Sleep and Cognitive Performance

By the Sleep and Neuro-imaging Laboratory, Department of Psychiatry, Beth Israel Deaconess Medical Center

Human relational memory requires time and sleep.

Relational memory, the flexible ability to generalize across existing stores of information, is a fundamental property of human cognition. Little is known, however, about how and when this inferential knowledge emerges. Here, we test the hypothesis that human relational memory develops during offline time periods.

Fifty-six participants initially learned five "premise pairs" (A>B, B>C, C>D, D>E, and E>F). Unknown to subjects, the pairs contained an embedded hierarchy (A>B>C>D>E>F). Following an offline delay of either 20 min, 12 hr (wake or sleep), or 24 hr, knowledge of the hierarchy was tested by examining inferential judgments for novel "inference pairs" (B>D, C>E, and B>E).

Despite all groups achieving near-identical premise pair retention after the offline delay (all groups, >85%; the building blocks of the hierarchy), a striking dissociation was evident in the ability to make relational inference judgments: the 20-min group showed no evidence of inferential ability (52%), whereas the 12- and 24-hr groups displayed highly significant relational memory developments (inference ability of both groups, >75%; P < 0.001). Moreover, if the 12-hr period contained sleep, an additional boost to relational memory was seen for the most distant inferential judgment (the B>E pair; sleep = 93%, wake = 69%, P = 0.03). Interestingly, despite this increase in performance, the sleep benefit was not associated with an increase in subjective confidence for these judgments.

Together, these findings demonstrate that human relational memory develops during offline time delays. Furthermore, sleep appears to preferentially facilitate this process by enhancing hierarchical memory binding, thereby allowing superior performance for the more distant inferential judgments, a benefit that may operate below the level of conscious awareness.

Time and Sleep Help Us to Understand The "Big Picture."

Sleep science and circadian biologyExit Site

Memorizing a series of facts is one thing, understanding the big picture is quite another. Now a new study demonstrates that relational memory – the ability to make logical "big picture" inferences from disparate pieces of information – is dependent on taking a break from studies and learning, and even more important, getting a good night’s sleep.

Led by researchers at Beth Israel Deaconess Medical Center (BIDMC) and Brigham and Women’s Hospital (BWH), the findings appear on-line in today’s Early Edition of the Proceedings of the National Academy of Sciences (PNAS).

"Relational memory is a bit like solving a jigsaw puzzle," explains senior author Matthew Walker, PhD, Director of the Sleep and Neuro-imaging Laboratory at BIDMC and Assistant Professor of Psychology at Harvard Medical School (HMS). "It’s not enough to have all the puzzle pieces – you also have to understand how they fit together."

Adds lead author Jeffrey Ellenbogen, MD, a postdoctoral fellow at HMS and sleep neurologist at BWH, "People often assume that we know all of what we know because we learned it directly. In fact, that’s only partly true. We actually learn individual bits of information and then apply them in novel, flexible ways."

For instance, if a person learns that A is greater than B and B is greater than C, then he or she knows those two facts. But embedded within those is a third fact – A is greater than C – which can be deduced by a process called transitive inference, the type of relational memory that the researchers examined in this study.

Earlier research by Walker and colleagues (Walker Sleep Lab) had shown that sleep actively improves task-oriented "procedural memory" – for example, learning to talk, to coordinate limbs, musicianship, or to play sports. Because relational memory is fundamental to knowledge and learning, Walker and Ellenbogen decided to explore how and when this "inferential" knowledge emerges, hypothesizing that it develops during "off-line" periods and that, like procedural memory, would be enhanced following a period of sleep.

So, the researchers tested 56 healthy college students, each of whom was shown five pairs of unfamiliar abstract patterns – colorful oval shapes resembling Faberge eggs. The students were then told that some of the patterns were "correct" while others were "incorrect," for example, Shape A wins over Shape B, Shape B wins over Shape C, and so on. All of the students learned the individual pairs but were not told that there was a hidden "hierarchy" linking all five of the pairs together.

After a 30-minute study period, the students were separated into three groups to test their understanding of the larger "big picture" relationship between the individual patterns: Group One was tested after a period of 20 minutes; Group Two was tested after a 12-hour period; and Group Three was tested after a 24-hour time span. In addition, approximately half of the students in Group Two slept during the 12-hour period, while the other half remained awake. All of the students in Group Three had a full night’s sleep.

The test results showed striking differences among the three groups, especially between the students who had a period of sleep and those who remained awake.

"Group One, the students who were tested soon after their initial learning period, performed the worst," says Walker. "While they were able to learn and recall the component pieces [for example, Shape A is greater than Shape B, Shape B is greater than Shape C] they could not discern the hierarchical relationships between the pieces [Shape A is greater than Shape C] – they couldn’t yet see ‘the big picture.’"

Groups Two and Three, on the other hand, demonstrated a clear understanding of the interrelationship between the pairs of shapes.

"These individuals were able to make leaps of inferential judgment just by letting the brain have time to unconsciously mull things over," he says. But, perhaps most notable, he adds, when the inferences were particularly difficult, the students who had had periods of sleep in between learning and testing significantly outperformed the other groups. "This strongly implies that sleep is actively engaged in the cognitive processing of our memories," notes Ellenbogen. "Knowledge appears to expand both over time and with sleep."

Concludes Walker, "These findings point to an important benefit [of sleep] that we had not previously considered. Sleep not only strengthens a person’s individual memories, it appears to actually knit them together and helps realize how they are associated with one another. And this may, in fact, turn out to be the primary goal of sleep: You go to bed with pieces of the memory puzzle, and awaken with the jigsaw completed."

Study coauthors include BIDMC researchers Peter Hu and Jessica Payne, PhD, and Debra Titone, PhD, of McGill University, Montreal, Canada.

This study was funded by grants from the National Institutes of Health and the American Academy of Sleep Medicine.

Beth Israel Deaconess Medical Center is a patient care, research and teaching affiliate of Harvard Medical School and ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of the Dana-Farber/Harvard Cancer Center. www.bidmc.harvard.eduExit Site

Sleep Inspires Insight

By Department of NeuroendocrinologyExit Site, University of Lubeck, Germany

Insight denotes a mental restructuring that leads to a sudden gain of explicit knowledge allowing qualitatively changed behaviour. Anecdotal reports on scientific discovery suggest that pivotal insights can be gained through sleep. Sleep consolidates recent memories and, concomitantly, could allow insight by changing their representational structure. Here we show a facilitating role of sleep in a process of insight. Subjects performed a cognitive task requiring the learning of stimulus-response sequences, in which they improved gradually by increasing response speed across task blocks. However, they could also improve abruptly after gaining insight into a hidden abstract rule underlying all sequences. Initial training establishing a task representation was followed by 8 h of nocturnal sleep, nocturnal wakefulness, or daytime wakefulness. At subsequent retesting, more than twice as many subjects gained insight into the hidden rule after sleep as after wakefulness, regardless of time of day. Sleep did not enhance insight in the absence of initial training. A characteristic antecedent of sleep-related insight was revealed in a slowing of reaction times across sleep. We conclude that sleep, by restructuring new memory representations, facilitates extraction of explicit knowledge and insightful behaviour.

Memory Consolidation during Sleep: Role of Cortisol Feedback

By Jan Born and Ullrich Wagner, Department of NeuroendocrinologyExit Site, University of Lubeck, Germany

Nocturnal cortisol release in humans is synergistically regulated by circadian rhythm and sleep. Cortisol concentrations typically reach a nadir during the slow wave sleep-rich periods of early nocturnal sleep, whereas during the late night, when rapid eye movement (REM) sleep predominates, cortisol levels are enhanced. Here we review a series of our own studies examining whether and how this regulation of cortisol release affects the consolidation of memories during sleep. The studies show that increasing cortisol during early slow wave sleep-rich periods of nocturnal sleep impairs hippocampus-dependent declarative memory formation. Preventing the natural increase in cortisol during REM sleep-rich sleep in the late night appears to enhance amygdala-dependent emotional memory. The findings are consistent with the view that cortisol via activation of limbic glucocorticoid receptors generally diminishes memory consolidation.

Bedtime, television and computer habits of primary school children in Germany

Institut fur Arbeits-, Sozial- und Umweltmedizin der Johannes Gutenberg-Universitat Mainz, Mainz, Germany.

BACKGROUND: Pediatricians recommend daily sleep of at least ten hours for children aged 9 and 10 years. Sufficient sleep is necessary for maintaining the body's homeostasis, as well as for fixing memories and learning. Lack of sleep in children has been associated with a diminished school performance, reduced attention span, and obesity. Adulthood is influenced by childhood lifestyle habits. Data from 4th graders in 34 schools in Mainz and its surroundings were analysed in order to determine negative health lifestyle factors in German primary school children, such as lack of sleep and increased leisure time spent watching television and computer gaming.

METHODS: Data from a cross-sectional study regarding cellular phone use in fourth-graders in Mainz were used for this analysis. Bedtime, television and computer use habits, as well as other factors were explored. A total of 1933 children from 34 schools participated by answering a questionnaire in the 2002-2003 school year (participation rate: 88%). Complete data for the secondary analysis were available from 1889 students (51% male, median age 10 years). RESULTS: Overall, 28% of the children reported going to bed after 9 pm on week nights, 16% reported watching television more than three hours daily, and 11% played computer or video games more than three hours daily. In the adjusted binary logistic regression model, being older, male, having older siblings, watching television (OR 1.82, 95% CI 1.28-2.61) and playing computer games (OR 3.23; 95% CI 2.24-4.67) for more than three hours daily, owning a mobile phone, and being in a school in the city were associated with going to bed after 9 pm.

CONCLUSION: Every fourth child does not obtain a sleep duration of 10 hours, under the assumption that primary schoolchildren need to be awake at 7 am on weekdays. Lifestyle factors that may negatively influence a child's development determine their actual and future habits. Sufficient sleep and less television and computer leisure times should be assertively emphasized to parents and carers of primary school students, in order to prevent the negative consequences of lack of sleep, such as diminished school performance. Developing reproductive-specific prevention programs, which take into account the complex lifestyles and habits of primary schoolchildren, seems to be relevant.

Snoring During Early Childhood and Academic Performance?

Journal of The American Academy of Pediatrics,www.pediatrics.orgExit Site

Young children who snore loudly and frequently during their sleep are at higher risk for exhibiting lower grades in school several years after the snoring has resolved. These findings substantiate the potential for adverse and sustained neurocognitive outcomes and diminished academic achievement being associated with sleep-disordered breathing, particularly when the latter occurs during critical phases of brain growth and development.

Sleep Research Resources

Valerian for Insomnia and Other Sleep DisordersExit Site - NIH, Office of Dietary Supplements

Melatonin FAQExit Site - American Academy of Family Physicians

Sleep Stategies for Shift WorkersExit Site - National Sleep Foundation




By the Sleep and Neuro-imaging Laboratory, Department of Psychiatry, Beth Israel Deaconess Medical Center, and Departments of Neurology and Medicine (Sleep Division), Brigham and Women's Hospital, Harvard Medical School, Boston, MA

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