By Andy Mannix
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The picture gets even more puzzling when you factor dreams into the mix. Coy Replogle relates this dream: "My wife and I were out walking in the wintertime. There was snow on the ground. We were walking and came to a little slope down to a creek bed. I started down and I held out my hand to help her across the ice. Then my feet slipped up, and I went feet-first through the ice. The creek bed must have been 2 feet deep. I could see myself underneath the water and the ice, bubbles coming up. I knew I had to get out of there and the only way to do it was to break the ice. I flipped over on my hands and knees... and I woke up."
Experiments show which parts of the brain are active during such a dream: Even though his eyes are closed, he's hallucinated an entire snowy landscape. So his visual pathways are firing away. His motor pathways are active, too (everyone knows the feeling of slipping down a slope--or flying, or running, or trying to--in a dream). He also feels fear. The part of his brain that controls emotions is sparking.
Similarly, you can tell which parts of the brain are not functioning, especially when you look at hundreds or thousands of similar dream reports: Smell, taste, and sensations of temperature and pain show up rarely, if ever. Studies indicate that memory doesn't function, or that it operates differently when we are asleep. Also lacking from the dreaming brain is insight--we seldom realize we are dreaming.
One of the more radical theories, one supported by the everyday occurrences in the sleep lab, holds that we are literally insane when we dream. "Four or five times a night, roughly every hour and a half, we become clinically insane," writes Harvard researcher Bob Stickgold. "We begin to hallucinate. We see things that aren't really there. We hear voices when in reality no one is speaking. Stories unfold before us, around us, including us, and we are deluded, believing it all to be true. We become paranoid or filled with delusions of grandeur. Impossible things happen without notice. People appear and disappear and change into other people. One moment we're in Boston, the next in Paris and we accept it all as normal.
"If we did this while walking on the streets in the daytime, we could only hope that some kind person would lock us up."
But there's no sign of this delirium in Steve's room in the sleep lab. On screen, he appears to be utterly calm. While he sleeps, the techs hurry from station to station. Then a kind of peace settles over the lab as one by one the patients fall asleep. Faint snores filter through the tinny speakers on the TV monitor. Someone shifts and sends their polygraph pens scratching frantically. In bed and on paper, they drift in and out of REM sleep until morning.
It's been some 15 years since the HCMC sleep team saw its first few patients who acted out violent dreams. One of the first, Jones (again, not his real name), described his nightmares: One night he dreamed he was back in high school playing halfback with a tackle moving in on him. He woke up after he smashed into his dresser. Another night he dreamed he was driving a motorcycle. A second motorcycle was following him, trying to run him off the road. He kicked out at it--and struck his wife. He dreamed he was trying to shoot someone and woke crouched over the bed, sighting down an imaginary barrel.
The doctors couldn't believe he was really dreaming REM-sleep dreams. That would violate a basic rule: The body is paralyzed during REM sleep. Maybe it was sleepwalking, or some other non-REM problem.
Jones came into the sleep lab for observation. There, judging from his polygraph, he had a fairly normal night: wakefulness, slow-wave sleep, not much REM sleep, and some nighttime "arousals" during which the patient woke up and then quickly dropped back to sleep. But the lab tech described these waking periods as bizarre arousals. The man moved around, but he appeared to be sleeping.
When Dr. Mark Mahowald, the neurologist who runs the center, examined a videotape of the episodes and compared it to the polygraph, he was even more confused. "One of the technologists was in during one of these episodes and it was clear on the videotaped interaction that this patient had not been awake, but had in fact been asleep," he remembers. "He reported dreams that correlated and corresponded with the observed behavior. But if you just looked at the data--without the technician, without videotape--it looked like the patient woke up."
Jones's EEG was cranking away. So were his chin sensors, the ones that measure muscle tone. But he was clearly dreaming. "This guy sat up and threw punches," remembers Dr. Carlos Schenk, the staff psychiatrist. "But otherwise the evidence was overwhelming that he was in REM sleep."
Andrea Patterson, the sleep-lab manager, remembers the confusion. "I remember how difficult it was to look at the data and believe what I was seeing." What they thought they were observing seemed crazy: that Jones's brain had failed to jam the signals to his spinal cord. His muscles were jumping to his dreaming mind's commands. He was acting out his dreams.
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