The boundaries between SLEEP and WAKEFULLNESS.
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People suffering from an arousal disorder enter a dissociative state,
as if beginning to wake up but failing to do so completely.
These disorders tend to run in families and are more common in children. Being over tired, having a fever or taking certain medications may make it worse.
Because disorders of arousal are less common in adults, having an evaluation is important.
Neither Awake nor Asleep
For as long as we have recognized walking and talking in our
sleep, we have also been aware of more extreme nighttime behaviors.
Homer’s epics mention a sleeper’s tragic suicide. In 1313
a church-led council concluded that a sleepwalking killer was
not culpable for his crimes. One of the first legal cases involving
sleep violence occurred in the central European region of Silesia
in 1791, in which a woodcutter killed his wife with an ax and
later insisted he was asleep at the time. We have no way of knowing
the truth of those matters; nonetheless, the medical literature
reflects many complex actions executed during sleep, including
driving, eating and sex, as well as murder, suicide and rape.
Getting through the Night
Sleep is not an all-or-none phenomenon. At times, the
boundaries between sleep and wakefulness are disrupted, and
individuals become caught between these states. The sleepwalker
who attacks a beloved family member, the narcoleptic who
is conscious but suddenly rendered unable to move by a bout of
laughter, and the lucid dreamer, perfectly aware of the fact that
his or her experiences are not real, are all examples. Such cases
of unusual sleep offer a window into consciousness. Not only
does consciousness vanish when we doze off and reappear in
full on waking, it can assume a variety of forms. It can range
from brief images that flash by as sleep sets in to vivid hallucinatory
experiences in dreams later in the night.
Because we can identify the brain regions involved in sleep
disorders, these conditions provide an excellent case study for
clarifying how the brain creates an integrated conscious experience.
The discoveries being made in sleep violence may have
moral, ethical and legal implications that society has barely begun
to recognize.
