Sleep & Dreams

Nighty Night: Unraveling the Mystery of Dreams and Sleep Disorders

Reported by Alexandra L. Woodruff, Ivanhoe Health Correspondent

(Ivanhoe Newswire) -- Sweet dreams are made of these . Dreams have been a constant for all of human kind, but dreams have not always been kind to the humans who try to explain them. Dreams can be a portal into our emotional lives, and opening the door of dreams can be as easy as one, two, dream.

During sleep, people alternate between two stages: rapid eye movement sleep and non-REM sleep. During REM sleep, brain activity is similar to waking levels, and the brain consumes the same amount of energy as during waking hours. Heart rate and breathing become irregular, muscle control is lost, and body temperature is not well regulated and drifts to the ambient temperature. Non-REM sleep, also known as quiet sleep, is characterized by decreased brain activity and regular breathing and heart rate. Most vivid dreaming happens during REM sleep, but new research shows dreaming can actually happen during the non-REM cycle.1

Not all experts agree on the meaning or significance of dreams, but most agree all humans dream, regardless of whether or not they remember the subconscious short stories. People who are deprived of REM sleep will start dreaming in non-REM stages, tend to be more day dreamy during the day, and it's more difficult for them to focus. "Dreaming is a sensory, usually visual, experience during sleep, which has a narrative continuity and occurs without your conscious participation in the selection of that narrative and is a normal part of every human being's sleep," said Rosalind Cartwright, Ph.D., chair of the psychology department at Rush University in Chicago.2

She believes dreams are an integral part of a person's mood and emotional well being. "For the most part, the major effect is on mood regulation. I think that's what dreaming does for us. Its primary function is that it deals with emotional material, and it helps regulate it," Cartwright says.3

She has found patients who are very depressed have bland dreams that lack emotional content. The dreamers don't develop good story lines and don't remember dreams even when awakened during REM sleep. She says the dream system is simply not doing its job of dream regulation. "Some of them do manage over time to get their lives back together, and the dreaming then becomes more rich and interesting and handles the emotion better. Then it's not that they wake up in a depressed state anymore, they wake up with their mood improved as their dream life becomes more vivid and exciting," explains Cartwright.4

During conscious hours, people have so many distractions that emotions are pushed into the periphery. When someone is troubled with psychological disturbances like panic disorders, nightmares or post-traumatic stress disorder, she records their dreams in a sleep laboratory and later goes over them in the office to find relationships between their present life and their dreams. "Sleep is devoted to handling the emotional meaning of our experience and putting it into perspective with our past and our hope for a future." Cartwright says.5

Those who don't have access to a clinical dream therapist can use a few simple steps to help them use dreams to guide them through emotional stumbling blocks. Dream therapy is only useful when you remember dreams, and Cartwright suggests a routine to help conjure up the tales of the subconscious. First, choose a night when you can sleep in and do not have to wake to an alarm. This increases the possibility of waking up during REM sleep when most dreaming takes place. Go to sleep with the intent of remembering the night's dreams. Keep a pen and piece of paper next to your bed. When you wake up, keep your eyes closed, go over your dream's narrative in your head. Give it a title; this will help you remember the dream. Then write down everything you remember about the dream. Also, make notes about possible triggers for the images in the dreams. For example, if you watched a film the night before, those images could be incorporated into your dreams. After you have a collection, go back over the dreams, find patterns, and interpret the dream imagery according to your personal experience.

"You can't really apply any other system to understanding them except help the individual understand their own material, but they can do it pretty quickly, and once they begin to get a clue as to what they're saying to themselves and they're feeling about themselves in the dream life, then you can begin to work with them about how to improve it, how to feel more positive," Cartwright says.6

Sleep Deprived Society:
Insomnia, the most common sleep disorder, affects 20 percent to 40 percent of adults every year. More than 70 million Americans are plagued with sleep disorders, with 60 percent of those suffering from a chronic disorder. Both men and women battle insomnia, but it's more common in females and older adults. The American Academy of Sleep Medicine estimates that sleep disorders, sleep deprivation, and sleepiness add an estimated $15.9 billion to the national health care bill.7

The symptoms include difficulty falling asleep, waking frequently during the night with difficulty falling back asleep, waking up too early in the morning, and feeling unrefreshed from sleep. There are varying levels of the disorder, which include feelings of restlessness, irritability, anxiety, daytime fatigue and tiredness.

Transient and intermittent insomnia: The patient complains of an insufficient amount of sleep and doesn't feel rested after a night of sleep. There is little or no evidence that social and occupational function is impaired. The episodes may not require treatment, as they only last a few days. Chronic insomnia: The patient complains nightly of an insufficient amount of sleep and doesn't feel rested after a night of sleep, but unlike milder forms suffers have severe impairment of social or occupational functioning. These individuals should consult a sleep practitioner for an evaluation and treatment options, which include relaxation therapy, sleep restriction, and reconditioning.8

Addressing insomnia is vital for proper psychological and physical health. "We would say that sleep is just as important for overall health and quality of life as our physical activity and healthy diet," says Carl E. Hunt, M.D., director of the National Center on Sleep Disorders Research, which is part of the National Institutes of Health's National Heart, Blood and Lung Institute.9

But our modern, fast-paced life of round-the-clock operations are keeping proper sleep patterns at arm's reach. Before industrialization and electricity, humans relied on the rising and the setting of the sun to determine their sleep cycles. For thousands of years, humans have adapted their bodies to this simple, somewhat consistent light-dark cycle. "It's not too strong a term to say that our species is facing a biologic challenge associated with 24-7 operations, and this challenge is as strong a challenge as our species faced when they left temperate climates and started to go north and south to seasonal changes where you needed shelter and clothes and you needed to find ways to store food and so on," says Merril Mittler, Ph.D., a program director at the National Institute of Neurological Disorders and Stroke who has researched sleep for 30 years.10

Throughout a 24-hour period, humans' biochemical processes increase and decrease according to the amounts of ambient light. There are literally thousands of these biological processes determining everything from body temperature to reasoning speed to how fast we run and how we secrete. These cycles, called circadian rhythms, have nothing to do with psychology and are biologically mediated. The functions are determined by the master clock in the hypothalamus. Shift work and rapid travel creates an environment where humans are forced to be awake and alert at times when they are programmed to be sleeping.

"We are trying to have these people do these very important tasks at the absolute worst time, and their ability to do these tasks at the worst times does not change by training them better or paying them more or yelling at them if they fall asleep. That does about as much good as telling someone who is 5-foot-2 to grow 6-foot-6 so they can play basketball. We need techniques that can overcome the biological limitations that are associated with our circadian rhythms," said Mitler.11

Researchers do not know how often one can reset the clock or how quickly it can be reset. Mitler says the research and the solutions for dealing with these environmental changes are rudimentary at best. Through light manipulations and artificial environments, researchers can fool the circadian rhythms into believing they're in a different time zone. This could be effective for people involved with shift work, but difficulties arise when they have to leave the controlled environments. Stimulants and other pharmacological medications can be used only as a crutch to mask the difficulties of improper sleep. Scientists are now working to understand how the cells in the master clock communicate. Once this is established, medication or perhaps an implantable device could help alleviate circadian rhythm upsets. Mitler says the consequences cannot be overstated.

"It's not a joke, it's not curiosity science because most of the major transportation and industrial accidents as well as individual passenger vehicle accidents that kill people occur between the hours of midnight and six in the morning. They do not because it's dark out per say but because this period represents a period of increased vulnerability to areas of performance. Not only is the operator hurt or killed, but frequently the vehicle kills other people as well," said Mitler.12

Laboratory testing using genetic manipulations of fruit flies seems to show the need for sleep and the ability to work graveyard shifts is genetically determined. Scientists are working to isolate the genes and hope to eventually use the information to help humans adapt to this relatively new work schedule.

Scientists know sleep is a necessary human function, but they still don't understand exactly why we do it or what it is for. Scientists generally believe sleep is most likely a way for the brain to rest and recover from daily mental activity, similar to the way muscles relax after a physical workout. "The real function of eating is to supply nutrients, and the function of breathing is to take in oxygen and expel carbon dioxide. But we have no comparably straightforward explanation for sleep," wrote Siegel.

More than a decade ago, researchers found rats died with total sleep deprivation. The animals lost weight despite increased food intake and died 10 to 20 days faster than if they were totally deprived of food, but slept normally.13

Untreated sleep apnea puts humans at a greater risk of high blood pressure and its complications which include coronary artery disease, stroke and heart failure.14

"We don't know if insomnia is a risk factor for developing medical and psychiatric disorders, or is it that the insomnia and those other disorders are both a consequence of some other vulnerability or predisposition that's just not been well identified," says Edward Stepanski, Ph.D., from Rush University's Sleep Disorders & Sleep/Wake Research Center.

Extreme sleep deprivation has many consequences including personality changes, decreased memory, and cognitive function. In less severe sleep deprivation, there is a change in the way people address their jobs and job tasks, which leads to degradations in performance. "People feel they can't concentrate as well during the day. Their memory is not as good during the day, those kinds of things and then some mood change is the second major set of changes which are usually people wanting to be more socially withdrawn, being a little more depressed, low energy, irritable," Stepanski says.16

While research shows humans need sleep, it's not exactly clear what kind of sleep they need. Early studies found that people who were deprived of REM sleep became psychotic. These tests were later proved wrong after discovering the researchers used amphetamines to deprive the sleep. It's now believed the subjects were reacting to the amphetamines and not the REM sleep deprivation. Patients who are denied REM sleep don't necessarily exhibit abnormal behavior. The only well-established connection between REM sleep and mental illness is depression. Some antidepressants, in particular MAO (monoamine oxidase) inhibitors, actually suppress REM sleep to treat the disease.

"People on MAO inhibitors have this spectacular suppression of REM sleep where it's almost completely gone, and literally millions of people have been on MAO inhibitors, so if there was some striking or peculiar consequence of loss of REM sleep you would think we would know it from the MAO inhibitor studies. In fact, not much has been reported, certainly not much in the way of cognitive function. These people have normal emotions, normal learning abilities, and side effects are more on the physiological side," Siegel says.17

He suggests some people who suffer from insomnia simply have a decreased need for sleep. Humans who sleep seven hours a night tend to have a longer life span. "Existing evidence indicates that 'helping' people increase sleep time with long-term use of sleeping pills produces no clear-cut health benefit and may actually shorten life span," wrote Siegel.18

Epidemiological studies suggest that taking daily use of hypnotics like valium and other benzodiazepines can decrease your life span as much as smoking a pack of cigarettes a day. "I know of no study showing that hypnotic use prolongs life span and now two studies that suggest that it shortens life span. So, an important health issue is to try to counter the self-serving publicity of drug companies that say if don't get enough sleep you should go see your doctor, which means you should get a hypnotic. Because if it were harmless it would be one thing, but if it's going to shorten your life span then that is a great disservice to the public that may take 20 years to prove," says Siegel.19

Also, the hangover effect of these drugs could be just as detrimental as simply not getting sleep. He says the long-term effects still need to be studied, but there is no evidence to suggest that on a long-term basis these drugs are good for you.

Summoning the Sandman:

The first thing doctors must do for a patient suffering from insomnia is to determine whether there are any underlying medical or psychological problems triggering the insomnia. Behavioral and lifestyle changes are a proven effective way to promote sleep and restfulness without the use of prescription medication.20

Set a rigid sleep schedule seven days a week: It is important to wake up and go to sleep at the same time every day, to help set the internal clock that controls circadian rhythms. Stick to the schedule on weekends. People who struggle with insomnia can start with a reduced time schedule. To start, try sleeping at five-hour intervals every night. Then every week add 15-minutes to the sleep period until you are sleeping enough to feel refreshed in the morning. This sleep deprivation therapy can help reset the body's clock.

Don't waste time in bed: People need less sleep as they get older. Experts say there is no normal amount of sleep for an adult. If you can't sleep, don't stay in bed and worry about not sleeping. The worry and anxiety of sleeplessness can perpetuate the problem. Get up, find another activity, and don't go back to bed until you are drowsy. If stress is always associated with the bedroom, it will make it more difficult for insomniacs to relax and fall asleep.

Sometimes simply not worrying about insomnia can decrease anxiety and induce drowsiness. Set aside quiet time before bed: People with busy schedules often head to bed without sorting out the nuances of the last day and the tasks for the day ahead. Bedtime is the first time these potential stresses are addressed. Experts suggest sitting down an hour or two before bedtime and review anything that is bothering you. Try to work out solutions, so you don't have to deal with them when your head hits the pillow. Exercise not too close to bedtime can also help clear the mind.

Make the bedroom a place for sleep: Modern bedrooms are no longer a place just to sleep, they are a place to watch TV, play video games, work on the computer, and talk on the phone. The bedroom should be a sanctuary for sleep and sex. These other distractions can create an overstimulating environment in a place originally meant for rest.

Avoid stimulants and alcohol after twilight: Don't eat chocolate, coffee and other beverages with caffeine after 4 p.m. Smoking is also a stimulant that should be avoided around bedtime. Alcohol at dinnertime can make you feel sleepy, but it depresses the central nervous systems and will usually disrupt your sleep in the middle of the night. Also, talk to your doctor about certain medications that could interfere with sleep.

Learn and practice relaxation techniques and mechanical aids: Deep diaphragm breathing can slow down breathing and promote relaxation. Relaxation tapes can help guide people through relaxation exercises. Focusing on pleasant thoughts before bedtime can also be beneficial. Earplugs can help block out unwanted noise, and eyeshades can help block out light.

Physical activity before sleep: Walking or other light physical activity in the late afternoon or early evening will fatigue the muscles and raise body temperature. Some researchers have found that sexual activity triggers hormonal mechanisms that help enhance sleep.

Take a warm bath: One theory is that body temperature plays a role in the body's circadian rhythms. Some believe that the body begins to get drowsy as its temperature drops, so taking a warm bath four or five hours before will raise that temperature. When the temperature starts to drop, it will be easier to fall asleep.21, 22

Bright light therapy can help people suffering from a circadian rhythm disorder. People are exposed to bright lights at the beginning of the day to make them believe it is dawn.

"It's actually like a dose-response relationship, so you can get a less bright light for an hour, and you'll get the equivalent change in resetting your biological clock, as you would be getting more intense light for half an hour. Light intensity is measure by lux. We're usually thinking 5,000 lux for an hour, and 10,000 lux for half an hour. The best thing I tell people is just use sunlight as much as possible. Just get outside, get exposure to sunlight, and that's going to be the best light source you'll ever find," says Stepanski.23

Melatonin, which is a naturally occurring brain chemical, is available in most health food stores and has been proven effective in people who are doing shift work and have to fall asleep at odd hours of the day.24

Herbal remedies such as valerian root and kava kava are used to promote sleep, but scientists say there is little or no evidence that they are effective. Stepanski says the only studies that have positive results for the homeopathic remedies have not used a placebo group, so the findings are suspect at best.25

Soporific Strides:

Sleep still remains a mystery to the scientific world, but researchers are making strides to uncover sleep's enigma. Scientists are refining pharmacological medications, and sleeping pills are becoming more specific and refined. "They keep trying to find the perfect sleeping pill, something that will last long enough to keep you asleep the whole night without having any residual sedation into the day," says Stepanski.26

Mitler and his laboratory are studying genetic mutations in fruit flies. They are developing flies that have varying sleep needs. "It allows us to look at these genes, look at the protein products of these genes, and see if there are analogous genes in the human that we might be able to adjust or tweak for therapeutic reasons. I think we're close. I think there's a lot of conservation in the genetic machinery that controls the clock. Once we identify these genes, then we have to find how you experimentally turn them on or off because they do carry over from animal to animal," says Mitler.27

Scientists have also found people who tend towards insomnia have a predisposition to hyper-arousal, which means their body's physiologically ramp up more quickly and easier than others. Their heart rates increase and show other signs of stress like increased cortisol levels. This response does tend to show up in families and is possibly gene related. "What they need to do now is more sophisticated genetic testing to see if they really can identify that that's true. The problem you have with family history is that it could also be learned behavior," says Stepanski.28

A Canadian psychiatrist has found that pumpkin seeds have an unusually high rate of tryptophan and has developed a pumpkin-seed-based supplement to promote sleep. Tryptophan is a naturally occurring chemical that is found in most of the foods we eat. If it is properly metabolized, it will create seratonin in the brain when it is light and melatonin in the brain if it is dark.

Hudson estimates we eat 1,000 milligrams to 1,500 milligrams of tryptophan every day, but only about 3 percent of that ever goes into the brain. Researchers have also found when there is a lot of insulin in the blood, tryptophan can get into the brain more easily. Knowing this he developed a method for tryptophan to be released into an insulin-rich blood stream, which will direct the chemical reactions to create melatonin.29

Tryptophan supplements were banned in the United States in the late '80's after fatalities resulted from using the supplements, but Hudson says his supplement would be excluded from the ban. "We checked with the FDA regulatory person at the time, and they're quite explicit that tryptophan is acceptable in the States provided it's in an intact protein, that was specifically excluded when they banned tryptophan. Tryptophan within protein is acceptable," says Hudson.30

Initial studies show the supplement was effective in helping subjects sleep. The hangover affects in the morning are milder than pure melatonin because once the subject is exposed to light, the body switches and starts creating seratonin.

Blue light may be better than any other wavelength for bright light therapy. Researchers from Brigham and Women's Hospital in Boston and Jefferson Medical College in Philadelphia have found that the body's natural biological clock is more sensitive to the shorter wavelengths of blue light than the longer wavelengths of green light. Researchers exposed 16 healthy subjects to the same amount of blue and green light and found the blue light was twice as effective as green light in resetting the internal biological clock. Researchers believe the relationship could be related to the fact that under normal daytime circumstances humans are exposed to a blue sky.31

As researchers delve deeper in the abyss of dreams and sleep, science gets closer to the understanding the labyrinth of the subconscious. .

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week.
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ENDNOTES 1. Siegel, Jerome M. "Why We Sleep," Scientific American, November 2003.
2. Cartwright, Rosalind, Ph.D., Interview on September 3, 2004.
3. Ibid.
4. Ibid.
5. Ibid.
6. Ibid.
7. American Academy for Sleep Medicine. "Insomnia," www.aasmnet.org.
8. Ibid.
9. Hunt, Carl E., M.D., Interview on September 2, 2004.
10. Mitler, Merrill, Ph.D., Interview on September 2, 2004.
11. Ibid.
12. Ibid.
13. Siegel, Jerome M. "Why We Sleep," Scientific American, November 2003.
14. Hunt, Carl E., M.D., Interview on September 2, 2004.
15. Stepanski, Edward, Ph.D., Interview on September 3, 2004.
16. Ibid.
17. Siegel, Jerry, Ph.D., Interview on September 1, 2004.
18. Siegel, Jerome M. "Why We Sleep," Scientific American, November 2003.
19. Siegel, Jerry, Ph.D., Interview on September 1, 2004.
20. Gale Group, Inc., "Sleep Disorders Treatment," National Women's Health Resource Center, January 28, 2004.
21. Ibid.
22. MotherNature.com. "19 Steps to a Good Night's Sleep," http://www.mothernature.com
23. Stepanski, Edward, Ph.D., Interview on September 3, 2004.
24. Ibid.
25. Ibid.
26. Ibid.
27. Mitler, Merrill, Ph.D., Interview on September 2, 2004.
28. Stepanski, Edward, Ph.D., Interview on September 3, 2004.
29. Hudson, Craig, M.D., Interview on September 2, 2004.
30. Ibid.
31. Health & Medicine Week. "Circadian Rhythm: Blue light important for setting biological clock," Health & Medicine Week via NewsRx.com and News.Rx.net, September 29, 2003.

REFERENCES
American Academy for Sleep Medicine. "Insomnia," http://www.aasmnet.org
Church, Michael. "Dream On," The Times Educational Supplement, The Inside Story, no. 4590, July 2, 2004, p. 8.

Cudworth, Laura. "Ticket to Dreamland? Stratford Study Leads to Development of Natural Sleep Aid," Stratford Beacon Herald, March 14, 2003, p.3.

Forna, Aminatta. "About Last Night," Observer Magazine, May 30, 2004, p.20.

Health & Medicine Week. "Circadian Rhythm: Blue light important for setting biological clock," Health & Medicine Week via NewsRx.com and News.Rx.net, September 29, 2003.

James, Steven P., M.D., M.B.A., and Wallace B. Mendelson, M.D., "Herbal and OTC Sleep Remedies; Implications for Pschychiatry," Psychiatric Times, November 1, 2003, p. 72.

Gale Group, Inc. "Sleep Disorders Treatment," National Women's Health Resource Center, January 28, 2004.

Jones, Dr. Hilary. "Sleep Eazzzy," News of the World, July 4, 2004

MotherNature.com. "19 Steps to a Good Night's Sleep," http://www.mothernature.com/ Siegel, Jerome M. "Why We Sleep," Scientific American, November 2003.

Springen, Karen with Pat Wingen. "Anxiety: Sweet, Elusive Sleep," Newsweek, August 9, 2004.

Toto, Christian. "Sleepless nights; Relieving insomnia a restless pursuit," the Washington Times, April 22, 2003, p. B01.

If you would like more information, please contact: Biosential Inc. Craig Hundson, M.D. 416-421-7445 Toll free: 800-725-4538 http://www.biosential.com/

National Center on Sleep Disorders Research
Carl E. Hunt, MD, Director
301-435-0190

The National Institute of Neurological Disorders and Stroke
Merrill Mitler, Ph.D.
301-496-9964

Rush University Medical Center
Media Contact: Chris Martin
Associate Director,
Media Relations
312.942.7820 cmartin@rush.edu http://www.rush.edu/news/media.html

Rosalind Cartwright, Ph.D.
312-942-2020
rcartwri@rush.edu

Edward Stepanski, Ph.D.
312-942-5440

UCLA Dept. of Psychiatry
Neurobiology Research 151A3,
VA GLAHS, North Hills California 91343
Jerry Siegel Ph.D.
818-891-7711 Ext. 7581
JSiegel@ucla.edu
http://www.npi.ucla.edu/sleepresearch/index.htm

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