The mechanisms of action and main clinical effects of melatonin are discussed. The focus is placed on the chronobiological action of melatonin and its adaptogenic and anticancer properties. The commonest manifestations of pineal melatonin deficiency are various functional psychopathological disorders in the form of insomnia, anxiety, or depression. Recommendations for the effective use of melatonin in conditions of melatonin deficiency are given.
According to current criteria, diagnosis of psychogenic motor deficit is based on tests providing objective recordings of movements in pseudoparalyzed limbs. We report here a patient with Munchausen's syndrome and psychogenic paralysis in the left arm, who was studied using polysomnography, electromyography, and video recordings of movement activity during sleep, which showed movements in the pseudoparalyzed left limb. In addition, there were decreases in movement activity during sleep in the whole of the left side of the body, which were especially severe in the pseudoparalyzed arm. The possibility of using recordings during sleep for the diagnosis of psychogenic motor defect is discussed.
Objectives. To assess the combined use of CPAP treatment (constant positive airway pressure) and testosterone replacement therapy (transdermal formulation – Androgel) on measures of polysomnographic monitoring with simultaneous investigation of erectile dysfunction and total testosterone levels. Materials and methods. The study included 26 men with diagnoses of combined moderately severe obstructive sleep apnea and age-related androgen deficit (mean age 46.1 ± 8.4 years, body mass index 35.2 ± 4.6 kg/m2). Subjects were divided into two groups depending on treatment type. Patients of group 1 (n = 14) received CPAP monotherapy, while patients of group 2 (n = 12) received combined therapy using CPAP and Androgel (50 mg once daily). CPAP was selected and delivered using automated Prisma 20 A (Weinemann, Germany) and iSleep (Breas, Sweden) devices. Treatment duration was two months. Results. After two-month treatment courses using these schemes, patients receiving combined treatment (CPAP + Androgel) showed a two-fold increase in the testosterone level (p < 0.05) and a statistically significant improvement in the altered measures of nocturnal penile episodes as compared with the analogous parameters in patients of the background of CPAP monotherapy. There were significant improvements in objective status, though no changes in polysomnographic characteristics were seen in either group. Conclusions. The study results demonstrated that combined treatment (CPAP + Androgel) was more effective in patients with obstructive sleep apnea syndrome and age-related androgen deficiency.
This review addresses contemporary experimental data on the functioning of the main neurotransmitter systems of the brain involved in arousal reactions and the maintenance of waking.
