<p>Syftet med denna litteraturstudie var att beskriva omständigheter som påverkade sömnen hos äldre samt vilka icke-medicinska omvårdnadsåtgärder som kan göras för att lindra sömnproblem. Äldre i studien var personer över 60 år, men det var ingen åldersbegränsning i urvalet av studierna. För att besvara frågeställningarna genomfördes en litteratursökning i databaserna Medline (Pubmed), Academic search elite, Science Direct utifrån inkulsionkriterierna. Det var 12 empiriska studier som inkluderades och granskades. Resultatet visade att omsändigheter för sömproblem var att vara äldre och att lida av depression. Yttre omsändigheter som påverkade sömnen var ljud, ljus, obekväm temperatur i rummet och okänd miljö. Inre omständigheter var inkontinens, mindre rölighet, nedsatt kognitiv förmåga, mediciner och smärta. Förebyggande omständigheter var aktivitet på dagen och tillfredställande socialt liv. Lindrande omständigheter på sömnproblemen var självvald musik. Varma och neutrala sockor hjälpte inte äldre personer med sömnproblem, men minskade insomningstiden hos äldre personer utan sömnproblem.</p> / <p>The aim of this literature review was to describe circumstances that affect the sleep in elderly people and to determine which non-pharmacological treatments that can be used to relive sleep disorder. Elderly in the review were people over 60 years, but there where no agelimitations in the selection of the studies. To answer the questions at issue a literature review was done in the following databases, Medline (Pubmed), Academic search elite and Science Direct on the basis of the inclusion criteria’s. There were 12 empirical studies that were included and reviewed. The result showed that circumstances for sleep disorder were to be old and to be depressed. External circumstances that affects the sleep: were noise, light, uncomfortable temperature in the room and an unknown environment. The internal circumstances were incontinence, reduced mobility, impaired cognitive capacity, medication and pain. Preventing circumstances were daytime activity and a satisfying social life. Alleviating circumstance on sleep disturbance was self selected music. Warm and neutral socks did not relive sleep problems in the elderly people with sleep problems, but relived on-set time in the elderly people without sleep problems.</p>

Syftet med denna litteraturstudie var att beskriva omständigheter som påverkade sömnen hos äldre samt vilka icke-medicinska omvårdnadsåtgärder som kan göras för att lindra sömnproblem. Äldre i studien var personer över 60 år, men det var ingen åldersbegränsning i urvalet av studierna. För att besvara frågeställningarna genomfördes en litteratursökning i databaserna Medline (Pubmed), Academic search elite, Science Direct utifrån inkulsionkriterierna. Det var 12 empiriska studier som inkluderades och granskades. Resultatet visade att omsändigheter för sömproblem var att vara äldre och att lida av depression. Yttre omsändigheter som påverkade sömnen var ljud, ljus, obekväm temperatur i rummet och okänd miljö. Inre omständigheter var inkontinens, mindre rölighet, nedsatt kognitiv förmåga, mediciner och smärta. Förebyggande omständigheter var aktivitet på dagen och tillfredställande socialt liv. Lindrande omständigheter på sömnproblemen var självvald musik. Varma och neutrala sockor hjälpte inte äldre personer med sömnproblem, men minskade insomningstiden hos äldre personer utan sömnproblem. / The aim of this literature review was to describe circumstances that affect the sleep in elderly people and to determine which non-pharmacological treatments that can be used to relive sleep disorder. Elderly in the review were people over 60 years, but there where no agelimitations in the selection of the studies. To answer the questions at issue a literature review was done in the following databases, Medline (Pubmed), Academic search elite and Science Direct on the basis of the inclusion criteria’s. There were 12 empirical studies that were included and reviewed. The result showed that circumstances for sleep disorder were to be old and to be depressed. External circumstances that affects the sleep: were noise, light, uncomfortable temperature in the room and an unknown environment. The internal circumstances were incontinence, reduced mobility, impaired cognitive capacity, medication and pain. Preventing circumstances were daytime activity and a satisfying social life. Alleviating circumstance on sleep disturbance was self selected music. Warm and neutral socks did not relive sleep problems in the elderly people with sleep problems, but relived on-set time in the elderly people without sleep problems.

The purpose of the study was to investigate whether sleep-disordered breathing (SDB) impairs executive functioning in children. Additionally, the study sought to identify the executive functions at risk in SDB and the contribution of daytime sleepiness. SDB represents a spectrum of upper airway conditions that can be mild, such as snoring, or severe, such as obstructive sleep apnea (OSA). Children with these problems may present with excessive sleepiness, failure to thrive, and a variety of cognitive and behavioral dysfunctions including impaired executive functioning. Beebe and Gozal (2002) developed a theoretical model to explain the impact of sleepiness and hypoxia on executive functioning. This model provided a framework to examine links between the medical disorder and the neuropsychological consequences. Twenty-seven children with suspected SDB were tested with polysomnography (PSG) and a neuropsychological battery. Parents completed subjective measures of cognitive function and sleep symptoms. The children were ages 8 to 18 and had no congenital or acquired brain damage. They were matched for age and gender with 21 healthy controls. The executive function protocol included subtests from the Delis-Kaplan Executive Function System (D-KEFS), the digit span subtest from the Wechsler Intelligence Scale for Children (WISC-IV), the Tower of London-II-Drexel University (TOL-II), the Behavioral Rating Inventory of Executive Functioning (BRIEF), and the Conners’ Continuous Performance Test (CPT-II). Statistical analysis was performed using 2 statistical software packages, SAS and NCSS. Regression analysis was used to evaluate all variables. Due to significant group differences in socio-economic status (SES), SES was included as a covariate, along with IQ. No group differences in IQ were found. Significantly less robust executive function in children with SDB was identified in the domains of cognitive flexibility and impulsivity. Additionally, poorer executive planning and overall inattentiveness was also associated with SDB. Level of significance was set at 0.05 and trends (0.05 < p < 0.10) were acknowledged. Other areas of executive function, including working memory, behavioral and emotional inhibition, and processing speed were not associated with SDB. Moreover, academic functioning was significantly lower in children with SDB, although the differences can be shared equally with SDB, SES and IQ.

CPAP is the most common treatment for moderate to severe sleep apnea in adults. Despite its efficacy, patients’ safety, comfort and compliance are issues to be considered and improved in CPAP design. The issues include condensation, carbon dioxide in inhaled air, humidity and temperature of inhaled air. When a CPAP user breaths deeply, there will be some air not fully expelled and may be driven back into the heated air delivery tube (HADT). An interest has existed in what impacts this so called reverse flow may bring about to the CPAP use. The main objectives of this research are to quantify the reverse flow and its influence on carbon dioxide re-breathing, delivered humidity to the patient and condensation in the HADT. Within this thesis, two computer models of the CPAP system have been constructed on Simulink™ in the Matlab™ environment. One is about the CPAP fluid dynamic performance and carbon dioxide re-breathing and the other is on thermodynamic performance. The models can predict the dynamic behaviour of the CPAP machine. They are able to mimic the breath induced airflow fluctuation, and flow direction changes over wide real working ranges of ambient conditions, settings and coefficients. These models can be used for future analysis, development, improvement and design of the machine. The fluid dynamic and thermodynamic models were experimentally validated and they have proved to be valuable tool in the work. The main conclusions drawn from this study are: • Reverse flow increases when breaths load increases and pressure setting decreases. • Reverse flow does not definitely add exhaled air to the next inhalation unless the reverse flow is relatively too much. • Mask capacity does not influence the reverse flow. • The exhaled air re-breathed is mainly due to that stays in the mask, therefore larger mask capacity increases the exhaled air re-breath and the percentage of exhaled air in next inhalation drops when the breath load increases. • Deep breathing does not significantly change the total evaporation in chamber. • When deep breathing induced reverse flow occurs, condensation occurs or worsens in the HADT near the mask. This happens only when the humidity of the airflow from the CPAP is much lower than that of the exhaled air and the tube wall temperature is low enough for condensation to occur. • The deep breathing and reverse flow do not significantly influence the average inhaled air temperature. • The overall specific humidity in inhaled air is lower under deep breathing. • Mask capacity does not influence the thermal conditions in the HADT and the inhaled air specific humidity. Also the mask capacity does not significantly influences the inhaled air temperature.

Introduktion: Kardiovaskulära sjukdomar är ett globalt folkhälsoproblem och den största dödsorsaken i världen. Sömnbesvär är ett eskalerande folkhälsoproblem och har en betydande risk för kardiovaskulär sjuklighet och död. Det krävs att kunskapen ökar gällande omvårdnadsinterventioner mot sömnbesvär hos personer med kardiovaskulära sjukdomar för att minska riskerna för folksjukdomar och för tidig död. Syfte: Redogöra för distriktssköterskans omvårdnadsinterventioner hos personer med kardiovaskulär sjukdom och sömnbesvär. Metod: En litteraturstudie med ett systematiskt arbetssätt har utförts, som utgår från Statens beredning för medicinsk utvärderings (SBU) riktlinjer. Åtta kvantitativa och tre kvalitativa studier inkluderades i resultatet. Resultat: I resultatet framkommer en huvudkategori samt fyra underkategorier av omvårdnadsinterventioner. Huvudkategorin: professionellt stöd och de fyra underkategorierna: kognitiv beteendeterapi mot sömnbesvär (KBT-I), individuella behandlingsplaner, utbildning samt komplementär och alternativmedicinsk behandling (KAM) som främjar sömnkvalitet hos patienter med kardiovaskulär sjukdom och sömnbesvär. Slutsats: Flera evidensbaserade omvårdnadsinterventioner har stor betydelse för att minska sömnbesvären och förbättra sömnkvalitet hos patienter med kardiovaskulär sjukdom och sömnbesvär. Det är av värde att behandlingen inkluderar professionellt stöd, sömnutbildning, sjukdomslära, läkemedelskunskap, erbjuda individanpassade behandlingar samt öka implementering av KBT-I. Omvårdnadsinterventioner kan appliceras inom alla områden som en distriktssköterska arbetar inom men det ställer högre krav på vården att få och erbjuda rätt utbildning. / Introduction: Cardiovascular disease is a global public health problem and the leading cause of death in the world. Sleep disorders are an escalating public health problem and sleep disorders have a significant risk of cardiovascular disease and death. Knowledge is required to increase current nursing interventions for sleep disorders in people with cardiovascular diseases in order to reduce the risks of common diseases and death. Aim: Describe the district nurse's nursing interventions in people with cardiovascular disease and sleep disorders. Method: A review with a systematic approach has been performed, which is based on SBU:s guidelines. Eight quantitative and three qualitative studies were included in the results. Results: The results show a main category and four subcategories of nursing interventions. The main category was professional support and the four subcategories were: cognitive behavioral therapy for sleep disorders (CBT-I), individual treatment, education and complementary and alternative medicine (CAM) that promotes sleep quality in patients with cardiovascular disease and sleep disorders. Conclusion: Several evidence-based nursing interventions are of great importance in reducing sleep disorders and improving sleep quality in patients with cardiovascular disease and sleep disorders. It is of value that all treatment includes professional support, training in sleep, pathology and pharmaceutical knowledge, offer individualized treatments and increase implementation of CBT-I. These nursing interventions can be applied in all areas in which a district nurse works, but it places higher demands on the care to receive and offer the right training.

Syfte: Att beskriva arbetsterapeuters erfarenheter av interventioner för klienter med sömnstörning, med en fördjupad inriktning mot tyngdtäcken. Metod: En kvalitativ studie med semistrukturerade intervjuer som datainsamlingsmetod. Deltagarna i studien utgjordes av åtta arbetsterapeuter, från samma geografiska område, med klinisk erfarenhet av arbete med interventioner vid sömnstörning. Insamlade data analyserades med induktiv ansats. Resultat: Analysen av data resulterade i fem kategorier: Vikten av en arbetsterapeutisk kartläggning för en framgångsrik intervention, Att kombinera interventioner vid sömnstörning, Tyngdtäckets inverkan på symptom kopplade till sömnstörning, Sömnstörningens och tyngdtäckets inverkan på möjlighet till delaktighet i aktivitet samt Organisatoriska förutsättningar för arbetsterapeutiska interventioner vid sömnstörning. Arbetsterapeuternas kliniska erfarenhet påvisade i denna studie att tyngdtäcke och sömnhygiensiska råd var betydande interventioner för klienter med sömnstörning. Resultatet visade att dessa interventioner kunde ha en positiv inverkan på klientens hälsa samt bidra till ökad förmåga att utföra vardagsaktiviteter. Slutsats: Studien har bidragit med kunskap kring arbetsterapeuters erfarenheter av interventioner vid sömnstörning och dess inverkan på klienterna. Vidare forskning krävs inom området för att ytterligare kunna styrka sömnhygieniska råden och tyngdtäckes positiva inverkan på individer med sömnstörning.

This study is the first examination on the association between seven types of sleep disorder and driving risk using large-scale naturalistic driving study data involving more than 3,400 participants. Regression analyses revealed that females with restless leg syndrome or sleep apnea and drivers with insomnia, shift work sleep disorder, or periodic limb movement disorder are associated with significantly higher driving risk than other drivers without those conditons. Furthermore, despite a small number of observations, there is a strong indication of increased risk for narcoleptic drivers. The findings confirmed results from simulator and epidemiological studies that the driving risk increases amongst people with certain types of sleep disorders. However, this study did not yield evidence in naturalistic driving settings to confirm significantly increased driving risk associated with migraine in prior research. The inconsistency may be an indication that the significant decline in cognitive performance among drivers with sleep disorders observed in laboratory settings may not nessarily translate to an increase in actual driving risk. Further research is necessary to define how to incentivize drivers with specific sleep disorders to balance road safety and personal mobility. / Master of Science

Objetivo Determinar la asociación entre calidad de sueño y otros factores con el dolor músculo esquelético en docentes de la facultad de ciencias de la salud en una universidad privada peruana Material y métodos Se realizó un estudio transversal con un total de 115 docentes universitarios que pertenecían a la facultad de Ciencias de la Salud los cuales respondieron a un cuestionario con 81 preguntas de identificación de dolor músculo esquelético, auto reporte brindado por el PhD Edgar Vieira (7), el cuestionario de calidad de sueño de Pittsburg, y el Inventario de Ansiedad de Beck. En relación con el análisis de múltiples variables, se utilizó regresión de Poisson con varianza robusta, de donde se calcularon PR crudos y ajustados con IC 95%. Resultados Se encuestaron a 115 profesores, con edad media de 41,44 + 10,46 años. El 94% del total de la muestra mostró dolor en una o más partes del cuerpo, mientras que el 90,4% del porcentaje mencionado presentó dolor en cuello o espalda alta o espalda baja. En relación con la calidad de sueño, los que presentaron perturbaciones de sueño de nivel mínimo fueron 72,6%. Se observó que la presencia de dolor músculo esquelético no estuvo asociado con la edad, el sexo ni con algún nivel de calidad de sueño (p >0.05) Conclusiones Aunque nuestro estudio no encontró asociación de dolor músculo esquelético con calidad de sueño, se halló una alta prevalencia de dolor músculo esquelético específicamente en la zona cervical y espalda baja para los docentes de todas las carreras. Además, no se ha encontrado asociación significativa entre ansiedad y dolor músculo esquelético. Se recomienda realizar más investigaciones, de naturaleza longitudinal. / Objective To determine the association between sleep quality and other factors with musculoskeletal pain in faculty of the School of Health Sciences in a Peruvian private University Material and methods A cross-sectional study was carried out with a total of 115 faculty belonging to the School of Health Sciences who answered a questionnaire with 81 musculoskeletal pain identification questions, a self-report provided by the PhD Edgar Vieira (7), the Pittsburg sleep quality questionnaire, and the Beck Anxiety Inventory. In relation to the analysis of multiple variables, Poisson regression with robust variance was used, where crude PR were calculated and adjusted with 95% CI. Results A total of 115 faculty were surveyed, with an average age of 41.44 + 10.46 years. 94% of the total sample showed pain in one or more parts of the body, while 90.4% of the mentioned percentage presented pain in the neck or upper back or lower back. In relation to the quality of sleep, those who presented disturbances of sleep of minimum level were 72.6%. It was observed that the presence of skeletal muscle pain was not associated with age, sex or with any level of quality of sleep (p> 0.05) Conclusions Although our study found no association of skeletal muscle pain with sleep quality, a high prevalence of musculoskeletal pain was found specifically in the cervical area and lower back for Faculty of all careers. In addition, there is no significant association between anxiety and skeletal muscle pain. / Tesis

<p>During the last 30 years, studies have shown self-help to be effective in a number of areas, and to produce equal or close to equal results compared to face-to-face therapy. The Internet can reach a large number of people at a low cost and add the possibility of two-way communication to self-help, thereby offering cost-effective psychological treatments.</p><p>This thesis is based on four studies and aiming to investigate if self-help treatment conducted through Internet can reduce problems with insomnia, stress and headache and reach effect sizes comparable to previous minimal contact treatment studies. Other aims were to investigate cost-effectiveness, and to examine if adding regular telephone contact would reduce drop-out rates. Treatments involved psychological techniques previously proved to be effective for each problem.</p><p>The first study showed a significant decrease in headache severity, and 50% of the participants in the treatment condition showed a clinically significant improvement. In Study II an Internet-based stress management program resulted in significant reductions of perceived stress, anxiety and depression. Improvements were found in both groups, with stronger effects in the self-help treatment group. Study III, a sleep management program, resulted in statistically significant improvements in the treatment group on all main variables, including total sleep time, total wake time in bed, and sleep efficiency. Some improvements were also found in the control group. Follow-up data indicated that improvements were sustained. Study IV did not confirm the hypothesis that the drop-out rates during headache treatment should decrease significantly if adding short and regular telephone contacts.</p><p>Results from this thesis suggest that Internet is a medium well suited for therapy, with effect sizes comparable to face-to-face therapy, that using Internet as a medium for treatment can reduce costs while still maintaining similar results, and that adding a small amount of telephone contact does not decrease attrition.</p>

During the last 30 years, studies have shown self-help to be effective in a number of areas, and to produce equal or close to equal results compared to face-to-face therapy. The Internet can reach a large number of people at a low cost and add the possibility of two-way communication to self-help, thereby offering cost-effective psychological treatments. This thesis is based on four studies and aiming to investigate if self-help treatment conducted through Internet can reduce problems with insomnia, stress and headache and reach effect sizes comparable to previous minimal contact treatment studies. Other aims were to investigate cost-effectiveness, and to examine if adding regular telephone contact would reduce drop-out rates. Treatments involved psychological techniques previously proved to be effective for each problem. The first study showed a significant decrease in headache severity, and 50% of the participants in the treatment condition showed a clinically significant improvement. In Study II an Internet-based stress management program resulted in significant reductions of perceived stress, anxiety and depression. Improvements were found in both groups, with stronger effects in the self-help treatment group. Study III, a sleep management program, resulted in statistically significant improvements in the treatment group on all main variables, including total sleep time, total wake time in bed, and sleep efficiency. Some improvements were also found in the control group. Follow-up data indicated that improvements were sustained. Study IV did not confirm the hypothesis that the drop-out rates during headache treatment should decrease significantly if adding short and regular telephone contacts. Results from this thesis suggest that Internet is a medium well suited for therapy, with effect sizes comparable to face-to-face therapy, that using Internet as a medium for treatment can reduce costs while still maintaining similar results, and that adding a small amount of telephone contact does not decrease attrition.