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.

For 23 years, Dresel bounced from doctor to doctor taking desperate remedies. She tried vitamins, acupuncture, injecting homeopathic medicine, walking, and every imaginable sleeping pill. But instead of getting better, her condition grew steadily worse. "She told me several times she attempted to jump off the bridge over the river, it got so bad," Howard says.

When HCMC's Schenk examined Dresel, he recognized her condition as a sleep disorder called restless-legs syndrome, which doctors believe is essentially a dopamine deficiency. Dopamine is one of several chemicals called neurotransmitters that convey electrical impulses from one brain cell, or neuron, to the next, in this case among the motor neurons. Schenk prescribed a dopaminergic drug, and the next night Dresel slept undisturbed.

Restless-legs syndrome is one of a set of parasomnias known as non-REM sleep parasomnias. They include sleepwalking, sleep terrors, and other "confusional arousals." Another non-REM disorder first described by Schenk and Mahowald, epic-dream disorder, almost always affects women: They dream nonstop of walking through mud or snow and wake exhausted.

If RBD suggests a mixture of REM sleep and waking states, confusional arousals are a mixture of non-REM sleep and waking states. A third disorder recently described by Schenk and Mahowald is status dissociatus, or "brain-in-a-blender." In this condition, Schenk explains, "basically all the major stages of sleep and wakefulness are intermixed." A polygraph on a patient suffering from this condition, commonly limited to chronic inebriates and people with unrelated brain disorders, will exhibit features of REM and non-REM sleep and wakefulness all at the same time. They spend their nights awake and asleep simultaneously--and they look it: twitching, jerking, dreaming, moaning, and speaking.

Observing these mixed states has led Mahowald and Schenk to a theory of brain states as simple as it is radical: that we cycle in and out of sleep and wakefulness constantly. In fact, we're never really completely awake or asleep. "It's very likely that dreamlike activity is going on continuously in both wake and sleep states," explains Mahowald. "During wakefulness our brains are paying attention to externally generated stimulation that suppresses awareness of dreamlike [thought]. When we lose external stimulation, when our brain does not or can not pay attention to it, the only thing the brain has to deal with is the spontaneously generated internal activity.

"Someone made the analogy: The stars are there all the time--during the daylight, and at night. It's just that we can't see them during the daytime. They are lost because of the intensity of the sunlight. Likewise, it may be that brain activity is going on, and we just can't pay attention to it."

Coy Replogle neveronce questioned his own sanity, and the first place he went for help was a sleep lab. In that, he's lucky. Many RBD patients find their way to HCMC after other doctors have given them wild diagnoses like "repressed aggression" or "familial alcoholic personality disorder." Until recent years, the medical establishment considered the parasomnias evidence of major psychiatric disturbance.

"Well, we started seeing adult after adult with terrible sleepwalking and sleep terrors," Mahowald says. "By observation, they did not appear to have any significant psychiatric problems. We undertook a systematic study. We had very detailed neurological and psychiatric and psychological studies completed on all these individuals, and in fact discovered that we had all been taught wrong. We found very little evidence of psychiatric disease. In fact, the most important determinant for being able to have a disorder of arousal is a positive family history."

Science has been slow to accept the idea that dreams are a function of genetics, not of psychoses--chemicals and electricity in the brain, not psychological problems. Indeed, there was a time when all these brain-based theories of dreaming were heretical.

For the past 100 years or so, the theories of Sigmund Freud have held sway (and in some quarters, still do). Freud held that dreams are the "royal road" to the unconscious, the inner self. Somewhere inside us, he theorized, is a primitive, instinctual self: our subconscious. During the day we repress the desires of this inner self. But at night these wishes (sexual and/or murderous more often than not) come out in our dreams (albeit disguised because, even asleep, they are too disgusting to face).

Some of the early brain-based explanations for sleep were just as erroneous. One physiologist suggested sleep was caused by a retreat of blood into the veins. Others have believed that our brain cells become saturated with water, that "sleep toxins" build up over the course of a day, or that some neurological sleep center regulated the entire process. Hundreds of theories like these have been proven false--a fact worth remembering when considering the current theories.

The stumbling block for all these ideas about sleep and dreams, Freud's included, is a lack of physical evidence. In fact, some of Freud's modern critics go so far as to say he deliberately ignored physiology to protect his theory from advances in neurobiology. You can't spend much time in a sleep-disorders clinic and keep up any faith in Freud.

"I think that the whole Freudian concept of dreams is on its way out fast," Mahowald growls. "Real fast. As well it should be. There's no science in it at all. We've seen our dogs and cats dream. Plainly our cats are not resolving deep psychological issues. Add the fact that in utero almost the entire existence is REM sleep; the fetus is probably not dealing with a bunch of psychologically significant stuff.

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