SLEEP WITHOUT DREAMS: DID WE SLEEP?

But everyone seems to know that they have slept, even though there is a blank in the memory during NREM sleep. How do we know that we have slept? We depend on two cues:

* Dreams, which are an inside cue

* The clock, which is an outside cue

When we wake from our dreams, we can recall the contents of the dream and we know that the dream is part of our normal sleep. Hence we are convinced that we have in fact slept. There are people who need to recall that they have dreamt before they are convinced that they have slept. Without dreams as a marker in the blank space in the NREM sleep, we are unable to give an account of what follows after the thought of ‘the wonderful lunch’.

The other cue is the clock. We look at the clock before we go to bed; it is 10.30 p.m. at night. We may wake up and go to the toilet, it is 2 a.m. When we wake up again and look at the clock it is 7 a.m. in the morning. Hence we are convinced that we must have slept about eight hours. Have you ever had the experience of the clock, for some mechanical reason, stopping at 6 a.m. in the morning, letting you believe that there was still an hour to sleep before your normal wake-up time. You go back to sleep, and later discover that the clock never went to 7 a.m.; the clock was not working! Too late, it was already 9 a.m. At night we are depending on the clock as an external cue, for during the NREM sleep our mind is blank.

A number of people constantly complain of chronic insomnia and always seek treatment. When they are placed in the sleep laboratory, however, the EEG and other recordings all confirm that I’ve been sleeping soundly. Yet, when they wake up, they insist they have not slept at all. These people cannot remember any dreams, and hence they do not have the inside cue to convince themselves that they have in fact been sleeping.

Most of us believe that we do in fact sleep. But this belief is not easily held in the absence of the dream experience or a visible clock. Those people who believe they do not sleep at night do so because they cannot experience sleep itself. All they can experience is the distress they feel while awake. I believe the blank period of NREM sleep is very important in understanding insomnia and overcoming it. People who suffer from insomnia nearly always underestimate the amount of sleep they really have. This is because individual’s own view of how much sleep he has is always inaccurate, as no one can recall how much NREM sleep he actually has.

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SLEEP WITHOUT DREAMS: NREM SLEEP

Biology of NREM sleep

We know there are two different kinds of sleep, and they alternate with each other throughout the night. During REM sleep dream are experienced, and during NREM sleep there are few or no dream at all. When we fall asleep we go through NREM sleep, then RE” sleep; these two combine to form one sleep cycle and we have few sleep cycles throughout the night. In this chapter we are going to study NREM sleep in detail.

In NREM or non-REM sleep there is an absence of rapid e movement as recorded by the electro-oculogram or EOG. The brain waves are also calmer, in contrast to those of REM sleep. During REM sleep, the brain waves are not much different from those the awake state. However, during NREM sleep the brain wav are slow and big and are divided into four stages according to the frequency.

During NREM sleep the mind is in complete rest, and is passive peaceful, and calm. In REM sleep, in contrast, the mind is active’ and explosive, and the whole brain is working to capacity. Some experts report a 40 per cent increase in the blood flow to the brain during REM sleep.

During NREM sleep, the breathing is slow and regular. The blood pressure is lower than when we are awake, and the heart rate also slower as if we are in complete rest. On the other hand, du ‘ REM sleep the breathing is very heavy, and irregular. The blood pressure can be sky-high and the heart rate can be as fast as we had just finished a 100 m race. It has been observed that a heart attack or stroke takes place during sleep at night, it occurs during the REM stage. However, the peak incidence of heart attacks is between 7 a.m. and 11 a.m. in the morning and not during sleep. So you can sleep easy.

What about the muscular system during sleep? During NREM •km the muscles are active and the muscular system is fully engaged with the brain. There are spontaneous movements in the body during NREM sleep. We turn over many times during the night. This movement is important. People who cannot move because of illness such as quadriplegia suffer from bedsores. They need to be turned by nursing staff continuously throughout the 24 hours. The reason is that if the body is not moving during sleep, the skin which is under pressure from the weight of the body will be blanched and the blood supply to that part of the skin will be insufficient. That area of skin will break down and slough off to form a bedsore. So it is important that the body turns automatically during sleep, turning and moving of the limbs prevents the stiff neck and joint pain that most people experience the morning after they en drunk the night before.

REM sleep the muscular system is disengaged, as if a mechanism is preventing the body from moving. This I the physical acting out of dreams. REM sleep is also called ‘paradoxical sleep’; the brain is so active and yet, paradoxically, the body is completely paralysed.

Is NREM sleep unconscious?

NREM sleep represents three-quarters of the time spent in sleep. Although a great deal of study has been carried out on the psychology is, no one has yet studied the psychology of NREM sleep, try to make amends here. Biologists and physiologists classify our state of awareness into two main types, the conscious state and the unconscious state. This grouping should not I with Freud’s concept of the conscious and unconsciouscious state is a state in which we are not aware of anything and from which we are not easily aroused. It includes such experiences as a black-out after a head injury, the complete blank while under general anaesthetic, and so on.

The conscious state, on the other hand, is a state in which we are continuously aware of what goes on around us or of what we are thinking. We can account for all events continuously. So we how we got out of bed in the morning, got dressed, t, went to work, said hello to the pretty secretary, worked hard, had a wonderful lunch with the secretary, went back to the office to work even harder, came home, had dinner, watched to bed (still thinking about the wonderful

lunch) … and then there is a blank, until we get out of bed again the next morning. (For the lady readers, please change ‘pretty secretary’ to ‘handsome assistant’, but note that the pretty secretary here just happens to be my wife!)

An interesting feature of the above is that we are able to give a continuous account until after our thoughts of ‘the wonderful lunch’. A blank follows. We are not unconscious, as we can be aroused easily. However, we are not conscious either, as there is a blank in the continuous account of the day’s event. This blank is NREM sleep, during which there is no thinking, no memory, and no account of what goes on, very much like the blankness we have when undergoing general anaesthetic. NREM sleep is classified under the conscious state because it is arousable, but it is much more like the unconscious state, as we have no thinking or memory and cannot give a continuous account of what goes on.

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SEX AND DREAMS: THE PENIS IMPLANT

The discovery of erection during REM sleep has helped progress the treatment of impotence. There are two main types of impotence. The first type arises for psychological reasons. It is well known that some men can have sex with their wives but are unable to with their mistresses, or vice versa. A variety of psychological reasons are involved, such as anxiety over the fear of being discovered an a sense of guilt, fear of catching venereal disease, etc. This psychological impotence is best treated by psychological means. The second type results from physical illness; after a bad accident or a major operation in the pelvic area, a man may not be able to have an erection at any time. A penis implant has now bee developed that can help those who are impotent because of physic illness. To sort out who is eligible for this implant, the impotent candidate has to spend a few nights in the sleep laboratory.

With the impotent candidate in the sleep laboratory, a gadget can be placed around the penis to record any erection occurring during REM sleep. This recording is called nocturnal penile tumescence or NPT, and a positive reading is a reliable indicator of psychological causes of impotence. In Melbourne, at the Cabrini Hospital, two strain gauges are placed around the penis and recordings are made on a scroll of graph paper running throughout the night. Patients who have positive NPT readings are having erections and are suffering from psychological impotence. Some times they can be woken up during an episode of REM sleep while they are having a dream erection. The mere demonstration of the ability to have an erection can give them tremendous confidence and their condition can sometimes be cured spontaneously as t’ now know that they are in fact potent.

Before the discovery of dream erections and the ability to measure NPT, most experts believed that 90 per cent of impotence resulted from psychological causes, and most impotent patients were s to see the psychiatrist. However, since the discovery of dream erections, there has been a complete change of attitude. The experts now believe that only about 50 per cent of cases of impotence arise from psychological causes, with the other 50 per cent being result of physical illness.

Patients who are impotent because of physical illness do not h positive NPT readings, and an implant may be able to reverse t’ status. There are now a variety of implants that can be surgically placed in the flaccid penis. One ingenious technique from the USA is to implant a long inflatable double sausage made of polyurethane into the penis. This is connected by thin tubes to a small bag ac as a reservoir of fluid and situated in the abdominal muscle is also connected by similar tubes to a small pump, rather like third testicle, in the scrotum. When the patient wants to have he can give his third testicle a squeeze, and the fluid is transferred from the reservoir to the inflatable implant in the penis to achieve a good erection. He can maintain this erection as long as his partner desires. When they have finished, all he has to do is give the third testicle another squeeze and a special valve allows the fluid to be transferred out of the penis. Nowadays these operations are performed all over the world.

What about women? The clitoris, the most sensitive part of the female genitalia, is the equivalent of the male penis. Developmentally, parts of the body undergo involution if they serve no purpose. An example is breasts in men, as they are not required to feed babies. During REM sleep, the clitoris goes into engorgement and hardening -penis in men. So for the lady reader, do not think – that dream erections refer only to men. Next time you wake up from a dream, feel your clitoris.

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