You Are How You Sleep

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True “sleep” is important. It is not just closing your eyes or even based upon the number of hours one lays in bed.  Learn how to properly fall asleep and then how to properly wake up.

There is a growing danger concerning the increasing use of “sleep medications” which medicate people but do not help them sleep. The re-enactment of negative memories increases the longer one uses these medications.  As a result the person is fooled into believing

  • that they need a stronger dose of medication

  • a new medication

  • or the addition of wine to “help” their medications function better.

Consequently, the person has more and more negative memories to suppress. These are continually created by the “sleep medications”.  So they are not tossing and turning in bed BUT tossing and turning in their mind. An interesting connection has been made to basic physiology as to why a person “will” need higher doses of any sleep medication to help them supposedly sleep. There are safe medicinal alternatives if one needs to help out their normal sleep physiology

New research shows:

  • Zolpidem  (Ambien, sanofi-aventis US),  a popular anti-insomnia medication, increases the ability to remember images, but only those that have negative or highly arousing content.

Investigators at the University of California, Riverside, improved memory by pharmacologically manipulating sleep in 28 healthy volunteers. Although the participants did not have sleep problems, study co-author Sara Mednick, PhD, said that the findings have potential ramifications for patients prescribed zolpidem for relief of insomnia due to anxiety disorders, including posttraumatic stress disorder (PTSD).

“Physicians should watch out for this countertherapeutic effect in patients with anxiety disorders and PTSD,” Dr. Mednick told Medscape Medical News. “These are people who already have heightened memory for negative and high-arousal memories.”

She cautioned, however, that it is premature to warn patients taking this drug of the potential for increased recollection of sad, frightening, or stimulating memories, saying further research is needed. The findings were June 14 in the Journal of Cognitive Neuroscience.

  • Manipulating Memory.  Sleep “spindles” is the mechanism that enables the brain to consolidate emotional memory. Sleep spindles are brief bursts of brain activity that occur primarily during non–rapid eye movement (REM) sleep. The current study shows that sleep spindles, not REM sleep, affect emotional memory.

These findings give hope that memory can be manipulated in positive ways, said William Kohler, MD, a spokesman for the American Academy of Sleep Medicine in Darien, Illinois, and the medical director of Florida Sleep Institute in Spring Hill, Florida. Dr. Kohler, who was not involved in the study, told Medscape Medical News,

“The more we know about the processes in memory, the better our ability to intervene clinically in patients with emotional problems and memory problems such as dementia — patients who have a high prevalence of insomnia.”

The study included 15 men and 13 women, aged 18 to 39 years, all of whom were normal sleepers. The researchers used 2 hypnotic medications, zolpidem and sodium oxybate (Xyrem, Jazz Pharmaceuticals, Inc.), to pharmacologically manipulate sleep spindle density. The authors note that previous research has shown that zolpidem increased spindle activity, whereas sodium oxybate decreased it.

 On 3 separate occasions in this crossover design:

  • The participants received, in an order that was “counterbalanced across participants 10 mg of zolpidem orally, and  2.5 g of sodium oxybate, or a placebo, with at least 5 days between study days to allow for drug washout. On the study days and 2 days before, participants reportedly did not consume alcohol, caffeine, or stimulants.
  • Participants performed a memory test before and after a 90-minute morning nap in a polysomnography-monitored sleep laboratory, where they had spent the preceding night.
  • Participants viewed on a computer monitor 100 target images, 20 from each of 5 stimulus groups known to evoke positive, negative, or neutral responses, to encode memories before the nap.

Participants received the study drug immediately before the nap. Several hours after their nap, they performed a memory retrieval test, which involved viewing the same 100 target images, which were randomly rearranged and mixed with 100 new, irrelevant images. A computer prompt asked them to respond by indicating how certain they were that the image was old or new, to determine memory accuracy (“memory discriminability”).

  • Ceiling Effect. Sleep spindles, Dr. Mednick said, appeared to be vital for enhancing emotional memory. The authors suggested that the lack of a significant positive correlation between spindle density and memory accuracy with zolpidem might be because that drug does not produce a great enough range of spindles, creating a “ceiling effect.”

They found that increasing sleep spindle density was associated with increased memory accuracy for highly arousing and negative stimuli only when the participants received sodium oxybate.

  • High Specificity.  The significant difference in memory accuracy with zolpidem existed for both negative and high-arousal stimuli but not for positive or low-arousal stimuli.

Dr. Mednick said in a statement, “I was surprised by the specificity of the results, that the emotional memory improvement was specifically for negative and high-arousal memories.”  Dr. Kohler said he also found the effect that zolpidem had on memory surprising Information from Industry.

“This article, even though a relatively small number of patients were involved, does give some correlation between zolpidem and increased spindle density, which was found to increase memory discrimination. It’s very interesting, but whether it’s replicable in other studies, we don’t know yet. We need to do a lot more investigating.”

Because benzodiazepines produce similar effects on sleep as zolpidem, Dr. Mednick said that future research should investigate whether benzodiazepinelike drugs increase retention of negative and arousing memories, especially in patients with PTSD.

This study was funded by an award from the National Institutes of Health. Dr. Mednick and Dr. Kohler have reported no relevant financial relationships.  J Cogn Neurosci. Early access publication June 14, 2011

Submitted by Dr. Collin Ross

*Find details on true ‘sleep’ in the presentation “Rock a Bye Baby” by Dr. Colin Ross*

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