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Sleep is also disturbed and diminished when the normal circadian rhythm of the sleep-wake cycle is exogenously altered This is observed most often in shift workers, who periodically change their work schedule from day to night, and as a result of transmeridional air travel ie, jet lag (Baker and Lee) Eastbound travelers fall asleep late and face an early sunrise The consequent fatigue is a product of both sleep deprivation and a phase change required by changing time zones One antidote is to reset one s watch on the plane and conform to the routine of the destination ie, to stay awake all day until the usual evening hour for sleep and to take a short-acting sedative (eg, triazolam) at bedtime Melatonin is also used for this purpose, but its effects have not been studied extensively These measures facilitate the resetting of the circadian rhythm Westbound travelers face a late sunset and a long night s sleep and adjust more readily to resetting of the circadian rhythm than do those traveling east Exposure to light during the extended day is helpful in entraining the sleep cycle; this adjustment is also accomplished more easily when traveling west than east Shifting of the circadian rhythm in animals suggests that brief exposure to light at crucial times effectively resets the sleep-wake cycle; apparently the period just before 4 AM is a nodal time for susceptibility to this phase change The sleep problems caused by shift work are more complicated (see Monk) The delayed-sleep-phase syndrome is a chronic inability to fall asleep and to arise at conventional clock times Sleep onset is delayed until 3 to 6 AM; the subject then sleeps normally until 11 AM to 2 PM An imposed sleep period from 11 PM to 7 AM leads to a prolonged sleep latency and daytime sleepiness The advanced-sleep-phase syndrome is characterized by an earlyevening sleep onset (8 to 9 PM) and early-morning awakening (3 to 5 AM) Simply delaying the onset of sleep usually fails to prevent early-morning awakening This pattern is not uncommon among healthy elderly persons (and also among college students), in whom it should probably not be digni ed as an insomnia syndrome Still other persons show a completely irregular sleep-wake pattern; sleep consists of persistent but variable short or long naps throughout the night and day, with a nearly normal 24-h accumulation of sleep.

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Included under this title are several diverse disorders, the distinctive feature of which is their occurrence only during sleep: somnolescent starts, sensory paroxysms, nocturnal paroxysmal dystonia, sleep paralysis, night terrors and nightmares, somnambulism, and REM sleep behavior disorder Somnolescent (Sleep, Hypnic) Starts As sleep comes on, certain motor centers may be excited to a burst of insubordinate activity

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Description This parameter is used to specify the Web item for which you want to restore the state This parameter is used to specify the list of Web items for which you want to restore the state