dreamdeath

What better way to die than in your sleep?

What worse way to end your days than in the throes of a nightmare?

The experience of nightmare could foreshadow that of Hell. Maybe the "incubus" of old first inspired visions of the Inferno.

Sleep reminds us of death, but this misleads us. The outward inactivity of sleep conceals a vital, even active kind of life. Within the sleeper, while breathing and heartbeat continue, so does an interior consciousness quite unlike waking awareness of the external world.

Strange mentation can occur throughout sleep, but the stage of Rapid Eye Movement (REM) sleep gives rise to those most vivid events we call dreams--and nightmares.

The role dreams play in life remains a mystery. We seem to "need" REM sleep in a way distinct from our need for the deeper, restful slow-wave sleep of stages III and IV. We uncover signs of this when a drug that suppresses REM sleep abruptly stops. This sets off a surge of REM sleep--called "REM rebound," which can give rise to protracted dreams and nightmares.

I will never forget a patient of mine, seemingly eons ago, whose withdrawal from an MAOI (monoamine oxidase inhibitor) antidepressant caused her such nocturnal horror that she awakened others in the apartment building with her screams!

Other disturbances, like obstructive sleep apnea (OSA), can selectively deprive us of REM sleep, because that stage often gives rise to the most frequent episodes of apnea. These in turn interrupt the continuity of sleep with "arousals," mostly falling short of wakening, yet maybe preventing satisfaction of the need for that stage of sleep. Likewise, the deeper stages of slow-wave, non-REM sleep yield more disruptive respiratory events than the lighter, less restful stages (I and II). Thereby light sleep may come to comprise most of the apneic's night.

Deprivation of deep sleep appears to cause daytime somnolence.

What harm does deprivation of REM sleep cause? No one seems to know.

To our surprise, REM sleep deprivation can have beneficial effects, at least on depressed people. One can accomplish this just by cutting short the night's sleep, eliminating the latter half when most REM activity occurs.

Some drugs, such as the MAOI antidepressants mentioned above, can suppress REM sleep completely for months, maybe forever, without obvious resulting ill effects.

Theories persist, without much basis, that REM sleep funtions in