Rapid eye movement sleep: Who needs it? Creativity mechanisms and psychiatric applications of REM sleep enhancement

Rapid eye movement sleep (REMS) has historically been associated with anecdotal 'creative insights', possibly due to the fantastical and ostensibly illuminating nature of its associated phenomena (dreams). REMS, characterised by rapid eye movements, muscle atonia, and high-energy neuronal activity, has been linked to memory consolidation and information processing, particularly regarding the formation of novel associations or reintegration of consolidated memories into new cognitive networks. However, studies in these domains have largely used methodology which deprived subjects (animal or human) of REMS, rather than enhanced it. Assumptions about the positive effects of enhancing REMS have thus been largely theoretical since they are based on REMS inhibition rather than REMS stimulation. The present review aims to summarise the scientific perspective on the relationship between REMS and creativity, highlights its possible applications in neuropsychiatric disorders and outlines the potential clinical use of orexin receptor antagonists in this context. The orexin system plays a central role in the regulation of sleep/wakefulness physiology, and dual orexin receptor antagonists enhance REMS. This feature enables investigations into the effect of enhancing REMS on creativity and the associated potential therapeutic potential in neuropsychiatric disorders characterised by rigid thinking patterns and disruptions in cognitive flexibility.