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The average individual spends about 2 hours dreaming, mostly during the second half of the night when REM (dream) cycles are longer.
Dreaming arises from signals in the pons which ascend through the thalamus into the cortex. There are also pontine signals that descend through the spinal cord causing motor paralysis. This muscle inhibition prevents motor activity during dreaming and can sometimes be lost, particularly in patients with Parkinson's disease. This entity is called REM sleep behavior disorder.
Respiratory muscles can be affected by this REM sleep paralysis. This may lead to breathing disturbances during dreaming. Changes in dreaming tendencies (e.g. "I feel like I dream all night long" or "I never dream anymore".) may be a sign of a sleep apnea or similar breathing disturbance.
Alcohol is a frequently used hypnotic in the United States. When ingested, alcohol is a potent inhibitor of REM sleep. Abstinence often causes a temporary increased in REM sleep called REM rebound. Other inhibitors of REM sleep include MAO inhibitors and tricyclic antidepressants.
There are no medications that can effectively treat obstructive sleep apnea syndrome (OSAS), a condition in which the airway repeatedly collapses during sleep leading to excessive daytime sleepiness.
The most common treatment for this condition is continuous positive airway pressure (CPAP). This device helps maintain upper airway patency and prevent breathing obstruction. With restored breathing comes restored sleep quality.
In some patients with OSAS, effective treatment does not bring about a solution to their sleepiness. Provigil can be a useful adjunctive agent to reduce daytime somnolence. This medication does not cure OSAS in anyway, a point that may be lost on some patients reading about the medication.
The goal of a sleep physician is to attempt to restore one's sleep to its normal state without using medication or by using it sparingly as indicated by current scientific thought. Many patients we see in our office are surprised, like the patient in the introduction, that we do not immediately reach for medication to improve sleep. While there are several excellent medications in a sleep doctor's bag, the use of medications in sleep disorders tends to be overemphasized by the media and doe not represent the answer for many patients.
