This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Anthony Kales, MD; Joyce Kales, MD

JAMA. 1970;213(13):2229-2235.

Abstract
Specific sleep stages are associated with or altered by clinical conditions such as aging, disease states, sleep disorders, and drug use. Gastric acid secretion in patients with duodenal ulcers and nocturnal angina attacks in patients with coronary disease are associated with rapid eye movement (REM) sleep. Sleepwalking and night terrors occur predominantly during stage 4 sleep, while attacks of dyspnea in asthmatic children occur in all stages except stage 4. Enuretic episodes occur predominantly in nonrapid eye movement (NREM) sleep. In treating insomnia, drugs which are effective in the sleep laboratory are recommended. Following the withdrawal of REM suppressant hypnotics, insomnia, increased dreaming, and nightmares may occur and lead to drug dependence. If these drugs are withdrawn, very gradual withdrawal is recommended as well as informing the patient of possible increases in dream frequency and intensity.

Author Affiliations
From the Department of Psychiatry and Brain Research Institute, Sleep Research and Treatment Facility (Dr. A. Kales), and the Department of Anatomy (Dr. J. Kales), UCLA Medical Center.

Footnotes
Reprint requests to UCLA Sleep Research and Treatment Facility, 760 Westwood Plaza, Los Angeles 90024 (Dr. A. Kales).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Treatment of Insomnia With Relaxation and Stimulus-Control Instructions Among Incarcerated Males
Toler
Criminal Justice and Behavior 1978;5:117-130.
ABSTRACT  

Recurrent Hypersomnia Secondary to Sleep Apnea
Spira and Scheinberg
Arch Neurol 1977;34:513-514.
ABSTRACT  

Drugs Five Years Later: Flurazepam Hydrochloride, a Benzodiazepine Hypnotic
GREENBLATT et al.
ANN INTERN MED 1975;83:237-241.
ABSTRACT  

Chronic Hypnotic-Drug Use: Ineffectiveness, Drug-Withdrawal Insomnia, and Dependence
Kales et al.
JAMA 1974;227:513-517.
ABSTRACT  

A Psychophysiological Study of Nightmares and Night Terrors: The Suppression of Stage 4 Night Terrors With Diazepam
Fisher et al.
Arch Gen Psychiatry 1973;28:252-259.
ABSTRACT  

The Clinical Choice of Sedative-Hypnotics
GREENBLATT and SHADER
ANN INTERN MED 1972;77:91-100.
ABSTRACT