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.

"Sleep is of the brain and for the brain," he continues. "The only part of the body that benefits from sleep is the brain. In fact, it's one of the most important functions of the brain. It's clearly a neurological function."

Freud and psychoanalysis are being replaced by a sort of old-fashioned, "natural history" approach: Scientists observe natural phenomena, describe them, and draw inferences from their observations. Some scientists maintain dreams are utterly random: fantasy nonsense the higher brain creates, trying to make sense of the bursts of emotion, motion, and vision we experience as we sleep. Others wonder if dreaming serves a purpose, either preparing us for tomorrow or restoring us from today.

One of the more controversial theories is posed by Harvard psychiatrist J. Allan Hobson, who argues that dreaming is delirium. Portions of Hobson's work are untested, but he is immensely influential. Like Mahowald and Schenk, Hobson maintains that our brain states are always in flux. The chemical soup in our heads is boiling one minute, simmering the next--dreaming one minute, awake the next.

Mahowald figures dreaming gives our brains a workout. "If we don't use certain circuits in our brain for a long time they will change function," he says. "If you blind very young animals and keep them blind through an important part of the development of the visual portion of the brain, then un-blind them, they remain blind. So the nervous system requires appropriate stimulation at appropriate times; the integrity and working properties of the brain are dependent upon its being used frequently enough and intensively enough so these neural pathways remain functioning. So the most important function of sleep is a systems activation, if you will, where the brain systematically activates all necessary neural circuits and networks to keep them functioning at peak performance."

In other words, when we sleep, the brain shuts down the body, and one by one blasts the dust out of each of its functions: vision, emotion, etc.

Hobson takes this idea another step: Dreaming, sleeping, and wakefulness are no different than, say, paranoid schizophrenia or being in love. In other words, our very consciousness is a product of the chemical soup and the neuron electrical storm in our skulls. Or, as philosopher John Searle, the author of The Mystery of Consciousness, writes, "Everything in our conscious life, from feeling pains, tickles, and itches to--pick your favorite--feeling the angst of postindustrial man under late capitalism or experiencing the ecstasy of skiing in deep powder--is caused by brain processes."

It's an idea slowly creeping into the mainstream and it's at least as radical as the belief that we are controlled by our genes. It seems a given that eventually doctors will invent a drug that can replacethe feeling of the angst of postindustrial man under late capitalism with the ecstasy of skiing in deep powder.

It's Tuesday,the day staff at the sleep center gather around a conference table to eat sandwiches and chips and trade interesting cases and stories. Sitting around the table are experts in a range of fields: adult and child psychiatry, neurology, pediatrics, pulmonary medicine, and ear, nose, and throat. "These meetings are incredibly educational," Mahowald says. "We learn things every week that you'll never learn in books." They are also a step back from the unending rounds with thousands of patients, from the grind of overnight lab shifts--the humdrum sleep deprivation associated with a modern, public clinic.

Mahowald, slouched behind a deep stack of charts, calls the meeting to order. He runs through a half-dozen patients, most of them suffering sleep apnea or narcolepsy, checking in with the nurses for updates.

Then, a young pediatrician brings up a new patient, a child he discovered on his rounds at the children's hospital who is suffering from severe sleep terrors. Sleep terrors usually strike at the onset of sleep. Victims wake screaming, yet typically remember nothing of the dream that set off the panic.

This child, the doctor says, has persistent, nightly sleep terrors lasting up to an hour. A collective gasp escapes the group. Her father yells at her, trying to wake her up. (Groans.) Her mom picks her up, takes her into the bathroom, and puts a cold washcloth on her forehead in an attempt to make her more comfortable. A few nights ago, the child sat shaking in bed for three hours.

Mahowald's face is creased from doctors' hours. He's chronically hoarse, and speaks in a low voice. He is seldom without a full mug of coffee. For a sleep doctor, he appears tired. "You've got to get her on something that works right away," he says, naming a few medicines that might do the job. "Anything to stop the symptoms. Then you can sort out what might be going on later." It could be genuine sleep terrors, he says, or it could be a nighttime seizure. Lab observation should provide an answer.

The story is a grim reminder of the practical realities in the sleep center: The only theories worth considering are those that work. It isn't that he's not interested in the bigger theoretical questions, Schenk explains. "It's on my list, but I'm not there yet," he says. "I still have a backlog of 20 articles [to write] just describing the parasomnias and their treatments."

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