Schizophrenia is a devastating mental disorder characterized by disrupted thought processes; cognitive symptoms may include hallucinations, delusions, and disorganized speech and thinking. Patients with the disorder also show impairments of learning and memory, and difficulty in carrying out complex tasks. A recent article by Dara Manoach and Robert Stickgold suggests that some of these symptoms may in turn be due to another, often-overlooked symptom of the disease: sleep disorders.
In healthy adults, sleep is known to affect consolidation: the process whereby information accumulated during the day is slowly integrated into the brain’s long-term networks, where it can become a lasting memory. In research studies, volunteers who learn a new skill or memorize new facts can sometimes perform better the next morning – after a good night’s sleep allows them to consolidate the information – than they did the day before.
The relationship between a good night’s sleep and good memory in healthy adults raises the possibility that sleep deprivation in schizophrenia may be a contributing cause to some of the cognitive disturbance in that disorder.
In fact, sleep complaints are common among patients with schizophrenia, and can include difficulty falling asleep and staying asleep. Even the type of sleep may be affected. During the course of a night, normal adults cycle through several stages of sleep, including periods of rapid eye movement (REM) sleep and “slow wave sleep” (SWS). One theory is that SWS may help stabilize or reinforce memories, while REM sleep helps these new memories become integrated into brain networks. Some patients with schizophrenia show almost a complete abolition of SWS, and a few studies have now shown that those patients with less SWS tend to be the same ones who show the poorest recall of information learned prior to sleep.
In their review of these studies, Manoach and Stickgold suggest that healthy adults use sleep to help automate recently-learned information and skills, so that performance can be faster and less dependent on voluntary attention. In effect, while we sleep, the brain figures out how to perform familiar tasks on “auto-pilot” so that we can focus our attention on other things. Patients with a breakdown of normal sleep-dependent consolidation would be correspondingly less able to automate tasks, meaning that they would have to spend more attention on these tasks – making it harder to carry out complex tasks with high attentional demands. This in turn might be the root cause of many of the cognitive deficits observed in schizophrenia.
The idea that sleep may be responsible for much of the cognitive impairment in schizophrenia is still highly theoretical. There is much more work to be done in this area, but the early results are suggesting a new way to understand at least some of the cognitive impairments in schizophrenia – which in turn may suggest that treating sleep disturbances might help provide relief from some of the symptoms of this devastating disorder.
Further reading:
D. S. Manoach and R. Stickgold (2009) Does abnormal sleep impair memory consolidation in schizophrenia? In, Frontiers in Human Neuroscience, vol. 3:21 (available online at: www.ncbi.nlm.nih.gov/pmc/articles/PMC274129).
R. Stickgold & M. P. Walker (2007) Sleep-dependent memory consolidation and reconsolidation. Sleep Medicine, vol. 8, pp. 331-343.
