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Local sleep and wakefulness—the concept and its potential for the understanding and treatment of insomnia disorder

Lokaler Schlaf- und Wachzustand – das Konzept und sein Potenzial für Verständnis und Therapie von Insomnien

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Abstract

In ancient mythology, sleep was often regarded as an inactive state, close to death. Research in the past century has, however, demonstrated that the brain is highly active and oscillates through well-defined stages during sleep. Yet it is only over the past decade that accumulating evidence has shown that sleep and wake processes can occur simultaneously, localized in distinct areas of the brain. The aim of this article is to review relevant aspects of the shift from global to local concepts of sleep–wake regulation and to further translate this perspective to the clinical problem of insomnia. Animal and human studies show that local wake-like activations (‘islands of wakefulness’) can occur during both major sleep stages, i.e. non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. Preliminary evidence suggests that higher levels of local wake-like activity, not captured in standard polysomnographic recordings, might underlie the perception of disrupted sleep or even wakefulness during polysomnographic epochs of sleep in patients with chronic insomnia. To further decipher the neural mechanisms, advanced techniques of high-density electroencephalography (hdEEG) and non-invasive brain stimulation techniques can be applied. Furthermore translating the concept of local sleep and wakefulness to the prevalent health problem of chronic insomnia might help to reduce the current mismatch between subjective sleep–wake perception and standard recordings, and might inform the development of new treatments.

Zusammenfassung

Im antiken Griechenland und über nachfolgende Jahrhunderte wurde Schlaf oftmals als ein inaktiver Zustand mit einer Nähe zum Tod angesehen. Arbeiten im letzten Jahrhundert zeigen hingegen, dass das Gehirn im Schlaf sehr aktiv ist und durch verschiedene, gut charakterisierte Schlafstadien oszilliert. Erst in den letzten Jahren wird zunehmend deutlich, dass Schlaf- und Wachprozesse zeitgleich nebeneinander in umschriebenen Arealen des Gehirns auftreten können. Das Ziel der vorliegenden Arbeit ist es, relevante Aspekte dieses Wechsels von globalen zu lokalen Konzepten der Schlaf-Wach-Regulation weiter herauszuarbeiten und diese Perspektive weiter für den Bereich der klinisch relevanten Insomnie zu erschließen. Studien an Tieren und Menschen zeigen, dass wachähnliche Aktivierungsmuster („lokale Inseln von Wachheit“) in beiden Hauptschlafstadien auftreten können, dem Non-Rapid-Eye-Movement(NREM)- und dem Rapid-Eye-Movement(REM)-Schlaf. Erste, jedoch nicht ausreichend replizierte Befunde weisen darauf hin, dass höhere Level von lokaler wachähnlicher Aktivität, die in Standardableitungen der Polysomnographie nicht erfasst werden, der oft berichteten Wahrnehmung von gestörtem Schlaf oder sogar dem Erleben von Wachheit während polysomnographischer Schlafphasen bei Patienten mit chronischer Insomnie zugrunde liegen könnten. Um die neuronalen Mechanismen lokaler Schlaf- und Wachaktivität näher zu verstehen, sind neuere Untersuchungsmethoden wie die High-Density-Elektroenzephalographie (hdEEG) oder nichtinvasive Gehirnstimulationsverfahren notwendig. Die weitere Übertragung des Konzepts lokaler Schlaf-Wach-Regulation auf das häufige Gesundheitsproblem Insomnie könnte die aktuell unzureichende Passung zwischen subjektiver Schlaf-Wach-Wahrnehmung und Standarduntersuchungsmethoden verbessern und eventuell zur Entwicklung neuer Therapieverfahren beitragen.

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Authors and Affiliations

  1. University of Oslo, Oslo, Norway

    Lina Stålesen Ramfjord

  2. University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland

    Elisabeth Hertenstein, Kristoffer Fehér, Christian Mikutta, Carlotta Louisa Schneider,  Christoph Nissen & Jonathan Gabriel Maier

  3. Privatklinik Meiringen, Meiringen, Switzerland

    Christian Mikutta

  4. Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Jonathan Gabriel Maier

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  1. Lina Stålesen Ramfjord
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  2. Elisabeth Hertenstein
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Correspondence to Christoph Nissen.

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L. Stålesen Ramfjord, E. Hertenstein, K. Fehér, C. Mikutta, C. Schneider, C. Nissen and J.G. Maier declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Stålesen Ramfjord, L., Hertenstein, E., Fehér, K. et al. Local sleep and wakefulness—the concept and its potential for the understanding and treatment of insomnia disorder. Somnologie 24, 116–120 (2020). https://doi.org/10.1007/s11818-020-00245-w

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