Dreamdeath

By Kerrin Leon White - January 5, 2001

dreamdeath, n. 1 A dream experience of one's own death. 2 Death that occurs while one is dreaming. See thanatosomnology, somnothany.

What better way to die than in your sleep?
What worse way to end your days than in the throes of a nightmare?

The experience of nightmare could foreshadow that of Hell. Maybe the "incubus" of old first inspired visions of the Inferno.

Sleep reminds us of death, but this misleads us. The outward inactivity of sleep conceals a vital, even active kind of life. Within the sleeper, while breathing and heartbeat continue, so does an interior consciousness quite unlike waking awareness of the external world.

Strange mentation can occur throughout sleep, but the stage of Rapid Eye Movement (REM) sleep gives rise to those most vivid events we call dreams--and nightmares.

The role dreams play in life remains a mystery. We seem to "need" REM sleep in a way distinct from our need for the deeper, restful slow-wave sleep of stages III and IV. We uncover signs of this when a drug that suppresses REM sleep abruptly stops. This sets off a surge of REM sleep--called "REM rebound," which can give rise to protracted dreams and nightmares.

I will never forget a patient of mine, seemingly eons ago, whose withdrawal from an MAOI (monoamine oxidase inhibitor) antidepressant caused her such nocturnal horror that she awakened others in the apartment building with her screams!

Other disturbances, like obstructive sleep apnea (OSA), can selectively deprive us of REM sleep, because that stage often gives rise to the most frequent episodes of apnea. These in turn interrupt the continuity of sleep with "arousals," mostly falling short of wakening, yet maybe preventing satisfaction of the need for that stage of sleep. Likewise, the deeper stages of slow-wave, non-REM sleep yield more disruptive respiratory events than the lighter, less restful stages (I and II). Thereby light sleep may come to comprise most of the apneic's night.

Deprivation of deep sleep appears to cause daytime somnolence.

What harm does deprivation of REM sleep cause? No one seems to know.

To our surprise, REM sleep deprivation can have beneficial effects, at least on depressed people. One can accomplish this just by cutting short the night's sleep, eliminating the latter half when most REM activity occurs.

Some drugs, such as the MAOI antidepressants mentioned above, can suppress REM sleep completely for months, maybe forever, without obvious resulting ill effects.

Theories persist, without much basis, that REM sleep functions in consolidating memory. Sigmund Freud's theory that dreams serve to release emotional material and conflicts repressed into the unconscious mind has fallen out of favor in this era of neurobiological speculation.

Regardless of its reason, REM sleep represents a state of heightened activation within sleep. Physiological functions like heart rate, breathing, and blood pressure increase and become more variable. Yet throughout most of the body, voluntary muscles lose almost all tension, effectively paralyzing the sleeper. Perhaps this works to prevent acting out the dream, as can occur in a pathological condition called "REM Behavior Disorder." The general reduction of tension can affect also those muscles responsible for keeping the upper airway open against the negative pressure set up by breathing in. This may contribute to the aggravation of apnea typical of REM sleep.

The respiratory events themselves contribute to exaggerating the fluctuations of physiological functions. Usually each apnea causes a peaking of blood pressure. At the end of the apnea, breathing may accelerate and deepen momentarily. Some apneas may result in cardiac rhythm disturbances such as premature ventricular contractions (PVC's); an excess of these can lead to life-threatening changes in heart rhythm. The dramatic fall in blood oxygen that sometimes occurs with prolonged apnea may damage any organ of the body.

This calls to mind the fact that people with OSA are at increased risk of death from cardiovascular causes--heart attacks and strokes in particular. How often do these occur during that stressful period of REM sleep?

No one seems to know this either. Under close monitoring in the sleep laboratory, very rarely do patients with OSA undergo cardiorespiratory events that demand emergency measures. But these many thousands of monitored nights represent only samples of a single night or two from any given patient. If only a few individuals live at real risk for "dying in their sleep" from apneas, then these thousands of nights may not suffice to see it happen in the lab. In any other situation save an Intensive Care Unit, fatal apnea would represent a solitary and unique event, that can occur only once in the life and death of an individual.

Sleep might be the best time to die, were it only dreamless and void of awareness, even internal. But just as it is a mistake to infer a deeper similarity of sleep to death than absence of visible action, so it is an error to equate sleeping with oblivion!

For more information on Sleep Apnea, please see our Sleep Apnea Section.