Sleep, Dreams and REM Sleep Behavior Disorder
Mahalia CohenThe discovery of rapid eye movement (REM) sleep suggested that sleep was not, as it was thought to be, a dormant state but rather a mentally dynamic one. Your brain is, in fact, very active in this state, almost to the level at which it is when a person is awake. Yet during this active stage in which most dreams occur, the movements of the rest of the body are completely stilled. To imagine this paralysis during dreams not occurring is a frightful image, since in many cases dreams are violent and active. When the neurotransmitters that control the movement of the body do not work properly the person develops REM sleep behavioral disorder (RBD).
While we are sleeping the sensory world is essentially revolving around us without our knowledge. Our senses of hearing, touch, taste, sight, and smell no longer function as they do when we are awake. Except for the threshold for each of these senses that each of us has while we sleep, our inner systems are working essentially free of input from the outside world. And yet people are able to have vivid dreams. The cortex can only pass into sleep mode with the help of the are of the brain called the thalamus. The thalamus is one of the two structures that make up the diencephalon, the lower part of the fore brain. Its main function in mammals is as the relay station of sensory information its way to the cortical center. Specific regions of the thalamus, as well as different nuclei process different sensory information on its way to the cortex.
In normal sleeping patterns a person usually passes through five phases of sleep, the fifth being REM. The sleeping human passes cyclically through these five phases throughout a night's rest. These phases can be defined in electrical activity of the brain; much like the activity of the heart is often defined. The technique of measuring the electrical activity of the brain is call Electro-encephalogram, or EEG. When the electrical events of a person's brain are graphed on a electrical magnitude versus time axis the graph of a person who is in different stages of being asleep or awake appear to have different levels of electrical activity occurring in the brain. (See (14) )
During the cycle of the phases each lasts for a different period of time during the time we are sleeping. The first stage is the lightest stage of sleep and is characterized by drifting in and out of sleep and slow muscle and eye activity. When people are awakened during this phase they usually have fragmented visual memory of what they were experiencing while asleep. The second stage is the one in which the most time is spent, close to fifty percent, during this stage three electrical activity, measured by electrodes, slows down except for infrequent bouts of rapid waves called sleep spindles. Stage three and four are considered stages of deep sleep, delta wave appear during phase three and are produced almost exclusively during phase four. Delta waves are extremely slow brain waves. Though there is no consistent eye movement or muscle activity during these two periods, they are the phases of sleep when some children experience bedwetting, night terrors, or sleepwalking ((12) ).
The next phase is REM sleep, after reaching stage four the pattern of progressively slower, larger brain wave and deeper sleep, reverses and sleep becomes lighter until the REM sleep state is reached. REM is the most active part of sleep, in which the rain waves, when viewed using EEG have a pattern the most similar to those of person who is awake. REM sleep and dreaming, which occurs mainly during REM, are triggered by the pons, a bridge that connects the brainstem with the cerebellum, and neighboring structures of the brainstem (See illustration ((10) )). A pathway originates in a group of acetylcholinergic neurons located in these rostral pons. These neurons project to the sensory areas of the thalamus and to the reticular nucleus. In the sensory areas of the thalamus control whether the gate that allows information from the outside world pass into the brain is open or closed. The acetylcholine produced by the pons' neurons sensitizes these neurons of the thalamus to sensory input by slightly depolarizing, and hence changing the level of potassium. By contrast the reticular nucleus is inhibited by the acetylcholine, as a result the thalamus lets sensory information through , and the cortex is highly active. This process is very similar to what occurs when a person is awake. In the other stage of sleep in which the brain is less active the system works in the opposite manner. The acetylcholine system is inactive, the reticular nucleus is uninhibited and can thus inhibit the thalamus, as a result the cortical neurons move in a slow rhythm , very different from the active state they are in while the creature is awake, or in REM sleep.
The majority of the Dreaming that occurs during a sleep cycle occurs during the REM or paradoxical sleep state. As described above the brain literally awakens internally during REM sleep. In a person with normal sleep behavior the REM sleep stage is one of near paralysis for the entire body other than the muscles of the eye and the middle ear. This occurs because of descending inhibition, in which a group of cells in the medulla that descend down the spinal cord and inhibit motor activity. RBD, rapid eye movement sleep behavior disorder, is characterized by the afflicted person acting out their dreams, which are usually violent in nature. The violent nature of these dream enactments is very distinct from the person's normal waking personality. This suggests that RBD is not only a motor control disorder, but a dream disorder as well. When the person awakens they can remember their dream vividly but cannot recall their physical actions during the dreams. Most of the incidents that occur within the dream are similar in affect to those that the individual was enacting, in one instance an adult male nearly strangled his wife while dreaming that he was saving her from drowning ((13) ).
The majority of patients afflicted with RBD though there are cases of females and children having this disorder. About 25% of diagnosed patients tested reported limb twitching, talking, yelling, jerking and a progressive decline in motor control during sleep ((9) ). These symptoms starkly contrast to the typical atonia, lack of normal muscle tension, which is associated with the REM phase of sleep. In very few isolated cases have any family history of RBD been found. In approximately half of the cases chronic RBD is associated with several different neuropathologies including: vascular insult, tumors, degenerative disorders, etc. In instances where RBD is not a consequence of some other affliction it may be a warning sign of Parkinson's disease.
RBD and other similar dissociative disorders bring up interesting questions about the self. In one respect an individual self is more active during these phases of sleep since there actions and functions are more similar to those that occur when that individual is awake, and supposedly has full use of the self. Yet during these sleep stages the individual loses awareness and control of there physical and mental self. The dreams that they experience, as seen in cases studies, are rarely attributed to what occur in their daily life, and thus are the vivid images are not provided for by their memory bank. Furthermore they have little control over their physical presence, which is controlled by the dream sequence and have no recollections of the actions that took place after they are awakened. These two opposing standpoints leave the question: is the self retained when awareness of the individuals own actions is lost?
WWW Sources1) The Study of Neurophysiological Mechanisms of Dreaming . By M. Jouvet and D. Jouvet
2) Paradoxical Sleep- A Study of its Nature and Mechanisms . By M. Jouvet
3) Paradoxical Sleep Mechanisms.  By M. Jouvet.
4) Why Do We Dream?  By Jarrett Carberry.
5) Sleep and Language 
6) Why Don't We Act On Our Dreams.  By Silvia Helena Cardoso, PhD.
7) The Science of Sleep and Dreams 
9)REM Sleep Behavior Disorder: A Neurologic Dissociative Sleep Disorder . By Niels C. Rattenborg.
10) Brain Briefings: REM Sleep .
12) Brain Basics: Understanding Sleep .
13) Slumber Interrupters 
14)Sleep stages in EEG 
I have a question that brought me to your Web site. Is it possible for vivid dreams to disrupt the normal functions during sleep? To rephrase, is there such a thing as the mind being too focused on the logical events of a dream that it fails to get enough rest? Sometimes I wake up in the morning after having a vivid dream and it's very difficult to get out of bed or I can't immediately focus on the world around me. This has occurred fairly often in the past two months, so I wanted to do some research. I'm not sure if you respond to individual e-mails, but I'd definitely appreciate it if you could reply. Greg Davidson
In response to the previous inquiry--sounds like you are having lucid dreams. Welcome to my world--I am experiencing a LOAD of problems due to this type of sleep.
AS THE ABOVE READER I TOO DREAM ALL NIGHT LONG. I WAKE UP SO EXHAUSTED I CAN HARDLY FUNCTION DURING THE DAY. EVEN WORSE THAN THAT I REMEMBER THE DREAM THE ENTIRE DAY AND IT I CLOSE MY EYES THE DREAM IS STILL GOING ON. WHEN I TELL PEOPLE MY DREAMS THEY THINK I'M CRAZY. MY HUSBAND HAS BEEN AWAKENED NUMEROUS TIMES TO FIND OUT WHO I AM TALKING WITH, ETC. MARY
I also have a very similar problem. Since I was a child I have always had very vivid dreams that feel like they last all night. Many times I talk (often panicked), sit up or stand up in the bed, get out of the bed, etc. The dreams in which I talk are typically nightmares like snakes in the bed, trapped somewhere, someone trying to "get" me, etc. The really frightening ones (devils, spirts, etc) often wake me. Not all of my dreams are bad, but many are. In the morning, I literally have to drag myself out of the bed. When I was an adolecent, my mom would try to wake me up in the morning to go to school and I would be so mean - just b/c I really did not want to get up b/c I was so tired. I can easily sleep 12 hours plus - dreaming the whole time - before I wake up on my own. I am really looking for a natural treatment so that I feel rested in the morning and get the restful sleep needed to be healthy.
After reading your article and the continued conversations at the end, I would also like to ask about "too much dreaming"...is my brain spending too much time in REM? I've read other articles that suggest diet has an affect (i.e. too much protein before bed). I'm a vegetarian and rarely get too much protein at any time of the day, so that can't be it. I'm considering finding a sleep research facility in my area and have an EEG run while I'm alseep to determine, in actuality, just how long my brain spends in REM and how long it spends in delta waves. Bring on the delta waves!
Hi, my husband is 28 years old and has had night terrors his whole life. We recently read in articles like yours that 40% of adults that suffer from night terrors go on to develop Parkinson's disease. Naturally, we are very worried about this. My husband wants to put off going to see a doctor or specialist for a year or so because this coming year will be a very busy and important one for him at work. But I keep trying to tell him that his health and emotional well-being is more important than work. Even if there is nothing the doctor can do to treat the night terrors, I feel that talking to a professional about it will help to ease his mind if he can get some answers about Parkinson's, etc. Ever since he found this information out, I can tell it is bothering him. How do I get him to go see a doctor? Thanks!
I have a 3 year old who can run for about 4.5 hours with very brief rest periods aprox. 3mins. He can not be in school because he is too active for the structured environment. I had to quit my job. He sleeps between 8pm - 9pm each noght.
He wakes up between 6am - 7:30am. He twicthes a lot when he is almost asleep. Not violently but I notice toes , fist and occassional his head twitch. When he wakes up in the morning, till about 11:30am, he will complain that he is soo tired. I thought it was boredom so I kept taking him to the park after he had painted, and done other projects he wanted to do. (that causes him to run /play for hours). I try to let him rest his body or sleep if he can before we go out. In any case immediately after he wakes up, he asks me if I am as tired as he is. He is always complaining that he is too tired. He is only 3 years old and this worries me. I am going to make an appiontment for him to see his pediatrician because I am confident he knows the difference between being bored and being tired. Any ideas? ... Catherine, 16 February 2006
I've had vivid dreams my entire life. I am 32 years old, so at least as far as I can remember. I used to have horrific nightmares growing up, and loud sounds like trains, or racing cars, for long periods of time. I've had several obe experiences, and have woken up only to see what can be described as ectoplasma in the shape of a human,leaving my presence. I've seen things standing above me that have taken my breath away, literally like it was actually sucking the air from my lungs. I could spend all night writing about my experiences, but I'm hoping to get a good night's sleep tonite, since I have a little girl who needs to be tended to. My most recent experiences outside of the dream world, have been hearing loud conversations directly in my ears, between two or more people speaking to each other. I feel like I'm awake and it can be very annoying, because I want to write down what they are saying, but I am not physically able to move, although I dream to be awake and get up to see if I'm really sleeping. Something similiar happened within the last year, where I heard loud music, almost as if I was in a church. It sounded like a soft worship song of a woman singing. A song I had never heard before, but was a beautiful sound. At first it was pleasing, but played over and over until I woke up. I waited to long to address it, then forgot what I had heard or made of for the lyrics. I can't find any reason for these occurances, but I would really like to find out as much info as possible. I am becoming more and more concerned now. Last night, it was two men talking to one another, and it was very loud for an extended period of time. Please respond. I don't take any medications, nor use mind altering drugs that would affect my sleep like this. I'm wondering if I need to seek a sleep disorder specialist, or I'm just tuned in to the spirit world. I don't know at this point. Thank you for your time ... Keli, 6 April 2006
hello, i've been taking the antidepressant, Effexor XR for over 5-years and experiencing vivid dreams, but mostly when i wake in the morning it takes 45-minutes or more to convince myself to get out of bed, and sometimes when i get out of bed i have feelings in my head that i'm going to drop from still being extremely tired. everyday this happens. shall i chalk it up to NOT being a morning person OR Sleep Behavior Disorder caused by taking Effexor XR? this is effecting my daily routine and being able to get to work on time. i can not stop taking the Effexor XR because i seem to be totally dependant on it. your opinion is greatly appreciated. my email is firstname.lastname@example.org ... Carlos Tomas, 26 June 2006
I am having a difficulty usually about 3 am. I think I am waking up while I am still dreaming. Real world superimposing onto the dream world. The best example of this I can give is a nightmare I had (my Mother was in reality standing in my doorway having a actual conversation with me) which I was concious of while I was also vividly dreaming a nightmare about someone who was killing people was superimposed over my room and Mom. I even told her the name that I was dreaming as I dreamed it. My worry is that this seems to be happening more frequently as I am getting older. Am I missing a vitiam or something? ... Anne, 15 August 2006
I also have the problems with my sleep that affects me alot like the people described here. I think I spend too much time in REM mode and it is really affecting my life. I have been dealing with this for over a year now and no one seems to be able to help. I was wondering if anyone on here has figured out exactly what is causing it? ... Faith Mrzlock, 25 August 2006
I experienced an awareness of the REM phase of sleep and it was very strange. I was lying in bed half asleep where I could not move but was aware that I was in bed. I moved my eyes to the left and heard and felt the wind sweep across the back of my head to the right side. I the moved my eyes to the right and the opposite happened. I thought maybe I was hearing the wind outside so I stopped and nothing happened. I then repeated it. The sensation across the back of my head felt good. Shortly after my eyes started twitching in different directions, not moving to the fullest extent in any particular direction. Along with the movement I felt zapping in my eyes. I then started to breathe faster and started to try to whimper so maybe my wife could hear me, but didn't make a sound. I then woke up with a little whimper.
I wanted to see if this is a known experience ... William, 22 September 2006
i have nightmares all the time and every time i shut my eyes to sleep, and during my dreams something bad happens, and it always ends at one section and the next night when i go back to sleep it carrys on where it left off and worst things happens it's just like a non- ending nightmare it's been going on for about 6 months know but i haven't told anyone yet no even my parenrts, okay well canu please email me and tell me what i can do thank you very much ... Elisabeth Carter, 19 October 2006
Hi. My name is Kayla. I'm 17 years old. And I have horrible nightmares. I honestly can't remember when I last had a good dream. I have these dreams that keep reocurring. Sometimes they'll stay for long. And then just go away. But they come back. And i'm very confused 'cause some of the dreams I have are really strange. And have nothing that I can relate to in reality. All of the dreams that i've had have always had my family and friends in them. Mostly my family. And something bad is always happening. But my dreams arent the same everytime I fall asleep. I fall asleep the first time and have the dream. And sometimes am so scared I wake up. But then if I can fall back asleep the dream continues. And it's the same dream. But everything get's harder. And every time I fall asleep and go back into the dream more occurs. For instance, in one of my dreams that i've had recently I'm in my room and my brother is standing next to my bed and I wake up and he's just staring into the hallway. And this guy comes in.. But he's nor a normal guy he's like rubbery texture. Like a mask. but his whole body is like that. And it's as if he comes from tv or a video game. But I have the instinct that I have to protect my brother. So I get up and fight him. And then after I kill him theres another guy that I have to kill. But it's always easy the first couple of times. But the more I wake up and then go back to sleep the harder they get to fight. And it's just odd because my brother just stands there not saying a word. Just watching. No emotion. I think the dreaming comes from somewhere. 'Cause my little brother also has Night Terrors. Horrible ones. Where he's half asleep and half awake. And it's so hard to calm him down because he doesnt see us as us. Normally were people that he's afraid of. And one time while one of his Night Terrors was happening my sister kept asking him what was going on and that time he kept repeating himself "They won't let me tell you, they won't let me tell you" While rocking back in form screaming and him trying to breath. But when he wakes up. He can't remember a thing. He's never been able to. And they used to be quite frenquent. But i'm not sure what exactly this all means. If at all possible, please email me back and try to explain. 'Cause some of the research i've been reading is scaring me ... Kayla, 18 January 2007
I have a friend and he just told me that over the past 6 months he has had very vivid dreams in the middle of regular activity during the day and they only seem to last a few seconds. He was in a parked car in the middle of the day and he looked out the window and saw sticks on the windshield and the moon coming through and thought he was in the woods when he was really on a street and a few sec. later it was over. Then one day he was driving and it happened again but this time he had clear recollection of sitting at the dinner table with his parents for a few sec. and when he came back he was still driving. I am concerned. He doesn't do drugs and is on no medication but he is anorexic and experiences some insomnia. Please help ... TJ, 27 January 2007
I have the same problem. I go to bed and I feel as though I'm in a very deep sleep. If I wake up at night I feel drowsy and it feels as though I've been in a deep sleep. Yet, in the morning, I wake up and I just so tired and I feel like I am not getting enough sleep ... Marisa, 7 February 2007
I have a problem to which I have no answer. Since childhood I can never remember actually dreaming and also cannot visualise or have no imaginative thoughts when i'm asleep and am wondering if there is a diagnosis for this condition as it truly does bother me. Please help me out on this one. I am a 38 yr old man am would like this problem solved ... Michael Alderman, 12 April 2007
I was recently hospitalized and was taken off my ADD Meds(Adderal-an amphetamine). I had been on this medication for several years. I roommate told me I talked a lot in my sleep. I don't remember this. Because I am aware that when I have discontinued this medication in the past I am more sexually driven, I am concerned that I may have acted out inapproriately. What are the chances of this happening? And what are the chances that I said embarrassing things while I was sleeping at the hospital? Would I have acted out in ways I never would while awake? It feels like I may have done somthing(s) that I should be embarrassed about! ... B. Oldham, 25 June 2007
MY HUSBAND YELLS KICKS AND SCREAMS ALL NIGHT LONG. WE HAVE TO SLEEP IN DIFFERENT ROOMS. HE SCREAMS SO LOUD THAT EVEN THE NEIGHBORS CAN HEAR. HIS SNORING IS ALSO VERY BAD. BUT NOT AS BAD AS THE YELLING ALL NIGHT LONG. IT PREVENTS THE HOUSEHOLD FROM SLEEPING. HE STARTED THIS ABOUT A YEAR AGO AND ITS VERY HARD TO TOLERATE. WHAT CAN BE DONE? ... Yvonne, 27 November 2007
I'd highly appreciate it if you could help me with a problem i have. Every month or so I have a sort of episode when i sleep. When it happens its like I'm aware of everything around me, (people talking, noises, ect.), but I'm in a deep sleep. I feel pressure on my chest and head, as if someone was pushing down on me, and i can't breathe for at least ten seconds. I try and wake myself, but anytime i can seem to get my eyes open its only for a quick second and then they automatically close again, back into the deep sleep. When i can finally bring myself to completely wake up, I'm gasping and usually crying. I'm sixteen, and generally all around healthy and i don't know what causes these episodes, or even what they are. I hope you can help. Thanks ... Christy, 27 December 2007