Humans can learn new information during sleep

Olfaction modulates cortical arousal independent of perceived odor intensity and pleasantness

Throughout history, various odors have been harnessed to invigorate or relax the mind. The mechanisms underlying odors' diverse arousal effects remain poorly understood. We conducted five experiments (184 participants) to investigate this issue, using pupillometry, electroencephalography, and the attentional blink paradigm, which exemplifies the limit in attentional capacity. Results demonstrated that exposure to citral, compared to vanillin, enlarged pupil size, reduced resting-state alpha oscillations and alpha network efficiency, augmented beta-gamma oscillations, and enhanced the coordination between parietal alpha and frontal beta-gamma activities. In parallel, it attenuated the attentional blink effect. These effects were observed despite citral and vanillin being comparable in perceived odor intensity, pleasantness, and nasal pungency, and were unlikely driven by semantic biases. Our findings reveal that odors differentially alter the small-worldness of brain network architecture, and thereby brain state and arousal. Furthermore, they establish arousal as a unique dimension in olfactory space, distinct from intensity and pleasantness.

Pain anticipation is a new behavioural sign of minimally conscious state

Probing cognition and consciousness in the absence of functional communication remains an extremely challenging task. In this perspective, we imagined a basic clinical procedure to explore pain anticipation at bedside. In a series of 61 patients with a disorder of consciousness, we tested the existence of a nociceptive anticipation response by pairing a somaesthetic stimulation with a noxious stimulation. We then explored how nociceptive anticipation response correlated with (i) clinical status inferred from Coma Recovery Scale-Revised scoring, (ii) with an EEG signature of stimulus anticipation-the contingent negative variation-and (iii) how nociceptive anticipation response could predict consciousness outcome at 6 months. Proportion of nociceptive anticipation response differed significantly according to the state of consciousness: nociceptive anticipation response was present in 5 of 5 emerging from minimally conscious state patients (100%), in 10 of 11 minimally conscious state plus patients (91%), but only in 8 of 17 minimally conscious state minus patients (47%), and only in 1 of 24 vegetative state/unresponsive wakefulness syndrome patients (4%) (χ 2  P < 0.0001). Nociceptive anticipation response correlated with the presence of a contingent negative variation, suggesting that patients with nociceptive anticipation response were more prone to actively expect and anticipate auditory stimuli (Fisher's exact test P = 0.05). However, nociceptive anticipation response presence did not predict consciousness recovery. Nociceptive anticipation response appears as a new additional behavioural sign that can be used to differentiate minimally conscious state from vegetative state/unresponsive wakefulness syndrome patients. As most behavioural signs of minimally conscious state, the nociceptive anticipation response seems to reveal the existence of a cortically mediated state that does not necessarily reflect residual conscious processing.

Taking consciousness for real: Increasing the ecological validity of the study of conscious vs. unconscious processes

The study of consciousness has developed well-controlled, rigorous methods for manipulating and measuring consciousness. Yet, in the process, experimental paradigms grew farther away from everyday conscious and unconscious processes, which raises the concern of ecological validity. In this review, we suggest that the field can benefit from adopting a more ecological approach, akin to other fields of cognitive science. There, this approach challenged some existing hypotheses, yielded stronger effects, and enabled new research questions. We argue that such a move is critical for studying consciousness, where experimental paradigms tend to be artificial and small effect sizes are relatively prevalent. We identify three paths for doing so-changing the stimuli and experimental settings, changing the measures, and changing the research questions themselves-and review works that have already started implementing such approaches. While acknowledging the inherent challenges, we call for increasing ecological validity in consciousness studies.

Respiration-triggered olfactory stimulation reduces obstructive sleep apnea severity: A prospective pilot study

Obstructive sleep apnea is a prevalent sleep-disordered breathing condition characterized by repetitive reduction in breathing during sleep. The current care standard for obstructive sleep apnea is continuous positive air pressure devices, often suffering from low tolerance due to limited adherence. Capitalizing on the unique neurocircuitry of olfactory perception and its retained function during sleep, we conducted a pilot study to test transient, respiration-based olfactory stimulation as a treatment for obstructive sleep apnea markers. Thirty-two patients with obstructive sleep apnea (apnea-hypopnea index ≥ 15 events per hr) underwent two polysomnography sessions, "Odour" and "Control", in random order. In "Odour" nights, patients were presented with transient respiratory-based olfactory stimulation delivered via a computer-controlled commercial olfactometer (Scentific). The olfactometer, equipped with a wireless monitoring, analysed respiratory patterns and presented odour upon detection of respiratory events. No odours were presented in "Control" nights. Following exclusions, 17 patients entered the analysis (four women, 47.4 (10.5) years, body mass index: 29.4 (6.3) kg m-2). We observed that olfactory stimulation during sleep reduced the apnea-hypopnea index ("Odour": 17.2 (20.9), "Control": 28.2 (18.6), z = -3.337, p = 0.000846, BF10 [Bayesian Factor 10]= 57.9), reflecting an average decrease of 31.3% in the number of events. Relatedly, stimulation reduced the oxygen desaturation index by 26.9% ("Odour": 12.5 (15.8), "Control": 25.7 (25.9), z = -3.337, p = 0.000846, BF10 = 9.522). This effect was not linked to the severity of baseline obstructive sleep apnea markers (ρ = -0.042, p = 0.87). Olfactory stimulation did not arouse from sleep or affect sleep structure, measured as time per sleep stage (F1,16 = 0.088, p = 0.77). In conclusion, olfactory stimulation during sleep was effective in reducing the severity of obstructive sleep apnea markers without inducing arousals, and may provide a novel treatment for obstructive sleep apnea, prompting continued research.

Episodic long-term memory formation during slow-wave sleep

We are unresponsive during slow-wave sleep but continue monitoring external events for survival. Our brain wakens us when danger is imminent. If events are non-threatening, our brain might store them for later consideration to improve decision-making. To test this hypothesis, we examined whether novel vocabulary consisting of simultaneously played pseudowords and translation words are encoded/stored during sleep, and which neural-electrical events facilitate encoding/storage. An algorithm for brain-state-dependent stimulation selectively targeted word pairs to slow-wave peaks or troughs. Retrieval tests were given 12 and 36 hr later. These tests required decisions regarding the semantic category of previously sleep-played pseudowords. The sleep-played vocabulary influenced awake decision-making 36 hr later, if targeted to troughs. The words' linguistic processing raised neural complexity. The words' semantic-associative encoding was supported by increased theta power during the ensuing peak. Fast-spindle power ramped up during a second peak likely aiding consolidation. Hence, new vocabulary played during slow-wave sleep was stored and influenced decision-making days later.

What Does the Human Olfactory System Do, and How Does It Do It?

Historically, the human sense of smell has been regarded as the odd stepchild of the senses, especially compared to the sensory bravado of seeing, touching, and hearing. The idea that the human olfaction has little to contribute to our experience of the world is commonplace, though with the emergence of COVID-19 there has rather been a sea change in this understanding. An ever increasing body of work has convincingly highlighted the keen capabilities of the human nose and the sophistication of the human olfactory system. Here, we provide a concise overview of the neuroscience of human olfaction spanning the last 10-15 years, with focus on the peripheral and central mechanisms that underlie how odor information is processed, packaged, parceled, predicted, and perturbed to serve odor-guided behaviors. We conclude by offering some guideposts for harnessing the next decade of olfactory research in all its shapes and forms.

Learning during sleep in humans - A historical review

Sleep helps to consolidate previously acquired memories. Whether new information such as languages and other useful skills can also be learned during sleep has been debated for over a century, however, the sporadic studies' different objectives and varied methodologies make it difficult to draw definitive conclusions. This review provides a comprehensive overview of the history of sleep learning research conducted in humans, from its empirical beginnings in the 1940s to the present day. Synthesizing the findings from 51 research papers, we show that several studies support the notion that simpler forms of learning, such as habituation and conditioning, are possible during sleep. In contrast, the findings for more complex, applied learning (e.g., learning a new language during sleep) are more divergent. While there is often an indication of processing and learning during sleep when looking at neural markers, behavioral evidence for the transfer of new knowledge to wake remains inconclusive. We close by critically examining the limitations and assumptions that have contributed to the discrepancies in the literature and highlight promising new directions in the field.

Behavioral and brain responses to verbal stimuli reveal transient periods of cognitive integration of the external world during sleep

Sleep has long been considered as a state of behavioral disconnection from the environment, without reactivity to external stimuli. Here we questioned this 'sleep disconnection' dogma by directly investigating behavioral responsiveness in 49 napping participants (27 with narcolepsy and 22 healthy volunteers) engaged in a lexical decision task. Participants were instructed to frown or smile depending on the stimulus type. We found accurate behavioral responses, visible via contractions of the corrugator or zygomatic muscles, in most sleep stages in both groups (except slow-wave sleep in healthy volunteers). Across sleep stages, responses occurred more frequently when stimuli were presented during high cognitive states than during low cognitive states, as indexed by prestimulus electroencephalography. Our findings suggest that transient windows of reactivity to external stimuli exist during bona fide sleep, even in healthy individuals. Such windows of reactivity could pave the way for real-time communication with sleepers to probe sleep-related mental and cognitive processes.

Subjectively intense odor does not affect dream emotions during rapid eye movement sleep

Dreams experienced during rapid eye movement (REM) sleep have emotional features. Intervention methods for dream affectivity have recently garnered interest; we previously demonstrated that negative dreams were induced during REM sleep by exposure to favorable or familiar odors. However, the underlying mechanisms behind this phenomenon remain unclear. Thus, to address this gap, we investigated whether more intense odors could induce negative dreams, as odors tend to be perceived as more intense when they are preferred or familiar. Contrary to our hypothesis, the results of our study indicated that subjective intense odors did not induce negative dreams. We initially anticipated stronger odors to have a greater impact on dream emotionality, as they stimulate the brain more intensely. Notably, during arousal, weak odors tended to evoke a more potent olfactory response, while strong odors tended to produce a weaker response. To investigate whether this difference influenced the effects on dreams, we compared the respiratory activities of the strongly and weakly perceived odor groups; however, no significant differences were observed. Our findings suggest that subjectively perceived strong odors are unlikely to affect dream emotionality and may be processed differently than favorable or familiar odors.

Olfactory-auditory sensory integration in the lateral entorhinal cortex

Multisensory integration plays an important role in animal cognition. Although many studies have focused on visual-auditory integration, studies on olfactory-auditory integration are rare. Here, we investigated neural activity patterns and odor decoding in the lateral entorhinal cortex (LEC) under uni-sensory and multisensory stimuli in awake, head-fixed mice. Using specific retrograde tracing, we verified that the LEC receives direct inputs from the primary auditory cortex (AC) and the medial geniculate body (MGB). Strikingly, we found that mitral/tufted cells (M/Ts) in the olfactory bulb (OB) and neurons in the LEC respond to both olfactory and auditory stimuli. Sound decreased the neural responses evoked by odors in both the OB and LEC, for both excitatory and inhibitory responses. Interestingly, significant changes in odor decoding performance and modulation of odor-evoked local field potentials (LFPs) were observed only in the LEC. These data indicate that the LEC is a critical center for olfactory-auditory multisensory integration, with direct projections from both olfactory and auditory centers.

Unconscious integration: Current evidence for integrative processing under subliminal conditions

Integrative processing is traditionally believed to be dependent on consciousness. While earlier studies within the last decade reported many types of integration under subliminal conditions (i.e. without perceptual awareness), these findings are widely challenged recently. This review evaluates the current evidence for 10 types of subliminal integration that are widely studied: arithmetic processing, object-context integration, multi-word processing, same-different processing, multisensory integration and 5 different types of associative learning. Potential methodological issues concerning awareness measures are also taken into account. It is concluded that while there is currently no reliable evidence for subliminal integration, this does not necessarily refute 'unconscious' integration defined through non-subliminal (e.g. implicit) approaches.

Updating memories of unwanted emotions during human sleep

Post-learning sleep contributes to memory consolidation. Yet it remains contentious whether sleep affords opportunities to modify or update emotional memories, particularly when people would prefer to forget those memories. Here, we attempted to update memories during sleep, using spoken positive words paired with cues to recent memories of aversive events. Affective updating using positive words during human non-rapid eye movement (NREM) sleep, compared with using neutral words instead, reduced negative affective judgments in post-sleep tests, suggesting that the recalled events were perceived as less aversive. Electroencephalogram (EEG) analyses showed that positive words modulated theta and spindle/sigma activity; specifically, to the extent that theta power was larger for the positive words than for the memory cues that followed, participants judged the memory cues less negatively. Moreover, to the extent that sigma power was larger for the positive words than for the memory cues that followed, participants forgot more episodic details about aversive events. Notably, when the onset of individual positive words coincided with the up-phase of slow oscillations (a state characterized by increased cortical excitability during NREM sleep), affective updating was more successful. In sum, we altered the affective content of memories via the strategic pairing of positive words and memory cues during sleep, linked with EEG theta power increases and the slow oscillation up-phase. These findings suggest novel possibilities for modifying unwanted memories during sleep, which would not require people to consciously confront memories that they prefer to avoid.

Reciprocal relationships between sleep and smell

Despite major anatomical differences with other mammalian sensory systems, olfaction shares with those systems a modulation by sleep/wake states. Sleep modulates odor sensitivity and serves as an important regulator of both perceptual and associative odor memory. In addition, however, olfaction also has an important modulatory impact on sleep. Odors can affect the latency to sleep onset, as well as the quality and duration of sleep. Olfactory modulation of sleep may be mediated by direct synaptic interaction between the olfactory system and sleep control nuclei, and/or indirectly through odor modulation of arousal and respiration. This reciprocal interaction between sleep and olfaction presents novel opportunities for sleep related modulation of memory and perception, as well as development of non-pharmacological olfactory treatments of simple sleep disorders.

Disrupted neural tracking of sound localization during non-rapid eye movement sleep

Spatial hearing in humans is a high-level auditory process that is crucial to rapid sound localization in the environment. Both neurophysiological models with animals and neuroimaging evidence from human subjects in the wakefulness stage suggest that the localization of auditory objects is mainly located in the posterior auditory cortex. However, whether this cognitive process is preserved during sleep remains unclear. To fill this research gap, we investigated the sleeping brain's capacity to identify sound locations by recording simultaneous electroencephalographic (EEG) and magnetoencephalographic (MEG) signals during wakefulness and non-rapid eye movement (NREM) sleep in human subjects. Using the frequency-tagging paradigm, the subjects were presented with a basic syllable sequence at 5 Hz and a location change that occurred every three syllables, resulting in a sound localization shift at 1.67 Hz. The EEG and MEG signals were used for sleep scoring and neural tracking analyses, respectively. Neural tracking responses at 5 Hz reflecting basic auditory processing were observed during both wakefulness and NREM sleep, although the responses during sleep were weaker than those during wakefulness. Cortical responses at 1.67 Hz, which correspond to the sound location change, were observed during wakefulness regardless of attention to the stimuli but vanished during NREM sleep. These results for the first time indicate that sleep preserves basic auditory processing but disrupts the higher-order brain function of sound localization.

Sleep as a window to target traumatic memories

Post-traumatic stress disorder (PTSD) is a severe psychiatric disorder in which traumatic memories result in flashbacks and nightmares. With one-third of patients not responding to standard exposure-based psychotherapy, new treatment strategies are needed. Sleep offers a unique time window to enhance therapeutic efficacy. Traumatic memories that are neutralized in therapy need to be stored back into memory (consolidated) during sleep to solidify the treatment effect. New basic research shows that memory consolidation can be enhanced by presenting sounds or scents that were linked to the memory at encoding, again during sleep. This procedure, termed targeted memory reactivation (TMR), has, despite its clinical potential, not been tested in (PTSD) patients. In this narrative review, we explore the potential of TMR as a new sleep-based treatment for PTSD. First we provide the necessary background on the memory and sleep principles underlying PTSD as well as the present applications and conditional factors of TMR. Then, we will discuss the outstanding questions and most promising experimental avenues when testing TMR to treat traumatic memories.

Reduced neural feedback signaling despite robust neuron and gamma auditory responses during human sleep

During sleep, sensory stimuli rarely trigger a behavioral response or conscious perception. However, it remains unclear whether sleep inhibits specific aspects of sensory processing, such as feedforward or feedback signaling. Here, we presented auditory stimuli (for example, click-trains, words, music) during wakefulness and sleep in patients with epilepsy, while recording neuronal spiking, microwire local field potentials, intracranial electroencephalogram and polysomnography. Auditory stimuli induced robust and selective spiking and high-gamma (80-200 Hz) power responses across the lateral temporal lobe during both non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. Sleep only moderately attenuated response magnitudes, mainly affecting late responses beyond early auditory cortex and entrainment to rapid click-trains in NREM sleep. By contrast, auditory-induced alpha-beta (10-30 Hz) desynchronization (that is, decreased power), prevalent in wakefulness, was strongly reduced in sleep. Thus, extensive auditory responses persist during sleep whereas alpha-beta power decrease, likely reflecting neural feedback processes, is deficient. More broadly, our findings suggest that feedback signaling is key to conscious sensory processing.

What Is It Like to Be a Bass? Red Herrings, Fish Pain and the Study of Animal Sentience

Debates around fishes' ability to feel pain concern sentience: do reactions to tissue damage indicate evaluative consciousness (conscious affect), or mere nociception? Thanks to Braithwaite's discovery of trout nociceptors, and concerns that current practices could compromise welfare in countless fish, this issue's importance is beyond dispute. However, nociceptors are merely necessary, not sufficient, for true pain, and many measures held to indicate sentience have the same problem. The question of whether fish feel pain - or indeed anything at all - therefore stimulates sometimes polarized debate. Here, we try to bridge the divide. After reviewing key consciousness concepts, we identify "red herring" measures that should not be used to infer sentience because also present in non-sentient organisms, notably those lacking nervous systems, like plants and protozoa (P); spines disconnected from brains (S); decerebrate mammals and birds (D); and humans in unaware states (U). These "S.P.U.D. subjects" can show approach/withdrawal; react with apparent emotion; change their reactivity with food deprivation or analgesia; discriminate between stimuli; display Pavlovian learning, including some forms of trace conditioning; and even learn simple instrumental responses. Consequently, none of these responses are good indicators of sentience. Potentially more valid are aspects of working memory, operant conditioning, the self-report of state, and forms of higher order cognition. We suggest new experiments on humans to test these hypotheses, as well as modifications to tests for "mental time travel" and self-awareness (e.g., mirror self-recognition) that could allow these to now probe sentience (since currently they reflect perceptual rather than evaluative, affective aspects of consciousness). Because "bullet-proof" neurological and behavioral indicators of sentience are thus still lacking, agnosticism about fish sentience remains widespread. To end, we address how to balance such doubts with welfare protection, discussing concerns raised by key skeptics in this debate. Overall, we celebrate the rigorous evidential standards required by those unconvinced that fish are sentient; laud the compassion and ethical rigor shown by those advocating for welfare protections; and seek to show how precautionary principles still support protecting fish from physical harm.

Learning New Vocabulary Implicitly During Sleep Transfers With Cross-Modal Generalization Into Wakefulness

New information can be learned during sleep but the extent to which we can access this knowledge after awakening is far less understood. Using a novel Associative Transfer Learning paradigm, we show that, after hearing unknown Japanese words with sounds referring to their meaning during sleep, participants could identify the images depicting the meaning of newly acquired Japanese words after awakening (N = 22). Moreover, we demonstrate that this cross-modal generalization is implicit, meaning that participants remain unaware of this knowledge. Using electroencephalography, we further show that frontal slow-wave responses to auditory stimuli during sleep predicted memory performance after awakening. This neural signature of memory formation gradually emerged over the course of the sleep phase, highlighting the dynamics of associative learning during sleep. This study provides novel evidence that the formation of new associative memories can be traced back to the dynamics of slow-wave responses to stimuli during sleep and that their implicit transfer into wakefulness can be generalized across sensory modalities.

State-dependent olfactory processing in freely behaving mice

Decreased responsiveness to sensory stimuli during sleep is presumably mediated via thalamic gating. Without an obligatory thalamic relay in the olfactory system, the anterior piriform cortex (APC) is suggested to be a gate in anesthetized states. However, olfactory processing in natural sleep states remains undetermined. Here, we simultaneously record local field potentials (LFPs) in hierarchical olfactory regions (olfactory bulb [OB], APC, and orbitofrontal cortex) while optogenetically activating olfactory sensory neurons, ensuring consistent peripheral inputs across states in behaving mice. Surprisingly, evoked LFPs in sleep states (both non-rapid eye movement [NREM] and rapid eye movement [REM]) are larger and contain greater gamma-band power and cross-region coherence (compared to wakefulness) throughout the olfactory pathway, suggesting the lack of a central gate. Single-unit recordings from the OB and APC reveal a higher percentage of responsive neurons during sleep with a higher incidence of suppressed firing. Additionally, nasal breathing is slower and shallower during sleep, suggesting a partial peripheral gating mechanism.

Schreck et al. examine how the olfactory system responds to the same peripheral stimulus during natural sleep and wake in mice. Larger responses along the pathway during sleep suggest the lack of a central gate, but slower and shallower breathing may act as a partial peripheral gate to reduce olfactory input.

Breathing coordinates cortico-hippocampal dynamics in mice during offline states

Network dynamics have been proposed as a mechanistic substrate for the information transfer across cortical and hippocampal circuits. However, little is known about the mechanisms that synchronize and coordinate these processes across widespread brain regions during offline states. Here we address the hypothesis that breathing acts as an oscillatory pacemaker, persistently coupling distributed brain circuit dynamics. Using large-scale recordings from a number of cortical and subcortical brain regions in behaving mice, we uncover the presence of an intracerebral respiratory corollary discharge, that modulates neural activity across these circuits. During offline states, the respiratory modulation underlies the coupling of hippocampal sharp-wave ripples and cortical DOWN/UP state transitions, which mediates systems memory consolidation. These results highlight breathing, a perennial brain rhythm, as an oscillatory scaffold for the functional coordination of the limbic circuit that supports the segregation and integration of information flow across neuronal networks during offline states.

Simple statistical regularities presented during sleep are detected but not retained

In recent years, there has been growing interest and excitement over the newly discovered cognitive capacities of the sleeping brain, including its ability to form novel associations. These recent discoveries raise the possibility that other more sophisticated forms of learning may also be possible during sleep. In the current study, we tested whether sleeping humans are capable of statistical learning - the process of becoming sensitive to repeating, hidden patterns in environmental input, such as embedded words in a continuous stream of speech. Participants' EEG was recorded while they were presented with one of two artificial languages, composed of either trisyllabic or disyllabic nonsense words, during slow-wave sleep. We used an EEG measure of neural entrainment to assess whether participants became sensitive to the repeating regularities during sleep-exposure to the language. We further probed for long-term memory representations by assessing participants' performance on implicit and explicit tests of statistical learning during subsequent wake. In the disyllabic-but not trisyllabic-language condition, participants' neural entrainment to words increased over time, reflecting a gradual gain in sensitivity to the embedded regularities. However, no significant behavioural effects of sleep-exposure were observed after the nap, for either language. Overall, our results indicate that the sleeping brain can detect simple, repeating pairs of syllables, but not more complex triplet regularities. However, the online detection of these regularities does not appear to produce any durable long-term memory traces that persist into wake - at least none that were revealed by our current measures and sample size. Although some perceptual aspects of statistical learning are preserved during sleep, the lack of memory benefits during wake indicates that exposure to a novel language during sleep may have limited practical value.

Sleep-learning impairs subsequent awake-learning

Although we can learn new information while asleep, we usually cannot consciously remember the sleep-formed memories - presumably because learning occurred in an unconscious state. Here, we ask whether sleep-learning expedites the subsequent awake-learning of the same information. To answer this question, we reanalyzed data (Züst et al., 2019, Curr Biol) from napping participants, who learned new semantic associations between pseudowords and translation-words (guga-ship) while in slow-wave sleep. They retrieved sleep-formed associations unconsciously on an implicit memory test following awakening. Then, participants took five runs of paired-associative learning to probe carry-over effects of sleep-learning on awake-learning. Surprisingly, sleep-learning diminished awake-learning when participants learned semantic associations that were congruent to sleep-learned associations (guga-boat). Yet, learning associations that conflicted with sleep-learned associations (guga-coin) was unimpaired relative to learning new associations (resun-table; baseline). We speculate that the impeded wake-learning originated in a deficient synaptic downscaling and resulting synaptic saturation in neurons that were activated during both sleep-learning and awake-learning.

Mutual Interactions between Brain States and Alzheimer's Disease Pathology: A Focus on Gamma and Slow Oscillations

Brain state varies from moment to moment. While brain state can be defined by ongoing neuronal population activity, such as neuronal oscillations, this is tightly coupled with certain behavioural or vigilant states. In recent decades, abnormalities in brain state have been recognised as biomarkers of various brain diseases and disorders. Intriguingly, accumulating evidence also demonstrates mutual interactions between brain states and disease pathologies: while abnormalities in brain state arise during disease progression, manipulations of brain state can modify disease pathology, suggesting a therapeutic potential. In this review, by focusing on Alzheimer's disease (AD), the most common form of dementia, we provide an overview of how brain states change in AD patients and mouse models, and how controlling brain states can modify AD pathology. Specifically, we summarise the relationship between AD and changes in gamma and slow oscillations. As pathological changes in these oscillations correlate with AD pathology, manipulations of either gamma or slow oscillations can modify AD pathology in mouse models. We argue that neuromodulation approaches to target brain states are a promising non-pharmacological intervention for neurodegenerative diseases.

The Impact of Earplugs and Eye Masks on Sleep Quality in Surgical ICU Patients at Risk for Frequent Awakenings

OBJECTIVES

Sleep disturbances may contribute to the development of delirium, prolonged ICU stay, and increased mortality. There is conflicting data on the effectiveness of earplugs and eye masks for sleep promotion in the ICU. This study evaluates the impact of earplugs and eye masks on sleep quality in postoperative surgical ICU patients at risk for frequent awakenings.

DESIGN

Prospective randomized controlled trial.

SETTING

Surgical ICU within the University of Texas Southwestern Medical Center.

PATIENTS

Adult, female patients admitted to the surgical ICU requiring hourly postoperative assessments following breast free flap surgery between February 2018 and October 2019.

INTERVENTIONS

Patients were randomized into an intervention group or a control group. The intervention group received earplugs and eye masks in addition to standard postoperative care, whereas the control group received standard postoperative care.

MEASUREMENTS AND MAIN RESULTS

The primary outcome was overall sleep quality assessed via the Richards-Campbell Sleep Questionnaire. Secondary outcomes of patient satisfaction and rates of ICU delirium were assessed with a modified version of the Family Satisfaction in the ICU survey and the Confusion Assessment Method for the ICU. After a planned interim analysis, the study was stopped early because prespecified criteria for significance were attained. Compared with the control group's average Richards-Campbell Sleep Questionnaire total score of 47.3 (95% CI, 40.8-53.8), the intervention group's average Richards-Campbell Sleep Questionnaire total score was significantly higher at 64.5 (95% CI, 58.3-70.7; p = 0.0007). There were no significant between-group differences for Confusion Assessment Method for the ICU scores or modified Family Satisfaction in the ICU survey scores.

CONCLUSIONS

These results suggest that earplugs and eye masks are effective in improving sleep quality in ICU patients undergoing frequent assessments. The results strengthen the evidence for nonpharmacologic sleep-promoting adjuncts in the ICU.

Lipids in the origin of intracellular detail and speciation in the Cambrian epoch and the significance of the last double bond of docosahexaenoic acid in cell signaling

One of the great unanswered biological questions is the absolute necessity of the polyunsaturated lipid docosahexaenoic acid (DHA; 22:6n-3) in retinal and neural tissues. Everything from the simple eye spot of dinoflagellates to cephalopods to every class of vertebrates uses DHA, yet it is abundant only in cold water marine food chains. Docosapentaenoic acids (DPAs; 22:5n-6 and especially 22:5n-3) are fairly plentiful in food chains yet cannot substitute for DHA. About 600 million years ago, multi-cellular, air breathing systems evolved rapidly and 32 phyla came into existence in a short geological time span; the "Cambrian Explosion". Eukaryotic intracellular detail requires cell membranes, which are constructed of complex lipids, and proteins. Proteins and nucleic acids would have been abundant during the first 2.5-5 billion years of anaerobic life but lipids, especially unsaturated fatty acids, would not. We hypothesize lipid biology was a key driver of the Cambrian Explosion, because it alone provides for compartmentalization and specialization within cells DHA has six methylene interrupted double bonds providing controlled electron flow at precise energy levels; this is essential for visual acuity and truthful execution of the neural pathways which make up our recollections, information processing and consciousness. The last double bond is critical for the evolution and function of the photoreceptor and neuronal and synaptic signaling systems. It completes a quantum mechanical device for the regulation of current flow with absolute signal precision based on electron tunneling (ET). DHA's methylene interruption distance is < 6 Å, making ET transfer between the π-orbitals feasible throughout the molecule. The possibility fails if one double bond is removed and replaced by a saturated bond as in the DPAs. The molecular biophysical foundation of neural signaling can also include the discrete pattern of paired spin states that arise in the DHA double bond and methylene regions. The complexity depends upon the number of C13 and H1 molecular sites in which spin states are coupled. Electron wave harmonics with entanglement and cohesion provide a mechanism for learning and memory, and power cognition and complex human brain functions.

Real-time dialogue between experimenters and dreamers during REM sleep

Dreams take us to a different reality, a hallucinatory world that feels as real as any waking experience. These often-bizarre episodes are emblematic of human sleep but have yet to be adequately explained. Retrospective dream reports are subject to distortion and forgetting, presenting a fundamental challenge for neuroscientific studies of dreaming. Here we show that individuals who are asleep and in the midst of a lucid dream (aware of the fact that they are currently dreaming) can perceive questions from an experimenter and provide answers using electrophysiological signals. We implemented our procedures for two-way communication during polysomnographically verified rapid-eye-movement (REM) sleep in 36 individuals. Some had minimal prior experience with lucid dreaming, others were frequent lucid dreamers, and one was a patient with narcolepsy who had frequent lucid dreams. During REM sleep, these individuals exhibited various capabilities, including performing veridical perceptual analysis of novel information, maintaining information in working memory, computing simple answers, and expressing volitional replies. Their responses included distinctive eye movements and selective facial muscle contractions, constituting correctly answered questions on 29 occasions across 6 of the individuals tested. These repeated observations of interactive dreaming, documented by four independent laboratory groups, demonstrate that phenomenological and cognitive characteristics of dreaming can be interrogated in real time. This relatively unexplored communication channel can enable a variety of practical applications and a new strategy for the empirical exploration of dreams.

Scientific investigations of dreaming have been hampered by the delay between a dream and when people report on their dream, and by a change in state from sleep to wake. To overcome this problem, Konkoly et al. show that individuals in REM sleep can perceive and answer an experimenter’s questions, allowing for real-time communication about a dream.

Neurobiological and Hormonal Mechanisms Regulating Women's Sleep

Sleep is crucial for optimal well-being, and sex differences in sleep quality have significant implications for women's health. We review the current literature on sex differences in sleep, such as differences in objective and subjective sleep measures and their relationship with aging. We then discuss the convincing evidence for the role of ovarian hormones in regulating female sleep, and survey how these hormones act on a multitude of brain regions and neurochemicals to impact sleep. Lastly, we identify several important areas in need of future research to narrow the knowledge gap and improve the health of women and other understudied populations.

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.

Olfaction Modulates Inter-Subject Correlation of Neural Responses

Odors can be powerful stimulants. It is well-established that odors provide strong cues for recall of locations, people and events. The effects of specific scents on other cognitive functions are less well-established. We hypothesized that scents with different odor qualities will have a different effect on attention. To assess attention, we used Inter-Subject Correlation of the EEG because this metric is strongly modulated by attentional engagement with natural audiovisual stimuli. We predicted that scents known to be "energizing" would increase Inter-Subject Correlation during watching of videos as compared to "calming" scents. In a first experiment, we confirmed this for eucalyptol and linalool while participants watched animated autobiographical narratives. The result was replicated in a second experiment, but did not generalize to limonene, also considered an "energizing" odorant. In a third, double-blind experiment, we tested a battery of scents including single molecules, as well as mixtures, as participants watched various short video clips. We found a varying effect of odor on Inter-Subject Correlation across the various scents. This study provides a basis for reliably and reproducibly assessing effects of odors on brain activity. Future research is needed to further explore the effect of scent-based up-modulation in engagement on learning and memory performance. Educators, product developers and fragrance brands might also benefit from such objective neurophysiological measures.

Olfaction scaffolds the developing human from neonate to adolescent and beyond

The impact of the olfactory sense is regularly apparent across development. The fetus is bathed in amniotic fluid (AF) that conveys the mother's chemical ecology. Transnatal olfactory continuity between the odours of AF and milk assists in the transition to nursing. At the same time, odours emanating from the mammary areas provoke appetitive responses in newborns. Odours experienced from the mother's diet during breastfeeding, and from practices such as pre-mastication, may assist in the dietary transition at weaning. In parallel, infants are attracted to and recognize their mother's odours; later, children are able to recognize other kin and peers based on their odours. Familiar odours, such as those of the mother, regulate the child's emotions, and scaffold perception and learning through non-olfactory senses. During juvenility and adolescence, individuals become more sensitive to some bodily odours, while the timing of adolescence itself has been speculated to draw from the chemical ecology of the family unit. Odours learnt early in life and within the family niche continue to influence preferences as mate choice becomes relevant. Olfaction thus appears significant in turning on, sustaining and, in cases when mother odour is altered, disturbing adaptive reciprocity between offspring and carer during the multiple transitions of development between birth and adolescence. This article is part of the Theo Murphy meeting issue 'Olfactory communication in humans'.

Dormio: A targeted dream incubation device

Information processing during sleep is active, ongoing and accessible to engineering. Protocols such as targeted memory reactivation use sensory stimuli during sleep to reactivate memories and demonstrate subsequent, specific enhancement of their consolidation. These protocols rely on physiological, as opposed to phenomenological, evidence of their reactivation. While dream content can predict post-sleep memory enhancement, dreaming itself remains a black box. Here, we present a novel protocol using a new wearable electronic device, Dormio, to automatically generate serial auditory dream incubations at sleep onset, wherein targeted information is repeatedly presented during the hypnagogic period, enabling direct incorporation of this information into dream content, a process we call targeted dream incubation (TDI). Along with validation data, we discuss how Dormio and TDI protocols can serve as tools for controlled experimentation on dream content, shedding light on the role of dreams in the overnight transformation of experiences into memories.

Effect of treatment with a full-occlusion biofeedback splint on sleep bruxism and TMD pain: a randomized controlled clinical trial

Objectives

The purpose of the present study was to analyze treatment outcome with a full-occlusion biofeedback (BFB) splint on sleep bruxism (SB) and TMD pain compared with treatment with an adjusted occlusal splint (AOS).

Materials and methods

Forty-one patients were randomly allocated to a test (BFB) or a control (AOS) group and monitored over a 3-month period. Output variables were frequency and duration of bruxing events (bursts) and various pain symptoms.

Results

The BFB group showed a statistically significant reduction in the frequency and duration of bursts and a statistically significant improvement in the patients’ global well-being and the facial muscle pain parameter. After the treatment was stopped, the BFB group showed a statistically significant reduction in the average and maximum duration but no statistically significant change in the frequency of bursts.

Conclusions

The tested BFB splint is highly effective in reducing SB at the subconscious level, i.e., without waking the patient, and in achieving improvements in global pain perception. The results suggest that the BFB splint also provides a better treatment option for bruxism-related pain than an AOS. However, further research is needed, and specifically studies with a larger patient population displaying higher levels of pain at baseline.

Clinical relevance

By reducing burst duration and therefore the pathological load on the masticatory apparatus, the BFB splint reduces TMD and bruxism-related symptoms and improves patients’ physical well-being. In the long term, this could prevent damage to the TMJ. This study confirms the effectiveness and safety of this splint.

The universal trial number

U1111-1239-2450

DRKS-ID registration

DRKS00018092

B or 13? Unconscious Top-Down Contextual Effects at the Categorical but Not the Lexical Level

Contextual effects require integration of top-down predictions and bottom-up visual information. Given the widely assumed link between integration and consciousness, we asked whether contextual effects require consciousness. In two experiments (total N = 60), an ambiguous stimulus (which could be read as either B or 13) was presented alongside masked numbers (12 and 14) or letters (A and C). Context biased stimulus classification when it was consciously and unconsciously perceived. However, unconsciously perceived contexts evoked smaller effects. This finding was replicated and generalized into another language in a further experiment (N = 46) using a different set of stimuli, strengthening the claim that symbolic contextual effects can occur without awareness. Moreover, four experiments (total N = 160) suggested that these unconscious effects might be limited to the categorical level (numbers context vs. letters context) and do not extend to the lexical level (words context vs. nonwords context). Taken together, our results suggest that although consciousness may not be necessary for effects that require simple integration or none at all, it is nevertheless required for integration over larger semantic windows.

Schwefelwasserstoffreize verkürzen im Schlaf- wie im Wachzustand die Ausatmung

Hintergrund Im aufmerksamen Wachzustand verlängern angenehme Gerüche häufig die Einatmung, während unangenehme Gerüche häufig die Ausatmung verkürzen. Es soll überprüft werden, ob dieses induzierte Atemmuster auch im Schlaf erhalten bleibt.

Methodik 23 gesunde normosmische Erwachsene wurden für 1 Nacht polysomnografisch untersucht und dabei entweder mit H2S, Phenylethylalkohol (PEA) oder CO2 über ein Fluss-Olfaktometer randomisiert impulsartig gereizt. Anhand der standardmäßig erfassten Polysomnografie-Kurven erfolgte die Bestimmung der Schlafstadien (REM, NREM, pWach), der Dauer der Inspiration (DIN) und der Dauer der Exspiration (DEX). DIN und DEX wurden von 6 prästimulatorischen Atemzügen und vom Reizatemzug (RAZ) bestimmt. Daraus wurde der Reaktionsindex (RI) berechnet, der angibt, ob eine bedeutsame Änderung von DIN und/oder DEX vorliegt. Die verschiedenen RI wurden um die spontanen RI korrigiert und entsprechend der Reizart und den Schlafstadien analysiert.

Ergebnis Reaktionsindizes mit Verkürzungen von DEX waren bei einer H2S-Reizung größer als spontane RI und RI bei einer PEA-Reizung. Bei einer CO2-Reizung waren RI mit Verkürzungen von DIN und DEX größer als bei olfaktorischer Reizung. Alle RI waren in ihrer Ausprägung zwischen den Schlafstadien gleich. Im REM war der Unterschied der olfaktorischen RI mit verkürzten DEX zwischen einer H2S- und PEA-Reizung am größten.

Schlussfolgerung Bei Reizung mit einem unangenehmen Geruch im Schlaf bleibt das respiratorische Reaktionsmuster aus dem Wachzustand erhalten. RI mit verkürzten DEX können als unvollkommene Arousals angesehen werden.

Olfactory sniffing signals consciousness in unresponsive patients with brain injuries

After severe brain injury, it can be difficult to determine the state of consciousness of a patient, to determine whether the patient is unresponsive or perhaps minimally conscious¹, and to predict whether they will recover. These diagnoses and prognoses are crucial, as they determine therapeutic strategies such as pain management, and can underlie end-of-life decisions^2,3. Nevertheless, there is an error rate of up to 40% in determining the state of consciousness in patients with brain injuries^4,5. Olfaction relies on brain structures that are involved in the basic mechanisms of arousal⁶, and we therefore hypothesized that it may serve as a biomarker for consciousness⁷. Here we use a non-verbal non-task-dependent measure known as the sniff response^8-11 to determine consciousness in patients with brain injuries. By measuring odorant-dependent sniffing, we gain a sensitive measure of olfactory function^10-15. We measured the sniff response repeatedly over time in patients with severe brain injuries and found that sniff responses significantly discriminated between unresponsive and minimally conscious states at the group level. Notably, at the single-patient level, if an unresponsive patient had a sniff response, this assured future regaining of consciousness. In addition, olfactory sniff responses were associated with long-term survival rates. These results highlight the importance of olfaction in human brain function, and provide an accessible tool that signals consciousness and recovery in patients with brain injuries.

The Trace Conditional Learning of the Noxious Stimulus in UWS Patients and Its Prognostic Value in a GSR and HRV Entropy Study

The assessment of the consciousness level of Unresponsive Wakefulness Syndrome (UWS) patients often depends on a subjective interpretation of the observed spontaneous and volitional behavior. To date, the misdiagnosis level is around 30%. The aim of this study was to observe the behavior of UWS patients, during the administration of noxious stimulation by a Trace Conditioning protocol, assessed by the Galvanic Skin Response (GSR) and Heart Rate Variability (HRV) entropy. We recruited 13 Healthy Control (HC) and 30 UWS patients at 31 ± 9 days from the acute event evaluated by Coma Recovery Scale–Revised (CRS-R) and Nociception Coma Scale (NCS). Two different stimuli [musical stimulus (MUS) and nociceptive stimulus (NOC)], preceded, respectively by two different tones, were administered following the sequences (A) MUS1 – NOC1 – MUS2 – MUS3 – NOC2 – MUS4 – NOC3 – NOC^*, and (B) MUS1^*, NOC1^*, NOC2^*, MUS2^*, NOC3^*, MUS3^*, NOC4^*, MUS4^*. All the (^*) indicate the only tones administration. CRS-R and NCS assessments were repeated for three consecutive weeks. MUS4, NOC3, and NOC^* were compared for GSR wave peak magnitude, time to reach the peak, and time of wave's decay by Wilcoxon's test to assess the Conditioned Response (CR). The Sample Entropy (SampEn) was recorded in baseline and both sequences. Machine Learning approach was used to identify a rule to discriminate the CR. The GSR magnitude of CR was higher comparing music stimulus (p < 0.0001) and CR extinction (p < 0.002) in nine patients and in HC. Patients with CR showed a higher SampEn in sequence A compared to patients without CR. Within the third and fourth weeks from protocol administration, eight of the nine patients (88.9%) evolved into MCS. The Machine-learning showed a high performance to differentiate presence/absence of CR (≥95%). The possibility to observe the CR to the noxious stimulus, by means of the GSR and SampEn, can represent a potential method to reduce the misdiagnosis in UWS patients.

Contingency awareness, aging, and the parietal lobe

Contingency awareness is thought to rely on an intact medial temporal lobe and also appears to be a function of age, as older subjects tend to be less aware. The current investigation used functional magnetic resonance imaging, transcranial direct current stimulation, and eyeblink classical conditioning to study brain processes related to contingency awareness as a function of age. Older adults were significantly less aware of the relationship between the tone-airpuff pairings than younger adults. Greater right parietal functional magnetic resonance imaging activation was associated with higher levels of contingency awareness for younger and older subjects. Cathodal transcranial direct current stimulation over the right parietal lobe led to lower levels of awareness in younger subjects without disrupting conditioned responses. Older adults exhibited hyperactivations in the parietal and medial temporal lobes, despite showing no conditioning deficits. These findings strongly support the idea that the parietal cortex serves as a substrate for contingency awareness and that age-related disruption of this region is sufficient to impair awareness, which may be a manifestation of some form of naturally occurring age-related neglect.

Neural Dynamics of Associative Learning during Human Sleep

Recent evidence indicates that humans can learn entirely new information during sleep. To elucidate the neural dynamics underlying sleep-learning, we investigated brain activity during auditory–olfactory discriminatory associative learning in human sleep. We found that learning-related delta and sigma neural changes are involved in early acquisition stages, when new associations are being formed. In contrast, learning-related theta activity emerged in later stages of the learning process, after tone–odor associations were already established. These findings suggest that learning new associations during sleep is signaled by a dynamic interplay between slow-waves, sigma, and theta activity.

Promoting memory consolidation during sleep: A meta-analysis of targeted memory reactivation

Targeted memory reactivation (TMR) is a methodology employed to manipulate memory processing during sleep. TMR studies have great potential to advance understanding of sleep-based memory consolidation and corresponding neural mechanisms. Research making use of TMR has developed rapidly, with over 70 articles published in the last decade, yet no quantitative analysis exists to evaluate the overall effects. Here we present the first meta-analysis of sleep TMR, compiled from 91 experiments with 212 effect sizes (N = 2,004). Based on multilevel modeling, overall sleep TMR was highly effective (Hedges' g = 0.29, 95% CI [0.21, 0.38]), with a significant effect for two stages of non-rapid-eye-movement (NREM) sleep (Stage NREM 2: Hedges' g = 0.32, 95% CI [0.04, 0.60]; and slow-wave sleep: Hedges' g = 0.27, 95% CI [0.20, 0.35]). In contrast, TMR was not effective during REM sleep nor during wakefulness in the present analyses. Several analysis strategies were used to address the potential relevance of publication bias. Additional analyses showed that TMR improved memory across multiple domains, including declarative memory and skill acquisition. Given that TMR can reinforce many types of memory, it could be useful for various educational and clinical applications. Overall, the present meta-analysis provides substantial support for the notion that TMR can influence memory storage during NREM sleep, and that this method can be useful for understanding neurocognitive mechanisms of memory consolidation. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Detection of arithmetic violations during sleep

Can the sleeping brain develop predictions of future auditory stimuli? Past research demonstrated disrupted prediction capabilities during sleep in the context of novel, arbitrary auditory sequences, but the availability of overlearned knowledge already stored in long-term memory could still be preserved. We tested the sleeping brain capabilities to detect violations of simple arithmetic facts. Sleeping participants were presented with spoken arithmetic facts such as "two plus two is nine" and brain responses to correct or incorrect results were recorded in electro and magneto-encephalography. Sleep responses were compared to both attentive and inattentive wakefulness. During attentive wakefulness, arithmetic violations elicited a succession of N400 and P600 effects, whereas no such activations could be recorded in sleep or in inattentive wakefulness. Still, small but significant effects remained in sleep, advocating for a preserved but partial accessibility to arithmetic facts stored in long-term memory and preserved predictions of low-level and already learned knowledge. Those effects were very different from residual activities seen in inattention, highlighting the differences of information processing between the sleeping and the inattentive brain.

Targeted memory reactivation during sleep boosts intentional forgetting of spatial locations

Although we experience thousands of distinct events on a daily basis, relatively few are committed to memory. The human capacity to intentionally control which events will be remembered has been demonstrated using learning procedures with instructions to purposely avoid committing specific items to memory. In this study, we used a variant of the item-based directed-forgetting procedure and instructed participants to memorize the location of some images but not others on a grid. These instructions were conveyed using a set of auditory cues. Then, during an afternoon nap, we unobtrusively presented a cue that was used to instruct participant to avoid committing the locations of some images to memory. After sleep, memory was worse for to-be-forgotten image locations associated with the presented sound relative to those associated with a sound that was not presented during sleep. We conclude that memory processing during sleep can serve not only to secure memory storage but also to weaken it. Given that intentional suppression may be used to weaken unpleasant memories, such sleep-based strategies may help accelerate treatments for memory-related disorders such as post-traumatic stress disorder.

Presentation of familiar odor induces negative dream emotions during rapid eye movement (REM) sleep in healthy adolescents

OBJECTIVE

Odor presentation is a crucial tool in the experimental investigation of dreaming since odors rarely cause arousal, and are processed in the brain during sleep. Our previous study demonstrated that the presentation of a preferred odor during rapid eye movement (REM) sleep-induced negative dream emotions. However, preference and familiarity of an odor are known to be strongly related to each other in olfactory perception. Consequently, the above result might have been due to the confounding effects of familiarity. Therefore, the present study was designed to clarify the effects of an individual's degree of familiarity with an odor on negative emotions experienced when dreaming.

METHODS

The airflow with phenylethyl alcohol (PEA: rose-like smell) was presented as a stimulus of experimental condition, and odorless airflow was presented as the control. Participants who were familiar (n = 7) and unfamiliar (n = 7) with the odor of PEA experienced both conditions during REM sleep in the second and later sleep cycle. Then, they were awakened, and they rated the characteristics of their dream using a questionnaire.

RESULTS AND CONCLUSIONS

Participants who were familiar with the odor of PEA rated their dreams more negatively in the experimental condition relative to the control condition. It is concluded based on these results that a familiar odor may induce negative emotion in dreams, possibly because familiar odors tend to be perceived more strongly, and the olfactory pathway has direct connections to the amygdala, which is primarily involved in processing negative emotions.

Neurochemical mechanisms for memory processing during sleep: basic findings in humans and neuropsychiatric implications

Sleep is essential for memory formation. Active systems consolidation maintains that memory traces that are initially stored in a transient store such as the hippocampus are gradually redistributed towards more permanent storage sites such as the cortex during sleep replay. The complementary synaptic homeostasis theory posits that weak memory traces are erased during sleep through a competitive down-selection mechanism, ensuring the brain's capability to learn new information. We discuss evidence from neuropharmacological experiments in humans to show how major neurotransmitters and neuromodulators are implicated in these memory processes. As to the major excitatory neurotransmitter glutamate that plays a prominent role in inducing synaptic consolidation, we show that these processes, while strengthening cortical memory traces during sleep, are insufficient to explain the consolidation of hippocampus-dependent declarative memories. In the inhibitory GABAergic system, we will offer insights how drugs may alter the intricate interplay of sleep oscillations that have been identified to be crucial for strengthening memories during sleep. Regarding the dopaminergic reward system, we will show how it is engaged during sleep replay, but that dopaminergic neuromodulation likely plays a side role for enhancing relevant memories during sleep. Also, we briefly go into basic evidence on acetylcholine and cortisol whose low tone during slow wave sleep (SWS) is crucial in supporting hippocampal-to-neocortical memory transmission. Finally, we will outline how these insights can be used to improve treatment of neuropsychiatric disorders focusing mainly on anxiety disorders, depression, and addiction that are strongly related to memory processing.