Implicit and Explicit Memory for Verbal Information Presented during Sleep

Challenges in diagnosing NREM parasomnias: Implications for future diagnostic classifications

NREM parasomnias are frequent and potentially disabling sleep disorders characterized by recurrent abnormal behaviors emerging from NREM sleep. Recently, several studies provided more detailed clinical and polysomnographic characterization of NREM parasomnia which may enhance the diagnostic process. Several revisions of the diagnostic criteria have been proposed in the classification of sleep disorders, the latest being ICSD-3-TR in 2023 with no changes on NREM parasomnias since ICSD-3 published in 2014. We performed an extensive literature review to assess the evidence on the procedure of its diagnosis. We dissected the inconsistencies and shortcomings in the ICSD-3-TR to propose a revision of the current diagnostic criteria. We highlighted the limits of several clinical criteria which should rather be supportive features than mandatory criteria. Infrared cameras with video-recordings with are promising tools to precisely characterize home episodes. Sensitive and specific polysomnographic markers of NREM parasomnias have been identified and should be considered in future revisions. We also suggest the use of diagnostic specifiers (clinical subtypes, clinical significance, levels of severity, age effect, levels of certainty) to define homogeneous subgroups of patients for therapeutic intervention and research purposes. In conclusion, we advocate for significant changes in the current diagnostic criteria of NREM parasomnias for future classification.

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.

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.

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.

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.

[Learning during sleep: pitfalls, advances and promises]

Sleep plays a crucial role in memory consolidation. Research dedicated to learning during sleep is based on a theory that new information can be also acquired in a sleep state. This review covers the studies that aim to form new memory traces during sleep that persist into wakefulness or try to uncover the mechanisms of such learning. The possibility of associative, perceptive and other forms of learning, primarily implicit learning, is shown.

Lack of frequency-tagged magnetic responses suggests statistical regularities remain undetected during NREM sleep

Hypnopedia, or the capacity to learn during sleep, is debatable. De novo acquisition of reflex stimulus-response associations was shown possible both in man and animal. Whether sleep allows more sophisticated forms of learning remains unclear. We recorded during diurnal Non-Rapid Eye Movement (NREM) sleep auditory magnetoencephalographic (MEG) frequency-tagged responses mirroring ongoing statistical learning. While in NREM sleep, participants were exposed at non-awakenings thresholds to fast auditory streams of pure tones, either randomly organized or structured in such a way that the stream statistically segmented in sets of 3 elements (tritones). During NREM sleep, only tone-related frequency-tagged MEG responses were observed, evidencing successful perception of individual tones. No participant showed tritone-related frequency-tagged responses, suggesting lack of segmentation. In the ensuing wake period however, all participants exhibited robust tritone-related responses during exposure to statistical (but not random) streams. Our data suggest that associations embedded in statistical regularities remain undetected during NREM sleep, although implicitly learned during subsequent wakefulness. These results suggest intrinsic limitations in de novo learning during NREM sleep that might confine the NREM sleeping brain's learning capabilities to simple, elementary associations. It remains to be ascertained whether it similarly applies to REM sleep.

Formation and suppression of acoustic memories during human sleep

Sleep and memory are deeply related, but the nature of the neuroplastic processes induced by sleep remains unclear. Here, we report that memory traces can be both formed or suppressed during sleep, depending on sleep phase. We played samples of acoustic noise to sleeping human listeners. Repeated exposure to a novel noise during Rapid Eye Movements (REM) or light non-REM (NREM) sleep leads to improvements in behavioral performance upon awakening. Strikingly, the same exposure during deep NREM sleep leads to impaired performance upon awakening. Electroencephalographic markers of learning extracted during sleep confirm a dissociation between sleep facilitating memory formation (light NREM and REM sleep) and sleep suppressing learning (deep NREM sleep). We can trace these neural changes back to transient sleep events, such as spindles for memory facilitation and slow waves for suppression. Thus, highly selective memory processes are active during human sleep, with intertwined episodes of facilitative and suppressive plasticity.Though memory and sleep are related, it is still unclear whether new memories can be formed during sleep. Here, authors show that people could learn new sounds during REM or light non-REM sleep, but that learning was suppressed when sounds were played during deep NREM sleep.

Implicit memory for words heard during sleep

When we fall asleep, our awareness of the surrounding world fades. Yet, the sleeping brain is far from being dormant and recent research unraveled the preservation of complex sensory processing during sleep. In wakefulness, such processes usually lead to the formation of long-term memory traces, being it implicit or explicit. We examined here the consequences upon awakening of the processing of sensory information at a high level of representation during sleep. Participants were instructed to classify auditory stimuli as words or pseudo-words, through left and right hand responses, while transitioning toward sleep. An analysis of the electroencephalographic (EEG) signal revealed the preservation of lateralized motor activations in response to sounds, suggesting that stimuli were correctly categorized during sleep. Upon awakening, participants did not explicitly remember words processed during sleep and failed to distinguish them from new words (old/new recognition test). However, both behavioral and EEG data indicate the presence of an implicit memory trace for words presented during sleep. In addition, the underlying neural signature of such implicit memories markedly differed from the explicit memories formed during wakefulness, in line with dual-process accounts arguing for two independent systems for explicit and implicit memory. Thus, our results reveal that implicit learning mechanisms can be triggered during sleep and provide a novel approach to explore the neural implementation of memory without awareness.

Word encoding during sleep is suggested by correlations between word-evoked up-states and post-sleep semantic priming

To test whether humans can encode words during sleep we played everyday words to men while they were napping and assessed priming from sleep-played words following waking. Words were presented during non-rapid eye movement (NREM) sleep. Priming was assessed using a semantic and a perceptual priming test. These tests measured differences in the processing of words that had been or had not been played during sleep. Synonyms to sleep-played words were the targets in the semantic priming test that tapped the meaning of sleep-played words. All men responded to sleep-played words by producing up-states in their electroencephalogram. Up-states are NREM sleep-specific phases of briefly increased neuronal excitability. The word-evoked up-states might have promoted word processing during sleep. Yet, the mean performance in the priming tests administered following sleep was at chance level, which suggests that participants as a group failed to show priming following sleep. However, performance in the two priming tests was positively correlated to each other and to the magnitude of the word-evoked up-states. Hence, the larger a participant's word-evoked up-states, the larger his perceptual and semantic priming. Those participants who scored high on all variables must have encoded words during sleep. We conclude that some humans are able to encode words during sleep, but more research is needed to pin down the factors that modulate this ability.

Sound asleep: processing and retention of slow oscillation phase-targeted stimuli

The sleeping brain retains some residual information processing capacity. Although direct evidence is scarce, a substantial literature suggests the phase of slow oscillations during deep sleep to be an important determinant for stimulus processing. Here, we introduce an algorithm for predicting slow oscillations in real-time. Using this approach to present stimuli directed at both oscillatory up and down states, we show neural stimulus processing depends importantly on the slow oscillation phase. During ensuing wakefulness, however, we did not observe differential brain or behavioral responses to these stimulus categories, suggesting no enduring memories were formed. We speculate that while simpler forms of learning may occur during sleep, neocortically based memories are not readily established during deep sleep.

Humans can learn new information during sleep

During sleep, humans can strengthen previously acquired memories, but whether they can acquire entirely new information remains unknown. The nonverbal nature of the olfactory sniff response, in which pleasant odors drive stronger sniffs and unpleasant odors drive weaker sniffs, allowed us to test learning in humans during sleep. Using partial-reinforcement trace conditioning, we paired pleasant and unpleasant odors with different tones during sleep and then measured the sniff response to tones alone during the same nights' sleep and during ensuing wake. We found that sleeping subjects learned novel associations between tones and odors such that they then sniffed in response to tones alone. Moreover, these newly learned tone-induced sniffs differed according to the odor pleasantness that was previously associated with the tone during sleep. This acquired behavior persisted throughout the night and into ensuing wake, without later awareness of the learning process. Thus, humans learned new information during sleep.

Characteristics of dissociable human learning systems

A number of ways of taxonomizing human learning have been proposed. We examine the evidence for one such proposal, namely, that there exist independent explicit and implicit learning systems. This combines two further distinctions, (1) between learning that takes place with versus without concurrent awareness, and (2) between learning that involves the encoding of instances (or fragments) versus the induction of abstract rules or hypotheses. Implicit learning is assumed to involve unconscious rule learning. We examine the evidence for implicit learning derived from subliminal learning, conditioning, artificial grammar learning, instrumental learning, and reaction times in sequence learning. We conclude that unconscious learning has not been satisfactorily established in any of these areas. The assumption that learning in some of these tasks (e.g., artificial grammar learning) is predominantly based on rule abstraction is questionable. When subjects cannot report the “implicitly learned” rules that govern stimulus selection, this is often because their knowledge consists of instances or fragments of the training stimuli rather than rules. In contrast to the distinction between conscious and unconscious learning, the distinction between instance and rule learning is a sound and meaningful way of taxonomizing human learning. We discuss various computational models of these two forms of learning.

The psychological unconscious and the self

Documentation of implicit expressions of memory in head-injured, mentally ill and normal individuals has offered a new perspective on the problem of unconscious influence on conscious experience, thought and action. The phenomenon of implicit memory is described and used as a basis to develop an analogous concept of implicit perception. In both cases the person shows the effects of current or past events, even though these events are not accessible to phenomenal awareness. There is collateral evidence for the emotional unconscious: emotional states can serve as evidence of implicit perception or memory, and there is evidence of desynchrony between the subjective experience of emotion, which can be identified with consciousness, and the effects of emotional responses on physiology and overt behaviour. Theoretical approaches to the psychological unconscious include a connectionist approach, which affords a limited role for conscious processing in mental life; a neuropsychological approach, involving the disconnection of a module serving consciousness from the rest of the cognitive system; and a psychological approach, which emphasizes the central role in conscious awareness of mental representations of the self as the agent or experiencer of events.

The myth of creating an integrative story: the therapeutic experience of Holocaust survivors

In this article, the authors explore how Holocaust survivors experience therapy. The qualitative method by which the authors illuminate the therapeutic experience is in-depth interviews with 11 survivors. They base their analysis on the phenomenological tradition and use psychodynamic perspective as a heuristic device, generating five main themes: (a) knowing and not knowing the story of the trauma, (b) therapy as a reproduction of the trauma and its aftermath, (c) the fight to keep the therapist as a split object, (d) the perception of therapy as interminable, and (e) creating alternative narratives. Overall, the findings contradict the traditional perception, in which the goal of therapy is defined as one of integrating the traumatic narrative with the entire life story. Successful therapy, as was found in the present study, is often experienced when the traumatic narrative is put into a capsule separated from other parts of the life story.

Sleeping brain, learning brain. The role of sleep for memory systems

The hypothesis that sleep participates in the consolidation of recent memory traces has been investigated using four main paradigms: (1) effects of post-training sleep deprivation on memory consolidation, (2) effects of learning on post-training sleep, (3) effects of within sleep stimulation on the sleep pattern and on overnight memories, and (4) re-expression of behavior-specific neural patterns during post-training sleep. These studies convincingly support the idea that sleep is deeply involved in memory functions in humans and animals. However, the available data still remain too scarce to confirm or reject unequivocally the recently upheld hypothesis that consolidations of non-declarative and declarative memories are respectively dependent upon REM and NREM sleep processes.

Beta EEG activity and insomnia

To date there have been seven studies which find that beta EEG is elevated at around sleep onset and during polysomnographic sleep in patients with insomnia. These findings suggest that insomnia may be characterized by central nervous system (CNS) hyperarousal. In this article, the seven studies are critically reviewed, two theoretical perspectives on beta EEG are presented, and the concept of hyperarousal as a three component process is discussed.

The mesograde amnesia of sleep may be attenuated in subjects with primary insomnia

In this study, we pilot tested one of the more controversial components of the Neurocognitive Model of Insomnia; the proposition that subjects with chronic primary insomnia are better able to recall and/or recognize information from sleep onset intervals than good sleeper controls. Nine subjects participated in this pilot study, five of whom had a complaint of insomnia. The remaining four subjects were self-reported good sleeper controls. Subjects were matched for age, sex, and body mass. All subjects spent two nights in the sleep laboratory. The first night served as an adaptation night. The second night served as the experimental night during which a forced awakening and memory task was deployed. In this procedure, subjects were played single-word stimuli across four time periods: at natural sleep onset (Trial 1) and at the sleep onset transitions following three forced awakenings (Trials 2-4 from Stage 2 sleep). All subjects were awakened after about 6 h had elapsed from lights out and were tested for free recall and recognition memory for the word stimuli. The insomnia subjects, tended to identify more of the word stimuli on the recognition task (average for the four trials) and recognized significantly more of the words that were presented at sleep onset proper (Trial 1). This finding suggests that the natural mesograde amnesia of sleep may be attenuated in subjects with insomnia.

Alpha sleep and information processing, perception of sleep, pain, and arousability in fibromyalgia

This study examined the relationship between alpha sleep and information processing during sleep, perception of sleep, musculoskeletal pain, and arousability in patients with fibromyalgia. Patients (n = 20) were allowed to sleep undisturbed for the first 60 minutes of the study to assess amount of alpha sleep and were classified as high or low alpha generators based on quantitative analyses of alpha activity during this period. The groups were compared for performance on two memory tasks, perceptions of polysomnographically-defined sleep and EEG arousals in response to auditory stimuli. Correlations between symptoms of fibromyalgia and alpha activity were also examined. Alpha activity during sleep in fibromyalgic patients was associated with the perception of shallow sleep and an increased tendency to arouse in relation to auditory stimuli. Alpha activity was not associated with increased memory for auditory stimuli presented during sleep, sleep state misperception, or with myalgia symptoms. Alpha sleep appears to be, electrophysiologically, a shallow form of sleep. Our results suggest that it is perceived as such phenomenologically and that it is also associated with increased arousability.

Conscious and pre-conscious processes as seen from the standpoint of sleep-waking cycle neurophysiology

The literature on state-dependent fluctuations in thalamocortical activities indicates that in electrophysiological terms, waking and paradoxical sleep are fundamentally identical states, with the provision that the handling of sensory information is altered in REM sleep. The central paradox of REM sleep, namely the apparent lack of cognitive responsiveness to sensory stimulation in spite of increased thalamocortical responsiveness to sensory stimuli, will lead us to hypothesize that the processing of sensory inputs in REM sleep is similar to that underlying preconscious processing of sensory inputs in the waking state. This will lead to a general discussion of the role of fast (approximately equal to 40 Hz) thalamocortical oscillations and temporal binding in sensory processing and conscious experience.

Accepting the null hypothesis

This article concerns acceptance of the null hypothesis that one variable has no effect on another. Despite frequent opinions to the contrary, this null hypothesis can be correct in some situations. Appropriate criteria for accepting the null hypothesis are (1) that the null hypothesis is possible; (2) that the results are consistent with the null hypothesis; and (3) that the experiment was a good effort to find an effect. These criteria are consistent with the meta-rules for psychology. The good-effort criterion is subjective, which is somewhat undesirable, but the alternative--never accepting the null hypothesis--is neither desirable nor practical.