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BACKGROUND: Several studies have shown the effectiveness of reflexology in different health problems as well as obtaining a high degree of relaxation during its application. A previous study suggested a possible relation between the relaxation obtained during the reflexology session and the sleep. However, the design of the study did not provide evidence for this hypothesis. In this study, we use a polysomnogram to investigate the effects during its application. METHOD: Prospective experimental study conducted in a sleep laboratory. Twelve healthy adults were enrolled. Two groups were created based on whether or not they had knowledge of reflexology. Reflexology was applied for 35 min and their sleep effects were measured by means of polysomnography. A descriptive and bivariate analysis was performed. A bivariate analysis conducted through chi-square test or ANOVA was considered appropriate. RESULTS: After controlling for baseline data, nine of the participants did move toward N1 (p = 0.833) and N2 (p = 0.227) stages, remaining in these states between 4 min and 25.5 min. No significant differences were found between the two groups. CONCLUSIONS: The application of reflexology induces changes in the activity of brain waves in correspondence with the appearance of a high degree of sleepiness and sleep (N1 and N2 NREM sleep). There is a gradual transition and an orderly progression from wakefulness to sleep, which could explain the effects of relaxation and well being obtained with this method, as well as many other benefits.

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Se calcula que el porcentaje de población adulta con problemas de sueño es cercano al 35-45%, y cada vez es más intensa la demanda del médico de atención primaria para atender a estos pacientes. Para ello el médico precisa disponer de formación adecuada en medicina de sueño, tiempo suficiente para dedicar a los pacientes, recursos materiales y humanos, y posibilidad de administrar tratamientos. Los pacientes habitualmente presentan uno de los siguientes síntomas: excesiva somnolencia en su esperado tiempo de vigilia, incapacidad para dormirse o mantenerse dormidos (insomnio) y conductas anómalas inmediatamente antes o durante el sueño. En el primer caso, por su potencial gravedad, se deberá sospechar síndrome de apnea-hipopnea de sueño, narcolepsia, hipersomnia idiopática o síndrome del sueño insuficiente, por lo que se debe solicitar el estudio de sueño oportuno y administrar el tratamiento adecuado. Si se considera necesario, se remitirá al paciente a un experto en sueño. En el caso del insomnio, se deberá investigar y tratar el trastorno subyacente y, en caso de ser necesario, solicitar la ayuda del especialista correspondiente. En el supuesto de que existan conductas anómalas inmediatamente antes o durante el sueño (síndrome de piernas inquietas, movimientos periódicos de las extremidades, sonambulismo, epilepsia, síndrome de comportamiento alterado del sueño REM, etc.) es aconsejable, especialmente en caso de duda, recurrir a un experto en sueño. En cualquier otra sintomatología el médico debería realizar sistemáticamente preguntas simples referentes a la cantidad y calidad del sueño para tener la máxima seguridad de que éste es correcto (AU)

The percentage of adult population with sleep disorders is approximately 35%-45%, and the demand of the primary care physician to attend these patients is becoming progressively more intense. To accomplish this task, primary physicians should receive proper education in sleep medicine, should have enough time to spend with the patients, should have material and human resources and should have the possibility of administering treatments. Patients usually complain of one of the following symptoms: excessive sleepiness in the suppossed waking time, inability to fall asleep or to remain asleep (insomnia) and abnormal behaviour prior or during the sleep time. In the first case, due to potential serious consequences, sleep apnea-hypopnea syndrome, narcolepsy, idiopathic hypersomnia or insufficient sleep syndrome should be suspected, the appropiate sleep study should be performed and the proper treatment must be administered. When considered necessary, the patient will be sent to the sleep expert. In insomnia the underlying disorder will be investigated and treated and, when necessary, the physician will apply to the help of the corresponding specialist. When an abnormal behaviour appears prior or during the sleep time (restless legs syndrome, periodic limb movements, sleepwalking, epilepsy, REM behaviour disorder, etc.) it is advisable, especially if there is any doubt, to turn to the sleep expert. In any other symptomatology the physician should systematically ask easy and simple questions related to the quantity and quality of the patient’s sleep in order to have the greatest security that the sleep is correct (AU)

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Para la evaluación de los ritmos circadianos y sus trastornos los estudios polisomnográficos son costosos y laboriosos y los estudios actigráficos poco concretos. Un calendario de sueño puede aportar abundante información objetiva y subjetiva. Se describe la estructura de un calendario de sueño que se combina con la escala de somnolencia de Stanford y que está basado en el diseñado por Metrodesign Associates-Charles Pollak. Se comenta el análisis numérico y gráfico y se describe el "corredor de máxima vigilia" y las "zonas de tendencia al sueño"; se concluye que con estos análisis se obtiene información acerca del tiempo de sueño que ha precisado cada persona día a día, del ritmo circadiano sueño-somnolencia-vigilia, de la latencia para conseguir la máxima vigilia (inercia de sueño), del promedio de la somnolencia, de los promedios correspondientes a tiempo de acostarse, latencia de sueño, número de despertamientos, hora final de despertar, de levantarse, tiempo total de sueño nocturno, tiempo que ha precisado para estar plenamente vigil tras el inicio del sueño y número y duración de las siestas. Todo ello permite conocer las horas más probables de máxima vigilia y de máxima tendencia al sueño y sirve de base para aconsejar la hora aproximada en que se debe iniciar y terminar el sueño de forma espontánea y adecuada al propio ritmo circadiano. Se comenta su posible utilidad individual y colectiva (AU)

In order to evaluate circadian rhythms and their disorders polysomnographic studies are expensive and time wasting and actigraphic studies are not specific. A sleep log can bring plenty of subjective and objective information.We describe the structure of a sleep log which is combined with the Stanford Sleepiness Scale and is based on the one designed by Metrodesign Associates-Charles Pollak. We comment both numeric and graphic analysis and describe the "maximum wakefulness corridor" and the "sleep trend zones" concluding that with these analysis we can get information about the day by day needed individual sleep time, the sleep-sleepiness-wake circadian rhythm, and the means related to maximum wakefulness latency (sleep inertia), sleepiness value, bedtime, sleep latency, number of awakenings, final wake up time, get up time, total nocturnal sleep time, time needed to become fully awake after sleep onset and number of siestas and their length. All these data allow knowing the most probable maximum alertness hours and the most probable maximum tendency to sleep hours and set the basis to recommend the approximate sleep and wake time in an spontaneous form and according to the own circadian rhythm. The possible individual and collective utility is commented (AU)

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Idiopathic hypersomnia of the central nervous system is a cause of excessive diurnal somnolence which affects 5-10% of the patients who attend sleep clinics for this reason. We describe three male patients who consulted for excessive diurnal somnolence. Nocturnal polysomnographic studies followed by tests for multiple latencies of sleep were done. In all cases there was confirmation of lengthening of the time of nocturnal sleep with normal phases of sleep and an increase in the number of sleep spindles in phase II. Similarly there was an average latency of sleep of less than 10 minutes and fewer than two phases of REM in the multiple latencies test. All patients improved with drugs stimulating vigil, two of them with centramine and the third with methilphenidate. We consider the clinical data the polysomnographic criteria which help to establish the diagnosis.

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La hipersomnia idiopática del sistema nervioso central constituye una causa de excesiva somnolencia diurna que afecta al 5-10 por ciento de pacientes que acuden a un centro de sueño por dicho motivo. Se describen tres pacientes varones que acudieron para estudio de excesiva somnolencia diurna y a los que se les efectuó un estudio polisomnográfico nocturno seguido de un test de las latencias múltiples del sueño. En todos los casos se confirmó un alargamiento del tiempo de sueño nocturno con normalidad de las fases de sueño y un incremento en el número de husos de sueño en fase II.Asimismo, se constató una latencia media de sueño inferior a los 10 minutos y menos de dos fases REM en el test de las latencias múltiples. Todos los pacientes mejoraron con fármacos estimulantes de la vigilia, dos de ellos con centramina y el tercero con metilfenidato. Se comentan los datos clínicos y los criterios polisomnográficos que ayudan a establecer el diagnóstico (AU)

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