Predicting Dream Recall: EEG Activation During NREM Sleep or Shared Mechanisms with Wakefulness?

Consciousness and sleep

Sleep is a universal, essential biological process. It is also an invaluable window on consciousness. It tells us that consciousness can be lost but also that it can be regained, in all its richness, when we are disconnected from the environment and unable to reflect. By considering the neurophysiological differences between dreaming and dreamless sleep, we can learn about the substrate of consciousness and understand why it vanishes. We also learn that the ongoing state of the substrate of consciousness determines the way each experience feels regardless of how it is triggered-endogenously or exogenously. Dreaming consciousness is also a window on sleep and its functions. Dreams tell us that the sleeping brain is remarkably lively, recombining intrinsic activation patterns from a vast repertoire, freed from the requirements of ongoing behavior and cognitive control.

Cortical hyperarousal in individuals with frequent nightmares

Nightmares are common among the general population and psychiatric patients and have been associated with signs of nocturnal arousal such as increased heart rate or increased high-frequency electroencephalographic (EEG) activity. However, it is still unclear, whether these characteristics are more of a trait occurring in people with frequent nightmares or rather indicators of the nightmare state. We compared participants with frequent nightmares (NM group; n = 30) and healthy controls (controls; n = 27) who spent 4 nights in the sleep laboratory over the course of 8 weeks. The NM group received six sessions of imagery rehearsal therapy (IRT), the 'gold standard' of cognitive-behavioural therapy for nightmares, between the second and the third night. Sleep architecture and spectral power were compared between groups, and between nights of nightmare occurrence and nights without nightmare occurrence in the NM group. Additionally, changes before and after therapy were recorded. The NM group showed increased beta (16.25-31 Hz) and low gamma (31.25-35 Hz) power during the entire night compared to the controls, but not when comparing nights of nightmare occurrence to those without. Moreover, low gamma activity in rapid eye movement sleep was reduced after therapy in the NM group. Our findings indicate, cortical hyperarousal is more of a trait in people with frequent nightmares within a network of other symptoms, but also malleable by therapy. This is not only a new finding for IRT but could also lead to improved treatment options in the future that directly target high-frequency EEG activity.

Morning naps architecture and mentation recall complexity

Mentation reports were collected after spontaneous awakenings from morning naps in 18 healthy participants, and associations between sleep stages duration and complexity of recalled mentation were investigated. Participants were continuously recorded with polysomnography and allowed to sleep for a maximum of 2 hr. Mentation reports were classified according to both their complexity (1-6 scale) and their perceived timing of occurrence (Recent or Previous Mentation with respect to the final awakening). The results showed a good level of mentation recall, including different types of mentation with lab-related stimuli. N1 + N2 duration was positively related to the complexity of Previous Mentation recall, while rapid eye movement sleep duration was negatively related. This suggests that the recall of complex mentation, such as dreaming with a plot, occurring far from awakening may depend on the length of N1 + N2. However, the duration of sleep stages did not predict the complexity of Recent Mentation recall. Nevertheless, 80% of participants who recalled Recent Mentation had a rapid eye movement sleep episode. Half of the participants reported incorporating lab-related stimuli in their mentation, which positively correlated with both N1 + N2 and rapid eye movement duration. In conclusion, nap sleep architecture is informative about the complexity of dreams perceived as having occurred early during the sleep episode, but not about those perceived as recent.

Longitudinal Findings on the Oneiric Activity Changes Across the Pandemic

Purpose

COVID-19 pandemic waves have strongly influenced individuals' behaviors and mental health. Here, we analyzed longitudinal data collected in the Spring 2020 and 2021 from a large Italian sample with the aim of assessing changes in dream features between the first and third wave. Specifically, we evaluated the modifications of pandemic dream activity as a function of the general distress variations over time. Also, we detected the best explanatory variables of nightmare frequency and distress.

Materials and Methods

Participants previously involved in the web survey during the first wave of the pandemic were asked to complete a new online survey on sleep and dream features available in Spring 2021 (N=728). Subjects decreasing their level of psychological general distress in the third (T3) vs the first (T1) pandemic wave were defined as "Improved" (N=330). In contrast, participants with an unchanged or increased level of general distress were defined as "Not Improved" (N=398).

Results

Statistical comparisons revealed that dream recall frequency, nightmare frequency, lucid dream frequency, and emotional intensity show a reduction in T3 than T1. Moreover, the Improved group is characterized by lower nightmare rate and nightmare distress than Not Improved people. Our findings confirmed that beyond the trait-like variables (ie, age, sex), specific sleep-related measures are related to nightmare features. In particular, poor sleep hygiene was one of the best determinants of nightmare distress among Not Improved subjects.

Conclusion

Our findings revealed that people experienced an adaptation to the pandemic during the third wave. We also strengthen the notion that nightmares and their variations over time are strongly related to human well-being, suggesting that specific trait-like and sleep-related factors could modulate the relationship between mental health and nightmare features.

The route to recall a dream: theoretical considerations and methodological implications

The goal of this paper is to shed new light on the relation between dream recall and dream experiences by providing a thorough analysis of the process that leads to dream reports. Three crucial steps of this process will be distinguished: dream production (the generation of a conscious experience during sleep), dream encoding (storing a trace of this experience in memory) and dream retrieval (accessing the memory trace upon awakening). The first part of the paper will assess how major theories think about the relationship between dream reports and these distinct steps. The second part will systematise how trait and state factors affecting dream recall-given different theoretical assumptions-might interact with dream production, encoding and retrieval. Understanding how the distinct steps of dream recall can be modulated by different factors is crucial for getting a better grip on how to acquire information about these steps empirically and for drawing methodological conclusions with regard to the tools dream research relies on to collect subjective data about dream experiences. The third part of the paper will analyse how laboratory reports, logs and retrospective scales interact with the different factors that affect the distinct steps leading to dream reports and will argue that prospective methods provide more direct access to data regarding dream production and encoding than retrospective methods, which-due to their inability to provide systematic control over the factors affecting the retrieval stage-screen-off the variability in the production and the encoding of dreams.

Dreaming during the COVID-19 pandemic: A narrative review

According to several influential models, dreams can be affected by state- and trait-like factors, sleep features, and diurnal experiences. The COVID-19 pandemic globally affected daily habits, emotional experiences, and sleep. Previous studies suggested an influence of collective traumatic events on dreaming. Starting from these premises, several studies assessed the effect of the pandemic on dreams. This paper aims to review findings concerning the oneiric activity during the COVID-19 pandemic. We report pandemic-related changes in dreams and nightmares, and we consider the possible factors associated with dreaming. Moreover, we provide results about changes in the oneiric activity in different phases of the pandemic. The reviewed findings suggest a pandemic-related enhancement of dream and nightmare frequency, emotional intensity, and distressing contents, modulated by modifications in restrictive measures and associated with diurnal experiences, emotional status, and sleep pattern. We highlight several methodological issues and a large heterogeneity in the present literature, limiting results’ generalizability. However, we provide possible interpretations of the most consistent findings in light of the main theoretical frameworks about dreaming.

The vision of dreams: from ontogeny to dream engineering in blindness

The mechanisms involved in the origin of dreams remain one of the great unknowns in science. In the 21st century, studies in the field have focused on 3 main topics: functional networks that underlie dreaming, neural correlates of dream contents, and signal propagation. We review neuroscientific studies about dreaming processes, focusing on their cortical correlations. The involvement of frontoparietal regions in the dream-retrieval process allows us to discuss it in light of the Global Workspace theory of consciousness. However, dreaming in distinct sleep stages maintains relevant differences, suggesting that multiple generators are implicated. Then, given the strong influence of light perception on sleep regulation and the mostly visual content of dreams, we investigate the effect of blindness on the organization of dreams. Blind individuals represent a worthwhile population to clarify the role of perceptual systems in dream generation, and to make inferences about their top-down and/or bottom-up origin. Indeed, congenitally blind people maintain the ability to produce visual dreams, suggesting that bottom-up mechanisms could be associated with innate body schemes or multisensory integration processes. Finally, we propose the new dream-engineering technique as a tool to clarify the mechanisms of multisensory integration during sleep and related mental activity, presenting possible implications for rehabilitation in sensory-impaired individuals. The Theory of Proto-consciousness suggests that the interaction of brain states underlying waking and dreaming ensures the optimal functioning of both. Therefore, understanding the origin of dreams and capabilities of our brain during a dreamlike state, we could introduce it as a rehabilitative tool.

CITATION

Vitali H, Campus C, De Giorgis V, Signorini S, Gori M. The vision of dreams: from ontogeny to dream engineering in blindness. J Clin Sleep Med. 2022;18(8):2051-2062.

What about dreams? State of the art and open questions

Several studies have tried to identify the neurobiological bases of dream experiences, nevertheless some questions are still at the centre of the debate. Here, we summarise the main open issues concerning the neuroscientific study of dreaming. After overcoming the rapid eye movement (REM) ‐ non‐REM (NREM) sleep dichotomy, investigations have focussed on the specific functional or structural brain features predicting dream experience. On the one hand, some results underlined that specific trait‐like factors are associated with higher dream recall frequency. On the other hand, the electrophysiological milieu preceding dream report upon awakening is a crucial state‐like factor influencing the subsequent recall. Furthermore, dreaming is strictly related to waking experiences. Based on the continuity hypothesis, some findings reveal that dreaming could be modulated through visual, olfactory, or somatosensory stimulations. Also, it should be considered that the indirect access to dreaming remains an intrinsic limitation. Recent findings have revealed a greater concordance between parasomnia‐like events and dream contents. This means that parasomnia episodes might be an expression of the ongoing mental sleep activity and could represent a viable direct access to dream experience. Finally, we provide a picture on nightmares and emphasise the possible role of oneiric activity in psychotherapy. Overall, further efforts in dream science are needed (a) to develop a uniform protocol to study dream experience, (b) to introduce and integrate advanced techniques to better understand whether dreaming can be manipulated, (c) to clarify the relationship between parasomnia events and dreaming, and (d) to determine the clinical valence of dreams.

The Oneiric Activity during and after the COVID-19 Total Lockdown in Italy: A Longitudinal Study

A growing body of evidence highlights that the COVID-19 pandemic affected oneiric activity. However, only a few studies have assessed the longitudinal changes in dream phenomenology during different phases of the pandemic, often focused on a limited number of dream variables. The aim of the present study was to provide an exhaustive assessment of dream features during total lockdown (TL) and a post-lockdown (PL) period characterized by eased restrictive measures in Italy. We performed a longitudinal study using a web-based survey to collect demographic, COVID-19 related, clinical, sleep, and dream data at TL and PL. Our final sample included 108 participants. The high frequency of poor sleep quality, anxiety, and depressive symptoms observed during TL remained stable at PL, while sleep latency (t = −4.09; p < 0.001) and PTSD-related disruptive nocturnal behaviors (t = −5.68; p < 0.001) exhibited a reduction at PL. A PL decrease in time spent with digital media was observed (t = −2.77; p = 0.007). We found a strong PL reduction in dream frequency (t = −5.49; p < 0.001), emotional load (t = −2.71; p = 0.008), vividness (t = −4.90; p < 0.001), bizarreness (t = −4.05; p < 0.001), length (t = −4.67; p < 0.001), and lucid dream frequency (t = −2.40; p = 0.018). Fear was the most frequently reported emotion in dreams at TL (26.9%) and PL (22.2%). Only the frequency of specific lockdown-related dream contents exhibited a reduction at PL. These findings highlight that the end of the home confinement had a strong impact on the oneiric activity, in the direction of reduced dream frequency, intensity, and lockdown-related contents. The co-occurrence of such changes with a decline in nocturnal PTSD-related symptoms, sleep latency, and time with digital media suggests an influence of post-traumatic stress levels, lifestyle modifications, and sleep pattern on dream changes during different phases of the pandemic. The stable prevalence of fear in dreams and the large frequency of poor sleep quality, depressive symptoms, and anxiety are probably related to the persistence of many negative consequences of the pandemic. Overall, these results are consistent with the continuity hypothesis of dreams.

Midline EEG Functional Connectivity As Biomarker for Conscious States in Sleep and Wakefulness

Functional connectivity (FC) between different cortical regions of the brain has long been hypothesized to be necessary for conscious states in several modeling and empirical studies. The work presented herein estimates the FC between two bipolar midline electroencephalogram (EEG) recordings to evaluate its utility in discriminating consciousness levels across wakefulness and sleep. Consciousness levels were defined as Low, Medium, and High depending upon the ability of a subject to self-report their experiences at a later stage. The sleep EDF [expanded] dataset available in the Physionet data repository was used for analyses. FC was estimated using the debiased estimator of the squared Weighted Phase Lag Index (dWPLI2) metric. A total of 40 features extracted from the FC spectra for 10 EEG sub-bands were considered. FC trends demonstrated the highest alpha synchrony in the 'Low' conscious state. While the 'Medium' conscious state demonstrated superior phase synchronization in the low-gamma band, the 'High' conscious state was characterized by comparatively lower phase synchronization in all frequency bands. A Multi-Layer Perceptron (MLP) framework using a combination of 7 features yielded the highest cross-validation accuracy of 95.15% in distinguishing these conscious states. The study results provide a pertinent validation for the hypothesis that midline EEG FC is a reliable and robust signature of conscious states in sleep and wakefulness.

Investigation on Neurobiological Mechanisms of Dreaming in the New Decade

Dream research has advanced significantly over the last twenty years, thanks to the new applications of neuroimaging and electrophysiological techniques. Many findings pointed out that mental activity during sleep and wakefulness shared similar neural bases. On the other side, recent studies have highlighted that dream experience is promoted by significant brain activation, characterized by reduced low frequencies and increased rapid frequencies. Additionally, several studies confirmed that the posterior parietal area and prefrontal cortex are responsible for dream experience. Further, early results revealed that dreaming might be manipulated by sensory stimulations that would provoke the incorporation of specific cues into the dream scenario. Recently, transcranial stimulation techniques have been applied to modulate the level of consciousness during sleep, supporting previous findings and adding new information about neural correlates of dream recall. Overall, although multiple studies suggest that both the continuity and activation hypotheses provide a growing understanding of neural processes underlying dreaming, several issues are still unsolved. The impact of state-/trait-like variables, the influence of circadian and homeostatic factors, and the examination of parasomnia-like events to access dream contents are all opened issues deserving further deepening in future research.

Pandemic dreams: quantitative and qualitative features of the oneiric activity during the lockdown due to COVID-19 in Italy

Objective

The lockdown due to COVID-19 pandemic had a strong impact on daily habits, emotional experience, mental health and sleep. A large body of evidence suggests that dreams are affected by both waking experiences and sleep pattern. In this view, the lockdown should have induced intense modifications in dreaming activity. The aim of the study was to assess dream features during the lockdown in Italy.

Methods

We used an online survey to collect self-reported demographic, clinical, sleep and dream data. Our sample included 1091 participants.

Results

Results point to an increased dream frequency, emotional load, vividness, bizarreness and length during the lockdown, compared to a pre-lockdown period. Higher dream frequency and specific qualitative features were found in females and subjects with poor sleep quality, nocturnal disruptive behaviours and depressive symptoms. Most of the dream features assessed during the lockdown were predicted by age, gender, depressive symptoms, presence/absence of other people at home, and territorial area. A specific focus on sleep features revealed that sleep duration and several sleep quality indexes were the best predictors of dream variables. During the lockdown, dreams were also characterized by increased negative emotions, which were particularly frequent in females, younger adults, and participants with poor sleep quality, nocturnal disruptive behaviours, anxiety and depressive symptoms.

Conclusions

Our results confirm the hypothesis of a strong influence of the pandemic on dreaming, supporting both the hypothesis of continuity between wake and sleep mental processes and the view of a crucial influence of sleep quality and duration on dreaming activity.

Pandemic nightmares: Effects on dream activity of the COVID-19 lockdown in Italy

COVID‐19 has critically impacted the world. Recent works have found substantial changes in sleep and mental health during the COVID‐19 pandemic. Dreams could give us crucial information about people's well‐being, so here we have directly investigated the consequences of lockdown on the oneiric activity in a large Italian sample: 5,988 adults completed a web‐survey during lockdown. We investigated sociodemographic and COVID‐19‐related information, sleep quality (by the Medical Outcomes Study‐Sleep Scale), mental health (by the Depression, Anxiety, and Stress Scales), dream and nightmare frequency, and related emotional aspects (by the Mannheim Dream Questionnaire). Comparisons between our sample and a population‐based sample revealed that Italians are having more frequent nightmares and dreams during the pandemic. A multiple logistic regression model showed the predictors of high dream recall (young age, female gender, not having children, sleep duration) and high nightmare frequency (young age, female gender, modification of napping, sleep duration, intrasleep wakefulness, sleep problem index, anxiety, depression). Moreover, we found higher emotional features of dream activity in workers who have stopped working, in people who have relatives/friends infected by or who have died from COVID‐19 and in subjects who have changed their sleep habits. Our findings point to the fact that the predictors of high dream recall and nightmares are consistent with the continuity between sleep mentation and daily experiences. According to the arousal‐retrieval model, we found that poor sleep predicts a high nightmare frequency. We suggest monitoring dream changes during the epidemic, and also considering the implications for clinical treatment and prevention of mental and sleep disorders.

Reduced Sleep Duration and Sleep Efficiency Were Independently Associated With Frequent Nightmares in Chinese Frontline Medical Workers During the Coronavirus Disease 2019 Outbreak

Objectives

Nightmares were related to emotion and behavioral problems and also emerged as one of the core features of post-traumatic stress disorder (PTSD). Our study aimed to investigate the associations of frequent nightmares with sleep duration and sleep efficiency among frontline medical workers in Wuhan during the coronavirus disease 2019 (COVID-19) outbreak.

Methods

A total of 528 health-care workers from the province of Fujian providing medical aid in Wuhan completed the online questionnaires. There were 114 doctors and 414 nurses. The age, sex, marital status, and work situation were recorded. A battery of scales including the Pittsburgh Sleep Quality Index (PSQI) and the 12-item General Health Questionnaire (GHQ-12) were used to evaluate subjects’ sleep and general mental health. Frequent nightmares were defined as the response of at least once a week in the item of “nightmare” of PSQI.

Results

Frequent nightmares were found in 27.3% of subjects. The frequent nightmare group had a higher score of PSQI-sleep duration and PSQI-habitual sleep efficiency (frequent nightmares vs. non-frequent nightmares: PSQI-sleep duration, 1.08 ± 0.97 vs. 0.74 ± 0.85, P < 0.001; PSQI-habitual sleep efficiency, 1.08 ± 1.10 vs. 0.62 ± 0.88, P < 0.001). Reduced sleep duration and reduced sleep efficiency were independently associated with frequent nightmares after adjustment for age, sex, poor mental health, and regular sleeping medication use (reduced sleep duration: OR = 1.96, 95% CI = 1.07–3.58, P = 0.029; reduced sleep efficiency: OR = 2.17, 95% CI = 1.09–4.32, P = 0.027). Subjects with both reduced sleep duration and sleep efficiency were also associated with frequent nightmares (OR = 2.70, 95% CI = 1.57–4.65, P < 0.001).

Conclusion

The present study found that sleep duration and sleep efficiency were both independently associated with frequent nightmares among frontline medical workers in Wuhan during the COVID-19 pandemic. We should pay attention to nightmares and even the ensuing PTSD symptoms among subjects with reduced sleep duration or sleep efficiency facing potential traumatic exposure.

EEG microstates of dreams

Why do people sometimes report that they remember dreams, while at other times they recall no experience? Despite the interest in dreams that may happen during the night, it has remained unclear which brain states determine whether these conscious experiences will occur and what prevents us from waking up during these episodes. Here we address this issue by comparing the EEG activity preceding awakenings with recalled vs. no recall of dreams using the EEG microstate approach. This approach characterizes transiently stable brain states of sub-second duration that involve neural networks with nearly synchronous dynamics. We found that two microstates (3 and 4) dominated during NREM sleep compared to resting wake. Further, within NREM sleep, microstate 3 was more expressed during periods followed by dream recall, whereas microstate 4 was less expressed. Source localization showed that microstate 3 encompassed the medial frontal lobe, whereas microstate 4 involved the occipital cortex, as well as thalamic and brainstem structures. Since NREM sleep is characterized by low-frequency synchronization, indicative of neuronal bistability, we interpret the increased presence of the “frontal” microstate 3 as a sign of deeper local deactivation, and the reduced presence of the “occipital” microstate 4 as a sign of local activation. The latter may account for the occurrence of dreaming with rich perceptual content, while the former may account for why the dreaming brain may undergo executive disconnection and remain asleep. This study demonstrates that NREM sleep consists of alternating brain states whose temporal dynamics determine whether conscious experience arises.

Unaltered EEG spectral power and functional connectivity in REM microstates in frequent nightmare recallers: are nightmares really a REM parasomnia?

BACKGROUND

Frequent nightmares show signs of hyperarousal in NREM sleep. Nevertheless, idiopathic nightmare disorder is considered a REM parasomnia, but the pathophysiology of REM sleep in relation to frequent nightmares is controversial. Cortical oscillatory activity in REM sleep is largely modulated by phasic and tonic REM periods and seems to be linked to different functions and dysfunctions of REM sleep. Here, we examined cortical activity and functional synchronization in frequent nightmare recallers and healthy controls, during phasic and tonic REM.

METHODS

Frequent nightmare recallers (N = 22) and healthy controls (N = 22) matched for high dream recall spent two nights in the laboratory. Phasic and tonic REM periods from the second nights' recordings were selected to examine differences in EEG spectral power and weighted phase lag index (WPLI) across groups and REM states.

RESULTS

Phasic REM showed increased power and synchronization in delta and gamma frequency bands, whereas tonic REM featured increased power and synchronization in the alpha and beta bands. In the theta band, power was higher during tonic, and synchronization was higher during phasic REM sleep. No differences across nightmare and control participants or patterns representing interactions between the groups and REM microstates emerged.

CONCLUSIONS

Our findings do not support the idea that abnormal REM sleep power and synchronization play a role in the pathophysiology of frequent nightmares. Altered REM sleep in nightmare disorder could have been confounded with comorbid pathologies and increased dream recall, or might be linked to more specific state factors (nightmare episodes).

The Dream Catcher experiment: blinded analyses failed to detect markers of dreaming consciousness in EEG spectral power

The Dream Catcher test defines the criteria for a genuine discovery of the neural constituents of phenomenal consciousness. Passing the test implies that some patterns of purely brain-based data directly correspond to the subjective features of phenomenal experience, which would help to bridge the explanatory gap between consciousness and brain. Here, we conducted the Dream Catcher test for the first time in a step-wise and simplified form, capturing its core idea. The Dream Catcher experiment involved a Data Team, which measured participants' brain activity during sleep and collected dream reports, and a blinded Analysis Team, which was challenged to predict, based solely on brain measurements, whether or not a participant had a dream experience. Using a serial-awakening paradigm, the Data Team prepared 54 1-min polysomnograms of non-rapid eye movement sleep-27 of dreamful sleep and 27 of dreamless sleep (three of each condition from each of the nine participants)-redacting from them all associated participant and dream information. The Analysis Team attempted to classify each recording as either dreamless or dreamful using an unsupervised machine learning classifier, based on hypothesis-driven, extracted features of electroencephalography (EEG) spectral power and electrode location. The procedure was repeated over five iterations with a gradual removal of blindness. At no level of blindness did the Analysis Team perform significantly better than chance, suggesting that EEG spectral power could not be utilized to detect signatures specific to phenomenal consciousness in these data. This study marks the first step towards realizing the Dream Catcher test in practice.

Dream Recall upon Awakening from Non-Rapid Eye Movement Sleep in Older Adults: Electrophysiological Pattern and Qualitative Features

Several findings support the activation hypothesis, positing that cortical arousal promotes dream recall (DR). However, most studies have been carried out on young participants, while the electrophysiological (EEG) correlates of DR in older people are still mostly unknown. We aimed to test the activation hypothesis on 20 elders, focusing on the Non-Rapid Eye Movement (NREM) sleep stage. All the subjects underwent polysomnography, and a dream report was collected upon their awakening from NREM sleep. Nine subjects were recallers (RECs) and 11 were non-RECs (NRECs). The delta and beta EEG activity of the last 5 min and the total NREM sleep was calculated by Fast Fourier Transform. Statistical comparisons (RECs vs. NRECs) revealed no differences in the last 5 min of sleep. Significant differences were found in the total NREM sleep: the RECs showed lower delta power over the parietal areas than the NRECs. Consistently, statistical comparisons on the activation index (delta/beta power) revealed that RECs showed a higher level of arousal in the fronto-temporal and parieto-occipital regions than NRECs. Both visual vividness and dream length are positively related to the level of activation. Overall, our results are consistent with the view that dreaming and the storage of oneiric contents depend on the level of arousal during sleep, highlighting a crucial role of the temporo-parietal-occipital zone.

Electrophysiological Correlates of Dream Recall During REM Sleep: Evidence from Multiple Awakenings and Within-Subjects Design

PURPOSE

In the current study, we aimed to investigate the EEG correlates of dream recall (DR) monitoring both the homeostatic and state-trait like factors. We assessed the influence of the time of night on the EEG correlates of DR from REM sleep. Specifically, we tested the continuity-hypothesis (on the theta EEG band) and the activation-hypothesis (on the delta and beta bands).

METHODS

Twenty-seven subjects underwent polysomnography with multiple provoked awakenings during REM sleep. Only the subjects showing combinations of dream recall (REC) and non-REC (NREC) conditions in both first (1st-2nd sleep cycle) and second (3rd-4th sleep cycle) part of the night were included in the analyses. The final sample was composed of 10 subjects (mean age 24±0.70). EEG power spectra of the 5-min of REM sleep preceding each awakening were computed by a fast Fourier transform. The following frequency bands were considered: delta (0.50-4.75 Hz), theta (5.00-7.75 Hz), and beta (16.00-24.75 Hz). We also calculated the delta/beta power ratio as an integrated EEG index of activation.

RESULTS

The 2×2 within-subjects ANOVA recall × time revealed: a) no significant effect for time and no interaction; b) significant differences over the occipital area in the beta band; c) significant differences over the parietal area for the activation index values. Overall, the results indicated that DR is associated with higher activation regardless of homeostatic pressure across the night of sleep.

CONCLUSION

In line with recent findings, we have shown that DR is predicted by desynchronized EEG activity during REM sleep, providing clear evidence in favor of the activation-hypothesis. We have also confirmed that the EEG pattern of DR can be ascribed to state-like factors. Further studies should assess whether homeostatic modulation may interact with some dream features and the related EEG predictors.

Mental Sleep Activity and Disturbing Dreams in the Lifespan

Sleep significantly changes across the lifespan, and several studies underline its crucial role in cognitive functioning. Similarly, mental activity during sleep tends to covary with age. This review aims to analyze the characteristics of dreaming and disturbing dreams at different age brackets. On the one hand, dreams may be considered an expression of brain maturation and cognitive development, showing relations with memory and visuo-spatial abilities. Some investigations reveal that specific electrophysiological patterns, such as frontal theta oscillations, underlie dreams during sleep, as well as episodic memories in the waking state, both in young and older adults. On the other hand, considering the role of dreaming in emotional processing and regulation, the available literature suggests that mental sleep activity could have a beneficial role when stressful events occur at different age ranges. We highlight that nightmares and bad dreams might represent an attempt to cope the adverse events, and the degrees of cognitive-brain maturation could impact on these mechanisms across the lifespan. Future investigations are necessary to clarify these relations. Clinical protocols could be designed to improve cognitive functioning and emotional regulation by modifying the dream contents or the ability to recall/non-recall them.

Oscillatory EEG Activity During REM Sleep in Elderly People Predicts Subsequent Dream Recall After Awakenings

Several findings underlined that the electrophysiological (EEG) background of the last segment of sleep before awakenings may predict the presence/absence of dream recall (DR) in young subjects. However, little is known about the EEG correlates of DR in elderly people. Only an investigation found differences between recall and non-recall conditions during NREM sleep EEG in older adults, while—surprisingly—no EEG predictor of DR was found for what concerns REM sleep. Considering REM sleep as a privileged scenario to produce mental sleep activity related to cognitive processes, our study aimed to investigate whether specific EEG topography and frequency changes during REM sleep in elderly people may predict a subsequent recall of mental sleep activity. Twenty-one healthy older volunteers (mean age 69.2 ± 6.07 SD) and 20 young adults (mean age 23.4 ± 2.76 SD) were recorded for one night from 19 scalp derivations. Dreams were collected upon morning awakenings from REM sleep. EEG signals of the last 5 min were analyzed by the Better OSCillation algorithm to detect the peaks of oscillatory activity in both groups. Statistical comparisons revealed that older as well as young individuals recall their dream experience when the last segment of REM sleep is characterized by frontal theta oscillations. No Recall (Recall vs. Non-Recall) × Age (Young vs. Older) interaction was found. This result replicated the previous evidence in healthy young subjects, as shown in within- and between-subjects design. The findings are completely original for older individuals, demonstrating that theta oscillations are crucial for the retrieval of dreaming also in this population. Furthermore, our results did not confirm a greater presence of the theta activity in healthy aging. Conversely, we found a greater amount of rhythmic theta and alpha activity in young than older participants. It is worth noting that the theta oscillations detected are related to cognitive functioning. We emphasize the notion that the oscillatory theta activity should be distinguished from the non-rhythmic theta activity identified in relation to other phenomena such as (a) sleepiness and hypoarousal conditions during the waking state and (b) cortical slowing, considered as an EEG alteration in clinical samples.

Diagnosis and management of nonrapid eye movement-parasomnias

PURPOSE OF REVIEW

Nonrapid eye movement (NREM) parasomnias are common sleep disorders that potentially have significant personal, social and forensic implications. They represent a unique opportunity in nature to explore the coexistence of sleep and wake-state in the human brain.

RECENT FINDINGS

Neuroimaging and electroencephalography have advanced our understanding of NREM-parasomnia pathophysiology, and the interplay between wakefulness and sleep. These disorders are increasingly viewed as resulting from an evolutionary process with a basis in uni-hemispheric brain activity in sleep seen in some animals, maintaining consciousness and ability to act against life-threatening situations. Although current classification of NREM parasomnia phenotypes distinguishes between disorders of arousal and other types of behaviours, evidence increasingly points to there being a significant overlap between the various phenotypes. Treatment practice appears more standardized nowadays based on larger case series, but randomized control trials are still needed.

SUMMARY

NREM-parasomnia is a very common disorder of uncertain pathogenesis but of known pathophysiology, the diagnosis of which remains primarily clinical.

Dream experiences and the neural correlates of perceptual consciousness and cognitive access

This paper approaches the debate whether perceptual consciousness requires cognitive access from the perspective of dream studies, and investigates what kind of findings could support the opposing views of this debate. Two kinds of arguments are discussed, one that claims that the hypoactivity of the dorsolateral prefrontal cortex in rapid eye movement sleep is directly relevant, and another that proposes that locating the neural correlates of dream experiences can indirectly inform the debate. It is argued that under closer reflection, neither the classical claim about dorsolateral prefrontal cortex hypoactivity nor the more recent emphasis on general posterior hot zone activity during dreaming stand up to scrutiny. White dreaming is identified as the phenomenon that, nevertheless, holds the most promise to have an impact on the debate. Going beyond the topic if studying dreams can contribute to this debate, it is argued that cognitive access is not a monolithic phenomenon, and its neural correlates are not well understood. There seems to be a relevant form of cognitive access that can operate in the absence of activity in the dorsolateral prefrontal cortex, and maybe also in the whole frontal region. If so, then exclusive posterior activation during conscious experiences might very well be compatible with the hypothesis that perceptual consciousness requires cognitive access.This article is part of the theme issue 'Perceptual consciousness and cognitive access'.

EEG predictors of dreaming outside of REM sleep

The stream of human consciousness persists during sleep, albeit in altered form. Disconnected from external input, the mind and brain remain active, at times creating the bizarre sequences of thought and imagery that comprise "dreaming." Yet despite substantial effort toward understanding this unique state of consciousness, no reliable neurophysiological indicator of dreaming has been discovered. Here, we identified electroencephalographic (EEG) correlates of dreaming using a within-subjects design to characterize the EEG preceding awakenings from sleep onset, REM (rapid eye movement) sleep, and N2 (NREM Stage 2) sleep from which participants were asked to report their mental experience. During the transition into sleep, compared to periods during which participants reported thinking, emergence of dream imagery was associated with increased absolute power below 7 Hz. During later N2, dreaming conversely occurred during periods of decreased relative power below 1 Hz, accompanied by an increase in relative power above 4 Hz. No EEG predictors of dreaming were identified during REM. These observations suggest an inverted-U relationship between dreaming and the prevalence of low-frequency EEG rhythms, such that dreaming first emerges in concert with EEG slowing during the sleep-wake transition, but then disappears as high-amplitude slow oscillations come to dominate the recording during later N2 sleep.

The Functional Role of Dreaming in Emotional Processes

Dream experience (DE) represents a fascinating condition linked to emotional processes and the human inner world. Although the overlap between REM sleep and dreaming has been overcome, several studies point out that emotional and perceptually vivid contents are more frequent when reported upon awakenings from this sleep stage. Actually, it is well-known that REM sleep plays a pivotal role in the processing of salient and emotional waking-life experiences, strongly contributing to the emotional memory consolidation. In this vein, we highlighted that, to some extent, neuroimaging studies showed that the processes that regulate dreaming and emotional salience in sleep mentation share similar neural substrates of those controlling emotions during wakefulness. Furthermore, the research on EEG correlates of the presence/absence of DE and the results on EEG pattern related to the incorporated memories converged to assign a crucial role of REM theta oscillations in emotional re-processing. In particular, the theta activity is involved in memory processes during REM sleep as well as during the waking state, in line with the continuity hypothesis. Also, the gamma activity seems to be related to emotional processes and dream recall as well as to lucid dreams. Interestingly, similar EEG correlates of DE have been found in clinical samples when nightmares or dreams occur. Research on clinical samples revealed that promoting the rehearsal of frightening contents aimed to change them is a promising method to treat nightmares, and that lucid dreams are associated with an attenuation of nightmares. In this view, DE can defuse emotional traumatic memories when the emotional regulation and the fear extinction mechanisms are compromised by traumatic and frightening events. Finally, dreams could represent a sort of simulation of reality, providing the possibility to create a new scenario with emotional mastery elements to cope with dysphoric items included in nightmares. In addition, it could be hypothesized that the insertion of bizarre items besides traumatic memories might be functional to "impoverish" the negative charge of the experiences.

Incorporation of recent waking-life experiences in dreams correlates with frontal theta activity in REM sleep

Rapid eye movement (REM) sleep and its main oscillatory feature, frontal theta, have been related to the processing of recent emotional memories. As memories constitute much of the source material for our dreams, we explored the link between REM frontal theta and the memory sources of dreaming, so as to elucidate the brain activities behind the formation of dream content. Twenty participants were woken for dream reports in REM and slow wave sleep (SWS) while monitored using electroencephalography. Eighteen participants reported at least one REM dream and 14 at least one SWS dream, and they, and independent judges, subsequently compared their dream reports with log records of their previous daily experiences. The number of references to recent waking-life experiences in REM dreams was positively correlated with frontal theta activity in the REM sleep period. No such correlation was observed for older memories, nor for SWS dreams. The emotional intensity of recent waking-life experiences incorporated into dreams was higher than the emotional intensity of experiences that were not incorporated. These results suggest that the formation of wakefulness-related dream content is associated with REM theta activity, and accords with theories that dreaming reflects emotional memory processing taking place in REM sleep.

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.

Bilateral Theta Transcranial Alternating Current Stimulation (tACS) Modulates EEG Activity: When tACS Works Awake It Also Works Asleep

PURPOSE

Recent studies demonstrate that 5-Hz bilateral transcranial alternating current stimulation (θ-tACS) on fronto-temporal areas affects resting EEG enhancing cortical synchronization, but it does not affect subjective sleepiness. This dissociation raises questions on the resemblance of this effect to the physiological falling asleep process. The current study aimed to evaluate the ability of fronto-temporal θ-tACS to promote sleep.

SUBJECTS AND METHODS

Twenty subjects (10 F/10 M; mean age: 24.60 ± 2.9 y) participated in a single-blind study consisting of two within-subject sessions (active/sham), one week apart in counterbalanced order. Stimulation effects on EEG were assessed during wake and post-stimulation nap. The final sample included participants who fell asleep in both sessions (n=17).

RESULTS

Group analyses on the whole sample reported no θ-tACS effects on subjective sleepiness and sleep measures, while a different scenario came to light by analysing data of responders to the stimulation (ie, subjects actually showing the expected increase of theta activity in the wake EEG after the θ-tACS, n=7). Responders reported a significant increase in subjective sleepiness during wakefulness after the active stimulation as compared to the sham. Moreover, the sleep after the θ-tACS compared to sham in this sub-group showed: (1) greater slow-wave activity (SWA); (2) SWA time-course revealing increases much larger as closer to the sleep onset; (3) stimulation-induced changes in SWA during sleep topographically associated to those in theta activity during wake.

CONCLUSION

Subjects who show the expected changes during wake after the stimulation also had a consistent pattern of changes during sleep. The enhancement of cortical synchronization by θ-tACS during wakefulness actually corresponds to increased sleep pressure, but it occurs only in some individuals. Thus, θ-tACS can enhance sleep, although individual factors to be further investigated affect the actual responsiveness to this treatment.

Narcolepsy and emotional experience: a review of the literature

Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis. This disease affects significantly the overall patient functioning, interfering with social, work, and affective life. Some symptoms of narcolepsy depend on emotional stimuli; for instance, cataplectic attacks can be triggered by emotional inputs such as laughing, joking, a pleasant surprise, and also anger. Neurophysiological and neurochemical findings suggest the involvement of emotional brain circuits in the physiopathology of cataplexy, which seems to depending on the dysfunctional interplay between the hypothalamus and the amygdala associated with an alteration of hypocretin levels. Furthermore, behavioral studies suggest an impairment of emotions processing in narcolepsy-cataplexy (NC), like a probable coping strategy to avoid or reduce the frequency of cataplexy attacks. Consistently, NC patients seem to use coping strategies even during their sleep, avoiding unpleasant mental sleep activity through lucid dreaming. Interestingly, NC patients, even during sleep, have a different emotional experience than healthy subjects, with more vivid, bizarre, and frightening dreams. Notwithstanding this evidence, the relationship between emotion and narcolepsy is poorly investigated. This review aims to provide a synthesis of behavioral, neurophysiological, and neurochemical evidence to discuss the complex relationship between NC and emotional experience and to direct future research.

Sleep talking: A viable access to mental processes during sleep

Sleep talking is one of the most common altered nocturnal behaviours in the whole population. It does not represent a pathological condition and consists in the unaware production of vocalisations during sleep. Although in the last few decades we have experienced a remarkable increase in knowledge about cognitive processes and behavioural manifestations during sleep, the literature regarding sleep talking remains dated and fragmentary. We first provide an overview of historical and recent findings regarding sleep talking, and we then discuss the phenomenon in the context of mental activity during sleep. It is shown that verbal utterances, reflecting the ongoing dream content, may represent the unique possibility to access the dreamlike mental experience directly. Furthermore, we discuss such phenomena within a cognitive theoretical framework, considering both the atypical activation of psycholinguistic circuits during sleep and the implications of verbal 'replay' of recent learning in memory consolidation. Despite current knowledge on such a common experience being far from complete, an in-depth analysis of sleep talking episodes could offer interesting opportunities to address fundamental questions on dreaming or information processing during sleep. Further systematic polysomnographic and neuroimaging investigations are expected to shed new light on the manifestation of the phenomenon and related aspects.

Brain structural basis of individual variability in dream recall frequency

Recent neuroimaging studies have indicated that inter-individual variability in dream recall frequency (DRF) is associated with both resting-state regional cerebral blood flow and task-induced brain activations. However, the brain structure underpinning this inter-individual variability in DRF remains unclear. The aim of the current study is to investigate the relationship between brain structural characteristics and DRF. We collected both T1-weighted and diffusion tensor magnetic resonance imaging data from 43 healthy volunteers. DRF was obtained from a two-week sleep diary with a subjective report of dream recall upon waking every morning. General linear model analysis was used to evaluate the relationship between brain structural characteristics (cortical volume and white matter integrity) and DRF. Not only the cortical volume of the medial portion of the right fusiform gyrus and parahippocampal gyrus but also the fractional anisotropy of white matter fibers connected to these regions were significantly negatively correlated with DRF, and these relationships were not modulated by a regular sleep. These findings provide direct evidence that brain structural characteristics are associated with inter-individual variability in DRF and may help us to better understand the structural mechanisms in the brain underlying dream recall.

Spotlight on dream recall: the ages of dreams

Brain and sleep maturation covary across different stages of life. At the same time, dream generation and dream recall are intrinsically dependent on the development of neural systems. The aim of this paper is to review the existing studies about dreaming in infancy, adulthood, and the elderly stage of life, assessing whether dream mentation may reflect changes of the underlying cerebral activity and cognitive processes. It should be mentioned that some evidence from childhood investigations, albeit still weak and contrasting, revealed a certain correlation between cognitive skills and specific features of dream reports. In this respect, infantile amnesia, confabulatory reports, dream-reality discerning, and limitation in language production and emotional comprehension should be considered as important confounding factors. Differently, growing evidence in adults suggests that the neurophysiological mechanisms underlying the encoding and retrieval of episodic memories may remain the same across different states of consciousness. More directly, some studies on adults point to shared neural mechanisms between waking cognition and corresponding dream features. A general decline in the dream recall frequency is commonly reported in the elderly, and it is explained in terms of a diminished interest in dreaming and in its emotional salience. Although empirical evidence is not yet available, an alternative hypothesis associates this reduction to an age-related cognitive decline. The state of the art of the existing knowledge is partially due to the variety of methods used to investigate dream experience. Very few studies in elderly and no investigations in childhood have been performed to understand whether dream recall is related to specific electrophysiological pattern at different ages. Most of all, the lack of longitudinal psychophysiological studies seems to be the main issue. As a main message, we suggest that future longitudinal studies should collect dream reports upon awakening from different sleep states and include neurobiological measures with cognitive performances.

REM Sleep Theta Changes in Frequent Nightmare Recallers

Study Objectives

To replicate and expand upon past research by evaluating sleep and wake electroencephalographic spectral activity in samples of frequent nightmare (NM) recallers and healthy controls.

Methods

Computation of spectral activity for sleep (non-REM and REM) and wake electroencephalogram recordings from 18 frequent NM recallers and 15 control participants.

Results

There was higher "slow-theta" (2-5 Hz) for NM recallers than for controls during wake, non-REM sleep and REM sleep. Differences were clearest for frontal and central derivations and for REM sleep cycles 2-4. There was also higher beta activity during NREM sleep for NM recallers. Findings partially replicate past research by demonstrating higher relative "slow-theta" (3-4Hz) for NM recallers than for controls.

Conclusions

Findings are consistent with a neurocognitive model of nightmares that stipulates cross-state anomalies in emotion processing in NM-prone individuals.