Obstructive sleep apnea syndrome severely affects psychological well-being. This syndrome frequently occurs in obesity; however, no previous study has investigated the level of psychological well-being in the case of OSA syndrome associated with obesity. In this work, we assessed the level of psychological well-being in fifty-two individuals affected by OSA syndrome and obesity through the Psychological General Well-Being Index. Moreover, we investigated the role of personality, cognitive functioning and attentional capabilities, subjective perception and objective measurement about sleeping, on (...) the subjective perception of psychological well-being. Our sample reported a lower level of psychological well-being; the participants’ scores were below the normative cut-off in all components, except for depression symptoms. A lower expression of harm avoidance temperament and a lower level of daily sleepiness predicted a higher level of psychological well-being. Psychological well-being seemed to be severely affected in individuals affected by OSA syndrome and obesity. The temperament and subjective perception of daily alertness and sleepiness, rather than the syndrome severity, seemed to play a crucial role in the individual perception of the psychological well-being. (shrink)

Obstructive sleep apnea (OSA) severely impacts sleep and has long-term health consequences. Treating sleep apnea with continuous positive airway pressure (CPAP) not only relieves obstructed breathing, but also improves sleep. CPAP improves sleep by reducing apnea-induced awakenings. CPAP may also improve sleep by enhancing features of sleep architecture assessed with electroencephalography (EEG) that maximize sleep depth and neuronal homeostasis, such as the slow oscillation and spindle EEG activity, and by (...) reducing neurophysiological arousal during sleep (i.e., beta EEG activity). We examined cross-sectional differences in quantitative EEG characteristics of sleep, assessed with power spectral analysis, in 29 adults with type 2 diabetes treated with CPAP and 24 adults undergoing SHAM CPAP treatment (total n = 53). We then examined changes in spectral characteristics of sleep as the SHAM group crossed over to active CPAP treatment (n = 19). Polysomnography (PSG) from the CPAP titration night was used for the current analyses. Analyses focused on EEG frequencies associated with sleep maintenance and arousal. These included the slow oscillation (0.5–1 Hz), sigma activity (12–16 Hz, spindle activity), and beta activity (16–20 Hz) in F3, F4, C3, and C4 EEG channels. Whole night non-rapid eye movement (NREM) sleep and the first period of NREM spectral activity were examined. Age and sex were included as covariates. There were no group differences between CPAP and SHAM in spectral characteristics of sleep architecture. However, SHAM cross-over to active CPAP was associated with an increase in relative 12–16 Hz sigma activity across the whole night and a decrease in average beta activity across the whole night. Relative slow oscillation power within the first NREM period decreased with CPAP, particularly for frontal channels. Sigma and beta activity effects did not differ by channel. These findings suggest that CPAP may preferentially enhance spindle activity and mitigate neurophysiological arousal. These findings inform the neurophysiological mechanisms of improved sleep with CPAP and the utility of quantitative EEG measures of sleep as a treatment probe of improvements in neurological and physical health with CPAP. (shrink)

ObjectiveThe aim of this study was to investigate possible associations between obstructive sleep apnea and fatigue. This naturally led to considering the association between OSA and excessive sleepiness, depression, and anxiety.BackgroundOSA is a highly prevalent sleep disorder, associated with a risk of hypertension, cardiovascular events, daytime sleepiness, poor cognitive function, and sudden death during sleep. Both excessive sleepiness, fatigue, and symptoms of depression are frequently reported.Method5,464 patients referred to a university hospital for obstructive sleep (...) class='Hi'>apnea underwent standard respiratory polygraphy. The severity of OSA was defined as either mild, moderate, or severe, using the apnea–hypopnea index. Validated questionnaires were used to assess excessive sleepiness, pathological fatigue, depression, and anxiety.ResultsNearly 70% of the patients were men, and median age was 50 years. One in three had moderate-to-severe OSA. Excessive sleepiness and pathological fatigue were present in 43 and 39%, respectively. The prevalence of possible depression and anxiety was 19 and 28%, respectively. The proportion of patients with male sex, obesity, and excessive sleepiness increased with the severity of OSA. In contrast, the proportion of patients with pathological fatigue did not increase with OSA severity, and there was a decrease in depression and anxiety with increasing OSA severity.ConclusionOur study reports that pathological fatigue, as well as anxiety and depression, did not increase with OSA severity, whereas excessive sleepiness did. Knowledge concerning conditions related to OSA severity may be indicative of pretest probability of OSA and thus change the priority for polygraphy. Furthermore, the high prevalence rates of fatigue, anxiety, and depression among these patients warrant further investigations. (shrink)

ObjectiveCo-morbid insomnia and sleep apnea is a common and debilitating condition that is more difficult to treat compared to insomnia or sleep apnea-alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia is effective in patients with COMISA, however, those with more severe sleep apnea and evidence of greater objective sleep disturbance may be less responsive to CBTi. Polysomnographic sleep study data has been used to predict treatment response to CBTi in patients (...) with insomnia-alone, but not in patients with COMISA. We used randomized controlled trial data to investigate polysomnographic predictors of insomnia improvement following CBTi, versus control in participants with COMISA.MethodsOne hundred and forty five participants with insomnia and sleep apnea [apnea-hypopnea index ≥ 15] were randomized to CBTi or no-treatment control. Mixed models were used to investigate the effect of pre-treatment AHI, sleep duration, and other traditional, and novel [quantitative electroencephalography ] polysomnographic predictors of between-group changes in Insomnia Severity Index scores from pre-treatment to post-treatment.ResultsCompared to control, CBTi was associated with greater ISI improvement among participants with; higher AHI, less wake after sleep onset, and less N3 sleep. No quantitative electroencephalographic, or other traditional polysomnographic variables predicted between-group ISI change.DiscussionAmong participants with COMISA, higher OSA severity predicted a greater treatment-response to CBTi, versus control. People with COMISA should be treated with CBTi, which is effective even in the presence of severe OSA and objective sleep disturbance. (shrink)

This study investigated the effect of obstructive sleep apnea on the neural mechanism of visual perception. A preliminary case-control study was conducted. Seventeen patients with moderate to severe OSA in the sleep center of Civil Aviation General Hospital and 20 healthy controls matched for age, sex, and education were recruited. The participants accepted the perceptual contour integration task, compared the differences in behavioral indicators between the two groups, and compared the differences in electroencephalography data between the two (...) groups through event-related potential technology. The groups did not differ significantly in age and gender, but they differed significantly in body mass index. The groups were not statistically different in terms of sleep structure and total sleep time. AHI, sleep efficiency, and minimal SaO2 value in the OSA group were significantly different from those of the control group. The results showed that the average reaction time of the OSA group was significantly longer than that of the healthy control group in the contour integration task. There was no significant difference in the accuracy rate. The results of EEG showed that the amplitudes of N100 of the OSA group were significantly higher than those of the control group at O1, Oz, and O2 electrodes. There was no significant difference in latency between the two groups. At the FCz electrode, the amplitudes of N200 of the OSA group were significantly higher than those of the control group. Therefore, we concluded that in the early stage of the perceptual integration task, although the neural response activity of patients with moderate and severe OSA was not accelerated, they need to call on more psychological resources, activate more neurons in the contour global recognition processing stage, and the compensatory effect of frontal lobe appeared in the stage of visual perception. (shrink)

ObjectiveThis study aims to investigate the lived experience in patients with obstructive sleep apnea syndrome and comorbid obesity following after continuous positive airway pressure therapy made with the disease the device, and to identify barriers and facilitators to the use of CPAP to improve rehabilitation provision and aid in disease self-management.MethodsQualitative research was conducted using three focus groups with a representative sample of 32 inpatients undergoing a 1-month pulmonary rehabilitation program at the IRCSS Istituto Auxologico Italiano San Giuseppe (...) Hospital, Verbania, Italy. The focus groups were recorded on tape, and contemporaneous notes were made. The tapes were transcribed verbatim, and Interpretative Phenomenological Analysis was used to develop themes.ResultsSix main themes were extracted: Living the diagnosis as a shock; You should not sleep on it: the importance of prevention; The adjustment to CPAP; Barriers and facilitators to the use of CPAP; Three in a bed; and The relationship with the healthcare system.ConclusionResults of this study suggest potential avenues for interventions to increase adherence to CPAP, including the provision of information and continued support. Individual counseling providing strategies aimed at helping the person to cope with the emotional problem and relational difficulties associated with the use of CPAP, and at strengthening self-efficacy and self-management skills are also encouraged for optimal care during the rehabilitation program. (shrink)

ObjectiveThis study aims to evaluate the effectiveness of the MotivAir program—a phone-based intervention based on Motivational Interviewing principles and techniques—in enhancing adherence to Continuous Positive Airway Pressure therapy among patients with Obstructive Sleep Apnea Syndrome.MethodsA multicenter randomized controlled trial design with random allocation at the level of the individual will be conducted to compare the impact of the experimental program with a control group receiving usual care only in improving selected clinical and psychological parameters in the patients. A (...) minimum sample of 80 participants will be recruited in each center according to the inclusion criteria. After the initial screening, participants will be randomly assigned to either the experimental group or the control condition. The program will last 180 days and will be delivered by a trained nurse. The impact of the MotivAir program on selected primary and secondary outcomes will be measured at baseline, and after 1-, 3-, and 6-month from CPAP initiation.DiscussionParticipants are expected to show an increased level of adherence to CPAP and to acquire the skills and self-confidence necessary to deal with the psychological consequences of their chronic condition. (shrink)

In this systematic review, we aim to describe the association between temporal lobe epilepsy and sleep, with bidirectional links in mechanisms and therapeutic aspects. Sleep stages may variably impact seizure occurrence, secondary generalization and the development, frequency and distribution of interictal epileptiform discharges. Conversely, epilepsy affects sleep micro- and macroarchitecture. TLE, the most frequent form of drug resistant epilepsy, shares an enduring relationship with sleep, with some intriguing potential mechanisms specific to anatomic localization, linking the two. (...) Sleep characteristics of TLE may also inform localizing properties in persons with DRE, since seizures arising from the temporal lobe seem to be more common during wakefulness, compared to seizures of extratemporal origin. Polysomnographic studies indicate that persons with TLE may experience excessive daytime somnolence, disrupted sleep architecture, increased wake after sleep onset, frequent shifts in sleep stages, lower sleep efficiency, decreased rapid eye movement sleep, and possibly, increased incidence of sleep apnea. Limited literature suggests that effective epilepsy surgery may remedy many of these objective and subjective sleep-related concerns, via multipronged effects, apart from reduced seizure frequency. Additionally, sleep abnormalities also seem to influence memory, language and cognitive-executive function in both medically controlled and refractory TLE. Another aspect of the relationship pertains to anti-seizure medications, which may contribute significantly to sleep characteristics and abnormalities in persons with TLE. Literature focused on specific aspects of TLE and sleep is limited, and heterogeneous. Future investigations are essential to understand the pathogenetic mechanisms linking sleep abnormalities on epilepsy outcomes in the important sub-population of TLE. (shrink)

Sleep is a major concern, especially in people with Down Syndrome. Beyond Obstructive Sleep Apnea, a number of other sleep difficulties have been reported in children with DS, such as delayed sleep onset, night-time awakenings, and early morning awakenings. The detrimental effect of sleep difficulties seems to contribute to and exacerbate the cognitive and behavioral outcomes of DS. Although the screening for sleep disorders is recommended early in age in DS, only a few (...) studies have evaluated the sleep profile in preschool-age children with DS. The aim of the current study was to assess the association between sleep disturbances and behavioral problems in a group of preschool-age children with DS, by means of a feasible and easy-to-administer parent-report questionnaires. Seventy-one preschool-age children with DS, ranging in age from 3 to 5.11 years, were included in this retrospective study. Sleep disturbances were evaluated by means of the Sleep Disturbance Scale for Children, while emotional and behavioral problems by means of the Child Behavior Checklist. Sleep breathing disorders were the most frequent sleep difficulties reported by parents. Moreover, children with clinical scores in total sleep problems exhibited elevation of psychopathological symptoms, namely Total problems, Affective problems, Anxiety problems, Pervasive Developmental Problems, and Attention Deficit/Hyperactivity Problems. The identification of the broader connection between sleep difficulties and emotional and behavioral problems in preschool-age children with DS leads to important considerations for intervention. (shrink)

Older adults were considered a vulnerable group for the COVID-19 infection and its consequences, including problems with sleep.AimTo evaluate the prevalence of sleep disorders in older adults, to describe their sleep patterns, as well as to analyse if there were any changes in comparison with the period pre-pandemic.Materials and MethodsOnline survey used for data collection received answers from 914 elderly age range 65–90 years, from April to August 2020. Results: 71% of the sample reported a pre-existent (...) class='Hi'>sleep disorder, and some of them worsened during the pandemic, especially Insomnia in women and Obstructive Sleep Apnea in men. No difference in sleep duration before and during the pandemic was found, although there was a worsening of some aspects related to sleep, such as sleep quality, sleep efficiency, awakening quality, sleep latency and nocturnal awakenings, especially in the female gender. Educational level influenced sleep latency, indicating higher sleep latency among those with primary education when compared with the ones with Ph.D.ConclusionThe pandemic had influenced sleep patterns among the elderly, as well as worsening of pre-existent sleep disorders. Female gender and low educational level were considered risk factors for sleep alterations, and high educational level, on its turn, appeared to be a protective factor. (shrink)

This article explains how the most recommended treatment for obstructive sleep apnea, the continuous positive airway pressure device, acts and interacts with users’ bodies, sleep partners’ bodies, and cultural discourses to produce emotions and practices that generate the subjectivity of a disabled or abled person. Drawing upon in-depth interviews with OSA patients, this article illustrates how introducing CPAP devices into patients’ lives may disturb their sleep and breathing, diminish their independence, disfigure their appearance, and problematize intimacy (...) with bed partners, thereby disrupting both the fleshy body and the culturally preferred image of a healthy, independent, and attractive individual. In response, many patients reject this treatment. ability as a subjective state is shown to emerge from associations in a network composed of heterogeneous entities that have agency. That is, disabled subjectivity emerges when the device prevents individuals from accomplishing what they consider to be the essential and socially significant aspects of sleep and primarily its disembodied and interembodied aspects. (shrink)

Patients with insomnia complain of problems with sleep onset or sleep maintenance or early morning awakenings, or a combination of these, despite adequate opportunity and circumstances for sleep. In addition, to fulfill the diagnostic criteria for insomnia the complaints need to be associated with negative daytime consequences. For chronic insomnia, the symptoms are required to be present at least 3 days per week for a duration of at least 3 months. Lastly, for insomnia to be defined as (...) a disorder, the sleep complaints and daytime symptoms should not be better explained by another sleep disorder. This criterion represents a diagnostic challenge, since patients suffering from other sleep disorders often complain of insomnia symptoms. For instance, insomnia symptoms are common in e.g., obstructive sleep apnea and circadian rhythm sleep-wake disorders. It may sometimes be difficult to disentangle whether the patient suffers from insomnia disorder or whether the insomnia symptoms are purely due to another sleep disorder. Furthermore, insomnia disorder may be comorbid with other sleep disorders in some patients, e.g., comorbid insomnia and sleep apnea. In addition, insomnia disorder is often comorbid with psychological or somatic disorders and diseases. Thus, a thorough assessment is necessary for correct diagnostics. For chronic insomnia disorder, treatment-of-choice is cognitive behavioral therapy, and such treatment is also effective when the insomnia disorder appears comorbid with other diagnoses. Furthermore, studies suggest that insomnia is a heterogenic disorder with many different phenotypes or subtypes. Different insomnia subtypes may respond differently to treatment, but more research on this issue is warranted. Also, the role of comorbidity on treatment outcome is understudied. This review is part of a Research Topic on insomnia launched by Frontiers and focuses on diagnostic and treatment challenges of the disorder. The review aims to stimulate to more research into the bidirectional associations and interactions between insomnia disorder and other sleep, psychological, and somatic disorders/diseases. (shrink)

This paper extends the evolutionary and developmental research model for SIDS presented in previous articles (McKenna 1990a, 1990b). Data from variety of fields were used to show why we should expect human infants to be physiologically responsive in a beneficial way to parental contact, one form of which is parent-infant co-sleeping. It was suggested that on-going sensory exchanges (touch, movement, smell, temperature, etc.) between co-sleeping parent-infant pairs might diminish the chances of an infantile cardiac-respiratory crisis (such as those suspected to (...) occur in some SIDS cases). In this article we review recent epidemiological data and sleep research findings on SIDS to show how they relate to evolutionary and cross-cultural perspectives. Results of a preliminary study of the co-sleeping behavior of mother-infant pairs indicate that, with respect to sleep, arousal, and respiratory patterns, co-sleeping mother-infant pairs affect each other in potentially important ways. We suggest specifically that co-sleeping may shorten periods of consolidated sleep among young infants by causing them to arouse more frequently. Moreover, we suggest that partner-induced arousals might help the infant to confront sleep crises more competently. In the long run, these arousals might prevent the premature emergence of prolonged (adultlike) sleep bouts from which some infants have difficulty arousing—especially during a breathing pause or apnea. (shrink)

High blood pressure is an important component of pre-eclampsia. The underlying mechanism of development of hypertension in pre-eclampsia is complicated and still remains obscure. Several theories have been advanced including endothelial dysfunction, uteroplacental insufficiency leading to generalized vasoconstriction, increased cardiac output, and sympathetic hyperactivity. Increased blood flow and pressure are thought to lead to capillary dilatation, which damages end-organ sites, leading to hypertension, proteinuria and edema. Additional theories have been put forward based on epidemiological research, implicating immunological and genetic factors. (...) None of these theories have been substantiated. Based on a review of literature this paper postulates that the initiating event for the development of preeclampsia is intermittent hypoxia associated with irregular breathing during sleep, hypoapnea, apnea,inadequate respiratory excursions during the waking hours and inadequate cardiopulmonary synchronization (abnormal sympatho-vagal balance). (shrink)

This paper examines the forms of life established through the visual governance of the Australian social security mobile app —the Express Plus Centrelink app. It is argued that the app exceeds established accounts of juridical and administrative power. The app involves a seeing that is not public, a responding that is not writing and a de-materialisation of an institution and its disciplinary apparatus. It is argued that the app creates proto-literate subjects that are required to respond to a real-time sequence (...) of images in a highly structured and circumscribed manner to become complicit in the digitalisation of their life. (shrink)

This paper examines three accounts of the sleeping beauty case: an account proposed by Adam Elga, an account proposed by David Lewis, and a third account defended in this paper. It provides two reasons for preferring the third account. First, this account does a good job of capturing the temporal continuity of our beliefs, while the accounts favored by Elga and Lewis do not. Second, Elga’s and Lewis’ treatments of the sleeping beauty case lead to highly counterintuitive consequences. The proposed (...) account also leads to counterintuitive consequences, but they’re not as bad as those of Elga’s account, and no worse than those of Lewis’ account. (shrink)

Adam Elga takes the Sleeping Beauty example to provide a counter-example to Reflection, since on Sunday Beauty assigns probability 1/2 to H, and she is certain that on Monday she will assign probability 1/3. I will show that there is a natural way for Bas van Fraassen to defend Reflection in the case of Sleeping Beauty, building on van Fraassen’s treatment of forgetting. This will allow me to identify a lacuna in Elga’s argument for 1/3. I will then argue, however, (...) that not all is well with Reflection: there is a problem with van Fraassen’s treatment of forgetting. Ultimately I will agree with Elga’s 1/3 answer. David Lewis maintains that the answer is 1/2; I will argue that cases of forgetting can be used to show that the premiss of Lewis’s argument for 1/2 is false. (shrink)

In the Sleeping Beauty problem, Beauty is woken once if a coin lands heads or twice if the coin lands tails but promptly forgets each waking on returning to sleep. Philosophers have divided over whether her waking credence in heads should be a half or a third. Beauty has centered beliefs about her world and about her location in that world. When given new information about her location she should update her worldly beliefs before updating her locative beliefs. When (...) she conditionalizes in this way, her credence in heads is a half before and after being told it is Monday. In applications of Dutch Book arguments to the Sleeping Beauty problem, the probability of a particular outcome has often been confounded with consequences of that outcome. Heads and tails are equally likely but twice as much is at stake if the coin falls tails because Beauty is fated to make the same choice twice. As a consequence, the possibility of tails should be given twice the weight of the possibility of heads when deciding whether to bet on heads even though heads and tails are equally likely. (shrink)

Unremarkable earlier draft of "Sleeping Beauty: A Critical Survey".

Cian Dorr (2002) gives an argument for the 1/3 position in Sleeping Beauty. I argue this is based on a mistake about Sleeping Beauty's epistemic position.

Volume 20, Issue 6, June 2020, Page 47-49.

Analyses of the Sleeping Beauty Problem are polarised between those advocating the “1/2 view” (“halfers”) and those endorsing the “1/3 view” (“thirders”). The disagreement concerns the evidential relevance of self-locating information. Unlike halfers, thirders regard self-locating information as evidentially relevant in the Sleeping Beauty Problem. In the present study, we systematically manipulate the kind of information available in different formulations of the Sleeping Beauty Problem. Our findings indicate that patterns of judgment on different formulations of the Sleeping Beauty Problem do (...) not fit either the “1/2 view” or the “1/3 view.” Human reasoners tend to acknowledge self-locating evidence as relevant, but discount its weight significantly. Accordingly, self-locating information may trigger more cautious judgments of confirmation than familiar kinds of statistical evidence. We also discuss how these results can advance the debate by providing a more nuanced and empirically grounded account or explication of the evidential impact of self-locating information. (shrink)

Volume 20, Issue 6, June 2020, Page 42-44.

The strong law of large numbers and considerations concerning additional information strongly suggest that Beauty upon awakening has probability 1/3 to be in a heads-awakening but should still believe the probability that the coin landed heads in the Sunday toss to be 1/2. The problem is that she is in a heads-awakening if and only if the coin landed heads. So, how can she rationally assign different probabilities or credences to propositions she knows imply each other? This is the problem (...) I address in this article. I suggest that ‘p whenever q and vice versa’ may be consistent with p and q having different probabilities if one of them refers to a sample space containing ordinary possible worlds and the other to a sample space containing centred possible worlds, because such spaces may fail to combine into one composite probability space and, as a consequence, ‘whenever’ may not be well defined; such is the main contribution of this article. 1The Sleeping Beauty Game2Groisman’s and Peter Lewis’s Approaches3Discussing Beauty’s Credences4The Principle of Equivalence's Failure5Making Sense of the Principle of Equivalence's Failure6Elga’s and Lewis’s Approaches7ConclusionAppendix. (shrink)

Rambling, largely unreadable survey of the Sleeping Beauty literature.

Volume 20, Issue 6, June 2020, Page 22-24.

Sleep has received limited attention in economics and sleep duration is usually made exogenous and fixed in models of time allocation. In our framework sleeping involves investing in alertness but also a sacrifice of waking time. We show how the inter-temporal utility-maximization problem on the length of sleep is analogous to the optimality conditions for resource extraction. We then test the theoretical predictions that emerge from the model, which include the effects of labor market opportunities and having (...) children, on sleep patterns. (shrink)

We hypothesize that rapid eye movement or REM sleep evolved, in part, to mediate sexual/reproductive behaviors and strategies. Because development of sexual and mating strategies depends crucially on early attachment experiences, we further hypothesize that REM functions to mediate attachment processes early in life. Evidence for these hypotheses comes from (1) the correlation of REM variables with both attachment and sexual/reproductive variables; (2) attachment-related and sex-related hormonal release during REM; (3) selective activation during REM of brain sites implicated in (...) attachment and sexual processes; (4) effects of maternal deprivation on REM; (5) effects of REM deprivation on sexual behaviors; and (6) the REM-associated sexual excitation. To explain why we find associations among REM sleep, attachment, and adult reproductive strategies, we rely on recent extensions of parent-offspring conflict theory. Using data from recent findings on genomic imprinting, Haig (2000) and others suggest that paternally expressed genes are selected to promote growth of the developing fetus/child at the expense of the mother, while maternally expressed genes counter these effects. Because developmental REM facilitates attachment-related outcomes in the child, developmental REM may be regulated by paternally expressed genes. In that case, REM may have evolved to support the “aims” of paternal genes at the expense of maternal genes. (shrink)

The Sleeping Beauty problem is presented in a formalized framework which summarizes the underlying probability structure. The two rival solutions proposed by Elga and Lewis differ by a single parameter concerning her prior probability. They can be supported by considering, respectively, that Sleeping Beauty is “fuzzy-minded” and “blank-minded”, the first interpretation being more natural than the second. The traditional absent -minded driver problem is reinterpreted in this framework and sustains Elga’s solution.

It is argued that thirder resolution of the Lewis - Elga controversy about Sleeping Beauty is more clear when the coin toss is replaced by a quantum measurement and the analysis is performed in the framework of the Many-Worlds Interpretation.

Sleep and dreaming are important daily phenomena that are receiving growing attention from both the scientific and the philosophical communities. The increasingly popular predictive brain framework within cognitive science aims to give a full account of all aspects of cognition. The aim of this paper is to critically assess the theoretical advantages of Predictive Processing (PP, as proposed by Clark 2013, Clark 2016; and Hohwy 2013) in defining sleep and dreaming. After a brief introduction, we overview the state (...) of the art at the intersection between dream research and PP (with particular reference to Hobson and Friston 2012; Hobson et al. 2014). In the following sections we focus on two theoretically promising aspects of the research program. First, we consider the explanations of phenomenal consciousness during sleep (i.e. dreaming) and how it arises from the neural work of the brain. PP provides a good picture of the peculiarity of dreaming but it can’t fully address the problem of how consciousness comes to be in the first place. We propose that Integrated Information Theory (IIT) (Oizumi et al. 2014; Tononi et al. 2016) is a good candidate for this role and we will show its advantages and points of contact with PP. After introducing IIT, we deal with the evolutionary function of sleeping and dreaming. We illustrate that PP fits with contemporary researches on the important adaptive function of sleep and we discuss why IIT can account for sleep mentation (i.e. dreaming) in evolutionary terms (Albantakis et al. 2014). In the final section, we discuss two future avenues for dream research that can fruitfully adopt the perspective offered by PP: (a) the role of bodily predictions in the constitution of the sleeping brain activity and the dreaming experience, and (b) the precise role of the difference stages of sleep (REM (Rapid eye movement), NREM (Non-rapid eye movement) in the constitution and refinement of the predictive machinery. (shrink)

Consciousness can be studied only if subjective experience is documented and quantified, yet first-person accounts of the effects of brain injury on conscious experience are as rare as they are potentially useful. This report documents the alterations in waking, sleeping, and dreaming caused by a lateral medullary infarct. Total insomnia and the initial suppression of dreaming was followed by the gradual recovery of both functions. A visual hallucinosis during waking that was associated with the initial period of sleep and (...) dream suppression is described in detail. Since the changes in sleep and their recovery are comparable to results of animal experiments, it can be concluded that damage to the medullary brain stem causes extreme but short-lived alterations in conscious state and that substantial recovery occurs even though the damage to the brain stem endures. (shrink)

Argues for the "thirder" solution to the Sleeping Beauty puzzle. The argument turns on an analogy with a variant case, in which a coin-toss on Monday night determines whether one's memories of Monday are permanently erased, or merely suspended in such a way that they will return some time after one wakes up on Tuesday.

PurposeThe COVID-19 pandemic caused a massive healthcare crisis. To investigate what makes healthcare system resilient and physicians better at coping during a crisis situation, our study investigated the role risk exposure, such as working at COVID-19 entry points, sleep, and perceived work safety played in reducing negative psychological functioning at work, as well as their effects on adverse and potentially fatal incidences of compromised safety and medical errors.MethodsOur study included a representative sample of 1,189 physicians, from all 12 Slovenian (...) regions and all medical occupations, as registered by the Medical Chamber of Slovenia. For the purposes of this study, a Questionnaire of Sleep and Psychological Functioning at Work was developed in the form of an online retrospective self-report. Additionally, our study included items assessing physicians perceived work safety and frequency of negative outcomes during the first month of the Covid-19 epidemic.ResultsPhysicians working at COVID-19 entry points were more likely to experience night awakening, slept less than 5 h per night, experience nightmares, and had lower levels of psychological functioning in comparison to other physicians. Both hypothesized models showed adequate fit. A higher score on the sleep scale has been shown to predict lower levels of negative psychological functioning at work and, indirectly, reduced incidences of compromised safety and medical errors. Contrary to our expectations, no significant direct effect of sleep on compromised safety and medical errors was found. When perceived work safety was added into the model, the model showed improved fit, with perceived work safety predicting better sleep, less negative psychological functioning at work, and less compromised safety.ConclusionSleep and safety both play an important role in reducing negative psychological functioning at work and, by doing so, decreasing the negative and potentially fatal incidents during the pandemic, such as compromised safety and medical errors. Further, research is needed to see how medical guidelines can be updated to ensure physicians sleep and that their safety is protected. (shrink)

The Sleeping Beauty problem is test stone for theories about self-locating belief, i.e. theories about how we should reasons when data or theories contain indexical information. Opinion on this problem is split between two camps, those who defend the "1/2 view" and those who advocate the "1/3 view". I argue that both these positions are mistaken. Instead, I propose a new "hybrid" model, which avoids the faults of the standard views while retaining their attractive properties. This model _appears_ to violate (...) Bayesian conditionalization, but I argue that this is not the case. By paying close attention to the details of conditionalization in contexts where indexical information is relevant, we discover that the hybrid model is in fact consistent with Bayesian kinematics. If the proposed model is correct, there are important lessons for the study of self-location, observation selection theory, and anthropic reasoning. (shrink)

The Sleeping Beauty paradox in epistemology and the many-worlds interpretation of quantum mechanics both raise problems concerning subjective probability assignments. Furthermore, there are striking parallels between the two cases; in both cases personal experience has a branching structure, and in both cases the agent loses herself among the branches. However, the treatment of probability is very different in the two cases, for no good reason that I can see. Suppose, then, that we adopt the same treatment of probability in each (...) case. Then the dominant ‘thirder’ solution to the Sleeping Beauty paradox becomes incompatible with the tenability of the many-worlds interpretation. (shrink)

The traditional solutions to the Sleeping Beauty problem say that Beauty should have either a sharp 1/3 or sharp 1/2 credence that the coin flip was heads when she wakes. But Beauty’s evidence is incomplete so that it doesn’t warrant a precise credence, I claim. Instead, Beauty ought to have a properly imprecise credence when she wakes. In particular, her representor ought to assign $R(H\!eads)=[0,1/2]$ . I show, perhaps surprisingly, that this solution can account for the many of the intuitions (...) that motivate the traditional solutions. I also offer a new objection to Elga’s restricted version of the principle of indifference, which an opponent may try to use to collapse the imprecision. (shrink)

Terence Horgan defends the thirder position on the Sleeping Beauty problem, claiming that Beauty can, upon awakening during the experiment, engage in “synchronic Bayesian updating” on her knowledge that she is awake now in order to justify a 1/3 credence in heads. In a previous paper, I objected that epistemic probabilities are equivalent to rational degrees of belief given a possible epistemic situation and so the probability of Beauty’s indexical knowledge that she is awake now is necessarily 1, precluding such (...) updating. In response, Horgan maintains that the probability claims in his argument are to be taken, not as claims about possible rational degrees of belief, but rather as claims about “quantitative degrees of evidential support.” This paper argues that the most plausible account of quantitative degree of support, when conjoined with any of the three major accounts of indexical thought in such a way as to plausibly constrain rational credence, contradicts essential elements of Horgan’s argument. (shrink)

Throughout, there are many case histories to illustrate the text.

The Sleeping Beauty transposon system is a nonviral DNA transfer tool capable of efficiently mediating transposition‐based, stable integration of DNA sequences of choice into eukaryotic genomes. Continuous refinements of the system, including the emergence of hyperactive transposase mutants and novel approaches in vectorology, greatly improve upon transposition efficiency rivaling viral‐vector‐based methods for stable gene insertion. Current developments, such as reversible transgenesis and proof‐of‐concept RNA‐guided transposition, further expand on possible applications in the future. In addition, innate advantages such as lack of (...) preferential integration into genes reduce insertional mutagenesis‐related safety concerns while comparably low manufacturing costs enable widespread implementation. Accordingly, the system is recognized as a powerful and versatile tool for genetic engineering and is playing a central role in an ever‐expanding number of gene and cell therapy clinical trials with the potential to become a key technology to meet the growing demand for advanced therapy medicinal products. (shrink)

Sleep is a form of rejuvenation, which can be treated as a source of energy. This energy is available in limited quantities and individuals must decide when it should be renewed and when it should be consumed. Sleeping involves investing in energy and alertness but also a sacrifice of time. We derive and solve the inter-temporal utility-maximization problem on the length of sleep to obtain optimality conditions for the length of sleep. Several applications emerge from the analysis. (...) These include the effects of labor-market opportunities on sleep patterns; the effect of having children; the consequences of decreased division of labor within the household; and the relationship between sleep deprivation and obesity. When data allows, those outcomes are tested using panel data from Iceland. The empirical results are consistent with the predictions of the theoretical model. (shrink)

Sleep is a fundamental property conserved across species. The homeostatic induction of sleep indicates the presence of a mechanism that is progressively activated by the awake state and that induces sleep. Several lines of evidence support that such function, namely, sleep need, lies in the neuronal assemblies rather than specific brain regions and circuits. However, the molecular mechanism underlying the dynamics of sleep need is still unclear. This review aims to summarize recent studies mainly in (...) rodents indicating that protein phosphorylation, especially at the synapses, could be the molecular entity associated with sleep need. Genetic studies in rodents have identified a set of kinases that promote sleep. The activity of sleep-promoting kinases appears to be elevated during the awake phase and in sleep deprivation. Furthermore, the proteomic analysis demonstrated that the phosphorylation status of synaptic protein is controlled by the sleep-wake cycle. Therefore, a plausible scenario may be that the awake-dependent activation of kinases modifies the phosphorylation status of synaptic proteins to promote sleep. We also discuss the possible importance of multisite phosphorylation on macromolecular protein complexes to achieve the slow dynamics and physiological functions of sleep in mammals. (shrink)

Rotating shifts are common among nurses to ensure continuity of care. This scheduling system encompasses several adverse health and performance consequences. One of the most injurious effects of night-time shift work is the deterioration of sleep patterns due to both circadian rhythm disruption and increased sleep homeostatic pressure. Sleep problems lead to secondary effects on other aspects of wellbeing and cognitive functioning, increasing the risk of errors and workplace accidents. A wide range of interventions has been proposed (...) to improve the sleep quality of nurses and promote an increase in attention levels. In recent years, particular attention has been paid to individual and environmental factors mediating the subjective ability to cope with sleep deprivation during the night shift. Given the predictive role of these factors on the negative impact of a night shift, an individualized intervention could represent an effective countermeasure by ensuring suitable management of shift schedules. Therefore, the aims of this mini-review are to: provide an updated overview of the literature on sleep problems in night shift nurses and their adverse consequences; and critically analyze the psychosocial factors that mediate the negative impact of shift work with the ultimate goal of defining an effective countermeasure based on an individualized approach. (shrink)

Individuals with chronic pain often experience co-existing sleep problems and depression-related states. Chronic pain, sleep problems, and depression interrelate, and have been shown to exacerbate one another, which negatively impacts quality of life. This study explored the relationships between pain severity, pain interference, sleep quality, and depression among individuals with chronic pain. Secondly, we tested whether sleep quality may moderate the relationship between pain and depression. A cross-sectional survey was completed by 1,059 adults with non-malignant chronic (...) pain conditions and collected measures related to pain severity, pain interference, sleep quality, and depression. Multiple regression analyses found that pain severity, pain interference, and sleep quality are all significantly associated with depression. Secondly, moderated regression analyses revealed that sleep quality moderates the relationship between pain interference and depression among individuals with chronic pain such that good sleep quality attenuates the effect of pain interference on depression, and poor sleep quality amplifies the effect of pain interference on depression. These findings suggest that sleep quality may be a relevant therapeutic target for individuals with chronic pain and co-existing depression. (shrink)