"I can't turn this around
I keep running into walls that I can't break down
I said I just wander around
With my eyes wide shut because of you
I'm a sleepwalker, walker, walker
Let me out of this dream...."
- Adam Lambert
Sleepwalking, insomnia, hypersomnia - the list of sleep disorders is long. Some, such as sleepwalking, occur mostly in children. Yet people of all ages, sexes and nationality have experienced sleep disorders throughout history. To fully understand sleep disorders, it is important to understand sleep itself.
There are two types of sleep: NREM and REM sleep. The first one stands for Non-Rapid Eye Movement; the second, Rapid Eye Movement. Normal sleep begins with NREM, which consists of three stages (previously 4 but you know those scientists!), followed by REM sleep. Sleep goes in cycles of NREM and REM throughout the period of time we are asleep. Keeping in mind there are 3 stages of NREM sleep, the "normal" cycle goes something like this:
1st stage NREM
2nd Stage NREM
3rd Stage NREM
2nd Stage NREM
REM is the "dream" stage of sleep. It is the shortest of the two types of sleep; in adults, about 90-120 minutes of sleep, or between 20 to 25 percent of sleep.
Starting at the beginning - with the first stage of NREM sleep. This is "light" sleep; the time when we can easily be awakened. A sort of half awake/half asleep state. The second stage is when we lose consciousness completely. This stage occupies about half of our sleep cycle all together. The third stage is known as the "deep sleep" stage. The cycle brings us back to the 2nd stage of NREM sleep, which is followed by REM, or dream, sleep. Each whole sleep cycle lasts about 90-110 minutes.
What sleep problems can occur at each stage?
Sleep walking, talking and bedwetting occur during the early parts of NREM sleep. Hypnogogic hallucinations occur during the first sleep stage. Sleep walking and bedwetting can also occur during the third stage of NREM sleep. Night terrors occur during this stage, too. In part, because "dreaming" in stage 3 NREM sleep tends to be disconnected, and more frequent than in the earlier stages of NREM sleep.
During REM sleep, that is the stage where vivid dreams occur and can be remembered more often.
Most sleep disorders either disrupt the sleep cycles or occur as a result of disruption in the sleep cycles. No matter how much or little sleep a person gets, as long as one is not drowsy or falling asleep during the day, one is getting a sufficient amount of sleep. Many external factors influences sleep - such as drugs, alcohol, caffeine, mother-in-laws, etc. Also, if you work different shifts, that, too, can affect your sleep cycles. It's like jet lag; our sleep cycles get out of sync. There's no synchronization between internal clocks and external daylight and darkness. Sleeping during the day after sleeping during the night can cause unpleasant changes in the cycles. People with seasonal affective disorder (SAD) experience symptoms similar to jet lag, too, only more severe. Physiological changes occur during each stage of the sleep cycle. Over 70 individual sleep disorders have been documented. The most common of these include insomnia, sleep apnea, restless leg syndrome, narcolepsy, and the parasomnias - those which occur during sleep such as night terrors, sleepwalking, sleep talking and bed wetting.
Sleep walking in adults occurs when the temporary muscle paralysis in REM sleep doesn't happen, causing the individual to act out behaviors during sleep. Narcolepsy - falling asleep suddenly at any time of day or night - is characterized by sleep paralysis, cataplexy, and hypnagogic hallucinations. Daytime sleep attacks occur without warning; night time sleep is fragmented. REM sleep frequently occurs at the onset of sleep, rather than after the stages of NREM sleep.
Sleep deprivation can cause depression and other psychological problems, as well as physical problems. People who don't get enough sleep double their risk of death as do those who sleep too much. Sleep is necessary for survival. Broken sleep impairs our concentration and memory processes. Sleep deprivation causes us to be more sensitive to pain, and magnifies the effects of alcohol and other depressants on our bodies.
The worst case scenario of insomnia is the disorder Fatal Familial Insomnia. It's a very very rare genetic disorder that causes a person to gradually lapse into total sleeplessness, and eventual death. It begins with increasing insomnia, which leads to panic attacks and anxiety followed by hallucinations and then the complete inability to sleep. Weight is lost rapidly, then dementia occurs, and finally, death. There is no known cure for this disorder, which affects about forty families worldwide.
A night eating syndrome is another rare sleep disorder, affecting mostly women. Late night eating binges occur, with no memory of the binges afterward. Nocturnal sleep related eating disorder is similar in that people go on eating binges when "asleep". It's connected to sleepwalking. Rather than eating "normal foods" the binges can involve weird combinations of foods or non foods, such as wood, or glue or other nonfood items. Buttered cigarettes and odd blender mixes are eaten, too.
I wanted to touch on hypnagogic hallucinations a moment in case anyone doesn't know what they are. These are brought on in the half sleep, half awake stage of sleeping. Hypnopompic hallucinations occurs in waking from REM sleep. These contain frightening and confusing images and situations, mostly nonsensical, along with a state of sleep paralysis. Both are accompanied by sleep paralysis, which can make one feel suffocated, or crushed while one is still asleep. Intense emotion, the presence of an unseen "entity" are common. This has also been an explanation used for "alien abduction" reports.
Dealing with sleep disorders is another whole column in itself, one which I'll leave to next week. We'll look at what works and what doesn't work in dealing with the common sleep disorders. We will also look at some self help treatments that may work, and when it is best to go to a doctor or sleep specialist or therapist for some disorders.
"Let me out of this dream...."