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gests a maturational failure of certain modulating nervous in uences An enuretic episode is most likely to occur 3 to 4 h after sleep onset and usually but not necessarily in stages 3 and 4 sleep It is preceded by a burst of rhythmic delta waves associated with a general body movement If the patient is awakened at this point, he does not report any dreams Imipramine (10 to 75 mg at bedtime) has proved to be an effective agent in reducing the frequency of enuresis A series of training exercises designed to increase the functional bladder capacity and sphincter tone may also be helpful Sometimes all that is required is to proscribe uid intake for several hours prior to sleep and to awaken the patient and have him empty his bladder about 3 h after going to sleep One interesting patient, an elderly physician with lifelong enuresis, reported that he had nally obtained relief (after all other measures had failed) by using a nasal spray of an analogue of antidiuretic hormone (desmopressin) at bedtime This has now been adopted for the treatment of intractable cases Diseases of the urinary tract, diabetes mellitus or diabetes insipidus, epilepsy, sleep apnea syndrome, sickle cell anemia, and spinal cord or cauda equina disease must be excluded as causes of symptomatic enuresis

The high incidence of thrombotic stroke that is apparent upon awakening, a phenomenon well known to neurologists, has been studied epidemiologically by Palomaki and colleagues These authors have summarized the evidence for an association between snoring, sleep apnea, and an increased risk for stroke As already mentioned, cluster headache and migraine have an intricate relationship to sleep, the former almost always occurring during or soon after the rst REM period and the latter often curtailed by a sound sleep Patients with duodenal ulcer secrete more HCl during sleep (peaks coincide with REM sleep) than normal subjects Patients with coronary arteriosclerosis may show ECG changes during REM sleep, and nocturnal angina has been recorded at this time Snoring is strongly associated with hypertension Asthmatics frequently have their attacks at night, but not concomitantly with any speci c stage of sleep; they do have a decreased amount of stage 4 NREM sleep and frequent awakenings, however Patients with hypothyroidism have shown a decrease of stages 3 and 4 NREM sleep and a return to a normal pattern when they become euthyroid Demented patients exhibit reduced amounts of REM sleep and stage 4 NREM sleep, as do children with Down syndrome, phenylketonuria, and other forms of brain damage A correlation has been demonstrated between the level of intelligence and the amount of REM sleep in all these conditions and in normal persons as well Alcohol, barbiturates, and other sedative-hypnotic drugs, which suppress REM sleep, permit extraordinary excesses of it to appear during withdrawal periods, which may in part account for the hyperactivity and confusion and perhaps the hallucinosis seen in these states

Nocturnal grinding of the teeth, sometimes diurnal as well, occurs at all ages and may be as distressing to the bystander as it is to the patient It may also cause serious dental problems unless the teeth are protected in some way There are many hypothetical explanations, all without proof Stress is most often blamed, and claimants point to EMG studies that show the masseter and temporalis muscles to be excessively contracted in states of nervous tension We are more inclined to regard it as a tic or automatism When present in the daytime, it may also represent a fragment of segmental dystonia or tardive dyskinesia

Description Allows the use of Personalization in the Web template Deletes the Personalization settings in the Web template This parameter is used to allow the business user to save their own personalization settings This parameter is used to create a bookmark for the Web application This parameter is used to specify whether the bookmark is to be added to the Web browser favorites or whether the bookmark ID is simply to be displayed as a message in the Web application If the parameter above is activated, this parameter is proposed as the title when users save the bookmark to their favorites Users can accept or overwrite the proposal This parameter is used to start a Web application that was saved using a bookmark This parameter is used to specify the technical name of the bookmark under which the Web application to be started was saved You must have saved the bookmark using the Save Bookmark command This parameter is used to specify whether the Web application to be started is to be opened in a new browser window

Nocturnal bedwetting with daytime continence is a frequent disorder during childhood, which may persist into adult life Approximately 1 of 10 children 4 to 14 years of age is affected, boys more frequently than girls (in a ratio of 4:3); even among adults (military recruits), the incidence is 1 to 3 percent The incidence is much higher if one or both parents were enuretic Although the condition was formerly thought to be functional, ie, psychogenic, the studies of Gastaut and Broughton revealed a peculiarity of bladder physiology The intravesicular pressure periodically rises to much higher levels in the enuretic than in normal persons, and the functional bladder capacity of the enuretic is smaller than normal This sug-

ALDRICH MS: Diagnostic aspects of narcolepsy Neurology 50 (suppl):S2, 1998 ASERINSKY E, KLEITMAN N: A motility cycle in sleeping infants as manifested by ocular and gross bodily activity J Appl Physiol 8:11, 1955 BAKER SK, ZEE PC: Circadian disorders of the sleep-wake cycle, in Key-

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