Selective REM sleep deprivation during daytime. II. Muscle atonia in non-REM sleep

Strained face during sleep in multiple system atrophy: not just a bad dream

STUDY OBJECTIVES

Patients with Parkinson's disease and multiple system atrophy may be subject to sleep state dissociation. Motivated by the fortuitous observation of prominent facial muscle activity during video-polysomnography in patients with multiple system atrophy, we assessed facial motor activity and chin muscle tone during sleep in multiple system atrophy compared to Parkinson's disease and controls.

METHODS

A sleep expert blinded to pathology and sleep stage retrospectively analyzed facial activity in 62 video-polysomnography (11 multiple system atrophy, 38 Parkinson's disease, and 13 controls). Facial movements were classified into six categories: "Eyes closing/opening," "Eyebrows frowning," "Raising eyebrows," "Smiling," "Other mouth movements," and "Strained face," an expression involving both the superior and inferior parts of the face. Chin electromyography activity was quantified during Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM) sleep using the atonia index, a validated algorithm.

RESULTS

Multiple system atrophy patients had an increased number of all facial movements compared to controls during NREM. "Strained face" was significantly more frequent in multiple system atrophy compared to Parkinson's disease, even after adjusting for the presence of REM sleep behavior disorder (RBD). Atonia index was lower in multiple system atrophy compared to controls and Parkinson's disease during REM and NREM sleep. This difference remained significant compared to Parkinson's disease in NREM sleep during N1 and N2 after adjusting for the presence of RBD.

CONCLUSIONS

Facial movements during sleep are frequent in multiple system atrophy, "strained face" appears to be a hallmark of this condition. The presence of increased facial activity and elevated muscle tone during all stages of sleep in multiple system atrophy may be a manifestation of sleep state dissociation, reflecting more severe neurodegeneration.

Detecting lucid dreams only by submentalis electromyography

Lucid dreams (LDs) occur when people become aware that they are dreaming. This phenomenon has a wide range of possible applications from the perspectives of psychology, training physical movements, and controlling computers while asleep, among others. However, research on LDs might lack efficiency because the standard LD verification protocol uses polysomnography (PSG), which requires an expensive apparatus and skilled staff. The standard protocol also may reduce LD-induction efficiency. The current study examines whether humans can send phasic signals through submentalis electromyography (EMG) during muscle atonia via pre-agreed chin movements (PACM). This ability would manifest both REM sleep and consciousness, which are the main features of LDs. In laboratory conditions volunteers were instructed to open their jaws three times while in an LD right after the standard verification protocol to achieve the research goal. Results: 4 of 5 volunteers proved to be in an LD using the standard protocol, and then all of them made PACM. The outcomes show that dream signals cannot be blocked in the submentalis area during muscle atonia. Also, this finding can be considered to develop a simplified, reliable LD protocol that needs only one EMG sensor. The cost of this protocol could be only a small percentage of the current protocol, making it more convenient for researchers and volunteers. It can also be used remotely by inbuilt in wearable gadgets. Considering PACM could speed up LD research and provide many discoveries and new opportunities. Also, it can be used in sleep paralysis studies.

Arousal and sleep circuits

The principal neurons of the arousal and sleep circuits are comprised by glutamate and GABA neurons, which are distributed within the reticular core of the brain and, through local and distant projections and interactions, regulate cortical activity and behavior across wake-sleep states. These are in turn modulated by the neuromodulatory systems that are comprised by acetylcholine, noradrenaline, dopamine, serotonin, histamine, orexin (hypocretin), and melanin-concentrating hormone (MCH) neurons. Glutamate and GABA neurons are heterogeneous in their profiles of discharge, forming distinct functional cell types by selective or maximal discharge during (1) waking and paradoxical (REM) sleep, (2) during slow wave sleep, (3) during waking, or (4) during paradoxical (REM) sleep. The neuromodulatory systems are each homogeneous in their profile of discharge, the majority discharging maximally during waking and paradoxical sleep or during waking. Only MCH neurons discharge maximally during sleep. They each exert their modulatory influence upon other neurons through excitatory and inhibitory receptors thus effecting a concerted differential change in the functionally different cell groups. Both arousal and sleep circuit neurons are homeostatically regulated as a function of their activity in part through changes in receptors. The major pharmacological agents used for the treatment of wake and sleep disorders act upon GABA and neuromodulatory transmission.

Supratrigeminal Bilaterally Projecting Neurons Maintain Basal Tone and Enable Bilateral Phasic Activation of Jaw-Closing Muscles

Anatomical studies have identified brainstem neurons that project bilaterally to left and right oromotor pools, which could potentially mediate bilateral muscle coordination. We use retrograde lentiviruses combined with a split-intein-mediated split-Cre-recombinase system in mice to isolate, characterize, and manipulate a population of neurons projecting to both the left and right jaw-closing trigeminal motoneurons. We find that these bilaterally projecting premotor neurons (BPNs) reside primarily in the supratrigeminal nucleus (SupV) and the parvicellular and intermediate reticular regions dorsal to the facial motor nucleus. These BPNs also project to multiple midbrain and brainstem targets implicated in orofacial sensorimotor control, and consist of a mix of glutamatergic, GABAergic, and glycinergic neurons, which can drive both excitatory and inhibitory inputs to trigeminal motoneurons when optogenetically activated in slice. Silencing BPNs with tetanus toxin light chain (TeNT) increases bilateral masseter activation during chewing, an effect driven by the expression of TeNT in SupV BPNs. Acute unilateral optogenetic inhibition of SupV BPNs identifies a group of tonically active neurons that function to lower masseter muscle tone, whereas unilateral optogenetic activation of SupV BPNs is sufficient to induce bilateral masseter activation both during resting state and during chewing. These results provide evidence for SupV BPNs in tonically modulating jaw-closing muscle tone and in mediating bilateral jaw closing.

SIGNIFICANCE STATEMENT

We developed a method that combines retrograde lentiviruses with the split-intein-split-Cre system in mice to isolate, characterize, and manipulate neurons that project to both left and right jaw-closing motoneurons. We show that these bilaterally projecting premotor neurons (BPNs) reside primarily in the supratrigeminal nucleus and the rostral parvicellular and intermediate reticular nuclei. BPNs consist of both excitatory and inhibitory populations, and also project to multiple brainstem nuclei implicated in orofacial sensorimotor control. Manipulation of the supratrigeminal BPNs during natural jaw-closing behavior reveals a dual role for these neurons in eliciting phasic muscle activation and in maintaining basal muscle tone. The retrograde lentivirus carrying the split-intein-split-Cre system can be applied to study any neurons with bifurcating axons innervating two brain regions.

Homeostatic regulation through GABA and acetylcholine muscarinic receptors of motor trigeminal neurons following sleep deprivation

Muscle tone is regulated across sleep-wake states, being maximal in waking, reduced in slow wave sleep (SWS) and absent in paradoxical or REM sleep (PS or REMS). Such changes in tone have been recorded in the masseter muscles and shown to correspond to changes in activity and polarization of the trigeminal motor 5 (Mo5) neurons. The muscle hypotonia and atonia during sleep depend in part on GABA acting upon both GABA_A and GABA_B receptors (Rs) and acetylcholine (ACh) acting upon muscarinic 2 (AChM2) Rs. Here, we examined whether Mo5 neurons undergo homeostatic regulation through changes in these inhibitory receptors following prolonged activity with enforced waking. By immunofluorescence, we assessed that the proportion of Mo5 neurons positively stained for GABA_ARs was significantly higher after sleep deprivation (SD, ~65%) than sleep control (SC, ~32%) and that the luminance of the GABA_AR fluorescence was significantly higher after SD than SC and sleep recovery (SR). Although, all Mo5 neurons were positively stained for GABA_BRs and AChM2Rs (100%) in all groups, the luminance of these receptors was significantly higher following SD as compared to SC and SR. We conclude that the density of GABA_A, GABA_B and AChM2 receptors increases on Mo5 neurons during SD. The increase in these receptors would be associated with increased inhibition in the presence of GABA and ACh and thus a homeostatic down-scaling in the excitability of the Mo5 neurons after prolonged waking and resulting increased susceptibility to muscle hypotonia or atonia along with sleep.

Microdream neurophenomenology

Nightly transitions into sleep are usually uneventful and transpire in the blink of an eye. But in the laboratory these transitions afford a unique view of how experience is transformed from the perceptually grounded consciousness of wakefulness to the hallucinatory simulations of dreaming. The present review considers imagery in the sleep-onset transition-"microdreams" in particular-as an alternative object of study to dreaming as traditionally studied in the sleep lab. A focus on microdream phenomenology has thus far proven fruitful in preliminary efforts to (i) develop a classification for dreaming's core phenomenology (the "oneiragogic spectrum"), (ii) establish a structure for assessing dreaming's multiple memory inputs ("multi-temporal memory sources"), (iii) further Silberer's project for classifying sleep-onset images in relation to waking cognition by revealing two new imagery types ("autosensory imagery," "exosensory imagery"), and (iv) embed a potential understanding of microdreaming processes in a larger explanatory framework ("multisensory integration approach"). Such efforts may help resolve outstanding questions about dream neurophysiology and dreaming's role in memory consolidation during sleep but may also advance discovery in the neuroscience of consciousness more broadly.

A new function of rapid eye movement sleep: improvement of muscular efficiency

Previously I demonstrated that the slow wave sleep (SWS) functioned to adjust the emotional balance disrupted by emotional memories randomly accumulated during waking, while the rapid eye movement (REM) sleep played the opposite role. Many experimental results have unambiguously shown that various emotional memories are processed during REM sleep. In this article, it is attempted to combine this confirmed function of REM sleep with the atonic state unique to REM sleep, and to integrate a new theory suggesting that improvement of muscular efficiency be a new function of REM sleep. This new function of REM sleep is more advantageous than the function of REM sleep in emotional memories and disinhibited drives to account for the phylogenetic variations of REM sleep, especially the absence of REM sleep in dolphins and short duration of REM sleep in birds in contrary to that in humans and rodents, the absence of penile erections in REM sleep in armadillo, as well as the higher voltage in EEG during REM sleep in platypus and ostrich. Besides, this new function of REM sleep is also advantageous to explain the association of REM sleep with the atonic episodes in SWS, the absence of drastic menopausal change in duration of REM sleep, and the effects of ambient temperature on the duration of REM sleep. These comparative and experimental evidences support the improvement of muscular efficiency as a new and major function of REM sleep.

NREM and REM Sleep: Complementary Roles in Recovery after Wakefulness

The overall function of sleep is hypothesized to provide "recovery" after preceding waking activities, thereby ensuring optimal functioning during subsequent wakefulness. However, the functional significance of the temporal dynamics of sleep, manifested in the slow homeostatic process and the alternation between non-rapid eye movement (NREM) and REM sleep remains unclear. We propose that NREM and REM sleep have distinct and complementary contributions to the overall function of sleep. Specifically, we suggest that cortical slow oscillations, occurring within specific functionally interconnected neuronal networks during NREM sleep, enable information processing, synaptic plasticity, and prophylactic cellular maintenance ("recovery process"). In turn, periodic excursions into an activated brain state-REM sleep-appear to be ideally placed to perform "selection" of brain networks, which have benefited from the process of "recovery," based on their offline performance. Such two-stage modus operandi of the sleep process would ensure that its functions are fulfilled according to the current need and in the shortest time possible. Our hypothesis accounts for the overall architecture of normal sleep and opens up new perspectives for understanding pathological conditions associated with abnormal sleep patterns.

Dreaming without REM sleep

To test whether mental activities collected from non-REM sleep are influenced by REM sleep, we suppressed REM sleep using clomipramine 50mg (an antidepressant) or placebo in the evening, in a double blind cross-over design, in 11 healthy young men. Subjects were awakened every hour and asked about their mental activity. The marked (81%, range 39-98%) REM-sleep suppression induced by clomipramine did not substantially affect any aspects of dream recall (report length, complexity, bizarreness, pleasantness and self-perception of dream or thought-like mentation). Since long, complex and bizarre dreams persist even after suppressing REM sleep either partially or totally, it suggests that the generation of mental activity during sleep is independent of sleep stage.

To what extent do neurobiological sleep-waking processes support psychoanalysis?

Sigmund Freud's thesis was that there is a censorship during waking that prevents memory of events, drives, wishes, and feelings from entering the consciousness because they would induce anxiety due to their emotional or ethical unacceptability. During dreaming, because the efficiency of censorship is decreased, latent thought contents can, after dream-work involving condensation and displacement, enter the dreamer's consciousness under the figurative form of manifest content. The quasi-closed dogma of psychoanalytic theory as related to unconscious processes is beginning to find neurobiological confirmation during waking. Indeed, there are active processes that suppress (repress) unwanted memories from entering consciousness. In contrast, it is more difficult to find neurobiological evidence supporting an organized dream-work that would induce meaningful symbolic content, since dream mentation most often only shows psychotic-like activities.

Changes in cardiac variability after REM sleep deprivation in recurrent nightmares

STUDY OBJECTIVES

To assess whether dysfunctional autonomic regulation during REM sleep as indexed by heart rate variability (HRV) is a pathophysiological factor in frequent nightmares (NMs).

DESIGN

Monitoring with polysomnography (PSG) and electrocardiography (ECG) for 3 consecutive nights: Night 1 (N1), adaptation night; N2, administration of partial REM sleep deprivation; N3, recovery night. Differences between NM and control (CTL) groups assessed for ECG measures drawn from wakefulness, REM sleep, and Stage 2 sleep on both N1 and N3.

SETTING

Hospital-based sleep laboratory.

PARTICIPANTS

Sixteen subjects with frequent NMs (> or = 1 NM/week; mean age = 26.1 +/- 8.7 years) but no other medical or psychiatric disorders and 11 healthy comparison subjects ( < 1 NM/month; mean age = 27.1+/- 5.6 years).

RESULTS

NM and CTL groups differed on 2 REM sleep measures only on N1; the NM group had longer REM latencies and REM/NREM cycle durations than did the CTL group. No differences were found on time domain and absolute frequency domain ECG measures for either N1 or N3. However, altered HRV for the NM group was suggested by significantly higher LFnu, lower HFnu, and higher LF/HF ratio than for the CTL group.

CONCLUSIONS

Results are consistent with a higher than normal sympathetic drive among NM subjects which is unmasked by high REM sleep propensity. Results also support a growing literature linking anxiety disorders of several types (panic disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder) to altered HR variability.

Dreaming and the brain: from phenomenology to neurophysiology

Dreams are a remarkable experiment in psychology and neuroscience, conducted every night in every sleeping person. They show that the human brain, disconnected from the environment, can generate an entire world of conscious experiences by itself. Content analysis and developmental studies have promoted understanding of dream phenomenology. In parallel, brain lesion studies, functional imaging and neurophysiology have advanced current knowledge of the neural basis of dreaming. It is now possible to start integrating these two strands of research to address fundamental questions that dreams pose for cognitive neuroscience: how conscious experiences in sleep relate to underlying brain activity; why the dreamer is largely disconnected from the environment; and whether dreaming is more closely related to mental imagery or to perception.

Status dissociatus evolving from REM sleep behaviour disorder in multiple system atrophy

OBJECTIVE

We present two patients, a 52-year-old man and a 56-year-old woman, with rapid eye movement sleep behaviour disorder (RBD) since the age of 50.

METHOD

In both the patients RBD was videopolysomnographically documented.

RESULTS

Both patients developed, with time, autonomic and motor symptoms consistent with the diagnosis of multiple system atrophy. During the course of the disease RBD episodes diminished in frequency but the patients' sleep became even more abnormal, with nearly continuous motor and verbal abnormal behaviours and ambiguous and rapid oscillations of state-determining polysomnographic variables, now consistent with status dissociatus (SD).

CONCLUSION

If SD represents the evolution and most extreme form of RBD it should be investigated longitudinally in neurodegenerative diseases.

Sleep and sleep regulation in the ferret (Mustela putorius furo)

We investigated sleep-wake (S-W) architecture and sleep regulation in the ferret: a phylogenetically primitive mammal increasingly used in neurobiological studies. Twenty-four hour S-W baseline data were collected in eight adult ferrets. Seven ferrets were then sleep deprived for 6h at the beginning of the light period. Like other placental mammals, ferrets exhibited the main vigilance states of wakefulness, rapid-eye-movement (REM) sleep and non-REM (NREM) sleep. Interestingly, the amount of REM sleep in the ferret was considerably higher (24.01+/-1.61% of total recording time) than typically reported in placental mammals. Ferret sleep was homeostatically regulated as sleep deprivation produced a significant increase in NREM EEG delta power during the recovery period. Therefore, ferret sleep in most respects is comparable to sleep in other placental mammals. However, the large amount of REM sleep in this phylogenetically more ancient species suggests that REM sleep may have been present in greater amounts in early stages of mammalian evolution.

Quantitative analysis of surface EMG activity of cranial and leg muscles across sleep stages in human

OBJECTIVE

The aim of this study was to make a quantitative analysis of the changes in cranial and limb muscle activity from wakefulness to light and deep sleep stages and during rapid eye movement (REM) sleep of normal subjects.

METHODS

Polysomnographic recordings were made of the sleep of 9 healthy human subjects, including electromyograms of the suprahyoid, temporalis and masseter cranial muscles and the anterior tibialis limb muscle. Quantitative assessments of EMG activity were carried out with root mean square (RMS) and frequency-spectral analysis (FSA) methods.

RESULTS

From wakefulness to sleep, a significant reduction (-25.2 to -71.2%; P < 0.01) was observed in EMG activity (for both RMS and FSA) of the 3 cranial muscles using both methods of analysis. The EMG activity of suprahyoid muscle further decreased from non-REM to REM sleep (-17.8 to -43.0%; P < 0.01). In contrast, the EMG activity of the anterior tibialis muscle was only slightly reduced across sleep stages and did not further reduce during REM sleep. During REM sleep, all the 4 muscles maintained minimal activity.

CONCLUSIONS

The maintenance of muscle activity during REM sleep suggests that a minimal level of activity is required to preserve physiological functions (e.g. airway patency, posture) related to homeostasis and bodily protection.

SIGNIFICANCE

This study suggests that quantitative sleep EMG analysis is important for understanding the mechanisms of sleep-related movement disorders or when objective assessment of changes in EMG activity are needed for diagnostic purposes or for the assessment of drug efficiency.

Non-rapid eye movement sleep with low muscle tone as a marker of rapid eye movement sleep regulation

BACKGROUND

It was recently reported that epochs of non-REM sleep (NREMS) with low muscle tone represent a partial correlate of REM sleep (REMS). To further investigate this phenomenon, episodes of restricted night-time sleep (23:00-03.00 h) and subsequent morning sleep (10:00-13:00 h) were analysed.

RESULTS

Epochs of NREMS with low muscle tone (NLMT) were identified. Their frequency was higher in morning sleep than in night sleep. At night, the latency to the first occurrence of NLMT showed a bimodal distribution with modes at sleep onset and close to REMS onset. In morning sleep, the distribution was unimodal with the mode at sleep onset. An episode of NLMT at sleep onset occurred in 35.5% of the night sleep episodes and in 60.9% of the morning sleep episodes without sleep onset REMS (SOREMS). Also SOREMS occurred predominantly in morning sleep. REMS episodes were longer and NREMS episodes shorter in morning sleep than in night sleep, whereas cycle duration did not differ. Simulating the time course of slow-wave activity revealed a close correspondence between empirical and computed values for night sleep, and some discrepancies for morning sleep.

CONCLUSION

The results provide further evidence that NREMS with low muscle tone is a marker of REMS regulation. NLMT at sleep onset may represent an early manifestation of REMS.

The dreaming sleep stage: A new neurobiological model of schizophrenia?

The rapid eye movement dreaming sleep stage and schizophrenia are both characterized by common intracerebral disconnections, disturbed responsiveness and sensory deafferentation processes. Moreover, in both states, there is dorsolateral prefrontal deactivation as shown by the decrease of blood flow. Finally, identical pharmacological and neurochemical variations are observed for acetylcholine, dopamine, noradrenaline, serotonin and glutamate concentrations. Consequently, rapid eye movement sleep could become a useful new neurobiological model of this mental disease since more functional than current rat models using stimulation, lesion or drugs.

Selective REM sleep deprivation during daytime I. Time course of interventions and recovery sleep

Although repeated selective rapid eye movement (REM) sleep deprivation by awakenings during nighttime has shown that the number of sleep interruptions required to prevent REM sleep increases within and across consecutive nights, the underlying regulatory processes remained unspecified. To assess the role of circadian and homeostatic factors in REM sleep regulation, REM sleep was selectively deprived in healthy young adult males during a daytime sleep episode (7-15 h) after a night without sleep. Circadian REM sleep propensity is known to be high in the early morning. The number of interventions required to prevent REM sleep increased from the first to the third 2-h interval by a factor of two and then leveled off. Only a minor REM sleep rebound (11.6%) occurred in the following undisturbed recovery night. It is concluded that the limited rise of interventions during selective daytime REM sleep deprivation may be due to the declining circadian REM sleep propensity, which may partly offset the homeostatic drive and the sleep-dependent disinhibition of REM sleep.