Transformations in hallucinosis and the receptivity of the analyst

Bion describes transformation in hallucinosis (TH) as a psychic defence present in elusive psychotic scenarios in which there is a total adherence to concrete reality: as the hallucinatory activity which physiologically infiltrates perception and allows us to know reality, setting it off against a background of familiarity; and then, surprisingly, as the ideal state of mind towards which the analyst has to move in order to intuit the facts of the analysis. When hallucinosis is followed by ‘awakening’, the analyst gains understanding from the experience and goes through a transformation that will inevitably be transmitted to the analytic field and to the patient. In this paper I illustrate Bion's concept and underline its eminently intersubjective nature. Then I differentiate it from two other technical devices: reverie, which unlike hallucinosis does not imply the persistence of a feeling of the real, and Ferro's transformation in dreaming, i.e. purposeful listening to everything that is said in the analysis as if it were the telling of a dream. Finally, I try to demonstrate the practical utility of the concept of transformation in hallucinosis in order to read the complex dynamics of a clinical vignette. Though not well known (only two references in English in the PEP archive), TH proves to be remarkably versatile and productive for thinking about psychoanalytic theory, technique and clinical work.     

Sleep and Sleep Disorders in Older Adults

A common but significant change associated with aging is a profound disruption to the daily sleep-wake cycle. It has been estimated that as many as 50% of older adults complain about difficulty initiating or maintaining sleep. Poor sleep results in increased risk of significant morbidity and mortality. Moreover, in younger adults, compromised sleep has been shown to have a consistent effect on cognitive function, which may suggest that sleep problems contribute to the cognitive changes that accompany older age. The multifactorial nature of variables affecting sleep in old age cannot be overstated. Changes in sleep have been thought to reflect normal developmental processes, which can be further compromised by sleep disturbances secondary to medical or psychiatric diseases (e.g., chronic pain, dementia, depression), a primary sleep disorder that can itself be age-related (e.g., Sleep Disordered Breathing and Periodic Limb Movements During Sleep), or some combination of any of these factors. Given that changes in sleep quality and quantity in later life have implications for quality of life and level of functioning, it is imperative to distinguish the normal age-related sleep changes from those originating from pathological processes.     

Sleep and psychopathology

This article examines the relationship between sleep disturbance and psychopathology. Epidemiological, cross-sectional, and longitudinal data suggest a high rate of comorbidity between sleep disturbance and psychopathology, particularly between insomnia, anxiety, and depression. Between 50% and 80% of psychiatric patients complain of sleep disturbances during the acute phase of their illness. Conversely, among treatment-seeking individuals with a primary complaint of insomnia and randomly selected community samples, approximately one third display a concurrent psychopathology, one third exhibit psychological symptoms that do not necessarily exceed the threshold for a psychiatric disorder, and another third present insomnia as a functionally autonomous disorder. There is a positive relationship between severity of sleep disturbances and concurrent psychopathology, but unequivocal evidence of a cause-and-effect relationship is still lacking. However, longitudinal data suggest that anxiety and stressful life events often precede acute sleep difficulties, whereas persistent insomnia may be a risk factor for subsequent development of depression. Implications for the prevention and treatment of coexisting sleep disturbance and psychopathology are discussed.     

Worry and Sleep Length Revisited: Worry,Sleep Length,and Sleep Disturbance Ascribed to Worry

The author administered university students (N = 222; 152 women, 70 men) the Worry Domains Questionnaire (F. Tallis, G. C. L. Davey, & A. Bond, 1994) and a newly constructed scale (the Sleep Disturbance Ascribed to Worry Scale) to measure sleep disturbance attributed to worry. To revisit previous studies (i.e., E. Hartmann, F. Baekeland, & G. R. Zwilling, 1972; S. J. H. McCann & L. L. Stewin, 1988) that suggested that sleep length was positively related to worry, the author also asked the students a question about habitual sleep length. The results indicated that worry and sleep disturbance attributed to worry were negatively related to sleep length. A regression analysis revealed that worry was significantly negatively related to habitual sleep length irrespective of sleep disturbance ascribed to worry.     

Sleep and Immunity: Cytokine Pathways Linking Sleep and Health Outcomes

ABSTRACT— The functions of sleep are enigmatic but are beginning to be delineated. Sleep has been long thought to be important for health, and poor sleep is prospectively associated with worsened health outcomes. Yet the mechanisms accounting for this are only partially understood. In this review, we suggest that the immune system plays a role in the relationship between sleep and health and that sleep processes and immunity show bidirectional interactions, as evidenced in both animal and human studies. Immunological signaling molecules, termed cytokines, are important in coordinating brain–immune system communication, and particular cytokines such as tumor necrosis factor, interleukin-1, and interleukin-6 play a crucial role in sleep regulation. Elevated levels of these cytokines are also associated with a number of chronic diseases and may provide a pathway linking poor sleep with health outcomes.     

Sleep and the Brain

Sleep is a fundamental behavior ubiquitous in the animal kingdom, necessary for the support of physical health and in humans for the maintenance of cognitive function. While it influences all body systems, it is particularly important for the brain and is typically characterized using measures of brain electrical activity. Sleep undergoes predictable changes across the lifespan, with notably dramatic alterations occurring during adolescence and with old age. Over and above the normal development changes, however, upwards of a third of the adult population experience some form of insomnia on a regular basis. This issue’s special section on “Sleep through the Ages” contains papers addressing the neurological and neuropsychological implications of sleep in adolescents, older adults and insomnia sufferers, highlighting relations of sleep with brain structure and function.     

Sleep and Infant Learning

Human neonates spend the majority of their time sleeping. Despite the limited waking hours available for environmental exploration, the first few months of life are a time of rapid learning about the environment. The organization of neonate sleep differs qualitatively from adult sleep, and the unique characteristics of neonatal sleep may promote learning. Sleep contributes to infant learning in multiple ways. First, sleep facilitates neural maturation, thereby preparing infants to process and explore the environment in increasingly sophisticated ways. Second, sleep plays a role in memory consolidation of material presented while the infant was awake. Finally, emerging evidence indicates that infants process sensory stimuli and learn about contingencies in their environment even while asleep. As infants make the transition from reflexive to cortically mediated control, learned responses to physiological challenges during sleep may be critical adaptations to promote infant survival.     

Sleep deprivation and naps

It is important for military commanders to know the likely effects of a small amount of sleep under conditions of sustained operations. To this end, two laboratory-based experiments on naps were carried out. The first examined the effect of 2 h of sleep following 90 h of wakefulness. Ten infantrymen subjects were not told the scheduled length of their vigil, or that they would be allowed a nap at some stage, until a few hours before the 2-h nap. After 3 nights without sleep, the subjects’ average cognitive performance was 55% of the control values. During a test session immediately before the 2-h nap, performance improved by 30%, to 85% of control values, indicating the considerable effect that the incentive of knowing that a nap is imminent can have on even severely sleep-deprived subjects. In the second experiment, two groups, each of six infantrymen, took part in a 5-day trial; for one group, 4 h of uninterrupted sleep was scheduled and for the other, four l-h naps in each 24-h period. There were no significant differences in cognitive test scores or mood between the two groups. On the last experimental day, cognitive test and mood scores were not significantly different from baseline values for either group, indicating the utility of 4 h of sleep, either in one uninterrupted block or in four scheduled 1-h naps per 24 h.     

Personality and Sleep: Neuroticism and Conscientiousness Predict Behaviourally Recorded Sleep Years Later

Sleep is one key feature of people's lives that defines their daily routine and reflects overall health and well‐being. To test the relevance of personality for core aspects of sleep, we examined if personality traits across the five broad personality domains predicted behaviourally recorded, week‐long sleep characteristics up to five years later (alongside subjective sleep quality). Data from 382 participants (63% female, aged 34–82 years) were drawn from the longitudinal study on Midlife in the United States Study—Biomarker project. In terms of mean tendencies, both neuroticism and conscientiousness signalled more sleep continuity (fewer interruptions) alongside better subjective quality. In terms of intra‐individual sleep variability, neuroticism predicted more variability in sleep duration, continuity, and subjective sleep quality, while conscientiousness predicted less variability in sleep duration and sleep continuity. Extraversion, agreeableness, and openness traits did not generally foreshadow behaviourally recoded sleep, only higher ratings of subjective quality. These links were robust to the impact of demographic factors and were not moderated by the duration of time between personality and sleep assessments. The findings distinguish which personality traits foreshadow core aspects of sleep and also implicate multiple traits as predictors of variability, not just mean tendencies, in behaviourally recorded sleep. © 2019 European Association of Personality Psychology     

The Relationship Between Parent and Child Dysfunctional Beliefs About Sleep and Child Sleep

Cognitive theories emphasise the role of dysfunctional beliefs about sleep in the development and maintenance of sleep-related problems (SRPs). The present research examines how parents’ dysfunctional beliefs about children’s sleep and child dysfunctional beliefs about sleep are related to each other and to children’s subjective and objective sleep. Participants were 45 children aged 11–12 years and their parents. Self-report measures of dysfunctional beliefs about sleep and child sleep were completed by children, mothers and fathers. Objective measures of child sleep were taken using actigraphy. The results showed that child dysfunctional beliefs about sleep were correlated with father (r = 0.43, p < 0.05) and mother (r = 0.43, p < 0.05) reported child SRPs, and with Sleep Onset Latency (r = 0.34, p < 0.05). Maternal dysfunctional beliefs about child sleep were related to child SRPs as reported by mothers (r = 0.44, p < 0.05), and to child dysfunctional beliefs about sleep (r = 0.37, p < 0.05). Some initial evidence was found for a mediation pathway in which child dyfunctional beliefs mediate the relationship between parent dysfunctional beliefs and child sleep. The results support the cognitive model of SRPs and contribute to the literature by providing the first evidence of familial aggregation of dysfunctional beliefs about sleep.     

Sleep Loss and Temporal Memory

Historical evidence suggests that sleep deprivation affects temporal memory, but this has not been studied systematically. We explored the effects of 36 hr of sleep deprivation on a neuropsychological test of temporal memory. To promote optimal performance, the test was short, novel, and interesting, and caffeine was used to reduce 'sleepiness'. A total of 40 young adults were randomized into four groups: control + caffeine (Cc), control + placebo (Cp), sleep deprived + caffeine (SDc), and sleep deprived + placebo (SDp). Controls slept normally. Caffeine (350 mg) or placebo were given just prior to testing. The task comprised colour photographs of unknown faces and had two components: recognition memory (distinction between previously presented and novel faces), and recency discrimination (temporal memory), when a previously shown face was presented. An interpolated task, self-ordered pointing, acted as a distraction. Caffeine had no effects within control conditions, but significantly reduced subjective sleepiness in SDc. Recognition was unaffected by sleep deprivation, whereas for recency, sleep deprivation groups scored significantly lower than controls. There was no significant improvement of recency with caffeine in the SDc group. Both sleep deprivation groups had poorer insight into their performance with recency. Self-ordered pointing remained unchanged. In conclusion, sleep deprivation impairs temporal memory (i.e. recency) despite other conditions promoting optimal performance.     

Sleep fragmentation and lucid dreaming

Lucid dreaming—the phenomenon of experiencing waking levels of self-reflection within one’s dreams—is associated with more wake-like levels of neural activation in prefrontal brain regions. In addition, alternating periods of wakefulness and sleep might increase the likelihood of experiencing a lucid dream. Here we investigate the association between sleep fragmentation and lucid dreaming, with a multi-centre study encompassing four different investigations into subjective and objective measures of sleep fragmentation, nocturnal awakenings, sleep quality and polyphasic sleep schedules. Results across these four studies provide a more nuanced picture into the purported connection between sleep fragmentation and lucid dreaming: While self-assessed numbers of awakenings, polyphasic sleep and physiologically validated wake-REM sleep transitions were associated with lucid dreaming, neither self-assessed sleep quality, nor physiologically validated numbers of awakenings were. We discuss these results, and their underlying neural mechanisms, within the general question of whether sleep fragmentation and lucid dreaming share a causal link.     

原发性失眠患者的主客观睡眠特征研究

目的：了解原发性失眠患者的睡眠特点,探讨其主客观睡眠的异同点。方法：对15例原发性失眠患者、20例正常人的主观睡眠（PSQI）和客观睡眠（PSG）特点进行比较,对原发性失眠患者进行主观睡眠（PSQI）和客观睡眠（PSG）的比较。结果：原发性失眠的PSG多项指标（睡眠总时间、睡后觉醒次数、觉醒总时间、睡眠潜伏期、睡眠效率、觉睡比、睡眠维持率、REM睡眠时间和REM百分比、REM睡眠潜伏期和REM活动密度）等方面与正常对照有显著差异（p〈0.05或p〈0.01）;原发性失眠的PSQI多项指标（PSQI总分、睡眠效率、睡眠时间、睡眠潜伏期）方面与正常组对照差异显著（p〈0.01）。原发性失眠的PSQI和PSG在睡眠效率、实际睡眠时间、睡眠潜伏期方面存在显著差异（p〈0.01）。结论：原发性失眠患者的PSQI和PSG均存在一定程度的异常,原发性失眠患者有高估自己睡眠障碍的倾向。     

Sleep and Affective Brain Regulation

Rapidly emerging evidence continues to describe an intimate and causal relationship between sleep and affective brain regulation. These findings are mirrored by long‐standing clinical observations demonstrating that nearly all mood and anxiety disorders co‐occur with one or more abnormalities of sleep. This review aims to (1) provide a synthesis of recent human evidence describing affective brain and behavioral benefits of sleep when it is obtained, and conversely, detrimental impairments following a lack thereof, (2) set forth a rapid eye movement sleep hypothesis of affective brain homeostasis, optimally preparing the organism for next‐day social and emotional functioning, and (3) outline how this model may explain the prevalent relationships observed between sleep and affective disorders, including relevant treatment mechanisms, with a particular focus on post‐traumatic stress disorder (PTSD).