Obesity and sleep disorder are mutual risk factors for each other. Late sleep onset and reduction of sleep have been shown to be risk factors of obesity in children. These symptoms with unstable wake onset are often seen in autistic children and well correlated with other mental problems. These findings suggest that feeding regulation and other brain functions including sleep-awake control and certain higher brain functions may share common control signaling. Lesion of suprachiasmatic nucleus in the hypothalamus induces not only disturbance of circadian rhythm but also obesity and metabolic dysfunctions. Lateral hypothalamic peptide orexin facilitates food intake and wakefulness but suppresses spatial memory and hippocampal long-term potentiation. In contrast, appetite-reducing substances such as glucose, cholecystokinin, leptin and 2-buten-4-olide facilitate spatial memory and hippocampal long-term potentiation. Sleep-awake cycles and feeding behavior are regulated by two physiological processes, homeostatic processes and circadian rhythm. We analyzed dynamical properties of irregular sleep-wake patterns of autistic children and revealed that the sleep-wake patterns of autistic children are under the control of the same deterministic rules of normal children with different parameter setting. Integrated analyses using mathematical model and molecular analyses may provide better understanding of the neural mechanisms of homeostatic problems in which many regulating factors are involved.

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The relationship between sleep disorders and lifestyle-related diseases was investigated in 5,747 subjects (mean age 43.8 years). The percentage of those with insomnia and depressive state was higher, in those who had lifestyle- related diseases than in those who did not. Moreover, the incidence of insomnia was higher in those who left lifestyle- related diseases untreated than in those who were under proper treatment, and was highest in those who left 3 major lifestyle-related diseases untreated. Conversely, the incidence of lifestyle-related diseases was significantly higher in those who had insomnia than in those who did not. Also, many subjects with insomnia were found to have left insomnia untreated without consulting a physician or being inquired by a physician about sleep. They tend to take a nightcap or OTC drugs by their own judgments, and do not receive appropriate treatment by prescription drugs. These results confirmed a close relationship between lifestyle-related diseases and sleep disorders, and suggested that insomnia can be a risk factor of lifestyle-related diseases.

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Sleep disturbance has been a growing problem in the medical"care and society. Many reasons were known for insomnia, we experience some patients with sleep disorders caused by environmental problems. In this study, we investigated whether or not the hospital and work environment had any effect on sleep or not. We surveyed 57 inpatients with physical diseases about the existence of insomnia, background, reason of referral from other departments and the approaches to patients. Of all inpatients, 61% had sleep problems. However, about a half of the patients with insomnia did not recognize their sleep disturbances as a main problem and a half of the doctors in charge considered the sleep disturbance a as not main problem, either. Many patients had problems in doctorpatient relationships and needed supportive psychotherapy. From the viewpoint of work environment, daytime workers showed higher anxiety and lower quality of life than shift workers. Many shift workers however had sleep disturbance. We had to put greater importance on the environmental factors in the management of sleep disturbance.

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Several epidemiological studies have shown that sleep problems are common in Japanese general population. When treating sleep disorders, it is important to aim both at improving the disorder as well as often related dysfunctional daily life patterns. Recent studies have been designed specifically to evaluate the impact of sleep disorders on QOL (quality of life). The objective of this paper is to review the influence on social life of insomnia and insufficient sleep, which are the most common sleep disorders. Insomnia is statistically linked to a worsening of health condition. Persistent insomnia increases the risk of several somatic diseases such as hypertension and diabetes mellitus. In addition, the disorder has also a negative impact on waking functions related to quality of life, e.g. impaired concentration, impaired memory, decreased ability to accomplish daily tasks, and decreased enjoyment of interpersonal relationships. The risk of both work-related accidents and motor-vehicle accidents are usually found to be higher in insomniacs than in controls. Moreover, several studies have provided data suggesting that insomnia is one of the risk factors for the development of depression. Although chronic insufficient sleep and sleep loss are highly frequent in Japanese population, the number of insufficient sleepers who consult medical facilities is thought to be relatively low. From our study, 22% of the patients with insufficient sleep syndrome reported having had accidents or near misses. Moreover, the group of patients reporting these mishaps showed higher sleepiness scores than the other patients. This finding leads us to emphasize that insufficient sleep should not be overlooked and should be treated by prolonging nocturnal sleep and/or taking an appropriate daytime nap. Substantial treatment for sleep disorders usually improves not only sleep itself but also QOL. The importance of early recognition and treatment of sleep disorders as well as campaigns for sleep health awareness must be emphasized.

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Objective : Atopic dermatitis (AD) is a chronic skin disorder. AD often develops between infancy and adolescence, runs a course of remissions and exacerbations. Originally, AD is child's skin disease. However, the number of AD patients is increasing. Adult AD patients generally show a high anxiety level. It is indicated that anxiety in adult patients causes high rate of scratching behavior. However, not much research on the anxiety to itch has been conducted enough in adult AD patients. The purpose of this study is to develop the Itch Anxiety Scale for Atopic Dermatitis (IAS-AD) to assess the anxiety to itch in adult AD patients. Method : The participants of this study were 294 undergraduate students. Forty-four undergraduate students were diagnosed as atopic dermatitis. The participant of this study completed the IAS-AD, the State-Trait Anxiety Inventory-form JYZ (STAI-JYZ), and the level of subjective itch by using Visual Analogue Scale (VAS). Results : Result of exploratory factor analysis revealed that the IAS-AD consisted of 17-items loading on two factors, which were named "Environmentally-induced type" and "Stress-induced type". Internal consistency of each factor was sufficiently high (α = 0.88-0.91). Result of t test revealed that undergraduate students with atopic dermatitis showed higher scores than healthy students in IAS-AD. In addition, a result of logistic regression analysis revealed that the IAS-AD predicted the morbidity of AD. Furthermore, for setting the cut-off point, ROC curve (Receiver operating characteristic curve) was calculated. Result of ROC analysis indicated that sensitivity and specificity were at their maximum when IAS-AD score was 37.5point. Therefore, the point of 37 was adopted as the cut-off point. Conclusion : It was concluded that the IAS-AD have high internal consistency and validity. It was suggested that the IAS-AD have potential significance for the clinical and research application. Finally, discussion was made on about IAS-AD with respect to severity of symptoms.

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This case report is of a female patient with prolonged anorexia nervosa who used a great deal of laxatives over a ten year period. Although the disease was intractable and the prognosis was poor, "cognitive behavioral therapy with behavioral limitation" was proved to be effective and the course after discharge was satisfactory. In "cognitive-behavioral therapy with behavioral limitation", the patients attempt to increase their weight and to confront their fears of gaining weight. At the same time, the problematic behaviors that come out during behavioral limitation are treated in a timely manner. This patient came to realize that the essential problem that needed to be solved was 'conflict evasion' ; avoidance of unpleasant things encountered in her life. As a result, her weight gained steadily as she learned not to escape from conflict. Moreover, the change was reflected in her cognition and behavior in relation to her family and interpersonal relationships. In this report, we show the process of change through treatment in both the cognition and the behavior of the patient and discuss points to keep in mind when treating such patients.

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