Olfactory aversive conditioning during sleep reduces cigarette-smoking behavior

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.

Disentangling affect from self-esteem using subliminal conditioning

Across three experiments, participants underwent conditioning sequences where the self-referential term I AM (Conditioned Stimulus, or CS+) or a scrambled counterpart M IA (CS-) was paired with either neutral (Unconditioned Stimulus, or US-) or positive attributes (US+). CS and US were presented under subliminal and/or visible conditions. A normalized indicator of affective shift and an explicit self-esteem measure were deployed as outcome measures. In Experiment 1 (N = 60), subliminal CS+ followed by visible US+ produced a significant affective shift only. Experiment 2 (N = 59) presented CS and US under subliminal conditions, which did not influence either outcome measure. In Experiment 3 (N = 60), visible CS appeared with visible US, which resulted in a significant effect on explicit self-esteem only. These findings highlight the central roles of CS and/or US visibility towards influencing reported affect and self-esteem. We theorize that configural components of subliminally presented stimuli can become perceptually encoded and influence self-related affect non-consciously.

Modulation of sleep using noninvasive stimulations during sleep

Among the various sleep modulation methods for improving sleep, three methods using noninvasive stimulation during sleep have been reviewed and summarized. The first method involves noninvasive direct brain stimulation to induce a current directly in the brain cortex. Electrically or magnetically applied stimulations trigger electrical events such as slow oscillations or sleep spindles, which can also be recorded by an electroencephalogram. The second method involves sensory stimulation during sleep, which provides stimulation through the sensory pathway to invoke equivalent brain activity like direct brain stimulation. Olfactory, vestibular, and auditory stimulation methods have been used, resulting in several sleep-modulating effects, which are characteristic and depend on the experimental paradigm. The third method is to modulate sleep by shifting the autonomic balance affecting sleep homeostasis. To strengthen parasympathetic dominance, stimulation was applied to decrease heart rate by synchronizing the heart rhythm. These noninvasive stimulation methods can strengthen slow-wave sleep, consolidate declarative or procedural memory, and modify sleep macrostructure. These stimulation methods provide evidence and possibility for sleep modulation in our daily life as an alternative method for the treatment of disturbed sleep and enhancing sleep quality and performance beyond the average level.

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.

Development and Study of Ezzence: A Modular Scent Wearable to Improve Wellbeing in Home Sleep Environments

Ezzence is the first smartphone-controlled olfactometer designed for both day and night conditions. We discuss the design and technical implementation of Ezzence and report on a study to evaluate the feasibility of using the device in home-based sleep environments. The study results (N = 40) show that participants were satisfied with the device and found it easy to use. Furthermore, participants reported a significant improvement in sleep quality when using the device with scent in comparison to the control condition (p = 0.003), as well as better mood the following morning (p = 0.038) and shorter time to sleep onset (p = 0.008). The device is integrated with a wearable EEG and real-time sleep staging algorithm to release scent during specific sleep stages (N1, N2, N3, and REM), which is important for certain use cases (e.g., to study the effect of scent on REM dreams, or to improve memory consolidation with a re-exposure of scent during N2 and N3). Ezzence can be used for several applications, including those that require scent triggered day and night. They include targeted memory reactivation, longitudinal health treatments, therapy, and mental or physical exercises. Finally, this article proposes an interaction framework to understand relationships between scents and environments based on proxemic dimensions and passive or active interactions during sleep.

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.

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.

Exposure to Olfactory Alcohol Cues During Non-rapid Eye Movement Sleep Did Not Decrease Craving in Patients With Alcohol Dependence

BACKGROUND AND OBJECTIVES

Cue exposure therapy (CET) has been used to reduce alcohol use, but the effect of CET during sleep on alcohol dependence (AD) is unclear. The present study examined the effect of repeated exposure to an olfactory stimulus during non-rapid eye movement (NREM) sleep on cue reactivity and craving in patients with AD.

METHODS

Thirty-five patients with AD were enrolled according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). All the subjects were randomly assigned to the experimental or control group. The experimental group was exposed to alcohol odor for 10 min during NREM sleep. The other group (controls) was exposed to water [control stimulus (CtrS)] for 10 min during NREM sleep. Demographic, alcohol-related, and clinical characteristics were collected at baseline. A cue-reactivity test was conducted before and after exposure to evaluate the effect of memory manipulation on acute response to an alcohol stimulus.

RESULTS

There were no significant time × group interactions according to the visual analog scale (VAS) score of craving intensity, skin conductance response (SCR), systolic blood pressure (SBP), and diastolic blood pressure (DBP; all p > 0.05). Two-way ANOVA showed significant main effects of time on SCR [F _(1,33) = 4.453, p = 0.043], SBP [F _(1,33) = 14.532, p = 0.001], DBP [F _(1,33) = 8.327, p = 0.007], Craving-VAS [F _(1,33) = 1.997, p = 0.167] in two groups.

CONCLUSION

Exposure to olfactory alcohol cues during NREM sleep had no significant effect on alcohol craving in subjects with AD during hospitalization.

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.

Building the Bridge: Outlining Steps Toward an Applied Sleep-and-Memory Research Program

Sleep’s beneficial role for memory is well documented, yet the translation of such fundamental memory processes into applications for improving memory function is limited so far. Although there are some commercial devices with varying levels of technical complexity that are claimed to improve sleep-dependent memory processing, none of them have been empirically validated. The main issue seems to be that there is basically no applied research in the field of sleep and memory. To change this, we identify the most promising targets for sleep-based memory-improvement applications. We outline the theoretical and technical aspects of the most promising memory-enhancing sleep interventions established in recent years and highlight potential targets of such interventions for different healthy and clinical populations. Finally, we propose a unifying framework that will lay the groundwork for a focused applied-research program in sleep and memory, bridging the gap between basic research and targeted application.

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.

Dream engineering: Simulating worlds through sensory stimulation

We explore the application of a wide range of sensory stimulation technologies to the area of sleep and dream engineering. We begin by emphasizing the causal role of the body in dream generation, and describe a circuitry between the sleeping body and the dreaming mind. We suggest that nearly any sensory stimuli has potential for modulating experience in sleep. Considering other areas that might afford tools for engineering sensory content in simulated worlds, we turn to Virtual Reality (VR). We outline a collection of relevant VR technologies, including devices engineered to stimulate haptic, temperature, vestibular, olfactory, and auditory sensations. We believe these technologies, which have been developed for high mobility and low cost, can be translated to the field of dream engineering. We close by discussing possible future directions in this field and the ethics of a world in which targeted dream direction and sleep manipulation are feasible.

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.

A Systematic Review of Closed-Loop Feedback Techniques in Sleep Studies-Related Issues and Future Directions

Advances in computer processing technology have enabled researchers to analyze real-time brain activity and build real-time closed-loop paradigms. In many fields, the effectiveness of these closed-loop protocols has proven to be better than that of the simple open-loop paradigms. Recently, sleep studies have attracted much attention as one possible application of closed-loop paradigms. To date, several studies that used closed-loop paradigms have been reported in the sleep-related literature and recommend a closed-loop feedback system to enhance specific brain activity during sleep, which leads to improvements in sleep's effects, such as memory consolidation. However, to the best of our knowledge, no report has reviewed and discussed the detailed technical issues that arise in designing sleep closed-loop paradigms. In this paper, we reviewed the most recent reports on sleep closed-loop paradigms and offered an in-depth discussion of some of their technical issues. We found 148 journal articles strongly related with 'sleep and stimulation' and reviewed 20 articles on closed-loop feedback sleep studies. We focused on human sleep studies conducting any modality of feedback stimulation. Then we introduced the main component of the closed-loop system and summarized several open-source libraries, which are widely used in closed-loop systems, with step-by-step guidelines for closed-loop system implementation for sleep. Further, we proposed future directions for sleep research with closed-loop feedback systems, which provide some insight into closed-loop feedback systems.

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.

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).

An Exploration of Form Factors for Sleep-Olfactory Interfaces

Releasing scent during sleep has been shown to influence the emotional valence of dreams, reduce cigarette smoking behavior, strengthen memories as well as enhance restorative slow-wave activity. Nevertheless, current scent technologies used in sleep laboratories are not portable and require the use of nasal masks and large olfactometers. In this paper we investigated the preferred form factor and acceptance of a set of biometric wearables that can release scent based on the user's physiological state. We conducted an online survey with 163 participants and evaluated 8 different form factors. The results showed that 73.5% of the subjects preferred the designs that are not wearable during the night but that can be worn during the day. We provide insights to take into account for the design of next generation sleep-olfactory technologies. We provide a literature review of sleep and scent studies and discuss the opportunities for well-being and memory applications.

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.

[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.

The Impact of Aversive Advice During Percutaneous Coronary Intervention on Smoking Cessation in Patients With Acute Coronary Syndrome

BACKGROUND

Smoking cessation is important to prevent recurrence of acute coronary syndrome (ACS), but even in patients with ACS, smoking is hard to quit.

OBJECTIVES

This study hypothesized that aversive advice during the percutaneous coronary intervention (PCI) procedure works effectively to promote smoking cessation in patients with ACS.

METHODS

This study was conducted as a prospective, single-blinded, randomized controlled trial. A total of 66 patients were randomly assigned to an aversive advice group or a control group and instructed to visit the outpatient clinic 1, 4, and 24 weeks after discharge. In the aversive advice group, a physician who did not participate in the patient follow-up said the following 3 sentences to the patients during the PCI procedure: "Smoking caused your chest pain"; "If you do not stop smoking right now, this pain will come again"; and "The next time you feel this pain you will probably die." All patients received usual advice on the importance of quitting smoking.

RESULTS

At 24 weeks after discharge, the smoking cessation rate was higher in the aversive advice group than in the control group. In a multivariable logistic regression analysis, after adjustment for age, smoking quantity, alcohol consumption, and disease severity, the result was maintained (odds ratio = 4.47, 95% confidence interval: 1.50 to 13.34).

CONCLUSIONS

Aversive advice during a PCI procedure is effective at smoking cessation in patients with ACS. A physician's attention and involvement during the PCI procedure improves the rate of smoking cessation in patients with ACS.

Pleasant olfactory cues can reduce cigarette craving

Cigarette craving is a cardinal feature of smoking, which is the leading preventable cause of death. Despite its clinical relevance, there remains a pressing need to develop new approaches for controlling craving. Although olfactory cues (OCs) are especially well suited to reduce affectively charged cravings, there has been surprisingly little research on the topic. We investigated the strategic use of OCs to reduce cigarette craving. Abstinent smokers (N = 232) initially sampled and rated a series of OCs. Participants then were exposed to in vivo smoking cues, which produced robust cigarette cravings. During peak craving, they were randomly assigned to sniff one of three types of OCs (all of which they had previously sampled) while their craving, and a set of responses thought to be associated with craving, were assessed. OCs that a participant had rated as pleasant reduced craving more than did exposure to odor blank (i.e., neutral) or tobacco-related OCs. This effect persisted over the course of 5 min. In addition, smokers with the most specific autobiographical memory systems were most responsive to the craving-reducing effects of pleasant OCs. About 90% of participants reported they could imagine using a pleasant OC to curb their craving in the natural environment. The present data suggest that OCs show promise for controlling cravings and highlight the need to conduct further research to test whether OCs may prove useful alone or in combination with existing approaches as a smoking cessation intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Targeted memory reactivation during sleep to strengthen memory for arbitrary pairings

A powerful way to investigate memory consolidation during sleep utilizes acoustic stimulation to reactivate memories. In multiple studies, Targeted Memory Reactivation (TMR) using sounds associated with prior learning improved later memory, as in recalling locations where objects previously appeared. In the present experiment, we examined whether a variant of the same technique could strengthen memory for the locations of pairs of objects. Each sound was naturally connected to one object from each pair, but we hypothesized that both memories could be improved with TMR. We first asked participants to memorize each of 50 pairs of objects by associating the two objects with each other and with the sound of one of the objects (e.g., cat-meow). Next, objects were presented in unique locations on a grid. Participants learned these locations in an adaptive procedure. During an afternoon nap, 25 of the sounds were quietly presented. In memory tests given twice before and twice after the nap, participants heard the sound for each object pair and were asked to recall the name of the second object and the locations of both objects. Forgetting scores were calculated using the mean difference between pre-nap and post-nap spatial recall errors. We found less forgetting after the nap for cued compared to non-cued objects. Additionally, the extent of forgetting tended to be similar for the two members of each pair, but only for cued pairs. Results thus substantiate the potential for sounds to reactivate spatial memories during sleep and thereby improve subsequent recall performance, even for multiple objects associated with a single sound and when participants must learn a novel sound-object association.

Unconscious Psychological Treatments for Physiological Survival Circuits

The idea of targeting unconscious or implicit processes in psychological treatments is not new, but until recently it has not been easy to manipulate these processes without also engaging consciousness. Here we review how this is possible, using various modern cognitive neuroscience methods including a technique known as Decoded Neural-Reinforcement. We discuss the general advantages of this approach, such as how it can facilitate double-blind placebo-controlled studies, and minimize premature patient dropouts in the treatment of fear. We also speculate how this may generalize to other similar physiological survival processes.

Stimulating the sleeping brain: Current approaches to modulating memory-related sleep physiology

BACKGROUND

One of the most audacious proposals throughout the history of psychology was the potential ability to learn while we sleep. The idea penetrated culture via sci-fi movies and inspired the invention of devices that claimed to teach foreign languages, facts, and even quit smoking by simply listening to audiocassettes or other devices during sleep. However, the promises from this endeavor didn't stand up to experimental scrutiny, and the dream was shunned from the scientific community. Despite the historic evidence that the sleeping brain cannot learn new complex information (i.e., words, images, facts), a new wave of current interventions are demonstrating that sleep can be manipulated to strengthen recent memories.

NEW METHOD

Several recent approaches have been developed that play with the sleeping brain in order to modify ongoing memory processing. Here, we provide an overview of the available techniques to non-invasively modulate memory-related sleep physiology, including sensory, vestibular and electrical stimulation, as well as pharmacological approaches.

RESULTS

N/A.

COMPARISON WITH EXISTING METHODS

N/A.

CONCLUSIONS

Although the results are encouraging, suggesting that in general the sleeping brain may be optimized for better memory performance, the road to bring these techniques in free-living conditions is paved with unanswered questions and technical challenges that need to be carefully addressed.

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.

Behavioral interventions to eliminate fear responses

Fear memory underlies anxiety-related disorders, including posttraumatic stress disorder (PTSD). PTSD is a fear-based disorder, characterized by difficulties in extinguishing the learned fear response and maintaining extinction. Currently, the first-line treatment for PTSD is exposure therapy, which forms an extinction memory to compete with the original fear memory. However, the extinguished fear often returns under numerous circumstances, suggesting that novel methods are needed to eliminate fear memory or facilitate extinction memory. This review discusses research that targeted extinction and reconsolidation to manipulate fear memory. Recent studies indicate that sleep is an active state that can regulate memory processes. We also discuss the influence of sleep on fear memory. For each manipulation, we briefly summarize the neural mechanisms that have been identified in human studies. Finally, we highlight potential limitations and future directions in the field to better translate existing interventions to clinical settings.

Emotion, emotion regulation and sleep: An intimate relationship

In recent years, research has witnessed an increasing interest in the bidirectional relationship between emotion and sleep. Sleep seems important for restoring daily functioning, whereas deprivation of sleep makes us more emotionally aroused and sensitive to stressful stimuli and events. Sleep appears to be essential to our ability to cope with emotional stress in everyday life. However, when daily stress is insufficiently regulated, it may result in mental health problems and sleep disturbances too. Not only does emotion impact sleep, but there is also evidence that sleep plays a key role in regulating emotion. Emotional events during waking hours affect sleep, and the quality and amount of sleep influences the way we react to these events impacting our general well-being. Although we know that daytime emotional stress affects sleep by influencing sleep physiology, dream patterns, dream content and the emotion within a dream, its exact role is still unclear. Other effects that have been found are the exaggeration of the startle response, decrease in dream recall and elevation of awakening thresholds from rapid eye movement (REM), REM-sleep, increased or decreased latency to REM-sleep, increase in percentage of REM-density, REM-sleep duration, as well as the occurrence of arousals in sleep as a marker of sleep disruption. Equally, the way an individual copes with emotional stress, or the way in which an individual regulates emotion may modulate the effects of emotional stress on sleep. The research presented here supports the idea that adaptive emotion regulation benefits our follow-up sleep. We thus conclude the current review with a call for future research in order to clarify further the precise relationship between sleep, emotion and emotion regulation, as well as to explain further how sleep dissolves our emotional stress.

Sleeping in a Brave New World: Opportunities for Improving Learning and Clinical Outcomes through Targeted Memory Reactivation

Neuroscientific insights into learning and memory have mostly concerned input and output, but intervening processing during the time between acquisition and retrieval is also critical. Indeed, intervening memory reactivation may regulate memory longevity, and a growing body of evidence implicates sleep in changing memory storage. For example, subtle auditory stimulation can be used experimentally to selectively encourage memory reactivation during sleep, which thereby improves learning. Much remains to be elucidated about how learning depends on sleep. Nevertheless, this methodology for modifying memory storage during sleep offers new opportunities for reinforcing learning to enhance clinical outcomes in conjunction with therapies engaged during waking. A variety of such possibilities must now be carefully investigated. Likewise, brain rhythms can be entrained to enhance sleep functions, facilitating further progress in understanding the neurophysiological basis of memory processing during sleep. Ultimately, empirical evidence may reveal the extent to which the way we behave when awake is a function of what our brains do when we are asleep. Through such research efforts, an advanced understanding of memory and sleep may allow us to both make better use of our time asleep and take steps toward better health.

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.

Effects of preference and sensory modality on behavioural reaction in patients with disorders of consciousness

BACKGROUND

Reliable evaluation of patients with unresponsive wakefulness syndrome (UWS) or in a minimally conscious state (MCS) remains a major challenge. It has been suggested that the expression of residual cerebral function could be improved by allowing patients to listen to their favourite music. However, the potential effect of music on behavioural responsiveness, as well as the effect of preferred stimuli in other sensory modalities (e.g. olfaction), remain poorly understood.

OBJECTIVE

The aim of our study was to investigate the effect of sensory modality (auditory versus olfactory) and preference (preferred versus neutral) of the test stimuli on patients' subsequent performance on the Coma Recovery Scale-Revised (CRS-R).

RESEARCH DESIGN

Within-subject design because of inter-individual differences between patients.

METHODS AND PROCEDURES

We studied four items from the CRS-R (visual pursuit using a mirror, auditory localization of the own name and two movements to command) in 13 patients (7 MCS; 6 UWS).

MAIN OUTCOMES AND RESULTS

Auditory stimuli triggered higher responsiveness compared to olfactory stimuli, and preferred stimuli were followed by higher scores than did neutral stimuli.

CONCLUSIONS

Findings suggest that preferred auditory stimuli at the bedside contribute to the expression of residual function and could improve the diagnostic assessment.

Napping: A public health issue. From epidemiological to laboratory studies

Sleep specialists have proposed measures to counteract the negative short- and long-term consequences of sleep debt, and some have suggested the nap as a potential and powerful "public health tool". Here, we address this countermeasure aspect of napping viewed as an action against sleep deprivation rather than an action associated with poor health. We review the physiological functions that have been associated positively with napping in both public health and clinical settings (sleep-related accidents, work and school, and cardiovascular risk) and in laboratory-based studies with potential public health issues (cognitive performance, stress, immune function and pain sensitivity). We also discuss the circumstances in which napping-depending on several factors, including nap duration, frequency, and age-could be a potential public health tool and a countermeasure for sleep loss in terms of reducing accidents and cardiovascular events and improving sleep-restriction-sensitive working performance. However, the impact of napping and the nature of the sleep stage(s) involved still need to be evaluated, especially from the perspective of coping strategies in populations with chronic sleep debt, such as night and shift workers.

Subliminal messages exert long-term effects on decision-making

Subliminal manipulation is often considered harmless because its effects typically decay within a second. So far, subliminal long-term effects on behavior were only observed in studies which repeatedly presented highly familiar information such as single words. These studies suggest that subliminal messages are only slowly stored and might not be stored at all if they provide novel, unfamiliar information. We speculated that subliminal messages might affect delayed decision-making especially if messages contain several pieces of novel information that must be relationally bound in long-term memory. Relational binding engages the hippocampal memory system, which can rapidly encode and durably store novel relations. Here, we hypothesized that subliminally presented stimulus pairs would be relationally processed influencing the direction of delayed conscious decisions. In experiment 1, subliminal face–occupation pairs affected conscious decisions about the income of these individuals almost half an hour later. In experiment 2, subliminal presentation of vocabulary of a foreign language enabled participants to later decide whether these foreign words are presented with correct or incorrect translations. Subliminal influence did not significantly decay if probed after 25 versus 15 min. This is unprecedented evidence of the longevity and impact of subliminal messages on conscious, rational decision-making.

Circuitry of self-control and its role in reducing addiction

We discuss the idea that addictions can be treated by changing the mechanisms involved in self-control with or without regard to intention. The core clinical symptoms of addiction include an enhanced incentive for drug taking (craving), impaired self-control (impulsivity and compulsivity), negative mood, and increased stress re-activity. Symptoms related to impaired self-control involve reduced activity in control networks including anterior cingulate (ACC), adjacent prefrontal cortex (mPFC), and striatum. Behavioral training such as mindfulness meditation can increase the function of control networks and may be a promising approach for the treatment of addiction, even among those without intention to quit.