Behandlungsempfehlungen Insomnie der Gruppe «Schlaf & Psychiatrie» der SGSSC

Die Insomnie ist eine häufige Störung der Schlaf-Wach-Regulation und tritt oft komorbid auf. Die nachfolgenden Behandlungsempfehlungen stellen evidenzbasierte Diagnostik- und Therapiestrategien vor und umfassen sowohl psychotherapeutische wie auch pharmakotherapeutische Interventionen. Diese Empfehlungen der Schweizerischen Gesellschaft für Schlafforschung, Schlafmedizin und Chronobiologie (SGSSC) für die Behandlung der Insomnie wurden auf Grundlage der Leitlinien der «European Sleep Research Society» (ESRS) von 2023 [1] sowie der S3-Leitlinie/Nationalen Versorgungsleitlinie «Nicht erholsamer Schlaf/Schlafstörungen» der Deutschen Gesellschaft für Schlafforschung und Schlafmedizin (DGSM) von 2017 [2] erstellt. Sie geben nicht unbedingt die Ansicht der SMF-Redaktion wieder. Der Inhalt untersteht der redaktionellen Verantwortung der unterzeichnenden Fachgesellschaft bzw. Arbeitsgruppe

The neural correlates of dreaming.

Consciousness never fades during waking. However, when awakened from sleep, we sometimes recall dreams and sometimes recall no experiences. Traditionally, dreaming has been identified with rapid eye-movement (REM) sleep, characterized by wake-like, globally 'activated', high-frequency electroencephalographic activity. However, dreaming also occurs in non-REM (NREM) sleep, characterized by prominent low-frequency activity. This challenges our understanding of the neural correlates of conscious experiences in sleep. Using high-density electroencephalography, we contrasted the presence and absence of dreaming in NREM and REM sleep. In both NREM and REM sleep, reports of dream experience were associated with local decreases in low-frequency activity in posterior cortical regions. High-frequency activity in these regions correlated with specific dream contents. Monitoring this posterior 'hot zone' in real time predicted whether an individual reported dreaming or the absence of dream experiences during NREM sleep, suggesting that it may constitute a core correlate of conscious experiences in sleep

The European Insomnia Guideline : An update on the diagnosis and treatment of insomnia 2023

Publisher Copyright: © 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).Peer reviewe

Sommeil, rêves et le système dopaminergique de récompense

Le système mésolimbique dopaminergique (ML-DA) permet d'interagir de façon adaptée avec l'environnement et est par conséquent d'une importance cruciale pour la survie des organismes. Ce système est impliqué dans des fonctions essentielles en lien avec les émotions et la motivation, en particulier le traitement des informations à valeur motivationnelle ou de « récompense », et il est typiquement perturbé dans l'addiction et la dépression. Le système ML-DA de récompense n'est pas activé seulement pendant la veille, mais aussi au cours du sommeil. Ici, nous présentons le Modèle d'Activation de Récompense ("Reward Activation Model", RAM) dans lequel nous proposons que l'activation du système de récompense pendant le sommeil contribue à des processus de mémoire, ainsi qu'à la genèse du sommeil paradoxal (ou "REM" en anglais) et des rêves. Cette activation reflète le traitement privilégié d'informations à haute valeur émotionnelle ou motivationnelle pendant le sommeil. En intégrant des données neurophysiologiques et comportementales complexes issues de la recherche animale et des études chez les humains sains ou les patients, le RAM permet des prédictions spécifiques qui peuvent être testées empiriquement. De plus, le RAM offre des perspectives cliniques prometteuses, notamment concernant les mécanismes impliqués dans la pathogénèse de certains troubles neuropsychiatriques, telles que la dépression et de l'addiction

I Have A Dream: exploring the neural correlates and functions of normal and pathological sleep mentation

The elusive nature of dreams has intrigued philosophers and scientists since the birth of human kind. Compared to waking consciousness, dreaming defies many concepts of our ordinary reality, which has prompted many scholars to formulate several theories about its origin, meaning and functions. Despite the existence of a thorough analysis of dream content from western and non-western civilizations and several attempts concerning its interpretation and links with our waking life, it has remained impossible to identify the physical origin of dreams to date. Recent years have seen considerable progress in the development of sophisticated neuroimaging methods (high-density EEG, fMRI) allowing a stringent characterization of the brain mechanisms of a conscious state. Combining such techniques with reliable phenomenological methods such as serial awakenings during sleep, we have been able to describe the neural correlates of the dreaming experience and of specific dream content in healthy individuals and in patients with nightmares. These studies demonstrated that similar cortical networks are implicated for the same conscious content (e.g. perceptions, thoughts, emotions) across sleep and wakefulness in both healthy subjects and patients. We assume that the origins of a dream are located in subcortical regions of the brain and are related to the offline processing of motivational and emotional memory content during sleep. Combining EEG/MRI with serial awakenings represents a promising avenue for future developments in the science of dreaming, with the potential for decoding mental content from ongoing cortical and subcortical brain activity. Further studies showed that dreaming serves an emotion regulation function by exposing the individual to specific emotional stimuli, which would result in adapted responses to real-life events during wakefulness. By extrapolating this finding to clinical applications, we can propose new sleep therapies, which will aim to potentiate the emotional function of sleep and dreaming in order to treat several psychiatric disorders

An evolutionary-emotional perspective of insomnia and parasomnias

Based on past literature, it is here supported that insomnia, and parasomnias such as sleepwalking, sleep terrors and nightmares, reflect an evolutionary survival mechanism, which has threat-related origins and which, in some vulnerable individuals, becomes persistent due to failure of a fear extinction function. Genetic determinants, personality traits and sleep disturbances seem to determine whether the individual will resume normal sleep after the acute phase (return to safety) or will develop the pathological condition of chronic insomnia, persistent sleepwalking in adulthood and nightmare disorder. Possible treatments targeting fear extinction are proposed, such as pharmacotherapy, cognitive behavioral therapy and targeted memory reactivation during sleep

The roles of the reward system in sleep and dreaming

The mesolimbic dopaminergic system (ML-DA) allows adapted interactions with the environment and is therefore of critical significance for the individual's survival. The ML-DA system is implicated in reward and emotional functions, and it is perturbed in schizophrenia, addiction, and depression. The ML-DA reward system is not only recruited during wakeful behaviors, it is also active during sleep. Here, we introduce the Reward Activation Model (RAM) for sleep and dreaming, according to which activation of the ML-DA reward system during sleep contributes to memory processes, to the regulation of rapid-eye movement (REM) sleep, and to the generation and motivational content of dreams. In particular, the engagement of ML-DA and associated limbic structures prioritizes information with high emotional or motivational relevance for (re)processing during sleep and dreaming. The RAM provides testable predictions and has clinical implications for our understanding of the pathogenesis of major depression and addiction

Douleurs et troubles du sommeil

Le nombre de patients douloureux chroniques avec des troubles du sommeil est élevé. Les données de la littérature suggèrent que les troubles du sommeil et la douleur sont liés. Cependant, des questions subsistent quant à la direction de la causalité de leur association, ainsi que les mécanismes qui peuvent expliquer cette association. Pour comprendre cette interrelation, il est primordial de prendre en compte le schéma dit biopsychosocial : trois dimensions fondamentales dans l’analyse des processus complexes et multidisciplinaires que sont la douleur et le sommeil. Cet article cite les résultats et observations des études scientifiques des dernières années sur ce thème ouvrant la réflexion d’une prise en charge multimodale inévitable chez ces patients comorbides

The role of NMDA receptors in human eating behavior: evidence from a case of anti-NMDA receptor encephalitis

Research in animal models has implicated N-methyl-D-aspartate (NMDA) receptors (NMDARs) in the control of food intake. Until now, these findings have been not replicated in humans. Here we describe a 22-year-old woman with anti-NMDAR encephalitis and no prior neurological or psychiatric history. Her clinical course was marked by successive eating disorders: anorexia followed by hyperphagia. We propose that, much as they do in other animals, NMDARs in humans interact with the neuroendocrine, homeostatic, and reward systems controlling food intake in the central and peripheral nervous system structures related to feeding and satiety