This fascinating reference covers the major topics concerning dreaming and sleep, based on the latest empirical evidence
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The Evolution, Function, Nature, and Mysteries of Slumber
Deirdre Barrett and Patrick McNamara, Editors
-r
Encyclopedia of Sleep and Dreams
' *
Encyclopedia of Sleep and Dreams THE EVOLUTION, FUNCTION, NATURE, AND MYSTERIES OF SLUMBER
VOLUME 2: M-Y
Deirdre Barrett and Patrick McNamara, Editors
Q GREENWOOD AN IMPRINT OF ABC-CLIO, LLC Santa Barbara, California • Denver, Colorado • Oxford, England
Copyright 2012 by ABC-CLIO, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, except for the inclusion of brief quotations in a review, without prior permission in writing from the publisher.
Library of Congress Cataloging-in-Publication Data Encyclopedia of sleep and dreams : the evolution, function, nature, and mysteries of slumber / Deirdre Barrett and Patrick McNamara, editors. 2 v. Includes bibliographical references and index. ISBN 978-0-313-38664-0 (alk. paper) — ISBN 978-0-313-38665-7 (e-ISBN) I. Barrett, Deirdre. II. McNamara, Patrick, 1956[DNLM: 1. Sleep—Encyclopedias—English. 2. Dreams—Encyclopedias—English. 3. Sleep Disorders—Encyclopedias—English. WL 13] 616.8'498003—dc23 2011045470 ISBN: 978-0-313-38664-0 EISBN: 978-0-313-38665-7 16
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This book is also available on the World Wide Web as an eBook. Visit www.abc-clio.com for details. Greenwood An Imprint of ABC-CLIO, LLC ABC-CLIO, LLC 130 Cremona Drive, P.O. Box 1911 Santa Barbara, California 93116-1911 This book is printed on acid-free paper (oo) Manufactured in the United States of America
To Ina Livia McNamara on her fourth birthday
Digitized by the Internet Archive in 2020 with funding from Kahle/Austin Foundation
https://archive.org/details/encyclopediaofsl0000unse_s0u1
Contents
VOLUME I List of Entries, ix Guide to Related Topics, xvii Preface, xxiii Entries, A-L
VOLUME 2 List of Entries, ix Guide to Related Topics, xvii Entries, M-Y Appendix: Additional Resources on Sleep, 813 About the Editors, 849 List of Contributors, 851 Index, 869
vii
List of Entries
Aboriginal Australia: Dreams and “the
Anthropology of Sleep
Dreaming”
Antiquity and Dreams
Achuar
Antrobus’s (1983) Word Information
Actigraphy and Sleep
Count (WIC)
Activation Synthesis Hypothesis of
Art Therapy and Dreams
Dreaming
Asian Americans and Dreamwork
Acute Sleep Deprivation
Asklepieia and Asklepian Rites
Adolescent Cell Phone Use and Sleep
Attention Defecit with Hyperactivity:
Adolescent Dreams
Dreaming in Children with ADHD
Adolescent Sleep, the Electroencephalogram,
Awake, Frozen with the Most Awful
and Brain Development
Fears, but Also Asleep
Adopted Women’s Dreams
Awakenings Protocol
African American Dream Beliefs and
Basics of Sleep Recordings
Practices
Bedouin Dream Traditions
Aging and Dreams
Belief in Dream Relevance and the
Alcohol and Sleep
Continuity Hypothesis
Alexithymia and Sleep
Bible and Dreams: Futher and Calvin, The
Alexithymia in Renal Disease
Big Dreams
Ancient Dream Theories
Bizarre Imagery and Thought in Sleep
Ancient Egypt and Dreams
and Waking
Ancient Greek Dream Beliefs
Body Dreamwork
Animal Figures in Dreams
Brain Correlates to Fucidity
Animation and the Dream
Brain Damage: Effects on Dreams
Anthropology and Dreams
Brain Energy, Metabolism, and Sleep
ix
x
|
List of Entries Brain Mechanisms of Vision in Dreams
Continuous Positive Airway Pressure
Brief History of Sleep Medicine
(CPAP) Therapy for Obstructive Sleep
Cancer Patients and Dreamwork Central Image (of the Dream) Characters in Dreams
Apnea Convergent Evolution of REM Sleep in Mammals and Birds Cortical EEG Oscillations, Local Sleep,
Children’s Dreams and Nightmares
and Dream Recall
Chinese Sex Symbols in Dreams
Co-Sleeping
Chronotype
Costly Signaling Theory
Church Dream Groups
Counterfactuals in Dreams
Cinema and Dreams
Creative Problem Solving in Dreams
Circadian Rhythms
Cross-Cultural Approaches to Dreams
Clinical Aspects of Nightmares Cognitive Approach to Dreaming Cognitive Expertise and Dreams Cognitive Theory of Dream Meaning, A
Cultural Dimensions of Sleep Cultural Diversity and Dreaming Definition of Sleep Delusions and the Classification of
Coleridge, Samuel Taylor, and Dreaming
Typical Dreams
Color in Dreams
Depictions of Dreams
Comics and Dreams
Depression and Dreaming
Comorbidity between Epilepsy and Sleep
Depression in Patients with Kidney
Disorders
Disease
Comparative Sleep Databases
Depth of Sleep
Comparative Sleep Regulation
Development and Initial Validation of the
Conceptions of Dreaming in the Western
Iowa Sleep Disturbances Inventory
Desert of Australia
Disconnection from the External Envi¬
Connection between Dreams and Mood,
ronment during Dreaming
The
Discovery of REM Sleep
Consciousness in Dreams Contemporary Theory of Dreaming,
Dissociated States of Being and Agrypnia Excitata
The
Distinctive Dream Content Associated
Content Analysis of Dreams: Basic
with REM Sleep Behavior Disorder
Principles Continuity Hypothesis and Colors in
Disturbed Sleep and Posttraumatic Stress Disorder
Dreams
Dream Interview: A Client-Defined,
Continuity Hypothesis of Dreaming
Metaphor-Based Interpretation
List of Entries
Dream Sharing as Social Interaction
Family Unconscious in Dreams
DreamBank.net: An Online Archive for
Fantasy Literature and Dreams
Studying Dream Content
Fetal Sleep
Dreaming: The Journal of the Association
Fetal Yawning
for the Study of Dreams Dream-Lag Effect
Flying Dreams Flying in Dreams: The Power of the
Dreamwork in Counseling
Image
Dynamic Structure of Reptilian EEG
Fornari, Franco
versus Mammalian Sleep EEG Ecstasy (MDMA) Use and Sleep Problems
Freud, Sigmund Freud’s Approach to Dreams Functional Neuroimaging during Human
Effect of Dreams on Waking Life
Sleep
Effect of Medications on Sleep and
Functional Theories of Dreaming
Dreaming Effects of Blindness and Deafness on Dream Content
Gender Differences in Dreaming Genetics and Epigenetics of Sleep Genetics of Mouse Sleep Physiology
Effects of Work on Sleep Gestalt Dreamwork Electromagnetic Fields of Mobile Telephones and Sleep Parameters Embodied Imagination Emotional Responses to Nightmares Endocrinology of Sleep
Graphic Novels and Dreams Group Work with Dreams Hall and Van de Castle System for the Study of Dream Content Handedness: A New Look at the Effects
Endometriosis and Dreams
on Dream Recall and Content
ESP in Dreams
Healing and Dreams
Evaluation of Tonsils in Patients with
Hill Dream Model
Sleep Apnea Evolution of Reptilian Sleep
Hypnagogic Imagery Hypocretin Gene Transfer in Mice
Evolutionary Approaches to Sleep
Models of Narcolepsy
Evolutionary Psychology Theories of
Hypothalamo-Pituitary-Adrenocortical
Dreams
(HPA) System and Sleep
Existential Dreams
Hypothalamo-Pituitary-Somatotrophic
External Sensory Stimulation as a
(HPS) System and Sleep
Technique to $tudy Dreaming
Illness and Dreams
False Awakenings
Illusory Contents in Dreams
|
xi
xii
|
List of Entries
Impactful Dreams
Media Use and Nightmares
Importance of Sleep Health for Children
Media Use and Sleep in Children and
Increasing Sleep Complaints
Adolescents
Incubation of Dreams
Medications Altering Dreaming
Incubus/Succubus
Medieval Hagiography and Dreams
Infant Sleep and Parenting
Melatonin Therapy for the Sleep
Infant Sleep Interventions Insomnia in Chronic Renal Failure International Association for the Study of Dreams Intersubjective Dreams Intuition in Dreams Involuntary Nature of Dreaming Islam and Dreams Isolated Sleep Paralysis
Disorders of Children Methodological Challenges in the Scientific Study of Dreams Middle Ages and Dreams Mugwort: A Dream-Stimulating Herb Music and Dreams Naps Narcolepsy and Dreaming Narcolepsy and Sleep Paralysis, Hypnopompic/Hypnagogic Hallucinations
Istikhara: Islamic Dream Incubation Journaling of Dreams Jung’s Dream Theory Jung’s The Red Book Jung’s Transcendent Function: Neurological Support Kleine-Levin Syndrome
Narcolepsy Symptoms, Abnormal REM Sleep, and Hypocretin Deficiency Native American Dreams Neural Metaphor and Dreams Neuroanatomical Correlates of Dream Censorship Neuroanatomical Correlates of
Leading Dream Groups
Dreamwork
Literature and Dreams
Neuroanatomy of Dreams
Little Dreams
Neuroanatomy of REM Sleep and
Logical Structure of Dreams and Their
Depression
Relation to Reality Lucid Dreaming
Neurobiology of Psychoanalysis in Wake and REM Sleep
Lucid Dreaming in Sports
Neurofeedback for Sleep Problems
Lucid Dreaming Therapy for Nightmares
Neuropsychology of Lost Dream Recall
Lucid Nightmares
Nightly Sleep Duration and Mortality:
Meaning of Dreams via Dream
The Story of a U-Shaped Relationship
Interpretation
Nightmare Content in Adults
List of Entries
Nightmares
Recall of Dreams
Objective and Subjective Dreams
Regulation of Sleep and Wake Systems
Obstructive Sleep Apnoea, Metabolism,
Religion and Dreams
and Hormones
REM-NREM Dream Content
Olfactory Stimuli and Dreams
Specializations
Overgeneral Memories
REM Sleep across the LifeSpan
Parapsychology and Dreams
REM Sleep Behavior Disorder
Parasomnias and Nocturnal Frontal Lobe
|
REM Sleep Properties
Epilepsy Partial Sleep Deprivation Phasic Ponto-Geniculo-Occipital/ Pontine Wave (PGO/P-Wave) Philosophy of Mind and Dream Characters Photography and Dreams Phylogenetic Comparative Methods and
REM Sleep Properties as Neurobiological Endophenotypes of Schizophrenia REM Sleep-Related Motor Paralysis Reverse Learning Theory Role of Subcortical Structures in Dreaming Safety in Dream Groups
Sleep
School of Metaphysics Approaches to
Phylogeny of Sleep
Dream Incubation
Phylogeny of Sleep Database
Seasonal Affective Disorder in Sleep
Pittsburgh Sleep Quality Index
Self-Assessment Tools of Circadian
Play and the Dream
Typology in Children, Adolescents, and Adults
Poetry and Dreams Portable Monitoring of Sleep Precognitive Dreaming Prefrontal Cortex in Dreaming Pregnancy Dreams Primary Disorders of Hypersomnolence and Dreams Psychiatric Diagnosis and Dreams Quaker Culture and Dreams Quality of Life and Sleep Disorders in
Self-Consciousness and Dreaming Self in Dreams, The Self-Organization from Chaos in Dreams Selfscape Dreams Serotonin in the Regulation of REM Sleep Sexual Dreams: Meaning and Practical Insight Shakespeare and Dreams
Chronic Kidney Disease
Shamanism and Dreams
Qur’an and Dreams
Short Sleep
Rapid Eye Movement Sleep in Critically
Significance of Dreams in Western
Ill Patients
Australian Desert Aboriginal Worldview
xiii
List of Entries
Sleep and Arthritis Sleep and Bird Songs Sleep and Brain Networks Sleep and Cardiometabolic Risk Sleep and Culture Sleep and Dreams in Psychiatric
Sleep EEG across Adolescent Development Sleep Fragmentation Sleep in Adolescents Sleep in Aquatic Mammals Sleep in Children with Cancer
Disorders and Autism
Sleep in Disorders of Consciousness
Sleep and Dreams in Western Antiquity
Sleep in Insects
Sleep and Evolution of Detailed Focal
Sleep in Patients with Alzheimer’s
Vision
Disease
Sleep and Growth Hormone Release
Sleep in Patients with Parkinson’s
Sleep and Mild Cognitive Impairment Sleep and Obesity Sleep and Shift Work Sleep and Suicide Sleep and the Endocrine System Sleep and the Generation of New Nerve Cells in the Adult Brain Sleep and the Metabolic Syndrome Sleep and Thermoregulation Sleep Apnea in Heart Failure
Disease Sleep in Patients with Wilson’s Disease Sleep, Inflammation, and Cardiovascular Disease Sleep Intensity and the Homeostatic Regulation of Sleep Sleep, Memory, and Dreams Sleep, Nightmares, and Psychiatry Sleep Pattern and Its Determining Factors in University Students Sleep Patterns in Patients with Acute
Sleep as We Age
Coronary Syndromes
Sleep Development in Infancy and Early
Sleep, Plasticity, and Metaplasticity
Childhood
Sleep Problems among Veterans of
Sleep Diaries
Foreign Wars
Sleep Disordered Breathing in Teenagers
Sleep, Psychiatric Disorders, and the
Sleep Disorders and Dreaming
Transdiagnostic Perspective
Sleep Disorders in Patients with Chronic
Sleep Quality: A Behavioral Genetic
Kidney Disease
Perspective
Sleep Disorders in Patients with Heart Failure
Sleep-Related Hallucinations and Ghost Tales
Sleep Disturbances in Posttraumatic
Sleep-Related Mental Activities in
Stress Disorder (PTSD)
Insomnia: Role and Assessment
Sleep, Dreams, and Personality
Sleep Spindles
Sleep, Dreams, and the Time Sense
Sleep Talking
List of Entries
Sleep Variables and Handedness:
Teaching Courses on Dreams
Methodological Issues and State
Teaching Dreams via Dream Lab
of the Field Sleepiness and Driving Sleeping and Dreaming Patterns in the Context of Attachment Relationships Social Network Analysis of Dream
Television Consumption and Dreaming Theoretical Models and Neural Basis Theory of Mind and Dreaming Threat Simulation Theory
Content
Traditional Korean Dreams
Sound-Work: The Neglected Sense
Traffic Noise and Autonomic Arousals
in Working with Dream Images
during Sleep
Space in Dreams
Transcendent Dreams
Sports and Dreaming
Trauma Treatment and Dreams
Stage behind the Eyes—Theatre
Types of Consciousness in Dreams
and Dreams
Ullman Method of Group Dreamwork
Stages of Sleep and Associated
The Unconscious and Dreams before
Waveforms
Freud
Structural Analysis of Dream Narratives
Use of Noninvasive Techniques in the
Subjective Experience across States
Study of Dreaming
of Sleep and Wakefulness
Using Dreams in Cognitive-Behavioral
Sumerian Dream Beliefs
Therapy
Survivors of the Holocaust and Rwandan
Video Game Play and Dreams
Genocide: Dream Accounts
Visual Art and Dreams
Synesthesia
White Noise and Sleep
Tarotpy Method
Women’s Dreams across the Life Cycle
Tau Protein and Sleep-Wake Cycle
Yawning
|
xv
Guide to Related Topics
Many of the cross references that appear
Achuar
after the entries refer to the following top¬
African American Dream Beliefs and Practices
ics and their related entries. For example,
Ancient Egypt and Dreams
after the “Achuar” entry: See also: entries
Anthropology and Dreams
related to Cross-Cultural Dreams.
Asian Americans and Dreamwork Bedouin Dream Traditions
Animal Sleep
Conceptions of Dreaming in the Western Comparative Sleep Regulation
Desert of Australia
Sleep and Bird Songs
Co-Sleeping
Sleep in Aquatic Mammals
Cross-Cultural Approaches to Dreams
Sleep in Insects
Cultural Diversity and Dreaming Native American Dreams
Brain Stimulation
Quaker Culture and Dreams Shamanism and Dreams
External Sensory Stimulation as a
Significance of Dreams in Western
Technique to Study Dreaming
Australian Desert Aboriginal
Use of Noninvasive Techniques in the
Worldview
Study of Dreaming
Traditional Korean Dreams
Comparative Sleep Databases Comparative Sleep Databases
Dream Content
Phylogeny of Sleep Database Animal Figures in Dreams Central Image (of the Dream)
Consciousness and Dreams
Characters in Dreams Cognitive Expertise and Dreams
Color in Dreams
Consciousness in Dreams
Content Analysis of Dreams: Basic
Self-Consciousness and Dreaming
Principles Counterfactuals in Dreams
Cross-Cultural Dreams
Delusions and the Classification of Typical Dreams
Aboriginal Australia: Dreams and “the
Depictions of Dreams
Dreaming” xvii
xviii
|
Guide to Related Topics
DreamBank.net: An Online Archive for Studying Dream Content Endometriosis and Dreams ESP in Dreams Existential Dreams
Dreams and Art Photography and Dreams Visual Art and Dreams
Dreams and Creativity
Flying Dreams Hall and Van de Castle System for the Study of Dream Content
Creative Problem Solving in Dreams Synesthesia
Impactful Dreams Intuition in Dreams
Dreams and Development
Nightmare Content in Adults
Adolescent Dreams
Olfactory Stimuli and Dreams
Children’s Dreams and Nightmares
REM-NREM Dream Content Specializations Selfscape Dreams Sleep, Dreams, and the Time Sense Sound-work: The Neglected Sense in Working with Dream Images Space in Dreams Structural Analysis of Dream Narratives Theory of Mind and Dreaming Transcendent Dreams
Dream Properties
Dreams and Fiction/Literature Fantasy Literature and Dreams Graphic Novels and Dreams Literature and Dreams Middle Ages and Dreams Poetry and Dreams Shakespeare and Dreams
Dreams and Memory Dream-Lag Effect Overgeneral Memories
Involuntary Nature of Dreaming Play and the Dream
Dream Theories Belief in Dream Relevance and the Conti¬ nuity Hypothesis Cognitive Theory of Dream Meaning, A Contemporary Theory of Dreaming, The Continuity Hypothesis of Dreaming
Dreams and Movies Animation and the Dream Cinema and Dreams Media Use and Nightmares Media Use and Sleep in Children and Adolescents Stage behind the Eyes—Theatre and Dreams
Functional Theories of Dreaming Illusory Contents in Dreams
Dreams and Religion
Jung’s Dream Theory Jung’s The Red Book Jung’s Transcendent Function: Neurological Support Neural Metaphor and Dreams Self-Organization from Chaos in Dreams
Bible and Dreams: Luther and Calvin Islam and Dreams Qur’an and Dreams
Dreams and Therapy
Teaching Dreams via Dream Lab
Art Therapy and Dreams
Threat Simulation Theory
Body Dreamwork
Guide to Related Topics
Cancer Patients and Dreamwork
|
Genetics of Sleep
Cognitive Approach to Dreaming Dreamwork in Counseling Embodied Imagination Gestalt Dreamwork Hill Dream Model
Genetics and Epigenetics of Sleep Genetics of Mouse Sleep Physiology
Infant Sleep Interventions Intersubjective Dreams Neuroanatomical Correlates of Dream Censorship
History of Dreams/Sleep Ancient Dream Theories Ancient Greek Dream Beliefs
Neuroanatomical Correlates of Dreamwork
Antiquity and Dreams
Neurofeedback for Sleep Problems
Bible and Dreams: Luther and
Objective and Subjective Dreams
Calvin
Ullman Method of Group Dreamwork
Brief History of Sleep Medicine
Using Dreams in Cognitive-behavioral
Fornari, Franco
Therapy
Dreams and Trauma Dream Accounts by Survivors of the Holocaust and Rwandan Genocide Trauma Treatment and Dreams
Evolution of Sleep Convergent Evolution of REM Sleep in Mammals and Birds
Freud, Sigmund Freud’s Approach to Dreams Incubation of Dreams Incubus/Succubus Medieval Hagiography and Dreams Religion and Dreams Sleep and Dreams in Western Antiquity Sumerian Dream Beliefs
Costly Signaling Theory Evolutionary Approaches to Sleep Evolutionary Psychology Theories of Dreams Phylogenetic Comparative Methods and Sleep Phylogeny of Sleep
Experimental Methodologies for Studying Dreams Awakenings Protocol Dream Interview: A Client-Defined, Metaphor-Based Interpretation Methodological Challenges in the Scientific Study of Dreams
Hormones in Sleep Endocrinology of Sleep Hypothalamo-Pituitary-Adrenocortical (HPA) System and Sleep Hypothalamo-Pituitary-Somatotrophic (HPS) System and Sleep Sleep and Growth Hormone Release Tau Protein and Sleep-Wake Cycle
Individual Differences in Dreaming Adopted Women’s Dreams Connection between Dreams and Mood, The Gender Differences in Dreaming
Fetal Sleep Fetal Sleep Fetal Yawning
Handedness: A New Look at the Effects on Dream Recall and Content Recall of Dreams
xix
xx
|
Guide to Related Topics
Infant Sleep
Reptilian Sleep
Infant Sleep and Parenting
Dynamic Structure of Reptilian EEG
Infant Sleep Interventions
versus Mammalian Sleep EEG Evolution of Reptilian Sleep
Lucid Dreaming Brain Correlates to Lucidity
Sex and Dreams
Lucid Dreaming
Chinese Sex Symbols in Dreams
Lucid Dreaming in Sports
Sexual Dreams: Meaning and
Lucid Dreaming Therapy for Nightmares
Practical Insight
Lucid Nightmares
Sleep and Culture Metabolic Syndrome Actigraphy and Sleep
Cultural Dimensions of Sleep Sleep and Culture
Antrobus’s (1983) Word Information Count (WIC)
Parapsychology and Dreams Parapsychology and Dreams
Sleep and Development Sleep Development in Infancy and Early Childhood Sleep in Adolescents
Precognitive Dreaming
Sleep and Emotion Parasomnias Dissociated States of Being and Agrypnia
Alexithymia and Sleep Partial Sleep Deprivation
Excitata Parasomnias and Nocturnal Frontal Lobe Epilepsy
Philosophy of Dreams Philosophy of Mind and Dream Characters Self in Dreams, The
Sleep and Health Alcohol and Sleep Importance of Sleep Health for Children Short Sleep Sleep, Psychiatric Disorders, and the Transdiagnostic Perspective Sleep Disorders in Patients with Heart
PTSD and Dreams/Sleep Disturbed Sleep and Posttraumatic Stress Disorder
Failure Sleep Patterns in Patients with Acute Coronary Syndromes
Sleep Disturbances in Post-Traumatic Stress Disorder (PTSD)
REM Sleep Brain Mechanisms of Vision in Dreams
Sleep and Renal Disease Alexithymia in Renal Disease Depression in Patients with Kidney Disease
REM Sleep across the Lifespan
Insomnia in Chronic Renal Failure
REM Sleep Properties
Quality of Life and Sleep Disorders in
REM Sleep-Related Motor Paralysis
Chronic Kidney Disease
Guide to Related Topics
Sleep Disorders in Patients with Chronic
|
Sleep Deprivation
Kidney Disease Acute Sleep Deprivation
Sleep and the Brain
Rapid Eye Movement Sleep in Critically Ill Patients
Functional Neuroimaging during Human
Sleep and Shift Work
Sleep Prefrontal Cortex in Dreaming
Sleep Disorders
Sleep and Brain Networks Stages of Sleep and Associated Waveforms
Attention Defecit with Hyperactivity: Dreaming in Children with ADHD Depression and Dreaming
Sleep Apnea
Hypocretin Gene Transfer in Mice Models of Narcolepsy
Continuous Positive Airway Pressure (CPAP) Therapy for Obstructive Sleep Apnea Evaluation of Tonsils in Patients with Sleep Apnea Obstructive Sleep Apnoea, Metabolism, and Hormones
Isolated Sleep Paralysis Medications Altering Dreaming Narcolepsy and Dreaming Narcolepsy and Sleep Paralysis, Hypnopompic/Hypnagogic Hallucinations Narcolepsy Symptoms, Abnormal REM Sleep, and Hypocretin Deficiency Psychiatric Diagnosis and Dreams
Sleep Assessment Pittsburgh Sleep Quality Index Portable Monitoring of Sleep Self-Assessment Tools of Circadian Typology in Children, Adolescents, and Adults Sleep Diaries
REM Sleep Behavior Disorder REM Sleep Behavior Disorder and Dreams REM Sleep Properties as Neurobiological Endophenotypes of Schizophrenia Seasonal Affective Disorder in Sleep Sleep, Nightmares, and Psychiatry Sleep and Suicide
Sleep Biology Definition of Sleep Depth of Sleep Phasic Ponto-Geniculo-Occipital/Pontine Wave (PGO/P-Wave) Sleep, Inflammation, and Cardiovascular Disease Sleep and Cardiometabolic Risk Sleep and Evolution of Detailed Focal
Sleep Disorders and Dreaming Sleep Fragmentation Sleep in Patients with Alzheimer’s Disease Sleep in Patients with Parkinson’s Disease Sleep in Patients with Wilson’s Disease Sleep Problems among Veterans of For¬ eign Wars Sleep-Related Hallucinations and Ghost Tales
Vision Sleep Spindles Sleep Variables and Handedness: Methodological Issues and State of the Field
Sleep Physiology Awake, Frozen with the Most Awful Fears, but Also Asleep
xxi
xxii
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Guide to Related Topics
Disconnection from the External Environ¬ ment during Dreaming REM Sleep across the Lifespan Serotonin in the Regulation of REM Sleep Sleep Intensity and the Homeostatic Regulation of Sleep
Social Psychology of Dreams Church Dream Groups Group Work with Dreams Journaling of Dreams Leading Dream Groups Safety in Dream Groups Social Network Analysis of Dream Content
Sleep-Wake Continuum Bizarre Imagery and Thought in Sleep and Waking Logical Structure of Dreams and Their Relation to Reality Subjective Experience across States of Sleep and Wakefulness
Teaching Courses on Dreams Television Consumption and Dreaming
Theories of Sleep Activation Synthesis Hypothesis of Dreaming Reverse Learning Theory
M Meaning of Dreams via Dream
This method has been found to be effec¬
Interpretation
tive (DeCicco, 2007a) and leads dream¬ ers to discovery through group work that
One of the most practical, important, and
could be otherwise difficult to establish on
valuable aspects of dreams is that people
their own (Wolman & Ullman, 1986). A
can draw meaning from their dreams via
third example is the Gestalt method, which
dream interpretation. It has been found that
is one where dreamers are guided to fully
dream interpretation can aid in the process
integrate the dream material via engag¬
of insight (Pesant & Zadra, 2004), can pro¬
ing in the bodily feelings and actions of
vide a means to explore emotions (Goelitz,
the dream (Pesant & Zadra, 2004). There
2001), can help decrease psychological dis¬
are many therapist-assisted techniques for
tress (Crook & Hill, 2003; Pesant & Zadra,
dream interpretation that are widely used
2004), help with feelings of isolation,
around the world and have merit in various
lack of support, life transition issues, and
situations and environments.
provide effective coping strategies (De-
Self-guided techniques (DeCicco, 2009)
Cicco, 2007a, 2007b, 2009; DeCicco &
are first taught by a therapist or work¬
Higgins, 2009). Meaning and insights are
shop leader with detailed instructions and
gained with a variety of methods, which
are then carried out by dreamers on their
generally fall into one of two categories:
own. Examples of these techniques are
(1) therapist-assisted methods of interpre¬
the
tation and (2) self-guided techniques.
interpretation (DeCicco, 2007b, 2009), the
storytelling method (TSM) of dream
Therapist-assisted techniques are used
dream interview method (DIM; Delaney,
in therapy sessions or in groups with a
1993), and meditative dream reentry (MDR;
therapist who guides or directs the tech¬
DeCicco, 2009). TSM provides dreamers
nique. One such technique is a cognitive-
with a worksheet that guides them from the
experiential method designed by Dr. Clara
dream, through associations, story-making,
Hill (Hill, 2003; Hill & O’Brien, 1999).
and finally, to the insight relating to wak¬
The method is therapist assisted with
ing life. The DIM is a contemporary method
three stages of interpretation: the explora¬
developed by Delaney (1993) and involves
tion, insight, and action stages. A second
the dreamer as the interpreter and has been
very successful and widely used method
shown to be successful in practice (Flow¬
is the Ullman method (Ullman & Zim¬
ers & Zweben, 1996). The third example,
merman, 1979), which employs the use
MDR, is one that combines relaxation train¬
of a group setting to create safety while
ing, guided imagery, and drawing therapy
leading dreamers to discovery or insight.
to aid in tapping into the deepest level of
407
408
|
Meaning of Dreams via Dream Interpretation
meaning of dreams—long-forgotten mem¬
References
ories and emotional shifting. The method
Crook, R.E., & Hill, C.E. (2003). Working with dreams in psychotherapy: The thera¬ pists’ perspective. Dreaming, 13(2), 83-96.
has been proven to be successful and is es¬ pecially applicable for dreams with negative imagery or emotions (DeCicco, 2009). Selfguided dream-interpretation techniques are generally user friendly, practical, and sci¬ entifically proven to lead dreamers to in¬ sight or discovery. Furthermore, they can be used in a formal therapy environment along with other therapeutic techniques (e.g., cognitive-behavioral therapy). Dream interpretation has been proven to be beneficial and effective in past re¬ search for those recovering from trauma, for nightmare treatment, for patients with depression and anxiety, for coping with
DeCicco, T.L. (2007a). Dreams of female university students: Content analysis and relationship to discovery via the Ullman method. Dreaming, 17(2), 98-112. DeCicco, T.L. (2007b). What is the story tell¬ ing? Examining discovery with the story¬ telling method (TSM) and testing with a control group. Dreaming, 17, 227-237. DeCicco, T.L. (2009). The giant compass: Navigating your life with your dreams.
North Carolina: Malito Press. DeCicco, T.L., & Higgins, H. (2009). The dreams of recovering alcoholics: Mood, dream content, discovery, and the storytell¬ ing method of dream interpretation. Inter¬
cancer, for treating patients with addic¬
national Journal of Dream Research, 2(2),
tions, with neurogenic communication dis¬
45-51.
orders, issues of family attachment, and fear and loss (see, e.g., DeCicco, 2007a; Eigen, 2004; Mellman,
David, Busta¬
mante, Torres, & Fins, 2001). Various tech¬ niques have also been found useful for those caring for the dying, coping with stressful life events, and for aiding in the develop¬ mental process of fully becoming one’s self (Wadensten, 2009). Lastly, dream interpre¬ tation has been found to be applicable for
Delaney, G. (1993). The dream interview. In G. Delaney (Ed.), New directions in dream interpretation (pp. 195-240). Albany: State University of New York Press. Eigen, M. (2004). Alone with God. Journal of Religion and Health, 43(3), 185-200. Flowers, L. K., & Zweben, J.E. (1996). The changing role of “using” dreams in addic¬ tion recovery. Journal of Substance Abuse Treatment, 15, 193-200.
of finding meaning in dreams with various
Goelitz, A. (2001). Nurturing life with dreams: Therapeutic dream work with cancer pa¬ tients. Clinical Social Work Journal, 29(4), 375-388.
methods. This is an important component
Hill, C.E. (2003). Working with dreams: Fa¬
of dream interpretation as it ensures that the
cilitating exploration, insight, and action.
methods are reliable and valid. Furthermore,
Washington, DC: American Psychological Association.
groups, couples, children, and adults. Cur¬ rent research continues to explore the value
dream-interpretation methods are being translated and tested in various languages other than English to make them widely accessible around the world (e.g., TSM— Italian version, TSM—Spanish version). Teresa L. DeCicco
Hill, C.E., & O’Brien, K. (1999). Working with dreams in psychotherapy. New York: Guil¬ ford Press. Mellman, T.A., David, D., Bustamante, V., Torres, J., & Fins, A. (2001). Dreams in the acute aftermath of trauma and their
Media Use and Nightmares
relationship to PTSD. International So¬ ciety for Traumatic Stress Studies, 74(1), 241-253. Pesant, N., & Zadra, A. (2004). Working with dreams in therapy: What do we know and what should we do? Clinical Psychology Review, 24, 489-512.
|
had not been exposed (Dworak, Schierl, Bruns, & S trader, 2007). This exposure ex¬ periment was very modest as the average young person is exposed to much more on a daily basis, often without any cooling-off period. The true impact of the excitement
Ullman, M., & Zimmerman, N. (1979). Work¬ ing with dreams. New York: Dellacorte Press.
caused by media content in natural settings
Wadensten, B. (2009). Older people’s experi¬ ence of dream coaching. Journal of Holistic Nursing, 27(4), 266-275.
to average media content. Research by
Wolman, B., & Ullman, M. (1986). Handbook of states of consciousness. New York: Van Nostrand Reinhold Company.
may therefore be much bigger. Children are, however, not only exposed Joanne Cantor (1998) has shown that ex¬ posure to scary films and TV content may lead to enduring fright reactions, even for decades after exposure. The news, too, is a source of scary images. The events of Sep¬ tember 11, 2001, for instance, have been shown to lead to posttraumatic stress disor¬
Media Use and Nightmares
ders and to recurring nightmares in children exposed to news about the events (Propper,
The greatest concern about the potential
Stickgold, Keeley, & Christman, 2007).
impact of the media on sleep is whether
A cross-sectional study of 2,500 Flem¬
media use displaces sleep. Television
ish children (Van den Bulck, 2004) showed
viewing, computer game play, or listening
that 33 percent of them had frequent night¬
to music—to name just those—are so ap¬
mares about TV content. Nightmares about
pealing that they vie for young people’s at¬
computer games were reported by 10 per¬
tention at the detriment of sleep time.
cent of the boys and 5 percent of the girls.
Even after the use of the media is aban¬
These findings were not limited to the
doned and sleep finally prevails, the impact
heavy users of the media—they occurred
of the media on sleep does not end. Media
at all levels of media use.
use may affect sleep quality as media con¬ tent may invade dreams.
Future research should study mediainduced nightmares with more valid instru¬
Even though little research has been
ments than self-reports, which are prone
done about this subject, a number of con¬
to over- and underreporting. Charting of
clusions can be drawn from existing stud¬
nightmares may reveal which types of
ies. In one study, school children were
content are most likely to lead to such re¬
exposed to television, to computer games,
actions. Because some images produce
or to a movie shortly before bedtime. Even
trauma-like responses, it may be impor¬
though a two- to three-hour cooling-off
tant to examine whether media nightmares
period was included, sleep was disturbed
need to be countered in a particular way.
in the children who had been exposed to
Finally, it is important to note that the
the media compared to a control group that
study of Flemish children quoted previously
409
410
|
Media Use and Sleep in Children and Adolescents
(Van den Bulck, 2004) also showed that
growth, behavioral development, and emo¬
more than half of the children reported
tional regulation. Specifically, insufficient
pleasant dreams induced by the various
sleep and poor sleep quality can result in
media. Coupled with research on the mood¬
a profound negative consequence in chil¬
enhancing properties of the media, this sug¬
dren and adolescents: first and above all,
gests that it is worth examining whether the
decreased concentration, impaired mem¬
processes leading to nightmares may also be
ory performance, and therefore poor aca¬
employed to improve sleep.
demic performance, followed by increased
Jan Van den Bulck See also: Nightmares
aggression and behavioral problems, de¬ creased reaction time and increased vul¬ nerability to injury, and, according to more
References
recent research, disordered energy regula¬
Cantor, J. (1998). “Mommy I’m scared”: How
tion, and increased obesity.
TV and movies frighten children and what
While the evidence for the importance
we can do to protect them. San Diego, CA:
of sleep and an association between poor
Harcourt Brace & Company. Dworak, M., Schierl, T., Bruns, T., & Striider, H. K. (2007). Impact of singular excessive computer game and television exposure on sleep patterns and memory performance of school-aged children. Pediatrics, 120, 978-985. Propper, R. E., Stickgold, R., Keeley, R., & Christman, S.D. (2007). Is television trau¬ matic? Dreams, stress, and media exposure in the aftermath of September 11,2001. Psy¬ chological Science, 18, 334-340. Van den Bulck, J. (2004). Media use and dreaming: The relationship among televi¬ sion viewing, computer game play, and nightmares and pleasant dreams. Dream¬ ing, 14, 43-49.
sleep and their negative consequences are becoming quite impressive, it is demon¬ strated that sleep duration among children and adolescents has decreased by approxi¬ mately 1 hour over the past 10 years and 1.5 to 2 hours over the past 50 years. These findings trigger the heightened concern on the impacts of rapid social development and technology evolution on children’s and adolescents’ sleep behaviors. According to the National Sleep Foun¬ dation’s 2006 Sleep in America Poll (2006), the majority of American schoolaged children and almost all adolescents had at least one electronic media device, such as bedroom television, videogames, mobile telephone, computer, Internet ac¬
Media Use and Sleep in Children and Adolescents
cess, and music player. Even in develop¬ ing countries, with the ongoing economic development, media devices have become
During recent decades, accumulating re¬
commonplace for children and adoles¬
searches reveal the importance of sleep
cents in urban areas. An increasing num¬
on human-health being. In children and
ber of studies consistently demonstrate
adolescents, sleep is considered particu¬
that media use has become an influential
larly crucial for learning and memory, as
factor in children’s and adolescents’ sleep.
well as having implications for physical
Among all of the previously mentioned
Media Use and Sleep in Children and Adolescents
|
media devices, television is the most pop¬
than one to two hours of quality program¬
ular and widely used. Therefore, our dis¬
ming per day. Furthermore, consistent with
cussion will begin with television.
common bedtime hygiene recommenda¬ tions, television sets should be removed from children’s bedrooms.
Television Viewing and Sleep It was reported that 98 to 100 percent of children and adolescents watch television in developed countries, with the average
Video/Computer Game Playing and Sleep
viewing time ranging from 6.3 to 15.4
Regarding video/computer game playing,
hours per week by different cultural back¬
their rapid popularity took place during
grounds and different age groups.
the past two decades in line with the inno¬
There is a general and clear recognition
vation and improvement of gaming tech¬
that television viewing has a negative im¬
nology. According to the National Sleep
pact on children’s and adolescents’ sleep,
Foundation’s 2006 Sleep in America Poll,
although little consensus regarding which
approximately half and one third of adoles¬
aspects of sleep may be related to televi¬
cents had their own videogames and com¬
sion viewing has been achieved. The most
puter/Internet access, respectively.
consistent results seem to be shorter sleep
Similar to television viewing, video/
duration, prolonged sleep-onset latency,
computer game playing has been associ¬
and delayed bedtime. In addition, there
ated with later bedtime, longer sleep-onset
is growing evidence that sleep disorders
latency, and shorter sleep duration. More¬
involving bedtime resistance, sleep anx¬
over, experimental research demonstrated
iety, parasomnia, and less often sleep-
that exposure to videogames for two to
disordered breathing are also related to
three hours prior to bedtime could change
television viewing. Interestingly, a study
sleep architecture, with less time spent in
found that, similar to television viewing,
slow-wave sleep, consequently resulting
passive television exposure during waking
in poor sleep quality and daytime sleepi¬
hours also had negative impacts on chil¬
ness. With respect to sleep disorders, a few
dren’s sleep, including decreased sleep
studies showed that video/computer game
duration and difficulties in initiating and
playing was linked to sleep latency and
maintaining sleep. In terms of television
subjective insomnia (see Figure 15).
viewing during daytime, in the evening, or at bedtime, we must emphasize the hazards of television viewing in the evening, espe¬ cially at bedtime. Taken together,
Mobile Telephone Use and Sleep With the rapid improvement in technol¬
viewing
ogy, mobile telephone usage increasingly
among children and adolescents should be
extends its functioning from the simple,
restricted, especially at bedtime. In 2001,
such as for making and receiving calls
the American Academy of Pediatrics rec¬
and text messaging, to the varied, such
ommended that children watch no more
as for entertainment, including playing
television
411
412
|
Media Use and Sleep in Children and Adolescents
Possible Mechanism? . Shortening Sleep Duration
• Later Bedtime
• Increasing Arousal Level
• Short Sleep Duration
• Altering Sleep Architecture
• Increased Sleep Problems
• Delaying Circadian Rhythm
Figure 15: The Potential Impact of Media Using on Sleep. Courtesy Shenghui Li.
games, listening to music, and accessing
a sleep aid among children and adoles¬
the Internet. In line with the functioning
cents. More research is needed to assess
development and widespread use, mobile
the positive and negative effects of music
phones have been considered a risk fac¬
on sleep—and the effects of different types
tor in children’s and adolescents’ sleep.
of music on sleep.
Although far from clear and without defi¬ nite results, several studies provided pre¬ liminary evidence that mobile phone use
Potential Mechanism
was associated with delayed sleep-wake
There are several hypotheses that have
cycle and disrupted sleep. Moreover, a re¬
been proposed regarding the potential
cent study in Sweden found a borderline
mechanisms of association between media
significant relationship between daytime
use and sleep. First, media use as a form
tiredness and mobile phone use. Given the
of unstructured activity, which usually
wide-ranging functioning and its portabil¬
lacks a clear beginning and end, is likely
ity, mobile phones could become the most
to be easily extended, leading to sacrifice
frequently used media device. More and
of sleep time, thus shortening sleep dura¬
further research is needed to specifically
tion. Second, exposure to the bright light of
and accurately clarify the impact of mobile
the viewing screen before sleep may affect
phone usage on sleep.
the sleep/wake cycle through suppression
Apart from television, video/computer
of the nocturnal salivary secretion of mela¬
games, and mobile phones, music players
tonin and consequently delay the circadian
also have been widely used. Surprisingly,
rhythm. Third, media use may increase the
the effect of music on the sleep of children
activity level of the nervous system and
and adolescents has rarely been studied. To
result in heightened alertness, physiologi¬
the best of our knowledge, only two stud¬
cal arousal, and difficulty in falling asleep.
ies explored the effectiveness of music as
It has been reported that there is a dose-
Medications Altering Dreaming
|
response relationship between light inten¬
dreaming had significant research advan¬
sity and human alertness. Finally, media
tages since dreaming/REM sleep could
use as a form of sedentary activity also may
be studied in animal models so that the
alter sleep architecture and lead to poor-
REM sleep-dreaming correlate became
quality sleep.
the routine approach utilized in studying dreaming in both animal models as well as in human subjects. REM sleep is con¬
Conclusions
trolled based on the interplay between two
It appears that the use of electronic media
major neuromodulator systems (aminergic
by children and adolescents does have a
and cholinergic) in the brainstem. More
negative impact on their sleep, although
recent versions of this once-simple sys¬
the precise effects and mechanisms remain
tem, now called AIM (activation, input,
unclear. Based on the previous clarifica¬
modulation), have become increasingly
tion, use of media devices, especially at
complex as other neurotransmitters and
bedtime, should be restricted. Particularly,
neuromodulators, including GABA, gluta¬
and most importantly, guidelines concern¬
mate, and glycine, histamine, nitric oxide,
ing the hygiene of electronic media use at
adenosine, dopamine, and other less well-
bedtime should be developed and tailored
described neuropeptides have been shown
for specific age groups of children and
to affect REM-sleep generation (Hobson,
adolescents.
Pace-Schott, & Stickgold, 2003, pp. 1-50). Shenghui Li
See also: Increasing Sleep Complaints
More recently, studies utilized data as to the reported effects of medications on dreaming derived from the clinical trials
Reference
required for the use and release of new
National Sleep Foundation. (2006). 2006 Sleep in America poll. Washington, DC: Author.
agents, as well as physician reports of ad¬ verse medication side effects. These stud¬ ies were carried out in human beings, the only species that can currently report both
Medications Altering Dreaming
the content and an experience of whether a dream has occurred. These data indicate that the medications that alter dreaming
A wide variety of prescriptive and supple¬
differ from those known to affect REM
mentary medications are reported to af¬
sleep with REM-sleep-suppressant medi¬
fect dreaming and/or induce nightmares.
cations inducing disturbed dreaming and
Until recently, studies addressing medi¬
nightmares,
cation effects on dreaming focused on
the primary REM-sleep neuromodulator,
those neurochemicals known to affect
acetylcholine, having minimal effects on
REM sleep based on the belief that these
dreaming. The group of pharmacological
medications would also affect dreaming.
preparations reported to alter sleep and
This approach of studying REM sleep as
dreaming is diverse and extensive. Almost
and medications
affecting
413
414
|
Medications Altering Dreaming
all of the agents exerting neurochemical
reported to alter dreaming are widely used
effects on dopamine, nicotine, histamine,
across-the-counter preparations, includ¬
GABA, serotonin, and norepinephrine will
ing the sedating antihistamines commonly
alter sleep and dreaming for some patients
used to treat allergies and induce sleep,
(Pagel, 2006, pp. 225-240; Pagel & Heifer,
and nicotine-replacement agents utilized
2003, pp. 59-67).
in helping individuals to stop smoking.
Disordered dreaming and nightmares
Among prescription medications in clini¬
are also commonly reported during the
cal use, antihypertensive beta-blockers af¬
withdrawal from addictive medications
fecting norepinephrine neuroreceptors are
and drugs of abuse. This finding has been
the agents most likely to result in patient
postulated to be secondary to the occurrence
complaints of disturbed dreaming. The
of REM-sleep rebound during withdrawal
strongest clinical evidence for a drug to
from REM-sleep-suppressant medication.
induce disordered dreaming or nightmares
However, nightmares and disordered
is for the selective serotonin-reuptake in¬
dreaming are often reported as part of the
hibitor, paroxetine—a medication known
withdrawal syndrome from addictive med¬
to suppress REM sleep.
ications not known to affect REM sleep,
Based on its neurochemistry, dreaming
such as cannabis, cocaine, and opiates.
does not appear to be a simple or deriva¬
Disturbed dreaming and nightmares may
tive state of REM sleep. Medications that
be an intrinsic part of the process of with¬
induce effects and/or side effects of arousal
drawal from addictive agents (Pagel, 2006,
(insomnia) and/or sedation are those that
pp. 225-240). Some antibiotics, antivirals,
most commonly were reported to alter
and immunosuppressant drugs can induce
dreaming and nightmare frequency. Dream
complaints of sedation, insomnia, and
frequency and content is most likely to be
nightmares. A clear, but poorly defined,
altered by medications inducing the effects
relationship exists between host defense
and/or side effects of insomnia or daytime
and infectious disease, and sleep/dream¬
sleepiness and altering our alertness and
ing. Some of the agents reported to cause
cognitive interaction with the world.
altered dreaming are induction anesthet¬ ics utilized in surgery, agents that can also induce waking hallucinations and confu¬ sion. This association suggests that agents which alter an individual’s conscious re¬ lationship to the external environment can alter dream and nightmare occurrence. The fact that a wide spectrum of phar¬ macological agents is reported to affect dreaming suggests that the biochemical
James F. Pagel
References Hobson, J., Pace-Schott, E., & Stickgold, R. (2003). Dreaming and the brain: Toward a cognitive neuroscience of conscious states in sleep and dreaming. In E. Pace-Schott, M. Solms, M. Blagrove, & S. Hamad (Eds.), Sleep and dreaming: Scientific advances
(pp. 1-50). Cam¬ bridge: Cambridge University Press. and reconsiderations
less understood than is generally sug¬
Pagel, J. F. (2006). The neuropharmacology of nightmares. In S.R. Pandi-Perumal, D.P. Cardinali, & M. Lander (Eds.), Sleep and
gested. The medications most commonly
sleep disorders: Neuropsychopharmacologic
basis for dreaming is more complex and
Medieval Hagiography and Dreams
|
approach (pp. 225-240). Georgetown, TX:
as a multifaceted phenomenon involving
Landes Bioscience.
the body, the mind, and the senses.
Pagel, J.F., & Heifer, P. (2003). Drug induced nightmares—An etiology based review. Human Psychopharmacology: Clinical and Experimental, 18, 59-67.
In medieval saints’ lives {vitae; hagi¬ ography), dreams appear during crucial stages in which the saint gains clarity of his life and grows spiritually. The conver¬ sion of the saint to a life in the footsteps of Jesus Christ and according to the teachings
Medieval Hagiography and Dreams
of the Gospel is a gradual process from a narrow orientation on worldly things to an open attitude toward supernatural signs
The great theologian Thomas Aquinas
and admonitions. In this process, the saint
(1225-1274) described four causes of
is continuously led by images in the form
dreams: “two inward ones, arising from
of visions, dreams, apparitions, or revela¬
daytime preoccupations and from physical
tions; terms that are not well defined and
humors, and two outward ones, arising from
not strictly demarcated from each other in
physical sources (temperature or astrologi¬
medieval hagiography. As topology dic¬
cal forces) and from God or demons” (Van
tates, their meaning is not clear to him
de Castle, 1994, p. 81). Another late me¬
from the beginning and he fails to interpret
dieval theologian, Bonaventure (ca. 1221—
them correctly. But with the help of God
1274), discerned five causes of dreaming:
he gradually experiences the true meaning
a disposition of the body; an anxiety of
of the images that are revealed to him, and
the mind; diabolic illusion; angelic revela¬
learns to act on them effectively. He ac¬
tion; and divine visitation (Kruger, 1992,
quires the habit of true interpretation: they
p. 190). Many more classifications regard¬
are all crucial signposts on his way to God.
ing cause and nature of dreams can be
The dreams and visions therefore function
found in medieval thought, which inherited
as a means for spiritual progress.
important classical categories and schemes
But they are also a measure for it: dreams
of dreams and dreamlike experiences, or
and visions signal important spiritual stages
created new ones in the same epistemic
that the saint goes through. The saint’s biog¬
tradition (Dinzelbacher, 1981). In general,
rapher uses them as important elements of a
medieval dream theory shows the ambigu¬
literary program, employing the rhetoric of
ous quality of dreams and similar vision¬
hagiography. He writes a biography within a
ary phenomena: they are either important
biography: the course of events in the saint’s
or unimportant, either psychological or
earthly life parallels the development of his
spiritual, either legal or illegal, either ma¬
spiritual life. Obviously, all natural facts and
levolent or benevolent. Dreams can be an
events take place under a supernatural direc¬
illusion as much as they can be a revelation
tion. Dreams and visions are exemplary for
(Kruger, 1992, p. 74). Furthermore, they
this, as they reveal the presence of the su¬
are never described in sec psychological or
pernatural in everyday circumstances and,
physiological terms, but always presented
at the same time, place natural images in
415
416
|
Melatonin Therapy for the Sleep Disorders of Children
a supernatural context. The dreams of the
dreaming individual itself (Frugoni, 1989,
saint are a most effective instrument in the
p. 76). Both the reception of hagiographi¬
hands of the medieval hagiographer, who
cal dreams by the medieval public and its
wishes to demonstrate to his faithful public
effects on medieval spirituality therefore
the divine origin of the saint’s actions and
need much further investigation. Krijn Pansters
the imitable aspects of his holiness. Medieval hagiographical dreams can therefore be said to be symbolic in content
See also: entries related to History of Dreams/ Sleep
as well as in function. The dreams of the man or woman of God are never considered
References
to be a normal, daily, anthropological phe¬
Dinzelbacher, P. (1981). Vision und Vision-
nomenon. As the materials of the account
sliteratur im Mittelalter. [Vision and vision
of a spiritual journey, they are symbolic in content, marking the most important stages on the saint’s way to sanctity (Frugoni, 1989, p. 73). They initiate new stages or conclude previous ones, as can be seen in the gradual conversion process of such great saints as Francis of Assisi (Pansters, 2009). The saint’s dreams are furthermore symbolic in function. They are portrayed as stemming from God, who leads the saint on his spiritual path, whereas in fact the biographer guides the saint’s admirer, the story’s reader or listener, on his path. If the saint really had dreams revealing that the will of God must remain unclear, the function of the biographical account is not the narration of the saint’s holiness in itself. Vitae are concerned with the exemplary il¬
literature during the Middle Ages.] Monographien zur Geschichte des Mittelalters [Monographs on the history of the Middle Ages] 23. Stuttgart: Hiersemann.
Frugoni, C. (1989). DieTraume inder Legende der drei Gefahrten. [Dreams in the legend of the three companions.] In A. Paravicini Bagliani & G. Stabile (Eds.), Traume im Mit¬ telalter.
lkonologische Studien
[Dreams
in the Middle Ages: Iconological studies]
(pp. 73-90). Stuttgart: Belser. Kruger, S.F. (1992). Dreaming in the Middle Ages. Cambridge Studies in Medieval Lit¬ erature 14. Cambridge: Cambridge Univer¬ sity Press. Pansters, K. (2009). Dreams in medieval saints’ lives: Saint Francis of Assisi. Dreaming, 19, 55-63. Van de Castle, R.L. (1994). Our dreaming mind: A sweeping exploration of the role that dreams have played in politics, art, re¬
lustration and divine legitimization of the
ligion, and psychology, from ancient civi¬
holiness of the saint as well as with the re¬
lizations to the present day. New York:
ligious incitement to holiness of its admir¬
Ballantine Books.
ers. Both of these aims are reflected in the typical and topological nature of the me¬ dieval biographical account. The dreams described are exemplary and paraenetic
Melatonin Therapy for the Sleep Disorders of Children
in character: they report miracles in order to create them and virtues in order to in¬
Melatonin research in sleep medicine
duce them. They are more concerned with
has been very active during the last 20
the dream-reading collective than with the
years. Since there are a huge number of
Melatonin Therapy for the Sleep Disorders of Children
|
publications on this topic, the readers are
sleep for six to eight hours. They are more
referred only to a couple of articles writ¬
beneficial for individuals who have pro¬
ten by our team ( Carr et al., 2007; Jan &
longed awakenings during the night, with
O’Donnell, 1996; Jan et al., 2007; Wasdell
or without difficulty falling asleep.
et al., 2008).
Melatonin is remarkably free from side
Melatonin (N-acetyl-5-ethoxytryptamine)
effects, even with high doses. It is not ad¬
is secreted by the pineal gland, usually
dictive and tolerance does not develop
throughout the night because healthy sleep
after prolonged use. In numerous animal
habits and darkness promote its produc¬
studies, melatonin during pregnancy has
tion; however, unhealthy sleep habits and
not caused any abnormalities in fetuses.
light inhibit it. It is also produced in min¬
It is also safe when taken during puberty,
ute amounts by most tissues. Melatonin is
and in humans it does not appear to affect
a small lipid and water-soluble molecule
its onset. Melatonin therapy does not cause
that readily enters the bloodstream, the spi¬
seizures, as once was thought; in fact it has
nal fluid, all body compartments, and cells.
anticonvulsant properties. It can be taken
It has many important functions, such as
with most other medications and it even
sleep regulation, brain development, pro¬
appears to reduce their side effects. One of
tection against toxins; it has anticonvul¬
the observations of some people who are
sant and anticancer properties; and it is also
on melatonin therapy is that their dreams
beneficial in treating many diseases. This
are more vivid but it is rarely disturbing
molecule is the most powerful antioxidant
enough to prevent treatment. This curious
known and is also a synchronizer of meta¬
effect of melatonin has not been studied
bolic activities in the body.
and the neurophysiological reasons for it
For the purpose of sleep promotion, mel¬
are not understood. However, melatonin
atonin is synthesized commercially and is
is known to influence both NREM- and
sold as an over-the-counter medication in
REM-sleep stages, and during REM sleep
the United States and Canada. In contrast,
dreaming is the most intense. With pro¬
in Europe it is a prescription drug. Melato¬
longed melatonin treatment, dreams tend
nin has very different properties from regu¬
to become less vivid.
lar hypnotics and although it has hypnotic
Melatonin therapy is recommended by
properties, it is not considered to be a sleep¬
the American Association for Sleep Medi¬
ing pill. The fast-acting formulations, such
cine for circadian rhythm sleep disorders
as sublingual tablets, capsules, and liquid
(CRSD), which include persistent diffi¬
begin to promote sleep within 30 minutes
culty falling asleep, prolonged awakenings
after swallowing them, but their effects
during the night, regular early morning
only last for four to five hours. They are
awakenings, and jet lag. There are also
most useful for those individuals who have
other, less common forms of CRSD. These
difficulty falling asleep. Most slow or con¬
circadian sleep disorders are characterized
trolled release Tablets release some mela¬
by dissociations between sleep-wake be¬
tonin quickly and some slowly; therefore,
haviors and the environment and are asso¬
depending on their makeup they promote
ciated with abnormally timed or impaired
417
418
|
Methodological Challenges in the Scientific Study of Dreams
pineal melatonin production. This is why
It can be stopped abruptly without ill ef¬
melatonin-replacement therapy is so ben¬
fects. It is recommended that the treatment
eficial for CRSD. Since the brain is closely
should be stopped every 6 to 12 months to
involved in pineal
see whether it is still necessary.
melatonin produc¬
James E. Jan
tion, these sleep disorders are common in children with various neurodevelopmen-
See also: entries related to Sleep Disorders
tal disabilities, especially with intellectual deficits. A medical evaluation prior to mela¬ tonin therapy is beneficial, because this treatment is mainly effective for CRSD, and sleep difficulties could be caused by more than the 100 sleep disorders that are known to occur in children. Prior to treat¬ ment, attempts should be made to establish healthy sleep habits, since milder sleep dis¬ turbances may respond to these measures alone. The oral dose of melatonin should be taken about 30 minutes prior to the desired bedtime. Some physicians also prescribe a smaller dose a few hours before bedtime, but we do not find this practice useful. There is no dose formula to fit everyone, because the type and severity of sleep dif¬ ficulties markedly vary. Starting with one to three milligrams is best, with small in¬ creases every couple of days, until the lowest and most effective dose is reached. Delayed sleep onset can usually be treated with smaller doses, in contrast to sleep-
References Carr, R., Wasdell, M.B., Hamilton, D., Weiss, M.D., Freeman, R. D., Tai, J., . . . Jan, J.E. (2007). Long-term effectiveness out¬ come of melatonin therapy in children with treatment-resistant circadian rhythm sleep disorders. Journal of Pineal Research, 43, 351-359. Jan, J.E., & O’Donnell, M.E. (1966). Use of melatonin in the treatment of paediatric sleep disorders. Journal of Pineal Research, 21, 193-199. Jan, J.E., Wasdell, M.B., Reiter, R.J., Weiss, M. D., Johnson, K. P., Ivanenko, A., & Free¬ man, R. D. (2007). Melatonin therapy of pe¬ diatric sleep disorders: Recent advances, why it works, who are the candidates and how to treat. Current Pediatric Reviews, 3, 214-224. Wasdell, M. B., Jan, J. E., Bomben, M. M., Free¬ man, R. D., Rietveld, W. J., Tai, J.,... Weiss, M. D. (2008). A randomized, placebo-con¬ trolled trial of controlled release melatonin treatment of delayed sleep phase syndrome and impaired sleep maintenance in children with neurodevelopmental disabilities. Jour¬ nal of Pineal Research, 44, 54-64.
maintenance difficulties. From time to time, when a person is more alert, another dose of melatonin may be taken at bedtime, or a couple of hours later, but repeating the
Methodological Challenges in the Scientific Study of Dreams
dose toward the morning is rarely helpful. Once the therapeutic threshold has been
The interdisciplinary field of dream studies
reached, additional melatonin does not re¬
is rife with questions regarding how, what,
sult in deeper sleep. Depending on the type
and why we dream. How are dreams con¬
of sleep disturbance, the treatment may be
structed? Why are dreams often difficult
required for only a short time, or for years.
to remember? Are most dreams bizarre?
Methodological Challenges in the Scientific Study of Dreams
|
What are the predictors of dream recall?
this distinction is not uniformly agreed
What is the connection between waking
upon by dream investigators (Pagel, 2008).
experience and dreaming? Does dream¬
Minimally, in any study of dreaming, the
ing serve a developmental function? Does
abstract concepts of dream and dreaming
dreaming assist with information process¬
must be translated into operational defi¬
ing and memory formation? Can work¬
nitions that specify, in precise behavioral
ing with dreams bring about personal
terms, exactly how a dream or dreaming
transformation?
will be measured.
Many methods are used to investigate
The second methodological challenge
dreaming, including phenomenology, eth¬
concerns how we study dreams and dream¬
nography, longitudinal case studies, and
ing; that is, how do we obtain evidence of
literary analysis. Each method has its own
dreaming? Questions associated with this
approach to the question of what consti¬
challenge include: What is the measure
tutes evidence for a truth claim. This entry
of dreaming? When and where are these
focuses on the use of scientific method in
measures obtained? Whose dreams are
dream studies. The application of the sci¬
sampled? We will consider each of these
entific method entails formulating test¬
questions in turn.
able hypotheses to assess the accuracy
What is the measure of dreaming? An
(validity) of theoretical claims and identi¬
intractable fact in dream studies is that any
fying the range of circumstances (bound¬
measure of dreaming is necessarily indi¬
ary conditions) under which these claims
rect: the dream as told is not the dream
hold true. Dream scientists face numer¬
as experienced. Verbal reports of dream¬
ous methodological challenges in these ef¬
ing are the typical index of dreaming. The
forts including how to maximize a study’s
reliance on verbal reports poses several
construct validity (e.g., how are dreams
challenges to the accuracy of claims made
defined, measured, sampled?), internal
about the features of dreams and about the
validity (e.g., are we studying dreaming
dream-generation process. Because the
as a type of subjective experience or as
narrative report is a verbal representation
an instance of autobiographical recall?),
of a multimodal experience that may be
and external validity (e.g., to whom do our
more or less difficult to describe in words,
findings apply?).
the report is typically guided by a narra¬
The first methodological challenge con¬
tive schema that emphasizes the dream
cerns the question of what we are studying.
story (who/what/when/where) over quali¬
Definitions of dreams vary from a detailed
tative aspects such as the perceptual, cog¬
narrative account of experiences recalled
nitive, or affective features of the dream
upon awakening from sleep to any experi¬
experience (Kahan, 1994). In short, certain
ence specific to the sleep state. Often, dream
features of subjective experience are more
is used to refer to the verbal report of an ex¬
likely than others to be included in the ver¬
perience occurring in sleep and dreaming
bal report.
is used to refer to the processes involved
Other measures of dream recall inclu¬
in generating the experience—but even
de questionnaire measures, diary reports,
419
420
|
Methodological Challenges in the Scientific Study of Dreams
Internet-based surveys, and the use of tar¬
Where
(under what conditions) are
geted probes to assess specific qualities of
measures of dreaming obtained? Dream
the dream experience. The recall of dreams
researchers disagree on whether dream
is sometimes compared with the recall of
experiences are best sampled in the home
waking experiences. Investigators disagree
setting or in the sleep laboratory. Labo¬
as to the best choice of waking-state com¬
ratory awakenings allow investigators to
parison: some argue that reports of dream¬
control the conditions under which dream
ing experience should be compared with
reports are obtained. They also minimize
reports of waking experience; others argue
the influence of memory factors such as the
for comparing the qualities of dreams with
salience or emotional intensity of the expe¬
the qualities of waking fantasy. The choice
rience on dream recall. Sampling dreams
of waking-state comparison is, in impor¬
from laboratory awakenings allows re¬
tant ways, influenced by one’s theoretical
searchers to test hypotheses concerning
perspective on the relationship between
the relationship between the qualities of
dreaming and waking. Investigators should
reported dreams and factors such as sleep
take steps to minimize the demand charac¬
stage, time of night, and method of awak¬
teristics in their studies and strive to ob¬
ening. On the other hand, laboratory-based
tain samples of dreaming and waking that
studies are expensive and time consuming
are as comparable as possible (Kahan &
for both participants and investigators.
LaBerge, 2011).
Some researchers have argued that dreams
When are measures of dreaming ob¬
sampled in the sleep lab are less vivid and
tained? A study of dreaming is, essen¬
detailed than those sampled in the home
tially, a study of autobiographical memory
setting;
(Horton & Conway, 2009). As the delay
studies comparing lab- and home-based
between a dream experience and the re¬
dream recall have found few reliable dif¬
port of that experience increases, the more
ferences (Strauch & Meier, 1996). Recent
the verbal report reflects autobiographical
technological developments in home-sleep
memory and its attendant constructive and
recording systems offer a hybrid approach
reconstructive processing. For example,
to those investigators interested in acquir¬
one recalls less of their dream experience
ing both sleep and dreaming data in the
when a demanding cognitive task inter¬
more naturalistic, home environment.
however,
carefully
conducted
venes between the dream experience and
Whose dreams are investigated? The
the dream report (Parke & Horton, 2009).
frequency, characteristics, and content of
A researcher’s concern with memory in¬
dreams are related to numerous individual
fluences on dream reporting will vary with
difference factors. These include gender,
the research question. Dream researchers
cognitive style, memory abilities, attention
who are interested in the cognitive or af¬
skills, attitude toward dreams, and cultural
fective processes involved in dream gen¬
or religious orientation, to name but a few.
eration should be especially attentive to the
Ultimately, the questions about dreams/
influence of memory processes, as well as
dreaming that can be investigated scientif¬
to the potential limits of verbal report data.
ically depend on the participants’ level of
Middle Ages and Dreams
|
dream recall, verbal expertise, and skill in
science, cognitive neuroscience, cognitive
self-observation. For example, investiga¬
psychology, anthropology, and sociology.
tors interested in comparing the qualities
Tracey Lea Kahan and
of dreaming versus waking experience are
Caroline L. Horton
concerned with obtaining reports of sub¬ jective experience that are as accurate as possible. In this regard, participants need excellent source-monitoring skills, nota¬ bly, the ability to distinguish between the characteristics of what they experienced prior to awakening (e.g., the dream expe¬ rience) and what they are inclined to add to the experience in the course of recall
References Horton, C.L., & Conway, M. A. (2009). The memory experiences and dreams question¬ naire: A validated measure of dream re¬ membering. Imagination, Cognition and Personality, 29(1), 3-29. Kahan, T.L. (1994). Measuring dream self¬ reflectiveness: A comparison of two ap¬ proaches. Dreaming, 4(3), 329-344.
may be needed to study particular quali¬
Kahan, T.L., & LaBerge, S. (2011). Dream¬ ing and waking: Similarities and differences revisited. Consciousness & Cognition, 20, 494-519.
ties of dreams, such as perceptual detail,
Pagel, J.F. (2008). The limits of dream: A sci¬
(e.g., commentary on connection to wak¬ ing life). A high level of dream recall also
bizarreness, emotion, cognitions, or self-
entific exploration of the mind/brain inter¬
reflective processes.
face. New York: Academic Press.
Individual differ¬
ence factors which may be correlated with dream recall, dream reporting, or dream qualities may be controlled or their influ¬ ence measured. Of course, the generalizability of the study’s findings must be
Parke, A.R., & Horton, C.L. (2009). A re-ex¬ amination of the interference hypothesis of dream recall and salience. The International Journal of Dream Research, 2(2), 60-69. Strauch, I., & Meier, B. (1996). In search of dreams: Results of experimental dream re¬
qualified accordingly. Finally, in view
search. Albany: State University of New
of the wide variation in dream recall and
York Press.
skill in dream reporting, dream researchers should be careful to include sample sizes large enough to detect small, yet meaning¬ ful, differences.
Middle Ages and Dreams
Researchers who endeavor to apply the scientific method to the study of dreams
During the Middle Ages, discussions of
and dreaming are encouraged to wrestle—
dreams and dream interpretation appeared
creatively, publicly, and persistently—with
in poetry, philosophy, theology, autobiog¬
the substantial methodological challenges
raphy, religious writings, and in other areas
inherent in dream science. Such efforts en¬
of thought. For example, three popular
hance the quality of the empirical evidence
types of interpretive manuals survive: the
obtained and the accuracy of claims made
dream alphabet, the dream lunar, and the
concerning what, how, and why we dream.
dream book proper, otherwise known as
Finally, these efforts help extend the reach
the Somniale Danielis, which was a key to
of dream research to the fields of sleep
dream imagery supposedly written by the
421
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Middle Ages and Dreams
prophet Daniel. All these interpretive sys¬
of oneirocriticism entered medieval culture
tems share the feature of not leaving much
through numerous Arabic translations and
room for either God’s or human will, ac¬
commentaries, whose influence permeated
cording to Steven Kruger, who writes that,
medical works in England and the conti¬
additionally, for more sophisticated medi¬
nent. Physicians used these texts as keys
eval authors, there was “a remarkable unity
to reliable diagnoses of patients’ illnesses
of opinion about the essential, fundamen¬
and built on their assertions, such as those
tally complex and ambiguous, nature of the
about the center of sense perception and
dream” (Kruger, 1992, p. 6). This entry will
the causes of sleep, with new discoveries.
focus on the impact of dreaming on three
Macrobius divides dreams into five
fields: philosophy, religion, and literature.
kinds, three of which are true or revela¬
In addition to the influential Aristotle
tory (oraculum, visio, and somnium) and
(.Parva Naturalia: De Somno et Vigilia,
two of which are false (insomnium and
De Insomniis [Little Nature: On the Sleep
visum). In doing so, he successfully brings
of Vigilance, on Insomnia] and De Divi-
together various ancient theories, from the
natione per Somnum [On Divination in
notion that dreams can be divine to the idea
Sleep]), on the one hand, and Augustine
that they are negligible because they result
(Confessions), on the other, Macrobius
from bad digestion. The genre of the som¬
(Commentary on the Dream of Scipio)
nium, or enigmatic dream, is the category
and Calcidius (Commentary on Plato’s 77-
of dream experience that is probably clos¬
maeus), two late antique writers, are im¬
est to the literary dream. The enigmatic
portant to medieval theories of dreaming
dream has five types (personal, alien, so¬
with their hierarchy of types of dreams,
cial, public, and universal), and it “stands
from the mundane to the visionary. Artemi-
between, and in some sense unites, the op¬
dorus’s Oneirocritica also is referred to in
posed realms of truth and falsehood” (Kru¬
the Middle Ages, particularly in Arabic-
ger, 1992, p. 23). For Macrobius, Cicero’s
language texts. His most influential idea is
“Dream of Scipio,” which appears at the
that the dream interpreter must know about
end of De Re Publica, contains elements
the personality, career, age, and other in¬
of the first three types, and he brings to
formation about the dreamer. For Aristotle,
bear wider topics such as mathematics,
dreams are merely physical, though he, like
astronomy, morality, geography, and reli¬
Artemidorus, admits that: “the most skilled
gion. He is the most influential of the alle-
interpreter of dreams is one who can
gorists who, as Patricia Cox Miller claims,
observe resemblances” (Aristotle, 1996,
“operated out of an expectation of textual
p. 115); he is also sympathetic to the idea
polysemy and so delighted in the conver¬
of prophecy, but not to a large degree. Ar¬
gence of infinite relationships that onei¬
istotle, who focused on physical ailments
ric images set in motion” (Miller, 1998,
that dreams can signal, was by far the most
p. 97). Interpreting a dream was like in¬
popular writer on dreams. Like the medi¬
terpreting a poem in full detail, with each
cal writings on dreams by Hippocrates and
image and action worthy of paragraphs of explication.
Galen, Aristotle’s naturalistic philosophy
Middle Ages and Dreams
|
Augustine’s ideas about dreams appear
for one’s sins, one’s interiority needs to be
in Confessions and De Continentia (On
disciplined, and that virtue is defined as the
Continence), where he holds that dreams
struggle to achieve this control.
can be compelling as well as prophetic, but
Religious writers during the Middle
also that at times another force takes over
Ages were preoccupied with dreams in
one’s body and creates the conditions in
Islamic, Jewish, and Christian contexts.
which sexual excitement is possible and
Medieval Islamic writers, including some
is not considered sinful. The Confessions
Sufis, were influenced by Artemidorus’s
contain an observation about the reliabil¬
Oneirocritica (second century AD), by Ar¬
ity of dreams: “Food pictured in dreams is
istotle, and by the Bible.1 They tended to
extremely like food received in the waking
concentrate on the role of the imagination
state; yet sleepers receive no nourishment,
in creating dreams; al-Ghazali (d. 1111)
they are simply sleeping. But those fanta¬
and Ibn al-’Arabi (d. 1240) are examples of
sies had not the least resemblance to you as
authors with such a preoccupation. Other
you have now told me, because they were
influential Muslim philosophers who dis¬
physical images, fictional bodily shapes....
cussed dreams are al-Farabi (d. 950) and
And yet again the pictures of these realities
Ibn Sina (d. 1037). “It was universally ac¬
which our imagination forms are more reli¬
cepted that those who had cultivated their
able than the mythological pictures of vast
inner faculties and insights could decipher
and unlimited entities” (Augustine, 1991,
the encoded messages of their own dreams
p. 41). His interest in prophetic dreams
as well as those of others” (Sviri, 1999,
is demonstrated through an account of
p. 252). Sufis recorded their dreams as well
a dream of his mother, in which she was
as those of others.
encouraged to allow him to live with her,
In medieval Judaism, Isaac Israeli (10th
and to sit at the same table in the house to¬
century) wrote that dream imagery for com¬
gether. She cries, and when a young man
mon people and in prophets’ revelations
asks why, she says she mourns her son’s
make “dreams a part of prophecy” (Sviri,
perdition (he has taken up with the wrong
1999, p. 255). Moses ibn Ezra, a poet,
crowd). He tells her not to worry and then
wrote that dreams derive either from within
she sees Augustine on same rule as this
or from celestial sources, and the latter are
young man: “By the dream the joy of this
the only veridical ones. One minor type of
devout woman, to be fulfilled much later,
dreaming was the astral dream, considered
was predicted many years in advance to
“the intersection between the astral order
give consolation at this time in her anxi¬
and private life, a moment of insight, ei¬
ety” (Augustine, 1991, p. 49). In De Con¬
ther a gift from above or a result of human
tinentia, Augustine addresses the issue of
initiative, enabling a person to peer into the
sexual continence; he had already done so
future by means of a mantic relationship
in the famous Chapter 10 of the Confes¬
to the celestial forces that shape that fu¬
sions, where the wet dream is a problematic
ture” (Idel, 1999, p. 236). More common
source of bodily knowledge for him. Au¬
were Kabbalistic dreams that were “a lin¬
gustine shows that when one is responsible
guistic kind of magic directed at angels”
423
424
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Middle Ages and Dreams
(Idel, 1999, p. 238), although instructions
they faced an uphill battle because of the
exist for being the recipient of a dream
increasing popularity of dream books and
after standing under the stars. In the 12th
other popular interpretive traditions.
century, Abraham ibn Ezra wrote on Dan¬
Medieval
literature contains
several
iel, both that naturalistic causes for dreams
famous instances of dreaming, from the
exist and that dreams could also be inter¬
framing of the poems Pearl and Piers
preted based on what hour a dream oc¬
Plowman to the work of Chaucer, who in¬
curred and the stars’ configuration at that
cludes dreams in several ways in his work.
time. His perspective on astral dreams ap¬
The Nun’s Priest’s Tale in The Canter¬
pears in the following century in an anon¬
bury Tales contains the story of a dream
ymous treatise. Maimonides was against
and its interpretation by the husband of
this practice, but a letter is attributed to him
the dreamer (both characters are birds),
that condones it and also uses a method of
and his narrative poems “The Book of the
purification, special language including
Duchess,” “The House of Fame,” and “The
anagrams, and the appearance within the
Parliament of Fowls” all contain dream
dream of Mercury (Hermes) to foster the
frames. A. C. Spearing, the most prolific of
dreamer’s “magical powers” (Idel, 1999,
a group of contemporary scholars of medi¬
p. 244) and greater understanding of the
eval dreaming, writes that “What especially
Torah. A treatise spuriously attributed to
interested Chaucer about the dream poem
ibn Ezra also contains an “astral-magic vi¬
as a genre, I suggest, were two things—on
sion of drawing down the emanation from
the one hand, the dream as one of the most
above by ritual means” (Idel, 1999, p. 246).
intriguing kinds of natural experience we
Christian authors were alternately fasci¬
have, and, on the other, the possibility of
nated by and hesitant about dreams. Many
constructing poems that reproduce certain
mystical writings, such as those by Julian
aspects of that experience as literary form”
of Norwich, Gertrude of Helfta, Guibert
(Spearing, 2010, p. 167). The aspects of
de Nogent, Hermann of Cologne, and The
dreaming that Chaucer seemed most eager
Book of Margery Kempe display an af¬
to represent include careful attention on the
finity for visions and often dedicate their
part of dreamers and interpreters alike to
lives to religious pursuits in accordance
details of language and dialogue, descrip¬
with their dictates. On an institutional
tions of landscapes that place the dreamer
level, however, dreams indicate “the basic
in realistic but also imaginative surround¬
limits of ecclesiastical power, showing it
ings, and a general tone of nostalgia as the
incapable of controlling all the arcane of
dream is recalled. Literary writers, philos¬
individual religious experience, even if
ophers, and religious writers alike found in
clerics assumed the essential role of sav¬
dreams intensely provocative and intensely
ing the dream narratives from oblivion by
illuminating material with which to ponder
recording, classifying, and judging them”
the epistemological status of mental activ¬
(Schmitt, 1998, p. 275). As much as au¬ thorities in the church wanted to limit indi¬
ity when it occurs in the absence of waking life’s stimuli.
vidual believers’ engagement with dreams,
Jenn Lewin
Mugwort: A Dream-Stimulating Herb
Note
(Doctoral dissertation, University).
poetry
1. A new English translation of Artemidorus’s Oneirocritica will appear in October 2012, with slightly revised Greek text and extensive introduction and commentary, written by Dan¬ iel E. Harris-McCoy, Artemidorus’ Oneirocrit¬ ica: Text, Translation, and Commentary (New York: Oxford University Press, 2012).
|
Princeton
Phillips, H., & Havely, N. (Eds.). (1997). Chau¬ cer’s dream poetry. London: Longman. Russell, J.S. (1988). The English dreamvision: Anatomy of a form. Columbus: Ohio State University Press. Schmitt, J.-C. (1998). Ghosts in the Middle Ages: The living and the dead in Medieval society (Trans. Teresa Lavender Fagan).
References
Chicago: University of Chicago Press.
Aristotle.
(1996). Aristotle on sleep and dreams: A text and translation (Trans. David Gallup). Warminster, UK: Aris & Philips.
Augustine. (1991). Confessions (Trans. Henry Chadwick). Oxford: Oxford University Press. Barr, J. (2010). Willing to know God: Dream¬ ers and visionaries in the later Middle Ages.
Columbus: Ohio State University Press. Edwards, R. (1991). The dream of Chaucer: Representation and reflection in the early narratives. Durham, NC: Duke University
Press. Idel, M. (1999). Astral dreams in Judaism: Twelfth to fourteenth centuries. In D.D. Shulman & G. G. Stroumsa (Eds.), Dream cultures: Explorations in the comparative
Shulman, D., & Strousma, G.G. (1999). Dream cultures: Explorations in the comparative history of dreaming. Oxford: Oxford Uni¬
versity Press. Spearing, A.C. (2010). Dream poems. In S. G Fein & R. Raybin (Eds.), Chaucer: Con¬ temporary approaches (pp. 159-178). Uni¬ versity Park: Pennsylvania State University Press. Sviri, S. (1999). Dreaming analyzed and re¬ corded: Dreams in the world of medieval Islam. In D. D. Shulman & G. G. Stroumsa (Eds.), Dream cultures: Explorations in the comparative history of dreaming (pp. 252273). New York: Oxford University Press. Windeatt, B. A. (Ed.). (1982). Chaucer’s dream poetry: Sources and analogues. Cambridge: D. S. Brewer.
history of dreaming (pp. 235-251). New
York: Oxford University Press. Kruger, S.F. (1992). Dreaming in the Middle Ages. Cambridge: Cambridge University Press.
Mugwort: A DreamStimulating Herb
Lynch, K.L. (1988). The high medieval dream and literary
Oneirogens are plants or other substances
form. Stanford, CA: Stanford University
that enhance dreaming (Toro & Thomas,
Press.
2007). One of the most widely used plants
vision: Poetry, philosophy,
Lynch, K. L. (Ed.). (2007). Geoffrey Chaucer, dream visions and other poems. New York: W.W. Norton. Miller, P.C. (1998). Dreams in late antiquity: Studies in imagination of a culture. Prince¬ ton, NJ: Princeton University Press.
associated with stimulating vivid dreams is mugwort. Its common name originates from its extensive use in brewing beer prior to the introduction of hops. Wort is an old English term for herb as many Harry Potter
Newman, F.X. (1963). Somnium: Medieval
fans have learned. Mugwort’s genus name
theories of dreaming and the form of vision
is Artemisia, which is linked to the Greek
425
426
|
Mugwort: A Dream-Stimulating Herb
goddess Artemis, who was associated with
The dream-inducing properties of mug¬
healing women’s diseases and helping
wort are generally accessed by making a
with childbirth along with connections to
dream pillow with dried mugwort leaves,
wilderness, wild animals, and hunting (Sil¬
often mixed with other herbs such as lav¬
verman, 1997). The strong fragrance, the
ender, which is reported to be soothing.
variations in the leaf shape and the unique
Pillows with mugwort can be purchased
two colored leaves with silvery fibers on
or made using cotton or other soft fabrics.
the bottom are probably what drew people
Users who enjoy crafts may want to design
to explore the uses of the plant in ancient
and decorate their own dream pillow with
times.
inspiring symbols or with images from
Mugwort is in the aster family (.Astera-
their own dreams. Fresh leaves on your
ceae), which has also been known as the
pillow are the easiest way to experiment.
daisy or sunflower family. The genus Ar¬
A tea is another way to try out the onei-
temisia is commonly found in North and
rogenic effects of mugwort. However, the
South America, Europe, Africa, and Asia
taste is bitter and those who want to ingest
(see the Viable Herbal Solutions website
the herb may prefer to purchase or make a
at http://www.viable-herbal.com/singles/
capsule with dried or powdered mugwort.
herbs/sl38.htm). One species of mug¬
The study of ethnobotany focuses on hu¬
wort, Artemisia vulgaris, is so common
mans relationships with plants (Veilleux &
in the eastern United States and Europe
King, n.d.). Agriculture- and plant-based
that it often appears as a weed (Artemisia
medicines developed as a result of cen¬
vulgaris, n.d.). Very similar in appear¬
turies of trial-and-error experimentation.
ance and usage is Artemisia douglasiana,
Many crucial advances in medicine have
which is common on the West Coast of the
come from plants and one of the many ra¬
United States in forests and undisturbed
tionales for preserving the earth’s rain
areas (Hickman, 1993). Mugwort is a
forests is the likelihood that crucial medic¬
highly aromatic plant that varies in height
inal and nutritional plants exist there that
from one to five feet tall with divided or
have yet to be studied or even discovered.
lobed leaves that are a darker olive green
Botanists have identified the chemical
on top and more of a silvery green color
properties of oneirogenic herbs that may
with white downy hairs on the bottom.
eventually be linked to influencing dreams
The leaves are polymorphic, meaning that
or other medicinal benefits. Along with
individual leaf shapes may vary with most
other avenues of dream research, learning
leaves having three to five lobes or divi¬
more about these plants may contribute to
sions that are mitten like (Foster & Hobbs,
understanding the nature of dreaming and
2002). It is easy to cultivate and can be¬
its use in healing and awareness.
come naturalized in a garden. It can be
Popular interest in dreams, natural heal¬
used fresh or dried and the procedures for
ing, and cross-cultural spiritual and me¬
gathering, drying, and storing mugwort
dicinal practices burgeoned in the late 20th
are similar to those used for other herbs,
century. This led to increased interest in
spices, and botanicals.
oneirogens such as mugwort to enhance
Mugwort: A Dream-Stimulating Herb
|
dream recall, stimulate vivid dreams, and
habitats or damage other plants that may
to cultivate lucid dreams that occur when
be less common.
the dreamer is aware they are dreaming.
While research on the oneirogenic plants
Despite increased interest and abundant
may proceed slowly, we know that there
anecdotal reports, research on the pos¬
are a number of potential therapeutic ben¬
sible benefits of oneirogenic plants and
efits common to all medicinal treatments.
other substances is proceeding slowly due
The first is the placebo effect that has a
to lack of funding. Most of the reported
powerful therapeutic impact and can en¬
oneirogenic benefits of mugwort and other
hance traditional and alternative medicine.
herbs and substances have not been scien¬
The patient’s expectation of healing can in¬
tifically confirmed. Therefore, it is impor¬
fluence the success of any treatment with
tant to keep in mind that the information in
traditional or alternative medicine. Also,
this article should be taken as educational
the relationship with the physician, psy¬
only and not as a medical recommendation
chotherapist, healer, or shaman can have a
or a substitute for any necessary treatments
positive influence. In addition, using onei-
that are evidence based or approved by the
rogens or other medical therapies in the
FDA or other governmental entities. In ad¬
context of strongly held cultural religious
dition, two important cautions to be con¬
beliefs and ritual may have an impact that
sidered are that some people are allergic
is synergistic, by combining the placebo
to the pollen from mugwort flowers, and
effect, positive expectations, and culturally
that any wild plant should be definitively
sanctioned results along with potential me¬
identified before using it to prevent inad¬
dicinal or psychoactive influences of mug¬
vertent exposure to a harmful plant such
wort or other oneirogens being used.
as poison oak or ivy, hemlock, or stinging
Plant-based oneirogens have been used
nettles. In addition, thujone, a compound
in two general ways. They are taken before
found in varying degrees in mugwort, can
sleep in various forms to stimulate dream¬
have neurotoxic and mutagenic side effects
ing and they are used to induce a dream¬
when used in excess, and pregnant women
like state that closely parallels the sensory
should avoid or use medical advice before
and mental experience of a vivid dream.
ingesting mugwort preparations (Artemisia
Some of the best known plant oneirogens
vulgaris, n.d.). In general, if a tea or extract
combine both effects. A good example of
is used, it is best to use water rather than
an herbal oneirogen used to induce both
oil to extract the medicinal effects because
dreamlike states and powerful dreams is
the resulting tea or tincture will be milder
ayahuasca (Banisteriopsis caapi), which
when steeped in water (Foster & Hobbs,
is used by tribes in the Amazon rainfor¬
2002). In addition, some people are aller¬
est region and is referred to as vine of the
gic to the pollen from mugwort flowers.
soul in the Quechua language. In addi¬
Cooking may reduce or eliminate the risk
tion to many medicinal properties, it has
to those who are allergic. Finally, consider
hallucinogenic effects and is used in reli¬
growing your own mugwort and if you do
gious rituals by many tribes and sometimes
harvest the plant be careful not to disturb
combined with other herbs. The Achuar of
427
428
|
Mugwort: A Dream-Stimulating Herb
Peru use ayahuasca to stimulate dream¬
Mugwort has been revered over the centu¬
ing as an integral part of shaman-guided
ries for its magical, mystical, and spiritual
dream healing rituals that are central to
uses especially for warding off evil spirits
the cultural and spiritual practices of the
or enemies and for clairvoyance and pro¬
tribe (Parry, 2008). Researchers (Arehart-
moting romantic success. A 3,600-year-
Treichel, 2011) and journalists (Isaacson,
old Egyptian papyrus described the plant
2010) have reported profound dreams fol¬
in detail (see the Viable Herbal Solutions
lowing the ayahuasca ceremonies as well
website at http://www.viable-herbal.com/
as intense dreamlike experiences during
singles/herbs/s 138.htm). In art, Venus, the
the rituals. Another well-known mind-
Roman goddess of love, is sometimes de¬
altering oneirogen is Ubulawu, also known
picted holding a spray of mugwort in her
as African Dream Root (Silene capensis).
hand (Artemisia vulgaris, n.d.). In the first
The root is used by shamans in southern
century AD, the Roman writer Pliny the
Africa. Its root contains triterpenoid sapo-
Elder extolled the virtues of mugwort for
nins, which in even small doses are said
combating fatigue and stated that, “The
to induce remarkably prophetic vivid and
wayfaring man that hath the herb tied about
very colorful dreams that often allow tribe
him feeleth no weariness at all and he can
member to contact their ancestors (Toro &
never be hurt by any poisonous medicine,
Thomas, 2007).
by any wild beast, neither yet by the sun
Examples of oneirogenic plants that do
itself” (Silverman, 1997).
not radically affect waking consciousness
Mugwort is one of the nine magical herbs
but significantly alter dreaming include
of the Druidic and Anglo-Saxon tribes and
Dream Herb or Bitter Grass the Leaf of
was associated with protection of travelers
God (Calea ternifolia), which is used by
and fertility rites (Artemisia vulgaris, n.d.).
the Chontal people of Oaxaca, Mexico, for
In the Middle Ages, mugwort was worn in
oneiromancy or predicting future events
mid-summer on St. John’s Eve to gain se¬
or receiving divine guidance in a dream
curity against threats of evil possession.
(Toro & Thomas, 2007). Scientific stud¬
Medieval legends held that a dream pillow
ies have confirmed that the plant increases
of mugwort would allow people to see their
dream recall (Olin & Schneider, 2001).
entire future in their dreams (Callegari &
Another oneirogen, Red Spider Lily, has
Durand, 1977). Native Americans rubbed
an alkaloid, galantamine, which report¬
the leaves on their body to prevent dream¬
edly enhances the experience of dreaming
ing of the dead and to ward off ghosts, and
(Yuschak, 2006). Although its oneirogenic
they smoked, drank, and burned the herb
effects have not yet been scientifically con¬
for ritual purification (Foster & Hobbs,
firmed, a synthetic extract of galantamine
2002). In the 21st century, mugwort is used
has shown success in treating symptoms
for inducing lucid dreams and for stimulat¬ ing vivid dreams.
of Alzheimer’s disease (Olin & Schneider,
2001).
Most of the known oneirogen plants have
The origins of human fascination with
other reported medicinal uses, often in¬
mugwort stretch back across millennia.
volving mental functioning or the nervous
Mugwort: A Dream-Stimulating Herb
|
system. Mugwort has been utilized for cen¬
in aiding digestion. Wormwood has been
turies in conjunction with acupuncture. The
used for centuries to treat intestinal worms,
white downy fuzz on the underside of mug-
hence the common name for the plant. As
wort’ s leaves is removed and fashioned into
early as the 10th century, medicinal trea¬
cubes that are burned as moxa by acupunc¬
tises touted Artemisia's use in repelling
turists The smoking moxa cubes are placed
worms and other pests. In addition to its
over specific energetic meridians either di¬
ancient use for brewing, it is still used for
rectly or indirectly to amplify the effects of
flavoring beer, especially in Great Brit¬
the treatment. Called moxibustion, this an¬
ain, and some microbreweries are bring¬
cient treatment is still widely used in Chi¬
ing back mugwort beers. Finally, mugwort
nese medicine in the 21st century and has
seeds have been used for baking and for
shown promise with difficulties in labor in
flavoring in many foods. It is used in Korea
conjunction with acupuncture (.Artemisia
as a common ingredient in rice cakes, teas,
vulgaris, n.d.).
soups, and pancakes, and mugwort rice
Mugwort has traditionally been used in
cakes, or kusa mochi, are used for Japa¬
herbal medicine for soothing anxiety and
nese sweets called Daifuku (which means
for calming people who have suffered a
great luck) (.Artemisia vulgaris, n.d.).
seizure or drug overdose. Wormwood is
In addition to whatever medicinal, psy¬
in the same genus (Artemisia) and closely
chological, or spiritual benefits that plant
related to mugwort. It was used to prepare
oneirogens, such as mugwort, may prove
Absinthe, a powerful alcoholic drink with
to have, they are an enjoyable way to focus
psychoactive properties. It was popular in
on remembering and exploring dreams,
the late 1880s and early 1900s with art¬
can lead to a more active connection with
ists and writers, such as Baudelaire, Edgar
dreams, and increase interest in cross-
Allan Poe, and Van Gogh. In that era, it was
cultural dream healing practices. In addi¬
linked to brain damage and banned prob¬
tion, learning about plant oneirogens make
ably due to toxic copper salts used to brew
us more sensitive and aware of our con¬
it. Absinthe has become popular again in
nection with nature and promotes interest
the 21st century with nontoxic brewing
in ethnobotany. Finally, the exploration of
procedures (.Artemisia vulgaris, n.d.).
plant oneirogens and medicinal and nutri¬
Mugwort has many other reported me¬
tional uses of wild plants heightens pub¬
dicinal uses not related to mental func¬
lic awareness about the preservation of
tioning, including beneficial effects for
native plant species, which could help to
menstrual difficulties and labor pains, and
slow the accelerating decimation of plant
for treating fungal and bacterial infections.
communities that may be crucial to human
It is beneficial as an insect repellent and
survival. Alan Siegel
helpful against moths and other insects that invade gardens. It is considered a topical
References
treatment when a person is exposed to poi¬
Arehart-Treichel, J. (2011, March 4). Amazon people’s dreams hold lessons for psycho¬ therapy. Psychiatric News, 46(5), 9.
son oak or poison ivy. Mugwort is consid¬ ered to be a bitter herb that is beneficial
429
430
|
Music and Dreams
Artemisia vulgaris, (n.d.). Wikipedia. Re¬ trieved from http://en.wikipedia.org/wiki/ Artemisia_vulgaris. Callegari, J., & Durand, K. (1977). Wild edible and medicinal plants of California. El Cer¬ rito: Callegari and Durand. Foster, S., & Hobbs, C. (2002). Western medic¬ inal plants and herbs. New York: Houghton Mifflin. Hanrahan, C. (2011). Mugwort. Encyclope¬ dia of alternative medicine. Retrieved from http://findarticles.eom/p/articles/mi_g2603/ is_0005/ai_2603000533/ Hickman, J. (1993). The Jepson manual: Higher plants of California. Berkeley: Uni¬ versity of California Press. Hurd, R. (2009). Enhance your dreamlife. Phil¬ adelphia: dreamstudies.org.
Music and Dreams Anecdotal reports of music occurring in dreams can be found in a variety of places ranging from concert halls to Internet chat rooms to the field notes of anthropologists. While it is likely easiest to find high oc¬ currences of musical dreams among mu¬ sicians and among shamans, anyone can dream of music. Popular interest in the topic is evidenced by the many questions related to dreaming of music that have been posted on the interactive website Yahoo! Answers (http://answers.yahoo.com). Vis¬ itors to the site can provide responses from their own experience to questions such as
Isaacson, A. (2010, October 13). Amazon awakening. New York Times.
“What does it mean when you dream about
Olin, J., & Schneider, L. (2001). Galantamine for Alzheimer’s disease (Cochrane Review). Adult and Geriatric Treatment and Preventative Interventions Branch, National Institute of Mental Health (Co¬ chrane Database Syst Rev 2001 ;4: CD 001747).
you’ve never heard before?” and “Strange
Parry, B. (2008, June 10). Peruvian jungle. Retrieved from the BBC website: http:// www.bbc.co.uk/amazon/sites/peruvianjun gle/pages/content.shtml
dream song is often a confirmation of the
Silverman, M. (1997). A city herbal: Lore, leg¬ end and use of weeds. Woodstock, NY: Ashtree Press.
music?” “Is it possible to dream of music music in dreams?” Down through history, in indigenous cultures where shamanism is practiced, it is common for practitioners to be given sacred songs in dreams. Receiving such a shaman’s calling, and these songs are used in healing rituals and as a way to connect with the spirit world. One major study of these practices is documented in the book Healing Sounds from the Malaysian Rain¬
Toro, G., & Thomas, B. (2007). Drugs of the dreaming: Oneirogens: Salvia divinorum and other dream-enhancing plants. Roch¬ ester, VT: Park Street Press.
forest by musicologist and anthropologist
Veilleux, C., & King, S. (n.d.). An introduction to ethnobotany (Ed. L. Morganstein). Re¬ trieved from http://www.accessexcellence. org/RC/Ethnobotany/page2.php
dreams. Her collection includes 50 such
Yuschak, T. (2006). Advanced lucid dreaming: The power of supplements. Lexington, KY: Lulu Press.
was received (Roseman, 1993, p. 58).
Marina Roseman (1993). Roseman spent two years living with the Temiar, collect¬ ing stories about the songs that came from stories which detail the events of the day leading up to the dream in which the song Although a large-scale study of how common musical dreams are in the general
Music and Dreams
|
population has yet to be undertaken, a 30-
Billy Joel, Shawn Colvin, Rodney Crow¬
day study by Valeria Uga et al. (2006) spe¬
ell, Bruce Cockburn, Rory Block, David
cifically designed to collect musical dreams
Bowie, Brooks Williams, jazz musicians
found music occurring in approximately 20
Patti Cathcart and Chick Corea, and the
percent of nonmusicians’ dreams (n = 30)
South African a cappella group Ladysmith
and in approximately 40 percent of mu¬
Black Mambazo (Barrett, 2001; Grace,
sicians’ dreams (n = 35). Among other
2001). In most of the previously mentioned
things, the study reported on three ways
cases, dreams have inspired the lyrics of
music appeared in dreams reported by the
part or all of a song, rather than the music.
musician group: music dreamed exactly as
Examples include Johnny Cash’s “When
it is known in waking life (55%), music
the Man Comes Around,” Shawn Colvin’s
known but dreamed in an unusual version
“Polaroids,” Sting’s “The Lazarus Heart,”
(17%), and an entirely unknown piece of
and Bruce Cockburn’s “Wondering Where
music appearing in a dream (28%) (Uga,
the Lions Are.” The Internet site Song-
Lemut, Zampi, Zilli, & Salzarulo, 2006).
facts.com lists 51 popular songs inspired
Dreams have provided inspiration to both
by dreams (Songs Inspired by Dreams,
classical andpopularmusicians.Beethoven’s
n.d.). No doubt a complete list would run
canon “O Tobias,” Igor Stravinsky’s “Rite
into the hundreds, if not thousands.
of Spring,” Taitini’s “The Devil’s Trill So¬
It is interesting to consider what it means
nata,” and Wagner’s “Tristan and Isolde”
that we dream of music at all, when dreams
are among the classical works that owe their
are predominantly made up of pictorial im¬
existence to dreams (Barrett, 2001). Irving
ages. Stefano Carta addresses this question
Massey (2006) cites additional examples in
from the perspective of analytical psychol¬
“The Musical Dream Revisited.”
ogy, in which dreams are viewed as self¬
The Beatles ballad “Yesterday” is likely
representations. He argues that sound and
the most famous and commercially suc¬
music correspond to a more archaic level
cessful song to have come from a dream.
of psychological functioning than imag¬
Paul McCartney dreamed the melody, and
ery, and therefore music in dreams under¬
at first was certain he must have heard it
lies visual imagery, and may be the purest
before, feeling skeptical that such a lovely
expression of the emerging self. When
tune had truly originated in a dream. But
music shows up in a dream, the acoustic
after playing it for many people he became
emotional qualities contained in the music
convinced it was a true dream composi¬
can provide a foundation through which
tion, at which point he wrote the song’s
to interpret the dream’s visual imagery
hauntingly beautiful lyrics, which have
(Carta, 2009).
stood the test of time (Barrett, 2001; Grace, 2001). Other contemporary
In conclusion, it must be noted that only a small amount of research has been done
who
to date on the prevalence, meanings, im¬
have dream-inspired songs to their credit
plications, and applications of music in
include Sting, Johnny Cash, Patti Smith,
dreams. This area of study is still in its in-
musicians
431
432
|
Music and Dreams
fancy, offering many paths to explore and
cultural
much more to be discovered.
of dreaming (pp. 167-172). New York: Nancy Grace
References Barrett, D. (2001). The devil plays the vio¬ lin: Dreams and music. In The committee
and psychological
dimensions
Palgrave. Massey, I. J. (2006). The musical dream revis¬ ited: Music and language in dreams. Psy¬ chology of Aesthetics, Creativity, and the Arts, 5(1), 42-50.
of sleep: How artists, scientists, and ath¬
Roseman, M. (1993). Healing sounds from the
letes use their dreams for creative problem¬
Malaysian rainforest: Temiar music and
solving—and how you can too (pp. 66-81).
medicine. Berkeley: University of Califor¬
New York: Crown Publishing.
nia Press.
Carta, S. (2009). Music in dreams and the emergence of the self. Journal of Analytical Psychology, 54, 85-102. Grace, N. (2001). Making dreams into music: Contemporary songwriters carry on an age-old dreaming tradition. In K. Bulkeley (Ed.), Dreams: A reader on the religious,
Songs inspired by dreams, (n.d.). Retrieved from the Song Facts website: http://www. songfacts.eom/eategory:songs_inspired_by_ dreams.php Uga, V., Lemut, M.C., Zampi, C., Zilli, I., & Salzarulo, P. (2006). Music in dreams. Con¬ sciousness and Cognition, 5, 351-357.
N Naps
or sustained operations; (3) pure appeti¬ tive drive, linked to sociocultural and in¬
Naps can be defined as short periods of
dividual characteristics. It is quite evident
sleep that can be taken at any time of the
that napping may be often considered a
24 hours.
pleasant activity, and many people report
Interestingly, there is no consensus yet
a psychological benefit for napping appar¬
on the maximum length for a sleep episode
ently independent from its physiological
to be defined a nap. In 1987, Dinges and
effects; (4) age-related polyphasic sleep-
colleagues proposed that a nap is shorter
wake rhythms, which occur in both infant
than half the habitual nocturnal sleep, but
and, to a lesser extent, elderly subjects.
almost all of the scientific literature puts the upper limit at two hours, or even one
How Frequent Are Naps?
hour, given the little feasibility of longer naps in most of the settings.
An overview of the most recent scientific
At variance with the vast majority of
literature shows that the overall prevalence
mammals, who are polyphasic sleepers
of napping ranges from approximately
(i.e., they have more than one sleep epi¬
10 to 65 percent. This large variance ob¬
sode, all over the 24 hours), humans tend
viously depends, on one hand, on the dif¬
to be monophasic in most cases, meaning
ferent instruments adopted (interviews,
that they concentrate waking time dur¬
diaries, objective measures) and, on the
ing the daytime/light hours and have only
other hand, on demographic characteristics
one major sleep period, usually placed at
of the population studied (age, nationality,
nighttime/dark hours.
sociocultural background).
However, there are exceptions to this
According to the 2005 National Sleep
general rule, and taking naps is a habit
Foundation poll on adults’ sleep hab¬
of several individuals. This habit can be
its, 55 percent of the general population
more or less frequent, and it can depend
in United States take a nap at least once
on a number of different reasons, includ¬
a week, and more than 10 percent at least
ing: (1) recuperative need, when the sleepy and fatigued subject has to recover from
four times a week. Within the United States, African Ameri¬
a previous sleep deprivation/restriction;
cans report more frequent napping than
(2) prophylactic strategies, which are
Caucasian individuals. The diffusion of
aimed at counteracting an expected sleep
napping behavior in the African culture
deprivation and to maintain performance
is supported by a very recent study find¬
in particular contexts such as shift work
ing high frequencies of habitual napping
433
434
|
Naps
in a sample of 276 Nigerian undergradu¬ ates, age range 19 to 35: 68.1 percent take
Naps and Health
one to three naps per week, 14.2 percent
Notwithstanding the widespread diffusion
take four to seven naps per week, with the
of napping, data on its impact on health are
mean duration of afternoon naps being
surprisingly scarce and generally limited to
70 minutes for males and 90 minutes for
elderly subjects. In elderly people, napping
females.
has been reported to be associated with in¬
Independent from geographical origin,
creased risk of mortality, diabetes, falls,
prevalence studies also suggest that habit¬
and hip fracture. Furthermore, a relation¬
ual nappers are more likely to be males,
ship between napping and cardiovascular
with higher educational levels than non-
disease risk has often been highlighted,
nappers. Napping tends to be a very com¬
though it remains unclear, with several
mon phenomenon in children, as well. For
studies reporting an association, but not
example, in Saudi Arabia daytime naps
all, and a few studies even reporting that
were reported in 40.8 percent of the chil¬
napping may decrease coronary heart dis¬
dren aged 5 to 13, and a recent study found
ease risk, depending on nap duration and
that among a group of 27 children, whose
health status. Napping may also be associ¬
sleep was accurately controlled through
ated with increased risk of cognitive im¬
actigraphy, 32 percent reported daytime
pairment, particularly with compromised
naps, a prevalence increasing up to almost
executive function in older women. This
50 percent in those children affected by
last observation would seem at odds with
asthma.
what will be said in a following section of
Finally, concerning older subjects, nap¬
this entry, which will highlight the positive
ping appears to be a quite common prac¬
impact of napping on cognition, especially
tice in community-dwelling older adults,
memory. However, it is important to dis¬
not necessarily detracting from nighttime
tinguish the potential beneficial effect of
sleep duration or quality. At least one nap
experimentally imposed naps on memory
per week was reported by 67.2 percent of
from the cognitive impairment associated
Chinese people aged more than 50, more
with the frequent napping of older adults in
commonly in the males (76.4%) than the
natural contexts. This contrast, along with
females (63.6%). Among these, 59.4 per¬
the conflicting findings mentioned previ¬
cent practiced daily. Similar prevalences
ously, clearly illustrates the complexity
have been obtained in elderly populations
of the interrelationships among napping,
of other geographical regions. This in¬
health, and cognition, which have yet to
crease of napping behavior across aging
be fully delineated. A further difficulty is
is likely the result of increases in night¬
that no specific causal relation can be in¬
time sleep disturbances, phase advance of
ferred from the whole bulk of data. Even
circadian rhythms, comorbid medical and
where clear associations emerge, it is im¬
psychiatric illnesses, and poor sleep habits,
possible to determine their direction. On
raising the question of how naps are related
one hand, as far as cardiovascular risk is
to subjects’ health conditions.
concerned, recent data show that heart rate
Naps
|
and blood pressure significantly increase
performance was shown to be a function
after awakenings, both from nocturnal and
of total daily time in bed independent of
daytime sleep, which would lead to an in¬
whether sleep was consolidated or split
terpretation of naps as protective against
into two parts. An important practical con¬
morbidity risk. However, it is more likely
sequence is that correctly timed split sleep,
that an increase in spontaneous napping, as
shown to have positive effects, or at least
generally observed with aging, represents
no negative consequences on neurobehav-
a consequence of lifestyle changes (above
ioral performance, might be used for sleep-
all, an increase of sedentariness), which in
wake schedules in work environments that
turn depend on health worsening. Indeed
involve restricted nocturnal sleep due to
it would probably be more useful to dis¬
critical task scheduling.
tinguish frequent, unplanned, longer naps,
Another major source of data is the
with a potential to negatively impact night¬
on-field studies on shift workers, clearly
time sleep quality and morbidity risk, from
showing that the alertness- and perfor¬
brief planned naps, which could instead be
mance-enhancing effects of naps during
of benefit to the function of older adults.
both night and afternoon shifts can be quite dramatic. It appears that a daytime nap as
Naps, Vigilance, and Performance
short as 10 minutes can improve alertness and performance of sleep-deprived sub¬
It is commonly accepted that sleep is nec¬
jects by about 2.5 hours and that short naps
essary for effective daytime functioning,
may even be beneficial in absence of sleep
especially in terms of vigilance and neu-
loss for those with moderately disturbed
rocognitive performance. Actually, in con¬
sleep and possibly for normal sleepers.
trast to the largely negative associations
To adequately adopt napping strategies
just described between habitual napping
as a part of programs aiming to improve
and general health, short-term laboratory
safety and health in the work place, some
studies generally report very beneficial ef¬
crucial aspects remain to be fully under¬
fects of a nap on these functions. There¬
stood: (1) what is the best nap duration to
fore, as mentioned in the previous section
achieve the most effective alerting effects:
“Naps and Health,” one common applica¬
it has been suggested that naps longer than
tion of naps would be to counteract vigi¬
45 minutes could be detrimental because
lance reduction in the work environment,
they would be frequently associated with
when prolonged operations (and thus,
awakenings from deep sleep, which in turn
sleep deprivations) are required.
result in a higher degree of sleep inertia
First of all, there have been intrigu¬
(i.e., experience of drowsiness and worsen¬
ing laboratory studies trying to clarify
ing of cognitive performance occurring at
whether a given amount of sleep can pro¬
awakening); (2) the possible combination
vide the same beneficial effects for vigi¬
with other behavioral or pharmacological
lance and performance when split into two
strategies (such as caffeine), to maximize
or more shorter episodes (split-sleep regi¬
alertness at crucial time points as a coun¬
mens). Results were encouraging, in that
termeasure to sleepiness in operational
435
436
|
Naps
shift work; (3) how neurocognitive effects
consolidation, more robust effects seem
of naps may be modulated by individual
to be given by slightly longer naps, about
variables (i.e., chronotypologies) and as a
60 to 90 minutes, likely due to the buildup
function of their circadian placement: for
of both short-wave sleep and REM sleep.
example, taking a nap too late in the day
The possible roles of sleep-states amount,
might deeply affect night-sleep continuity
sleep continuity, and organization remain
and make it difficult to fall asleep at habit¬
to be verified, as well the hypothesis that a
ual bedtime, whereas taking it in the morn¬
memory-enhancing process is triggered by
ing hours could be hampered by the low
sleep onset per se.
circadian sleep propensity (i.e., the rising
The purported beneficial impact of naps
curve of body temperature would result in a
on memory should deserve special atten¬
short, fragmented and possibly ineffective
tion at early ages, because this might be of
nap); finally, (4) whether and how differ¬
interest with respect to learning processes
ent cognitive functions (attention, working
and school performance. A final statement
memory, higher cognitive functions such
could be made on oneiric activity during
as decision making and planning) are dif¬
naps. Occasionally, the presence of dream
ferentially influenced by napping.
recall has been found after all awakenings from nap, with longer recalls after REM
Naps, Memory, and Dreams
awakenings than after NREM awakenings. However, it is still unknown how the con¬
According to studies carried out in the last
tents of dream during naps may differ from
10 years, the facilitating role of sleep for
those of night-sleep dreams.
memory consolidation of what is learnt before sleep (the so-called sleep effect) would be observed even for the short sleep
Gianluca Ficca
See also: entries related to Sleep and Develop¬ ment; entries related to Sleep Assessment
episodes. Quite surprisingly, and differ¬ ently from what has been reported for the
References
night-sleep effect, a beneficial nap effect
Dhand, R., & Sohal, H. (2006). Good sleep, bad sleep! The role of daytime naps in healthy adults. Current Opinion in Pulmonary Med¬ icine, 12, 379-382.
was consistently found for any kind of memory (i.e., both procedural and declar¬ ative tasks). However, the effect strength ranges from quite dramatic changes, even including the actual improvement of mem¬ ory performance at awakening, to less rel¬ evant modifications, usually limited to a reduction of the forgetting/deteriora¬ tion rate, which seemingly depends on numerous factors, either related to sleep or memory. Although there is not yet a clear knowledge of what sleep features are crucial for the nap effect on memory
Dinges, D. F., Ome, M. T., Whitehouse, W. G., & Orne, E.C. (1987). Temporal placement of a nap for alertness: contributions of cir¬ cadian phase and prior wakefulness. Sleep, 10(4), 313-329. Ficca, G„ Axelsson, J., Mollicone, D. J., Muto, V., & Vitiello, M.V. (2010). Naps, cogni¬ tion and performance. Sleep Medicine Re¬ views, 14, 249-258. National Sleep Foundation (NSF). (2005). Adult sleep habit: 2005 poll. Retrieved from http://www.sleepfoundation.org/
Narcolepsy and Dreaming
Picarsic, J.L., Glynn, N.W., Taylor, C.A., Katula, J.A., Goldman, S.E., Studenski, S.A., & Newman, A. B. (2008). Selfeported napping, sleep duration and quality in the Lifestyle Interventions and Indepen¬ dence for Elders Pilot (LIFEP) Study. Jour¬ nal of the American Geriatric Society, 56, 1674-1680. Takahashi, M. (2003). The role of prescribed napping in sleep medicine. Sleep Medicine Reviews, 7, 227-235.
|
alternative treatment modalities for narco¬ lepsy included electroshock therapy and psychosurgery. Before the use activating medications for narcolepsy became ac¬ cepted in the 1930s, many narcoleptics un¬ derwent extensive psychoanalysis. Freud postulated that dreams were protectors of sleep, with sleep viewed as a temporary escape from harsh reality into a memory of protected intrauterine nirvana. Psychodynamically, narcolepsy became viewed as a disease of psychological regression.
Narcolepsy and Dreaming
Theoretic constructs based on repression, abuse, mythology, and transference served
Narcolepsy is a neurological illness occur¬
as a basis for attempts at intense interper¬
ring secondary to damage to central ner¬
sonal therapy for patients with the diag¬
vous system (CNS) cells utilizing oxexin
nosis. However, there is little evidence,
as their primary neurotransmitter. Narco¬
even based on anecdotal case studies, that
lepsy patients present with symptoms of
psychoanalysis led to an improvement in
extreme daytime sleepiness usually de¬
patient symptoms or affected the course
velop these symptoms during the psy¬
of the illness for individual patients in a
chologically and sexually stormy years of
positive fashion (Pagel & Scrima, 2010,
adolescence. Most narcoleptics are intense
pp. 129-134). Community and medical
dreamers who often experience dream¬
conceptions of narcolepsy continue to be
like epiphenomena, including hypnogogic
affected by this psychogenic history with
hallucinations and sleep paralysis. In 50
the diagnosis viewed as one based on sup¬
percent of narcoleptics, REM-sleep intru¬
pressed, guilt-ridden, sexual drives. This
sion into wakefulness results in symptoms
conceptual association may contribute to
of cataplexy—abrupt episodes of motor
social and medical handicaps for some
weakness occurring with emotion.
narcolepsy patients with physicians and
Narcolepsy was first described as a diag¬
cohorts demonstrating a lack of under¬
nosis during a period when diseases such
standing and on occasions taking a moral
as narcolepsy and epilepsy, now known to
stance in labeling them as “lazy, unable to
have clear neurological basis, were clas¬
work, or unable to face the vicissitudes”
sified among the psychoses and neurosis.
(Zarcone, 1973, pp. 1156-1168).
Freud’s first book on dreaming, published
In the current era, narcolepsy is clearly a
in 1900, led to a psychoanalytic fascina¬
neurological illness with a well-defined ge¬
tion with the dreamlike epiphenomena
netic and neurotransmitter basis. Psycho-
of narcolepsy. It is not surprising that
analysis-based therapy is rarely used in its
psychoanalysis was used to treat narco¬
treatment; however, this history continues
lepsy, particularly during an era in which
to affect social and medical attitudes toward
437
438
|
Narcolepsy and Sleep Paralysis, Hypnopompic/Hypnagogic Hallucinations
patients. While psychoanalysis has failed
psychodynamically primitive state of CNS
as a treatment and psycho-pathogenesis as
activation parodying the psychoanalytic id
a model when applied to the clinical di¬
persists in modern versions of activation-
agnosis of narcolepsy; the psychoanalytic
synthesis theory, including the activation,
theory of narcolepsy, as well as the associa¬
input, modulation model (Hobson, 1999,
tion of narcolepsy with REM-sleep epiphe-
pp. 188-215). While today, psychoanalysis
nomena, has been integrated and applied
is only rarely utilized in the clinical treat¬
in forming the conceptual framework for
ment of narcolepsy, psychoanalytic per¬
some of the most widely accepted neuro¬
spectives of the dreamlike epiphenomena
scientific theories of consciousness. Nar¬
of narcolepsy continue to be incorporated
colepsy epiphenomena were postulated to
into popular and theoretical conceptions of
be related to normal dreaming since they
dreaming, sleep, and consciousness. James F. Pagel
were associated with REM sleep, a state that theoretically came to be equated with the presence of dreaming. This associa¬
See also: entries related to Sleep Disorders
tion between REM sleep, narcolepsy, and
References
dreaming forced psychoanalysts to stretch the definition of dreaming to include the
Crick, F., & Mitchinson, G. (1983). The func¬ tion of dream sleep. Nature, 304, 111-114.
REM sleep associated with bizarre, hallu¬
Hobson, J. A. (1999). Abnormal states of con¬
cinatory mental activity of narcolepsy that
sciousness: AIM as a diagnostic tool in con¬
could occur in both sleep and wake states. This definition, “bizarre mental activity occurring in either sleep or wake,” is cur¬ rently the generally accepted psychoana¬ lytic definition of dreaming (Pagel et al., 2001, pp. 195-202). This postulate, that dreams are bizarre, hallucinatory mental activity, has been extended into the the¬ ory that dreams are a form of visual hal¬ lucination and a valid model for psychosis. Dreaming viewed as perceptual hallucina¬
sciousness. New York: Scientific American
Library. Pagel, J.F., Blagrove, M., Levin, R., et. al. (2001). Defining dreaming—A paradigm for comparing disciplinary specific defini¬ tions of dream. Dreaming, 11(4), 195-202. Pagel, J.F., & Scrima, L. (2010). In M. Goswami, S.R. Pandi-Perumal, & M. Thorpy (Ed.). Psychoanalysis and narcolepsyin narcolepsy—A clinical guide (pp. 129134). New York: Springer/Humana Press. Zarcone, V. (1973.) Narcolepsy. New England Journal of Medicine, 288, 1156-1168.
tion can be considered as a simple mean¬ ingless, perceptual state based on primitive brain-stem activity (REM sleep of the selfreferenced mind utilized by the CNS during sleep to detoxify the system of unwanted
Narcolepsy and Sleep Paralysis, Hypnopompic/ Hypnagogic Hallucinations
memories of potentially pathological na¬ ture such as obsessions, hallucinations,
Narcolepsy is a rare and chronic sleep dis¬
and delusions [Crick & Mitchinson, 1983,
order affecting approximately 0.04 percent
pp. 111-114]). The conception of REM
of the population. Narcoleptic patients ex¬
dreaming as bizarre and REM sleep as a
perience excessive daytime sleepiness,
Narcolepsy and Sleep Paralysis, Hypnopompic/Hypnagogic Hallucinations
|
cataplexy, and manifestations related to
experience a brief loss of voluntary muscle
rapid eye movement (REM) sleep, such as
control with an inability to move or speak;
sleep paralysis and hypnopompic/hypna-
however, awareness is preserved. Unlike
gogic hallucinations. The loss of a central
cataplexy, these episodes are not provoked
nervous system peptide called hypocretin
by intense emotional states. It can be a
is the reason for the development of narco¬
frightening experience because the indi¬
lepsy. Hypocretin has important functions
vidual attempts to, but is unable to move,
in promoting wakefulness. Excessive day¬
open eyes, or even speak, and is very aware
time sleepiness, sleep paralysis, and hyp-
of this occurrence. Sleep paralysis is often
nopoinpic/hypnagogic hallucinations can
associated with very frightening hypno-
also occur in individuals who are severely
pompic/hypnagogic
sleep deprived; only cataplexy is unique to
episodes are brief lasting several seconds
narcolepsy.
to minutes, and with time, the experience
Sleep-wake-cycle instability is an im¬
hallucinations.
The
becomes less frightening.
portant hallmark of narcolepsy, specifi¬
Hypnopompic/hypnagogic hallucinations
cally between REM sleep and wake states.
are intense dreamlike states that occur at
Sleep paralysis and hypnopompic/hypna-
sleep onset (hypnagogic) or more com¬
gogic hallucinations are a consequence
monly upon awakening (hypnopompic).
of REM sleep-wake-cycle instability. In
Like normal dreams, hallucinations are vi¬
REM sleep, the body loses muscle tone and
sual in nature, but unlike normal dreams,
dreaming occurs. During this physiologi¬
they are vivid, frightening, or disturbing
cally normal process, essentially all muscles
to the individual. They may involve other
of the body are paralyzed with the excep¬
senses such as hearing or smell. Visual
tion of the diaphragm, the primary muscle
hallucinations consist of simple forms and
of breathing. In narcoleptic patients, REM
shapes to very intricate images including
sleep is considered to be unstable because
animals or people. Auditory hallucinations
it inappropriately intrudes into their waking
may be threatening, leaving the individual
states. In other words, REM sleep seems to
upset or terrified. Individuals may report
be inappropriately jumping into wakeful¬
hallucinations such as body floating in air,
ness, causing the individual to be paralyzed
falling from air, or out-of-body experi¬
while awake. Narcoleptic patients experi¬
ences. The exact boundary between hyp¬
ence some aspects of REM sleep during
nopompic/hypnagogic hallucinations and
wakefulness (such as loss of muscle tone
dreams is not a clear one.
as seen in cataplexy) or during transitions
Treatment of narcolepsy includes medi¬
from sleep to wake states (sleep paralysis).
cations that suppress REM-sleep instabil¬
Sleep paralysis is the inability to pur¬
ity and prevent daytime sleepiness. These
posefully move one’s muscles at sleep
medications will also treat sleep paralysis
onset or upon awakening. In sleep paraly¬
and hypnopompic/hypnagogic hallucina¬
sis, componenls of REM sleep occur inap¬
tions in the same manner by stabilizing
propriately as the individual falls asleep or
REM sleep. One category of antidepres¬
awakens. Individuals with sleep paralysis
sants known as selective norepinephrine/
439
440
|
Narcolepsy Symptoms, Abnormal REM Sleep, and Hypocretin Deficiency
serotoninergic reuptake inhibitors is used to treat narcolepsy with cataplexy and is effective for sleep paralysis and hypnopompic/hypnagogic hallucinations.
The
most commonly used drug of this class is venlafaxine, a potent inhibitor of two wake-promoting chemicals in the brain: serotonin and norepinephrine. New treat¬ ment options are under investigation for the treatment of narcolepsy including hypocretin replacement therapy, gene ther¬ apy, and stem-cell transplantation. It is important to remember that sleep paralysis and hypnopompic/hypnagogic hallucinations are present in other sleep-
Nishino, S., Okuro, M., Kotorii, N., et al. (2010). Hypocretin/orexin and narcolepsy: New basic and clinical insights. Acta Physiologica, 198, 209-222. Ohayon, M.M., Priest, R.G., Caucet, M., et al. (1996). Hypnagogic and hypnopompic hal¬ lucinations: Pathological phenomenon? Brit¬ ish Journal of Psychiatry, 169, 459-467. Rechtschaffen, A., Wolpert, E., Dement, W. C., et al. (1963). Nocturnal sleep of narcolep¬ tics. Electroencephalography and Clinical Neurophysiology, 15, 599-609. Takahashi, Y., & Jimbo, M. (1963). Poly¬ graphic study of narcoleptic syndrome with special reference to hypnagogic halluci¬ nations and cataplexy. Folia Psychiatrica Neurologica Japan, 7(Suppl), 343-347.
related disorders, including any condi¬ tion that causes severe sleep deprivation. The two phenomena also commonly occur in the general population. Medications used for narcolepsy will also treat sleep
Narcolepsy Symptoms, Abnormal REM Sleep, and Hypocretin Deficiency
paralysis and hypnopompic/hypnagogic hallucinations; however, they are not rec¬
Narcolepsy, a condition affecting about 1
ommended as treatment for isolated sleep
in 2,000 individuals, is caused by the auto¬
paralysis and/or hypnopompic/hypnago¬
immune destruction of ~70,000 hypotha¬
gic hallucinations. If an individual experi¬
lamic neurons producing the neuropeptide
ences recurrent episodes of sleep paralysis
hypocretin/orexin, a neurobiological sys¬
and/or hypnopompic/hypnagogic halluci¬
tem involved in sleep regulation. Since its
nations, it is recommended that he or she
description, the disorder has fascinated re¬
be evaluated for the presence of an undi¬
searchers and clinicians, notably because
agnosed sleep-related disorder, such as ob¬
patients experience not only sleepiness and
structive sleep apnea or narcolepsy.
disturbed sleep but also unusual symptoms
Michelle Cao
such as cataplexy, sleep paralysis, REM sleep behavior disorder (RBD), and hyp¬
See also: entries related to Sleep and Health;
nagogic hallucinations,
entries related to Sleep Physiology
are best explained by a blurring of wake¬
References Cao, M. (2010). Advances in narcolepsy. Medical Clinics of North America, 94(3),
541-555. Dauviliers, Y., Arnulf, I., & Mignot, E. (2007). Narcolepsy with cataplexy. Lancet, 369, 499-511.
symptoms that
fulness with rapid eye movement (REM) sleep. In sleep paralysis and cataplexy, monosynaptic reflexes are abolished, as they are during REM sleep, suggesting the engagement similar final common neuroanatomical pathways. Similarly, RBD, vivid dreaming, and hallucinations are
Narcolepsy Symptoms, Abnormal REM Sleep, and Hypocretin Deficiency
|
commonly referred as dissociated REM-
be due to the difficulty of identifying this
sleep events, in which the cardinal features
symptom in young children.
of REM-sleep atonia, vivid dreaming, and
It is also notable that around the onset
loss of awareness are uncoordinated with
of narcolepsy, spontaneous muscle weak¬
each other. Narcolepsy is thus an experi¬
ness episodes affecting the jaw or head, or
ment of nature, in which unique subfea¬
a generalized feeling of weakness with an
tures of REM sleep can be isolated and
unstable gait are commonly reported rather
subjected to investigation.
than typical cataplexy.
Often,
several
Part of the narcolepsy phenotype is di¬
months are required before cataplexy be¬
rectly caused by the removal of the effects
comes stereotyped and triggered by usual
of hypocretin/orexin on REM sleep and
emotions—laughing or humor. These suc¬
wake propensity. Indeed, pharmaceutical
cessive changes suggest that cataplexy is
studies using antagonists or agonists sup¬
the result of network remodeling, perhaps
port this concept, as does the common ob¬
to compensate for what was initially a
servation of reduced REM-sleep latency
more-generalized muscle weakness. Sim¬
and the presence of sleepiness in narco¬
ilarly, whereas abnormal dreaming in re¬
lepsy. Importantly, however, the phenotype
cent onset narcolepsy immediately impairs
of narcolepsy cannot be recapitulated by
sleep, the occurrence of prolonged night¬
REM sleep or total sleep deprivation alone.
time awakenings often occurs later once
Shortened REM sleep, sudden dreaming,
the full syndrome is established. This may
hypnagogic hallucinations, or sleep paral¬
be explained by the delayed engagement
ysis may occur following sleep deprivation
of compensatory wake-promoting systems
or sleep fragmentation; in contrast, cata¬
that could be equally functioning at night
plexy has never been reported under these
and during the day.
conditions. This suggests that cataplexy is
As noted by many authors, the projec¬
somewhat uniquely different from REM-
tions of the hypocretin system are anatomi¬
sleep atonia, a concept also supported by
cally widespread, providing the anatomical
differential neurochemical control in phar¬
basis for independent effects on selected
macological studies.
REM sleep and non-REM sleep correlates.
Much has also been learned from re¬
For example, hypocretin projections to
cent observations on the natural history of
the sublaterodorsal tegmental nucleus (an
the disease. Following the development of
REM sleep-on region of the brain stem),
hypocretin deficiency in narcolepsy, sleep¬
the locus coeruleus, or even the spinal cord
iness and abnormal dreaming are usually
could all be involved in the regulation of
first to appear, followed by cataplexy and a
REM-sleep atonia, whereas projection to
distressing inability to maintain sleep. Ex¬
the basal forebrain may be more important
cessive sleep is also common shortly after
for forebrain activation. It is not unreason¬
onset, subsequently replaced by an inability
able to postulate that differential redun¬
to stay awake and asleep for long periods
dancy (and thus variable compensation
of time. Sleep paralysis is less-commonly
after depletion) occurs for hypocretin pro¬
reported prior to puberty, a finding that
jections regulating individual REM-sleep
may reflect a maturational effect or could
features. This compensation is also likely
441
442
|
Native American Dreams
more effective depending on the state of engagement of these systems in other tasks. For example, the reversal of atonia may be most difficult in wakefulness and
Serra, L., Montagna, P., Mignot, E., Lugaresi, E., & Plazzi, G. (2008). Cataplexy features in childhood narcolepsy. Movement Disor¬ ders, 23(6), 858-865.
during sleep-wake transitions, explaining sleep paralysis. Similarly, a pathway com¬
Native American Dreams
pensating for atonia may also be uniquely challenged when laughing, an act report¬
Among indigenous peoples, dreams and
edly associated with a brief suppression of
dreaming are highly valued and often in¬
the spinal monosynaptic H reflex. One of
corporated into ritual practices. Dreams
the candidates for this last pathway could
are a primary source for cultural innova¬
involve adrenergic activation, as adren¬
tion, ritual renewal, communal activities,
ergic uptake inhibitors (i.e., some antide¬
and personal guidance. With more than
pressants) are profoundly anticataplectic
140 recognized Native American commu¬
agents. Further, stimulation of the locus
nities, each speaking a diverse language,
coeruleus seems to gate some of the hypo-
dream categorization and theory is com¬
cretin effects following optogenetic stimu¬
plex and irreducible to any single metathe¬
lation, in particular muscle atonia.
ory or specific cosmology. Overall, the
As illustrated previously, narcolepsy is
emphasis tends to be on the value of the
a unique experiment of nature that has yet
dream as empowering actions that serve
to reveal its full potential as a tool to un¬
the needs of the community. In many com¬
derstanding various aspects of REM-sleep
munities, dreams are indexed typologically
circuitry and its plasticity in response to
in terms of the degree of power transmit¬
hypocretin depletion. Imaging studies in
ted to the dreamer. For example, among the
dissociated states, may, for example, pro¬
Apsarokee dreams are analyzed into four
vide us with a better understanding one day
primary categories (Irwin, 2005a, 2005b):
of how the brain is or is not aware dur¬
no account (most dreams), wish fulfilling
ing REM sleep, and why the experience
(compensatory dreams), medicine dreams
of dreaming is normally so rapidly for¬
(power is given to the dreamer), and what
gotten (or in abnormal instances patho¬
is truly seen (dreams of knowledge often
logically retained). Similarly, optogenic or
linked to a variety of psychic abilities, in¬
localized genetic rescue experiments in re¬
cluding clairvoyance and controlled out-
ceptor knockout narcoleptic animals will
of-body projection). Medicine dreams are
likely improve our understanding of REM-
rare and given utmost attention as a source
sleep-regulating networks.
of success in life; what is truly seen dreams
Emmanuel Mignot
See also: entries related to Hormones in Sleep
usually occur to only developed shaman dreamers. Medicine dreams that confer some de¬
References
gree of power or ability are attained in
Bassetti, C., Billiard, M., & Mignot, E. (2007). Narcolepsy and hypersomnia. New York: Informa Healthcare.
three ways: spontaneously and unsought, spontaneously in times of crisis linked to prayer and petition to the spirit world,
Native American Dreams
|
and sought dreams or visions through in¬
success based on the match between the
tense ritual practices. The source of the
communal need and the specific ability of
dream is usually mapped to the cosmo¬
the dreamer. Someone with a specific ill¬
logical and spiritual world of the seeker in
ness may not be healed because the gift of
which causal agents are identified as giv¬
healing is meant only for certain types of
ing a dream of power as a gift from the
illness; or, a dreamer is given diagnostic
spirit world. The appropriate attitude of
power in the dream but may not be able to
the dreamer in seeking a dream is humility,
diagnose correctly if an illness exceeds the
clear intention, and thankfulness; dreams
knowledge given in the dream. Dreamers
are sought by shedding tears (occasion¬
may fast for additional dream powers and
ally blood, e.g., cutting a finger) and pray¬
those who failed in a dream quest may try
ing intensely without food or water over
again. Dream powers given may include
many days while often confined within a
hunting ability, success in warfare, psychic
12-foot fasting circle. The seeker walks
abilities, herbal knowledge, ritual direc¬
toward each of the four directions, with
tions and songs, as well as various types of
small steps, holding a pipe and praying
ambiguous power that might harm others.
with each step. Vision-dreams may come
Another major dream category is prophetic
while the faster is asleep or wide awake.
dreams, which are the source of many na¬
Other traditions involve confinement in a
tive religious movements based on in¬
fasting hut (often for women), in a tree, or
structions received in big dreams meant to
while wandering without eating in the for¬
reconstruct native religious practices and
est. The seeker is usually observed by an
beliefs in the face of colonialism, mission-
experienced elder dreamer who can assess
ization, and aggressive assault by church
the state and well-being of the faster. The
and government (Irwin, 2008). More re¬
ritual fast is normally preceded by a sweat
search is needed in the area of specific
lodge before and after the fast; in the final
dream practices in contemporary native
sweat, dreams are shared and interpreted
urban life and in prisons.
by elders in utmost privacy. Generally, a dreamer does not discuss a dream with others except with dream experts or with
Lee Irwin
See also: entries related to Cross-Cultural Dreams
members of a dream society based on those having similar dreams (Irwin, 1994).
References
The proof of the dream is in the enact¬
Irwin, L. (1994). The dream seekers: Native
ment. As dreams are considered sources of
American visionary traditions of the Great
sacred power, the successful dreamer must be able to give a public demonstration of that power. Failure to heal after dreams of healing signals a discontinuity between the dreamer aftd the causal agency of the dream; repeated failure means the dream was not understood. Native dream theory incorporates some degree of variability of
Plains. Norman: University of Oklahoma
Press. Irwin, L. (2005a). Dreams and visions. In S. Crawford & D Kelly (Eds.), Encyclopedia of American Indian religions (Vol. 1, pp. 240-249). Santa Barbara, CA: ABC-CLIO. Irwin, L. (2005b). Vision quest rites. In S. Crawford & D Kelly (Eds.), Encyclope¬ dia of American Indian religions (Vol. 3,
443
444
|
Neural Metaphor and Dreams
pp. 1127-1134). ABC-CLIO.
Santa
Barbara,
CA:
primary metaphors neurally bind with each other and other concepts to form many
Irwin, L. (2008). Coming down from above:
thousands of conceptual metaphors, all
Prophecy, renewal and resistance in Native
physically in the brain, all mapping infer¬
American religions. Norman: University of
Oklahoma Press.
ences from source to target domains, and all fixed and ready to be unconsciously ac¬ tivated whether you are awake or dreaming. Primary metaphors are embodied in
Neural Metaphor and Dreams
three ways: they arise from bodily experi¬ ences, they are physically in the brain, and
In the three decades since the discovery
they give rise to physical behavior, as re¬
that ordinary thought is largely metaphori¬
cent experiments on embodied cognition
cal, metaphor researchers have come to
have shown. Subjects at Yale University
understand that, like all other concepts,
were given either warm or cold coffee and
conceptual metaphors are physical circuits
then asked to describe someone they imag¬
in the brain. Primary metaphors are ac¬
ined just meeting. Those who had the warm
quired by the hundreds in childhood, often
coffee imagined meeting friendly, affec¬
prior to language, just by living in the ev¬
tionate people. Affection is warmth was ac¬
eryday world, where different kinds of ex¬
tivated by the warm coffee. Subjects who
periences often come together.
were asked to say nasty lies about other
Every time a child is held affectionately
people chose to either wash their hands or
by a parent, the child experiences affection
use cleansing wipes afterward. The moral¬
and warmth together, and he or she acti¬
ity is purity metaphor was at work. And so
vates different brain regions. Every time a
on for dozens of experiments.
child sees more water or milk poured into
In dreams, concerns and experiences of
a glass and sees the level rise, distinct brain
the day tend to activate preexisting meta¬
regions for quantity and verticality are ac¬
phor circuitry to produce dreams of rele¬
tivated. When two brain regions are acti¬ vated repeatedly, their synapses strengthen,
vance to the concerns most active in one’s brain during the day.
activation spreads over existing pathways,
A woman dreamt that she was walk¬
with synapses strengthening every time the
ing on a dirt road that became narrower
two regions are activated together. Even¬
and narrower, then became an uphill trail
tually, the shortest pathway is found, and
through dense brush. She climbed to the
a circuit is formed. That circuit is a meta¬
top of the hill where she saw an anthro¬
phor physically in the brain. That is how
pology professor of her acquaintance com¬
primary metaphors such as affection is
ing out of Trader Joe’s. “Don’t bother,” he
warmth and more is up are formed.
Hundreds of primary metaphors are
said. “The anthropologists have cleaned out the place.”
learned in this way. Because 98 percent
She had, after years of motherhood, got
of thought is unconscious, the use of such
a PhD in anthropology, but could not get
metaphors usually goes unnoticed. The
a regular job, only teaching a class here
Neuroanatomical Correlates of Dream Censorship
|
and there. She was about to give up and
where there is a conflict between the met¬
go into another profession. Trader Joe’s is
aphors for strictness versus nurturance.
the place where the local academics buy party goods. The dream activated wide¬ spread conceptual metaphors: a career
George Lakoff
See also: entries related to Dream Content
is a journey upward (climbing the ladder
References
of success); dijficulties are impediments
Lakoff, G. (1993, June). How metaphor struc¬ tures dreams: The theory of conceptual met¬ aphor applied to dream analysis, Dreaming.
to motion (roadblocks, glass ceilings); achieving as purpose is getting a desired object, typically food (as in the fruits of
one’s labor). In the dream, her career path was long and difficult, it narrowed, the uphill climb was difficult. An academic job in anthropology would have been the fruit of her labor, but the fruit was all taken.
Lakoff, G. (1996). Moral politics. Chicago: University of Chicago Press. Lakoff, G. (1997). How unconscious meta¬ phorical thought shapes dreams. In D. J. Stein (Ed.), Cognitive science and the Un¬ conscious. American Psychiatric Press.
A friend was distraught after splitting up
Lakoff, G., & Johnson, M. (1980). Metaphors we live by. Chicago: University of Chicago Press.
with his lover. He dreamed that night that
Lakoff, G., & Johnson, M. (1999). Philoso¬
they had started driving north on a local
phy in the flesh: The embodied mind and its
freeway. As they reached the freeway bridge, a storm blew up and the bridge was
challenge to Western thought. New York:
Basic Books.
blown into the bay. The widespread metaphors here are love is a journey—in which difficulties are an
impediment to motion—and emotional
Neuroanatomical Correlates of Dream Censorship
states are weather states. The lovers start
out on their journey, emotional storms
The term censor was coined by Sigmund
arise, and the bridge blown out makes the
Freud to denote the critical and prohib¬
journey of life impossible.
iting agency in the mind. Since the es¬
Much of child rearing is based on met¬
tablishment of the structural model of
aphors of morality that shape family life.
personality, Freud gradually replaced this
The two most prominent are morality is
term with the term superego to reify the
obedience, giving rise to a strict father
roles of this prominent entity of the mind
family, and morality is nurturance, giving
in both nocturnal and daytime psychic life.
rise to a nurturant parent family. The obe¬
The censor or superego is acquired largely
dience metaphor makes the strict father the
from experiences and interactions with
moral authority in the family whose word
significant others. It begins to develop in
is law and who has to physically punish
the oedipal phase (around three years of
all of children’s wrongdoings. Therapists
age) when the ego learns to master the in¬
have reported to me that bad dreams and
stinctual impulses arising from the id in a
corresponding neuroses result, especially
bid to preserve the object relation via the
445
446
|
Neuroanatomical Correlates of Dream Censorship
mechanisms of identification and reaction
apathy, and sociopathic behaviors. It has
formation. The primary purpose of the cen¬
also been observed that people with antiso¬
sorship is to screen out disagreeable ideas,
cial disorders or moral dysfunctions show
memories, and motives before they enter
neurological symptoms of autonomic and
into the conscious or preconscious system.
emotional underarousal, and lower fear¬
During sleep, however, this censorship
fulness, poor fear conditioning, and poor
function becomes weaker, thus allowing
avoidance learning. Accordingly, it may
material from the id to surface in the form
be the case that emotional and autonomic
of dreams.
arousal constitutes the structural bedrock
The censorship or moral function is an
for conditioning, which is critical for the
intricate process in both the psychody¬
development and maintenance of moral
namic and the neurodynamic senses. It is
and inhibitory functions. The orbitofron¬
the amalgam of primitive inclination and
tal cortex clearly functions for primitive
adaptation and of acquired self-monitoring
inhibition and morality, not necessarily
and moral reasoning. Nevertheless, the
sustained by logical scaffoldings; instead,
most basic form of the censor or super¬
under the predisposition of genetic pro¬
ego can be conceived as a mental agency
gramming and alterations, it is modulated
that inherits basic sensitivity to emotions;
and maintained through social affective in¬
in particular, to anxiety (1). Therefore, it
teractions and stimulus-response learning.
is capable of detecting error, danger, or
This primitive inhibitory and moral func¬
punishment (2), and is able to develop and
tion, which can transpire unconsciously, is
learn through behavioral and social condi¬
a pivotal part of the censor.
tioning (3). As such, it can make decisions
The
prefrontal convexity—including
as to whether or not to inhibit directly (4) or
the orbitofrontal cortex—is deactivated
it can trigger other mechanisms to defend
throughout the sleep cycle, while the me¬
against dangerous or punishable imme¬
sial frontal region—the neural substrate
diate satisfaction (5), to avoid the nega¬
for the instinctual reservoir—are highly
tive consequence resulting from doing so
active (for details see Yu, 2001, 2003,
(6). In this sense, the censor may influence
2007). This neuropsychological manifes¬
the process of dream formation but is not
tation is reminiscent of Freud’s descrip¬
necessarily the agency that carries out the
tion that the censor is crippled during
dream formation or distortion.
dreaming sleep and thus its governance
According to Yu (2003, 2006), all fore¬
over the id energies is loosened. It should
going six functional features of the censor
be noted, however, that although the pre¬
can be localized in the orbitofrontal cortex.
frontal cortex is significantly deactivated,
It has been known that lesions in this region
activity is still present—in other words, it
of the brain lead to a group of disorders re¬
remains operative. On the strength of the
lated to moral and affective functioning,
neuroimaging findings, Braun et al. (1997)
including poor judgment, moral confu¬
hypothesized that REM episodes occur¬
sion, misinterpretation of the moods and
ring later in the sleep period would be
feelings of others, empathic changes and
characterized by increasing coherence of
Neuroanatomical Correlates of Dreamwork
prefrontal, dorsomedial thalamic, and stri¬ atal activity, which could in turn correlate with the time-of-night-dependent changes in the length and complexity of REMsleep dream reports. Indeed, the level of activation or deactivation of the prefrontal cortex may change across different REM episodes within one sleep epoch and grad¬ ually recover its normal activity from its lowest point in the first REM episode, via progressive activation in the intermediate REM episodes, to its full convalescence
|
frontal region controversy (dream instiga¬ tion). Neuro-Psychoanalysis, 3, 193-201. Yu, C.K.-C. (2003). Neuroanatomical cor¬ relates of dreaming, III: The frontal-lobe controversy (dream censorship). NeuroPsychoanalysis, 5, 159-169. Yu, C.K.-C. (2006). Commentary on Simon Boag’s “Freudian dream theory, dream bi¬ zarreness, and the disguise-censor contro¬ versy.” Neuro-Psychoanalysis, 8, 53-59. Yu, C.K.-C. (2007). Cessation of dreaming and ventromesial frontal-region infarcts. NeuroPsychoanalysis, 9, 85-92.
in postsleep waking. By implication, not only is this vigilant agency never totally quiescent during all REM episodes, it also gradually recuperates from deep relax¬
Neuroanatomical Correlates of Dreamwork
ation and becomes highly alert toward the end of sleep.
Sigmund Freud (1900) believed that the
Contemporary brain-imaging research
manifest content of dreams was not nec¬
has resulted in a consistent picture of the
essarily the direct representation of the
neural network of dreaming. While the
dreamers’ thoughts and motives. He delin¬
most robust activity in the mesial frontal
eated some dreamwork processes through
region is observed in dreaming sleep and
which the latent dream thoughts are trans¬
the most precipitous decreases are found
formed into the manifest content. The most
in the prefrontal cortex, the most tranquil
prominent of these distortion processes are
moment of the mesial frontal region oc¬
regression, condensation, displacement,
curs in presleep wakefulness, while at the
and symbolism. On the strength of neu¬
same time the prefrontal cortex is most ac¬
roanatomical evidence, some researchers
tivated. These oscillatory neurodynamics
(Solms, 1997; Yu, 2001, 2006) postulate
between the prefrontal and subcortical ac¬
that dreamwork is orchestrated by the neu¬
tivities seem to mirror the psychodynamics
ral network made up of the prefrontal cor¬
between the censor and the id.
tex, the supramarginal gyrus in the inferior
Calvin Kai-Ching Yu
parietal lobule, and the inferior mesial tem¬ poral lobe.
References Braun, A. R., Balkin, T.J., Wesensten, N.J., Carson, R.E., Varga, M., Baldwin, P., . . . Herscovitch, P. (1997). Regional cere¬ bral blood flow throughout the sleep-wake cycle. Brain, *120, 1173-1197. Yu, C.K.-C. (2001). Neuroanatomical cor¬ relates of dreaming, II: The ventromesial
The growth of the prefrontal cortex, which continues after birth and does not end until late adolescence, is susceptible to environmental modifications. As the prefrontal cortex develops, a child’s be¬ havior begins to become subordinated to logical reasoning, complex programs, and
447
448
|
Neuroanatomical Correlates of Dreamwork
evaluation and correction of errors. Brain¬
via the retrograde pathway provided by
imaging studies have repeatedly found that
the inferior parietal lobule. This is ex¬
the prefrontal convexity is substantially
actly what Freud meant by topographical
deactivated during dreaming when the
regression—the most essential part of the
subcortical regions are highly active. Ac¬
process whereby dreams are formed. Be¬
cording to Yu (2003, 2007), these findings
cause of this topographical regressive pro¬
provide evidence for the mechanism of
cess, away from the motor system and
temporal regression that through dream¬
toward the perceptual system, dreamers do
ing, mental activity regresses developmen¬
not actually engage in motivated activity
tal^ from the experience-dependent adult
during sleep but imagine they are doing so.
cortex back to the instinctual and motiva¬
From an anatomical perspective, there
tional system of the brain that dominates
are probably multiple pathways for con¬
in infancy and childhood; mature logical
necting the subcortical motivational sys¬
reasoning and modes of thinking are tem¬
tem and the visual cortex. The inferior
porarily suspended in the service of illogi¬
mesial temporal lobe has been identified
cal, narcissistic, childish ones.
as one of the crucial pathways, in addi¬
The dorsolateral frontal cortex is one
tion to the supramarginal gyrus, for the
of the major divisions of the prefrontal
generation of dreams (Yu, 2001). The in-
convexity. Its primary function is to con¬
ferotemporal cortex has intense afferent
vert thoughts into action by programming
and efferent connections to both the visual
motor sequences. The inferior parietal lob¬
representation cortex and the subcortical
ule, and in particular the supramarginal
motivational system. It is well known that
gyrus, participates in the highest levels of
abnormal excitation of the temporal lobe
perceptual information processing, includ¬
alone during an epileptic attack or explor¬
ing symbolic operations. This function is
atory electrical stimulation during surgery
required for the conversion of concrete
can lead to experiential hallucinations and
perception into abstract thinking, and for
perceptual illusions that bear a resem¬
the retention of organized experience. The
blance to a dreaming state. The experien¬
dorsolateral frontal cortex is deactivated
tial hallucinations caused by excitations to
during dreaming, suggesting that the motor
the temporal cortex are often reported to
gateway from motives to actions is blocked
be unfamiliar, strange, and senseless, but
(see Yu [2003] for a review of neurolog¬
after exploration can be broken up into
ical evidence). By contrast, the posterior
shorter or longer sequences of earlier ex¬
brain plays an active part in dream forma¬
periences. This is similar to what Freud
tion (Yu, 2001, 2006), and lesions in the
referred to as condensation. The percep¬
supramarginal gyrus result in global ces¬
tual illusions triggered by the stimulation
sation of dreaming (Solms, 1997). Accord¬
of the temporal cortex involve a sudden
ingly, the focal point of mentation activity
change in the perceived appearance of an
shifts from the dorsolateral frontal region,
object or in the subjective feeling toward
the executive end of the motor system in
an object, including, for example, things
waking life, toward the perceptual system,
suddenly becoming familiar or appearing
Neuroanatomy of Dreams
to be strange, becoming larger or smaller, and coming closer or going farther away. From the Freudian perspective, any event of incoherent, accentuated, or diminished intensity occurring in dreams is ascribed to the effect of displacement. The inferior temporal cortex is function¬ ally specialized for object representations. This area of the brain is driven by complex¬ ity rather than specificity. The activation of the inferior temporal cortex provides rela¬ tively coarse and imprecise representations of visual objects. Additionally, the inferior
|
gyrus controversy (dream work). NeuroPsychoanalysis, 3, 47-59. Yu, C.K.-C. (2003). Neuroanatomical cor¬ relates of dreaming, III: The frontal-lobe controversy (dream censorship). NeuroPsychoanalysis, 5, 159-169. Yu, C.K.-C. (2006). Memory loss is not equal to loss of dream experience: A clinicoanatomical study of dreaming in patients with posterior brain lesions. NeuroPsychoanalysis, 8, 191-198. Yu, C.K.-C. (2007). Cessation of dreaming and ventromesial frontal-region infarcts. NeuroPsychoanalysis, 9, 85-92.
temporal cortex is centrally engaged in clas¬ sifying visual stimuli into certain behaviorally meaningful categories, and therefore,
Neuroanatomy of Dreams
forging connections between visual expe¬ riences, complex or sequential behavioral
Dreaming is a complex neurophysiologi¬
patterns, and temporal emotional experi¬
cal process that requires the correct state
ences. This capacity of the inferior tempo¬
and intact neuroanatomy. Although it can
ral cortex is essential for symbolism to take
emerge from any sleep stage, rapid eye
place. Therefore, as with condensation and
movement (REM) sleep is the most com¬
displacement, the dreamwork mechanism
mon stage for dreaming. Because the act
of symbolism most probably transpires in
of dreaming involves visual imagery, som-
the inferior temporal lobe. Taken together,
esthetic perception, memory, emotion, and
dreamwork or dream formation may not only
perhaps the subconscious mind, almost
be facilitated by the pervasive deactivation
any region of the brain may be involved.
of the dorsolateral prefrontal cortex but also
For these reasons, accurate assessment of
positively caused by the activation of the pos¬
the neuroanatomy of dreaming is challeng¬
terior brain and inferior temporal structures.
ing and best achieved by dividing the phe¬
Calvin Kai-Ching Yu
nomenon into two constituent parts; the neuroanatomy of REM sleep and the neu¬
References Freud, S. (1900). The interpretation of dreams. In J. Strachey (Ed. & Trans.), The standard edition of the complete works of Sigmund Freud (Vols. 4-5). London: Hogarth Press.
Solms, M. (1997). The neuropsychology of dreams: A clinico-anatomical study. Hills¬ dale, NJ: Erlbaum. Yu, C.K.-C. (2001). Neuroanatomical corre¬ lates of dreaming: The supramarginal
roanatomy of the dreaming process. REM sleep is an ultradian physiologi¬ cal state that occupies approximately 20 percent of a healthy adult’s night sleep and is characterized by REMs, muscle atonia, and a low-voltage, fast electro¬ encephalogram (EEG). REM-sleep epi¬ sodes become progressively longer as the sleep period progresses, with the longest
449
450
|
Neuroanatomy of Dreams
REM episodes occurring in the morning
dream researcher J. Allan Hobson (2002)
before arising. REM sleep is driven by
provided a first-person account of sleep
a mutually inhibitory flip-flop switch in
and dream loss and peduncular hallucinosis
the mesopontine tegmentum consisting of
following an acute ischemic lateral medul¬
REM-off (e.g., ventrolateral periaqueduc¬
lary cerebrovascular accident. Although
tal gray and lateral pontine tegmentum)
these and other cases have been reported,
and REM-on (e.g., sublaterodorsal nu¬
detailed neuroimaging, polysomnography,
cleus and precoeruleus) areas. Each area
and neuropsychological testing have been
contains y-aminobutyric acid (GABA-er-
lacking, throwing into question whether
gic) neurons that heavily innervate and
the neurological insult actually eliminated
inhibit the opposing area. The REM-on
dreaming, or just compromised the abil¬
area also contains glutaminergic neurons
ity to generate REM sleep or report dream
located in two areas, with one regulating
content (e.g., visual nonremembrance).
the REM EEG through projections to the
More recently Bischof and Bassetti re¬
basal forebrain, and the other regulating
ported the case of a 73-year-old female
REM atonia through projections to the
with acute total dream loss following bi¬
medulla and spinal cord (Lu et ah, 2006).
lateral posterior cerebral artery infarction.
Other important brain regions include the
Polysomnography
pedunculopontine, laterodorsal tegmen¬
REM sleep, but dreams were not recalled,
tal, and extended ventrolateral preoptic
even following multiple awakenings from
nuclei, all of which inhibit REM-off neu¬
polysomnographically determined REM
rons, and the dorsal raphe, locus coeru-
sleep. Neuropsychological testing was un¬
leus, and orexin (hypocretin) producing
remarkable and primary sleep disorders
neurons, all of which excite REM-off neu¬
were absent. Detailed neuroimaging re¬
rons. The orexin (hypocretin) neurons sta¬
vealed infarction of the bilateral occipital
bilize the REM-sleep flip-flop switch and
lobes, including the visual cortices as well
prevent unwanted switching of the sleep/
as the right inferior lingual gyrus and right
wake state or intrusion of REM phenom¬
posterolateral thalamus (Bischof & Bas¬
enon (such as atonia during cataplexy, or
setti, 2004). This important case demon¬
dreams during hypnagogic hallucinations)
strates that dreaming and REM sleep are
into wakefulness (Lu et al., 2006).
dissociable states. REM sleep alone is not
demonstrated
intact
Much has been learned regarding func¬
sufficient for the generation of dreaming,
tional human neuroanatomy by studying
but rather other processes, particularly
loss of function following neurological in¬
those emanating from the occipital lobes
sult. Cessation of dreaming following neu¬
and the inferior lingual gyrus (a brain re¬
rological damage was first observed by
gion involved with the processing of emo¬
Jean-Martin Charcot in 1883, followed by
tions and visual memories) appear to be
Hermann Wilbrand in 1887, resulting in the
crucial to the dreaming process.
term CWS (Charcot-Wilbrand syndrome)
In conclusion, dreaming is a complex
to describe this phenomenon (Charcot,
neurophysiological process
1883; Wilbrand, 1887). Recently, sleep and
sleep playing a crucial role. Although many
with
REM
Neuroanatomy of REM Sleep and Depression
|
neuroanatomical regions have been impli¬
may stay in REM too long. Now NREM
cated, it appears that the occipital lobes,
sleep is affected in depression as well, and
and perhaps the inferior lingual gyrus, are
things get quite complex once you start ask¬
key components of the dreaming mecha¬
ing questions such as are the REM changes
nism. The complexities of dreaming make
characteristic of all forms of depression?
creation of an animal model to study the
(No) or do they occur in all demographic
phenomenon unrealistic. Therefore, future
groups? (No) and so forth. Nevertheless,
studies focusing on loss of function follow¬
there does seem to be a deep relationship
ing neurological insult are likely to provide
between REM sleep per se and depression.
the best insights into this fascinating phe¬
The definitive evidence for this comes
nomenon going forward.
from neuroanatomy and from the fact that
Nathaniel F. Watson
See also: entries related to Sleep and the Brain
REM deprivation temporarily reverses the depression, at least in most people with major depression. Most investigators sus¬
References
pect that the reason for the deep relation
Bischof, M., & Bassetti, C.L. (2004). Total dream loss: A distinct neuropsychological dysfunction after bilateral PCA stroke. An¬ nals of Neurology, 56(4), 583-586.
between REM and major depressive dis¬
Charcot, M. (1883). Un cas de suppression brusque et isole'e de la vision mentale des signes et des objets (formes et couleurs). Progressive Medicine, 2, 568-571.
order (MDD) may lie in the neuroanatomy of both states. So it is worth reviewing the neuroanatomy of REM sleep and of de¬ pression to see how they overlap and caus¬ ally interact. MDD (American Psychiatric Associa¬
Hobson, J. A. (2002). Sleep and dream suppres¬ sion following a lateral medullary infarct: A first-person account. Consciousness and Cognition, 11, 377-390.
tion, 2000) is associated with a range of
Lu, J., Sherman, D., et al. (2006). A putative flip-flop switch for control of REM sleep. Nature, 447(7093), 589-594.
ture a barrage of negative self-appraisals
Wilbrand, H. (1887). Ein Fall von Seelenblindheit und Hemianopsie mit Sectionsbefund. Dtsch Z Nervenheilkd, 2, 361-387.
symptom clusters, including the hallmark persistent sad, anxious, or empty feelings. Cognitive distortions of depression fea¬ that lead to feelings of hopelessness and/ or pessimism, guilt, worthlessness, and/ or thoughts of suicide, or even suicide at¬ tempts. Memory too is affected with neg¬ ative and painful memories favored in recall and in acquisition and consolida¬
Neuroanatomy of REM Sleep and Depression
tion processes. Dreams become intensely unpleasant experiences with elevated lev¬ els of what used to be called masochistic
One of the best-documented relationships
content or scenes of aggression by un¬
between mood disorders and sleep is the
known strangers against the dreamer/self.
relationship between depression and REM
Nightmares become more frequent occur¬
sleep. The basic finding is that depressed
rences in the dream life of the depressed
people go into REM too quickly and some
individual.
451
452
|
Neuroanatomy of REM Sleep and Depression
Although REM sleep has long been
assume that they operate in mutual inhibi¬
known to be altered in depression, its role in
tory balance with the dorsal system play¬
production of symptomology of depression
ing the leading role. Its job you might say
has never been adequately clarified (for re¬
is to regulate arousal levels in the ventral
views see Armitage, 2007; Nutt, Wilson, &
system. If the dorsal system is damaged or
Paterson, 2008; Tsuno, Besset, & Ritchie,
inhibited by any physiological dysfunction
2005). The repeatedly confirmed fact that
then the ventral system would be released
both selective REM and total sleep depri¬
from regulatory constraints and would ex¬
vation provides dramatic and immediate
hibit chronic overactivation.
(though temporary) relief for some people
Consistent with the regulatory role of the
with depression (Vogel, 1975) supports the
dorsal system over paralimbic and other
claim that REM does indeed play some role
preferontal circuits and functions; and con¬
in production of at least some depressive
sistent
symptoms in some people with MDD.
model of depression, resting-state PET
with
Mayberg’s
limbic-cortical
Mayberg (1997) presented a limbic-
and single-photon emission computed to¬
prefrontal interactional model of the neu¬
mography studies in patients with unipolar
roanatomy of depression that consists of
depression have most consistently found
three neurofunctional compartments that
decreased function in the dorsolateral pre¬
account for differing clusters of depressive
frontal (e.g., Mayberg, Lewis, Regenold, &
systems. Cognitive disturbances of depres¬
Wagner, 1994) and increased activation
sion are related to dysfunction in the dorsal
in ventral system structures (Liotta et al.,
compartment of the model, which includes
2000). Once the dorsal system is impaired,
the dorsolateral prefrontal cortex and dor¬
the systems it regulates are released from
sal anterior cingulate, and posterior cingu¬
top-down inhibitory control and you get in¬
late. Emotional, vegetative, and somatic
creases in activation of ventral system struc¬
symptoms of depression (affect sleep and
tures in depressed patients. Such increases
appetite) are associated with disturbances
in activity in depressed patients have been
of the ventral compartment, which consists
documented via rCMRglc (regional cere¬
of orbitofrontal, paralimbic cortical, sub¬
bral metabolic glucose) and rCBF (regional
cortical, and brainstem regions. The rostral
cerebral blood flow) studies in ventrolat¬
compartment (the rostral anterior cingulate
eral, ventromedial, and orbitofrontal cortex
cortex, corresponding to Brodmann area
and subgenual prefrontal cortex, amygdala,
24a) has connections to both the dorsal
and insular cortex (Liotta et ah, 2000).
and ventral compartments and may serve
Consistent with an etiological role of
an important regulatory role in the overall
these overactivated brain systems in pro¬
network. I will focus here on interactions
duction
between the dorsal and ventral components
pretreatment abnormalities found in pre¬
of the model as these seem most relevant
frontal, and limbic-paralimbic areas in de¬
to sleep in depression.
pressed patients appear to normalize with
To understand interactions of dorsal ver¬ sus ventral components in sleep we have to
of
depressive
symptomology,
recovery from depression (Drevets et ah,
2002;).
Neuroanatomy of REM Sleep and Depression
|
Now we know from neuroimaging stud¬
Thus, attention to the overlap of the neu¬
ies of REM sleep in healthy people that
roanatomy of REM sleep and of depres¬
REM is associated with downregulation
sion yields insights into treatment options.
of the dorsal system and upregulation of
What remains unanswered, however, is
the ventral system during each episode of
why REM sleep would reproduce the anat¬
REM. REM normally activates the ventral
omy of depression in the first place? Why
system and deactivates the dorsal system
would Mother Nature create a physiologi¬
in healthy people, thus reproducing the de¬
cal system that each night periodically ac¬
pressive state. Brain-activation patterns in
tivates the ventral system and activates it
REM demonstrate high activation levels
in such a way as to enhance negative affect
in limbic/amygdaloid sites and portions of
(after all, most dreams contain significant
medial prefrontal cortex but hypoactiva-
amounts of negative affect)?
tion of dorsolateral prefrontal cortex sites
(Pace-Schott, 2005). Thus, it appears that each REM episode is associated with a re¬
Patrick McNamara
See also: entries related to Sleep and the Brain
production of key aspects of the neuroanat¬
References
omy of depression, and it is therefore not
American Psychiatric Association.
(2000).
unreasonable to ask if REM can negatively
Diagnostic and statistical manual of men¬
impact dorsal and ventral systems in such a
tal disorders (4th ed.). Washington, DC:
way as to be depressogenic.
Author.
If it is true that REM reproduces the neu¬ roanatomy of depression during each REM episode then how does that manifest in people with depression to begin with? We would predict that REM measures would be enhanced in people with depression; that is, if we could dampen down or suppress those REM phenomena, the depression would be relieved. It is well known that cer¬ tain REM-sleep indices are enhanced in de¬ pression. Reduced REM-sleep latency and increased REM density and REM time are commonly observed in depressed patients (Tsuno et al., 2005). REM-sleep depriva¬ tion can temporarily alleviate depressive symptoms (Vogel, Thurmond, Gibbons, Sloan, & Walker, 1975). Most antidepres¬ sant drugs suppress some aspect of REM sleep and degfee of REM suppression is correlated with degree of symptomatic re¬ lief in responders (Vogel et al., 1975).
Armitage, R. (2007). Sleep and circadian rhythms in mood disorders. Acta Psychiatrica Scandinavica, 115(S433), 104-115. Drevets, W.C., Price, J.L., Bardgett, M.E., Reich, T., Todd, R. D., & Raichle, M.E. (2002). Glucose metabolism in the amyg¬ dala in depression: Relationship to diag¬ nostic subtype and plasma cortisol levels. Pharmacology Biology & Behavior,
71,
431-447. Liotta, M., Mayberg, H. S., Brannan, S. K., Mc¬ Ginnis, S., Jerabek, P., & Fox, P.T. (2000). Differentials corticolimbic correlates of sadness and anxiety in healthy subjects: Im¬ plications for affective disorders. Biological Psychiatry, 48, 30-42. Mayberg, H. S. (1997). Limbic-cortical dysregulation: A proposed model of depression. Journal of Neuropsychiatry and Clinical Neurosciences, 9, 471—481.
Mayberg, H. S., Lewis, P.J., Regenold, W., & Wagner, H.N. (1994). Paralimbic hypoper¬ fusion in unipolar depression. Journal of Nuclear Medicine, 35, 929-934.
453
454
|
Neurobiology of Psychoanalysis in Wake and REM Sleep
Nutt, D.J., Wilson, S.J., & Paterson, L.M. (2008). Sleep disorders as core symptoms of depression. Dialogues in Clinical Neuro¬ science, 10(3), 329-335.
the efficiency of censorship is decreased,
Pace-Schott, E.F. (2005). The neurobiology of dreaming. In M. H. Kryger, T. Roth, & W. C. Dement (Eds.), Principles and prac¬ tice of sleep medicine (4th ed., pp. 551— 572). Philadelphia: Elsevier.
by
Tsuno, N., Besset, A., & Ritchie, K. (2005). Sleep and depression. Journal of Clinical Psychiatry, 66, 1254-1269.
ple would give way to the primary process
Vogel, G. W. (1975). A review of REM sleep deprivation. Archives of General Psychia¬ try, 32, 749-761.
of unconscious wishes. Today, several experimental psychology
Vogel, G.W., Thurmond, A., Gibbons, P., Sloan, K„ & Walker, M. (1975). REM sleep reduction effects on depression syn¬ dromes. Archives of General Psychiatry, 32, 765-777.
allowing latent thought content to enter the dreamer’s consciousness under the figu¬ rative form of manifest content, produced dreamwork involving condensation
and displacement. When this happens, the elaborated processes that regulate wakingmind function and follow the reality princi¬ which follows the pleasure principle, lead¬ ing to disguised phantasmatic satisfaction
studies have confirmed that there are indeed active processes that suppress (repress) un¬ wanted memories from entering conscious¬ ness during waking, with neuroimaging studies even suggesting the primary in¬ volvement of the prefrontal cortex in their generation. Indeed, the more this brain level
Neurobiology of Psychoanalysis in Wake and REM Sleep
is activated—as memory-controlling struc¬ tures (hippocampus) are deactivated—the more effective the repression of memories is. This repression ability is favored by sleep
Sigmund Freud (1917) wrote that “we must
and decreases with advancing age.
recollect that all of our provisional ideas
In contrast, it is difficult to find any
in psychology will presumably one day be
neurobiological support for an organized
based on an organic substructure.” To what
dreamwork that would produce mean¬
extent has his prediction been confirmed?
ingful symbolic content during the REM
Freud’s basic theory was that a form of
dreaming sleep stage, since dream menta¬
unconscious censorship blocks access to
tion only shows psychotic-like properties.
consciousness of memories, drives, wishes,
Indeed, electroencephalographic studies of
and feelings because they would induce
gamma rhythm and central responsiveness
behavioral disturbances (anxiety) due to
(evoked potential findings) clearly show
their emotional or ethical unacceptabil¬
disconnections between forebrain struc¬
ity. However, the intrusion of such uncon¬
tures, as is seen in schizophrenia, and also
scious events can be incidentally observed
show disinhibitory processes, which is an
through parapraxes (slips of the tongue, of
index of deficits in central control processes.
the pen, forgetting, misreading, mislaying).
Neuroimaging results also mainly indicate
Further, during dreaming, as developed in
deactivation of the dorsolateral prefrontal
his The Interpretation of Dreams (1900),
cortex, which is activated during waking,
Neurobiology of Psychoanalysis in Wake and REM Sleep
|
emphasizing the loss of brain-control pro¬
disturbed brain. First, cortisol, which in¬
cesses during REM sleep. Moreover, it has
hibits memorization, is released by the su-
long been established by pharmacological
prarenals in the early morning. Also, in the
research that dopamine receptor blockers,
seconds preceding behavioral arousal, wak¬
which suppress psychotic symptoms, tend
ing function reappears in the brain with the
to decrease dreaming; also, new neurolep¬
release of noradrenaline; this could favor a
tics used in the treatment of schizophrenia
break with previously present psychologi¬
increase noradrenergic and serotonergic
cal processes. Recent research has also in¬
function, and both of these neuromodula¬
dicated that endogenous increases in Ca2+/
tors are nearly entirely absent during REM
calmodulin-dependent protein kinases II
sleep. Finally, neurochemical results have
(CaMKII) upon arousal, or a transient de¬
shown that dopamine levels are reduced
crease in the sensitivity of (3-noradrenergic
in the prefrontal cortex during REM sleep
receptors could explain the nonrecording
while glutamate levels remain unchanged,
of dreams in the waking memory. Finally,
in both cases similar to what is observed
it has been established that the specific
in schizophrenia. Further, there is a maxi¬
dorsolateral prefrontal cortex, which is
mal release of dopamine and a decrease in
involved in memory processes, recovers
glutamate in the nucleus accumbens during
its waking properties with a longer delay
REM sleep, again as is seen in schizophre¬
than do all other forebrain structures. This
nia. These results underline the conclusion
could also contribute to the obliteration of
that increases in central dopamine and de¬
dreams.
creases in glutamate induce both psychotic symptoms and vivid dreaming.
Consequently, today’s neurobiological knowledge tends to support the psychoana¬
In view of the previous results, it is im¬
lytic theory of unconscious processes with
probable that, in the context of such disor¬
respect to the repression of access of men¬
ganized brain function and in the presence
tal content to the waking consciousness.
of such psychological abnormalities, there
In contrast, because of the major distur¬
is an organized censorship that acts during
bances that occur in brain function during
REM sleep to modify mental content and
REM sleep, sooner or later in dreams there
make it acceptable to an unconscious.
is usually a disintegration, a loss of coher¬
Finally, another significant assertion of
ence, an appearance of a psychotic-like
Freud now encounters difficulties in view
kind of mentation that is incompatible with
of modern neurobiological knowledge:
Freud’s postulated lucid yet unconscious
“The forgetting of dreams remains inexpli¬
censorship that would transform unaccept¬
cable unless the power of the psychical cen¬
able mental content to render it acceptable.
sorship is taken into account.” It has been
Finally, with respect to dream recall, there
established that there is, generally, evanes¬
is often some rebuilding of content upon
cence of dreams upon awakening. However,
arousal (Gottesmann, 2010).
several knowjn physiological processes are
Claude Gottesmann
better able than Freud’s theory to explain this forgetting in such a neurobiologically
See also: entries related to Sleep and the Brain
455
456
|
Neurofeedback for Sleep Problems
References
brain activity, which is associated with
Freud, S. (1900). The interpretation of dreams. London: The Hogart Press.
various disorders such as epilepsy, at¬
Freud, S. (1917). The history of the psychoana¬ lytic movement (Trans. A. A. Brill). In Ner¬
sleep disorders. Unfortunately, much of the previous
vous and mental disease monograph series,
research concerning neurofeedback has
no. 25. (Original work published 1914.) Gottesmann, C. (2010). To what extent do neurobiological sleep-waking processes sup¬ port psychoanalysis. International Review of Neurobiology, 92, 233-290.
tention deficit hyperactivity disorder, or
suffered from a lack of standardized mea¬ sures of target symptoms, neglected the assessment of actual training-related EEG changes, and conducted studies with in¬ appropriate control groups or insufficient sample sizes. Additional, well-controlled
Neurofeedback for Sleep Problems
empirical studies are thus recommended before neurofeedback can be considered a reliable nonpharmacological treatment.
Neurofeedback is a sophisticated type of
Concerning sleep and sleep problems we
biofeedback, which basically refers to
recently focused our research on the sen¬
an operant-conditioning paradigm. Par¬
sorimotor cortex, which shows a very dis¬
ticipants are instructed to learn to self
tinct oscillatory pattern in a frequency
regulate distinct parameters of their cor¬
range between 12 and 15 Elz, also termed
tical activity as assessed by the means of
sensorimotor rhythm (SMR). SMR ap¬
electroencephalography (EEG). The aim
pears to (1) be dominant during quiet but
of neurofeedback is to teach individuals
alert wakefulness, and (2) synchronizes by
what specific states of cortical arousal
the inhibition of motor behavior. Further¬
feel like and how to activate such states
more, this frequency range is known to be
voluntarily. During neurofeedback EEG
abundant during light nonrapid eye move¬
is recorded and the relevant components
ment (NREM) sleep, and is overlapping
are extracted and fed back to the individ¬
with the sleep spindle frequency band.
ual using an online feedback loop (audio,
Sterman, Elowe, and MacDonald (1970)
visual, or audiovisual). The individual’s
were the first to demonstrate that operant
task may then be to increase/decrease the
conditioning of SMR during wakefulness
respective cortical parameter. When the
can influence subsequent sleep. Hauri and
correct EEG pattern is produced, the sub¬
colleagues (1981) then applied neurofeed¬
ject receives a positive response or reward
back of various EEG parameters to disor¬
by the computer. There is a growing body
dered sleep. These early results revealed
of evidence (for review, see Hoedlmoser,
that patients benefit from that kind of
Dang-Vu Thien, Desseilles, & Schabus,
SMR training; then, surprisingly, research
2010) suggesting that it is feasible to learn
on that topic faded away. Currently we in¬
to regulate specific brain oscillations by
tend to clarify the nature of these effects
neurofeedback. Thereby it becomes possi¬
in healthy controls as well as insomnia patients.
ble to directly counteract the maladaptive
Neuropsychology of Lost Dream Recall
In the first study (Hoedlmoser et al., 2008) healthy subjects who were randomly
conditioning of EEG can directly target clinically altered brain activity.
assigned to either a SMR-conditioning protocol or to a randomized-frequencyconditioning protocol were studied. Re¬
|
Kerstin Hoedlmoser See also: entries related to Dreams and Therapy
sults confirmed the increase of 12 to 15 Hz
References
activity over the course of 10 training ses¬
Hauri, P. (1981). Treating psychophysiologic insomnia with biofeedback. Archives of General Psychiatry, 38, 752-758.
sions in the experimental group. Interest¬ ingly, the increased SMR activity (1) was also expressed during subsequent sleep by eliciting positive changes in various sleep parameters such as sleep spindle number or sleep onset latency and (2) was associ¬ ated with the enhancement of declarative memory performance. As these fascinating results pointed to the possibility that peo¬ ple suffering from insomnia could likewise benefit from these protocols, we conducted a second study with subjects suffering from primary insomnia. Results indicate an increase of 12 to 15 Hz activity over the course of 10 SMR neurofeedback sessions. Furthermore, the change in SMR activity tends to be correlated with a reduction in
Hoedlmoser, K., Dang-Vu Thien, T., Desseilles, M., & Schabus, M. (2010). Nonpharmacological alternatives for the treatment of insomnia. In Y.E. Soriento (Ed.), Melatonin, sleep and insomnia (pp. 69-101). New York: Nova Science Publishers. Hoedlmoser, K., Pecherstorfer, T., Gruber, G., Anderer, P., Doppelmayr, M., Klimesch, W., & Schabus, M. (2008). Instrumental conditioning of human sensorimotor rhythm (12-15 Hz) and its impact on sleep as well as declarative learning. Sleep, 31, 1401-1408. Sterman, M.B., Howe, R.C., & MacDonald, L.R. (1970). Facilitation of spindle-burst sleep by conditioning of electroencephalographic activity while awake. Science, 167, 1146-1148.
the number of awakenings from pre- to post-SMR training. Interestingly, subjec¬ tive sleep quality was also enhanced over the course of neurofeedback and further¬
Neuropsychology of Lost Dream Recall
more sleep onset latency was tendentiously reduced after SMR but not after random¬
There are two core issues in the neuro¬
ized training. Last but not least slow sleep
psychology of dream recall, and they are
spindles during deep NREM sleep were
linked. The first is that dreams are noto¬
found to be exclusively enhanced after
riously difficult to remember. The second
SMR training. In summarizing, results
is that some people recall no dreams upon
indicate that healthy individuals as well
waking and claim on this basis that they do
as people suffering from primary insom¬
not dream at all. Among the latter group
nia can experience subjective as well as
particular interest attaches to those who
objective benefits from SMR condition¬
claim to have lost the ability to dream fol¬
ing. Further refining and empirically as¬
lowing focal brain damage. This is because
sessing respective protocols for clinical
the site of the damage could identify parts
use appears worthwhile as instrumental
of the brain that are pivotal for dreaming.
457
458
|
Neuropsychology of Lost Dream Recall
This in turn may yield new insights into the
undermines dreaming; this does not provide
function of dreams.
much insight into the function of dreams. It
The first systematic study of this (Solms,
merely confirms that they are a primarily
1997) revealed two significant facts. The
visual form of hallucination. The situation
first was that reported cessation of dream¬
is different when it comes to ventromesial
ing was indeed associated with damage to
frontal white matter. Recent research has
a specific part of the brain (in fact to two
narrowed the focus to the dopaminergic
specific parts of the brain). The second was
part of the ventromesial frontal white mat¬
that it was not associated with damage to
ter (Dahan et al., 2007; Lena et al., 2005;
the part of the brain that generates REM
Solms, 2001)—which is implicated in ap¬
sleep—which had hitherto been assumed
petitive reward-seeking behavior (Pank-
to also generate dreams. Surprisingly, no¬
sepp, 1998). This suggests that dreams are
body had ever determined whether damage
generated by (or) responses to instinctual
to the cholinergic pontine brainstem causes
urges (Solms, 2011). This has major theo¬
loss of dreaming. This is a minimum re¬
retical significance (cf. Lreud, 1900).
quirement for any structural-functional
Unsurprisingly, these conclusions led
correlation in neuropsychology: if a par¬
many commentators (e.g., Hobson & Pace-
ticular structure performs a particular func¬
Schott, 1999) to question their method¬
tion then loss of the first must cause loss of
ological basis. How do we know whether
the second. If not, then the structure does
patients who report loss of dreaming fol¬
not perform the function at issue. Solms
lowing brain damage are really not dream¬
(1997, 2000) therefore concluded that
ing; is it not possible that they are merely
dreams are not generated in the pontine
forgetting their dreams? This brings us
brainstem.
back to the unreliability of dream recall,
Loss of dreaming turned out to be as¬ sociated with damage in higher structures:
which is presumably exacerbated by brain damage.
(1) ventromesial frontal lobe white matter
This challenge can be met in three ways,
and (2) occipito-temporal cortex. (Solms
first, the memory functions of dreaming
initially thought the critical region was
and nondreaming patients with similar le¬
the so-called overlap zone between oc¬
sions can be compared. In doing so, Solms
cipital, temporal, and parietal cortex but
(1997) found differences in visual short
subsequent research narrowed the focus
term but not visual or verbal long-term
to Brodmann areas 19 and 37 [Bischof &
memory. This confirms the conclusion
Bassetti, 2004; Poza & Marti Masso, 2006;
reached previously: dreaming is contin¬
Yu, 2001].) What are the functions of these
gent on intact visual working memory. The
two parts of the brain and what do they re¬
fact that long-term memory is completely
veal about dreaming? The occipito-tempo¬
preserved in nondreaming patients, how¬
ral region is implicated in visual short-term
ever, suggests that these patients would
memory and therefore in the capacity to
encode new long-term memories of dream
generate visuospatial mental imagery. It
episodes if they occurred. A second ap¬
is not surprising that loss of this capacity
proach is to examine the dream-recall
Neuropsychology of Lost Dream Recall
capacities of patients with confirmed in¬ ability to encode episodic memories. This has not been systematically investigated but anecdotal reports exist, which con¬ firm that densely amnesic patients—such as the famous case of HM (S. Corkin, per¬ sonal communication, 2009)—do indeed report dreams immediately upon awaken¬ ing from REM sleep. This is because vi¬ sual working memory is preserved in such patients (Moscovitch et al., 2005). A third approach is to subject nondreaming pa¬
|
Hobson, J.A., & Pace-Schott, E. (1999) Re¬ sponse to commentaries. Neuropsychoanal¬ ysis, 1, 206-224. Lena, I., Parrot, S., Deschaux, O., MuffatJoly, S., Sauvinet, V., Renaud, B., et al. (2005). Variations in extracellular levels of dopamine, noradrenaline, glutamate, and aspartate across the sleep—wake cycle in the medial prefrontal cortex and nucleus accumbens of freely moving rats. Journal of Neuroscience Research, 81(6), 891-899. Michel, F., & Sieroff, E. (1981). Une approche anatomo-clinique des deficits de l’imagerie oneirique, est-elle possible? In Sleep: Pro¬
tients to REM awakening, thereby ensur¬
ceedings of an international colloquium.
ing maximal temporal proximity to dream
Milan: Carlo Erba Formitala.
episodes. All such studies to date of non¬ dreaming neurological patients confirm the absence of dream reports upon REM awak¬ ening (Bischof & Bassetti, 2004; Michel & Sieroff, 1981; Poza & Marti Masso, 2006; Schanfald, Pearlman, & Greenberg, 1985). In short, notwithstanding the method¬ ological challenges of all dream research, the available evidence strongly supports the view that acquired loss of dreaming (so-called Charcot-Wilbrand syndrome) does indeed occur. Mark Solms
References Bischof, M., & Bassetti, C.L. (2004). Total dream loss: A distinct neuropsychological dysfunction after bilateral PCA stroke. An¬ nals of Neurology, 56, 583-586. Dahan, L., Astier, B., Vautrelle, N., Urbain, N., Kocsis, B., & Chouvet, G. (2007). Promi¬ nent burst firing of dopaminergic neurons in the ventral tegmental area during para¬ doxical sleep. Neuropsychopharmacology, 32, 1232-1241.
Freud, S. (100/2001). The interpretation of dreams. Empire Books, NY.
Moscovitch, M., Rosenbaum, R., Gilboa, A., Addis, D., Westmacott, R., Grady, C., . . . Nadel, L. (2005). Functional neuroanatomy of remote episodic, semantic and spatial mem017: A unified account based on multiple trace theory. Journal of Anatomy, 207, 35-66. Panksepp, J. (1998). Affective neuroscience: The foundations of human and animal emo¬ tions. New York: Oxford University Press.
Poza, J., & Marti Masso, J. (2006). Total dream loss secondary to left temporo-occipital brain injury. Neurologia, 21, 152-154. Schanfald, D., Pearlman, C., & Greenberg, R. (1985). The capacity of stroke patients to re¬ port dreams. Cortex, 21, 237-247. Solms, M. (1997). The neuropsychology of dreams: A clinico-anatomical study. Mahwah, NJ: Erlbaum. Solms, M. (2000). Dreaming and REM sleep are controlled by different brain mechanisms. Behavioral and Brain Sciences, 23, 843-850. Solms, M. (2001). The neurochemistry of dreaming: Cholinergic and dopaminergic hypotheses. In E. Perry, H. Ashton, & A. Young (Eds.), The neurochemistry of con¬ sciousness (pp. 123-131). John Benjamin’s Publishing Co. Solms, M. (2011). Neurobiology and the neuro¬ logical basis of dreaming. In P. Montagna & S. Chokroverty (Eds.), Handbook of clinical
459
460
|
Nightly Sleep Duration and Mortality: The Story of a U-Shaped Relationship
neurology, 98: Sleep disorders—Part 1 (3rd
from 16 studies, Cappuccio et al. (2010)
series, pp. 519-544). New York: Elsevier.
estimated that long sleepers, generally de¬
Yu, C. (2001). Neuroanatomical correlates of dreaming: The supramarginal gyrus contro¬ versy (dream work). Neuropsychoanalysis, 30, 47-59.
fined as individuals reporting nine or more hours of sleep per night, were 30 percent more likely to die than normal sleepers. This increased risk associated with long sleep appears to be stronger among older compared to younger individuals (46% vs.
Nightly Sleep Duration and Mortality: The Story of a U-Shaped Relationship
22% increase in the risk of mortality), but does not differ by sex. There is also some evidence to suggest a stronger relationship between long sleep and mortality among
Shorter nightly sleep duration is a hallmark
studies conducted in East Asia compared to
of modem Western society, thought to be
studies conducted in Europe and the United
due, in part, to longer work schedules and
States (48% vs. 25% increase in the risk
a greater allotment of time to leisure ac¬
of mortality). Cappuccio et al. (2010) hy¬
tivities such as television and the Internet.
pothesized that this may be due to a lon¬
This trend is troublesome, as, overwhelm¬
ger life expectancy in Asian countries such
ingly, the epidemiological evidence indi¬
as Japan and that, in general, the studies
cates that short sleep is related to a higher
conducted in Asia were composed of older
risk of overall, as well as cardiovascular,
individuals.
mortality (Cappuccio, D’Elia, Strazzullo,
Despite the consistency of the relation¬
& Miller, 2010; Gallicchio & Kalesan,
ships between sleep duration and mortal¬
2009). In a meta-analysis of 25 cohorts
ity, there is some debate in the literature
from 15 studies, Cappuccio et al. (2010)
as to whether the increases in mortality
showed that short sleepers, defined gen¬
risk associated with both short and long
erally as individuals reporting less than
sleep are real or whether they are due to
seven hours per night, had a statistically
other (confounding) variables (Cappuccio
significant 12 percent increased risk of
et al., 2010; Gallicchio & Kalesan, 2009).
death compared to normal sleepers (gen¬
Numerous factors are related to both sleep
erally defined as those sleeping seven to
duration and mortality that could serve as
eight hours per night). This increase in risk
potential confounders, including age, ed¬
associated with short sleep appears to be
ucation, marital status, health behaviors
consistent among men and women, across
(e.g., smoking), and the presence of health
age groups, and by country (Cappuccio
conditions such as hypertension and de¬
et al., 2010).
pression (Grandner, Hale, Moore, & Patel,
Similarly, the epidemiological literature
2010). While most of the epidemiological
indicates that longer sleep duration is also
literature examining sleep duration and
related to an increased risk of death (Cap¬
mortality from which the Cappuccio et al.
puccio et al., 2010; Gallicchio & Kale¬
(2010) results were derived took into ac¬
san, 2009). Based on data from 27 cohorts
count these potential confounding factors,
Nightmare Content in Adults
|
there remains the potential for bias due
short sleep duration is a true risk factor for
to unmeasured confounding (i.e., other
mortality, with the increasing number of
important confounding factors that have
individuals reporting shorter sleep times,
not been identified or were not measured
such an intervention would have a large
or considered in the analyses) or residual
public health impact. Research in this area
confounding by factors that have been in¬
is needed, as well as in the area of mecha¬
cluded in the published studies.
nisms by which shorter and longer sleep
Yet, despite the debate, the results re¬
may lead to an increased risk of death.
ported in the epidemiological literature are
Lisa Gallicchio
generally consistent, suggesting that the as¬ sociations are real. However, the specific mechanisms underlying the associations
See also: entries related to Sleep and Develop¬ ment; entries related to Sleep Disorders
between sleep duration and mortality are
References
poorly understood. Short-term forced sleep
Cappuccio, F. P., D’Elia, L., Strazzullo, P., & Miller, M. A. (2010). Sleep duration and all¬ cause mortality: A systematic review and meta-analysis of prospective studies. Sleep, 33, 585-592.
deprivation has been shown in experimen¬ tal studies to cause adverse endocrinologic, immunologic, and metabolic effects (Spie¬ gel, Leproult, & Van Cauter, 2005), but it is unknown whether these studies are ap¬ plicable to chronic sleep deprivation. Inter¬ estingly, it may be that short sleep elevates stress levels, leading to disease, neuronal damage, and earlier aging (Grandner et al., 2010). Even less is known about potential mechanisms underlying the association be¬ tween long sleep and mortality. Among the postulated mechanisms are an increased amount of sleep fragmentation among long sleepers compared to normal sleepers, ad¬ verse changes in cytokine levels associated
Gallicchio, L., & Kalesan, B. (2009). Sleep duration and mortality: A systematic re¬ view and meta-analysis. Journal of Sleep Research, 18, 148-158. Grandner, M.A., & Drummond, S.P. (2007). Who are the long sleepers? Towards an un¬ derstanding of the mortality relationship. Sleep Medicine Reviews, 11, 341-360. Grandner, M. A., Hale, L., Moore, M., & Patel, N. P. (2010). Mortality associated with short sleep duration: The evidence, the possible mechanisms, and the future. Sleep Medicine Reviews, 14, 191-203.
cal challenge such that long sleepers are
Spiegel, K., Leproult, R., & Van Cauter, E. (2005). Metabolic and endocrine changes. In C. Kushida (Ed.), Sleep deprivation:
not exposed to potentially beneficial mild
Basic science, physiology, and behavior
with long sleep, and lack of physiologi¬
stressors (Grandner & Drummond, 2007).
(pp. 293-317). New York: Marcel Dekker.
The state of the research on sleep dura¬ tion indicates that sleep duration is a risk marker for mortality; it is yet unknown as
Nightmare Content in Adults
to whether interventions aimed at modify¬ ing sleep behaviors would serve to decrease
Nightmares are defined as disturbing men¬
morbidity and overall mortality in the gen¬
tal experiences that generally occur during
eral population. Indeed, if, in particular,
REM sleep and often result in awakening
461
462
|
Nightmare Content in Adults
(ICSD-2 [Internationa] Classification of
(13%), sinister presence (13%), being
Sleep Disorders-2]). Whereas nightmare
late (5%), suffocation (3%), hallucinated
frequency in different populations have
creatures (3%), and being paralyzed (3%).
been studied extensively—see, for ex¬
The most detailed study was carried out
ample, the meta-analysis by Schredl and
by Zadra, Duval, Begin, and Pilon (2004)
Reinhard (2011), research regarding night¬
analyzing 125 nightmares reported by 125
mare content is rather scarce, especially in
women (mean age: 32 years) who kept a
adults.
dream diary, one dream per participant.
Garfield (1984) analyzed 158 nightmares
The thematic analyses yielded the follow¬
in children, who reported that the most com¬
ing distribution of nightmare topics: phys¬
mon themes were: being chased (49%), sens¬
ical aggression (26%), ominous mood
ing something scary (18%), injury/death
(12%), failure/helplessness (10%), inter¬
(17%), losing something (5%), and fall¬
personal conflicts (9%), and being ignored
ing (3%). In another content analytic study
or rejected (6%). Other themes occurring 5
(N - 381 dreams), Schredl and Pallmer
percent or less included being chased but
(1998) obtained comparable results: being
not caught, presence of demons, frighten¬
chased (42%), sensing something scary
ing insects or spiders, health problems or
(20%), deaths/injuries of significant oth¬
concerns, being stuck or trapped, and ac¬
ers (20%), and falling (11%). Other topics
cidents. The present study investigated
such as examinations (3%), natural disas¬
nightmare frequency and the frequency of
ters (4%), or war (5%) occurred less often.
various topics in them. The five most com¬
For adults, three studies (Dunn & Bar¬
mon nightmare topics in a representative
rett, 1988;Hearne, 1991; Kales etal., 1980)
German sample (N = 1,022) were falling,
elicited nightmare content in small clini¬
being chased, paralyzed, being late, and the
cal samples (sample sizes varied from 30
deaths of close persons (Schredl, 2010).
to 38, the mean ages of the samples were
Summarizing the results while keep¬
about 35 years). The four most prominent
ing in mind that the methodological ap¬
themes in the Kales et al. (1980) study
proaches and samples have been very
were fear of attack (73%), fear of falling
different, the main topics seem to be being
(73%), fear of death (60%), and choking/
chased, injury/death of others, falling, and
suffocation (30%). The nightmare topics
witnessing violence. Even though several
in the sample of Dunn and Barrett (1988)
topics can be explained by the continuity
were distributed as follows: being chased
hypothesis of dreaming (e.g., the higher
(72%), deaths of family/friends (64%),
occurrence of examination dreams in per¬
falling (53%), own death (39%), threaten¬
sons with high educational levels; Schredl,
ing animals/monsters (33%), and violent
2010), further research is needed to inves¬
destruction scenes such as war and natural
tigate the possibly metaphoric relationship
disasters (24%). The nightmare sufferers
between nightmare topics such as falling
in the Heame (1991) study reported other
or being chased and waking-life stressors.
themes to be most prominent in their night¬
Michael Schredl
mares: witnessing horror/violence (32%), experiencing attack/danger (29%), flight
See also: entries related to Dream Content
Nightmares
|
References
distress or impairment. A DSM-IV (Di¬
Dunn, K. K., & Barrett, D. (1988). Character¬ istics of nightmare subjects and their night¬ mares. Psychiatric Journal of the University of Ottawa, 13, 91-93.
agnostic and Statistical Manual of Men¬
Garfield, P.L. (1984). Your child’s dreams. New York: Ballentine. Hearne, K.M.T. (1991). A questionnaire and personality study of nightmare sufferers. Journal of Mental Imagery, 15(3-4), 55-64. Kales, A., Soldatos, C.R., Caldwell, A., Charney, D., Kales, J. D., Markel, D., et al. (1980). Nightmares: Clinical characteristics and personality pattern. American Journal of Psychiatry, 137, 1197-1201. Schredl, M. (2010). Nightmare frequency and nightmare topics in a representative German sample. European Archives of Psychiatry and Clinical Neuroscience, 260, 565-570. Schredl, M., & Pallmer, R. (1998). Geschlechtsunterschiede in Angsttraumen von Schiilerlnnen. Praxis der Kinderpsychologie und Kinderpsychiatrie, 47, 463^476. Schredl, M., & Reinhard, I. (2011). Gender differences in nightmare frequency: A meta-analysis. Sleep Medicine Reviews, 15, 115-121. Zadra, A., Duval, M„ Begin, E., & Pilon, M. (2004). Content analysis of nightmares. Sleep Supplement, 27, A64.
tal Disorders-IV) diagnosis of nightmare disorder is made when the frequency and
severity of nightmares result in significant distress or impairment—usually consid¬ ered to be at least one such nightmare per week. Although nightmares may occur in the course of a general medical condition or as a result of using, abusing, or with¬ drawing from medications or other drugs, the DSM-IV considers them in such cases to be only secondary to a nightmare dis¬ order diagnosis, and a diagnosis of night¬ mares due to a general medical condition
or substance-induced nightmare disorder would be applied instead. Nightmares may also occur in the course of several other mental disorders such as generalized anxiety disorder, social anxi¬ ety disorder, panic disorder, schizophre¬ nia, mood disorders, adjustment disorders,
and personality disorders. And they fre¬ quently occur in the course of normal and atypical bereavement during which grief figures as the predominant dysphoric dream emotion; these may form a distinct subtype of dreams (Kuiken, Lee, Eng, & Singh, 2006). It is important to distinguish
Nightmares
nightmare disorder from posttraumatic
nightmares, which are more severe, more Nightmares are repeated occurrences of
disturbing, and often, but not necessar¬
dreams that are extremely dysphoric, ex¬
ily, associated with acute stress disorder
tended in time and well remembered upon
or posttraumatic stress disorder (PTSD).
awakening; they usually involve active
Both nightmare disorder and PTSD night¬
efforts to avoid apparent threats to one’s
mares are distinguished from sleep terrors,
survival, security, or physical integrity.
which also involve fear-based arousals
Nightmare episodes generally occur dur¬
but which typically arise from non-REM
ing the second half of the sleep period. On
sleep, are not accompanied by such vivid
waking up, the nightmare experience, or the
and elaborate dreams, and do not result in
sleep disturbance that it produces, usually
awakenings from which recall of the expe¬
leads to a degree of clinically significant
rience is as clear and detailed.
463
464
|
Nightmares
Nightmares typically occur in a lengthy
ranging from approximately 2:1 to 4:1.
and elaborate dream sequences that seem
The gender difference continues in adult¬
real while they occur and cause anxiety,
hood even though nightmare prevalence
fear, terror, or some other dysphoric emo¬
decreases steadily with age for both sexes.
tion such as anger or disgust. The content
Among adults, prevalence is 2 to 5 percent
of the nightmares usually focuses on the
for nightmares often or always and 8 to 30
individual’s attempts to avoid or cope with
percent for nightmares one or more per
imminent physical danger such as being
month. Prevalence for adult/elderly sam¬
pursued, attacked, or injured, but it may
ples is only 1 to 2 percent for nightmares
also involve themes that evoke anger, re¬
often or always. Twin studies have identified genetic ef¬
vulsion, and other negative emotions. Because dreaming is usually longer
fects on the disposition to nightmares and
and more intense in the second half of the
on the co-occurrence of nightmares and
night, nightmares are also more likely to
other parasomnias such as somniloquy.
occur later in the night. However, any fac¬
PTSD nightmares are unique in that
tor that increases dream intensity earlier
they replicate, in whole or in part, the ter¬
in the night (e.g., sleep fragmentation or
rifying and often-excruciating experiential
deprivation, jet lag, REM-sensitive medi¬
details of the trauma (Mellman & Pigeon,
cations) might also lead to nightmares at
2005). About 50 percent of patients report
this time. Some nightmares may not induce
such replicative nightmares (Wittmann,
an awakening and only be recalled in the
Schredl, & Kramer, 2007). PTSD night¬
morning or later in the day, possibly be¬
mares also depict modified replays that
cause their associated dysphoric emotions
change details of the trauma but preserve
are less intense; some refer to these as bad
or amplify associated emotions (Hart¬
dreams (Zadra, Pilon, & Donderi, 2006).
mann, Zborowski, Rosen, & Grace, 2001;
Body
movements
and
vocalizations
Mellman & Pigeon, 2005). So although
are not characteristic of nightmare disor¬
50 percent of combat veterans with PTSD
der because of the loss of skeletal muscle
report dreams containing explicit combat
tone that normally occurs during REM
details (Esposito, Benitez, Barza, & Mell¬
sleep, but they may occur under situa¬
man, 1999), a much greater proportion
tions of emotional stress or sleep frag¬
(83%) report dreams containing threats
mentation (e.g., pregnancy, postpartum
(Esposito et al., 1999) compared with non-
state). Some parents (1.3% to 3.9%) report
PTSD combat controls (46%) (Hall & van
that their preschool children have night¬
de Castle, 1966). PTSD nightmares may
mares often or always. The prevalence
also contain elements of much earlier trau¬
of nightmares increases from ages 10 to
matic and adverse events, or repetitious
13 for both males and females but there¬
but nontraumatic elements (Wittmann et
after continues to increase to ages 20 to
al., 2007). To illustrate, survivors of Hur¬
29 for females but decrease variably for
ricane Iniki reported dreams about general
males. Adult females report having night¬
stressors (74% vs. 48% for controls) and
mares more often than do men, with ratios
about especially stressful life experiences
Nightmares
(67% vs. 37%), but only rarely about the hurricane itself (13%) (Pagel, Vann, & Altomare, 1995). Theoretical and empirical work on night¬ mares from Freud to the present day con¬ verges on, and to some extent supports, the notions that (1) emotion regulation is a normal function of dreaming and (2) night¬ mares are either exemplary expressions or psychopathological disturbances of this function (Nielsen & Lara-Carrasco, 2007). The work has produced several possible mechanisms that may be central to emo¬ tion regulation during dreaming, including desomatization, contextualization, progres¬ sive emotional problem solving, and fearmemory extinction. It provides suggestive evidence that some aspects of dream con¬ tent (e.g., self-character interactions, emo¬ tions), and not simply the physiological state of REM sleep per se, are implicated in the emotion regulation function. There are several recent comprehensive reviews of nightmares available (Levin & Nielsen, 2007; Nielsen, 2010; Nielsen & Zadra, 2010; Phelps, Forbes, & Creamer, 2008; Spoormaker, Schredl, & Bout, 2005). Tore Nielsen
See
also:
Lucid
Dreaming
Therapy
for
Nightmares
References Esposito, K., Benitez, A., Barza, L., & Mellman, T. (1999). Evaluation of dream content in combat-related PTSD. Journal of Trau¬ matic Stress, 12, 681-687.
|
in dreams: More intense after abuse and trauma. Dreaming, 11, 115-126. Kuiken, D., Lee, M.-N., Eng, T., & Singh, T. (2006). The influence of impactful dreams on self-perceptual depth and spiritual trans¬ formation. Dreaming, 16, 258-279. Levin, R., & Nielsen, T.A. (2007). Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model. Psychological Bulletin, 133, 482-528. Mellman, T. A., & Pigeon, W. R. (2005). Dreams and nightmares in posttraumatic stress disorder. In M. H. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and prac¬ tice of sleep medicine (4th ed., pp. 573578). Philadelphia: Elsevier Saunders. Nielsen, T.A. (2010). Disturbed dreaming as a factor in medical conditions. In M. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and practice of sleep medicine (5th ed., pp. 1116-1127). New York: Elsevier. Nielsen, T.A., & Lara-Carrasco, J. (2007). Nightmares, dreaming and emotion regula¬ tion: A review. In D. Barrett & P. McNamara (Eds.), The new science of dreams (pp. 253284). Westport, CT: Praeger Greenwood. Nielsen, T. A., & Zadra, A. (2010). Idiopathic nightmares and dream disturbances asso¬ ciated with sleep-wake transitions. In M. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and practice of sleep medi¬ cine (5th ed., pp. 1106-1115). New York:
Elsevier. Pagel, J.F., Vann, B.H., & Altomare, C.A. (1995). Reported association of stress and dreaming—Community background levels and changes with disaster (Hurricane Iniki). Dreaming, 5, 43-50.
Hall, C., & van de Castle, R.I. (1966). The content analysis of dreams. New York: Appleton-Gentury-Crofts.
Phelps, A.J., Forbes, D., & Creamer, M. (2008). Understanding posttraumatic night¬ mares: An empirical and conceptual re¬ view. Clinical Psychology Review, 28(2), 338-355.
Hartmann, E., Zborowski, M., Rosen, R., & Grace, N. (2001). Contextualizing images
Spoormaker, V.I., Schredl, M., & Bout, J.V. (2005). Nightmares: From anxiety symptom
465
466
|
Nightmares
to sleep disorder. Sleep Medicine Reviews, 10, 19-31. Wittmann, L., Schredl, M., & Kramer, M. (2007). Dreaming in posttraumatic stress disorder: A critical review of phenome¬ nology, psychophysiology and treatment.
Psychotherapy and Psychosomatics,
76,
25-39. Zadra, A., Pilon, M., & Donderi, D.C. (2006). Variety and intensity of emotions in night¬ mares and bad dreams. Journal of Nervous and Mental Disease, 194, 249-254.
o Objective and Subjective Dreams
pertain to that person in actuality. The dream may be showing our subjective pic¬ ture of that person or it may be using that
In popular culture, it is commonly assumed
figure to signify an aspect of ourselves. To
that dreams pertain primarily, if not solely,
understand the direction a dream faces, a
to the personality of the individual dreamer.
process of discernment needs to be under¬
This attribution, which corresponds to
taken; this will counteract any tendency to
the ethos of separatism that characterizes
take the dream superficially at face value.
American society, is not found in dream¬
From a collection of dreams made over a
ing cultures. In most indigenous traditions,
10-year period, those determined to be out¬
it is recognized that there are little dreams
ward facing rather than subjective showed
pertaining to the daily life of the dreamer
certain specific characteristics: (1) Their
and big dreams pertaining to the ongoing
imagery is very plain, without fantastical or
life of the tribe.
dreamlike elements; (2) the action is much
In his first essay on dreams, written in
as it would be in waking life; (3) there is
1917, C.G. Jung made a distinction be¬
little or no emotion on the dreamer’s part;
tween subjective dreams, which refer to the
(4) the dreamer often has few if any asso¬
dreamer and their worldview, and objec¬
ciations to the dream, and meaning can be
tive dreams, which refer to the larger world
made of it only when it is considered to be
around. He recognized that these adjectives
outward facing (Sabini, 2006).
were value laden, with objectivity being
Western psychology has contributed to
privileged over subjectivity (Jung, 1966,
an understanding of projection, the sub¬
para. 130). Since the dreaming mind is capa¬
liminal process by which we give over to
ble of distinguishing between inside and out¬
others a tendency or quality that belong to
side, self and other, we might think instead
ourselves. The opposite process, absorb¬
of dreams being inward facing and outward
ing into ourselves a quality or tendency
facing (Sabini, 2008). Dreams themselves
that belongs to others, has received much
often indicate which direction they face: we
less attention. This distinction between the
dream of being inside our childhood home
subjective and objective dimensions of
or outside on a city street, of repairing the
dreams, by which their contents face in¬
interior of our home or changing the outgo¬
ward or outward, provides an important
ing message on our voicemail.
template for discerning the purpose or
Dreams that refer to a person known
function a dream may have. It is a heu-
to us do not necessarily imply that they
ristically important template with many
467
468
|
Obstructive Sleep Apnoea, Metabolism, and Hormones
possible applications for both dream re¬
apnoea belongs to the metabolic syndrome
search and dreamwork.
cluster—the association with visceral obe¬ Meredith Sabini
sity, male gender preponderance, post¬ menopausal increase of its prevalence, and
References Jung, C.G. (1966). Two essays on analytical psychology. Princeton, NJ: Princeton Uni¬ versity Press. Sabini, M. (2006). Dreams about others: How can we recognize them? DreamTime, 23(2), 32-33. Sabini, M. (2008). Encountering the primordial self. Jung Journal: Culture & Psyche, 2(4), 34-69.
systemic effects, for example, hypertension and diabetes. OSA is also more common in ethnic minorities (African Americans and Hispanics) who are at increased risk of the metabolic syndrome and diabetes.
OSA, Diabetes, and Metabolic Syndrome There is a high prevalence of OSA in obese individuals and a high prevalence
Obstructive Sleep Apnoea, Metabolism, and Hormones
of obesity in patients with OSA (Svatikova et al., 2005). The impact of obe¬ sity on OSA includes impact on upper
Obstructive sleep apnoea (OSA) is a com¬
airway anatomy, ventilatory control, and
mon condition that is increasing in preva¬
pharyngeal airway tone. Leptin resistance
lence in parallel with obesity and type-2
in obesity may also have an impact on
diabetes mellitus. While obesity is a key
ventilatory control. OSA may perpetu¬
factor in the development of OSA, only up
ate obesity through effects on sleep frag¬
to 50 percent of OSA is due to obesity. With
mentation and loss. Visceral obesity is a
obesity being a key player in OSA, any in¬
major driver for type-2 diabetes mellitus
dependent impact of OSA on circulating
and the metabolic syndrome. Diabetes is
metabolic hormones and/or metabolism is
more prevalent in patients with sleep-dis¬
difficult to confirm definitively. Neverthe¬
ordered breathing (SDB, which includes
less, accumulating evidence points toward
OSA) and this relationship appears to be
important interactions among OSA, hor¬
independent of other risk factors. How¬
mones, and metabolism. These interactions
ever, it is not clear whether SDB is causal
can be through hormone-related conditions
in the development of diabetes. A study
(e.g., obesity, hypothyroidism) predispos¬
examining the potential association of
ing to or aggravating OSA, and/or OSA
OSA with the metabolic syndrome found
(through mechanisms such as intermittent
that
hypoxia and increased sympathetic ner¬
ated with increased systolic and diastolic
vous system activity) predisposing or ag¬
blood pressure, higher fasting insulin and
gravating hormone-related conditions such
triglyceride levels, decreased HDL cho¬
as diabetes mellitus, hypertension, and the
lesterol, increased cholesterokHDL ratio,
metabolic syndrome. A number of asso¬
and a trend toward higher homeostatic
ciated features of OSA suggest that sleep
model assessment (a measure of insulin
OSA
was
independently
associ¬
Obstructive Sleep Apnoea, Metabolism, and Hormones
|
resistance) values. They also found that
duration of CPAP treatment. Ongoing
metabolic syndrome was 9.1 times (95%
and future studies should clarify whether
confidence interval 2.6, 31.2: p < .0001)
CPAP improves diabetes control and pre¬
more likely to be present in patients with
vents or delays diabetes complications.
OSA (Coughlin, Mawdsley, Mugarza, Calverley, & Wilding, 2004). The prevalence of OSA in patients with
Hypothyroidism and Acromegaly
type-2 mellitus ranges from 20 percent to
Hypothyroidism is a common condition
as high as 80 percent depending on the pop¬
(more common in women) associated with
ulation studied and the study setting (Fos¬
weight gain and dyslipidemia. It can pre¬
ter et al., 2009). The association between
dispose to obstructive sleep apnea through
OSA and glucose metabolism is complex
not only weight gain but also through mu-
(Wolk & Somers, 2007). A common con-
copolyscacharide and protein deposition in
founder in the studies is visceral obesity.
the pharynx. Testing for hypothyroidism is
Data from animal models of hypoxia show
thus important in patients presenting with
that intermittent hypoxia can induce insu¬
OSA, although in the majority of cases,
lin resistance. Insulin resistance is also ob¬
the two conditions are coincidental. Acro¬
served in physiological hypoxia in humans
megaly is a rare disease that affects both
such as at high altitude and in pathological
sexes equally and has a prevalence rate
conditions associated with hypoxia such
between 38 and 60 cases out of 1,000,000
as chronic obstructive pulmonary disease.
population. Acromegaly is the result of
Apart from hypoxia, human laboratory
excess growth-hormone secretion usually
sleep-deprivation studies show that sleep
caused by a pituitary tumor. This excess of
loss is associated with insulin resistance.
growth hormone leads to an insidious de¬
Sleep loss and fragmentation can enhance
velopment of coarse facial features, bone
levels of insulin counter-regulatory hor¬
growth, and soft tissue swelling. A large
mones such as cortisol. OSA is also char¬
number of publications have described the
acterized by a pro-inflammatory state and
association between sleep apnoea and ac¬
elevated cytokine levels (e.g., tumor ne¬
romegaly. A correlation has been estab¬
crosis factor-a), which may lead to insu¬
lished between craniofacial changes and
lin resistance (Ciftci, Kokturi, Bukan, &
the presence and severity of apnoeas. Other
Bilgihan, 2004). If OSA has an independent relationship
mechanisms for sleep apnea in acromeg¬
with insulin resistance, then treatment
in ventilatory control, and obesity. Treat¬
with continuous positive airway pressure
ment of acromegaly improves OSA. Some
(CPAP) should improve insulin sensitiv¬
have suggested that growth-hormone de¬
ity. Studies on the effect of CPAP have,
ficiency, as occurs commonly in patients
however, reported conflicting results. The
treated for pituitary disorders, may also
reasons for conflicting findings include
be associated with OSA; further studies
patient selection, initial diabetes control,
are required to investigate this potential
diabetes duration, control treatments, and
association.
aly include pharyngeal edema, alterations
469
470
|
Obstructive Sleep Apnoea, Metabolism, and Hormones
Sex Hormones and Polycystic Ovarian Syndrome (PCOS)
is independent of visceral adiposity is un¬ clear. OSA treatment with CPAP in women with PCOS has been shown to improve in¬
Decreased libido is frequently reported
sulin sensitivity and reduce blood pressure.
in male patients with OSA. Reduced li¬
These responses are, however, dependent
bido has also been observed in women
on associated degree of obesity and CPAP
with OSA. Few studies have examined
usage duration.
the impact of CPAP treatment on sexual dysfunction. OSA is associated with de¬ creased pituitary-gonadal function; low
Conclusions
luteinizing hormone and testosterone lev¬
The metabolic syndrome represents a con¬
els are observed suggesting a central prob¬
stellation of cardiovascular risk factors and
lem (central hypogonadism). While these
is developing into a major public health
alterations may be related to obesity, some
problem. The increased prevalence of the
may be secondary to sleep deprivation and/
metabolic syndrome is linked to the epi¬
or intermittent hypoxia (Grunstein et al.,
demic of obesity, which is also accompa¬
1989). Androgens may have an influence
nied by an increasing prevalence of OSA.
on ventilatory control. Androgen replace¬
OSA and the metabolic syndrome show
ment may exacerbate preexisting OSA, al¬
many common features, and in fact, may
though evidence for this is weak.
often coexist. The coexistence of OSA
PCOS is defined as oligoovulation or
with the metabolic syndrome may contrib¬
anovulation, hyperandrogenemia or clini¬
ute to the clustering of abnormalities de¬
cal manifestations of androgen excess,
fined as the metabolic syndrome and may
and polycystic ovaries as demonstrated
have widespread implications for cardio¬
by ultrasonography. It is the most com¬
vascular morbidity and mortality. Whether
mon endocrine-related condition of re¬
the association of OSA with the metabolic
productive-aged women, affecting nearly
syndrome and diabetes is independent of
four million women in the United States
visceral adiposity is debatable. Neverthe¬
alone. Obesity is seen in many of these
less, OSA may independently contrib¬
women and is frequently central in nature
ute to morbidity and mortality in patients
(increased
Women
with the metabolic syndrome and diabetes
with PCOS have an increased prevalence
mellitus. OSA is associated with several
of type-2 diabetes and lipid abnormalities.
hormone abnormalities and endocrine dis¬
Insulin resistance, hyperinsulinemia, and
orders. Clinical vigilance is necessary to
beta-cell dysfunction are common in PCOS
recognize these associations so that appro¬
(Diamati-Kandarakis, 2006). Women with
priate treatment can be instituted. Under¬
PCOS are up to 30 times more at risk of
standing the associations of hormones with
OSA compared to women without PCOS.
OSA will increase our understanding of the
Also, women with PCOS and OSA are
potential role of various hormones in ven¬
more likely to be insulin resistant. Whether
tilatory control and pharyngeal anatomy,
the association between PCOS and OSA
and the roles of sleep fragmentation, short
waist-to-hip ratio).
Olfactory Stimuli and Dreams
sleep duration, and intermittent hypoxia on endocrine function. Marzieh Hosseini Araghi and Shahrad Taheri
See also: entries related to Hormones in Sleep; entries related to Sleep and Development
Note Both Dr. Shahrad Taheri and Dr. Marzieh Hosseini Araghi are funded by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC-BBC) program. The views expressed in this publication are not nec¬ essarily those of the NIHR, the Department of Health, NHS South Birmingham, University of Birmingham, or the CLAHRC-BBC Theme 8 Management/Steering Group.
References Babu, A.R., Herdegen, J., Fogelfeld, L., Shott, S., & Mazzone, T. (2005). Type 2 diabe¬ tes, glycemic control, and continuous pos¬ itive airway pressure in obstructive sleep apnea. Archives of Internal Medicine, 165, 447-452. Blanco, P., Blanco-Ramos, J.J., Zamarron Sanz, M.A., Souto Fernandez, C., Mato Mato, A., & Lamela Lopez, J. (2004). Acro¬ megaly and sleep apnea. Archivos de Bronconeumologia, 40, 355-359. Ciftci, T. U., Kokturi, O., Bukan, N., & Bilgihan, A. (2004). The relationship between serum cytokine levels with obesity and ob¬ structive sleep apnea syndrome. Cytokine, 28, 87-91. Coughlin, S.R., Mawdsley, L., Mugarza, J. A., Calverley, P. M., & Wilding, J. P. (2004, May). Obstructive sleep apnoea is indepen¬ dently associated with an increased preva¬ lence of metabolic syndrome. European Heart Journal, 25(9), 735-741. Diamati-Kandarakis, E. (2006). Insulin resis¬ tance in PCOS. Endocrine, 30, 13-17.
|
Foster, G. D., Sanders, M.H., Millman, R., Zammit, G., Borradaile, K. E., Newman, A.B., . . . Sleep AHEAD Research Group. (2009). Obstructive sleep apnea among obese patients with type 2 diabetes. Diabe¬ tes Care, 32(6), 1017-1019. Grunstein, R. R., Handlesman, D. J., Lawrence, S. J., Blackwell, C., Caterson, I.D., & Sulli¬ van, C.E. (1989). Neuroendocrine dysfunc¬ tion in sleep apnea: Reversal by continuous positive airways pressure therapy. Journal of Clinical Endocrinology and Metabolism, 68, 352-358.
Punjabi, N. M. (2008). The epidemiology of adult obstructive sleep apnea. Proceed¬ ings of the American Thoracic Society, 5,
136-143. Svatikova, A., Wolk, R., Garni, A. S., Pohanka, M. & Somers, V. K. (2005). Interactions be¬ tween obstructive sleep apnea and the meta¬ bolic syndrome. Current Diabetes Report, 5, 53-58. Svatikova, A., Wolk, R., Lerman, L. O., Juncos, L.A., Greene, E. L., McConnell, J. P. & Somers, V. K. (2005). Oxidative stress in obstructive sleep apnoea. European Heart Journal, 26, 2435-2439. Tasali, E., & Ip, M. S. (2008). Obstructive sleep apnea and metabolic syndrome: Alterations in glucose metabolism and inflammation. Proceedings of the American Thoracic So¬ ciety, 5, 207-217.
Wolk, R„ & Somers, V.K. (2007). Sleep and the metabolic syndrome. Experimental Physiology, 92, 67-78.
Olfactory Stimuli and Dreams Whether and how external stimuli are processed during sleep has been studied mainly by two different paradigms: eventrelated potentials and incorporation into dream content. Using olfactory stimuli is of interest because of several reasons.
471
472
|
Olfactory Stimuli and Dreams
First, Stuck et al. (2007) showed that ol¬
smelled like lemons instead of garde¬
factory stimuli without trigeminal com¬
nias. (Trotter et al., 1988, p. 95)
ponents such as hydrogen sulfide do not cause arousals even in high concentrations.
No effect of the pleasantness of the stim¬
On the other hand, Stuck, Weitz, Hor-
uli (pleasant stimuli: coffee, peanut butter,
mann, Maurer, and Hummel (2006) found
roses, cinnamon, chocolate, lemon; un¬
that olfactory event-related potentials can
pleasant stimuli: wood alcohol, dirty ash¬
be measured during sleep indicating that
tray, match smoke, mold, dog feces, onion)
chemosensory stimuli are processed by the
on dream emotions was reported (Trotter
sleeping brain. Secondly, olfactory stim¬
et al., 1988). Several methodological is¬
uli were processed differently within the
sues, such as lack of control condition and
brain compared to auditory stimuli: This
presentation technique (inducing arous¬
includes the predominantly ipsilateral pro¬
als), however, limit the generalizability of
cessing of the olfactory stimuli, and the al¬
this findings. The second study (Schredl
most direct projection from the olfactory
et al., 2009) used a sophisticated stimula¬
bulb to the amygdala (areas for the pro¬
tion methodology (stimulation without dis¬
cessing of memories and emotions) and
turbing the sleeper, no odor present at the
the association to the hippocampus via the
moment of awakening, control condition)
transitional entorhinal cortex. The fact that
and did not find any explicit incorporation
olfactory information processing largely
of olfactory stimuli in the dream reports
bypasses the spinal cord, the brain stem,
(N = 15 participants). In accordance with
and the thalamus—in contrast to all other
the specific processing of olfactory stim¬
sensory systems—explains the small num¬
uli within the brain, the emotional quality
ber of arousals after stimulation because
of the olfactory stimuli using H2S (smell
thalamic reticular nuclei are involved in
of rotten eggs) and phenyl ethyl alcohol
arousal generation (Stuck et al., 2007).
(PEA) (smell of roses) affected the emo¬
Two sleep laboratory studies have been
tional content of dreams: the positively
conducted in this area so far. Trotter, Dal¬
toned stimulus yielded more positively
las, and Verdone (1988) carried out a small
toned dreams, whereas the negative stimu¬
pilot study with five participants to study
lus was followed by more negatively toned
the effect of olfactory stimuli on dream
dreams.
content. The incorporation rate was 19
The findings indicate that olfactory
percent (79 successful trials in 22 nights).
stimuli are processed by the sleeping
The following example was reported by a
brain; it would be interesting to carry out
participant after presentation of a freshly
learning experiments (associating specific
cut lemon:
odors with declarative material) to study whether this declarative material is in¬
I dreamed I was in Golden Gate Park.
corporated into subsequent dreams if the
I was walking by some gardenias. They
corresponding odor cue is presented dur¬
were just opening. All of a sudden, I
ing sleep—as olfactory stimuli might en¬
could smell the gardenias, but they
hance sleep-related memory consolidation
Overgeneral Memories
|
(Rasch, Buchel, Gais, & Born, 2007). It
abilities, and mood regulation. Overgen¬
would also be interesting to study the ef¬
erality refers to a lack of specificity when
fect of positively toned olfactory stimuli on
recalling a certain event. Unlike specific
nightmares.
memories, which have taken place in less Michael Schredl
See also: entries related to Dream Content
than one day and are linked with a particu¬ lar place and time, overgeneral memories usually take place over a range of time. Be¬
References
cause that period of time may be definite
Rasch, B., Buchel, C., Gais, S., & Born, J. (2007). Odor cues during slow-wave sleep prompt declarative memory consolidation. Science, 775(5817), 1426-1429.
(i.e., have an explicit beginning and end¬
Schredl, M., Atanasova, D., Hormann, K., Maurer, J.T., Hummel, T., & Stuck, B.A. (2009). Information processing during sleep: The effect of olfactory stimuli on dream content and dream emotions. Jour¬ nal of Sleep Research, 18, 285-290. Stuck, B. A., Stieber, K., Frey, S., Freiburg, C., Hormann, K., Maurer, J.T., et al. (2007). Arousal responses to olfactory or trigemi¬ nal stimulation during sleep. Sleep, 30, 506-510. Stuck, B. A., Weitz, H., Hormann, K., Maurer, J.T., & Hummel, T. (2006). Chemosensory event-related potentials during sleep— A pilot study. Neuroscience Letters, 406, 222-226. Trotter, K„ Dallas, K„ & Verdone, P. (1988). Olfactory stimuli and their effects on REM dreams. Psychiatric Journal of the Univer¬ sity of Ottawa, 13, 94-96.
ing) or be less distinct, overgeneral memo¬ ries tend to be more variable than specific memories. For example, literature has defined three subtypes of overgeneral memories: categoric, extended, and lifetime period. Categoric memories refer to a series of
repeated events or a single event that oc¬ curs multiple times (e.g., brushing my teeth every morning; visiting my grandmother’s house every year for Christmas dinner). Extended nonspecific memories are mem¬
ories that have continued for more than one day, but still have a distinct beginning and end (e.g., being sick with pneumonia, tak¬ ing a semester of calculus, traveling to Ni¬ agara Falls on vacation). Lifetime-period
memories (Conway & Pleydell-Pearce, 2000) usually have a less clear beginning and end, but demonstrate basic thematic knowledge about general locations, activi¬ ties, plans, behaviors, etc., that are char¬ acteristic of a certain period of time (e.g.,
Overgeneral Memories
when / was young 1 used to be afraid of the dark; when I was dating my high school
Autobiographical memory is the aspect
boyfriend 1 wanted to become a chef).
of memory that is concerned with the rec¬
As
“mental
ollection of personally experienced past
from
events. It is of fundamental significance to
(Conway & Pleydell-Pearce, 2000, p. 261),
an individual’s sense of self, and thus, is
autobiographical memories are sensi¬
related to other aspects of human function¬
tive to cues. Most studies investigating
ing such as goal pursuit, problem-solving
autobiographical memory use a cuing
an
constructions
underlying
generated
knowledge
base”
473
474
|
Overgeneral Memories
methodology referred to as the autobio¬
(feelings of extreme sadness and hopeless¬
graphical memory test (AMT). During
ness), cognitive changes (low self-esteem,
the AMT, both positively (e.g., happy, ex¬
guilt, memory and concentration difficul¬
cited, proud) and negatively (e.g., scared,
ties), changes in behavior and motivation
angry, disappointed) valenced cue words
(feeling agitated or slowed down, reduced
are presented to participants. Participants
interest in social or recreational activi¬
are prompted to recall if a specific event
ties), and changes in bodily functioning
reminds them of that word. In response
(sleep, appetite, energy). Thus, it is not
to cues, executive control processes often
surprising that numerous studies of over¬
reshape or recall autobiographical knowl¬
generality in autobiographical memory is
edge that is salient to a person’s working
correlated with poor problem-solving per¬
sense of self. In accordance with this no¬
formance (Goddard, Dritschel, & Burton,
tion, several studies have demonstrated
1996) and the prediction of persistence of
that not only do suicidally depressed pa¬
depression (Dalgleish, Spinks, Yiend, &
tients usually respond more slowly to pos¬
Kuyken, 2001).
itively valenced cues, but they reported
In addition, observing overgenerality
more overgeneral memories than healthy
holds significance because memory re¬
control participants. Perhaps more inter¬
mains nonspecific in people with a history
estingly, several studies have replicated
of emotional disorder, even if not currently
the finding that group differences between
in an episode. The fact that overgenerality
suicidal patients and controls are due to in¬
can be seen without needing to be activated
creased retrieval of categorical memories,
by low mood indicates that overgenerality
with no such differences in numbers of ex¬
in autobiographical memory may act as a
tended memories (Williams et al., 2007).
between-episode marker of future vulner¬
Williams and colleagues reviewed re¬
ability to depression. Thus, not only may
search examining the specificity of mem¬
nonspecific memory assessed when one
ory in people suffering from affective
is not depressed predict later mood dis¬
disorders (e.g., major depressive disor¬
turbance, but overgenerality appears to be
der [MDD], posttraumatic stress disorder
more of a trait marker that causes a vul¬
[PTSD], etc.). Overall, emotionally dis¬
nerability to depression, rather than a state
turbed patients tend to summarize catego¬
marker of depression (Brittlebank, Scott,
ries of events rather than retrieving a single
Williams, & Ferrier, 1993).
episode when asked to recall autobiograph¬
Because self-concept and autobiograph¬
ical experiences (Williams et al., 2007).
ical memories are so intimately related, the
Such findings may suggest that overgen¬
level of specificity when recalling a certain
eral memories serve to protect against re¬
event has obvious implications for one’s
call of painful personal events.
sense of self. Discrepancies between re¬
A closer look at patients with MDD
called memories and one’s perceived self
explains the far-reaching effects of over¬
may produce feelings of internal inconsis¬
general memory recollection. In MDD,
tency. When memories are specific, self¬
patients experience emotional changes
discrepancies usually provide the type of
Overgeneral Memories
|
psychological tension necessary to mo¬
supports the correlation between sleep dys¬
tivate a person to set personal goals and
function and mood dysregulation. With the
generate plans to attain those goals—
negatively valenced mnemonic content of
demonstrating how memory affects moti¬
REM sleep, and REM’s role in distorted
vation and goal pursuit. In turn, emotions
memory functions in both PTSD and de¬
are often impacted by goal pursuit and goal
pression (McNamara, Auerbach, Johnson,
attainment, evidencing autobiographical
Harris, & Doros, 2010), it would not be far¬
memories’ ultimate role in mood regula¬
fetched to consider a correlation between
tion. Both a top-down and bottom-up pro¬
REM sleep and overgeneral memories.
cess, “autobiographical knowledge can ...
A pilot study investigating how sleep fa¬
constrain the goal structure of the working
cilitates the production and recall of over¬
self, but it is also evident that the working
general memories was conducted in 2009
self may determine what autobiographical
with 50 healthy, college-aged participants.
knowledge can be accessed and how that is
Participants slept in the sleep lab for two
to be constructed into a memory” (Conway
consecutive nights. While the first night
& Pleydell-Pearce, 2000, p. 272). In fact,
was a habituation night, the second night
very vivid and specific memories often
participants underwent an overnight poly¬
arise in response to experiences in which
somnography in which electroencepha¬
the self and goals are highly integrated (e.g.,
lography activity was monitored as each
experiences of goal attainment or progress
participant was awoken twice by a sleep
toward attainment) or markedly inhar¬
technician (once in REM sleep and once
monious (e.g., plan failure) (Conway &
in NREM sleep).
Pleydell-Pearce, 2000).
All subjects performed a series of cogni¬
In particular, Beike and Landoll (2000)
tive tasks four times throughout the night:
investigated how several types of cognitive
once before going to bed, once after being
reactions to personally discordant recalled
awoken from REM sleep, once after being
events could resolve feelings of internal
awoken from NREM sleep, and once in
inconsistency. Providing justifications for
the morning. The tasks were both written
the
inconsistency, recruiting additional
and spoken, taking about 15 minutes to
specific events that oppose those recalled,
complete each time. Some of these tasks
and putting the event behind oneself (clo¬
required participants to recall a dream
sure) were three cognitive reactions found
or dreams they might have had prior to
to moderate the relationship between in¬
awakening. Another task was similar to
consistent recall and well-being. While
the AMT, where participants were pre¬
overgeneral memories may promote the
sented with positively (e.g., happy), neg¬
perpetuation of depression and other affec¬
atively (e.g., lonely), and neutrally (e.g.,
tive disorders, gaining control of memory,
apathetic) valenced cue words during each
particularly memory specificity may have
condition. They then were asked to recall
far-reaching implications for mental health.
a personal memory in response to each
While the role of memory specificity
word, recording the memory and providing
and sleep is less obviously related, research
its approximate date on audio tape. Each
475
476
|
Overgeneral Memories
cued memory was later transcribed verba¬
her new college friends were her new best
tim and blindly scored for specificity.
friends. And I was just really apathetic to¬
Excluding memories that were recalled
wards the whole situation, even though I
after positive and negative cue words (be¬
should have really cared about it, just be¬
cause such emotionally valenced words are more likely to elicit specific responses), overgeneral memories were more frequent
cause that’s how she’s kind of always been. She’s always been really easily influenced. So ... I just really didn’t care about it. It wasn ’t anything new to me. ”
after REM sleep than after NREM-sleep awakenings. In REM sleep, 38.6 percent
This participant reported an unrelated
of memories were overgeneral while only
overgeneral memory in response to the
27.9 percent of NREM-sleep memories
neutral cue word (apathetic) presented
were overgeneral (y2(l, 27 = 87) = 0.02,
after her REM awakening. The dream that
p < .05) (Abrams & McNamara, 2009).
she recalled after her REM awakening ap¬
Findings suggest that REM sleep may help
pears negative, as she accounts the recent
to modulate memories via generation of
end of a friendship and the awkwardness
nonspecific memories.
she felt at an imaginary Thanksgiving din¬
In addition, findings support the pos¬
ner when she realized their families were
sibility that REM sleep is depressogenic,
still friends. In the previous case, one could
implying that REM sleep may help to cre¬
argue that REM sleep may have contrib¬
ate nonspecific memories that contribute
uted to the production of an overgeneral
to negative ruminations central to depres¬
memory as if to protect the participant
sion. Following is an example of an over¬
from a painful past event (i.e., the loss of
general memory protecting from a painful
a friendship). Although dreams are not al¬
past event:
ways based on reality, they often do play a role in memory consolidation and the
Negative REM Dream
processing of information collected during the day. In the previous case, the dream
•
“I dreamt about my friend ... me and my
recalled after awakening from REM was
roommate stopped being friends ... a month
triggered by a recent event in her life, and
ago. So, I think / dreamt about her. And. . .
her tendency toward overgenerality may
we were at Thanksgiving together and it was
have guarded the participant from having
just really awkward. And it ended up that our
to process the painful specifics surround¬ ing the event.
families were actually friends together. ”
Although the pilot study had several
Neutral Memory Recalled after that REM Awakening
limitations such as a small sample size (N - 50), a lack of diversity in the sam¬
ple (predominantly college aged, Ameri¬ • “I was really apathetic about a month ago
can, Caucasian, and middle class), and the
when one of my best friends got . . . really
use of only self-reported measures of well¬
wrapped up in college and with her new
being, the study highlights the potential
friends. And she was just . . . saying how
role of REM sleep in overgeneral memory
Overgeneral Memories
production. Thus, findings further support the relationship between mood dysregulation and sleep dysfunction. Overall, the widely replicated finding that overgeneral memories are more fre¬ quently recalled in patients with affective disorders than healthy controls suggests a strong relationship between overgen¬ eral autobiographical memories and selfconcept. Whether overgeneral memories cause, are caused, or just contribute to mood dysregulation is less obvious. How¬ ever, because autobiographical memories either reflect or project an individual’s selfconcept, autobiographical memories and the degree of specificity in which they are
Brittlebank, A.D., Scott, J., Williams, M.G., & Ferrier, I.N. (1993). Autobi¬ ographical memory in depression: State or trait marker? British Journal of Psychia¬ try, 162, 118-121. Conway, M.A., & Pleydell-Pearce, C.W. (2000). The construction of autobiograph¬ ical memories in the self-memory system. Psychological Review, 107, 261-288. Dalgleish, T., Spinks, H., Yiend, J., & Kuyken, W. (2001). Autobiographical memory style in seasonal affective disorder and its re¬ lationship to future symptom remission. Journal of Abnormal Psychology,
Goddard, L., Dritschel, B., & Burton, A. (1996). Role of autobiographical memory in social problem solving and depression.
recalled will either reflect or project onto
Journal of Abnormal Psychology,
other aspects of their functioning.
609-616.
Emily Abrams
References Abrams, E., & McNamara, P. (2009, October 16). Overgeneral memories are more frequent after REM than NREM sleep awakenings. Poster presented at the UROP Symposium at Boston University, Boston, MA. Beike, D.R., & Landoll, S.L. (2000). Striving for a consistent life story: Cognitive reac¬ tions to autobiographical memories. Social Cognition, 18, 292-318.
110,
335-340.
105,
McNamara, P., Auerbach, S., Johnson, P., Har¬ ris, E., & Doros, G. (2010). Impact of REM sleep on distortions of self concept, mood and memory in depressed/anxious partici¬ pants. Journal of Affective Disorders, 122, 198-207. Williams, J., Thorsten Barnhofer, M.G., Crane, C., Hermans, D., Raes, F., Watkins, E., & Dalgleish, T. (2007). Autobiograph¬ ical memory specificity and emotional disorder. Psychological Bulletin, 133, 122-148.
p Parapsychology and Dreams
monitored (Ullman, Krippner, & Vaughan, 1973). The transmitter was given a ran¬
Parapsychology can be defined as disci¬
domly selected envelope and retired to
plined inquiry into reported experiences
a distant room; the envelope contained
and behaviors that seem to defy mainstream
an art print (the target). The transmitter
science’s concepts of space, time, and en¬
would open the envelope, view the target,
ergy. Several parapsychologists (most of
and attempt to send its images to the par¬
them psychologists or psychiatrists) have
ticipant, who, in turn, had been told to at¬
studied dream reports in which these ef¬
tempt incorporating the images into his/her
fects are alleged to have occurred. These
dreams. Experimenters awakened the par¬
unusual dreams have been a topic of fasci¬
ticipant during REM sleep, tape recording
nation throughout the millennia and were
all dream reports, which were later tran¬
usually attributed to supernatural forces,
scribed. Upon the completion of the ex¬
finding their way into the mythologies and
perimental series (typically 8 to 10 nights),
sacred writings of various faiths. However,
outside judges worked blind and indepen¬
the first attempt to study them experimen¬
dently with these transcripts and copies of
tally was published in 1895 by G. Erma-
the art prints, assigning numerical scores
cora, who worked with an Italian claimant
to
medium who attempted to influence the
These scores were analyzed statistically
dreams of a child, a phenomenon referred
to determine if the correct transcript-
to as telepathy by parapsychologists. In
target matches differed from the in¬
1966 L. Rhine and colleagues surveyed
correct matches. This occurred often
some 7,000 anecdotal reports of interest to
enough to confirm the telepathy hypoth¬
parapsychologists, noting that nearly two
esis; indeed, a meta-analysis of some 450
thirds reputedly occurred in dreams (Rhine,
nighttime dream sessions at Ullman’s lab¬
Pratt, Stuart, Smith, & Greenwood, 1966).
oratory produced odds of 75 million to 1
In 1966 M. Ullman and colleagues initi¬
against achieving such results by chance.
ated a decade-long experimental study in
Notably, five professional magicians vis¬
a medical center sleep laboratory; a pro¬
ited the laboratory and examined the re¬
tocol was devised in which a telepathic
search protocol, concluding that it was too
transmitter would interact with a research
tight to permit unconscious cueing or con¬
participant who would then enter a sound¬
scious deceit on the night of the experi¬
proof sleep room for the night, with elec¬
ment, the only possibilities for chicanery
trodes attached so that periods of rapid
being on the part of staff members who
eye movement (REM) sleep could be
could have altered the transcripts before
479
each
transcript-target
combination.
480
|
Parapsychology and Dreams
sending them to the judges or on the part of
Ullman experiments and those done else¬
those statisticians who analyzed the data.
where (principally in British university set¬
As a result, the transcribers were advised
tings with participants who stayed at home
to keep duplicate copies of the transcripts
and were awakened at random intervals by
should an investigation be called for, and
telephone) C. Roe and S. Sherwood (2009)
the analysis was assigned to outside stat¬
concluded that “combined effect size esti¬
isticians who were not members of the
mates for both sets of studies suggest that
laboratory staff.
judges could correctly identify target ma¬
Several attempted replications were car¬
terials more often than would be expected
ried out by investigators in other laborato¬
by chance, using dream reports” (p. 211).
ries. Many well-known dream researchers
They also reported a significant difference
initiated these studies, including I. Strauch
between the two datasets; the results favor¬
and D. Foulkes, who obtained negative re¬
ing those carried out at Ullman’s laboratory.
sults; C. Hall, who reported positive results
One psychic claimant participated in
(but with data too sparse to permit statisti¬
two eight-night studies in which he at¬
cal analysis); and G. Globus, who reported
tempted to dream about a target that would
ambiguous results. After examining the
be randomly selected once he awoke; a phenomenon referred to as precognition by parapsychologists; both studies produced significant results but no attempt was made to repeat them in other laboratories. Critics of this body of work cite the lack of replicability. However, S. Krippner (2007) and his associates conducted ret¬ rospective studies indicating a correspon¬ dence between putative telepathic and precognitive dream reports and geomag¬ netic activity, specifically low sunspot activity and electrical storms while par¬ ticipants were dreaming. Hence, if future studies yield greater replicability, and if they are executed under conditions that rule out coincidence, sensory cueing, sta¬ tistical artifacts, and fraud, these data sug¬ gest that there are biological capacities for unusual behaviors that may be sensitive to
Moonchild by Dierdre Luzwick symbolizes what parapsychologists suspect is the hidden tele¬ pathic entanglement of people who, on the surface, seem to be cut off from others. (Repro¬ duced from the original art of Dierdre Luzwick)
geomagnetic activity, bringing these para¬ psychology-derived data closer to similar environment-brain interactions already re¬ ported in mainstream science. Stanley C. Krippner
Parasomnias and Nocturnal Frontal Lobe Epilepsy
|
References
(always or often) is 1 to 11 percent. The ae-
Friedman, H.L., & Krippner, S. (2010). Edi¬ tors’ epilogue: Is it time for a detente? In S. Krippner & H. L. Friedman (Eds.), De¬ bating psychic experience: Human poten¬ tial or human illusion? (pp. 195-204). Santa Barbara, CA: Praeger.
tiopathogenesis remains unknown, but an
Krippner, S. (2007). Anomalous experiences and dreams. In D. Barrett & P. McNamara (Eds.), The new science of dreaming (Vol. 2, pp. 285-306). Westport, CT: Praeger. Rhine, J. B., Pratt, J. G., Stuart, C. E., Smith, B. M., & Greenwood, J. A. (1966). Extra¬ sensory perception after sixty years. Bos¬ ton: Bruce Humphries. Roe, C. A., & Sherwood, S. J. (2009). Evidence for extra-sensory perception in dream con¬ tent: A review of experimental studies. In S. Krippner & D.J. Ellis (Eds.), Perchance to dream: The frontiers of dream psychology (pp. 211-238). New York: Nova Science. Ullman, M., Krippner, S., & Vaughan, A. (1973). Dream telepathy. London: Turn¬ stone Books.
underlying impairment of arousal mecha¬ nisms triggering dissociation between the motor component of the awake state and EEG electrical activity (i.e., dissociated state) has been postulated (Mahowald & Schenck, 2005). Nocturnal frontal lobe epilepsy (NFLE) is a partial epilepsy in which seizures, characterized by complex, often bizarre, motor behavior or sustained dystonic posture, occur almost exclusively during sleep (non-REM sleep in 97% of cases). The clinical spectrum of nocturnal frontal lobe seizures (NFLS) comprises distinct paroxysmal sleep-related attacks of vari¬ able semiology, intensity, and duration, representing different aspects of the same epileptic condition (Tinuper & Lugaresi, 2002) (see Table 4). Seizures have a re¬ markable interindividual stereotyped se¬ miology. Due to the rarity of this condition, epidemiological data are lacking. Onset is
Parasomnias and Nocturnal Frontal Lobe Epilepsy Table 3: Parasomnias According to ICSD-2 Parasomnias are defined as “clinical dis¬ orders that are not abnormalities of the processes responsible for sleep and awake states per se but are undesirable physical phenomena that occur predominantly dur¬ ing sleep” (American Academy of Sleep Medicine, 2005). Parasomnias, compris¬ ing a dozen clinical features, are divided into three groups (see Table 3). With the exception of REM behavior disorder, pa¬ rasomnias usually occur during childhood, more often \yith episodic recurrence, but
Arousal disorders Confusional arousals Sleep terrors Sleepwalking
Parasomnias usually associated with REM sleep Nightmares REM behavior disorder Sleep paralysis
Other parasomnias Sleep enuresis
onset or persistence during adulthood is
Source: Adapted from ASDA & American
not rare. The prevalence in the population
Academy of Sleep Medicine (2005).
481
482
|
Parasomnias and Nocturnal Frontal Lobe Epilepsy
mainly during adolescence and males are
is named autosomal dominant NFLE.
more frequently affected. Neurological
Mutations in genes coding for the alfa4,
and neuropsychological examinations and
alfa2, and beta2 subunits of the neuronal
neuroradiological findings are normal in
nicotinic acetylcholine receptor have been
86 percent of cases and interictal and even
identified, confirming genetic heterogene¬
ictal EEG fails to disclose epileptiform ab¬
ity (Marini & Guerrini, 2007).
normalities in half of the patients. Carba-
Since the first description in 1981, the
mazepine completely abolishes NFLS or
problem of the differential diagnosis be¬
gives remarkable relief in two thirds of pa¬
tween NFLS, parasomnias, and pseudosei¬
tients, whereas the seizures prove resistant
zures has been debated (see Table 5). The
to any antiepileptic drug treatment in the
difficulty in differential diagnosis between
remainder (Provini et al., 1999).
NFLE and parasomnias is hampered by the
NFLE is a syndromic entity that in¬
possible coexistence in NFLE patients or
cludes both sporadic and familial cases. In
their relatives of nocturnal parasomnic at¬
familial cases, NFLS recur in an autoso¬
tacks. We recently documented by a large
mal dominant manner and this condition
case-control study a higher frequency of
Table 4: Clinical Features of Nocturnal frontal Lobe Seizures (NFLS) and The Most Common Parasomnias Hypermotor seizures Body movements that can start in the limbs, head, or trunk Complex, often violent behavior Often with a dystonic-dyskinetic component Sometimes with cycling or rocking or repetitive body movements Prevalent in the trunk or legs The patient may vocalize, scream, or swear Fear is a frequent expression Asymmetric, bilateral tonic seizures Sustained non-customary forced position Paroxysmal arousals Bilateral and axial involvement resembling a sudden arousal Opening of the eyes Sitting up in bed Sometimes frightened expression Epileptic wanderings Same beginning as above Semi-purposeful ambulatory behavior Mimicking sleepwalking Source: Tinuper et al. (2007).
Parasomnias and Nocturnal Frontal Lobe Epilepsy
|
arousal parasomnias not only in patients
complex genetic component may be shared
with NFLE but also in their relatives, sug-
by parasomnias and NFLE causing an im-
gesting an abnormal, possibly cholinergic,
pairment in the pathway controlling phys-
arousal system as the common physiopath-
iological arousal. Prospective studies on
ological substrate (Bisulli et ah, 2010). A
children with parasomnias are needed to
Table 5: Clinical Features of Nocturnal frontal Lobe Seizures (NFLS) and The Most Common Parasomnias Disorders of arousal
Nightmares
RBD
NFLS
3-8
Usually 3-6
After 50
Any age
Either
Either
Male
Male
predominance
predominance
Age at onset (years) Gender
+
+
-
+
Spontaneous evolution
Tend to disappear
Tend to disappear
Rare spontaneous remission
Increased
Episodes / month
Sporadic
Sporadic
Almost every night
Almost every night
Occurrence during
First third
Last third
At least 90 minutes
Any time
Family history of parasomnias
after sleep onset
the night Sleep stage onset of episodes Triggering factors
frequency?
NREM sleep (st. 3-4)
REM sleep
REM sleep
NREM (mainly st. 2) +/-
++ ++ (sleep deprivation, (stress, traumatic febrile illness)
events)
Episodes / night
Usually one
Usually one
From one to several
Several
Episodes duration
1-10 minutes
3-30 minutes
1-2 minutes
seconds to 3 minutes
-
-
-
+
+++
+
-
++(+)
Impaired
Normal
Normal
Normal
No
Yes
Yes
Inconstant
Stereotypic motor pattern Autonomic discharge Consciousness if awakened Recall of the episode on awakening Source: Tinuper et al. (2007).
483
484
|
Parasomnias and Nocturnal Frontal Lobe Epilepsy
clarify the long-term evolution of these
References
sleep disturbances and verify the percentage
American Academy of Sleep Medicine. (2005). The international classification of sleep dis¬ orders: Diagnostic and coding manual (2nd ed., Ed. ASDA). Westchester, IL: American Academy of Sleep Medicine.
of subjects subsequently developing NFLE. Another crucial clinical point is the semeiological overlap between NFLS and parasomnias. Whereas some ictal fea¬ tures of NFLS seem to be typical of the mesial frontal epileptic zones (asymmet¬ ric tonic posturing), others are hard to confine to a specific cortical frontal area and are quite similar to parasomnic be¬ havior. Furthermore, dystonic-dyskinetic elements suggest an ictal involvement of subcortical structures. Therefore the ictal cortical discharges may not be confined to the orbitofrontal regions but disinhibit other cortical (deep temporal) or subcor¬ tical structures and provoke primitive be¬ haviors (Tassinari, Gardella, Meletti, and Rubboli, 2003). Irrespective of the nature of the causal trigger the complex motor semiology characterizing NFLS and some parasomnias is the same and consists in the activation of repetitive motor patterns related to the activation of central pattern generators. Invasive studies using deep im¬ planted electrodes in drug-resistant NFLE patients could clarify this point. Even though many aspects of parasom¬ nias and NFLE have been clarified in the last two decades, the problem of differen¬ tial diagnosis remains a challenge for cli¬ nicians. The difficulties in distinguishing nocturnal epileptic seizures from parasom¬ nias reflect just one aspect of the intriguing issue of the pathophysiological relation¬ ships between all types of paroxysmal motor behaviors during sleep. Francesca Bisulli and Paolo Tinuper See also: entries related to Sleep Disorders
Bisulli, F., Vignatelli, L., Naldi, I., Licchetta, L., Provini, F., Plazzi, G., . . . Tinuper, P. (2010, April). Increased frequency of arousal parasomnias in families with noctur¬ nal frontal lobe epilepsy: A common mecha¬ nism? Epilepsia, 51(9), 1852-1860. Mahowald, M.W., & Schenck, C.H. (2005). Insights from studying human sleep disor¬ ders. Nature, 43, 1279-1285. Marini, C., & Guerrini, R. (2007). The role of the nicotinic acetylcholine receptors in sleep-related epilepsy. Biochemical Phar¬ macology, 74, 1308-1314. Provini, F., Plazzi, G., Tinuper, P., Vandi, S., Lugaresi, E., & Montagna, P. (1999). Noc¬ turnal frontal lobe epilepsy: A clinical and polygraphic overview of 100 consecutive cases. Brain, 122, 1017-1031. Scheffer, I.E., Bhatia, K. P., Lopes-Cendes, I., Fish, D. R., Marsden, C. D., Andermann, F., Andermann, E., et al. (1994, February 26). Autosomal dominant frontal epilepsy misdi¬ agnosed as sleep disorder (Review). Lancet, 343(8896), 515-517. Tassinari, C.A., Gardella, E., Meletti, S., & Rubboli, G. (2003). The neuroethological interpretation of motor behaviours in “nocturnal-hyperkynetic-frontal-seizures”: Emergence of “innate” motor behaviours and role of central pattern generators. In A. Beaumanoir, F. Andermann, P. Chauvel, L. Mira, & B. Zifkin (Eds.), Frontal lobe sei¬ zures and epilepsies in children (pp. 43-45). New Barnet, UK: B„ John Libbey. Tinuper, P., & Lugaresi, E. (2002). The con¬ cept of paroxysmal nocturnal dystonia. In C. W. Bazil, B. A. Malow, & M. R. Sammaritano (Eds.), Sleep and epilepsy: The clini¬ cal spectrum (pp. 277-282). New York: Elsevier Science.
Partial Sleep Deprivation
Tinuper, P., et al. (2007). Disorders in sleep: Guidelines for differentiating epileptic from non-epileptic motor phenomena aris¬ ing from sleep. Sleep Medicine Reviews, 11, 255-267. Tinuper, P., et al. (2010). Familial frontal lobe epilepsy and its relationship with other nocturnal paroxysmal events. Epilepsia, 57(Suppl. 1), 51-53.
|
Sleep Deprivation”) except that they are generally milder when the partial sleep loss is for only one to two nights. How¬ ever, chronic partial sleep deprivation that allowed four hours of sleep per night for two weeks resulted in cognitive deficits that were of the same magnitude as those seen after one to two nights of total sleep deprivation. Data also suggest that chronic partial sleep deprivation can have cumula¬ tive or stress-related effects that can differ
Partial Sleep Deprivation
from findings after a short period of total sleep deprivation.
Sleep deprivation refers to having wake¬
Studies have shown that adults are signif¬
fulness that is extended beyond the 16
icantly more sleepy, as measured by falling
hours that is considered a normal day.
asleep more rapidly in naps, after only one
Acute sleep deprivation refers to a single
night with time in bed reduced from eight to
episode of reduced sleep (see the entry
six hours. Sleepiness on the following day
“Acute Sleep Deprivation”). Partial sleep
increases as time in bed decreases. Sleepi¬
deprivation refers to a reduction in total
ness also becomes more apparent as con¬
sleep rather than complete deprivation of
secutive nights of reduced sleep increase.
sleep. The amount of partial sleep loss
One large study found that performance on
can vary from just getting up an hour ear¬
a reaction time task, a memory task, and
lier than normal to many nights with total
a math task was consistently decreased
sleep reduced to four hours or less. Most
after sleep had been restricted to four or
research with partial sleep deprivation has
six hours for several nights. Both time to
examined changes in function after one or
react and the number of very slow or absent
two nights with total sleep reduced to four
responses (called lapses in attention) were
or six hours. Understanding partial sleep
increased. Such data suggest some over¬
loss is important because questionnaires
all cognitive slowing and increases in mi¬
have suggested that 15 percent of normal
crosleeps, .5- to 10-second periods of loss
adults sleep less than six hours per night
of attention where external awareness is
on weekday nights and therefore suffer
briefly lost. These cognitive and response
from some amount of partial sleep depri¬
speed changes suggest that partial sleep de¬
vation on a weekly basis.
privation could also have a negative impact on driving. A study has shown that there
Behavioral Effects
is an increased incidence of sleep-related motor vehicle crashes in drivers sleeping
The general effects of partial sleep depri¬
less than seven hours per night. Empirical
vation are similar to those seen after acute
studies have shown decreased driving abil¬
sleep deprivation (see the entry “Acute
ity in driving simulators after one night of
485
486
|
Partial Sleep Deprivation
sleep reduced to two hours or with sleep
than a short sleep requirement. However,
chronically reduced to four or six hours.
studies have shown that there is an increased mortality risk for individuals reporting less
Physiological Effects of Partial Sleep Deprivation
than six hours of sleep per night. Similarly, an increased risk of coronary events was found in women sleeping seven hours per
A number of physiological changes be¬
night or less in one study and with individu¬
come apparent during partial sleep depri¬
als sleeping less than five hours per night in
vation. For example, subjects allowed three
another study. Sleeping less than five hours
or five hours in bed for seven nights had
per night has also been associated with an
more slow eye movements (consistent with
increased risk of hypertension.
early signs of sleep onset) and an increased latency to pupil constriction. An increase in slow EEG frequencies, often associated
Individual Differences
with sleep onset or sleep, and a decrease in
It is known that some individuals are con¬
higher EEG frequency alpha activity, as¬
sistently more sensitive to the loss of even
sociated with wakefulness, was also found
small amounts of sleep while others are not
in subjects with sleep reduced to four or six
impaired by greater loss of sleep. How¬
hours per night for several nights.
ever, these differences are not always ap¬
Studies of partial sleep deprivation have suggested that sleep restriction to four
parent to the individual and have not been related to other variables at this time.
hours per night for six nights may result in increased sympathetic activation, de¬ creased glucose tolerance, and increased risk of inflammation (as measured by Creactive protein). Other studies of immune function have shown some decrease in im¬ mune function. One study showed that the antibody response to an influenza vaccina¬ tion was decreased by more than 50 percent 10 days after a vaccination that followed six nights of sleep restricted to four hours per night. Responses were the same three to four weeks later, but the results imply that partial sleep deprivation could alter acute immune responses. A number of studies have shown negative health consequences associated with short
Recovery Sleep is all that is needed to reverse the negative effects of partial sleep depriva¬ tion in humans. Partial sleep deprivation typically results in a disproportionate re¬ duction in REM sleep because individu¬ als typically have much more REM sleep near the end of their sleep period (which is cut off during partial sleep deprivation). As a result, recovery sleep after partial sleep deprivation is typically character¬ ized by an increase in total sleep time with a particular increase in REM sleep called REM rebound. Michael H. Bonnet
habitual sleep durations, although it is not always clear that short sleep durations re¬
See also: Acute Sleep Deprivation; entries re¬
flect chronic partial sleep deprivation rather
lated to Sleep Physiology
Phasic Ponto-Geniculo-Occipital/Pontine Wave (PGO/P-Wave)
References Ayas, N.T., White, D.P., Manson, J.E., Stampfer, M.J., Speizer, F. E., Malhotra, A., & Hu, F. B. (2003). A prospective study of sleep duration and coronary heart disease in women. Archives of Internal Medicine, 163(2), 205-209. Banks, S., & Dinges, D.F. (2010). Chronic sleep deprivation. In M. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and prac¬ tice of sleep medicine. Philadelphia, PA: Saunders.
|
Phasic Ponto-GeniculoOccipital/Pontine Wave (PGO/P-Wave) Prominent phasic events of REM sleep are field potentials in the pontine tegmentum, which begin just prior to the onset of REM sleep and continue through its duration (Datta, 1997, 2010). These field potentials have been recorded in both the lateral ge¬ niculate body (LGB) and the occipital cor¬
Gangwisch, J.E., Heymsfield, S.B., BodenAlbala, B., Buijs, R. M., Kreier, F., Opler, M.G., . . . Malaspina, D. (2008). Sleep du¬ ration associated with mortality in elderly, but not middle-aged, adults in a large US sample. Sleep, 31, 1087-1096.
tex of the cat. Since, in the cat, these field
Philip, P., Sagaspe, P., Taillard, J., Valtat, C., Moore, N., Akerstedt, T., . . . Bioulac, B. (2005). Fatigue, sleepiness, and perfor¬ mance in simulated versus real driving con¬ ditions. Sleep, 28(12), 1511-1516.
tent of the thalamus and cortex. However,
Rosenthal, L., Roehrs, T.A., Rosen, A., & Roth, T. (1993). Level of sleepiness and total sleep time following various time in bed conditions. Sleep, 16, 226-232. Spiegel, K., Sheridan, J.F., & Van Cauter, E. (2002). Effect of sleep deprivation on response to immunization. Journal of the American Medical Association, 288, 1471-1472. Van Dongen, H.P.A., Maislin, G., Mullington, J.M., & Dinges, D.F. (2003). The cumula¬ tive cost of additional wakefulness: Doseresponse effects on neurobehavioral func¬ tions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep, 26, 117-126.
potentials originate in the pons (P) and then propagate to the geniculate (G) and occipital cortex (O), they are called PGO waves. PGO waves in the cat could also be recorded at points throughout the ex¬ such PGO waves reach their highest am¬ plitude in the LGB, primary visual cortex, and association visual cortex. In addition to the pons, thalamus, and cortex, phasic potentials have been recorded in both the oculomotor nuclei and the cerebellum of the cat. Phasic potentials of pontine origin have also been recorded in the amygdala, cingulate gyrus, and hippocampus, sug¬ gesting that PGO waves also occur in the limbic system. More importantly, mapping techniques have demonstrated that (for the cat at least) the pons is the primary site of origin for PGO-wave activity. PGO waves have also been documented and studied in other mammalian species, including non¬ human primates, humans, and rodents. In nonhuman primates, PGO-wave-like pha¬ sic field potentials have been recorded
Vgontzas, A. N., Liao, D., Bixler, E. O., Chrousos, G.P., & Vela-Bueno, A. (2009). In¬ somnia with- objective short sleep duration is associated with a high risk for hyperten¬ sion. Sleep, 32, 491-497.
from the LGB and pons of macaques and in the LGB of baboons. In humans, phasic potentials have been recorded in the striate cortex during REM sleep. Such striate field
487
488
|
Phasic Ponto-Genicuio-Occipital/Pontine Wave (PGO/P-Wave)
potentials are probably cortical compo¬
sleep and are independent of eye move¬
nents of state-specific phasic potentials of
ment; conversely, clusters of PGO waves
pontine origin. PGO waves have also been
(Type II waves) are associated with eye-
recorded in the human pons during and im¬
movement bursts and are typically indic¬
mediately before REM sleep. In rats, initial
ative of REM sleep. Type II PGO-wave
attempts to record potentials in the LGB,
activity accounts for 55 to 65 percent of the
based on PGO-wave recordings in the
total number of PGO waves recorded dur¬
cat, were unsuccessful. Subsequent stud¬
ing REM sleep (Datta & Patterson, 2003).
ies have recorded PGO-like waves in the
Since PGO/P-wave activity always pre¬
pons of the rat that are equivalent to those
cedes REM sleep, several investigators
in the pons of the cat. The initial failures
have proposed that PGO/P-wave mech¬
indicated that state-specific pontine phasic
anisms are causally linked to the cellu¬
waves in rats do not excite LGB neurons in
lar and molecular mechanisms for both
a way that could produce geniculate com¬
the triggering and regulation of the total
ponents of PGO waves. More recently, the
amount of REM sleep. In addition to REM-
absence of PGO-wave-like activity in the
sleep induction, PGO/P-waves have also
rat LGB has shown to be due to the lack
been implicated in several other important
of afferent inputs from P-wave-generating
brain functions such as sensorimotor inte¬
cells to the LGB (Datta, Siwek, Patterson,
gration, learning and memory, dreaming,
& Cipolloni, 1998). This field potential in
self-organization, development of the vi¬
the rat is therefore called a P-wave, since
sual system, and startle responses (Datta,
it does not activate the geniculate nucleus.
1997, 2010; Morrison & Bowker, 1975).
The waveform, amplitude, and fre¬
Although several functional roles for PGO/
quency characteristics of PGO waves re¬
P-wave activity have been proposed, other
corded from the pons, geniculate, and
than memory consolidation these functions
occipital cortex have been most intensively
remain mostly correlative.
examined in the cat (Datta, 1997; Datta &
Utilizing
chemical
microstimulation,
MacLean, 2007). PGO waves are biphasic
cell-specific lesions, and single-cell re¬
in shape with a duration of 60 to 120 mil¬
cording techniques, the PGO/P-wave gen¬
liseconds and an amplitude between 200
erator in the cat was localized within the
and 300 microvolts. The P-wave in the rat
caudolateral-peribrachial
is equivalent to the pontine component of
(Datta, 1997; Datta & MacLean, 2007).
the PGO wave in the cat, with similar dura¬
Subsequently, using similar experimen¬
tion (75-100 milliseconds) and amplitude
tal techniques to those used in the cat, the
(100-150 microvolts). PGO/P-waves dur¬
P-wave generator in the rat was localized
ing REM sleep can occur as a singlet or
within the dorsal part of the subcoeru-
as clusters containing a variable number
leus nucleus (Datta, 2006; Datta & Patter¬
of waves (three to five waves per burst)
son, 2003). In humans, as in the cat, the
at a density range of 30 to 60 spikes/min¬
PGO/P-wave generator is located in the
ute. Singlet PGO/P-waves, known as Type
C-PBL area. Immunohistochemical iden¬
I waves, occur commonly in non-REM
tification of cholinergic and glutamatergic
(C-PBL)
area
Phasic Ponto-Geniculo-Occipital/Pontine Wave (PGO/P-Wave)
|
cell types in the brainstem indicates that
the predatory mammalian (such as the cat
PGO/P-wave-generating cells in the cat
and human) PGO-wave generator is farther
are capable of synthesizing both acetyl¬
from the LC and instead close to the PPT.
choline and glutamate, and thus these
Since predators rarely face the threat of
cells could be labeled as both cholinergic
predation, there is no advantage to having
and glutamatergic; whereas in the rat, P-
a quick arousal response to any nonthreat¬
wave-generating cells have been identi¬
ening type of noise during REM sleep.
fied by specific monoclonal antibodies as
Furthermore, frequent interruptions could
glutamatergic, but not cholinergic (Datta,
actually harm a predatory animal by pre¬
2006). These P-wave-generating neurons
venting the necessary regenerative func¬
project to the hippocampus, amygdala, en-
tions of REM sleep. Thus, for these types
torhinal cortex, and many other regions of
of noises, the P-wave generator signals the
the brain known to be involved in cogni¬
cholinergic PPT to intensify REM sleep
tive processing. The PGO/P-wave genera¬
rather than wake the animal up by activat¬
tor in both the cat and rat receives afferent
ing the LC.
projections from the raphe nucleus and nu¬
It has been demonstrated that choliner¬
cleus locus coeruleus (LC). These P-wave-
gic activation of the PGO/P-wave genera¬
generating glutamatergic neurons remain
tor increases glutamate release in the dorsal
silent during wakefulness and slow-wave
hippocampus (DH). In addition, P-wave
sleep (SWS), but during the transition
activity has been shown to have a positive
from SWS to REM sleep and throughout
influence on hippocampal theta-wave ac¬
REM sleep these neurons discharge high-
tivity in the DH. Most recently, it has been
frequency spike bursts in the background
demonstrated that the activation of these
of tonically increased firing rates (Datta,
P-wave-generating neurons increases glu¬
2006; Datta & Elobson, 1994).
tamate release and activates postsynaptic
Since the P-wave generator is also in¬
N-Methyl-D-aspartate (NMDA) receptors
volved in sensorimotor integration, the
in the DH. Activation of P-wave-generat¬
differences in the anatomical location and
ing neurons increases phosphorylation of
neurotransmitter identity of the P-wave
the transcription factor cAMP response el¬
generator between the rat and cat may pro¬
ement binding protein (CREB) in the DH
vide a species-specific advantage (Datta,
and amygdala by activating intracellular
2006). Specifically, in prey animals (i.e.,
protein kinase A (PKA). The P-wave-
the rat), the P-wave generator is anatom¬
generating neurons activation-dependent
ically closer to the LC. This shorter dis¬
PKA-CREB
tance is advantageous during REM sleep
the expression of activity-regulated cyto-
(when animals are naturally paralyzed due
skeletal-associated protein (Arc), brain-
to muscle atonia) because it permits quick
derived nerve growth factor (BDNF), and
communication with the LC for flight re¬
early growth response-1 (Egr-1) genes in
sponse, and facilitates escape from preda-
the DH and amygdala. The P-wave genera¬
tors. This rapid flight response is vital for
tor activation-induced increased activation
the survival of prey animals. In contrast,
of PKA and expression of pCREB, Arc,
phosphorylation
increases
489
490
|
Philosophy of Mind and Dream Characters
BDNF, and Egr-1 in the DH are shown
movements. Journal of Neurophysiology,
to be necessary for REM-sleep-dependent
71, 95-109.
memory processing (Datta, Li, & Auer¬ bach, 2008). These findings are significant because they provide the most direct evi¬ dence to substantiate the idea that P-wave generator activation during post-training REM sleep is critical for REM-sleepdependent memory processing. Although the functions of PGO/P-waves remain a mystery in neuroscience, ongoing re¬ search on their generation and functions is very promising. Hopefully in the near fu¬ ture, a complete and detailed mechanism for the regulation of PGO/P-wave genera¬ tor activity will be discovered, which will then be vital to unraveling the functions of PGO/P-wave activity. Subimal Datta See also: entries related to Sleep Physiology
Note This work is supported by the U.S. National Institutes of Health Research grants NS34004 and MH59839.
References Datta, S. (1997). Cellular basis of pontine ponto-geniculo-occipital wave generation and modulation. Cellular and Molecular Neurobiology, 17, 341-365. Datta, S. (2006). Activation of phasic pontinewave generator: A mechanism for sleepdependent memory processing. Sleep and Biological Rhythms, 4, 16-26. Datta, S. (2010). Sleep: Learning and memory. G. F. Koob, M. Le Moal, & R. F. Thompson (Eds.), Encyclopedia of behavioral neuro¬ science (Vol. 3, pp. 218-226). Oxford: Aca¬ demic Press. Datta, S., & Hobson, J. A. (1994). Neuronal ac¬ tivity in the caudo-lateral peribrachial pons: Relationship to PGO waves and rapid eye
Datta, S., Li, G., & Auerbach, S. (2008). Ac¬ tivation of phasic pontine-wave generator in the rat: A mechanism for expression of plasticity-related genes and proteins in the dorsal hippocampus and amygdala. European Journal of Neuroscience, 27, 1876-1892. Datta, S., & MacLean, R.R. (2007). Neurobiological mechanisms for the regulation of mammalian sleep-wake behavior: Reinter¬ pretation of historical evidence and inclu¬ sion of contemporary cellular and molecular evidence. Neuroscience and Biobehavioural Reviews, 31, 775-824. Datta, S., & Patterson, E.H. (2003). Activation of phasic pontine wave (P-wave): A mecha¬ nism of learning and memory processing. In J. Maquet, R. Stickgold, & C. Smith (Eds.), Sleep and brain plasticity (pp. 135-156). Oxford: Oxford University Press. Datta, S., Siwek, D.F., Patterson, E. H., & Cipolloni, P.B. (1998). Localization of pon¬ tine PGO wave generation sites and their anatomical projections in the rat. Synapse, 30, 409^423. Morrison, A.R., & Bowker, R.M. (1975). The biological significance of PGO spikes in the sleeping cat. Acta Neurobiologiae Experimentalis, 35, 821-840.
Philosophy of Mind and Dream Characters How should we regard the characters that appear in dreams? Are they mere inven¬ tions of the mind of the dreamer? Or are they something more than that? To what extent do they exhibit full-fledged criteria of mind and agency? If they do satisfy cri¬ teria of the mental, do they then deserve some sort of moral status as well? To what extent can we accord them the status of the
Philosophy of Mind and Dream Characters
|
real? Perhaps they are best treated as we
recurring dream series and in dream series
do characters in a novel or a movie. Are
that occur across a single night when they
they simply creatures of the imagination?
appear to remember previous interactions
We will see that this option is not open for
with the dreamer and adjust their behavior
characters in dreams and thus their onto¬
accordingly. Characters can either be de¬
logical status remains undecided.
picted quite realistically or they can simply
Philosophers claim that a person is de¬
just be known to be present. This feature of
fined as a being who is capable of rea¬
dream characters indicates that the dream
soning, who displays intentionality and
ego is using theory of mind skills to cog¬
emotion, who is self-conscious, and who
nize the presence and intentions of other
has an identity that persists through time.
dream characters.
Surprisingly, there is evidence that ei¬
A substantial proportion (between 25%
ther the dreamer (dream ego) or other
and 48% depending on definitions) of male
dream characters display these criteria for
characters is unknown or unfamiliar to the
mentality.
dreamer (Hall & Van de Castle, 1966;
Besides the dreamer himself, dream
Kahn, Pace-Schott, & Hobson, 2002). In
characters appear in more than 95 percent
an early study of more than 1,000 dreams,
of adult reports of dreams (Hall & Van de
Hall (1963) reported (1) that strangers in
Castle, 1966). In children, dream characters
dreams were most often males; (2) that ag¬
involve people, animals, and unusual be¬
gressive encounters were more likely to
ings like monsters and spirits. In adults, the
occur in interaction with an unknown male
same range of characters appear but with
than with an unknown female or a familiar
a reduction in the frequency with which
male or female; and (3) that unknown males
animals appear. For most adults, the aver¬
appeared more frequently in dreams of
age number of characters in every dream
males than of females. Using the Hall-Van
in addition to the dream ego is between
de Castle system, Domhoff (1996) looked
three and four (Hall, 1951; Kahn, Stick-
at the role of enemies in dreams. Enemies
gold, Pace-Schott, & Hobson, 2000). Male
were defined as those dream characters
characters slightly predominate in wom¬
who typically interacted (greater than 60%
en’s dreams and definitely predominate in
of the cases) with the dreamer in an aggres¬
men’s dreams. Belying the common con¬
sive manner. Those enemies turned out to
ception of dreams as bizarre, dream char¬
be male strangers and animals. Interactions
acters are only very rarely (only 14% of all
with female strangers are predominantly
instances) depicted in any kind of a bizarre
friendly in the dreams of both males and fe¬
manner. Dream characters also show stay¬
males. Domhoff (2003) more recently has
ing power across dream episodes (Foulkes
shown that when male strangers appear in
& Schmidt, 1983)—they are not fleeting
a dream, the likelihood that physical ag¬
inventions of the mind. They change and
gression will occur in that dream far ex¬
grow in way^ appropriate to the narra¬
ceeds what would be expected on the basis
tive of the dream series they are appear¬
of chance. In short, male strangers signal
ing in. Dream characters can reappear in
physical aggression. This is an extremely
491
492
|
Philosophy of Mind and Dream Characters
important result of research on dream con¬
exchanges have repeatedly been demon¬
tent, as it suggests that dream characters
strated to be syntactically well-formed ut¬
may encode selected emotional signals
terances that were entirely appropriate to
in rule-governed ways, thus pointing to a
the dream context.
mental operation whereby characters em¬ body intense emotional charge.
In summary, dream characters seem to be fully imagined or fully realized persons.
While menacing strangers are certainly
They have minds, intentions, desires, and
emotionally compelling, other dream char¬
emotions that operate independently of the
acters that are not strangers can be as well.
will of the dreamer. They may even have
We have all experienced the reappearance
memories. To underline the autonomous
of a loved one in a dream. Whether the
character of dream characters consider the
loved one was lost simply due to breakup
fact that dream characters not only think
or separation or via death, the reappearance
in ways that are totally independent of
in the dream can be startlingly real. In the
the will of the dream ego or dreamer, but
case of bereavement, vivid images of the
they also act in ways that are totally in¬
deceased may persist for years in dreams
dependent of the will of the dreamer. As
(Cookson, 1990). When the loved one ap¬
mentioned previously, dream characters
pears in dreams, there is a tendency to want
appear to initiate emotional encounters
to stay in the dream world and not wake up.
with the dream ego, whether the dream
These sorts of dreams feel like visitations
ego likes it or not. Indeed, some dream
more than fleeting impressions. They are
characters will touch, push, or attack the
experienced as communications from the
dreamer—in ways the dreamer dislikes,
loved one. In this case, the dream charac¬
fears, or hates—events that the dreamer
ter comes alive and temporarily revives the
clearly does not want to happen. When
emotional life of the bereaved—such is the
the dreamer is under attack from some
power of dream characters.
other character, the dreamer never wishes
What do characters (other than the
it were so. Instead, the dreamer does ev¬
dreamer himself) do in dreams? Generally
erything he or she can to flee the aggres¬
speaking, they engage in social interac¬
sion. Aggression against the dreamer is
tions of various kinds. About 68.2 percent
also quite common, at least in dreams that
of aggressive actions and 52 percent of
come from the REM sleep state. If we take
friendly interactions are initiated by other
a very common dream theme such as the
characters. When the dreamer is the initia¬
dreamer being chased by a male stranger
tor of an interaction, most aggressive inter¬
who intends to hurt the dreamer, we will
actions occur in REM dreams and friendly
see that attribution of intentional states and
interactions occur in NREM dreams (Mc¬
other mental states to the dream character
Namara, McLaren, Smith, Brown, & Stick-
does occur as a normal part of the dream¬
gold, 2005; McNamara et al., 2010).
ing process. Fifty-nine percent of the time
Interactions between the dreamer and an¬
the intention of the attacker is known to
other character very often involve conver¬
the dreamer, and 75 percent of the time the
sation or thought exchanges. These verbal
dream ego does nothing to cause or incite
Philosophy of Mind and Dream Characters
|
the attack (Hall, 1955). The character who
emotionally
is chasing the dreamer clearly satisfies cri¬
characters we meet in waking life are
teria for possessing mind or consciousness.
not. Whatever the philosophical status of
He can manipulate his attention. Indeed, he
dream characters as full-fledged men¬
keeps his eye on the dreamer and can ad¬
tal agents, our ancestors certainly treated
just his chase route to catch the dreamer
them as such. It may even be said that
as she attempts to lose him. The stranger
dream characters were just as important
also evidences will and volition when he
emotionally to persons in those days as
intends his target and adjusts his actions to
were other waking characters.
get his target. The stranger also evidences
compelling in
ways
that
Patrick McNamara
awareness of subjective experiences when his rage levels change as a function of the
References
chase. His mood changes from menacing
Cookson, K. (1990). Dreams and death: An ex¬ ploration of the literature. Omega Journal of Death and Dying, 21, 259-281.
and hate-filled rage to malicious delight and satisfaction when the target is about to be caught. Now all of these consider¬ ations concerning the mental status of the stranger character in a dream also apply, except more strongly to the case of the
Domhoff, G.W. (1996). Finding meaning in dreams: A quantitative approach. New York: Plenum. Domhoff, G.W. (2003). The scientific study of dreams: Neural networks, cognitive devel¬
dreamer herself. The dreamer is a charac¬
opment, and content analysis. Washington,
ter in the dream too. She intends to escape.
DC: American Psychological Association.
She plans and adjusts her behavior accord¬ ingly. She has internal subjective expe¬ riences of fear, terror, relief, or despair, depending on the outcome of the chase. In addition, she can also access memories that attest to her persisting identity across time periods and beyond the current dream epi¬ sode. In lucid dreams, where the dreamer is aware that she is dreaming, other charac¬ ters in the dream demonstrate a striking in¬ dependence of mind and feeling, as well as separate perspectives and knowledge not available to the dreamer (Tholey, 1989). In short, dream characters, both the dreamer and other characters within a dream, appear to satisfy some of the most stringent criteria philosophers have pro¬ duced for mind, agency, or personhood. Dream characters
act as
independent
agents in dreams. They are sometimes
Foulkes, D., & Schmidt, M. (1983). Temporal sequence and unit composition in dream re¬ ports from different stages of sleep. Sleep, 6, 265-280. Hall, C. (1963). Strangers in dreams: An empir¬ ical confirmation of the Oedipus complex. Journal of Personality, 31, 336-345. Hall, C., & Van de Castle, R.I. (1966). The content analysis of dreams. New York: Appleton-Century-Crofts. Hall, C.S. (1951). What people dream about. Scientific American, 184, 60-63. Hall, C.S. (1955). The significance of the dream of being attacked. Journal of Per¬ sonality, 24, 168-180. Kahn, D., Pace-Schott, E., & Hobson, J.A. (2002). Emotion and cognition: Feeling and character identification in dreaming. Con¬ sciousness and Cognition, 11, 34-50. Kahn, D., Stickgold, R., Pace-Schott, E.F., & Hobson, J.A. (2000). Dreaming and wak¬ ing consciousness: A character recognition
493
494
|
Photography and Dreams
study.
Journal
of Sleep
Research,
9,
317-325.
From the beginning, an expressive ap¬ proach to image making has woven through
McNamara, P., Andresen, J., Clark, J., Zborowski, M., & Duffy, C.A. (2001). Im¬ pact of attachment styles on dream recall and dream content: A test of the attachment hypothesis of REM sleep. Journal of Sleep Research, 10, 117-127.
the history of photography as an alterna¬
McNamara, P., Johnson, P., McLaren, D., Harris, E., Beauharnais, C., & Auerbach, S. (2010). REM and NREM sleep mentation.
their interest in dreams and synchronistic
International Review of Neurobiology, 92,
69-86. McNamara, P., McLaren, D., Smith, D., Brown, A., & Stickgold, R. (2005). A “Jekyll and Hyde” within: Aggressive versus friendly interactions in REM and non-REM dreams. Psychological Science, 16, 130-136. Merritt, J.M., Stickgold, R., Pace-Schott, E., Williams, J., & Hobson, J. A. (1994). Emo¬ tion profiles in the dreams of men and women. Consciousness and Cognition, 3, 46-60. Tholey, P. (1989). Consciousness and abilities of dream characters observed during lucid dreaming. Perceptual and Motor Skills, 68, 567-578.
tive to documentary photography, and this has included dream imagery. In the 1930s, the surrealists in Paris developed a style of street photography that reflected experiences. In 1941, Bill Brandt, a Brit¬ ish documentary photographer who had briefly been an assistant to Man Ray, pub¬ lished a dream sequence, “Nightwalk: A Dream Phantasy in Photographs,” in Coro¬ net. In the 1950s and 1960s, Minor White,
an influential teacher and founder of the journal Aperture developed an approach to photography as spiritual practice that em¬ phasized exploring inner states by captur¬ ing their equivalents in the physical world. But it was in the 1960s and 1970s that dream imagery became an explicit genre in photography, through the work of early pi¬ oneers such as Jerry Uelsmann (who stud¬ ied with White), Ralph Gibson, and Arthur Tress. Uelsmann’s (1982) work was sem¬ inal; although not about dreams, his use
Photography and Dreams
of multiple enlargers to create complex, dreamlike montages offered an alternative
The use of photography as a medium for
to documentary photography by showing
dream imagery seems paradoxical. Pho¬
that powerful photographic images could
tography is a recording medium; the pho¬
be created in the darkroom.
tographic image captures patterns of light
Photographers have developed different
reflected off objects in the physical world.
strategies for working with dream imag¬
The dream is a subjective experience.
ery. Ralph Gibson shoots straight photog¬
Since dreaming is not an experience of the
raphy, but the dreamy quality of his work
physical world, it would seem an unlikely,
is enhanced in the darkroom through a
if not impossible, subject matter for pho¬
grainy, high contrast look. At the other
tography. Yet artists working in this me¬
end of the spectrum, Uelsmann’s com¬
dium argue that it is precisely the implied
plex method of creating montages in the
verity of the photograph that gives photo¬
darkroom has been succeeded by the dig¬
graphic dream images their power.
ital composite, a form being explored by
Phylogenetic Comparative Methods and Sleep
|
many contemporary photographers, in¬
brainwaves known as slow-wave activity
cluding his wife, Maggie Taylor. In the
(non-REM or NREM sleep). To obtain data
1970s, Ralph Eugene Meatyard and Les
on sleep in different species, researchers
Krims staged dreamlike tableaus which
typically take an experimental approach in
they then photographed, an approach later
which they use electroencephalograms to
used by Anders Aabel to create images
quantify the relative amounts of REM and
from his own dreams. Arthur Tress, and
NREM sleep. From these studies, we have
later Wendy Ewald, interviewed children
learned much about individual differences
about their dreams and enlisted their help
in sleep; the cyclicity of sleep between
in staging and photographing their dream
these two states; and sleep in relation to
images. Duane Michals stages scenes and
disease, life history events, and external
then creates narrative sequences of photo¬
stimuli.
graphic images that tell dreamlike stories. Richard A. Russo
Imagine that we take the data from many different studies of REM and NREM, ag¬ gregate the data into means for the different
References
species, and systematically examine varia¬
Aabel, A., & Knarvik, J. C. (2002). Somnia: En bok om drommer. Oslo: Schibsted. Ewald, W. (2000). Secret games: Collabora¬ tive works with children 1969-1999. Zur¬ ich: Scalo Publishers.
tion in sleep characteristics across species (Allison & Cicchetti, 1976; Zepelin & Rechtschaffen, 1974). From such a compara¬ tive approach, we gain new insights to the
Gibson, R. (1970). The Somnambulist. New York: Lustrum Press.
evolution of sleep that are not possible with
Meatyard, R.E. (1974). Ralph Eugene Meatyard (Ed. with text by J. B. Hall). Millerton, NY: Aperture.
ative approach has long been the corner¬
Michals, D. (1984). Sleep and dream. New York: Lustrum Press.
way to understand general evolutionary
Tress, A. (1972). The dream collector. New York: Avon Books. Uelsmann, J. (1982). Jerry N.
Uelsmann:
Twenty-five years a retrospective (Ed. J. L.
Enyeart). New York: Little, Brown.
studies of individual species. The compar¬ stone of efforts to understand biological diversity because comparison provides a patterns and to test specific hypotheses. More recently, biologists have devel¬ oped statistically rigorous ways to investi¬ gate the evolution of traits on evolutionary trees (Harvey & Pagel, 1991; Martins, 1996; Nunn, 2011). These phylogenetic comparative methods have revolutionized
Phylogenetic Comparative Methods and Sleep
our understanding of evolution and greatly expanded the questions that can be ad¬ dressed. With these methods, for example,
Sleep in mammals and birds occurs in
researchers can investigate how two traits
two physiologically distinct states: active
covary through evolutionary time (corre¬
sleep involves .desynchronized brain states
lated evolution), they can make inferences
and rapid eye movements (REM sleep),
about the evolutionary history of a trait
while quiet sleep involves synchronized
(reconstruct ancestral states), and they can
495
496
|
Phylogenetic Comparative Methods and Sleep
examine how the evolution of a trait has in¬
demonstrated several interesting patterns
fluenced subsequent patterns of speciation
in mammals, including that basal meta¬
and extinction (diversification analysis).
bolic rate and predation risk at the sleep
To appreciate these methods, it is impor¬
site correlate negatively with sleep quotas
tant to understand that the history of life on
(Capellini et al., 2008; Lesku, Roth, Am-
earth can be represented as an evolutionary
laner, & Lima, 2006), and white blood cell
tree, or phytogeny, where the branches rep¬
counts and sleep quotas show a positive
resent lineages of organisms through time,
association (Preston et al., 2009). Results
and the nodes represent speciation events
involving brain size have produced mixed
in which a lineage is separated into two or
results (Capellini et al., 2008; Capellini, Mc¬
more descendent lineages. Two species
Namara, Preston, Nunn, & Barton, 2009;
that share a more recent common ancestor
Lesku et al., 2006), suggesting that cogni¬
are more closely related. More closely re¬
tive factors are not a primary driver of vari¬
lated species also tend to have more similar
ation in sleep architecture. In birds, greater
trait values, that is, the traits show phyloge¬
exposure to predation was shown to reduce
netic signal (Blomberg & Garland, 2002).
slow-wave sleep durations (Roth, Lesku,
Such effects can be seen on a phylogeny,
Amlaner, & Lima, 2006).
with more closely related species having
In terms of reconstructing ancestral states,
more similar sleep characteristics (see Ca¬
the methods again make use of phylogenetic
pellini, Barton, McNamara, Preston, &
signal, and a critical issue involves quanti¬
Nunn, 2008; Preston, Capelleni, McNa¬
fying the statistical confidence we can place
mara, Barton, & Nunn, 2009).
in particular reconstructions. For example,
Researchers interested in sleep have
instead of simply putting a value at an inter¬
used phylogenetic methods to investi¬
nal node on the tree, recent methods allow
gate correlated evolution and ancestral
evolutionary biologists to assess the proba¬
sleep states in mammals, birds, and other
bility of a particular character state (such as
animals (Lesku, Roth, Rattenborg, Am-
presence of REM sleep), or to put a 95 per¬
laner, & Lima, 2009; McNamara, Barton,
cent confidence interval on a quantitative
& Nunn, 2010). In studies of correlated
measure of sleep (such as the duration of
evolution, the methods overcome an im¬
REM sleep). Reconstruction methods have
portant statistical issue—the nonindepen¬
been used less commonly to study sleep.
dence of data points—and provide a way
In one recent example, Nunn et al. (2010)
to estimate the degree of phylogenetic sig¬
used Bayesian methods to estimate that the
nal in the data. When phylogenetic signal
ancestral primate slept for 11.3 hours per
exists, it indicates that different lineages
night, with a 95 percent confidence inter¬
have evolved independently yet still retain
val ranging from 9.4 to 13.4 hours. In this
some variation through common ancestry.
context, it is interesting that the typical
This pattern also means that it is important
human sleep duration of around 8.5 hours
to take phylogenetic history into account
lies outside this confidence interval. In the
when analyzing comparative data. Studies
future, ancestral state reconstructions could
that used phylogeny-based methods have
be used to investigate broader evolutionary
Phylogeny of Sleep
patterns of sleep characteristics, including a formal test for the independent evolution of REM sleep in mammals and birds (Rattenborg & Amlaner, 2010). Charles Nunn
References Allison, T., & Cicchetti, D. V. (1976). Sleep in mammals—Ecological and constitutional correlates. Science, 194, 732-734. Blomberg, S.P., & Garland, T. (2002). Tempo and mode in evolution: Phylogenetic inertia, adaptation and comparative methods. Jour¬ nal of Evolutionary Biology, 15, 899-910. Capellini, I., Barton, R.A., McNamara, P., Preston, B., & Nunn, C.L. (2008). Ecology and evolution of mammalian sleep. Evolu¬ tion, 62, 1764-1776. Capellini, I., McNamara, P., Preston, B., Nunn, C., & Barton, R. (2009). Does sleep play a role in memory consolidation? A compara¬ tive test. PLoS ONE, 4. Harvey, P. H„ & Pagel, M. D. (1991). The com¬
|
Nunn, C., McNamara, P., Capellini, I., & Bar¬ ton, R. (2010). Primate sleep in comparative perspective. In C. Nunn, P. McNamara, & R. Barton (Eds.), Evolutionary and phylo¬ genetic perspectives on sleep (pp. 123-144). Cambridge: Cambridge University press. Preston, B.T., Capelleni, I., McNamara, P., Barton, R.A., & Nunn, C.L. (2009). Para¬ site resistance and the adaptive significance of sleep. BMC Evolutionary Biology, 9. Rattenborg, N.C., & Amlaner, C.J. (2010). A bird’s-eye view of the function of sleep. In P. McNamara, R. Barton, & C. Nunn (Eds.), Evolution of sleep: Phylogenetic and func¬ tional perspectives. Cambridge: Cambridge
University Press. Roth, T. C., Lesku, J.A., Amlaner, C.J., & Lima, S.L. (2006). A phylogenetic analysis of the correlates of sleep in birds. Journal of Sleep Research, 15, 395M02. Zepelin, H., & Rechtschaffen, A. (1974). Mammalian sleep, longevity, and energy metabolism. Brain Behavior and Evolution, 10, 425M70.
parative method in evolutionary biology.
Oxford: Oxford University Press. Lesku, J., Roth, T., Rattenborg, N., Amlaner, C., & Lima, S. (2009). History and future of comparative analyses in sleep research. Neuroscience and Biobehavioral Reviews, 33, 1024-1036.
Lesku, J.A., Roth II, T. C., Amlaner, C.J., & Lima, S.L. (2006). A phylogenetic analysis of sleep architecture in mammals: The intergration of anatomy, physiology, and ecol¬ ogy. The American Naturalist, 168, 1-13.
Phylogeny of Sleep Sleep and sleep-like rest have been de¬ scribed in several vertebrates and inverte¬ brates (Cirelli & Tononi, 2008; McNamara, Barton, & Nunn, 2010; Siegel, 2008). The evolution of sleep, however, has been studied mostly in mammals where data for several species are available. In placen¬
Martins, E. P. (Ed.). (1996). Phylogenies and
tal and marsupial mammals and in birds
the comparative method in animal behavior.
sleep is composed by two distinct neuro¬
New York: Oxford University Press.
physiological states, a rapid eye movement
McNamara, P., Barton, R., & Nunn, C. (2010). Evolution of sleep: Phylogenetic and func¬ tional perspectives. Cambridge: Cambridge
University Press. Nunn, C. L. (2011). The comparative approach
(REM) sleep, and a non-REM (NREM) sleep. During a sleep cycle, episodes of NREM sleep are followed by episodes of REM sleep, and several REM-NREM
in evolutionary anthropology and biology.
sleep cycles are repeated throughout
Chicago: University of Chicago Press.
a bout of sleep. Monotremes—echidna
497
498
|
Phylogeny of Sleep
platy¬
or polyphasic when two or more sleep
anatinus)—have
bouts are alternated with bouts of activ¬
NREM sleep and some signs of REM
ity (Capellini et al., 2010; McNamara
sleep, while there is currently no convinc¬ ing evidence of REM-like sleep in reptiles
et al., 2008). This diversity in mammalian sleep pat¬
(McNamara, Nunn, Barton, Elarris, & Ca¬
terns is not randomly distributed with re¬
pellini, 2007). Therefore it is still unclear
spect to phylogeny. Conversely, closely
whether REM sleep evolved from a mixed
related species sharing recent common an¬
REM-NREM sleep state of early reptiles
cestors exhibit strong similarities in sleep
or it evolved independently in mammals
times (Capellini, Barton, McNamara, Pres¬
and birds. Aquatic mammals and birds can
ton, & Nunn, 2008a; see Figure 16).
('Tachyglossus
pus
aculeatus)
(Ornithorhynchus
and
also sleep unihemispherically, with uni-
Thus, like all biological traits, mam¬
hemispheric NREM sleep being obligatory
malian sleep patterns are shaped by the
only in cetaceans (Rattenborg, Amlaner, &
evolutionary history of the species—with
Lima, 2000).
closely related species being more similar
Mammals
and birds
exhibit great
to one another than expected by chance—
variation in sleep patterns. This in¬
and natural selection. Natural selection
cludes differences among species in
promotes sleep because of its adaptive
the daily REM- and NREM-sleep dura¬
benefits but constrains time for sleep be¬
tions, REM-NREM sleep-cycle length,
cause of its ecological costs (Capellini
and in how sleep is accommodated in
et al., 2010). Ultimately, natural selec¬
the 24 hours (e.g., the number and du¬
tion leads to divergence in sleep patterns
ration of daily sleep bouts, the phasing
between species when these are under
of sleep). Mammalian total daily sleep
different selective pressures, but also de¬
time, as sum of REM- and NREM-sleep
termines convergence when analogous
durations, varies between 3 to 4 hours
selective pressures act on different spe¬
in ungulates and 20 hours in armadil¬
cies, leading to similar sleep patterns to
los (Chaetophractus villosus), with an REM-NREM sleep cycle ranging from
evolve independently in distantly related species.
6 minutes in the chinchilla (Chinchilla
Hypotheses on the benefits of sleep for
laniger) to 90 minutes in humans and
the brain are abundant, such as consolidat¬
chimpanzees {Pan troglodytes) (Cape¬
ing memories, promoting brain develop¬
llini, Preston, McNamara, Barton, &
ment, maintenance, or repair, but support
Nunn, 2010; McNamara, et al. 2008).
for these ideas is mixed (Siegel, 2001,
Unlike mammals, birds have very short
2005; Stickgold, 2005; Zepelin, Siegel, &
episodes of REM sleep, generally lasting
Tobler, 2005). Contrary to suggestions that
less than 10 seconds (Rattenborg & Am¬
a major function of NREM sleep in mam¬
laner, 2010). The phasing of sleep can
mals and birds is energy conservation, be¬
be monophasic when all sleep is consol¬
cause of their great energetic expenditure
idated into one daily bout, or biphasic
to maintain a high metabolic rate and body
Phylogeny of Sleep
|
Male ibex (Capra ibex) sleeping in Gran Paradiso National Park (Italy). Artiodactyls, like the ibex, sleep the least among all mammals. (Roberta Pedrotti)
temperature (Berger & Phillips, 1995), re¬
mammals that evolved longer sleep times
cent studies have found that species with
have higher immunity levels and lower in¬
higher energy requirements have the short¬
fection levels (Preston, Capellini, McNa¬
est—not the longest—sleep durations (Ca¬
mara, Barton, & Nunn, 2009).
pellini et ah, 2008a; Lesku, Roth, Amlaner,
Beyond parasites, other ecological fac¬
& Lima, 2006). Indeed the amount of energy
tors influence sleep evolution. Sleeping
saved during sleep appears to be negligible
individuals are more vulnerable to preda¬
(Stahel, Megirian, & Nicol, 1984). There
tion because sleep is accompanied by re¬
is instead growing evidence that sleep pro¬
duced responsiveness to external stimuli
motes immunocompetence. Not only does
(Lima, Rattenborg, Lesku, & Amlaner,
sleep facilitate an immune response in in¬
2005). High predation risk promotes the
dividuals challenged by parasitic infections
evolution of short sleep durations in mam¬
(Bryant, Trinder, & Curtis, 2004), but also
mals and birds; thus species that sleep in
499
Total daily sleep duration (hrs) NREM sleep REM sleep
Erinaceus europaeus
Eutamias sibiricus Spermophilus lateralis Spermophilus tridicemlineatus Spermophilus parryi
Phodopus sungorus Dicrostonyx torquatus Neotomodon alstoni -
\
.
a-~r~ ezz LI
-I
'
4
- ! ..
-r——r Siqmodon hispidus
~~r. Bradypus tridactylus
|
Dasypus novemcinctus Chaetophractus villosus Priodontes maximus
Tenrec ecaudatus Didelphis marsupialis Lutreolina crassicaudata Trichosurus vulpecola Potorous tridactylus
Figure 16: Closely related species sharing a more recent common ancestor exhibit more similar sleep times than more distantly related species. Thus, sleep durations are not randomly distributed with respect to phytogeny. For example, all macaques (genus Macaca) sleep for about 8 to 9 hours a day, with approximately 1 hour REM sleep, while more distantly related primates, such as lemurs, sleep 10 to 15 hours a day (From McNamara et al. [2010], Reprinted with permission.)
Phylogeny of Sleep
|
forage frequently in small mammals, char¬ acterized by relatively high energetic re¬ quirements for their size and limited fat reserves, might also be responsible for the evolution of polyphasic sleep and short REM-NREM sleep cycles in these species (Capellini et al., 2008b). There¬ fore polyphasic sleep is mostly found in small mammals, while monophasic sleep evolved in association with a medium to large body size (see Figure 17; Capellini et al., 2008b). Body size is instead unre¬ lated to sleep durations in both mammals and birds (Capellini et al., 2008a; Lesku et al., 2006; Roth et al., 2006). Finally, the distribution of resources in the en¬ vironment can potentially influence the Red panda (Ailurus fulgens) sleeping on a bam¬ boo roof in a Paris zoo. Red pandas are solitary
evolution of sleep. For example, when food resources and sleeping sites are dis¬
and are active during the night, dawn, and dusk.
tant from one another, monophasic sleep
Their sleep pattern has not been studied yet. (Isa¬
and shorter sleep durations should evolve
bella Capellini)
to save time for traveling between sites (Acerbi, McNamara, & Nunn, 2008).
exposed sites, such as the ground in open
Whether shorter sleep times are evolu¬
grassland, sleep less than species that sleep
tionary compensated by increases in sleep
in protected sites, such as tree holes or dens
intensity is still an open question. However,
(Capellini et al., 2008a; Lesku et al., 2006;
monophasic sleep, characterized by longer
Roth, Lesku, Amlaner, & Lima, 2006).
sleep cycles, might deliver the benefits
However, predation risk does not explain
of sleep more efficiently than polyphasic
species differences in phasing of sleep and
sleep with its shorter sleep cycles (Ca¬
REM-NREM sleep-cycle length (Capel¬
pellini et al., 2008b). Longer sleep cycles
lini, Nunn, McNamara, Preston, & Barton,
probably reduce the total daily sleep time
2008b). Because time for sleep is detracted
because they limit the total time in tran¬
to other important activities, such as rear¬
sitional sleep stages needed to enter deep
ing offspring, sleep should be associated
NREM sleep (see Figure 18). Indeed, mono¬
with opportunity costs. Mammals that
phasic sleep, which evolved from polypha¬
need to spend much time foraging, such
sic sleep (see Figure 17), is associated with
as those with high energetic requirements
shorter sleep durations, and might represent
or herbivorous diet, or social species that
an evolutionary advantage of larger-bodied
need time for social interactions, sleep less
species (Capellini et al., 2008b).
(Capellini et al., 2008a). The necessity to
Isabella Capellini
501
Giraffa Camelopardalis Bos taurus Ovis aries Sus scrofa Equus asinus Equus caballus Mustela putorius furo Canis familiaris Vulpes vulpes Panthera tigris Felis catus Erinaceus eropaeus Condylura cristata Scalopus aquaticus Mus musculus Rattus norvegicus Meriones unguiculatus Mesocricetus auratus Phodpus sungorus Cricetomys gambianus Nannospatax ehrenbergi Octodon degus Chinchilla lanigera Cavia porcellus Aplodontia rufa Eutamias sibiricus Tamias striatus Spermophilus lateralis Spermophilus tridicemlineatus Spermophilus parryi Spermophilus undulatus Oryctolagus cuniculus Tupaia glis Petterus macaco Microcebus murinus Callithrix jacchus Saimiri sciureus Aotus trivirgatus Macaca mulatta Macaca arctoides Macaca nemestrina Papio anubis Papio papio Theropithecus gelada Pan troglodytes Bradypus tridactylus Choloepus hoffmanni Dasypus novemcintus Heterohyrax brucei Procavia johnstoni Elephas maximus Loxodonta africana Potorous tridactylus Didelphis marsupialis Tachyglossus aculeatus Ornithorhynchus anatinus
Figure 17: Evolutionary History of Phasing of Sleep (Maximum Likelihood Reconstruction). Polyphasic sleep (black) is strongly supported as the ancestral character state in mammals, while monophasic sleep (white) has independently evolved multiple times in medium- and large-bodied mammals. (From McNamara et al. [2010]. Reprinted with permission.)
Phylogeny of Sleep
|
Total sleep
(a)
(b)
=
10
Figure 18: Longer Sleep Cycles Require Less Time in Transitional Sleep Stages, Ultimately Leading to a Reduction in Total Daily Sleep Time. In (a) a hypothetical species sleeping nine units of time in deep sleep (darker shade), needs 3 units of time in transitional sleep (one per unit of deep sleep; lighter shade) when the total deep sleep is partitioned in three blocks; this leads to a total of 12 units of sleep. Conversely, in (b) only 1 unit of time in transitional sleep is needed if all the deep sleep is consolidated into one block, leading to a total of 10 units of sleep. Thus monophasic sleep, that is associated with longer sleep cycles and shorter daily sleep time, might deliver the benefits of sleep more efficiently than polyphasic sleep. (Redrawn from Capellini et al. [2010]. Reprinted with permission.)
References Acerbi, A., McNamara, P., & Nunn, C.L. (2008). To sleep or not to sleep: The ecol¬ ogy of sleep in artificial organisms. BMC Evolutionary Biology, 8, 10. Berger, R.J., & Phillips, N. H. (1995). Energy conservation and sleep. Behavioral Brain Research, 69, 65-73. Bryant, P.A., Trinder, J., & Curtis, N. (2004). Sick and tired: Does sleep have a vital role in the immune system? Nature Reviews Im¬ munology, 4, 457-467. Capellini, I., Barton, R. A., McNamara, P., Preston, B.T., & Nunn, C.L. (2008a). Phy¬ logenetic analysis of the ecology and evo¬ lution of mammalian sleep. Evolution, 62, 1764-1776. Capellini, I., Nunn, C.L., McNamara, P., Pres¬ ton, B.T., & Barton, R.A. (2008b). Ener¬ getic constraints, not predation, influence the evolution of sleep patterning in mam¬ mals. Functional Ecology, 22, 847-853. Capellini, I., Preston, B.T., McNamara, P., Barton, R. A., & Nunn, C.L. (2010). Eco¬ logical constraints on mammalian sleep ar¬ chitecture. In P. McNamara, R. A. Barton, & C.L. Nunn (Eds.), Phylogeny of sleep
(pp. 12-33). Cambridge: Cambridge Uni¬ versity Press. Cirelli, C., & Tononi, G. (2008). Is sleep essen¬ tial? PLoS Biology, 6, 1605-1611. Lesku, J.A., Roth, T. C., Amlaner, C.J., & Lima, S.L. (2006). A phylogenetic analysis of sleep architecture in mammals: The in¬ tegration of anatomy, physiology and ecol¬ ogy. American Naturalist, 168, 441^153. Lima, S.L., Rattenborg, N.C., Lesku, J.A., & Amlaner, C.J. (2005). Sleeping under the risk of predation. Animal Behaviour, 70, 723-736. McNamara, P., Barton, R.A., & Nunn, C.L. (Eds). (2010). Evolution of sleep. Cam¬ bridge: Cambridge University Press. McNamara, P., Capellini, I., Harris, E., Nunn, C.L., Barton, R.A., & Preston, B. (2008). The phylogeny of sleep database: A new re¬ source for sleep scientists. The Open Sleep Journal, 1, 11-14. McNamara, P., Nunn, C. L., Barton, R. A., Har¬ ris, E., & Capellini, I. (2007). Phylogeny of sleep and dreams. In D. Barrett & P. McNa¬ mara (Eds.), The new science of dreaming: Biological aspects (pp. 12-22). Westport, CT: Praeger.
503
504
|
Phylogeny of Sleep Database
Preston, B.T., Capellini, I., McNamara, P., Barton, R. A, & Nunn, C.L. (2009). Para¬ site resistance and the adaptive significance of sleep. BMC Evolutionary Biology, 9, 7. Rattenborg, C.N., & Amlaner, C.J. (2010). A bird’s-eye view of the function of sleep. In P. McNamara, R.A. Barton, & C.L. Nunn (Eds.), Phylogeny of sleep (pp. 145-171). Cambridge: Cambridge University Press. Rattenborg, C. N., Amlaner, C. J., & Lima, S. L. (2000). Behavioral, neurophysiological and evolutionary perspectives on unihemispheric sleep. Neuroscience and Biobehavioral Reviews, 24, 817-842. Roth, T. C., Lesku, J. A., Amlaner, C.J., & Lima, S.L. (2006). A phylogenetic analysis of the correlates of sleep in birds. Journal of Sleep Research, 15, 395^102.
data on sleep expression in as many species as possible. Early comparative databases on sleep durations in mammals contained only about 40 or so species and the quality of some of the data points was question¬ able. The largest database on comparative sleep patterns constructed to date is prob¬ ably the database housed at Boston Uni¬ versity and known as “The phylogeny of sleep” database. It is accessible online at www.bu.edu/phylogeny. This Web site provides background on the database it¬ self, hypotheses regarding the evolution of sleep expression and functions, details on how the database was constructed, and a portal to search the latest version of the
Siegel, J.M. (2001). The REM-sleep mem¬ ory-consolidation hypothesis. Science, 294, 1058-1063.
database. If the database is ever transferred
Siegel, J.M. (2005). Clues to the function of mammalian sleep. Nature, 437, 1264-1271.
will be provided.
Siegel, J.M. (2008). Do all animals sleep? Trends in neuroscience, 31, 208-213.
Sleep database was constructed with sup¬
Stahel, C.D., Megirian, D., & Nicol, S.C. (1984). Sleep and metabolic rate in the lit¬ tle penguin (Eudyptula minor). Journal of
from Boston University to some other lo¬ cation, forwarding links and information The current version of the Phylogeny of port from the National Institute of Mental health and contains sleep quotas retrieved from 178 separate literature references rep¬
Comparative Physiology B: Biochemical,
resenting 130 different mammalian species
Systemic and Environmental Physiology,
in 50 families and 17 orders. Sleep quotas
154, 487-494.
refer to sleep durations of the two major
Stickgold, R. (2005). Sleep-dependent memory consolidation. Nature, 437, 1272-1278.
phases of mammalian sleep: rapid eye
Zepelin. H., Siegel, J.M., & Tobler, I. (2005). Mammalian sleep. In M.H. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and practices of sleep medicine. New York: Saunders.
In addition to containing data on sleep
movement or REM sleep and non-REM sleep. for the largest number of species ever as¬ sembled the data in the database are also scored for quality. Previous comparative datasets did not score their data for qual¬
Phylogeny of Sleep Database
ity indices, such as whether the data were collected from restrained animals, the du¬
One way to study potential functions of
ration of recording, or the availability of
sleep as well as the evolutionary history of
food and water during observations. These
sleep is to construct databases that contain
experimental procedures likely impact the
Phylogeny of Sleep Database
|
estimates of REM- and NREM-sleep dura¬
fur seals) and Phocidae (true seals), show
tions as studies of selected species’ sleep
both unihemispheric and bihemispheric
in the wild versus in the lab have shown.
forms of sleep. Phocids sleep under water
Luckily most studies of sleep expression
(obviously holding their breath), and both
in animals published since 1953—the year
hemispheres exhibit either REM or SWS.
REM was discovered—did in fact provide
Amazonian Manatees (Trichechus inun¬
detailed descriptions of the methods under
guis) also sleep while under water exhibit¬
which sleep data were gathered.
ing three sleep states: bihemispheric REM,
Data for the Phylogeny of Sleep database
bihemispheric SWS, and unihemispheric
were obtained from previous data compi¬
SWS. Both hemispheres awaken to sur¬
lations, as well as an exhaustive literature
face and breathe. A further complication
search dating back to 1953, to gather new
of sleep expression in these animals is that
data. Key terms used in literature searches
some facultatively adjust their sleep pat¬
were REM, NREM, sleep architecture,
terns when sleeping on land. Thus to fully
EEG, and total sleep time. Searches were
capture daily sleep quotas in these animals
conducted within bibliographic databases
one would want to record sleep times for
that cover publications in English, French,
both REM and NREM in both the right and
Russian, German, and Spanish. Whenever
left hemispheres on land and in the water.
possible, investigators recorded the sex
With respect to assessing and improv¬
and age of the individual animals whose
ing data quality in the Phylogeny of Sleep
sleep was measured, breaking down male
database, information was extracted on
and female values when possible.
the following laboratory conditions and
Although data on sleep of aquatic mam¬
experimental procedures from the original
mals are included in the database, extreme
sources:
caution should be used when analyzing this
•
Recording method (EEG). Whether sleep
data until a consensus emerges among ex¬
duration estimates were based on EEG re¬
perts on sleep in these animals as to how
cordings or not.
best to summarize sleep expression in
•
Telemetry (yes or no). Whether sleep dura¬
these animals. Members of three different
tion estimates were based on telemetric re¬
orders that contain aquatic mammals—
cordings in the wild.
cetaceans
(dolphins,
porpoises,
and
•
egorical three-state variable). Studies were
whales), carnivores (seals, sea lions, and
assigned to one of three categories: ■ / v
r3 . Ts
^V\^,^/^VsW^v-v
Ts * 01 *
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M f 1 ’ V'“vV\ / H v« V Asf'V/S.^' \''"V“k'. V',‘V','W,VAN
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Unihemispheric sleep in a bottlenose dolphin. Top row: Electroencephalogram (EEG) of the right (R) and left (L) cortical hemispheres during waking (A), right (B) and left (L) hemispheric slow-wave sleep. Middle row: Slow-wave activity (SWA, EEG power in the range of 1.2-4.0 Hz, 30 sec epochs) in the two hemispheres recorded over a period of 2 hours and 20 minutes showing episodes of unihemispheric sleep in the right and left hemispheres. EEG power was normalized as a percentage of the maximum power in each hemisphere during this period. Letters a, b, and c mark the time of polygrams expanded in the top row. Bottom row: The state of each dolphin eye (R, right; L, left) over the same period scored in real time (O, open; I, intermediate; or C, closed) and then categorized for 30-second epochs. Each mark represents one epoch. (Oleg Lyamin)
eye directed toward the mother is open
is open or in an intermediate state (95%
more often than the eye directed to the
to 98% of the observation time), while
opposite direction, suggesting that calves
the eye contralateral to the sleeping hemi¬
continue to maintain visual contact with
sphere was largely closed (40% to 60%). In
their mothers during sleep (Lyamin et al.,
contrast to terrestrial mammals, both eyes
2007). Studies on belugas and bottlenose
were rarely noted to be closed in dolphins
dolphins revealed that during USWS, the
and belugas (less than 2.0% of the observa¬
eye contralateral to the waking hemisphere
tion time). All these data provide support
663
664
|
Sleep in Aquatic Mammals
for the hypothesis that USWS in cetaceans
southern sea lion), five true seals (the gray
serves a sentinel function, specifically
seal, Caspian seal, harp seal, northern el¬
to scan at least half the environment for
ephant seal, harbor seal), and in the only
predators and to maintain coherence of the
leaving species of walruses.
group while asleep (Lyamin et al., 2004, 2008c).
Among the eared seals (fur seals and sea lions, the Otariidae family), sleep has been
The need to come to the surface to breathe
most extensively studied in the northern
is an obvious life sustaining requirement
fur seal (e.g., Lyamin et al., 2008b; Ly¬
for any aquatic mammal. Small-sized ce¬
amin & Mukhametov, 1998). When on
taceans (e.g., the harbor porpoise) main¬
land, fur seals predominately display bi¬
tain regular breathing when continuously
lateral SWS and REM sleep in the range
swimming and being asleep with respira¬
of normal variations. Both are typical for
tory pauses that rarely exceed 60 seconds
all terrestrial mammals. At the same time
in duration. Respiratory acts in dolphins
fur seals exhibit SWS with greatly ex¬
are fully compatible with uninterrupted
pressed interhemispheric EEG asymmetry
USWS; that is, they do not necessarily
(also called asymmetrical SWS), which re¬
cause arousal and behavioral awakening
sembles USWS in cetaceans. The propor¬
(Lyamin et al., 2008c). Larger cetaceans
tion of asymmetrical SWS while on land is
(e.g., the beluga) display long apneas (lon¬
minimal in 10- to 20-day-old fur seal pups
ger than 10 minutes) during sleep while
(on average 5% of the total SWS time) and
floating at the surface and submerging to
maximal in juveniles (45%). The degree
depth. It is known that barbiturates induce
of EEG asymmetry in fur seals greatly in¬
bilateral high-voltage SWS in dolphins,
creases when they sleep in water. At the
which immediately caused a cessation of
same time the amount of REM sleep sub¬
breathing. Diazepam (or valium) depend¬
stantially decreases (up to 90% of REM
ing on the dose induces either USWS or
sleep on land) and can be virtually absent
high-voltage bilateral SWS without a ces¬
for a period of one to two weeks. Another
sation of breathing. However, immedi¬
remarkable feature is striking motor asym¬
ately prior to each respiration the EEG
metry in fur seals when they are sleeping
amplitude in one or in both hemispheres
in water. They sleep at the surface on their
drops, so that dolphins enter the state of
sides, paddling with one foreflipper, while
either USWS or waking (Mukhametov &
holding the three other above the surface.
Polyakova, 1981). These data are con¬
The paddling flipper is always contralateral
sidered to support the idea that USWS is
to the waking hemisphere. This behavior
necessary for autonomic breathing in ceta¬
and sleep posture prevents heat loss while
ceans (Mukhametov, 1984).
fur seals are asleep in water. The last but
In contrast to fully aquatic cetaceans,
not the least is that fur seals can sleep with
pinnipeds live both on land and water. To
only one eye closed while the other eye
date, sleep has been examined in 10 species
briefly opens. Similar to that in dolphins,
of pinnipeds: four eared seals (the northern
the open eye is always contralateral to the
fur seal, Cape fur seal, Steller’s sea lion,
waking hemisphere while the closed eye
Sleep in Aquatic Mammals
|
is contralateral to the sleeping hemisphere.
Lyamin, Oleksenko, & Polyakova, 1993;
The association between USWS, motion,
Mukhametov, Supin, & Polyakova, 1984).
and brief opening of one eye suggests that
The majority of SWS recorded in the
USWS in fur seals serves (1) to maintain
only electrophysiologically examined wal¬
vigilance to detect predators and conspe-
rus was scored as bilateral SWS. When in
cifics as well as (2) to sustain motion and
water, sleep occurred while the walrus was
sleep posture to optimize thermoregula¬
floating motionless at the surface or lying
tion while asleep (Lyamin et al., 2004). As
on the bottom of the pool. Episodes of
in terrestrial mammals, the breathing pat¬
asymmetrical SWS were occasionally re¬
tern of fur seals during SWS is regular. In
corded both on land and in water and corre¬
REM sleep, breathing becomes irregular
lated with a brief one eye opening as in fur
but apneas rarely last longer than 30 sec¬
seals (Lyamin et al., 2008a). A behavioral
onds. The studies in other otariids revealed
study also revealed that walruses occa¬
largely a similar sleep pattern and sleep be¬
sionally become almost continuously ac¬
haviors as described for the northern fur
tive (80% to 99% of the time) for a period
seal (Pryaslova et al., 2009).
of three to four days which was followed
Regardless of if true seals (the Phocidae
by extended periods of rest lasting up to
family) sleep on land or in water, SWS in
19 hours. The breathing pattern in walruses
these animals is always bilateral, as in ter¬
was regular during quiet wakefulness and
restrial mammals. Individual REM-sleep
SWS while on land as in fur seals and it
episodes in phocids are shorter then in
was interrupted while in water with alter¬
otariids. They usually occur in series fol¬
nating apneas and ventilations as in eared
lowing SWS. In contrary to dolphins and
seals (Pryaslova et al., 2009). Therefore,
fur seals, there are no reports of asymmet¬
the pattern of sleep in the walrus appears
rical eye opening in sleeping true seals.
to be linked to the need to sleep while sub¬
Phocids can hold their breath for doz¬
merged as it is in phocids.
ens of minutes (in some species for one
In conclusion, the need to come to the
hour) while asleep. During SWS, sleep
surface to breathe, more efficient monitor¬
apneas alternate with periods of fast regu¬
ing of the environment, and thermogenesis
lar breathing. During REM sleep, breath¬
appear to be the main factors that have led
ing becomes sporadic and many episodes
to the evolution of the present sleep phe¬
occur within a single apnea. The sleep
nomenology in aquatic mammals. Sleep in
of phocids in water is also accompanied
water while in motion (cetaceans, fur seals)
by complete immobility but they usu¬
is one strategy. At these times sleep devel¬
ally wake up when surfacing to breathe.
ops unihemispherically, and it is USWS
Many phocids live in cold freezing seas
that allows motion (muscle thermogenesis
with limited access to the open water.
and postural thermoregulation) and asym¬
The ability to sleep during apneas mini¬
metrical eye opening (monitoring of the en¬
mizes time spent at the water surface. It
vironment). The second strategy of sleep in
is seen as a vital adaptive feature of the
water is to become apneac diving for sleep
phocid sleep (e.g., Castellini et al., 1994;
(bilateral SWS and REM) to depth or under
665
666
|
Sleep in Children with Cancer
ice (true seals and walruses), which would
Pinnipeds. Italian Archives of Biology, 142,
be the only way to survive in freezing seas
557-568.
as well as an efficient retreat from poten¬ tial predators. At the same time, the neuro¬ physiological mechanisms underlying the described aquatic mammal sleep phenom¬ enology are largely unknown. Oleg Lyamin
See also: entries related to Evolution of Sleep References Castellini, M. A., Milsom, W. K., Berger, R.J., et al. (1994). Patterns of respiration and heart rate during wakefulness and sleep in elephant seal pups. American Journal of Physiology, 266, R863-R869. Goley, P. D. (1999). Behavioral aspects of sleep in pacific white-sided dolphins (Lagenorhynchus obliquidens, Gill 1865). Marine Mammal Science, 15, 1054-1064. Lilly, J.C. (1964). Animals in aquatic envi¬ ronments: Adaptations of mammals to the ocean. In D. B. Dill (Ed.), Handbook of phys¬ iology—environment (pp. 741-747). Wash¬ ington, DC: American Physiology Society. Lyamin, O., Kosenko, P., Lapierre, J., et al. (2008c). Study of sleep in a walrus. Sleep, 31, A24. Lyamin, O. I., Lapierre, J.L., Kosenko, O.P., et al. (2008b). EEG asymmetry and spectral power in the fur seal. Journal of Sleep Re¬ search, 17, 154-165. Lyamin, O.I., Manger, P. R., Ridgway, S.H., et al. (2008a). Cetacean sleep: An unusual form of mammalian sleep. Neuroscience and Biobehavioral Review, 32, 1451-1484. Lyamin, O.I., & Mukhametov, L. M. (1998). Organization of sleep in the northern fur seal. In V.E. Sokolov, A. A. Aristov, & T. U. Lisitzina (Eds.), The northern fur seal: Systematic, morphology, ecology, behavior
Lyamin, O.I., Oleksenko, A. I., & Polyakova, I. G. (1993). Sleep in the harp seal (Pagophilus groenladnica). Peculiarities of sleep in pups during the first month of their lives. Journal of Sleep Research, 2, 163-169. Lyamin, O.I., Pryaslova, J., Kosenko, P.O., et al. (2007). Behavioral aspects of sleep in bottlenose dolphin mothers and their calves. Physiology and Behavior, 92, 725-733. Lyamin, O. I., Pryaslova, J., Lance, V., et al. (2005). Animal behaviour: Continuous ac¬ tivity in cetaceans after birth. Nature, 435, 1177. Lyamin, O.I., Shpak, O.V., Nazarenko, E. A., et al. (2002). Muscle jerks during behavioral sleep in a beluga whale (Delphinapterus leucas L.). Physiology and Behavior, 76, 265-270. Mukhametov, L. M. (1984). Sleep in marine mammals. Experimental Brain Research, 8, 227-238. Mukhametov, L.M., & Polyakova, I.G. (1981). EEG investigation of sleep in por¬ poises (Phocoena phocoena). Journal of High Nerve Activity, 31, 333-339. Mukhametov, L.M., Supin, A., & Polyakova, I. G. (1977). Interhemispheric asymmetry of the electroencephalographic sleep pattern in dolphins. Brain Research, 134, 581-584. Mukhametov, L. M., Supin, A., & Polyakova, I.G. (1984). Sleep in Caspian seals (Phoca caspica). Journal of High Nerve Activity, 34, 259-264. Pryaslova, J.P., Lyamin, O.I., & Siegel, J.M., et al. (2009). Behavioral sleep in the walrus. Behavioral Brain Research, 19, 80-87.
Sleep in Children with Cancer
(pp. 280-302), Moscow: Nauka. Lyamin, O.I., Mukhametov, L.M., & Siegel, J.M. (2004). Association between EEG asymmetry and eye state in Cetaceans and
Sleep is a fundamental biological process necessary for life and well-being that is woven into the fabric of our lives. Cancer
Sleep in Children with Cancer
|
disrupts this process. Cancer occurs in
respiratory control center and lead to sleep
about 15 per 100,000 children (Reis et al.,
disordered breathing. Injury to the hypo¬
2005). The most common childhood can¬
thalamus, thalamus, and brain stem may re¬
cers are leukemia and brain tumors, ac¬
sult in excessive daytime sleepiness (EDS).
counting for 27 and 22 percent of all
Brain trauma resulting in seizures may lead to sleep fragmentation causing EDS and un¬
childhood cancers. At present the overall survival rate for all childhood malignan¬ cies is 79 percent, which has led to a large
usual nocturnal awakenings. 2. Side effects of chemotherapy—dexamethasone in adolescent and young adults—often
population of children and young adults
leads to insomnia; in preadolescents dexa-
who are cancer survivors. However, neu¬
methasone may result in EDS (Hinds et al.,
rosurgery and the toxic therapies used to
2007).
successfully treat cancer result in a great
3. Fatigue
is
almost
universal
in
adults
deal of collateral damage, which together
and children with cancer (Ancoli-Israel,
are termed late effects, present in up to
Moore, & Jones, 2001). Fatigue often leads
75 percent of childhood cancer survivors.
to daytime napping and decreased daytime
Sleep problems are one of the least well-
activity, which in turn may disrupt the cir¬
recognized late effects of cancer treatment.
cadian sleep/wake rhythm causing both in¬ somnia and EDS.
The unique causes of sleep problems
4. Radiation therapy—radiation hypersomnia
seen in children with cancer relate to:
is seen in 60 percent of children treated with
1. Central nervous system (CNS) injury caused
>2400 cGray of CRT and typically appears
by brain tumors, neurosurgical procedures,
3 to 14 days after treatment. Though usu¬
or cranial radiation therapy (CRT). Injury
ally transient, increase in total sleep time
to the medulla oblongata may damage the
and persistent EDS are described in some
Table 6: Children with Cancer Seen in Sleep Clinic Children with cancer seen
Total # EDS/long N=
sleepers
Apnea
Insomnia
Circadian
Parasomnia
70% of total
42/70 (60%)
28/70 (40%)
17/70 (24%)
3/70 (4%)
6/70 (9%)
35
28/35
16/35
2/35
2/35
%
(80%)
(46%)
5/35 (14%)
(6%)
(6%)
Posterior fossa
7
6
2
2
0
1
Cortex
6
4
2
1
0
2
18
6/18 (33%)
7/18
1/18
1/18
%
4/18 (22%)
(39%)
(6%)
(6%)
4
0
2
2
0
0
in sleep clinic 1994-2009 Total
Tumors of central
48
nervous system Hypothalamus/brainstem
Leukemia/other blood Other solid tumors
667
668
|
Sleep in Children with Cancer
Table 7: Treatments of Sleep Problems in Children with Cancer (children may have more than one problem) Sleep problems
Anticonvulsants—3
Parasomnia N = 6 Seizures Confusional arousals Sleep eating Sleep disordered breathing N = 28 OSA At = 20
CSA A = 6
Hypoxia N = 2 EDS/long sleeper At = 42
Treatments
#
2
Clonazepam—1 Sleep extension/ sleep hygiene—1
1
Topiramate
1
Tracheotomy
8
CPAP/BIPAP
4
T&A No treatment (Al < 5) BIPAP + rate + 02 Tracheotomy + ventilator
3
7 1 1 1 2 1
Diaphramatic pacers
2
Oxygen
42 17 6 4 4 1 1 1
No treatment Anticonvulsants
Sleep hygiene and extension Methylphenidate Modafanil Amphetamine salts Declined stimulants Treatment of drug abuse CPAP anticonvulsants
Insomnia At = 17
9
Sleep hygiene and sleep restriction
3 3
Pain control Sedative hypnotics
2
Melatonin
Blindness
1
Melatonin + sleep hygiene
DSPS Irregular sleep/wake
1 1
Melatonin + sleep hygiene
Circadian rhythm At = 3
Sleep hygiene
T&A—tonsillectomy and adenoidectomy; OSA—obstructive sleep apnea; CSA—central sleep apnea; CPAP—continuous positive airway pressure; BIPAP—bilevel positive airway pressure; Al—apnea index; DSPS—delayed sleep-phase syndrome
individuals, though the mechanism is not understood. 5. Pain is common in children with cancer and often leads to sleep disruption.
6. Stress, anxiety, depression, posttraumatic stress disorder are all commonly described in children with cancer (Langeveld et al., 2004) and sleep problems, particularly
Sleep in Children with Cancer
|
insomnia, nightmares, and EDS may be sec¬
circadian-rhythm disorders) and are often
ondary symptoms of these conditions.
present in combinations. Children with can¬
7. Twenty-seven percent of cancer survivors
cers involving the CNS, particularly brain
have severe or life-threatening medical
stem, thalamus, and hypothalamus were
late effects, and 45 percent will have some chronic medical problems as a direct result of their cancer treatment (Oeffinger et al., 2006). Endocrine deficiencies of thyroid, cortisol, growth hormone, and vasopres¬
the most frequently referred for sleep eval¬ uation and the most commonly seen sleep problems were EDS and sleep disordered breathing. The unusual distribution of the
sin are common after CRT and may impact
types of cancers and types of sleep prob¬
on sleep. Cardiorespiratory, gastrointes¬
lems seen in this referral population may be
tinal, neurological, and musculoskeletal
the result of two factors. Children with can¬
later effects are all common after cancer
cer are likely to have the same background
treatment and all may affect sleep (see
prevalence of the common sleep disorders
Table 6).
seen in any child; and CNS-directed thera¬ pies affecting areas of the brain most im¬
The largest review of sleep problems in
portant in sleep/wake regulation, the brain
children with cancer is a 15-year retrospec¬
stem, thalamus, and hypothalamus are
tive case series of children referred for a
more likely to lead to EDS, obstructive
comprehensive sleep evaluation (Rosen &
sleep apnea, and central sleep apnea.
Brand, 2010). Though there is obvious re¬
Gerald Rosen
ferral bias in this population, it does allow for the characterization of the sleep prob¬ lems in children with cancer. The sleep
See also: entries related to Sleep and Develop¬ ment; entries related to Sleep Disorders
problems and types of cancers are described
References
in the first table; the treatment is described
Ancoli-Israel, A., Moore, P., & Jones, V. (2001). The relationship between fatigue and sleep in cancer patients: A review. Eu¬ ropean Journal of Cancer, 10, 245-255.
in the second table. Sixty-eight percent of the children with cancer referred for sleep evaluation had brain tumors. Tumors in¬ volving the thalamus, hypothalamus, and brain stem accounted for 50 percent of the referrals, though this group of tumors com¬ prises only 15 percent of all pediatric malig¬ nancies. The most common sleep problems found in these children with cancer were EDS/long sleepers seen in 60 percent of the children and sleep apnea in 40 percent. Both of these problems were successfully treated once they were recognized (see Table 7). The sleep problems of children with
Hinds, P., Hockenberry, M., Gattuso, J., et al. (2007). Dexamethasone alters sleep and fa¬ tigue in pediatric patients with acute lympho¬ blastic leukemia. Cancer, 110, 2321-2330. Langeveld, N., Grootenhuis, M., Voute, P., et al. (2004). Posttraumatic stress symptoms in adult survivors of childhood cancer. Pedi¬ atric Blood Cancer, 42, 604-610. Oeffinger, K., Mertens, A., Sklar, C., et al. (2006). Chronic health conditions in adult survivors of childhood cancer. New England Journal of Medicine, 355(15), 1572-1582. Reis, L., Eisner, M., Kosary, C., et al. (2005).
cancer span the full spectrum of clini¬
SEER
cal sleep disorders (EDS, insomnia, sleep
2002. Bethesda, MD:
disordered breathing, parasomnias, and
Institute.
cancer statistics
review,
1975-
National Cancer
669
670
|
Sleep in Disorders of Consciousness
Rosen, G., & Brand, S. (2010). Sleep in chil¬ dren with cancer: Case review of 70 chil¬ dren evaluated in a comprehensive pediatric sleep center. Support Care Cancer, DOI 10.1007/S00520-010-0921.
for BIPs, as sleep deprivation is known to have major and devastating impacts on immune functioning. And probably most alarming, sleep disruptions can induce sympathetic activation and elevation of blood pressure, which can contribute to
Sleep in Disorders of Consciousness
the patient’s morbidity. In summary, little is known about the sleep experienced by BIPs and careful
While it is well known that abnormalities
examination of sleep in disorders of con¬
of sleep are extremely common in criti¬
sciousness, including circadian regula¬
cally ill patients (for review see Parthasara-
tion is warranted. Guidelines on how to
thy & Tobin, 2004); mechanisms are still
improve sleep in these patients are thus
poorly understood and fine-grained anal¬
needed (e.g., curtailing unnecessary vis¬
yses are missing (for review see Cologan
its by hospital personnel during habitual
et al., 2010). In brain-injured patients
sleep times or reduce noise and introduce
(BIPs) about half of total sleep time occurs
ambient light levels), might support bet¬
during the day time, andcircadian rhy thmic-
ter recovery and might intercept complica¬
ity is markedly diminished or even lost. In
tions that are related to weakened immune
addition to sleep, the biological clock reg¬
system functioning due to insufficient
ulates several physiological, behavioral,
amounts of restful sleep.
and biochemical rhythms. However, poly¬
Additionally, EEG patterns resembling
graphic recordings are needed to reliably
sleep have been considered as favorable
measure sleep quantity, quality, as well as
prognostic markers for long (e.g., Ber-
circadian regulation in BIPs. Patients ex¬
gamasco, Bergamini, Doriguzzi, & Fabi-
hibit more frequent arousals and awaken¬
ani, 1968) and it has been reported that
ings than normal, and decreases in REM
sleep patterns continue to improve during
and slow-wave sleep are common (e.g.,
rehabilitation together with the recovery of
Freedman, Gazendam, Levan, Pack, &
cognitive functions (Ron, Algom, Hary, &
Schwab, 2001). Note that the degree of
Cohen, 1980). In a study by Evans and
sleep fragmentation is at least equivalent
Bartlett (1995), it was shown that sleep¬
to that seen in patients with obstructive
like traces with K-complexes in response
sleep apnoea. However, causes for sleep
to stimulation are indicative of a good out¬
problems in BIPs are generally unknown
come, whereas traces with no spontaneous
although severity of the underlying dis¬
arousal activity were indicative of death or
ease is likely to be an important factor.
vegetative state. A more recent study by
Further factors contributing to sleep ab¬
Valente and colleagues (2002) compared
normalities in BIPs include acute illness,
the predictivity of different levels of sleep-
pain, discomfort, and increased alert¬
wake organization with other possible
ness induced by continuous exposure to
prognostic indexes such as neuroradiolog-
light. This is probably especially critical
ical findings, age, or Glasgow coma scale
Sleep in Insects
scores. In this study based on 24 hours of polysomnographic recordings, the authors report that the presence of organized sleep patterns is highly predictive for good out¬ come. Especially NREM-sleep elements such as K-complexes and sleep spindles as well as REM-sleep elements alternating with NREM-sleep elements were related to good recovery. It is concluded that polysomnography might carry considerable information about the ability of BIPs to recover by reflecting
|
Parthasarathy, S., & Tobin, M. J. (2004). Sleep in the intensive care unit. Intensive Care Medicine, 30(2), 197-206. Ron, S., Algom, D., Hary, D., & Cohen, M. (1980). Time-related changes in the distri¬ bution of sleep stages in brain injured pa¬ tients. Electroencephalography & Clinical Neurophysiology, 48(4), 432^441. Valente, M., Placidi, F., Oliveira, A. J., Bigagli, A., Morghen, I., Proietti, R., et al. (2002). Sleep organization pattern as a prognos¬ tic marker at the subacute stage of posttraumatic coma. Clinical Neurophysiology, 113(11), 1798-1805.
the residual integrity of the central nervous system and functionality of the brain (for review see Cologan et al., 2010). Yet the
Sleep in Insects
major challenge when studying sleep in critically ill patients remains; that is, scor¬
The origins and functions of sleep are on¬
ing sleep in extremely altered and slowed
going biological mysteries. Did the first
EEG traces.
primitive organisms that occupied and Manuel Schabus
References Bergamasco, B., Bergamini, L., Doriguzzi, T., & Fabiani, D. (1968). EEG sleep patterns as a prognostic criterion in post-traumatic coma. Electroencephalography & Clinical Neurophysiology, 24(4), 374-377. Cologan, V., Schabus, M., Ledoux, D., Moonen, G., Maquet, P., & Laureys, S. (2010). Sleep in disorders of consciousness. Sleep Medi¬ cine Reviews, 14(2), 97-105. Evans, B.M., & Bartlett, J.R. (1995). Predic¬ tion of outcome in severe head injury based on recognition of sleep related activity in the polygraphic electroencephalogram. Journal
then emerged onto land from the primordium of ancient oceans sleep? Did dino¬ saurs sleep? And if these organisms did sleep, what function, if any, did sleep serve in the survival of species? One approach to answering these questions may be to exam¬ ine living organisms with ancient origins that have changed little from their ancient fossil ancestors. Mammalian species, most often the subject of modern sleep studies, emerged relatively recently in the fossil record, between 100 and 74 million years ago (Bininda-Emonds et al., 2007). On the other hand, a living, diverse group of
of Neurology, Neurosurgery, and Psychia¬
organisms with ancient origins is insects.
try, 59(1), 17-25.
Insects first appeared in the fossil record
Freedman, N. S., Gazendam, J., Levan, L., Pack, A. I., & Schwab, R.J. (2001). Ab¬ normal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. American Journal
approximately 400 million years ago, and modern insect orders, many of which have changed little from their early ancestors, have a fossil record extending to approxi¬
of Respiratory and Critical Care Medicine,
mately 250 million years ago (Grimaldi &
163(2), 451-457.
Engel, 2005). Thus, by studying insects,
671
672
|
Sleep in Insects
clues to the origins and function of sleep
the day with locomotor activity and de¬
in living organisms could potentially be
creased at night with behavioral quies¬
discovered.
cence. The homeostatic response to sleep
The first issue in studying insect sleep
deprivation in the honey bee was further
is whether insects meet the behavioral cri¬
documented as were age-related changes in
teria for sleep. The evidence strongly sug¬
rest-activity cycles. Differences in honey
gests that insects do, in fact, meet these
bee castes have been associated with differ¬
criteria. The behavioral criteria include a
ences in the circadian rhythmicity of sleep.
species-specific posture, behavioral quies¬
Finally, neuroanatomical plasticity in sen¬
cence, elevated arousal thresholds, revers¬
sory processing centers in the insect brain,
ibility of quiescence with stimulation, and
specifically the mushroom bodies, suggests
the homeostatic drive or rebound in sleep
that aging and social experience may affect
following deprivation. The first naturalistic
the expression of sleep in insects.
observational studies of wasps, bees, flies,
The most detailed information on the
dragonflies, butterflies, and moths at the
physiology and neurochemistry of sleep
beginning of the 20th century are consis¬
has emerged from studies in Drosophila,
tent with these well-established behavioral
the fruit fly. Drosophila has been proposed
criteria. Recent work in the cockroach has
as a model organism for the study of sleep.
demonstrated that the metabolic response
This small organism presents several ad¬
to sleep deprivation as well as the effects of
vantages in the study of basic sleep mech¬
sleep deprivation on longevity are similar
anisms, including (1) the similarities in
to those in mammals, further strengthening
genetic sequence to human disease genes;
the argument that quiescence in insects is,
(2) the identification of well-studied mam¬
in fact, sleep, and that this quiescence is
malian neurotransmitter systems, with the
functionally similar to sleep in mammals
exception of orexin/hypocretin; and (3) the
(Stephenson, Chu, & Lee, 2007).
small size, rapid reproductive cycle, and
With the exception of an expanding lit¬
short life span that allow for rapid assess¬
erature in Drosophila, the number of sys¬
ment of genetic and molecular manipula¬
tematic studies on insect sleep is relatively
tions. However, the question arises as to
small. (For a full review of this literature
whether Drosophila meets the criteria for
see Hartse, 2010.) Although the electro¬
sleep and whether it can be used as a model
physiology of sleep is most often studied in
for the broader study of sleep mechanisms.
mammals, the electrophysiology of insect
The literature strongly supports simi¬
sleep is virtually unknown with a few ex¬
larities between behavioral sleep in Dro¬
ceptions. In one of a series of detailed stud¬
sophila and mammalian sleep. Drosophila
ies on the honey bee, performed by Kaiser
exhibits a species-specific posture during
and associates, the electrophysiology of
quiescence, elevated arousal thresholds,
optomotor interneurons displayed a circa¬
and a homeostatic response to quiescence
dian sensitivity to horizontal movement of
deprivation. Furthermore, there are age-
a light stimulus (Kaiser & Steiner-Kaiser,
related declines in behavioral quiescence
1983). This sensitivity increased during
similar to those observed in mammals, and
Sleep in Insects
|
A busy day in the flowers before the sun goes down. (Kristyna M. Hartse)
in both mammals and Drosophila there is a
One important area in which it is unlikely
similar alerting response to drugs, includ¬
that there will ever be convincing similari¬
ing caffeine, modafinil, and methamphet-
ties between mammals and Drosophila is
amine. Likewise, there is a similar response
in the electrophysiology of sleep, due to
of increasing quiescence following antihis¬
the neuroanatomical dissimilarities in brain
tamine administration in both mammals
structure. There is, however, evidence to
and Drosophila. Besides these findings,
suggest an electrophysiological correlate
there are additional important similarities
of quiescence recorded from Drosophila
between mammalian sleep and Drosophila
mushroom bodies. During waking there are
quiescence.
bursting local field potentials (LFPs) in the
673
674
|
Sleep in Patients with Alzheimer’s Disease
mushroom bodies, which diminish with be¬ havioral sleep, although it is clear that the absence of a waveform during Drosophila behavioral sleep is not equivalent to the presence of, for example, slow waves and sleep spindles, during mammalian sleep.
Grenyer, R., et al. (2007). The delayed rise of present-day mammals. Nature, 446, 507-512. Grimaldi, D., & Engel, M. S. (2005). Evolution of the insects. Cambridge: Cambridge Uni¬ versity Press.
The genetic identification of short-
Hartse, K. M. (2010). Sleep in insects. In P. Mc¬ Namara, R. A. Barton, & C.L. Nunn (Eds.),
sleeping fly strains as well as the genetic
Evolution of sleep: Phylogenetic and func¬
identification
tional perspectives (pp. 34-55). Cambridge:
of
differences
between
male and female flies suggest possible applications to human sleep disorders. Furthermore, the effect of aging on the de¬ terioration in human sleep quality has been well studied, and studies in Drosophila suggest that oxidative stress produces de¬ terioration of sleep in aged tlies. Another area of similarity between mammalian and Drosophila sleep is in the similari¬ ties of response to signaling pathways and neurotransmitters,
including
Cambridge University Press. Kaiser, W., & Steiner-Kaiser, J. (1983). Neu¬ ronal correlates of sleep, wakefulness, and arousal in a diurnal insect. Nature, 301, 707-709. Stephenson, R., Chu, K. M., & Lee, J. (2007). Prolonged deprivation of sleep¬ like rest raises metabolic rate in the Pa¬ cific beetle cockroach, Diploptera punctata (Eschscholtz). Journal of Experimental Bi¬ ology, 210, 2540-2547.
serotonin,
dopamine, and GABA. There may be neu¬ rotransmitters unique to Drosophila and other invertebrates, such as octopamine,
Sleep in Patients with Alzheimer’s Disease
and neurotransmitters unique to mammals, such as orexin/hypocretin, which serve
Alzheimer’s disease (AD) is the most
unique functions in each species.
common form of dementia in the United
The study of insects, and specifically
States. Current estimates indicate that 5.1
Drosophila, provides a potentially unique
million Americans are living with AD.
portal into the genetic and neurochemi¬
The prevalence increases with age, with
cal bases of the mysteries of sleep. Ide¬
60 percent of those more than the age of
ally, insect studies will ultimately have
85 years affected. It is estimated that by
broader applicability to the understanding
the year 2050, 11 to 16 million individu¬
of human sleep disorders and consequently
als will have AD (Plassman et al., 2007).
to the development of more effective, tar¬
Cross-sectional studies suggest that ap¬
geted treatments for these disorders.
proximately 25 to 35 percent of individuals
Kristyna M. Hartse See also: entries related to Evolution of Sleep
with AD have problems sleeping (Dauvilliers, 2007). Sleep disturbances in AD are complex. These patients are susceptible to
References
all of the sleep problems related to aging,
Bininda-Emonds, O.R.P., Cardillo, M., Jones, K. E., MacPhee, R.D.E., Beck, R.M.D.,
as well as to a progressive deterioration and decrease in the number of neurons in
Sleep in Patients with Alzheimer’s Disease
|
the suprachiasmatic nucleus (SCN), which
of N2 sleep from N1 sleep. Sleep spindles
is critical in the homeostatic maintenance
and K-complexes are poorly formed. They
of the circadian rhythm (Wu & Swaab,
are also of lower amplitude, shorter dura¬
2007). Common symptoms include night¬
tion, and less numerous (Montplaisir, Petit,
time sleep fragmentation, increased sleep
Lorrain, Gauthier, & Nielsen, 1995; Prinz
latency, decreased slow-wave sleep, and
et al., 1982) than is the case in normal aging.
increased daytime napping.
The proportion of NREM sleep increases
The relationship between sleep pathol¬
with further disappearance of the true delta
ogy and the pathogenesis of AD may be
wave pattern of slow-wave sleep (Mont¬
even more complex. Amyloid-(3 (A|3) ac¬
plaisir et al., 1995; Prinz et al., 1982). The
cumulation in the brain extracellular space
percentage of time spent in REM sleep,
is considered to be a hallmark of AD, al¬
which remains stable with normal aging, is
though the precise role of A (3 in patho¬
reduced in patients with AD. A decrease in
gens is still not completely understood.
the mean REM-sleep-episode duration and
In a transgenic mouse model, it has been
REM-sleep percentage has been attributed
shown that chronic sleep restriction sig¬
to degeneration of the nucleus basalis of
nificantly increased A(3 plaque formation
Meynert. The nucleus normally exerts an
while a dual orexin receptor antagonist de¬
inhibitory influence on the nucleus reticu¬
creased A(3 plaque formation. Thus, the
laris of the thalamus, the rhythm generator
sleep-wake cycle and orexin may play
responsible for NREM sleep (Buzsaki et
a role in the pathogenesis of AD (Kang
al., 1998). REM sleep also depends on the
et al., 2009). This relationship between
abundance and integrity of the choliner¬
sleep and the pathophysiology of AD may
gic system. The cholinergic disturbance in
also be reflected in the observation that
AD is accompanied by worsening of REM
sleep disturbances should be considered as
sleep. In addition, many subcortical struc¬
one of the core noncognitive symptoms of
tures such as the basal forebrain, distal and
mild cognitive impairment, or MCI, a con¬
superior raphe nucleus, and the reticular
dition often thought to be a precursor to
formation of the pons and medulla seem
AD (Beaulieu-Bonneau & Hudon, 2009).
to be involved in the initiation of sleep and oscillation between REM and non-REM
Sleep Architecture
states. All of these structures may be af¬ fected by the degenerative changes that
Certain sleep changes in AD seem to rep¬
are part of AD. Their deterioration may ac¬
resent an exaggeration of changes that
count for the sleep architecture and rhythm
appear with normal aging. AD patients
changes in AD (Weldemichael & Gross-
spend an increased amount of time in the
berg, 2010). The impact on REM may also
N1 stage of sleep with increased number
be reflected in the observation that REM
and duration of awakenings, compared
sleep without atonia may be more common
to age-matched non-AD controls (Prinz
in AD, even though the behavioral corre¬
et al., 1982). With disease progression, it is
late of REM sleep behavior disorder is rel¬
also very difficult to separate EEG features
atively uncommon (Gagnon et al., 2006).
675
676
|
Sleep in Patients with Alzheimer’s Disease
Circadian Rhythms
frequencies of REM-sleep EEG, suggest¬ ing a possible action on REM sleep-related
There is also a progressive deterioration
cholinergic neurons in patients with AD.
of circadian rhythms with aging. These in¬
Furthermore, REM sleep alpha power may
clude changes manifested by reductions in
predict the cognitive response to donepe¬
sleep quality and impairment in cognitive
zil (Moraes Wdos et ah, 2006). Although
performance (Yu et ah, 2009). The changes
some reviews suggest no particular impact
in the sleep-wake cycle have been attrib¬
of galantamine on REM sleep (Stahl, Mar¬
uted to alterations in the SCN and melato¬
kowitz, Papadopoulos, & Sadik, 2004),
nin secretion (Hu, Van Someren, Shea, &
there are case reports of galantamine caus¬
Scheer, 2009). Though not clear, genetic
ing unusual nightmares (Iraqi & Hughes,
risk factors such as in AD patients who
2009) and rivastigmine causing REM sleep
are negative for the ApoE4 allele have also
behavior disorder (Yeh, Yeh, & Schenck,
been implicated in the development of
2010) . The impact of donepezil on REM
sleep problems (Craig, Hart, & Passmore,
sleep is not always clear (Cooke et ah,
2006).
2006), but there are studies suggesting
Studies of circadian core body tempera¬
an increase in REM sleep with treatment
ture rhythms in patients with probable AD
by donepezil in healthy volunteers after
have shown a reduction in endogenous cir¬
a single dose (Kanbayashi et ah, 2002).
cadian amplitude and a delay in endogenous circadian phase of core body temperature (Ancoli-Israel et ah, 1997). AD patients, however, have shown only a slight de¬ crease in endogenous circadian amplitude when compared to normal aging, so it is unclear whether this is simply an exaggera¬ tion of normal aging (Czeisler et ah, 1992).
Donepezil may also reduce decline in rec¬ ognition performance in individuals vul¬ nerable to the effects of sleep deprivation (Chuah et ah, 2009). Of additional note is that cholinergic activity follows a circa¬ dian pattern. As a consequence, improved function may be seen during the day, but at night, there is an increased risk of sleep disruption (Davis & Sadik, 2006). Sanford Auerbach
Impact of Commonly Used Medications in AD
See also: entries related to Sleep and the Brain
Acetylcholinesterase inhibitors (ACHEIs)
References
are a group of agents that have been FDA
Ancoli-Israel, S., Klauber, M. R., Jones, D. W., Kripke, D. F., Martin, J., Mason, W.,... Fell, R. (1997). Variations in circadian rhythms of activity, sleep, and light exposure related to dementia in nursing-home patients. Sleep, 20(1), 18-23.
approved for the treatment of AD. The commonly used ACHEIs include donepezil, rivastigmine, and galantamine. These are of particular interest because of con¬ cern that the central cholinergic effect will have an impact on sleep and, in particular, REM sleep. Donepezil treatment appears to enhance REM sleep and reduce slow
Beaulieu-Bonneau, S., & Hudon, C. (2009). Sleep disturbances in older adults with mild cognitive impairment. International Psy¬ chogeriatrics, 27(4), 654-666.
Sleep in Patients with Alzheimer’s Disease
Buzsaki, G., Bickford, R. G., Ponomareff, G., Thai, L.J., Mandel, R., & Gage, F.H. (1998). Nucleus basalis and thalamic con¬ trol of neocortical activity in the freely mov¬ ing rat. Journal of Neuroscience, 8(11), 4007-4026. Chuah, L.Y., Chong, D.L., Chen, A.K., Rekshan, W.R., III, Tan, J. C., Zheng, H., & Chee, M.W. (2009). Donepezil improves episodic memory in young individuals vul¬ nerable to the effects of sleep deprivation. Sleep, 82(8), 999-1010. Cooke, J. R., Loredo, J. S., Liu, L., Marler, M., Corey-Bloom, J., Fiorentino, L., . . . Ancoli-Israel, S. (2006). Acetylcholinesterase inhibitors and sleep architecture in patients with Alzheimer’s disease. Drugs and Aging, 25(6), 503-511.
|
Hu, K., Van Someren, E.J., Shea, S.A., & Scheer, F. A. (2009). Reduction of scale in¬ variance of activity fluctuations with aging and Alzheimer’s disease: Involvement of the circadian pacemaker. Proceedings of the National Academy of Sciences of the United States of America, 706(8), 2490-2494.
Iraqi, A., & Hughes, T. L. (2009). An unusual case of nightmares with Galantamine. Jour¬ nal of the American Geriatrics Society,
57(3), 565. Kanbayashi, T., Sugiyama, T., Aizawa, R., Saito, Y., Ogawa, Y., Kitajima, T., . . . Shi¬ mizu, T. (2002). Effects of donepezil (Aricept) on the rapid eye movement sleep of normal subjects. Psychiatry and Clinical Neurosciences, 56(3), 307-308.
Craig, D., Hart, D. J., & Passmore, A. P. (2006). Genetically increased risk of sleep disrup¬ tion in Alzheimer’s disease. Sleep, 29(8), 1003-1007.
Kang, J.E., Lim, M.M., Bateman, R.J., Lee, J. J., Smyth, L. P., Cirrito, J. R.,... Holtzman, D.M. (2009). Amyloid-beta dynamics are regulated by orexin and the sleep-wake cycle. Science, 326(5955), 1005-1007.
Czeisler, C.A., Dumont, M., Duffy, J.F., Steinberg, J.D., Richardson, G. S., Brown, E.N., . . . Ronda, J.M. (1992). Association of sleep-wake habits in older people with changes in output of circadian pacemaker. Lancet, 540(8825), 933-936.
Montplaisir, J., Petit, D., Lorrain, D., Gauthier, S., & Nielsen, T. (1995). Sleep in Alzheim¬ er’s disease: Further considerations on the role of brainstem and forebrain choliner¬ gic populations in sleep-wake mechanisms. Sleep, 18(3), 145-148.
Dauvilliers, Y. (2007). Insomnia in patients with neurodegenerative conditions. Sleep Medicine, 4(Suppl. 4), S27-S34. (Note: This article reviews neurodegenerative disorders associated with dementing illnesses and characteristic sleep disturbances related to these conditions.)
MoraesWdos,S.,Poyares,D.R.,Guilleminault, C., Ramos, L. R., Bertolucci, P. H., & Tufik, S. (2006). The effect of donepezil on sleep and REM sleep EEG in patients with Al¬ zheimer disease: A double-blind placebocontrolled study. Sleep, 29(2), 199-205.
Davis, B., & Sadik, K. (2006). Circadian cho¬ linergic rhythms: Implications for cho¬ linesterase inhibitor therapy. Dementia and Geriatric Cognitive Disorders, 21(2),
120-129. Gagnon, J.F., Petit, D., Fantini, M.L., Rompre, S., Gauthier, S., Panisset, M., . . . Montplaisir, J. (2006). REM sleep behavior disorder and REM sleep without atonia in probable Alzheimer disease. Sleep, 29(10), 1321-1325.
Plassman, B.L., Langa, K.M., Fisher, G.G., Herringa, S.G., Weir, D. R., Ofstedal, M. B.,... Wallace, R. B. (2007). Prevalence of dementia in the United States: The aging, demographics, and memory study. Neuro¬ epidemiology, 29(1-2), 125-132. Prinz, P.N., Peskind, E. R., Vitaliano, P.P., Raskind, M. A., Eisdorfer, C., Zemcuznikov, N. , & Gerber, C.J. (1982). Changes in the sleep and waking EEGs of nondemented and demented elderly subjects. Journal of the American Geriatrics Society, 50(2), 86-93.
677
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Sleep in Patients with Parkinson’s Disease
Stahl, S.M., Markowitz, J.S., Papadopoulos, G., & Sadik, K. (2004). Examination of nighttime sleep-related problems dur¬ ing double-blind, placebo-controlled trials of galantamine in patients with Alzheim¬ er’s disease. Current Medical Research and Opinion, 20(4), 517-524.
patients, virtually all of them manifest in¬
Weldemichael, D.A., & Grossberg, G.T. (2010). Circadian rhythm disturbances in patients with Alzheimer’s disease: A re¬ view. International Journal of Alzheimer’s Disease, Article ID 716453, 9 pages.
pressed and not demented show decreases
Wu, Y.H., & Swaab, D.F. (2007). Disturbance and strategies for reactivation of the circa¬ dian rhythm system in aging and Alzheim¬ er’s disease. Sleep Medicine, 8(6), 623-636. Yeh, S. B., Yeh, P. Y„ & Schenck, C. H. (2010). Rivastigmine-induced REM sleep behavior disorder (RBD) in a 88-year-old man with Alzheimer’s disease. Journal of Clinical Sleep Medicine, 6(2), 192-195. Yu, J.M., Tseng, I.J., Yuan, R. Y., Sheu, J.J., Liu, H.C., & Hu, C.J. (2009). Low sleep efficiency in patients with cognitive impair¬ ment. Acta Neurologica Taiwanica, 18(2), 91-97.
somnia, excessive daytime sleepiness, in¬ tense dreams, and abnormal movements at night. Laboratory (polysomnographic and electroencephalographic or EEG) studies of sleep in PD patients who are not de¬ in sleep efficiency, as well as increases in sleep fragmentation with multiple nightwakings. By contrast, in normal aging, sleep problems typically involve a reduc¬ tion in slow-wave sleep duration and few if any abnormalities of REM sleep. Why might PD be associated with sleep problems? The neuropathology of PD is consis¬ tent with dysfunction of sleep mechanisms in PD patients. The classical sleep cen¬ ters that control sleep onset and offset as well as sleep intensity are located in the brain stem and hypothalamus—both sites that are severely affected by PD. In addi¬ tion, the primary pathology of PD involves loss of dopaminergic cells in the substan¬ tia nigra (SN) and in the ventral tegmental
Sleep in Patients with Parkinson’s Disease
area. These two subcortical dopaminergic sites give rise to two projection systems important for arousal, motor, affective,
Although Parkinson’s disease (PD) is pri¬
and cognitive functioning. The nigrostria-
marily thought of as a motor disorder (the
tal system, primarily implicated in motor
shaking palsy), sleep problems of varying
functions, originates in the pars compacta
degrees and types occur in up to 74 to 98
of the SN and terminates in the striatum.
percent of patients with PD. Sleep prob¬
The meso-limbic-cortical system origi¬
lems may even predict the onset of PD
nates in the ventral tegmental area (VTA)
by some 5 to 10 years. Sleep problems,
and terminates in the ventral striatum, lim¬
finally, may contribute to or exacerbate
bic sites, amygdala, frontal lobes, and some
some of the mood and cognitive disorders
other basal forebrain areas. Dopamine lev¬
seen in PD patients. Thus, PD might be bet¬
els in the ventral striatum, frontal lobes,
ter understood as both a motor and a sleep
and hippocampus of PD patients are ap¬
disorder. Although the kinds and severity
proximately 40 percent of normal. The
of sleep problems vary tremendously in PD
termination sites of both the nigrostriatal
Sleep in Patients with Parkinson’s Disease
|
and the meso-cortical dopamine systems
Insomnia refers to the inability to fall
are all important for sleep processes, par¬
asleep or to stay asleep long enough to
ticularly REM sleep. Disrupting these sites
achieve restorative benefits of sleep. PD
via reduced dopaminergic stimulation may
patients with insomnia lie awake at night,
also affect sleep.
and when they finally fall asleep, they
In addition to the dopaminergic dysfunc¬
awaken a couple of hours later feeling un¬
tion associated with PD there is also Lewy
refreshed. Polysomnographic and EEG
body (LB) degeneration, and Alzheimer-
studies of sleep in PD patients who are not
type changes that have been notedin brain
depressed show decreases in deep sleep,
stem nuclei (including the noradrener¬
too much light sleep (Stage II), as well as
gic locus coeruleus and the serotonergic
increases in sleep fragmentation and mul¬
dorsal raphe nucleus—two sites impli¬
tiple night-wakings.
cated in sleep and arousal mechanisms), limbic structures, cholinergic forebrain structures, and in the cerebral cortex. The cholinergic pathology in the basal fore¬
Excessive Daytime Sleepiness (EDS) in PD
brain structures and the LB-type degenera¬
EDS is found in as many as 50 percent of
tion in limbic and in the cerebral cortex are
PD patients and serious fatigue in about
also likely contributors to sleep disorders,
60 percent of patients. Periodic limb
dementia of PD, and to affective dysfunc¬
movements, obstructive sleep apnea, and
tion of PD.
depression may all contribute to sleep
In summary, there is no shortage of rea¬
maintenance problems and EDS. In addi¬
sons to expect sleep dysfunction in PD pa¬
tion, parkinsonian medications themselves
tients. But we can cite further contributing
may contribute to the excessive sleepiness.
factors as well: The classic motor problems
There have been several reports arguing
of PD such as rigidity make it difficult to
that use of dopamine agonists, pramipex-
get comfortable or to turn over in bed. The
ole, and ropinirole is associated with sud¬
medications used to treat motor symptoms
den and irresistible sleep attacks during the
of PD may have all kinds of contradictor ef¬
day in some PD patients. But other stud¬
fects on sleep: some may make the patient
ies have failed to find any association be¬
drowsy while others may over arouse the
tween agonists and EDS. Mood problems
patient. Linally the anxiety and depression
also seem to be related to ESD in PD pa¬
associated with PD may influence ability
tients. In some recent studies EDS was
to fall asleep or to achieve restful sleep.
related primarily to anxiety levels rather
I now turn to a brief survey of major sleep disorders of PD.
than to depression, stress, stage of dis¬ ease, neuropsychological dysfunction, or to medication-related factors. In sum, the
Insomnia in PD
causes of EDS in PD patients remain un¬ clear, but dopaminergic medications and
There are no good estimates of the num¬
anxiety levels are likely to be important
ber of PD patients who report insomnia.
contributors.
679
680
|
Sleep in Patients with Parkinson’s Disease
Sleep Disorder Breathing and Sleep Apnea in PD
REM Sleep Behavior Disorder (RBD)
Apnea refers to episodes of cessation of
This is the disorder that may herald the
breathing during sleep. Central sleep apnea
onset of PD by as much as 10 to 15 years.
refers to a problem in the brain stem centers
RBD involves the loss of the normal motor
that control respiration. Obstructive sleep
inhibition associated with REM sleep so
apnea refers to blockage in the breathing
that patients literally begin to act out their
passages (nose, throat, etc.). When the pa¬
dreams. While estimates vary dramatically,
tient with sleep apnea attempts to enter
it appears that approximately 50 percent of
deep sleep, he stops breathing and then
PD patients have partial or complete loss of
this lack of oxygen prompts him to wake
muscle atonia during rapid eye movement
up briefly to get some air. The awakening
(REM) sleep. It is particularly interesting
may not be conscious as it is often very
that most of the dreams that RBD patients
brief, but it may happen dozens of times
act out and report upon awakening are
each night so that the person’s sleep is
filled with aggression. Common themes
fragmented and filled only with light rather
are that the patient or his wife or bed part¬
than deep restorative sleep. During the
ner is being attacked by intruders, etc.,
daytime, the individual feels overwhelm¬
and the patient physically, and sometimes
ing fatigue and a drive for sleep. Prelimi¬
violently, defends against the attack. One
nary studies of sleep disordered breathing
recent study of dream content in RBD pa¬
in PD populations suggests that more than
tients demonstrated that compared to con¬
half of PD patients suffer some degree of
trols, patients with RBD reported a very
apnea with obstructive sleep apnea being
high degree of aggression in their dreams.
the most commonly documented form.
Sixty-six percent of RBD dreams and only 15 percent of control dreams had at least
Periodic Limb Movement Disorder and Restless Legs Syndrome (RLS)
one episode of aggression. The percentage
Periodic limb movements during the night
that of controls (86% vs. 44%).
of aggressive episodes to friendly interac¬ tions in dreams of RBD patients was twice
are quite common in the elderly, including
The dream-enactment episodes are so
PD patients. RLS, which is frequently as¬
real for the patients that they often injure
sociated with periodic limb movements, is
themselves during an episode. Indeed, in¬
frequently seen in the middle-aged popu¬
juries are reported by more than 75 per¬
lation, in the elderly, and in PD patients.
cent of patients. Video-polysomnographic
In both disorders, there is a sensation in
monitoring reveals that hallucinatory epi¬
the legs that causes the patient to move his
sodes typically occur during REM sleep.
or her extremities and may contribute to
Interestingly, varying degrees of RBD
insomnia. The PD patient with RLS often
may be present for years before the motoric
feels an irresistible urge to move the legs
manifestations of PD develop. One study
around during the night to get comfortable.
of PD patients with RBD investigators
Sleep in Patients with Parkinson’s Disease
|
found that the nighttime dream-related en¬
matter how long one stays in bed or sleeps.
actment behaviors developed an average
Some of these same sleep-related phenom¬
of three years before the motoric disorder
ena occur in PD patients with depression,
(parkinsonism) in about half of those who
but there are few controlled studies that
had both conditions.
have identified special aspects of sleep dys¬ function in PD patients with depression.
Sleep and Hallucinations in PD Vivid dreams in PD patients often predict daytime hallucinations. Many PD patients without overt RBD report episodes of hal¬ lucinations. Hallucinations are thought to be experienced by as many as 33 percent of PD patients during the course of their illness. They are generally thought to be a complication of dopaminergic pharma¬ cotherapy and when present limit drug therapy for motor disability. They are, fur¬ thermore, a significant risk factor for nurs¬ ing home placement. Hallucinations in PD patients tend to occur in the visual rather than auditory modality and are frequently associated with vivid dreams. Interest¬ ingly, sleep disturbance is more common in hallucinators than in nonhallucinators, and therefore sleep problems rather than the medications per se may be potent con¬ tributors to hallucinosis in PD patients.
Sleep and Cognitive Disorders of PD It should be noted briefly that PD is also associated
with
cognitive
deficits—
especially in mid and later stages of the dis¬ ease. These deficits involve problems with memory, attention, and concentration. Be¬ cause sleep is known to be involved in consolidation of memory, it follows that disruption of sleep, as occurs in PD, may also contribute to cognitive disorders of PD—but this proposition has not been thoroughly tested as yet. In summary, disturbances in sleep, with its related consequences for mood and mind, obviously cause problems and re¬ duce the quality of life for both the patient and for the caregiver. Furthermore, an un¬ derstanding of the causal relationships be¬ tween sleep and PD symptoms may lead to better treatment and to better quality of
Sleep and Depression in PD Chronic depression is seen in approxi¬ mately 40 percent of PD patients but major depression in PD is unlike reactive forms of depression in that it is characterized by prominent anxiety and less proclivity to¬ ward self-punitive ideation. In other forms of major depression sleep dysfunction is a prominent and core symptom of the disease. Typically the problem is reduced REM latency and nonrestorative sleep no
life for PD patients and their caregivers. In particular, if sleep dysfunction contrib¬ utes to the development of cognitive (e.g., dementia) and affective (e.g., depression) dysfunction in PD patients, then early and aggressive therapies to treat sleep disor¬ ders could delay the development of cog¬ nitive, mood, and dementing illnesses in this population. Patrick McNamara See also: entries related to Sleep and the Brain
681
682
|
Sleep in Patients with Wilson’s Disease
Reference
WD patients and their physicians paying
Stacy, M. (2002). Sleep disorders in Par¬
no attention to them. The first to notice in¬
kinson’s disease: Epidemiology and man¬
creased sleep problems in a significant co¬
agement. Drugs Aging, 79(10), 733-739.
hort were Portala, Westermark, Ekselius, and Broman (2002). The authors examined a group of 24 WD patients in a question¬
Sleep in Patients with Wilson’s Disease
naire study, and found statistic differences from their reference group in quantitative sleep variables (difficulties falling asleep,
Wilson’s disease (WD) is an autosomal
greater number of awakenings per night,
recessive inherited disorder of copper me¬
sleepiness during the day), in daytime
tabolism resulting in pathological accumu¬
functions (fatigue, taking naps), and in
lation of copper in many organs and tissues.
REM-sleep disturbances (sleep paralysis,
The disease is caused by a deficiency of a
cataplexy). A total of 42 percent of treated
copper-transporting P-type ATPase (Bull,
WD patients had sleep problems. The con¬
Thomas, Rommens, Forbes, & Cox, 1993),
clusion was that the sleep complaints can
encoded by mutation of the ATP7B gene on
be explained by disturbances in monoami-
chromosome 13 (band ql4.3). More than
nergic neurons (REM-off neurons) at the
500 different forms of mutation have been
brain stem level resulting in altered REM-
identified up to now. Copper accumulation
sleep function. Enhancement by altered
results in a variety of symptoms ranging
circadian functions, localized in suprachi-
from neurological and/or psychiatric dis¬
asmatic nuclei, can be considered as well.
turbances to acute or chronic liver disease.
The high frequency of sleep comorbidity
Two main clinical forms—hepatic and
compared with the control group was cor¬
neurological—are usually distinguished.
roborated in another study (Nevsfmalova
The latter—present in about 40 percent of
et al., in press). Its authors examined 55
those affected—include dysarthria, dys¬
patients with WD in a questionnaire study,
praxia, ataxia, and extrapyramidal signs,
and the results correlated with age- and
mostly of the dystonic kind (Kitzberger,
sex-matched control subjects. The ques¬
Madl, & Ferenci, 2005). Neuropsychi¬
tions were centered on sleep habits and
atric features include a cognitive decline
sleep disorder comorbidities. The patients,
together with personality changes, mood
as well as the control group, were then
disorders; even schizophreniform disor¬
asked to fill in the Epworth sleepiness scale
ders can accompany the clinical symp¬
measuring chronic sleepiness and a screen¬
toms. Treatment with penicillamine, zinc,
ing questionnaire for REM sleep behavior
or trientine is lifelong (even in asymptom¬
disorder (RBD). Twenty-four patients un¬
atic cases) for a good response. Most WD
derwent a sleep study—nocturnal video¬
patients can resume a good quality of life.
polysomnography, followed by daytime
Sleep complaints, relatively frequently
multiple sleep latency testing (MSLT).
accompanying the clinical features of WD,
According to the results, the values
however, mostly go unrecognized with
of daytime napping, excessive daytime
Sleep, Inflammation, and Cardiovascular Disease
|
sleepiness, cataplexy-like episodes, and
of the sleep/wake symptoms also includes
poor nocturnal sleep were significantly
altered REM-sleep-dissociated symptoms.
higher. Elevated subjective sleepiness was
Sana Nevsimalova
found in almost one third of our WD ques¬ tionnaire respondents, and MSLT revealed
See also: entries related to Hormones in Sleep; entries related to Sleep and the Brain
borderline or shortened mean sleep latency again in one third of the cohort. Although
References
the changes were found more frequently
Barthel, H., Hermann, W., Kluge, R., Hesse, S., Collingridge, D. R., Wagner, A., & Sabri, O. (2003). Concordant pre- and postsynaptic deficits of dopaminergic neurotransmission in neurologic Wilson disease. American Journal of Neuroradiology, 24, 234-238.
in patients with the neurological than in the hepatic form, the difference was non¬ significant. There were also surprisingly many
REM-sleep
dissociation
symp¬
toms occurring in narcolepsy, particularly cataplexy-like episodes and vivid dreams, but neither nocturnal polysomnography nor MSLT confirmed any sleep-onset REM periods in the patients’ records. Al¬ most half the WD patients responded posi¬ tively to five or more screening questions suggesting conceivable clinical symptoms of RBD, more frequently so patients treated with D-penicillamine. Horrible nightmares accompanied by screaming loud and even nocturnal injuries were among their com¬ plaints. However, signs of REM sleep without atonia, which is typical of RBD, appeared in several patients, but none
Bull, A. I., Thomas, G. R., Rommens, J. M., Forbes, J. R„ & Cox, D. W. (1993). The Wil¬ son disease gene is a putative copper trans¬ porting P-type ATPase similar to Menkes disease gene. Nature Genetics, 5, 327-337. Kitzberger, R., Madl, C., & Ferenci, P. (2005). Wilson disease. Metabolic Brain Disease, 20, 295-302. Nevsimalova, S., Buskova, J., Bruha, R., Kemlink, D., Sonka, K., Vitek, L., & Marecek, Z. (in press). Sleep disorders in Wilson’s dis¬ ease. European Journal Neurology. Portala, K., Westermark, K., Ekselius, L., & Broman, J.E. (2002). Sleep in patients with treated Wilson’s disease: A questionnaire study. Nordic Journal of Psychiatry, 56, 291-297.
reached the straightforward criteria of 20 percent of the REM record that is neces¬ sary for RBD diagnosis. WD is supposed to be associated with a
Sleep, Inflammation, and Cardiovascular Disease
dopaminergic deficit (Barthel et al., 2003), which can explain at least some of the clin¬
Although scientists noted a relationship
ical symptoms. Therefore, impairment of
between inflammation and cardiovascu¬
basal ganglia at the nigrostriatal dopami¬
lar disease (CVD) as early as the 1920s, it
nergic level, and dysfunction of monoami-
was not until decades later that research¬
nergic neurons at the brain stem level help
ers began to examine more direct linkages
to account for the clinical variety of sleep
among
disturbances. In conclusion, WD patients often suffer
and CVD. Within the past 10 years there has been burgeoning interest in under¬
from sleep disturbances, and the spectrum
standing the mechanistic processes of
disturbed
sleep,
inflammation,
683
684
|
Sleep, Inflammation, and Cardiovascular Disease
how inflammation mediates the relation¬
(Mills & Dimsdale, 2004). Circulating
ship between disturbed sleep and CVD.
levels of IL-6 and TNF-a are elevated in
Cytokines regulate and mediate immune
individuals with obstructive sleep apnea
and other inflammatory-related responses.
(OSA) and are correlated with carotid
The functions of proinflammatory cyto¬
intima-media thickness, suggesting that
kines are diverse, including developing and
apnea-related systemic inflammation is
proliferating immune cell subsets, activat¬
associated with progression of atheroscle¬
ing adhesion molecules and blood coagula¬
rosis and increased risk of cardiovascular
tion pathways, supporting atherosclerotic
morbidity. The circulating soluble receptor
processes, and altering neurochemical and
1 of TNF is also elevated in sleep apnea
neuroendocrine processes. While acutely
and associated with the number of arous-
heightened inflammation states are a natu¬
als during the night, as well as associated
ral and needed part of the body’s immune re¬
with CVD incidence. One of the reasons
sponse to infection and injury, such states can
that nighttime sleep disturbance may in¬
adversely affect sleep quality and duration.
crease CVD risk is that although inflam¬
For example, interluekin-6 (IL-6) and tumor
mation is increased throughout the night
necrosis factor-alpha (TNF-a) are acutely el¬
in response to apneic events, it can remain
evated in response to bacterial infection and
elevated throughout the next day (Mills,
are associated with sickness behaviors, in¬
Natarajan, von Kanel, Ancoli-Israel, &
cluding fatigue and increased sleep duration.
Dimsdale, 2009).When sleep apnea is suc¬
Low-grade, chronic inflammation also
cessfully treated with continuous positive
brings adverse consequences to sleep that are
airway pressure, the inflammation associ¬
unremitting and ultimately can further exac¬
ated with apneic events is reduced.
erbate disease. For example, heart failure is
In addition to cytokines and their recep¬
characterized by significant inflammation
tors, endothelin-1 (ET-1) has been associ¬
across an extensive spectrum of pathways,
ated with disturbed sleep and CVD. ET-1
including immune cells, endothelial cells,
is a potent vasoconstrictor and mediator of
cardiac cells, and the liver. Heart failure is
inflammation that is elicited from endothe¬
also characterized by disturbed sleep, in¬
lial cells. The increase in blood pressure
cluding sleep apnea. Currently investiga¬
that acutely accompanies apneic events
tors are examining the degree to which the
can also increase endothelial shear stress,
chronic inflammation in heart failure is as¬
which results in endothelial production of
sociated with ongoing sleep disturbances,
ET-1. In OSA patients, ET-1 is strongly
and the potential for feedback loops of in¬
related to degree of hypertension (Gjorup
flammatory processes that further exac¬
et ah, 2007). The elevation of ET-1 in sleep
erbate symptoms and functional capacity
apnea appears to be' related to hypoxia, a
(Khayat, Patt, & Hayes, 2009).
state of inadequate oxygen saturation that
Sleep apnea is a good example of how
results from repeated breath suspensions.
disturbed sleep can enhance inflamma¬
Elevated ET-1 levels have been associated
tory states and subsequently contribute to
with greater sleep latency, greater rapid
the development or exacerbation of CVD
eye movement (REM) latency, and more
Sleep, Inflammation, and Cardiovascular Disease
|
slow-wave sleep in sleep apneics. Elevated
In summary, inflammation may medi¬
levels of ET-1 may be a consequence rather
ate the relationship between inadequate
than a determinant of sleep quality.
sleep and CVD risk. Studies of diseased
Although disease states provide settings
populations generally demonstrate that el¬
where the association between inflamma¬
evated levels of inflammation are associ¬
tion and sleep can be more easily observed,
ated with more disturbed sleep, and worse
such relationships can also be found in
cardiac prognosis. Although the data are
healthy individuals. Within normal phys¬
less straightforward for healthy individu¬
iological ranges, elevated circulating lev¬
als, there is also evidence to suggest that
els of IL-6 have been associated with
over time insufficient sleep may contribute
decreased slow-wave sleep and increased
to low-grade inflammation and, ultimately,
REM sleep. Elevated levels of IL-6 appear
increase risk of cardiac events.
to be associated with poor sleep quality; however, there is still no formal consensus on the relationship of IL-6 or any other in¬
Jessica Ann Jimenez and Paul J. Mills See also: entries related to Sleep and Health; entries related to Sleep Disorders
flammatory biomarker on sleep architec¬ ture in healthy individuals. Sleep disruption in healthy individu¬ als provides another setting for examining sleep and inflammation. Total or partial sleep deprivation can lead to significant short-term increases of daytime levels of IL-6, C-reactive protein, and TNF re¬ ceptors. These findings beg the question of whether chronic insufficient sleep in healthy individuals contributes to lowgrade inflammation and increased CVD risk. There is evidence to support such a position. Caregivers of Alzheimer’s dis¬ ease patients, who are at increased risk of CVD, show disrupted sleep as a result of their caregiving role, including greater amounts of time spent awake after initial sleep onset and lower overall sleep effi¬ ciency. These sleep disturbances are asso¬ ciated with elevated levels of IL-6 as well as the coagulation marker D-dimer (von Kanel, Loredo, Ancoli-Israel, & Dimsdale, 2006), both important mediators of the in¬ flammatory processes of CVD and both predict CVD outcomes.
References Gjorup, P. H., Sadauskiene, L., Wessels, J., Nyvad, O., Strange, B., & Pedersen, E.B. (2007). Abnormally increased endothelin-1 in plasma during the night in obstructive sleep apnea: Relation to blood pressure and severity of disease. American Jounral of Hypertension, 20(1), 44-52. Khayat, R., Patt, B., & Hayes, D. (2009). Ob¬ structive sleep apnea: The new cardiovascu¬ lar disease. Part I: Obstructive sleep apnea and the pathogenesis of vascular disease. Heart Failure Reviews, 74(3), 143-153. Mills, P.J., & Dimsdale, J.E. (2004). Sleep apnea: A model for studying cytokines, sleep, and sleep disruption. Brain, Behav¬ ior, and Immunity, 7S(4), 298-303. Mills, P., Natarajan, L., von Kanel, R., Ancoli-Israel, S., & Dimsdale, J. (2009). Diurnal variability of C-reactive protein in obstructive sleep apnea. Sleep and Breath¬ ing, 75(4), 415-420. von Kanel, R., Loredo, J., Ancoli-Israel, S., & Dimsdale, J. (2006). Association between sleep apnea severity and blood coagulabil¬ ity: Treatment effects of nasal continuous positive airway pressure. Sleep and Breath¬ ing, 70(3), 139-146.
685
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Sleep Intensity and the Homeostatic Regulation of Sleep
Sleep Intensity and the Homeostatic Regulation of Sleep
animals is not building up some chemical that is depleted during waking, such as ad¬ enosine build-up in mammals. Moreover, SWA does not appear to increase after
The importance of the intensity dimen¬
sleep deprivation. Unlike mammals, sleep
sion of sleep was first uncovered in exper¬
spindles are absent during NREM in birds.
iments on effects of sleep deprivation. The
As in aquatic mammals, unilateral eye clo¬
most dramatic effect of sleep deprivation
sure and unihemispheric slow-wave sleep
in every mammalian species studied thus
(SWS) also occur in birds. In both mam¬
far has been the phenomenon of compen¬
malian and in avian species compensatory
satory rebound, or the increase over base¬
rebound involves a change in sleep-cycle
line of sleep times and intensity, where
lengths.
intensity is measured by higher arousal
Borbely (1982) first formalized the in¬
thresholds, enhanced slow-wave activity
sight that mammalian sleep involved a
(SWA; particularly enhanced delta power
balance between sleep amount and sleep
when spectral EEG analysis is used), en¬
intensity and that sleep was therefore under
hanced REM frequencies per unit time,
homeostatic control. In his two-process
and deeper and longer sleep cycles. After
model of sleep regulation a sleep need pro¬
sleep deprivation, mammalian animals
cess (Process S) increases during waking
attempt to make up for lost sleep by en¬
(or sleep deprivation) and decreases dur¬
hancing the intensity and duration of sub¬
ing sleep. This part of the model indexes
sequent sleep. During the wakefulness or
restorative aspects of sleep and explicitly
deprivation period, neurochemicals are
predicts that sleep is required for some re¬
thought to accumulate in proportion to the
storative process of the brain or the body or
length of the wake period. One such possi¬
both. Process S is proposed to interact with
ble chemical is adenosine, which acts in a
input from the light-regulated circadian
sleep center (possibly the basal forebrain)
system (Process C) that is independent of
to inhibit arousal/increase sleepiness and
sleep and wakefulness rhythms. SWA is
then dissipates at a rate depending on sleep
taken as an indicator of the time course of
intensity until it returns to baseline dur¬
Process S, because SWA is known to cor¬
ing sleep. Birds too demonstrate a com¬
relate with arousal thresholds and to mark¬
pensatory rebound after sleep deprivation,
edly increase during the previous waking
but the rebound involves increased over¬
period and during the rebound period after
all sleep times and cycles rather than en¬
sleep deprivation in all mammals stud¬
hancements in SWA. Birds also appear to
ied. Once a threshold value of Process S
exhibit a special form of SWA and very
is reached (i.e., once the appropriate
little REM-like sleep. SWA in birds, how¬
amount and intensity of SWS is reached),
ever, does not appear to be homeostatically
Process C will be activated. Simulations
regulated. SWA in NREM sleep in pi¬
using the model’s assumptions show that
geons does not decline in the course of the
the homeostatic component of sleep falls
dark period, suggesting that SWA in these
in a sigmoidal manner during waking and
Sleep, Memory, and Dreams
|
rises in a saturating exponential manner
values for sleep cycle were very low; and
during sleep.
(3) no concerted attempts were made to
The two-process model does not ad¬
collect new data that index intensity (e.g.,
dress homeostatic aspects of REM. REM,
SWA). Nor had previous analyses con¬
however, evidences rebound after sleep
trolled for variables that are now known
deprivation, but here the intensity com¬
to alter intensity measures (torpor or
ponent is likely to be some process asso¬
hibernation).
ciated with frequency (density) of REMs per unit time. In any case both REM and NREM are under homeostatic control
Patrick McNamara See also: entries related to Sleep Assessment
and enhancements of sleep intensity over
Reference
baseline addresses the homeostatic need
Borbely, A. A. (1982). A two process model of sleep regulation. Human Neurobiology, 1, 195-204.
for sleep. In short, these findings led to the assumption that sleep intensity indexes functional need. Researchers have used a variety of mea¬ sures to evaluate sleep intensity, includ¬ ing SWA, duration of Stages III and IV or SWS, sleep-cycle length, spindling activ¬
Sleep, Memory, and Dreams Memory
ity, REM densities, and arousal thresholds.
Memory
These measures of intensity, however,
whereby recently acquired information is
need to be evaluated (via both reliability
converted to a more permanent, long-term
analyses and via exhaustive review of the
state, less vulnerable to disruption or loss.
literature on each measure) for their power
This dynamic process takes place over a
to index sleep intensity (Are they all mea¬
period of days, weeks, months, and even
suring the same thing?) and then ranked in
years. There are now understood to be at
order of reliability. It may be that SWA and
least two different memory systems, de¬
sleep-cycle lengths will rank first and sec¬
clarative and nondeclarative, that are rela¬
ond, as these are the measures that to date
tively independent of each other.
appear to best linked to restorative aspects of sleep.
consolidation
is
the
process
Declarative material is easily accessi¬ ble to verbal description. The individual
Past comparative analyses of functional
is aware of the information that is to be
correlates of sleep quotas did not look
learned and aware that it can be accessed
at correlated evolution of sleep intensity
from memory store when desired. Declar¬
with other ecological and life-history
ative memory is further divided into se¬
variables. Analyses using proxies for in¬
mantic and episodic categories. Semantic
tensity (e.g., SWA, SWS, or sleep-cycle
memories comprise our factual knowledge
length) were necessarily limited because
of the world. Thus most of us know that
(1) no compilations of mean duration of
Paris is the capital of France. However,
SWS (Stage II and III NREM) were at¬
memory of when we acquired this infor¬
tempted; (2) the number of species with
mation is likely not available. Episodic
687
688
|
Sleep, Memory, and Dreams
memories include the information of in¬
The third type of NREM sleep consists of
terest as well as the contextual location of
large amplitude delta waves (1 to 4 Hz).
acquisition in time and place. Being able
This type of sleep, often called slow-wave
to recall what you ate for lunch as well as
sleep (SWS), is most prominent in the first
the fine details of who you were with and
third of the night and is minimal or absent
where you ate, is an example of an episodic
in the last third of the night. There is re¬
memory.
duced muscle tension in the large skel¬
Nondeclarative memories are not easily
etal muscle groups during NREM sleep,
accessible to verbal description. Usually,
but some tension remains and movement
learning does not occur at the conscious
is possible. There are no eye movements
level.
nondeclarative
during NREM sleep. During REM sleep,
memories exist can best be done by ob¬
the EEG frequency is 7 to 10 Hz. There are
serving behavior. If someone says that they
phasic conjugate rapid movements of the
have learned to skate, the best indication
eyes while the large skeletal muscles are
that they have done so is to give a skating
completely immobilized and movement is
demonstration. There are several subtypes
not possible.
Assessment
that
of nondeclarative memory. They include
Throughout the night of sleep there is
procedural memory (skills and habits),
a 90-minute ultradian rhythm. Healthy
priming, and simple classical conditioning
young individuals begin the night with a
(which include emotional responses and
few minutes of Stage 1, which then gives
skeletal musculature responses) (Maquet,
way to Stage 2, which is then followed by
Smith, & Stickgold, 2003).
SWS. SWS is followed by a return to Stage 2 sleep and then a period of REM sleep oc¬
Sleep States
curs. The time for this cycle to complete is approximately 90 minutes. The individual
The states of sleep in humans are conven¬
then repeats the cycle by going from REM
tionally divided into two separate catego¬
sleep to Stage 2, SWS, and then REM again.
ries, rapid eye movement sleep (REM) and
As the night continues, the amount of SWS
nonrapid eye movement sleep (NREM).
diminishes and the amount of REM sleep
NREM sleep is further subdivided into
increases. By the last third of the night,
three categories. Stage 1 is a light stage of
only Stage 2 and REM sleep occur.
sleep, typically seen at sleep onset with an electrical brain wave (EEG) frequency of 7 to 9 Hz. It typically does not last more than a few minutes before giving way to
Sleep States and Memory Consolidation
Stage 2 sleep. This stage has a slower EEG
Three main approaches have been used
frequency of 5 to 7 Hz (often called theta
to
waves), as well as special intermittent fea¬
sleep states and memory processes. One
tures including the spindle (12 to 16 Hz)
method involved observing the changes
and the K-complex. About 50 percent of
in sleep EEG following task acquisition
the night is spent in this stage of sleep.
compared with baseline and control values.
examine
the
relationship
between
Sleep, Memory, and Dreams
More recently, brain-imaging techniques
|
Declarative Memory and Sleep
have been used to observe changes in neural activity during postlearning sleep.
Declarative memory consolidation has
A second approach has been to examine
been reportedly enhanced by SWS, partic¬
performance of participants exposed to
ularly episodic memory. Memory for such
postlearning sleep deprivation and com¬
tasks as paired associate words, prose pas¬
pare their performance with those allowed
sages, landscapes, object locations, faces,
normal postacquisition sleep. More re¬
and navigation within virtual or natural en¬
cently, a day-night design has been used
vironments was superior following SWS.
to avoid possible stress confounds. Partici¬
Several studies enhanced memory by ar¬
pants either learn a task in the morning and
tificially
are tested 12 hours later with no intervening
activity. Some studies have reported that
sleep or learn the task in the evening and
Stage 2 sleep is also important, with most
are tested 12 hours later in the morning.
increasing
postlearning
SWS
observing a postlearning increase in Stage
For this group, a normal night of sleep is in¬
2 spindle activity. REM sleep was also re¬
cluded in the 12-hour time span. The third
portedly involved in a small number of
approach has been to present various kinds of sensory stimulation during postlearn¬ ing sleep to artificially enhance mem¬
declarative learning studies. An imaging study suggests that SWS aids consolida¬ tion of semantic memories as well.
ory consolidation. These methods have all provided evidence for a close relation¬ ship between sleep states and memory
Nondeclarative Memory and Sleep
consolidation (Maquet et al., 2003; Smith,
Skills and habits refer to learning that in¬
2010).
cludes such activities as novel perceptual, motor, and cognitive tasks. Acquisition
Emotional Memory
of a visual texture discrimination task re¬ quired both SWS and REM sleep. Efficient
Generally, emotionally charged memories
consolidation of motor tasks, such as the
are better consolidated after REM sleep
finger-tapping sequence task and visuo-
than after NREM sleep. However, while
motor tasks, like the rotary pursuit task,
emotionally positive material is vulnera¬
appear to involve Stage 2 sleep, although
ble to REM-sleep loss, emotionally nega¬
REM sleep has also been implicated. The
tive material is not. A brain-imaging study
type of sleep involved appears to depend
suggests that the negatively charged ma¬
on the initial skill level of the participant.
terial can be consolidated by an alternate
In the rotary pursuit task, participants with
neural route if necessary. The results in¬
low initial skill levels showed postlearn¬
dicate an alternate system for memorizing
ing increases in REM sleep, while partici¬
extremely important survival information
pants with high initial skill levels showed
in case sleep becomes impossible for the
postlearning increases in Stage 2 sleep pa¬
organism following a traumatic natural
rameters. It has been suggested that indi¬
event.
viduals were using one of two overlapping
689
690
|
Sleep, Memory, and Dreams
consolidation systems. Those that found
declarative tasks appear to be enhanced by
the task to be novel and were required to
postlearning sleep, it does not seem as vital
come up with a new cognitive strategy
for procedural tasks.
showed increases in REM-sleep parame¬
The recall rate for children is much
ters (such as minutes of REM sleep, den¬
lower than for young adults. For example,
sity of actual REMs). Those that found the
children age 9 to 11 have a recall rate of
task to be similar to other activities that
20 to 30 percent from REM awakenings
they already had learned, showed increases
and only 6 percent from NREM awak¬
in Stage 2 sleep parameters (such as min¬
enings. Dream reports are less mature in
utes of Stage 2, density, and average size of
children and appear to mirror cognitive
sleep spindles). This idea is consistent with
development. No dreams have been col¬
the finding that cognitively more complex
lected in a formal experimental paradigm
tasks, novel to the learner, require REM
following successful acquisition of a task
sleep for most efficient memory consoli¬
in young children. However, given that the
dation (Smith, Aubrey, & Peters, 2004).
dreams are quite immature at young ages, while ability to learn many tasks is possi¬
Dreams and Sleep States
ble, it would seem unlikely that dreams are necessary for learning (Domhoff, 2010).
A dream can be defined as mental activity reported on awakening from a sleep state. Traditionally, dreams were considered to occur primarily during REM sleep. More
Dream Content Following Task Acquisition
recently, it has become clear that menta¬
There are not many studies that have ex¬
tion can be reported from NREM awaken¬
amined the dream content of post-training
ings as well, although the probability of
sleep. Most studies examined the dreams
obtaining a report (approximately 50%) is
in post-training REM sleep or looked at the
less likely than from REM sleep (80% to
mentation at sleep onset.
90%). REM reports may be more salient as
Several studies asked subjects to play the
well. It is generally agreed that sleep men¬
Tetris computer game, where shapes fall
tation reports reflect the ongoing life of the dreamer.
down the screen and must be manipulated
Since children are learning a multi¬
ened just after sleep onset reported seeing
tude of things from a very young age, it
the pieces falling. Similar results were ob¬
might be expected that their dreams would
tained using a downhill skiing simulator
reflect this activity during postlearning
(Alpine Racer). There was little evidence
sleep. However, the dreams of young chil¬
of episodic replay mentation from either
dren are less well developed than those of
task. Subjects did not recall the room, the
adults. Firstly, sleep states do not seem as
experimenter, or other facets of the lab.
closely related to memory consolidation in
Since one group in the first experiment was
young children compared to adults. While
amnesic (temporal lobe damage), yet still
to fit into a structure. Participants awak¬
Sleep, Memory, and Dreams
|
experienced postgame Tetris piece menta¬
task. In a second study, using the same
tion, it was concluded that the mentation
experimental paradigm, subjects were ex¬
was from a semantic rather than an epi¬
posed to another cognitive procedural task
sodic source. This idea was consistent with
(mirror trace). Participants had to draw
the results of another study reporting only
pencil lines inside the margins of complex
1 to 2 percent of dreams actually replayed
figures by watching their hand in the mir¬
waking experience.
ror. Dream length was found to be signifi¬
For REM-sleep mentation, one study ex¬
cantly longer for the test group compared
amined the dreams of individuals habitu¬
to control groups, although time spent in
ated to functioning with inverted prisms on.
REM sleep was equal for all groups. It was
While there were few direct incorporations
considered possible that the dreams were
of this experience there was indirect meta¬
more intense for the test group. The most
phorical content. For example, “I wanted to
popular dream metaphor was reference to
know what it was. Then I looked at a word,
driving cars and trying to stay on the road.
but it was upside down.” The dreams usu¬
Dreams generally reflected the problem of
ally reflected increases in visual and motor
staying on a road or path. There was virtu¬
difficulties. In another study, participants
ally no episodic replay observed (Smith,
were exposed to second language learning.
2010).
All students were in a French immersion
In summary, sleep mentation appears to
environment for several weeks. Learning
reflect memory consolidation activity in
progress was correlated with increased
certain situations. Present evidence does
time in REM sleep. For dream content, the
not provide support for the idea that sleep
more progress the student made, the shorter
mentation aids memory consolidation. Carlyle Smith
was the latency to French incorporations and communications.
Students making
minimal progress did not report any French incorporations in their dreams. In a memory-enhancement study, par¬ ticipants were trained in a cognitive pro¬ cedural task. A clicking sound was present in the background during acquisition and acted as the conditioned stimulus (CS). Dur¬ ing the postlearning sleep night, they were subjected to the CS via mini-earphone. The clicks were triggered by maximum deflec¬ tion of actual rapid eye movements during REM sleep. Test subjects were 23 percent better than controls. The clicks were be¬ lieved to have acted as reminders to re¬ member to process the recently acquired
See also: Sleep and Mild Cognitive Impairment References Domhoff, G. W. (2010). Dream content is con¬ tinuous with waking thought, based on pre¬ occupations, concerns, and interests. Sleep Medicine Clinics, 5, 203-215. Maquet, P., Smith, C., & Stickgold, R. (2003). Sleep and brain plasticity. Oxford: Oxford University Press. Smith, C.T. (2010). Sleep states, memory pro¬ cessing and dreams. Sleep Medicine Clinics, 5, 217-228. Smith, C.T., Aubrey, J.B., & Peters, K.R. (2004). Different roles for REM and Stage 2 sleep in motor learning: A proposed model. Psychologica Belgica, 44, 81-104.
691
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|
Sleep, Nightmares, and Psychiatry
sleep time. More interestingly, reduced
Sleep, Nightmares, and Psychiatry
REM-sleep latency was identified as an objective indicator of depressive disorder and an inverse correlate of its severity. Re¬
Sleep and circadian rhythms are strongly
duced REM latency has proved to be one of
related to physical and mental health. Sleep
the specific features of sleep in depressed
disturbances and circadian changes affect
patients. Other reported abnormalities in
body functions as well as mood and cog¬
REM sleep include a prolonged duration of
nitions. Sleep abnormalities are very com¬
the first REM period, an increased density
mon in psychiatric disorders, in particular,
of eye movements, and an increased REM
in mood disorders and anxiety disorders.
percentage of total sleep time. Slow-wave
This is because hormonal changes in body
sleep time is also reduced in depressed pa¬
and monoaminergic dysregulations in the
tients than healthy subjects. Among en¬
central nervous system are described both
dogenous depressive symptoms, terminal
in sleep disorders and in mood/anxiety
insomnia, pervasive anhedonia, unreactive
disorders. Thus, sleep disturbances and
mood, and appetite loss are reported to be
dreaming disorders are one of the central
related to short REM latency in depressed
issues of depression and anxiety disorders.
patients.
Insomnia is common among typical de¬
Anxiety is commonly related to sleep
pressed patients. On the other hand, hyper¬
disturbances.
Sleep
panic
attacks
are
somnia often occurs in atypical depressive
frequent in patients with panic disorder.
patients, bipolar depressed patients, and
Approximately one third of patients with
adolescent depressives. Depressed patients
panic disorder reports recurrent sleep
often report difficulty in falling sleep,
panic. Interestingly, recurrent sleep panic
maintenance problems of sleep, and early
is correlated with suicidality and depres¬
awaking, named as initial, middle, and ter¬
sion among panic disordered patients.
minal insomnia, respectively. Sleep distur¬
Posttraumatic stress disorder and other
bances may have prognostic significance
anxiety disorders are also associated with
in predicting suicide among patients with
sleep-pattern changes.
mood disorders. Among objective mark¬
Nightmares are long frightening dreams
ers of sleep abnormalities in depression,
involving threats to survival or security,
reduced REM-sleep latency was identified
from which the sleeper awakens, and
as an objective indicator of depressive dis¬
should be distinguished from sleep terrors,
order and an inverse correlate of its sever¬
narcolepsy, sleep panic attacks, and other
ity. Reduced REM latency has proved to be
awakenings. Nightmares typically occur
one of the robust and specific features of
later in the night during REM sleep and
sleep in depressed patients. Other reported
produce vivid dream imagery, complete
abnormalities in REM sleep include a pro¬
awakenings, autonomic arousal, and de¬
longed duration of the first REM period,
tailed recall of the event and may cause
an increased density of eye movements,
psychological distress and social or occu¬
and an increased REM percentage of total
pational dysfunction.
Sleep Pattern and Its Determining Factors in University Students
|
Recurrent nightmares may be associated
self. Smoking, caffeine, and alcohol intake
with a high comorbidity of mood and anxi¬
increase it. Several disorders may be re¬
ety disorder, in particular in young adults
sponsible for causing nocturnal violence:
and adults. Frequent nightmares and termi¬
sleepwalking, sleep terrors, REM sleep
nal insomnia are common in melancholic
behavior disorder, nocturnal psychogenic
depression.
dissociative disorders, nocturnal seizures,
The association of dream disturbances with ?ashbacks related to the trauma sug¬ gests that nightmares appear to be an effec¬ tive coping mechanism in trauma victims. A relationship between dream anxiety and
obstructive sleep apnea, and periodic limb movement disorder. Mehmed Y. Agargun
See also: entries related to Sleep and Health
dissociative experiences and the causal role of childhood traumatic events may play a role in this relationship. Nightmare disorder seems to be associ¬ ated with self-mutilation, suicidal behav¬
Sleep Pattern and Its Determining Factors in University Students
ior, and borderline personality. It may be reasonable to attribute a role to nightmares
Sleep patterns of university students are
as an adaptive coping strategy in dissocia¬
likely to become delayed and irregular. A
tive disorders and borderline personality
considerable number of students meet the
disorder. The dreams reduce the inten¬
diagnostic criteria for delayed sleep-phase
sity of the emotional distress by juxtapos¬
syndrome (DSPS), which is characterized
ing the current trauma with various other
by delayed habitual sleep-wake time rela¬
events in the person’s life, making con¬
tive to desired and socially acceptable time
nections to other similar or not-so-similar
(Hazama, Inoue, Kojima, Ueta, & Naka-
events. When trauma is dreamt about, it is
gome, 2008). Because the sleep phase is
no longer uniquely distressing; it gradu¬
prone to delay with advancing age during
ally becomes part of a fabric or network.
adolescence, the remarkable phenomenon
Thus, dreaming has an adaptive function
of sleep-phase delay in university students
and nightmares are common following a
could reflect the maturational process
trauma. Thus, we suggest that nightmares
of biological rhythms. However, a lon¬
are useful dreams to cope with the conflicts
ger delay in the sleep pattern is observed
of traumatic events, if they are worked on
among university students than among
appropriately in therapy.
nonuniversity students of the same age,
Sleep-related violence is also a popular
such as workers. Since the sleep-wake
topic. It has forensic importance as well as
phase of students is dramatically delayed
clinical interest. Violent behavior during
shortly after they enter the university, we
sleep includes a broad range of behaviors:
believe that milder regulation of sched¬
self-mutilation, sexual assault, murder at¬
ules and restrictions by the university than
tempt, murder, and suicide and can be di¬
those by high school might contribute to
rected to other subjects, to objects, or to
the delayed sleep patterns.
693
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|
Sleep Pattern and Its Determining Factors in University Students
Similar to other cohorts, the amount of
rather than the total sleep duration, has a
nocturnal sleep in university students has
stronger effect on their academic perfor¬
decreased by more than an hour in the last
mance. A delayed bed off time, in particular,
few decades. Steptoe, Peacey, and Wardle
showed a strong association with poor aca¬
(2006) surveyed the sleep pattern of uni¬
demic performance (Eliasson, Lettieri, &
versity students in 24 countries and showed
Eliasson, 2010), and therefore, low GPA
that 21 percent of the students were con¬
could be a result of absence from morning
sidered short sleepers with less than seven
classes, which is attributable to the delayed
hours of nocturnal sleep (Steptoe et al.,
sleep phase.
2006). They also suggested a relationship
Factors influencing the sleep pattern of
between short sleep and poor health. A
university students have been discussed in
survey conducted on a large population of
many studies. These studies showed that
university students revealed that more than
students’ sleep patterns vary depending
60 percent of the study population had poor
on their nationality, academic year, and
sleep quality, which was measured using
their resident status, that is, whether they
the Pittsburgh Sleep Quality Index (Lund,
lived with or without their family. Univer¬
Reider, Whiting, & Prichard, 2010). As ex¬
sity students in Asian countries (Steptoe
pected, the inadequate sleep time and ir¬
et al., 2006) and senior students (Asa-
regular/delayed sleep pattern was likely to
oka, Fukuda, & Yamazaki, 2004; Hazama
be related to poor sleep quality. In addition,
et al., 2008) have specifically been reported
their poor sleep quality also led to various
with poor sleep habits. A study using sleep
daytime malfunctions such as increased
logs showed that students who lived alone
depression-like symptoms and irritabil¬
had a more delayed sleep phase on week¬
ity, disturbed concentration, and daytime
days than those who lived with their fam¬
sleepiness, all of which possibly lead to
ilies (Asaoka et al., 2004). In this study,
students dozing off while attending classes
there was no difference between these two
or driving. The deterioration of academic
groups in terms of the sleep phase on week¬
performance, that is, low grade point aver¬
ends, and the students living with their
age (GPA), is also related to the students’
family had a longer commuting time than
poor sleep habits. Many studies have sug¬
those living alone. Thus, existence of fa¬
gested that inadequate sleep causes a de¬
milial time cue and longer commuting time
crease in cognitive performance such as
for the students who live with their fam¬
the learning-memory process, which is es¬
ily might be responsible for the early sleep
sential for maintaining good academic per¬
phase in this group of students.
formance (Curcio, Ferrara, & De Gennaro,
Daily activities such as watching televi¬
2006). It is speculated that the decrease
sion (TV), surfing the Internet, playing vid¬
in cognitive performance and the dozing
eogames, attending classes, and working
off during classes due to inadequate night
part-time are also known determinants of
sleep lead to a low GPA. Moreover, inter¬
sleep pattern. Many studies have suggested
estingly, some studies have suggested that
a relationship between the sleep pattern and
among university students, the sleep phase,
these activities, especially during the night.
Sleep Pattern and Its Determining Factors in University Students
|
However, the extent to which each activity
cross-sectional questionnaires. Therefore,
affects sleep patterns remains unknown. A
the causal relationships between the pre¬
study that investigated this issue in Japa¬
viously mentioned variables and students’
nese students through a time-use survey
sleep patterns are still unclear, despite the
(Asaoka et al., 2010) showed that the in¬
various studies. An intervention study was
fluence of the daily activities on the stu¬
recently carried out, in which the dura¬
dents’ sleep patterns differed between the
tion of watching TV was restricted to 30
students living alone and those living with
minutes or less per day for the univer¬
their families. Among the students living
sity students (Asaoka, Fukuda, Tsutsui, &
alone, inteipersonal communication late
Yamazaki, 2007). The results showed that
at night was most prominently associated
they went to bed 26 minutes earlier than
with delayed bedtime. In addition, their
their usual bedtime and increased their
sleep patterns seemed to change depending
total nocturnal sleep time by 69 minutes;
on the whether or not they had a class the
however, their morning physical activity
next morning. On the other hand, students
declined after the intervention. This find¬
who lived with their family did not show
ing suggests that watching TV may be one
change in their sleep patterns irrespective
of the important factors for delayed bed¬
of their class schedules, and their sleep pat¬
time, but it may also play a role as a so¬
tern was affected mainly by indoor activi¬
cial time cue for maintaining regular sleep
ties such as watching TV and surfing the
patterns, which help in maintaining their
Internet. Although the differences between
circadian rhythm. Future studies should be
the two groups might partially depend on
conducted to confirm whether restriction
the existence/absence of familial time cue,
of other nocturnal activities such as surf¬
further study is required to clarify the un¬
ing the Internet is helpful in both increas¬
derlying cause of this phenomenon.
ing students’ sleep duration and preventing
A good sleep pattern is an important
a delay in their bedtime.
factor for university students to maintain
Apart from the restrictions on nocturnal
not only good health but also a good aca¬
activities, education on good sleep habits
demic life, and hence, it is essential that
is also essential to improve students’ sleep
their bedtime is not delayed. Previous stud¬
habits. A previous study reported that a
ies have suggested that restricting the use
sleep education program that included
of visual media and socializing activities
sleep-hygiene guidelines, stimulus-control
at night could be effective in preventing
instructions, and information about caf¬
the sleep-phase delay. Moreover, a revi¬
feine products improved the sleep quality
sion of university schedules, such as the
of the study participants (Brown, Buboltz,
intensive morning schedules, may help
& Soper, 2006). Concurring with the phe¬
in maintaining early bedtime, especially
nomenon that sleep-deprived subjects can¬
for the students living alone. However,
not comprehend a decrease in the quality
most studies .exploring the relationship be¬
and quantity of their daily tasks, most uni¬
tween students’ sleep pattern and the de¬
versity students with poor sleep habits are
terminant factors were conducted by using
unaware of the fact that their poor academic
695
696
|
Sleep Patterns in Patients with Acute Coronary Syndromes
performance is a result of their disturbed
academic performance. Sleep Medicine Re¬
sleep patterns. In addition, a certain pro¬
views, 10, 323-337.
portion of university students adopt irra¬ tional countermeasures for their deficient nocturnal sleep. For example, students try to compensate their sleep deficit by tak¬ ing long daytime naps and/or prolonging their nocturnal sleep until the afternoon on weekends. Such behavior can disturb their sleep-wake rhythms, and possibly result in circadian-rhythm sleep disorders, especially DSPS. Therefore, sleep educa¬ tion that includes rational knowledge and the effects of sleep on the academic life and health of university students would be desirable. Shoichi Asaoka and Yuichi Inoue
See also: entries related to Sleep and Devel¬
Eliasson, A. H., Lettieri, C. J., & Eliasson, A. H. (2010). Early to bed, early to rise! Sleep habits and academic performance in college students. Sleep and Breathing, 14, 71-75. Hazama, G.I., Inoue, Y., Kojima, K., Ueta, T., & Nakagome, K. (2008). The prevalence of probable delayed-sleep-phase syndrome in students from junior high school to univer¬ sity in Tottori, Japan. The Tohoku Journal of Experimented Medicine, 216, 95-98. Lund, H.G., Reider, B.D., Whiting, A.B., & Prichard, J.R. (2010). Sleep patterns and predictors of disturbed sleep in a large pop¬ ulation of college students. Journal of Ado¬ lescent Health, 46, 124-132. Steptoe, A., Peacey, V., & Wardle, J. (2006). Sleep duration and health in young adults. Archives
of
Interned
Medicine,
166,
1689-1692.
opment
References Asaoka, S., Fukuda, K., Tsutsui, Y., & Yamazaki, K. (2007). Does television viewing cause delayed and/or irregular sleep-wake patterns? Sleep and Biological Rhythms, 5, 23-27.
Sleep Patterns in Patients with Acute Coronary Syndromes
Asaoka, S., Fukuda, K., & Yamazaki, K. (2004). Effects of sleep-wake pattern and residential status on psychological distress in university students. Sleep and Biological Rhythms, 2, 192-198.
Sleep is essential for several restorative,
Asaoka, S., Komada, Y., Fukuda, K., Sugiura, T., Inoue, Y., & Yamazaki, K. (2010). Ex¬ ploring the daily activities associated with delayed bedtime of Japanese university stu¬ dents. The Tohoku Journal of Experimental Medicine, 221, 245-249.
metabolic, and immunologic functions. Restful sleep requires a normal sleep macro- and micro-architecture. There is plentiful scientific evidence to support the fact that sleep disruption leads to unde¬ sirable consequences (Banks & Dinger, 2007), especially for critically ill patients. Sleep disruption with acute quantitative or qualitative sleep deprivation, which has
Brown, F.C., Buboltz, W.C., Jr., & Soper, B. (2006). Development and evaluation of the Sleep Treatment and Education Program for Students (STEPS). The Journal of American College Health, 54, 231-237.
been studied mainly in healthy subjects,
Curcio, G., Ferrara, M., & De Gennaro, L. (2006). Sleep loss, learning capacity and
et al., 1999), endocrine and metabolic func¬
may impair physiological functions impor¬ tant for recovery, including tissue repair, overall cellular immune function (Oztiirk tions (Spiegel, Leproult, & Van Cauter,
Sleep Patterns in Patients with Acute Coronary Syndromes
|
1999), and energy balance (Scrimshaw
cycle. Methods used to assess sleep include
et al., 1966). In addition it can induce sym¬
bedside inspection, patient’s perception,
pathetic activation and elevation of blood
polysomnography
pressure (Leung & Bradley, 2001), which
phy. Attended overnight PSG remains the
may contribute to patient morbidity. It is
gold standard for sleep evaluation, but
not difficult to imagine that an individual
entails several technical difficulties and
who has already become ill and requires
limitations when performed in the ICU
hospitalization, such as a patient with acute
environment, especially in patients recov¬
coronary syndrome, should be more vul¬
ering from critical illness. There are a num¬
nerable to medical problems when sleep is
ber of studies evaluating sleep in critically
disrupted. Research into the role of sleep
ill patients, some involving polysomno-
and the effects of sleep deprivation in criti¬
graphic recordings over 24 hours (Cooper
cally ill patients has been limited by con¬
et al., 2000; Freedman et al., 2001; Gabor
founding factors that make it difficult to
et al., 2003), others with polysomnographic
quantify and isolate the effects of sleep on
recordings during nighttime alone (Aaron
clinical recovery.
et al., 1996; Broughton & Baron, 1978;
(PSG),
and
actigra-
Sleep disruption in the intensive care
Richards, Anderson, Chesson, & Nagel,
unit (ICU), including the coronary care
2002), and studies without polysomno¬
unit (CCU), is a well-recognized phe¬
graphic recordings (Olson et al., 2001;
nomenon that can have important adverse
Nelson et al., 2001). Investigators differ in
consequences for the critically ill patient.
their conclusions as to whether critically ill
Patients experience severe alterations of
patients are sleep deprived, reporting large
sleep, with sleep loss, sleep fragmenta¬
variations in total sleep time among pa¬
tion, and sleep-wake cycle disorganiza¬
tients in the ICU. Some studies found that
tion. Many factors may contribute to these
critically ill patients have a normal or near
abnormalities,
environmental
normal total sleep time (Cooper et al., 2000;
factors such as noise, patient care activi¬
Freedman et al., 2001), while other investi¬
ties, disturbed light-dark cycle, medica¬
gators found a decrease in total sleep time
tions (sedatives and inotropes), therapeutic
(Gabor et al., 2003). The different findings
and diagnostic procedures, and mechani¬
among these studies may be due to different
cal ventilation (Hardin, 2009); however,
populations with different underlying med¬
the contribution of each factor is not clear.
ical and surgical problems, small groups of
The severity of the underlying disease is
patients, or interference with the natural en¬
likely to be an important factor and needs
vironment or routine treatment in ICU.
including
The quality and distribution of sleep
to be determined. Sleep can be assessed in terms of quan¬
over 24 hours are also affected, even in
tity (total sleep time and time spent in each
ICU hospitalized patients who have nor¬
sleep stage), quality (fragmentation due
mal total sleep time. About half of total
to micro-arpusals,
sleep-stage changes,
sleep time occurs in the daytime and the
wake after sleep onset, EEG sleep pat¬
circadian rhythm is markedly impaired
terns), and distribution over the 24-hour
(Cooper et al., 2000; Gabor et al., 2003).
697
698
|
Sleep Patterns in Patients with Acute Coronary Syndromes
Critically ill patients exhibit more frequent
were no sudden changes in sleep archi¬
arousals and awakenings than normal. The
tecture after transfer to the general ward.
degree of sleep fragmentation is at least
However,
equivalent to that seen in patients with ob¬
patient-care activities, and disturbances of
structive sleep apnea (Guilleminault et al.,
the light-dark exposure to sleep disruption
1988). Additionally, an impairment in the
in the CCU and general ward were not ad¬
distribution of sleep stages has been rec¬
dressed specifically. Sleep abnormalities
ognized. Critically ill patients spent less
improved gradually over time with trans¬
of their sleep time in rapid eye movement
fer to the hospital ward, even though nor¬
(REM) sleep or in Stages 3 and 4, known
mal sleep patterns were not restored in
as slow-wave (SWS) or deep sleep, which
patients with acute MI until nine days after
is considered the most restorative type
discharge from the ICU. The altered sleep
of sleep (Cooper et al., 2000; Freedman
patterns were largely attributed to the in¬
et al., 2001). Factors disturbing sleep,
farction itself. However, subsequent angi¬
such as noise, may result in electroen-
nal attacks peaked at day 4 to day 5 and
cephalographic arousals and awakenings,
occurred more often during REM sleep.
which may not only affect sleep micro¬
Similar results were obtained by Dohno
architecture but prevent the normal prog¬
et al. (1979), who observed sleep disrup¬
ress into deeper sleep stages (Carskadon &
tions regardless of type of unit, length
Dement, 2005). This disturbed sleep pat¬
of hospitalization, gender, or medica¬
tern may take several days to normalize
tions in coronary patients in an open-
after discharge from the ICU.
ward CCU and in a semiprivate telemetry
the
contributions
of noise,
There is little knowledge about sleep
unit (Dohno et al., 1979). Moreover, they
quality impairment in patients admitted to
found that patients in the greater severity-
the CCU with acute coronary syndromes
of-illness group, as judged by a cardiolo¬
(ACS). Early studies of patients in coro¬
gist, had more nocturnal awakenings and
nary care after acute myocardial infarction
more sleep-stage changes, consistent with
(MI), 30 years ago, had already recognized
greater sleep fragmentation, than a compa¬
disturbed sleep architecture but suggested
rable group with lesser severity of illness,
increased total sleep time (TST; Brough¬
indicating that severity of illness may turn
ton & Baron, 1978; Dohno et al., 1979).
out to be a very important cause of sleep
Broughton et al., reported findings in 12
disturbance in ICU patients.
patients after an acute MI who underwent
In a more recent study, Ahmed BaHam-
overnight PSGs in the ICU and thereafter
mam evaluated the sleep quality of 20 pa¬
in the ward, comparing them to matched
tients with acute MI within three days of
controls (Broughton & Baron, 1978). The
the acute event and six months later, in the
results were similar to other ICU patients,
sleep disorder center, outside the CCU en¬
with increased wakefulness, more arous¬
vironment (BaHammam, 2006). Despite
als and sleep-stage shifts, a low percentage
controlling for common sleep-disrupting
of REM sleep, and an absence of the usual
environmental factors, patients with AMI
circadian variation in heart rate. There
had altered sleep architecture. Arousal
Sleep Patterns in Patients with Acute Coronary Syndromes
|
index, spontaneous arousals, stage shifts,
The findings of the previously mentioned
REM latency, and wake time were signifi¬
studies highlight the major contribution of
cantly greater, while TST, sleep efficiency,
the illness severity and associated physi¬
and (REM) sleep were significantly less
ological and inflammatory changes to al¬
during the acute event compared with six
terations in sleep architecture and deserve
months later, findings that are in accor¬
further research. The expression of many
dance with previous studies. The authors
cytokines is unregulated in healing myo¬
concluded that factors other than the CCU
cardial infarcts (Frangogiannis & Entman,
environment, patient care activities, me¬
2005), with inflammatory cytokines hav¬
chanical ventilation, and medications are
ing both somnogenic and sleep-inhibitory
involved in sleep disruption, such as the
effects, and it has been reported to influ¬
underlying infarction itself. However, this
ence sleep and sleep depth (Krueger et al.,
study did not objectively assess the pos¬
1995). It is known that proinflammatory
sible influence of circadian-rhythm dis¬
cytokines, such as interleukin-1 (IL-1),
turbances, while the patients studied were
IL-6, and tumor necrosis factor-alpha, are
heterogeneous with respect to concomitant
released after MI (Deten & Zimmer, 2002;
sleep disorders, such as sleep-breathing
Francis et al., 2004). It is worth noting that
disorders, restless legs syndrome (RLS),
a recent study demonstrated that MI in
and periodic limb movement disorder
rats is associated with the release of fac¬
(PLMD). The most recent study from our
tors that provoke the inflammation of tis¬
group assessed 22 patients with first ever
sues, including the brain, and specifically
ACS, who were not on sedation or inotro-
the regions that control sleep, notably the
pes, with attended overnight PSG in the
REM-sleep phase (Bah et al., 2010). The
sleep disorders unit within three days of the
authors reported decreased REM-sleep
ACS and one and six months later (Schiza
time, comparable with what has been ob¬
et al., 2010). This was the first study ob¬
served in patients after MI (BaHammam,
jectively controlled for circadian-rhythm
2006; Dohno et al., 1979; Leung & Brad¬
disturbances and selected patients with¬
ley, 2001; Schiza et al., 2010), which could
out concomitant diseases that could affect
be associated with a reduced number of
sleep architecture, such as RLS, PLMD,
brain stem neurons. However, the mech¬
and current smoking. In accordance with
anisms by which brain stem neurons are
the BaHammam study, TST, sleep ef¬
lost after MI are unclear and need further
ficiency, SWS, and REM sleep were
investigation. One possibility is that pro-
significantly reduced and a significant im¬
inflammatory cytokines could be involved
pairment in sleep micro-architecture was
in the decreased post-MI duration of REM
noted due to an increased arousal index,
sleep reported here, through apoptosis in
during the acute event. Sleep architecture
the cholinergic neurons in the brain stem,
was improved one month later, while six
which control REM sleep. This study indi¬
months after,the acute event sleep duration
cates that the damaging effects of MI are
as well as sleep stages were within the nor¬
apparently not confined to the heart, but
mal ranges.
also affect the brain. Furthermore, it might
699
700
|
Sleep Patterns in Patients with Acute Coronary Syndromes
provide useful data related to the associa¬ tion between cardiac pathophysiology and sleep alterations in such patients. It seems likely that sleep is important to the recovery process as an integral homeo¬ static mechanism. Indeed, it is well known that sleep plays a crucial role in postinfarc¬ tion remission. Quality rather than quan¬ tity of sleep should be our primary target in the management of sleep disruption in ACS. Any preventive, pharmacological, or behavioral treatment is certainly a path¬ way that should be considered. However,
Bah, T. M., Laplante, F., Wann, B. P., Sullivan, R., et al. (2010). Paradoxical sleep insom¬ nia and decreased cholinergic neurons after myocardial infarction in rats. Sleep, 7(33), 1703-1710. BaHammam, A. (2006). Sleep quality of pa¬ tients with acute myocardial infarction outside the CCU environment: A prelimi¬ nary study. Medical Science Monitor, 12, 168-172. Banks, S., & Dinger, D.F. (2007). Behavioral and physiological consequences of sleep re¬ striction. Journal of Clinical Sleep Medi¬ cine, 3, 519-528.
enhance the quantity and quality of sleep
Broughton, R., & Baron, R. (1978). Sleep pat¬ terns in the intensive care unit and on the ward after acute myocardial infarction.
during recovery from critical illness or
Electroencephalography and Clinical Neu¬
injury are lacking. It remains to be deter¬
rophysiology, 45, 348-360.
research into the effects of protocols that
mined whether improving sleep will have an impact on ACS. In conclusion, sleep in patients with
Carskadon, M.A., & Dement, W.C. (2005). Normal human sleep: An overview. In M. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and practice of sleep medicine
ACS poses unique challenges for patients,
(pp. 13-23). Philadelphia, PA: WB Saunders.
clinicians, and researchers. These patients
Cooper, A. B., Thornley, K. S., Young, G.B., Slutsky, A. S., et al. (2000). Sleep in criti¬ cally ill patients requiring mechanical ven¬ tilation. Chest, 117, 809-818.
experience severe sleep alterations, with reductions in several sleep stages, marked sleep fragmentation, and circadian-rhythm disorganization. The impact of these acute sleep alterations on the health of ICU pa¬ tients remains unknown. These effects may delay recovery and decrease the chances for a positive outcome, but it remains to be determined if improving sleep will have an impact on patients with ACS. Sophia E. Schiza
See also: entries related to Sleep Disorders References Aaron, J.N., Carlisle, C.C., Carskadon, M. A., Meyer, T.J., et al. (1996). Environmental noise as a cause of sleep disruption in an in¬ termediate respiratory care unit. Sleep, 19, 707-710.
Deten, A., & Zimmer, H.-G. (2002). Heart function and cytokine expression is similar in mice and rats after myocardial infarction but differences occur in TNFalpha expres¬ sion. Pflugers Archives, 445, 289-296. Dohno, S., Paskewitz, D. A., Fynch, J.J., Ken¬ neth, S., et al. (1979). Some aspects of sleep disturbance in coronary patients. Perceptual and Motor Skills, 48, 199-205. Francis, J., Chu, Y., Johnson, A. K., Weiss, R.M., et al. (2004). Acute myocardial in¬ farction induces hypothalamic cytokine synthesis. American Journal of Physiology Heart and Circulatory Physiology, 286,
H2264-H2271. Frangogiannis, N. G„ & Entman, M. F. (2005). Chemokines in myocardial ischemia. Trends in Cardiovascular Medicine, 15, 163-169.
Sleep, Plasticity, and Metaplasticity
Freedman, N.S., Gazendam, J., Levan, L., Pack, A. I., et al. (2001). Abnormal sleep/ wake cycles and the effect of environmen¬ tal noise on sleep disruption in the intensive care unit. American Journal of Respiratory and Critical Care Medicine, 163, 451-457. Gabor, J.Y., Cooper, A.B., Crombach, S.A., Lee, B., et al. (2003). Contribution of the intensive care unit environment to sleep dis¬ ruption in mechanically ventilated patients and healthy subjects. American Journal of Respiratory and Critical Care Medicine, 167, 708-715.
Guilleminault, C., Partinen, M., Quera-Salva, M. A., Hyes, B., et al. (1988). Determinants of daytime sleepiness in obstructive sleep apnea. Chest, 94, 32-37. Hardin, K. A. (2009). Sleep in the ICU: Poten¬ tial mechanisms and clinical implications. Chest, 136, 284-294. Krueger, J.M., Takahashi, S., Kapas, L., Bredow, S., et al. (1995). Cytokines in sleep regulation. Advances in Neuroimmunology, 5, 171-188. Leung, R. S., & Bradley, T.D. (2001). Sleep apnea and cardiovascular disease. American Journal of Respiratory and Critical Care Medicine, 164, 2147-2165.
Nelson, J. E., Meier, D. E., Oei, E. J., Nierman, D. M., et al. (2001). Self-reported symptoms experience of critically ill cancer patients re¬ ceiving intensive care. Critical Care Medi¬ cine, 29, 277-282. Olson, D. M., Borel, C.O., Laskowitz, D.T., Moore, D.T., et al. (2001). Quiet time: A nursing intervention to promote sleep in neurocritical care units. American Journal of Critical Care, 10, 74-78. Oztiirk, L., Pehn, Z., Karadeniz, D., Kaynak, H., et al. (1999). Effects of 48 hours sleep deprivation on human immune profile. Sleep Research Online, 2, 107-111. Richards, K.€., Anderson, W.M., Chesson, A.L., & Nagel, C.L. (2002). Sleep related breathing disorders in patients who are
|
critically ill. Journal of Cardiovascular Nursing, 17, 42-55.
Schiza, S.E., Simantirakis, E., Bouloukaki, I, Mermigkis, C., et al. (2010). Sleep patterns in patients with acute coronary syndromes. Sleep Medicine, 11, 149-153. Scrimshaw, N.S., Habicht, J.-P., Pellet, P., Piche, M.L., et al. (1966). Effects of sleep deprivation and reversal of diurnal activ¬ ity on protein metabolism of young men. American Journal of Clinical Nutrition, 19,
313-319. Spiegel, K., Leproult, R., & Van Cauter, D. (1999). Impact of sleep dept on meta¬ bolic and endocrine function. Lancet, 354, 1435-1439.
Sleep, Plasticity, and Metaplasticity Throughout a lifetime of experience, our knowledge base and skills continue to evolve in a dynamic and flexible way. Fun¬ damentally, such information storage and memory is represented in the brain by the strength of the connections, or synapses, between neurons within neuronal circuits. When synapses are strengthened, commu¬ nication is enhanced, and neural activity generates stronger responses in connected neurons; when synapses are weakened, the evoked responses in connected neu¬ rons are reduced. Plasticity is a term used to describe these changes in the strength of neural connections as a result of experi¬ ence. Metaplasticity reflects the regulation of plasticity, or a shift in the capacity for a synapse to undergo future plasticity based on its recent history (Abraham, 2008). A growing body of literature suggests that sleep may engage processes of plastic¬ ity. Plasticity is not a unitary phenomenon,
701
702
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Sleep, Plasticity, and Metaplasticity
taking many different forms and reflect¬
signal-to-noise ratio can have a benefit on
ing diverse molecular and cellular mecha¬
memory recall. These models are not mu¬
nisms. Similarly, sleep is not a homogenous
tually exclusive, potentially reflecting si¬
state, encompassing distinct stages and a
multaneous and complementary processes.
variety of electrophysiological processes.
The relationship between metaplasticity
The complexity of these physiological
and sleep has not been well studied, with
processes suggest that there may be mul¬
only one recent study in humans (Cohen
tiple mechanisms linking sleep and plas¬
et al., 2010). That study used noninvasive
ticity, potentially explaining the difficulty
brain stimulation to induce plasticity in the
in establishing a unified conceptual frame¬
motor cortex, evidenced by the change in
work to reconcile conflicting findings in
the size of evoked motor responses mea¬
the sleep and memory literature (Rauchs,
sured in the hand. Each participant had
Desgranges, Foret, & Eustache, 2005). In
two plasticity-induction sessions spaced
recent years, two dominant models in the
12 hours apart, either over day or over¬
field have emerged. The first model in¬
night. This study demonstrated that a night
volves reactivation or replay during sleep
with sleep was associated with a twofold
of neuronal firing patterns experienced
increase in the magnitude of the evoked
during recent wakefulness. For example,
motor response in the second session com¬
sequences of neuronal activity patterns re¬
pared to the first. In contrast, in the over¬
corded from different brain areas of rats
day group, the degree of induced plasticity
while they are learning to navigate a maze
was the same for both sessions. In other
show coordinated replay during subsequent
words, a night with sleep enhanced the ca¬
slow-wave sleep (Ji & Wilson, 2007). Such
pacity for the brain to undergo subsequent
reactivation or replay can promote a use-
plasticity when the same environmental
dependent strengthening of synaptic con¬
exposure was repeated.
nections,
enhancing
recently
acquired
In conclusion, sleep appears to engage
memories for facts, events, and skills.
processes of plasticity to modify existing
The second model is known as the syn¬
knowledge and skills, either through neu¬
aptic homeostasis hypothesis (Tononi &
ronal replay, general synaptic downscaling,
Cirelli, 2003). This model suggests that
or perhaps other mechanisms. In addition,
wakefulness is associated with widespread
sleep may engage processes of metaplas¬
increases in synaptic strength, which taxes
ticity such that synapses may become more
finite space and energy resources in the
responsive to undergo future changes in
brain. Sleep, and in particular slow-wave
response to a given stimulus, perhaps one
sleep, is proposed to cause a general down-
mechanism in which sleep could promote
scaling, or weakening, of synaptic strength
the process of leamihg to learn. A greater
to restore synaptic balance while maintain¬
understanding of how sleep engages the
ing the relative connection strengths. In this
processes of plasticity and metaplasticity
model, the general weakening of connec¬
can have widespread applications from
tions during sleep reduces the background
education and training to rehabilitation of
noise in neural activity, and improved
patients after neurological injury. Future
Sleep Problems among Veterans of Foreign Wars
|
work should also target the role of the cir¬
impaired functioning of affected individ¬
cadian timekeeping system or its interac¬
uals. We now have a name for one form
tion with sleep state to modulate plasticity.
of the array of postcombat mental prob¬
Daniel Aaron Cohen
lems that affect our veterans. That name of
See also: Sleep, Memory, and Dreams
course is posttraumatic stress disorder, or PTSD. One of the core symptoms of PTSD
References Abraham, W. C. (2008). Metaplasticity: Tuning synapses and networks for plasticity. Nature Reviews Neuroscience, 9(5), 387-399. Cohen, D. A., Freitas, C., Tormos, J.M., Oberman, L., Eldaief, M., & Pascual-Leone, A. (2010). Enhancing plasticity through re¬ peated rTMS sessions: The benefits of a night of sleep. Clinical Neurophysiology, 727(12), 2159-2164. Ji, D., & Wilson, M.A. (2007). Coordinated memory replay in the visual cortex and hippocampus during sleep. Nature Neuro¬ science, 70(1), 100-107. Rauchs, G., Desgranges, B., Foret, J., & Eustache, F. (2005). The relationships between memory systems and sleep stages. Journal of Sleep Research, 74(2), 123-140. Tononi, G., & Cirelli, C. (2003). Sleep and syn¬ aptic homeostasis: A hypothesis. Brain Re¬ search Bulletin, 62(2), 143-150.
is sleep disturbance. PTSD is a major health concern for the Veterans Administration (VA) and the veterans it serves. A 2005 report from the VA’s Office of the Inspector General noted that the number of veterans receiv¬ ing compensation for PTSD between 1999 and 2004 grew to 215,871 cases (Depart¬ ment of Veterans Affairs [DVA], 2005). Review of state variances in VA disability compensation payments (DVA, 2005), and continued increases are likely to have oc¬ curred with the subsequent intensification of the wars in Iraq and Afghanistan. Rates of PTSD diagnoses are likely to dramati¬ cally increase due to the ongoing Iraq/Af¬ ghan wars and indeed due to wars around the world. Surveys show that at least 11 to 17 percent of combat veterans are at risk for mental disorders, including PTSD, in the three to four months after return from
Sleep Problems among Veterans of Foreign Wars
combat duty and probably for much longer periods of time after return. One such sur¬ vey assessed 16,318 Afghan veterans and
People who witness or participate in com¬
222,620 Iraq veterans and found that 19.1
bat are exposed to levels of violence and
percent returnees from Iraq compared with
trauma the rest of us can only imagine. In
11.3 percent returnees from Afghanistan
wars past, very little help was available for
screened positive for mental health prob¬
the veteran who experienced postcombat
lems, including PTSD. Thirty-five per¬
mental and sleep problems. From a policy
cent of Iraq war veterans accessed mental
point of view, this past neglect of postcom¬
health services in the year after returning
bat mental problems was unfortunate, as
home; 12 percent per year were diagnosed
these sorts of problems eventually extract
with a mental health problem. Roughly
a cost to both military effectiveness and
20 percent of active and 42.4 percent of re¬
civilian economic performance due to the
serve component soldiers required mental
703
704
|
Sleep, Psychiatric Disorders, and the Transdiagnostic Perspective
health treatment. Of 103,788 operation en¬
dream-related indicators in individuals at
during freedom veterans seen at VA health
risk for suicide, he or she could potentially
care facilities, 25,658 (25%) received
identify early warning signs of new ide¬
psychiatric diagnoses, including PTSD;
ation around suicide and could therefore
56 percent of whom had two or more dis¬
act to prevent a new suicide attempt. In¬
tinct mental health diagnoses. Overall,
dividuals who have served their country in
31 percent received mental health and/or
combat deserve to have their sleep prob¬
psychosocial diagnoses. In a later study,
lems seriously and conscientiously ad¬
Seal et al. (2007) found that among 750
dressed by the health care system whose
Iraq and Afghanistan veterans who were
mission it is to serve veterans.
referred to a VA medical center and five associated community clinics, 338 under¬ went postdeployment screening with 233
Patrick McNamara
See also: entries related to PTSD and Dreams/ Sleep
(69%) screening positive for mental health problems. New treatment approaches are desper¬ ately needed to meet the mental health needs of the veteran population. Studies of sleep contributions to PTSD symptoms hold promise for developing better diag¬ nostic techniques for PTSD and for devel¬ oping innovative treatment approaches to PTSD and other mental health disorders of returning vets. Identifying specific effects of sleep disturbance on PTSD symptoms in the home environment should be con¬ sidered as well since nightmares are more likely to occur in the home environment than in the sleep lab. Investigators should
References Department of Veterans Affairs (DVA). (2005) Report no. 05-00765-137. Washington, DC: VA Office of Inspector General. Seal, K. H., Bertenthal, D., Maguen, S., Gima, K., Chu, A., & Marmar, C.R. (2008). Ad¬ ministration postdeployment mental health screening of veterans returning from Iraq and Afghanistan. American Journal of Pub¬ lic Health, 705(4), 40-47. Seal, K. H., Bertenthal, D., Miner, C.R., Sen, S., & Marmar, C.R. (2007). Bringing the war back home: Mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affair facilities. Archives of Inter¬ nal Medicine, 767(5), 476-482.
seek to clarify the role of sleep dysregulation in production of PTSD symptomology and thus allow for better and more targeted therapeutic interventions for PTSD. REM sleep-related measures such as REM-sleep
Sleep, Psychiatric Disorders, and the Transdiagnostic Perspective
density and REM-sleep dreams and night¬ mares are significant predictors of sui¬
It is unequivocally the case that sleep dis¬
cidal ideation in patients with trauma and
turbance commonly co-occurs with psy¬
in depressed individuals. Some individu¬
chiatric disorders. Insomnia, the most
als with sleep problems and with PTSD
common sleep disturbance, is an ongo¬
are at greater risk for suicidal ideation. If
ing difficulty initiating sleep, maintaining
a clinician monitored such REM sleep and
sleep, waking up too early, or experiencing
Sleep, Psychiatric Disorders, and the Transdiagnostic Perspective
|
chronically nonrestorative sleep. Insomnia
day interferes with nighttime sleep, which
is listed as a symptom in the current def¬
in turn contributes to mood regulation dif¬
inition of many psychiatric disorders and
ficulty and symptoms on the subsequent
there are many other disorders where in¬
day (Harvey, 2008).
somnia is not listed as a formal symptom but insomnia is a known common feature. The goal of this article is to address two
Is Insomnia Transdiagnostic?
questions that arise from recognizing the
There has been a resurgence of inter¬
comorbidity between insomnia and psy¬
est in explicitly identifying and studying
chiatric disorders: (1) is insomnia an epi-
the common, or transdiagnostic, processes
phenomenon or a mechanism and (2) is
across psychiatric disorders. This is in
insomnia transdiagnostic?
contrast to the disorder focused approach often taken in which classification systems
Is Insomnia an Epiphenomenon or a Mechanism?
and research programs tend to specialize
A widely held assumption is that insom¬
tenance, and treatment. We propose that
nia is secondary to, or an epiphenomenon
consideration be given to insomnia as a
of, the so-called primary psychiatric disor¬
transdiagnostic process on the basis of (1)
der. However, evidence has accumulated
the high rates of co-occurrence between in¬
to indicate that insomnia is not an epiphe¬
somnia and psychiatric disorders, (2) the
nomenon, but is often a key mechanism
evidence across a range of disorders that
contributing to the multi factorial causa¬
the insomnia is not an epiphenomenon but
tion of psychiatric disorders. Specifically,
contributes to onset, relapse, and mainte¬
insomnia is a risk factor for, and can con¬
nance, and (3) the transdiagnostic applica¬
tribute to, the development and/or main¬
bility of the bidirectional sleep and mood
tenance of psychiatric disorders. Second,
framework.
in one disorder, seeking to systematically illuminate that one disorder’s cause, main¬
there is substantial evidence that insom¬
The advantages of explicitly recogniz¬
nia impairs quality of life and incurs great
ing insomnia as a transdiagnostic process
personal costs due to economic and social
are threefold. First, the results of the Na¬
disability. Third, evidence from the sleep-
tional Comorbidity Survey make a strong
deprivation literature indicates that one of
case for the relative rarity of pure cases.
the strongest adverse effects of sleep de¬
The majority of the lifetime disorders
privation is increased negative mood. Fi¬
are comorbid disorders. A transdiagnos¬
nally, studies have shown adverse effects
tic perspective argues that perhaps disor¬
of sleep deprivation on cognitive function¬
ders co-occur because they share common
ing, which may impair problem-solving
mechanisms
ability. Moreover, it seems likely that there
if some psychiatric disorders are similar
is a bidirectional sleep and mood relation¬
with respect to the processes that maintain
ship whereby an escalating cycle of distur¬
them, then advances made in the context of
bance in mood and symptoms during the
one disorder will be more rapidly tested for
(e.g.,
insomnia).
Second,
705
706
|
Sleep Quality: A Behavioral Genetic Perspective
their application to other disorders. Third,
References
a transdiagnostic approach might lead to
Harvey, A.G. (2008). Insomnia, psychiatric disorders, and the transdiagnostic perspec¬ tive. Current Directions in Psychological Science, 17, 299-303.
the specification of a single treatment or treatment components that are effective across a wide range of disorders (Harvey, 2008).
Treatment Implications Is it possible to develop one transdiag¬
Manber, R., Edinger, J., Gress J., San PeddroSalcedo, M., Kuo, T., & Kalista, T. (2008). Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep, 31, 489^-95.
nostic treatment protocol that effectively treats insomnia in all psychiatric disor¬ ders? This is important, as developing and disseminating transdiagnostic treat¬
Sleep Quality: A Behavioral Genetic Perspective
ment protocols would have massive pub¬ lic health implications by reducing the heavy burden on clinicians, who must al¬ ready learn multiple treatment protocols that often share many common theoreti¬ cal underpinnings and interventions. Also, given the association between poor sleep and impaired quality of life, it is possible that improving sleep improves the func¬ tioning of individuals with a range of psychiatric disorders. Finally, if insomnia and the symptoms/processes of psychi¬
Sleep quality refers to a collection of mea¬ surements of sleep including sleep latency (the time in minutes taken to get to sleep), sleep duration, sleep efficiency (time in bed divided by total sleep time), number of disturbances from sleep such as awak¬ enings due to bad dreams or poor com¬ fort, and the daytime effects of a poor night’s sleep, among others. Subjective sleep quality is often assessed by selfreport questionnaires and has widely been
atric disorders are mutually maintaining,
assessed by the Pittsburgh Sleep Quality
then does a transdiagnostic treatment also
Index (PSQI: Buysse, Reynolds, Monk,
reduce symptoms and processes associ¬
Berman, & Kupfer, 1989). The PSQI taps
ated with the comorbid psychiatric dis¬
into seven components of sleep that can be
order? One landmark study suggests the
combined to yield an overall measure of
answer to the latter question is a resound¬
sleep quality. Sleep quality varies between
ing yes! Depression outcomes were sub¬
individuals and this variation is accounted
stantially improved by administering the
for by a combination of genetic and envi¬
frontline treatment for insomnia, namely
ronmental influences. Behavioral genetic
cognitive-behavioral therapy for insomnia
studies using twins'provide a useful tool
(Manber et al., 2008).
for assessing the relative contribution of
Jennifer C. Kanady and
genes and environments to any trait under
Allison G. Harvey
study. By comparing the similarity within monozygotic twins (who share
See also: entries related to Sleep Disorders
100%
of their genes) to the similarity within
Sleep Quality: A Behavioral Genetic Perspective
|
dizygotic twins (who share on average
that sleep patterns are significantly under
50% of their segregating genes) on a trait,
genetic control, and that regularity in sleep
twin studies allow us to determine the rel¬
stages may be important for good sleep
ative contribution of additive genetic (the
quality.
extent to which genes add up to influence
Recent work has aimed to further under¬
behavior), shared environmental (envi¬
stand the individual components of sleep
ronments that act to make twins within a
quality. Barclay and colleagues (2010)
pair similar), and nonshared environmen¬
examined the extent to which genes and
tal (environments that contribute to twin
environments account for the individual
dissimilarity) influences on a trait. Using
components of sleep quality, the pheno¬
this technique, genetic influences have
typic associations between them, and the
been found to account for around 33 to
overlap in the genetic and environmental
44 percent of the variance in subjective
influences accounting for the associations.
sleep quality (Heath, Kendler, Eaves, &
Genetic influences accounted for between
Martin, 1990; Partinen, Kaprio, Kosken-
30 and 47 percent of variance in the indi¬
vuo, Putoken, & Langinvainio, 1983).
vidual components, although there was no
These heritability estimates can be di¬
evidence for genetic effects on sleep dura¬
rectly compared to those of other phe¬
tion. It is likely that since sleep length is
notypes such as IQ—the heritability of
largely under voluntary control, environ¬
which has been estimated to be between
mental influences contribute a greater ex¬
50 and 90 percent. The remaining source
tent. Consequently the effect of genes is
of variance in sleep quality is largely ac¬
attenuated by social pressures to stay out
counted for by the nonshared environ¬
late at night coupled with the need to arise
ment. Such environmental influences may
early in the morning—thus reducing one’s
include negative life events, family con¬
sleep length. The individual components
flict, relationship issues, ill health, or un¬
of sleep quality were largely correlated,
employment—all of which are known to
which demonstrates that each of these as¬
be associated with poor sleep quality.
pects of sleep contribute to an underlying
Objective measures of sleep quality can
construct. Furthermore, genetic overlap
also be obtained using polysomnography.
between the components was substantial,
The latency, duration, and nightly patterns
which suggests that similar genes may be
of the four sleep stages, as well as rapid
responsible for different aspects of sleep
eye movement sleep (REM), may give an
quality. Behavioral genetic studies assess¬
indication of sleep quality. Using a twin
ing the genetic overlap between traits may
design, Linkowski (1999) observed that
help to guide molecular genetics. Knowl¬
genetic influences accounted for around
edge of the genes influencing one aspect
50 percent of the variation in Stages 2, 4,
of sleep may be useful for identifying
and delta sleep, although evidence for ge¬
genes associated with correlated symp¬
netic effects on REM sleep was inconclu¬
toms. Future studies aimed at identifying
sive. While this does not directly inform
specific gene variants implicated in differ¬
us about quality of sleep, it demonstrates
ent aspects of sleep are necessary to further
707
708
|
Sleep-Related Hallucinations and Ghost Tales
understand the complex processes under¬
into the Taxi” in Japan (Furuya et al., 2009;
lying sleep quality.
Kon-no, 1975). Recently, we suggested the Nicola L. Barclay
See also: entries related to Genetics of Sleep
possibility that the vivid visual hallucina¬ tions seen in progressive posterior cortical atrophy (PCA) share a similar mechanism
References
with some of the ghost tales experienced
Barclay, N.L., Eley, T.C., Buysse, D.J., Rijsdijk, F. V., & Gregory, A.M. (2010). Ge¬ netic and environmental influences on different components of the “Pittsburgh Sleep Quality Index” and their overlap. Sleep, 33, 659-668.
by normal people (Furuya, Ikezoe, Ohyagi,
Buysse, D.J., Reynolds, C.F., Monk, T. H., Berman, S.R., & Kupfer, D.J. (1989). The Pittsburgh Sleep Quality Index: A new in¬ strument for psychiatric practice and re¬ search. Psychiatry Research, 28, 192-213. Heath, A. C., Kendler, K. S., Eaves, E.J., & Martin, N.G. (1990). Evidence for genetic influences on sleep disturbance and sleep pattern in twins. Sleep, 13, 318-335. Linkowski, O. (1999). EEG sleep patterns in twins. Journal of Sleep Research, 8, 11-13. Partinen, M., Kaprio, J., Koskenvuo, M., Putoken, P., & Langinvainio, H. (1983). Genetic and environmental determination of human sleep. Sleep, 6, 179-185.
Miyoshi, & Fujii, 2006). Furthermore, re¬ ports of REM sleep behavior disorder or somnambulism
(sleepwalking)
(RBDS)
are becoming
more common
(Stores,
2007). Based on several review papers (Fuyuya et al., 2006; Stores, 2007), we developed diagnostic criteria consisting of central and core features to classify the ghost tales as far as possible into the four types described in Table 8.
Classification of Four Types of Hallucination Hypnagogic Hallucination-Like Ghost Tales (HyH) This type of hallucination is in principle the hypnagogic hallucination that occurs
Sleep-Related Hallucinations and Ghost Tales Though there are many ghost stories in various cultures around the world, the pathogenesis of a few types remains to be figured out. One is the hypnagogic hallu¬ cination, usually observed in narcolepsy,
in narcolepsy patients. The ghost image is not vivid but often rather vague, and it is sometimes accompanied by a cenesthopathy such as an incubus/succubus, a sense of being touched. The ghost sometimes speaks, makes a noise, or shakes the bed or room, and on rare occasions, converses with the sleeper.
when experienced by normal people with¬ out other diagnostic criteria. The other is
Highway Hypnosis-Like Ghost
highway hypnosis, in which fear is a com¬
Tales (HHy)
ponent. Highway hypnosis is illustrated by
Highway hypnosis (white-line fever or the
tales such as “The Vanishing Hitchhiker”
vanishing hitchhiker) has been defined as a
in the United States and “The Ghost Getting
tendency to become drowsy and suddenly
Sleep-Related Hallucinations and Ghost Tales
|
Table 8: Major Criteria for Classification of Ghost Tales of Normal People. (Three core features are sufficient for a definite diagnosis, two for a probable diagnosis, and one for a possible diagnosis.) 1. Hypnagogic hallucination-like ghost tales (HyH) Central features (essential for a diagnosis of HyH): HyH appears while the experiencer is sleeping or when they are waking from sleep. Core features: a. The image of the ghost is clear or vague but not very vivid. b. It sometimes accompanied by cenesthopathy such as an incubus/succubus, a feeling of being touched or a feeling of breathed on. c. The ghost sometimes speaks, makes a noise, or converses with the experiencer. Differential diagnosis: narcolepsy, schizophrenia 2. Highway hypnosis-like ghost tales (HHy) Central features (essential for a diagnosis of HHy): HHy is a tendency to become drowsy and suddenly fall asleep, sometimes into the REM stage, when driving an automobile. In HHy, the conscious and subconscious minds appear to concentrate on different things. Thus, this hallucination appears while the experiencer does not recognize the change of consciousness level. Core features: a. The sleep- or trance-like state can occur with the driver (experiencer) sitting in an upright position and staring ahead. b. The image of ghost is usually clear but sometimes vague. c. The ghost sometimes speaks or has a conversation with the experiencer. Differential diagnosis: complex partial seizure, temporal lobe epilepsy 3. REM sleep behavior disorder or somnambulism-like ghost tales (RBDS) Central features (essential for a diagnosis of RBDS): In REM sleep behavior disorder, the loss of motor inhibition leads to a wide spectrum of behaviors during sleep. In the case of somnambulism, it is usually defined by or involves the person performing normal actions as if awake. Thus, RBDS is closely related to sleep. Core features : a. The experiencer of RBD often has a dream at the same time, which convinces him/her that the events were real. b. The experiencer notices an abnormality in the bedroom or the experiencer himself or a bed partner after awakening, when the RBD is accompanied by somnambulism. c. The image of ghost is not as clear as it is in HHy because it is a part of dream. Differential diagnosis: early stage of dementia with Lewy bodies (DLB, parkinsonism), drug abuse (including alcoholism), malingering disorder 4. Vivid hallucination-like ghost tales (VH) Central features (essential for a diagnosis of VH): VH is similar to the hallucination occurred in a patient with DLB or Charles-Bonnet syndrome (CBD). The ghost appears without any relation to sleep.
(Continued)
709
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Sleep-Related Hallucinations and Ghost Tales
Table 8: Major Criteria for Classification of Ghost Tales of Normal People. (Three core features are sufficient for a definite diagnosis, two for a probable diagnosis, and one for a possible diagnosis.) (Continued) Core features: a. The image of the ghost is clear or vivid. b. Hallucinations are purely visual (i.e., the ghost never talks or tries to touch the experiencer.) c. The ghost vanishes into air when the experiencer tries to touch it or throw something at the ghost. Differential diagnosis: early stage DLB (parkinsonism), CBD, drug abuser (including alcoholism), schizophrenia
fall asleep, sometimes into the REM stage,
like a ghost or monstrous creature has en¬
while driving an automobile (Furuya et al.,
tered in the bedroom and done something.
2009). Theoretically, highway hypnosis is
Thus, RBDS is closely related to sleep.
a kind of mental state that also occurs when a person concentrates on a simple mechan¬ ical task, so it may happen relatively fre¬ quently and in common situations; for example, workers performing simple re¬ petitive tasks while deprived of sleep and walkers concentrating on the road at night using the faint light of a lantern may expe¬ rience highway hypnosis. Thus, this type of hallucination seems to be unrelated to sleep at first, and the hallucinator does not
Vivid Hallucination-Like Ghost Tales (VH) Vivid hallucination is similar to the hal¬ lucinations that occur in patients with de¬ mentia with Lewy bodies, some types of PCA, and Charles-Bonnet syndrome (Fu¬ ruya et al., 2006; Stores, 2007). The ghost appears without any relationship to sleep at first and is a purely visual hallucination.
recognize the change in his or her con¬ sciousness level. The image of the ghost is usually clear but sometimes vague.
Classification and Analysis of Ghost Tales
REM Sleep Behavior Disorder or Somnambulism-Like Ghost Tales (RBDS)
We analyzed 183 reliable ghost tales col¬
In REM sleep behavior disorder, the loss of
to 1970 (Kon-no, 1975; Yanagita, 2006)
motor inhibition leads to a wide spectrum
and found that 66.1 percent of the tales
of behaviors during sleep. Somnambulism
of ghosts could be classified into the four
is usually defined by or involves the per¬
types listed (see Table 8) (Furuya et al.,
son performing normal actions as if awake
2009); 32.2 percent were sleep related
(walking, opening/closing a door or win¬
(HyH and RBDS), and 35.0 percent were
dow, and other acts) (Stores, 2007). The
not sleep related (HHy and VH) (Furuya et al., 2009).
sleeper thinks that someone or something
lected by Japanese folklorists from 1900
Sleep-Related Mental Activities in Insomnia: Role and Assessment
|
Conclusion We propose the possibility that almost two thirds of ghost tales may be classified into one of four types of hallucinations expe¬ rienced by normal people, which means that most of them are attributable to the same mechanisms as neurophysiological and neurodegenerative or psychological disorders. Akihiro Watanabe and Hirokazu Furuya See also: entries related to Sleep Disorders References Furuya, H., Ikezoe, K., Ohyagi, Y., Miyoshi, T., & Fujii, N. (2006). A case of progressive posterior cortical atrophy (PCA) with vivid hallucination: Are some ghost tales vivid hallucinations in normal people? Journal of Neurology, Neurosurgery, and Psychiatry, 77, 424-425. Furuya, H., Ikezoe, K., Shigeto, H., et al. (2009). Sleep- and non-sleep-related hal¬ lucinations—Relationship to ghost tales and their classifications. Dreaming, 19, 232-238. Kon-no, E. (1975). Nihon Kaidan Syu [Ghosts tales in Japan] (1st ed.). Tokyo, Japan: Syakaishisou-sya (in Japanese). Stores, G. (2007). Clinical diagnosis and misdi¬ agnosis of sleep disorders. Journal of Neu¬ rology, Neurosurgery, and Psychiatry, 78, 1293-1297. Yanagita, K. (2006). Toh-no Monogatari [The “Toh-no” Folktales] (8th ed.). Tokyo, Japan: Kadokawa-Shoten (in Japanese). Ghost of Oyuki (artist unknown, but presented as a work of Maruyama Ckyo, 1733-1795; Japa¬ nese artist) (Hanging scroll picture: ink and colors on paper). Note the vague image of the lower part of the body, corresponding to the hypnagogic hallucination-like ghost (HyH; Table). (Extended loan to the University of California, Berkeley Art Museum from a private collection)
Sleep-Related Mental Activities in Insomnia: Role and Assessment Insomnia is a widespread complaint af¬ fecting about 10 percent of the general
711
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Sleep-Related Mental Activities in Insomnia: Role and Assessment
population on a chronic basis. Insomnia
A growing number of researchers and
is commonly explained by a hyperarousal
clinicians are recognizing the potential
state, present at bedtime, which could be
role of sleep-disruptive cognitions in in¬
cognitive as well as physiological, that
somnia and are thus incorporating cogni¬
interferes with normal sleep. Frequently,
tive therapy as a therapeutic component of
sleep habits and mental activities are
psychological interventions for insomnia.
modified following a night where insom¬
Some clinical trials have shown that these
nia is experienced to try to cope with the
therapeutic targets, including faulty be¬
situation. Therefore, as time passes, sleep
liefs and attitudes about sleep, are respon¬
habits, environment (such as a bedroom
sive to treatment and may actually play
or bedtime), and even mental activities
an important mediating role in reducing
become, by association, stimuli related to
insomnia symptoms and in maintaining
sleep disturbance and produce an insom¬
sleep improvements over time (Edinger,
nia state via a learning process (Morin,
Wohlgemuth, Radtke, Marsh, & Quillian,
1993).
Sleep-related mental activities
2001). To be able to assess these thoughts
such as faulty beliefs, worry, attribution,
and beliefs related to insomnia, specific
attentional bias, sleep perception, and
inventories or questionnaires are needed.
expectation play an important mediat¬
Such inventories will help in evaluating
ing role in perpetuating and exacerbating
patients’ responses to insomnia treatment,
insomnia (Harvey, Tang, & Browning,
which is of great clinical value. One of the
2005; Morin, 1993). To date, it is ac¬
first questionnaires related to thoughts in
knowledged that mental activities might
the context of insomnia was developed in
contribute to cognitive arousal at bedtime
1993 and is called Dysfunctional Beliefs
(Harvey et al., 2005). For instance, some
and Attitudes about Sleep questionnaire
insomnia sufferers tend to have unrealis¬
(Morin, 1993). It comprises 36 items eval¬
tic expectations about their sleep require¬
uating five dimensions of beliefs. Later,
ments and worry excessively when such
several shorter versions of this question¬
requirements are not met. Others fear
naire were developed, the most recent
the potential consequences of insomnia
being the DBAS-16 (Morin, Vallieres, &
on their daytime functioning and tend
Ivers, 2007). The DBAS-30 is also trans¬
to selectively channel their attention to¬
lated into several languages and is widely
ward any evidence of such consequences.
used around the world. This question¬
Some also evaluate quality of their sleep
naire, which possesses adequate psycho¬
upon awakening in the morning and will
metric properties, is an essential tool in
modify their daily functioning according
evaluating beliefs and thoughts pertaining
to their first sleep perception. However,
to insomnia. Other questionnaires target¬
such faulty expectations, perceptions,
ing cognitive process at bedtime or cogni¬
and excessive worry are producing emo¬
tive arousal have also been developed. To
tional distress and heightening arousal,
name only a couple there are the presleep
and will in turn feed the vicious cycle of
arousal scale (Nicassio, Mendlowitz, Fus¬
insomnia.
sed, & Petras, 1985) and Glasgow Content
Sleep Spindles
of Thoughts Inventory (Harvey & Espie, 2004). In summary, the role mental activities play in insomnia is well acknowledged al¬
|
Nicassio, P.M., Mendlowitz, D. R., Fussell, J. J., & Petras, L. (1985). The phenomenol¬ ogy of the pre-sleep state: The development of the pre-sleep arousal scale. Behaviour Research and Therapy, 23, 263-271.
though not yet clearly understood and dem¬ onstrated. Sleep-related mental activities include cognitions such as sleep percep¬
Sleep Spindles
tion, attentional bias, worry, and specific faulty beliefs about sleep. Moreover, given
Sleep stages are defined according to arbi¬
the importance attributed to cognitive pro¬
trary criteria based on the occurrence and
cess, it would be warranted to evaluate the
amount of specific phasic activities. Dur¬
unique contribution of cognitive interven¬
ing NREM sleep, brain activity is orga¬
tion alone to insomnia as it has not yet been
nized by spontaneous coalescent cerebral
assessed. Finally, a theoretical model that
rhythms: spindles, delta, and slow oscilla¬
includes the full range of potentially in¬
tions. On EEG recordings, spindles appear
volved cognitive processes is warranted to
as waxing-and-waning oscillations at a fre¬
provide a global view of mental activities
quency of about 11 to 15 Hz and a duration
in insomnia.
of more than 500 milliseconds. Spindles Annie Vallieres
are prominent during N2 sleep and are pro¬ gressively replaced during deeper stages
See also: entries related to Sleep Disorders
by low-frequency high-amplitude (slow
References
and delta) waves. Besides, spindles are
Edinger, J.D., Wohlgemuth, W. K., Radtke, R.A., Marsh, G. R., & Quillian, R.E. (2001). Does cognitive-behavioral insom¬ nia therapy alter dysfunctional beliefs about sleep? Sleep, 24, 591-599.
grouped by the slow oscillation. Spindles
Harvey, A. G., Tang, N.K., & Browning, L. (2005). Cognitive approaches to insomnia. Clinical Psychology Review, 25, 593-611.
The thalamus is a central structure for the
Harvey, K.J., & Espie, C.A. (2004). Devel¬ opment and preliminary validation of the Glasgow Content of Thoughts Inventory (GCTI): A new measure for the assessment of pre-sleep cognitive activity. British Jour¬ nal of Clinical Psychology, 43, 409-420. Morin, C.M. (1993). Insomnia: Psychological assessment and management. New York: The Guilford Press. Morin, C. M., Vallieres, A., & Ivers, H. (2007). Dysfunctional beliefs and attitudes about sleep (DBAS): Validation of a brief version (DBAS-16). Sleep, 30, 1547-1554.
are suppressed during surface negative half-waves of the slow oscillation (down state), but increased during positive half¬ waves (up state). generation of spindles. Within the thala¬ mus, pacemakers of spindle oscillations are located in thalamic reticular neurons. This assumption is supported by the finding that spindles are preserved within the reticular thalamus disconnected from the remaining thalamus and cerebral cortex. Although spindles can be generated within the thala¬ mus in the absence of the cerebral cortex, the neocortex is essential for the induction, synchronization, and termination of spin¬ dles. In the intact brain, spindles are pro¬ duced through thalamo-cortico-thalamic
713
714
|
Sleep Spindles
loops (cf. Steriade & McCarley, 2005). In
in rats, hippocampal ripples were found
humans, EEG recordings have character¬
to occur in temporal proximity to corti¬
ized spindle oscillations in terms of scalp
cal sleep spindles, indicating an informa¬
topography. Although they are detectable
tion transfer between the hippocampus and
on all EEG scalp derivations, spindles are
neocortex (Siapas & Wilson, 1998). This
most prominent over centro-parietal areas
neuronal replay in turn has been suggested
with a frequency above 13 Hz (De Genn-
as the basis for reorganization and consoli¬
aro & Ferrara, 2003). A second cluster of
dation of memories (Buzsaki, 1996; Steri¬
spindles is visible over frontal areas, with
ade, 1999). Gais and colleagues were then
a frequency of about 12 Hz. From this
the first to demonstrate that sleep spindle
topographical segregation the hypothesis
density is also related to declarative learn¬
emerged that two types of spindles are pro¬
ing in humans (Gais, Molle, Helms, &
duced by distinct biological mechanisms.
Bom, 2002). Interestingly, it has also been
In addition this is in line with the finding
postulated that an individual’s learning
that both spindle subtypes are differentially
potential might be well reflected in sleep
modulated by age, circadian and homeo¬
spindle activity (cf. Schabus et al., 2006).
static factors, menstrual cycle, pregnancy,
Manuel Schabus
and drugs (De Gennaro & Ferrara, 2003). EEG/fMRI studies of human sleep also support the existence of two spindle types (Schabus et al., 2007). In particu¬ lar these data revealed that—besides in¬ creased brain responses in the lateral and
posterior aspects of the thalamus, as well as in paralimbic (anterior cingulate cor¬ tex, insula) and neocortical areas—the fast spindle type is associated with increased hemodynamic activity in hippocampal and sensorimotor regions. This finding also in¬ dicated a possible differential functional significance of these two spindle types, with the fast spindle being more closely as¬ sociated with cognitive functioning (e.g., Morin et al., 2008). Yet more research is needed to unravel the functional signifi¬ cance of these two spindle types. In general spindles are of interest for cognition research as they have been di¬ rectly related to the repeated activation of thalamo-cortical or hippocampo-cortical networks after learning. Specifically,
See also: entries related to Sleep Assessment References Buzsaki, G. (1996). The hippocampo-neocortical dialogue. Cerebral Cortex, 6(2), 81-92. De Gennaro, L., & Ferrara, M. (2003). Sleep spindles: An overview. Sleep Medicine Re¬ views, 7(5), 423-440. Gais, S., Molle, M., Helms, K., & Born, J. (2002). Learning-dependent increases in sleep spindle density. Journal of Neurosci¬ ence, 22(15), 6830-6834. Morin, A., Doyon, J., Dostie, V., Barakat, M., Hadj Tahar, A., Korman, M., et al. (2008). Motor sequence learning increases sleep spindles and fast frequencies in post¬ training sleep. Sleep, 31(8), 1149-1156. Schabus, M., Dang-Vu, T.T., Albouy, G., Balteau, E., Boly, M., Carrier, J., et al. (2007). Hemodynamic cerebral correlates of sleep spindles during human non-rapid eye movement sleep. Proceedings of the National Academy of Sciences USA, 104 (32), 13164-13169. Schabus, M., Hodlmoser, K., Gruber, G., Sauter, C., Anderer, P., Klosch, G., et al. (2006).
Sleep Talking
Sleep spindle-related activity in the human EEG and its relation to general cognitive and learning abilities. European Journal of Neuroscience, 23(1), 1738-1746. Siapas, A.G., & Wilson, M. A. (1998). Coor¬ dinated interactions between hippocampal ripples and cortical spindles during slowwave sleep. Neuron, 21(5), 1123-1128. Steriade, M. (1999). Coherent oscillations and short-term plasticity in corticothalamic net¬ works. Trends in Neurosciences, 22(8), 337-345. Steriade, M. & McCarley, R. W. (2005). Brain control of wakefidness and sleep. New York: Springer.
|
There are three patterns in occurrence. The first and largest subgroup (about two thirds of childhood sleep talkers) is formed by real childhood sleep talkers; that is, those who do so as adults quite rarely or not at all. In the second subgroup are those that talked in their sleep frequently as children and continued to do so quite frequently as adults. These persons can be called persis¬ tent sleep talkers, and this subgroup forms about one fifth of those who talked in their sleep as children. The third and the small¬ est group (less than one tenth of adult sleep talkers) is formed by those adults who started to talk in their sleep as adults; that
Sleep Talking
is, adult-onset sleep talking (Hublin et al., 1998).
In sleep talking (somniloquy), the essen¬
Genetic effects play a role in sleep talk¬
tial feature is talking, with varying degrees
ing (Hublin & Kaprio, 2003). In a twin
of comprehensibility, during sleep (Inter¬
study, the proband-wise concordance rate
national Classification of Sleep Disorders
for childhood sleep talking was 0.53 in the
[ICSD-2], 2005). It can occur in both REM
monozygotic (MZ) pairs, and 0.36 in the
and non-REM sleep at any time during the
dizygotic (DZ) pairs. For adults, the pro-
night
&
band-wise concordance rate was 0.23 for
Shapiro, 1962). Sleep talking is highly
the MZ pairs and 0.14 for the DZ pairs. The
prevalent, occurring in childhood always
proportion of total phenotypic variance in
or often in 4 to 14 percent and now and
liability to sleep talking attributed to ge¬
then in 22 to 60 percent, and as adults in 1
netic influences in childhood sleep talking
to 5 percent and in 20 to 45 percent, respec¬
was 54 percent in males and 51 percent in
tively (Hublin & Kaprio, 2003). The true
females, and for adults it was 37 percent
prevalence is not easy to estimate because
among males and 48 percent among fe¬
subjects as a rule do not remember or are
males (Hublin et al., 1998).
(Rechtschaffen,
Goodenough,
not aware of their sleep talking. There is no
Traditionally sleep talking has been
clear gender difference in childhood sleep
classified as one of the parasomnias,
talking, but in adults it may be more com¬
which are undesirable physical events or
mon in males (Hublin, Kaprio, Partinen, &
experiences during the entry to sleep,
Koskenvuo, 1998). The occurrence of childhood and adult
within sleep, or during arousals from
sleep talking are highly correlated: about
tem activation (ICSD-2, 2005). Now it
80 percent of adults with sleep talking have
is considered more as a sleep-related
done so as a child (Hublin et al., 1998).
symptom that lies on the border between
sleep, reflecting central nervous
sys¬
715
716
|
Sleep Variables and Handedness
normal and abnormal sleep. It is com¬ mon that parasomnias co-occur (Hublin, Kaprio, Partinen, & Koskenvuo, 2001). In childhood, the correlations were high¬ est in sleep talking for co-occurrence with sleepwalking (r = 0.73), nightmares (0.50), and bruxism (0.43). The results are similar in co-occurrence as adults,
Hublin, C., Kaprio, J., Partinen, M„ & Kosken¬ vuo, M. (1998). Sleeptalking in twins: Epi¬ demiology and psychiatric co-morbidity. Behavior Genetics, 28, 289-298. Hublin, C., Kaprio, J., Partinen, M., & Ko¬ skenvuo, M. (2001). Parasomnias: Co¬ occurrence and genetics. Psychiatric Genet¬ ics, 11, 65-70. International
Classification
of Sleep
Dis¬
although the correlations are somewhat
orders: Diagnostic and Coding Manual
lower (0.56, 0.43, and 0.39, respec¬
(ICSD-2) (2nd ed.). (2005). Chicago: Amer¬ ican Academy of Sleep Medicine.
tively). In MZ twins the co-occurrence of sleepwalking and sleep talking is clearly higher (0.31) compared to DZ twins (0.05).
Rechtschaffen, A., Goodenough, D. R., & Sha¬ piro, A. (1962). Patterns of sleeptalking. Ar¬ chives of General Psychiatry, 7, 418-426.
The correlations are substantial (>0.15 in MZ pairs) in three combinations: sleep talking-sleepwalking,
sleep
talking-
bruxism, and sleep talking-nightmares. Sleep talking is usually benign but
Sleep Variables and Handedness: Methodological Issues and State of the Field
chronic cases in adults may relate to psy¬ chopathology (Rechtschaffen et al., 1962).
There are several issues that make it dif¬
In adults, psychiatric comorbidity is about twice as common in those with frequent
ficult to determine if sleep variables might
sleep talking (highest in those with adult-
(handedness). Nevertheless, because indi¬
onset sleep talking, odds ratio 3.8), com¬
vidual variations in handedness may re¬
pared to those with infrequent or no sleep
flect individual variations in functional
talking, but most cases of sleep talking are
and structural brain organization, it is
not associated with serious psychopathol¬
worthwhile to examine the sleep of differ¬
ogy (Hublin et al., 1998).
ent handedness groups. Ultimately, such
vary as a function of hand use preference
In conclusion, sleep talking is common
investigations could help to shed light on
but little studied, reflecting the fact that it is
neurophysiological processes that occur
usually a harmless phenomenon. However, if it is frequent or loud it can be disturbing,
during sleep, as well as on the functions of sleep in general.
and sometimes the content can cause prob¬
One issue that makes it difficult to deter¬
lems in intimate relationships. Christer Hublin See also: entries related to Parasomnias
mine handedness-sleep relationships in¬ volves the very definition of handedness. Traditionally, handedness has been divided into left- versus right-handers, with perfor¬
References
mance on one (e.g., writing hand) or multi¬
Hublin, C., & Kaprio, J. (2003). Genetic as¬ pects and genetic epidemiology of parasom¬ nias. Sleep Medicine Reviews, 7, 413—421.
ple test items (e.g., drawing, using a knife, etc.) indicating handedness. Thus, the di¬ rection of hand preference—right versus
Sleep Variables and Handedness
|
left (regardless of whether one strongly
sleep length, while others focused on is¬
prefers to use one vs. the other hand)—
sues of sleep quality, such as insomnia-
is the important measure. However, other
related measures. Some work objectively
work suggests that how strongly one pre¬
recorded sleep, while some focused on
fers to use one hand (e.g., always one vs.
self-reported, subjective measures of sleep
the other hand, sometimes one vs. the
variables. Any attempt at synthesis of the
other, or no preference) across a variety of
literature must take this methodological
test items is also, or in some cases more,
variation into account; as will be seen,
important to investigate. Thus, in these
methodology can interact with both the
latter
hand
measure examined and with the handed¬
preference—consistent versus inconsistent
ness groups tested, resulting in complex
(e.g., regardless of direction; that is, regard¬
relationships between these variables.
investigations,
degree
of
less of left vs. right hand)—is the means
Given the methodological challenges
by which handedness is categorized. Still
outlined earlier, why would one bother to
other studies examine handedness by cat¬
suspect that individual differences in hand
egorizing across both degree and direction,
preference might indicate individual dif¬
comparing consistently left, consistently
ferences in sleep measures? First, NRH
right, and inconsistent-handers.
versus RH differ neuroanatomically. For
Unfortunately, investigations of hand¬
example, NRH compared to RH have a
edness-sleep relationships have not been
larger corpus callosum, that part of the brain
consistent in their division of the hand¬
responsible for connecting the two cerebral
edness groups; it is therefore difficult to
hemispheres (e.g., Denenberg, Kertesz, &
synthesize the body of literature into a co¬
Cowell, 1991; Witelson & Goldsmith,
herent whole. Given the inconsistent clas¬
1991). NRH also have decreased neuro-
sification of the handedness groups across
anatomical asymmetries; for example, in
studies, in the present article consistent-
language-related areas (e.g., Propper et ah,
left-handers and inconsistent-handers are
2010). In addition to differences in struc¬
collapsed into a non-right-handed (NRH)
tural organization, NRH versus RH differ
group that is compared to right-handers
in the functional organization of the brain,
(RH). It is hoped that what may be lost
with reversed or bilateral lateralization of
in lack of precision will be gained in
cerebral functions in NRH (Hellige, 1993).
coherence.
For example, NRH is associated with in¬
A second issue that makes it difficult
creased incidence of right hemisphere or
to determine handedness-sleep relation¬
bilateral language processing (e.g., Knecht
ships involves the methodology used to
et al., 2000), as well as with atypical neu-
collect and define sleep variables. For ex¬
roanatomic asymmetries in language areas
ample, while some studies examined the
(e.g., Propper et al., 2010). To the extent
sleep of different handedness groups in a
sleep recruits the same neuroanatomi-
sleep laboratory, others examined equally
cal substrates that differ between NRH
important home sleep. Some studies fo¬
and RH, the handedness groups will dif¬
cused on sleep-quantity measures, such as
fer in their sleep. Comparisons between
717
718
|
Sleep Variables and Handedness
handedness groups can therefore inform
issue, several other investigations have re¬
us about the neuroanatomical structures
ported no handedness differences in sleep
involved in, and functional organization
quality (e.g., Porac & Searleman, 2006;
of the brain during, sleep.
Violani, De Gennaro, & Solano, 1988).
In fact, despite the infancy of the field,
Other measures of sleep also demon¬
there are demonstrated differences in sleep
strate handedness effects, although again,
variables between
groups.
these effects vary as a function of method¬
For example, sleep quality may differ as
ology. For example, self-reports indicate
a function of handedness, especially in
decreased sleep, and possibly decreased
studies examining self-report measures, or
sleep needs, in NRH compared to RH
that look at pathologies associated with
(Hicks, Pellegrini, & Hawkins, 1979; Prop¬
sleep.
self-report
per, 2000). At least partly consistent with
greater symptoms of insomnia (Coren &
the self-report literature, Kilgore, Lipizzi,
Searlman, 1987; Hicks, DeHaro, Inman, &
Grugle, Killgore, and Balkin (2009) re¬
Hicks, 1999), including greater difficulty
ported increased sleep duration, and better
falling asleep, more middle-of-the-night
sleep, in RH compared to NRH, in a sleep
awakenings, and greater difficulty falling
laboratory, but not in at-home measures.
back to sleep, compared to RH. In labora¬
However, Lehnkering Strauss, Wegner,
tory examinations, NRH also suffer from
and Siegmund (2006) reported actigraph-
more severe sleep apnea compared to RH (Hoffstein, Chan, & Slutsky, 1993). The
measured sleep-duration differences be¬
NRH have a higher incidence of enuresis
having a longer sleep duration compared
(Ferrara et al., 2001) as well. However,
to RH. Finally, sleep diary (Violani et al.,
in the only studies explicitly attempting
1988) and home monitoring (Propper et al.,
to disentangle the contribution of direc¬
2004, 2007) showed no handedness differ¬
tion versus degree of hand preference to
ences in sleep length.
handedness
For example,
NRH
tween the handedness groups, with NRH
sleep using objective at-home sleep moni¬
Differences between handedness groups
toring, RH and left-handers, compared to
in
inconsistent-handers, demonstrated longer
sured by sleep-duration deviation from a
time to fall asleep and an increased amount
standard norm have also been reported,
of time spent awake during the night
although again the direction of this dif¬
(Propper, Christman, & Olejarz, 2007;
ference has been conflicting. Hicks and
Propper, Lawton, Przyborski, & Christ¬
colleagues (1979), using a questionnaire,
man, 2004), the opposite of what would
reported greater deviation from a standard
have been expected based on the self-report
norm in the inconsistent-handers versus
literature, suggesting an effect of methods
consistent-handers, while Violani and col¬
of sleep assessment on sleep variables,
leagues (1988), using a sleep diary, re¬
and the possibility that degree, rather than
ported the opposite. Propper and colleagues
direction, of hand preference may be an
(2004) found no handedness effects on this
important mediator of handedness-sleep
measure examining objectively recorded home sleep.
relationships. To further confound the
sleep-duration
variability
as
mea¬
Sleep Variables and Handedness
|
Very few other studies have gone be¬
with NRH demonstrating no change in am¬
yond description of sleep duration or qual¬
plitude as a function of sleep time, and RH
ity as a function of handedness. Those that
demonstrating decreased amplitude during
have, have found a relationship between
the last four hours of sleep in both the left
handedness and sleep architecture, or be¬
and right hemisphere.
tween handedness and other physiological
There are several points to be taken from
components of sleep. For example, Prop-
the previously mentioned review. First, the
per et al. (2004, 2007) found differences
method of sleep monitoring is an impor¬
in sleep architecture among consistently
tant variable to consider in examinations
left-, consistently right-, and inconsis¬
of handedness-sleep relationships. For ex¬
tently handed individuals in objective
ample, self-report measures may not actu¬
home sleep. Left-handers spent the most
ally measure sleep, but rather some other
time (M = 76%) in nonrapid eye move¬
cognitive process involved in the percep¬
ment (NREM) sleep, inconsistent-handers
tion of sleep. The bulk of the literature in¬
spent the second most time (M = 72%) in
dicates that it is in the self-perception of
NREM, and RH the least amount of time
sleep in which the handedness groups dif¬
in NREM (M = 62%). The opposite pat¬
fer. Specifically, it is interesting to note
tern was obtained for rapid eye movement
that the perception of sleep quality and
(REM) sleep: left-handers spent the least
duration, measured via self-report, does
amount of time in REM (M = 20%), incon¬
vary as a function of hand preference, with
sistent-handers the second most amount of
NRH believing they need less, receive
time in REM (M - 24%), and right-handers
less, and have poorer, sleep. It is not clear,
the most (M = 31%). The number of dis¬
on the other hand, if objective measures
crete REM episodes, however, showed a
of sleep quality (other than examination
different story, with inconsistent-handers
of sleep-associated pathological condi¬
having the most REM episodes (M = 4.7),
tions) or sleep duration show differences
left-handers the second most (M= 3.8), and
between handedness groups. Second, al¬
right-handers the least (M = 3.2).
though
The handedness groups also differ in
sleep-duration
measure
results
are conflicting, and vary as a function of
measures.
methodology, laboratory measures clearly
Nielsen, Abel, Lorrain, and Montplaisir
indicate differences between the handed¬
(1990) reported increased electroenceph-
ness groups in sleep architecture and neu¬
alographic coherence in NRE1 versus RH
rophysiology. The results of these studies
during wake, Stage 2, and REM sleep.
suggest that during sleep, patterns of in-
Murri and colleagues (1984) found dif¬
terhemispheric communication vary as a
ferences between NRH and RH in REM-
function of hand preference. It is likely that
sleep EEG asymmetry as measured by
these individual differences in handedness
EEG power. Finally, Serafetinides (1991)
effects reflect the differences in brain or¬
reported differences in EEG amplitude as a
ganization between NRH and RH; specifi¬
function of both handedness and sleep time
cally, larger corpus callosum in the NRH
(first four hours vs. last four hours of sleep),
may result in increased interhemispheric
sleep-related
physiological
719
720
|
Sleep Variables and Handedness
communication during sleep. Such find¬ ings suggest that sleep itself involves alter¬ ations in interhemispheric communication, possibly as a function of sleep stage. Third, given the overall paucity of studies ex¬ amining sleep-handedness relationships, clearly more research is needed to disen¬ tangle the effects of the latter variable on the former. Ruth E. Propper See also: entries related to Sleep and the Brain
Knecht, S., Drager, B., Deppe, M., Bobe, F., Fohmann, H., Floel, A.R.,. . . Henningsen, H. (2000). Handedness and hemispheric language dominance in healthy humans. Brain, 123, 2512-2518. Fehnkering, H., Strauss, A., Wegner, B., & Siegmund, R. (2006). Actigraphic inves¬ tigations on the activity-rest behavior of right- and left-handed students. Interna¬ tional Chronobiology, 23, 593-605. Murri, F., Stefanini, A., Bonanni, E., Cei, G., Navona, C., & Denoth, F. (1984). Hemi¬ spheric EEG differences during REM sleep in dextrals and sinistrals. Research Com¬
References
munications in Psychology: Psychiatric Be¬
Coren, S., & Searleman, A. (1987). Left sid¬ edness and sleep difficulty: The Abnor¬ mal Syndrome. Brain and Cognition, 6, 184-192.
havior, 9, 109-120.
Denenberg, V. H., Kertesz, A., & Cowell, P. E. (1991). A factor analysis of the human’s corpus callosum. Brain Research, 548, 126-132. Ferrara, P., Ruggiero, A., Diocialuti, L., Paolini Paoletti, F., Chiozza, M.L., & Calone, P. (2001). Primary Nocturnal Enuresis and left-handedness. Scandinavian Journal of Urology and Nephrology, 35, 184-185. Hellige, J. B. (1993). Hemispheric asymmetry: What’s right and what’s left. Cambridge, MA: Harvard University Press. Hicks, R. A., DeHaro, D., Inman, G., & Hicks, G.J. (1999). Consistency of hand use and sleep problems. Perceptual and Motor Skills, 89, 49-56. Hicks, R.A., Pellegrini, R.J., & Hawkins, J. (1979). Handedness and sleep. Cortex, 15, 327-229. Hoffstein, V., Chan, C. K., & Slutsky, A.S. (1993). Handedness and sleep apnea. Chest, 103, 1860-1862. Kilgore, W.D., Lipizzi, E.L., Grugle, N.F., Killgore, D.B., & Balkin, T.J. (2009). Handedness correlates with actigraphically measured sleep in a controlled environment. Perceptual and Motor Skills, 109, 395-400.
Nielsen, T., Abel, A., Forrain, D., & Montplaisir, J. (1990). Interhemispheric EEG coherence during sleep and wakefulness in left-and right-handed subjects. Brain and Cognition, 14, 113-125. Porac, C., & Searleman, A. (2006). The rela¬ tionship between hand consistency, health, and accidents in a sample of adults over the age of 65 years. Laterality, 11, 405^-14. Propper, R.E. (2000, June). Perceived sleep needs and feelings of alertness: Handedness and familial sinistrality effects. Poster pre¬
sented at the American Psychological Soci¬ ety, Miami, Florida. Propper, R.E. (2004). Handedness differences in self-assessment of sleep quantity: Non¬ right versus strong-right-handers. Sleep and Biological Rhythms, 2, 99-101 Propper, R.E., Christman, S.D., & Olejarz, S. (2007). Home-recorded sleep architecture as a function of handedness II: Consistent right-versus consistent left-handers. Jour¬ nal of Nervous and Mental Disease, 195,
689-692. Propper, R.E., Lawton, N„ Przyborski, M., & Christman, S.D. (2004). An assessment of sleep architecture as a function of degree of handedness in college women using a home sleep monitor. Brain and Cognition, 54, 186-197.
Sleepiness and Driving
|
Propper, R.E., O’Donnell, L.E., Whalen, W., Tie, Y., Norton, I.H., Suarez, R.O., . . . & Golby, A.J. (2010). A combined fMRI and DTI examination of functional language lat¬ eralization and arcuate fasciculus structure: Effects of degree versus direction of hand preference. Brain and Cognition, 73, 85-92.
drugs that act on the central nervous system
Serafetinides, E. A. (1991). Cerebral domi¬ nance and sleep: A comparison according to handedness and time of sleep. Interna¬ tional Journal of Neuroscience, 61, 91-92.
sive sleepiness (Drake et al., 2010).
Violani, C., De Gennaro, L., & Solano, L. (1988). Hemispheric differentiation and dream recall: Subjective estimates of sleep and dreams in different handedness groups.
(CNS), and diseases that affect the CNS (Roehrs, Carskadon, Dement, & Roth, 2005). In the general population, insuffi¬ cient sleep due to reduced time in bed at night is the most common cause of exces¬ The proportion of accidents related to specific sleep disorders is not known. One study indicates an accident rate of 13 per million kilometers for those with a sleep disorder, compared to 0.8 for a control group (Horstmann et al., 2000). There is
International Journal of Neuroscience, 39,
evidence that those with obstructive sleep
9-14.
apnoea hypopnea syndrome
Witelson, S.F., & Goldsmith, C.H. (1991). The relationship of hand preference to anatomy of the corpus callosum in men. Brain Re¬ search, 545, 175-182.
(OSAHS)
have up to seven times greater risk of crashes compared to those without OSA (Teran-Santos, Jimenez-Gomez, & Cordero-Guevara, 1999). The majority of sleep-related crashes are not in people with predisposing condi¬
Sleepiness and Driving
tions but in drivers, largely young males, who are sleep deprived and who fall asleep
Anecdotally, motor vehicle accidents due
while driving at night. There are clear ef¬
to sleepiness have been reported since
fects of time of day on motor vehicle acci¬
1929 (Kennedy, 1929). Epidemiological
dents, with peaks in the early morning and
studies indicate that sleep-related crashes
midafternoon (Akerstedt et al., 1994b; Lan¬
represent up to 20 percent of all traffic ac¬
glois et al., 1986). Research has shown that
cidents in industrial societies (Connor et
sleep restriction for 24 hours impairs driver
al., 2002). In the United States, Israel, Ger¬
performance to the same extent as alcohol
many, and Sweden, sleep-related vehicle
intoxication (Dawson & Reid, 1997).
accidents account for many accidents on
Estimates of the proportion of accidents
nonurban roads and cause greater driver
attributable to sleep vary widely: 1 to 3 per¬
mortality and morbidity than other types of
cent in the United States and 10 percent in
accidents because of the greater speed on
France. In the United Kingdom, approxi¬
impact (Akerstedt et al., 1994a; Langlois,
mately 300 people are killed on the roads
Smolensky, His, & Weir, 1986).
per year due to a driver falling asleep at the
Numerous studies have demonstrated
wheel. In the United States, an estimated
that the underlying causes of excessive
1,202 people were killed annually as a re¬
sleepiness include reduced or fragmented
sult of sleepiness, drowsiness, and fatigue
sleep, circadian variations in alertness,
driving in 2009.
721
722
|
Sleepiness and Driving
Many sleep-related vehicle accidents
than their employees, and can be crimi¬
occur while drivers are at work (Leger,
nally liable for breaching the legislation.
1988)—for example, driving company
Additionally, organizations may be pros¬
cars or lorries (Maycock, 1996). The De¬
ecuted under the Corporate Manslaughter
partment of Motor Transportation in the
and Corporate Homicide Act 2007 in the
United States now considers that there
event of a fatality due to a gross failing
is a high likelihood that every lorry will
in their management of health and safety.
be involved in at least one sleep-related
It is therefore important for employers to
crash during the lifetime of the vehicle
meet their legal duties to the public, while
(Knipling &Wang, 1994). Around 40 per¬
protecting the health and safety of its driv¬
cent of sleep-related crashes involve com¬
ers and ensuring the need to improve pub¬
mercial vehicles. This type of accident is
lic safety.
most frequent on highways/motorways
STATS
19,
the
United
Kingdom’s
and similar roads. In the United Kingdom,
national database for road accidents, does
fatal road accidents involving lorries, per
not normally record causal factors. Even
100 million vehicle kilometers, is almost
when these (or contributory) factors are as¬
double that for cars (averaging 2.1 vs. 1.1
signed, they are often assigned incorrectly
over the past five years). A survey in the
(Horne & Reyner, 1999). For example, many
United Kingdom found that 29 percent of
sleep-related vehicle accidents, whether
4,600 respondents admitted to having felt
these involve cars, lorries, or other vehicles,
close to falling asleep at the wheel in the
are simply attributed to driver inattention.
previous year, and 17.9 percent had acci¬
This general situation regarding unreliable
dents during the previous three years. Of
national statistics on sleep-related vehicle
these, and for those accidents on motor¬
accidents is typical for most other Western
ways, 15 percent were sleep-related vehi¬
countries (Akerstedt et al., 1994a,b).
cle accidents (Knipling & Wang, 1994).
Another reason for drivers to deny hav¬
Most drivers causing sleep-related ve¬
ing fallen asleep may be that the driver
hicle accidents usually deny having fallen
genuinely had no recollection of actually
asleep. The evidence pointing to the ac¬
having fallen asleep. Sleep laboratory stud¬
cident being related to sleep has to come
ies show that people who fall asleep typi¬
from other sources. There are different pos¬
cally deny having been asleep if awoken
sible reasons for this denial—such as loss
within a minute or two (Bonnet & Moore,
of insurance indemnity and fear of prosecu¬
1982). It has been shown that two to four
tion. The law puts the responsibility on the
minutes of sleep had to elapse before >50
driver not to drive if sleepy. The U.K. Road
percent of people acknowledged that they
Traffic Act 1988 (as amended) states that
were asleep (Gastaut & Broughton, 1965).
a driver must not drive without due care
Drivers may be aware of precursory feel¬
and attention. Section 3(1) of the Health
ings of sleepiness, although they may not
and Safety at Work etc Act 1974 (HSW
acknowledge having fallen asleep and may
Act) makes clear that employers (and self-
not even remember this after the accident
employed people) have duties to those other
(Horne & Reyner, 1999).
Sleepiness and Driving
|
OSAHS is the best studied cause of
subsequent risk of a motor vehicle acci¬
sleepiness and its effects on driving perfor¬
dent is necessary, matched by an increase
mance. One study estimated that up to 15
in public awareness of the risks of driving
percent of lorry drivers may have sleep ap-
while sleepy.
noea and sleepiness (Howard et ah, 2004).
Sopna Choudhury, Ajit Thomas, Shahrad
In the United Kingdom, there are approx¬
Taheri, and Dev Banerjee
imately 500,000 drivers and that would equate to around 75,000 with OSAHS. U.K. Driver and Vehicle Licensing
See also: Primary Disorders of Hypersom¬ nolence and Dreams; entries related to Sleep Disorders
Agency (DVLA) guidelines recommend that, for group-2 LGV/PCV license hold¬ ers: For patients diagnosed with OSAHS “Driving must cease until satisfactory con¬ trol of symptoms has been attained with ongoing compliance with treatment, con¬ firmed by consultant/specialist opinion (i.e., can restart driving commercial vehi¬ cles). Regular, normally annual, licensing review [is] required.” This means that the DVLA does permit drivers with OSA to get back to driving once their symptoms
Note Both Dr. Shahrad Taheri and Dr. Sopna Choud¬ hury are funded by the National Institute for Health Research (NIHR) through the Collabo¬ rations for Leadership in Applied Health Re¬ search and Care for Birmingham and Black Country (CLAHRC-BBC) programme. The views expressed in this publication are not nec¬ essarily those of the NIHR, the Department of Health, NHS South Birmingham, University of Birmingham, or the CLAHRC-BBC Theme 8 Management/Steering Group.
are controlled. Across the United King¬ dom, this is commonly within 14 days of starting continuous positive airway pres¬ sure (CPAP) therapy (CPAP delivers air to the airways to keep them open). There¬ fore, commercial drivers should neither fear the necessary tests for OSAHS, nor that the DVLA will revoke their licenses, provided they are compliant with the effec¬ tive therapy (Banerjee, 2011). Sleep-related motor vehicle accidents can be reduced through a greater aware¬ ness by drivers and employers of the dan¬ ger of driving while sleepy, and that such driving behavior is unacceptable. The risk of motor vehicle accidents among people with OSA can be reduced by its clinical diagnosis and treatment with CPAP. More research into the aware¬ ness of sleepiness among drivers and the
References Akerstedt, T., Czeisler, C.A., Dinges, D., et al. (1994a). Accidents and sleepiness: A consensus statement. Journal of Sleep Re¬ search, 4, 195. Akerstedt, T., Kecklund, G., Zulley, J., Cronlein, T., Hell, W., & Langwieder, K. (1994b). Fatal highway accidents mainly caused by falling asleep. In T. Akerstedt & G. Kecklund (Eds.), Work hours, sleepiness and accidents (Stress Research Report No 248, Section of Stress Research, p. 104). Stockholm: Karolinska Institute. Banerjee, D. (2011). Sleep, work and health; Part 2 obstructive sleep apnoea and the work place—The impact on road safety. Occupa¬ tional Health at Work, 7(6), 16-18. Bonnet, M. H., & Moore, S.E. (1982). The threshold of sleep: Perception of sleep as a function of time asleep and auditory thresh¬ old. Sleep, 5, 267-276.
723
724
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Sleeping and Dreaming Patterns in the Context of Attachment Relationships
Connor, J. R., Norton, J., Ameratunga, S., Rob¬ inson, E., Civil, I., Dunn, R., . . . Jackson, R. (2002). Driver sleepiness and risk of se¬ rious injury to car occupants: Populationbased case-control study. British Medical Journal, 324(7346), 1125-1128. Dawson, D., & Reid, K. (1997). Fatigue, al¬ cohol and performance impairment. Nature, 388, 235. Drake, C., Roehrs, T., Breslau, N., Johnson, E., Jefferson, C., Scofield, H., & Roth, T. (2010, June 1). The 10-year risk of verified motor vehicle crashes in relation to physi¬ ologic sleepiness. Sleep, 3(6), 745-752. Gastaut, H., & Broughton, R. (1965). A clinical and polygraphic study of episodic phenom¬ ena during sleep. In J Words (Ed.), Recent advances in biological psychology (pp. 197-223). New York: Plenum Press. Horne, J., & Reyner, L. (1999). Vehicle acci¬ dents related to sleep: A review. Occupa¬
on Sleep Disorders Research. Sleep, 17, 84-93. Maycock, G. (1996). Sleepiness and driving: The experience of UK car drivers. Journal of Sleep Research, 5, 229-237. Roehrs, T., Carskadon, M., Dement, W., & Roth, T. (2005). Daytime sleepiness and alertness. In M. H. Kryger, T. Roth, & W. C. Dement (Eds.), Principles and practice of sleep medicine (4th ed., pp. 39-50). Phila¬ delphia: Elsevier. Teran-Santos, J., Jimenez-Gomez, A., & Cordero-Guevara, J. (1999). The association between sleep apnea and the risk of traffic accidents. New England Journal of Medi¬ cine, 340, 847-851.
Sleeping and Dreaming Patterns in the Context of Attachment Relationships
tional and Environmental Medicine, 56,
289-294. Horstmann, S., Hess, C.W., & Bassetti, C., et al. (2000). Sleepiness related accidents in sleep apnoea patients. Sleep, 23, 383-389. Howard, M.E., Desai, A.V., Grunstein, R.R., et al. (2004). Sleepiness, sleep-disordered breathing, and accident risk factors in com¬ mercial vehicle drivers. American Journal of Respiratory and Critical Care Medicine, 170(9), 1014-1021.
Kennedy, A. M. (1929). A note of narcolepsy. British Medical Journal, 1, 1112-1113.
McNamara and colleagues (McNamara, 1996; Zborowski & McNamara, 1998) the¬ orized that REM sleep and dreams evolved (in part) to promote and facilitate attach¬ ment bonds. This theory stemmed from a line of evidence highlighting REM-sleep correlates, including amygdala and lim¬ bic system activation, increased levels of oxytocin, vasopressin, arginine vasotocin, testosterone (in men), other reproductive
Knipling, R. R., & Wang, J-S. (1994). Crashes
and caregiving neurochemicals, and sex¬
and fatalities related to driver drowsiness/
ual arousal. In addition, infants who sleep
fatigue (research note). Washington, DC:
separated from their primary caregivers
Office of Crash Avoidance Research, U.S. Department of Transportation.
are more likely to be classified as inse¬
Langlois, P. H., Smolensky, M. H., His, B. P., & Weir, F.W. (1986). Temporal patterns of reported single-vehicle car and truck ac¬ cidents in Texas USA during 1980-1983. Chronobiology International, 2, 131-146. Leger, D. (1988). The cost of sleep-related acci¬ dents: A report for the National Commission
curely attached, and insecure infants ex¬ perience more night awakenings and sleep disorders. McNamara (2004) proposed that REM sleep is a viable candidate for a physiological mechanism through which humans can consolidate and integrate at¬ tachment experiences. Recent research on
Sleeping and Dreaming Patterns in the Context of Attachment Relationships
|
adult attachment has shown that anxious attachment contributes to decreased Stages 3^1 sleep in depressed women (Troxel, Cyranowski, Hall, Frank, & Buysse, 2007) and poorer sleep quality in the elderly (Verdecias et ah, 2009). Anxious attachment is also associated with a-EEG anomalies (Sloan, Maunder, Hunter, & Moldofsky, 2007). Extending this work into the realm of dream research, McNamara, Andresen, Clark, Zborowski, and Duffy (2001) found that anxious-attached individuals recalled more dreams than their secure counter¬ parts. In addition, their dreams were longer and contained more high-intensity central
Secure base support for exploration. (Photo pro¬ vided by Dylan Selterman)
images. The authors proposed that dream¬ ing exists in part to promote relational strategies and processes, and therefore anxious-attached individuals would dream
Selterman and Drigotas (2009) exam¬
more frequently due to their hyperactivat¬
ined the dreams of individuals in com¬
ing attachment patterns.
mitted dating relationships. Anxious- and
Avihou (2006; unpublished dissertation)
avoidant-attachment scores both uniquely
documented associations between dream
predicted stress, conflict, and anxiety
content and attachment styles. Anxious-
levels in dreams that contained roman¬
attached individuals dreamt of themselves
tic partners. The effects were stronger for
as
while
avoidant attachment. Anxious attachment
avoidant-attached individuals dreamt of
also correlated with feelings of jealousy,
themselves as distant, uncooperative, emo¬
and avoidant attachment correlated with
tionally unexpressive, or angry. Mikulincer,
anger and less affection in dreams contain¬
Shaver, Sapir-Lavid, and Avihou-Kanza
ing romantic partners.
weak,
helpless,
or unloved,
(2009) separately reported findings from
An important point to note is that
the same sample, coding a subset of distress
(nearly) all the effects listed earlier re¬
dreams using three attachment-specific be¬
mained significant when statistically con¬
havioral tendencies: (1) support seeking,
trolling for general, nonattachment distress
(2) support availability, and (3) distress re¬
(anxiety, depression), as well as other so¬
lief. Anxious-attachment scores correlated
cial/emotional/personality variables. This
negatively with support availability and
demonstrates the unique contribution of
distress relipf, while avoidant-attachment
attachment to sleeping and dreaming pro¬
scores correlated negatively with support
cesses over and above other psychologi¬
seeking and support availability.
cal variables. Another consistent trend in
725
726
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Social Network Analysis of Dream Content
this literature is the strong association be¬ tween anxious attachment and sleep pat¬ terns, while avoidant attachment appears largely absent. However, effects between avoidant attachment and dream content are just as strong as effects for anxious at¬ tachment (if not more so). Future research should probe deeper into this discrep¬ ancy. Researchers should also examine how sleep and dream patterns impact re¬ lationship functioning and maintenance. Perhaps dream sharing/disclosure with at¬ tachment figures exists as a form of secure base support seeking, or as an intimacy¬ building activity.
Veredecias, N. R., Jean-Louis, G., Zizi, F., Casimir, G. J., & Browne, R. C. (2009). Attachment styles and sleep measures in a community-based sample of older adults. Sleep Medicine, 10, 664-667. Troxel, W.M., Cyranowski, J.M., Hall, M., Frank, E., & Buysse, D.J. (2007). Attach¬ ment anxiety, relationship context, and sleep in women with recurrent major depression. Psychosomatic Medicine, 69(1), 692-699. Zborowski, M.J., & McNamara, P. (1998). Attachment hypothesis of REM sleep: To¬ ward an integration of psychoanalysis, neu¬ roscience, and evolutionary psychology and the implications for psychopathology re¬ search. Psychoanalytic Psychology, 75(1), 115-140.
Dylan Selterman
References McNamara, P. (1996). REM sleep: A social bonding mechanism. New Ideas in Psychol¬ ogy, 74(1), 35^16. McNamara, P. (2004). An evolutionary psy¬ chology of sleep and dreams. Westport, CT: Praeger. McNamara, P., Andresen, J., Clark, J., Zborowski, M., & Duffy, C.A. (2001). Im¬ pact of attachment styles on dream recall and dream content: A test of the attachment hypothesis of REM sleep. Journal of Sleep Research, 70(2), 117-127. Mikulincer, M., Shaver, P. R., Sapir-Lavid, Y., & Avihou-Kanza, N. (2009). What’s inside the minds of securely and insecurely at¬ tached people? The secure-base script and its associations with attachment-style di¬ mensions. Journal of Personality and So¬ cial Psychology, 97(4), 615-633. Selterman, D., & Drigotas, S. (2009). Attach¬ ment styles and emotional content, stress, and conflict in dreams of romantic partners. Dreaming, 19(3), 135-151. Sloan, E.P., Maunder, R.G., Hunter, J.J., & Moldofsky, H. (2007). Insecure attachment is associated with the a-EEG anomaly during sleep. BioPsychoSocialMedicine, 7(20), 1-6.
Social Network Analysis of Dream Content In a social network, people are represented by points, and if two people have a cer¬ tain relationship, for example, are friends, their corresponding points are connected by a line. Although social networks have complex and individualistic structures, they tend to have some simple properties in common, such as short paths between points. In a dream social network, points represent characters in the dreams of an in¬ dividual and a line connecting two points indicates that the corresponding characters were in a dream together. A dream social network shows how the dreamer’s mem¬ ory for people is organized in the dream¬ ing brain. Social interactions are a large part of the contents of dreams. During rapid eye movement (REM) sleep, when most dreams occur, a component of the brain involved in processing social interactions, the amygdala, is more active than during
Social Network Analysis of Dream Content
|
waking life. More social interactions occur
Van de Castle, 1966). The system gives
during an interval of REM sleep than in
simple rules for determining when to code
an equal interval of waking life (McNa¬
a character of a dream. For example, the
mara, McLaren, Smith, Brown, & Stick-
first rule that leads to a character being
gold, 2005). In any one, dream characters
coded is “The character is described as
may seem to appear in a haphazard way,
being physically present in the dream.”
but over many dreams a systematic struc¬ ture emerges.
With the system, a character need not be present in the dream to be coded. For ex¬
The dream social network for Arlie,
ample, if a belonging of a person is pres¬
a middle-aged woman, is shown in the
ent in the dream, the person is coded as
dream social network image. An isolated
a character of the dream. The system was
point corresponds to a character in a dream
modified for the purpose of constructing
with no other character present except the
networks, so a character is coded as pres¬
dreamer. Islands of points connected to
ent in a dream if the character interacted, or
each other but not connected to the rest of
could have interacted, with another char¬
the network represent characters appear¬
acter or with the dreamer (Schweickert,
ing in a dream with each other, but not
2007). Characters include people and per-
appearing in any other dream. A network
son-like entities such as mythological fig¬
constructed from the first few dreams of
ures and talking animals.
a series would consist mostly of islands.
Social networks of characters in dreams
After many dreams, most points become
have some of the same properties as social
connected in a large subnetwork, called the
networks of people in waking life. A well-
giant component. Because the dreamer is
known property of a friendship network
in every dream, illustrating her would clut¬
is a short average path length, sometimes
ter the network, so she is not represented.
dubbed six degrees of separation: Between
An exception is made when the dreamer is
two arbitrarily chosen people one can usu¬
present in a metamorphosed form, as in a
ally find a short path of friends and acquain¬
dream in which a woman dreamt she was
tances. A network formed by connecting
a little boy. Metamorphosed forms of the
points together at random also tends to
dreamer are represented by points.
have short average path length. Perhaps
Dream reports of Arlie and many other
surprisingly, the average path length in a
people are available on the DreamBank
typical waking-life social network is ap¬
Web site (Schneider & Domhoff, 2011).
proximately the same as that of a random
To construct the network one needs a re¬
network with the same number of points
liable way to determine who is present in
and lines. Another property of waking-life
a dream. There is no way to learn who a
social networks is high clustering: If A is
dreamer is dreaming about by examining
a friend of B and B is a friend of C, then A
brain waves or other external measures;
and C tend to be friends of each other. In a
one must consider what the dreamer says.
random network, clustering is low; A and C
In a classic work, Calvin S. Hall and Rob¬
are joined by a line with the same probabil¬
ert Van De Castle developed a system for
ity whether or not A and C are both joined
coding contents of dream reports (Hall &
to B by lines. The two properties of short
727
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Social Network Analysis of Dream Content
average path length and high clustering do
to other points. One consequence is that a
not ordinarily occur in the same network.
short path between two points can usually
Networks with both properties are special,
be formed by starting at one point, going
and are called small world networks.
to a hub, and then proceeding to the other
Many, but not all, dream social networks
point. Degrees in both waking life and
are small world networks. For the net¬
dream social networks typically have Zipf
work in the dream social network image,
degree distributions.
the average path length is short, near that
One might think that a dream social net¬
of a comparable random network. But its
work is simply a copy of the dreamer’s
clustering is high, far greater than that of
waking-life social network, and thus they
a comparable random network. This net¬
have properties in common. But this can¬
work is a small world network.
not be the explanation. Characters in dream
A dream social network that is not a
social networks include celebrities and car¬
small world network is that of the engine
toon characters, not people the dreamer in¬
man, given this name because of the prev¬
teracts with while awake. Sometimes one
alence of locomotives in his dreams. The
character metamorphoses into another, not
network has many sequences where A is in
an event of waking life. A poignant demon¬
a dream with B, and B is in a dream with C,
stration that dream- and waking-life social
but A and C are not in a dream together.
networks differ is that the person occurring
Triangles tend not to be completed and the
most often in the dreams of Merri is her sis¬
clustering is near that of a comparable ran¬
ter, but her sister was killed in an accident
dom network. The average path length is
three years before Merri began her dream
short, a little larger than that of a compa¬
journal.
rable random network.
A more likely explanation of the com¬
Another property of social networks has
mon properties of dream- and waking-life
to do with the number of points a given
social networks is that the dreamer’s as¬
point is connected to. The number of points
sociative memory has the properties of
connected by a line to a given point is the
short pathways, high clustering, and a
degree of the given point. Many quantities
Zipf degree distribution. Human semantic
in nature follow a normal distribution, with
networks, such as a network made from
middle values the most common and high
the
and low values uncommon. Degrees in so¬
(Steyvers & Tenenbaum, 2005). Charac¬
cial networks do not follow a normal dis¬
ters in dreams correspond to concepts of
tribution. The lowest values are the most
people and the concepts include mytho¬
common and the highest values the least
logical figures, talking animals, cartoon
common. The probability distribution of
characters, and so on. Characters occur in
degrees is a Zipf distribution, sometimes
a dream together when they are associated
called a power law. The higher a degree
somehow in the dreamer’s memory. One
the less likely it is to occur; the probability
piece of evidence for this is that when an
a degree is k is inversely proportional to k.
entity metamorphoses into another entity,
A few points, hubs, are highly connected
the entities tend to be conceptually close.
thesaurus,
have
these
properties
Sound-Work: The Neglected Sense in Working with Dream Images
People metamorphose into other people more often than into animals, and more often into animals than into objects (Schweickert & Xi, 2009). Deceased people and those who have moved away continue to appear if they are associated with peo¬ ple currently in the dreamer’s waking-life social network. In REM sleep the dreamer follows associative pathways, and the
|
Schweickert, R., & Xi, Z. (2009). Metamor¬ phosed characters in dreams: Constraints of conceptual structure and amount of theory of mind. Cognitive Science, 34, 665-684. Steyvers, M., & Tenenbaum, J.B. (2005). The large-scale structure of semantic networks: Statistical analysis and a model of semantic growth. Cognitive Science, 29, 41-78. Watts, D. J. (2003). Six degrees: The science of a connected age. New York: W.W. Norton.
structure of these pathways becomes vis¬ ible in the dream social network. One of many open questions is why some dream social networks have high clustering and some do not. To answer such questions we will need more infor¬ mation about the daily lives of dreamers, to compare dream- and waking-life so¬
Sound-Work: The Neglected Sense in Working with Dream Images Sound Awareness
cial networks. Sleep is known to be im¬
Sound is the most direct, immediate, ef¬
portant for memory consolidation, and
ficient, and effective way to perceive and
it is likely that the contents of dreams
transform that which vibrates with, with¬
are manifestations of some kind of mem¬
out, and within us. The word sound, let us
ory processing during sleep. Observing
recall, also means healthy, well, whole¬
how dream social networks change over
some, robust, and is often used to imply
periods of time may shed light on this
vigor, strength, sensitivity, energy, sturdy,
processing.
intact, whole. Richard Schweickert
References Hall, C.S., & Van de Castle, R. (1966). The content analysis of dreams. New York: Appleton-Century-Crofts. McNamara, P., McLaren, D., Smith, D., Brown, A., & Stickgold, R. (2005). A “Jekyll and Hyde” within: Aggressive versus friendly interactions in REM and non-REM dreams. Psychological Science, 16, 130-136. Schneider, A., & Domhoff, G.W. (2011). DreamBank. Retrieved from http://www. dreambank.net/ Schweickert, R. (2007). Properties of the organizatiorf of memory for people: Evidence from dream reports. Psychonomic Bulletin & Review, 14, 270-276.
While sound—the audible aspect of vi¬ bration—accompanies all movement and serves to orient us, and much more, we tend to take it for granted in our lives, and certainly in our dreamwork. We generally take image as primary—but, let us not over¬ look that as vibration, sound is there from the beginning (notice the role of sound in creation myths from around the globe), and comes with each and every encounter. All meetings involve, reflect, and pro¬ duce new sounds. At the most basic physi¬ cal level, sound travels in waves that affect and have an effect on the bodies they touch, generating further vibrations. We respond when touched.
729
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Sound-Work: The Neglected Sense in Working with Dream Images
Sound has a double effect, literally it dis¬
Automatic aspects of our being ap¬
solves (releases, breaks, cleanses, opens)
pear in the sounds that we unexpectedly
and it coagulates (shapes, limits, orga¬
and involuntarily find ourselves emitting,
nizes, creates)—structuring new and con¬
often revealing something essential to
stantly changing forms. Brought into being
the emotional—inner—sense of what we
by movement, sound also brings forth new
are saying. For those interested in uncon¬
movements.
scious manifestations and synchronicities,
While much therapeutic and spiritual
our voice offers vast and multifaced mir¬
work is being done with sound (music, ton¬
rors to help us recognize all sorts of uncon¬
ing, singing), surprisingly little attention
scious phenomena. Becoming sensitive to
has been given to linking sound-work to
the sounds in our voice can guide us in re¬
images from our dreams (and lives). Here,
fining how we perceive and react reflex-
a case is made for developing an awareness
ively, in how we think, feel, see, and take
founded on hearing, emitting, and listening
ourselves into the world.
experiences. Whether or not we are aware
All the more influential when unnoticed,
of sound—or participate consciously in it
sounds can dominate our relationships with
as a specific sense—it is constantly giving
others. We have only to note carefully what
form to invisible and unknown aspects of our lives.
we communicate and convey with the tone, speed, volume, intention, attitude, energy,
The potential of this proposal is revealed
sense, and direction of what we say. In¬
in what happens to the life of a person that
dependently of the meanings we attach to
explores and discovers him—or herself by
words, sounds touch us directly and often
working with vocal awareness, mindful¬
more deeply. How something is said usu¬
ness, and practice. This proposal wants to
ally carries much more meaning than what
incite interest and practice with the outer
is actually said. And it seems evident that
and inner sounds that come along with the
we frequently react and respond more to
images in our dreams (and lives).
the tone and rhythm of what is said than to the content itself. The challenge is to develop a heightened
Vocal Sound Awareness
awareness of the medium we call sound: It is not difficult to hide from our sounds.
around (outside) us, and within us.
Actually hearing the sounds we emit tends to be disconcerting; it makes ev¬ ident the scopes and limitations of our
Sound-Work and Dreams
defense mechanisms. Listening to the
Outer and inner happenings meet in our
sounds that we emit frequently has the
dream images, triggering vibrations at all
effect of deconstructing the mind’s be¬
levels of our being. This proposal involves
lief systems,
(un¬
resonating with the images that affect, as
conscious) somatic, emotional, mental,
much as reflect, our different realities. The
and spiritual phenomena instantly more
notion of resonance implies that vibrat¬
apparent.
ing with something triggers movements to
making automatic
Sound-Work: The Neglected Sense in Working with Dream Images
|
differentiate, and invites us to enter a met¬
generating images. New images inevitably
aphorical experience, relevant to multiple
appear and transform with sound, reveal¬
levels of our inner and outer reality.
ing the primary, intimate, dynamic, and
Like life itself, dreams present us with scenarios, which at any given moment con¬
transformative relationship between sound and image.
ceal as much as they reveal. A dream scene is a place in which something is constel¬ lated; different aspects are highlighted as
Sound-Work and Imagination
they come together to form a momentary
Neither images, nor our phenomenologi¬
whole. Scenes in dreams offer specifically
cal experience of them are in themselves
different perspectives that somehow draw
perceptions. Rather, they are the result of
our attention to at least one nodal moment
an imaginal activity that affects and chal¬
in the dream sequence, in which a cer¬
lenges us to question our perceptions. In
tain tension—or dissonance—signals that
the first paragraph of his book Air and
something vital is at stake.
Dreams, Gaston Bachelard writes: “The
Dreams can be imagined as invitations
imagination ... deforms what we perceive;
to discover perspectives that may be new
it is, above all, the faculty that frees us from
and different, and even alien to those of the
immediate images and changes them. If
ego; this is why our approach to dreams
there is no change . . . there is no imagina¬
should not be ego-syntonic. My proposal is
tion; there is no imaginative act.”
to use sound as a means to access, reveal,
Dream images are not meant to be
and connect with the dream experience
taken literally, concretely, objectively,
beyond the ego’s control. Sound-work im¬
nor to be translated into the language of
plies nurturing a palpable relationship with
the ego’s well-rehearsed day-world per¬
the invisible.
spectives (usually designed, as we know,
Describing a sound without having
to avoid fears of some kind of pain or
heard it is like describing an image with¬
discomfort)—nor to be converted, through
out having seen it. We must literally emit
interpretations,
a sound to actually hear and listen to it. Let
than what they simply are—very precise
us give importance to the sounds that come
experiences.
to being through our mouths.
into
something
other
While taking the literalness away from
That the sounds in a dream image are
words and content both awakens and weak¬
sometimes not easily recognized does not
ens our defenses, it also allows the person
mean that they are not present in the telling
to focus with increasing concentration on
(and reliving) of the dramatic scenes in the
listening for the intention and emotional
image, and in the experience of the tension
tone and sense of what is being expressed
within the images themselves. This tension
through the sound.
is made palpable and brought even more into life with sound awareness.
In themselves, images manifest, involve, express, and contain sound. Particular
Most significant is that sound is a sim¬
scenes are breeding grounds for new im¬
ple, basic, obvious, and immediate way for
ages to gestate and take form. Sound-work
731
732
|
Sound-Work: The Neglected Sense in Working with Dream Images
activates and releases this inherent poten¬
most of us only sporadically notice sound
tial in dreams.
in our dreams. (2) Recognizing and explor¬
As living metaphors, dream scenarios
ing the sounds that correspond with spe¬
are a medium for presenting the dreamer
cific actions in our dream image sequences,
with what is called for to bring new move¬
and the resonance of this in our present-
ment to his or her life. Sound-work facili¬
day lives. (3) Working with how we tell the
tates this; certain moments in some images
dream to others. (4) Giving vocal form to
are setups for sound experiences.
the emotions awakened by our attending to
Sound-work frees us of literal perspec¬
the images presented by the dream.
tives and personal needs for concluding
In addition, it is critically important to
and resolving things; it opens new ways of
work consistently to recognize and put all
imagining, and allows the dream images to
sorts of judgments and prejudices to one
reveal aspects and perspectives alien to the
side, and to remember that the goal is not a
ego’s natural tendencies and inclinations.
cathartic experience. Instead, this proposal
The sounds implicit to particular scenes in
aims at connecting and relating ever more
the dream—and the sounds we emit while
deeply to the issues that call attention to
resonating with its images—are our prima
themselves in and through our dreams.
materia.
Through sound-work, the inner sense
More than wanting to be understood,
of things becomes more palpable and con¬
images that come back in dreams—and
sciously experienced, allowing the person
stay with us—beg to be reexperienced.
to be constructively transformed by taking
Sound-work inevitably makes this happen,
into account concerns that go beyond his
consistently dissolving our identifications,
or her ego’s reach. Emitting sound gener¬
attachments, and interpretations, which
ates different kinds of inner movements.
usually translate into the meanings that
Sound forces us to breath, to take in, and
we give to our dreams. At the same time,
to release—it involves our physical, emo¬
vital issues take on new forms: something
tional, mental, and spiritual bodies in a
unexpected coagulates. As the alchemists
wide range of dynamics and processes.
practiced and proclaimed for centuries:
While we may not notice the sounds that
dissolve that which is coagulated and co¬
invariably accompany our dreams, it is vir¬
agulate that which is dissolved.
tually impossible to listen to the sounds we
Experiencing dream images through
emit without indelibly altering our experi¬
sound-work leaves multiple impressions
ence of the initial images, and generating
in its wake, making it very difficult for all
new images. Trying to emit the sounds that
those involved to find themselves in a situ¬
we hear in our dreams—or in our working
ation similar to the sound experience with
with them—inevitably makes us experi¬
the dream without reacting and respond¬
ence something essential to the sound, and to our lives.
ing in surprisingly creative and construc¬ tive ways.
People
sometimes
hesitate
in
con¬
This particular sound-work proposal en¬
sciously emitting the sounds that appear
compasses: (1) Going beyond the literal, as
in (and with) the images in their dreams.
Sound-Work: The Neglected Sense in Working with Dream Images
|
As if there were a kind of knowing that to
led him to allow the sounds that he could
emit the sound is to experience it. Not al¬
not stop from hearing inside himself to
lowing the sound to take actual form is to
emerge from the depths of his being and
somehow deny a highly dynamic aspect of
take form as sound.
it. The more willing a person is to allow the
The exercise took him beyond the reach
sounds that emerge from deeply within to
of his ego’s limits and control, and through
appear and take form, the deeper the trans¬
a series of vivid experiences of sensations,
formative experience.
emotions, feelings, thoughts, memories, associations, and unexpected new images, which in the end freed him of his inner
The Imagination Is Vivified by Sound-Work
torment.
The call is to allow dream images to be¬
Wolfsohn had discovered that sustaining a
come deeply rich day-world experiences.
focused vocal sound long enough, led be¬
More than an idea about something, sound-
yond cathartic moments—and beyond all
work is in itself an experience.
that we think and feel that we know of our
Whether
wittingly
or
instinctively,
This proposal, therefore, is an invitation
cry (be it one of joy, of lament, of com¬
to allow sound-work to convert certain sce¬
plaint, of desire)—brings more than relief
narios in our dreams into present-day lived
to a condition: it actually transforms it.
experiences: relevant to ongoing cycles of
Alfred Wolfsohn was transformed, and
transformation, to our creativity, and to
discovered the power that comes with al¬
fundamental well-being in our everyday
lowing the dissonant, uncomfortable, pos¬
lives.
sibly horrible sounds that unexpectedly emerge from the depths of our souls to
Source of Inspiration: Alfred Wolfsohn (1896-1962)
guide us into fundamental shifts in our relationship with ourselves and with the world around us.
A medic during the World War I, Alfred
This vocal sound-work proposal honors
Wolfsohn was a man haunted by night¬
Alfred Wolfsohn and attempts to further
mares and auditory hallucinations, cer¬
his insights with practice. Sven Doehner
tainly influenced by his terrible memories of carrying wounded men, howling with pain, away from combat zones on his stretcher. With no anesthesia to diminish their suf¬ fering, we can only imagine the sounds that emerged from the agony of those desper¬ ate men. Long after the war, these primi¬ tive piercing sounds continued to haunt Wolfsohn, not letting him be. Until the day when what we could only call desperation,
See also: entries related to Dream Content
References Bachelard, G. (1999). Water and dreams: An essay on the imagination of matter (3rd ed.) (Trans. E. R. Farrell). Bachelard Translation Series. Dallas, TX: The Dallas Institute of Humanities and Culture. Hillman, J. (1979). The dream and the under¬ world. New York: HarperPerennial.
733
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Space in Dreams
Ihde, D. (2007). Listening and voice, phenomenologies of sound. Albany: State University of New York Press.
During any stage of sleep, activation of the parietal lobe might indicate the pres¬ ence of spatial experience. In a study of several hundred neurological and neuro¬
Space in Dreams
surgical patients, Solms (1995) observed that patients experiencing disturbances in
Space is generally regarded as an expanse
waking visual-spatial abilities as well as a
measurable in terms of known dimensions:
complete loss of dreaming had brain dam¬
height, width, depth, and time, absolutely
age located in the parietal region. During
or relatively. While dreaming, the dreamer
REM sleep, positron emission tomography
produces visual abstractions in space. Pri¬
(PET) and statistical parametric mapping
marily thought-like, experiences in dreams
indicated activation of the right inferior pa¬
might be accompanied by visual abstrac¬
rietal lobe (Maquet et al., 1996). A PET
tions in space, of which the dreamer might
scan study indicated some activation in the
or might not be aware; there might be an
parietal cortex during REM sleep (Maquet,
imaginary sphere of the body that provides
2000). Based on the presence of positive
an orientation to space; the symmetry of
electroencephalograph (EEG) brain poten¬
spatial experiences while awake might
tials, the brain’s parietal-occipital area be¬
be contracted, expanded, or transformed
came active immediately following REM
while dreaming.
sleep (Ogawa, Nittono, & Hori, 2002).
From the theoretical perspective of quan¬
Brenneis (1970), Foulkes, Pivik, Stead¬
tum physics, Bohm (Briggs & Peat, 1987)
man, Spear, and Symonds (1967), and
proposed that space, time, and matter are
Trosman, Rechtschaffen, Offenkrantz, and
abstractions that unfold from the implicate
Wolpert (1960) have all researched the
order—a vast, boundless energy space—
subject of spatial experiences in dreams.
and surface, become explicit, in the ex¬
Brenneis (1970) studied the dreams of
plicate order. In accordance with Bohm,
183 male and female college students.
Ullman (1987) suggested that dreams vac¬
From a spatial perspective, he concluded
illate between the two orders and therefore
that males had a tendency to structure the
might present spatial and temporal content
space in their dreams in terms of extension
regarded as unusual to the dreamer.
and separateness from others and females
Snyder and Gackenbach (1991) dis¬
in terms of closeness and intimacy. Erik-
cussed spatially oriented body movement,
son (1954) believed there were aspects of
a function of the vestibular system and the
dreams that could be arranged in a con¬
essential role of space in dreams. They re¬
figuration and manifest in one dream or a
ferred to the intense activation of vestib¬
series of dreams. He' identified spatial as
ular nuclei in the brain stem during rapid
one of seven possible manifest configura¬
eye movement (REM) dreaming as well
tions, along with verbal, sensory, tempo¬
as the likelihood of the predominance of
ral, somatic, interpersonal, and affective.
vestibular-bound imagery and movement
Erikson characterized the spatial aspect
patterns during dreaming.
of dreams according to spatial extension
Space in Dreams
|
and motion. When analyzing Freud’s Irma
Brenneis (1970), Foulkes et al. (1967),
dream, Erikson interpreted festivity in the
and Trosman et al. (1960) have all re¬
dream as a reflection of affect, and he asso¬
searched the subject of spatial experiences
ciated festivity affect with spaciousness, a
in dreams and have reported that dreamers
spatial variable. He interpreted urgency in
experience space, although the researchers
a dream as a reflection of affect, and he as¬
themselves, not the dreamers, made this de¬
sociated urgency affect with constriction, a
termination and described the experiences.
spatial variable.
Tyburczy (2008) requested 28 dreamers
Foulkes et al. (1967) categorized spa¬
to recall and describe spatial experiences in
tial and temporal experience together as
their dreams in their own words as well as
a dimension of dreams. After independent
by selecting and using spatial terms from
raters reviewed the dreams of 32 boys,
22 spatial parameter, spatial experiential,
the researchers reported that the spatial
and spatial view descriptor categories con¬
and temporal dimension was identified in
tained in a content validated instrument,
76 percent of dreams. Trosman et al. (1960)
Spatial Questionnaire Selections 2 (see
considered spatiality in dreams in terms of
Table 9).
spatial expanse. The researchers assessed
The dreamers were also requested to
the dreams of two participants over a pe¬
select terms from emotions categories
riod of 34 nights in a sleep lab after record¬
contained in Emotions Questionnaire Se¬
ing an average of four or five dreams per
lections that was adapted from Goleman’s
night from each participant. Each dream
(1995, p. 289) research on emotions to re¬
was assessed on the basis of 12 dimen¬
call and describe emotional experiences
sions: spatial expanse, hedonic tone, ex¬
in their dreams. Spatial parameter catego¬
citation,
ries include density, depth, dimension in
activity,
observer-participant,
interpersonal involvement,
clarity,
the¬
space, direction, distance, energy, height,
matic coherence, plausibility, elaboration,
position in space, shape, spatially unusual
resolution, and success (p. 603). Defined
or bizarre, time, and width. Spatial expe¬
in terms of geographical space, spatial ex¬
riential categories include controlled in
panse was rated as low when the space was
space, supported in space, contained in
considered constricted and as high when
space, free of gravity in space, grounded
the space was considered expansive. Tros¬
in space, motion in space, and precarious
man et al. (1960) reported a high positive
position in space. Emotions categories in¬
correlation between spatial expanse and
clude anger, sadness, fear, enjoyment, love,
the dimensions of excitation, referring to
surprise, and disgust. Response percent¬
degree or charge of emotional expression;
ages for all research questions indicated
activity, referring to amount of kinetic ac¬
that participants described experiences in
tivity; interpersonal involvement, referring
dreams in terms of the spatial parameter
to degree of emotionally charged interac¬
categories of density (48.5%),, distance
tion; clarity & referring to vividness and lack
(48%), and position in space (48%), and in
of ambiguity; and elaboration, referring to
terms of enjoyment (46.4%) from the emo¬
the quality and diversity of dream content.
tions categories. Significant relationships
735
Table 9: Spatial Questionnaire Selections 2 Area: spatial parameters Spatial parameter categories (bold); terms (not bold) Density: cramped; cluttered; compacted; compressed; crowded; crushed; dense; full; heavy; open; packed; spacious; thick; uncluttered; vacant; voluminous Depth: abyss; bottomless; deep; downward; fathom; shallow; steep Dimension in space: inner space; outer space Direction: across; backward; down; east; forward; north; northeast; northwest; parallel; perpendicular; sideways; south; southeast; southwest; up; upward; west Distance: away; close; distant; extension; far; gap; long; near; nearby; space; span Energy: electrical; gaseous; solid Height: apex; ceiling; elevation; heavenward; high; lifted; lofty; low; peak; pinnacle; short; summit; tall; top; upward; vast; vertical; zenith Position in space: above; adjacent; behind; below; beneath; beside; extended; in; in front of; in the back; in the front; laterally; level with; location; lower; out; over; parallel with; point; positioned; prone; traversal; under; underneath Shape: circle; crescent; ellipse; parallelogram; polygon; quadrilateral; rectangle; rhombus; sphere; spiral; square; star; trapezoid; triangle Size: big; breadth; huge; immense; large; microscopic; minute; small; vast; voluminous Spatially unusual or bizarre: channels switching; metamorphosis; superimposition; transfiguration; transformation Time: accelerated; back; delayed; eternal; fast forward; forward; future; infinity; interval; past; present; rewind; timeless Width: expanse; horizontal; narrow; wide
Area: spatial/experiential Spatial/experiential categories (bold); terms (not bold) Controlled in space: confined; constricted; harnessed; held down; impacted; manipulated; pinned down; pressured; smothered; suffocated; surrounded; trapped Supported in space: boosted; carried; elevated; extended; held up; hovering; lifted Contained in space: bound; closed-in; cramped; crowded; embodied; enclosed; entombed; encapsulated; immersed; in; sheltered Free of gravity in space: boundless; floating; flying; weightless Grounded in space: grounded; rooted; secured Motion in space: ascend; bouncing; bounding; descend; elevated; falling; flung; glide; out of control; plummeted; propelled; pulled; pushed; raised; released; rising; rotating; sinking; soaring; spinning; spiraling; swaying; swinging; swooping; thrown; thrust; transported; trapped; turning; unleashed; wedged Precarious position in space: bottomless; claustrophobic; cornered; dangled; frozen; hanging; paralyzed; perched; plummeted; suspended; tottering; unbalanced
Area: spatial view descriptors Spatial view categories (bold); terms (not bold) Obstructed/unobstructed: close; clear; cluttered; constricted; crowded; endless; expansive; far; horizon; near; opaque Illumination: bright; dark; dim; light; well lit Note: Developed by Susan M. Tyburczy, 2007-2008.
Space in Dreams
|
at the .01 level occurred between terms in
Sixteen participants reported observ¬
categories reported in dreams, such as di¬
ing themselves as observers in their own
rection and time, dimension in space and
dreams from 33 different positions in
spatially unusual or bizarre, size and time,
space grouped by the researcher into posi¬
supported in space and contained in space,
tion headings, including above, adjacent,
energy and precarious position in space,
below, level with, and multipositions.
and depth and sadness.
Future
research
topics
considering
In response to specific interview ques¬
human experiences with space in dreams
tions, 27 of 28 dreamers reported experi¬
might include spatial experiences in pre-
encing space on their own, 21 with other
cognitive, lucid, or telepathic dreams or
people, 8 with living things, 20 with ob¬
nightmares, spatially bizarre aspects of
jects, and 18 with a visual-perceptual
dreams, or the phenomenon of dream¬
view. While experiencing space on their
ers observing themselves as observers
own, participants most frequently reported
from spatial perspectives. The relationship
density (82.1%) and position in space
between space and time in dreams is also a
(82.1%) from the spatial parameters cat¬
potential research topic. The roles that spa¬
egory, motion in space (71.4%) from the
tial experiences in dreams play in problem
spatial/experiential category, and enjoy¬
solving or memory-consolidation processes
ment (75%) and fear (75%) from the emo¬
might be explored.
tions category. While sharing space with
cal studies concerning the dreaming brain
other people in recalled dreams, partici¬
while experiencing space in specific situa¬
pants most frequently reported distance
tions are also suggested for future research.
(75%) from spatial parameters, contained
Susan M. Tyburczy
Further neurologi¬
in space (46.4%), controlled in space (46.4%), and motion in space (46.4%) from spatial/experiential, and fear (60.7%) and love (60.7%) from emotions. While sharing space with living things other than people in their dreams, participants most frequently recalled and reported experi¬ encing distance (75%) from spatial pa¬ rameters, controlled in space (17.9%), and contained in space (17.9%) from spatial/ experiential, and surprise (21.4%) from emotions in recalled dreams. While shar¬ ing space with objects in their recalled dreams, participants most frequently re¬ called density (64.3%) from spatial pa¬ rameters, contained in space (39.3%) from spatial/experiential, and enjoyment (53.6%) from emotions.
References Brenneis, C.B. (1970). Male and female ego modalities in manifest dream content. Jour¬ nal Abnormal Psychology, 76, 434-442. Briggs, J., & Peat, F. D. (1987). Interview, David Bohm. Omni, 9, 68-76. Erikson, E. (1954). The dream specimen of psy¬ choanalysis. J Am Psychoanal Assoc, 2-5. Erikson, E. (1979). The dream specimen of psychoanalysis. In R. P. Knight & C.R. Friedman (Eds.), Psychoanalytic psychia¬ try and psychology: Clinical and theoretical papers (pp. 131-173). New York: Interna¬
tional University Press. Foulkes, D., Pivik, T., Steadman, H.S., Spear, P. S., & Symonds, J.D. (1967). Dreams of the male child: An EEG study. Journal of Abnormal Psychology, 72, 457-467.
737
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Sports and Dreaming
Goleman, D. (1995). Emotional intelligence. New York: Bantam Books.
One study, for example, demonstrated that
Maquet, P. (2000). Functional neuroimaging of normal human sleep by positron emission tomography. Journal of Sleep Research, 9, 207-231.
ing activities (e.g., car driving) is related
Maquet, P., Peters, J.M., Aerts, J., Delfiore, G., DeGueldre, C., Luxen, A., & Franck, G. (1996). Functional neuroanatomy of human rapid-eye-movement sleep and dreaming. Nature, 383, 163-166. Ogawa, K., Nittono, H., & Hori, T. (2002). Brain potentials associated with the onset and offset of rapid eye movement (REM) during REM sleep. Psychiatry and Clinical Neurosciences, 56, 259-260. Snyder, T. J., & Gackenbach, J. (1991). Vestibu¬ lar involvement in the neurocognition of lucid dreaming. In J. Gackenbach & A. Sheikh (Eds.), Dream images: A call to mental arms (pp. 55-78). Amityville, NY: Baywood. Solms, M. (1995). New findings on the neu¬ rological organization of dreaming: Impli¬ cations for psychoanalysis. Psychoanalytic Quarterly, 64, 43-67. Trosman, H., Rechtschaffen, A., Offenkrantz, W., & Wolpert, E. (1960). Studies in psy¬ chophysiology of dreams. Archives of Gen¬ eral Psychiatry, 55, 602-607. Tyburczy, S.M. (2008). Recall of space in dream reports and exploring dreaming from a spatial perspective. PhD diss., Saybrook
Graduate School and Research Center, ProQuest (AAT 3379048).
the amount of time spent in different wak¬ to the occurrence of the corresponding activity in dreams; that is, the continuity hypothesis is largely supported by studies investigating different types of waking-life experiences, for example, divorce, stress, life events, on dream content (for an over¬ view see Schredl, 2003). For the topic of sports, several pilot studies (for an over¬ view see Erlacher & Schredl, 2004) and single case studies (e.g., Domhoff, 1996) in athletes indicate that the continuity is also present for athletic activities—that is that frequent practicing during the day is reflected in the heightened occurrence of sport dreams. Up to now, only three studies (Erlacher & Schredl, 2004, 2010a; Schredl & Erlacher, 2008) investigated the relationship between daytime sport activi¬ ties and dreams in a systematic way. In the first study, Erlacher and Schredl (2004) demonstrated in a dream-diary study that sport students dream more often about sports (active participation and gen¬ eral sport themes) than do psychology students, reflecting sport students’ engage¬ ment in sport activities and sport theory. In the second study, Schredl and Erlacher (2008) showed that the percentage of sport
Ullman, M. (1987). Wholeness and dreaming. In B.J. Hiley & F. D Peat (Eds.), Quan¬
dreams for sport students was directly re¬
tum implications: Essays in honor of David
lated to the amount of time spent with wak¬
Bohm (pp. 386-395). New York: Routledge
ing sport activities. As the group factor was
& Kegan Paul.
still significant after controlling for amount of practicing sport, it was hypothesized
Sports and Dreaming
that sport students talk and think about sports more often and may be more emo¬
The continuity hypothesis in dream re¬
tionally involved in sports than psychol¬
search suggests that the dream content re¬
ogy students. In a large sample of German
flects waking experiences (Schredl, 2003).
athletes (N = 632; study 3), the frequency
Stage behind the Eyes—Theater and Dreams
of sports dreams was very high, almost 90 percent of the athletes reported this kind of dream (Erlacher & Schredl, 2010a). Within the athletes the frequency of sport dreams was associated with dream-recall frequency (entered as a control variable into the analysis), the number of practice hours per week, and the number of competitions/ games during the last 12 months. This find¬ ing indicates that the continuity not only reflects the amount of time spent with the particular activity during the day but also
|
Erlacher, D., & Schredl, M. (2010b). Practicing a motor task in a lucid dream enhances sub¬ sequent performance: A pilot study. Sport Psychologist, 24, 157-167. Schredl, M. (2003). Continuity between wak¬ ing and dreaming: A proposal for a math¬ ematical model. Sleep and Hypnosis, 5, 38-52. Schredl, M., & Erlacher, D. (2008). Rela¬ tionship between waking sport activities, reading and dream content in sport and psy¬ chology students. Journal of Psychology, 142, 267-275.
might reflect worries and stress about per¬ forming experienced by the athletes. To summarize, sport is reflected in the
Stage behind the Eyes— Theater and Dreams
dreams of persons actively engaged in this waking-life activity. In the context of
Since the dawn of the Western drama in
completion, it would be very interesting to
ancient Greece, dreams have featured fre¬
study whether dreams reflect worries or
quently in and been used as inspiration
even sport-related nightmares might have
for plays and other dramatic performance
an effect on the athletes’ performance. As
pieces. In this entry, I will touch on some
there is evidence from case reports and a
examples and discuss why the relationship
pilot study that athletes can train their sport
between dreams and theater seems so natu¬
within lucid dreams (Erlacher & Schredl,
ral. I will end with a suggestion for further
2010b), it would be very promising to train
exploration of dream material in dramatic
athletes using lucid-dreaming techniques
writing and performance.
to increase their performance.
Dreams have found their way into sto¬
Michael Schredl and
rytelling from earliest times. From Gil-
Daniel Erlacher
gamesh’s dream of a great axe to Jacob’s stairway to heaven dream in the Bible and
References
the dreams of Agamemnon and Penelope
Domhoff, G.W.
in Homer’s Iliad and Odyssey, dreams
(1996). Finding meaning in dreams: A quantitative approach. New York: Plenum Press.
Erlacher, D., & Schredl, M. (2004). Dreams reflecting waking sport activities: A com¬ parison of sport and psychology students. International Journal of Sport Psychology, 35, 301-308.
Erlacher, D., & Schredl, M. (2010a). Frequency of sport dreams in athletes. International Journal of Dream Research, 3, 91-94.
have always served to highlight important moments in narratives—the prophetic, the fantastic, the seemingly prosaic. The first clear instance of a dream ap¬ pearing in a theater piece is Atossa’s dream in Aeschylus’ The Persians (first performed in 472 BCE). Since that time theatrical storytellers have frequently used dreams as plot points, framing devices, and
739
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Stage behind the Eyes—Theater and Dreams
stylistic models. Dreams and dream refer¬
In Richard III (the play in which the word
ences appear more than 200 times in works
dream appears most often—26 times),
by Shakespeare, most significantly perhaps
Clarence recounts a harrowing dream of
in Richard III and A Midsummer Night’s
drowning, which becomes a metaphor for
Dream. They appear in the works of other
his guilt and a premonition of his actual
dramatists as various as Calderon (Life Is
fate. Brakenbury, listening to the descrip¬
a Dream), Strindberg (A Dream Play), and
tion, is terrified, as Shakespeare means
J.B. Priestley (the “Time Plays”).
us to be as we empathize with Clarence’s
One reason for the connection between
dire and emotion-filled predicament. Other
dreams and theater is that in both we read¬
dreams are woven contrapuntally through
ily accept that anything is possible. In
the drama as enticements to action or in¬
dreams as in plays the prophetic and the
action, as punishments and rewards, re¬
magical, no matter how outlandish or ab¬
minding us of the ever-present interplay of
surd, can seem true and real, and the com¬
opposites and contradictions in our lives.
monplace significant.
In A Midsummer Night’s Dream, the
Another reason for the connection is
emphasis is on the comical, sexual, and
that in both the theater of sleep (Almansi
transformative qualities of dreams and the
& Beguin, 2009) and the playhouse we can
emotions they provoke. The play can be
experience an intensity of emotion that in
seen as a series of dreams within dreams,
our waking lives we would try to avoid as
into which we are invited to enter willingly
embarrassing or outrageous. No performer
and from which, having learned something
wants to portray a character who is slightly
about ourselves, we awaken changed. Bot¬
homicidal, a tiny bit in love; dramatic char¬
tom’s famous dream of becoming a donkey
acters tend to feel strongly and behave
turns out to be partly real, as does Hermia’s
boldly, often irrationally. Hence powerful
about a serpent, with its implications of
dream stories can serve as excellent mod¬
sexuality, temptation, and danger. In fact
els for drama. As Jon Lipsky (2009) writes
all the lovers’ actions are laced with im¬
in his wonderful book on group dream en¬
ages of good and bad dreams which un¬
actment, Dreaming Together, “We experi¬
leash emotions and behavior that would
ence in sleep the passions of a Cyrano, of
otherwise be prohibited. Even Titania,
a Hedda Gabler, of a Richard III. We be¬
Queen of the Fairies, is herself bewitched
come a thief, a movie star, a randy lover”
by the dream image of falling in love with
(p. 14). The continuing success of the the¬
an ass (Bottom as donkey). The play’s end¬
ater confirms our urgent desire to experi¬
ing leaves the characters finally awake and
ence the full range of emotions that life has
the audience with the wistful feeling of loss
to offer, and dream material can give us the
that so often follows a wonderful dream.
dramatic license to incarnate those emo¬ tions on stage and examine them.
Playwrights have often appropriated the elasticity of time and space that we
As in so many areas of dramaturgy,
feel in dreams. J.B. Priestley (1937) wrote
Shakespeare realized the usefulness of
his Time and the Conways to explore the
dreams as drama more fully than anyone.
ideas of circular or serial time as put forth
Stage behind the Eyes—Theater and Dreams
|
by amateur dream researcher J. W. Dunne
can help break through barriers of per¬
(1927) in his essay An Experiment with
formance anxiety to enhance the truth¬
Time, which argues that precognitive im¬
ful enactment of strong emotional states.
ages in dreams suggest that time is not
Performers can consciously draw on and
linear. Priestley believed in Dunne’s con¬
effectively embody the vivid scenes and
clusions and saw great dramatic possi¬
feelings revealed in dreams, combining
bilities in them. Presenting the Conway
them with other story elements to great
family, happy and unified after World War
effect.
I but tom apart on the eve of World War II,
It is important to touch on the question
Priestley manages to combine with great
of how to distinguish between dramati¬
force and emotion the family’s story, the
cally useful dream material and that which
politics and social milieu of England be¬
seems only the meaningless flotsam and
tween the wars, and his ideas about time.
jetsam of our ever-crowded minds. The an¬
As in dreams, images in his drama both
swers are certainly as varied and layered
embody meaning and obscure it, causing
as the people and dramatic pieces that at¬
us to consider the more closely what we
tempt to incorporate dream imagery, and it
have seen.
would be useless to try to lay down strict
August Strindberg’s (1919) theatrical explorations are described in his preface
rules. However, there are solid principles that can act as guides.
to A Dream Play, where he writes that he
In my own work as a theater direc¬
“sought to imitate the disjointed yet seem¬
tor, I have often used dream material in
ingly logical shape of a dream. Everything
company-devised work. In doing so I have
can happen, everything is possible and
been careful first to define a clear theme
probable. Time and space do not exist; the
for the piece and then to choose or reject
imagination spins, weaving.. .a mixture of
dream images or sequences based on how
memories, experiences, free associations,
well they develop that theme. In What
absurdities and improvisations. The char¬
Dreams May Come, a piece inspired by
acters split, double, multiply, evaporate,
the book Nightmares by neuropsycholo¬
condense, dissolve and merge. But one
gist Patrick McNamara (2008), a company
consciousness rules them all: the dream¬
of 10 university acting students were asked
er’s; for him there are no secrets, no incon¬
to do dream journaling over the course of
sistencies, no scruples and no laws.”
several weeks and were then taken through
The dreamlike weaving together of dis¬
a series of exercises designed to capture
parate images that Strindberg mentions can
nightmare images, narrative sequences,
be a source of inspiration to the performer
and dialogue generated by their own sub¬
working to build authentic character and
conscious minds on the theme “Face Your
narrative. Theater artists know that, like
Fears.” Young actors usually respond im¬
dreams, the best dramatic creations affect
mediately to the idea of dream enactment
the viewer on many levels, as much intui¬
because it gives them license to explore
tively as consciously. And using strong im¬
and to play. In this case, scores of dream
ages mined from one’s own subconscious
fragments were written down, recorded,
741
742
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Stages of Sleep and Associated Waveforms
or worked out in movement. Many of these, however, were ultimately rejected as being either too obscure or too obvious. The weaving together of the remaining ele¬ ments with video, sound, and group move¬ ment resulted in sequences that brought to coherent life on stage the universal and
McNamara, P. (2008). Nightmares: The sci¬ ence and solution of those frightening vi¬ sions during sleep. Westport, CT: Praeger
Perspectives. Priestley, J.B. (1937). Time and the Conways. New York: Harper Brothers. Strindberg, A. (1919). A dream play. University of California Press.
often enigmatic qualities of nightmares and powerfully illustrated the theme. There are other examples too numer¬
Stages of Sleep and Associated Waveforms
ous to mention here, but before closing I can suggest an area of potential study that
We are living in a rhythmic environment.
might combine scientific and performance
Temperature and daylight vary with the
research. Brain-imaging techniques such as
seasons and with it vegetation and nature
functional magnetic resonance imaging have
changes, as does the behavior of animals,
advanced in recent years to allow research¬
humans, yet all living organisms. In short,
ers to see emotional responses in the brain.
to be successful in the course of evolution
Perhaps it will be possible in the future to
and everyday-life behavior of any crea¬
observe more closely a dreamer’s emotional
ture must oscillate with the cadences of its
responses during sleep and to compare them
environment. The most striking and obvi¬
with the subject’s memories of the dream.
ous periodic behavior is the alternation be¬
The conjunctions and disjunctions in these
tween waking and sleeping behavior. The
two narratives could be put into theatrical
electrical rhythms generated by the massed
form to explore the relation of truth and fic¬
firing of neuronal tissue in the brain char¬
tion or the idea of multiple realities.
acterize these two distinct states and are
Given the variety of the treatment of
recorded by EEG, first described in 1929
dreams in the history of theater, it is safe
by the Austrian psychiatrist Hans Berger.
to say that we have not yet exhausted the
In general, high-frequency, low-amplitude
fruitfulness of studying the interrelation of
rhythms are associated with alertness and
these two modes of self-knowledge.
waking or the dreaming stages of sleep.
Robert Shampain
Low-frequency, high-amplitude oscilla¬ tions on the other hand are associated with
References
nondreaming sleep stages and with the
Almansi, G., & Beguin, C. (2009). Theatre of sleep (online Creative Commons Copyright). Retrieved from http://www. archive.org/stream/TheatreOfSleep/theatre_ of_sleep_01.txt
pathological state of coma.
Dunne, J.W. (1927). An experiment with time. London: Faber & Faber.
is not logical and can only be understood in
Lipsky, J. (2009). Dreaming together. Burdett, NY: Larson Publications.
tentials recorded from the scalp of normal
The rhythms are categorized by their frequency range each named after a Greek letter. The sequence of these Greek letters historical terms. The frequencies of the po¬ humans typically vary from 0.5 to 50 Hz,
Stages of Sleep and Associated Waveforms
|
and the amplitudes typically lie between 10
is normally not prevalent in the awake
and 50 pV.
adult, but is a prominent feature of sleep
Since even the earliest empirical find¬
and becomes increasingly dominant dur¬
ings in EEG research the alpha (a) rhythm
ing the progress from light to deep stages.
(8-13 Hz) has presented itself as the most
Delta waves have the largest amplitudes,
dominant brain oscillations in the human
normally between 20 and 200 pV. Electro-
EEG. The a-rhythm does tend to increase
encephalographic activity between 4 and
in amplitude during rest and relaxation
7 Hz or theta (0) activity is seen in normal
and is relatively absent during intellec¬
drowsiness and sleep, and during wakeful¬
tual functioning (for review see Klimesch,
ness in young children. Theta is also pres¬
1999). Thus, a strong a-rhythm can gen¬
ent in normal waking adults and has been
erally be observed in relaxed individu¬
related to the encoding of new information
als who are awake with their eyes closed.
(cf. Klimesch, 1999).
Sensory stimulation or strain during the re¬ cording usually causes significant reduc¬ tion of the a-rhythm and replacement with lower voltage, faster frequencies. The find¬ ing that alpha desynchronizes or becomes suppressed during mental activity was al¬ ready described in the late 1920s by Berger (1929). Alpha often has a mean frequency cen¬ tering around 10 Hz with the maximum voltage over the parieto-occipital elec¬ trodes. However, evidence provided by Klimesch (1999) indicates that within the 8- to 13-Hz alpha range, different fre¬ quency bands should be differenced; lower alpha (6-10 Hz) reflecting attentional pro¬ cesses and upper alpha (10-12 Hz) reflect¬ ing the processing of sensory-semantic information. The a-rhythm is thought to be generated in thalamo-cortical feedback loops as discussed in detail by Lopes da Silva (1999). Beta (P) waves (>14 Hz) occur in all in¬ dividuals, are usually of low amplitude, and are normally distributed maximally over frontal and central regions. Gener¬
Stages of Sleep According to the new sleep classification from the American Academy of Sleep Medicine (AASM) (Iber, Ancoli-Israel, Chesson, & Quan, 2007) waking (W) is associated with trains of sinusoidal 8 to 13 Hz activity (predominantly over occip¬ ital brain areas). Light sleep (Nl) is asso¬ ciated with low amplitude, predominantly 4 to 7 Hz activity and sharply contoured vertex waves (with duration 0.5 seconds in du¬ ration) and sleep spindles (12-15 Hz wax¬ ing and waning oscillatory bursts). Last but not least, rapid eye movement sleep (R) is reflected by low-amplitude, mixedfrequency EEG, sawtooth waves (trains of sharply contoured 2-6 Hz waves), low chin EMG, and rapid eye movements in the electrooculogram. Manuel Schabus
ally spoken, beta rhythms signal an acti¬ vated cortex. Delta () activity (0.5-4 Hz)
See also: entries related to Sleep Assessment
743
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Structural Analysis
Dream Narratives
References
similar temporal-linear, organized, struc¬
Berger, H. (1929). Uber das Elektroenkephalogramm des Menschen. Archives Psychiatriaca Nervenkraus, 87, 527-570.
tural schema to that of narratives of every¬
Iber, C., Ancoli-Israel, S., Chesson, A., & Quan, S.F. (2007). The AASM manual for
is based on five narrative units, includ¬
the scoring of sleep and associated events: Rules terminology and technical specifica¬ tions. Westchester, IL: American Academy
of Sleep Medicine. Klimesch, W. (1999). EEG alpha and theta oscillations reflect cognitive and memory performance: A review and analysis. Brain Research Reviews, 29, 169-195.
day personal events (Cariola, 2008). The temporal sequence of dream narratives ing (1) topic introduction, (2) orientation, (3) complication, (4) evaluation, and (5) coda. The topic introduction unit represents a conversation turn sequence in which the topic of dreams may be introduced through sharing one’s own dream memory in a so¬ cial situation or in the form of a question
Lopes da Silva, F.H. (1999). Dynamics of EEGs as signals of neuronal populations: Models and theoretical considerations. In E. Niedermeyer & F. Lopes da Silva (Eds.),
The topic introduction is also often reintro¬
Electroencephalography: Basic principles,
duced at the beginning of the orientation
clinical applications,
and related fields
unit; for example, in my dream. Orienta¬
(pp. 149-173). Baltimore, MD: Williams & Wilkins.
tion units can be differentiated between
directed at the conversational partner; for example, “What did you dream last night?”
real-life orientations and dream content orientations. Real-life orientations assume
Structural Analysis of Dream Narratives
a causal and temporal boundary function with the narrator typically disclosing a per¬ sonal event that is associated as a possible
A structural and functional approach to
trigger for the dream event; for example,
the analysis of everyday personal narra¬
“One day I think. . .it leads from. . .1 let
tives was first proposed by Labov and
my dog out in the garden once when she
Waletzky (1967). They defined narratives
was younger. She was a rescue dog and I
as “one method of recapitulating past ex¬
had to have a lot of control over her be¬
perience by matching a verbal sequence of
cause she was very scared of people and
clauses to the sequence of events that actu¬
she’d bite them.” Real-life orientations
ally occurred” (Labov & Waletzky, 1967,
also represent a bridge between an actual
p. 20). They also suggested that narratives
self-awareness of a waking conscious state
follow a distinctive sequencing schema,
and a self-awareness of a narrative con¬
resulting in a fixed temporal order of six
scious state. Dream content orientations
narrative units: (1) abstract, (2) orientation,
introduce the dream event in the form of
(3) complication, (4) evaluation, (5) reso¬
spatial contextual information, thus creat¬
lution, and (6) coda.
ing a virtual spatiotemporal frame in which
Dream narratives are a type of per¬
the actions of the characters are situated;
sonal narrative, and it has been shown
for example, “But that same night when I
that orally elicited dream recall follows a
went to sleep I had a dream about me and
Structural Analysis of Dream Narratives
|
my dog... uh.. .taking my dog to an island
unit, whereas positive dreams may or may
very strange on a boat.”
not imply a conflict, arousing positive emo¬
The complication unit communicates the
tions and therefore not calling for a resolu¬
actions and encountered problems of the vir¬
tion unit” (Cariola, 2008, p. 17). Habermas,
tual protagonist. It can also be differentiated
Meier, and Mukhtar (2009) have, however,
between simple and developing complica¬
identified linguistic and structural differ¬
tions. Simple complications draw on a soli¬
ences in adults’ and children’s emotionally
tary complication event; for example, “I was
positive and negative personal narratives;
at my parents’ house and my teeth started
for example, fear narratives reflected the
crumbling. And then they just stalled falling
lowest frequency of complication units as
out and crumbling. Then I remember look¬
compared with other types of negative nar¬
ing into the mirror and trying to smile and
ratives, whereas happy and sad narratives
seeing lots of gaps,” whereas a developing
reflected a sudden closing sequence in the
complication conveys a complication that
form of a complication unit without the use
develops throughout the narrative in the¬
of a following successive resolution unit.
matically and causally linked event.
Consequently, future research might in¬
The complication unit is followed by the
vestigate qualitatively and quantitatively
evaluation unit that conveys, implicitly or
the structural and functional framework of
explicitly, the narrator’s personal attitude,
pleasant dreams and nightmares and thus
feelings, and phenomenological point of
establish a comprehensive linguistic and
view about the dream event; for example,
structural model of dream narratives.
“It was a bit weird.” The evaluation unit
Laura Annamaria Cariola
may also function as a preclosing sequence that coincides with the coda unit; for ex¬
See also: entries related to Dream Content
ample, “That is sort of the dream I can only remember. It seems quite short although in your mind you.. .it felt for ages. But that’s pretty much the dream I had.” The coda unit represents the closing se¬ quence of the narrative, most typically in the form of a closing statement of the mo¬ ment of awakening “and then I woke up” or the recall of the dream; for example, “I cannot remember anything more.” The coda unit may also coincide with the reso¬ lution unit (Labov, 1997). Empirical research has not yet assessed the structural and functional framework of pleasant dreams and nightmares, for which “nightmares laden with tension and con¬ flicts may or may not propose a resolution
References Cariola, L.A. (2008). A structural and func¬ tional analysis of dream narratives. Dream¬ ing, 18, 16-26. Habermas, T., Meier, M., & Mukhtar, B. (2009). Are specific emotions narrated dif¬ ferently? Emotion, 9, 751-762. Labov, W. (1997). Some further steps in narra¬ tive analysis. Journal of Narrative and Life History, 7, 395—415. Labov, W., & Waletzky, J. (1967). Narrative analysis: Oral versions of personal experi¬ ence: Essays on the verbal and visual arts. In June Helm (Ed.), American Ethnological Society (pp. 12-44). Seattle: University of Washington Press. Toolan, M. (2005). Narrative: A critical lin¬ guistic introduction. New York: Routledge.
745
746
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Subjective Experience across States of Sleep and Wakefulness
Subjective Experience across States of Sleep and Wakefulness
experiences often occur outside of REM
Historically, dreaming has been viewed
rates of dream recall (with participants re¬
as a state of consciousness largely dispa¬
calling dreaming about 80% of the time
rate from that of waking cognition. Due
when awakened from REM sleep), and
to their apparently bizarre nature, dreams
dreams during REM tend to be particularly
were once ascribed to external origins, as
complex and emotional. However, dream¬
supernatural omens or messages from the
ing is reported approximately 50 percent
gods. In the early 1900s, Freud translated
of the time from non-REM sleep as well,
this otherworldly view of dreams as mes¬
and cognition during these sleep stages can
sages into psychological terms, populariz¬
at times be as bizarre, vivid, and story-like
ing the notion that dreams originate from
as REM dreaming, particularly late in the
repressed wishes in an unconscious por¬
night. These observations suggest that the
tion of the mind that is inaccessible to our
generation of hallucinatory imagery and
waking thoughts. As this specific view of
thought during sleep in general must be ex¬
dreaming fell out of favor, more modern
plained by mechanisms that are common to
neuroscience-based approaches continued
all stages of sleep.
(Foulkes, 1967), including during the deep¬ est stages of slow-wave sleep. The REM state is consistently associated with high
to emphasize dreaming as a neurophysio¬
In fact, recent evidence suggests that
logical state best viewed as distinct from
dreaming is best viewed as a part of a con¬
all other forms of cognition. Following the
tinuum of spontaneously generated cogni¬
first all-night electrophysiological stud¬
tion that occurs in all states of sleep, and
ies of the sleeping brain in the 1950s, the
which shares meaningful features with
discovery of rapid eye movement sleep
waking thought and imagery during peri¬
(REM) provided an attractive candidate
ods of rest, when attention to sensory input
for a brain-state correlate of dream experi¬
is reduced. Research on the default mode of
ence. At the time, dreams were thought to
cognition during resting wakefulness has
be confined exclusively to REM sleep (De¬
been particularly helpful in understand¬
ment & Kleitman, 1957). The activation-
ing the neural basis of daydreaming (An-
synthesis hypothesis of Hobson and Mc-
drews-Hanna, Reidler, Huang, & Buckner,
Carley (1977) built on this notion of REM
2010), and how the study of waking cog¬
as the neural substrate for dreaming, link¬
nition may inform our understanding of
ing proposed features of dreaming (such
sleep and dreaming states (Wamsley &
as bizarreness, intense emotionality, and
Stickgold, 2010). The term default net¬
hallucination) to the elevated acetylcho¬
work refers to a collection of brain regions
line levels, brain stem activity, and de¬
that are particularly active during resting
synchronized
characterizes
wakefulness (including medial temporal,
the REM state. However, subsequent re¬
medial prefrontal, midline, and parietal
search revealed that to the contrary, dream
regions). This rest-activity network has
EEG
that
Subjective Experience across States of Sleep and Wakefulness
|
been linked to the processing of memory,
understand dreaming, we must first under¬
theory of mind, and preparation for fu¬
stand the general mechanisms that produce
ture experience, reminding the neurosci¬
spontaneous mental imagery in any state
ence community that in rest, as in sleep,
of consciousness. To date, a strong focus
the brain continues to process information
on interstate variations in cognition may
and to generate conscious experience. This
have hindered progress in understanding
network pattern during quiet wakefulness
these more basic neural correlates of off¬
may provide a partial explanation for the
line cognition. Following recent work on
construction of daydreaming, with one re¬
the default mode of brain function, future
cent study reporting that individuals who
research could profitably explore neural
experience more daydream-like thoughts
mechanisms of off-line cognition common
of the past and future during a resting con¬
to REM sleep, NREM sleep, and wake¬
dition exhibit increased functional connec¬
fulness. In particular, the engagement of
tivity between components of the default
memory systems during quiet resting and
network (Andrews-Hanna et al., 2010).
during sleep states, both of which are asso¬
Thus, this activity pattern appears to sup¬
ciated with the reactivation of recent mem¬
port the generation of spontaneous thought
ory traces, suggests a common function
and imagery during wakefulness. Tell¬
for dream experience and waking cogni¬
ingly, similar patterns of brain activity are
tion in the processing of new memories
present throughout sleep, as medial tempo¬
(Wamsley & Stickgold, 2010). Erin J. Wamsley
ral and midline frontal regions remain rela¬ tively active during both REM and NREM
See also: Sleep and Mild Cognitive Impairment
stages. As sleep and default-mode cogni¬ tion also share electrophysiological and
References
neurochemical features thought to sup¬
Andrews-Hanna, J.R., Reidler, J.S., Huang, C., & Buckner, R.L. (2010). Evidence for the default network’s role in spontaneous cognition. Journal of Neurophysiology, 104(1), 322-335.
port the generation of mental imagery, this thriving line of research in the cognitive neurosciences provides a promising win¬ dow into mechanisms that may support dream experience. Certainly, there are meaningful distinc¬ tions to be made between various states of sleep and wakefulness in terms of the form that subjective experience takes. That dreaming is more prevalent and more emotional in REM than in NREM sleep, for example, may yet prove to be instruc¬ tive in linking particular qualities of dream experience to patterns of neural activity in the REM state. Yet at the same time, to
Dement, W., & Kleitman, N. (1957). The re¬ lation of eye movements during sleep to dream activity: An objective method for the study of dreaming. Journal of Experimental Psychology, 55(5), 339-346. Foulkes, D. (1967). Nonrapid eye movement mentation. Experimental Neurology (Suppl. 4), 28-38. Hobson, J. A., & McCarley, R. W. (1977). The brain as a dream state generator: An acti¬ vation-synthesis hypothesis of the dream process. American Journal of Psychiatry, 134(12), 1335-1348.
747
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Sumerian Dream Beliefs
Wamsley, E. J„ & Stickgold, R. (2010). Dream¬ ing and offline memory processing. Current Biology, 20(23), R1010-R1013.
very limited in Sumer; only a special class of scribes drawn mostly from the upper classes received training in the difficult cuneiform script. In later times, a special class of specialist priests and priestesses
Sumerian Dream Beliefs
called shailu, or questioners, were called on to interpret dreams by asking specific
Sumerian civilization was the first to de¬
questions of the dreamer from long lists of
velop writing and the first from which lit¬
dream symbols and their correspondences
erary texts remain, dating back to the late
provided on archival tablets. The corre¬
third millennium BCE. Some of these texts
spondences included many mechanisms
contain accounts of dreams, especially of
for dream insight on which we still rely
royal figures. The Sumerians made a dis¬
today: analogy, punning references, free
tinction between clear dreams, which come
association, and inversion. Their goal was
only to people who have observed the
to solve the dream, image by image, almost
proper ritual preparations, and obscure or
as if it were a cryptic equation with but a
symbolic dreams, which come to everyone
single solution, and Noegel (2001, p. 53)
else and require professional interpreta¬
comments that “in this sense dream inter¬
tion. A ruler who wished to obtain guidance
pretation in Mesopotamia represents less a
from dreams would go to a special incuba¬
preoccupation with ambiguity than an at¬
tion hut made of reeds to sleep. The walls
tempt at rendering ambiguity into a pro¬
of the hut were permeable, so as to receive
jected and authoritative reality.”
dream messages from the gods. The earli¬
The earliest of the Sumerian dream texts,
est Sumerian flood hero, Ziusudra, enters
and evidently the earliest recorded dream
such a reed hut for incubation. Ziusudra is
in history, is the dream of Dumuzi of Elruk.
a model of piety: “humbly obedient, rev¬
Not only is the dream text itself included
erent, attending daily, constantly, bringing
but also its interpretation, by Dumuzi’s sis¬
forth all kinds of dreams, uttering the name
ter Geshtin-anna. Her role as a professional
of heaven and earth” (Kramer, 1958, p. 29).
dream interpreter indicates that as early as
His reward is a dream from his god, Enki,
the middle of the third millennium BCE
warning him of the coming flood. Similarly,
dreams—especially those of monarchs—
in the Epic of Gilgamesh, the bull-man En-
were taken seriously and acted on. She in¬
kidu has a pair of dreams that clearly fore¬
terprets the symbols in Dumuzi’s dream,
tell his death, and no further interpretation
on a one-for-one basis, as representing a
is necessary (Speiser, 1958, pp. 58-59).
danger to her brother, and urges him to
The second type of dream is described
flee. Bendt Alster (1972, p. 43), who pub¬
in a text as “a closed archive basket of the
lished the first critical edition of this text,
gods” (Noegel, 2001, p. 47). This links the
has provided ample evidence that the text
idea of interpretation with the act of read¬
of Dumuzi’s dream has a formulaic quality
ing a cuneiform tablet, as archival docu¬
that derives from poetic rather than oneirocritic demands.
ments were stored in baskets. Literacy was
Survivors of the Holocaust and Rwandan Genocide: Dream Accounts
Such one-for-one interpretations are common in later dream-interpretation texts. In the Babylonian Epic ofGilgamesh, there is another example of dream interpretation by a female figure. Gilgamesh, the young king of Uruk, has angered the elders of the town. They complain to the gods, who create Enkidu, a wild man who combines human and bull characteristics. As Enkidu
|
pp. 28-30). Princeton, NJ: Princeton Uni¬ versity Press. Kramer, S.N. (1963). The Sumerians: Their history, culture, and character. Chicago: University of Chicago Press. Noegel, S. (2001). Dreams and dream inter¬ preters in Mesopotamia and in the Hebrew bible (Old Testament). In K. Bulkeley (Ed.), Dreams (pp. 45-72). New York: Palgrave.
approaches Uruk, Gilgamesh has two sig¬
Speiser, E. A. (1958). Akkadian myths and epics. In J.B. Pritchard (Ed.), The ancient
nificant dreams that he brings to his mother,
Near East: An anthology of texts and pic¬
the goddess Nin-sun, Lady Wild-Cow, for
tures (Vol. 1, pp. 31-86). Princeton, NJ:
interpretation. She interprets the symbols
Princeton University Press.
of the dream on a one-for-one basis, indi¬ cating the coming of a companion (Speiser, 1958, p. 46). Similarly when the historical gover¬ nor of the city of Lagash, Gudea, was
Survivors of the Holocaust and Rwandan Genocide: Dream Accounts
perplexed by a dream, he brought it to a priestess of the goddess Nanshe, a daugh¬
Trauma experienced by genocide survi¬
ter of Enki. Speaking as the goddess, the
vors is extreme to a level almost beyond
priestess interpreted the dream, using the
comprehension. Many survivors witnessed
same image-for-image method, indicating
the brutal murders of family and friends.
that Gudea should build a temple to his god
Often their communities have been de¬
Ningishzida, the consort of Geshtin-anna
stroyed, and many have suffered physi¬
(Kramer, 1963, p. 138). Gudea’s statues
cally from their ordeals. They are left with
commemorate both the dream and the re¬
the feeling that the world failed them. Life
sulting construction project.
for them will never again be the same.
Curtiss R. Hoffman
The dreams of genocide survivors provide a glimpse into significant posttraumatic
See also: entries related to History of Dreams/
stress disorder. These dreams frequently
Sleep
include seeing or receiving messages from deceased family members or reliving the
References Alster, B. (1972). Dumuzi’s dream: Aspects of oral poetry in a Sumerian myth. In Meso¬ potamia: Copenhagen studies in Assyriology, 1. Copenhagen, Denmark: Akademisk
Forlag. Kramer, S. N..5,(1958). A Sumerian myth. In J. B. Pritchard (Ed.), The ancient Near East: An anthology of texts and pictures (Vol. 1,
horror through nightmares. During the Holocaust, dreams of food were quite common. As prisoners were given barely enough food to survive, their bodies diseased and emaciated, food often became the main theme of their dreams. While some might consider these to be wish-fulfillment dreams, perhaps another
749
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Survivors of the Holocaust and Rwandan Genocide: Dream Accounts
purpose of these dreams was the mind’s
brothers were also killed, leaving him as
final attempt to fool the body a short while
the only surviving member of his family.
longer as a means of survival. Some Ho¬
He survived alone in the wilderness for 103
locaust survivors described dreams that
days at the age of 10 before being found
helped them to survive. In one example, a
by Rwandan Patriotic Front soldiers. He
survivor heard his deceased father telling
told of one of his post-genocide dreams in
him to run. He awoke from his dream and
which he was standing in the halls of the
escaped from the concentration camp with
United Nations, pleading for someone to
other boys after the watchman had fallen
listen and come save his people. No one
asleep, thereby avoiding the gas chamber.
would listen. His dream was quite literal in
Another man who had decided to commit
his desire to share his story with the world.
suicide dreamed of his mother telling him
One of the themes of some dreams of geno¬
that he must live because there was no one
cide survivors is their desire to try and tell
else left in the family to tell their story.
the world, or to make the world a better
In the years following the Holocaust,
place.
guilt became a common theme among
Many people who were not targeted in
survivors. In order to avoid death in the
genocides, but who were witnesses in some
camps, one often had to choose his or her
regard, also experience nightmares. A re¬
own best interests over that of fellow pris¬
porter during the genocide in Rwanda has
oners. Stealing bread or taking someone
since spoken of dreams of corpses and road
else’s shoes was often a necessity to avoid
blocks, which go along with his feelings
death, the cost of which was looking back
of failure to be able to help the people at
years later with painful regret. After lib¬
the time. Similar dreams have been experi¬
eration, the minds of survivors were free
enced by people who were not targeted by
to begin contemplating the events they had
the Nazis during the Holocaust. Fear pre¬
lived through and all that they had lost.
vented people from intervention, and that
Nightmares of being back in the camps
fear combined with guilt manifested itself
were very common among survivors in
in the dreams of these people.
the years and decades following liberation.
The magnitude of genocide is such that
The 1994 genocide against Tutsi in
the effects of it are multigenerational. It
Rwanda was much different than the Ho¬
may take several more years to understand
locaust as the killings took place over a pe¬
the extent of this fact with the Rwandan
riod of only about 100 days. Survivors did
genocide as most of the survivors are still
not live in concentration camps for weeks
young adults. The Holocaust provides
or months on end as they did in the Holo¬
more historical evidence of the effects of
caust. However, most of them personally
it on second-generation and even third-
witnessed the gruesome deaths of their
generation survivors. The children of Ho¬
families. Jean Nepomuscene Sibomana
locaust survivors grew up often knowing
lost his family in the genocide. He watched
little about their parents’ ordeals and fam¬
as his mother and sister were hacked to
ily history, leaving many with unanswered
death with machetes. His father and three
questions.
Second-generation
survivors
Synesthesia
|
also dealt with feelings of shame over their
such that a person might see pain or taste a
parents’ lack of social and language skills
sound. Intrigued by the not possible nature
in their adopted countries. Dream reports
of it, also characteristic of many dreams,
from second-generation survivors often
an independent dream researcher collected
include Nazis, swastikas, cattle cars, and
reports of synesthetes’ dreams and dream¬
other symbols commonly associated with
ers’ experiences of synesthesia. She sug¬
the Holocaust.
gests the two fields of study might have David L. Kahn
insights to offer each other, particularly about metaphor and psi.
References Frankl, V.E. (1984). Man's search for mean¬ ing: An introduction to logotherapy (3rd ed.). New York: Simon & Schuster. Ilani, O. (2008, January 5). What did con¬ centration camp inmates dream about?
Retrieved from http://www.haaretz.com/ hasen/spages/97981 l.html Ilani, O. (2008, May 2). My mother came to
In synesthesia, when a person perceives a stimulus, another specific sensation oc¬ curs at the same time. The musical note B might come with a taste like almonds. Or temperature may come with sound. Or pain with color. Or (in the standard notation for connecting an inducer with its synesthetic correlate), emotion -A smell.
tell me I had to remain among the living.
At least 63 such combinations have
Retrieved from http://www.haaretz.com/ hasen/spages/979526.html
been observed (Day, 2010). Color is by
Ilibagiza, I. (2007). Left to tell: Discovering God amidst the Rwandan Holocaust. New York: Hay House.
mates of synesthesia’s prevalence vary
Papirblat, S. (2006, April 25). Holocaust ef¬ fects: Son of Holocaust survivor still car¬ ries scars; will next generation be different?
Retrieved from ynetnews.com
far the most common correlate. Esti¬ widely, but some researchers speculate that basic forms of syn, too, might be universal. Some forms are intramodal (e.g., a vi¬ sual inducer linked with a visual correlate),
Rusesabagina, P., & Zoellner, T. (2006). An ordinary man. New York: Penguin Group.
some are intermodal or cross-dimensional
Sebarenzi, J. (2009). God sleeps in Rwanda. New York: Atria Books, a Division of Simon & Shuster.
touch —»taste), and some are conceptual—
Weiss, I., & Kosino, B. (1998). Czechoslova¬ kia, 1923. In A. Brostoff & S. Chamovitz (Eds.), Flares of memory: Stories of child¬ hood during the Holocaust (pp. 198-224). New York: Oxford University Press.
(two different sensory channels, such as one of the most common being a sense that days of the week or months of the year are arrayed spatially around the person. Com¬ binations can be more complex, such as [pain -a color, motion, location], and many synesthetes have more than one type. All combinations are one-way streets from in¬ ducer to correlate.
Synesthesia
Synesthesia is instantaneous, an insepa¬ rable part of the experiencer’s reality, al¬
Synesthesia is a neurological blending
though it can fade if a person stops paying
of sensory experiences in unusual ways.
attention to it. Most synesthesia has its
751
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Synesthesia
such as those of Des Hegarty. In a post to The Synesthesia List (May 18,2004), a pri¬ vate e-mail community, he said, “As I relax in meditation or about to drop into sleep, if I am disturbed by a noise, it stimulates my visual senses and produces a short burst of what could best be described as TV snow.” At the other end are the long, elabo¬ rate experiences of the late Shawn Allen O’Neal, an artist, musician, and sound de¬ signer. His synesthesia was strongest in the hypnogogic state and did not require an ex¬ ternal stimulus (personal communication, June 8, 2003): A typical specific instance might in¬ volve a self-generating saxophone solo, In Zig Zag, Carol Steen has realistically depicted
which appears as a silvery, mercurial,
her synesthetic experience of color and form
highly reflective, morphing and vibrat¬
constants that coupled with the sensations of an
ing orb which may leave an intermittent
acupuncture session, she writes. “I watched the
“trail” of its various forms as it (and I
visions come once all the needles were in place. I
with it) accelerates, swooping and zoom¬
saw swirling greens, and this amazing zig zag ... What I paint is realistic. It’s considered abstract by those who cannot see what I see, and ac¬ curate in feeling and gesture by those who [have similar synesthetic correlates].” (Carol Steen)
ing forward in space. “Chords” of neon “worms” may chase and writhe around this form. “Beneath” this might be a rhythm section of percussion, marimbas, basses, etc., where each note “appears” in space as part of a “geodesic series” or fabric of spinning, multi-colored tri¬
origins in early childhood, but it can also
angular panels, flocking, re-arranging
result from brain injury, the use of halluci¬
and bursting forward like a scintillating
nogenic drugs, or epileptic seizure. Studies have established that syn is not just vivid imagination or learned associations. Brain imaging shows perception activates more
reptilian skin, the faceted note-shapes with the most emphasis always glinting perfectly with the most light. (And yes, this is all without the aid of psychedelic drugs.)
areas in synesthetes than nonsynesthetes, and psychological tests find that individ¬
Experiences can differ between waking
ual synesthetes’ responses to a stimulus are
and dreaming. For O’Neal (who went by
consistent over long periods, unlike those
his initials, Sao, in some online forums),
of nonsynesthetes.
the synesthesia so abundant as he fell
Yet syn experiences are highly individu¬
asleep nearly disappeared in his dreams.
alistic. Responses can be brief and simple,
On a few occasions, the syn in author Pat
Synesthesia
|
Duffy ’ s (2001) dreams has been of a differ¬
music professor. In it, the motion of trees
ent type than the grapheme -» color corre¬
is music:
spondences in her waking life. In a Biology 202 paper online, Bryn Mawr College stu¬
The trees were all blowing. The wind was blowing, and some were blowing
dent Sadie White (2002), a nonsynesthete, wrote:
that way and some were blowing this
I was staring, entranced, at a delicate
. . . Then gradually they all started to
white flower. It was like nothing I had
line up toward this climax, and I real¬
way. And it was a counterpoint of trees
seen or experienced in my waking life,
ized then in that dream how to write a
because the pristine, thinly-veined petals
climax in music. . . .
were such an exquisite color that it mani¬ fested itself upon my dreaming brain as a color and a sound. The white song was
Unlike the musical compositions and other expressions it may inspire, though,
a single note—like a distant choir lifting
synesthesia does not generate integrated
its voice in concerted wonder.
perceptions. In that sense, it is also unlike
Wide-ranging individuality is something synesthesia and dreams have in common. So is the strong sense that the experience is real; is full of nuance and often difficult to describe; and has strong emotional in¬ volvement. (“Synesthetes often gush over trivial tasks such as remembering a name or phone number, calling it ‘gorgeous’ or ‘delightful,’ whereas mismatched per¬ ceptions—such as seeing a letter printed in the wrong color ink—can be like fin¬ gernails on a blackboard,” say neurolo¬ gist Richard Cytowic and neuroscientist David Eagleman [2009, p. 54].) For these reasons, perhaps, both dreams and syn are sources of creative material for much artis¬
dreams, many of which are full of distinct characters, landscapes, and objects (all considered to be imagery) and extensive narratives. Instead, syn generates generic tastes, sounds, and shapes—blobs, trian¬ gles, lines, spirals, and other geometric form constants.
Yet there is some overlap here with dream studies. In the hypnopompic state between dreaming and awakening, George Gillespie (1997) observes lattices. Ed Kel¬ logg (1999) perceives basic forms in lucid dreams when he resists the human ten¬ dency to identify things. Dale Graff (2004) has found form constants to be integral to dreams:
tic expression (e.g., by synesthetes Vladi¬
In the mid-1970s, I began incubating
mir Nabokov, Wassily Kandinsky, David
dreams that hopefully would reveal
Hockney, and Alexander Scriabin), or sim¬ ply interesting enough to inspire great ef¬ forts at precise expression.
something basic about the nature of dream imagery and how [dreams] were constructed.
The creativity of syn and dreams over¬
In time, the dreams presented only hon¬
lapped in a life-guiding way for G. Roger
eycombs, grids, lines (vertical, angled,
Davis. A dream recounted in the jour¬
horizontal), spirals and whirling white area
nal Dreaming (Knudson, 2001) inspired
globs! . . .At. . . times the dynamic forms
Davis in his career as a composer and
merge to create recognizable shapes, as if
753
754
|
Synesthesia
a subconscious process was occurring that
missing, and that synesthesia involves un¬
selected, fragment by fragment, what was
usual feedback or feed-forward along the
required to build up the image.
brain’s nerve pathways. As a group, syn
Graff is a physicist and former director
investigators acknowledge that their re¬
of the federal government’s remote view¬
search has focused almost exclusively on
ing research, Project Stargate. He says
color-involved
remote viewing perceptions, too, come
the grapheme —» color type, and that their
through as form constants.
theories cannot yet account for learning
Cytowic and Eagleman (2009) have
synesthesia,
particularly
(of, e.g., the days of the week).
noted that unusual experiences such as deja
Given the importance of metaphor to
vu, clairvoyance, and a sense of porten¬
dream interpretation, one of the most in¬
tousness seem somewhat common among
triguing ideas about synesthesia is that it
synesthetes, and at least seven synesthetes
has played a role in binding meanings as
among the small sample Sturzenacker con¬
well—that it, is the source of metaphor,
tacted reported psi experiences—several
and from that, language. Eric Odgaard and
of them attesting they have them often.
Lawrence Marks (2004) say it is important
If researchers can discover how percep¬
to distinguish between the vivid concur¬
tions are tied together in synesthesia, they
rents of strong synesthesia, which is rare,
will have contributed to solving the larger
and the everyday weak synesthesia that
binding problem. Very small regions of the
they liken to metaphor. A 1929 experiment
brain specialize in analyzing different as¬
asked people to match each of two made-
pects of an object or scene, from the shape
up words, bouba and kiki, with one of two
of a pen to its color to its orientation to how
pictures. Across cultures, they overwhelm¬
light changes at its edges. The question is
ingly matched the first to an amoeba-like
how the brain puts all that data together
shape and the second to a jagged, pointy
into an integrated perception so a person
one. Cytowic and Eagleman (2009) extend
can accurately reach for the pen and pick it
the case that metaphor arises from physi¬
up without a moment’s hesitation.
cal experience rather than being derived
Several theories exist (Ramachandran &
from abstract language. They propose a
Hubbard, 2003). From prenatal develop¬
cognitive continuum: perceptual similari¬
ment into early childhood, humans have
ties —» synesthetic equivalences —> meta¬
an overabundance of connections among
phoric identities —> abstract language.
various brain regions. Around age three,
Shawn O’Neal (2003) posted this de¬
the number becomes drastically reduced,
scription of what happens once he tunes
or pruned. A dominant theory is that syn¬
into the flow of synesthetic sensations in
esthesia is a greater-than-usual cross-ac¬
the hypnogogic state. Could it be an actual
tivation of different regions that results
experience of moving along the continuum
from an absence or inadequacy of prun¬
from synesthesia to metaphor?
ing. A variation is that neurotransmitters
I am able to look back and see that not
do the cross-activating. Another theory is
only have larger patterns been created by
that some inhibitory mechanism might be
whatever I am watching and listening to
Synesthesia
close up—but these larger patterns con¬ tinue to evolve, or branch off and recon¬ nect, so that the whole composition may fill enormous panoramic volumes of space, sometimes creating landscapes or archi¬ tecture and sometimes simply accelerating nonobjectively into a void. Complete, co¬ herent scenes may form and break up again in perfect synchronicity to the sounds, and often these scenes will suddenly, momen¬ tarily, poignantly reflect the sort of actual, natural scenes one might be reminded of by ordinary listening (such as “this reminds me of being on the ocean” or “in a valley of aspen trees at twilight” or “in a particular room”). Here too, the lapse of being aware that I am reminded of something and per¬ ceiving the manifestation of the thing I am reminded of is startlingly instantaneous. What might researchers in the two fields, dreaming and synesthesia, be able to learn from focusing closely on how the abun¬ dant, mostly visual metaphors observed in dreaming are created? Gloria Sturzenacker
References Cytowic, R.E., & Eagleman, D. M. (2009). Wednesday is indigo blue: Discovering the brain of synesthesia. Cambridge, MA: The MIT Press.
|
Day, S. (2010). Types of synesthesia. Synes¬ thesia. Retrieved from http://home.Comcast. net/~sean.day/html/types.html Duffy, P. L. (2001). Blue cats and chartreuse kittens: How synesthetes color their worlds. New York: Times Books. Gillespie, G. (1997). Hypnopompic imagery and visual dream experience. Dreaming, 7(3). Kellogg III, E.W. (1999, October 7-9). Lucid dreaming and the phenomeno¬ logical epoche. Presented at the Society for Phenomenology and the Human Sci¬ ences Conference, Eugene, Oregon. (Ab¬ stract available at http://dreamtalk.hy permart.net/2001 /abstracts/2001 _kellogg_ 01.htm) Knudson, R. (2001). Significant dreams: Bi¬ zarre or beautiful? Dreaming, 11(4). Odgaard, E.C., & Marks, L.E. (2004). Devel¬ opmental constraints on theories of synes¬ thesia. In L.C. Robertson & N. Sagiv (Eds.), Synesthesia: Perspectives from cognitive neuroscience. New York: Oxford Univer¬ sity Press. Ramachandran, V. S., & Hubbard, E. M. (2003, May). Hearing colors, tasting shapes. Scien¬ tific American, 288(5), 52-59. White, S. (2002). Synesthesia, report for Biology 202 course at Bryn Mawr Col¬ lege. Retrieved from http://serendip.bryn mawr.edu/bb/neuro/neuro01/webl/White. html
755
T Tarotpy Method
unconscious material and intuition to flow between client and therapist.
Pioneered during the early 1980s by Lau¬
While Tarotpy functions as a projec¬
ren Z. Schneider, MA, MFT, Tarotpy® is
tive tool for assessment and exploration,
an innovative approach to dreamwork and
a wealth of documented cases offers em¬
depth psychotherapy. Evolved over 25
pirical evidence of an unconscious mas¬
years, Tarotpy combines psychotherapeu¬
termind at play in the random selection
tic methods, dreamwork, hypnotherapy,
of cards and images. The process appears
family systems, semiotics, and Eye Move¬
more intentional than random in bringing
ment Desensitization and Reprocessing
information vital to emotional, physical,
(EMDR) with metaphysical tools.
and spiritual growth into consciousness.
Tarotpy uses the rich symbolic imagery of tarot, dream cards, and other image sys¬
First Case
tems to actively engage unconscious and intuitive processes. These archetypal im¬
Sue was a young 21 year old, struggling
ages arise from the same psychic pool as
to take her first steps toward financial
dreams. Tarotpy enhances dreamwork by
and emotional independence. After two
bringing further insight to a specific night
Tarotpy sessions, she shared a nightmare:
dream or stimulating imagination oth¬
“I’m in my room and there are ghosts. I
erwise blocked in some clients. Often, a
crawl terrified to my parents’ room. I have
Tarotpy session is followed by reports of
no voice to call out. I’m scared to enter,
more vivid dreaming.
but break through the fear and go in. They
As with dreamwork, the core principle
wonder what’s wrong with me. Finally I
of Tarotpy is profound respect for the in¬
cry out. There are ghosts in my room!’
herent wisdom, creativity, and wholeness
Then I’m holding a large cell phone with
of the psyche.
letters on the screen that spell ‘Tarotpy’.”
The client is instructed to select the
The phone image suggested that Tarotpy
deck, number of cards, formation, and
might offer further guidance into the
name of each placement, creating a lay¬
dream. I invited Sue to turn her attention
out. The client thus lays the unconscious
inward and ask her unconscious: “How
on the table, participating in a dreamlike
many cards do I need to see?” The num¬
consciousness with eyes wide open. Ap¬
ber four came immediately into her mind.
proached without preconceived ideas and
She selected a deck from the 30 plus decks
with a respectful desire to discover their
in my office and randomly chose four
intelligence, the images create a bridge for
cards, assigning each placement a special
757
758
|
Tarotpy Method
significance,
specifically
fight,
doubt,
courage, and strength. Sue stared at the first card: The image
voice. The phrase letting go and the image of water dropping from a leaf prompted a visceral sense of peace and calmness.
of the dark-haired woman closely resem¬
Tarotpy opens a door beyond our per¬
bled Sue, and the ghostlike hands pulling
sonal, material, or rationalistic orientation
the woman’s hair matched the ghost image
and enters the realm of the dream where
in her dream.
events are not linear and causal, but rather
I asked about the card’s explicit label,
multilayered and simultaneous, where the
guilt; Sue said she felt guilty all the time.
ordinary and extraordinary merge. The
I reflected that children often take on the
meaningful connection between the card
guilt of their parents’ unresolved issues. As
images and the client’s dream has a pow¬
the child of an alcoholic, Sue was trying to
erful impact, spontaneously evoking new
directly voice these family ghosts.
perceptions on emotional cognitive and
The second card, entitled reception,
embodied levels.
is the archetype of the mother; the third, creative, that of the father. The images in Sue’s layout constellated the images in her dream. She was powerfully affected.
Second Case Mary came in greatly depleted and desper¬
“Amazing,” Sue responded. “Tarotpy is
ate. She explained that she took care of her
helping me communicate with my intuitive
mother, who was in her early 90s. Mary felt
self.” As the dream phone indicated, Tarotpy
that since childhood she had had to parent
tapped into her cellular connection.
her mother. She was also taking care of her
Sue next focused on the placement she
husband, who had become ill three years
had named strength. Reflecting on the
ago. Mary was the sole bread winner. I sug¬
dream, Sue recognized two acts of strength:
gested that Tarotpy might offer insight into
going into her parents’ room and finding her
what she deemed a hopeless trap.
OSHOZen Tarot: The Transcendental Game of Zen, (c) OSHO International Foundation, www.osho.
com/copyright / Tao Oracle: An Illuminated New Approach to the I Ching, Ma Deva Padma (c) 2002, www.thetaooracle. com, www. embraceart. com)
Tau Protein and Sleep-Wake Cycle
Even the first step of choosing from a variety of decks proved significant: Mary was exercising choice at a time when she felt she had none. Contemplating the random selection of cards, Mary focused on a card depicting a dragon.
|
“You dreamed of a dragon?” I asked as we both stared awestruck at the card. The dragon symbol is rarely found in tarot; against the odds Mary selected the image from her dream. I inquired how she might feed her inner dragon.
When asked what the dragon image evoked, Mary softened and said: “My animals.” “What do you get from your relationship with your animals?” I asked.
“With my creativity,” she responded. I pointed out that dragon is a symbol for creativity throughout Eastern culture. The synchronicity between her dream and the dragon image dramatically shifted her per¬
“Unconditional love,” she said.
spective; she accessed that unconditionally
She relaxed and became fully present.
loving and creative part in herself and felt
I was impressed by this significant shift.
renewed optimism.
“Oh,” she suddenly remembered, “I had
Tarotpy’s integrative method can accel¬
a dream last night. In my backyard, there
erate the course of discovery, awareness,
was a green creature. It was part snake, part
and transformation, reducing what may
alligator—Oh! It was a dragon and I was
take months or years of treatment to a few
feeding it.”
sessions. Through actively engaging with imagery, a client can transform entrenched unconscious patterns and have more con¬ scious choice over attitudes and behavior. The synchronicity between dreams and images creates awe-inspiring moments that prompt healing of the mind, body, and spirit and reconnect us with our inner ca¬ pacity for self-awareness and wholeness. Lauren Schneider
References Padma, D. (1994) Osho zen tarot. New York: St. Martin’s Press. Waldherr, K. (1997). Lover’s path tarot. Stam¬ ford, CT: U.S. Games Systems.
Tau Protein and Sleep-Wake Cycle SE^EN OF STAVES (Kris Waldherr)
Tau is a neuronal microtubule-associated protein
implicated
in
microtubules
759
760
|
Tau Protein and Sleep-Wake Cycle
stabilization, axonal establishment, and
bouts. Altered sleep structure in tau knock¬
elongation during neuronal morphogenesis
out mice is accompanied by a decline in
(Avila, Lucas, Perez, & Hernandez, 2004).
delta power together with an enhanced
Tau knockout animals, although pheno-
spectral density of sleep spindles during
typically normal, have shown a significant
NREM sleep. REM sleep, however, seems
delay in the axonal extension of hippocam¬
to be unaltered by the lack of tau.
pal neurons and lag in stage development
The mechanistic role of tau protein in
(Dawson et al., 2001), which may affect
the sleep-wake cycle is supported by dif¬
both neural coordination and synaptic ef¬
ferent lines of evidence. Tau interacts
ficiency in local- and long-range circuits.
with the neural membrane through its
This hypothesis has been recently sup¬
amino-terminal projection domain. And
ported by in vivo electrophysiological stud¬
slow-wave activity (1 Hz) and excitatory effects when pre¬
memory task (thus, approximately 60 to 90
sented at high frequencies (>5 Hz).
minutes poststimulation). In another well-
Although TMS studies have not yet di¬
controlled study, Nitsche et al. (2010) in¬
rectly examined dreaming, some have in¬
vestigated the effects of tDCs applied to
vestigated hallucinations, sleep states, and
the prefrontal cortex during REM sleep
consciousness. For instance, the results of
on the consolidation of a motor sequence
a recent meta-analysis have supported the
learnt before sleeping. It was found that
conclusion that low-frequency rTMS over
anodal tDCs stimulation of the prefrontal
the temporoparietal junction is effective in
791
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Use of Noninvasive Techniques in the Study of Dreaming
reducing auditory hallucinations in schizo¬
that cognitive effects may be observed
phrenia (see George et al., 2009). In regard
when such stimulation is directed at brain
to sleep, Massimini et al. (2010) found that
regions implicated in the dream report pro¬
from TMS of the right premotor cortex dur¬
cess. The most suitable cortical targets for
ing short-wave sleep SWS produced very
tDCs would therefore be the prefrontal and
focal high-density multisite EEG activa¬
the PTO association cortex due to: (1) its
tion patterns localized at the site of TMS
accessibility with tDCs (compared to the
stimulation. However, TMS applied dur¬
brain stem, thalamus and anterior cingulate
ing REM sleep triggered more widespread
gyrus), and (2) the fact that these regions
and differentiated cortical EEG activation
are implicated as key cortical regions in
patterns, similar to that found during wake¬
dream reporting as evidenced by neuroim¬
fulness. Consistent with this result, Ferra-
aging and lesion studies.
relli et al. (2010) administered TMS to a
Antonia J. Jakobson, Paul B.
group of healthy individuals during wake¬
Fitzgerald, and Russell Conduit
fulness as well as during pharmacologi¬ cally induced loss of consciousness. They
See also: entries related to Sleep and the Brain;
found that compared to wakefulness, TMS
entries related to Sleep Assessment
applied during a loss of consciousness was characterized by short-lasting local activity
References
that failed to propagate beyond the site of
Antal, A., & Paulus, W. (2008). Transcranial direct current stimulation and visual percep¬ tion. Perception, 37, 367-374.
stimulation. Thus, such authors have con¬ cluded that the EEG responses observed during SWS and loss of consciousness reflect a breakdown in cortical effective
Ferrarelli, F., et al. (2010). Breakdown in cortical effective connectivity during midazolam-induced loss of consciousness.
connectivity and that the spread of cortical
Proceedings of the National Academy of
activity observed during REM sleep repre¬
Science U.S.A., 107, 2681-2686.
sents intact consciousness, possibly dream consciousness, which is disconnected from the outside world. No study to date has in¬ vestigated the relationship between such cortical interconnectivity and dreaming.
Conclusions Currently, no study has examined the ef¬ fect of TMS or tDCs during sleep related to subsequent dream reporting. If TMS and tDCs can affect cognitive functioning in both waking and sleeping participants, as demonstrated by several previous stud¬ ies, then it is not unreasonable to propose
Fregni, F., et al. (2005). Anodal transcranial di¬ rect current stimulation of prefrontal cortex enhances working memory. Experimental Brain Research, 166, 23-30. George, M.S., et al. (2009). Controversy: Re¬ petitive transcranial magnetic stimulation or transcranial direct current stimulation shows efficacy in treating psychiatric dis¬ eases (depression, mania, schizophrenia, obsessive-compulsive disorder, panic, posttraumatic stress disorder). Brain Stimula¬ tion, 2, 14-21. Marshall, L., Molle, M., Hallschmid, M., & Born, J. (2004). Transcranial direct current stimulation during sleep improves declara¬ tive memory. The Journal of Neuroscience, 24, 9985-9992.
Using Dreams in Cognitive-Behavioral Therapy
Massimini, M., et al. (2010). Cortical reactiv¬ ity and effective connectivity during REM sleep in humans. Cognitive Neuroscience, 1, 176-183. Nitsche, M.A., et al. (2008). Transcranial di¬ rect current stimulation: State of the art 2008. Brain Stimulation, 1, 206-223. Nitsche, M. A., et al. (2010). Contribution of the premotor cortex to consolidation of motor sequence learning in humans dur¬ ing sleep. Journal of Neurophysiology, 104, 2603-2614. Zaghi, S., et al. (2010). Noninvasive brain stimulation with low-intensity electrical currents: Putative mechanisms of action for direct and alternating current stimulation. The Neuroscientist, 16, 285-307.
|
example, Arthur Freeman has been doing so and found that dream content can be subject to the same cognitive restructuring (change of viewpoint) as waking thoughts, and Barry Krakow has developed an effi¬ cient treatment for recurrent nightmares. The use of dreams in CBT can be gener¬ alized if therapists adopt a conception of dreaming radically different from those of psychoanalysts and an interpretation method compatible with the methodology and principles of CBT. As far as the con¬ ception of dreaming is concerned, Beck already stressed the continuity between dream content and mental representations in the waking. Montangero (2009) pre¬ sented a cognitive conception in which
Using Dreams in CognitiveBehavioral Therapy
dreams are the extreme form of thinking with relaxed control, on a continuum start¬ ing with spontaneous remembrances and
Working with dreams is very unusual
anticipations. He explained the specifics
among psychotherapists practicing cogni¬
of dream content by the deactivation of
tive-behavioral therapy (CBT). Yet Aaron
certain cognitive abilities (executive func¬
Beck, one of the main founders of cogni¬
tions) and by the necessity of representing
tive therapy, advocated the use of dreams
ideas in a concrete, at least partly visual,
in a 1971 paper, asserting that the cli¬
and economic way. According to him,
ents’ idiosyncratic way of conceptualizing
dreams can express any topic of interest
themselves and the outside world greatly
or concern for the dreamer, usually when
influenced dream content. However, any
it has been insufficiently processed in the
reference to dreams disappeared from the
daytime.
subsequent writings of Beck and of his
As far as dream interpretation is con¬
main followers. The reasons were, first,
cerned, Montangero proposes a method
that dreams were closely associated with
according to which the therapist has no
psychoanalysis, second that their experi¬
preconceived idea as to what the dream is
mental study was difficult and, third, that
about. The meaning of the dream (i.e., the
behavioral therapists, with whom Beck
relationship between the dream and con¬
started a close relationship, were not inter¬
cerns, topics of interest, and life episodes
ested in such material.
of the dreamer) is discovered thanks to
Only a very limited number of CBT
the descriptions, memories, and personal
therapists have been using dreams (see
ideas of the client related to the dream con¬
Rosner, Lyddon, & Freeman, 2004). For
tent. The work with the dream comprises
793
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Using Dreams in Cognitive-Behavioral Therapy
three steps before the client finds an inter¬
Once these topics are discovered, the
pretation (which is the fourth step). First,
therapist can use them in various ways, for
the complete description of the dream im¬
instance:
merses the client in the memory of the dream experience. Everything that was vi¬ sualized and everything that was present
•
client’s life. •
without being visualized has to be men¬
Draw the client’s attention on the biased way of representing the topic, which is often par¬
tioned, concerning the events or actions, the setting, the characters, and possible
Discuss the importance of this topic in the
ticularly apparent in the dream representation. •
Ask the client whether there would be a
objects. The client is also asked whether
more realistic and pleasant way to deal with
s/he felt an emotion during the dream scene.
the same situation.
The second step is the systematic search for memory sources. The client is asked what memory comes to his/her mind about each main element of the dream report. For in¬ stance, “What memory comes to your mind about elephants?” and not “about the small brown elephant of your dream.” For each retrieved memory source, the client spec¬ ifies its subjective meaning; that is, the ideas and emotions linked to that episode. Third, the client is asked to reformulate the
•
Underline any representation in the dream of the client’s resources.
This kind of dreamwork yields comple¬ mentary information about the client and provides concrete and metaphorical repre¬ sentations of his/her problems and strate¬ gies. Research on the impact of dreamwork in CBT is needed, and will be possible when a sufficient number of therapists use a similar method. Jacques Montangero
dream report by replacing the words of the initial report by a personal definition of the element, or by its function, its encom¬ passing category, or the subjective mean¬ ing of the memory source related to that content. This reformulation in general terms usually permits the client to discover relationships between the dream report and concerns, topics of interest, or life episodes.
See also: Cognitive Approach to Dreaming
References Montangero, J. (2009). Using dreams in cognitive-behavioral therapy: Theory, method and examples. Dreaming, 19, 239-254. Rosner, R. I., Lyddon, W.J., & Freeman, A. (Eds). (2004). Cognitive therapy and dreams. New York: Springer.
V Video Game Play and Dreams
that while nonplayers trained with up to 1,000 hours of play improved their perfor¬
It is important to consider why video game
mance, they did not reach the skill levels
play is relevant for understanding dreams.
on the cognitive/perceptual tasks as expert
Several points can be made. First, Revon-
players. Boot et al. (2011) estimated ex¬
suo (2009) argues that dreams are useful
pert players came into the laboratory con¬
for understanding the binding problem in
dition with tens of thousands of hours of
consciousness. He defines consciousness-
video game play. One can make the case
related binding as the connection between
that high-end gamers bring to research a
our personal sense that our conscious¬
lifetime of neuronal network effects that
ness is unified and the underlying biologi¬
may depart from ordinary conscious expe¬
cal mechanisms. This is illustrated in the
riences including dreams.
dream state with its inherent bizarre nature.
The second reason why inquiry into
While during waking these semantic neu¬
video games is important for dream re¬
ral networks are hidden, due to the dom¬
searchers deals with one potential evo¬
ination of sensory stimuli, dream study
lutionary function of dreaming, threat
allows for their unfettered examination.
simulation
In other words, bizarreness in dreams illu¬
dealing with threats in dreams has evolu¬
minates semantic neuronal networks. One
tionary functionality in that it would re¬
type of bizarreness happens due to a skip
sult in better performance in subsequent
in the track of the semantic network but it
waking. Video gaming may reduce this
does not go too far afield. Other types of
dream function because this need is being
bizarreness indicate major departures from
addressed in another imaginal realm (i.e.,
a given network.
during a video game). Thus, video gaming
(Revonsuo,
2009).
Practice
Thus, having a waking situation, namely
offers the potential to investigate this evo¬
video game play, where subjects are ex¬
lutionary function of dreams. Relatedly,
posed for long periods of time to unusual
threats in dreams are often nightmarish.
or bizarre experiences, can help to fur¬
Thus, the rehearsal of nightmares while
ther illuminate the nature of bizarreness
awake as a technique to decrease their in¬
in dreams. Such a situation is not easily
tensity and persistence can be argued is the
created in a laboratory with a few hours
essence of some video games.
of viewing or interacting with media. In
The third reason that studying video
fact, in a study of video game effects on
gaming informs dream studies is the po¬
various cognitive and perceptual tasks,
tential of video gaming to act as prepara¬
Boot, Blakely, and Simons (2011) found
tion or training for dreaming lucidly and
795
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Video Game Play and Dreams
commanding some control over the dream
exposure on dreams is important in and
as it progresses. Practice in this technolog¬
of itself. Although video games are escap¬
ically generated imaginal realm seems to
able, and dreams typically less so (an ex¬
be associated with consciousness emerg¬
ception being lucid-control dreams), there
ing in dreams. Thus such inquiries inform
are many parallels between them in the
not only the question of how to have a lucid
sense that video games offer experience
dream but also the broader question of the
in an alternative reality that is accessible
nature of consciousness when it emerges in
by most people. Other alternative reali¬
sleep. Likewise, gamers are well practiced
ties, such as those created in hypnosis, are
and expect to be in command of threaten¬
less widely accessible. Video gaming pro¬
ing enemies in virtual worlds so that in the
vides experiences in deep absoiption not
biologically virtual world of the dream this
normally available to those without access
skill is quickly utilized. In other words,
to experiences that can result in alternative
gamers show more dream control.
realities. Supporting this conjecture is a re¬
Finally, on a pragmatic level, video
cent study in our laboratory. We found that
games offer an opportunity for sleep and
the degree of self-reported presence, sense
dream researchers to manipulate presleep
of being there, in dreams versus in a video
stimuli within closely controlled condi¬
game was not different, belying the oft-
tions. An easily controlled and impactful
cited assumption that dreams are the gold
presleep event is the use of a film to in¬
standard of presence.
vestigate the nature of dream incorpora¬
As communication studies history has
tion. Films have been used to investigate
taught, the typical introduction of new
stress. The advantage of a film is it allows
media is accompanied by fearful reactions
presleep controlled manipulation to inves¬
from the public and existing media. Thus
tigate incorporation questions.
negative findings such as modeling of ag¬
However, as our media landscape is
gression, the potential for addiction, and
changing, so too are our opportunities to
lack of physical activity are most often
use media to investigate issues of dream
discussed. However, numerous positive
incorporation. The problem with film, tele¬
consequences of video game play have
vision, or radio is that they are all unidirec-
also been found from practice in social
tionally presented, or pushed at the passive
realms to various improvements in cog¬
viewer. In our waking lives we are not pas¬
nitive skills. Our research effort has been
sive viewers, but active participants. This
the impact of video game play on night¬
active participatory element is captured in
time dreams. That impact could have been
computer use and, especially, video game
positive or negative, but it appears to be
play.
associated with largely positive dream out¬
It is important to keep in mind that due
comes. Video game play may act as a type
to the increasing gaming pervasiveness
of meditative experience to the extent that
in North American society, 67 percent
it requires similar levels of attentional ab¬
of homes report video game play (ESA,
sorption. Video gaming enhances the expe¬
2011), and the effects of such VR-type
rience of dream lucidity along the lines of
Video Game Play and Dreams
|
meditators’ experiences of lucidity. These
2009) was for data from subjects who re¬
findings can be interpreted equally in terms
ported normal sleep length where they felt
of a psychology of imaginative absorption.
rested. Of the 800 plus college student re¬
The question posed in our laboratory
spondents, only 152 fit these criteria. In a
is what are the effects on the biologically
factor analysis of these dreams with dream
constructed alternative realities of dreams
type, media use, and gamer-history infor¬
by immersion in the technologically con¬
mation, lucid and control dreaming were as¬
structed worlds experienced during video
sociated with high-end gamer history and
game play? Throughout these studies we
heavier media use the day before the dream.
generally defined the hard-core gamer as
While video game play was the marker on
someone who:
this factor, all media use was associated
1. Plays video games on average several times a week, 2. Has a typical playing session of more than 2 hours; 3. Played 50 or more video games over their lifetime; and 4. Has been playing video games since grade three or earlier.
with lucid and control dreams. This is im¬ portant to note as while not everyone may be gaming, just about everyone is using var¬ ious electronic media and thus engaged to some extent in virtual worlds. However, the lucid-dream-gaming asso¬ ciation is less robust than the control-dream¬ gaming link. When asked to provide lucid dreams there was no difference between
The dream dimensions that we have
high- and low-end gamers in their self-
examined thus far include lucid dreams,
reported incidence. But control of dreams
dreams where you know you are dream¬
seems to emerge as superior in high-end
ing while the dream is ongoing; control
gamers across data-collection methods. This
dreams, where the dreamer has control over
difference was most recently illuminated in
some aspects of the dream; bizarreness,
a study where gamers were compared to two
the degree to which dreams are unusual or
other groups frequently engaging in absorb¬
odd; and nightmares, dreams that are so
ing activities, for example, prayer/medita-
frightening that they wake the sleeper.
tion and control group. Those who pray/ meditate a lot had the highest levels of lu¬
Lucid and Control Dreams
cidity but gamers were significantly higher on lucidity than any other absorbing activ¬
In several studies we were able to show
ity group. However, when it came to dream
that high-end gamers had more lucid and
control, it was gamers who reported signifi¬
control dreams than those who rarely game
cantly more than both of the other absorb¬
(Gackenbach & Kuruvilla, 2008). This
ing groups.
dream information was initially based on
Why might we expect this parallel be¬
retrospective reflections on dream history
tween video game play and lucid-control
and more recently on dream reports from
dreaming? There are several reasons.
the previous night’s sleep. The first of
Video games are technologically con¬
these last night dream studies (Gackenbach,
structed alternative realities while dream
797
798
|
Video Game Play and Dreams
worlds are biologically constructed alter¬
groups. In addition to the online dream-
native realities. One could argue that there
diary study we also asked the research par¬
is simply a practice effect. If you are in an
ticipants about features that were bizarre
artificial reality for hours a day, is it any
for the subjects themselves, as well as vari¬
surprise that you recognize something sim¬
ous media-use information. For those who
ilar when you are in another one at night?
fulfilled the criteria for the dream-diary
Video gaming has been associated with
component of the research project, we ad¬
improved spatial skills as has lucid dream¬
ministered a verbal and figural creativity
ing. A lack of proneness to motion sick¬
test. It was found that high-end gamers had
ness is needed to play a lot of these games
more bizarre than nonbizarre dreams than
and lucid dreamers have better vestibular
low-end gamers of both the self-reported
systems; thus, they are not susceptible to
and judges’-reported types, while the op¬
motion sickness. Finally, the high attention
posite was the case for nonbizarre dream
and absorption reported by players and in
elements. It is important to point out that
research on gaming is reminiscent of the
media use the day before was controlled,
same qualities associated with meditation,
and therefore a straight incorporation of
a group that has been found to have very
bizarre game or other media elements into
high levels of lucidity in sleep.
the dream does not account for this find¬ ing. In terms of the creativity assessment, no significant difference for verbal test re¬
Dream Bizarreness
sulted but significant differences for the fig¬
Based on dreams collected and analyzed in
ural test favoring the high-end gamer group
hour-long interviews with hard-core gam¬
were identified. We concluded that bizarre¬
ers, higher imaginal and dead characters
ness in gamers’ dreams is at least associated
were found in gamers’ dreams than in the
with their creativity and with their history
norms (Gackenbach et al., 2009). We pur¬
of media use in the form of gaming, but not
sued this bizarreness finding in gamers’
associated with the day before media use.
dreams in two additional studies (Gack¬ enbach, Kuruvilla, & Dopko, 2009). In the first of these two studies (Gackenbach
Nightmares
et al., 2009) recent dreams were collected
Due to our findings in an interview study
in an online questionnaire from college
of high-end gamers (Gackenbach et al.,
students.
informa¬
2009), we became curious about night¬
tion was also gathered. It was found that
mares. Less misfortune and more intense
high-end gamers evidenced more bizarre
aggression, when it happened but occur¬
dreams than low-end gamers in two of the
ring less often, was found among these
three types of bizarreness categories.
hard-core gamers. This combination of
Various
media-use
In the second study a two-week online
findings led us to wonder about gamers’
dream diary was gathered from preselected
nightmares. We explored this question
research participants who varied on the
with additional content analysis on larger
four game-play criteria mentioned earlier.
samples of gamers’ dreams (Gackenbach &
This resulted in high- and low-end gamer
Kuruvilla,
2008),
replicating
these
Video Game Play and Dreams
|
aggression and misfortune findings. Thus
When we examined the dreamers self-
three studies were undertaken to further
reported emotions during these two types of
examine these results. In all three studies
negative dreams, negative emotions (anxi¬
threat simulation, as an explanation for the
ety, frustration, and fear) were found to be
aggression and misfortune findings, was
higher in bad dreams for high-end gamers,
explored (Gackenbach & Kuruvilla, 2008).
while positive emotions (sexual arousal
Revonsuo (2009) argues that dreaming
and happiness) were found to be greater
is an adaptive process with an evolution¬
in nightmares for high-end gamers. When
ary foundation. It allows us to simulate
these same dreams were analyzed for threat
threatening situations in the safety of a
simulation as a function of gamer history,
virtual environment of dreams. This con¬
there was an interaction between dream
tinued practice during dreaming would
type (nightmare x bad dream) and gamer
allow an individual to better prepare for
group (high vs. low). The high-end gamers
these possibly dangerous instances, were
showed the expected less threat in night¬
they to arise in the waking world. Gack¬
mares but more in bad dreams while the
enbach and Kuruvilla (2008b) asked the
low-end gamers evidenced less of a differ¬
question, might gamers’ dreams be lower
ence in threat between the two dream types.
in threat simulation because they have al¬
This study was followed by one examin¬
ready practiced these responses in their
ing soldiers who play video games. In this
game play during the day? Revonsuo
case they were asked for a recent dream
(2000) method of dream content analysis
and a military dream. Information was also
for threat simulation was used on these
gathered on these military gamers’ emo¬
dreams experienced the night before filling
tional reactivity and history of trauma, in¬
out the questionnaire. In a factor analysis
cluding military, which has been shown to
of media use (including gaming history),
be predictive of nightmares. When these
threat simulation content variables, and
predictive factors were controlled, fre¬
various self-report variables of dream con¬
quent gaming was associated with signifi¬
tent, we found that when high-end gam¬
cantly less threat in military dreams. Thus
ers reported playing a lot of games the
it may be that high-end gaming may act
day prior to a reported dream, there was
as an inoculation against the nightmare at
no association to threat in their dreams nor
least in situations where there is real-world
were these dreams seen as nightmarish or
threat, such as being deployed for war.
scary by the gamers despite reporting that the dreams were violent. In contrast, the low-end gamers did not play games the
Conclusions and Implications
day before the dream but did watch vio¬
Three general dream types have been
lent television shows or movies and had
examined in our program looking at the
dreams that were not only high in threat
relationship between video game play and
simulation, but also in violence, nightmar-
dreams. A participant-observer gamer in
ishness, and scariness. Thus we concluded
our research program illuminates our major
that gaming might be viewed as a protec¬
findings. When asked, he responded that
tion against threat simulation in dreams.
yes his dreams were lucid and bizarre, and
799
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Visual Art and Dreams
he sometimes has aggression in his dreams but rarely nightmares. Rather he pointed out that he was in the third person in his dreams: I’ve just noticed that sometimes I’m just there as a hovering spirit watching things go on and I don’t really have a role . . . I don’t even pop up in my dreams, it’s just like I’m watching a movie ... I feel emotion definitely regardless of whether or not I’m the person involved. (Jordan Olischefski; Gackenbach et ah, 2009)
In this entry, we reviewed three major areas of inquiry into dreams of gamers: lucid/control dreams, bizarre dreams, and nightmares. We have found higher lucid/ control dreams in gamers and wonder if this is indicative of improved metacogni¬ tion in dreams. Increased bizarreness in gamers might imply that gamers are capa¬ ble of improved novel adaptive responses as per the global workspace theory of con¬ sciousness or creativity. Finally, in terms of aggression/misfortune in dreams we found some association between gaming serving a threat simulation function in waking and potentially a protective function regarding nightmares, if not bad dreams. While not entirely clear, taken together it seems that
ESA (2011). http://www.theesa.com/Entertain merit Software Association. Gackenbach, J.I. (2008). Video game play and consciousness development: A transper¬ sonal perspective. Journal of Transpersonal Psychology, 40(1), 60-87. Gackenbach, J.I. (2009). Electronic media and lucid-control dreams: Morning after reports. Dreaming, 19(1), 1-6. Gackenbach, J.I., Ellerman, E., & Hall, C. (2011). Video game play as nightmare pro¬ tection: A preliminary inquiry on military gamers. Dreaming: APA ’s Online First (August 22, 2011). Gackenbach, J.I., & Kuruvilla, B. (2008). The relationship between video game play and threat simulation dreams. Dreaming, 18(4), 236-256. Gackenbach, J.I., Kuruvilla, B., & Dopko, R. (2009). Video game play and dream bizarre¬ ness. Dreaming, 19(4), 218-231. Gackenbach, J.I., Matty, I., Kuruvilla, B., Samaha, A.N., Zederayko, A., Olischefski, J., & Von Stackelberg, H. (2009). Video game play: Waking and dreaming consciousness. In S. Krippner (Ed.), Perchance to dream (pp. 239-253). Hauppauge, NY: Nova Sci¬ ence Publishers. Gackenbach, J. I., Rosie, M., Bown, J., & Sam¬ ple, T. (2011). Dream incorporation of video game play as a function of interactivity and fidelity. Dreaming, 21(1), 32-50.
while awake may make positive contribu¬
Revonsuo, A. (2000). Behavioral and Brain Sciences, 23(6), 887-901; discussion 904— 1121. Review.
tions to dreaming and is reminiscent of
Revonsuo, A. (2009). Inner presence: Con¬
a case can be made that video game play
sciousness as a biological phenomenon.
meditators’ dreams.
Cambridge, MA: MIT Press. Jayne Gackenbach
See also: entries related to Dream Content
References Boot, W.R., Blakely, D.P., & Simons, D.J. (2011). Do action video games improve per¬ ception and cognition? Frontiers in Psychol¬ ogy, 2, 226.
Visual Art and Dreams Historically widespread concepts of the dream as sometimes prophetic and su¬ pernatural in origin lie behind the most
Visual Art and Dreams
|
obviously dream-related visual art, which
The 19th and 20th centuries opened up a
depicts specific dreams of important spiri¬
broader set of options for the visual arts to
tual and historic figures, often representing
engage dreaming. Changes in the role of the
both dreamer and dream. Such artworks
artist and art patronage, associated with the
were initially generated and viewed in a
rise of individualism and the bourgeoisie,
context of understanding shared by patron,
enabled artists to explore dream experience
artist, and audience. In European Chris¬
from more personal and introspective per¬
tian art, especially in medieval illuminated
spectives. Romanticism, with its valoriza¬
manuscripts and church sculpture, the Bib¬
tion of subjective experience; symbolism,
lical dreams of Jacob, the Pharaoh, and the
with its interest in hidden meaning; modem
Three Magi are the most frequently repre¬
abstraction, with its disorienting approaches
sented, with some attention to dreams of
to the material world; and especially surre¬
saints in Renaissance paintings. Through¬
alism, with its explicit focus on the dream,
out the Buddhist diaspora, the dream of
offered fertile ground for dream content. In
Maya, mother-to-be of the Buddha, has
recent years, a number of survey exhibi¬
been the basic dream subject. In Islamic
tions with substantial catalogues in North
manuscript illuminations, the night visions
America and Europe have mapped the terri¬
of the Prophet epitomize the divine dream.
tory, though further dream-specific studies
South Asian art, especially in illustrated
would be helpful for every artist, move¬
manuscript books, draws on the Hindu
ment, and period involved. Lynn Gamwell’s
Puranas for dream stories. In Egyptian and
landmark exhibition assembled a particu¬
Greco-Roman antiquity, iconic sculptural
larly comprehensive look at 20th-century
figures of gods and goddesses associated
art of the dream; her essay in the catalogue
with dream incubation (such as Asklepios,
Dreams 1900-2000: Science, Art, and the
Amphiarion, Isis, and Serapis) were in¬
Unconscious Mind (2000) addresses the in¬
stalled at incubation sites.
fluence of Freud on art, proposing that two
Many tribal and indigenous cultures
major streams of 20-century art-making, the
create visual mappings and artifacts refer¬
unconscious mind and art-about-art, would
ring to shamanic and initiatory journeys
have been inconceivable without Freud’s
in dream and to dreams of special signifi¬
theories of the dream and the unconscious.
cance to the community or an individual.
Neuroscientist J. Allan Hobson and art his¬
A useful gathering of such work, with
torian Hellmut Wohl detail correlations be¬
brief commentary, is provided by David
tween late 20th-century neuroscience of the
Coxhead and Susan Hiller in their gen¬
dreaming brain and Western art 1780-1950
eral survey Dreams: Visions of the Night
in From Angels to Neurones: Art and the
(1976), including examples from Iroquois,
New Science of Dreaming (2005). An ex¬
Chumash, Chippewa, and Navajo Native
emplary in-depth study of a single work is
American tribes, shamanic traditions of
Norman Gee’s Ernst: Pieta or Revolution
northern Europe and Asia, aboriginals in
by Night (1986), which traces Max Ernst’s
Central Australia, and the Saora in Orissa,
deployment of Freud’s dream theory both in
India.
process and in content.
801
802
|
Visual Art and Dreams
Dream of the Magi, stone capital, Cathedrale Saint-Lazare, Autun, by Gislebertus (French, 12th cen¬ tury). (GiraudonFThe Bridgeman Art Library International)
The later 20th century and early 21st
to visual art. In The Committee of Sleep:
century have again expanded the range of
How Artists, Scientists, and Athletes Use
dream-related visual art. New art media and
Dreams for Creative Problem-Solving—
formats such as video and the artist book
and How You Can Too (2001), Deirdre
have proven especially receptive to dream
Barrett opens with a chapter on painting
content. In contemporary performance and
and sculpture which interrogates with nu-
installation art, the public or documented
anced understanding a few dozen histori¬
act of dreaming may be itself the artwork.
cal and contemporary examples, including
Art-making practices such as collage have
Salvador Dali, Frida Kahlo, and Jasper
been developed as dreamwork methods,
Johns.
shifting perceptions of dream art from pro¬
With the possible exception of medieval
fessional artists and passive viewers to a
European work, which has been well stud¬
participatory workshop context with aims
ied, the entire field is still wide open for
beyond the boundaries of traditional art
dream-focused studies that integrate con¬
worlds.
cepts of the dream, the science of dream¬
Studies of the functions of dreaming
ing, and dreamwork practices with visual
in creativity have particular relevance
art perspectives. Asian, Middle Eastern,
Visual Art and Dreams
|
and indigenous contexts especially need
for creative problem-solving—and how you
far more attention. Studies that include
can too.
New York: Crown Publishers.
and process in contemporary work could
Coxhead, D., & Hiller, S. (1976). Dreams: Vi¬ sions of the night. New York: Crossroad.
be facilitated by the backlog of artist inter¬
Gamwell, L. (Ed.). (2000). Dreams 1900-
the voice of the artist on issues of origin
views and statements gathered in periodi¬ cals such as Dreamworks in the 1980s and DreamTime since the 1990s. Betsy Davids
2000: Science, art, and the unconscious mind.
Ithaca, NY: Cornell University
Press. Gee, N. (1986). Ernst: Pieta or revolution by night. London: The Tate Gallery. Hobson, A., & Wohl, H. (2005). From an¬
References
gels to neurones: Art and the new science
Barrett, D. (2001). The committee of sleep: How
of dreaming.
artists, scientists, and athletes use dreams
Fidenza: Mattioli. (Originally published in 1885.)
803
*
1
.
w White Noise and Sleep
who reported waking more than once per night or taking longer than 30 minutes to
College students require between eight
fall asleep to participate in a study examin¬
and nine hours of sleep every night for
ing the efficacy of continuous white noise
peak performance during the day; how¬
for reducing sleep difficulties in college
ever, research indicates that most only
students. These students were provided
receive between seven and eight hours
with a Tranquil Moments Plus white noise
each night (Carskadon, 2002). In addition,
generator. Participants were instructed to
Forquer and colleagues (2008) found that
use the white noise setting between 60
33 percent of college students at North Cen¬
and 75 decibels and set to play continu¬
tral University, in Minneapolis, reported
ously from bedtime to wake time. Partic¬
sleep latencies of more than 30 minutes and
ipants kept sleep diaries throughout the
43 percent reported waking more than once
course of the experiment in which they
each night. Finally, a survey by the Amer¬
recorded their bedtime, sleep latency,
ican College Health Association (2005)
number and length of night-wakings, and
reported that college students rated sleep
rise times. White noise generators were
difficulties as the third-largest impediment
implemented according to a nonconcur¬
to academic performance, behind stress and
rent multiple baseline across subjects de¬
illness. Therefore, it was hypothesized that
sign, which involved baselines of varying
improving sleep in college students may be
lengths and introduction of white noise
associated with complementary improve¬
at different points in time for each par¬
ments in academic performance.
ticipant. All four participants reported de¬
Several strategies have been shown to
creases in both frequency of night-waking
help college students sleep better at night,
and sleep latency while using the white
including maintaining a consistent sleep
noise; however, some of their sleep diffi¬
schedule, improving sleep hygiene, and
culties returned to baseline levels follow¬
the use of continuous white noise. Con¬
ing discontinuation of the sound. Attempts
tinuous white noise, sound that covers
to link improved sleep using white noise
the entire range of human hearing from
to improved academic performance were
20 to 20,000 Hz, has been shown to im¬
largely unsuccessful due to the types of
prove sleep in adults and small children,
cognitive measures being utilized. The
but had never been systematically exam¬
free association task employed was too
ined in college, students. Forquer and John¬
easy, leading to potential ceiling effects.
son (2007) recruited four college students
Finally, students reported that they were
805
806
|
Women’s Dreams across the Life Cycle
comfortable using white noise and would recommend it to other students experienc¬
and night waking in college students. Sleep and Hypnosis, 9, 60-66.
ing sleep problems. There are several possible explanations for the effectiveness of continuous white noise for reducing sleep difficulties, includ¬
Women’s Dreams across the Life Cycle
ing decreased arousal through the process of habituation, masking extraneous noises
The notion that dreams reflect the concep¬
that may interfere with sleep, the resetting
tion of the self, of its relation with others,
of the biological clock so that it does not in¬
and with the environment is well suited to
clude frequent night-waking or long sleep
explore changes in women’s dreams par¬
latencies, and stimulus control. Stimulus
allel to developmental changes in waking
control is the process by which white noise
life (Hall, 1953). While content analysis
may come to act as a discriminative stim¬
of long dream series suggests that few
ulus in the presence of which decreased
changes take place in a person’s dreams
arousal is reinforced by sleep causing sleep
throughout adulthood (Domhoff, 2003),
to occur more frequently in its presence.
cross-sectional studies of home-collected
Additional research is needed with larger
dreams found changes, starting in early
samples, possible group designs, and the
adulthood.
use cognitive tasks that more closely re¬ semble actual academic performance. LeAnne M. Forquer
A study by Brenneis (1975), taking into account psychosocial changes from early adulthood to the 70s, led me to explore dreams of different age groups. While no
See also: Increasing Sleep Complaints
evidence of drastic changes was found in the dreams of women from their mid¬
References
dle 20s to the 40s, the impact of develop¬
American College Health Association. (2005). The American College Health Associa¬ tion National College Health Assessment (ACHA-NCHA), Spring 2003 reference group report. Journal of American College Health, 53, 199-210.
mental changes became noticeable by the
Carskadon, M. A. (2002). Adolescent sleep pat¬ terns: Biological, social, and psychological influences. New York: Cambridge Univer¬ sity Press. Forquer, L. M., Camden, A. E., Gabriau, K. M., & Johnson, C.M. (2008). Sleep patterns of college students at a public university. Journal of American College Health, 56, 563-565. Forquer, L.M., & Johnson, C.M. (2007). Con¬ tinuous white noise to reduce sleep latency
middle 50s (Cote, Lortie-Lussier, Roy, & De Koninck, 1996). Inconsistent or mar¬ ginally significant results of other studies, resulting from small samples or from dif¬ ferences in data collection, limit the gener¬ alization of their findings. More systematic and inclusive studies were in order to trace the ontogenetic evolution of dreams from adolescence up to old age. A large study of the dreams of Canadian women and men, Francophone and Anglophone, ranging in age from 12 to 80 years, was initiated in 2005 at the University of Ottawa by Joseph De Koninck.
Women’s Dreams across the Life Cycle
Home dream reports have been collected since then in Ottawa, the National Capital
|
finding meaningful relationships find their way in dreams.
of Canada. Participants were contacted in
The dreams of the 25 to 39 group are
high schools, universities, workplaces, and
as lengthy as those of the younger adults,
community centers. The present sample in¬
with a marked decrease in the number of
cludes 412 women, distributed in five age
characters, male and female, and in the fre¬
groups: 88 from 12 to 17, 81 from 18 to
quency of aggressions. Dreamers entertain
24, 80 from 25 to 39, 82 from 40 to 64, 81
more friendly interactions with familiar
from 65 up. One or two dreams from dif¬
characters than any other group, suggest¬
ferent nights were collected with instruc¬
ing intimacy, accentuated by interior set¬
tions to report as many details as possible.
tings. Emotions are similar to the younger
Two independent judges scored them with
women’s. The high incidence of failure is a
the Hall and Van De Castle categories.
unique characteristic, while success is only
Data were submitted to statistical analy¬
occasional. Continuity with waking is re¬
ses, after controlling for length. Reporting
flected in concerns central to that period,
of the results takes into account psycho¬
including marriage or partnership, work
social changes characteristic of successive
and children. The conception of the self is
life stages.
one of inward reflection.
Findings relative to adolescence support
In the middle adulthood group, aged
those of previous studies. Teenagers chat
40 to 64, dreams are shorter than the
in their dreams. Highlights of their reports
younger groups’, contain fewer characters
are activities and friendly interactions,
of either sex and less friendly and aggres¬
generally in the company of girls. But the
sive interactions, consistent with previous
reporting is factual and lacks emotion. Of
studies. Three components emerge: the
all age groups they are the most successful.
dreamers are significantly more often ag¬
They portray themselves as victims of ag¬
gressors, more successful, and angrier than
gressions, physical or verbal. Their dreams
any other group. It could reflect the inde¬
reveal little about the age-related task of
pendence and assertiveness women gain as
finding one’s self through relationships
they reach middle adulthood, in line with
with parents and other adults.
theories of female aging. It could refer to
Young adults (18 to 24), mostly uni¬
decreasing happiness, due to unmet expec¬
versity students, have longer dreams than
tations during this period, which coincides
adolescents, with characters most often
with pre- and post-menopause.
females. Friendly and aggressive interac¬
Findings about the oldest group are con¬
tions are more frequent than in the older
sistent with most studies devoted to this pe¬
groups. They are both aggressors and vic¬
riod. This is valid for the length of dreams,
tims of aggressions. Sadness and anger are
decreased number of characters, familiar
distinctive dream features. Success and
and females, friendly and aggressive inter¬
failure are less frequent than in the other
actions, and total of emotions. Two results
adult groups. Overall dreams reflect tense
stand out: the sharp increase in outdoor
relationships with friends. Concerns about
settings and the prevalence of sadness, at
807
808
|
Women’s Dreams across the Life Cycle
variance with other studies. The salience of sadness may reflect a sense of loss, an interpretation that theories about old age would support. This overview of age-related changes in dreams is but a summary of the issues re¬ lating to the inner life of women, during transitions from the security of one period to the unknown perspectives of the follow¬ ing one. Completing the normative study should provide answers. Monique Lortie-Lussier
References Brenneis, C.B. (1975). Developmental as¬ pects of aging. A comparative study of
dreams. Archives of General Psychiatry, 32, 429-434. Cote, L., Lortie-Lussier, M., Roy, M.J., & De Koninck, J. (1996). Continuity and change: The dreams of women throughout adult¬ hood. Dreaming, 6, 187-192. Domhoff, G. W. (2003). The scientific study of dreams: Neural networks, cognitive de¬ velopment, and content analysis. Wash¬ ington, DC: American Psychological Association. Hall, C.S. (1953). A cognitive theory of dreams. Journal of General Psychology, 49, 273-283. Neugarten, B. J. (1979). Time, age and the life cycle. American Journal of Psychiatry, 136, 887-894.
Y Yawning
periods (e.g., predatory carnivores and primates) yawn much more frequently
The yawn is a stereotyped and often re¬
(following a circadian rhythm) than herbi¬
petitive motor act characterized by gaping
vores. In humans, daily frequency of yawn¬
of the mouth accompanied by a long in¬
ing varies between 5 and 15 times per day.
spiration of breath, a brief acme, and then
The diurnal distribution of yawning fre¬
a short expiration of breath. Stretching
quency is illustrated by higher frequency
and yawning simultaneously is known as
upon waking and before sleep.
pandiculation. It is not merely a simple
A good number of clinical and pharma¬
opening of the mouth but a complex co¬
cological data indicate that yawning in¬
ordinated movement bringing together a
volves a group of oxytocinergic neurons
flexion followed by an extension of the
originating in the paraventricular nucleus
neck, a wide dilatation of the pharyngo-
of the hypothalamus (PVN), and project¬
larynx with strong stretching of the dia¬
ing to extrahypothalamic brain areas (e.g.,
phragm and anti gravity muscles.
hippocampus, medulla oblongata, and spi¬
Ethologists agree that almost all ver¬
nal cord). The PVN is an integration center
tebrates yawn. Yawning is morphologi¬
between the central and peripheral auto¬
cally similar in reptiles, birds, mammals,
nomic nervous systems. It is involved in a
and fish. These behaviors may be ances¬
number of functions ranging from feeding
tral vestiges maintained throughout evolu¬
and metabolic balance to sexual behavior
tion, with little variation (phylogenetic old
and yawning. Activation of these neurons
origins). Correlatively, yawning can be vi¬
by dopamine and its agonists, excitatory
sualized as early as 12 weeks during the
amino acids (N-methyl-D-aspartic acid),
period of fetal development.
oxytocin itself, or by electrical stimulation
Systematic and coordinated pandicula-
leads to yawning; conversely their inhibi¬
tions occur in a similar pattern and form
tion by gamma-aminobutyric acid and its
across all animals, and consistently occur
agonists or by opioid peptides and opiate¬
during behaviors associated with cyclic
like drugs inhibit both yawning and sex¬
life rhythms: sleep arousal, feeding, and
ual response. Other compounds modulate
reproduction. Yawning appears as one un¬
yawning by activating central oxytociner¬
directed response to an inner stimulation,
gic neurons: sexual hormones, serotonin,
underlying the homeostasis of these three
hypocretin, and endogenous peptides (ad-
behaviors.
renocorticotropin-melanocyte-stimulating 'If
hormone). Oxytocin activates choliner¬
Species that sleep 8 to 12 hours and alternate
between
active
and
gic neurotransmission in the hippocampus
inactive
809
810
|
Yawning
and the reticular formation of the brain¬
pathology (serotoninergic agents, apo-
stem. Acetylcholine induces yawning via
morphine, acetylcholinesterase inhibitors,
the muscarinic receptors of effectors from
opiate withdrawal) is the most frequent
which the respiratory neurons in the me¬
explanation of pathologic cases.
dulla; the motor nuclei of the 5th,7th, 9th,
Yawning does not accelerate blood
10th, and 12th cranial nerves; the phrenic
flow. This blood-flow theory argued that
nerves (C1-C4); and the motor supply to
yawning improved the oxygenation of the
the intercostal muscles.
brain, in response to cerebral anemia. The inaccuracy of this hypothesis was for¬
Contagiousness of Yawning
mally invalidated by Provine, Tate, and Geldmacher (1987). In his studies, he has
It seems that hominids have the unique ca¬
demonstrated that breathing neither pure
pacity to be receptive to the contagious¬
02 nor gases high in C02 had any signifi¬
ness of yawning. In humans, echokinesis
cant effect on yawning, although both in¬
only occurs in situations of minimal men¬
creased breathing rate. In a second study,
tal stimulation (public transport, waiting);
he has found that exercise sufficient to
people are not susceptible to this phenom¬
double breathing rate had no effect on
enon during prolonged intellectual effort.
yawning.
Yawning appears to trigger a sort of so¬
Although the available data are far from
cial coordination function and reflects the
providing a complete and generally ac¬
capacity to unconsciously and automati¬
cepted account of the physiological func¬
cally be influenced by the behavior of
tion of yawning, progress has been made
others. Autistic individuals who are char¬
in ruling out previously held hypotheses.
acterized by impaired mental state attri¬ bution do not show contagious yawning. All these data support the hypothesis that
Conclusion
contagious yawning shares the neural net¬
Yawning and pandiculation are transi¬
works implicated in self-recognition and
tional behaviors, universal among verte¬
mental state attribution; it may therefore
brates, closer to an emotional stereotypy
be that yawning is involved in empathy.
than a reflex. Phylogenetically ancient and
Excessive yawning is a source of embar¬
ontogenetically primitive, they may pro¬
rassment in social circles. There are mul¬
vide some evolutionary advantage. They
tiple causes of excessive yawning, that is, a
seem to exteriorize homeostatic processes
cluster of 10 to 50 yawns, many times a day.
of systems controlling wakefulness, sati¬
Of short duration, they may predict a vaso¬
ety, and sexuality in the diencephalon.
vagal reaction or neurovegetative disorders
'Olivier Nils Walusinski
(dyspepsia, migraine-like syndromes). All insults to the intracranial central nervous system or the hypothalamo-hypophyseal region may be involved: tumors with intra¬ cranial hypertension, infections, temporal epilepsy, strokes, etc. Actually, iatrogenic
See also: Fetal Sleep References Barbizet, J. (1958). Yawning. Journal of Neu¬ rology, Neurosurgery, and Psychiatry, 21(3), 203-209.
Yawning
|
Collins, G.T., & Eguibar, J. R. (2010). Neurophamacology of yawning. Frontiers of Neu¬ rology and Neuroscience, 28, 90-106.
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811
4
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Papers with Adult Sea Mammal Data Lyamin, O.I. (1987). [The ontogenetic devel¬ opment of the interhemispheric asymmetry of the EEG during slow-wave sleep in north¬ ern fur seals] (in Russian). Zh Vyssh Nerv Deiat lm 1P Pavlova, 57(1), 157-159. Lyamin, O.I., & Chetyrbok, I.S. (1992). Uni¬ lateral EEG activation during sleep in the Cape fur seal, Arctocephalus pusillus. Neu¬ roscience Letters, 143(1-2), 263-266. Lyamin, O.I., Mukhametov, L. M., & Polyakova, I.G. (1986). [Peculiarities of sleep in water in northern fur seals] (in Rus¬ sian). Zh Vyssh Nerv Deiat lm I P Pavlova, 36(6), 1039-1044. Lyamin, O.I., Mukhametov, L.M., & Siegel, J. M. (2004). Relationship between sleep and eye state in cetaceans and pinnipeds. Archives of Italian Biology, 142, 557-568.
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Appendix: Additional Resources on Sleep
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Strijkstra, A.M., & Daan, S. (1997). Ambient temperature during torpor affects NREM sleep EEG during arousal episodes in hiber¬ nating European ground squirrels. Neuro¬ science Letters, 221(2-3), 177-180.
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Tobler, I., & Schwierin, B. (1996). Behavioural sleep in the giraffe (Giraffa Camelopardalis) in a zoological garden. Journal of Sleep Re¬ search, 5(1), 21-32. Toutain, P. L., & Ruckebusch, Y. (1975). Arousal as a cyclic phenomenon during sleep and hibernation in the hedgehog (Erinaceus europaeus). Experientia, 31, 312-314. Ursin, R. (1968). The 2 stages of slow-wave sleep in the cat and their relation to REM sleep. Brain Research, 11, 347-356. Valatx, J. L., & Bugat, R. (1974). [Genetic fac¬ tors as determinants of the waking-sleep cycle in the mouse (author’s transl)]. Brain Research, 69(2), 315-330. Van Twyver, H. (1969). Sleep patterns in five rodent species. Physiology & Behavior, 4, 901-905. Van Twyver, H., & Allison, T. (1970). Sleep in the opossum Didelphis marsupialis. Elec¬ troencephalography and Clinical Neuro¬ physiology, 29(2), 181-189.
Tauber, E. S., Michel, F., & Roffwarg, H.P. (1968). Preliminary note on the sleep and waking cycle in the desert hedgehog (Paraechinus hypomalas) [Abstract]. Psycho¬ physiology, 5, 201.
Van Twyver, H., & Allison, T. (1974). Sleep in the armadillo Dasypus novemcinctus at moderate and low ambient tempera¬ tures. Brain, Behavior and Evolution, 9(2), 107-120.
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Tobler, I. (1992). Behavioral sleep in the Asian elephant in captivity. Sleep, 15(1), 1-12. Tobler, I., & Deboer, T. (2001). Sleep in the blind mole rat Spalax ehrenbergi. Sleep, 24(2), 147-154. Tobler, I., Franken, P., & Scherschlicht, R. (1990). Sleep and EEG spectra in the rab¬ bit under baseline conditions and following sleep deprivation. Physiology & Behavior, 48, 121-129. Tobler, I., & Jaggi, K. (1987). Sleep and EEG spectra in the Syrian hamster (Mesocricetus auratus) under baseline conditions and fol¬ lowing sleep deprivation. Journal of Com¬ parative Physiology A, 161(3), 449-459.
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Appendix: Additional Resources on Sleep
sleep of Macaca mulatto.. Archives of Neu¬ rology, 12, 463^467. Wexler, D.B., & Moore-Ede, M.C. (1985). Circadian sleep-wake cycle organization in squirrel monkeys. American Journal of Physiology—Regulatory, Integrative and Comparative Physiology, 248, R353-R362. Zepelin, H. (1970). Sleep of the jaguar and the tapir: A prey-predator contrast [Abstract], Psychophysiology, 7, 305-306. Zepelin, H. (1989). Mammalian sleep. In M. H. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and practices of sleep medicine
(pp. 81-92). Philadelphia: Saunders. Zepelin, H., & Rechtschaffen, A. (1974). Mam¬ malian sleep, longevity, and energy metabo¬ lism. Brain, Behavior and Evolution, 70(6), 425-470. Zolovick, A., Stern, W., Jalowiec, J., Panksepp, J., &Morgane, P. (1973). Sleep-waking pat¬ terns in cats: Effects of 6-hydroxy dopamine given into the dorso-lateral pontine tegmen¬ tum [Abstract], Sleep Research, 2, 74.
Mammal Articles with REM Density Data Balzamo, E., Bradley, R.J., & Rhodes, J.M. (1972). Sleep ontogeny in the chimpan¬ zee: From two months to forty-one months. Electroencephalography and Clinical Neu¬ rophysiology, 33, 47-60.
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|
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77(4), 259-262. Strijkstra, A.M., & Daan, S. (1997). Ambient temperature during torpor affects NREM sleep EEG during arousal episodes in hiber¬ nating European ground squirrels. Neuro¬ science Letters, 227(2-3), 177-180. Tenaza, R., Ross, B.A., Tanticharoenyos, P., & Berkson, G. (1969). Individual behaviour
839
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Appendix: Additional Resources on Sleep
and activity rhythms of captive slow lorises (Nycticebus coucang). Animal Behavior, 17, 664-669. Van Twyver, H., & Allison, T. (1970). Sleep in the opossum Didelphis marsupialis. Elec¬ troencephalography and Clinical Neuro¬ physiology, 29(2), 181-189.
Walker, J.M., Glotzbach, S.F., Berger, R.J., & Heller, H.C. (1977). Sleep and hiber¬ nation in ground squirrels (Citellus spp): Electrophysiological observations. Ameri¬ can Journal of Physiology—Regulatory, Integrative and Comparative Physiology, 233(5), R213-R221.
Mammal Sleep Papers with Spindling Data Adams, P., & Barratt, E. (1974). Nocturnal sleep in squirrel monkeys. Electroencepha¬ lography & Clinical Neurophysiology, 36,
201-204. Affani, J. (1972). Observations on the sleep of some South American marsupials and edenates. Persped Brain Sci, 1, 21-23. Affanni, J.M., Cervino, C.O., & Marcos, H.J.A. (2001). Absence of penile erections during paradoxical sleep. Peculiar Journal of Sleep Research. Penile events during wakefulness and slow wave sleep in the ar¬ madillo, 10, 219-228. Allison, T., Gerber, S.D., Breedlove, S.M., & Dryden, G.L. (1977). A behavioral and polygraphic study of sleep in the shrews Suncus murinus, Blarina brevicauda, and Cryptotis parva. Behavioral Biology, 20(3), 354-366.
Ambrosini, M. V., Gambelunghe, C., Mariucci, G., Bruschelli, G., Adami, M., & Guiditta, A. (1994). Sleep-wake variables and EEG power spectra in Mongolian gerbils and Wistar rats. Physiology & Behavior, 56(5), 963-968. Ayala-Guerrero, F., Vargas-Reyna, L., Ramos, J.F, & Mexicano, G. (1998). Sleep patterns of the volcano mouse (Neotomodon alstoni alstoni). Physiology & Behavior, 64(A), 577-580. Balzamo, E. (1973). Etude des etats de vigi¬ lance chez Papio cynocephalus adulte. C R Seances Soc Biol, 167, 1168-1172. Balzamo, E., & Bert, J. (1975). Sleep in Papio anubis: Its organization and lateral genicu¬ late spikes [Abstract]. Sleep Research, 4, 138. Balzamo, E., Bradley, R.J., & Rhodes, J.M. (1972). Sleep ontogeny in the chimpan¬ zee: From two months to forty-one months. Electroencephalography and Clinical Neu¬ rophysiology, 33, 47-60.
Balzamo, E., Vuillon-Cacciuttolo, G., & Bert, J. (1978). Cercopithecus aethiops: EEG et organization des etats de vigiliance. Wake Sleep, 2, 223-230. Balzamo, E., Vuillon-Cacciuttolo, G., Petter, J., & Bert, J. (1978). Etats de vigiliance chez deux Lemuridae: Rhythmes EEG et organi¬ zation obtenus par telemesure. Wake Sleep, 2, 237-245. Barre, V., & Petter-Rousseaux, A. (1988). Seasonal variations in sleep-wake cycle in Microcebus murinus. Primates, 19(2), 53-64.
Allison, T., & Van Twyver, H. (1970). Sleep in the moles, Scalopus aquaticus and Condylura cristata. Experimental Neurology, 27(3), 564-578.
Batini, C., Radulovacki, M., Kado, R.T., & Adey, W.R. (1967). Effect of interhemispheric transection on the EEG patterns in sleep and wakefulness in monkeys. Electro¬
Allison, T., Van Twyver, H., & Goff, W. R. (1972). Electrophysiological studies of the echidna, Tachyglossus aculeatus, I: Wak¬ ing and sleep. Comparative Biochemistry
encephalography and Clinical Neurophysi¬
and Physiology Part A: Molecular & Inte¬ grative Physiology, 110, 145-184.
ology, 22, 101-112.
Bell, F. R., & Itabisashi, T. (1973). The elec¬ troencephalogram of sheep and goats with special reference to rumination. Physiology & Behavior, 11, 503-514.
Appendix: Additional Resources on Sleep
Berger, R.J., & Walker, J.M. (1972). A poly¬ graphic study of sleep in the tree shrew (Tupaia glis). Brain, Behavior and Evolution, 5(1), 54-69. Bert, J., Balzamo, E., Chase, M., & Pegram, V. (1975). The sleep of the baboon, Papio papio, under natural conditions and in the laboratory. Electroencephalography and Clinical Neurophysiology, 39, 657-662.
|
Crowley, T.J., Kripke, D.F., Halberg, F., Pe¬ gram, G. V., & Schildkraut, J. J. (1972). Cir¬ cadian rhythms of Macaca mulatto: Sleep, EEG, body and eye movement, and temper¬ ature. Primates, 13, 149-168. Dallaire, A., & Ruckebusch, Y. (1974). Restactivity cycle and sleep patterns in captive foxes (Vulpes Vulpes). Experientia, 30, 59-60.
Bert, J., Collomb, H., & Martino, A. (1967). L’electroencephalogramme du sommeil d’un prosimien. Sa place dans V organisation du sommeil chez les primates. Electroen¬
Dallaire, A., & Ruckebusch, Y. (1974). Sleep and wakefulness in the housed pony under different dietary conditions. Canadian Jour¬ nal of Comparative Medicine, 38, 65-71.
cephalography and Clinical Neurophysiol¬
Deboer, T., & Tobler, I. (1996). Shortening of the photoperiod affects sleep distribution, EEG and cortical temperature in the Djungarian hamster. Journal of Comparative Physiology A, 179(4), 483-492.
ogy, 23, 342-350.
Bert, J., Kripke, D. F., & Rhodes, J. (1970). Elec¬ troencephalogram of the mature chimpanzee: Twenty-four hour recordings. Electroen¬ cephalography and Clinical Neurophysiol¬ ogy, 28, 32-40.
Bert, J., & Pegram, V. (1969). L’electroence¬ phalogramme du sommeil chez les Cercopithecinae: Erythrocebus patas et Cerpothiecus aethiops
sabaeus.
Folia
Primatol,
11,
151-159. Bert, J., Pegram, V., Rhodes, J. M., et al. (1970). A comparative sleep study of two cercopithecinae. Electroencephalography and Clini¬ cal Neurophysiology, 28(1), 32^40.
Galvao de Moura Filho, A. G., Huggins, S.E., & Lines, S.G. (1983). Sleep and waking in the three-toed sloth, Bradypus tridactylus. Comparative Biochemistry and Physiology Part A: Molecular & Integrative Physiol¬ ogy, 76(2), 345-355.
Gonzalez, F. F., Zaplana, J., Ruiz de Elvira, C., & Delgado, J.M. (1979). Nocturnal and diurnal sleep in Macaca sylvana. Electro¬ encephalography and Clinical Neurophysi¬ ology, 46(1), 13-28.
Breton, P., Gourmelon, P., & Court, L. (1986). New findings on sleep stage organization in squirrel monkeys. Electroencephalogra¬
Leinonen, L., & Stenberg, D. (1986). Sleep in Macaca arctoides and the effects of prazosin. Physiology & Behavior, 37(2), 199-202.
phy and Clinical Neurophysiology, 40(6),
Lucas, E.A. (1979). Effects of a short lightdark cycle on the sleep-wake patterns of the cat. Sleep, 7(3), 299-317.
563-567. Carskadon, M.A., & Dement, W.C. (2006). Normal human sleep: An overview. In M. H. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and practice of sleep medicine
(4th ed., pp. 13-23). Philadelphia: WB Saunders. Crofts, H. S., Wilson, S.,Muggleton,N. G.,Nutt, D. J., Scott, E. A., & Pearce, P.C. (2001). In¬ vestigation of the sleep electrocorticogram of the common marmoset (Callithrix jacchus) using radiotelemetry. Clinical Neuro¬ physiology, 772(12), 2265-2213.
Lucas, E. A., Powell, E. W., & Murphree, O. D. (1977). Baseline sleep-wake patterns in the pointer dog. Physiology & Behavior, 19, 285-291. Lucas, E.A., & Sterman, M.B. (1974). The polycyclic sleep-wake cycle in the cat: Ef¬ fects produced by sensorimotor rhythm conditioning. Experimental Neurology, 42, 347-368. Lyamin, O.I., & Chetyrbok, I.S. (1992). Uni¬ lateral EEG activation during sleep in the
841
842
|
Appendix: Additional Resources on Sleep
Cape fur seal, Arctocephalus pusillus. Neu¬ roscience Letters, 143(1-2), 263-266.
correlates. Physiology & Behavior, 245-251.
16,
Lyamin, O. I., Mukhametov, L. M., Chetyrbok, I. S., & Vassiliev, A.V. (2002C). Sleep and wakefulness in the southern sea lion. Behav¬ ioural Brain Research, 128, 129-138.
Ruckebusch, Y„ & Bell, F.R. (1970). Etude polygraphique et comportementale es etats dev veille et de sommeil chez la vache (Bos taurus). Ann Rech Vet, 1, 41-62.
Marks, G. A., & Shaffery, J.P. (1996). A pre¬ liminary study of sleep in the ferret, Mustela putorius furo: A carnivore with an extremely high proportion of REM sleep. Sleep, 19(2), 83-93.
Sterman, M.B., Knauss, T., Lehmann, D., & Clemente, C. D. (1965). Circadian sleep and waking patterns in the laboratory cat. Elec¬
McNew, J.J., Howe, R.C., & Adey, W.R. (1971). The sleep cycle and subcorticalcortical EEG relations to the unrestrained chimpanzee. Electroencephalography and Clinical Neurophysiology, 30(6), 489-503.
Sunquist, M., & Montgomery, G. (1973). Ac¬ tivity patterns and rates of movement of two-toed and three-toed sloths, Choloepus hoffmani and Bradypus infuscatus. Journal of Mammalogy, 54, 946-954.
Nicol, S. C., Andersen, N. A., Phillips, N. H., & Berger, R. J. (2000). The echidna manifests typical characteristics of rapid eye move¬ ment sleep. Neuroscience Letters, 283(1), 49-52.
Susie, V., & Masirevic, G. (1986). Sleep pat¬ terns in the Mongolian gerbil (Meriones unguilculatus). Physiology & Behavior, 37, 257-261.
Nishino, S., Riehl, J., Hong, J., Kwan, M., Reid, M., & Mignot, E. (2000). Is narcolepsy a REM sleep disorder? Analysis of sleep ab¬ normalities in narcoleptic dobermans. Neu¬ roscience Research, 38, 437-446. Pivik, R.T., Bylsma, F.W., & Cooper, P. (1986). Sleep-wakefulness rhythms in the rabbit. Behavioral and Neural Biology, 45(3), 275-286. Prudom, A.E., & Klemm, W.R. (1973). Elec¬ trographic correlates of sleep behavior in a primitive mammal, the Armadillo Dasypus novemcinctus. Physiology & Behavior, 10,
275-282. Reite, M. L., Rhodes, J. M., Kavan, E., & Adey, W.R. (1965). Normal sleep patterns in Ma¬ caque monkey. Archives of Neurology, 12, 133-144. Reite, M., & Short, R. (1985). Behavior and physiology in young bonnet monkeys. Developmental
Psychobiology,
19(6),
567-579. Reite, M., Stynes, A.J., Vaughn, L., Pauley, J. D., & Short, R.A. (1976). Sleep in infant monkeys: Normal values and behavioral
troencephalography & Clinical Neurophys¬ iology, 19, 509-517.
Tobler, I., & Deboer, T. (2001). Sleep in the blind mole rat Spalax ehrenbergi. Sleep, 24(2), 147-154. Toutain, P. L., & Ruckebusch, Y. (1975). Arousal as a cyclic phenomenon during sleep and hibernation in the hedgehog (Erinaceus europaeus). Experientia, 31, 312-314. Ursin, R. (1968). The 2 stages of slow-wave sleep in the cat and their relation to REM sleep. Brain Research, 11, 347-356. Valatx, J.L., & Bugat, R. (1974). [Genetic fac¬ tors as determinants of the waking-sleep cycle in the mouse]. Brain Research, 69(2), 315-330. Van Twyver, H., & Allison, T. (1970). Sleep in the opossum Didelphis marsupialis. Elec¬ troencephalography and Clinical Neuro¬ physiology, 29(2), 181-189.
Van Twyver, H., & Allison, T. (1974). Sleep in the armadillo Dasypus novemcinctus at moderate and low ambient tempera¬ tures. Brain, Behavior and Evolution, 9(2), 107-120. Walker, J. M., Glotzbach, S.F., Berger, R.J., & Heller, H.C. (1977). Sleep and hiber¬ nation in ground squirrels (Citellus spp):
Appendix: Additional Resources on Sleep
Electrophysiological observations. Ameri¬ can Journal of Physiology—Regulatory, Integrative and Comparative Physiology, 233(5), R213-R221.
Wauquier, A., Verheyen, J. L., van den Broeck, W. A., & Janssen, P. A. (1979). Visual and computer-based analysis of 24 h sleep¬ waking patterns in the dog. Electroenceph¬ alography and Clinical Neurophysiology,
46(1), 33^18. Weitzman, E. D., Kripke, D.F., Pollack, C., & Domingues, J. (1965). Cyclic activity in sleep of Macaca mulatto. Archives of Neu¬ rology, 12, 463-467. Zepelin, H. (1989). Mammalian sleep. In M. H. Kryger, T. Roth, & W. C. Dement (Eds.), Principles and practices of sleep medicine
(pp. 81-92). Philadelphia: Saunders.
Mammal Papers with Duration of Stages 3 and 4 of NREM or SlowWave Activity Adams, P., & Barratt, E. (1974). Nocturnal sleep in squirrel monkeys. Electroencepha¬ lography & Clinical Neurophysiology, 36,
201-204. Balzamo, E. (1973). Etude des etats de vigi¬ lance chez Papio cynocephalus adulte. C R Seances Soc Biol, 167, 1168-1172. Balzamo, E., & Bert, J. (1975). Sleep in Papio anubis: Its organization and lateral genicu¬ late spikes [Abstract], Sleep Research, 4, 138. Balzamo, E., Bradley, R. J., & Rhodes, J.M. (1972). Sleep ontogeny in the chimpan¬ zee: From two months to forty-one months. Electroencephalography and Clinical Neu¬ rophysiology, 33, 47-60.
Balzamo, E., Vuillon-Cacciuttolo, G., & Bert, J. (1978). Cercopithecus aethiops: EEG et organization des etats de vigiliance. Wake Sleep, 2, 223^230.
Balzamo, E., Vuillon-Cacciuttolo, G., Petter, J., & Bert, J. (1978). Etats de vigiliance chez
|
deux Lemuridae: Rhythmes EEG et organi¬ zation obtenus par telemesure. Wake Sleep, 2, 237-245. Batini, C., Radulovacki, M., Kado, R.T., & Adey, W. R. (1967). Effect of interhemispheric transection on the EEG patterns in sleep and wakefulness in monkeys. Electro¬ encephalography and Clinical Neurophysi¬ ology, 22, 101-112.
Berger, R.J., & Walker, J.M. (1972). A poly¬ graphic study of sleep in the tree shrew (Tupaia glis). Brain, Behavior and Evolution, 5(1), 54-69. Bert, J. (1970). Adaptation du sommeil aux conditions experimentales d’enregistrement chez deux Cercopithecinae (Papio papio et Macaca radiata). Proceeding of the 3rd Inter¬ national Congress in Primatology, 2, 49-53. Bert, J. (1973). Similitudes et differences du sommeil chez deux babouins, Papio hamadryas et Papio papio. Electroencephalogra¬ phy and Clinical Neurophysiology, 35(2),
209-212. Bert, J., Balzamo, E., Chase, M., & Pegram, V. (1975). The sleep of the baboon, Papio papio, under natural conditions and in the laboratory. Electroencephalography and Clinical Neurophysiology, 39, 657-662. Bert, J., Collomb, H., & Martino, A. (1967). L’electroencephalogramme du sommeil d’un prosimien. Sa place dans l’organisation du sommeil chez les primates. Electroen¬ cephalography and Clinical Neurophysiol¬ ogy, 23, 342-350.
Bert, J., Kripke, D.F., & Rhodes, J. (1970). Elec¬ troencephalogram of the mature chimpanzee: Twenty-four hour recordings. Electroen¬ cephalography and Clinical Neurophysiol¬ ogy, 28, 32—40.
Bert, J., & Pegram, V. (1969). L’electroencep¬ halogramme du sommeil chez les Cercopith¬ ecinae: Erythrocebus patas et Cerpothiecus aethiops
sabaeus.
Folia
Primatol,
11,
151-159. Bert, J., Pegram, V., & Balzano, E. (1972). Comparison du sommeil de deux macaques
843
844
|
Appendix: Additional Resources on Sleep
(Macaca radiata et Macaca mulatta). Folia Primal, 17, 202-208.
Bert, J., Pegram, V., Rhodes, J.M., Balzano, E. , & Naquet, R. (1970). A comparative sleep study of two cercopithecinae. Electro¬ encephalography and Clinical Neurophysi¬ ology, 28(1), 32^40.
Breton, P., Gourmelon, P., & Court, L. (1986). New findings on sleep stage organization in squirrel monkeys. Electroencephalogra¬ phy and Clinical Neurophysiology, 40(6),
563-567. Crofts, H.S., Wilson, S., Muggleton, N. G., Nutt, D.J., Scott, E.A., & Pearce, P.C. (2001). Investigation of the sleep electrocorticogram of the common marmoset (Callithrix jacchus) using radiotelemetry. Clinical Neurophysiology, 112(12), 2265-2213.
Crowley, T.J., Kripke, D. F., Halberg, F., Pe¬ gram, G. V., & Schildkraut, J. J. (1972). Cir¬ cadian rhythms of Macaca mulatta: Sleep, EEG, body and eye movement, and temper¬ ature. Primates, 13, 149-168. Freemon, F. R., McNew, J.J., & Adey, W.R. (1971). Chimpanzee sleep stages. Electro¬ encephalography and Clinical Neurophysi¬ ology, 31, 485-489.
Galvao de Moura Filho, A.G., Huggins, S.E., & Fines, S.G. (1983). Sleep and waking in the three-toed sloth, Bradypus tridactylus. Comparative Biochemistry and Physiology Part A: Molecular & Integrative Physiol¬ ogy, 76(2), 345-355.
Hunter, J.D., & Milson, W.K. (1998). Corti¬ cal activation states in sleep and anesthesia. I: Cardio-respiratory effects. Respiratory Physiology, 772(1), 71-81. Immelman, K., & Gebbing, H. (1962). Schlaf bei Giraffiden. Z Tierpsychol, 19, 84-92. Kaemingk, K., & Reite, M. (1987). Social environment and nocturnal sleep: Stud¬ ies in peer-reared monkeys. Sleep, 10, 542-550. Karmanova, I. G., Maksimuk, F. M., Murav’ eva, F. N., Pastukhov, Y.F., & Sazonov, V.S. (1979). [Specific features of the cycle “wakefulness-sleep” in the arctic lemming
Dicrostonyx torquats] (in Russian). Zh Evol Biokim Fiziol, 15, 190-195. Feinonen, F., & Stenberg, D. (1986). Sleep in Macaca arctoides and the effects of prazosin. Physiology & Behavior, 37(2), 199-202. Fyamin, O.I., & Chetyrbok, I. S. (1992). Uni¬ lateral EEG activation during sleep in the Cape fur seal, Arctocephalus pusillus. Neu¬ roscience Letters, 143(1-2), 263-266. Fyamin, O. I., Mukhametov, F. M., Chetyrbok, I.S., & Vassiliev, A.V. (1994). Sleep and wakefulness in southern sea lions (Otari byronia). Journal of Sleep Research, 3(Suppl. 1), 152. Fyamin, O. I., Mukhametov, F. M., Chetyrbok, I.S., & Vassiliev, A.V. (2002). Sleep and wakefulness in the southern sea lion. Behav¬ ioural Brain Research, 128, 129-138. Fyamin, O.I., Oleksenko, A. I., & Sevostiyanov, V.F. (2000). Behavioral sleep in captive sea otters. Aquatic Mammals, 26, 132-136. McNew, J.J., Howe, R.C., & Adey, W.R. (1971). The sleep cycle and subcorticalcortical EEG relations to the unrestrained chimpanzee. Electroencephalography and Clinical Neurophysiology, 30(6), 489-503. Miller, V.M., & South, F.E. (1981). Entry into hibernation in M. flaviventris: Sleep and behavioral thermoregulation. Physiology & Behavior, 27(6), 989-993. Mukhametov, F.M., Fyamin, O.I., & Polyakova, I.G. (1985). Interhemispheric asynchrony of the sleep EEG in northern fur seals. Experientia, 47(8), 1034—1035. Mukhametov, L. M., Supin, A. Y., & Polyakova, I.G. (1977). Interhemispheric asymmetry of the electroencephalographic sleep pat¬ terns in dolphins. Brain Research, 134(3), 581-584. Nicol, S.C., Andersen, N.A., Phillips, N.H., & Berger, R.J. (2000). The echidna manifests typical characteristics of rapid eye movement sleep. Neuroscience Letters, 283(1), 49-52. Nishino, S., Riehl, J., Hong, J., Kwan, M., Reid, M., & Mignot, E. (2000). Is narcolepsy a REM sleep disorder? Analysis of sleep
Appendix: Additional Resources on Sleep
abnormalities in narcoleptic dobermans. Neuroscience Research, 38, 437-446. Palchykova, S., Deboer, T., & Tobler, I. (2002). Selective sleep deprivation after daily torpor in the Djungarian hamster. Journal of Sleep Research, 11, 313-319. Pivik, R.T., Bylsma, F.W., & Cooper, P. (1986). Sleep-wakefulness rhythms in the rabbit. Behavioral and Neural Biology, 45(3), 275-286. Reite, M. L., Rhodes, J. M., Kavan, E., & Adey, W. R. (1965). Normal sleep patterns in Ma¬ caque monkey. Archives of Neurology, 12, 133-144. Reite, M., Stynes, A.J., Vaughn, L., Pauley, J. D., & Short, R.A. (1976). Sleep in in¬ fant monkeys: Normal values and behav¬ ioral correlates. Physiology & Behavior, 16, 245-251. Robinson, E. L., Hsieh, J. K., & Fuller, C.A. (2003). A primate model of sleep regulation [Abstract], Sleep, 2 The Bible and dreams: Church dream groups, 123-24; Luther and Calvin, 78-80; Middle Ages and dreams, 423; poetry and dreams, 508; stories about dreams, 123; theater and dreams, 739
Index
Bidart, Frank, 510
Born, J., 791
The Big Dream Interpretation Book (Taf-
Bosnak, Robert, 244, 393
seer Al-ahlam Al-kabir) (Ibn Sirin), 75
Big dreams, 81-82, 344, 374, 378, 390, 392-93. See also Little dreams Bion, Wilfred, 314
|
Botz-Borstein, 197 Boulware, L. E., 201 Boundary Questionnaire, 133 Boys: animal figures in dreams, 37;
Birds: NREM sleep patterns, 498
dream content compared with girls, 14,
Bird sleep studies, 153, 154, 169-71,
115; themes of dreams, 115
260-61
Brain, sleep, and dreams: adult new nerve
Bird songs, and sleep, 596-97
cell generation, 627-29; basis of dream
Bishop, Bridget, 353
consciousness, 159-60; and basis of
Bizarre imagery and thought in sleep and
dream consciousness, 159-60; blind¬
waking (IT), 82-84 Bizarreness of dreams, for video game players, 795, 798
ness effects on sleep and dreams, 239; and blindness effects on sleep and dreams, 239; circadian rhythmicity,
Black Dog (De Vere), 39-40
131-32; and circadian rhythmicity,
Blagrove, M., 233, 234
131-32; colors in dreams, 144-45; and
Blake, H„ 154, 209
colors in dreams, 144-45; and comics
Blake, William, 182, 196, 390
reading, 311; default mode network,
Bless me, Ultima (Anaya), 391
598-602; and detailed focal vision,
Blindness, effects on dream content of
615-17; disconnection from external
deafness and, 238-40
environment during dreaming, 206-7;
Bly, Robert, 509-10
dream-lag/day-residue effects, 228;
BMI (body mass index): and sleep dura¬
fetal development and yawning, 282;
tion studies, 619-20, 631; and sleepi¬
and handedness, 320-22; hypnago¬
ness in teens, 644. See also Obesity,
gic dream state, 328; and hypnagogic
and sleep
dream state, 328; illusory content in
Body dreamwork, 84-89; dream story/
dreams, 342-43; and illusory content
continuation, 89; new energy require¬
in dreams, 342-43; neuropsychology
ments, 86; obtaining help from the
of lost dream recall, 458; noninvasive
dream, 86-87; sources of questions,
research techniques, 790; olfactory
86; working with dream characters,
stimuli and dreams, 471-73; PGO cor¬
87-88
tical spikes of REM sleep, 83; poste¬
Bokert, E., 66
rior cingulate cortex, 294, 452, 559,
Book of the Duchess (Chaucer), 508
598-99; prefrontal cortex in dream¬
Boot, W. R„ 795
ing, 91-92, 446-47, 513-17; regula¬
Borbeley, Alexander, 154
tion of sleep, 45; research of Antrobus,
Borderline personality disorder (BPD),
52; role of subcortical structures in
607, 693
dreaming, 562-63; and SWS genera¬
Borg, Isak, 128
tion, 212-13; yawning mechanisms,
Borges, Jorge Luis, 279, 390
809-10. See also Acetylcholine;
873
874
|
Index
EEG measures; Neural metaphor and
Brink, T. L., 284
dreams; Neuroanatomical correlates
Brinton, Howard, 528
of dream censorship; Neuroanatomi¬
Bronte, Emily, 390
cal correlates of dreamwork; Neuro¬
Broughton, James, 130
anatomy of REM sleep and depression;
Brown, Michael, 191
Neurobiology of psychoanalysis in
Brunt, L„ 188-89
wake and REM sleep; NREM (non¬
Bruvel, Gil, 182
rapid eye movement) sleep; Phasic
Buchignani, C., 164
ponto-geniculo-occipital/pontine wave;
Buddhism: Buddhist-oriented dreams,
REM (rapid eye movement) sleep;
801; dream groups, 123-24
Sleep, dreams, and personality; Sleep
Bunuel, Luis, 129, 130, 197
and the generation of new nerve cells
Burne-Jones, Edward, 182
in the adult brain
Burton, Tim, 39
Brain correlates to lucidity, 90-92, 398
Burwell, C. S„ 101
Brain damage, effects on dreams, 93-95 Brain energy, metabolism, and sleep, 95-97 Brain imaging techniques: as comple¬
Caffeine: and adolescent consumption, 660; benefits and use of, 11; and de¬ creased sleep, 96; and sleep interfer¬
mentary assessment method, 72; de¬
ence, 347; and university students
velopment of, 8; for lucid dreaming
usage, 695; vs. prophylactic naps, 10
assessment, 91; by positron emission
Calder, Alexander, 197
tomography (PET), 96. See also Com¬
Callen, F„ 234
puted tomography; Functional mag¬
Calvin, John, 78-80; attitude towards
netic resonance imaging; Functional
dreams, 79-80; theological points of,
neuroimaging during human sleep;
79-80. See also The Bible and dreams
Positron emission tomography; Single¬
Cancer patients and dreamwork, 105-9;
photon emission computed tomography
dream reentry technique, 107-8; ef¬
Brain-injured patients (BIPs), 670-71
fects of healing dreams, 108-9; goals/
Brain mechanisms of vision in dreams,
projective approach, 107; healing
97-99
dreams, 106-7; healing imagery, 107,
Brain networks and sleep, 597-602
325; integrative approach, 105-6; out¬
Brain tumors, 667, 669
comes, 108; and Qi Gong, 105; use of
Brakhage, Stan, 125, 130
guided imagery CDs, 107-8
Brandt, Bill, 494 Brazilian dream reports, 186, 348
The Canterbury Tales (Chaucer), 391,
424
Brazilian studies, 348
Cardiometabolic risk, and sleep, 602-3
Breastfeeding (effects on infant sleep),
Cardiometabolic risk and sleep, 602-3
174-78, 354-55 Brenneis, C. B., 806
Cardiorespiratory polysomnography, 71-72
Brilmayer, H., 209
Cardiovascular disease (CVD), 201; and
Brine, Katherine, 96
depression, 201; and effects of work
Index
|
on sleep, 241; inflammation, and sleep,
nightmare analysis, 462; self-
683-85; and napping relationship, 434;
assessment tools of Circadian typology,
and OS A, 167-68; and sleep apnea,
572-73; sleep and nap patterns, 46;
529, 638, 684-85; and sleep defi¬
television viewing, 411
ciencies, 602-3. See also Metabolic syndrome
Children’s dreams and nightmares, 114-19; common themes, 115-16;
Carroll, Lewis, 279
dream development, 134; Dream¬
Carroll, Noel, 126
ing publication, 226; effect of divorce
Carta, Stefano, 431
on, 116-17; and illusory contents in
Cash, Johnny, 431
dreams, 343-44; imaginary rescript¬
Casto Spirituality Scoring System, 187
ing method, 118; night terrors, 117;
The Catalogue of Phenomenon of
posttraumatic nightmares, 117-18; and
Dreams, as Connecting Sleeping and
Sigmund Freud’s work, 291; studies of
Waking (Shelley, P. B.), 183
dreams, 139
Caton, R., 100
Children with cancer and sleep, 666-69
Cats: and brain lesions, 101; dream con¬
China: dream beliefs, 55; hallucinations
tent studies, 213; in metabolic tests,
in sleep paralysis, 64; polyphasic sleep
96; phasic twitching, 170; REM sleep
culture in, 189
research on, 209; in subject’s dreams,
Chinese sex symbols in dreams, 119-21
37-38
Chouinard, S., 607
Cats, research on REM sleep, 209
Christianity/Christian Church: dream
The Cat with Hands (Morgan), 40
groups, 123-24; and erotic dreams,
Cayce, Edgar, 350
352; European art representations, 801;
Cell phone use: adolescents and sleep,
Luther, Calvin, the Bible and dreams,
12-13; and sleep, 411-12 Central image (Cl) of the dream, 109-10, 161-62 Central sleep apnea (CSA), 636, 649 Chaos in dreams, self-organization from, 577-78 Characters in dreams, 110-13
78-80 Christman, S. D., 321, 322 A Christmas Carol, 128
Chronic kidney disease and sleep disor¬ ders, 201-2, 528-30, 647-48 Chronic renal failure, insomnia in, 357-58
Chaucer, Geoffrey, 391, 508
Chronotype, 121-22, 573
Chenier, V., 322
Church dream groups, 123-24
Cheyne, Allan, 367
Cinema and dreams, 124-31; dream-film
Child, Charles, 185
analogy theory, 125-26; dream inter¬
Children and sleep: ADHD and dreaming,
pretation plots, 130; dream journey
62-63; and bedtime, 15-16; cell phone
plots, 128-29; film as dream represen¬
use, 411-12; and co-sleeping, 174-78;
tations, 124-25; horror and nightmare
importance oj7 sleep health for, 346-47;
plots, 129-30; metaphysical fantasy
melatonin therapy for sleep disor¬
plots, 129; surrealist films, 130. See
ders, 416-18; napping frequency, 434;
also individual films
875
876
|
Index
Circadian rhythms, 131-32; actigraphic measurements, 4; in adolescent sleep cycles, 15, 642-43, 660-61; and chro-
Cohen, D. B., 321, 322 Coleridge, Samuel Taylor, and dreaming, 142-43, 390, 509
notype, 121; in consciousness disorders,
College students and sleep, 805
670; and dream-lag effect, 228; and
Color in dreams, 144-45, 164-65, 370
gene modification, 303; and hibernators,
Color psychology studies, 144
635; in honeybees, 672; and hormonal
Colvin, Shawn, 431
secretions, 624-25; influence of mela¬
Comics and dreams, 146-47
tonin, 5; and mouse studies, 306-7; and
The Committee of Sleep: How Artists, Sci¬
napping, 434, 436; PSG measurements,
entists, and Athletes Use Dreams for
72; role in sleepiness, 10; and shift work
Creative Problem-Solving-and How
effects on, 621-22; and short sleep,
You Can Too (Barrett), 802
589; and university students, 695-96; and work schedule effect on, 241; and yawning, 809. See also Self-assessment
Comorbidity between epilepsy and sleep disorders, 147-49 Comparative sleep databases, 149-52;
tools of Circadian typology in children,
data obtained in laboratories vs. in the
adolescents, and adults
wild, 151-52; data quality, 150-51; of
Circadian rhythm sleep disorders (CRSD), 417-18, 696
dream colors, 145; of dream journaling, 373, 375; historical development, 50;
“The Circular Ruins” (short story), 279
phylogeny of sleep database, 504-6;
Cirelli, C., 307
sleep expression comparative statistical
Cl score sheet, 109-10
analysis, 152-53; sleep quotas, 149-50
City of Women (film), 128
Comparative sleep regulation, 153-54
Clairvoyance, 256-57
Complaints, increasing sleep, 347-49
Clark, J„ 322
Computed tomography (CT), 258
Classifications of dreams, 195-95
Conceptions of dreaming in the Western
Climatic factors of sleep, 45-46
Desert of Australia, 155-56
Clinical aspects of nightmares, 132-33
Confessions (Augustine), 423
Cockburn, Bruce, 431
Confusional arousals, 481
Cocteau, Jean, 131
Connection between dreams and mood,
Cognitive approach to dreaming, 133-35, 364
156-58
Cognitive-behavior therapy (CBT): imag¬
Consciousness disorders and sleep, 670-71
ery-rehearsal treatment, 133, 216, 401;
Consciousness in dreams, 159-60,
for nightmares and insomnia, 217, 401; for reducing cognitive hyperarousal,
781-82
655; for reducing depression, 706;
Consistent right-handedness (CRH), 320-22
using dreams in, 793-94
Contemporary theory of dreaming,
Cognitive expertise and dreams, 135-38 Cognitive theory of dream meaning, 139-41
161-62 Content analysis of dreams: basic princi¬ ples, 162-63
Index
Continuity hypothesis and colors in dreams, 164-65 Continuity hypothesis of dreaming, 156-57,165-67, 199, 302 Convergent evolution of REM sleep in mammals and birds, 169-71 Cortical EEG oscillations, local sleep, and dream recall, 172-73 Corticotropin-releasing hormone CRH, 330-33 Cortisol, 249-51, 330-34, 337, 339,
|
Crick, Francis, 299, 561-62 Crime and Punishment (Dostoevsky),
390 Crispe, Thomas, 527 Critically ill patients and REM (rapid eye movement) sleep, 533-36 Cross-cultural approaches to dreams, 186-88 CST. See Costly signaling theory (CST) Cultural dimensions of sleep, 188-89 Cultural diversity and dreaming, 190-92
455, 469, 578.625-26, 631, 651, 669;
Culture and sleep, 604-5
and diabetes, 631; in endocrinology
Cushing’s disease, 333
of sleep, 249-51, 625-26; and growth
CVD. See Cardiovascular disease (CVD)
hormone releasing hormone, 337, 339;
Cytokines, 201, 594-95, 684, 699
and HPA system, 330-34; and PTSD, 651; and sleep loss/fragmentation, 469 Co-sleeping, 47-48, 174-78; cultural
Dali, Salvador, 130, 182, 197, 235, 328 Damasio, Antonio, 579-80
differences, 175, 177-78, 189, 605;
Dangarembga, Tsitsi, 391
mother-infant sleep proximity, 174; re¬
Daniel (Old Testament), 79
lationship with breastfeeding, 174-78;
Daniel (Old Testament), 79
and risk factors, 177-78; vs. solitary
Darwin, Erasmus, 143
sleeping infants, 175
Databases of comparative sleep, 149-52
Costly signaling theory (CST), 178-81;
Davis, F. C., 280
and emotions, 180; examples in ani¬
Davis, Lucy, 182
mals, 179-80; relationship to dreams,
Dayak people, 190
180-81 Counterfactuals in dreams (imaginative scenarios), 181-82 Coxhead, David, 801 CPAP (continuous positive airway pres¬
A Daydream (poem), 143
Daydreaming, 13, 143, 159, 161,746-47 Day-residue effect, 227-28 Daytime sleepiness. See Excessive day¬ time sleepiness (EDS)
sure) treatment: adherence challenges,
Dead of Night (film), 128
168-69; advances in technology, 169;
Deafness, effects on dream content of
and Alzheimer’s disease, 168; and heart
blindness and, 238-40
failure patients with OS A, 636; for
Death themes in dreams, 199
hypertension and cardiac conditions,
DeCicco, T., 341
167-68; for OSA, 148, 167-69,469
Declarative memory: and dream recall,
Creative problem solving in dreams, 182-85 Creativity: art therapy and dreams, 52-54; dreams as inspiration for, 235
173; neurofeedback effects on, 457; and spindles, 293; in transcranial direct current stimulation studies, 791. See also Sleep, memory, and dreams
877
878
|
Index
De Continentia (On Continence) (Augus¬
tine), 423
Developmental psychology research, 13 Development and initial validation of
“Deep Image” poets, 509
Iowa Sleep Disturbances Inventory
Default mode network (DMN), 598-602
(ISDI), 204-5
De Gennaro, L., 26, 321
De Vere, Alison, 39-40
De Koninck, J., 607
Devereux, G., 190
Delaney, G., 350
The Devil in dreams, 353
Delaney, Gayle, 350, 393
Diabetes: and alexithymia, 29; and
Delayed sleep-phase syndrome (DSPS), 132, 693,696
chronic kidney disease, 529; and chronic renal failure, 358; and napping,
Delirium tremens, 212
434; and OSA, 468-70; and risks from
Delta (stage 4) sleep, 203
short sleep, 590; and sleep shortages,
Deluge, Yves, 275 Delusions and the classification of typical dreams, 194-95 De Manaceine, M., 208-9
45 Diabetes and obstructive sleep apnea, 468-69 Diagnostic and Statistical Manual of
Dement, W„ 209, 297-98, 656
Mental Disorders: assessment of de¬
Dement, W., 83, 100
pression, 202; classification system
Dement, William, 185
comparison, 524; illustration of grandi¬
Dementia with Lewy bodies, 101
ose delusions, 194; nightmare disorder
Demographic factors of sleep, 45-46
inclusion, 248, 463; nightmares inclu¬
Demon dreams, 403
sion, 401, 650; psychiatric disorders,
Demonic dream dictionary (Ancient
definition, 606; PTSD inclusion, 606;
Egypt), 34 Depictions of dreams, 195-98 Depression: and alexithymia, 26-28; as
seasonal affective disorder description, 570 Diagnostic and Statistical Manual of
cause of sleep shortages, 45; connec¬
Mental Disorders (DSM), 194, 202,
tion to dream imagery, 157; in dream
248
analysis, 162; and dreaming, 199-200;
Dickens, Charles, 128
in patients with kidney disease, 201-2;
Diet: in Bedouin tradition, 73-74; Kel¬
and reduced dream recall, 199-200.
logg’s dream recommendations, 375
See also Major depressive disorder
Disconnection from the external environ¬
Deprivation of sleep: for long periods, 45
ment during dreaming, 206-7
Depth of sleep, 202-4
Discovery of REM sleep, 208-9
Derbyshire, A. J., 209
The Discreet Charm of the Bourgeoisie
Deren, Maya, 125, 130, 197, 198 De Saint Denys, Hervey, 208 De Santo, R. M., 29
(film), 129 Disguise-censorship paradigm (Freud), 9, 445-46
A Descent into the Maelstrom (Poe), 278
Distinctive dream content associated with
Detailed focal vision, sleep and evolution
REM sleep behavior disorder (RBD),
of, 615-17
213-15
Index
|
Disturbed sleep and posttraumatic stress disorder (PTSD), 215-17
Dream-film analogy (academic film the¬
Divination During Sleep (Aristotle), 613
Dream groups: leadership of, 387-89;
ory), 126
Divorce and children’s dreams, 116-17
safety factors, 565-66; in varying reli¬
Dizygotic (MZ) twins, 303
gions, 123-24
Djonlagic, Ina, 185 DMN (default mode network). See Brain networks and sleep
Dream imagery, 134, 218; ancient Greek, 32; cancer patient dream work, 105-8; healing using, 108; and mood, 157-58;
Doll, E„ 163
pain-dream connection in endometrio¬
Domhoff, Bill, 393-94
sis patients, 255-56; usage in dream art
Don Quixote (Cervantes), 390
therapy, 54
Doucet, Julie, 147 Dr. Jekyll and Mr. Hyde (Stevenson),
362
The Dream in Clinical Practice (ed. Nat-
terson), 524 Dream incubation: Islamic dream incuba¬
Draper, P., 266
tion, 370-71; school of metaphysics
“Dream, Caused by the Flight of a Bum¬
approaches to, 566-69
blebee around a Pomegranate a Second
Dreaming, functional theories of, 297-99;
Before Awakening” (painting) (Dali),
an alternative theory, 299; critique of
197
evidence in favor of dream function,
A Dream (poem), 196
298; evidence against the dream-func¬
“The Dream Approaches” (painting)
tion hypothesis, 298-99; philosophical
(Dali), 182 Dream art therapy, 54 “Dreamatarian Diet,” 375 DreamBank.net: an online archive for studying dream content, 141, 223-25, 727 Dream cachet (protection amulet), 75 Dream censorship, neuroanatomical cor¬ relates of, 445-47 Dream characters, 110-13; gender differ¬
issues, 297-98 Dreaming: The Journal of the Association
for the Study of Dreams, 226, 360 Dreaming and sleep disorders, 645-46 Dream interpretation, and meaning of dreams, 407-8 Dream interview: a client-defined, meta¬ phor-based interpretation, 217-19 Dream Interview Method (Delaney), 393 Dream journaling, 105,373-77
ences, 301; gender distribution of, 115,
Dream journals, 141, 223-24, 257
491; and handedness, 322; and phi¬
Dream-lag effect, 227-28
losophy of mind, 490-93; use in child
Dream narratives, structural analysis of,
therapy, 118
744-45
Dream consciousness, 159-60
Dream News (e-newsletter of IASD), 360
Dream-content analysis, 8-9, 223-25,
“Dream of a Girl Chased by a Nightin¬
301 Dream content analysis: basic principles, 162-63 “The Dream” (painting) (Dali), 182
gale” (painting) (Ernst), 182 Dream of Scipio (Cicero), 508 Dream of the Rarebit Fiend (comic strip),
127, 146
879
880
|
Index
Dream of the Red Chamber (China), 390 Dream phenomenology, 135 Dream recall, 537-38; age and frequency
Dream sharing as social interaction,
219-22 DreamShift process, 362-63
of, 21-22; in alexithymia, 26; in Bed¬
Dreamside (Joyce), 279
ouin culture, 74; and brain damaged
Dreams of the Rarebit Fiend serial news¬
patients, 94-95; in children, 62, 115;
paper comic, 146
and cognitive approach to dreaming,
“Dreams of Venus” (painting) (Dali), 197
134-35, 137; cortical EEG oscillations,
Dreams That Money Can Buy (film), 197
local sleep, and, 172-73; declines in
Dream Telepathy (Ullman, Krippner, &
elderly, 638; and depression, 199-200; effects of medication, 237; frequency discrepancies, 298, 421, 512, 521;
Vaughan), 257 Dream theory (Jung), 314, 324, 341, 361, 377-78,380-81
gender differences, 301; and handed¬
Dream Threat Scale, 18
ness, 320-22, 320-22; and local sleep,
Dream Time (magazine of IASD), 360
172-73; memory challenges, 94; neu¬
DreamTime periodical, 803
rophysiology of lost dream recall,
Dreamtoons graphic novel (Reklaw), 311,
457-59; predictors of, 419; and sleep
314
disorders, 645-46; value of, 299; and
Dreamt songs, 2
waking life effects, 235
“A Dream within a Dream” (poem), 278
Dream reporting, 133, 135, 162-63, 186-88, 219, 223-24; and cognitive
Dreamwork in counseling, 229-30, 308-10, 325-27
approach to dreaming, 133, 135; and
Dreamworks periodical, 803
content analysis of dreams, 162-63;
Driving and sleepiness, 721-23
cross cultural approaches, 186-88;
Drosophila (fruit fly) studies, 154, 306,
DreamBank.net, 223-24 Dream Research Program, 239 “The Dream” (painting) (Rousseau), 197
672-74 DSM. See Diagnostic and Statistical Manual of Mental Disorders (DSM)
Dreams (film), 197
Duchamp, Marcel, 197
Dreams, logical structure of, and their re¬
Duration of sleep and mortality, 460-61
lation to reality, 394-96
Durer, Albrecht, 182
Dreams, memory, and sleep, 687-91
Duval, M„ 209
Dreams: Visions of the Night (Coxhead
Dynamic structure of reptilian EEG ver¬
and Hiller), 801 Dreams 1900-2000: Science, Art, and the Unconscious Mind (Gamwell), 197
sus mammalian sleep EEG, 231 Dysfunctional Beliefs and Attitudes about Sleep questionnaire, 712
Dreams as inspiration for artists, 182-85 DreamSat (software), 141, 318
Eberwein, Robert, 126
Dreamscape (film), 129
Ecology of sleep, 45-46
Dream self, 110-13
Ecstasy (MDMA) use and sleep prob¬
Dream series collections (of Domhoff, Hall, Van de Castle), 393-94
lems, 233-34 The Edge of Dreaming (film), 325
Index Edison, Thomas, 362
Embodied imagination (El), 244-46
EEG (electroencephalography) measures:
Emecheta, Buchi, 391
and adolescent brain development,
|
EMF. See Electromagnetic fields of mo¬
15-16, 657-58; and alcohol use, 23;
bile telephones and sleep parameters
basics of sleep recordings, 69-71; in
EMG (electromyography) measures: ab¬
bird sleep studies, 170-71; and bizarre
normalities/increases with RBD, 214,
imagery and though, 82-83; cortical
216; cardiorespiratory polysomnogra¬
oscillations, local sleep, and dream re¬
phy, 71-72; common artifacts, 72
call, 172-73; delta activity measure¬
Emotionally intense dreams, 25-26
ments, 96; and depth of sleep, 203;
Emotions Questionnaire Selections, 735
and disconnection from external en¬
Endocrine system and sleep, 624-27
vironment during dreaming, 206-7;
Endocrinology of sleep, 249-54; galanin,
dynamic structure of reptilian versus
251; gonadal hormones, 252; hypocre-
mammalian sleep EEG, 231; and Ec¬
tins/orexins, 251-52; hypothalamo-
stasy users, 233; features of NREM
pituitary-thyroid system, 250-51;
sleep, 100, 153-54; and HPA system,
neuroactive steroids, 252, 254; Prolac¬
331-34; low-voltage activity, 193, 206,
tin, vasoactive intestinale polypeptide,
208-9; in mammalian sleep cycle stud¬
249-50
ies, 150-51; and mouse studies, 307;
Endometriosis and dreams, 255-56
and neuroimaging research, 293, 598;
End-stage renal disease (ESRD), 201-2,
polysomnography (sleep EEG), 249;
528-29
in REM research on cats, 209; reptil¬
Energy level assessment, 95-97
ian versus mammalian sleep EEG, 231;
Engelhardt, H., 62
role in discovery of REM sleep, 208-9;
English Romanticism, 142
seep and brain networks, 597-602;
EOG (electrooculogram) measures,
slow-wave activity in NREM sleep,
69-72,71,98,212
153-54; spindles, 253-54, 456-57,
The Epic of Gilgamesh, 278
657, 689, 713-14. See also Neuroana-
Epilepsy: CPAP treatment for, 148; noc¬
tomical correlates of dream censorship;
turnal frontal lobe type, 147-48; and
Neuroanatomical correlates of dream-
obstructive sleep apnea (OSA) corre¬
work; Neuroanatomy of dreams; Neu¬
lation, 147-48; seizures, 147-48; and
rofeedback for sleep problems
sleep disorders, 147-49
“The Effect of Dream Deprivation” (ar¬ ticle), 297-98 Egypt. See Ancient Egypt dream beliefs 8V2
(film), 128, 196
Episodic memory, 95 Erections (penile): and flying dreams, 284; and REM sleep, 151, 208-9, 284 Ermacora, G., 479
Elderly persons: REM sleep, vs. adoles¬
Ernst, Max, 182, 197
cents, 21 Electromagnetic fields of mobile tele¬
Ernst: Pieta or Revolution by Night
phones and sleep parameters, 243-44 Elias, M. F., 176
(Gee), 801 ESP (extrasensory perception) in dreams,
256-58, 277
881
882
|
Index
ESRD. See End-stage renal disease
Female genitals in dreams (China), 120
Eternal Sunshine of the Spotless Mind
Fetal sleep, 279-81
(film), 129 Evolutionary approaches to sleep,
Fetal yawning, 281-83 Fine, G„ 219-20
262-67; attachment theory, 266-67;
Finland sleep surveys, 348
behavioral ecology and life history,
Fireworks (film), 130
262- 63; parent-offspring conflict,
Fisher, C., 656
265-66; pregnancy and genetic con¬
Fisher, Farry, 191
flict, 264-65; sex-ratio determination,
Five Fectures on Psycho-Analysis
263- 64; sleep as a scarce resource, 263 Evolutionary psychology theories of
(Freud), 292-93 The 5000 Fingers of Dr. T. (film), 128
dreams: costly signaling theory, 268;
Flanagan, Owen, 299
dreaming as psychotherapy, 268; sen¬
Fleming, Victor, 197
tinel theory, 267; simulation theories,
“Flight through the Tunnel” (painting)
268; threat-simulation theory, 268-69 Excessive daytime sleepiness (EDS), 101, 667-69, 679
(Bosch), 196 Flying dreams, 283-85 Flying in dreams: the power of the image,
Existential dreams, 269-71, 345
285-88; air-robics: the phenomenon of
Experimental dream psychology, 133
dream flying, 285-86; intention flying
Extended overgeneral memories, 473
and guided imaging, 287, 289; styles of
External sensory stimulation as a tech¬
dream flying, 287
nique to study dreaming, 271-74; PGO
fMRI (functional magnetic resonance
wave and dream theories, 271-72;
imaging): alexithymia and dreams,
PGO waves, eye movements, and ex¬
97; and comic book readers, 311; and
ternal stimuli, 273-74; problems of
neuroimaging research, 293, 598; and
testing a PGO model, 272
sleep spindles, 714; studies of REM
Eyes Wide Shut (film), 129
sleep, 162; vision in dreams studies, 97-99. See also Functional neuroimag¬
Fabiao, Solange, 182
ing during human sleep
Fairbairn, W.R.D., 579-80
Foer, Safran, 392
Faith, L., 186
Forbes, A., 209
False-awakening dreams, 403
Forced sleep, short-term, 461
False awakenings, 275-76
The Forgotten Ones (film), 197
Family unconscious in dreams, 276-78
Fomari, Franco, 288-89
Fantasy literature and dreams, 278-79 Faraday, Ann, 393
Foulkes, D., 114-15, 134, 139, 141, 289, 343, 480
Fatal familial insomnia (FFI), 212, 303
Fox, George, 527-28
Fechner, Gustav, 574
Fragmentation of sleep, 658-59; and al¬
Federn, Paul, 284
cohol intake, 23; in Alzheimer’s, 675;
Feeling and Form (Langer), 125
and arthritis, 593-94; in conscious¬
Fellini, Federico, 128, 183, 196
ness disorders, 670; in critically ill
Index
|
patients, 533-36, 697-98, 700; and
studies, 385; and lesion studies in
mild cognitive impairment, 618; in
humans animals, 789, 792; of lucid
narcolepsy, 329, 441; and nightmares,
dreaming, 90-91; measures of shar¬
464; and obesity, 468; in obstructive
ing in waking and dreaming, 97-99;
sleep apnea, 148, 303, 468-70; in older
and neurological damage, 450; of OSA
women, 638; in Parkinson’s disease,
patients, 148; and personality studies,
678-79; and suicide, 624
653; and PGO testing limitations, 272;
Fragrance and dreams. See Olfactory stimuli and dreams Frank, M. G„ 280
and prefrontal cortex studies, 515-16; sleep compared to waking studies, 513 Fuseli, Henry, 196
Frankenstein (Shelley), 183
Freeman, Arthur, 793
Gackenbach, Jayne, 226, 799
Freud, Sigmund: approach to dreams,
Gaiman, Neil, 147, 279, 311
218, 276, 291-93, 437, 447-48, 454,
Galanin, 251
574; condensation concept, 448-49;
Galen, 341, 361
disguise-censorship paradigm, 9,
Gamers. See Video game play and
445-46; distinctions of dream the¬
dreams
ory, 388; flying in dreams, 284; influ¬
Gamwell, Lynn, 197, 801
ence on art, 801; opinion of Jung, 377;
The Garden of Boccaccio (poem), 143
pre-Freud unconscious and dreams,
Garfield, Patricia, 324
787-88; sexuality in dreams, 89; tages-
Gee, Norman, 801
reste (day residue) usage, 165; talking
Geldmacher, L. L., 810
cure use of dreams, 523. See also The
Gender differences in dreams, 301-2
Interpretation of Dreams
Gendlin, Eugene, 85
From Angels to Neurones: Art and the New Science of Dreaming (Hobson and
Wohl), 801 Functional magnetic resonance imag¬
Generalized anxiety disorder (GAD), 463, 606 Genesis (Old Testament), 78-80 Gene therapy, 328-29
ing (fMRI): alexithymia and dreams,
Genetics and epigenetics of sleep, 302-4
97; and comic book readers, 311; and
Gene transfer, hypocretin in mice models
neuroimaging research, 293; studies of
of narcolepsy, 328-29 Genital symbolism in dreams (China),
REM sleep, 162; vision in dreams stud¬ ies, 97-99 Functional neuroimaging during human
119-20 Genomic imprinting, 304
sleep, 293-95; alexithymia measure¬
Gerard, R. W„ 154
ment, 25, 97; and brain-activation lev¬
Gestalt dreamwork, 308-10, 326
els of REM sleep, 181, 453, 454-55;
GH (growth hormone), 249, 250, 330,
and discovery of REM sleep, 208; dreams, personality and, 653; and external extrasensory stimulation, 273-74; and Kleine-Levin syndrome
332, 334, 625-26 Ghost tales. See Sleep-related hallucina¬ tions and ghost tales Ghouls, in Bedouin tradition, 76
883
884
|
Index
Ghrelin, 336, 339-40, 590, 603, 625-26, 631, See also leptin GHRH (growth hormone releasing hor¬ mone), 336-38 Gibson, Ralph, 494 Gilgamesh (poem), 389, 508
Hagiography (medieval) and dreams,
415-16 Haig, D., 264-65 Hallam, F. M., 208 Hall and Van De Castle scoring system, 807
Gilliam, Terry, 39
Hallowed, A. I., 190
Ginsberg, Allen, 509
Hallschmid, M., 791
Girls: animal figures in dreams, 37;
Hallucinations: hypnagogic hallucina¬
dream content compared with boys, 14,
tions, 100, 211, 303, 351, 354, 368,
115 Globalization and culture change, 48
438-40; hypnopompic hallucinations, 132, 327, 438-40; sexual, 64, 366,
Globus, G., 480
368; in sleep paralysis, 64, 366; sleep-
Gluck, Louise, 510
related, and ghost tales, 708-11
Glucocorticoid, synthetic, 333
Hall-Van de Castle coding system for the
Godbout, R., 607
study of dream content, 140-41, 186,
The Golden Ass (Apuleius), 278
187, 214, 223, 317-19, 373-74, 491,
Gomez, E., 238
727
Gonadal hormones, 252
Hamid, Alexander, 197, 198
Gondry, Michael, 131
Handedness: effects of dream recall and
Grade point average (GPA) and sleep is¬ sues, 694
content, 320-22; sleep variables and,
716-20
Graff, Dale, 257
Hardie, Amy, 325
Grandner, M. A., 348
Harmala plant (Bedouin psychoactive
Granger causality, 207
plant), 74
Graphic novels and dreams, 310-14
Harry Potter (Rowling), 279
“The Great Red Dragon and the Woman
Hartley, David, 143, 299
Clothed with the Sun” (painting) (Blake), 196
Hartmann, Earnest, 106, 109, 161-62, 226, 322
Gregor, T., 186
Harvard University, 185
Gross, Anthony, 40
Harvey, E. N., 209
Group work with dreams, 314-16; and
Hauri, P., 200
Buddhism, 315; and Islam, 315; and
Hayano, J., 29
Judaism, 315; and Presbyterians, 315.
Head, Bessie, 391
See also Ullman method of group
Healing and dreams, 323-25
dreamwork
Healing Dreams (Barasch), 324
Growth hormone release, 617 Gujar, N., 25
The Healing Power of Dreams (Garfield),
324 Healing Power of Dreams project, 105
I Had the Craziest Dream Last Night
(Rabinowe), 53
Healing Sounds from the Malaysian Rain¬ forest (Roseman), 430
Index
Heart failure patients and sleep disorders,
648-50
Hufford, David, 351, 367 Hiillstrung, H., 209
Hecht, Ben, 130
Humanistic Movement, 308, 395
Hellenistic Greek cultures, 61
Hurovitz, C. S., 238, 239
Heller, H. C„ 96, 280
Huxster, J. K., 233, 234
Hemodialysis (HD), 29, 201, 529, 647-48
HVS (high-voltage spike), 260-61
Hemo-dialysis (HD), 201-2
Hypermotor seizures, 482
Herbed pillows of Bedouins, as sleep aid,
Hypersomnia: effects of medication
75
on, 236-37; idiopathic hypersomnia,
Herodotus, 51
520-21, 645-46; Kleine-Levin syn¬
Hibernation: and seasonal affective dis¬
drome, 385-86; and psychiatric dis¬
order, 571; and thermoregulation,
orders, 692; and seasonal affective
633-35
disorder symptoms, 570; and suicide,
Hill dream model, 325-27 Hiller, Susan, 801
623; vs. narcolepsy, 645-46 Hypersomnolence. See Idiopathic hyper¬
Hinduism, 541
somnia; Primary disorders of hyper¬
Hippocrates, 22, 323-25, 341, 350, 361,
somnolence and dreams; Recurrent
422 Historical background of sleep medicine,
101-2 History (Herodotus), 51
|
hypersomnias Hypnagogic hallucination-like ghost tales (HyH), 708 Hypnagogic hallucinations, 438-40,450;
Hitchcock, Alfred, 130, 197
and Agrypnia Excitata, 211; and hyper¬
Hobart, G. A., 209
somnolence, 520; and isolated sleep pa¬
Hobson, J. Allan, 7, 187, 269, 272, 284,
ralysis, 351, 354, 368; and narcolepsy,
656, 801 Hoffman, V. J., 365-66 Holocaust and Rwandan genocide survi¬ vors, dream accounts, 749-51 Homeostatic regulation of sleep, and sleep intensity, 121-22, 686-87 Homer, 35, 49, 278 Hoppin, Hector, 40 Horowitz, Paul, 184 Hoss, Robert, 144, 257, 309-10 HPA (hypothalamo-pituitary-adreno-
303, 441, 521; and REM sleep, 100, 553 Hypnagogic hypnosis-like ghost tales (HHy), 708, 710 Hypnagogic imagery, 100, 132, 136, 245, 303, 327-28 Hypnopompic hallucinations, 132, 327,
438-40 Hypocretin deficiency, and narcolepsy symptoms, 440-42 Hypocretin/orexins, and narcolepsy, 100,
328-29
cortical) system and sleep, 249, 250,
330-34 HPS (hypothalamo-pituitary-somatotrophic) system and sleep, 249, 330, 334,
336-40 Huang, Alan, 184
IASD Ethical Guidelines (IASD), 387
ICSD (International Classification of Sleep Disorders), 63 Idiopathic hypersomnia (IH), 520-21, 643, 645-46
885
886
|
Index
idiopathic REM Behavior Disorder (iRBD), 554-56
(RLS), 358; and suicide, 622-23; and video/computer game playing, 411. See
Iliad (Homer), 35, 49, 57, 278
also Sleep, psychiatric disorders, and
Illness and dreams, 341-42
the transdiagnostic perspective; Sleep
Illusory contents in dreams, 342-44
disorders and dreaming; Sleep-related
Imagery rehearsal therapy (IRT), 133,
mental activities in insomnia: role and
401-2, 606 Imaginary rescripting method, for chil¬ dren, 118 Imaginative scenarios (counterfactuals), 181-82 Impactful dreams, 344-45 “In a Dream” (drawing) (Kubin), 197 Inception (film), 129
Inconsistent handedness (IH), 320-22
assessment Insulin: and CPAP therapy, 168; and level variance in sleep, 626; obesity and insulin resistance, 630; and OSA, 468-69, 468-70; and short sleep, 590, 631; and sleep loss, 603 Interictal EEG epileptiform abnormalities (IEAs), 148 International Association for the Study of
Incubation of dreams, 349-50
Dreams (IASD), 359-60; cancer pa¬
Incubus/succubus, 351-54
tient dreamwork program, 105; Dream¬
In Dreams (film), 129
ing journal creation, 226; and dream
Infancy and early childhood, sleep devel¬
journaling, 374; dreamwork ethics
opment, 639-41 Infant sleep and parenting, 354-55 Infant sleep interventions, 356-57
statement, 387, 565; educational offer¬ ings, 765; origins of, 314 International Association for the Study
Inland Empire (film), 129
of Dreams (IASD), 105-9, 226, 314,
Insects and sleep, 671-74
359-60
De Insominiis (On Dreams) (Synesius of
Cyrene), 390
International Classification of Sleep Dis¬ orders: and adult nightmare content,
Insomnia: actigraphic evaluation, 4-5;
385; Kleine-Levin syndrome diagnostic
alexithymia and, 26-27; Brazilian
criteria, 385; paradoxical insomnia cri¬
study, 348; and causal medications,
teria, 655; REM sleep behavior disor¬
638; in chronic renal failure, 357-58;
der criteria, 550; on sleep paralysis, 63;
drug therapy for, 358; fatal familial in¬
sleep talking criteria, 715
somnia, 212, 303; female prevalence of, 348; genetic influences, 303; hy¬ pothyroidism association, 250; im¬
International Diabetes Foundation (IDF), 630, 632 International Statistical Classification of
mune function and, 30; influence of
Diseases and Related Health Problems
alcohol, 23-24; Iowa Sleep Distur¬
(WHO), 524
bances Inventory study, 204-5; life
Interpersonal Reactivity Index, 653
course symptoms, 47-48; medication
The Interpretation of Dreams (Freud), 17,
influence, 236-37, 414; physiological
229, 235, 291-92, 298, 377, 454, 509,
changes, 339; and psychiatric disor¬
787
ders, 692; and restless legs syndrome
Intersubjective dreams, 361
Index Intuition in dreams. See ESP (extrasen¬ sory perception) in dreams “Invasion of the Night” (painting) (Matta), 197
Joel, Billy, 183-84, 431 Johns, Jasper, 183 La Joie de Vivrer (Hoppin and Gross), 40
Jones, Ernest, 351, 367
Involuntary nature of dreams, 363-64
Jones, K. A., 233, 234
Iowa Gambling Task, 92
Joseph (Old Testament), 79
Iowa Sleep Disturbances Inventory
Journaling of dreams, 105, 373-77
(ISDI), development and initial valida¬
Jouvet, Michel, 228
tion of, 204-5
Joyce, Graham, 279
iRBD (idiopathic REM Behavior Disor¬ der), 554-56
|
Judaism: dream groups, 123-24; and the Hebrew Bible, 541; Israeli’s writings
Iroquois dream practices, 192
on dream imagery, 423; Kabbalistic
Islam and dreams, 364-66; Bedouin
dream interpretation, 423-24
dream traditions, 73-76; bizarre and
Juliet of the Spirits (film), 128
jumbled dreams subtype, 365; dream
Jung, Carl: archetypal dream symbols de¬
groups, 123-24; Ru’ya subtype,
velopment, 116, 378; distinctions of
364-65; self-talk subtype, 365; Tabir
dream theory, 388; dream journaling
dream interpretation science, 365
of, 373; dream theory, 314, 324, 341,
Islamic dream incubation (Istikhara),
361, 377-78, 380-81; on four orient¬
370-71 Isolated sleep paralysis (ISP), 366-69;
ing functions of consciousness, 145; in the function of dreams, 80; “On the Na¬
and Hmong refugees, 369; and hypo-
ture of Dreams” (essay), 81; opinion of
cretin deficiency, abnormal REM sleep,
Freud, 377; on sexuality, 89; subjective
440-42; and narcolepsy, 438-40;
dream distinction, 467; synchronicity
physical correlates, 367-68; psycho¬
definition, 375; transcendent function:
logical and co-creation, 366; role in
neurological support, 380-82; under¬
history and myth, 368-69
standing of dream images, 394. See
Isola Tiberi healing shrine, 57
also The Red Book
Israeli, Isaac, 423
Jtirgenssen, Birgit, 196
Italian Psychoanalytic Society, 288
Juvenile idiopathic arthritis (JIA), 593-94
Jackson, John Hughlings, 208
Kabbalistic dream interpretation, 423-24
James, William, 574-75
Kafka, Franz, 390
Japan: dream beliefs, 55; increased life
Kahlo, Frida, 182, 197, 235
expectancy, 460; polyphasic sleep cul¬
Kalapalo people, 190
ture in, 189; recognition of hypersom¬
Kant, Immanuel, 208
nia, 520
Kapukurri (dream), in Kukatja language, 1
Japanese dream reports, 187
Kaufman, Charlie, 131
Jeremiah (Old Testament), 79
Keaton, Buster, 128
Jeunet, Jean-Pierre, 39
Kerouac, Jack, 183, 509
Joel (Old Testament), 79
Kerr, N. H„ 238
887
888
|
Index
The Key of Dreams (Artemidoris of Ephe¬
sus), 611
Langer, Susanne, 125, 126 The Lathe of Heaven (LeGuin), 279
Kidney disease. See Renal disease
Leading dream groups, 387-89
King, Stephen, 183, 390
Leger, Fernand, 197
King Lear (Shakespeare), 584
LeGuin, Ursula K., 279
Klein, Melanie, 288, 314
Leighton, L., 219-20
Kleine-Levin Syndrome, 385-86
Leptin, 468, 590, 603, 619, 626, 631, See
Kleitman, Nathaniel, 7, 22, 100, 208, 209, 297-98, 656
also ghrelin Let Me Dream Again (film), 127
Koffel, Erin, 205
Levertov, Denise, 510
Kohlschutter, Ernst Otto Heinrich, 202-3
Lewin, Bertram, 126
Kohut, Heinz, 579-80
Lewis, Jacquie, 38
Kojima, M., 29
Liddon, Sim, 351
Kooiman, C. G., 26
Life cycle, and women’s dreams, 806-8
Korean culture: dream beliefs, 55; tradi¬
Light phase response curve (PRC), 121
tional dreams, 774-75
Lilith (Babylonian demonness), 352, 368
Krakow, Arthur, 793
Linklater, Richard, 40, 131
Kramer, Milton, 200, 523
Literature and dreams, 389-92
Krims, Les, 495
Little dreams, 392-94. See also Big
Krippner, Stanley, 186, 187, 480 Kroeber, Alfred, 192 Kronholm, E., 348
dreams Little Nemo in Slumberland (comic strip),
146-47
Kubin, Alfred, 197
Living in Oblivion (film), 129
“Kubla Khan” poem (Coleridge), 143,
Locke, John, 143
509
Loewi, Otto, 184, 298
Kubrick, Stanley, 129
Loewy, R., 209
Kuiken, Don, 226, 235
Logical structure of dreams, and their re¬
Kumin, Maxine, 510
lation to reality, 394-96
Kunzendorf, Robert, 197-98
Long sleep duration, 460-61
Kupka, Frantisek, 196-97
Long-term (dream) journal keeping
Kurnai people (of Gippsland), 1
(LTJK), 374-76
Kurosawa, Akira, 131, 183, 197
Loomis, A. L., 100, 209
LaBerge, Stephen, 325, 656
Lost dream recall, neuropsychology of, 457-59
Labrador, sleep paralysis beliefs, 64
Lovecraft, H. P., 278-79
Lacan, Jacques, 126
Lucid dreaming therapy for nightmares,
Ladysmith Black Mambazo, 431 Laertius, Diogenes, 60 “Landscape from a Dream” (painting) (Nash), 182 Langer, Susanne, 314
401-2 Lucid dreams and dreaming, 397-98; and Agrypnia Excitata, 211; brain corre¬
lates to lucidity, 90-92, 398; definition, 397-98; experiences of shamans, 129,
Index
191; false awakenings and, 275-76;
Massine, Leonide, 197
genital arousal association, 353; global
Mathematical modeling of sleep, wake
definitions of, 187; and handedness,
rhythms, 122
321; and healing processes, 325; and
Matta, Roberto, 197
impactful dreams, 344; and isolated
Maury, Alfred, 208, 327-28, 655
sleep paralysis, 369; in literature, 279;
McCarley, Robert, 7, 272, 284
mechanics of, 275, 325; in reports of
McCartney, Paul, 184, 235, 431
Bedouins, 74; and sleep paralysis, 369;
McCay, Winsor, 127, 146-47
in sports, 400-401; and states of being,
McGinn, Colin, 126
211; and time sense, 656; video gaming
McNamara, Patrick, 111, 129-30, 268,
association, 796-98 Lucid nightmares, 403-6 Lucretius, 169, 208 Lumiere, Auguste and Louis, 124, 128 Luminet, O., 25
|
322, 724-25 MDD (major depressive disorder), 451-52, 474, 606-7 MDMA (Ecstasy) use and sleep prob¬ lems, 233-34
Lumley, M. L., 26
Meatyard, Ralph Eugene, 495
Lundh, L.-G., 26-27
Media use: and nightmares, 409-10; and
Luther, Martin, 78-80. See also The
sleep in children, adolescents, 410-13;
Bible and dreams
television consumption and dreaming,
Lynch, David, 39, 129
767-68; video game play and dreams, 795-800
Lyons, Tallulah, 105, 325
Medications, effects of on sleep and Mack, John E., 129
dreaming, 235-38, 413-14, 413-14
Mack, Phyllis, 527
Medicine dreams of Native Americans,
Mackiewicz, M., 307 Mahowald, Mark, 7, 211 Maimonides Hospital (Brooklyn) ESP study, 257 Major depressive disorder (MDD),
442-43 Medieval hagiography and dreams,
415- 16 Mehinaku tribe (Amazonian), 186, 190 Meier, Carl Alfred, 59
451-52, 474, 606-7. See also
Melatonin, 131
Depression
Melatonin therapy: efficacy studies,
Malay people, 190
5; mechanism of release in body,
Male genitals in dreams (China), 119-20
412; role in circadian rhythms, 131;
Maleus Maleficarum (witch-hunting man¬
for sleep disorders of children, 347,
ual), 353 Malinowski, Bronislaw, 190
416- 18
Mardu people (of Australia), 1 Martin, Susanna, 353
Melies, Georges, 127-28, 196 Melville, Herman, 63 Memory. See Autobiographical memory;
Maslow, Abmham, 314
Declarative memory; Dreams, memory,
Massey, Irving, 431
and sleep; Nondeclarative memory
Massimini, M., 792
Mendeleev, Dmitri, 184, 362
889
890
|
Index
Merchant of Venice (Shakespeare), 584 Meshes of the Afternoon (film), 130, 197,
198 Metabolic syndrome: and obstruc¬ tive sleep apnea, 468-69; and sleep,
629-32
Morningness-Eveningness Questionnaire for Children and Adolescents (MEQCA), 573 Morvan’s chorea, 212-13 Motor vehicle sleep related accidents, 721-23
Metamorphoses (Ovid), 278
Moulton, S. T., 246
Metaphysics. See School of Metaphysics
Mouse sleep physiology, genetics of,
approaches to dream incubation Metaplasticity, plasticity, and sleep,
701-3 Methodological challenges in scientific studies of dreams, 418-21 Metz, Christian, 126
305-7 Mugwort herb, dream-stimulating proper¬ ties, 425-29, 428 Mulholland Drive (film), 129
Multiple sleep latency test (MSLT), 10, 520-21,682-83
Meyers, Stephanie, 279
Multiple system atrophy, 101
Michals, Duane, 495
Mulvihill-Smith syndrome, 125, 212-13
Microsleeps (defined), 10
Miinsterberg, Hugo, 125
Middendorf, Helmut, 197
The Murders in the Rue Morgue (Poe), 278
Middle Ages and dreams, 421-24; conse¬
“The Musical Dream Revisited”
quences experienced by women, 369;
(Massey), 431
religious dream depiction, 196; use of
Music and dreams, 430-32
mugwort in amulets, 428
Muslim dream practices, 365
Middle Kingdom (Ancient Egypt), 33 Midsummer Night’s Dream (Shake¬
Muzio, J. N., 656 “My Dream” (painting) (Pankejeff), 197
speare), 584 Mikolajczak, M., 25
Naparstek, Belleruth, 107
Mild cognitive impairment and sleep,
Naps, 433-36; and acute sleep depri¬
618-19
vation, 10; Agrypnia Excitata and,
Mitchson, Graeme, 561-62
212; China and Japan’s polyphasic
Mobile phones. See Cell phone use
sleep cultures, 189; cultural varia¬
Moby Dick (Melville), 63
tions, 433-34, 604-5; defined, 433;
Molinari, Sergio, 289
frequency of African Americans,
Molle, M„ 791
433; health benefits of, 434; memory,
Monophasic sleep cultures, 189
dreams, and, 436; REM sleep studies,
Montangero, Jacques, 793
25, 160; sleep patterns of children, 46,
Mood and connection between dreams,
639-40; vigilance, performance, and,
156-58 Morgan, Robert, 40
435-36 Narcolepsy, 351; and abnormal REM
Morningness, age-related, 122
sleep, hypocretin deficiency, 440-42;
Morningness-Eveningness Questionnaire
and African Americans, 100; defined,
(MEQ), 573
438-39; and dissociated states, 211;
Index
|
and dreaming, 437-38, 521; gene
Neural metaphor and dreams, 444-45
therapy treatment for, 328-29, 440;
Neuroactive steroids, 252-54
and genetics in sleep, 303; hypocre-
Neuroanatomical correlates of dream cen¬
tin gene transfer in mice models of,
sorship, 445-47
328-29; and isolated sleep paralysis, 366, 438-40; and REM sleep, 437-38;
Neuroanatomical correlates of dream-
and sleep medicine, 100; subcategories
Neuroanatomy of dreams, 449-51
of, 520. See also Hypnagogic halluci¬
Neuroanatomy of REM sleep and depres¬
nations; Hypnopompic hallucinations; Primary disorders of hypersomno¬ lence and dreams; Sleep disorders and dreaming Nash, Paul, 182 National Cholesterol Education Program (NCEP), 630 National Health Interview Survey, 593 National Institute of Mental Health (NIMH), 504 National Sleep Foundation (U.S.): report
work, 447-49
sion, 451-53 Neurobiology of psychoanalysis in wake and REM sleep, 454-55 Neurofeedback for sleep problems,
456- 57 Neuroimaging, functional during human sleep Neuropsychology of lost dream recall,
457- 59 Newfoundland, sleep paralysis beliefs, 64 New Kingdom (Ancient Egypt), 33-34
on use of electronic media devices,
Nielsen, Tore, 7-8, 227-28, 322
410-11; sleep recommendations for
Nigerian tribal study, 187
adolescents, 16; 2005 poll on adults’
Nightly sleep duration and mortality,
sleep habits, 433; 2006 Sleep in Ameri¬
460-61
can Poll, 410-11; 2007 sleep quality
The Nightmare (film), 127
study, 348
Nightmare disorder, 248, 463, 464, 693
Native Americans: ceremonial use of
“The Nightmare” (painting) (Fuseli), 196
mugwort, 428; dream beliefs, 567;
A Nightmare on Elm Street (film), 129
dream catchers, 74-75; dreams of,
Nightmares, 463-65; Brazilian sleep
442-43; importance of dreams for,
studies, 348; and Brazilian sleep
585-86; influence on African Ameri¬
studies, 348; children’s dreams and,
can dreams, 19; plants used in sweat
dreams, 801. See also Shamanism and
114-19; children’s dreams and night¬ mares, 114-19; clinical aspects of, 132-33; clinical definition, 401; con¬ tent in adults, 461-62; effects of sleep
dreams
medications on, 236; effects on day¬
lodges, 74; shamanic traditions, 801; vision quests of, 349; visual art and
Natterson, Joseph, 524
time mood, 235; emotional responses
Naturalistic philosophy (Aristotle), 422
to, 247-48; and endometriosis patients,
Negative REM dream, 476
256; and existential dreams, 269-71; as
Neider, Michelle, 92
film plots, 129-30, 197; of flying, 286;
Neural basis and theoretical models,
gender differences effect on, 301; im¬
768-70
agery-rehearsal therapy treatment, 133;
891
892
|
Index
and impactful dreams, 345; and insom¬
69; changes during adolescence, 657;
nia, 645; as inspiration for painters,
and characters in dreams, 111; as com¬
196-98; as inspiration for poetry, 142,
ponent of sleep definition, 193; and
196; and the ISDI, 205; lucid dreaming
CRH, 148, 331; in different mammals,
therapy for, 401-2, 405; lucid night¬
149-50; and disconnection from ex¬
mares, 403-6; media use and, 409-10;
ternal environment during dreaming,
posttraumatic, 117-18; in PTSD,
206-7; and dream characters, 111; and
106, 118, 215-17, 270, 401, 463-64,
dream consciousness, 160; dream oc¬
510-11, 606; and REM sleep, 117-18;
currence during, 7-8; EEG features
research studies, 133; sleep, psychiatry,
of, 100, 153-54; and endocrinology of
and, 692-93; sleep paralysis, confusion
sleep, 249-54; and epileptic seizures,
with, 367; treatment modalities, 401; of
148; and fetal sleep, 280; five levels
video game players, 798-99; vs. night
of, 100; and genetics, 304; and growth
terrors, 117; waking distress, 248
hormone release, 617; heartbeat rhythm
Night terrors: dopamine (medication) as¬
during, 71; and hippocampal cell pro¬
sociation, 237; in Hicks’ dream divi¬
liferation, 628; and illusory content in
sions, 321; vs. isolated sleep paralysis,
dreams, 342-43; linguistic content of
366; vs. nightmares, 117; in young
dream reports, 653; and mouse stud¬
children, 132
ies, 306-7; and napping, 436; and neu¬
“NIghtwalk: A Dream Phantasy in Photo¬ graphs” (Man Ray), 494 Nocturnal frontal lobe epilepsy (NFLE), 147-48, 481-84
rofeedback, 456; neuroimaging and, 293, 295, 597-98; and night terrors, 117, 132; and overgeneral memories, 476; regulation of sleep and wake sys¬
Nocturnal seizures, 556, 693
tems, 539-40; relative to sleep quota
Noise sensitivity, and depth of sleep,
databases, 149-50; and reptilian sleep,
203-4
260-61; and sleep problems, 456; of
Nondeclarative memory, 688-89. See
songbirds sleep, 596; transcranial direct
also Sleep, memory, and dreams
current stimulation, 791; and VIP, 250.
Noninvasive techniques in dream studies,
789-92 North American Indians animal dreams, 38 Norton, M. I., 77
See also REM-NREM dream content
specializations; REM (rapid eye move¬ ment) sleep Nwapa, Flora, 391
Nostalghia (film), 196
NREM arousal parasomnias, 148 NREM (non-rapid eye movement) sleep:
Obesity, and sleep, 590, 619-20; alexithymia issues, 25; cardiometabolic
adolescents vs. elderly people, 21; and
risks, 602-3; children’s issues, 346,
alcohol use, 23-24; and apneas, 148;
410; endocrine system involvement,
and arthritis patients, 594; awaken¬
630; obstructive sleep apnea issues,
ings protocol, 65-67; basics of sleep
101, 168, 258, 468-69; quality of life
recordings, 69; and behavioral ecol¬
issues, 529; women’s issues, 470. See
ogy, 263; and brain energy balance,
also Metabolic syndrome
Index Obesity-hypoventilation syndrome, 535. See also Obstructive sleep apnea
|
OSA. See Obstructive sleep apnea (OSA) Osteoarthritis (OA), 594
Objective and subjective dreams, 467-68
Othello (Shakespeare), 585
Obstructive sleep apnea (OSA): and
Our Dreaming Mind (Van de Castle), 37,
aging, 638-39; and arthritis, 593;
257
CPAP treatment for, 148, 167-69; and
Overgeneral memories, 473-77
diabetes, 468-70; epilepsy correlation,
Ovid (author), 278
147-48; and heart failure, 636; and iso¬ lated sleep paralysis, 366; risk factors
Pabst, G. W„ 130
for hypertension, cardiac conditions,
Pachamama Alliance, 4
167-68; and sleep medicine, 101; and
“The Pains of Sleep” poem (Coleridge),
teenagers, 643. See also Sleep disor¬ ders and dreaming Obstructive sleep apnea (OSA), metabo¬ lism and hormones, 468-71 Obstructive sleep apnea syndrome (OSAS), 258-59, 303, 643, 647
509 Pandya, Vishvajit, 191-92 Panic disorder, 463, 692 Pankejeff, Sergei, 197 Pannier, Wendy, 105, 325 Paperhouse (film), 129
Odyssey (Homer), 35, 49, 278
Paprika (film), 129
Oedipus the King (film), 130
Parapsychology and dreams, 479-80
Ojibwa tribe, 190
Parasomnias, 148, 351, 715-16; coexis¬
Old Kingdom (Ancient Egypt), 33
tence with epileptic seizures, 148; de¬
Olfactory stimuli and dreams, 471-73
fined, 481; effects of medication, 236;
On Divination through Sleep (Aristotle),
and nocturnal frontal lobe epilepsy,
51
481-84; NREM arousal parasomnias,
On Dreams (Aristotle), 613
148; from television viewing, 411. See
Oneirocritica (Interpretation of Dreams)
also Incubus/succubus; Sleep terrors;
(Artemidoris of Daldis), 32, 50-61, 352, 422, 423 Oneirocriticism, 389-90, 422 The Oneirocriticon ofAchmet (10th-
century book on dreams), 390
Sleepwalking Parintintin (Amazonian Brazil people), 191, 192 Parkinson’s disease (PD) and sleep,
678-81; actigraphy measures, 5-6; and
Ongis of Little Andaman Island, 192
alexithymia in renal disease, 29; cog¬
On Interpretation of Dreams (Antiphon-
nitive disorders of, 681; depression in,
tes), 611
681; effect on dream studies, 99; ex¬
On Regimen (Hippocrates), 51
cessive daytime sleepiness in, 679-80;
On Sleep and Waking (Aristotle), 613
hallucinations in, 681; insomnia in,
“On the Nature of Dreams” (Jung), 81
679; periodic limb movement disorder
“On the Relation of Analytical Psychol¬
in, 680; RBD association with, 101,
ogy to Poetry” (Jung), 509
214, 554, 556; and REM sleep behav¬
Open-access dream archives, 141
ior disorder, 101; and restless leg syn¬
Open Your Eyes (film), 129
drome, 680; sleep and hallucinations,
893
894
|
Index 681; sleep disorder breathing and sleep
leg syndrome, 101-2. See also Medica¬
apnea in, 680
tions, effects of on sleep and dreaming
Parliament of Fowls (Chaucer), 508
Parrott, A. C., 233, 234 Partial sleep deprivation, 485-86, 601; behavioral effects, 485-86; individual differences, 486; physiological inflam¬ mation caused by, 685; psychological effects, 486; recovery, 486 Partridge, C. P„ 17-18 Patient Health Questionnaire (PHQ-9),
202 Paulus, W„ 791
Phase response curve (PRC) measures,
121 Phasic ponto-geniculo-occipital/pontine wave (PGO/P-wave), 487-90 Phillips, Maggi, 391 Philosophy of mind, and dream charac¬ ters, 490-93 Philosophy of the Implicit (Gendlin), 85
Photography and dreams, 494-95 Phylogenetic comparative methods and sleep, 495-97
Pearson, Cynthia, 375, 376
Phylogeny of sleep, 152-53, 497-503
Peck, Gregory, 130
Phylogeny of Sleep database, 504-6
Pediatric Daytime Sleepiness Scale
Physiological influences (in acute sleep
(PDSS), 643-44
deprivation), 11
Periodic Limb Movement Disorder, 680
Piaget, Jean, 508
Periodic limb movements, 62, 552, 638,
The Picture (poem), 143
646, 649-50, 679-80
Pietrowsky, R., 235
Peris, Fritz, 308-9, 314
Pillows of Bedouins, as sleep aid, 75
Personality disorders, 194, 463, 524, 545,
Pirona, A., 233, 234
607 Personality traits: effects on dreams, 166; and incorporation of experience (PERS), 166; sleep, dreams, and per¬ sonality, 652-54
Pittsburg Sleep Diary, 641 Pittsburg Sleep Quality Index (PSQI), 29-30, 507, 650, 694, 706 Plasticity, metaplasticity, and sleep,
701-3
Peruvian animal dreams, 38-39
Plato, 142, 341,612-13
PET (positron emission tomography), 72,
Play and the dream, 507-8
96, 162, 293, 597 PGO. See Pontine-geniculate-occipital (PGO) cortical spikes PGO waves, 193, 271-74 Pharmacological studies, 96-97; ADHD
Poe, Edgar Allen, 278 Poetry and dreams, 125, 142-43, 183,
421,508-10 Polycystic ovarian syndrome (PCOS), and obstructive sleep apnea, 470
children and dreaming, 62; brain en¬
Polyphasic sleep cultures, 189
ergy and metabolism, 96; depression
Polysomnographic (PSG) sleep studies,
and dreaming, 200; disturbed sleep and
4-6; arthritis studies, 593-94; cardio¬
PTSD, 216; dreaming altered by medi¬
respiratory polysomnography, 71-72;
cations, 413-14; historical background
and mild cognitive impairment, 618;
of sleep medicine, 101-2; and REM
of PTSD, 510; of RBD, 214, 550;
sleep behavior disorder, 553; restless
short sleep assessment, 589; and sleep
Index duration, 620; Types II-IV portable
during pregnancy studies, 417; Na¬
equipment, 511
tive American beliefs, 19; relation to
Pontine-geniculate-occipital (PGO) corti¬ cal spikes, 83 Portable monitoring of sleep, 510-11. See also Polysomnographic (PSG) sleep
studies
dreaming, 1-2. See also Fetal sleep; Fetal yawning Pregnancy dreams, 518-19 Primary disorders of hypersomnolence and dreams, 520-21
Porter, Edwin S., 127-28, 197
Primitive sleep, 261, 615-16
Positron emission tomography (PET),
PRL (prolactin), 249-51, 281, 625
72, 96, 162, 293, 295, 452, 513, 555,
Problem solving in dreams, 182-85
597- 98, 734
Profile of Mood States, 157
Posterior cingulate cortex, 294, 452, 559, 598- 99
|
Prophetic dreams, 800-801 Protestant Reformation, 78
Posttraumatic nightmares, 106, 117-18
Protoconsciousness theory, 269
Posttraumatic stress disorder (PTSD),
Psoriatic arthritis (PsA), 594
118; disturbed sleep and, 215-17; and
Psychiatric diagnosis and dreams, 522-25
insomnia, 606; lucid dreaming rescript¬
Psychiatric disorders: and autism, 606-8;
ing for, 405-6; nightmares as part of,
nightmares, sleep and, 606-8; and the
270, 401, 463-64; PSG studies of, 510;
transdiagnostic perspective, 704-6
rescripting approach to nightmares, 106; and sleep disturbances, 650-52. See also Veterans of foreign wars,
sleep problems Poulin, J., 607 Powell, R. A., 227-28 The Power of Movies: How Screen and Mind Interact (McGinn), 126
PRA (plasma renin activity), 624 Prader-Willi syndrome (PWS), 304 Precognitive dreaming, 256-57, 512-13
Psychoactive substances, in Bedouin tra¬ dition, 73-74 The Psychoanalysis of War (Fornari),
288 The Psychodynamic Diagnostic Manual,
524 Psychological primaries (colors), 145 PTSD. See Post traumatic stress disorder (PTSD) Purunas (Hindu literature), dream stories, 801
Predictive dreams (of African Ameri¬ cans), 20 Prefrontal cortex in dreaming, 91 -92, 446-47, 513-17 Pregnancy: Aboriginal women and dreaming, 1; African dreams of pre¬ diction, 20; effect of SWS on fetus,
Quaker culture and dreams, 527-28, 565 Quality of life and sleep disorders in chronic kidney disease, 528-30 “Queen Katherine’s Dream” (painting) (Blake), 196 Quiet sleep, 280, 495, 640, See also
280-81; female influence of gender,
NREM (non-rapid eye movement)
263; and genetic conflict, 264-65; go¬
sleep
nadal hormones and REM sleep, 252; Korean dream traditions, 55; melatonin
Qur’an and dreams, 75-76, 364-66, 530-31,541-42
895
896
|
Index
Rabid Eye graphic novel (Veitch), 311
REM-NREM dream content specializa¬
Rabinowe, Victoria, 53
tions, 542-46 REM (rapid eye movement) sleep: ab¬
Ramanujan, Srinivasa, 185 Ramesside Period (Ancient Egypt), 34
normal REM sleep and narcolepsy,
Rare Bit Fiend comic strip, 310
440-42; across the lifespan, 546-50;
Ray, Man, 197, 494
aging effects on, 637; association to
RBD. See REM sleep behavior disorder
CST, 180-81; association with vivid
Reality, logical structure of dreams and
visuomotor perception, 8; and attach¬
their relation to, 394-96 Recalling dreams, absence of, 457-59. See also Dream recall
ment theory, 267; and autism, 608; awakenings protocol, 65-67; and be¬ havioral ecology, 263; and bizarre im¬
Rechtschaffen, A., 164
agery and thought in sleep waking,
Recordings of sleep, basics, 69-72.
83-84; and blindness studies, 238-39;
See also Actigraphy; EEG (electro¬
changes during adolescence, 657;
encephalography) measures; EMG
characteristics of, 69, 71; and charac¬
(electromyography) measures; EOG
ters in dreams, 110-13; and children’s
(electrooculogram) measures; NREM
dreams and nightmares, 114-16; and
(non-rapid eye movement) sleep; REM
colors in dreams, 144; as component of
(rapid eye movement) sleep
sleep definition, 193; convergent evo¬
Recovery from acute sleep deprivation, 11
lution in mammals and birds, 169-71; and costly signaling theory, 268; and
Recurrent hypersomnias, 520
CRH, 331-32; and deprivation recov¬
The Red Book (Jung), 373, 377-78,
ery, 11; and depth of sleep, 203; de¬
379-80 Regulation of sleep and wake systems,
539-40
scribed, 495; in different mammals, 149-50; and disconnection from ex¬ ternal environment during dreaming,
Reid, Thomas, 403
206-7; discovery of, 7, 133, 208-9;
Reklaw, Jesse, 147, 311
and disruptions of in PTSD, 216-17;
Religion and dreams, 123-24, 540-42.
and dream characters, 110-12; and
See also Buddhism; Christianity/Chris¬
dream consciousness, 139, 159-60;
tian Church; Judaism
and dream function, 298; dream mean¬
Religious symbolism in dreams (Christian Church), 123-24 REM dreaming intrusion: and hypersom¬
ing studies, 139; and dream recall, 94; and Ecstasy (MDMA) users, 233-34; effects of anti-depressants on, 200;
nias, 520; and ISP, 367; and narco¬
and endocrinology of sleep, 249-54;
lepsy, 211-13, 437; and orexin levels,
erections and, 208-9; and fetal REM
252, 450; and PWS, 304; and RBD,
sleep, 269, 280; and genetics, 304; and
211-13
handedness, 321-22; heartbeat rhythm
REM muscle atonia, 69, 100-101, 211, 214, 280, 367
during, 71; and hippocampal cell pro¬ liferation, 628; hypnagogic dreams vs.
Index
|
REM dreams, 328; and illusory content
21-22. See also Brain networks and
in dreams, 342-43; and involuntary
sleep; Neuroanatomy of dreams; Neu¬
nature of dreaming, 364; and journal¬
roanatomy of REM sleep and depres¬
ing of dreams, 373; linguistic content
sion; Neurobiology of psychoanalysis
of dream reports, 653; and lost dream
in wake and REM sleep; REM-NREM
recall, 459; and lucid dreaming, 91-92;
dream content specializations
in mammals and birds, 498; meaning
REM-sleep atonia, 441
studies, 139; medication influences,
REM sleep behavior disorder (RBD),
413-14; and medications effect on,
101, 550-56, 680-81; altered dream
235-37; and mild cognitive impair¬
content, 215; and dementia with Lewy
ment, 618; and mouse studies, 306-7;
bodies, 101; and dissociated states,
and napping, 436; and narcolepsy,
211; distinct dream content associated
437-38; negative REM dream, 476;
with, 213-15; and narcolepsy, 440; and
neuroimaging and, 294-95, 597-98;
Parkinson’s disease, 101; in Wilson’s
and nightmares, 117-18, 461-62; and
disease patients, 682-83
overgeneral memories, 475-76; PET studies of, 162; PGO waves during, 271; precognitive dream studies, 512; and prolactin, 249-51; and psychiat¬
REM sleep behavior disorder or somnambulism-like ghost tales, 708, 710 REM (rapid eye movement) sleep in criti¬ cally ill patients, 533-36
ric disorders, 692; regulation of sleep
REM sleep properties, 557-58; as neuro-
and wake systems, 539-40; regulation
biological endophenotypes of schizo¬
role of serotonin, 207, 233, 237, 414,
phrenia, 558-60
440, 539, 578, 580-82; and relation to Cl intensity, 110; relative to sleep quota databases, 149-50; REM sleep
REM sleep-related motor paralysis,
560-61 Renal disease: alexithymia in, 29-30;
latency and psychiatric disorders, 692;
chronic kidney disease, 201-2,
and reptilian sleep, 260-61; research mental dream psychology, 133; role
528-30; chronic renal failure and in¬ somnia, 357-58; and depression, 201-2; end-stage renal disease, 201,
in first-year brain development, 114;
528-29; sodium intake, 30
on cats, 209; and resurgence of experi¬
and schizophrenia, 607-8; and sentinel
Repici, L., 613-15
theory, 267; and sleep hallucinations,
Reptilian sleep, evolution of, 260-61
352; and sleep medicines, 100-101;
The Republic (Plato), 36
sleep onset REM periods, 520-21; and
Resting-state networks (RSNs), 598,
sleep paralysis, 63-64, 190, 367; and
600-601. See also Brain networks and
slow wave sleep, 589, 637, 746, 776;
sleep
of songbirds, 596; thermoregulatory
Restless Legs Syndrome (RLS), 680; and
inactivation during, 633-34; and VIP,
arthritis, 593; and genetics, 303; and
249-50; apd vision in dreams, 97-99;
insomnia, 358; and sleep medicine,
young adults vs. elderly persons,
101-2
897
898
|
Index
Reverse learning theory, 561-62
properties as neurobiological endophe-
Revonsuo, A., 209, 268-69, 795, 799
notypes of, 558-60; review of sleep
Rheumatoid arthritis (RA), 29, 593, 595
studies, 607-8; treatment modalities,
Rice, Anne, 183
455, 792
Richter, Hans, 197
Schneider, D., 187
Robbins, Jerome, 197
School of Metaphysics approaches to
Rogers, Carl, 314
dream incubation, 566-69
Rogers, William, 527
Schopenhauer, Arthur, 208
Romeo and Juliet (Shakespeare), 585
Schredl, M., 62, 77, 163, 235, 301, 656
Roschke, J., 243
Schwitzgebel, E., 164-65
“The Rose Bower” (painting) (Burne-
Science (industry journal), 297
Jones), 182
SDB (sleep-disordered breathing),
Rosetti, Cristina, 183
258-59 Seasonal Affective Disorder, 569-71
Rossi, Ernest, 325
Seasonal affective disorder (SAD) in
Roseman, Marina, 430
Rossman, Martin, 107
sleep, 569-71
Rousseau, Henri, 197
Secrets of a Soul (film), 130
Rowling, J. K., 279
Seki, Tom, 95-96
RSNs (resting-state networks). See Brain
Selective serotonin re-uptake inhibitors
networks and sleep Russian dream reports, 187 Rwandan genocide and Holocaust survi¬ vors, dream accounts, 749-51
(SSRIs), 200, 237, 414 Self-assessment tools of Circadian ty¬ pology in children, adolescents, and adults, 572-73 Self-consciousness and dreaming, 574-75
Sabiston, Bob, 40
Self-consciousness insight, 90
Sachs, Hans, 130
The self in dreams, 575-77
The Sacred Tales (Aristides), 58
Self-organization from chaos in dreams,
Safety in dream groups, 565-66
577-78
Saint-Denys, Hervey de, 403
Selfscape dreams, 579-80
Salem Witch Trials in Colonial America,
Sendak, Maurice, 391
353, 369
Serotonin in the regulation of REM sleep,
Sambian culture, 221
207, 233, 237, 414, 440, 539, 578,
Sandman (comic series), 147, 279
580-82
Santa Barbara Healing Sanctuary, 246 Schenck, Carlos H., 7, 211 Schizophrenia, 463; abnormalities cre¬
Sex hormones and obstructive sleep apnea, 470 Sexual dreams, meaning and practical
ated by, 99, 194; brain disconnections
insight, 34, 119-21, 187, 190, 353,
in, 454; differential diagnosis of, 709,
582-83
710; effect on dream studies, 99; and nightmares, 463; presence of shortREM sleep latency, 607; REM sleep
Sexual symbolism in dreams (China), 119-21 Shabalala, Joseph, 183-84, 185
Index Shakespeare, William, and dreams, 508,
583-85 Shamanism and dreams, 3, 54, 129, 181, 191, 221, 325, 361, 428, 430, 442, 542,
585-89, 801
|
Sleep and evolution of detailed focal vi¬ sion, 615-17 Sleep and growth hormone release, 617 Sleep and mild cognitive impairment,
618-19
Shelley, Mary, 183
Sleep and the endocrine system, 624-27
Shelley, Percy Bysshe, 183
Sleep and the generation of new nerve
Sherlock Jr. (film), 128
cells in the adult brain, 627-29
Shift work and sleep, 621-22
Sleep and thermoregulation, 633-35
Short Life (motion picture), 40
Sleep and wake sytsems, regulation of,
Short REM sleep latency, 607, 692 Short sleep, 412, 436, 460-61, 486,
589-90, 603,619
539-40 Sleep apnea. See Central sleep apnea; Ob¬ structive sleep apnea
Sikora, S., 235
Sleep apnea in heart failure, 635-37
Sim, Wonjin, 56
Sleep as we age, 637-39
Simonsson-Samecki, M., 26-27
Sleep databases, 149-52
Single-photon emission computed tomog¬
Sleep deprivation: acute, 9-11, 485;
raphy (SPECT), 452, 555, 597 Sleep (music video), 40
Sleep, definition of, 193 Sleep, dreams, and personality, 652-54 Sleep, dreams, and the time sense, 655-56 Sleep, inflammation, and cardiovascular disease, 683-85 Sleep, memory, and dreams, 687-91;
partial, 485-86, 601, 685. See also Insomnia Sleep development in infancy and early childhood, 639-41 Sleep diaries, 5, 321, 357, 641-42, 718, 805 Sleep-disordered breathing (SDB), 148, 470; causes of, 258; in children with
declarative memory and sleep, 689;
cancer, 667-69; CPAP treatment for,
dream and sleep states, 690; emotional
168; in diabetes, 468; in heart-failure
memory, 689; memory, 687-88; non¬
patients, 648-50; in Parkinson’s dis¬
declarative memory and sleep, 689-90;
ease, 680; REM-related SDB, 535; risk
post task regulation dream content,
factors, 603, 636; in teenagers, 642-44;
690-91; sleep states, 688; sleep states
television viewing influence, 411
and memory consolidation, 688-89 Sleep, plasticity and metaplasticity,
701-3 ; in birds, 596; and dream recall, 173; in honeybees, 672; and mouse studies, 307; and narcolepsy, 442; in neurogenesis studies, 628-29 Sleep, psychiatric disorders, and the transdiagnpstic perspective, 704-6 Sleep, psychiatry, and nightmares,
692-93
Sleep disorders and dreaming, 645-46 Sleep disorders in patients with chronic kidney disease, 201-2, 647-48 Sleep disorders in patients with heart fail¬ ure, 648-50 Sleep disturbances, 604; actigraphic stud¬ ies of, 5; and alcohol use, 23; and ar¬ thritic conditions, 593-94, 593-95; and cardiovascular disease, 683-84; and childhood traumas, 114; and children’s
899
900
|
Index
sleep health, 346; and cultural sleep practices, 604-5; and depression, 333;
Sleep quality, behavioral genetic perspec¬ tive, 706-8
and depth of sleep, 203-4; and endo¬
Sleep quotas, 149-52, 496, 504-5, 661,
crine system, 626; and family dream
687 Sleep-related hallucinations and ghost
sharing, 117; and melatonin-replace¬ ment therapy, 418; and mild cognitive impairment, 618; and negative moods,
tales, 708-11 Sleep-related mental activities in insom¬
157; and nocturnal frontal lobe epi¬
nia: role and assessment, 711-13
lepsy, 484; and suicide, 623-24; in
Sleep spindles, 69, 71, 100, 252, 598,
Wilson’s disease patients, 682; and withdrawal from addictions, 24 Sleep EEG across adolescent develop¬ ment, 657-58 Sleep fragmentation. See Fragmentation of sleep “The Sleep Goes Away” (painting) (Bruvel), 182
657, 671,675,713-14 Sleep talking (somniloquy), 715-16 Sleep terrors, 132, 211, 463, 481, 556, 692-93 Sleep variables and handedness, 716-20 Sleep-wake cycles: actigraphic research of, 4, 6, 69; and aging, 638; brain en¬ ergy restoration, 95; and circadian ty¬
Sleep in children with cancer, 666-69
pology, 573; and critically ill patients,
Sleep in disorders of consciousness,
533; effect of mobile phone use, 412;
670-71
and ICU patients, 534; and melatonin
Sleepiness and driving, 721-23
production, 417-18; and mouse stud¬
Sleeping and dreaming patterns in the
ies, 307; and naps, 435; and narco¬
context of attachment relationships,
lepsy, 439; in rats, 154; and seasonal
724-26
affective disorder, 571; and tau protein,
Sleep in patients with Wilson’s disease,
682-83 Sleep intensity and the homeostatic regu¬ lation of sleep, 686-87 Sleep medicine: effect on sleep depth,
759-61; and work schedules, 241, 621 Sleepwalking (somnambulism), 72, 211, 481,482, 556,584, 693 Slow Wave comic strip, 311
Slow-wave EEG activity (SWA), 15-16,
204; historical background, 101-2
132, 172, 193, 254, 260, 686-87
Sleep onset REM periods (SOREMPS),
Slow wave sleep (SWS): and adoles¬
520-21 Sleep paralysis, 63-64, 189, 190, 351. See also Isolated sleep paralysis
Sleep pattern and its determining factors in university students, 693-96 Sleep pattern in patients with acute coro¬ nary syndromes, 696-700 Sleep problems among veterans of for¬ eign wars, 703-4
cent EEG, 657; and Agrypnia Excitata, 211-12; and animal predatory behav¬ ior, 496; circadian rhythms and, 132; described, 654; EMF fields and, 244; endocrine system'and, 249; fear condi¬ tioning research, 216; and HPA system, 330; and HPS system, 336; maternal SWS and nursing, 265; mice research findings, 149, 306; and NREM sleep,
Index
513-14, 544, 617, 650; and PGO/P-
|
Spirituality: and Casto Spirituality Scor¬
wave generation, 489; pregnancy and,
ing System, 187; and dreamwork coun¬
280; and psychiatric disorders, 606;
seling, 230; medieval times, 416; in
and REM sleep, 589, 637, 746, 776;
Native American dreams, 585. See also
reptile sleep research, 231; and sleep
Religion and dreams; Shamanism and
disruptions in ICU, 534; sleep frag¬
dreams
mentation and, 618; and video/com¬
Spondyloarthropathies, 594
puter game playing, 411. See also
Sports: and dreaming, 738-39; lucid
Unihemispheric slow-wave sleep Smell and dreams. See Olfactory stimuli and dreams
dreaming in, 400-401 SSRIs. See Selective serotonin re-uptake inhibitors (SSRIs)
Smith, Patti, 431
St. Paul Boux (French poet), 182
Snake image, 75-76
Stage behind the eyes—theater and
Snoring, 348, 643; and OSA, 259, 303, 649; and polysomnographic studies, 71; prevalence in men vs. women, 348; and SDB, 258, 643; and teenag¬ ers, 643
dreams, 739-42 Stages of sleep and associated wave¬ forms, 742-43 Statement on Ethics of Dreamwork (of the IASD), 360
Sobel, Mechal, 528
Status Dissociatus, 211
Social anxiety disorder, 463
Steger, B., 188-89
Social Cognition and Object Relations
Steinbeck, John, 182
Scale, 112 Social network analysis of dream content,
726-29
Steinberg, L., 266 Stevenson, Robert Lewis, 183, 235, 278, 362
Solano, L., 321, 322
Stewart, Charles, 353
Somatostatin, 338, 617
Stickgold, Robert, 185, 656
Somniale Danielis (Middle Age dream
Sting, 431 Storytelling method (TSM), of dream in¬
book), 421-22 Sophocles, 130 Sound-work: the neglected sense in work¬ ing with dream images, 729-33
terpretation, 407 The Strange Case of Dr. Jekyll and Mr. Hyde (Stevenson), 183, 235, 278
South Pacific islanders animal dreams, 38
Stravinsky, Igor, 184, 431
Space in dreams, 734-37
Structural analysis of dream narratives,
Sparrow, Gregory Scott, 325, 404-5
744-45
Spearman rank correlations, 163
Sturzenacker, Gloria, 375-76
SPECT. See single-photon emission com¬
Subcortical structures in dreaming, role
puted tomography
of, 562-63
Spellbound (film), 130, 197
Subjective dreams, 467-68
Spencer, Baldwin, 1
Subjective experience across states of
Spinhoven, P., 26
sleep and wakefulness, 746-47
901
902
|
Index
Succubus, 351-54 Sudden infant death syndrome (SIDS), 176-77, 604 Suicide and sleep, 622-24 Sumerian dream beliefs, 748-49
Teenagers and sleep disordered breathing
(SDB), 642-44 Telemetric techniques, 152 Television consumption and dreaming,
411,767-68
Supernatural dreams, 800-801
The Tempest (Shakespeare), 508, 584
Survivors of the Holocaust and Rwandan
Tent of Bedouins, as dream portal, 74-75
genocide survivors, dream accounts,
749-51
Tetrahydrodeoxycorticosterone (THDOC). See Endocrinology of sleep
Svankmajer, Jan, 40
Thalamic reticular nucleus (TRN), 98
Swedenborg, Baxter and, 143
Theater and dreams, 739-42
SWS (slow-wave sleep), 211, 231, 249,
Theoretical models and neural basis,
250, 251,280, 281,330, 332-33 Symbol interpretation: Bedouin tradition, 75-76; in Istikhara, 370-71 Synchronicity, 123-24
768-70 Theory of mind and dreaming, 770-71 Therapist-assisted dream interpretation, 407
Synesthesia, 751-55
Thermoregulation and sleep, 633-35
Systemic lupus erythemotosus, 594
Threat simulation theory, 772-74
Szabo, Sarolta, 40
Three-factor model of dream classifica¬ tion, 195
Tabir (Muslim science of dream interpre¬ tation), 365 Tales ofSinuhe Ancient (Egypt), 33 The Talmud, 352
Tarkovsky, Andrei, 196 Tarotpy method, 757-59 Tartini, Giuseppe, 184 TAS-20 studies in alexithymia, 26-27, 29-30 Tau protein and sleep-wake cycle,
759-61 Tavistock lectures, 341 Taylor, Maggie, 495 Teaching courses on dreams, 761-65; dream course topics, 764-65; humani¬ ties and arts, 762-64; sciences and so¬ cial sciences, 761-62 Teaching dreams via dream lab, 766 Teachings of Ptahhotep (Egypt), 33 Teach Me Dreams (Sobel), 528
Tedlock, Barbara, 77, 221
Time of night (TN), 167 Time sense in dreams and sleep, 655-56 Tiwi people (of Melville and Bathurst Is¬ lands), 2 Tjukurrpa (creative period), in Kukatja
language, 1 Tonsils, evaluation of in patients with sleep apnea, 258-59 Traditional Korean dreams, 774-75 Traffic noise and autonomic arousals dur¬ ing sleep, 776-77 Tranquil Moments Plus white noise gen¬ erator, 805 Transcendent dreams, 269, 345, 777-79 Transcendent function: neurological sup¬ port (of Jung), 380-82 Transcranial direct current stimulation (tDCs), 789-91 Transcranial magnetic stimulation (TMS), 5, 791-92 Trauma and Dreams (ed. Barrett), 524
Index Trauma treatment and dreams, 166,
779-80
Vanilla Sky (film), 129
Vann, B., 221-22
Tress, Arthur, 494, 495
Van Nuys, D. W„ 321,322
Trobriand people, 190
Vasopressin, 332, 669, 724
Truk Islander animal dreams, 38
Veatch, James, 197-98
TSH (thyroid stimulating hormone), 626
Vedic culture (India), 541
TSM (storytelling method), of dream in¬
Veitch, Rick, 147, 310-11
terpretation, 407 Tuhkanen, Mikko, 391 Turtiainen, J., 12-13
|
Veterans of foreign wars, sleep problems,
703-4 Video game play and dreams, 795-800;
Twilight (Meyers), 279
alternate world of video games,
2006 Sleep in American Poll (National
797-98; dream bizarreness, 798; find¬
Sleep Foundation), 410-11
ings on nightmares, 798-99; lucid and
Tyler, Parker, 125, 130
control dreams, 797-98; research im¬
Type of waking-life experience (TYPE),
plications, 799-800
166
Virtual reality, 245, 268-69, 299 Visionary Women (Mack), 527
Uelsmann, Jerry, 494-95
Vision dreams of Native Americans, 443
Ullman method of group dreamwork,
Visual art and dreams, 800-803
783-87 Ultradian rhythms, 228
Vivid hallucination-like ghost tales (VH), 710
Un chien andalu (film), 130
Vogel, G„ 100
Unconscious and dreams before Freud,
Voices, 20
787-88
Voss, Ursula, 91-92
Unihemispheric slow-wave sleep (USWS), 661-65, 686 Universal Mobile Telecommunications Systems (UMTS), 244 University students, sleep patterns,
693-96
Wake-NREM-REM combinations, 211 Wake promoting systems, 539-40 Wake-REM combinations, 211 Waking life: ADHD symptoms in chil¬ dren, 62-63; aggression and gender
Upanishads (Vedic literature), 541
differences, 301-2; color perception,
Using dreams in cognitive-behavior ther¬
164; continuity hypothesis, 156-57,
apy, 793-94
165-67; and dreaming consciousness, 139; and dream interviews, 218; ef¬
Valli, K., 799 Van Beethoven, Ludwig, 184
fect of dreams on, 235-36; experiences
Van de Castle, R„ 13, 37, 55, 83, 139-41,
dreamwork, 309; Hill dream method,
186, 284, 301 Van den Bulck, J., 13
and effects on dreams, 166; and Gestalt 325-27; relation to dream life, 3-4; and REM sleep intrusion, 367
Van den Noort, Stanley, 96
Waking Life (film), 129
Van Eeden, Frederick Willem, 403-4
Waking Life (Sabiston), 40
903
904
|
Index
Waking-to-dreaming continuum function, 162
Wisconsin Sleep Cohort Study, 340 The Wizard of Oz (film), 128, 197
Waking visions, 20
Wohl, Helmut, 801
Watkins, Mary, 77
“The Wolf Man” (painting) (Midden-
Wayusa (dream sharing), 3
dorf), 197 Wolfsohn, Alfred, 733
We Are Near to Awakening, When We Dream That We Dream (photographic
Wollman, M., 83
image), 196
Women: adopted women’s dreams,
Welles, Orson, 183
17-18; dreams across the life cycle,
The Wellness Community (TWC), 105
806-8
Welty, Eudora, 183
Woolf, Virginia, 118
Western antiquity, sleep and dreams in,
The Word for World is Forest (LeGuin),
609-15 Western Arnhem Land, songs of the dreamer, 2 Western art, 801 Where the Wild Things Are (Sendak), 391
White, Minor, 494 White, Robert, 32 White Broom shrub (Bedouin psychoac¬ tive plant), 74
279 Work, effects of on sleep, 240-43 Work-family conflict sleep effects, 241 World Health Organization (WHO), 524 World Information Count (WIC) (Antrobus), 52 Wright, Richard, 391 Wuthering Heights (Bronte), 390
White noise and sleep, 805-6; EM sup¬ pression during REM sleep from, 273; reasons for effectiveness, 806; use as a masking device, 203-4 Wideband code-division multiple access (WCDMA), 244 Wilbrand, Hermann, 93 Wild Strawberries (film), 128, 197, 198,
Yawning, 809-10. See also Fetal yawning The Yellow Emperor’s Classic of Internal Medicine (Hippocrates), 323-25
“Yesterday” (Beatles), 184, 235, 431 “Young Night’s Thought” (painting) (Blake), 182
235 Wilson’s disease patients and sleep, 682-83
Zap Comix (comic strip), dream se¬
quences, 147
A Winter’s Tale (Shakespeare), 584
Zulu people, 190
Wisconsin Card Sort Task, 92
Zuni people, 219, 221, 222
The Evolution, Function, Nature, and Mysteries of Slumber Why do dreams change across a lifetime? Do animals dream? These are just two of the many mysteries concerning the state of sleep. Humankind has been fascinated with dreams since the beginning of time, and recent breakthroughs in sleep research and the study of dreams now reveal the scientific rationale for previously unexplained phenomena. While many books have been written on the subject, no other resource has provided the depth of empirical evidence concerning sleep and dreams, nor revealed the latest scientific breakthroughs in the field. Encyclopedia of Sleep and Dreams: The Evolution, Function, Nature, and Mysteries of Slumber explores the evolution, nature, and functions of sleep and dreams. The encyclopedia is divided into two volumes and is arranged alphabetically by entry. Topics include nightmares and their treatment, how sleep and dreams change across the lifetime, and the new field of evolution of sleep and dreams. While this book includes ample material on the science of sleep and dreams, content is drawn from a broad range of disciplinary contexts, including history, anthropology, and neuroscience. Deirdre Barrett, PhD, is assistant clinical professor of psychology, Harvard Medical School, Boston, MA. Her published works include Waistland: The R/evolutionary Science Behind Our Weight and Fitness Crisis; Supernormal Stimuli: Flow Primal Urges Overran Their Evolutionary Purpose; and Praeger's The New Science of Dreaming. Patrick McNamara, PhD, is director of the Evolutionary Neurobehavior Laboratory at Boston University School of Medicine, Boston, MA. He has published numerous articles and is the author of The Evolutionary Psychology of Sleep and Dreams and coeditor of Praeger's The New Science of Dreaming. Visit www.abc-clio.com for a complete list of our titles. Cover design by Silverander Communications Cover photos: Counting jumping sheep on the farm, illustration. (Wd2007/Dreamstime.com); Green graph brain wave EEG. (Dule964/Dreamstime.com); White pillow. (emrah_oztas/iStockphoto)
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