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Dreams may be recalled after awakening from sleep following a defined electroencephalographic pattern that involves local decreases in low-frequency activity in the posterior cortical regions. Although a dreaming experience implies bodily changes at many organ, system, and timescale levels, the entity and causal role of such peripheral changes in a conscious dream experience are unknown. We performed a comprehensive, causal, multivariate analysis of physiological signals acquired during rapid eye movement (REM) sleep at night, including high-density electroencephalography and peripheral dynamics including electrocardiography and blood pressure. In this preliminary study, we investigated multiple recalls and nonrecalls of dream experiences using data from nine healthy volunteers. The aim was not only to investigate the changes in central and autonomic dynamics associated with dream recalls and nonrecalls, but also to characterize the central-peripheral dynamical and (causal) directional interactions, and the temporal relations of the related arousals upon awakening. We uncovered a brain-body network that drives a conscious dreaming experience that acts with specific interaction and time delays. Such a network is sustained by the blood pressure dynamics and the increasing functional information transfer from the neural heartbeat regulation to the brain. We conclude that bodily changes play a crucial and causative role in a conscious dream experience during REM sleep.

The strong law of large numbers and considerations concerning additional information strongly suggest that Beauty upon awakening has probability 1/3 to be in a heads-awakening but should st...

Objectives: HLD200, a once-daily, evening-dosed, delayed-release and extended-release methylphenidate (DR/ER-MPH), was designed to provide therapeutic effect beginning upon awakening and lasting into the evening. This pivotal, randomized, double-blind, multicenter, placebo-controlled, phase 3 trial assessed improvements in functional impairment across the day using multiple validated measures tailored for different settings and time of day in children (6–12 years) with attention-deficit/hyperactivity disorder (ADHD). Methods: Following a 6-week, open-label titration of DR/ER-MPH to an optimal dose (20, 40, 60, 80, or 100 mg/day) and dosing time (8:00 PM ±1.5 hours), participants were randomized to treatment-optimized DR/ER-MPH or placebo for 1 week. The primary endpoint was the model-adjusted average of postdose Swanson, Kotkin, Agler, M-Flynn, and Pelham Scale combined scores (SKAMP CS) over a 12-hour laboratory classroom day (8:00 AM to 8:00 PM). The key secondary endpoint was the Parent Rating of Evening and Morning Behavior-Revised, Morning (PREMB-R AM) subscale. Secondary/exploratory measures included the PREMB-R Evening (PREMB-R PM) subscale and Permanent Product Measure of Performance (Attempted [PERMP-A] and Correct [PERMP-C]). Safety endpoints included treatment-emergent adverse events (TEAEs). Results: After the treatment-optimization phase, the mean optimized dose was 66.2 mg and the most common prescribed dosing time was 8:00 PM. Double-blind DR/ER-MPH treatment significantly improved functional impairment versus placebo in the early morning (PREMB-R AM: p

Sleep inertia is a disabling state of grogginess and impaired vigilance immediately upon awakening. The adenosine receptor antagonist, caffeine, is widely used to reduce sleep inertia symptoms, yet the initial, most severe impairments are hardly alleviated by post-awakening caffeine intake. To ameliorate this disabling state more potently, we developed an innovative, delayed, pulsatile-release caffeine formulation targeting an efficacious dose briefly before planned awakening. We comprehensively tested this formulation in two separate studies. First, we established the in vivo caffeine release profile in 10 young men. Subsequently, we investigated in placebo-controlled, double-blind, cross-over fashion the formulation’s ability to improve sleep inertia in 22 sleep-restricted volunteers. Following oral administration of 160 mg caffeine at 22:30, we kept volunteers awake until 03:00, to increase sleep inertia symptoms upon scheduled awakening at 07:00. Immediately upon awakening, we quantified subjective state, psychomotor vigilance, cognitive performance, and followed the evolution of the cortisol awakening response. We also recorded standard polysomnography during nocturnal sleep and a 1-h nap opportunity at 08:00. Compared to placebo, the engineered caffeine formula accelerated the reaction time on the psychomotor vigilance task, increased positive and reduced negative affect scores, improved sleep inertia ratings, prolonged the cortisol awakening response, and delayed nap sleep latency one hour after scheduled awakening. Based on these findings, we conclude that this novel, pulsatile-release caffeine formulation facilitates the sleep-to-wake transition in sleep-restricted healthy adults. We propose that individuals suffering from disabling sleep inertia may benefit from this innovative approach.Trials registration: NCT04975360.

Nurses experience poor sleep and high stress due to demanding work environments. Night shift work is common among nurses and may exacerbate stress-sleep associations. We examined bidirectional associations between daily stress and sleep, and moderation by recent shift worker status and daily work schedule among nurses. Participants were 392 nurses (92% female; 78% White, mean age = 39.54, SD = 11.15) who completed 14 days of electronic sleep diaries and actigraphy. They simultaneously completed assessments of daily stress and work schedule upon awakening (day shift vs. night shift [work between 9 p.m.-6 a.m.] vs. off work). Participants were classified as recent night shift workers if they worked at least one night shift during the past 14 days (n = 101; 26%). In the entire sample, greater daily stress predicted shorter self-reported total sleep time and lower self-reported sleep efficiency that night. Shorter self-reported and actigraphy total sleep time and lower self-reported sleep efficiency predicted higher next-day stress. Compared with recent night shift workers, day workers reported higher stress after nights with shorter total sleep time. Stress-sleep associations mostly did not vary by nurses' daily work schedule. Sleep disturbances and stress may unfold in a toxic cycle and are prime targets for tailored interventions among nurses. Night shift workers may be less susceptible to the effects of short sleep on next-day stress. Research is needed to understand the short- and long-term effects of shift work and address the unique sleep challenges nurses face.

Using a long-term prospective longitudinal study of U.S. men and their fathers, the present study examined the extent to which the quantity (i.e., shared activities between fathers and sons) and the quality (i.e., assessors’ ratings of fathers’ positive behaviors toward sons and the relationship quality between fathers and sons) of father involvement during childhood influenced sons’ diurnal patterns of salivary cortisol in adulthood (late 30s) directly and indirectly through substance use across the 20s. Findings indicated that the quantity of father involvement during childhood was directly associated with sons’ diurnal cortisol patterns assessed almost 30 years later. Specifically, the quantity of father involvement in childhood significantly increased the intercept (i.e., upon awakening) and also led to a greater reduction in cortisol across the day, suggesting a well-regulated diurnal cortisol pattern. The quantity of father involvement significantly reduced the amount of sons’ illicit drug and tobacco use across the 20s. Tobacco use across the 20s was associated with a lower cortisol intercept level (upon awakening), although the mediating path was not significant. The present study provided empirical evidence demonstrating long-term physiological and behavioral consequences of father involvement in childhood and its potency as a crucial early caregiving environment for sons.

Sleep inertia, or the grogginess felt upon awakening, is associated with significant cognitive performance decrements that dissipate as time awake increases. This impairment in cognitive performance has been observed in both tightly controlled in-laboratory studies and in real-world scenarios. Further, these decrements in performance are exaggerated by prior sleep loss and the time of day in which a person awakens. This review will examine current insights into the causes of sleep inertia, factors that may positively or negatively influence the degree of sleep inertia, the consequences of sleep inertia both in the laboratory and in real-world settings, and lastly discuss potential countermeasures to lessen the impact of sleep inertia.

In experiments with daytime sleep, according to data obtained from 23 subjects, changes in the spectral characteristics of the EEG in the period preceding the moment of awakening, which was recorded to restore the psychomotor test, were studied. During one short experiment, it can be used to investigate several consecutive episodes: the disappearance of conscious cognitive activity when falling asleep and its resumption upon spontaneous awakening. The study of the characteristics of the EEG before awakening is important for assessing the transients of the sleep-wake cycle, determining the degree of recovery of psychomotor activity upon awakening and the level of the accompanying consciousness. It is shown that the alpha activation observed upon awakening is often preceded by the appearance of K-complexes, of varying degrees of severity, on which low-frequency alpha oscillations are superimposed, which can be regarded as slow sigma spindles. This pattern most likely reflects the action of a universal thalamocortical activating mechanism, the same for both night and daytime sleep, regardless of whether it follows a short-term activation followed by sleep or further begins a cognitive activity.

Introduction: Twenty-five percent of strokes are detected upon awakening (‘wake-up strokes’; WUS) and are not amenable to thrombolytic therapy via existing time-based treatment approaches. We performed a systematic review and meta-analysis of the efficacy and safety of thrombolysis in patients with WUS using imaging-based selection algorithms. Methods: This systematic review was registered through PROSPERO (CRD42020151552). We searched PubMed, Web of Science, and Scopus between January 1, 2006 and April 30, 2020 for controlled trials and observational cohort studies (prospective or retrospective), in which adults with WUS were administered thrombolysis after MR- or CT-based imaging. Our primary outcome was recovery (mRS 0-2) at 90 days and our secondary outcome was symptomatic intracranial hemorrhage (sICH). We assessed risk of bias using the Cochrane Risk of Bias 2.0 and ROBINS-I tools. Results: We included 16 studies that enrolled a total of 14,017 patients. Sixty-one percent of patients receiving tPA achieved a functional recovery at 90 days (95% CI: 51% to 70%; 12 studies), with a relative risk (RR) of recovery of 1.21 compared with patients not receiving tPA (95% CI 1.01 to 1.46; 4 comparative studies). As shown in Figure 1, 3% of patients receiving tPA in the treated WUS stroke group experienced sICH, an RR of 4.0 (95% CI 2.85-5.61) compared with patients not receiving tPA. On meta-regression, advancing age was negatively associated with the RR of recovery (p Conclusions: In patients with WUS, thrombolysis is associated with functional recovery and with a low risk of sICH. This risk is comparable to the sICH rate from tPA-treatment of stroke utilizing the standard protocol timeframe (2.4% in ECASS III). Thrombolysis should be considered in the treatment of WUS in patients with favorable neuroimaging.

Contains fulltext : 237640.pdf (Publisher’s version ) (Open Access) Upon awakening from nighttime sleep, the stress hormone cortisol in humans exhibits a robust rise within thirty to forty-five minutes. This cortisol awakening response (CAR), a crucial point of reference within the healthy cortisol circadian rhythm, has been linked to various psychological, psychiatric and health-related conditions. The CAR is thought to prepare the brain for anticipated challenges of the upcoming day to maintain one's homeostasis and promote adaptive responses. Using brain imaging with a prospective design and pharmacological manipulation, we investigate the neurobiological mechanisms underlying this preparation function of the CAR across two studies. In Study 1, a robust CAR is predictive of less hippocampal and prefrontal activity, though enhanced functional coupling between those regions during a demanding task hours later in the afternoon. Reduced prefrontal activity is in turn linked to better working memory performance, implicating that the CAR proactively promotes brain preparedness based on improved neurocognitive efficiency. In Study 2, pharmacologically suppressed CAR using Dexamethasone mirrors this proactive effect, which further causes a selective reduction of prefrontal top-down functional modulation over hippocampal activity. These findings establish a causal link between the CAR and its proactive role in optimizing functional brain networks involved in neuroendocrine control, executive function and memory.

Upon awakening from nighttime sleep, the stress hormone cortisol exhibits a burst in the morning within 30-minutes in humans. This cortisol awakening response (CAR) is thought to prepare the brain for upcoming challenges. Yet, the neurobiological mechanisms underlying the CAR-mediated ‘preparation’ function remains unknown. Using blood-oxygen-level-dependent functional magnetic resonance imaging (BOLD-fMRI) with a dedicated prospective design and pharmacological manipulation, we investigated this proactive mechanism in humans across two fMRI studies. In Study 1, we found that a robust CAR was predictive of less hippocampal and prefrontal activity, though enhanced functional coupling between those regions and facilitated working memory performance, during a demanding task later in the afternoon. These results implicate the CAR in proactively promoting brain preparedness based on improved neural efficiency. To address the causality of this proactive effect, we conducted a second study (Study 2) in which we suppressed the CAR with a double blind, placebo controlled, randomized design using Dexamethasone. We found that pharmacological suppression of CAR mirrored the proactive effects from Study 1. Dynamic causal modeling analyses further revealed a reduction of prefrontal top-down modulation over hippocampal activity when performing a cognitively demanding task in the afternoon. These findings establish a causal link between the CAR and its proactive role in optimizing brain functional networks involved in neuroendocrine control and memory.

To examine non-restorative sleep and its impact on quality of life (QOL) in Chinese adolescents, this cross-sectional study included 2827 students aged 12&ndash, 20 who were selected from 15 secondary schools in Hong Kong, China. Non-restorative sleep was assessed by a single item, rated on a 0&ndash, 10 scale: &ldquo, To what extent did you feel refreshed upon awakening over the past month?&rdquo, QOL was evaluated by the World Health Organization Quality of Life Measure&mdash, Abbreviated Version Hong Kong Chinese Version. Univariable and multivariable linear mixed-effects regressions were conducted to examine the influence of non-restorative sleep (NRS) on QOL. In the present sample, the mean overall QOL was 13.83, and the extent of feeling refreshed upon awakening was 4.75 on average. In multivariable linear mixed-effects regression, one unit feeling less refreshed upon awakening was associated with 0.37 units of poorer overall QOL after adjusting for age, gender, medical conditions, parental education and occupation, weekly hours of aerobic exercises, smoking and drinking habits. Additionally, adolescents with a significantly poorer overall QOL were more likely to be older, have medical problems, have parents with an educational level of primary school or below, have an unemployed father, engage in less weekly aerobic exercise, and be current smokers or former drinkers. Adolescents who experienced non-restorative sleep had a poorer QOL. Future studies are needed to alleviate non-restorative sleep to improve health outcomes in adolescents.

Publisher's version (útgefin grein), Aims: To describe prevalence of symptoms of anxiety and depression in surgical patients at three time points: at hospital postsurgery (T1), 6 weeks (T2) and 6 months (T3) postdischarge from hospital; and detect situations and experiences that predict symptoms of anxiety and depression at T2 and T3. Design: Prospective, explorative two-site follow-up study. Methods: Patients having selected surgeries from January–July 2016 were invited to participate. Final participation was 390 patients. Participation involved answering questionnaires, including the Hospital Anxiety and Depression Scale (HADS). A stepwise multiple linear regression model was employed to calculate predictors of anxiety and depression. Results: The proportion of patients presenting with moderate-to-severe anxiety or depression ranged from 5.4%–20.2% at different times. Major predictors of anxiety at both times were not feeling rested upon awakening and higher scores on HADS-Anxiety at T1 and T2 and at T2 also experiencing more distressing postoperative symptoms. For depression, the major predictors were at both times higher scores on HADS-Depression at T2 and T3 and also at T2 not feeling rested upon awakening and at T3 reporting delayed or very delayed recovery. The four models explained from 43.9%–55.6% of the variance in symptoms of anxiety and depression. Our findings show that patients presenting with psychological distress at the hospital are in a vulnerable position. Also, that benefits of good sleep during the recovery should be emphasized during hospital stay., The authors thank Guðný Bergþóra Tryggvadóttir, specialist at the Social Science Research Institute at the University of Iceland for providing statistical support, nurses at the Landspítali University and at Akureyri Hospital who participated in data collection and the participants who gave valuable information about themselves.

Sleep paralysis is an inability to move at sleep onset or upon awakening. It is often a distressing experience that can be associated with significant clinical consequences. Few studies have focussed on pleasant sleep paralysis episodes. The present study aimed to determine the relative prevalence of pleasant episodes of sleep paralysis as well as variables that may make them more likely to occur. Participants (N = 172) with recurrent episodes of sleep paralysis completed a battery of questionnaires investigating sleep paralysis episodes, trauma symptoms, life satisfaction, and Big Five personality traits. Pleasant sleep paralysis was found to be a fairly common experience (i.e. 23%). Episodes were emotionally complex, with pleasant episodes often involving some admixture of fear. In terms of hallucinations, pleasant episodes were more likely to involve vestibular-motor sensations (i.e. illusory body movements) and some individuals reported an ability to induce these hallucinations. Contrary to expectation, neither lower trauma symptomatology nor higher levels of reported life satisfaction predicted pleasant sleep paralysis. However, the ability to lucid dream and higher levels of trait openness to new experiences appeared to make pleasant episodes more likely. Clinical implications are discussed.

Typical clinical manifestations related to COVID‐19 include fever, fatigue and respiratory syndrome. However, an increasing number of reports of neurological manifestations emerged1. We report the case of a 57‐year‐old woman referred early April 2020 to the neurology inpatient ward because of acute left‐side facial nerve palsy noticed upon awakening.

The cognitive construct of prospective memory (PM) refers to the capacity to encode, retain and execute delayed intentions (e.g. to remember to buy milk on the way home). Although previous research suggests that PM performance is enhanced by healthy sleep, conclusions tend to be drawn based on designs featuring ecologically unnatural manipulations (e.g. total sleep deprivation). This study investigates whether a more common everyday experience (bedtime stress) affects next-day PM performance and, in so doing, also contributes to the heretofore inconsistent literature on stress and PM. Forty young adults received PM task instructions and were then assigned to either a stress condition (exposure to a laboratory-based stress-induction manipulation; n = 20, 9 women) or a non-stress condition (exposure to a non-stressful control manipulation; n = 20, 12 women). After completing the experimental manipulation, all participants had their objective sleep quality measured over a full night of polysomnographic monitoring. Upon awakening, they completed the PM task. Analyses detected significant between-group differences in terms of stress outcomes, sleep quality and PM performance: Participants exposed to the manipulation experienced heightened signs of stress (captured using a composite variable that included self-report, psychophysiological and endocrinological measures), had longer sleep latencies and poorer sleep depth and displayed significantly longer reaction times to PM cues. An interaction between experimental condition (being exposed to the stressor) and disrupted sleep (longer sleep latency) significantly predicted poorer next-day PM reaction time. We interpret these findings as indicating that bedtime stress, which leads to heightened presleep arousal, affects sleep processes and, consequently, the deployment of attentional resources during next-day execution of a delayed intention.

Objectives: Fatigue and sleep disturbance are common in adults with T2D. The symptoms carry contextual variations and may influence physical activity (PA). This study examined the associations between these symptoms and PA measured by an accelerometer. Methods: Fifty-three T2D adults completed a 7-day period during which they wore an ActiGraph-GT3X on the non-dominant wrist and completed a diary each morning. The diary assessed prior-night sleep and fatigue level (0-10) and feeling rested (1-5) upon awakening. Daytime PA data from the ActiGraph-GT3X were scored following the Freedson algorithm, including sedentary behavior, light- and moderate-intensity PA. The repeated 7-day data were analyzed using linear mixed models including both inter- and intra-individual sleep and fatigue variables as predictors of PA. Results: Participants were 60.3 (range 50-76) years and 29 (54.7%) were females. The mean values for fatigue and feeling rested were 3.1 (range 0-8.6) and 3.3 (range 1.6-5.0), respectively. Controlling for age, sex, BMI, and diabetes duration (estimate=-2.4, p=0.021), inter-individual fatigue and feeling rested were not related to moderate-intensity PA; however, intra-individual fatigue (estimate=-4.0, p=0.029) and feeling rested (estimate=8.0, p=0.045) upon awakening were significantly associated with moderate-intensity PA. There were no significant associations between other sleep variables (e.g., sleep duration and efficiency) and PA variables. Conclusions: At the inter-individual level, fatigue and feeling rested were not related to moderate-intensity PA. In contrast, at the individual level, lower fatigue and more restful sleep were associated with higher levels of moderate-intensity physical activity. These findings highlight the importance of addressing both inter- and intra-individual effects of symptoms commonly reported by T2D patients on physical activity in research and clinical practice. Disclosure B. Zhu: None. M. Kim: None. C. Fritschi: None. Funding University of Illinois at Chicago; National Institute on Aging (P30AG022849)

When on-call workers wake during the night to perform work duties, they may experience reduced alertness and impaired performance as a result of sleep inertia. After performing their duties, on-call workers may have the opportunity to return to sleep. Thus, it is important that sleep inertia countermeasures do not affect subsequent sleep. Exercise may be a suitable countermeasure; however, the impact on subsequent sleep is untested. Healthy participants (n = 15) completed three conditions in a counterbalanced order: sedentary, low-intensity exercise or high-intensity exercise, performed for 2 min upon awakening. Sleep was recorded 2 hr later using polysomnography, the Karolinska Sleepiness Scale was administered to measure subjective sleepiness, and core body temperature was measured continuously. Results indicate there was no effect of condition on most sleep variables; however, three variables had small differences, with longer total sleep time (p = .006), higher sleep efficiency (p = .006) and shorter N3 latency (p

Why do some individuals recall dreams every day while others hardly ever recall one? We hypothesized that sleep inertia—the transient period following awakening associated with brain and cognitive alterations—could be a key mechanism to explain interindividual differences in dream recall at awakening. To test this hypothesis, we measured the brain functional connectivity (combined electroencephalography–functional magnetic resonance imaging) and cognition (memory and mental calculation) of high dream recallers (HR, n = 20) and low dream recallers (LR, n = 18) in the minutes following awakening from an early-afternoon nap. Resting-state scans were acquired just after or before a 2 min mental calculation task, before the nap, 5 min after awakening from the nap, and 25 min after awakening. A comic was presented to the participants before the nap with no explicit instructions to memorize it. Dream(s) and comic recall were collected after the first post-awakening scan. As expected, between-group contrasts of the functional connectivity at 5 min post-awakening revealed a pattern of enhanced connectivity in HR within the default mode network (DMN) and between regions of the DMN and regions involved in memory processes. At the behavioral level, a between-group difference was observed in dream recall, but not comic recall. Our results provide the first evidence that brain functional connectivity right after awakening is associated with interindividual trait differences in dream recall and suggest that the brain connectivity of HR at awakening facilitates the maintenance of the short-term memory of the dream during the sleep–wake transition.

Study Objectives Sleep regularity, in addition to duration and timing, is predictive of daily variations in well-being. One possible contributor to changes in these sleep dimensions are early morning scheduled events. We applied a composite metric—the Composite Phase Deviation (CPD)—to assess mistiming and irregularity of both sleep and event schedules to examine their relationship with self-reported well-being in US college students. Methods Daily well-being, actigraphy, and timing of sleep and first scheduled events (academic/exercise/other) were collected for approximately 30 days from 223 US college students (37% females) between 2013 and 2016. Participants rated well-being daily upon awakening on five scales: Sleepy–Alert, Sad–Happy, Sluggish–Energetic, Sick–Healthy, and Stressed–Calm. A longitudinal growth model with time-varying covariates was used to assess relationships between sleep variables (i.e. CPDSleep, sleep duration, and midsleep time) and daily and average well-being. Cluster analysis was used to examine relationships between CPD for sleep vs. event schedules. Results CPD for sleep was a significant predictor of average well-being (e.g. Stressed–Calm: b = −6.3, p < 0.01), whereas sleep duration was a significant predictor of daily well-being (Stressed–Calm, b = 1.0, p < 0.001). Although cluster analysis revealed no systematic relationship between CPD for sleep vs. event schedules (i.e. more mistimed/irregular events were not associated with more mistimed/irregular sleep), they interacted upon well-being: the poorest well-being was reported by students for whom both sleep and event schedules were mistimed and irregular. Conclusions Sleep regularity and duration may be risk factors for lower well-being in college students. Stabilizing sleep and/or event schedules may help improve well-being. Clinical Trial Registration NCT02846077.

International audience; At the extreme spectrum of consciousness during sleep, some patients with rare hypersomnias reported experiencing a specific night 'blackout' when sleeping, i.e., an absence of experiences or recall of them from sleep onset to offset. Thus, we explored through questionnaires the conscious experiences (dreaming experience, mind, self) during the night in 133 patients with idiopathic hypersomnia, 108 patients with narcolepsy, and 128 healthy controls. The night blackout was more frequent in idiopathic hypersomnia than in narcolepsy and control groups. Patients with idiopathic hypersomnia and frequent night amnesia had lower dream recall frequencies, and felt more often sleep as deep and mind as blank during the night. They had a higher proportion of slow wave sleep on their (retrospectively collected) sleep recordings than those without night blackout. This night blackout provides a new model for studying loss of consciousness during sleep, here as a contentless, selfless and timeless feeling upon awakening.

International audience; A ‘compressed’ shift schedule (substitution of a rest day by a shift, shortening the duration of work breaks) was introduced for a better fit with aircraft traffic load. Thereafter, the company asked for a survey assessing the effects of the compressed shift system. Air traffic controllers (ATCOs) completed retrospectively a specific questionnaire assessing the effects of shift schedule (modified vs. initial) and of traffic load on fatigue, alertness (on-shift, upon awakening, during daily non-work activities), and sleep (duration, satisfaction). Work organization had marginal and unexpected effects, which might indicate ATCOs’ disapproval of the intervention. Traffic load affected sleep satisfaction and alertness during work and non-work activities. Specific effects of shift included reduced sleep time prior to morning shifts compared to night shifts, whereas alertness and fatigue were rated at comparable levels for both shifts. Results suggest that shiftwork features which favor sleep loss across a work cycle have deleterious consequences on alertness and increase the need for recovery, which are further enhanced by traffic load.

Two studies were designed to examine the role of self-compassion on sleep quality. One hundred and forty-two participants completed a one-time survey in which they reported their trait level self-compassion, sleep quality assessment and perceived stress over last month. Mediation analysis using regression and bootstrapping indicated that self-compassion was positively related to sleep quality assessment, and this relationship was mediated by perceived stress. Higher levels of self-compassion were associated with lower levels of perceived stress, and the latter were linked to better sleep. A 2-week diary study with a subsample of fifty-nine participants was followed to examine the effect of self-compassion on sleep outcomes within and between individual on a daily basis. Participants rated their stressor of the day before bed and sleep quality upon awakening. Multilevel models supported the positive effect of self-compassion on everyday sleep outcomes. Specifically, self-compassion buffered the negative effect of daily stressor on sleep latency. Experiencing stressful events during the day were associated with taking a longer time to fall asleep at night, except for participants with higher levels of self-compassion. Higher levels of self-compassion were also indirectly associated with a better mood and more alertness upon awakening. Self-compassion could benefit sleep quality both through the buffering effect and the indirect effect.

A tendency for experiencing unusual dream and sleep-wake transition phenomena (e.g., recurrent dreams, hypnagogic hallucinations, and confusion upon awakening), labeled general sleep experiences (GSEs), is linked with stress as well as psychological distress, explicit as well as covert. We hypothesized that alexithymia may moderate the relationship between stress and GSEs. Undergraduate students (N = 187) completed online questionnaires; Three months later, n = 78 of them reported perceived stress and dreaming each day for 14 days. Regression analyses for trait data and multilevel modeling for daily diary data both revealed a pattern of two competing alexithymic mechanisms: difficulty in identifying feelings was related to increased GSEs, whereas externally-oriented thinking was related to decreased GSEs. As hypothesized, a cross-level interaction was found: daily stress predicted daily GSEs of the following night, only among those who reported difficulty identifying their emotions. It seems that those who experience GSEs following stress, tend to be internally-oriented (i.e., notice their inner experiences), yet find it difficult to understand and identify those experiences. GSEs seem to represent a nocturnal manifestation of unprocessed emotion.

There is apt evidence in favor of a significant association between sleep and mortality. So far, most studies examine sleep problems using comprehensive, time-consuming tools and questions. In this study, we investigated the ability of four simple “yes” or “no” answered questions (i.e. easiness to fall asleep, restful upon awakening, sleep satisfaction and presence of insomnia) to predict 12-year all-cause and cardiovascular mortality in a rural population of 1519 citizens. The sample consisted of 652 males and 867 females, with a mean age of 56.9 years old (range 15–102 years old). Age, gender, education, smoking, body mass index and health status were used as confounders in the Cox proportional hazard models. 293 (19.3%) deaths were recorded. After adjusting for confounders, difficulty to fall asleep was significantly related to an increased risk of cardiovascular death in smokers (aHR 3.71, 95% CI 1.01–13.62). Male individuals, not feeling restful upon awakening were at a significantly increased risk of all-cause (aHR 2.08, 95% CI 1.33–3.24) and cardiovascular mortality (aHR 6.24, 95% CI 1.90–20.49), in the latter case only if they were non-smokers. Smokers, not satisfied with their sleep, were at a significantly increased risk of cardiovascular death (aHR 5.44, 95% CI 1.73–17.09). The presence of insomnia significantly increased the risk of all-cause mortality (aHR 8.10, 95% CI 1.66–39.57) in smokers of basic education and cardiovascular mortality (aHR 26.68 95% CI 4.78–148.49) in smokers. In conclusion, simple sleep questions can predict mortality, at least in rural populations. Future studies should expand these results to other populations.

Similar to other endocrine substances, cortisol secretion follows a pulsating rhythm. The cortisol awakening response (CAR) occurs upon awakening in the absence of any apparent stressful situation or imminent danger, which is a very intriguing feature. When confronting any stressful situation, two systems are activated. One system is regulated by the hypothalamic-pituitary-adrenal axis (HPA), and the other system is regulated by cerebral structures that control the activity of the autonomic sympathetic nervous system. Both systems receive inputs from emotional memory circuits, namely the amygdala, the hippocampus, the medial prefrontal cortex, and lateral septal nuclei, among others. This circuit integrates sensory information that comes from thalamic nuclei. The acquisition, retention, and evocation of recent and remote memories that are processed by the emotional memory circuit allow the selection of strategies for survival. The diurnal secretion of cortisol occurs near the time of awakening (i.e., after a period of rest or sleeping) and persists for several hours in the absence of any current stressful situation. The CAR seems to represent an ancient adaptive-allostatic feature that prepares an individual to face eventualities that are forthcoming during the day. The CAR is regulated by hypothalamic nuclei that modulate circadian rhythm, namely the suprachiasmatic nucleus and its connections with the paraventricular nucleus, and then activate the HPA axis. The CAR may represent a useful preparatory process that occurs before a stressful situation. The participation of emotional memory circuits may modify the CAR and contribute to resilient or vulnerable reactions when coping with threatening situations.

Introduction The ability to be fast alert and to interact with the environment without motor impairment upon waking up, is a critical feature of natural sleep. DORAs represent a new class of insomnia medications that specifically inhibit the wake-promoting effects of orexin neuropeptides. Daridorexant is a potent and selective DORA under late stage development for the treatment of insomnia. Here, we assessed the impact of sleep-promoting doses of daridorexant on rats’ and dogs’ behaviour upon forced awakening. Zolpidem (a positive GABAA receptor modulator) was used as active comparator in rats because of its known negative impact on motor functions. Methods Rats were woken up at different time points after oral administration of daridorexant (10, 30, 100 mg/kg) or zolpidem (30, 100 mg/kg) during their inactive phase, and repeatedly subjected to two motor tasks: 1) the rotating rod test (lasting 120 sec, at each time point) assessing gross motor skills and coordination, and 2) the forepaw grip strength test assessing fine motor skills and muscle strength. Dogs were presented with food as an external, salient stimulus, three hours after administration of daridorexant in gelatin capsules (10, 30 or 90 mg/dog) during their active phase. Behaviour and signs of muscle weakness, after having woken up, were assessed by manual inspection of video recordings and concomitant electroencephalogram/electromyogram recordings. Results In both the rotarod and grip tests, daridorexant treatment had no effect on motor behavior at any dose or time point tested, while zolpidem significantly reduced the time spent on the rotarod and the grip strength in a dose and time-dependent manner (N=12/group; p Conclusion The type of sleep promoted by daridorexant is surmountable in rats and dogs and similar to physiological sleep. It allows animals to easily wake up, to behave normally without motor impairment and to respond efficiently to the environmental conditions. Support (if any) Funded by Idorsia Pharmaceuticals Ltd

Introduction: Nightmares have been defined as bad dreams that produce awakenings and have content which can be recalled upon awakening. Frequent nightmares have been linked to many negative outcomes, such as depression and suicide. Research has demonstrated that stress can impact the likelihood and frequency of nightmare occurrences. Furthermore, extreme stress (such as trauma) can produce chronically recurring nightmares. Given the rise in societal stress as a result of the Covid-19 pandemic, one could expect an increase in nightmares within the general population. With this in mind, our project sought to examine if nightmares are occurring more frequently during the Covid-19 pandemic. Methods: Our project measured sleep quality and disordered symptoms in N = 2,126 undergraduate college students from the years 2017 to 2020 via online surveys. Data from 2020 was only gathered after the start of the Covid-19 pandemic (which was defined as March 11th 2020). Nightmares were assessed with a self-report questionnaire which asked, “have you experienced a nightmare within the past month”, to which respondents could respond with “yes”, “no”, or “unsure”. Prior to this question participants were told a nightmare is being defined as a bad dream that wakes one up and has remembered dream content upon awakening. Frequencies between years were compared using ANOVA techniques. Results: In regard to the percentage of our sample that reported a nightmare during the previous month, the year 2020 was significantly higher (41.1%;F = 10.27, p < 0.001) than all other years assessed (2017 = 27.0%;2018 = 25.3%;2019 = 31.7%). Furthermore, there was no significant difference between any of the pre-Covid-19 years. Conclusion: In 2020, A higher percentage of students reported experiencing a nightmare within the past month than any of our other captured years. Given our 2020 data only assessed students post the start of the pandemic, the significant increase of nightmares experienced by our sample could be related to stress produced by the Covid- 19 pandemic. Considering that nightmares have been found related to several negative outcomes, such as depression and suicide, both assessment of, and treatments for nightmares may be especially needed during our current climate.

Objective: Evening-dosed HLD200 is a delayed-release and extended-release methylphenidate (DR/ER-MPH) formulation consisting of uniform, dual-layered microbeads with an inner drug-loaded core. DR/ER-MPH is designed to delay the initial release of drug by 8–10 hours, and thereafter, provide a controlled, extended drug release to target onset of effect upon awakening that lasts into the evening. This phase 3 study evaluated the safety and efficacy of DR/ER-MPH on symptoms and temporal at-home functional impairment in children with attention-deficit/hyperactivity disorder (ADHD). Methods: This 3-week, randomized, double-blind, multicenter, placebo-controlled, parallel-group, forced-dose titration trial evaluated DR/ER-MPH (40–80 mg/day) in children aged 6–12 years with ADHD. Primary efficacy endpoint was the ADHD rating scale–IV (ADHD-RS-IV), and the key secondary endpoints were the Before-School Functioning Questionnaire (BSFQ), and Parent Rating of Evening and Morning Behavior-Revised, morning (PREMB-R AM) and evening (PREMB-R PM). Safety measures included spontaneously reported treatment-emergent adverse events (TEAEs) and two TEAEs of special interest, appetite suppression and insomnia (with direct questioning on sleep disturbance). Results: One hundred sixty-one participants were included in the intent-to-treat population (DR/ER-MPH, n = 81; placebo, n = 80). After 3 weeks, DR/ER-MPH achieved significant improvements versus placebo in ADHD symptoms (least-squares [LS] mean ADHD-RS-IV: 24.1 vs. 31.2; p = 0.002), and at-home early morning (LS mean BSFQ: 18.7 vs. 28.4; p

Summary Sleep inertia is affected by circadian phase, with worse performance upon awakening from sleep during the biological night than biological day. Visual search/selective visual attention performance is known to be sensitive to sleep inertia and circadian phase. Individual differences exist in the circadian timing of habitual wake time, which may contribute to individual differences in sleep inertia. Because later chronotypes awaken at an earlier circadian phase, we hypothesized that later chronotypes would have worse visual search performance during sleep inertia than earlier chronotypes if awakened at habitual wake time. We analysed performance from 18 healthy participants [five females (22.1 ± 3.7 years; mean ± SD)] at ~1, 10, 20, 30, 40 and 60 min following electroencephalogram-verified awakening from an 8 h in-laboratory sleep opportunity. Cognitive throughput and reaction times of correct responses were impaired by sleep inertia and took ~10–30 min to improve after awakening. Regardless whether chronotype was defined by dim light melatonin onset or mid-sleep clock hour on free days, derived from the Munich ChronoType Questionnaire, the duration of sleep inertia for cognitive throughput and reaction times was longer for later chronotypes (n = 7) compared with earlier chronotypes (n = 7). Specifically, performance for earlier chronotypes showed significant improvement within ~10–20 min after awakening, whereas performance for later chronotypes took ~30 min or longer to show significant improvement (P

This brief review aims to provide an updated account of the cardiovascular events of awakening, proposing a testable conceptual framework that links these events with the neural control of sleep and the autonomic nervous system, with focus on the hypothalamic orexin (hypocretin) neurons. Awakening from non-rapid-eye-movement sleep entails coordinated changes in brain and cardiovascular activity: the neural "flip-flop" switch that governs state transitions becomes biased toward the ascending arousal systems, arterial blood pressure and heart rate rise toward waking values, and distal skin temperature falls. Arterial blood pressure and skin temperature are sensed by baroreceptors and thermoreceptors and may positively feedback on the brain wake-sleep switch, thus contributing to sharpen, coordinate, and stabilize awakening. These effects may be enhanced by the hypothalamic orexin neurons, which may modulate the changes in blood pressure, heart rate, and skin temperature upon awakening, while biasing the wake-sleep switch toward wakefulness through direct neural projections. A deeper understanding of the cardiovascular events of awakening and of their links with skin temperature and the wake-sleep neural switch may lead to better treatments options for patients with narcolepsy type 1, who lack the orexin neurons.

Actigraphy is a versatile tool for evaluating sleep-wake cycles over time in the home-environment. Patients using the Phillips Actiwatch place an event marker when going to sleep and upon awakening. We investigate compliance in pressing the Actiwatch event marker button for patients referred for insomnia, hypersomnia and disorders of circadian rhythm. We retrospectively analysed event markers from 150 patients undergoing actigraphy for 2,117 nights combined. Compliance was evaluated from inspection of actigraphy records, and coded as full or partial. From patient records, a construct called the C-factor, designed to describe poor social resources and chronic unemployment, was used together with age and sex to predict compliance. We found a mean compliance between 54.0% and 76.3% for a median monitoring duration of 14 days. There was an overall insignificant effect of age (p = .081), but when analysed only for females there was a significant effect of 0.56% pr. year (p = .0038). Compliance was higher for women, Cohen's d = 0.65 (p = .01). The C-factor predicts 18.3% (confidence interval 9%-27.5%) lower compliance. Morning and evening compliance are correlated at r = .65. In conclusion, actigraphy event marker compliance is generally moderate or high, with older women exhibiting the highest compliance. C-factor predicts lower compliance, and this pattern may further translate to other circumstances. If compliance is important, clinicians may want to consider the effects of age, sex and C-factor.

Background Earlier evidence indicated an association between chronotype and the cortisol awakening response (CAR). However, these earlier data were collected without objective control for participant compliance being available, which, following recent guidelines, is considered critical for ensuring data validity. Here, we are seeking to replicate these earlier findings within a well-controlled sleep laboratory set up. Methods The sample consisted of 103 young males, including 12 participants defined as ‘evening’ (MEQ 59) types. All participants slept for one night in a sleep laboratory and were wakened at 6:30 AM the next morning. Saliva samples for the assessment of the CAR were collected under strict supervision at 0, 15, and 30 min post-awakening. Results Significant effects of chronotype emerged consistently from both dimensional analyses across the entire sample and from comparisons between morning vs. evening type. Overall, greater morningness was associated with an increased cortisol level upon awakening (S1) as well as with a greater overall cortisol output (AUCG), however, it was not associated with the CAR (AUCI). Discussion Our data corroborate earlier evidence by showing that, under well-controlled sleep-laboratory conditions, chronotype is related to an altered cortisol secretion over the post-awakening period with no association with the CAR. However, the results have to be replicated since it is only a single day study design.

Purpose The current study investigated diurnal cortisol dynamics in adults with and without aphasia, along with subjective reports of stress and measures of language production. Dysregulation of cortisol, a common biomarker of stress, is associated with cognitive dysfunction in different clinical populations. However, little is known about the consequences of stress-induced cortisol disturbances for stroke survivors, including those with aphasia. Method Nineteen participants with aphasia and 14 age-matched neurotypical adults were tested. Saliva samples were collected from participants to assess the cortisol awakening response, a marker of the integrity of the hypothalamic-pituitary-adrenal (HPA) axis. Participants also completed 2 subjective stress questionnaires. Language was evaluated using 3 short, picture description narratives, analyzed for discourse (dys)fluency and productivity markers. Results In contrast to neurotypical participants, adults with aphasia did not show the predictable cortisol awakening response. Participants with aphasia also showed an unusual heightened level of cortisol upon awakening. Additionally, neurotypical participants demonstrated an association between intact language performance and the cortisol awakening response, whereas the participants with aphasia did not, although they did perceive the language tasks as stressful. Conclusion This study indicates that the functionality of the HPA axis, as indexed by cortisol, contributes to optimal language performance in healthy adults. The absence of an awakening response among participants with aphasia suggests that stroke leads to dysregulation of the HPA axis, although the degree to which this impairment affects language deficits in this population requires further investigation.

The authors discuss modern ideas about the neurophysiological mechanisms of awakening from sleep and the results of own EEG studies of the spatio-temporal dynamics of the activity of the cerebral hemispheres using the own experimental model for studying consciousness in the sleep-wake paradigm. This model is based on continuous execution of a monotonous psychomotor test performed lying down with eyes closed and allows observing several short-term sleep episodes during a 1-hour experiment, followed by spontaneous awakening and restoration of the psychomotor test. A necessary condition for the restoration of activity during spontaneous awakening is the emergence of the EEG alpha rhythm, the parameters of which determine the effectiveness of the restoration of the psychomotor test and, accordingly, the achievement of a certain level of consciousness, and therefore can be considered as a neurophysiological correlate of consciousness activation upon awakening. The considered experimental model of consciousness can be useful for analyzing the neurophysiological mechanisms of consciousness activation in patients with chronic impairments of consciousness and for searching for effective methods for the rehabilitation of such patients.В статье рассматриваются современные представления о нейрофизиологических механизмах пробуждения от сна и результаты собственных электроэнцефалографических (ЭЭГ) исследований пространственно-временной динамики активности коры больших полушарий с использованием разработанной нами экспериментальной модели исследования сознания в парадигме сон—бодрствование. Эта модель основана на непрерывном выполнении монотонного психомоторного теста, выполняемого лежа с закрытыми глазами, она позволяет в течение 1-часового эксперимента наблюдать несколько кратковременных эпизодов сна с последующим спонтанным пробуждением и восстановлением выполнения психомоторного теста. Необходимым условием восстановления деятельности при спонтанном пробуждении является возникновение альфа-ритма ЭЭГ, параметры которого определяют эффективность восстановления психомоторного теста и соответственно достижения определенного уровня сознания, и поэтому это может рассматриваться как нейрофизиологический коррелят его активации при пробуждении. Рассматриваемая экспериментальная модель исследования сознания может быть полезна для анализа нейрофизиологических механизмов его активации у пациентов с хроническими нарушениями сознания и для поиска эффективных методов реабилитации таких больных.

Nonrestorative sleep (NRS), characterized by a lack of refreshment upon awakening, has received little attention in the sleep literature even though it can occur and cause impairment apart from other sleep difficulties associated with insomnia. The Restorative Sleep Questionnaire (RSQ) is one of the first validated self-report instruments for investigating NRS severity, presenting new opportunities to explore what factors predict and perhaps contribute to unrefreshing sleep. The present study sought to determine whether inherent circadian preference for morning or evening activity, known as chronotype, predicted restorative sleep in 164 college undergraduates who completed daily RSQs over 2 weeks. The participants who endorsed greater orientation to evening activity on the morningness-eveningness questionnaire reported significantly less average restorative sleep across their full sampling period, and this association was maintained after accounting for demographic factors, number of sleep-relevant psychiatric and medical diagnoses, sleep diary parameters, self-reported status as an insomniac and ratings of sleep quality. When analyses were conducted separately for weekday and weekend RSQ scores, eveningness predicted NRS independently of extraneous variables only during the workweek, not during Saturday and Sunday. These findings have implications for the developing conceptualization of NRS, and continue the work of elucidating the interconnections between common sleep disturbances and the circadian system.

Cortisol awakening response (CAR) has been studied in children with ADHD, and some authors have reported morning cortisol differences among ADHD subtypes. Despite, only half of the children with ADHD continue to exhibit the disorder into adulthood, CAR has not been studied in adults so far. One hundred and nine adults with ADHD according to the DSM-IV criteria (46 inattentive and 63 combined) ranging in age from 18 to 55 years, and 27 healthy controls were included. Psychiatric and organic comorbidities were excluded. Salivary cortisol samples were obtained at 0, 30, 45 and 60 minutes after awakening. CAR was present in 84% of the healthy controls but in only 64% of the adults with ADHD (68% of the inattentive and 61% of the combined were CAR-positive). There were no significant differences in any of the morning cortisol measures between patients and controls or between the combined and inattentive subtypes of ADHD. Among the inattentive subtype but not in the combined patients, significant positive correlations were observed between the CAR and emotional lability (p=0.05), or self-concept (p=0.014) CAARS subscales, as well as with the cognitive impulsivity subscale of the Barratt impulsiveness scale (p=0.028). These results suggest that adults with ADHD exhibit normal cortisol responses upon awakening and thus cannot be defined in terms of hypo-arousal. Neurobiological differences between the combined and inattentive subtypes involving cortisol, are discussed.

> “Mirrors,” she said, “are never to be trusted.” > Neil Gaiman, Coraline The ability to recognize oneself in the mirror is often held as evidence of self-awareness. However, children under the age of 2 y and most animals do not behave as if their mirrored reflection represents their own face or body, calling their capacity for self-awareness into doubt. In PNAS, Chang et al. (1) build on prior work (2) to provide further evidence that—with extensive training—rhesus macaques pass the mirror self-recognition test, suggesting this training either uncovers latent self-awareness or teaches the monkeys a new cognitive skill. Have monkeys finally earned a hard-won spot among the few exalted species to display self-awareness? If so, what does mirror self-recognition imply for our understanding of the brain mechanisms that support it? Upon initial exposure to a mirror, most animals react to their reflection as if seeing another animal. Gallup (3) first observed that, after repeated exposure to a mirror, chimpanzees began to interact with it in a more self-directed and less social way. To test whether the chimps actually recognized themselves, Gallup marked the animals’ foreheads with an odorless dye while the chimps were anesthetized. Upon awakening, chimpanzees spontaneously began touching the otherwise imperceptible mark using their reflection in the mirror. Gallup, and many others thereafter, argued that such behavior is a decisive measure of self-awareness. Since Gallup’s pioneering study, the mark procedure has become the litmus test for self-awareness. Human toddlers begin to pass a version of the mark test, not requiring anesthesia, at around 16 mo to 24 mo (4), whereas individuals with certain neuropsychiatric disorders, notably schizophrenia, show impairments in mirror self-recognition (5). In addition to chimpanzees, a menagerie of distantly related species, from elephants to magpies, have passed the mark test (6). Other primates, including gorillas and (previously) … [↵][1]1To whom correspondence should be addressed. Email: mplatt{at}mail.med.upenn.edu. [1]: #xref-corresp-1-1

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.

For the study of neuronal correlates of consciousness, a simple and effective model is the comparison of sleeping and waking states. Consciousness turns off during sleep and turns on at waking. The moment of awakening from sleep is a promising model for the study of neurophysiological correlates of consciousness. We developed a psychomotor test, the monotonous performance of which, causes within 60 min alternating episodes with the disappearance of consciousness when falling asleep (the “microsleep”) and its restoration upon awakening (wakefulness). When performing this test, the subject with closed eyes counts from 1 to 10 and simultaneously presses sensitive buttons, alternately with the right and left hands. Spontaneous restoration of the test after the episode of “microsleep” requires the activation of consciousness, which is accompanied by consciously performing the test with counting and simultaneously pressing the buttons. EEG methods allow you to accurately assess the moments of the transition of sleep/wakefulness, the levels of wakefulness and the depth of sleep, and behavioral methods, by indicators of the correctness of the performance of the psychomotor test - to determine the levels of consciousness. We showed reproducibility of this test obtained both under normal conditions and in conditions of functional magnetic resonance imaging (fMRI) procedure. In 10 out of 14 subjects during a 60-min experiment performed in the MRI scanner, 3–48 episodes of “microsleep” were recorded with subsequent awakening. Preliminary results showed an increase in the activity of the visual regions (the region of the calcarine sulcus) of the cerebral cortex, left pre-cuneus/cuneus, etc. during sleep and regions of the right thalamus, left cuneus, cerebellar zones, stem structures, etc. at the moment of awakening and resumption of conscious activity.

Congenital harlequin syndrome is rare dysautonomia of the face most often reported in adults and rarely in infants and children. It is a diagnosis of exclusion and a seemingly benign condition. We report a case of a 6-month-old girl with episodic unilateral and bilateral facial flushing provoked upon awakening and resolved with sleeping with associated autonomic features consistent with harlequin syndrome. This is followed by a review of cases identified regarding this condition in infants and children.

Background Up to 25% of acute stroke patients first note symptoms upon awakening. We hypothesized that patients awaking with stroke symptoms may be safely treated with intravenous alteplase (IV tPA) using non-contrast head CT (NCHCT), if they meet all other standard criteria. Methods The SAfety of Intravenous thromboLytics in stroke ON awakening (SAIL ON) was a prospective, open-label, single treatment arm, pilot safety trial of standard dose IV tPA in patients who presented with stroke symptoms within 0–4.5 hours of awakening. From January 30, 2013, to September 1, 2015, twenty consecutive wakeup stroke patients selected by NCHCT were enrolled. The primary outcome was symptomatic intracerebral hemorrhage (sICH) in the first 36 hours. Secondary outcomes included NIH stroke scale (NIHSS) at 24 hours; and modified Rankin Score (mRS), NIHSS, and Barthel index at 90 days. Results The average age was 65 years (range 47–83); 40% were women; 50% were African American. The average NIHSS was 6 (range 4–11). The average time from wake-up to IV tPA was 205 minutes (range 114–270). The average time from last known well to IV tPA was 580 minutes (range 353–876). The median mRS at 90 days was 1 (range 0–5). No patients had sICH; two of 20 (10%) had asymptomatic ICH on routine post IV tPA brain imaging. Conclusions Administration of IV tPA was feasible and may be safe in wakeup stroke patients presenting within 4.5 hours from awakening, screened with NCHCT. An adequately powered randomized clinical trial is needed. Clinical trial registration ClinicalTrials.gov NCT01643902.

Difficult early morning awakening is one of the defining symptoms of delayed sleep–wake phase disorder. It is accompanied by low cognitive arousal and drowsiness resulting in difficulty concentrating and focusing attention upon awakening. We designed the current study to quantitate cognitive performance (i.e. omissions, commissions, reaction time [average and variability]) and cognitive domains (i.e. focused attention, sustained attention, impulsivity and vigilance) with Conners’ Continuous Performance Test II during both habitual and conventional (00:00–07:00 hr) sleep–wake schedule in young adult patients with delayed sleep–wake phase disorder (n = 20, mean age = 24.8 years, SD = 3.0) and controls (n = 16, mean age = 24.4 years, SD = 3.4). Conners’ Continuous Performance Test II was administered after awakening and in the afternoon during both habitual and conventional conditions. In‐laboratory polysomnography was performed for 2 nights. We assessed sleep, tiredness, chronotype and depression using questionnaires. Saliva was sampled for dim light melatonin onset measurements. Repeated‐measures ANOVAs were applied for the Conners’ Continuous Performance Test II measures with group (patient/control), time (afternoon/morning) and condition (habitual/conventional schedule) as fixed factors. Patients with delayed sleep–wake phase disorder had reduced reaction times, especially in the morning, greater response speed variability, and made more omission and commission errors compared with controls. Patients with delayed sleep–wake phase disorder also had reduced focused attention, especially upon forced early awakening. The short total sleep time of patients with delayed sleep–wake phase disorder could not statistically explain this outcome. In conclusion, we observed a state‐dependent reduced ability to focus attention upon early morning awakening in patients with delayed sleep–wake phase disorder. Patients also had more omissions, longer reaction time and increased RT variability after habitual sleep, suggesting a possible small cognitive trait dysfunction in delayed sleep–wake phase disorder. This is the peer reviewed version of the following article:Cognitive performance in DSWPD patients upon awakening from habitual sleep compared with forced conventional sleep. Journal of Sleep Research 2018 s. 1-10, which has been published in final form at https://doi.org/10.1111/jsr.12730 This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.

Chlorogenic acids (CGAs) are found in abundance in coffee beans and have numerous health benefits. This study investigated the effect of CGAs extracted from coffee beans on fatigue and sleep in healthy participants. This crossover study involved 16 men (aged 30–54 years) who were daytime workers with weekends off work. The participants were randomized into two groups: One group was given a placebo beverage, and the other was given an active beverage containing 300 mg of CGAs. The test beverages were consumed for 13 days starting on a Sunday. The evaluation criteria were feelings of fatigue and sleep quality, sleep‐related indices recorded by an activity meter, and biomarkers. Feelings of fatigue and sleep‐related indices during the first (first half of week 1) and second (second half of week 2) halves of the consumption periods were compared. Within the first half of week 1, no differences in feelings of fatigue were observed between the groups. However, during the second half of week 2, fatigue upon awakening and sleep quality in the active group were significantly improved compared with those in the placebo group. Sleep efficiency and total nocturnal awakening time were significantly deteriorated in the second half of week 2 compared with the first half of week 1 in the placebo group. Furthermore, significant differences in these indices were observed between the two groups in the second half of week 2. These results suggest that the daily consumption of CGA‐containing beverages may improve fatigue upon awakening and sleep quality.

An 86-year-old male visited our emergency room because of a sudden visual loss in both eyes noted that morning. He had been drinking alcoholic beverages with his friends 2 days prior to admission. According to the patient, there were four different brands of alcoholic beverages consumed—one bought at the grocery store and three provided by friends. The patient noticed bilateral visual loss upon awakening and was brought to the emergency room by his family. He reported a past medical history of hypertension, diabetes mellitus, and coronary artery disease with congestive heart failure.

Current guidelines recommend IV administration of recombinant tissue plasminogen activator (rtPA) to carefully selected patients who can be treated within 4.5 hours of ischemic stroke onset. Patients whose neurologic symptoms are discovered upon awakening (wake-up stroke) generally are not given rtPA because of the uncertainty about the time of stroke onset. This group of patients may be relatively large. Preliminary reports suggest that patients with wake-up stroke who can be treated within 4.5 hours of discovery may respond similarly to patients with an established time of stroke onset. Clinical trials, which are selecting patients to treat primarily based on imaging surrogates, are under way. Pending the results of these trials, data about the utility of clinical or imaging findings that would identify those patients who could be treated and information about the safety and efficacy of IV rtPA in this situation are not available.

Objective Behavioral and physiological indexes of high sleep inertia (SI) characterize the awakening from recovery (REC) sleep after prolonged wakefulness, but the associated electroencephalogram (EEG) topography has never been investigated. Here, we compare the EEG topography following the awakening from baseline (BSL) and REC sleep. Methods We have recorded the EEG waking activity of 26 healthy subjects immediately after the awakening from BSL sleep and from REC sleep following 40 h of prolonged wakefulness. In both BSL and REC conditions, 12 subjects were awakened from stage 2 sleep, and 14 subjects from rapid eye movement (REM) sleep. The full-scalp waking EEG (eyes closed) was recorded after all awakenings. Results Subjects awakened from REC sleep showed a reduction of fronto-central alpha and beta-1 activities, while no significant effects of the sleep stage of awakening have been observed. Positive correlations between pre- and post-awakening EEG modifications following REC sleep have been found in the posterior and lateral cortices in the frequency ranges from theta to beta-2 and (only for REM awakenings) extending to the fronto-central regions in the beta-1 band, and in the midline central and parietal derivations for the alpha and delta bands, respectively. Conclusions These findings suggest that the higher SI after REC sleep may be due to the fronto-central decrease of alpha and beta-1 activity and to the persistence of the sleep EEG features after awakening in the posterior, lateral, and fronto-central cortices, without influences of the sleep stage of awakening.

The cortisol awakening response (CAR) has been associated with depression and a broader range of internalizing problems. Emerging adulthood is characterized by numerous stressful transitional life events. Furthermore, the functioning of the neurobiological stress system changes across development. These considerations underscore the importance of evaluating the physiological stress system in emerging adults in identifying the extent to which cortisol levels vary with risk and protective factors for mental health. The present study evaluated the association between internalizing symptoms and perceived life satisfaction with CAR in 32 young adults. Three saliva samples were collected to measure cortisol levels upon awakening and participants completed the Depression Anxiety Stress Scale (DASS) and Satisfaction with Life Scale (SWLS). Results show a significant positive correlation between area under the curve for CAR with internalizing symptoms (DASS total) and the DASS-depression subscale, but not with life satisfaction. Study limitations, implications, and future directions for these finding were discussed.

Night terrors, also known as sleep terrors, are an early childhood parasomnia characterized by screams or cries, behavioral manifestations of extreme fear, difficulty waking and inconsolability upon awakening. The mechanism causing night terrors is unknown, and a consistently successful treatment has yet to be documented. Here, we argue that cultural practices have moved us away from an ultimate solution: cosleeping. Cosleeping is the norm for closely related primates and for humans in non-Western cultures. In recent years, however, cosleeping has been discouraged by the Western medical community. From an evolutionary perspective, cosleeping provides health and safety benefits for developing children. We discuss night terrors, and immediate and long-term health features, with respect to cosleeping, room-sharing and solitary sleeping. We suggest that cosleeping with children (≥1-year-old) may prevent night terrors and that, under certain circumstances, cosleeping with infants (≤11-months-old) is preferable to room-sharing, and both are preferable to solitary sleeping.

A rare condition characterized by a transient inability to open one or both eyes upon awakening from sleep was first described in 1897. Although less than a handful of papers have been written about this condition since its initial description, a well-defined clinical entity emerges from the available literature. This article reviews the history and clinical features of this unusual condition.