Psychiatric Database for Writers: Sleep and Parasomnias

Sleeping Man DrawingYou don’t have to look far to find parasomnias in the media.  Poltergeist: a woman floating in the air, fidgeting and making strange noises.  Nightmare on Elm Street: the wondrous Freddy Krueger who likes to scare teenagers where they’re most vulnerable… their dreams.  Media aside, abnormal experiences during sleep are rampant everywhere, even in straight-science clinical medicine.  We psychiatrists call these experiences parasomnias — though I’ll admit parasomniacs never float.  And they rarely get killed in their sleep either.  Let’s start with the basics.


What, why, how, and where… sleep? 

Contrary to popular belief, we don’t sleep to “rest” our brains.  In fact, studies using electroencephalograms (EEGs) demonstrate the mind is just as active when asleep as when awake.  EEGs reveal two types of brainwaves during sleep: dream and non-dream.  A typical night starts with non-dream, then oscillates between dream and non-dream repeatedly until the sleeper wakes up in the morning.

Non-dream sleep (also called non-REM sleep) is marked by four stages.  Stage one (also called alpha waves) occurs when the sleeper is just starting to drift off.  In stage two, waves on the EEG gets bigger and slower.  We spend about 50% of our total sleep in stage two.  By stages three and four, the waves have slowed even more, and fluctuations in energy are greater. It is difficult to wake someone during the third and fourth stage, thus the name “deep sleep” for these two stages.

The dream part of sleep is called REM, or “rapid eye movement,” due to the eyes’ tendency to move around while dreaming.  Some scientists refer to REM as stage five.  While EEG findings during REM and wakefulness are almost identical, REM sleep is accompanied by total paralysis; that is, the dreamer doesn’t move when he dreams he’s moving.  This paralysis disappears during non-dream sleep. We typically spends two hours a night (about 20%) dreaming.  Dreams get longer as the night progresses.


What are parasomnias?

Unlike insomnia, which is defined as difficulty initiating or staying asleep, parasomnias occur during sleep.  They are disturbances of sleep architecture or behavior that seep into the waking world, causing trouble for the sleeper when they aren’t sleeping.  Here’s a little info about the most common parasomnias.

Most of us have nightmares from time to time.  A person is said to have a nightmare disorder when his nightmares interfere with his waking life, usually the result of recurring intense, horrifying dreams that the sufferer remembers upon wakening.  Nightmares are common in people with a history of severe trauma. Treatment involves medications that inhibit REM, like benzodiazepines, tricyclic antidepressants, or Prazosin.

Unlike nightmares, sleep terror disorder occurs during non-dream sleep. This is a disorder of sleep stages three and four (deep sleep) and is limited to the first third of the night. Sufferers wake up in a screaming panic, confused, short of breath, and unaware of their surroundings. This confusion lasts until they fall back to sleep. The next morning nothing is remembered. . . These episodes are NOT linked to nightmares. Treatment includes medications that block non-REM sleep.

Like sleep terror disorder, sleepwalking occurs in the first third of the night, during non-REM sleep. While sleepwalking, the sleeper has a blank, staring look on his face. He doesn’t respond to communication and can be difficult to wake up. When he does wake up – either from sleepwalking or the next morning – the sleepwalker doesn’t remember anything of the event. Contrary to popular belief, it isn’t dangerous to wake someone when they are sleepwalking.

Sleep paralysis happens during that twilight zone between wakefulness and sleep. It’s normal to be paralyzed during REM sleep, but occasionally paralysis slips into wakefulness: the sufferer wakes up to find he can’t move. The experience of being “stuck” can be terrifying. However, the paralysis goes away within minutes and typically doesn’t require treatment. Sleep paralysis can run in families. It’s common in people with narcolepsy.

Conclusion

I’d like to believe sleep is an existential happening, a gateway to an alternative version of reality, a world where questions are answered, where poetry waxes physical law… but there’s no proof to my hypothesis, not yet.  A shame, really.   But reality and sleep can be synonymous with fiction and sleep, if you look at everything with the right pair of glasses on your nose.  Consider the following:

“People say, ‘I’m going to sleep now,’ as if it were nothing. But it’s really a bizarre activity. ‘For the next several hours, while the sun is gone, I’m going to become unconscious, temporarily losing command over everything I know and understand. When the sun returns, I will resume my life.’

If you didn’t know what sleep was, and you had only seen it in a science fiction movie, you would think it was weird and tell all your friends about the movie you’d seen.

They had these people, you know? And they would walk around all day and be OK? And then, once a day, usually after dark, they would lie down on these special platforms and become unconscious. They would stop functioning almost completely, except deep in their minds they would have adventures and experiences that were completely impossible in real life. As they lay there, completely vulnerable to their enemies, their only movements were to occasionally shift from one position to another; or, if one of the ‘mind adventures’ got too real, they would sit up and scream and be glad they weren’t unconscious anymore. Then they would drink a lot of coffee.’

So, next time you see someone sleeping, make believe you’re in a science fiction movie. And whisper, ‘The creature is regenerating itself.”

–George Carlin, Brain Droppings


That said, pleasant parasomnias!Alex Natalian, Psychiatrist and Author
Alex Natalian is a penname for psychiatrist KRR.

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