Sleep medicine: Practice, challenges and new frontiers

Abstract

Sleep medicine is an ambitious cross-disciplinary challenge, requiring the mutual integration between complementary specialists in order to build a solid framework. Although knowledge in the sleep field is growing impressively thanks to technical and brain imaging support and through detailed clinic-epidemiologic observations, several topics are still dominated by outdated paradigms. In this review we explore the main novelties and gaps in the field of sleep medicine, assess the commonest sleep disturbances, provide advices for routine clinical practice and offer alternative insights and perspectives on the future of sleep research.

Fearful arousals in sleep terrors and sleep-related hypermotor epileptic seizures may involve the salience network and the acute stress response of Cannon and Selye

“…The convincing data about the shared arousal-relatedness and the similarities of DOA and SHE episodes and the gain-of function mutation of the NAChR gene subunit found in SHE patients suggest a common cholinergic origin of these conditions [24] , [26] .…”

“…The events of both conditions link to arousals from slow wave sleep, strictly coupled with microstructural oscillations, such as the slow waves of the cyclic alternating pattern type A1. Both SHE and DOA episodes accumulate in the first and second sleep cycles when the homeostatic sleep pressure is the highest [23] , [24] . The transit periods from the descending to the ascending slopes of the first sleep cycles (the latter preparing NREM to REM transitions) are critical in facilitating sleep dissociation, especially at the trough (the turning point from the descending to the ascending slope) of the cycle, where sleep promoting and arousal forces coexist (and “clash”) [25] .…”

Overview of the hypnodensity approach to scoring sleep for polysomnography and home sleep testing

“…Besides sleep duration, depth, and continuity, sleep restorative properties depend on the capacity of the brain to create periods of sustained stable sleep (Parrino et al, 2012). As discussed by Parrino et al (2022), NREM sleep is bimodal with stable and instable periods, or alternatively conceptualized by the authors as effective and ineffective. Thus, the stability domain has only 2 forms of NREM sleep-stable and unstable where N3 is usually stable, N1 is always unstable, but N2 may be stable or unstable.…”

Диагностические Возможности Анализа Сновидений: Теоретические Предпосылки И Методические Подходы

“…Так, согласно психодинамической модели З. Фрейда и М. Солмса, в основе этого процесса лежит процесс активного вытеснения (Фрейд, 2021). В трехмерной модели Хобсона забывание сновидений связано с изменением состояния, обусловленным снижением активности моноаминергических систем («аминергическая демодуляция») и снижением активности дорсолатеральной префронтальной коры (Hobson, Pace-Schott, & Stickgold, 2000;Parrino et al, 2022). Нейрокогнитивная модель, основателями которой являются У. Домхофф и К. Холл, утверждает, что сны обычно забываются, поскольку часто внутреннее повествование сновидения контекстуально не связано с событиями и объектами в бодрствовании (Wamsley, 2013;Domhoff & Fox, 2015;Alcaro & Carta, 2019).…”