Time-of-night variations in the story-like organization of dream experience developed during rapid eye movement sleep.

This study aimed to investigate the cycles (2nd/4th) and duration-related (5/10 min) variations in the story-like organization of dream experience elaborated during rapid eye movement (REM) sleep. Dream reports were analysed using story grammar rules. Reports were provided by those subjects (14 of 22) capable of reporting a dream after each of the four awakenings provoked in 2 consecutive nights during REM sleep of the 2nd and 4th cycles, after periods of either 5 or 10 min, counterbalanced across the nights. Two researchers who were blind as to the sleep condition scored the dream reports independently. The values of the indicators of report length (measured as value of total word count) and of story-like organization of dream reports were matched taking time-of-night (2nd and 4th cycles) and REM duration (5 versus 10 min) as factors. Two-way analyses of variance showed that report length increased significantly in 4th-cycle REM sleep and nearly significantly for longer REM duration, whereas the number of dream-stories per report did not vary. The indices of sequential (number of statements describing the event structure developed in the story) and hierarchical (number of episodes per story) organization increased significantly only in dream-stories reported after 10 min of 4th-cycle REM sleep. These findings indicate that the characteristics of structural organization of dream-stories vary along with time of night, and suggest that the elaboration of a long and complex dream-story requires a fairly long time and the availability of a great amount of cognitive resources to maintain its continuity and coherence.

Hippocampal slow EEG frequencies during NREM sleep are involved in spatial memory consolidation in humans.

The hypothesis that sleep is instrumental in the process of memory consolidation is currently largely accepted. Hippocampal formation is involved in the acquisition of declarative memories and particularly of spatial memories. Nevertheless, although largely investigated in rodents, the relations between spatial memory and hippocampal EEG activity have been scarcely studied in humans. Aimed to evaluate the effects of spatial learning on human hippocampal sleep EEG activity, we recorded hippocampal Stereo-EEG (SEEG) in a group of refractory epilepsy patients undergoing presurgical clinical evaluation, after a training on a spatial navigation task. We observed that hippocampal high-delta (2-4 Hz range) activity increases during the first NREM episode after learning compared to the baseline night. Moreover, the amount of hippocampal NREM high-delta power was correlated with task performance at retest. The effect involved only the hippocampal EEG frequencies inasmuch no differences were observed at the neocortical electrodes and in the traditional polysomnographic measures. The present findings support the crucial role of hippocampal slow EEG frequencies during sleep in the memory consolidation processes. More generally, together with previous results, they suggest that slow frequency rhythms are a fundamental characteristic of human hippocampal EEG during both sleep and wakefulness, and are related to the consolidation of different types of memories.

Processing of invisible social cues.

Successful interactions between people are dependent on rapid recognition of social cues. We investigated whether head direction--a powerful social signal--is processed in the absence of conscious awareness. We used continuous flash interocular suppression to render stimuli invisible and compared the reaction time for face detection when faces were turned towards the viewer and turned slightly away. We found that faces turned towards the viewer break through suppression faster than faces that are turned away, regardless of eye direction. Our results suggest that detection of a face with attention directed at the viewer occurs even in the absence of awareness of that face. While previous work has demonstrated that stimuli that signal threat are processed without awareness, our data suggest that the social relevance of a face, defined more broadly, is evaluated in the absence of awareness.

Can taking a nap during a night shift counteract the impairment of executive skills in residents?

OBJECTIVES: Long and repeated periods of sustained wakefulness constitute a serious problem for shift workers in general and for medical interns in particular. In a real clinical setting, we investigated whether taking a long nap can counteract the negative consequences of acute sleep deprivation on executive skills in residents. METHODS: Fifty-four interns at the Faculty of Medicine of the University of L'Aquila (Italy) participated in the study. Thirty-two participants who worked the night shift were assigned to a wake or nap group (WG, NG). The remaining 22 participants, who maintained regular diurnal working hours, were assigned to a control sleep group (SG). Each participant performed task switching and go/no-go tasks in three sessions, carried out on 3 consecutive days, to provide baseline and experimental (after the night shift [WG and NG]) data and data subsequent to having a normal night's sleep at home (SG) and subsequent to recovery (after a night's sleep at home). The dependent variables were submitted to a mixed-model analysis of variance (anova). RESULTS: After the night shift, SG and NG participants demonstrated better performance speed at task switching than WG participants. Moreover, WG participants showed lower accuracy throughout the study protocol compared with SG and NG participants. CONCLUSIONS: Taking a long nap proved to be effective in ameliorating the deterioration in executive skills that accompanies night shift-working in interns. This finding raises the two entwined issues of how long a nocturnal nap should be and when it should best occur in order to support the maintenance of an effective process of consolidation of new executive skills.

Recalling and forgetting dreams: theta and alpha oscillations during sleep predict subsequent dream recall.

Under the assumption that dream recall is a peculiar form of declarative memory, we have hypothesized that (1) the encoding of dream contents during sleep should share some electrophysiological mechanisms with the encoding of episodic memories of the awake brain and (2) recalling a dream(s) after awakening from non-rapid eye movement (NREM) and rapid eye movement (REM) sleep should be associated with different brain oscillations. Here, we report that cortical brain oscillations of human sleep are predictive of successful dream recall. In particular, after morning awakening from REM sleep, a higher frontal 5-7 Hz (theta) activity was associated with successful dream recall. This finding mirrors the increase in frontal theta activity during successful encoding of episodic memories in wakefulness. Moreover, in keeping with the different EEG background, a different predictive relationship was found after awakening from stage 2 NREM sleep. Specifically, a lower 8-12 Hz (alpha) oscillatory activity of the right temporal area was associated with a successful dream recall. These findings provide the first evidence of univocal cortical electroencephalographic correlates of dream recall, suggesting that the neurophysiological mechanisms underlying the encoding and recall of episodic memories may remain the same across different states of consciousness.

Slow EEG rhythms and inter-hemispheric synchronization across sleep and wakefulness in the human hippocampus.

Converging data that attribute a central role to sleep in memory consolidation have increased the interest to understand the characteristics of the hippocampal sleep and their relations with the processing of new information. Neural synchronization between different brain regions is thought to be implicated in long-term memory consolidation by facilitating neural communication and by promoting neural plasticity. However, the majority of studies have focused their interest on intra-hippocampal, rhinal-hippocampal or cortico-hippocampal synchronization, while inter-hemispheric synchronization has been so far neglected. To clarify the features of spontaneous human hippocampal activity and to investigate inter-hemispheric hippocampal synchronization across vigilance states, pre-sleep wakefulness and nighttime sleep were recorded from right and left homologous hippocampal loci using stereo-EEG techniques. Hence, quantitative and inter-hemispheric coherence analyses of hippocampal activity across sleep and waking states were carried out. The results showed the presence of delta activity in human hippocampal spontaneous EEG also during wakefulness. The activity in the delta range exhibited a peculiar bimodal distribution, namely a low frequency non-oscillatory activity (up to 2 Hz) synchronized between hemispheres mainly during wake and REM sleep, and a faster oscillatory rhythm (2-4 Hz). The latter was less synchronized between the hippocampi and seemed reminiscent of animal RSA (rhythmic slow activity). Notably, the low-delta activity showed high inter-hemispheric hippocampal coherence during REM sleep and, to a lesser extent, during wakefulness, paralleled by a (unexpected) decrease of coherence during NREM sleep. Therefore, low-delta hippocampal state-dependent synchronization starkly contrasts with neocortical behavior in the same frequency range. Further studies might shed light on the role of these low frequency rhythms in the encoding processes during wakefulness and in the consolidation processes during subsequent sleep.

Amygdala and hippocampus volumetry and diffusivity in relation to dreaming.

Microstructural analyses by MRI brain scans and by DTI analysis of MR images were used to investigate the possible relationship between deep gray matter structures (amygdala and hippocampus) and dreaming in healthy subjects. Thirty-four subjects ranging in age 20s to 70s underwent to a MRI protocol for the assessment of volume and mean diffusivity (MD) in the amygdala and hippocampus and were asked to fill out a dream diary via audiotape recording upon morning awakening for two weeks. Multiple regression analyses evaluated the relationships between anatomical measures and quantitative and qualitative measures of the reported dreams. The main result points to a dissociation between some quantitative and qualitative aspects of dream reports. While the mean number of dreams recalled per day did not show any significant relationship with the neuroanatomical measures, significant associations with some qualitative features of the recalled dreams (emotional load, bizarreness, and vividness) and, to some extent, with the length of dream reports were observed. Particularly, a higher MD of the left amygdala, reflecting a decreased microstructural integrity, was associated with shorter dream reports and lower scores on emotional load. Bizarreness of dream reports was negatively correlated with the left amygdala volume and positively correlated with the right amygdala MD. Some specific, although weaker, relationships were also found between bizarreness and hippocampal measures. These findings indicate some direct relationships between volumetric and ultrastructural measures of the hippocampus-amygdala complex and specific qualitative features of dreaming.

Judging health care priority in emergency situations: Patient facial appearance matters.

RATIONALE: Extensive research has shown that implicit trait inferences from facial appearance can bias everyday life in a pervasive way, influencing our decisions in different social contexts such as mate choice, political vote and criminal sentence. In situations characterized by time pressure and scant information, decisions based on inferences from facial appearance may have particularly critical and serious consequences, such as in emergency healthcare. No studies today have investigated this aspect in an actual emergency. OBJECTIVE: The aim of the present study was to go beyond this gap and to determine whether implicit inferences from patients' facial appearance could be predictive of disparities in clinical evaluations and priority of treatment. METHODS: In total, 183 cases of patients were evaluated by independent judges at zero acquaintance on the basis of different implicit facial appearance-based inferences, including trustworthiness and distress. Color-based priority code (White, Green, or Yellow) attributed by the triage nurse at the end of the registration process were recorded. RESULTS: Our results showed that more trustworthy- and distressed- looking patients' faces have been associated with a higher priority code. CONCLUSIONS: The present study shows that specific facial appearance-based inferences influence the attribution of priority code in healthcare that require quick decisions based on scarce clinical information such as in emergency. These results suggest the importance to bring to the attention of the healthcare professionals' the possibility of being victims of implicit inferences, and prompt to design educational interventions capable to increase their awareness of this bias in clinical evaluation.

Dream Generation and Recall in Daytime NREM Sleep of Patients With Narcolepsy Type 1.

The less rigid architecture of sleep in patients with narcolepsy type 1 (NT1) compared with healthy subjects may provide new insights into some unresolved issues of dream experience (DE), under the assumption that their DE frequencies are comparable. The multiple transition from wakefulness to REM sleep (sleep onset REM period: SOREMP) during the five trials of the Multiple Sleep Latency Test (MSLT) appears of particular interest. In MSLT studies, NT1 patients reported a DE after about 80% of SOREMP naps (as often as after nighttime REM sleep of themselves and healthy subjects), but only after about 30% of NREM naps compared to 60% of daytime and nighttime NREM sleep of healthy subjects. To estimate accurately the "real" DE frequency, we asked participants to report DE ("dream") after each MSLT nap and, in case of failure, to specify if they were unable to retrieve any content ("white dream") or DE did not occur ("no-dream"). The proportions of dreams, white dreams, and no dreams and the indicators of structural organization of DEs reported after NREM naps by 17 adult NT1 patients were compared with those reported by 25 subjects with subjective complaints of excessive daytime sleepiness (sc-EDS), who take multiple daytime NREM naps. Findings were consistent with the hypothesis of a failure in recall after awakening rather than in generation during sleep: white dreams were more frequent in NT1 patients than in sc-EDS subjects (42.86 vs 17.64%), while their frequency of dreams plus white dreams were similar (67.86 and 61.78%) and comparable with that of NREM-DEs in healthy subjects. The longer and more complex NREM-DEs of NT1 patients compared with sc-EDS subjects suggest that the difficulty in DE reporting depends on their negative attitude toward recall of contents less vivid and bizarre than those they usually retrieve after daytime SOREMP and nighttime REM sleep. As this attitude may be reversed by some recall training before MSLT, collecting wider amounts of DE reports after NREM naps would cast light on both the across-stage continuity in the functioning of cognitive processes underlying DE and the difference in content and structural organization of SOREM-DEs preceded by N1 or also N2 sleep.

Structural organization of dream experience during daytime sleep-onset rapid eye movement period sleep of patients with narcolepsy type 1.

STUDY OBJECTIVE: To assess the frequency of dream experience (DE) developed during naps at Multiple Sleep Latency Test (MSLT) by patients with narcolepsy type 1 (NT1) and establish, using story-grammar analysis, the structural organization of DEs developed during naps with sleep onset rapid eye movement (REM) period (SOREMP) sleep compared with their DEs during early- and late-night REM sleep. METHODS: Thirty drug-free cognitively intact adult NT1 patients were asked to report DE developed during each MSLT nap. Ten NT1 patients also spent voluntarily a supplementary night being awakened during the first-cycle and third-cycle REM sleep. Patients provided dream reports, white dreams, and no dreams, whose frequencies were matched in naps with SOREMP versus non-REM (NREM) sleep. All dream reports were then analyzed using story-grammar rules. RESULTS: DE was recalled in detail (dream report) by NT1 patients after 75% of naps with SOREMP sleep and after 25% of naps with NREM sleep. Dream reports were provided by 8 out of 10 NT1 patients after both awakenings from nighttime REM sleep. Story-grammar analysis of dream reports showed that SOREMP-DEs are organized as hierarchically ordered sequences of events (so-called dream-stories), which are longer and more complex in the first and fourth SOREMP naps and are comparable with nighttime REM-DEs. CONCLUSIONS: The similar structural organization of SOREMP-DEs with nighttime REM-DEs indicates that their underlying cognitive processes are highly, albeit not uniformly, effective during daytime SOREMP sleep. Given the peculiar neurophysiology of SOREMP sleep, investigating SOREMP-DEs may cast further light on the relationships between the neurophysiological and psychological processes involved in REM-dreaming.

Sleep and time course of consolidation of visual discrimination skills in patients with narcolepsy-cataplexy.

The level of procedural skills improves in normal individuals when the acquisition is followed by a period of sleep rather than wake. If sleep plays an important role in the consolidation process the advantage it provides should be reduced or delayed when its organization is altered, as in patients with chronic sleep disorders. To test this prediction in patients with narcolepsy-cataplexy (NC), who usually have a more fragmented organization of sleep than normals, we compared the initial, intermediate and delayed level of consolidation of visual skills. Twenty-two drug-naive NC patients and 22 individually-matched controls underwent training at a texture discrimination task (TDT) and were re-tested on the next morning (after a night spent in laboratory with polysomnography) and after another six nights (spent at home). TDT performance was worse in patients than controls at training and at both retrieval sessions and the time course of consolidation was different in NC patients (who improved mainly from next-day to 7th-day retrieval session) compared with controls. Moreover, the less-improving patients at next-day retrieval had a wider disorganization of sleep, probably because of an episode of rapid eye movement (REM) sleep at sleep onset REM, on post-training night more frequently than more-improving patients. These findings suggest that the time course of the consolidation process of procedural skills may be widely influenced by the characteristics of sleep organization (varying night-by-night much more in NC patients than controls) during post-training night.

Cortical activation during sleep predicts dream experience in narcolepsy.

Objective: Narcolepsy type 1 widely affects the architecture of sleep with frequent fast transition to REM sleep at both nighttime and daytime sleep onset. The occurrence of repeated sleep onset REM periods over the Multiple Sleep Latency Test offers a unique opportunity to identify EEG patterns predictive of successful dream recall after short periods composed of only REM or NREM sleep. It also permits to disentangle state- from trait-like differences in dream recall, by using a within-subjects design. Methods: A consecutive series of 115 first-diagnosed drug-free adult narcolepsy-type 1 patients underwent Multiple Sleep Latency Tests and were asked after each nap opportunity if they had or had not a dream experience. Scalp EEG power and a specific index of cortical activation (delta/beta power ratio), obtained from naps of 43 patients with both presence and absence of dream recall in the same sleep stage, were compared separately for REM and NREM sleep. Results: Successful dream recall was associated with an increased EEG desynchronization in both REM and NREM over partially overlapping cortical areas. Compared to unsuccessful recall, it showed (1) lower delta power over centro-parietal areas during both stages, (2) higher beta power in the same cortical areas during NREM, and (3) lower values in the delta/beta ratio during NREM in most scalp locations. Interpretation: A more activated electrophysiological milieu in both REM and NREM sleep promotes dream recall, strengthening the notion that the parietal areas are crucial not only in generating dream experience, as shown in brain-damaged patients, but also in the memory processing leading to recall.

Searching for a marker of REM sleep behavior disorder: submentalis muscle EMG amplitude analysis during sleep in patients with narcolepsy/cataplexy.

STUDY OBJECTIVES: To evaluate the amplitude of submentalis muscle EMG activity during sleep in patients with narcolepsy/cataplexy with or without REM sleep behavior disorder (RBD). DESIGN: Observational study with consecutive recruitment. SETTINGS: Sleep laboratory. PATIENTS: Thirty-four patients with narcolepsy/cataplexy and 35 age-matched normal controls. MEASUREMENTS AND RESULTS: Half the patients (17 subjects) had a clinical and video polysomnographic diagnosis of RBD. The average amplitude of the rectified submentalis muscle EMG signal was used to assess muscle atonia, and the new REM sleep Atonia Index was computed. Chin muscle activations were detected and their duration and interval analyzed. REM sleep Atonia Index was lower in both patient groups (with narcolepsy patients with RBD showing the lowest values) with respect to controls, and it did not correlate with age as it did in controls. The total number of chin EMG activations was significantly higher in both patient groups than controls. No significant differences were found between the two groups of patients, although more chin EMG activations were noted in narcolepsy patients with RBD than those without. CONCLUSIONS: Elevated muscle activity during REM sleep is the only polysomnographic marker of RBD. This study shows that polysomnographically evident RBD is present in many patients with narcolepsy/ cataplexy. This condition might be specific to narcolepsy/cataplexy, reflecting a peculiar form of REM sleep related motor dyscontrol (i.e., status dissociatus), paving the way to enacting dream behaviors, and correlated with the specific neurochemical and neuropathological substrate of narcolepsy/cataplexy.

Clinical, behavioural and polysomnographic correlates of cataplexy in patients with narcolepsy/cataplexy.

BACKGROUND: Cataplexy is the main motor symptom of narcolepsy/cataplexy and is considered a form of rapid eye movement (REM) sleep motor dyscontrol appearing during wakefulness and elicited by emotions. This study examined the relationship between the frequency of cataplectic attacks in patients with narcolepsy/cataplexy and (a) the clinical and behavioural characteristics of cataplectic attacks, including the emotional tone of trigger events, and (b) the polysomnographic characteristics of daytime sleepiness, nocturnal sleep structure and indices of motor disorders during sleep. METHODS: A consecutive series of 44 first-diagnosed drug-naive patients with narcolepsy/cataplexy, fulfilling the International Classification of Sleep Disorders, 2nd edition (ICSD-2) clinical and polysomnographic diagnostic criteria, were interviewed to estimate the frequency and clinical characteristics of cataplectic attacks and the occurrence of REM sleep behaviour disorder (RBD). All patients also underwent a video-polysomnographic recording to assess their sleep parameters and indices of altered motor control during sleep. RESULTS: Patients were divided into two groups on the basis of the frequency of cataplectic attacks, namely high-frequency (n=30) or low-frequency (n=14) depending on whether they estimated they had more or less than one attack per month. High-frequency patients (with a larger proportion of men) reported attacks more often affecting mainly the head, jaw and shoulder muscles and experienced more events among those listed as possible triggers of attacks. Sixty-one percent of patients reported RBD and 43% had an RBD episode at video-polysomnography regardless of the frequency of cataplectic attacks or gender. Lastly, the frequency of periodic leg movements (PLM) per hour was higher in men than women and increased with age. CONCLUSIONS: Patients with more than one cataplectic attack per month had more frequent involvement of head, jaw and shoulder muscles and were mainly men. The proportions of patients with clinically assessed RBD and an RBD episode documented by video-polysomnography, as well as conspicuous values of PLM per hour, are fairly consistent with those reported in recent small-group studies. Therefore, it seems legitimate to argue that RBD and PLM are nocturnal manifestations intrinsic to narcolepsy/cataplexy and that the gender-related differences in the frequency of attacks and the value of PLM per hour may be indicative of a larger difference in the clinical and polysomnographic characteristics of narcolepsy/cataplexy than hitherto suspected.

Beyond the neuropsychology of dreaming: Insights into the neural basis of dreaming with new techniques of sleep recording and analysis.

Recent advances in electrophysiological [e.g., surface high-density electroencephalographic (hd-EEG) and intracranial recordings], video-polysomnography (video-PSG), transcranial stimulation and neuroimaging techniques allow more in-depth and more accurate investigation of the neural correlates of dreaming in healthy individuals and in patients with brain-damage, neurodegenerative diseases, sleep disorders or parasomnias. Convergent evidence provided by studies using these techniques in healthy subjects has led to a reformulation of several unresolved issues of dream generation and recall [such as the inter- and intra-individual differences in dream recall and the predictivity of specific EEG rhythms, such as theta in rapid eye movement (REM) sleep, for dream recall] within more comprehensive models of human consciousness and its variations across sleep/wake states than the traditional models, which were largely based on the neurophysiology of REM sleep in animals. These studies are casting new light on the neural bases (in particular, the activity of dorsal medial prefrontal cortex regions and hippocampus and amygdala areas) of the inter- and intra-individual differences in dream recall, the temporal location of specific contents or properties (e.g., lucidity) of dream experience and the processing of memories accessed during sleep and incorporated into dream content. Hd-EEG techniques, used on their own or in combination with neuroimaging, appear able to provide further important insights into how the brain generates not only dreaming during sleep but also some dreamlike experiences in waking.

Sleep habits, circadian preference, and school performance in early adolescents.

OBJECTIVE: This study aimed to cast light on the relationships between sleep habits, perceived sleep problems and school performance in Evening-type (E-type) compared with Morning-type (M-type) early adolescents. METHODS: Comparison of questionnaire data of E-type and M-type adolescents random-selected from a large sample of eight-grade adolescents who took part in a national survey of competence in mathematics and science. RESULTS: The proportions of sleep problems that were observed to occur more than once per week and the frequency of struggling to fall asleep and/or falling asleep in distinct everyday situations were much higher in E-type than in M-type adolescents. Moreover, E-type adolescents showed more disturbed and poorer sleep during both school and weekend days and reported lower grades in mathematics, science and Italian. CONCLUSIONS: E-type adolescents showed a partial recovery of sleep debt during weekend days. This finding suggests that they could improve their school performance if tests and classwork would be scheduled on their most alert school days, namely the post-weekend ones.

Familiarity facilitates feature-based face processing.

Recognition of personally familiar faces is remarkably efficient, effortless and robust. We asked if feature-based face processing facilitates detection of familiar faces by testing the effect of face inversion on a visual search task for familiar and unfamiliar faces. Because face inversion disrupts configural and holistic face processing, we hypothesized that inversion would diminish the familiarity advantage to the extent that it is mediated by such processing. Subjects detected personally familiar and stranger target faces in arrays of two, four, or six face images. Subjects showed significant facilitation of personally familiar face detection for both upright and inverted faces. The effect of familiarity on target absent trials, which involved only rejection of unfamiliar face distractors, suggests that familiarity facilitates rejection of unfamiliar distractors as well as detection of familiar targets. The preserved familiarity effect for inverted faces suggests that facilitation of face detection afforded by familiarity reflects mostly feature-based processes.

Consolidation effect of repeated processing of declarative knowledge in mental experiences during human sleep.

Sleep may positively influence declarative memory through the processing, which transforms items of declarative knowledge into contents of mental sleep experience (MSE). A prediction from this general hypothesis is that the consolidation level should be higher for the output of items repeatedly processed and transformed into identical or very similar (so-called interrelated) contents of distinct MSEs of the same night rather than for the output of items presumably processed once (that is, all other, non-interrelated contents). Two experiments examined whether and how far the frequency and long-term retention of interrelated contents depend on the repeated processing of given items rather than on the experimental procedure applied for detection of interrelated contents. This procedure entails both multiple awakenings and a verbal report of MSE after awakening. Multiple awakenings could facilitate the re-access and elaboration of some contents into the subsequent (i.e. contiguous) MSE rather than non-contiguous MSEs; verbal reports could enhance the delayed recall of interrelated contents in as much as repeatedly encoded. The first experiment showed that interrelated contents were more frequent and better retained than both non-interrelated and pseudo-interrelated (i.e. by-chance similar or identical) contents, and even more in pairs of contiguous than non-contiguous MSEs collected from the first four periods of REM sleep on each experimental night. The second experiment showed that the frequency and retention rate of interrelated contents, while higher than those of non-interrelated and pseudo-interrelated contents, were not significantly different in pairs of MSEs which were verbally or mentally recalled after awakening provoked during the first four periods of REM sleep in each experimental night. Taken together, these findings indicate that the advantage provided by repeated processing during REM sleep for the consolidation of the output of items of declarative knowledge is conspicuous and largely independent from the experimental procedure, as this only slightly enhances the frequency and retention rate of interrelated contents.

Semantic priming effect during REM-sleep inertia in patients with narcolepsy.

Patients with narcolepsy-cataplexy (NC) present excessive daytime sleepiness (EDS), cataplexy and an altered architecture of nocturnal sleep, with frequent episodes of REM-sleep at sleep onset (SOREM-sleep). This altered organization of nocturnal sleep may be accompanied by some differences in the functioning of the cognitive processes involved in the access, organization and consolidation of information during sleep. This study attempts to ascertain whether the activation of semantic memory during REM-sleep, as measured using a technique of semantic priming (namely, the facilitation of the activation of strongly-related rather than weakly-related and, overall, unrelated pairs of prime-target words) is different in NC patients compared to normal subjects. A lexical decision task (LDT) was carried out twice in wakefulness (at 10a.m. and after a 24h interval) and twice in the period of sleep inertia following awakening from SOREM and 4th-cycle REM-sleep on 12 NC patients and from 1st- and 4th-cycle REM-sleep on 12 matched controls. Reaction time (RT) to target words, taken as a measure of the semantic priming effect, proved to be longer (a) in NC patients than in control subjects; (b) in the period of REM-sleep inertia than in wakefulness; (c) in the first rather than the second session; and (d) for unrelated compared to weakly-related and, overall, strongly-related prime-target pairs. RT in post-REM-sleep sessions was less impaired, compared to waking sessions, and less dependent on the associative strength of prime-target pairs in NC patients than in normal subjects. Finally, RT of NC patients, although longer than that of normal subjects in waking sessions, significantly improved in the second session, as a consequence of either the amount of exercise or the consolidation advantage provided by REM-sleep for the procedural components of the task. The whole picture suggests a greater effectiveness of the activation of semantic memory during (SO)REM-sleep in NC patients rather than in normal subjects, and overall for the organization of new and unexpected relationships (such as those between unrelated pairs) between items of information.

Consolidation effect of the processing of declarative knowledge during human sleep: evidence from long-term retention of interrelated contents of mental sleep experiences.

Sleep may partly exert a positive influence on memory through the processing underlying the transformation of items of declarative knowledge into contents of mental sleep experience (MSE). This hypothesis implies that the level of consolidation (and thus, long-term retention) should be enhanced for those items which are repeatedly processed and transformed into identical or very similar (so-called interrelated) contents of distinct MSEs developed over the same night. To test this prediction, we examined accessibility at delayed recall (i.e., the next morning) of the interrelated contents of MSEs reported (immediate recall) by 14 subjects who were awakened during the first four periods of rapid eye-movement (REM) sleep in two experimental nights. Interrelated contents were much more frequent, and at delayed recall much better retained, than other, non-interrelated contents in report pairs of MSEs. Moreover, they were also more frequent and better retained than by-chance similar or identical contents, as estimated in report pairs of MSEs of different subjects. These findings provide partial but coherent evidence in favour of the hypothesis that a generation effect occurs during sleep, with a further consolidation of the input and the output of MSE processing (respectively, the items of declarative knowledge and the contents of MSEs resulting from their elaboration during sleep).