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    Sleep and motor learning: implications for physical rehabilitation after stroke

    Sleep is essential for healthy brain function and plasticity underlying learning and memory. In the context of physical impairment such as following a stroke, sleep may be particularly important for supporting critical recovery of motor function through similar processes of reorganisation in the brain. Despite a link between stroke and poor sleep, current approaches to rehabilitative care often neglect the importance of sleep in clinical assessment and treatment. This review assimilates current evidence on the role of sleep in motor learning, with a focus on the implications for physical rehabilitation after stroke. We further outline practical considerations for integrating sleep assessment as a vital part of clinical care.
    Attached Files
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

  • #2
    Sleep parameters, functional status, and time post-stroke are associated with offline motor skill learning in people with chronic stroke

    http://journal.frontiersin.org/artic...015.00225/full

    Background: Mounting evidence demonstrates that individuals with stroke benefit from sleep to enhance learning of a motor task. While stage NREM2 sleep and REM sleep have been associated with offline motor skill learning in neurologically intact individuals, it remains unknown which sleep parameters or specific sleep stages are associated with offline motor skill learning in individuals with stroke.

    Methods: Twenty individuals with chronic stroke (>6 months following stroke) and 10 control participants slept for three consecutive nights in a sleep laboratory with polysomnography. Participants practiced a tracking task the morning before the third night and underwent a retention test the morning following the third night. Offline learning on the tracking task was assessed. Pearson’s correlations assessed for associations between the magnitude of offline learning and sleep variables, age, upper-extremity motor function, stroke severity, depression, and time since stroke occurrence.

    Results: Individuals with stroke performed with significantly less error on the tracking task following a night of sleep (p = 0.006) while the control participants did not (p = 0.816). Increased sleep efficiency (r = −0.285), less time spent in stage NREM3 sleep (r = 0.260), and more time spent in stage REM sleep (r = −0.266) were weakly-to-moderately associated with increased magnitude of offline motor learning. Furthermore, higher upper-extremity motor function (r = −0.400), lower stroke severity (r = 0.360), and less time since stroke occurrence (r = 0.311) were moderately associated with increased magnitude of offline motor learning.

    Conclusion: This study is the first study to provide insight into which sleep stages and individual characteristics may be associated with offline learning in people with stroke. Further research is needed to delineate which factors or combination of factors promote offline motor learning in people with neurologic injury to best promote motor recovery in these individuals.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

    Comment


    • #3
      REM sleep rebound as an adaptive response to stressful situations

      http://journal.frontiersin.org/artic...012.00041/full

      Stress and sleep are related to each other in a bidirectional way. If on one hand poor or inadequate sleep exacerbates emotional, behavioral, and stress-related responses, on the other hand acute stress induces sleep rebound, most likely as a way to cope with the adverse stimuli. Chronic, as opposed to acute, stress impairs sleep and has been claimed to be one of the triggering factors of emotional-related sleep disorders, such as insomnia, depressive- and anxiety-disorders. These outcomes are dependent on individual psychobiological characteristics, conferring even more complexity to the stress-sleep relationship. Its neurobiology has only recently begun to be explored, through animal models, which are also valuable for the development of potential therapeutic agents and preventive actions. This review seeks to present data on the effects of stress on sleep and the different approaches used to study this relationship as well as possible neurobiological underpinnings and mechanisms involved. The results of numerous studies in humans and animals indicate that increased sleep, especially the rapid eye movement phase, following a stressful situation is an important adaptive behavior for recovery. However, this endogenous advantage appears to be impaired in human beings and rodent strains that exhibit high levels of anxiety and anxiety-like behavior.



      The Secret Connection Between Anxiety and Sleep

      http://neurosciencenews.com/sleep-anxiety-7016/

      Encountering predators, adapting to a novel environment or expecting a reward ? these stressful or emotionally-salient situations require animals to shift their behavior to a vigilant state, altering their physiological conditions through modulation of autonomic and endocrine functions.

      The bed nucleus of the stria terminalis (BNST) is a part of the extended amygdala, which is generally considered as a key player in stress response, fear and anxiety. Through projections to various brain regions including relay nuclei of the autonomic nervous system, hypothalamic regions and the central nucleus of the amygdala, the BNST controls endocrine and autonomic reactions in response to emotionally-salient stimuli, along with behavioral expression of anxiety and fear.
      Update 04/07/2017
      Last edited by Jo Bowyer; 04-07-2017, 12:13 PM.
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


      • #4
        Nonpharmacological Treatments of Insomnia for Long-Term Painful Conditions: A Systematic Review and Meta-analysis of Patient-Reported Outcomes in Randomized Controlled Trials

        Abstract

        Study Objectives:

        Insomnia is a debilitating comorbidity of chronic pain. This study evaluated the effect of nonpharmacological sleep treatments on patient-reported sleep quality, pain, and well-being in people with long-term cancer and non-cancer (e.g., back pain, arthritis, fibromyalgia) pain conditions.


        Design:

        We systematically searched Cochrane CENTRAL, MEDLINE, Embase, and PsychINFO for relevant studies. Search period was set to inception of these databases to March 2014. Studies were included if they were: original randomized controlled trials (RCTs); testing a nonpharmacological intervention; that targets sleep; in adults; with painful health conditions; that has a control group; includes a measure of sleep quality; and at least one other health and well-being outcome.


        Measurement and Findings:

        Means and standard deviations of sleep quality, pain, fatigue, depression, anxiety, physical and psychological functioning were extracted for the sleep treatment and control groups at baseline, posttreatment and final follow-up. Methodological details concerning the treatment, participants, and study design were abstracted to guide heterogeneity and subgroup analyses. Eleven RCTs involving 1,066 participants (mean age 45–61 years) met the criteria for the meta-analysis. There was no systematic evidence of publication bias. Nonpharmacological sleep treatments in chronic pain patients were associated with a large improvement in sleep quality (standardized mean difference = 0.78, 95% Confidence Interval [0.42, 1.13]; P < 0.001), small reduction in pain (0.18 [0, 0.36] P < 0.05), and moderate improvement in fatigue (0.38 [0.08, 0.69]; P < 0.01) at posttreatment. The effects on sleep quality and fatigue were maintained at follow-up (up to 1 year) when a moderate reduction in depression (0.31, [0.09, 0.53]; P < 0.01) was also observed. Both cancer and non-cancer pain patients benefited from nonpharmacological sleep treatments. Face-to-face treatments achieved better outcomes than those delivered over the phone/internet.


        Conclusions:

        Although the body of evidence was small, nonpharmacological sleep interventions may represent a fruitful avenue for optimizing treatment outcomes in patients with chronic pain.

        Registration:

        PROSPERO registration: CRD42013004131.


        Citation:

        Tang NK, Lereya T, Boulton H, Miller MA, Wolke D, Cappuccio FP. Nonpharmacological treatments of insomnia for long-term painful conditions: a systematic review and meta-analysis of patient-reported outcomes in randomized controlled trials. SLEEP 2015;38(11):1751–1764.
        Jo Bowyer
        Chartered Physiotherapist Registered Osteopath.
        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

        Comment


        • #5
          Pain in Sleepwalking: A Clinical Enigma

          http://www.journalsleep.org/ViewAbstract.aspx?pid=30287

          Study Objectives:

          Sleepwalking is a disorder characterized by arousal specifically from slow wave sleep with dissociated brain activity that may be related to lower nociceptive state. Our objectives were to assess the frequency of chronic pain, headache, and migraine in sleepwalkers compared to controls, examine the impact and determinants of pain in sleepwalkers, and report analgesia frequency during injurious parasomnia episodes.


          Design:

          Cross-sectional case-control study.


          Setting:

          Data were collected at the Sleep Disorders Center, Montpellier, France.


          Participants:

          One hundred patients with sleepwalking were assessed for disease characteristics, sleep (polysomnography, sleepiness, and insomnia), pain (chronic pain, multidimensional pain inventory, headache, and migraine), depressive symptoms, and quality of life compared to 100 adult controls. Pain perception was retrospectively assessed during injurious parasomnia episodes.


          Measurements and Results:

          Raw association data showed that lifetime headache, migraine, and chronic pain at time of study were significantly associated with sleepwalking (also called somnambulism). Compared to controls, sleepwalkers reported more frequent daytime sleepiness, and depressive and insomnia symptoms. After adjustments, sleepwalking was associated with increased risk for headache and migraine only. Compared to pain-free sleepwalkers, sleepwalkers with chronic pain were more likely to be older and to have greater daytime sleepiness, insomnia, and depressive symptoms, with no difference in polysomnography assessment. Of the 47 sleepwalkers with at least one previous violent parasomnia episode, 78.7% perceived no pain during episodes, allowing them to remain asleep despite injury.


          Conclusion:

          Our results highlight the clinical enigma of pain in sleepwalking patients with complaints of frequent chronic pain, migraine, and headache during wakefulness but who report retrospectively experience of analgesia during severe parasomnia episodes, suggesting a relationship between dissociated brain activity and nociceptive dysregulation.
          Citation:

          Lopez R, Jaussent I, Dauvilliers Y. Pain in sleepwalking: a clinical enigma. SLEEP 2015;38(11):1693–1698.


          There were several sleepwalkers at the boarding school to which I was sent at the age of eight and they were extraordinarily difficult to wake. We tended to guide them back to bed without waking them. One managed to get out of bed and knock her front teeth out without waking herself or the rest of us and the first we knew about it was when the morning bell was rung and we all awoke to find the dorm looking like an abbatoir.

          During my on call nights at the hospital, I tended not to sleep at all if I had patients that needed to be seen two hourly and there were always patients who were in a light sleep in obvious pain. Opiates were supposed to be given four hourly through ports in the IVs, but the timings could go awry if there was an emergency which delayed the drug round.
          Last edited by Jo Bowyer; 12-05-2017, 10:20 PM.
          Jo Bowyer
          Chartered Physiotherapist Registered Osteopath.
          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

          Comment


          • #6
            Somnambulism analgesia

            http://noijam.com/2015/11/19/somnambulism-analgesia/

            I’ve asked the question whether it is possible to feel pain while asleep before. It led to some great discussion, as well as a fascinating first hand report. A recent paper in Sleep (I love these simple, unambiguous journal titles) reported on an experiment that asked known somnambulists about their experiences of pain. A press release from the American Academy of Sleep Medicine detailed some intriguing results:
            Jo Bowyer
            Chartered Physiotherapist Registered Osteopath.
            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

            Comment


            • #7
              Losing Neutrality: The Neural Basis of Impaired Emotional Control without Sleep

              http://www.jneurosci.org/content/35/38/13194

              Abstract

              Sleep deprivation has been shown recently to alter emotional processing possibly associated with reduced frontal regulation. Such impairments can ultimately fail adaptive attempts to regulate emotional processing (also known as cognitive control of emotion), although this hypothesis has not been examined directly. Therefore, we explored the influence of sleep deprivation on the human brain using two different cognitive–emotional tasks, recorded using fMRI and EEG. Both tasks involved irrelevant emotional and neutral distractors presented during a competing cognitive challenge, thus creating a continuous demand for regulating emotional processing. Results reveal that, although participants showed enhanced limbic and electrophysiological reactions to emotional distractors regardless of their sleep state, they were specifically unable to ignore neutral distracting information after sleep deprivation. As a consequence, sleep deprivation resulted in similar processing of neutral and negative distractors, thus disabling accurate emotional discrimination. As expected, these findings were further associated with a decrease in prefrontal connectivity patterns in both EEG and fMRI signals, reflecting a profound decline in cognitive control of emotion. Notably, such a decline was associated with lower REM sleep amounts, supporting a role for REM sleep in overnight emotional processing. Altogether, our findings suggest that losing sleep alters emotional reactivity by lowering the threshold for emotional activation, leading to a maladaptive loss of emotional neutrality.


              A lack of sleep makes everything harder. Focusing, finishing assignments, and coping with everyday stress can become monumental tasks.

              https://www.sciencedaily.com/release...0418151243.htm

              People with anxiety and depression often have sleep problems. But little has been known about whether or how their poor sleep affects a specific region of the brain known to be involved in regulating negative emotional responses.

              Researchers at the University of Illinois at Chicago College of Medicine have found that this area of the brain, the dorsal anterior cingulate cortex, may have to work harder to modify negative emotional responses in people with poor sleep who have depression or anxiety. The finding is reported in the journal Depression and Anxiety.

              The research team, led by Heide Klumpp, assistant professor of psychiatry at UIC, used functional MRI to measure the activity in different regions of the brain as subjects were challenged with an emotion-regulation task. Participants were shown disturbing images of violence -- from war or accidents -- and were asked to simply look at the images and not to try to control their reaction or to "reappraise" what they saw in a more positive light.

              An example of reappraisal would be to see an image of a woman with a badly bruised face and imagine her as an actress in makeup for a role, rather than as a survivor of violence, Klumpp said.

              "Reappraisal is something that requires significant mental energy," she said. "In people with depression or anxiety, reappraisal can be even more difficult, because these disorders are characterized by chronic negativity or negative rumination, which makes seeing the good in things difficult."
              Update 19/04/2017
              Last edited by Jo Bowyer; 19-04-2017, 12:12 PM.
              Jo Bowyer
              Chartered Physiotherapist Registered Osteopath.
              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

              Comment


              • #8
                Humans evolved to get better sleep in less time

                http://www.sciencedaily.com/releases...1214130926.htm

                "Humans are unique in having shorter, higher quality sleep," said anthropologist and study co-author David Samson of Duke, who logged nearly 2,000 hours watching orangutans in REM and non-REM sleep as part of his dissertation research prior to coming to Duke.

                The human sleep gap isn't merely the result of round-the-clock access to artificial light from streetlamps and computer screens, the researchers say. A separate study of the sleep habits of people living in three hunter-gatherer societies without electricity in Tanzania, Namibia and Bolivia found they get slightly less shut-eye than those of us with electronic gadgets.

                If artificial light and other aspects of modern life were solely responsible for shortening our sleep, we'd expect hunter-gatherer societies without access to electricity to sleep more, Samson said.

                Rather, the study by Samson and Duke anthropologist Charlie Nunn suggests that humans replaced sleep quantity with sleep quality long before the glare of smartphones came to be.

                The researchers attribute the shift towards shorter, more efficient sleep in part to the transition from sleeping in "beds" in the trees, as our early human ancestors probably did, to sleeping on the ground as we do today.

                Once on the ground, Samson said, early humans likely started sleeping near fire and in larger groups in order to keep warm and ward off predators such as leopards and hyenas -- habits which could have enabled our ancestors to get the most out of their sleep in the shortest time possible.

                Shorter sleep also freed up time that could be devoted to other things, like learning new skills and forging social bonds, while deeper sleep helped to cement those skills, sharpen memory and boost brainpower, Samson said.
                I don't much at night, which often leads to curiosity from those in different time zones.

                Being on call and participating in a demanding sport has enabled me to develop the ability to take short sleeps during the day if the opportunity arises.

                Those who are ill, injured, anxious/depressed, probably need more in the way of deep sleep and suitable strength and conditioning exercise that they are currently getting.
                Jo Bowyer
                Chartered Physiotherapist Registered Osteopath.
                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                Comment


                • #9
                  LUCID DREAMING MAY HELP US UNRAVEL THE MYSTERIES OF CONSCIOUSNESS

                  http://neurosciencenews.com/consciou...dreaming-3363/

                  Lucid dreaming is still an understudied subject, but recent advances suggest it’s a hybrid state of waking consciousness and sleep.
                  Jo Bowyer
                  Chartered Physiotherapist Registered Osteopath.
                  "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                  Comment


                  • #10
                    The spectral composition of evening light and individual differences in the suppression of melatonin and delay of sleep in humans

                    http://onlinelibrary.wiley.com/enhan...c4153c210ced8b

                    Abstract

                    Abstract:  The effect of light on circadian rhythms and sleep is mediated by a multi-component photoreceptive system of rods, cones and melanopsin-expressing intrinsically photosensitive retinal ganglion cells. The intensity and spectral sensitivity characteristics of this system are to be fully determined. Whether the intensity and spectral composition of light exposure at home in the evening is such that it delays circadian rhythms and sleep also remains to be established. We monitored light exposure at home during 6–8 wk and assessed light effects on sleep and circadian rhythms in the laboratory. Twenty-two women and men (23.1 ± 4.7 yr) participated in a six-way, cross-over design using polychromatic light conditions relevant to the light exposure at home, but with reduced, intermediate or enhanced efficacy with respect to the photopic and melanopsin systems. The evening rise of melatonin, sleepiness and EEG-assessed sleep onset varied significantly (P < 0.01) across the light conditions, and these effects appeared to be largely mediated by the melanopsin, rather than the photopic system. Moreover, there were individual differences in the sensitivity to the disruptive effect of light on melatonin, which were robust against experimental manipulations (intra-class correlation = 0.44). The data show that light at home in the evening affects circadian physiology and imply that the spectral composition of artificial light can be modified to minimize this disruptive effect on sleep and circadian rhythms. These findings have implications for our understanding of the contribution of artificial light exposure to sleep and circadian rhythm disorders such as delayed sleep phase disorder.
                    From the Wiley Neuroscience twitter feed
                    Jo Bowyer
                    Chartered Physiotherapist Registered Osteopath.
                    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                    Comment


                    • #11
                      Sleep Loss Boosts Hunger and Unhealthy Food Choices

                      http://neurosciencenews.com/endocann...p-hunger-3767/

                      Sleep-deprived participants in this study—all young, healthy volunteers—were unable to resist what the researchers called “highly palatable, rewarding snacks,” meaning cookies, candy and chips, even though they had consumed a meal that supplied 90 percent of their daily caloric needs two hours before. The effects of sleep loss on appetite were most powerful in the late afternoon and early evening, times when snacking has been linked to weight gain.

                      “We found that sleep restriction boosts a signal that may increase the hedonic aspect of food intake, the pleasure and satisfaction gained from eating,” said Erin Hanlon, PhD, a research associate in endocrinology, diabetes and metabolism at the University of Chicago. “Sleep restriction seems to augment the endocannabinoid system, the same system targeted by the active ingredient of marijuana, to enhance the desire for food intake.”
                      Jo Bowyer
                      Chartered Physiotherapist Registered Osteopath.
                      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                      Comment


                      • #12
                        Involvement of Ca2+-Dependent Hyperpolarization in Sleep Duration in Mammals

                        http://neurosciencenews.com/sleep-calcium-camk2-3884/

                        Highlights
                        •A simple model predicts Ca2+-dependent hyperpolarization regulates sleep duration
                        •Impaired/enhanced Ca2+-dependent hyperpolarization decreases/increases sleep duration
                        •Impaired Ca2+-dependent hyperpolarization increases neural excitability
                        •Impaired Ca2+/calmodulin-dependent kinases (Camk2a/Camk2b) decreases sleep duration

                        Summary
                        The detailed molecular mechanisms underlying the regulation of sleep duration in mammals are still elusive. To address this challenge, we constructed a simple computational model, which recapitulates the electrophysiological characteristics of the slow-wave sleep and awake states. Comprehensive bifurcation analysis predicted that a Ca2+-dependent hyperpolarization pathway may play a role in slow-wave sleep and hence in the regulation of sleep duration. To experimentally validate the prediction, we generate and analyze 21 KO mice. Here we found that impaired Ca2+-dependent K+ channels (Kcnn2 and Kcnn3), voltage-gated Ca2+ channels (Cacna1g and Cacna1h), or Ca2+/calmodulin-dependent kinases (Camk2a and Camk2b) decrease sleep duration, while impaired plasma membrane Ca2+ ATPase (Atp2b3) increases sleep duration. Pharmacological intervention and whole-brain imaging validated that impaired NMDA receptors reduce sleep duration and directly increase the excitability of cells. Based on these results, we propose a hypothesis that a Ca2+-dependent hyperpolarization pathway underlies the regulation of sleep duration in mammals.

                        “Involvement of Ca2+-Dependent Hyperpolarization in Sleep Duration in Mammals” by Fumiya Tatsuki, Genshiro A. Sunagawa, Shoi Shi, Etsuo A. Susaki, Hiroko Yukinaga, Dimitri Perrin, Kenta Sumiyama, Maki Ukai-Tadenuma, Hiroshi Fujishima, Rei-ichiro Ohno, Daisuke Tone, Koji L. Ode, Katsuhiko Matsumoto, and Hiroki R. Ueda in Neuron. Published online January 191 2016 doi:10.1016/j.neuron.2016.02.032
                        Jo Bowyer
                        Chartered Physiotherapist Registered Osteopath.
                        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                        Comment


                        • #13
                          Crash risk soars among truck drivers who fail to adhere to sleep apnea treatment

                          https://www.sciencedaily.com/release...0321081224.htm

                          The largest study of obstructive sleep apnea and crash risk among CMV drivers involved 1,613 truck drivers with sleep apnea and an equal number of controls. The rate of preventable crashes was 5 times higher among truck drivers with sleep apnea who failed to adhere to PAP therapy, compared with matched controls. In contrast, the crash rate of drivers with sleep apnea who were fully or partially adherent with treatment was statistically similar to controls.
                          Jo Bowyer
                          Chartered Physiotherapist Registered Osteopath.
                          "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                          Comment


                          • #14
                            Enhancing Sleep After Brain Injury Reduces Brain Damage and Cognitive Decline in Rats

                            http://neurosciencenews.com/tbi-slee...oscience-3924/

                            Traumatic brain injury is a major cause of death and disability worldwide. While brain cells at the site of impact are damaged immediately, many more cells can perish in the hours and days after the trauma as damaged axons succumb to injury. Studies suggest that widespread axonal injury contributes to many of the long-lasting problems with learning, memory, and movement commonly associated with head injuries. Molecular waste products also build up in the brain after head injury. Recent studies indicate the brain clears out this molecular buildup during the slow-wave stage of sleep where brain activity synchronizes into high-amplitude waves.
                            Jo Bowyer
                            Chartered Physiotherapist Registered Osteopath.
                            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                            Comment


                            • #15
                              Neuronal Firing Rate Homeostasis Is Inhibited by Sleep and Promoted by Wake

                              http://www.cell.com/cell/fulltext/S0...2816%2930060-5

                              Neocortical networks must generate and maintain stable activity patterns despite perturbations induced by learning and experience-dependent plasticity, and this stability must be maintained across distinct behavioral states with very different sensory drive and modulatory tone.
                              from Adam J Calhoun's twitter feed
                              Jo Bowyer
                              Chartered Physiotherapist Registered Osteopath.
                              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                              Comment

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