“NYAM CHIEM” RECONSTRUCTING AND PERFORMING NIGHTMARE: A DANCE RESEARCH IN PERFORMANCE OF SLEEP PARALYSIS.

This paper is a documentation of a practice-based dance work of the creative process, research and performance presentation of the piece “Nyam chiem.” This thesis examines the phenomenon of sleep paralysis through a personal reflexive research. The work challenges the notion that sleep paralysis is evil, revealing the phenomenon as a part of the human experience. The research is in two parts, practical and theory. The practical component includes; dance rehearsals, and staging of the piece as presentation. The theoretical component includes the documentation of the work in a written format capturing my personal stories, and salient issues arising from the process into a scholarly paper.

Ufologia ja ufokokemukset uskonnollisina ilmiönä : Teoreettinen tutkimus

The main question of my doctoral thesis is whether ufology and UFO experiences are or can be explained as religious phenomena. My research is theoretical in the sense that I combine and systematise cultural scientific knowledge concerning the religiosity of ufology and UFO experiences and complete this theoretical effort with empirical subject matter. The research material for my study consists of theoretical literature and empirical texts written by ufologists and those who have had UFO experiences. I defined the material in a way that it became full and extensive with regard to ufology, stories about UFO experiences and the cultural scientific literature concerning them. In addition, I present a source criticism for the literature because it is in part informal. The method is analysing and synthesising the material in the context of spiral of hermeneutic inferential process. Definitions of religion, ufology and UFO experience, developed by myself, serve as guide lines for the process. The conclusions of my research are as follows. For the most part, ufology and UFO experiences belong to the category of religion and only a fraction of these instances can be explained as something else, for example psychiatric phenomena. From the religious viewpoint I explain ufology and UFO experiences on four different but interlinked levels: historical, comparative, sociological and psychological. Historically ufology and UFO experiences include esoteristic, Christian and folk religious elements. In addition UFO experiences have significant similarities with folk religious stories and shamanistic experiences. From the perspective of the sociology, of religion ufology and UFO experiences can be analysed as products of our scientific and technological Western culture. Social crisis and social psychological group mechanisms affect the appearance of ufological ideas and UFO experiences. Psychologically, in the background of religious UFO experiences there can be found several factors, such as wishful thinking. Concerning UFO sightings these are misinterpretations of certain ordinary and some rare or exotic natural and technical phenomena. Intense UFO experiences, such as UFO abductions, are stimulated for the most part by hallucinations, sleep paralysis disorders, lively fantasies (in case of fantasy prone personalities) and false memories. In group cases social pressure, small group delusion and the guilt of exposing the true nature of a story come into play. A UFO experience can be traumatising because of certain inferential mechanisms and cognitive dissonance involved in the process of conversion as a UFO experiencer. UFO religiosity is a cross cultural, widespread and a significant field of phenomena, which can offer insight about religious developments in the future. However, UFO religiosity has not been studied extensively. This research is one effort to address this lack of documentation. The motivation behind my thesis was to make ufology and UFO experiences more understandable.

Descrição de uma população narcoléptica portuguesa

Tese de mestrado, Ciências do Sono, Faculdade de Medicina, Universidade de Lisboa, 2015

La farmacogenetica della narcolessia: comorbidità psichiatriche e risvolti in sanità pubblica

La farmacogenetica fornisce un importante strumento utile alla prescrizione farmacologica, migliorando l’efficacia terapeutica ed evitando le reazioni avverse. Il citocromo P450 gioca un ruolo centrale nel metabolismo di molti farmaci utilizzati nella pratica clinica e il suo polimorfismo genetico spiega in gran parte le differenze interindividuali nella risposta ai farmaci. Con riferimento alla terapia della narcolessia, occorre premettere che la narcolessia con cataplessia è una ipersonnia del Sistema Nervoso Centrale caratterizzata da eccessiva sonnolenza diurna, cataplessia, paralisi del sonno, allucinazioni e sonno notturno disturbato. Il trattamento d’elezione per la narcolessia include stimolanti dopaminergici per la sonnolenza diurna e antidepressivi per la cataplessia, metabolizzati dal sistema P450. Peraltro, poiché studi recenti hanno attestato un’alta prevalenza di disturbi alimentari nei pazienti affetti da narcolessia con cataplessia, è stata ipotizzata una associazione tra il metabolismo ultrarapido del CYP2D6 e i disturbi alimentari. Lo scopo di questa ricerca è di caratterizzare il polimorfismo dei geni CYP2D6, CYP2C9, CYP2C19, CYP3A4, CYP3A5 e ABCB1 coinvolti nel metabolismo e nel trasporto dei farmaci in un campione di 108 pazienti affetti da narcolessia con cataplessia, e valutare il fenotipo metabolizzatore in un sottogruppo di pazienti che mostrano un profilo psicopatologico concordante con la presenza di disturbi alimentari. I risultati hanno mostrato che il fenotipo ultrarapido del CYP2D6 non correla in maniera statisticamente significativa con i disturbi alimentari, di conseguenza il profilo psicopatologico rilevato per questo sottogruppo di pazienti potrebbe essere parte integrante del fenotipo sintomatologico della malattia. I risultati della tipizzazione di tutti i geni analizzati mostrano un’alta frequenza di pazienti con metabolismo intermedio, elemento potenzialmente in grado di influire sulla risposta terapeutica soprattutto in caso di regime politerapico, come nel trattamento della narcolessia. In conclusione, sarebbe auspicabile l’esecuzione del test farmacogenetico in pazienti affetti da narcolessia con cataplessia.

Cues to starting CPAP in obstructive sleep apnoea : development and validation of the cues to CPAP Use Questionnaire (CCUQ)

Background: The reasons that a patient has to start treatment, their “Cues to Action”, are important for determining subsequent health behaviours. Cues to action are an explicit component of the Health Belief Model of CPAP acceptance adherence. At present there is no scale available to measure this construct for individuals with Obstructive Sleep Apnoea (OSA). This paper aims to develop, validate and describe responding patterns within an OSA patient sample to the Cues to CPAP Use Questionnaire (CCUQ).----- Method: Participants were 63 adult patients diagnosed with OSA who had never tried CPAP when initially recruited. The CCUQ was completed at one month after being prescribed CPAP.----- Results: Exploratory factor analysis (EFA) showed a three factor structure of the 9-item CCUQ, with “Health Cues”, “Partner Cues” and “Health Professional Cues” subscales accounting for 59.91% of the total variance. The CCUQ demonstrated modest internal consistency and split-half reliability. The questionnaire is brief and user-friendly, with readability at a 7th grade level. The most frequently endorsed cues for starting CPAP were Health Professional Cues (prompting by the sleep physician) and Health Cues such as tiredness and concern about health outcomes.----- Conclusions: This study validates a measure of an important motivational component of the Health Belief Model. Health Professional Cues and internal Health Cues were reported to be the most important prompts to commence CPAP by this patient sample.

Infant wrapping as an evidence-based strategy to encourage settling and the utilisation of the supine sleep position

Objective: To identify knowledge, attitudes and practices of child health nurses relating to infant wrapping as an effective settling/sleep strategy. Methods: A pre-test/post-test intervention design was used to explore knowledge, attitudes and practices relating to wrapping in a sample of child health nurses (n=182): a) pre-test survey; b) educational intervention incorporating evidence relating to infant wrapping; SIDS&KIDS endorsed infant wrapping pamphlet; Safe Sleeping recommendations. Emphasis was placed on infant wrapping as an effective settling strategy for parents to use as an alternative to prone positioning; c) post-test survey to evaluate intervention effectiveness. Results: Pretest results identified wide variation in nurses’ knowledge, attitudes and practices of infant wrapping as a settling/sleep strategy. The intervention increased awareness of wrapping guidelines and self-reported practices relating to parent advice. Significant positive changes in nurses’ awareness of wrapping guidelines (p<0.001); to wrap in supine position only (p<0.001); and parental advice to use wrapping as an alternative strategy to prone positioning to assist settling/sleep (p<0.01), were achieved post-test. Conclusions: Managing unsettled infants and promoting safe sleeping practices are issues routinely addressed by child health nurses working with parents of young infants. Queensland has a high incidence of prone sleeping. Infant wrapping is an evidence-based strategy to improve settling and promote supine sleep consistent with public health recommendations. Infant wrapping guidelines are now included in Queensland Health’s state policy and Australian SIDSandKids information relating to safe infant sleeping. In communicating complex health messages to parents, health professionals have a key role in reinforcing safe sleeping recommendations and offering safe, effective settling/sleep strategies to address the non-recommended use of prone positioning for unsettled infants.

An investigation of the relationship between subjective sleep quality, loneliness and mood in an Australian sample: Can daily routine explain the links?

Background: Loneliness and low mood are associated with significant negative health outcomes including poor sleep, but the strength of the evidence underlying these associations varies. There is strong evidence that poor sleep quality and low mood are linked, but only emerging evidence that loneliness and poor sleep are associated. Aims: To independently replicate the finding that loneliness and poor subjective sleep quality are associated and to extend past research by investigating lifestyle regularity as a possible mediator of relationships, since lifestyle regularity has been linked to loneliness and poor sleep. Methods: Using a cross-sectional design, 97 adults completed standardized measures of loneliness, lifestyle regularity, subjective sleep quality and mood. Results: Loneliness was a significant predictor of sleep quality. Lifestyle regularity was not a predictor of, nor associated with, mood, sleep quality or loneliness. Conclusions: This study provides an important independent replication of the association between poor sleep and loneliness. However, the mechanism underlying this link remains unclear. A theoretically plausible mechanism for this link, lifestyle regularity, does not explain the relationship between loneliness and poor sleep. The nexus between loneliness and poor sleep is unlikely to be broken by altering the social rhythm of patients who present with poor sleep and loneliness.

Magnetic resonance spectroscopy and neurocognitive dysfunction in obstructive sleep apnea before and after CPAP treatment

STUDY OBJECTIVES: To determine whether cerebral metabolite changes may underlie abnormalities of neurocognitive function and respiratory control in OSA. DESIGN: Observational, before and after CPAP treatment. SETTING: Two tertiary hospital research institutes. PARTICIPANTS: 30 untreated severe OSA patients, and 25 age-matched healthy controls, all males free of comorbidities, and all having had detailed structural brain analysis using voxel-based morphometry (VBM). MEASUREMENTS AND RESULTS: Single voxel bilateral hippocampal and brainstem, and multivoxel frontal metabolite concentrations were measured using magnetic resonance spectroscopy (MRS) in a high resolution (3T) scanner. Subjects also completed a battery of neurocognitive tests. Patients had repeat testing after 6 months of CPAP. There were significant differences at baseline in frontal N-acetylaspartate/choline (NAA/Cho) ratios (patients [mean (SD)] 4.56 [0.41], controls 4.92 [0.44], P = 0.001), and in hippocampal choline/creatine (Cho/Cr) ratios (0.38 [0.04] vs 0.41 [0.04], P = 0.006), (both ANCOVA, with age and premorbid IQ as covariates). No longitudinal changes were seen with treatment (n = 27, paired t tests), however the hippocampal differences were no longer significant at 6 months, and frontal NAA/Cr ratios were now also significantly different (patients 1.55 [0.13] vs control 1.65 [0.18] P = 0.01). No significant correlations were found between spectroscopy results and neurocognitive test results, but significant negative correlations were seen between arousal index and frontal NAA/Cho (r = -0.39, corrected P = 0.033) and between % total sleep time at SpO(2) < 90% and hippocampal Cho/Cr (r = -0.40, corrected P = 0.01). CONCLUSIONS: OSA patients have brain metabolite changes detected by MRS, suggestive of decreased frontal lobe neuronal viability and integrity, and decreased hippocampal membrane turnover. These regions have previously been shown to have no gross structural lesions using VBM. Little change was seen with treatment with CPAP for 6 months. No correlation of metabolite concentrations was seen with results on neurocognitive tests, but there were significant negative correlations with OSA severity as measured by severity of nocturnal hypoxemia. CITATION: O'Donoghue FJ; Wellard RM; Rochford PD; Dawson A; Barnes M; Ruehland WR; Jackson ML; Howard ME; Pierce RJ; Jackson GD. Magnetic resonance spectroscopy and neurocognitive dysfunction in obstructive sleep apnea before and after CPAP treatment.

Mothers' sleep and driving in the postpartum period

Introduction: Previous studies investigating mothers’ sleep in the postpartum period commonly demonstrated elevated levels of sleepiness in this population. A Karolinska Sleepiness Scale (KSS) rating of 5 or above is associated with an exponential increase in vehicle crash risk. To date, no studies have investigated the relationship between mothers’ sleep in the postpartum period and their driving behaviour. Methods: Sleep-wake diary data was collected from 14 mother-infant dyads during two 7-day assessment periods when the infants were 6 and 12 weeks old. The mothers’ indicated all driving episodes during these weeks and their respective sleepiness level using the KSS. Semi-structured interviews were conducted with the mothers when their infant was 12 weeks old. Results: The infants slept significantly more than their mothers at 6 weeks and 12 weeks of age. During both time points, mothers and infants had a similar number of night awakenings (waking between 22:00 and 06:00), with some mothers experiencing greater than 19 awakenings over 7 nights. Notably, 36% of the mothers did not experience a continuous sleep period longer than 4.5 hours when their infant was 6 weeks old. A total of 141 driving episodes were reported during the 7 day assessment period when the infants were 6 weeks old. Over 50% of the driving episodes were denoted with a KSS score of 5 or above. Strategies mothers cited they employed during this period included only driving when feeling alert, postponing driving until another person is present, and driving in the morning when less sleepy. Conclusion: Mothers are experiencing disrupted sleep at night and some mothers do not obtain more than 4.5 hours of continuous sleep during the early postpartum weeks. In this sample, some mothers reported self-regulating driving behaviour, however over half of the driving episodes were undertaken with a sleepiness rating linked with elevated crash risk.

Do high levels of physical activity favor favorable cardiovascular risk factors regardless of sleep?

This study suggests that physical activity is a more important lifestyle modification than sleep to improve cardiovascular risk factors in postmenopausal women; however both lifestyle modifications, including, ensuring sufficient sleep quality and duration and increasing physical activity should be strongly encouraged by menopause practitioners in postmenopausal women care.