Sleep and Sleep Disorders

Part 1 of 3

INTRODUCTION

We spend a good deal of our lives in sleep. It is fair to say that sleep is essential to wellbeing, and a necessary biological process for living. All living things sleep (or at least rest in a state of stasis that looks like sleep).

Sleep, in humans, is more than simply stasis. Rather, it is a complex process involving the brain, mind, and body. Why is it complex? There are a number of reasons. First, we don’t have very good access to what goes on, at least within our psyche, during sleep. We certainly know less about what goes on psychologically or emotionally in sleep than when we are awake. Second, there are situations, or even people, with certain characteristics where sleep becomes elusive. In general, when sleep is elusive people feel tormented by it.

There are all kinds of scientific or psychiatric labels for sleep disorders and I will review these in a later part of this (three-part) entry, but the main issues of sleep here are: 1. Difficulty falling asleep, 2. Difficulty staying asleep; that is, waking up prematurely, and 3. Unusual (or disruptive) patterns of sleeping, waking, sleeping, waking during the night along with unusual physiological sequelae (sleep walking) while in a state of sleep.

A perplexing feature of sleep, as a state of mind, is dreaming. Dreaming is the emergence, in sleep, of a kind of biologically-induced virtual reality. This VR state seems to occur in a stage of sleep known as REM (or rapid eye movement), where our eyelids flutter and it seems we are having some kind of an internal experience, but this experience, most of the time, is not subject to reality, we are not engaging our physiology at least actively actively, during this time, and any action that occurs exists within the dreamer’s mind.

The dream state appears to be a primitive part of our human nature and writings about dreaming go way back to as early as we have records from human beings. Some believe, and I tend to agree with these people, that even higher order animals (dogs, cats, whales and the like) all experience some kind of alternative VR state during specific periods of time in sleep. If you’ve ever had a pet, you will recognize this from time to time while the pet is sleeping and may be making unusual movements and/or sounds.

Sleep was around of course during Greek and Roman times and there is even a God, Morpheus, associated with sleep and dreaming. In Ovid’s Metamorphoses he was the son of Somnus (another derivative word for sleep) appearing in human form in people’s dreams.

I like this early etching of Morpheus (to the right, standing by the man in the bed; this is likely an apparition of Morpheus). It seems in this etching Morpheus is leaving the sleeper (see the woman walking through the doorway with the lighted candle who is bringing the end of sleep and who seems totally unaware of Morpheus). The etching appears to depict a dreamer longing for Morpheus to stay, suggesting that sleep in this case is desirable. Morpheus is completely naked, which I take to mean that sleep is the most authentic form of existence.

Morpheus is an interesting character who is clearly related to sleep initiation as well as to sleep quality; that is, seeing Morpheus while dreaming is a sign that your sleep will be deep, meaningful, and ongoing in duration. I personally, have never seen Morpheus in a dream, so my assumption is that Morpheus is an artists rendition of sleep and dreaming as a desirable state.

Sleep as an Altered State of Consciousness

I can’t possibly discuss all aspects of sleep in this short blog entry, or even in a three-part series, so I will focus instead on what my clients ask me about sleep and dream issues.

What is it that they want to know?

Why they are afraid of sleep or the lack thereof. I will also describe why I prioritize learning about a client’s state of sleep almost every time I meet with the client. Sleep quality is always part of my clinical interview.

The Mystery of Dreams

Most clients, at one time or another, ask me about dreams, and there are many variations of questions I hear. One of the most frequently asked question is the following:

Doc, I had a dream that I can only partly remember, but some details still stick with me today. Was this a dream about my future? Can dreams foretell the future?

At first blush, most people would say, No, dreams cannot foretell the future. I think this is probably a fair response for our day and age. At least as far as I am aware, dreams have no reliable capacity in and of themselves to foretell the future because dreams are simply an intra-psychic experience driven by a persons mind, body, and soul.

That being said, the better question might be for this client, “Can I (the client) foretell the future?” Because the dream is an expression that is coming from the client. So, if the mind, body, soul or some interaction between the three can in a given individual foretell the future, then maybe there is a “Yes” response to this question.

Here, we get into historical/scriptural writings of persons in literature who had the capacity to dream about the future and then another person, say, who could actually foretell the future by discerning the dream. The person (future-teller) has a dream, and the discerner, so-to-speak, interprets the dream. The future is then foretold. What I’ve just said might not make sense at first read, but think of the Bible Story of Joesph’s Interpretation of Dreams:

Joseph and the Dream: The Bible

Lay Synopsis

Joseph was forsaken by his brothers into Egypt and then sold to Potiphar, an important official. Potiphar’s wife made advances toward Joseph…Joseph rejected Potiphar’s wife and was sent to jail. In jail, Joseph met with two inmates. One was the cupbearer to the pharaoh. The cupbearer had a dream that involved three bunches of grapes squeezed into a cup. The other inmate was a baker, who dreamt of carrying little cakes he had baked on his head on a tray, and how the birds ate them. They did not know what the dreams meant, but Joseph said, “I can interpret dreams”, which he did. He told the cupbearer, “You’re going to go free in three days” and to the baker, “You’re going to be hanged in three days.” Both of these interpretations came true. The baker was executed, and the cupbearer freed. Joseph said to the cupbearer, “Don’t forget me when you get back to the pharaoh’s palace.” But he forgot Joseph who remained in jail. Later, the pharaoh had dreams where he saw seven lean cows devouring seven fat cows, and also seven lean ears of corn devouring seven fat ears of corn. The Pharaoh called his magicians to interpret the dream, but they could not do it. That was when the cupbearer remembered Joseph, the dream interpreter. Joseph was called to interpret the pharaoh’s dreams. Joseph said, “It means that you’re going to have seven lean years eventually, but then you’ll have seven good years first.” Based on Joseph’s interpretation of dreams, the economy of Egypt was planned for the next 14 years and Egypt survived a drought.

Who knows if this story is accurate, but the point is this story underscores a potential extra-human quality of both dreaming (the expression of the future) and interpretation of dreams (discerning from the dream a future reality).

Stories like this proliferate in religious and spiritual writing, so it is easy to see why people have come to believe that dreams are connected with the future.

I did have a client, once who told me that she knew that her dreams could foretell the future. Like the story of Joseph, some of the events that this client dreamed about were bad future outcomes for herself and for those around her. They happened on a schedule that she could not predict, but she knew when she dreamed a prescient dream that an event would occur, and she was in a constant state of anxiety when this happened. She stated that she wanted to turn this part of herself off, but she was unable to do it. She needed my help.

I saw this client for less than a year, then one day she just didn’t show for therapy, she disappeared. I was never able to locate her whereabouts again, so I wondered what happened to her. Did she have another dream? Who knows. But, again, this was all by her self-report, so the difficulty here was whether her reports of these dreams to me were accurate or whether they were fabricated in terms of telling the future. I will never know.

Interpretation of Dreams

Theories of the human psyche that are comprehensive, such as Freud’s theory of psychoanalysis and the unconscious, derive some kind of explanation for why dreams occur and how they intersect with intrapsychic features of the individual.

Freud was interested in dreams as a window into intrapsychic processes or what he termed, the unconscious. He wrote one book, “Interpretation of Dreams” where he attempted to put “Dream Work” into a larger context of unconscious manifestations.

Freud’s view of dreams was what I like to call, a within subjects perspective, that is, the dream does not predict future reality, rather, it is a manifestation of the internal hydraulics operating on the unconscious state. Another way of describing this is to say that something might be bothering a person, but has been buried in the unconscious, and the dream is a state where those bothersome issues can manifest themselves.

There is a famous client, Wolf Man, who was the a focus of Freud’s analysis and writings. In fact, Wolfman had a dream that Freud spent long hours of focus on:

Here is the dream:

This was shortly before Wolfman’s 4th birthday. Wolfman was relating the dream to Freud as an adult:

‘I dreamt that it is night and that I am lying in my bed (the foot of my bed was
under the window, and outside the window there was a row of old walnut trees. I know it was winter in my dream, and night-time). Suddenly the window opens of its own accord, and terrified, I see that there are a number of white wolves sitting in the big walnut tree outside the window. There were six or seven of them. The wolves were white all over and looked more like foxes or sheepdogs because they had big tails like foxes and their ears were pricked up like dogs watching something. In great terror evidently of being eaten by the wolves, I screamed and woke up. Obviously fearful that the wolves were going to gobble me up I screamed and woke up. My nurse hurried to my bedside, to see what had happened. It was some time before I could be convinced that it had only been a dream, because the image of the window opening and the wolves sitting in the tree were so clear and lifelike. Eventually I calmed down, feeling as if I had been liberated from danger, and went back to sleep.’

Wolfman’s real name was Sergei Pankejeff (client). Sergei’s described his early relationship with his father as excellent. In 1906, the client’s older sister, Anna, committed suicide by poisoning herself, and shortly thereafter, the client began experiencing symptoms of depression (low mood). In 1907 his father committed suicide, overdosing on sleeping pills. Client’s symptoms increased after this and he began seeking treatment for his own depression and, in 1910, the client’s physician took him to Vienna to see Freud. By client’s report, early years were dominated by a neurotic disorder which began shortly before his fourth birthday as anxiety hysteria (animal phobia) and then turned into an obsessive-compulsive neurosis, religious in content. The effects of which persisted until the client was 10 y/o. Freud saw the dream as a manifestation of a repressed traumatic event that appeared in the conscious mind as childhood neuroticism and phobias. The dream was the impact of this trauma on the client’s unconscious.

ENTRY ONGOING: Last Writing 12/18/21