Sleep and emotional processing

Identification of hub genes correlated with sleep deprivation using co-expression analysis

BACKGROUND

Sleep deprivation (SD) has become a serious concern worldwide. This study aimed to identify key modules and candidate hub genes correlated with diseases caused by SD, using co-expression analysis.

METHODS

The weighted gene co-expression network analysis was performed to construct a co-expression network of hub genes correlated with SD. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed to search for signaling pathways. The protein-protein interaction network analysis of central genes was performed to recognize the interactions among central genes. Molecular Complex Detection, a plugin in Cytoscape, was used to discover the hub gene clusters involved in SD.

RESULTS

A total of 564 genes in the yellow module were identified based on the results of topological overlap measure-based clustering. The yellow module showed a pivotal correlation with SD. Six hub gene clusters prominently associated with SD were identified. Heat shock protein family and circadian clock genes among them may be the hub genes involved in SD.

CONCLUSIONS

These genes and pathways might become therapeutic targets with clinical usefulness in the future.

Pain Catastrophizing and Arthritis Self-Efficacy as Mediators of Sleep Disturbance and Osteoarthritis Symptom Severity

OBJECTIVE

Sleep and pain-related experiences are consistently associated, but the pathways linking these experiences are not well understood. We evaluated whether pain catastrophizing and arthritis self-efficacy mediate the association between sleep disturbance and osteoarthritis (OA) symptom severity in patients with knee OA.

METHODS

We analyzed cross-sectional baseline data collected from Veterans Affairs (VA) patients enrolled in a clinical trial examining the effectiveness of a positive psychology intervention in managing pain from knee OA. Participants indicated how often in the past two weeks they were bothered by trouble falling asleep, staying asleep, or sleeping too much. We used validated scales to assess the primary outcome (OA symptom severity) and potential mediators (arthritis self-efficacy and pain catastrophizing). To test the proposed mediation model, we used parallel multiple mediation analyses with bootstrapping, controlling for sociodemographic and clinical characteristics with bivariate associations with OA symptom severity.

RESULTS

The sample included 517 patients (Mage = 64 years, 72.9% male, 52.2% African American). On average, participants reported experiencing sleep disturbance at least several days in the past two weeks (M = 1.41, SD = 1.18) and reported moderate OA symptom severity (M = 48.22, SD = 16.36). More frequent sleep disturbance was associated with higher OA symptom severity directly (b = 3.08, P <0.001) and indirectly, through higher pain catastrophizing (b = 0.60, 95% confidence interval [CI] = 0.20 to 1.11) and lower arthritis self-efficacy (b = 0.84, 95% CI = 0.42 to 1.42).

CONCLUSIONS

Pain catastrophizing and arthritis self-efficacy partially mediated the association between sleep disturbance and OA symptom severity. Behavioral interventions that address pain catastrophizing and/or self-efficacy may buffer the association between sleep disturbance and OA symptom severity.

The association between poor sleep quality and anxiety and depression symptoms in Chinese patients with coronary heart disease

Poor sleep quality might be a potentially modifiable predictor of prognosis in patients with coronary heart disease (CHD). Anxiety and depression symptoms are highly prevalent in these patients. Whether anxiety and depression symptoms are risk factors for poor sleep quality in Chinese patients with CHD is unclear. This study is intended to examine the prevalence of poor sleep quality in Chinese patients with CHD and its associations with anxiety and depression symptoms, and to explore whether sex, obesity and CHD type modify these associations. Three hundred and forty-eight participants were included. The Pittsburgh Sleep Quality Index (PSQI, >7 was defined as poor sleep quality) and Hospital Anxiety and Depression Scale (HADS) were used to assess sleep quality and psychological symptoms. 47.1% of the participants had poor sleep quality. Logistic regression analysis showed that poor sleep quality was independently associated with anxiety and depression symptoms adjusting for demographic and clinical factors. However, adjusted for anxiety symptoms, poor sleep quality was no longer associated with depression symptoms. Subgroup and interaction analysis showed that poor sleep quality was associated with markedly higher HADS anxiety and depression scores among patients with stable angina than those with acute coronary syndrome (ACS). These findings suggest that poor sleep quality was associated with both anxiety and depression symptoms in Chinese patients with CHD. However, in the case of concurrent anxiety and depression, anxiety was the main related factor of a high prevalence of poor sleep quality. The association between poor sleep quality and psychological symptoms was influenced by CHD type.

Nightly sleep-wake concordance and daily marital interactions

OBJECTIVE

We and others have found that couples' sleep is a shared and dyadic process. Couples' sleep-wake concordance (whether couples are awake or asleep at the same time) is associated with couples' relationship factors; however, we know little of the temporal associations between concordance and daily relationship characteristics. The purpose of this study was to examine daily positive and negative interpersonal interactions to determine how they predict, and are predicted by, nightly sleep-wake concordance.

METHOD

Participants were 48 heterosexual couples between 18 and 45 years of age who shared a bed with their spouse. Couples completed questionnaires and daily assessments of positive and negative interactions. Each member of the dyad wore wrist actigraphs for 10 days. Sleep-wake concordance was calculated as the percentage of time couples were awake or asleep throughout the night at one-minute intervals. Multilevel modeling with lagged effects determined bidirectional and lagged associations between concordance and couples' daily interactions.

RESULTS

Couples had more negative interactions than their usual following nights with higher concordance than their usual (but not vice versa) and this was more pronounced for well-adjusted couples. In contrast, across all couples, more positive interactions and perceived warmth and support from partners were associated with higher concordance.

CONCLUSIONS

Our findings demonstrate that the valence of sleep-wake concordance depends on relationship quality characteristics (eg, marital adjustment). Future research on relationships, sleep, and health should consider couples' shared sleep behaviors as one mechanism by which relationships are associated with long-term health outcomes.

The Effects of Sleep Quality on Dream and Waking Emotions

Despite the increasing interest in sleep and dream-related processes of emotion regulation, their reflection into waking and dream emotional experience remains unclear. We have previously described a discontinuity between wakefulness and dreaming, with a prevalence of positive emotions in wakefulness and negative emotions during sleep. Here we aim to investigate whether this profile may be affected by poor sleep quality. Twenty-three ‘Good Sleepers’ (GS) and 27 ‘Poor Sleepers’ (PS), identified through the Pittsburgh Sleep Quality Index (PSQI) cut-off score, completed three forms of the modified Differential Emotions Scale, assessing, respectively, the frequency of 22 emotions over the past 2 weeks, their intensity during dreaming and during the previous day. The ANOVA revealed a different pattern of emotionality between groups: GS showed high positive emotionality in wakefulness (both past 2 weeks and 24 h) with a significant shift to negative emotionality in dreams, while PS showed evenly distributed emotional valence across all three conditions. No significant regression model emerged between waking and dream affect. In the frame of recent hypotheses on the role of dreaming in emotion regulation, our findings suggest that the different day/night expression of emotions between groups depends on a relative impairment of sleep-related processes of affect regulation in poor sleepers. Moreover, these results highlight the importance of including sleep quality assessments in future dream studies.

Effects of 2.45 GHz Wi-Fi exposure on sleep-dependent memory consolidation

Studies have reported that exposure to radiofrequency electromagnetic fields (RF-EMF) emitted by mobile telephony might affect specific sleep features. Possible effects of RF-EMF emitted by Wi-Fi networks on sleep-dependent memory consolidation processes have not been investigated so far. The present study explored the impact of an all-night Wi-Fi (2.45 GHz) exposure on sleep-dependent memory consolidation and its associated physiological correlates. Thirty young males (mean ± standard deviation [SD]: 24.1 ± 2.9 years) participated in this double-blind, randomized, sham-controlled crossover study. Participants spent five nights in the laboratory. The first night was an adaptation/screening night. The second and fourth nights were baseline nights, each followed consecutively by an experimental night with either Wi-Fi (maximum: psSAR10g = <25 mW/kg; 6 min average: <6.4 mW/kg) or sham exposure. Declarative, emotional and procedural memory performances were measured using a word pair, a sequential finger tapping and a face recognition task, respectively. Furthermore, learning-associated brain activity parameters (power spectra for slow oscillations and in the spindle frequency range) were analysed. Although emotional and procedural memory were not affected by RF-EMF exposure, overnight improvement in the declarative task was significantly better in the Wi-Fi condition. However, none of the post-learning sleep-specific parameters was affected by exposure. Thus, the significant effect of Wi-Fi exposure on declarative memory observed at the behavioural level was not supported by results at the physiological level. Due to these inconsistencies, this result could also be a random finding.

Relationships Among Delayed Sleep Phase Disorder, Emotional Dysregulation, and Affective Temperaments in Adults With Attention Deficit Hyperactivity Disorder and Cyclothymia

This study aims to explore the relationships between delayed sleep phase disorder (DSPD) and emotional dysregulation in 240 patients (134 with cyclothymia, 81 with attention deficit hyperactivity disorder [ADHD] and 25 with both conditions). DSPD was assessed using the Morningness-Eveningness Questionnaire, followed by a clinical evaluation. Affective temperaments and emotional dysregulation were also investigated through the brief version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego and the Reactivity, Intensity, Polarity, Stability questionnaires, respectively. Clinical variables were compared in patients with and without DSPD, and a logistic regression model was used to identify the predictive value of the clinical characteristics on the presence of DSPD. DSPD patients (19% of the total sample) were significantly younger than patients without DSPD, showed an about 4 times higher lifetime history of comorbid ADHD and cyclothymia, and reported higher scores in the irritable and cyclothymic temperamental subscales and in the affective instability and impulsivity dimensions. In the multiple logistic regression, we found a negative predictive value of increasing age on the presence of DSPD, whereas comorbid cyclothymia and ADHD and cyclothymic temperament seem to represent risk factors for DSPD.

A combined fMRI and EMG study of emotional contagion following partial sleep deprivation in young and older humans

Sleep deprivation is proposed to inhibit top-down-control in emotion processing, but it is unclear whether sleep deprivation affects emotional mimicry and contagion. Here, we aimed to investigate effects of partial sleep deprivation on emotional contagion and mimicry in young and older humans. Participants underwent partial sleep deprivation (3 h sleep opportunity at the end of night), crossed-over with a full sleep condition in a balanced order, followed by a functional magnetic resonance imaging and electromyography (EMG) experiment with viewing of emotional and neutral faces and ratings of emotional responses. The final sample for main analyses was n = 69 (n = 36 aged 20–30 years, n = 33 aged 65–75 years). Partial sleep deprivation caused decreased activation in fusiform gyri for angry faces and decreased ratings of happiness for all stimuli, but no significant effect on the amygdala. Older participants reported more anger compared to younger participants, but no age differences were seen in brain responses to emotional faces or sensitivity to partial sleep deprivation. No effect of the sleep manipulation was seen on EMG. In conclusion, emotional contagion, but not mimicry, was affected by sleep deprivation. Our results are consistent with the previously reported increased negativity bias after insufficient sleep.

The Stockholm sleepy brain study: effects of sleep deprivation on cognitive and emotional processing in young and old. https://clinicaltrials.gov/ct2/show/NCT02000076.

Cognitive arousal mediates the relationship between perceived ostracism and sleep quality but it is not moderated by experiential avoidance

Previous research suggests that longer-term perceived ostracism is related to poor sleep quality. In this study, we investigated the mediating effect of cognitive arousal on the perceived ostracism-sleep quality relationship. We also investigated whether experiential avoidance was a moderator of the cognitive arousal-sleep quality relationship. Participants (N = 251) were recruited through online research portals to take part in an online survey. A path analysis was used to test a moderated mediation effect between variables. It was found that cognitive arousal mediated the perceived ostracism-sleep quality relationship; however, experiential avoidance was not a significant moderator. These findings suggest that further research needs to be conducted to elucidate the mechanism of experiential avoidance to account for when it may impact sleep quality. Moreover, treatment interventions targeted at reducing cognitive arousal (e.g., cognitive behavioural therapy) prior to sleep are likely to bear some fruit.

Considering the relationship between sleep and empathy and compassion in mental health nurses: It's time

Sleep plays a critical role in overall health, well-being, and daytime functioning. Provision of 24-hour care means that nurses undertake shift work and therefore have been found to commonly not get the recommended amount of sleep, resulting in sleep deprivation. Research to date has focused on how sleep deprivation impacts their cognitive performance (e.g., reaction time, memory consolidation); however, less considered is how nurses' sleep impacts on their ability to understand and provide emotional care to consumers. In this paper, we examine how sleep may influence nurses' ability to empathize and provide compassionate care, both of which are fundamental aspects of their work. We begin by considering the unique challenges nurses face as shift workers and the impact of sleep on physical and psychological functioning. We examine how empathy and compassion drive nurses' attempts to understand consumers' perspectives and experiences and motivate them to want to help those in their care. Work directly investigating the relationship between sleep and these processes indicates emotional recognition and experience are hampered by poor sleep, with greater compassion towards oneself or from others associated with better sleep. Much of this work has, however, been conducted outside of the nursing or health professional space. We discuss issues that need to be addressed in order to move understanding forward regarding how sleep impacts on mental health nurses' empathy and compassion, as well as how an understanding of the sleep-empathy/compassion link should be an important priority for nurse education and well-being.

Pandemic Dreams: Network Analysis of Dream Content During the COVID-19 Lockdown

We used crowdsourcing (CS) to examine how COVID-19 lockdown affects the content of dreams and nightmares. The CS took place on the sixth week of the lockdown. Over the course of 1 week, 4,275 respondents (mean age 43, SD = 14 years) assessed their sleep, and 811 reported their dream content. Overall, respondents slept substantially more (54.2%) but reported an average increase of awakenings (28.6%) and nightmares (26%) from the pre-pandemic situation. We transcribed the content of the dreams into word lists and performed unsupervised computational network and cluster analysis of word associations, which suggested 33 dream clusters including 20 bad dream clusters, of which 55% were pandemic-specific (e.g., Disease Management, Disregard of Distancing, Elderly in Trouble). The dream-association networks were more accentuated for those who reported an increase in perceived stress. This CS survey on dream-association networks and pandemic stress introduces novel, collectively shared COVID-19 bad dream contents.

Relationships between Dream and Previous Wake Emotions Assessed through the Italian Modified Differential Emotions Scale

Despite the increasing interest in sleep and dream-related processes of emotion regulation, their reflection into wake and dream emotional experience remains unclear. Here, we aimed to assess dream emotions and their relationships with wake emotions through the modified Differential Emotions Scale (Fredrickson, 2003), which includes a broad array of both positive and negative emotions. The scale has been first validated on 212 healthy Italian participants, in two versions: a WAKE-2wks form, assessing the frequency of 22 emotions over the past 2 weeks, and a WAKE-24hr form, assessing their intensity over the past 24 h. Fifty volunteers from the wider sample completed the WAKE-24hr mDES for several days until a dream was recalled, and dream emotions were self-reported using the same scale. A bifactorial structure was confirmed for both mDES forms, which also showed good validity and reliability. Though Positive and Negative Affect (average intensity of positive and negative items, PA, and NA, respectively) were balanced in dreams, specific negative emotions prevailed; rmANOVA showed a different pattern (prevalence of PA and positive emotions) in wake (both WAKE-2wks and WAKE-24hr), with a decrease of PA and an increase of NA in the dream compared to previous wake. No significant regression model emerged between waking and dream affect, and exploratory analyses revealed a stable proportion of PA and NA (with prevailing PA) over the 3 days preceding the dream. Our findings highlight a discontinuity between wake and dream affect and suggest that positive and negative emotions experienced during wake may undertake distinct sleep-related regulation pathways.

Overnight sleep benefits both neutral and negative direct associative and relational memory

Strong evidence suggests that sleep plays a role in memory consolidation, which involves both stabilizing memory into long-term storage as well as integrating new information into existing stores. The current study investigated consolidation, across a day of wakefulness or night of sleep, of emotional and neutral directly learned visual paired associates (A-B/B-C pairs) as well as formation of memory for relational pairs formed via overlapping learned components (A-C pairs). Participants learned 40 negative and 40 neutral face-object pairs followed by a baseline test in session 1 either in the morning or evening. They then spent a 12-hour retention period during which participants either went about their normal day or spent the night in the sleep lab. During session 2, participants completed a surprise test to assess their memory for relational pairs (A-C) as well as memory for direct associates (A-B/B-C). As hypothesized, the results demonstrated that a 12-hour retention period predominantly spent asleep, compared to awake, benefited memory for both relational and direct associative memory. However, contrary to the hypothesis that emotional salience would promote preferential consolidation, sleep appeared to benefit both negative and neutral information similarly for direct associative and relational memories, suggesting that sleep may interact with other factors affecting encoding (e.g., depth of encoding) to benefit direct and relational associative memory. As one of the few studies examining the role of nocturnal sleep and emotion on both direct and relational associative memory, our findings suggest key insights into how overnight sleep consolidates these different forms of memory.

Partial and Total Sleep Deprivation Interferes With Neural Correlates of Consolidation of Fear Extinction Memory

BACKGROUND

We assessed the impact of total and partial sleep loss on neural correlates of fear conditioning, extinction learning, and extinction recall in healthy young adults.

METHODS

Participants (56.3% female, age 24.8 ± 3.4 years) were randomized to a night of normal sleep (NS) (n = 48), sleep restriction (SR) (n = 53), or sleep deprivation (SD) (n = 53). All completed fear conditioning and extinction learning phases the following morning. Extinction recall was tested in the evening of the same day. Task-based contrasts were modeled at the beginning of, at the end of, and across the fear conditioning and extinction learning phases, and at the beginning of extinction recall. These contrasts were compared among the 3 groups by means of analysis of variance. Nonparametric permutation corrected analyses using a cluster-determining threshold of p < .005 and a familywise error of p < .05.

RESULTS

At the end of fear conditioning, NS activated medial prefrontal regions, SR activated motor areas, and participants in the SD group showed no significant activations. Across extinction learning, only NS activated both salience (fear) and extinction (regulatory) areas. For extinction recall, SD activated similar regions as NS across extinction learning, while SR activated salience and motor areas. During early fear conditioning, compared with NS, SD activated more medial prefrontal and SR activated more salience network areas. For extinction recall, NS activated more prefrontal areas and SD activated more of both salience- and extinction-related areas than SR.

CONCLUSIONS

Relative to NS, SR may enhance fear-related and diminish extinction-related activity, whereas SD may delay engagement of extinction learning. Findings may have clinical implications for populations and occupations in which sleep loss is common.

Sleep and immunity in times of COVID-19

BACKGROUND

Analyze how the COVID-19 (SARS-CoV-2) pandemic and its social restriction measures affect sleep quality and the immunological system.

METHODS

An integrative bibliographical review was carried out using scientific articles from the last five years, from the PUBMED databases, with the descriptors: Sleep; Quarantine; COVID-19; Immunity; Mental Health. Besides the books "Oxford textbook of sleep disorders", "Cellular and molecular immunology", and "Treaty of Infectology".

RESULTS

Sleep affects immunity. This happens through the regulation of immunological markers and their cells. Therefore, the COVID-19 pandemic can promote sleep disturbances and harm the immune system function.

CONCLUSION

Sleep exercises a direct influence on immunity maintenance and immunological response. Circadian rhythm alterations, associated with the psychological problems imposed by the COVID-19 pandemic compromise the quality of sleep and, for that reason, the immune system.

Memory and Sleep: How Sleep Cognition Can Change the Waking Mind for the Better

The memories that we retain can serve many functions. They guide our future actions, form a scaffold for constructing the self, and continue to shape both the self and the way we perceive the world. Although most memories we acquire each day are forgotten, those integrated within the structure of multiple prior memories tend to endure. A rapidly growing body of research is steadily elucidating how the consolidation of memories depends on their reactivation during sleep. Processing memories during sleep not only helps counteract their weakening but also supports problem solving, creativity, and emotional regulation. Yet, sleep-based processing might become maladaptive, such as when worries are excessively revisited. Advances in research on memory and sleep can thus shed light on how this processing influences our waking life, which can further inspire the development of novel strategies for decreasing detrimental rumination-like activity during sleep and for promoting beneficial sleep cognition.

Compliance of indoor air quality during sleep with legislation and guidelines - A case study of Lisbon dwellings

This study aimed to provide a comprehensive characterisation of the indoor air quality during the sleeping period of 10 couples at Lisbon dwellings, using a multi-pollutant approach, and to understand how the compliance with legislation and guidelines was to assure a good indoor air quality. The assessment of indoor air quality was conducted in the cold season using real time monitors during the sleeping period for comfort parameters (temperature and relative humidity) and air pollutants (carbon dioxide - CO₂, carbon monoxide - CO, formaldehyde - CH₂O, total volatile organic compounds - VOCs, and particulate matter - PM_2.5 and PM₁₀), together with active sampling of bioaerosols (fungi and bacteria) before and after the sleeping period. Lower compliance (less than 50% of the cases) with the Portuguese legislation was found for temperature, CO₂ (3440 ± 1610 mg m^-3), VOCs (1.79 ± 0.99 mg m^-3) and both bioaerosol types. In 70% of the cases, PM_2.5 (15.3 ± 9.1 μg m^-3) exceeded the WHO guideline of 10 μg m^-3. All bedrooms presented air change rates above the recommended minimum value of 0.7 h^-1, highlighting that a good indoor air quality during sleep is not guaranteed.

Sharp Wave-Ripples in Human Amygdala and Their Coordination with Hippocampus during NREM Sleep

Cooperative interactions between the amygdala and hippocampus are widely regarded as critical for overnight emotional processing of waking experiences, but direct support from the human brain for such a dialog is absent. Using overnight intracranial recordings in 4 presurgical epilepsy patients (3 female), we discovered ripples within human amygdala during nonrapid eye movement (NREM) sleep, a brain state known to contribute to affective processing. Like hippocampal ripples, amygdala ripples are associated with sharp waves, linked to sleep spindles, and tend to co-occur with their hippocampal counterparts. Moreover, sharp waves and ripples are temporally linked across the 2 brain structures, with amygdala ripples occurring during hippocampal sharp waves and vice versa. Combined with further evidence of interregional sharp-wave and spindle synchronization, these findings offer a potential physiological substrate for the NREM-sleep-dependent consolidation and regulation of emotional experiences.

Brain mechanisms of insomnia: new perspectives on causes and consequences

While insomnia is the second most common mental disorder, progress in our understanding of underlying neurobiological mechanisms has been limited. The present review addresses the definition and prevalence of insomnia and explores its subjective and objective characteristics across the 24-hour day. Subsequently, the review extensively addresses how the vulnerability to develop insomnia is affected by genetic variants, early life stress, major life events, and brain structure and function. Further supported by the clear mental health risks conveyed by insomnia, the integrated findings suggest that the vulnerability to develop insomnia could rather be found in brain circuits regulating emotion and arousal than in circuits involved in circadian and homeostatic sleep regulation. Finally, a testable model is presented. The model proposes that in people with a vulnerability to develop insomnia, the locus coeruleus is more sensitive to-or receives more input from-the salience network and related circuits, even during rapid eye movement sleep, when it should normally be sound asleep. This vulnerability may ignite a downward spiral of insufficient overnight adaptation to distress, resulting in accumulating hyperarousal, which, in turn, impedes restful sleep and moreover increases the risk of other mental health adversity. Sensitized brain circuits are likely to be subjectively experienced as "sleeping with one eye open". The proposed model opens up the possibility for novel intervention studies and animal studies, thus accelerating the ignition of a neuroscience of insomnia, which is direly needed for better treatment.

miR-187-3p participates in contextual fear memory formation through modulating SATB2 expression in the hippocampus

PURPOSE

When threatened, fear is one of the most important responses that an organism exhibits. The mechanisms involved in forming fear memories include specific neurological structures, neural circuits and detailed molecular interactions.

METHODS

MicroRNAs (miRNAs, small non-coding RNAs) act as endogenous functional small molecules that participate in or interfere with the formation of new fear memory by inhibiting the expression of mRNA targets. MicroRNA-187 (miR-187) is a newly reported miRNA that is related to cancer, but it has not been investigated regarding fear memory formation.

RESULTS

In the present study, we observed a transient reduction in the level of miR-187 in the dorsal hippocampus after a classic contextual fear conditioning (CFC) training. Overexpression of miR-187-3p in the DH using miR-187-3p agomir was detrimental in the formation of CFC memory, whereas downregulation of miR-187-3p using antagomir enhanced the formation of CFC memory. Additionally, utilization of bioinformatic methods and luciferase reporter assay revealed that miR-187-3p targets SATB2, and therefore miR-187-3p agomir can decrease the protein level of SATB2. Furthermore, we determined that SATB2 plays a role in the formation of CFC memory by miR-187-3p, which can be mediated by altering SATB2 expression.

CONCLUSION

Altogether, evidence obtained from both in-vitro and in-vivo experiments indicated that miR-187-3p is involved in CFC memory formation through modulation of SATB2. Our data provides a basis for the potential therapeutic benefits of miR-187-3p/SATB2 in the treatment of anxiety disorders induced from fear memory.

Sleep-Dependent Directional Interactions of the Central Nervous System-Cardiorespiratory Network

OBJECTIVE

We investigated the nature of interactions between the central nervous system (CNS) and the cardiorespiratory system during sleep.

METHODS

Overnight polysomnography recordings were obtained from 33 healthy individuals. The relative spectral powers of five frequency bands, three ECG morphological features and respiratory rate were obtained from six EEG channels, ECG, and oronasal airflow, respectively. The synchronous feature series were interpolated to 1 Hz to retain the high time-resolution required to detect rapid physiological variations. CNS-cardiorespiratory interaction networks were built for each EEG channel and a directionality analysis was conducted using multivariate transfer entropy. Finally, the difference in interaction between Deep, Light, and REM sleep (DS, LS, and REM) was studied.

RESULTS

Bidirectional interactions existed in central-cardiorespiratory networks, and the dominant direction was from the cardiorespiratory system to the brain during all sleep stages. Sleep stages had evident influence on these interactions, with the strength of information transfer from heart rate and respiration rate to the brain gradually increasing with the sequence of REM, LS, and DS. Furthermore, the occipital lobe appeared to receive the most input from the cardiorespiratory system during LS. Finally, different ECG morphological features were found to be involved with various central-cardiac and cardiac-respiratory interactions.

CONCLUSION

These findings reveal detailed information regarding CNS-cardiorespiratory interactions during sleep and provide new insights into understanding of sleep control mechanisms.

SIGNIFICANCE

Our approach may facilitate the investigation of the pathological cardiorespiratory complications of sleep disorders.

Analyzing human sleep EEG: A methodological primer with code implementation

Recent years have witnessed a surge in human sleep electroencephalography (EEG) studies, employing increasingly sophisticated analysis strategies to relate electrophysiological activity to cognition and disease. However, properly calculating and interpreting metrics used in contemporary sleep EEG requires attention to numerous theoretical and practical signal-processing details that are not always obvious. Moreover, the vast number of outcome measures that can be derived from a single dataset inflates the risk of false positives and threatens replicability. We review several methodological issues related to 1) spectral analysis, 2) montage choice, 3) extraction of phase and amplitude information, 4) surrogate construction, and 5) minimizing false positives, illustrating both the impact of methodological choices on downstream results, and the importance of checking processing steps through visualization and simplified examples. By presenting these issues in non-mathematical form, with sleep-specific examples, and with code implementation, this paper aims to instill a deeper appreciation of methodological considerations in novice and non-technical audiences, and thereby help improve the quality of future sleep EEG studies.

Categorization of Emotional Faces in Insomnia Disorder

It has been proved that emotionally positive facial expressions are categorized much faster than emotionally negative facial expressions, the positive classification advantage (PCA). In the present study, we investigated the PCA in primary insomnia patients. In comparison with controls, insomnia patients categorized emotional faces more slowly but there was no significant reduction in accuracy. In normal controls, happy faces were categorized faster than sad faces (i.e., PCA), which disappeared in the inverted condition. Insomnia patients did not show evident PCA except for the overall delayed response for the inverted compared to the upright condition. These data suggest the dysfunction of categorization of emotional faces in insomnia patients.

Investigation of brain-heart network during sleep

Interactions between brain and heart play an important role for sleep quality and control. However, the influence mechanism was still unclear. This study aimed to further investigate this mechanism according to build an information transfer network of brain-heart coupling. This study included 24 healthy individuals and both of them underwent overnight polysomnography. The relative spectral powers of five frequency bands and the high frequency power of heart rate variability were extracted from six electroencephalogram (EEG) channels and electrocardiography (ECG) respectively. For each EEG channel, brain-heart interaction networks were built and a directionality analysis was conducted by using multivariate transfer entropy. Results revealed the bidirectionality of information transfer between brain and heart during sleep, and the information was dominantly transfer from heart to brain. The information transfer strength between brain and heart were significantly stronger than which between frequency bands in each EEG channels. Besides, the frequency bands and EEG channels had evident influence on these interactions. This study exposed more detailed characteristics of brain-heart interaction, which will facilitate the future study about the sleep control and the diagnose of sleep related disease.

Sleep Quality and Psychological Status in a Group of Italian Prisoners

Prison could be considered a prolonged stressful situation that can trigger not only a dysregulation of sleep patterns but can also bring out psychiatric illness, such as anxiety and depression symptoms. Our study is aimed at exploring sleep quality and sleep habits in an Italian prison ward with three different security levels, and to attempt to clarify how anxiety state and the total time spent in prison can moderate insomnia complaints. There were 129 participants divided into three groups who enrolled in this study: 50 were in the medium-security prison ward (Group 1), 58 were in the high-security prison ward (Group 2) and 21 were in the medium-security following a protocol of detention with reduced custodial measures (Group 3). All participants filled in a set of questionnaires that included the Beck Depression Inventory (BDI-2), the State-Trait Anxiety Inventory (STAI), the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). Based on their responses, we observed that all participants showed poor sleep quality and insomnia, mild to moderate depressive symptoms that tended to a higher severity in Groups 1 and 3, and the presence of clinically significant anxiety symptoms, mainly in Groups 1 and 3. Our study shows that increased anxiety state-level and the presence of mood alteration corresponds to an increase in both poor sleep quality and, more specifically, insomnia complaints. Finally, we propose that TiP (total time in prison) could have an interesting and stabilizing paradox-function on anxiety state and insomnia.

Ecological Studies of Sleep Disturbances During Suicidal Crises

PURPOSE OF REVIEW

Several reviews and metanalyses have shown that sleep disturbances, such as insomnia and nightmares, can predict suicidal ideations and behaviors. Common physio-pathological pathways may explain this relationship. However, only in recent years, some research groups have tried to apply this knowledge in the quest for a reliable tool of suicide risk prediction. We aim to describe in this paper the results of studies using ecological or quasi-ecological assessment methods that connect sleep disturbances and suicide risk.

RECENT FINDINGS

Our review confirms the paucity of studies on this topic. The few studies that we could analyze suggest the interest of ecological methods of sleep assessment since sleep disturbances predicted the onset or worsening of suicidal ideations and behaviors. Ecological assessment of sleep can help to understand how sleep disturbances contribute to the emergence of suicidal ideations and behaviors. Sleep disturbances appear as a promising "real-life" marker of risk, but further studies are needed to determine if sleep monitoring could guide preventive interventions.

Psychotic-like experiences in patients with insomnia or sleep apnea: associations with sleep parameters

OBJECTIVES

There are strong links between sleep and psychotic-like experiences (PLE), such as magical ideations or persecutory ideas. Sleep disturbances seem to play an important role in the occurrence of such symptoms, but studies investigating PLE in patients with sleep disorders are lacking.

METHODS

We studied 24 subjects with insomnia disorder (41 ± 13 years) and 47 participants with obstructive sleep apnea (OSA, 47 ± 11 years) in the sleep laboratory and 33 healthy controls. Sleep in patients with sleep disorders was recorded and scored according to standard criteria of the American Academy of Sleep Medicine. PLE were measured by the Magical Ideation Scale (MIS, short form with 10 items) and by the Peters et al., Delusions Inventory (PDI, 21 items). Additionally, cognitive tests and further psychological self-rating tests such as the Beck Depression Inventory (BDI) and the Pittsburgh Sleep Quality Index (PSQI) were administered.

RESULTS

Patients with insomnia had significantly higher scores of magical and delusional ideations compared to healthy controls. Sleep apnea patients showed a tendency of a higher score of delusional beliefs in comparison to controls. Magical ideations in insomnia subjects were significantly negatively correlated with the number of sleep spindles. In a subgroup of insomnia patients without antidepressants, delusional beliefs were negatively associated with rapid eye movement (REM)-sleep.

CONCLUSIONS

As there are indications that diminutions of sleep spindles are a biomarker for dysfunctional thalamo-cortical circuits underlying the neuropathology of psychosis, we conclude that there might be a sub-group of insomnia patients with fewer sleep spindles which is more vulnerable to developing a psychotic disorder in the future.

Facial Emotion Recognition and Executive Functions in Insomnia Disorder: An Exploratory Study

BACKGROUND

Clinical and experimental findings suggest that insomnia is associated with changes in emotional processing and impairments in cognitive functioning. In the present study, we investigate the relationship between facial emotion recognition and executive functioning among individuals with insomnia as well as healthy controls.

METHOD

A total of 11 individuals (mean age 31.3 ± 9.4) diagnosed with insomnia disorder and 15 control participants (mean age 24.8 ± 4.6) took part in the study. Participants responded to a facial emotion recognition task which presented them with static and dynamic stimuli, and were evaluated with regard to cognition, sleep, and mood.

RESULTS

Compared to controls, we found that participants with insomnia performed worse in the recognition of the facial emotion of fear (p = 0.001; η p 2 = 0.549; β = 0.999) and had lower scores in tests of verbal comprehension and perceptual organization (104.00 vs. 115.00, U = 135.5; p = 0.004; Cohen's, 2013 d = 1.281). We also found a relationship between facial emotion recognition and performance in cognitive tests, such as those related to perceptual organization, cognitive flexibility, and working memory.

CONCLUSION

Results suggest that participants with insomnia may present some impairment in executive functions as well as in the recognition of facial emotions with negative valences (fear and sadness).

The impact of five nights of sleep restriction on emotional reactivity

An inadequate amount of sleep can negatively affect emotional processing, causing behavioural and neurofunctional changes. However, unlike the condition of total sleep deprivation, which has been extensively studied, the effects of prolonged sleep restriction have received less attention. In this study, we evaluated, for the first time, the effects of five nights of sleep restriction (5 hr a night) on emotional reactivity in healthy subjects. Forty-two subjects were selected to participate, over two consecutive weeks, in two experimental conditions in counterbalanced order. The subjects were tested the morning after five nights of regular sleep and after five consecutive nights of sleep restriction. During the test, participants evaluated valence and arousal of 90 images selected from the International Affective Picture System. The subjects perceived pleasant and neutral pictures in a more negative way in the sleep-restriction condition compared to the sleep condition. This effect survived after removing the contribution of mood changes. In contrast, there was no significant difference between conditions for ratings of unpleasant pictures. These results provide the first evidence that an inadequate amount of sleep for five consecutive nights determines an alteration of the evaluation of pleasant and neutral stimuli, imposing a negative emotional bias. Considering the pervasiveness of insufficient sleep in modern society, our results have potential implications for daily life, as well as in clinical settings.

Haunted by the past: old emotions remain salient in insomnia disorder

Studies suggest that sleep supports persistent changes in the neuronal representation of emotional experiences such that they are remembered better and less distressful when recalled than when they were first experienced. It is conceivable that sleep fragmentation by arousals, a key characteristic of insomnia disorder, could hamper the downregulation of distress. In this study, we sought further support for the idea that insomnia disorder may involve a lasting deficiency to downregulate emotional distress. We used functional MRI in insomnia disorder (n = 27) and normal sleepers (n = 30) to identify how brain activation differs between novel and relived self-conscious emotions. We evaluated whether brain activity elicited by reliving emotional memories from the distant past resembles the activity elicited by novel emotional experiences more in insomnia disorder than in normal sleepers. Limbic areas were activated during novel shameful experiences as compared to neutral experiences in both normal sleepers and insomnia disorder. In normal sleepers, reliving of shameful experiences from the past did not elicit a limbic response. In contrast, participants with insomnia disorder recruited overlapping parts of the limbic circuit, in particular the dorsal anterior cingulate cortex, during both new and relived shameful experiences. The differential activity patterns with new and old emotions in normal sleepers suggest that reactivation of the long-term memory trace does not recruit the limbic circuit. The overlap of activations in insomnia disorder is in line with the hypothesis that the disorder involves a deficiency to dissociate the limbic circuit from the emotional memory trace. Moreover, the findings provide further support for a role of the anterior cingulate cortex in insomnia.

Anxiolytic Effect of Increased NREM Sleep after Acute Social Defeat Stress in Mice

Social defeat stress (SDS) plays a major role in the pathogenesis of psychiatric disorders like anxiety and depression. Sleep is generally considered to involve recovery of the brain from prior experience during wakefulness and is altered after acute SDS. However, the effect of acute SDS on sleep/wake behavior in mice varies between studies. In addition, whether sleep changes in response to stress contribute to anxiety is not well established. Here, we first investigated the effects of acute SDS on sleep/wake states in the active period in mice. Our results showed that total sleep time (time in rapid eye-movement [REM] and non-REM [NREM] sleep) increased in the active period after acute SDS. NREM sleep increased mainly during the first 3 h after SDS, while REM sleep increased at a later time. Then, we demonstrated that the increased NREM sleep had an anxiolytic benefit in acute SDS. Mice deprived of sleep for 1 h or 3 h after acute SDS remained in a highly anxious state, while in mice with ad libitum sleep the anxiety rapidly faded away. Altogether, our findings suggest an anxiolytic effect of NREM sleep, and indicate a potential therapeutic strategy for anxiety.

Among Persons With Multiple Sclerosis (MS), Objective Sleep, Psychological Functioning, and Higher Physical Activity Scores Remained Stable Over 2 Years-Results From a Small Study Under Naturalistic Conditions

Background: Persons with multiple sclerosis (PwMS) are at increased risk to report poor sleep patterns and lower physical activity indices. To date, data on longitudinal objectively sleep assessment is missing. In the present study, we investigated the pattern of objective sleep and subjective physical activity indices over a period of 13.5 months, under naturalistic conditions. Method: 13.5 months after their first assessment, a total of 16 PwMS (mean age = 49.13 median EDSS score: 5; 11 females) were reassessed on their objective sleep via portable sleep-electroencephalogram (EEG-) devices, along with their subjective sleep patterns (symptoms of insomnia, restless legs syndrome (RLS), and sleep-disordered breathing), physical activity indices, psychological functioning (symptoms of depression, fatigue, daytime sleepiness), and MS-related information (fatigue, EDSS; disease-modifying treatments). While the baseline assessment was performed in a rehabilitation center, the follow-up assessment took place at participants' naturalistic and familiar setting. Results: Statistically, symptoms of depression and fatigue, subjective sleep, and physical activity levels did neither increase, nor decrease over time, although descriptively, both moderate and vigorous physical activity levels decreased, and fatigue and subjective insomnia increased. Time awake after sleep onset statistically significantly decreased, while light sleep duration increased by trend. Conclusions: Among a smaller sample of PwMS, objective sleep in their naturalistic setting remained fairly stable over a mean time lapse of 13.5 months after clinic discharge. Physical activity levels descriptively decreased. The present results are of clinical and practical importance for treatment counseling: PwMS can be reassured that their sleep quality does not deteriorate, once they have left a rehabilitation center. Further, they should be encouraged to keeping their physical activity levels as stable as possible.

Mental Violence: The COVID-19 Nightmare

The year 2020 has generated profound changes in personal and working relations, and in dreams of millions of people worldwide. The aim of this study was to investigate the frequency and content of nightmares during the COVID-19 pandemic in Brazil, evaluating its associations with sociodemographic, occupational, and clinical factors. Cross-sectional exploratory study, including 1,057 participants who responded to an online survey about mental violence and nightmares during the pandemic, between May 25 and June 1, 2020. A descriptive analysis of the results was done to obtain frequency tables. McNemar's non-parametric test was used to compare the frequency of nightmares before and after the pandemic, and logistic regression models, to identify factors most strongly associated with the pandemic nightmares. Participants were from 21 Brazilian states, with a mean age of 38 ± 14 years, and 78% women. Half of them (n = 529) reported at least one nightmare episode during the pandemic, and 32.9% (n = 348) described a pandemic content. There was nearly a 3-fold increase in the occurrence of nightmares "once a week or more" during the pandemic, 9% before vs. 25% after. Prior psychiatric care, suicidal ideation, sleep medication, increased pandemic alcohol consumption, perceiving high risk of contamination, being woman, and of younger age were factors associated with having nightmares during the pandemic. Prior psychiatric care, sleep medication, and age remained significant after excluding participants without nightmares and comparing between individuals with and without a pandemic content. We conclude the COVID-19 pandemic has affected people's dreams. The increase in the frequency of nightmares, their pandemic content, and association with previous conditions are a concerning public mental health issue and should be taken into consideration by authorities and policy makers.

The effect of anticipatory stress and openness and engagement on subsequently perceived sleep quality-An Experience Sampling Method study

High stress levels can influence sleep quality negatively. If this also applies to anticipatory stress is poorly documented, however. Across insomnia severity levels, this study examined participants' evening levels of (a) anticipatory stress and (b) their skills hypothesized to downregulate the impact of stress, namely openness to internal experiences and continuous engagement in meaningful activities (openness and engagement) and their association with the quality of the subsequent night's sleep. The moderating role of insomnia severity was also tested. We used a quasi-experimental longitudinal design with Experience Sampling Method using smartphones over the course of 1 week (3,976 assessments; 93.2% of prompted queries). Participants recorded their sleep quality, anticipatory stress, and openness and engagement within their daily context. Participants included in the study were diagnosed with major depressive disorder (n = 118), social phobia (n = 47) or belonged to the control group (n = 119). Both anticipatory stress and openness and engagement predicted subsequent sleep quality. Diagnostic group was associated with overall sleep quality, but did not interact with the predictors. These findings were invariant across levels of self-reported insomnia severity. Furthermore, openness and engagement and anticipatory stress did not interact in their effect on sleep quality. The results suggest that both stress reduction and increased openness and engagement are associated with improved subjective sleep quality on a day to day basis, regardless of insomnia severity. Targeting these variables may help improve sleep quality. Future research should disentangle the effects of openness and engagement on anticipatory stress.

Infection with Herpes Simplex virus type 1 (HSV-1) and sleep: The dog that did not bark

Persistent infection with Herpes Simplex viruses (HSV) and other brain infections is consistently associated with cognitive impairment. These infections can also affect sleep. Thus, sleep abnormalities could explain the cognitive dysfunction. We investigated the association between sleep variables and persistent HSV-1, HSV-2, cytomegalovirus (CMV) and Toxoplasma gondii (Tox) infections. Sleep data were collected from older adults with or without insomnia (N = 311, total); a subset completed polysomnographic and actigraphy studies (N = 145). No significant associations were found between the infections and insomnia or the remaining sleep variables following corrections for multiple comparisons. Sleep dysfunction is unlikely to explain the infection-related cognitive dysfunction.

Sleep preserves subjective and sympathetic emotional response of memories

Sleep consolidates episodic content of emotional memories. Whether it likewise preserves or, to the contrary, depotentiates the emotional response associated with memory content is unclear, as there is conflicting evidence. In the current study, we investigated the influence of an afternoon nap (2-hr nap opportunity) on emotional responses of memories using multiple simultaneous measures. Young adults viewed 45 negative and 45 neutral pictures before taking a nap (measured with polysomnography) or remaining awake. Following the nap or wake period, participants viewed the same pictures intermixed with novel ones and indicated whether they remembered each picture. Emotional response to each picture was measured at both time points both subjectively, with valence and arousal ratings, and objectively, with recordings of electrodermal activity, electrocardiography, and corrugator supercilii electromyography. Compared to waking, a nap led to preserved subjective valence for negative pictures and preserved/increased skin conductance response in general. On the other hand, heart rate deceleration response decreased over the nap compared to wake interval, and this result was not influenced by picture type. These data suggest that sleep consolidates aspects of both subjective and physiological emotional response associated with episodic memory content. While sympathetic response appears to be preserved over sleep, parasympathetic response may be diminished.

Sleep in posttraumatic stress disorder: A systematic review and meta-analysis of polysomnographic findings

Polysomnographic studies have been performed to examine sleep abnormalities in posttraumatic stress disorder (PTSD), but clear associations between PTSD and sleep disturbances have not been established. A systematic review of the evidence examining the polysomnographic changes in PTSD patients compared with controls was conducted using MEDLINE, EMBASE, All EBM databases, PsycINFO, and CINAHL databases. Meta-analysis was undertaken where possible. The searches identified 34 studies, 31 of which were appropriate for meta-analysis. Pooled results indicated decreased total sleep time, slow wave sleep and sleep efficiency, and increased wake time after sleep onset in PTSD patients compared with healthy controls. PTSD severity was associated with decreased sleep efficiency and slow wave sleep percentage. Rapid eye movement (REM) sleep percentage was significantly decreased in PTSD patients compared with controls in studies including participants with mean age below 30 y, but not in studies with other mean age groups (30-40 y and >40 y). Our study shows that polysomnographic abnormalities are present in PTSD. Sex, age, PTSD severity, type of controls, medication status, adaptation night, polysomnographic scoring rules and study location are several of the demographic, clinical and methodological factors that contribute to heterogeneity between studies.

Mechanisms of systems memory consolidation during sleep

Long-term memory formation is a major function of sleep. Based on evidence from neurophysiological and behavioral studies mainly in humans and rodents, we consider the formation of long-term memory during sleep as an active systems consolidation process that is embedded in a process of global synaptic downscaling. Repeated neuronal replay of representations originating from the hippocampus during slow-wave sleep leads to a gradual transformation and integration of representations in neocortical networks. We highlight three features of this process: (i) hippocampal replay that, by capturing episodic memory aspects, drives consolidation of both hippocampus-dependent and non-hippocampus-dependent memory; (ii) brain oscillations hallmarking slow-wave and rapid-eye movement sleep that provide mechanisms for regulating both information flow across distant brain networks and local synaptic plasticity; and (iii) qualitative transformations of memories during systems consolidation resulting in abstracted, gist-like representations.

Effects of two types of exercise training on psychological well-being, sleep, quality of life and physical fitness in patients with high-grade glioma (WHO III and IV): study protocol for a randomized controlled trial

BACKGROUND

There is existing evidence on whether and to what degree regular exercise training improves the quality of life (QoL) among cancer survivors. However, in regards to patients with high-grade glioma (HGG; WHO grade III and IV), no conclusive study has been performed so far. The present trial aims to fill this gap by examining whether psychological well-being, sleep, QoL and physical fitness might be improved with two different types of exercise, as compared to an active control condition. Active control condition represent individuals participating at regular meetings to talk about their current life situation, though, the meetings were not intended as that of the psychotherapy group. Regular meetings are of the same frequency, duration, and intensity as the exercise interventions.

METHODS

A total of 45 patients with HGG after undergoing neurosurgery and adjuvant radiotherapy, chemotherapy, or chemoradiotherapy will be consecutively and randomly assigned to (a) an endurance training, (b) a resistance training or (c) to an active control condition. The intervention will last for 6 consecutive weeks, consisting of 2 weekly sessions (30-45 min per session). Measurements would take place at three time points, namely at the beginning of the study (baseline), 3 weeks after the beginning of the study, and 6 weeks after the beginning of the study. The last measurement also represents the end of the study. Aerobic exercise performance will be assessed objectively with a 6-min walking test, and a handgrip test will be used to assess the upper body strength. Further, participants will complete a battery of questionnaires covering sociodemographic information, QoL, sleep quality and sleep patterns, coping with stress, state- and trait-anxiety, depression, and fatigue. In parallel, experts will use the Hamilton Depression Rating Scale to determine and rate participants' symptoms of depression.

SIGNIFICANCE

The present study will be the first to investigate and compare the impact of two different exercise modalities, namely endurance and resistance training, on physical fitness and dimensions of well-being, and sleep among patients with HGG who underwent neurosurgery followed by adjuvant radiotherapy, chemotherapy, or chemoradiotherapy. Importantly, unlike the majority of previous studies, the control condition consists of an active set-up to detect possible factual beneficial effects of exercise training, irrespective of social interactions. Trial registration https://register.clinicaltrials.gov ; identifier: NCT03775369.

Measuring Counterintuitiveness in Supernatural Agent Dream Imagery

The present article tests counterintuitiveness theory and methodology in relation to religious dream imagery using data on religious dream content. The endeavor adopts a "fractionated" or "piecemeal" approach where supernatural agent (SA) cognition is held to be a pivotal building block of purportedly religious dreaming. Such supernaturalistic conceptualizations manifest in a cognitive environment of dream simulation processes, threat detection, and violation of basic conceptual categorization characterized by counterintuitiveness. By addressing SA cognitions as constituents of allegedly religious dream imagery, additional theorizing and supporting data are presented in a growing body of research in the cognitive science of religion (e.g., Barrett et al., 2009;Hornbeck and Barrett, 2013;Barrett, 2017) and on religious dreaming (McNamara and Bulkeley, 2015;McNamara, 2016). The aim of the article is partly to map and align contemporary theorizing regarding counterintuitiveness and CI schemes with empirical qualification of the prosaic hypothesis about the predominance of supernaturalism in allegedly religious dreaming. This is done by (1) exploring the crucial topic of the pervasiveness of cognitive counterintuitiveness; (2) testing Barrett's counterintuitiveness coding and quantifying scheme (CI scheme) for counterintuitiveness in the context of religious dreaming by assessing intercoder reliability; and (3) exploring the prevalence and base rate frequency of counterintuitiveness in dream reports. This undertaking aims to contribute to the methodology and understanding of religious dream cognition, as well as to establish the cross-cultural base rates of counterintuitiveness in dreams for future research.

British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update

This British Association for Psychopharmacology guideline replaces the original version published in 2010, and contains updated information and recommendations. A consensus meeting was held in London in October 2017 attended by recognised experts and advocates in the field. They were asked to provide a review of the literature and identification of the standard of evidence in their area, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aiming to reach consensus where the evidence and/or clinical experience was considered adequate, or otherwise to flag the area as a direction for future research. A draft of the proceedings was circulated to all speakers for comments, which were incorporated into the final statement.