Functions of Sleep Architecture and the Concept of Protective Fields

Things that go bump in the night

Sleep disturbances take many forms. Negative health consequences are associated with nearly all of them. Insomnia, the most common sleep disturbance, can present as an inability to initiate sleep or to maintain sleep such that the restorative benefits of sleep are limited. This case report describes a client in her 60s who sought treatment for early morning awakening that persisted for four years despite the use of sleep-inducing medications. Her successful course of treatment utilized hypnotic suggestions and interactions that targeted distinctive features of the sleep cycle as well as her daily transition from wakefulness to sleep to early morning reawakening. The article highlights the coordination of neurophysiological features of sleep, psychological dynamics at play while awake and in her dream sleep, and how attention to their interplay utilizing hypnosis enabled the client to reestablish restorative sleep patterns in a treatment process spanning less than a dozen treatment sessions.

The Effect of Type-2 Diabetes Mellitus on Sleep Architecture and Sleep Apnea Severity in Patients With Obstructive Sleep Apnea Syndrome

INTRODUCTION

Obstructive sleep apnea syndrome (OSAS) is a severe condition that is characterized by recurrent partial or complete breathing interruptions during sleep, leading to insulin resistance, microvascular complications, and cardiovascular complications. It is of great importance to know the impact of type 2 diabetes mellitus (DM), which is prevalent in the world and in our country, Turkey, leads to significant mortality and morbidity, significantly affects the quality of life, and requires continuous follow-up, on sleep in patients with OSAS and to raise awareness on this issue. In this study, we aimed to determine the effects of diabetes on sleep duration and sleep architecture in patients with OSAS and to investigate the relationship between OSAS severity and DM control.

METHODS

Fifty diabetic and 42 non-diabetic patients diagnosed with OSAS at the Sleep Disorders Center of Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey, between October 2022 and March 2023 were included in the study. Polysomnographic and biochemical parameters of the two groups were compared. The effect of OSAS severity and sleep architecture on diabetes control was investigated.

RESULTS

No significant difference was found between diabetic and non-diabetic patients in terms of total sleep duration, sleep efficiency, and sleep latency, whereas REM (rapid eye movement) latency was prolonged and REM sleep duration and percentage were significantly lower in diabetic patients. The severity of OSAS was found to be greater in diabetic patients and they spent significantly more time below 90% saturation during sleep. No correlation was found between the groups in the glycated hemoglobin (HbA1c) parameter, which we examined in terms of diabetes control, sleep architecture, and OSAS severity.

CONCLUSION

The presence of diabetes aggravates the severity of OSAS, prolongs the transition to REM sleep, and leads to a decrease in REM duration. Sleep is essential for both mental and physical well-being. In this regard, it is of utmost importance to examine diabetic patients for OSAS and to perform polysomnography in appropriate patients.

Sensory gating and gaining in sleep: the balance between the protection of sleep and the safeness of life (a review)

Sleep is a brain state characterised by a low vigilance level and diminished consciousness. Reaction to and processing of external stimuli is attenuated in sleep. During sleep, the reticular thalamic nucleus reduces the flow of sensory activity to the cerebral cortex through inhibition of the thalamus. This sensory gating process facilitates sleep. After reaching the afferent layers of primary cortex, the reduced sensory flow is adjusted, gained, and processed within various cortical layers before being transferred by the corticofugal system back to appropriate subdivisions of the thalamus as feedback. Thalamic subdivisions then dispatch this sensory information to related areas of the cerebral cortex, where it is (sub)consciously perceived. When necessary, a sleeping individual can be awakened by a wake-up call, either by stimuli indicating danger, or by personally meaningful stimuli. It is safe for a sleeping individual that it can be aroused when necessary. Evidently, there are two processes by which the brain adjusts the response to sensory stimuli before entering (sub)consciousness. Firstly 'sensory gating', a process favourable to the maintenance of sleep by reducing the sensory input to the brain through the reticular thalamic nucleus and secondly 'sensory gaining', a process implying that the gained preserved sensory input is continuously analysed by the corticofugal system to detect dangerous and relevant environmental elements, indispensable for safeness and well-being of the sleeper.

Sound reasons for unsound sleep: Comparative support for the sentinel hypothesis in industrial and nonindustrial groups

Background and objectives

Sleep is a vulnerable state in which individuals are more susceptible to threat, which may have led to evolved mechanisms for increasing safety. The sentinel hypothesis proposes that brief awakenings during sleep may be a strategy for detecting and responding to environmental threats. Observations of sleep segmentation and group sentinelization in hunter-gatherer and small-scale communities support this hypothesis, but to date it has not been tested in comparisons with industrial populations characterized by more secure sleep environments.

Methodology

Here, we compare wake after sleep onset (WASO), a quantitative measure of nighttime awakenings, between two nonindustrial and two industrial populations: Hadza hunter-gatherers (n = 33), Malagasy small-scale agriculturalists (n = 38), and Hispanic (n = 1,531) and non-Hispanic White (NHW) (n = 347) Americans. We compared nighttime awakenings between these groups using actigraphically-measured sleep data. We fit linear models to assess whether WASO varies across groups, controlling for sex and age.

Results

We found that WASO varies significantly by group membership and is highest in Hadza (2.44 h) and Malagasy (1.93 h) and lowest in non-Hispanic Whites (0.69 h). Hispanics demonstrate intermediate WASO (0.86 h), which is significantly more than NHW participants. After performing supplementary analysis within the Hispanic sample, we found that WASO is significantly and positively associated with increased perception of neighborhood violence.

Conclusions and implications

Consistent with principles central to evolutionary medicine, we propose that evolved mechanisms to increase vigilance during sleep may now be mismatched with relatively safer environments, and in part responsible for driving poor sleep health.

Non-invasive sleep EEG measurement in hand raised wolves

Sleep research greatly benefits from comparative studies to understand the underlying physiological and environmental factors affecting the different features of sleep, also informing us about the possible evolutionary changes shaping them. Recently, the domestic dog became an exceedingly valuable model species in sleep studies, as the use of non-invasive polysomnography methodologies enables direct comparison with human sleep data. In this study, we applied the same polysomnography protocol to record the sleep of dog’s closest wild relative, the wolf. We measured the sleep of seven captive (six young and one senior), extensively socialized wolves using a fully non-invasive sleep EEG methodology, originally developed for family dogs. We provide the first descriptive analysis of the sleep macrostructure and NREM spectral power density of wolves using a completely non-invasive methodology. For (non-statistical) comparison, we included the same sleep data of similarly aged dogs. Although our sample size was inadequate to perform statistical analyses, we suggest that it may form the basis of an international, multi-site collection of similar samples using our methodology, allowing for generalizable, unbiased conclusions. As we managed to register both macrostructural and spectral sleep data, our procedure appears to be suitable for collecting valid data in other species too, increasing the comparability of non-invasive sleep studies.

Narrative review: pathogenesis, diagnosis, and treatment of sleep-related painful erection

Objective

Through critical analysis and comprehensive review of the limited literature, this paper can help clinicians better identify the pathophysiology of sleep-related painful erections (SRPE) and provide direction for future treatment research.

Background

Patients with SRPE will be awakened by painful erections during sleep, which affects their sleep process and general health. At present, literatures of experimental and clinical research on SRPE disease are limited, as well as long-term reports on its pathogenesis and clinical management.

Methods

We use the PubMed database to obtain sleep-related peer erection literature. The search terms used include sleep, painful, penis and erection. After rigorous screening, the search returned 21 references published between 1987 and 2021.

Conclusions

The main cause of SRPE is obstructive sleep apnea (OSA) syndrome, psychological and spiritual factors, androgen elevation, neuroendocrine regulation and threshold of pain in the REM phase. The combination of multiple medications is the most effective approach to treat sleep-pain-related erections. The combination of CPAP, REM inhibitors and Baclofen has significant effect on SRPE caused by OSA syndrome. This article provides effective support and strategies for doctors to manage SRPE patients through a comprehensive analysis of the pathogenesis mechanism and clinical treatment strategies of SRPE.

The subthalamic corticotropin-releasing hormone neurons mediate adaptive REM-sleep responses to threat

When an animal faces a threatening situation while asleep, rapid arousal is the essential prerequisite for an adequate response. Here, we find that predator stimuli induce immediate arousal from REM sleep compared with NREM sleep. Using in vivo neural activity recording and cell-type-specific manipulations, we identify neurons in the medial subthalamic nucleus (mSTN) expressing corticotropin-releasing hormone (CRH) that mediate arousal and defensive responses to acute predator threats received through multiple sensory modalities across REM sleep and wakefulness. We observe involvement of the same neurons in the normal regulation of REM sleep and the adaptive increase in REM sleep induced by sustained predator stress. Projections to the lateral globus pallidus (LGP) are the effector pathway for the threat-coping responses and REM-sleep expression. Together, our findings suggest adaptive REM-sleep responses could be protective against threats and uncover a critical component of the neural circuitry at their basis.

Developmental features of sleep electrophysiology in family dogs

Age-related differences in dog sleep and the age at which dogs reach adulthood as indexed by sleep electrophysiology are unknown. We assessed, in (1) a Juvenile sample (n = 60) of 2-14-month-old dogs (weight range: 4-68 kg), associations between age, sleep macrostructure, and non-rapid eye movement (NREM) EEG power spectrum, whether weight moderates associations, and (2) an extended sample (n = 91) of 2-30-months-old dogs, when sleep parameters stabilise. In Juvenile dogs, age was positively associated with time in drowsiness between 2 and 8 months, and negatively with time in rapid eye movement (REM) sleep between 2 and 6 months. Age was negatively associated with delta and positively with theta and alpha power activity, between 8 and 14 months. Older dogs exhibited greater sigma and beta power activity. Larger, > 8-month-old dogs had less delta and more alpha and beta activity. In extended sample, descriptive data suggest age-related power spectrum differences do not stabilise by 14 months. Drowsiness, REM, and delta power findings are consistent with prior results. Sleep electrophysiology is a promising index of dog neurodevelopment; some parameters stabilise in adolescence and some later than one year. Determination of the effect of weight and timing of power spectrum stabilisation needs further inquiry. The dog central nervous system is not fully mature by 12 months of age.

The ecology of sleep in non-avian reptiles

Sleep is ubiquitous in the animal kingdom and yet displays considerable variation in its extent and form in the wild. Ecological factors, such as predation, competition, and microclimate, therefore are likely to play a strong role in shaping characteristics of sleep. Despite the potential for ecological factors to influence various aspects of sleep, the ecological context of sleep in non-avian reptiles remains understudied and without systematic direction. In this review, we examine multiple aspects of reptilian sleep, including (i) habitat selection (sleep sites and their spatio-temporal distribution), (ii) individual-level traits, such as behaviour (sleep postures), morphology (limb morphometrics and body colour), and physiology (sleep architecture), as well as (iii) inter-individual interactions (intra- and inter-specific). Throughout, we discuss the evidence of predation, competition, and thermoregulation in influencing sleep traits and the possible evolutionary consequences of these sleep traits for reptile sociality, morphological specialisation, and habitat partitioning. We also review the ways in which sleep ecology interacts with urbanisation, biological invasions, and climate change. Overall, we not only provide a systematic evaluation of the conceptual and taxonomic biases in the existing literature on reptilian sleep, but also use this opportunity to organise the various ecological hypotheses for sleep characteristics. By highlighting the gaps and providing a prospectus of research directions, our review sets the stage for understanding sleep ecology in the natural world.

Interhemispheric asymmetry during NREM sleep in the dog

Functional hemispheric asymmetry was evidenced in many species during sleep. Dogs seem to show hemispheric asymmetry during wakefulness; however, their asymmetric neural activity during sleep was not yet explored. The present study investigated interhemispheric asymmetry in family dogs using non-invasive polysomnography. EEG recordings during 3-h-long afternoon naps were carried out (N = 19) on two occasions at the same location. Hemispheric asymmetry was assessed during NREM sleep, using bilateral EEG channels. To include periods with high homeostatic sleep pressure and to reduce the variance of the time spent in NREM sleep between dogs, the first two sleep cycles were analysed. Left hemispheric predominance of slow frequency range was detected in the first sleep cycle of sleep recording 1, compared to the baseline level of zero asymmetry as well as to the first sleep cycle of sleep recording 2. Regarding the strength of hemispheric asymmetry, we found greater absolute hemispheric asymmetry in the second sleep cycle of sleep recording 1 and 2 in the frequency ranges of alpha, sigma and beta, compared to the first sleep cycle. Differences between sleep recordings and consecutive sleep cycles might be indicative of adaptation-like processes, but do not closely resemble the results described in humans.

Puppet resting behavior in the Tibetan antelope (Pantholops hodgsonii)

Rest contributes a large part of animals' daily life, and animals usually rest in two ways, standing or in recumbence. Small or medium sized ungulates bed to rest in most cases, and standing rest is very rare and hardly seen. Here we described a standing rest behavior of Tibetan antelopes (Pantholops hodgsonii) living on the Tibet Plateau which has not been reported before. We named the standing rest behavior Puppet behavior, since the antelope stand still for a certain time. Of the 304 individuals observed, 48.3% (98/203) of adult and sub-adult males expressed the Puppet behavior, whereas only 6.3% (6/96) of females did, indicating an obvious sexual difference. Puppet behavior occurred more frequently at noon and in the afternoon on sunny and cloudy days, meaning that daytime and weather were both influential factors. Puppet behavior was usually accompanied with rumination and sometimes ended with leg-shaking. Our results suggest that Puppet behavior may be an adaptive form of rest, which may serve a thermoregulatory and anti-predation function, and may be simpler and safer than recumbent rest.

Pleasure: The missing link in the regulation of sleep

Although largely unrecognized by sleep scholars, sleeping is a pleasure. This report aims first, to fill the gap: sleep, like food, water and sex, is a primary reinforcer. The levels of extracellular mesolimbic dopamine show circadian oscillations and mark the "wanting" for pro-homeostatic stimuli. Further, the dopamine levels decrease during waking and are replenished during sleep, in opposition to sleep propensity. The wanting of sleep, therefore, may explain the homeostatic and circadian regulation of sleep. Accordingly, sleep onset occurs when the displeasure of excessive waking is maximal, coinciding with the minimal levels of mesolimbic dopamine. Reciprocally, sleep ends after having replenished the limbic dopamine levels. Given the direct relation between waking and mesolimbic dopamine, sleep must serve primarily to gain an efficient waking. Pleasant sleep (i.e. emotional sleep), can only exist in animals capable of feeling emotions. Therefore, although sleep-like states have been described in invertebrates and primitive vertebrates, the association sleep-pleasure clearly marks a difference between the sleep of homeothermic vertebrates and cool blooded animals.

Episodic hormone secretion: a comparison of the basis of pulsatile secretion of insulin and GnRH

Rhythms govern many endocrine functions. Examples of such rhythmic systems include the insulin-secreting pancreatic beta-cell, which regulates blood glucose, and the gonadotropin-releasing hormone (GnRH) neuron, which governs reproductive function. Although serving very different functions within the body, these cell types share many important features. Both GnRH neurons and beta-cells, for instance, are hypothesized to generate at least two rhythms endogenously: (1) a burst firing electrical rhythm and (2) a slower rhythm involving metabolic or other intracellular processes. This review discusses the importance of hormone rhythms to both physiology and disease and compares and contrasts the rhythms generated by each system.

A comparison of inspiratory airflow dynamics during sleep between upper airway resistance syndrome patients and healthy controls

OBJECTIVES

A test of the hypothesis that upper airway resistance syndrome (UARS) patients have an increased prevalence of inspiratory airflow limitation (IFL) during sleep compared to healthy controls.

METHODS

We compared inspiratory airflow dynamics during sleep between 12 UARS patients (nine females and three males) and 12 healthy controls matched for age, gender and obesity with maximal age limited at 45 years. A standard clinical polysomnogram (airflow measured with a nasal/oral pressure catheter) was performed to assess the impact of SDB on the participants' natural sleep. A second full-night polysomnogram with a pneumotachograph and a supraglottic pressure catheter to measure airflow and effort was performed to compare the maximal inspiratory airflow and effort and the percentage of flow-limited breaths during supine, continuous stage 2 sleep between groups.

RESULTS

During clinical polysomnography, UARS participants did not differ significantly from controls in sleep architecture or fragmentation. We observed a small difference in apnea hypopnea index between UARS participants and controls (1.6 ± 1.9 vs. 0.4 ± 0.3, respectively; p = 0.035). During supine, continuous stage 2 sleep, 64.2 % (35.8; mean (SD)) of UARS participants' breaths were flow-limited compared with 34.0 % (39.3) of controls' breaths (p = 0.06). The groups did not differ in maximal inspiratory airflow or inspiratory effort.

CONCLUSIONS

Our findings indicate a less-than-robust difference in respiratory parameters during sleep between UARS patients and healthy controls and no difference in standard sleep parameters or sleep fragmentation. We consider a pathophysiology of UARS that incorporates these findings.

Treatment resistant adolescent depression with upper airway resistance syndrome treated with rapid palatal expansion: a case report

Introduction

To the best of our knowledge, this is the first report of a case of treatment-resistant depression in which the patient was evaluated for sleep disordered breathing as the cause and in which rapid palatal expansion to permanently treat the sleep disordered breathing produced a prolonged symptom-free period off medication.

Case presentation

An 18-year-old Caucasian man presented to our sleep disorders center with chronic severe depression that was no longer responsive to medication but that had recently responded to electroconvulsive therapy. Ancillary, persistent symptoms included mild insomnia, moderate to severe fatigue, mild sleepiness and severe anxiety treated with medication. Our patient had no history of snoring or witnessed apnea, but polysomnography was consistent with upper airway resistance syndrome. Although our patient did not have an orthodontic indication for rapid palatal expansion, rapid palatal expansion was performed as a treatment of his upper airway resistance syndrome. Following rapid palatal expansion, our patient experienced a marked improvement of his sleep quality, anxiety, fatigue and sleepiness. His improvement has been maintained off all psychotropic medication and his depression has remained in remission for approximately two years following his electroconvulsive therapy.

Conclusions

This case report introduces the possibility that unrecognized sleep disordered breathing may play a role in adolescent treatment-resistant depression. The symptoms of upper airway resistance syndrome are non-specific enough that every adolescent with depression, even those responding to medication, may have underlying sleep disordered breathing. In such patients, rapid palatal expansion, by widening the upper airway and improving airflow during sleep, may produce a prolonged improvement of symptoms and a tapering of medication. Psychiatrists treating adolescents may benefit from having another treatment option for treatment-resistant depression.

Individual variation in sleep-wake rhythms in free-living birds

Ultradian rhythms, such as sleep-wake periodicities, during the night might represent basic rest-activity cycles of organisms that are fundamental to the temporal organization and synchronization of behavior throughout the day. However, in contrast to circadian rhythms, little is known about the underlying oscillators and molecular mechanisms of higher-frequency rhythms. A fundamental step for the understanding of the mechanisms of these latter periodicities is the analysis of variation in sleep-wake cycles in free-living animals, which can help in estimating the relative importance of genetic and environmental influence on the rhythmicity. We analyzed variation in the level of rhythmicity and period length (τ) of behaviorally defined sleep-wake cycles in a natural population of blue tits Cyanistes caeruleus. Our results indicate that the expression of periodicity in sleep-wake patterns, but not τ, has a strong individual-specific basis. The within-individual repeatability estimate of the expression of periodicity was .45 (95% confidence interval: .35-.55) when data from males and females were combined. In addition, periodicity was influenced by specific environmental factors, such as night temperature, seasonal date, and age of the individual. Most strikingly, low nighttime temperature negatively affected periodicity of sleep-wake patterns, potentially via a hypothermic response of the birds. Our results further suggest that τ is influenced by photoperiod. Blue tits showed longer sleep-wake rhythms when the nights were longer. These observations suggest a genetic basis for the incidence of rhythmic sleep-wake behavior in addition to environmental modifications of their specific expression.

Functional somatic syndromes, anxiety disorders and the upper airway: a matter of paradigms

The relationship between the functional somatic syndromes, anxiety disorders and the upper airway (particularly, sleep disordered breathing) remains ambiguous. This ambiguity, despite a growing body of research supporting a relationship, may result from the absence of a paradigm to explain how upper airway dysfunction can promote disorders commonly associated with one's mental health. This review models the functional somatic syndromes and anxiety disorders as consequences of chronically increased hypothalamic-pituitary-adrenal axis activity. It then examines the literature supporting a relationship between these disorders and upper airway dysfunction during wakefulness and sleep. Finally, building upon an existing paradigm of neural sensitization, sleep disordered breathing is linked to functional somatic syndromes and anxiety disorders through chronic activation of the hypothalamic-pituitary-adrenal axis.

The effect of nasal continuous positive airway pressure on the symptoms of Gulf War illness

PURPOSE

We performed a pilot study to determine whether nasal continuous positive airway pressure (CPAP) alleviates the symptoms of veterans with Gulf War illness (GWI) and sleep disordered breathing (SDB).

METHODS

Eighteen male veterans with GWI and SDB recruited by advertisement, participated in a randomized, single-masked, sham-controlled treatment trial. Participants received 3 weeks of treatment during sleep with either therapeutic nasal CPAP or sham nasal CPAP. Using validated questionnaires, pain, fatigue, cognitive function, sleep disturbance, and general health were assessed by self-report before and after treatment. One of the participants assigned to therapeutic CPAP was excluded from the trial before starting treatment, leaving 17 participants.

RESULTS

Compared to the nine sham nasal CPAP recipients, the eight participants receiving therapeutic nasal CPAP experienced improvements in pain (34%; p = 0.0008), fatigue (38%; p = 0.0002), cognitive function (33%; p = 0.004), sleep quality (41%; p = 0.0003), physical health (34%; p = 0.0003), and mental health (16%; p = 0.03).

CONCLUSIONS

Our findings in this pilot study suggest that nasal CPAP may greatly improve symptoms in veterans with GWI and SDB.

An evolutionary hypothesis of depression and its symptoms, adaptive value, and risk factors

Major depression is an evolutionary paradox: it carries great disadvantages for survival and reproduction of both patients and their relatives, yet it is common and has significant heritability. We propose a new hypothesis to help explain many of depression's symptoms and its risk factors, most of them not explained by previous evolutionary theories. We hypothesize that the evolutionary costs of depression are offset by its benefits in combating existing infections and avoiding new ones. As our hypothesis predicts, depression can be elicited by various infections as well as by environmental stressors that compromise immune function. Moreover, many depressive symptoms tend to aid immune function and reduce exposure to new infections and stressors. The hypothesis makes many predictions about the epidemiology and physiology of depression that are supported by available evidence. The hypothesis also suggests that possible underlying infectious and immune factors deserve greater consideration in prevention and treatment of depression.

Relationships between the number of ultradian cycles and key sleep variables in outpatients with major depressive disorder

The regulation of the alternation between rapid eye movement sleep (REMS) and non-rapid eye movement sleep (NREMS) is still a matter of much debate. It is also an important topic for psychiatric research, since both sleep components show anomalies in Major Depressive Disorders (MDD) and related syndromes. In previous studies on healthy controls, we showed preferential links of the number of ultradian cycles with REMS-related variables rather than with NREMS-related variables. REMS Latency (RL), for example, was shown to be inversely related to the number of cycles. The present study replicates these analyses in a group of 29 patients with MDD (age range: 23-56; 16 females), after two adaptation nights. Results showed significant correlations between the number of cycles and REMS, and between the number of cycles and RL, whereas correlations with NREMS were not significant. This indirectly supports regulation hypotheses considering REMS as the main focus of the oscillation, inhibiting and interrupting NREMS. Also, when the RL is shorter, there are more ultradian cycles than when the RL is long. This adds an interesting element in the elucidation of the physiological meaning of anomalies of RL.

Energetic constraints, not predation, influence the evolution of sleep patterning in mammals

Mammalian sleep is composed of two distinct states - rapid-eye-movement (REM) and non-REM (NREM) sleep - that alternate in cycles over a sleep bout. The duration of these cycles varies extensively across mammalian species. Because the end of a sleep cycle is often followed by brief arousals to waking, a shorter sleep cycle has been proposed to function as an anti-predator strategy. Similarly, higher predation risk could explain why many species exhibit a polyphasic sleep pattern (division of sleep into several bouts per day), as having multiple sleep bouts avoids long periods of unconsciousness, potentially reducing vulnerability.Using phylogenetic comparative methods, we tested these predictions in mammals, and also investigated the relationships among sleep phasing, sleep-cycle length, sleep durations and body mass.Neither sleep-cycle length nor phasing of sleep was significantly associated with three different measures of predation risk, undermining the idea that they represent anti-predator adaptations.Polyphasic sleep was associated with small body size, shorter sleep cycles and longer sleep durations. The correlation with size may reflect energetic constraints: small animals need to feed more frequently, preventing them from consolidating sleep into a single bout. The reduced daily sleep quotas in monophasic species suggests that the consolidation of sleep into one bout per day may deliver the benefits of sleep more efficiently and, since early mammals were small-bodied and polyphasic, a more efficient monophasic sleep pattern could be a hitherto unrecognized advantage of larger size.

Pulse transit time and blood pressure changes following auditory-evoked subcortical arousal and waking of infants

STUDY OBJECTIVES

To establish a normal range of data in 3-month-old infants in relation to changes in cardiovascular measurements, with particular reference to pulse transit time (PTT), following subcortical arousals and awakenings from sleep.

DESIGN

Prospective study.

SETTING

Sleep laboratory, Dunedin Hospital

PARTICIPANTS

Twenty healthy infants aged 9-12 weeks.

METHODS

Nap studies were performed using a standard polysomnographic setup with the addition of a Portapres blood pressure (BP) cuff (wrist application) and a piezoelectric sensor on the foot. PTT was measured from the ECG-R waveform to the arrival of the pulse peripherally. Infants were exposed to white noise from 50 to 100 dB at 10 dB intervals within REM and NREM sleep.

RESULTS

Awakening thresholds were higher (P = 0.01) in NREM (>90 dB) than REM sleep (mean +/- SD; 74.3 +/- 9.4dB). Subcortical thresholds were always 10 dB below waking thresholds. Following awakening, there was an immediate increase in HR, SBP, and DBP of 21%, 14%, and 17%, respectively, and a 13% decrease in PTT returning to baseline within 25-30 seconds. PTT at baseline measured 140 +/- 11 and 139 +/- 9 msec in NREM and REM sleep, respectively, and decreased approximately 20 msec with waking. PTT changes were negatively correlated with heart rate (HR) but not BP, although a trend was evident.

CONCLUSIONS

At 3 months of age, infants provoked to arouse from sleep showed PTT changes that inversely mimicked BP trends, suggesting that PTT could be useful in infant studies as a marker for autonomic perturbations that occur during sleep in both clinical and research settings.

The trivial function of sleep

Rest in poikilothermic animals is an adaptation of the organism to adjust to the geophysical cycles, a doubtless valuable function for all animals. In this review, we argue that the function of sleep could be trivial for mammals and birds because sleep does not provide additional advantages over simple rest. This conclusion can be reached by using the null hypothesis and parsimony arguments. First, we develop some theoretical and empirical considerations supporting the absence of specific effects after sleep deprivation. Then, we question the adaptive value of sleep traits by using non-coding DNA as a metaphor that shows that the complexity in the design is not a definitive proof of adaptation. We then propose that few, if any, phenotypic selectable traits do exist in sleep. Instead, the selection of efficient waking has been the major determinant of the most significant aspects in sleep structure. In addition, we suggest that the regulation of sleep is only a mechanism to enforce rest, a state that was challenged after the development of homeothermy. As a general conclusion, there is no direct answer to the problem of why we sleep; only an explanation of why such a complex set of mechanisms is used to perform what seems to be a simple function. This explanation should be reached by following the evolution of wakefulness rather than that of sleep. Sleep could have additional functions secondarily added to the trivial one, although, in this case, the necessity and sufficiency of these sleep functions should be demonstrated.

Functional microstates within human REM sleep: first evidence from fMRI of a thalamocortical network specific for phasic REM periods

High thalamocortical neuronal activity characterizes both, wakefulness and rapid eye movement (REM) sleep, but apparently this network fulfills other roles than processing external information during REM sleep. To investigate thalamic and cortical reactivity during human REM sleep, we used functional magnetic resonance imaging with simultaneous polysomnographic recordings while applying acoustic stimulation. Our observations indicate two distinct functional substates within general REM sleep. Acoustic stimulation elicited a residual activation of the auditory cortex during tonic REM sleep background without rapid eye movements. By contrast, periods containing bursts of phasic activity such as rapid eye movements appear characterized by a lack of reactivity to sensory stimuli. We report a thalamocortical network including limbic and parahippocampal areas specifically active during phasic REM periods. Thus, REM sleep has to be subdivided into tonic REM sleep with residual alertness, and phasic REM sleep with the brain acting as a functionally isolated and closed intrinsic loop.

A Phylogenetic Analysis of Sleep Architecture in Mammals: The Integration of Anatomy, Physiology, and Ecology

Among mammalian species, the time spent in the two main "architectural" states of sleep--slow-wave sleep (SWS) and rapid-eye-movement (REM) sleep--varies greatly. Previous comparative studies of sleep architecture found that larger mammals, those with bigger brains, and those with higher absolute basal metabolic rates (BMR) tended to engage in less SWS and REM sleep. Species experiencing a greater risk of predation also exhibited less SWS and REM sleep. In all cases, however, these studies lacked a formal phylogenetic and theoretical framework and used mainly correlational analyses. Using independent contrasts and an updated data set, we extended existing approaches with path analysis to examine the integrated influence of anatomy, physiology, and ecology on sleep architecture. Path model structure was determined by nonmutually exclusive hypotheses for the function of sleep. We found that species with higher relative BMRs engage in less SWS, whereas species with larger relative brain masses engage in more REM sleep. REM sleep was the only sleep variable strongly influenced by predation risk; mammals sleeping in riskier environments engage in less REM sleep. Overall, we found support for some hypotheses for the function of sleep, such as facilitating memory consolidation or learning, but not others, such as energy conservation.

Role of monitoring and blunting coping styles in primary insomnia

OBJECTIVE

Primary insomnia is one of the most prevalent sleep disorders and assumed to be initiated and maintained, among other factors, by psychological variables such as coping strategies, sleep hygiene techniques, and arousability. Althouugh the number and kind of stressors seem to be important initiators of insomnia, individual coping dispositions appear to play a larger role in maintaining it. This study explores the relationship between different coping dispositions (monitoring/blunting) and insomnia. Monitoring refers to information-seeking behavior under threat; blunting pertains to distractive strategies utilized in situations implying threat or danger.

METHODS

The study compares 37 primary insomniacs (DSM IV criteria) and 47 good sleepers. Dependent measures included self-rating scales concerning sleep quality (Schlaffragebogen part B, Frankfurter Schlaffragebogen), coping styles (Frankfurt Monitoring Blunting Scales), and psychopathology (Neo Five Factors Inventory, Beck Anxiety Inventory). All measures had documented psychometric properties.

RESULTS

Primary insomniacs were significantly more likely to rigidly resort to monitoring strategies in controllable as well as uncontrollable situations. Further, 73% of all rigid monitors identified in the sample were rated as primary insomniacs, whereas 86% of all rigid Blunters were good sleepers. Insomniacs showed higher levels of anxiety than good sleepers, coping style groups differed in anxiety and neuroticism scores.

CONCLUSION

The study further supports the hypothesis that a monitoring coping style is related to primary insomnia. Blunting appears to be a good predictor of high sleep quality. The results are discussed with regard to improving treatment for patients suffering from primary insomnia.

Mechanisms of arousal from sleep and their consequences

PURPOSE OF REVIEW

In recent years, understanding of the mechanisms by which sleep is maintained and the consequences of abnormal arousal from sleep has improved rapidly. This review describes the recent insights into the nature of sleep and arousal and the particular insights gained in common disease states such as sleep-disordered breathing.

RECENT FINDINGS

Expansion of the definitions of the classic stages of non-REM and REM sleep to include consideration of the role of cyclic alternating pattern sleep as a gating mechanism for arousal and maintenance of stable sleep has led to a significant advancement in understanding the nature of normal and pathologic arousals from sleep. In addition, the effect of arousals from sleep on cerebral cortical electrophysiology and autonomic activation has been further defined, with a potential effect on clinical practice.

SUMMARY

Arousal from sleep is dependent on wake-promoting influences overwhelming forces promoting sleep. Autonomic activation and cortical arousal can significantly affect and destabilize sleep homeostasis. The understanding of sleep-respiration interactions continues to evolve. The definition of the minimal arousal event is an important research goal. It will be important in clinical practice and research to consider sleep stability domains as a complement to sleep depth staging to allow better understanding of the relative stability and instability of the system and to consider all components of the consequences of arousal.