EEG and sleep in aged hospitalized patients with senile dementia: 24-h recordings

Polygraphic recordings of wake and sleep were performed on 10 partly bed-ridden, severely deteriorated patients with senile dementia. Compared with healthy elderly persons these subjects showed less SWS (slow wave sleep, characterized by high amplitude, slow EEG waves), less REM sleep (rapid eye movement sleep, usually accompanied by dream activity) and poorly organized stage 2 sleep (no sleep spindles, i.e. phasic EEG activity with a frequency of 12-14 Hz). Six of the 10 patients had no dominant alpha rhythm during wakefulness; this seemed to be related to their more deteriorated clinical state, to still less SWS and REM sleep and more time spent in stage 2. The basic NREM-REM cycle of sleep, i.e. the regular alternation between non-REM- and REM-periods, could still be distinguished, however, and showed similar average temporal characteristics as in healthy old and younger people. Similarly, although sleep was severely fragmented in most patients and many sleep episodes occurred during the day, the day-night alternation of wakefulness and sleep was maintained in the sample as a whole.     

Genetics of sleep and sleep disorders

Genetic factors affect sleep. Studies in twin pairs demonstrate that the strong hereditary influences on sleep architecture and some sleep disorders are transmitted through families. Evidence like this strongly suggests that sleep regulation receives significant influence from genetic factors. Although recent molecular technologies have revealed evidence that genetic traits or gene products trigger particular changes in sleep electroencephalogram activity, we are still far from finding candidate genes or multiple mutations responsible for individual sleep disorders. Sleep is a very complex phenotype. Genetic susceptibility and environmental factors should be also considered as contributors to sleep phenotype. The aim of this review is to present a current summary and future prospects for genetic studies on sleep and selected sleep-associated disorders. An erratum to this article is available at .     

Chronobiology of sleep in humans

Periodic circadian (24-h) cycles play an important role in daily hormonal and behavioural rhythms. Usually our sleep/wake cycle, temperature and melatonin rhythms are internally synchronized with a stable phase relationship. When there is a desynchrony between the sleep/wake cycle and circadian rhythm, sleep disorders such as advanced and delayed sleep phase syndrome can arise as well as transient chronobiologic disturbances, for example from jet lag and shift work. Appropriately timed bright light is effective in re-timing the circadian rhythm and sleep pattern to a more desired time, ameliorating these disturbances. Other less potent retiming effects may also be obtained from the judicious use of melatonin and exercise.     

Sleep in an Amazonian manatee, Trichechus inunguis.

For the first time, sleep was studied in a representative of the order of Sirenia. Slow wave sleep occupied 27%, and paradoxical sleep 1% of the total recording time in the Amazonian manatee. Trichechus inunguis. The circadian rhythmicity of sleep was pronounced. During the sleep period, the manatee woke up for a short time for each respiratory act. Interhemispheric asynchrony of the electrocortical slow wave activity was found.     

Experimental dissociation between hippocampal theta activity in wakefulness and hippocampal theta activity in paradoxal sleep in the rat]

The effects of electrolytic lesion of the septum on the theta activity of the dorsal hippocampus were studied in the chronically implanted Rat during wakefulness and paradoxical sleep. The experimental results show that depending on its localization, septal lesion can either: (1) eliminate the wakefulness theta rhythm without suppressing that of paradoxical sleep; (2) eliminate the paradoxical sleep theta rhythm without suppressing that of wakefulness. These results suggest that there are two kinds of theta activity having different anatomophysiological bases and a different functional significance: one associated with wakefulness and the other with paradoxical sleep.     

Sleep in an Amazonian manatee,Trichechus inunguis

For the first time, sleep was studied in a representative of the order of Sirenia. Slow wave sleep occupied 27%, and paradoxical sleep 1% of the total recording time in the Amazonian manatee,Trichechus inunguis. The circadian rhythmicity of sleep was pronounced. During the sleep period, the manatee woke up for a short time for each respiratory act. Interhemispheric asynchrony of the electrocortical slow wave activity was found.     

Sleep in the tortoiseKinosternon sp.

Summary Individuals ofKinosternon sp., previously confined to laboratory conditions, were chronically implanted with electrodes for electroencephalogram, electro-oculogram and electrocardiogram recording. Behavioral states of waking and sleep were clearly observed. Two sleep stages were present: quiet sleep and REM or active sleep. Electrical cerebral activity was polymorphic and irregular. EEG frequencies declined and amplitudes diminished with sleep. Arrhythmic spikes occurred during behavioral sleep and declined with waking. Heart rate decreased when passing from wakefulness to quiet sleep. It was slightly but consistently higher during active sleep compared with quiet sleep.     

The transcendental meditation technique, adrenocortical activity, and implications for stress.

The practice of the transcendental meditation technique in subjects eliciting this state regularly for 3--5 years is correlated with acute decline of adrenocortical activity not associated with sleep during the practice.     

Behavioral phenomenology of sleep (somatic and vegetative)

Conclusions The foregoing analysis of behavioral sleep phenomenology shows that the most significant factual and theoretical aspects of sleep can be logically organized only according to several criteria, it being impossible to choose a singli one as truly paradigmatic. For this reason an ordinal classification of sleep phases was preferred. This fact does not detract from the usefulness of classifications based consistently on 1 criterion at a time (e.g.: synchronized-desynchronized; quiet-active; orthodoxical-paradoxical; NREM-REM; homeostatic-poikilostatic; spindle wave-slow wave-fast wave; external appetitive-internal appetitive-internal consummatory; and so on). In this respect, the bioelectrical classification is surely the best as it allows an analytical subdivision of the evolution of sleep with high resolving power^137–139. In particular, the electroencephalographic activity of late phase II (stage 4 in man¹³⁹ and slow wave¹¹ or deep slow wave¹⁴⁰ sleep in the cat) appears to be related to the triggering mechanisms and to the quantitative regulation of the circadian amount of phase III^3,5,11,140. However, in extending the field of functional implications of sleep phenomenology other criteria may be more significant. In fact, the somatic and vegetative events of sleep also lend themselves to an analysis according to the behavioral model of ethology^6,141–144 and the theory of homeostasis^{3–5, 145}, respectively. As an example, a number of classifying criteria are indicated in the table, where others, particularly neurochemical ones^146,147, could be added. At any rate, the difficulty of organizing sleep events into a satisfactory operational scheme is due to the fact that sleep is still an open problem as far as its mechanisms and functional significance are concerned.     

The transcendental meditation technique,adrenocortical activity,and implications for stress

Summary The practice of the transcendental meditation technique in subjects eliciting this state regularly for 3–5 years is correlated with acute decline of adrenocortical activity not associated with sleep during the practice.     

Transport of the synthetic peptide DSIP through the blood-brain barrier in rabbit

The synthetic delta sleep inducing peptide (DSIP) passes the blood-brain barrier, since i.v. injection in free moving rabbits (30 nmoles/kg) significantly increases the cortical delta activity and decreases the motor activity during 5 h.     

Sleep disturbance due to transportation noise: ear plugs vs oral drugs

Conclusion Sleep is not only the output of an EEG machine but a global phenomenon with unique physiological, environmental and psychological features occurring in a given individual. There is no question that statistical evaluation of noise-induced sleep disturbances in non homogeneous groups of subjects has resulted in the construction of a magnificent neurophysiological edifice by assembling a few individual bricks. In this respect, whether subjectively disturbed or not, we now know that when we sleep in noisy areas our delta sleep is reduced, our heart rate fails to habituate to individual noises, and we are more likely to develop psychic disturbances than residents in quiet areas. Data from these studies are however interspersed with results from a number of experiments during which the subject has been looked upon as nothing but a sleeper, i.e., experiments in which day-time stresses and noises were considered as irrelevant for the night-time study. It seems important therefore that future studies should gather more longitudinal data based on a limited number of subjects selected according to their day-time habits and psychological (e.g., extroverts/introverts) and physiological (e.g., short or long sleepers) characteristics. The knowledge about these situational factors and personality traits might provide new insights into individual biological strategies developed to cope with noise stress. The difficulties in assessing the effect of noise on sleep are particularly obvious if we consider another finding: deaf subjects spend significantly less time in delta sleep than do control subjects⁴⁷ and they present sleep pattern alterations remarkably similar to those which are most consistently described in noisy conditions.Research by the authors has been supported by grants from the Ministère de la Qualité de la Vie et de l'Environnement (France) and Commission of European Communities.     

Human slow wave sleep: a review and appraisal of recent findings, with implications for sleep functions, and psychiatric illness.

Recent findings concerning human slow wave sleep (hSWS-stages 3 + 4; delta EEG activity) are critically reviewed. Areas covered include the significance of the first hSWS cycle; hSWS in extended sleep; relationship between hSWS, prior wakefulness and sleep loss; hSWS influence on sleep length; problems with hSWS deprivation; influence of the circadian rhythm; individual differences in hSWS, especially, age, gender and constitutional variables such as physical fitness and body composition. Transient increases in hSWS can be produced by increasing both the quality and quantity of prior wakefulness, with an underlying mechanism perhaps relating to the waking level of brain metabolism. Whilst there may also be thermoregulatory influences on hSWS, hypotheses that energy conservation and brain cooling are major roles for hSWS are debatable. hSWS seems to offer some form of cerebral recovery, with the prefrontal cortex being particularly implicated. The hSWS characteristics of certain forms of major psychiatric disorders may well endorse this prefrontal link.     

Human slow wave sleep: A review and appraisal of recent findings,with implications for sleep functions,and psychiatric illness

Recent findings concerning human slow wave sleep (hSWS-stages 3+4; delta EEG activity) are critically reviewed. Areas covered include the significance of the first hSWS cycle; hSWS in extended sleep; relationship between hSWS, prior wakefulness and sleep loss; hSWS influence on sleep length; problems with hSWS deprivation; influence of the circadian rhythm; individual differences in hSWS, especially, age, gender and constitutional variables such as physical fitness and body composition. Transient increases in hSWS can be produced by increasing both the quality and quantity of prior wakefulness, with an underlying mechanism perhaps relating to the waking level of brain metabolism. Whilst there may also be thermoregulatory influences on hSWS, hypotheses that energy conservation and brain cooling are major roles for hSWS are debatable. hSWS seems to offer some form of cerebral recovery, with the prefrontal cortex being particularly implicated. The hSWS characteristics of certain forms of major psychiatric disorders may well endorse this prefrontal link.     

Internal interactions within the human circadian system: the masking effect

In the realm of human circadian rhythms, the masking effect is defined as the change in the course of deep body temperature induced by changes in the degree of physical activity, or by the alteration between sleep and wake. This effect is particularly obvious during internal desynchronization where the rhythms of deep body temperature, and the sleep-wake sleep cycle - i.e. one of the masking factors - run with different periods. Every sleep onset is accompanied by a rapid drop, and wake onset by a rapid rise in deep body temperature, each one with an overshoot of about 50% of the steady state variations. When rhythms are calculated, with the dominant temperature period as the screening period, exclusively from data obtained during sleep episodes, on the one hand, and from those obtained exclusively during wake, on the other, two average cycles emerge: the 'sleep temperature curve' and the 'wake temperature curve'. Both run in parallel but are separated by the 'masking effect'. As derived from many experiments, the mean masking effect amounts to 0.28 +/- 0.06 degree C. The masking effect also depends to some extent on the phase of the temperature rhythm; it is larger than average around the temperature maximum and during the descending phase of the temperature cycle, where the alertness commonly is highest and the probability to sleep, in general, and the REM sleep propensity, in particular, are smaller than average. This also can be interpreted to indicate that the sleep temperature curve is phase advanced relative to the wake temperature curve; this, on the average, by 0.9 +/- 0.3 h. If the individually determined amount of masking is added to the temperature data obtained during sleep, or subtracted from the temperature data obtained during wake, a temperature curve emerges that can be thought of as being 'purified' of the masking effect. Analyses of this artificial curve allow estimation of that part of the internal interactions uninfluenced by the masking effect. On the average, about half of the amount of interaction between the rhythm of sleep-wake and that of deep body temperature is explained by the masking effect, whereas the other half is 'oscillatory interaction'. Both types of interaction are inherent and inseparable parts of the circadian clock mechanism, as can be deduced from model considerations.     

Memory processes during sleep: beyond the standard consolidation theory

Two-step theories of memory formation suggest that an initial encoding stage, during which transient neural assemblies are formed in the hippocampus, is followed by a second step called consolidation, which involves re-processing of activity patterns and is associated with an increasing involvement of the neocortex. Several studies in human subjects as well as in animals suggest that memory consolidation occurs predominantly during sleep (standard consolidation model). Alternatively, it has been suggested that consolidation may occur during waking state as well and that the role of sleep is rather to restore encoding capabilities of synaptic connections (synaptic downscaling theory). Here, we review the experimental evidence favoring and challenging these two views and suggest an integrative model of memory consolidation.     

Statistical relationship between "slow-wave sleep" and "paradoxical sleep" in rats]

In the Rat, statistical analysis of slow sleep (SS) and paradoxical sleep (PS) episodes disclosed two significant (p less than 0,01) positive correlations: (1) Over a four-hour period, the mean duration of PS episodes was correlated to the mean of the just preceding "light" SS episodes; (2) On the contrary, from cycle to cycle of sleep-wakefulness, the duration of each PS episode was correlated to that of the "light" SS episode of the next cycle.     

Proposed effects of brain noradrenaline on neuronal activity and cerebral blood flow during REM sleep.

We propose that the observed increases of both neuronal activity and cerebral blood flow seen throughout the brain during REM sleep may be effects of decreased central noradrenaline release.     

Proposed effects of brain noradrenaline on neuronal activity and cerebral blood flow during REM sleep

Summary We propose that the observed increases of both neuronal activity and cerebral blood flow seen throughout the brain during REM sleep may be effects of decreased central noradrenaline release.