Rude Awakenings

Carol Dresel has restless-legs syndrome. Coy Replogle flails around and whacks his wife. Local sleep researchers hope to put such nightmares to rest-- and find out what dreams are made of.

A 30-year-old animal experiment finally confirmed the doctors' hunch. In the late '50s, the French neurologist Michel Jouvet cut the neurons that cause cats to be paralyzed during REM sleep. His findings, as summarized in the journal Neurology, were conclusive: "After adequate lesions the cat has dramatic... behavior during REM sleep, seeming to fight imaginary enemies or to play with an absent mouse, striking out with forelimbs and manifesting fear reactions.... During all this hallucinatory behavior, the nicitating membrane and the pupils are myotic, indicating that the animal is asleep."

What the cats couldn't tell the sleep-center doctors, but RBD patients have, is that the dreams are different, too. "It's not just a behavior disorder," Schenk explains. "It's also a dream disorder, because these patients enact unusual and violent dreams involving a lot of physical activities or confrontations with humans or animals. They don't act out their normal dreams."

A little tinkering and a happy accident led the doctors to a treatment. Jones twitched when he was trying to sleep. They treated his leg jerks with the drug Klonopin. "Lo and behold," says Schenk, "it worked on his RBD, too." He doesn't know how or why, but Klonopin jams the motion signals going from brain to spinal cord. Later, the doctors published their findings, first in the journal Sleep and then in the prestigious Journal of the American Medical Association, putting the HCMC sleep center on the map.

"We were very excited about it," Mahowald says. "But for many years it was called the 'Minnesota Disease.' People thought they weren't seeing it, when in fact they just weren't appreciating it. They would say that REM behavior disorder only happens in Minnesota. Now it's very well accepted."

For the patients who suffer from the disorder, the discovery and successful treatment of RBD is a relief. The rest of us learn some interesting information about our bodies. First of all, RBD illustrates why our bodies are paralyzed during the vivid dreams of REM sleep: because our brains are sending inappropriate messages to our bodies. If that is true, then it follows that the imagery of dreams, the movement we feel in dreams, is a result of motor neurons firing as opposed to something conjured by the psyche.

"A vital amount of the high energy that exists in REM sleep is devoted to inhibiting the muscles," Schenk explains. "It's like a taboo against movement. And that's very interesting because in non-REM sleep we still have muscle tone; there's passive withdrawal of the urge to move. So you don't need the muscle paralysis. If there's not going to be the urge to do something you don't need the inhibition. It's only when you have a strong urge to do something, i.e., in REM sleep, that you get the active inhibition of muscles."

So dream motion and waking motion are the same--but in normal dreamers, the signals never make it to the muscle. It turns out that "seeing" in dreams is a similar event. The structures in the brain that control vision are pulsing away, but no signals are coming in from the eyes. What we see in dreams are images generated by the brain itself.

None of this tells us why we dream. But it must be something important, because sleeping puts us at incredible risk. Imagine it: Not only are we paralyzed during sleep, but we're cut off from the world. When we're dreaming, we can't regulate our own body temperature. We can't see, feel, hear, or smell danger. Our brains are completely closed off, and at the same time scrambled with delusions and hallucinations.

When Carol Dresel was 30, right after the birth of her last child, she stopped sleeping. Or rather, she found herself unable to sleep because, suddenly and of their own accord, her legs began thrashing during the night. "There's no pain, no twitching, no aching," she says. "I just can not hold my legs still."

Her husband, Howard Dresel, suffered along with her. "She would thrash all the time," he says. "Very often she would turn herself completely around in the bed, head where her feet should be, feet up on the pillow thrashing all night long. She would just be on the move all the time. She just could never fall asleep. It was like, say you were lying down on your bed and your child poked you with a pin. You're going to just twitch; you're going to jerk. Or more like somebody walks up behind you and gooses you."

At first it only happened in the early evening. But over the years it got so bad she spent most of the night wandering around the house in a kind of trance. "I had to keep my body moving." From the bedroom she would roam to the kitchen, where she snacked on sweets compulsively, and often without any memory of having done so. Then she would continue wandering, down to the basement or out into the garage.

"One time I looked all over the house for her," Howard recalls. "In the garage, in the car. She was in the closet. It's just a little coat closet. There she was, wadded up in a ball in the fetal position trying to sleep. Five-thirty in the morning she would just drop. She'd wear herself out."

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