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Gott J, Rak M, Bovy L, Peters E, van Hooijdonk CFM, Mangiaruga A, Varatheeswaran R, Chaabou M, Gorman L, Wilson S, Weber F, Talamini L, Steiger A, Dresler M. Sleep fragmentation and lucid dreaming. Conscious Cogn 2020; 84:102988. [PMID: 32768920 DOI: 10.1016/j.concog.2020.102988] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
Lucid dreaming-the phenomenon of experiencing waking levels of self-reflection within one's dreams-is associated with more wake-like levels of neural activation in prefrontal brain regions. In addition, alternating periods of wakefulness and sleep might increase the likelihood of experiencing a lucid dream. Here we investigate the association between sleep fragmentation and lucid dreaming, with a multi-centre study encompassing four different investigations into subjective and objective measures of sleep fragmentation, nocturnal awakenings, sleep quality and polyphasic sleep schedules. Results across these four studies provide a more nuanced picture into the purported connection between sleep fragmentation and lucid dreaming: While self-assessed numbers of awakenings, polyphasic sleep and physiologically validated wake-REM sleep transitions were associated with lucid dreaming, neither self-assessed sleep quality, nor physiologically validated numbers of awakenings were. We discuss these results, and their underlying neural mechanisms, within the general question of whether sleep fragmentation and lucid dreaming share a causal link.
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Affiliation(s)
- Jarrod Gott
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Michael Rak
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Leonore Bovy
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Emma Peters
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carmen F M van Hooijdonk
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Rivierduinen Institute for Mental Healthcare, Leiden, the Netherlands
| | - Anastasia Mangiaruga
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | | - Axel Steiger
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Martin Dresler
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands.
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Liu Y, Zhang J, Lam V, Ho CKW, Zhou J, Li SX, Lam SP, Yu MWM, Tang X, Wing YK. Altered Sleep Stage Transitions of REM Sleep: A Novel and Stable Biomarker of Narcolepsy. J Clin Sleep Med 2015; 11:885-94. [PMID: 25979093 DOI: 10.5664/jcsm.4940] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/16/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To determine the diagnostic values, longitudinal stability, and HLA association of the sleep stage transitions in narcolepsy. METHODS To compare the baseline differences in the sleep stage transition to REM sleep among 35 patients with type 1 narcolepsy, 39 patients with type 2 narcolepsy, 26 unaffected relatives, and 159 non-narcoleptic sleep patient controls, followed by a reassessment at a mean duration of 37.4 months. RESULTS The highest prevalence of altered transition from stage non-N2/N3 to stage R in multiple sleep latency test (MSLT) and nocturnal polysomnography (NPSG) was found in patients with type 1 narcolepsy (92.0% and 57.1%), followed by patients with type 2 narcolepsy (69.4% and 12.8%), unaffected relatives (46.2% and 0%), and controls (39.3% and 1.3%). Individual sleep variables had varied sensitivity and specificity in diagnosing narcolepsy. By incorporating a combination of sleep variables, the decision tree analysis improved the sensitivity to 94.3% and 82.1% and enhanced specificity to 82.4% and 83% for the diagnosis of type 1 and type 2 narcolepsy, respectively. There was a significant association of DBQ1*0602 with the altered sleep stage transition (OR = 16.0, 95% CI: 1.7-149.8, p = 0.015). The persistence of the altered sleep stage transition in both MSLT and NPSG was high for both type 1 (90.5% and 64.7%) and type 2 narcolepsy (92.3% and 100%), respectively. CONCLUSION Altered sleep stage transition is a significant and stable marker of narcolepsy, which suggests a vulnerable wake-sleep dysregulation trait in narcolepsy. Altered sleep stage transition has a significant diagnostic value in the differential diagnosis of hypersomnias, especially when combined with other diagnostic sleep variables in decision tree analysis.
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Affiliation(s)
- Yaping Liu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Venny Lam
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Crover Kwok Wah Ho
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Junying Zhou
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shirley Xin Li
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Siu Ping Lam
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Mandy Wai Man Yu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiangdong Tang
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yun-Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Buguet A, Chapotot F, Ngampo S, Bouteille B, Cespuglio R. Management of African trypanosomiasis of the CNS: polysomnography as a noninvasive staging tool. FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.12.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Human African trypanosomiasis staging follows human African trypanosomiasis diagnosis (trypanosomes in blood and/or lymph glands, trypanosome-positive). Staging determines treatment, as stage 2 medications are toxic and/or difficult to administer. It relies on cerebrospinal fluid examination: stage 1 (no cerebrospinal fluid trypanosome, trypanosome-negative; white blood cell count ≤5/µl); stage 2 (trypanosome-positive and/or white blood cell count ≥20/µl); intermediate stage (6–19 white blood cell/µl; trypanosome-negative). Lumbar puncture is repeated biannually during the 24-month post-treatment follow-up to confirm cure or detect relapse. Sleep disorders are major at stage 2, with a two-symptom polysomnographic syndrome: sleep–wake circadian disruptions; and sleep-onset rapid eye movement sleep periods. Polysomnography (PSG) was proposed as a noninvasive diagnostic tool, and 24-h PSG recordings were performed throughout a 5-year survey in Congo. Before treatment, 76 patients were included and recorded. Normal sleep–wake patterns occurred in 45 out of 47 stage 1 patients and in 16 out of 19 intermediate-stage patients. PSG syndrome was observed in seven out of ten stage 2 patients. During post-treatment follow-up, PSG syndrome occurrence indicated relapse at stage 2. Thus, noninvasive PSG may represent a valuable alternative for human African trypanosomiasis staging, especially in the post-therapeutic follow-up. The detection of a PSG syndrome would then provoke examination of the patient’s cerebrospinal fluid.
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Affiliation(s)
- Alain Buguet
- Polyclinique Marie-Louise Poto-Djembo, Siafoumou, B.P. 49, Pointe-Noire, Congo
- Centre de recherche en neurosciences de Lyon, Inserm U-468, Université Claude-Bernard Lyon 1, 8 Avenue Rockefeller, 69373 Lyon cedex 08, France
| | - Florian Chapotot
- Department of Medicine, The University of Chicago, 5841 South Maryland Avenue, MC 1027, Chicago, IL 60637, USA
| | - Stéphane Ngampo
- Programme national de lutte contre la trypanosomiase humaine africaine, B.P. 1066, Brazzaville, Congo
| | - Bernard Bouteille
- Département de parasitologie, CHRU Dupuytren, 2 Avenue Martin-Luther King, 87042 Limoges, France
| | - Raymond Cespuglio
- Centre de recherche en neurosciences de Lyon, Inserm U-468, Université Claude-Bernard Lyon 1, 8 Avenue Rockefeller, 69373 Lyon cedex 08, France
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USUI A, KITAHARA Y, MATSUSHITA Y, KITAJIMA M, SAKAMOTO R, WATANABE T, MOTOHASHI N. Do you perform the multiple sleep latency test according to the guidelines? A case with multiple sleep onset REM periods. Sleep Biol Rhythms 2008. [DOI: 10.1111/j.1479-8425.2008.00334.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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TAKEUCHI T. Dream mechanisms: Is REM sleep indispensable for dreaming? Sleep Biol Rhythms 2005. [DOI: 10.1111/j.1479-8425.2005.00165.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Takeuchi T, Ogilvie RD, Murphy TI, Ferrelli AV. EEG activities during elicited sleep onset REM and NREM periods reflect different mechanisms of dream generation. Electroencephalograms. Rapid eye movement. Clin Neurophysiol 2003; 114:210-20. [PMID: 12559227 DOI: 10.1016/s1388-2457(02)00385-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To be the first to compare EEG power spectra during sleep onset REM periods (SOREMP) and sleep onset NREM periods (NREMP) in normal individuals and relate this to dream appearance processes underlying these different types of sleep periods. METHODS Eight healthy undergraduates spent 7 consecutive nights in the sleep lab including 4 nights for SOREMP elicitation using the Sleep Interruption Technique. This enabled us to control preceding sleep processes between SOREMP and NREMP. EEG power spectra when participants did and did not report 'dreams' were compared between both types of sleep. Sleep stages, subjective measurements including dream property scores, sleepiness, mood, and tiredness after awakenings were also examined to determine their consistency with EEG findings. RESULTS Increased alpha EEG activities (11.72-13.67 Hz) observed mainly in the central area were related to the absence of SOREMP dreams and appearance of NREMP dreams. Analyses of sleep stages combining two studies (16 participants) also supported the Fast Fourier Transform findings, showing that when dreams were reported there were decreased amounts of stage 2 and increased stage REM in SOREMP and increased stage W in NREMP. SOREMP dreams were more bizarre than NREMP dreams. Participants felt more tired after SOREMP with dreams than without dreams, while the opposite was observed after NREMP episodes. CONCLUSIONS EEG power spectra patterns reflected different physiological mechanisms underlying generation of SOREMP and NREMP dreams. The same relationships were also reflected by sleep stage analyses as well as subjective measurements including dream properties and tiredness obtained after awakenings. This study not only supports the hypothesized relationships between REM mechanisms and REM dreams as well as arousal processes and NREM dreams, it also provides a new perspective to dream research due to its unique techniques to awaken participants and collect REM dreams during experimentally induced SOREMP.
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Affiliation(s)
- Tomoka Takeuchi
- Centre d'Etude du Sommeil, Hôpital du Sacré-Coeur de Montréal, Québec, Canada.
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