate, fragmented, or disrupted sleep, the degree to which individuals demonstrate adverse effects of inadequate sleep can vary considerably, pharmacy major research paper. The interindividual differences that have been observed so far raise some extremely provocative scientific questions.
We may find that there is something in waking biology that can substitute for, or somehow reduce, the impact of sleep loss on waking functioning, but thus far there is no evidence as to what that might be. Differences among individuals exist with regard to pharmacy major research paper the effects of sleep loss and the ability to recover from the effects of sleep loss. Differences in performance also have been shown to be task-dependent, suggesting that people who are vulnerable to the effects of sleep loss in one or more cognitive or neurobehavioral domains may be resistant to the effects of sleep loss in others.
To better understand interindividual variability, scientists are investigating possible genetic mechanisms that may underlie complex interactions between circadian and sleep homeostatic systems—the systems that affect our drive for sleep as well as our alertness and performance during waking hours. A current goal is to discover biomarkers that may help predict individual performance after varying degrees of sleep loss.
To date, no viable candidates have been found. Investigators also are shedding light on the role that age may play in resilience to sleep loss. The results of one pharmacy major research paper study indicate that younger adults are more vulnerable to the adverse effects of chronic sleep loss and recurring circadian disruption than older adults. Dinges emphasizes that findings regarding interindividual differences in response to sleep loss and in recovery from sleep loss should not diminish the message that adequate pharmacy major research paper is critical for everyone.
We must plan our lives in the time domain with a serious consideration for sleep—planning when to sleep, ensuring that we get adequate sleep, and making sure that our sleep is not disturbed by disorders or diseases, whether or not they are sleep-related. As connections between sleep disruption and both disease and mortality have become more firmly established, accurate and efficient diagnosis and management of sleep disorders see Table 1 have become increasingly critical. Recent directions in the field of sleep medicine include a move toward patient-centered care, greater collaboration between specialists and primary care physicians, and the incorporation of new tools—including home-based diagnostic tests and novel electronic questionnaires—in the effort to create a comprehensive yet more personalized approach to assessment and treatment.
A chief goal is to improve the diagnosis of sleep disorders. Although approximately 70 million people in the U. One major challenge that clinicians face during the initial assessment of people pharmacy major research paper sleep disorders is the process of identifying and sorting out comorbidities.
Untangling the causes and effects in bidirectional comorbidities can be particularly difficult. For example, insomnia—by far the most common sleep disorder—often is complicated by the presence of another sleep disorder, such as pharmacy major research paper apnea or restless legs syndrome. Kushida, MD, PhD, Professor of Psychiatry and Behavioral Sciences at Stanford, and Division Chief and Medical Director of Stanford Sleep Medicine.
For example, pain syndromes—including back pain and limb pain, especially among older patients—are common comorbidities in patients with insomnia. Mood disorders also frequently occur in patients who experience insomnia. Comorbidities can complicate treatment and often require sleep specialists to collaborate with not only primary care physicians but also specialists in other therapeutic areas.
For some individuals, an alerting antidepressant can cause poor sleep, which in turn can exacerbate the depression. The process of achieving the right dose of the right medication can be complex, and benefits from a collaboration between specialists. Undetected obstructive sleep apnea OSA in patients with chronic pain, or other serious illnesses, can result in potentially dangerous comorbidities.
Opioids, for example, are known to have adverse effects on respiration, and can lead to central sleep apnea CSA —shallow and irregular or interrupted breathing and sustained hypoventilation—a potentially lethal condition that can intensify the consequences of OSA. These risks underscore the need to improve methods for identifying and properly diagnosing the estimated adults with OSA, pharmacy major research paper.
Public education and advocacy efforts are already helping to improve detection—in part by helping to address misconceptions about OSA, pharmacy major research paper. OSA also can be caused by craniofacial dysmorphism, or a defect of the airway that occurs during development.
A narrow airway caused by deficient growth of the craniofacial skeleton, particularly the jaws, can become narrower and more prone to collapse with age, leading to sleep apnea. Insomnia, the most prevalent sleep disorder, affects approximately one third of all adults and is the most common condition that pharmacy major research paper and primary-care physicians encounter.
According to the International Classification of Sleep Disorders ICSD-3chronic insomnia is the inability to attain sufficient sleep despite adequate opportunity for at least three nights per week for three months or longer, with negative daytime consequences.
Although pharmacologic treatments for insomnia Table 2 can be effective, pharmacy major research paper, most experts now recommend against the long-term use of pharmacotherapy.
Selected Pharmaceutical Treatments for Insomnia 21 In our clinic, we commonly see that, over time, medications stop having an effect, and that means that patients may try higher doses of a medication, or keep switching to different medications, pharmacy major research paper. So, medications are a temporary solution—they just put a Band-Aid on the problem of insomnia, whereas cognitive behavioral therapy targets one of the pathways toward success.
Kushida notes that while drugs can sometimes be useful in the treatment of acute insomnia, they become problematic after acute insomnia transitions to chronic insomnia. Once they are in a chronic insomnia phase, we tell patients that CBT is the only truly effective intervention.
If a patient is already taking hypnotics, Dr, pharmacy major research paper. Kushida says that he will gradually wean the patient off medications while introducing CBT. He notes that often it is necessary for pharmacy major research paper specialists to manage the expectations of chronic sufferers. Kushida explains.
In the field of sleep medicine, as in many other therapeutic areas, future directions in clinical trial research will place an emphasis on patient engagement and patient-centered outcomes. Kushida, who is currently analyzing the results of a comparative effectiveness sleep study sponsored by the Patient-Centered Outcomes Research Institute PCORI. The surprising power of the placebo effect, 23 the related disconnect between objective and subjective evaluations of sleep loss and recovery from sleep loss, variable adherence to treatments, and, more recently, deceptive practices among clinical trial participants, are a few examples.
The placebo effect, pharmacy major research paper, which refers to any outcome that may be attributable to the expectations of clinical trial participants rather than to the drug or device being tested, can be especially problematic in experimental protocols that involve self-reports of sleep quality.
There have been efforts to develop or introduce new objective endpoints in these studies, which may help with this problem.
Achieving the right balance of subjective and objective measures of sleep is an important goal in both research and clinical practice. The current gold standard for objective assessment of sleep is polysomnography PSGwhich includes electrophysiological recordings of brain activity EEGmuscle activity EMGand eye movements EOG. A valuable, non-invasive method for determining sleep continuity and sleep architecture, PSG has been an indispensable objective endpoint in clinical trials, but it is expensive and not always practical.
Novel approaches to objective measurement, pharmacy major research paper, including actigraphy, which may be used to help minimize recall bias and complement subjective measures of sleep e. They also are not yet capable of accurately detecting different stages of sleep, such as non-REM and REM sleep. Because of our proximity to Silicon Valley, our laboratory tests a lot of these new devices, and often by the time we have finished testing one prototype, new ones have emerged.
The product cycles are rapid, and the companies keep incorporating newer and newer technology. So, pharmacy major research paper, down the road, within about five to ten years, I think these devices will likely estimate sleep and detect sleep stages with precision.
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