0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Conferences |

Sleep and Dreams: Recent Research on Clinical Aspects

ANTHONY KALES, M.D.; GILDON N. BEALL, M.D.; RALPH J. BERGER, PH.D.; GUNNAR HEUSER, M.D.; ALLAN JACOBSON, M.D.; JOYCE D. KALES, M.D.; ARTHUR H. PARMELEE JR., M.D.; and RICHARD D. WALTER, M.D.
Ann Intern Med. 1968;68(5):1078-1104. doi:10.7326/0003-4819-68-5-1078
Text Size: A A A
SUMMARY:

Sleep begins with non-rapid eye movement (NREM) phases, and after 60 to 90 min, the first rapid eye movement (REM) period starts; thereafter, REM sleep occurs cyclically at about 90-min intervals. After infancy, the percentage of REM sleep remains relatively stable through life, while total sleep and stage 4 sleep decrease progressively with increasing age. Dream recall is most frequent if subjects are awakened from REM sleep but may also occur after awakening from NREM sleep. During REM sleep, neuronal and metabolic activity and antonomic functions such as heart rate, respirations, and blood pressure are at increased levels, often comparable to those of the waking state.

Sleepwalking and bedwetting occur predominantly during stages 3 and 4, while seizure discharge rates are higher during these sleep stages than in REM sleep. The sleep of narcoleptics with cataplexy is characterized by REM sleep at sleep onset, while coronary artery and duodenal ulcer patients experience angina and increased gastric acid secretion, respectively, during REM sleep. Nocturnal asthmatic episodes occur out of all sleep stages proportionally to the time in each stage. (See summarized findings in Table 6.)

Selective deprivation of REM or stage 4 sleep is followed by compensatory increases in the deprived stage on recovery nights. Total sleep deprivation in man produces on recovery nights an initial increase in stage 4 sleep over base-line levels, followed by increases in REM sleep. Behavioral changes are frequent after prolonged sleep deprivation, while behavioral changes associated with REM deprivation have been varied and subtle.

Sleep alterations are induced by most psychotropic drugs; REM sleep is generally suppressed during drug administration and increased after drug withdrawal. Withdrawal of patients addicted to sedatives and antidepressants has produced marked rebound increases in the percentage of REM sleep. These REM sleep changes, together with the observations of nightmares and insomnia after withdrawal, may be significant in the development of dependence to these compounds.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)