The present study assessed brain perfusion patterns with single-photon emission computed tomograp... more The present study assessed brain perfusion patterns with single-photon emission computed tomography (SPECT) during sleepwalkers' post-sleep deprivation slow-wave sleep (SWS) and resting-state wakefulness. Following a 24 hr period of sleep deprivation, 10 sleepwalkers and 10 sex- and age-matched controls were scanned with a high-resolution SPECT scanner. Participants were injected with 99mTc-ethylene cysteinate dimer after 2 min of stable SWS within their first sleep cycle as well as during resting-state wakefulness, both after a subsequent 24 hr period of sleep deprivation. When compared with controls' brain perfusion patterns during both SWS and resting-state wakefulness, sleepwalkers showed reduced regional cerebral perfusion in several bilateral frontal regions, including the superior frontal, middle frontal, and medial frontal gyri. Moreover, reduced regional cerebral perfusion was also found in sleepwalkers' left postcentral gyrus, insula, and superior temporal gyru...
Study Objectives: Idiopathic hypersomnia is characterized by excessive daytime sleepiness, despit... more Study Objectives: Idiopathic hypersomnia is characterized by excessive daytime sleepiness, despite normal or long sleep time. Its pathophysiological mechanisms remain unclear. This pilot study aims at characterizing the neural correlates of idiopathic hypersomnia using single photon emission computed tomography. Methods: Thirteen participants with idiopathic hypersomnia and 16 healthy controls were scanned during resting wakefulness using a high-resolution single photon emission computed tomography scanner with 99m Tc-ethyl cysteinate dimer to assess cerebral blood flow. The main analysis compared regional cerebral blood flow distribution between the two groups. Exploratory correlations between regional cerebral blood flow and clinical characteristics evaluated the functional correlates of those brain perfusion patterns. Significance was set at p < .05 after correction for multiple comparisons. Results: Participants with idiopathic hypersomnia showed regional cerebral blood flow decreases in medial prefrontal cortex and posterior cingulate cortex and putamen, as well as increases in amygdala and temporo-occipital cortices. Lower regional cerebral blood flow in the medial prefrontal cortex was associated with higher daytime sleepiness. Conclusions: These preliminary findings suggest that idiopathic hypersomnia is characterized by functional alterations in brain areas involved in the modulation of vigilance states, which may contribute to the daytime symptoms of this condition. The distribution of regional cerebral blood flow changes was reminiscent of the patterns associated with normal non-rapid-eye-movement sleep, suggesting the possible presence of incomplete sleep-wake transitions. These abnormalities were strikingly distinct from those induced by acute sleep deprivation, suggesting that the patterns seen here might reflect a trait associated with idiopathic hypersomnia rather than a non-specific state of sleepiness.
Objective: Adult somnambulism can result in injury to the sleeper and to others. Attempts to indu... more Objective: Adult somnambulism can result in injury to the sleeper and to others. Attempts to induce sleepwalking episodes in the sleep laboratory have yielded mixed results. 1, 2 Having shown that sleepwalkers have lower slow-wave activity power than control ...
Crimes carried out during or arising from sleep highlight many difficulties with our current law ... more Crimes carried out during or arising from sleep highlight many difficulties with our current law and forensic sleep medicine clinical practice. There is a need for clarity in the law and agreement between experts on a standardised form of assessment and diagnosis in these challenging cases. We suggest that the time has come for a standardised, internationally recognised diagnostic protocol to be set as a minimum standard in all cases of suspected sleep-related forensic cases. The protocol of a full medical history, sleep history, psychiatric history, neuropsychiatric and psychometric examination and electroencephalography (EEG), should be routine. It should now be mandatory to carry out routine polysomnography (PSG) to establish the presence of precipitating and modulating factors. Sleepwalking is classified as insane automatism in England and Wales and sudden arousal from sleep in a non-sleepwalker as sane automatism. The recent case in England of R v. Lowe (2005) highlights these anomalies. Moreover, the word insanity stigmatises sleepwalkers and should be dropped. The simplest solution to these problems would be for the law to be changed so that there is only one category of defence for all sleep-related offences-guilty by reason of sleep disorder. This was rejected by the House of Lords for cases of automatism due to epilepsy, and is likely to be rejected for sleepwalkers. Removing the categories of automatism (sane or insane) would be the best solution. Risk assessment is already standard practice in the UK and follow up, subsequent to disposal, by approved specialists should become part of the sentencing process. This will provide support for the defendant and protection of the public.
Little is known about pain in dreams. Some studies indicate that it is rare and that it may be be... more Little is known about pain in dreams. Some studies indicate that it is rare and that it may be beyond the representational capability of dreaming. However, the present study describes experiences of dreamed pain that were reported incidentally in experiments on the effects of somatosensory stimulation administered during rapid eye movement (REM) sleep. Dreams were selected from five subjects who had reported at least one instance of dreamed pain in these studies. The subjects had undergone 42 stimulation trials over 20 nights and had reported a total of 13 dreams (31%) with one or more references to pain. Most often, these references appeared to be direct, untransformed incorporations of real sensations produced by stimulation. Pain was the principal motivating agent in a majority of these dreams and was in many cases associated with strong emotion--typically anger. Dreams often depicted the subjects' attempts to obtain relief from pain, in some cases by repetition of actions, i...
Objectives: Sleepwalking (SW) often has been associated with psychopathology, but the nature and ... more Objectives: Sleepwalking (SW) often has been associated with psychopathology, but the nature and magnitude of this relation remains unclear. The aim of our study was to investigate the presence of psychopathology in a large cohort of sleepwalkers and to determine if levels of psychopathology showed differential relations to specific characteristics of the disorder, including clinical history. Methods: One-hundred and five sleepwalkers (39 men, 66 women; mean age, 32.4 ± 9.5 years) referred to our sleep disorders clinic for chronic SW underwent a comprehensive clinical investigation that included an overnight polysomnography (PSG) assessment in 90% of cases. All participants also completed a series of questionnaires, including the Beck Depression Inventory, Second Revision (BDI-II), the Beck Anxiety Inventory (BAI), and the Symptom Checklist 90-Revised (SCL-90-R). Results: The proportion of sleepwalkers who scored above the minimal clinical threshold on the BDI-II, BAI, and SCL-90-R was 27%, 40%, and 28%, respectively. Only 15% of sleepwalkers showed moderate to severe symptoms on the BDI-II and 19% on the BAI. Taken as a whole, these profiles are similar to those observed in the general adult population. The presence of psychopathology in sleepwalkers was associated with a negative family history for SW, a higher frequency of nightmares, and with potentially injurious behaviors enacted during somnambulistic episodes. Conclusions: A majority of adult sleepwalkers consulting for the disorder do not report clinically significant levels of depression or anxiety. Overall, sleepwalkers with and without psychopathology appear more similar than dissimilar.
Résumé L&#x27;objectif de cet article est de présenter une brève revue de la documentation s... more Résumé L&#x27;objectif de cet article est de présenter une brève revue de la documentation scientifique sur l&#x27;intrusion de sensations douloureuses lors du sommeil. Historiquement, il est reconnu qu&#x27;un sujet humain peut rapporter une expérience douloureuse associée à un rêve. Toutefois, l&#x27;analyse du contenu onirique révèle que la douleur est rarement présente dans les rêves d&#x27;un sujet normal. D&#x27;autre part, des études
Abstract 1. A multivariate comparison was made among 52 recurrent, past-recurrent, and nonrecurre... more Abstract 1. A multivariate comparison was made among 52 recurrent, past-recurrent, and nonrecurrent dreamers aged 18–21 yrs. The participants completed measures of well-being and collected a 14-day sample of their own remembered dreams. Multivariate analysis ...
Considerable progress has been made in the systematic study of nonrapid eye movement (NREM) sleep... more Considerable progress has been made in the systematic study of nonrapid eye movement (NREM) sleep parasomnias. This chapter focuses on the clinical features, prevalence, pathophysiology, associated sleep parameters, and clinical variants of the prototypic NREM sleep parasomnias, namely confusional arousals, sleepwalking, and sleep terrors. Whereas the occurrence of NREM parasomnias in children is frequently viewed as relatively benign, these disorders often pose greater problems, including sleep-related injuries, in affected adults. Most episodes arise from sudden but incomplete arousal from slow-wave sleep and sometimes from stage 2 sleep. Factors that deepen or fragment sleep can facilitate or precipitate NREM parasomnias in predisposed individuals. NREM parasomnias can be associated with various primary sleep disorders or with medical conditions. Diagnosis of NREM parasomnias can often be made based on a detailed history, although some patients may require more extensive evaluations, including polysomnographic study with an expanded EEG montage. Sleep deprivation and the presentation of auditory stimuli during slow-wave sleep are two techniques that can increase the occurrence of behavioral manifestations under laboratory conditions. A variety of nonpharmacological treatments have been recommended for long-term management of NREM parasomnias, whereas pharmacological agents should be considered only if the behaviors are hazardous or extremely disruptive.
Although a potentially helpful therapeutic tool, dream interpretation or dream work is only used ... more Although a potentially helpful therapeutic tool, dream interpretation or dream work is only used occasionally in most forms of psychotherapy. Despite an interest from clinicians and clients alike in using dreams within therapy, many therapists feel unprepared to attend to their clients' dreams. The main goals of this article are to make clinicians aware that integrating dreams into their clinical
Objective: Adult somnambulism can result in injury to the sleeper and to others. Attempts to indu... more Objective: Adult somnambulism can result in injury to the sleeper and to others. Attempts to induce sleepwalking episodes in the sleep laboratory have yielded mixed results. 1, 2 Having shown that sleepwalkers have lower slow-wave activity power than control ...
The present study assessed brain perfusion patterns with single-photon emission computed tomograp... more The present study assessed brain perfusion patterns with single-photon emission computed tomography (SPECT) during sleepwalkers' post-sleep deprivation slow-wave sleep (SWS) and resting-state wakefulness. Following a 24 hr period of sleep deprivation, 10 sleepwalkers and 10 sex- and age-matched controls were scanned with a high-resolution SPECT scanner. Participants were injected with 99mTc-ethylene cysteinate dimer after 2 min of stable SWS within their first sleep cycle as well as during resting-state wakefulness, both after a subsequent 24 hr period of sleep deprivation. When compared with controls' brain perfusion patterns during both SWS and resting-state wakefulness, sleepwalkers showed reduced regional cerebral perfusion in several bilateral frontal regions, including the superior frontal, middle frontal, and medial frontal gyri. Moreover, reduced regional cerebral perfusion was also found in sleepwalkers' left postcentral gyrus, insula, and superior temporal gyru...
Study Objectives: Idiopathic hypersomnia is characterized by excessive daytime sleepiness, despit... more Study Objectives: Idiopathic hypersomnia is characterized by excessive daytime sleepiness, despite normal or long sleep time. Its pathophysiological mechanisms remain unclear. This pilot study aims at characterizing the neural correlates of idiopathic hypersomnia using single photon emission computed tomography. Methods: Thirteen participants with idiopathic hypersomnia and 16 healthy controls were scanned during resting wakefulness using a high-resolution single photon emission computed tomography scanner with 99m Tc-ethyl cysteinate dimer to assess cerebral blood flow. The main analysis compared regional cerebral blood flow distribution between the two groups. Exploratory correlations between regional cerebral blood flow and clinical characteristics evaluated the functional correlates of those brain perfusion patterns. Significance was set at p < .05 after correction for multiple comparisons. Results: Participants with idiopathic hypersomnia showed regional cerebral blood flow decreases in medial prefrontal cortex and posterior cingulate cortex and putamen, as well as increases in amygdala and temporo-occipital cortices. Lower regional cerebral blood flow in the medial prefrontal cortex was associated with higher daytime sleepiness. Conclusions: These preliminary findings suggest that idiopathic hypersomnia is characterized by functional alterations in brain areas involved in the modulation of vigilance states, which may contribute to the daytime symptoms of this condition. The distribution of regional cerebral blood flow changes was reminiscent of the patterns associated with normal non-rapid-eye-movement sleep, suggesting the possible presence of incomplete sleep-wake transitions. These abnormalities were strikingly distinct from those induced by acute sleep deprivation, suggesting that the patterns seen here might reflect a trait associated with idiopathic hypersomnia rather than a non-specific state of sleepiness.
Objective: Adult somnambulism can result in injury to the sleeper and to others. Attempts to indu... more Objective: Adult somnambulism can result in injury to the sleeper and to others. Attempts to induce sleepwalking episodes in the sleep laboratory have yielded mixed results. 1, 2 Having shown that sleepwalkers have lower slow-wave activity power than control ...
Crimes carried out during or arising from sleep highlight many difficulties with our current law ... more Crimes carried out during or arising from sleep highlight many difficulties with our current law and forensic sleep medicine clinical practice. There is a need for clarity in the law and agreement between experts on a standardised form of assessment and diagnosis in these challenging cases. We suggest that the time has come for a standardised, internationally recognised diagnostic protocol to be set as a minimum standard in all cases of suspected sleep-related forensic cases. The protocol of a full medical history, sleep history, psychiatric history, neuropsychiatric and psychometric examination and electroencephalography (EEG), should be routine. It should now be mandatory to carry out routine polysomnography (PSG) to establish the presence of precipitating and modulating factors. Sleepwalking is classified as insane automatism in England and Wales and sudden arousal from sleep in a non-sleepwalker as sane automatism. The recent case in England of R v. Lowe (2005) highlights these anomalies. Moreover, the word insanity stigmatises sleepwalkers and should be dropped. The simplest solution to these problems would be for the law to be changed so that there is only one category of defence for all sleep-related offences-guilty by reason of sleep disorder. This was rejected by the House of Lords for cases of automatism due to epilepsy, and is likely to be rejected for sleepwalkers. Removing the categories of automatism (sane or insane) would be the best solution. Risk assessment is already standard practice in the UK and follow up, subsequent to disposal, by approved specialists should become part of the sentencing process. This will provide support for the defendant and protection of the public.
Little is known about pain in dreams. Some studies indicate that it is rare and that it may be be... more Little is known about pain in dreams. Some studies indicate that it is rare and that it may be beyond the representational capability of dreaming. However, the present study describes experiences of dreamed pain that were reported incidentally in experiments on the effects of somatosensory stimulation administered during rapid eye movement (REM) sleep. Dreams were selected from five subjects who had reported at least one instance of dreamed pain in these studies. The subjects had undergone 42 stimulation trials over 20 nights and had reported a total of 13 dreams (31%) with one or more references to pain. Most often, these references appeared to be direct, untransformed incorporations of real sensations produced by stimulation. Pain was the principal motivating agent in a majority of these dreams and was in many cases associated with strong emotion--typically anger. Dreams often depicted the subjects' attempts to obtain relief from pain, in some cases by repetition of actions, i...
Objectives: Sleepwalking (SW) often has been associated with psychopathology, but the nature and ... more Objectives: Sleepwalking (SW) often has been associated with psychopathology, but the nature and magnitude of this relation remains unclear. The aim of our study was to investigate the presence of psychopathology in a large cohort of sleepwalkers and to determine if levels of psychopathology showed differential relations to specific characteristics of the disorder, including clinical history. Methods: One-hundred and five sleepwalkers (39 men, 66 women; mean age, 32.4 ± 9.5 years) referred to our sleep disorders clinic for chronic SW underwent a comprehensive clinical investigation that included an overnight polysomnography (PSG) assessment in 90% of cases. All participants also completed a series of questionnaires, including the Beck Depression Inventory, Second Revision (BDI-II), the Beck Anxiety Inventory (BAI), and the Symptom Checklist 90-Revised (SCL-90-R). Results: The proportion of sleepwalkers who scored above the minimal clinical threshold on the BDI-II, BAI, and SCL-90-R was 27%, 40%, and 28%, respectively. Only 15% of sleepwalkers showed moderate to severe symptoms on the BDI-II and 19% on the BAI. Taken as a whole, these profiles are similar to those observed in the general adult population. The presence of psychopathology in sleepwalkers was associated with a negative family history for SW, a higher frequency of nightmares, and with potentially injurious behaviors enacted during somnambulistic episodes. Conclusions: A majority of adult sleepwalkers consulting for the disorder do not report clinically significant levels of depression or anxiety. Overall, sleepwalkers with and without psychopathology appear more similar than dissimilar.
Résumé L&#x27;objectif de cet article est de présenter une brève revue de la documentation s... more Résumé L&#x27;objectif de cet article est de présenter une brève revue de la documentation scientifique sur l&#x27;intrusion de sensations douloureuses lors du sommeil. Historiquement, il est reconnu qu&#x27;un sujet humain peut rapporter une expérience douloureuse associée à un rêve. Toutefois, l&#x27;analyse du contenu onirique révèle que la douleur est rarement présente dans les rêves d&#x27;un sujet normal. D&#x27;autre part, des études
Abstract 1. A multivariate comparison was made among 52 recurrent, past-recurrent, and nonrecurre... more Abstract 1. A multivariate comparison was made among 52 recurrent, past-recurrent, and nonrecurrent dreamers aged 18–21 yrs. The participants completed measures of well-being and collected a 14-day sample of their own remembered dreams. Multivariate analysis ...
Considerable progress has been made in the systematic study of nonrapid eye movement (NREM) sleep... more Considerable progress has been made in the systematic study of nonrapid eye movement (NREM) sleep parasomnias. This chapter focuses on the clinical features, prevalence, pathophysiology, associated sleep parameters, and clinical variants of the prototypic NREM sleep parasomnias, namely confusional arousals, sleepwalking, and sleep terrors. Whereas the occurrence of NREM parasomnias in children is frequently viewed as relatively benign, these disorders often pose greater problems, including sleep-related injuries, in affected adults. Most episodes arise from sudden but incomplete arousal from slow-wave sleep and sometimes from stage 2 sleep. Factors that deepen or fragment sleep can facilitate or precipitate NREM parasomnias in predisposed individuals. NREM parasomnias can be associated with various primary sleep disorders or with medical conditions. Diagnosis of NREM parasomnias can often be made based on a detailed history, although some patients may require more extensive evaluations, including polysomnographic study with an expanded EEG montage. Sleep deprivation and the presentation of auditory stimuli during slow-wave sleep are two techniques that can increase the occurrence of behavioral manifestations under laboratory conditions. A variety of nonpharmacological treatments have been recommended for long-term management of NREM parasomnias, whereas pharmacological agents should be considered only if the behaviors are hazardous or extremely disruptive.
Although a potentially helpful therapeutic tool, dream interpretation or dream work is only used ... more Although a potentially helpful therapeutic tool, dream interpretation or dream work is only used occasionally in most forms of psychotherapy. Despite an interest from clinicians and clients alike in using dreams within therapy, many therapists feel unprepared to attend to their clients' dreams. The main goals of this article are to make clinicians aware that integrating dreams into their clinical
Objective: Adult somnambulism can result in injury to the sleeper and to others. Attempts to indu... more Objective: Adult somnambulism can result in injury to the sleeper and to others. Attempts to induce sleepwalking episodes in the sleep laboratory have yielded mixed results. 1, 2 Having shown that sleepwalkers have lower slow-wave activity power than control ...
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