Absence of nystagmus during REM sleep in patients with vestibular neuritis

Abstract

Saccades, including fast phases of nystagmus, disappear during drowsiness and non-rapid eye movement (NREM) sleep, but are present during the alert state and REM sleep. The purpose of this study was to determine whether spontaneous nystagmus is present in patients with vestibular neuritis during REM sleep.Eight patients with spontaneous nystagmus due to vestibular neuritis and eight control patients without any nystagmus underwent at least one night of polysomnography. Fast phases of nystagmus were analyzed. The number of right and left horizontal saccades were counted, first during 3-5 minute samples of the awake state before sleep onset, then during the first REM episode and the last REM episode of nocturnal sleep, and finally during the alert state in the morning after nocturnal sleep.All patients with vestibular neuritis showed significantly more saccades (fast phases) towards the side contralateral to their vestibular lesion in the awake state before and after the polysomnography. This reflects their spontaneous nystagmus. By contrast, during REM sleep the patients with vestibular neuritis showed no preponderance in saccade direction. The eye movement pattern in REM was the same for patients and controls.In conclusion, peripheral vestibular imbalance producing nystagmus in vestibular neuritis in the awake state is not active at the brain stem level during REM sleep. (J Neurol Neurosurg Psychiatry 2001;71:386-389)

The Effect of Vestibular Stimulation in a Four-Hour Sleep Phase Advance Model of Transient Insomnia

“…However, it seems possible that vestibular stimulation might effect sleep via the established physiological connections between the vestibular system and sleep systems. [8][9][10][11][12][13][14][15] This study provides evidence that vestibular stimulation is associated with an excellent safety profile. The only adverse effects occurring in more than one individual that received vestibular stimulation were headache and dizziness.…”

“…[5][6][7] We examined vestibular stimulation as a treatment because a series of studies suggest links between the vestibular system and sleep. These include physiological evidence that the vestibular system can affect REM sleep, [8][9][10][11][12][13] that there is influence of labyrinthine inputs on the pontine reticular formation neu-rons involved in mediating switching between sleep states, 14,15 and that the medial vestibular nucleus has projections to regions mediating arousal and some aspects of sleep which receive orexinergic inputs from the lateral hypothalamus. 15 The sensation of rocking, which is created by electrical stimulation of the vestibular system also has the potential to have a therapeutic effect on sleep.…”