Successful treatment of sleep paralysis with the Sleep Position Trainer: a case report

Sleep paralysis is a period of paralysis at either sleep onset or upon awakening and is often accompanied by terrifying hallucinations. We report a case of a 32-year-old healthy men with a history of mild positional obstructive sleep apnea and sleep paralysis. The positional sleep apnea was successfully treated with the Sleep Position Trainer. Remarkably, he did no longer experience episodes of sleep paralysis since using the Sleep Position Trainer. This case highlights a possible elegant noninvasive long-term solution for the treatment of sleep paralysis.

CITATION

Cui N, van Looij MA, Kasius KM. Successful treatment of sleep paralysis with the Sleep Position Trainer: a case report. J Clin Sleep Med. 2022;18(9):2317-2319.

Dream enactment behavior: review for the clinician

NONE

Dream enactment behavior commonly occurs on occasion in normal children and adults. Disruptive and frequent dream enactment behavior may come to the attention of the clinician either as the primary reason for consultation or as a prominent characteristic of a patient with other sleep disorders. Questioning patients with chronic neurologic and psychiatric disorders may also reveal previously unrecognized behavior. In the absence of sleep pathology, process of dream enactment likely begins with active, often emotionally charged dream content that may occasionally break through the normal REM sleep motor suppressive activity. Disrupted sleep resulting from many possible causes, such as circadian disruption, sleep apnea, or medications, may also disrupt at least temporarily the motor-suppressive activity in REM sleep, allowing dream enactment to occur. Finally, pathological neurological damage in the context of degenerative, autoimmune, and infectious neurological disorders may lead to chronic recurrent and severe dream enactment behavior. Evaluating the context, frequency, and severity of dream enactment behavior is guided first and foremost by a structured approach to the sleep history. Physical exam and selected testing support the clinical diagnosis. Understanding the context and the likely cause is essential to effective therapy.

Brain-derived neurotrophic factor is a biomarker for subjective insomnia but not objectively assessable poor sleep continuity

OBJECTIVES

Brain-derived neurotrophic factor (BDNF) is a central mediator of the effects of stress on neuronal plasticity. Patients with subjective insomnia have significantly lower serum BDNF (sBDNF) levels. The aims of the present study were to investigate the associations of sBDNF with, 1) subjective and 2) objective sleep; 3) to investigate the associations between dimensions of psychopathology, subjective sleep and sBDNF, and 4) to investigate the associations between insomnia, sBDNF and cortisol.

METHODS

60 patients with insomnia (IG; mean age: 40.4 years; 48.3% females) and 30 healthy, age and gender-matched controls (CG) took part in the study. Subjective sleep was assessed using the Insomnia Severity Index (ISI), objective sleep was assessed once via sleep-EEG recordings. Both sBDNF and salivary cortisol were sampled once the following morning. Last, experts rated participants' symptoms of depression and anxiety.

RESULTS

sBDNF was significantly lower in the IG than in the CG (large effect size; Hedge's g = 1.75), while higher insomnia scores, but not depression or anxiety ratings, predicted lower sBDNF levels. Concerning objective sleep, low sBDNF did not correlate with sleep continuity measures, but with decreased REM-sleep; the latter was also characteristic of the IG. sBDNF and salivary morning cortisol were unrelated.

CONCLUSIONS

Independently of symptoms of depression or anxiety, sBDNF appears to be a biomarker for the clinical diagnosis of insomnia, but not for objectively assessed poor sleep continuity. A possible link between sBDNF and insomnia seems to be via regulation of REM-sleep, but not salivary morning cortisol.

Sleep-Dependent Consolidation of Rewarded Behavior Is Diminished in Children with Attention Deficit Hyperactivity Disorder and a Comorbid Disorder of Social Behavior

Children suffering from attention-deficit hyperactivity disorder (ADHD) often also display impaired learning and memory. Previous research has documented aberrant reward processing in ADHD as well as impaired sleep-dependent consolidation of declarative memory. We investigated whether sleep also fosters the consolidation of behavior learned by probabilistic reward and whether ADHD patients with a comorbid disorder of social behavior show deficits in this memory domain, too. A group of 17 ADHD patients with comorbid disorders of social behavior aged 8–12 years and healthy controls matched for age, IQ, and handedness took part in the experiment. During the encoding task, children worked on a probabilistic learning task acquiring behavioral preferences for stimuli rewarded most often. After a 12-hr retention interval of either sleep at night or wakefulness during the day, a reversal task was presented where the contingencies were reversed. Consolidation of rewarded behavior is indicated by greater resistance to reversal learning. We found that healthy children consolidate rewarded behavior better during a night of sleep than during a day awake and that the sleep-dependent consolidation of rewarded behavior by trend correlates with non-REM sleep but not with REM sleep. In contrast, children with ADHD and comorbid disorders of social behavior do not show sleep-dependent consolidation of rewarded behavior. Moreover, their consolidation of rewarded behavior does not correlate with sleep. The results indicate that dysfunctional sleep in children suffering from ADHD and disorders of social behavior might be a crucial factor in the consolidation of behavior learned by reward.