The role of monoamines and acetylcholine-containing neurons in the regulation of the sleep-waking cycle

We propose that the function of dream sleep (more properly rapid-eye movement or REM sleep) is to remove certain undesirable modes of interaction in networks of cells in the cerebral cortex. We postulate that this is done in REM sleep by a reverse learning mechanism (see also p. 158), so that the trace in the brain of the unconscious dream is weakened, rather than strengthened, by the dream.

The function of dream sleep

The reexperiencing ofa traumatic event in the form of repetitive dreams, memories, or flashbacks is one of the cardinal manifestations of posttraumatic stress disorder (PTSD). The dream disturbance associated with PTSD may be relatively specific for this disorder, and dysfunctional REM sleep mechanisms may be involved in the pathogenesis of the posttraumatic anxiety dream. Furthermore, the results of neurophysiological studies in animals suggest that CNS processes generating REM sleep may participate in the control of the classical startle response, which may be akin to the startle behavior commonly described in PTSD patients. Speculating that PTSD may be fundamentally a disorder of REM sleep mechanisms, the authors suggest several strategies for future research. (Am J Psychiatry 1989; 146:697-707)

Sleep Disturbance as the Hallmark of Posttraumatic Stress Disorder

Changes in sleep cycle patterns with age

Molecular Neurobiology of the Mammalian Brain

Sleep patterns were studied longitudinally in six acute schizophrenic patients throughout most of their hospital stays, ranging from 25 to 224 consecutive nights, and the data were compared with those from 15 normal control subjects. The sleep patterns of these six patients showed unique differences from those of the control subjects as well as from sleep patterns of severely depressed patients and normal subjects under experimental conditions. However, no definitive interpretation of these findings can yet be made; further extensive and systematic case studies are needed to determine whether the sleep disturbances reported here are an inherent aspect of all acute schizophrenic exacerbations.

Sleep Disturbance in Acute Schizophrenic Patients

NORMAL sleep in man consists of two alternating phases which may be distinguished by electroencephalographic (EEG), electromyographic, electro-occulographic, autonomic and psychologic criteria1–3. The initial period of nocturnal sleep is characterized by EEG spindles and slow waves, partial preservation of muscle tone, and regularity of pulse and respiratory rates. After about 90 min, this non-rapid eye movement (NREM) phase of sleep gives way to a period of irregular, low voltage electrocortical activity, bursts of rapid eye movements, profound hypotonia of certain muscles, rapid alterations in cardiorespiratory function and in human dreaming. Ordinarily, rapid eye movement (REM) sleep alternates with NREM sleep four or five times each night, and occupies 20 per cent to 25 per cent of total sleep time.

Effect of L -Dopa on the Sleep of Man

Effects of Para-chlorophenylalanine on sleep in man

Monoamine oxidase inhibitors suppressed REM sleep during longitudinal sleep studies in four subjects. While the REM suppression occurred during maximum dosages, one normal subject showed an increase in REM time during the initial phase of drug administration. One patient had a marked REM compensation after the drug was discontinued. There were no consistent changes in Non-REM sleep. Monoamine oxidase inhibition was measured by plasma and platelet studies, as well as by 24-hour urinary tryptamine levels.

Longitudinal studies of the effect of monoamine oxidase inhibitors on sleep in man.

The effect of lithium carbonate on sleep was studied in seven patients with a manic-depressive or depressive illness. Drug administration had significant effects on the sleep pattern, especially on rapid eye movement (REM) and delta sleep. The REM sleep time, as well as the phasic REM elements, were reduced by lithium carbonate. Partial to complete reversal of the REM suppression occurred in the two patients in whom the dosage of the drug was reduced or discontinued. Delta sleep time was elevated with the use of lithium carbonate, and a higher dosage increased delta sleep to a greater extent than a moderate dosage in one patient.

Jimmy Scott

Papers

Sleep Disturbance in Acute Schizophrenic Patients

Effect of L -Dopa on the Sleep of Man

Effects of Para-chlorophenylalanine on sleep in man

Longitudinal studies of the effect of monoamine oxidase inhibitors on sleep in man.

Lithium carbonate and sleep in affective illness.