Neuropharmacology of Sleep and Wakefulness

Restoring consciousness with pharmacologic therapy: Mechanisms, targets, and future directions

Severe brain injury impairs consciousness by disrupting a broad spectrum of neurotransmitter systems. Emerging evidence suggests that pharmacologic modulation of specific neurotransmitter systems, such as dopamine, promotes recovery of consciousness. Clinical guidelines now endorse the use of amantadine in individuals with traumatic disorders of consciousness (DoC) based on level 1 evidence, and multiple neurostimulants are used off-label in clinical practice, including methylphenidate, modafinil, bromocriptine, levodopa, and zolpidem. However, the relative contributions of monoaminergic, glutamatergic, cholinergic, GABAergic, and orexinergic neurotransmitter systems to recovery of consciousness after severe brain injury are unknown, and personalized approaches to targeted therapy have yet to be developed. This review summarizes the state-of-the-science in the neurochemistry and neurobiology of neurotransmitter systems involved in conscious behaviors, followed by a discussion of how pharmacologic therapies may be used to modulate these neurotransmitter systems and promote recovery of consciousness. We consider pharmacologic modulation of consciousness at the synapse, circuit, and network levels, with a focus on the mesocircuit model that has been proposed to explain the consciousness-promoting effects of various monoaminergic, glutamatergic, and paradoxically, GABAergic therapies. Though fundamental questions remain about neurotransmitter mechanisms, target engagement and optimal therapy selection for individual patients, we propose that pharmacologic therapies hold great promise to promote recovery and improve quality of life for patients with severe brain injuries.

Association of methyl donor nutrients dietary intake and sleep disorders in the elderly revealed by the intestinal microbiome

Currently, sleep disorders (SD) in the elderly are gaining prominence globally and are becoming a significant public health concern. Methyl donor nutrients (MDNs), such as vitamin B6, vitamin B12, folate, and choline, have been reported to have the potential to improve sleep disorders. Moreover, MDNs help to maintain gut flora homeostasis, and are closely associated with the development of SD. Nevertheless, there has been a lack of comprehensive human studies examining the association between MDNs intake and SD. In our study, we comprehensively evaluated the association between MDNs intake and SD in the elderly and used 16S rRNA gene sequencing to explore the underlying mechanism. We found that the SD group (n = 91) had a lower methyl-donor nutritional quality index (MNQI) and a trend toward lower intake compared to the control group (n = 147). Based on the intestinal microbiome, the beta diversity of the intestinal flora was higher in the high methyl-donor nutritional quality (HQ) group compared to the low methyl-donor nutritional quality (LQ) group, and it was lower in the SD group compared to the control group. This suggests that MDNs may regulate sleep by modulating the abundance distribution of the microbiota. Subsequently, we performed correlation analyses between the relative abundance of the microbiota, MDNs intake, and the Pittsburgh Sleep Quality Index (PSQI), identifying five genera with potential regulatory roles. The KEGG pathway analysis indicated that energy metabolism and one-carbon metabolism might be the pathways through which MDNs modulate sleep. This study offers dietary guidance strategies for managing SD in the elderly and provides insights for targeted microbiota intervention.

Relation between dietary inflammatory potential and sleep features: Systematic review of observational studies

BACKGROUND: Diet and sleep represent key behavioral risk factors for major non-communicable diseases. Dietary factors may modulate systemic inflammation and potentially affect the human brain functionality, finally affecting the sleep-wake cycle. In this context, the Dietary Inflammatory Index (DII) has been studied as a tool to investigate the dietary inflammatory potential and its relationship with a variety of health conditions. OBJECTIVE: The aim of this study was to perform a systematic revision of observational studies on the inflammatory potential of the diet assessed through the DII and sleep features. METHODS: A systematic search of observational studies on DII and sleep features was conducted on Pubmed and EMBASE electronic databases. The Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines were used to plan the methodology. Studies identified through the search were selected according to inclusion/exclusion criteria. RESULTS: The systematic search and review led to the selection of 13 studies. Most studies including the general population reported an association between higher inflammatory potential of the diet and worse sleep quality and suboptimal sleep duration. Some studies also reported an association with daytime sleepiness and sleep apnea. However, some studies including younger individuals (i.e., college students or young employees) reported null findings. Four studies conducted in individuals with a variety of health conditions also showed some relation between DII and sleep features, although results were not fully consistent. CONCLUSIONS: Data published so far suggests an association between DII and sleep features. However, lack of randomized clinical trials and better designed observational studies, imply that further research on this matter is warranted to understand whether a causal relation could explain current findings.

A Comprehensive Review of Solriamfetol to Treat Excessive Daytime Sleepiness

Purpose of Review

This is a comprehensive review of the literature regarding the use of Solriamfetol for excessive daytime sleepiness. It covers the background and current therapeutic approaches to treating excessive daytime sleepiness, the management of common comorbidities, and the existing evidence investigating the use of Solriamfetol for this purpose.

Recent Findings

Excessive daytime sleepiness leads to worse quality of life, a medical sequela and significant economic cost. There are multiple phenotypes of excessive daytime sleepiness depending on the comorbidity making treatment challenging. Due to the complexity of etiology there is not a cure for this ailment. Solriamfetol is a norepinephrine/dopamine dual reuptake antagonist that can be used to manage daytime sleepiness. Solriamfetol was first approved by the FDA in 2018 for use in excessive daytime sleepiness associated with obstructive sleep apnea and narcolepsy. Ongoing literature has proved this drug to be a safe and effective alternative pharmacotherapy.

Summary

Recent epidemiological data estimate up to one-third of the general adult population suffers from excessive daytime sleepiness. There is no cure to daytime somnolence and current pharmacotherapeutic regimens have worrisome side effect profiles. Solriamfetol is a new class of drug that offers a safe and effective alternative option for clinical providers treating excessive daytime sleepiness.

Apigenin: a natural molecule at the intersection of sleep and aging

NAD+, a pivotal coenzyme central to metabolism, exhibits a characteristic decline with age. In mice, NAD+ levels can be elevated via treatment with apigenin, a natural flavonoid that inhibits the NAD+-consuming glycoprotein CD38. In animal models, apigenin positively impacts both sleep and longevity. For example, apigenin improves learning and memory in older mice, reduces tumor proliferation in a mouse xenograft model of triple-negative breast cancer, and induces sedative effects in mice and rats. Moreover, apigenin elongates survival in fly models of neurodegenerative disease and apigenin glycosides increase lifespan in worms. Apigenin's therapeutic potential is underscored by human clinical studies using chamomile extract, which contains apigenin as an active ingredient. Collectively, chamomile extract has been reported to alleviate anxiety, improve mood, and relieve pain. Furthermore, dietary apigenin intake positively correlates with sleep quality in a large cohort of adults. Apigenin's electron-rich flavonoid structure gives it strong bonding capacity to diverse molecular structures across receptors and enzymes. The effects of apigenin extend beyond CD38 inhibition, encompassing agonistic and antagonistic modulation of various targets, including GABA and inflammatory pathways. Cumulatively, a large body of evidence positions apigenin as a unique molecule capable of influencing both aging and sleep. Further studies are warranted to better understand apigenin's nuanced mechanisms and clinical potential.

Cardio-audio synchronization elicits neural and cardiac surprise responses in human wakefulness and sleep

The human brain can encode auditory regularities with fixed sound-to-sound intervals and with sound onsets locked to cardiac inputs. Here, we investigated auditory and cardio-audio regularity encoding during sleep, when bodily and environmental stimulus processing may be altered. Using electroencephalography and electrocardiography in healthy volunteers (N = 26) during wakefulness and sleep, we measured the response to unexpected sound omissions within three regularity conditions: synchronous, where sound and heartbeat are temporally coupled, isochronous, with fixed sound-to-sound intervals, and a control condition without regularity. Cardio-audio regularity encoding manifested as a heartbeat deceleration upon omissions across vigilance states. The synchronous and isochronous sequences induced a modulation of the omission-evoked neural response in wakefulness and N2 sleep, the former accompanied by background oscillatory activity reorganization. The violation of cardio-audio and auditory regularity elicits cardiac and neural responses across vigilance states, laying the ground for similar investigations in altered consciousness states such as coma and anaesthesia.

Neuromodulation via muscarinic acetylcholine pathway can facilitate distinct, complementary, and sequential roles for NREM and REM states during sleep-dependent memory consolidation

Across vertebrate species, sleep consists of repeating cycles of NREM followed by REM. However, the respective functions of NREM, REM, and their stereotypic cycling pattern are not well understood. Using a simplified biophysical network model, we show that NREM and REM sleep can play differential and critical roles in memory consolidation primarily regulated, based on state-specific changes in cholinergic signaling. Within this network, decreasing and increasing muscarinic acetylcholine (ACh) signaling during bouts of NREM and REM, respectively, differentially alters neuronal excitability and excitatory/inhibitory balance. During NREM, deactivation of inhibitory neurons leads to network-wide disinhibition and bursts of synchronized activity led by firing in engram neurons. These features strengthen connections from the original engram neurons to less-active network neurons. In contrast, during REM, an increase in network inhibition suppresses firing in all but the most-active excitatory neurons, leading to competitive strengthening/pruning of the memory trace. We tested the predictions of the model against in vivo recordings from mouse hippocampus during active sleep-dependent memory storage. Consistent with modeling results, we find that functional connectivity between CA1 neurons changes differentially at transition from NREM to REM sleep during learning. Returning to the model, we find that an iterative sequence of state-specific activations during NREM/REM cycling is essential for memory storage in the network, serving a critical role during simultaneous consolidation of multiple memories. Together these results provide a testable mechanistic hypothesis for the respective roles of NREM and REM sleep, and their universal relative timing, in memory consolidation.

Significance statement

Using a simplified computational model and in vivo recordings from mouse hippocampus, we show that NREM and REM sleep can play differential roles in memory consolidation. The specific neurophysiological features of the two sleep states allow for expansion of memory traces (during NREM) and prevention of overlap between different memory traces (during REM). These features are likely essential in the context of storing more than one new memory simultaneously within a brain network.

The relationship between sleep, gut microbiota, and metabolome in patients with depression and anxiety: A secondary analysis of the observational study

BACKGROUND

Growing attention is paid to the association between alterations in the gut microbiota and their metabolites in patients with psychiatric disorders. Our study aimed to determine how gut microbiota and metabolomes are related to the sleep quality among patients with depression and anxiety disorders by analyzing the datasets of our previous study.

METHODS

Samples were collected from 40 patients (depression: 32 patients [80.0%]); anxiety disorders: 8 patients [20.0%]) in this study. Gut microbiomes were analyzed using 16S rRNA gene sequencing and gut metabolomes were analyzed by a mass spectrometry approach. Based on the Pittsburgh Sleep Quality Index (PSQI), patients were categorized into two groups: the insomnia group (PSQI score ≥ 9, n = 20) and the non-insomnia group (PSQI score < 9, n = 20).

RESULTS

The insomnia group showed a lower alpha diversity in the Chao1 and Shannon indices than the non-insomnia group after the false discovery rate (FDR) correction. The relative abundance of genus Bacteroides showed a positive correlation with PSQI scores in the non-insomnia group. The concentrations of glucosamine and N-methylglutamate were significantly higher in the insomnia group than in the non-insomnia group.

CONCLUSIONS

Our findings suggest that specific taxa could affect the sleep quality among patients with depression and anxiety disorders. Further studies are needed to elucidate the impact of sleep on specific gut microbiota and metabolomes in depression and anxiety disorders.

Experimentally induced active and quiet sleep engage non-overlapping transcriptional programs in Drosophila

Sleep in mammals can be broadly classified into two different physiological categories: rapid eye movement (REM) sleep and slow-wave sleep (SWS), and accordingly REM and SWS are thought to achieve a different set of functions. The fruit fly Drosophila melanogaster is increasingly being used as a model to understand sleep functions, although it remains unclear if the fly brain also engages in different kinds of sleep as well. Here, we compare two commonly used approaches for studying sleep experimentally in Drosophila: optogenetic activation of sleep-promoting neurons and provision of a sleep-promoting drug, gaboxadol. We find that these different sleep-induction methods have similar effects on increasing sleep duration, but divergent effects on brain activity. Transcriptomic analysis reveals that drug-induced deep sleep ('quiet' sleep) mostly downregulates metabolism genes, whereas optogenetic 'active' sleep upregulates a wide range of genes relevant to normal waking functions. This suggests that optogenetics and pharmacological induction of sleep in Drosophila promote different features of sleep, which engage different sets of genes to achieve their respective functions.

Psychiatric Adverse Events of Acetylcholinesterase Inhibitors in Alzheimer's Disease and Parkinson's Dementia: Systematic Review and Meta-Analysis

BACKGROUND

The acetylcholinesterase inhibitors (AChEIs) donepezil, galantamine, and rivastigmine are commonly used in the management of various forms of dementia.

OBJECTIVES

While these drugs are known to induce classic cholinergic adverse events such as diarrhea, their potential to cause psychiatric adverse events has yet to be thoroughly examined.

METHODS

We sought to determine the risk of psychiatric adverse events associated with the use of AChEIs through a systematic review and meta-analysis of double-blind randomized controlled trials involving patients with Alzheimer's dementia and Parkinson's dementia.

RESULTS

A total of 48 trials encompassing 22,845 patients were included in our analysis. Anorexia was the most commonly reported psychiatric adverse event, followed by agitation, insomnia, and depression. Individuals exposed to AChEIs had a greater risk of experiencing appetite disorders, insomnia, or depression compared with those who received placebo (anorexia: odds ratio [OR] 2.93, 95% confidence interval [CI] 2.29-3.75; p < 0.00001; decreased appetite: OR 1.93, 95% CI 1.33-2.82; p = 0.0006; insomnia: OR 1.55, 95% CI 1.25-1.93; p < 0.0001; and depression: OR 1.59, 95% CI 1.23-2.06, p = 0.0004). Appetite disorders were also more frequent with high-dose versus low-dose therapy. A subgroup analysis revealed that the risk of insomnia was higher for donepezil than for galantamine.

CONCLUSIONS

Our findings suggest that AChEI therapy may negatively impact psychological health, and careful monitoring of new psychiatric symptoms is warranted. Lowering the dose may resolve some psychiatric adverse events, as may switching to galantamine in the case of insomnia.

CLINICAL TRIAL REGISTRATION

The study was pre-registered on PROSPERO (CRD42021258376).

Experimentally induced active and quiet sleep engage non-overlapping transcriptional programs in Drosophila

Sleep in mammals can be broadly classified into two different physiological categories: rapid eye movement (REM) sleep and slow wave sleep (SWS), and accordingly REM and SWS are thought to achieve a different set of functions. The fruit fly Drosophila melanogaster is increasingly being used as a model to understand sleep functions, although it remains unclear if the fly brain also engages in different kinds of sleep as well. Here, we compare two commonly used approaches for studying sleep experimentally in Drosophila: optogenetic activation of sleep-promoting neurons and provision of a sleep-promoting drug, Gaboxadol. We find that these different sleep-induction methods have similar effects on increasing sleep duration, but divergent effects on brain activity. Transcriptomic analysis reveals that drug-induced deep sleep ('quiet' sleep) mostly downregulates metabolism genes, whereas optogenetic 'active' sleep upregulates a wide range of genes relevant to normal waking functions. This suggests that optogenetics and pharmacological induction of sleep in Drosophila promote different features of sleep, which engage different sets of genes to achieve their respective functions.

The claustrum and consciousness: An update

The seminal paper of Crick and Koch (2005) proposed that the claustrum, an enigmatic and thin grey matter structure that lies beside the insular cortex, may be involved in the processing of consciousness. As a result, this otherwise obscure structure has received ever-increasing interest in the search for neural correlates of consciousness. Here we review theories of consciousness and discuss the possible relationship between the claustrum and consciousness. We review relevant experimental evidence collected since the Crick and Koch (2005) paper and consider whether these findings support or contradict their hypothesis. We also explore how future experimental work can be designed to clarify how consciousness emerges from neural activity and to understand the role of the claustrum in consciousness.

Influence of glutamatergic and GABAergic neurotransmission on obstructive sleep apnea

Glutamate and γ-aminobutyric acid (GABA) are the two main neurotransmitters in the human brain. The balance between their excitatory and inhibitory functions is crucial for maintaining the brain's physiological functions. Disturbance of glutamatergic or GABAergic neurotransmission leads to serious health problems including neurodegeneration, affective and sleep disorders. Both GABA and glutamate are involved in the control of the sleep-wake cycle. The disturbances in their function may cause sleep and sleep-related disorders. Obstructive sleep apnea (OSA) is the most common sleep respiratory disorder and is characterized by repetitive collapse of the upper airway resulting in intermittent hypoxia and sleep fragmentation. The complex pathophysiology of OSA is the basis of the development of numerous comorbid diseases. There is emerging evidence that GABA and glutamate disturbances may be involved in the pathogenesis of OSA, as well as its comorbidities. Additionally, the GABA/glutamate targeted pharmacotherapy may also influence the course of OSA, which is important in the implementation of wildly used drugs including benzodiazepines, anesthetics, and gabapentinoids. In this review, we summarize current knowledge on the influence of disturbances in glutamatergic and GABAergic neurotransmission on obstructive sleep apnea.

What daily factors affect the sleep habits of Japanese toddlers?

STUDY OBJECTIVES

Good sleep, especially during early childhood, is important for development. In Japan, the mean nocturnal sleep duration of toddlers is < 10 hours, and even if toddlers slept for > 11 hours/day, as recommended by the National Sleep Foundation, some of them showed late bedtime and late wake-up time or took long naps. Therefore, we provisionally assumed the minimal sleep conditions for Japanese toddlers, named Nenne-criteria, such as bedtime before 10:00 pm, nocturnal sleep duration of ≥ 9 hours, and < 1 average time of awakening after sleep onset, and investigated the important factors for good sleep.

METHODS

We analyzed cross-sectional data from online surveys describing the sleep-related behaviors of 2,124 toddlers and their caregivers. We compared the daily schedules that affect sleep between the Nenne-criteria-meet group and the not-meet group.

RESULTS

The Nenne-criteria-meet group showed better daytime behaviors than the not-meet group. Structural equation modeling on daily schedules revealed that, to increase sleep pressure at the appropriate time, it is important to restrict media viewing, play outdoors in the morning, have an early nap ending time, avoid hyperarousal-inducing behaviors before bedtime, maintain daily schedules regularly, and decrease social jetlag.

CONCLUSIONS

The Nenne-criteria are useful for screening Japanese toddlers who require intervention for sleep hygiene. To improve toddlers' sleep, it is important not only to guide the ideal bedtime but also to provide tips for improving daily schedules and to avoid suboptimal sleep-related behaviors.

CITATION

Murata E, Yoshizaki A, Fujisawa TX, Tachibana M, Taniike M, Mohri I. What daily factors affect the sleep habits of Japanese toddlers? J Clin Sleep Med. 2023;19(6):1089-1101.

Proteostasis failure exacerbates neuronal circuit dysfunction and sleep impairments in Alzheimer's disease

Failed proteostasis is a well-documented feature of Alzheimer's disease, particularly, reduced protein degradation and clearance. However, the contribution of failed proteostasis to neuronal circuit dysfunction is an emerging concept in neurodegenerative research and will prove critical in understanding cognitive decline. Our objective is to convey Alzheimer's disease progression with the growing evidence for a bidirectional relationship of sleep disruption and proteostasis failure. Proteostasis dysfunction and tauopathy in Alzheimer's disease disrupts neurons that regulate the sleep-wake cycle, which presents behavior as impaired slow wave and rapid eye movement sleep patterns. Subsequent sleep loss further impairs protein clearance. Sleep loss is a defined feature seen early in many neurodegenerative disorders and contributes to memory impairments in Alzheimer's disease. Canonical pathological hallmarks, β-amyloid, and tau, directly disrupt sleep, and neurodegeneration of locus coeruleus, hippocampal and hypothalamic neurons from tau proteinopathy causes disruption of the neuronal circuitry of sleep. Acting in a positive-feedback-loop, sleep loss and circadian rhythm disruption then increase spread of β-amyloid and tau, through impairments of proteasome, autophagy, unfolded protein response and glymphatic clearance. This phenomenon extends beyond β-amyloid and tau, with interactions of sleep impairment with the homeostasis of TDP-43, α-synuclein, FUS, and huntingtin proteins, implicating sleep loss as an important consideration in an array of neurodegenerative diseases and in cases of mixed neuropathology. Critically, the dynamics of this interaction in the neurodegenerative environment are not fully elucidated and are deserving of further discussion and research. Finally, we propose sleep-enhancing therapeutics as potential interventions for promoting healthy proteostasis, including β-amyloid and tau clearance, mechanistically linking these processes. With further clinical and preclinical research, we propose this dynamic interaction as a diagnostic and therapeutic framework, informing precise single- and combinatorial-treatments for Alzheimer's disease and other brain disorders.

The Relationship Between Thiamine Intake and Long Sleep Duration: Results From the Korea National Health and Nutrition Examination Survey

OBJECTIVES

Thiamine is thought to modify sleeping patterns, while alcohol use diminishes internal thiamine levels. We investigated the association between thiamine intake and sleep duration and explored possible heterogeneity in the effect according to alcohol use.

METHODS

In total, 15 384 participants aged 19-64 were obtained from the Korea National Health and Nutrition Examination Survey 2012-2016. Nutrient intake, including thiamine, was measured using a food frequency questionnaire. Sleep duration was measured by a self-reported questionnaire. The highest thiamine intake quartile was set as the reference group. Participants were divided into 3 groups, with 7-8 hours of daily sleep as a reference group and those who slept more or less than that as "oversleeping" and "insufficient sleeping," respectively. Multivariate logistic regression was used, adjusting for socioeconomic, medical, and nutritional factors. Additionally, participants were stratified according to high-risk alcohol use defined by the World Health Organization standards on alcohol use.

RESULTS

Low thiamine intake was associated with oversleeping (Q3: odds ratio [OR], 1.06; 95% confidence interval [CI], 0.86 to 1.32; Q2: OR, 1.24; 95% CI, 0.99 to 1.55; Q1: OR, 1.49; 95% CI, 1.16 to 1.91) and showed a significant trend for higher ORs at lower intake levels (p-trend&lt;0.001). The effect was stronger in the high-risk alcohol use group (Q1: OR, 1.78; 95% CI, 1.28 to 2.49).

CONCLUSIONS

Low thiamine intake was associated with oversleeping, and alcohol use intensified that association. These results were found in a context where overt clinical symptoms due to thiamine deficiency are considered rare. More awareness of the potential relationship of thiamine intake with oversleeping and its related risks should be considered.

The Potential of Cinnamon Extract (Cinnamomum burmanii) as Anti-insomnia Medication through Hypothalamus Pituitary Adrenal Axis Improvement in Rats

OBJECTIVE

This study aimed to explore the efficacy of cinnamon extract as an anti-insomnia medication in experimental animals by evaluating the levels of hormones and neurotransmitters related to insomnia.

MATERIALS AND METHODS

A total of 30 male Wistar rats were divided into six groups. Induction of insomnia in animal models was done by administration of p-chloro-phenylalanine (PCPA) compounds. Estazolam was administrated to the positive control group. Cinnamon extract administration was divided into 3 doses, namely: 25 mg/kg BW, 50 mg/kg BW and 100 mg/kg BW. Evaluation of the organ coefficient was conducted to evaluate drug toxicity to the organs. The enzyme-linked-immunoassay method assessed hormones and neurotransmitters in the serum and hypothalamus related to insomnia.

RESULTS

There was a decrease in the adrenal coefficient in the cinnamon extract group compared to the PCPA group (0.011+0.001, P<0.05). In addition, there was a decrease in the corticotropin-releasing hormone, adrenocorticotropin hormone, and corticosterone levels in the serum of animals who received cinnamon extract. Our study found a dose of cinnamon extract of 50 mg/kg BW was the best dose to balance neurotransmitter levels in insomniac rats.

CONCLUSION

The cinnamon extract increased serotonin and melatonin levels and decreased norepinephrine levels in the insomnia-induced group. Cinnamon extract has potential as an anti-insomnia medication through hypothalamus-pituitaryadrenal axis improvement and brain neurotransmitter regulation in an animal model of insomnia.

Nutritional Biomarkers and Factors Correlated with Poor Sleep Status among Young Females: A Case-Control Study

Poor sleep status is associated with several health problems. Nutritional biomarkers and factors related to poor sleep are understudied. This study aimed to identify nutrition biomarkers and factors related to sleep status in healthy young Saudi females. The study included 92 normal-weight and obese Saudi females aged 19−25. Fasting blood glucose, insulin, and lipid profiles were measured. Insulin resistance was calculated on the basis of the homeostasis model assessment of insulin resistance (HOMA-IR) method. Anthropometric, stress, physical activity, and dietary data were collected. Data on the polyphenol content in foods were retrieved from the Phenol-Explorer database. The sleep status was assessed using the Pittsburgh sleep quality index (PSQI). Associations between variables were assessed using the multiple logistic regression model. Around 76% of the participants had poor sleep status (PSQI > 5). Multiple logistic regression reported high polyphenol intake as a protective factor against poor sleep (OR 0.24; 95% CI 0.07−0.83; p = 0.03) and HOMA-IR as an independent risk for poor sleep (OR 4.97; 95% CI 1.11−22.31; p = 0.04). Other nutritional biomarkers and factors, such as BMI, lipid profile, and vitamins, revealed a trend but were not significant. In conclusion, poor sleep status is associated with insulin resistance and low polyphenol intake among women of reproductive age.

Recent advances in the utilization of tea active ingredients to regulate sleep through neuroendocrine pathway, immune system and intestinal microbiota

Sleep disorders have received widespread attention nowadays, which have been promoted by the accelerated pace of life, unhealthy diets and lack of exercise in modern society. The chemical medications to improve sleep has shown serious side effects and risks with high costs. Therefore, it is urgent to develop efficient nutraceuticals from natural sources to ensure sleep quality as a sustainable strategy. As the second most consumed beverage worldwide, the health-promoting effects of tea have long been widely recognized. However, the modulatory effect of teas on sleep disorders has received much less attention. Tea contains various natural sleep-modulating active ingredients such as L-theanine (LTA), caffeine, tea polyphenols (TPP), tea pigments, tea polysaccharides (TPS) and γ-aminobutyric acid (GABA). This review focuses on the potential influence and main regulating mechanisms of different tea active ingredients on sleep, including being absorbed by the small intestine and then cross the blood-brain barrier to act on neurons in the brain as neurotransmitters, manipulating the immune system and further affect sleep-wake cycle by regulating the levels of cytokines, and controlling the gut microbes to maintain the homeostasis of circadian rhythm. Current research progress and limitations are summarized and several future development directions are also proposed. This review hopes to provide new insights into the future elucidation of the sleep-regulating mechanisms of different teas and their natural active ingredients and the development of tea-based functional foods for alleviating sleep disorders. HighlightsNatural sleep-modulating active ingredients in tea have been summarized.Influences of drinking tea or tea active ingredients on sleep are reviewed.Three main regulating mechanisms of tea active ingredients on sleep are explained.The associations among nervous system, immune system and intestinal microbiota are investigated.The potential of developing delivery carriers for tea active ingredients is proposed.

Circadian and Sleep Modulation of Dreaming in Women with Major Depression

Growing evidence indicates an association between reduced dream recall and depressive symptomatology. Here, we tested the prediction that reduced dream recall in individuals experiencing major depressive disorder (MDD) is due to alterations in circadian and sleep processes. Nine young healthy women (20−31 years) and eight young unmedicated women (20−31 years) diagnosed with MDD underwent a 40 h multiple nap protocol with ten alternating cycles of 150 min wake/75 min sleep under a stringently controlled circadian laboratory protocol. After each nap, we assessed dream recall, number of dreams and dream emotional load using the Sleep Mentation Questionnaire. Dream recall and the number of dreams did not significantly differ between groups (pFDR > 0.1). However, there was a significant difference for the dream emotional load (interaction of “Group” vs. “Time”, pFDR = 0.01). Women with MDD had a two-fold higher (negative) emotional load as compared to healthy control women, particularly after naps during the circadian night (between ~22:00 h and ~05:00 h; Tukey−Kramer test, p = 0.009). Furthermore, higher (negative) dream emotional load was associated with impaired mood levels in both groups (R2 = 0.71; p < 0.001). Our findings suggest that the circadian and sleep modulation of dreaming may remain intact in unmedicated young women experiencing MDD.

Dynamical Mechanism Underlying Scale-Free Network Reorganization in Low Acetylcholine States Corresponding to Slow Wave Sleep

Sleep is indispensable for most animals' cognitive functions, and is hypothesized to be a major factor in memory consolidation. Although we do not fully understand the mechanisms of network reorganisation driving memory consolidation, available data suggests that sleep-associated neurochemical changes may be important for such processes. In particular, global acetylcholine levels change across the sleep/wake cycle, with high cholinergic tone during wake and REM sleep and low cholinergic tone during slow wave sleep. Furthermore, experimental perturbation of cholinergic tone has been shown to impact memory storage. Through in silico modeling of neuronal networks, we show how spiking dynamics change in highly heterogenous networks under varying levels of cholinergic tone, with neuronal networks under high cholinergic modulation firing asynchronously and at high frequencies, while those under low cholinergic modulation exhibit synchronous patterns of activity. We further examined the network's dynamics and its reorganization mediated via changing levels of acetylcholine within the context of different scale-free topologies, comparing network activity within the hub cells, a small group of neurons having high degree connectivity, and with the rest of the network. We show a dramatic, state-dependent change in information flow throughout the network, with highly active hub cells integrating information in a high-acetylcholine state, and transferring it to rest of the network in a low-acetylcholine state. This result is experimentally corroborated by frequency-dependent frequency changes observed in vivo experiments. Together, these findings provide insight into how new neurons are recruited into memory traces during sleep, a mechanism which may underlie system memory consolidation.

Replay in Deep Learning: Current Approaches and Missing Biological Elements

Replay is the reactivation of one or more neural patterns that are similar to the activation patterns experienced during past waking experiences. Replay was first observed in biological neural networks during sleep, and it is now thought to play a critical role in memory formation, retrieval, and consolidation. Replay-like mechanisms have been incorporated in deep artificial neural networks that learn over time to avoid catastrophic forgetting of previous knowledge. Replay algorithms have been successfully used in a wide range of deep learning methods within supervised, unsupervised, and reinforcement learning paradigms. In this letter, we provide the first comprehensive comparison between replay in the mammalian brain and replay in artificial neural networks. We identify multiple aspects of biological replay that are missing in deep learning systems and hypothesize how they could be used to improve artificial neural networks.

PtNPt/MWCNT-PEDOT:PSS-Modified Microelectrode Arrays for the Synchronous Dopamine and Neural Spike Detection in Rat Models of Sleep Deprivation

In this study, a biosensor assembly based on microelectrode arrays (MEAs) modified with PtNPt/MWCNT-PEDOT:PSS nanocomposites is presented to synchronously detect the dopamine (DA) and electrophysiological activities in rat brains. Different morphological and electrochemical characterizations were conducted to show the excellent mechanical and electrical properties of the as-prepared probes. The developed biosensors realized the sensitive and selective detection of DA with the existence of significant interferences such as uric acid (UA), ascorbic acid (AA), glutamate (Glu), and 3,4-dihydroxyphenylacetic acid (DOPAC). Calibration curve for the DA response was linear with the concentration from 0.05 μM to 79 μM (R = 0.999), with a sensitivity of 30.561 pA/μM and detection limit as low as 50 nM. Finally, the proposed microelectrode was applied to be implanted into the cortex and caudate putamen (CPU) of rats, which was demonstrated to stably measure the synchronous neurochemical and neurophysiological changes caused by 72 h sleep deprivation. The in vivo measuring results showed that the sleep deprivation increased the DA release and neural spike activity in both cortex and CPU. The local field potential (LFP) power in the delta and theta band was significantly increased as well. These changes in brain may reflect the brain's adaptive reaction toward the side effects induced by sleep deprivation and may partially explain the mechanism of forced wakefulness in the presence of accumulated sleep pressure.

Sesamin Activates Nrf2/Cnc-Dependent Transcription in the Absence of Oxidative Stress in Drosophila Adult Brains

Sesamin, a major lignin in sesame seeds, possesses health-promoting properties. Sesamin feeding suppresses several aging-related phenotypes such as age-dependent accumulation of damaged proteins in the muscles and neuronal loss in the brains of Drosophila adults with high levels of reactive oxygen species. Sesamin promotes the transcription of several genes that are responsible for oxidative stress, although the underlying mechanism remains unclear. Here, we aimed to demonstrate that sesamin mediates its action through activation of a transcription factor, Nrf2 (Cnc in Drosophila), essential for anti-aging oxidative stress response. Nrf2/Cnc activation was determined using the antioxidant response element, Green Fluorescence Protein reporter, that can monitor Nrf2/Cnc-dependent transcription. We observed strong fluorescence in the entire bodies, particularly in the abdomens and brains, of adult flies fed sesamin. Interestingly, Nrf2/Cnc was strongly activated in neuronal cells, especially in several neuron types, including glutamatergic and cholinergic, and some dopaminergic and/or serotonergic neurons but not in GABAergic neurons or the mushroom bodies of flies fed sesamin. These results indicate that the anti-aging effects of sesamin are exerted via activation of Nrf2/Cnc-dependent transcription to circumvent oxidative stress accumulation in several types of neurons of adult brains. Sesamin could be explored as a potential dietary supplement for preventing neurodegeneration associated with accumulation of oxidative stress.

Molecular Regulation of Betulinic Acid on α3β4 Nicotinic Acetylcholine Receptors

Betulinic acid (BA) is a major constituent of Zizyphus seeds that have been long used as therapeutic agents for sleep-related issues in Asia. BA is a pentacyclic triterpenoid. It also possesses various anti-cancer and anti-inflammatory effects. Current commercially available sleep aids typically use GABAergic regulation, for which many studies are being actively conducted. However, few studies have focused on acetylcholine receptors that regulate wakefulness. In this study, we utilized BA as an antagonist of α3β4 nicotinic acetylcholine receptors (α3β4 nAChRs) known to regulate rapid-eye-movement (REM) sleep and wakefulness. Effects of BA on α3β4 nAChRs were concentration-dependent, reversible, voltage-independent, and non-competitive. Site-directed mutagenesis and molecular-docking studies confirmed the binding of BA at the molecular level and showed that the α3 subunit L257 and the β4 subunit I263 residues affected BA binding. These data demonstrate that BA can bind to a binding site different from the site for the receptor's ligand, acetylcholine (ACh). This suggests that BA may be an effective antagonist that is unaffected by large amounts of ACh released during wakefulness and REM sleep. Based on the above experimental results, BA is likely to be a therapeutically useful sleep aid and sedative.

The effect of rosemary essential oil inhalation on sleepiness and alertness of shift-working nurses: A randomized, controlled field trial

BACKGROUND

Sleepiness during the night shift is a common complaint of shift workers, including the nurses. This study investigated the effects of inhaled rosemary oil on sleepiness and alertness of shift-working nurses.

METHODS

Eighty shift-working nurses were selected and assigned randomly into control (n = 40) and intervention (n = 40) groups. Both groups completed the Karolinska Sleep Questionnaire and Epworth Sleepiness Survey before the intervention. The intervention group received one drop of rosemary essential oil using a mask. The control group received a drop of distilled water instead, after which the questionnaires were completed for a second time.

RESULTS

The sleepiness mean score in the intervention group reduced from 12.15 to 8.3, while it increased from 11.41 to 13.76 in the control group (P < 0.001). The alertness mean scores changed from 4.45 to 3.25 and from 4.41 to 5.34 in intervention and control groups, respectively (P < 0.001).

CONCLUSION

Rosemary aroma decreased sleepiness and increased alertness in shift-working nurses.

Breathing Re-Education and Phenotypes of Sleep Apnea: A Review

Four phenotypes of obstructive sleep apnea hypopnea syndrome (OSAHS) have been identified. Only one of these is anatomical. As such, anatomically based treatments for OSAHS may not fully resolve the condition. Equally, compliance and uptake of gold-standard treatments is inadequate. This has led to interest in novel therapies that provide the basis for personalized treatment protocols. This review examines each of the four phenotypes of OSAHS and explores how these could be targeted using breathing re-education from three dimensions of functional breathing: biochemical, biomechanical and resonant frequency. Breathing re-education and myofunctional therapy may be helpful for patients across all four phenotypes of OSAHS. More research is urgently needed to investigate the therapeutic benefits of restoring nasal breathing and functional breathing patterns across all three dimensions in order to provide a treatment approach that is tailored to the individual patient.

Association between diet and sleep quality: A systematic review

Dietary habits are considered a leading behavioral risk factor for human health. There is growing scientific evidence suggesting that diet and sleep may be related. The aim of this study was to review the evidence of association between diet and sleep quality. A systematic search in electronic databases PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials was conducted from their inception to November 2019. Studies investigating parameters of diet quality (including dietary patterns or individual healthy/unhealthy foods) and sleep quality (assessed through self-reported or objective methods) were included. The NIH Quality Assessment Tools were used to evaluate the study quality. Twenty-nine studies were reviewed: in summary, consumption of healthy foods was associated with better sleep quality, while higher intake of processed and free-sugar rich foods was associated with worse sleep features. Despite a certain consistency between studies have been observed, the overall poor-to-fair quality of study design (mostly represented by cross-sectional investigations) does not allow to conclude a causal relation. However, diet-related variables are associated with sleep quality, but further studies are needed to corroborate this finding.

Intranasal Allopregnanolone Confers Rapid Seizure Protection: Evidence for Direct Nose-to-Brain Delivery

Allopregnanolone, a positive modulator of GABAA receptors with antiseizure activity, has potential in the treatment of seizure emergencies. Instillation of allopregnanolone in 40% sulfobutylether-β-cyclodextrin into the nose in mice rapidly elevated the seizure threshold in the timed intravenous pentylenetetrazol (ED50, 5.6 mg/kg), picrotoxin (ED50, 5.9 mg/kg), and bicuculline seizure tests. The effect peaked at 15 min, decayed over 1 h, and was still evident in some experiments at 6 h. Intranasal allopregnanolone also delayed the onset of seizures in the maximal PTZ test. At an allopregnanolone dose (16 mg/kg) that conferred comparable effects on seizure threshold as the benzodiazepines midazolam and diazepam (both at doses of 1 mg/kg), allopregnanolone caused minimal sedation or motor toxicity in the horizontal screen test whereas both benzodiazepines produced marked behavioral impairment. In addition, intranasal allopregnanolone failed to cause loss-of-righting reflex in most animals, but when the same dose was administered intramuscularly, all animals became impaired. Intranasal allopregnanolone (10 mg/kg) caused a rapid increase in brain allopregnanolone with a Tmax of ~5 min after initiation of the intranasal delivery. High levels of allopregnanolone were recovered in the olfactory bulb (Cmax, 16,000 ng/mg) whereas much lower levels (Cmax, 670 ng/mg) were present in the remainder of the brain. We conclude that the unique ability of intranasal allopregnanolone to protect against seizures without inducing behavioral adverse effects is due in part to direct nose-to-brain delivery, with preferential transport to brain regions relevant to seizures. Benzodiazepines are commonly administered intranasally for acute seizure therapy, including for the treatment of acute repetitive seizures, but are not transported from nose-to-brain. Intranasal allopregnanolone acts with greater speed, has less propensity for adverse effects, and has the ability to overcome benzodiazepine refractoriness. This is the first study demonstrating rapid functional central nervous system activity of a nose-to-brain-delivered steroid. Intranasal delivery circumvents the poor oral bioavailability of allopregnanolone providing a route of administration permitting its evaluation as a treatment for diverse neuropsychiatric indications.

Associations between dietary inflammatory index and sleep problems among adults in the United States, NHANES 2005-2016

OBJECTIVES

To examine the associations between Dietary Inflammatory Index (DII) scores and sleep measures of sleep duration and self-reported sleep disturbance.

DESIGN

Cross-sectional study.

SETTING

The United States.

PARTICIPANTS

Participants from the 2005-2016 National Health and Nutrition Examination Survey (NHANES) who were 20 years old or older (n = 30,121).

MEASUREMENTS

Sleep duration, classified as short (≤6 hours), long (≥9 hours) and recommended (6-9 hours) duration, and the presence of self-reported sleep disturbance were the outcome variables. The energy-adjusted DII (E-DII) was computed based on the dietary intake data using a single-day 24-hour dietary recall. Multinomial logistic regression was used to examine the associations.

RESULTS

After adjusting for confounders, participants in the highest quintile (most proinflammatory E-DII) had a 40% increase in the odds of short sleep duration compared to the lowest quintile (most anti-inflammatory E-DII)(OR_quintile5vs1 = 1.40 [95% confidence interval {CI}, 1.21, 1.61]). The odds of short sleep duration was increased by 26% in quintile 4 compared to quintile 1 (OR _quintile4vs1 = 1.26 [95% CI, 1.10, 1.43]). Similarly, the odds of long sleep duration was increased in higher E-DII quintiles (OR_quintile5vs1 = 1.23 [95% CI, 1.03, 1.46] and OR_quintile4vs1 = 1.24 [95% CI, 1.03, 1.49]). Participants in the highest E-DII quintile also were more likely to report sleep disturbances (OR_quintile5vs1 = 1.14 [95% CI, 1.02, 1.27]).

CONCLUSIONS

Adults consuming proinflammatory diets were more likely to have short sleep duration, long sleep duration, and/or self-reported sleep disturbances. Future, especially longitudinal, studies need to examine the impact of anti-inflammatory diets in mitigating extreme sleep durations and sleep disturbances.

Stress-related endogenous neuropeptides induce neuronal excitation in the Laterodorsal Tegmentum

Stress is a physiological response that promotes maintenance of balance against harmful stimuli. Unfortunately, chronic activation of stress systems facilitates the development of psychiatric disorders. A stress-mediated hypercholinergic state could underlie this facilitation, as cholinergic mechanisms have been suggested to play a role in anxiety, depression, and substance use disorder (SUD). Stimulation by stress hormones, urocortin (Ucn1) or corticotropin-releasing factor (CRF), of the CRF receptor type 1 (CRFR1) of acetylcholine-containing neurons of the laterodorsal tegmental nucleus (LDT) could be involved in modulation of cholinergic transmission during periods of stress hormone activation, which could play a role in psychiatric disorders as cholinergic LDT neurons project to, and control activity in, mood-, arousal- and SUD-controlling regions. The present study investigated for the first time the membrane effects and intracellular outcomes of CRFR1 activation by endogenous stress hormones on LDT neurons. Patch clamp recordings of immunohistochemically-identified cholinergic and non-cholinergic LDT neurons with concurrent calcium imaging were used to monitor cellular responses to CRFR1 stimulation with Ucn1 and CRF. Postsynaptically-mediated excitatory currents were elicited in LDT cholinergic neurons, accompanied by an enhancement in synaptic events. In addition, CRFR1 activation resulted in rises in intracellular calcium levels. CRFR1 stimulation recruited MAPK/ERK and SERCA-ATPase involved pathways. The data presented here provide the first evidence that Ucn1 and CRF exert pre and postsynaptic excitatory membrane actions on LDT cholinergic neurons that could underlie the hypercholinergic state associated with stress which could play a role in the heightened risk of psychiatric disorders associated with a chronic stress state.

Sleep in autism: A biomolecular approach to aetiology and treatment

People with autism spectrum disorder (ASD) commonly experience other comorbidities. Studies indicate that between 50% and 83% of individuals with ASD have sleep problems or disorders. The most commonly reported sleep problems are: (a) insomnia symptoms including the inability to get to sleep or stay asleep; and (b) circadian rhythm sleep-wake disorders, defined as a misalignment between the timing of endogenous circadian rhythms and the external environment. The circadian system provides timing information for the sleep-wake cycle that is regulated by the interaction of an endogenous processes (circadian - Process C, and homeostatic - Process S) and synchronizing agents (neurohormones and neurotransmitters), which produce somnogenic activity. A clinical priority in ASD is understanding the cause of these sleep problems in order to improve treatment outcomes. This review approaches sleep in autism from several perspectives: Sleep-wake mechanisms and problems, and brain areas and molecules controlling sleep (e.g., GABA and melatonin) and wake maintenance (e.g., serotonin, acetylcholine and glutamate). Specifically, this review examines how altered sleep structure could be related to neurobiological alterations or genetic mutations and the implications this may have for potential pharmacological treatments in individuals with ASD.

The effect of general anaesthetics on brain lactate release

The effects of anaesthetic agents on brain energy metabolism may explain their shared neurophysiological actions but remain poorly understood. The brain lactate shuttle hypothesis proposes that lactate, provided by astrocytes, is an important neuronal energy substrate. Here we tested the hypothesis that anaesthetic agents impair the brain lactate shuttle by interfering with astrocytic glycolysis. Lactate biosensors were used to record changes in lactate release by adult rat brainstem and cortical slices in response to thiopental, propofol and etomidate. Changes in cytosolic nicotinamide adenine dinucleotide reduced (NADH) and oxidized (NAD⁺) ratio as a measure of glycolytic rate were recorded in cultured astrocytes. It was found that in brainstem slices thiopental, propofol and etomidate reduced lactate release by 7.4 ± 3.6% (P < 0.001), 9.7 ± 6.6% (P < 0.001) and 8.0 ± 7.8% (P = 0.04), respectively. In cortical slices, thiopental reduced lactate release by 8.2 ± 5.6% (P = 0.002) and propofol by 6.0 ± 4.5% (P = 0.009). Lactate release in cortical slices measured during the light phase (period of sleep/low activity) was ~25% lower than that measured during the dark phase (period of wakefulness) (326 ± 83 μM vs 430 ± 118 μM, n = 10; P = 0.04). Thiopental and etomidate induced proportionally similar decreases in cytosolic [NADH]:[NAD⁺] ratio in astrocytes, indicative of a reduction in glycolytic rate. These data suggest that anaesthetic agents inhibit astrocytic glycolysis and reduce the level of extracellular lactate in the brain. Similar reductions in brain lactate release occur during natural state of sleep, suggesting that general anaesthesia may recapitulate some of the effects of sleep on brain energy metabolism.

Association of sleep among 30 antidepressants: a population-wide adverse drug reaction study, 2004-2019

Background

Sleep is one of the most essential processes required to maintain a healthy human life, and patients experiencing psychiatric illness often experience an inability to sleep. The aim of this study is to test the hypothesis that antidepressant compounds with strong binding affinities for the serotonin 5-HT2C receptor, histamine H1 receptors, or norepinephrine transporter (NET) will be associated with the highest odds of somnolence.

Methods

Post-marketing cases of patient adverse drug reactions were obtained from the United States Food and Drug Administration Adverse Events Reporting System (FAERS) during the reporting window of January 2004 to September 2019. Disproportionality analyses of antidepressants reporting somnolence were calculated using the case/non-case method. The reporting odds-ratios (ROR) and corresponding 95% confidence interval (95% CI) were computed and all computations and graphing conducted in R.

Results

There were a total of 69,196 reported cases of somnolence out of a total of 7,366,864 cases reported from January 2004 to September 2019. Among the 30 antidepressants assessed, amoxapine (n = 16) reporting odds-ratio (ROR) = 7.1 (95% confidence interval [CI] [4.3–11.7]), atomoxetine (n = 1,079) ROR = 6.6 (95% CI [6.2–7.1]), a compound generally approved for attention deficit hyperactivity disorder (ADHD), and maprotiline (n = 18) ROR = 6.3 (95% CI, 3.9–10.1) were the top three compounds ranked with the highest reporting odds of somnolence. In contrast, vortioxetine (n = 52) ROR = 1.3 (95% CI [1.0–1.8]), milnacipran (n = 58) ROR = 2.1 (95% CI [1.7–2.8]), and bupropion (n = 1,048) ROR = 2.2 (95% CI [2.1–2.4]) are least significantly associated with somnolence. Moreover, levomilnacipran (n = 1) ROR = 0.4 (95% CI [0.1–2.9]) was not associated with somnolence.

Conclusion

Among the thirty tested antidepressants, consistent with the original hypothesis, amoxepine has strongest 5-HT2C receptor binding affinity and has the highest reporting odds of somnolence. Atomoxetine, ranked second in reporting odds of somnolence overall, binds to the NET with with the strongest binding affinity among the thirty compounds. Mirtazapine, a tetracyclic antidepressant, was ranked 11th in reporting odds of somnolence and had the strongest H1 receptor binding affinity. This study provides an informative ranking of somnolence among thirty antidepressant compounds with an already wide array of clinical indications as well as provides insight into potential drug repurposing in psychopharmacology.

Pharmacologic Characterization of JNJ-42226314, [1-(4-Fluorophenyl)indol-5-yl]-[3-[4-(thiazole-2-carbonyl)piperazin-1-yl]azetidin-1-yl]methanone, a Reversible, Selective, and Potent Monoacylglycerol Lipase Inhibitor

The serine hydrolase monoacylglycerol lipase (MAGL) is the rate-limiting enzyme responsible for the degradation of the endocannabinoid 2-arachidonoylglycerol (2-AG) into arachidonic acid and glycerol. Inhibition of 2-AG degradation leads to elevation of 2-AG, the most abundant endogenous agonist of the cannabinoid receptors (CBs) CB1 and CB2. Activation of these receptors has demonstrated beneficial effects on mood, appetite, pain, and inflammation. Therefore, MAGL inhibitors have the potential to produce therapeutic effects in a vast array of complex human diseases. The present report describes the pharmacologic characterization of [1-(4-fluorophenyl)indol-5-yl]-[3-[4-(thiazole-2-carbonyl)piperazin-1-yl]azetidin-1-yl]methanone (JNJ-42226314), a reversible and highly selective MAGL inhibitor. JNJ-42226314 inhibits MAGL in a competitive mode with respect to the 2-AG substrate. In rodent brain, the compound time- and dose-dependently bound to MAGL, indirectly led to CB1 occupancy by raising 2-AG levels, and raised norepinephrine levels in cortex. In vivo, the compound exhibited antinociceptive efficacy in both the rat complete Freund's adjuvant-induced radiant heat hypersensitivity and chronic constriction injury-induced cold hypersensitivity models of inflammatory and neuropathic pain, respectively. Though 30 mg/kg induced hippocampal synaptic depression, altered sleep onset, and decreased electroencephalogram gamma power, 3 mg/kg still provided approximately 80% enzyme occupancy, significantly increased 2-AG and norepinephrine levels, and produced neuropathic antinociception without synaptic depression or decreased gamma power. Thus, it is anticipated that the profile exhibited by this compound will allow for precise modulation of 2-AG levels in vivo, supporting potential therapeutic application in several central nervous system disorders. SIGNIFICANCE STATEMENT: Potentiation of endocannabinoid signaling activity via inhibition of the serine hydrolase monoacylglycerol lipase (MAGL) is an appealing strategy in the development of treatments for several disorders, including ones related to mood, pain, and inflammation. [1-(4-Fluorophenyl)indol-5-yl]-[3-[4-(thiazole-2-carbonyl)piperazin-1-yl]azetidin-1-yl]methanone is presented in this report to be a novel, potent, selective, and reversible noncovalent MAGL inhibitor that demonstrates dose-dependent enhancement of the major endocannabinoid 2-arachidonoylglycerol as well as efficacy in models of neuropathic and inflammatory pain.

Synergy of Glutamatergic and Cholinergic Modulation Induces Plateau Potentials in Hippocampal OLM Interneurons

Oriens-lacunosum moleculare (OLM) cells are hippocampal inhibitory interneurons that are implicated in the regulation of information flow in the CA1 circuit, inhibiting cortical inputs to distal pyramidal cell dendrites, whilst disinhibiting CA3 inputs to pyramidal cells. OLM cells express metabotropic cholinergic (mAChR) and glutamatergic (mGluR) receptors, so modulation of these cells via these receptors may contribute to switching between functional modes of the hippocampus. Using a transgenic mouse line to identify OLM cells, we found that both mAChR and mGluR activation caused the cells to exhibit long-lasting depolarizing plateau potentials following evoked spike trains. Both mAChR- and mGluR-induced plateau potentials were eliminated by blocking transient receptor potential (TRP) channels, and were dependent on intracellular calcium concentration and calcium entry. Pharmacological tests indicated that Group I mGluRs are responsible for the glutamatergic induction of plateaus. There was also a pronounced synergy between the cholinergic and glutamatergic modulation, plateau potentials being generated by agonists applied together at concentrations too low to elicit any change when applied individually. This synergy could enable OLM cells to function as coincidence detectors of different neuromodulatory systems, leading to their enhanced and prolonged activation and a functional change in information flow within the hippocampus.

Insomnia: Risk Factor for Neurodegenerative Diseases

Insomnia can be defined as difficulty falling asleep or maintaining sleep, waking up earlier than expected, or having non-restorative sleep. It is one of the most common sleep disorders in the world. Insomnia is a common symptom of many neurodegenerative diseases but only recently has it been found that it is a risk factor for neurodegenerative disorders such as Alzheimer's disease and Parkinson's disease. We did a traditional review to analyze the relationship between insomnia and neurodegenerative diseases. We analyzed all the relevant articles on Pubmed and included studies done on humans over the last 10 years with full text available. After reviewing the available literature on Pubmed, we conclude that insomnia is an important risk factor for neurodegenerative diseases. In addition, insomnia and neurodegenerative disorders have a complex and bi-directional relationship. We think it requires further study to understand the sole contribution of insomnia to the development of various neurodegenerative diseases when different factors like mood problems, genetic factors, and environmental factors also contribute to the disease. It would also be advisable to use cognitive screening questionnaires in all sleep clinics in insomnia patients over 50 years of age to diagnose dementia early and to gather more sleep study data for prospective and retrospective research. The role of hypnotics in preventing neurodegenerative diseases through treating insomnia should also be assessed.

Fatigue, Sleep, and Autoimmune and Related Disorders

Profound and debilitating fatigue is the most common complaint reported among individuals with autoimmune disease, such as systemic lupus erythematosus, multiple sclerosis, type 1 diabetes, celiac disease, chronic fatigue syndrome, and rheumatoid arthritis. Fatigue is multi-faceted and broadly defined, which makes understanding the cause of its manifestations especially difficult in conditions with diverse pathology including autoimmune diseases. In general, fatigue is defined by debilitating periods of exhaustion that interfere with normal activities. The severity and duration of fatigue episodes vary, but fatigue can cause difficulty for even simple tasks like climbing stairs or crossing the room. The exact mechanisms of fatigue are not well-understood, perhaps due to its broad definition. Nevertheless, physiological processes known to play a role in fatigue include oxygen/nutrient supply, metabolism, mood, motivation, and sleepiness-all which are affected by inflammation. Additionally, an important contributing element to fatigue is the central nervous system-a region impacted either directly or indirectly in numerous autoimmune and related disorders. This review describes how inflammation and the central nervous system contribute to fatigue and suggests potential mechanisms involved in fatigue that are likely exhibited in autoimmune and related diseases.

Alzheimer's disease: Neurotransmitters of the sleep-wake cycle

With aging, our sleeping pattern alters. Elderly often wake unrested because their sleep time and sleep efficacy is reduced. In Alzheimer's disease (AD) patients, these alterations are even more pronounced and may further aggravate cognitive decline. Therefore, sleep disturbances greatly impact self-care ability, caregiver exhaustion and institutionalization rate. Reestablishing an effective sleep-wake cycle in these patients still remains an unresolved challenge, partly because sleep physiology is quite complex and multiple neurotransmitter systems contribute to a single process. Gaining a better understanding of sleep physiology will be crucial for further research. Conjointly, animal models, along with a multidisciplinary approach, will be of great value to establish a common ground between AD and sleep disturbances and work towards a potential therapeutic application.

How Sleep Shapes Thalamocortical Circuit Function in the Visual System

Recent data have shown that sleep plays a beneficial role for cognitive functions such as declarative memory consolidation and perceptual learning. In this article, we review recent findings on the role of sleep in promoting adaptive visual response changes in the lateral geniculate nucleus and primary visual cortex following novel visual experiences. We discuss these findings in the context of what is currently known about how sleep affects the activity and function of thalamocortical circuits and current hypotheses regarding how sleep facilitates synaptic plasticity.

Acute and Chronic Sleep Deprivation-Related Changes in N-methyl-D-aspartate Receptor-Nitric Oxide Signalling in the Rat Cerebral Cortex with Reference to Aging and Brain Lateralization

Aging and chronic sleep deprivation (SD) are well-recognized risk factors for Alzheimer’s disease (AD), with N-methyl-D-aspartate receptor (NMDA) and downstream nitric oxide (NO) signalling implicated in the process. Herein, we investigate the impact of the age- and acute or chronic SD-dependent changes on the expression of NMDA receptor subunits (NR1, NR2A, and NR2B) and on the activities of NO synthase (NOS) isoforms in the cortex of Wistar rats, with reference to cerebral lateralization. In young adult controls, somewhat lateralized seasonal variations in neuronal and endothelial NOS have been observed. In aged rats, overall decreases in NR1, NR2A, and NR2B expression and reduction in neuronal and endothelial NOS activities were found. The age-dependent changes in NR1 and NR2B significantly correlated with neuronal NOS in both hemispheres. Changes evoked by chronic SD (dysfunction of endothelial NOS and the increasing role of NR2A) differed from those evoked by acute SD (increase in inducible NOS in the right side). Collectively, these results demonstrate age-dependent regulation of the level of NMDA receptor subunits and downstream NOS isoforms throughout the rat brain, which could be partly mimicked by SD. As described herein, age and SD alterations in the prevalence of NMDA receptors and NOS could contribute towards cognitive decline in the elderly, as well as in the pathobiology of AD and the neurodegenerative process.

Does Playing Video Games Before Bedtime Affect Sleep?

Sleep serves a vital role in our ability to function on a daily basis and may be affected by various activities such as playing video games. Teenagers are one of the largest consumers of video games and if played before bedtime may lead to the release of certain neurotransmitters which may, in turn, alter sleep architecture and reduce sleep efficiency. The purpose of this study is to measure 1) sleep efficiency 2) sleep latency 3) time spent in rapid eye movement (REM) stage with and without playing video games 30 minutes to 60 minutes before bedtime. For this study, one patient was recruited. The study was completed using a television, video game console, and a video game (Red Dead Redemption 4), Apnea Risk Evaluation System (ARES) nocturnal polysomnogram (NPSG) unit, a bed and a blanket situated in a quiet room, a computer, printer, and a notebook for data recording. REM time and sleep latency were also measured. There were 45.6 minutes of REM with video games and 56.4 minutes of REM without video games. This was equivalent to 13.06% and 15.74% of the total sleep time, respectively. The sleep latency with video games was shorter than without video games (11.4 and 23 minutes, respectively). Result suggests that there is no significant difference in sleep efficiency with and without video games. However, sleep latency decreased, and REM increased with video games.

On the Abilities of Unconscious Freudian Motivational Drives to Evoke Conscious Emotions

Human beings use conscious emotions to direct their behaviors. There is some agreement in the scientific community that unconscious motivations are able to evoke conscious emotions. This manuscript focuses on Freudian motivational drives as inductors for unconscious motivation, and also on Panksepp's framework of affective neuroscience for describing the generation of emotions. Recently, it has been suggested that imperative motor factors of Freudian drives (i.e., the hormones ghrelin, testosterone, angiotensin II and adenosine) have the ability to activate both a drive-specific brain area and brain areas of the SEEKING command system. In fact, this manuscript contends that all imperative motor factors have typical SEEKING targets (i.e., so-called receptors) in the brain areas of both nucleus accumbens and lateral hypothalamus. In addition, all imperative motor factors are able to target the central amygdala directly, a brain area classified by Panksepp as the instinctual part of the FEAR command system. Another point of interest may be the evaluation that imperative motor factors of the sexual drive, hunger and thirst can directly activate the RAGE command system by targeting the medial amygdala. Surprisingly, all imperative motor factors are able to modulate Panksepp's granddaddy mechanism, i.e., to stimulate all seven command systems via the lateral hypothalamus. Orexinergic neurons exclusively located in the lateral hypothalamus have targets for imperative motor factors and project axons to characteristic brain areas of all seven command systems. From the fact that the imperative motor factors of the sexual drive and hunger act in an excitatory manner on orexinergic neurons whereas those of thirst and sleep inhibit such neurons, temporary termination of hunger by thirst may be understood as a very simple example of a co-regulation of Freudian drives. The author wishes to note that there are motivational drives other than the ones described by Freud. Bowlby was obviously the first in describing such drives, and Bowlbyian drive activities cannot be explained with the intermediacy of imperative motor factors. Nevertheless, the ignorance of the magnificent importance of imperative motor factors must be discarded.

On the Drive Specificity of Freudian Drives for the Generation of SEEKING Activities: The Importance of the Underestimated Imperative Motor Factor

Doubters of Freud's theory of drives frequently mentioned that his approach is outdated and therefore cannot be useful for solving current problems in patients with mental disorders. At present, many scientists believe that affects rather than drives are of utmost importance for the emotional life and the theoretical framework of affective neuroscience, developed by Panksepp, strongly underpinned this view. Panksepp evaluated seven so-called command systems and the SEEKING system is therein of central importance. Panksepp used Pankseppian drives as inputs for the SEEKING system but noted the missing explanation of drive-specific generation of SEEKING activities in his description. Drive specificity requires dual action of the drive: the activation of a drive-specific brain area and the release of the neurotransmitter dopamine. Noticeably, as Freud claimed drive specificity too, it was here analyzed whether a Freudian drive can evoke the generation of drive-specific SEEKING activities. Special importance was addressed to the imperative motor factor in Freud's drive theory because Panksepp's formulations focused on neural pathways without specifying underlying neurotransmitter/endocrine factors impelling motor activity. As Panksepp claimed sleep as a Pankseppian drive, we firstly had to classified sleep as a Freudian drive by using three evaluated criteria for a Freudian drive. After that it was possible to identify the imperative motor factors of hunger, thirst, sex, and sleep. Most importantly, all of these imperative motor factors can both activate a drive-specific brain area and release dopamine from dopaminergic neurons, i.e., they can achieve the so-called drive specificity. Surprisingly, an impaired Freudian drive can alter via endocrinological pathways the concentration of the imperative motor factor of a second Freudian drive, obviously in some independence to the level of the metabolic deficit, thereby offering the possibility to modulate the generation of SEEKING activities of this second Freudian drive. This novel possibility might help to refine the general understanding of the action of Freudian drives. As only imperative motor factors of Freudian drives can guarantee drive specificity for the generation of SEEKING activities, the impact of Freud's construct Eros (with its constituents hunger, thirst, sex, and sleep) should be revisited.

Sleep- and Wake-Like States in Small Networks In Vivo and In Vitro

Wakefulness and sleep are highly complex and heterogeneous processes, involving multiple neurotransmitter systems and a sophisticated interplay between global and local networks of neurons and non-neuronal cells. Macroscopic approaches applied at the level of the whole organism, view sleep as a global behaviour and allow for investigation into aspects such as the effects of insufficient or disrupted sleep on cognitive function, metabolism, thermoregulation and sensory processing. While significant progress has been achieved using such large-scale approaches, the inherent complexity of sleep-wake regulation has necessitated the development of methods which tackle specific aspects of sleep in isolation. One way this may be achieved is by investigating specific cellular or molecular phenomena in the whole organism in situ, either during spontaneous or induced sleep-wake states. This approach has greatly advanced our knowledge about the electrophysiology and pharmacology of ion channels, specific receptors, intracellular pathways and the small networks implicated in the control and regulation of the sleep-wake cycle. Importantly though, there are a variety of external and internal factors that influence global behavioural states which are difficult to control for using these approaches. For this reason, over the last few decades, ex vivo experimental models have become increasingly popular and have greatly advanced our understanding of many fundamental aspects of sleep, including the neuroanatomy and neurochemistry of sleep states, sleep regulation, the origin and dynamics of specific sleep oscillations, network homeostasis as well as the functional roles of sleep. This chapter will focus on the use of small neuronal networks as experimental models and will highlight the most significant and novel insights these approaches have provided.

Leukocyte Expression of Type 1 and Type 2 Purinergic Receptors and Pro-Inflammatory Cytokines during Total Sleep Deprivation and/or Sleep Extension in Healthy Subjects

The purinergic type P1 (adenosine A₁ and A_2A) receptors and the type P2 (X7) receptor have been suggested to mediate physiological effects of adenosine and adenosine triphosphate on sleep. We aimed to determine gene expression of A₁R (receptor), A_2AR, and P2RX₇ in leukocytes of healthy subjects during total sleep deprivation followed by sleep recovery. Expression of the pro-inflammatory cytokines IL-1β and TNF-α were also determined as they have been characterized as sleep regulatory substances, via P2RX₇ activation. Blood sampling was performed on 14 young men (aged 31.9 ± 3.9) at baseline (B), after 24 h of sleep deprivation (24 h-SD), and after one night of sleep recovery (R). We compared gene expression levels after six nights of habitual (22.30–07.00) or extended (21.00–07.00) bedtimes. Using quantitative real-time PCR, the amount of mRNA for A₁R, A_2AR, P2RX₇, TNF-α, and IL-1β was analyzed. After 24 h-SD compared to B, whatever prior sleep condition, a significant increase of A_2AR expression was observed that returned to basal level after sleep recovery [day main effect, F_{(2, 26)} = 10.8, p < 0.001]. In both sleep condition, a day main effect on P2RX₇ mRNA was observed [F_{(2, 26)} = 6.7, p = 0.005] with significant increases after R compared with 24 h-SD. TNF-α and IL-1β expressions were not significantly altered. Before 24 h-SD (baseline), the A_2AR expression was negatively correlated with the latency of stage 3 sleep during the previous night, while that of the A₁R positively. This was not observed after sleep recovery following 24 h-SD. This is the first study showing increased A_2AR and not A₁ gene expression after 24 h-SD in leukocytes of healthy subjects, and this even if bedtime was initially increased by 1.5 h per night for six nights. In conclusion, prolonged wakefulness induced an up-regulation of the A2A receptor gene expression in leukocytes from healthy subjects. Significant correlations between baseline expression of A₁ and A_2A receptors in peripheral cells and stage 3 sleep suggested their involvement in mediating the effects of adenosine on sleep.