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The article by Leon Grinberg, titled “Dreams and Acting Out,” published in the Psychoanalytic Quarterly in 1987, explores the complex relationship between dreams and the phenomenon of acting out within psychoanalytic theory and clinical practice. Grinberg proposes a nuanced framework for understanding different types of dreams and their inverse relationship to acting out behaviors. His discussion integrates Freudian and post-Freudian psychoanalytic thought, providing insights into the dynamic processes of the psyche as observed in psychoanalytic treatment.
Grinberg categorizes dreams into three main types:
evacuative, mixed, and elaborative, based on their functions and characteristics:
Grinberg’s discussion extends to the role of dreams in the psychoanalytic process, emphasizing their importance as clinical indicators of the patient’s level of regression, capacity for insight, and progress in treatment. He integrates concepts from Freud, Melanie Klein, and Bion, among others, to elaborate on the transformative power of dreams in facilitating psychic work and working through.
The relationship between dreams and acting out is further explored, with Grinberg noting that a greater production of dreams, particularly elaborative ones, is inversely related to the tendency to act out. Acting out is seen as a failure to process and integrate painful emotions and experiences through psychic work, leading to their enactment in behavior. Grinberg illustrates this dynamic with clinical examples, demonstrating how understanding and working with dreams can provide crucial insights into the patient’s internal world and facilitate therapeutic progress.
The phenomenon of vivid and lucid dreaming in narcolepsy, characterized by a blend of wakefulness and REM sleep intrusions, presents a fascinating and complex topic for exploration within the context of dream science and consciousness studies. Narcolepsy, a sleep disorder marked by excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations, offers a unique window into the mechanics of dreaming and consciousness. This condition exemplifies how the intrusion of REM sleep phenomena into waking life can blur the traditional boundaries between the dream world and reality, thereby enriching our understanding of the subconscious mind.
Narcolepsy disrupts the normal sleep-wake cycle, causing elements of REM sleep, such as vivid dreaming and muscle atonia, to occur during wakefulness. This results in a direct portal into the dream world, which is usually hidden from our conscious experience.
From a psychological perspective, narcolepsy could be seen as a manifestation of the unconscious mind breaking through the barriers that normally separate it from conscious awareness. The vivid dreams and hallucinations experienced by narcoleptics are rich with symbolic content, offering insights into the personal and collective unconscious.
The content of these vivid dreams and hallucinations could be interpreted as expressions of repressed desires or unresolved conflicts, making narcolepsy a fascinating condition for psychoanalytic exploration. The dreamer’s ability to remember and reflect on these experiences provides a unique opportunity to analyze the workings of the subconscious mind.
This condition also raises interesting questions about the nature of consciousness and the experience of reality. Lucid dreaming, in which the dreamer is aware that they are dreaming, becomes a more common occurrence, suggesting that the boundaries between conscious and unconscious states are more permeable than previously thought.
The therapeutic potential of these vivid dreams and hallucinations should not be overlooked. They can serve as a creative wellspring, inspiring artistic and problem-solving breakthroughs. By examining the content of these dreams, we can also gain insights into the dreamer’s emotional state and psychological needs.
The frequency and vividness of dreams in narcolepsy could provide valuable data for dream research, challenging existing theories about the function of dreaming. This might lead us to reconsider our understanding of why we dream and what role dreams play in cognitive and emotional processes.
It’s crucial to consider the neurological underpinnings of narcolepsy and its impact on the brain’s architecture of dreaming. By studying how narcolepsy alters the normal patterns of sleep and dreaming, we can learn more about the brain mechanisms that govern these states and how they intersect with consciousness.
In conclusion, the phenomenon of vivid and lucid dreaming in narcolepsy not only offers profound introspective insights and spiritual experiences for individuals but also serves as a valuable lens through which scientists and scholars can explore the intricate relationship between dreaming, consciousness, and the subconscious mind.
picture by DALL-E2
DR George Northoff in his book “neuropsychoanalysis in practice” discusses the question of why dreams appear so real and vivid, and why they contain objects. The author suggests that the brain is predisposed to creating a sense of space and time, and that this is what makes dreams feel so real. Additionally, the author suggests that the objects in dreams are created by the brain based on memories of past experiences.
* Rest-state activity in the brain: The author suggests that different levels of activity in different parts of the brain during sleep may lead to different dream experiences.
* Phenomenal space and time: This refers to the subjective experience of space and time, which is created by the brain. The author suggests that this is what makes dreams feel so real.
* Rest-stimulus interaction: This refers to the way that the brain interacts with external stimuli while we are awake. The author suggests that a similar process occurs during sleep, but with internal stimuli instead of external stimuli.
* Brain-object differentiation: This refers to the process by which the brain distinguishes between itself and the external world. The author suggests that this process also occurs during sleep, but that the objects in dreams are internal rather than external.
The author concludes by suggesting that the reason why dreams seem so real and vivid is because the brain is constantly creating a sense of space and time, and that the objects in dreams are created based on memories of past experiences.
It is important to note that this is just one theory about why dreams occur, and there is still much that we do not know about them.
*Key Points
* *Focus on Neuroscience:* Our Website approach often looks at dreams through a neuroscientific lens. He investigates the physiological and neurological changes that occur during dreaming to understand why they happen. This approach aligns with the theory explaining how differences in brain activity affect dream experiences.
* *The Brain as Author:* Both the image’s theory and Our Website approach likely agree on the idea that the brain is the primary creator of our dream experiences. The brain draws on memories, sensations, and emotions to construct the dreamscape.
* *Exploration of Dream Realism:* Our Website approach has likely explored questions similar to why dreams feel so real. This focus ties into the text’s exploration of “phenomenological space and time” – the brain’s way of creating a sense of reality within the dream.
Below are some notable works by Dr. Georg Northoff:
The exploration of sleep disorders such as REM Behavior Disorder (RBD), narcolepsy, sleep paralysis, and hypnagogic hallucinations reveals a complex interplay between neurological processes, autoimmune reactions, and the creative depths of the human mind. These conditions not only present significant challenges for those affected but also provide valuable insights into the functioning of the brain during sleep.
It particularly highlights the concept of double consciousness, where the perception of reality coexists alongside a dream world
REM Behavior Disorder (RBD) and Its Neurodegenerative Links RBD is characterized by the failure of the brain’s mechanisms to maintain paralysis during REM sleep, causing individuals to act out their dreams. This disorder predominantly affects older adults and has been linked to an increased risk of developing neurodegenerative diseases such as Parkinson’s disease. The connection between RBD and literary figures like Don Quixote highlights a long-standing curiosity about the disorder. Research, such as the study by Postuma et al. (2023), emphasizes the predictive value of RBD for neurodegenerative diseases, suggesting that early identification of RBD could lead to potential interventions to slow or prevent the onset of these conditions.
illustration with DALL·E 2
Narcolepsy and Its Autoimmune Underpinnings Narcolepsy is marked by symptoms such as inappropriate sleep paralysis and cataplexy, reflecting a malfunction in the regulation of sleep and wakefulness. The discovery of the autoimmune destruction of hypocretin-producing neurons in the hypothalamus, as discussed in research by Black et al. (2023), offers a deeper understanding of narcolepsy’s etiology. This autoimmune perspective opens new pathways for therapeutic approaches aimed at targeting the underlying causes of narcolepsy, rather than merely managing its symptoms.
Sleep Paralysis and Hypnagogic Hallucinations: A Dual Perspective Sleep paralysis, experienced by both the healthy population and more frequently by those with narcolepsy, manifests as an inability to move or speak during the transition between sleep and wakefulness. Accompanied by vivid, often unsettling hallucinations, sleep paralysis represents a disruption in the normal sleep cycle, with Jalal’s (2022) neurocognitive model suggesting a key role for disturbances in REM sleep. Hypnagogic hallucinations, on the other hand, are seen as a manifestation of the brain’s creative potential, with research by Mallett (2023) linking these experiences to creativity and altered states of consciousness. These hallucinations challenge our perceptions of reality and highlight the brain’s capacity for imagination and problem-solving.
RBD and Neurodegenerative Links:
Narcolepsy and Autoimmune Insights:
Sleep Paralysis – A Neurocognitive Model:
Hypnagogic Hallucinations – Creativity and Consciousness:
The central myth of human culture, and particularly of Western culture, is the victory over and taming of the beast, even killing or sacrificing it. The god, the ancient king, and the hero are depicted as those who can conquer the primal beast and dominate it, or as accompanied by a beast they control, symbolizing their power.
Human consciousness fundamentally requires the suppression, weakening, restriction, and even denunciation of the animalistic-instinctual elements because they symbolize the unconscious power threatening to take over. Consciousness is built by strengthening the control of consciousness over the instincts within the psyche. In Western cultures, the beast as a symbol of physical instincts is considered inferior. Many parts of the body are deemed impure; the organs of excretion, body secretions, and menstrual blood. The distinction in Judaism and other ancient cultures between an impure and pure animal is one way to differentiate between the threatening and the positive elements of the beast. Purification rituals related to the body help to accept the physical and neutralize its negative quality.
Animals symbolize in myths, legends, and dreams the unconscious instinctual-impulsive-physical-sensory aspects of ourselves that belong to the realm of the body. Freud called them ‘id’, and Jung called them ‘shadow’, with which we come into the world. The tendency is to regard the ‘id’ and ‘shadow’ as negative, although in the natural kingdom of the psyche, nothing is inherently good or bad.
Therefore, as compensation for this view, stories have emerged that restore value to the body’s beast: in healing tales, often the animal the person encounters is their guide. It shows them the way. One may need to learn to accept the beast with its repulsive parts to reveal its quality nature. Thus, in the story ‘The Frog Prince’, where the girl has to kiss the frog and then he is revealed to be a prince. And in the tale ‘Beauty and the Beast’, where what seems ugly and beastly is redeemed through love. This is the alchemical transformation of the beast’s inferior element into its noble aspect. In these instances, the beast symbolizes the person’s shadow aspect, which they learn to live with peacefully and discover its beneficial qualities.
Sleep paralysis is a phenomenon that manifests at the boundaries of wakefulness and sleep, characterized by a temporary inability to move or speak while transitioning into or out of sleep. This state is marked by the individual’s consciousness of their surroundings paired with a form of paralysis akin to the muscle atonia typically experienced during REM (Rapid Eye Movement) sleep, which prevents the enactment of dreams. Notably, sleep paralysis can also be accompanied by vivid hallucinations, categorized as hypnagogic when occurring before sleep and hypnopompic upon awakening. These hallucinations often include sensory experiences of sight, sound, and touch, such as seeing moving figures or feeling an oppressive weight on the chest, historically depicted in art and literature as demonic or supernatural encounters.
Despite its potentially frightening nature, sleep paralysis is generally considered benign, occurring sporadically in healthy individuals. However, it is more frequent among those with narcolepsy. Sleep paralysis can manifest intensely, provoking significant distress, characterized by feelings of entrapment in a liminal space between reality and imagination, with the afflicted unable to move or seek help despite being cognizant of their hallucinations.
The phenomenon has been linked to various factors, including the disjunction of dream components during wakefulness, such as paralysis and the generation of hallucinations. This aspect of sleep paralysis is of particular interest to scientists, as it provides insights into how the healthy human brain can produce hallucinations, thereby contributing to our understanding of similar phenomena in psychopathological conditions like psychosis and delirium.
The underpinnings of sleep paralysis are rooted in the brain’s mechanisms governing muscle atonia during REM sleep, as demonstrated by Michel Jouvet’s experiments in 1979. Jouvet’s work with cats, which involved disabling the brainstem areas responsible for sleep paralysis, revealed that the absence of this paralysis allowed the cats to physically act out their dreams, suggesting that muscle atonia during REM sleep serves to prevent the enactment of dreams, thereby safeguarding the sleeper from potential harm. This mechanism is believed to facilitate the processing of instincts and emotions in a safe environment, free from the constraints of physical reality.
Furthermore, sleep paralysis has historically been associated with other phenomena, such as out-of-body experiences and sensations of floating, which have been interpreted through mystical and supernatural lenses. The scientific exploration of sleep paralysis challenges these interpretations, proposing a neurological basis for these experiences and underscoring the complexity of the human brain’s function during different states of consciousness.
sleep paralysis represents a fascinating intersection of sleep physiology, neurology, and psychology, offering a window into the mechanisms of the sleeping brain and the boundaries between the conscious and unconscious mind. Its study not only illuminates the biological underpinnings of this common phenomenon but also enhances our understanding of human cognition, dream states, and the nature of consciousness itself.
The phenomenon of sleep paralysis provides a compelling glimpse into the complex interplay between consciousness and the physiological mechanisms of sleep. This state, which straddles the realms of wakefulness and sleep, is a manifestation of the brain’s intricate control over the body, particularly during the REM phase of sleep, which is characterized by vivid dreaming and muscle atonia. The temporary paralysis experienced during sleep paralysis reflects this protective mechanism, designed to prevent the physical enactment of dreams, ensuring the sleeper’s safety.
The occurrence of vivid hallucinations during sleep paralysis—hypnagogic as one falls asleep and hypnopompic upon awakening—further underscores the nuanced relationship between the brain’s perceptual and motor systems. These hallucinations, which can range from benign to intensely frightening experiences, serve as a testament to the brain’s powerful capacity for generating sensory perceptions in the absence of external stimuli. This aspect of sleep paralysis is particularly intriguing for its potential to mimic the hallucinatory experiences associated with certain psychopathological conditions, offering a naturalistic window into the study of hallucinations and their neural substrates.
Michel Jouvet’s foundational experiments with cats in the 1970s highlighted the biological necessity of REM-induced muscle atonia, revealing the potential consequences of its absence. These findings underscore the evolutionary significance of sleep paralysis as a mechanism to facilitate the safe processing of emotional and instinctual content during dreams. By inhibiting physical movement, the brain creates a virtual reality where scenarios can be played out, experiences can be simulated, and emotions can be processed without the risks associated with real-world interactions.
The association of sleep paralysis with phenomena such as out-of-body experiences and sensations of floating suggests a broader spectrum of consciousness experiences that occur at the interface of sleep and wakefulness. These experiences, often framed within supernatural or mystical contexts, are increasingly being understood through a scientific lens that acknowledges the brain’s capacity to generate complex perceptual states under specific conditions.
Sleep paralysis, therefore, represents more than just a peculiar quirk of sleep. It is a window into the profound capabilities of the human brain, offering insights into the nature of consciousness, the architecture of dream states, and the psychological underpinnings of our experience of reality. The scientific exploration of sleep paralysis challenges traditional interpretations of these experiences, advocating for a neurological understanding that respects the complexity and adaptability of the brain. Through this lens, sleep paralysis is not only a subject of scientific inquiry but also a reflection of the broader human experience, encapsulating the mysteries of the mind and the boundless landscapes of the human psyche.
The phenomenon of sleep paralysis has been extensively studied and documented across various cultures and scientific disciplines, offering a rich body of knowledge that spans neuropharmacology, cultural interpretations, and clinical management strategies.
Sleep paralysis is typically associated with the REM phase of sleep, characterized by muscle atonia which prevents movement in response to dreams. This state can result in a dissociation between perception and motor control if the individual achieves wakefulness, leading to the characteristic inability to move or speak. This condition has been linked with various factors, including narcolepsy, parasomnias, and sleep-wake disorders.
A systematic review exploring the lifetime prevalence rates of sleep paralysis highlights its commonality among the general population, with increased frequency observed in students and psychiatric patients. The condition can cause significant distress, notably when accompanied by vivid hallucinations and a sensation of pressure on the chest, often described in cultural lore as the “nightmare” or the incubus phenomenon.
Research into the neuropharmacology of sleep paralysis has pointed towards the serotonin 2A receptor’s role in the hallucinatory experiences associated with this condition, suggesting potential avenues for therapeutic intervention. Cultural interpretations vary widely, with some societies attributing sleep paralysis to supernatural causes or experiences, while others recognize it as a medical condition. This disparity underscores the importance of understanding sleep paralysis within both medical and cultural contexts.
The relationship between sleep paralysis and lucid dreaming has also been investigated, with studies indicating a significant correlation between the two phenomena. Both are connected to REM sleep but differ in emotional tone and perceived controllability. Furthermore, strategies for the prevention and disruption of isolated sleep paralysis episodes have been studied, though research in this area remains limited and calls for standardized methods of examination.
Additionally, the role of the right superior parietal lobe has been explored in relation to the “bedroom intruder” hallucinations experienced during sleep paralysis, suggesting a neurological basis for the phenomenon alongside the cultural constructions of these experiences.
This multidisciplinary exploration into sleep paralysis reveals it as a complex condition influenced by both biological mechanisms and cultural interpretations. It underscores the need for continued research to better understand its causes, manifestations, and treatment options within varied cultural contexts.
From an art theory perspective, lucid dreaming can be seen as a form of ultimate creative expression, where the dreamer, aware they are dreaming, becomes both artist and audience to the unfolding narrative of their dream. This aligns with the concept of the “artist’s mind” as a space of limitless potential, where imagination is unbounded by physical laws or societal constraints.
Theatre theory provides a lens to view lucid dreaming as a performative and narrative space, much like the stage, where the dreamer assumes multiple roles—director, actor, and spectator.
By viewing lucid dreaming through the prisms of art and theatre theory, we gain valuable insights into its role as a space for creative exploration, narrative construction, and self-expression. These perspectives highlight the dream state’s potential as a canvas for artistic inspiration and a stage for existential and emotional exploration. Lucid dreaming, in this light, is not just a psychological phenomenon but also a profoundly creative and performative experience that intersects with the realms of art and theatre, offering endless possibilities for exploration and expression.
Interdisciplinary Connections: The dialogue between lucid dreaming and art theory can be enriched by incorporating insights from psychoanalytic theory, particularly those of Sigmund Freud and Carl Jung. Freud’s concept of the dream as the “royal road” to the unconscious offers a foundational understanding of how dreams can serve as a medium for exploring repressed desires and deep-seated emotions. Jung’s emphasis on the collective unconscious and archetypes further complements the analysis, suggesting that lucid dreaming can access universal symbols and motifs that resonate on a broader cultural and artistic level. This intersection underscores the dream state’s potential as a profound source of creativity that taps into both personal and collective unconscious material.
Philosophical Implications: Philosophically, the notion of lucid dreaming as a creative canvas aligns with existential and phenomenological theories that emphasize the subjective experience of reality. Maurice Merleau-Ponty’s phenomenology, which focuses on the primacy of perception and the embodied experience of being in the world, can offer a nuanced understanding of how lucid dreaming alters the dreamer’s relationship with their own perceptions and experiences. This philosophical perspective enriches the discussion by framing lucid dreaming as an experiential exploration of reality, consciousness, and the self, offering a space for existential questioning and self-discovery.
Emotional Resonance and Authenticity: Expanding on Stanislavski’s system, the concept of emotional memory in lucid dreaming can be further explored through the lens of modern psychological theories on memory and emotion. The integration of cognitive psychology with theatrical theory can provide a deeper understanding of how lucid dreaming engages with emotional memories, offering a more nuanced view of the dreamer’s ability to authentically express and explore complex emotional landscapes. This approach underscores the therapeutic potential of lucid dreaming in processing emotions and traumatic memories, aligning with contemporary therapeutic practices such as drama therapy.
Meta-theatrical Elements: The application of Bertolt Brecht’s Epic Theatre concepts to lucid dreaming invites further exploration of meta-theatrical elements in the dream state. Lucid dreaming can be seen as an inherently meta-cognitive process, where the dreamer is both participant and observer, actively engaging with and reflecting on the dream narrative. This dual role parallels the meta-theatrical techniques used in postmodern theatre, where the boundaries between performance and reality are blurred, encouraging the audience to reflect on the nature of art, illusion, and truth.
I once experienced a lucid dream where I was walking with a friend, D., in an open field. Throughout the dream, I was acutely aware of its nature as a dream, yet everything appeared vividly real. D.’s image was indistinguishable from her real-life appearance, and the sensation was akin to reality, despite my conscious awareness of dreaming.
During the dream, I reached a point where I felt compelled to disclose its true nature to D. I turned to her and said, ‘D., I need to tell you something important. We are currently in my dream. You are not real …. as I am merely dreaming of you now..’.
Her reaction was striking and unforgettable. With a look of profound astonishment, she replied in a puzzled tone, ‘Tell me, Raz – are you crazy?’
I felt scolded and totally helpless, as I couldn’t any possible way to convince her of her non-reality and the fact that she was an imagined part of my dream.
While ‘I’ was the dreamer, aware of the dream’s nature, my mind created the entire scenario, including D.’s response. Yet, her reaction felt as surprising to me as it would be to anyone if I attempted to convince them that they were merely a part of my dream.
This dream raised in me the question: Who truly dreamed of D.? 💎
Understanding Nightmares: Insights from Science and Psychoanalysis
Nightmares vs. Nocturnal Panic Attacks
Unlike nocturnal panic attacks, which typically occur in the first half of the night during non-REM sleep, nightmares predominantly arise during REM sleep, a phase marked by rapid eye movements and vivid dreaming. As REM sleep periods lengthen towards morning, nightmares become more frequent, often remembered in vivid detail for their anxiety-inducing content.
Clinical Definition and Characteristics
The ICD-10 classifies nightmares as intensely distressing dreams filled with fear or anxiety, often featuring existential threats. These dreams can recur, haunting some individuals repeatedly over years, and may lead to significant autonomic nervous system activation, including increased heart rate and sweating. Despite the paralysis that characterizes REM sleep, the vividness and emotional turmoil of these dreams can awaken individuals abruptly, leaving them with a heightened sense of alertness and detailed recollection of the dream.
Triggers and Developmental Perspectives
Nightmares are common in childhood and adolescence, periods of intense change, but can also plague adults during times of emotional stress, symbolically expressing inner conflicts. Various factors, including medication for anxiety, depression, Parkinson’s, and certain withdrawal syndromes, can exacerbate these dreams.
Treatment Approaches
Cognitive techniques, such as guided imagery and pre-sleep strategies, help in altering dream narratives, suggesting a psychological intervention can influence dreaming processes.
The Link to Mental Trauma
Often, nightmares are a symptom of post-traumatic stress disorder (PTSD), representing not symbolic expressions but direct re-enactments of traumatic events. This repetition might be an attempt at processing trauma, though opinions vary on whether this facilitates recovery or perpetuates distress.
Freud’s Conundrum
Freud initially struggled to fit nightmares into his theory of dreams as wish fulfillment. He later adjusted his perspective, suggesting that anxiety dreams might reflect a failure of the dream work process, indicating an attempt at wish fulfillment that sometimes fails due to the overwhelming nature of repressed material or the activation of the superego.
Evolving Theories
Freud, Cartwright, and Kohut: Diverse Perspectives on the Significance of Nightmares
Freud’s Evolving Understanding
In his later works, Freud revisited his initial interpretation of dreams, including nightmares, recognizing the complexity of dream functions beyond simple wish fulfillment. He acknowledged that nightmares might represent the psyche’s struggle to manage overwhelming repressions or unmet desires, suggesting a nuanced interplay between the conscious and unconscious mind.
Rosalind Cartwright’s Contributions
Cartwright, a prominent figure in sleep research, offers a modern perspective on the role of dreams and nightmares. She views them as mechanisms for emotional regulation and problem-solving, suggesting that nightmares can help individuals work through personal conflicts or emotional distress. Cartwright’s research underscores the adaptive value of dreaming, including the processing and integration of emotional experiences.
Heinz Kohut’s Self Psychology Approach
Kohut, a pioneer of self psychology, provides a groundbreaking lens through which to view nightmares. He distinguishes between dreams that arise from unconscious drives and conflicts and those that reflect states of the self, particularly focusing on pre-verbal traumas or fears related to the disintegration of the self. Kohut’s theory suggests that nightmares can be expressions of the psyche’s efforts to cope with internal threats to the cohesion of the self, offering a pathway to understanding and healing.
Nightmares as Signals of Internal Processes
Both Kohut and Cartwright, building on and diverging from Freud’s foundational ideas, illuminate the potential therapeutic significance of nightmares. By signaling unresolved conflicts, pre-verbal traumas, or ongoing emotional turmoil, nightmares may serve as a call to attention for the individual, pointing towards areas in need of psychological exploration and healing.
I have attempted to summarize the key aspects of narcolepsy, as this information may offer valuable insights into various states of double consciousness
When a dream bursts into reality: what can be learned from this double consciousness state? Narcolepsy is a disease characterized by unexpected bursts of sleep in the middle of the day and extremely realistic dreams. Understanding the syndrome can shed light on the mechanism of consciousness Narcolepsy is a disease characterized by unexpected bursts of sleep during waking hours; These bursts occur especially in active situations, and their frequency increases in situations of great excitement. Situations such as fear, laughter or the excitement of an orgasm can induce entry into a state of sudden dreaming in the middle of a state of full wakefulness and alertness. Patients with narcolepsy quickly sink into sleep states, and usually immediately plunge into dream consciousness. This is in contrast to normal sleep, in which the dreams appear only towards the end of the first cycle, that is to say – close to 90 minutes after falling asleep (see box on stages of sleep). The incidence of the disease is approximately one in two thousand, and it has a clear hereditary basis. It seems to be very common in certain countries, such as Japan, and rarer among Jews (there are debates about its prevalence in Israel, since it is possible that many of those who suffer from it are not diagnosed). Four main symptoms characterize narcolepsy, not all of them appear in all patients: 1. Sudden or gradual outbreaks of pronounced sleepiness during the day. The patient can fall asleep many times a day, for periods of minutes. These short periods of sleep often refresh the patient. The existence of this symptom can be checked in a sleep laboratory. The subject is asked to arrive after a good night’s sleep, then he is asked to fall asleep several times during the day. Most people will not be able to fall asleep more than twice during the day, and even then it will take a long time. On the other hand, those who can quickly cross the invisible barrier between wakefulness and sleep – within a few minutes, many times – are defined as suffering from one of the main symptoms of narcolepsy. The index of REM latency (the time that elapses until the appearance of the first REM state in the sleep chart) also indicates a considerable shortening and sharp transitions from sleep to REM, without the usual transition stages of sleep. Narcolepsy is characterized by rapid transitions from dreaming to intense dreaming and back again. There is also a reversal in the organization of the stages of sleep: while in most healthy people, the REM states are longer and more frequent towards the morning, in narcolepsy patients the REM states are compressed mainly at the beginning of sleep. It is interesting to note that a similar phenomenon also exists among patients suffering from depression 2. Flaccid paralysis, cataplexy – an attack of muscle weakness while awake. Narcolepsy patients tend to suffer from flaccid paralysis in situations of excitement, such as fear, anger or laughter. An example of this is a patient who suddenly collapsed in the middle of his own wedding. The paralysis is lax (ie: the body muscles are relaxed and not contracted), and is similar to the natural paralysis that occurs during dream sleep (REM sleep), and apparently prevents us from performing the movements we perform in our dreams. 3. Sleep paralysis (Sleep Paralysis) – complete inability to move a few minutes before falling asleep or a few minutes after waking up. This is a separate phenomenon from the phenomenon of cataplexy during excitement, which was described in the previous section. Even healthy people experience sleep paralysis sometimes, but those with narcolepsy experience it more frequently. This condition can appear as a phenomenon in itself, regardless of narcolepsy or another disorder. The sleep paralysis is accompanied by great anxiety. People describe it as suffering and fear, when they suddenly feel “trapped” in the world of imagination, unable to move or cry for help, when they experience hallucinations. These hallucinations occur already while awake and mix with the perception of reality. Although consciousness is already awakening, and the dreamer realizes that he is experiencing hallucinations, he is unable to prevent them. Sometimes the situation is accompanied by a feeling of a “foreign presence” near the dreamer, and sometimes even by a feeling of such a presence inside him. Sometimes the experience is of a figure sitting and pressing on the chest. Because of this, this situation has been described many times in history, including in paintings, as a figure – a witch or a demon – sitting on the dreamer and pressing his chest (the so-called “Incubus”). It should be emphasized that these unusual experiences occur when the person is in a state of alertness, usually in the minutes after waking up, sometimes before falling asleep. Although this is a common condition and usually does not indicate any disorder, it can cause many anxieties and doubts. One can understand why in the past mystical interpretations were attributed to this situation. Even today, some of those who suffer from this condition are afraid to talk about their experiences, lest they be perceived as mentally retarded. As the public’s awareness of this phenomenon increases, and people exchange experiences in forums that were established specifically for this purpose, it turns out that the phenomenon is relatively widespread. Sufferers are relieved when they discover that this is a known phenomenon. Little by little, the “sleep-paralyzed” are coming out of the closet, or at least – out of bed…
some relevant references: