Hypnagogic Research Articles

The Field by Robert Andrew Perez

Reviewed by: The Field by Robert Andrew Perez Kamden Hilliard (bio) Robert Andrew Perez. The Field. Omnidawn. Robert Andrew Perez’s The Field is Californian: the “quivered spotty orange” (“poppies. poppies.”), “the cashew and kidney pools / like turquoise healing stones” (“desert sonnet”), and too, of course, the clouds, like “semen ribboning in chlorine” [End Page 184] (“hailing clouds”). Though Californian in intent and delivery, like Didion, Perez moves through language with a laidback vigor. In the opening poem, “erasure,” Perez’s “state, figuratively, / is pre-fire. [he] carr[ies] the threat of combustion; all [he] need[s] is sapphire.” A state, which, at once, is the governmental state and the state of being. The poems are associative and exacting in their execution, but it’s not all fire and political theory—it’s actually both. Readers are encouraged to “think back to seeing nicole richie in a papasan in the westwood / urban outfitters,” and even though “no one / knows [him] or nicole anymore,” Perez demands to know “with everything falling apart, why can’t the monolith of patriarchy?” But Perez has his answer, he already knows to vote, like prayeris to believe in something that will fail you . . . (“this world”) Failure is a tricky project in this collection, for failure is a wide thing, washing up on the shores of queer and performance theories, but more plainly, the poems examine a failure of futurism, which declares itself with friends “writing poems for/about their kids” (“erasure”), while the poet is still writing about fucking guys and fuckingloser guys and fucking loser guys and fucking loose guys, fucking losing loose, loserguys. (“erasure”) There is something tragic (and hilarious) at the heart of this self-criticism, which stakes its claim in California—land of the eternal west, land of the escaped queer, land of writing and rewriting where the poet hasn’t “forgotten to grieve” (“never been kissed”) but accepts “the momentum of / newness” as a motor. Similarly, the collection gathers energy from the “hypnagogia logia” poems, which seem to operate somewhere between prophecy, delirium, and revisionism. The poems feature the only omissions (bracketed blank space) and revisions (stuck-out text) in the collection, while eclipsing conceits of craft and science. In this series, the speaker trades their willful, sundrenched melding of theory and pop culture for an opaque truth-telling: . . . this is a memoryrecurring, continually distorted.the dreamspeak speak: don’tremember so hard. the next timethe sky may shatter & all the brokenglass that doesn’t fall in falls out. youmay very well land on it. (“hypnagoia logia”) [End Page 185] These poems are less invested in explicit communication than in the oddities of the hypnagogic state, in between the sleeping and waking lives. Instead of a living, breathing California—full of living, breathing people—these poems want the “he of the / phantasmagorical real” (“hypnagogia logia”). Similarly, Perez confronts the question of a borderless, boundless, undifferentiated nature. This collection fills itself on fires, water (in pools, oceans, and bays), sunshine, and clouds. The mind, after all, “is a cloud: write it before it disappears” (“a desert sonnet”). The natural world is its own master, and in a collection that does seem obsessed—in those petty and honest ways—with making queer love meaningful in a world where futurism challenges the need of queers, the natural world provides an exciting, associative model. In this collection, fire leads to “a plan. / an escape” (“hypnagogia logia”). In this collection, “all that mattered, / was the dust mattering the windless air,” (“hypnagogia logia”) and the “night sky, in its mostly darkness, / is the most banal of mysteries (“enantiodromia”). Children, too, seem alien. Untamed: “those / cascading hills, my inner-child. / mum’s the world.” But it’s not silence that Perez leaves the reader. No. In fact, the poet leaves us with a poem damn near perfect: “poppies. poppies.” Perez knows “california is full of it: gold,” and finds more in the “the burning sun / cools itself by dipping into the blue, / that’s golden, too.” California isn’t the sole heir to the golden, nor is nature, for Perez has already confessed that “we / used to, like others, say...

Efficiency of a Combination of Pharmacological Treatment and Nondrug Interventions in Childhood Narcolepsy.

Objective Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic and/or hypnopompic hallucinations, and sleep paralysis. It is one of the most important causes of excessive daytime sleepiness in the pediatric population. The aim of this study is to present the clinical and laboratory findings, and treatment results of pediatric patients with narcolepsy. Materials and Methods We studied five unrelated consecutive children with narcolepsy, focusing on clinical and laboratory features, the therapy and outcome over the 33-month follow-up period. Results The study subjects included two boys and three girls. The mean age at diagnosis was 11.8 ± 3.3 years (range: 8-16 years). Three patients had cataplexy. There were no hypnagogic hallucinations and/or sleep paralysis in any patients. All patients were educated about sleep hygiene, appropriate nutrition, and regular exercise. Three patients were treated with modafinil, while two patients received methylphenidate. Sodium oxybate was added to existing treatment in patients with cataplexy. Cataplexy attacks did not respond well to the treatment in one patient; therefore intravenous immunoglobulin therapy was given. Conclusions Early diagnosis is important to help narcoleptic patients in improving their quality of life. A combination of pharmacological treatment and nondrug interventions can greatly improve children's clinical symptoms.

Franz Kafka's insomnia and parasomnias

Franz Kafka (1883–1924) was one of the most influential writers of the 20th century. His large collection of diaries and correspondence is a precious information source about Kafka's life and literary work. For Franz Kafka, insomnia was a literary methodWe read with great interest the Focal Point by Antonio Perciaccante and Alessia Coralli1 about Franz Kafka's insomnia and parasomnias. For all his writing life, Kafka had insomnia and the hypnagogic hallucinations arising from his lack of sleep shaped much of his writing. However, to conclude, as the authors do, that “The Metamorphosis” can be read as a metaphor for ill effects of insomnia would be incorrect. Full-Text PDF

60. Hallucinations with sexual context as manifestation of narcolepsy without cataplexy. Case report

Objective Description of clinical case of hypnagogic visual hallucinations and narcolepsy without cataplexy. Case report Female 24 years old, at age 8 begins with auditory and visual hallucinations, 3 min long (6 month). She was diagnosed as epileptic and antiepileptic handled without improvement. At 18 years of age, begins with excessive daytime sleepiness, feeling unable to move in bed wanting to wake up and start the dream hallucinations consisting in that she was raped and fought against their aggressors; these episodes became frequent after 22 years. Neurological examination, EEG and brain MRI were normal. Epilepsy and psychiatric disorders were ruled out. Narcolepsy was suspected, but PSG was normal. Then multiple sleep latency test was compatible with narcolepsy without cataplexy. Currently she is under modafinil and antidepressant treatment with decrements un hallucinations and improved alertness during the day. Comment There are scarce cases in the literature with hypnagogic hallucinations with sexual contexts, as a manifestation of narcolepsy. Faced with a poor clinical symptomatology, epilepsy or psychiatric illness can be misdiagnosed, so it is important to know their existence and Para clinical findings may help to integrate a correct diagnosis and treatment.

Narcolepsia canina

Canine narcolepsy is a neurological disorder that affects the appearance and organization of sleep. It is characterized by excessive daytime sleepiness, cataplexy and hypnagogic hallucinations. In Doberman and Labrador breeds, narcolepsy is transmitted hereditarily by the canarc-1 recessive gene, which has complete penetrance and causes a mutation in the receptor for hypocretin-2, a neuropeptide that prevents entry into REM sleep by activating specific neurons. Diagnosis can be achieved by observing the symptoms. Cataplexy is a key factor for diagnosis of narcolepsy and must be carefully distinguished from other neurological diseases and reversible paralytic disorders. Treatment is palliative and based on the administration of stimulants of the central nervous system (CNS) and tricyclic antidepressants.

What Is the Link Between Hallucinations, Dreams, and Hypnagogic-Hypnopompic Experiences?

By definition, hallucinations occur only in the full waking state. Yet similarities to sleep-related experiences such as hypnagogic and hypnopompic hallucinations, dreams and parasomnias, have been noted since antiquity. These observations have prompted researchers to suggest a common aetiology for these phenomena based on the neurobiology of rapid eye movement (REM) sleep. With our recent understanding of hallucinations in different population groups and at the neurobiological, cognitive and interpersonal levels, it is now possible to draw comparisons between the 2 sets of experiences as never before. In the current article, we make detailed comparisons between sleep-related experiences and hallucinations in Parkinson's disease, schizophrenia and eye disease, at the levels of phenomenology (content, sensory modalities involved, perceptual attributes) and of brain function (brain activations, resting-state networks, neurotransmitter action). Findings show that sleep-related experiences share considerable overlap with hallucinations at the level of subjective descriptions and underlying brain mechanisms. Key differences remain however: (1) Sleep-related perceptions are immersive and largely cut off from reality, whereas hallucinations are discrete and overlaid on veridical perceptions; and (2) Sleep-related perceptions involve only a subset of neural networks implicated in hallucinations, reflecting perceptual signals processed in a functionally and cognitively closed-loop circuit. In summary, both phenomena are non-veridical perceptions that share some phenomenological and neural similarities, but insufficient evidence exists to fully support the notion that the majority of hallucinations depend on REM processes or REM intrusions into waking consciousness.

P.036 Clarithromycin induced sleep paralysis: a case report and review of literature

Background: Clarithromycin is a macrolide antibiotic, which has been successfully used for treating narcolepsy without cataplexy and primary hypersomnia. Sleep-paralysis has not been reported as a side effect of this medication. Methods: We report a 44-year-old right-handed female, who presented with three episodes of paralysis over 2-day. Each spell occurred upon awakening or while falling asleep lasting less than 2-minute. Only one episode was accompanied by tingling and numbness. She denied cataplexy, sleep attacks, hypnopompic and hypnagogic hallucinations. She had no history of similar episodes. She had never experienced migraine with or without aura. She was obese and suffered nocturnal snoring. She had recently been started on Clarithromycin for pneumonia. Her neurological examination was normal. Results: Brain MRI was normal. Stroke work up including carotids CT angiogram, 24-hour Holter monitoring and echocardiogram were unremarkable. Polysomnogram when she was not on Clarithromycin indicated mild obstructive sleep apnea and no narcolepsy. She had no further episodes of sleep paralysis after Clarithromycin was discontinued. Conclusions: We believe that administration of Clarithromycin was the cause of sleep paralysis. We hope that this case report increases awareness about this particular side effect of Clarithromycin and leads to further investigation about the etiology of sleep paralysis.

Narcolepsy in Adolescents: A Review and Three Case Reports

Background: Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic and/or hypnopompic hallucinations, and sleep paralysis. Due to symptom overlap and comorbidity between narcolepsy and other psychiatric disorders, narcolepsy in children and adolescents can be easily misdiagnosed. Diagnostic delay is common. Method: We review the clinical presentations, epidemiology, etiology, diagnostic criteria, and treatment of this disabling disorder. We also present three examples of cases initially diagnosed as either a medical or psychiatric disorder, leading to a delay in management ranging from seven months to seven years. Discussion: These cases highlight the importance for psychiatrists and other mental health professionals who work with adolescents to become familiar with this uncommon disorder to shorten time to treatment of this patient population. Keywords: Narcolepsy, narcolepsy misdiagnosis, narcolepsy with cataplexy, narcolepsy without cataplexy.

Emerging treatments options for narcolepsy throughout a case

BackgroundNarcolepsy is a neurological disorder characterized by disturbances in REM sleep. The symptoms that the patient could present are excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and disrupted nocturnal sleep. Its etiology is unknown. Currently, there is established pharmacotherapy for symptomatic treatment, which are often unsatisfactory.ObjectiveReview of new treatments for narcolepsy based on recent advances about its ethiopathogenesis.MethodSeventy-five year-old female with a personal history of arterial hypertension and obstructive sleep apnea syndrome. The patient presented several episodes of abrupt muscular weakness, nightmares, sleep paralysis and excessive daytime sleepiness. Diagnosed of narcolepsy and treated with methylphenidate immediate-release (IR) 10 mg, alprazolam 1 mg, and trazodone 100 mg with good response.ResultsDue to persistent symptoms, treatment was modified to osmotic-release oral system (OROS) – methylphenidate resulting on a substantial weight loss (12 kg) and persistence of symptoms. Another methylphenidate preparations were unsuccessfully tested. Currently she continues treatment based on methylphenidate release-release and she improved significantly though she sometimes presented daytime sleepiness.DiscussionRecent studies have shown that a loss of the hypothalamic neuropeptide hypocretin causes Narcolepsy with cataplexy and that an autoimmune mechanism may be responsible for this loss (related to HLA DQB*0602). Pathophysiology of narcolepsy without cataplexy is less understood.Although amphetamines and its derivatives are the mainstay of management, therapies that involve hypocretine seems to be hopeful (intranasal, peripherical or hipocretin cell transplantation). Monotherapy with GHB, H3 antagonist receptors, TRH analogs and immunotherapy are also being studied.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Parasomnias and panic attacks: A case report

IntroductionParasomnias are a category of sleep disorders in which abnormal events occur during sleep, due to inappropriately timed activation of physiological systems.Case reportwe report the case of a 41-year-old female who has no psychiatric history. The patient went to emergency department because when she was starting to sleep, in the first state of sleep, she felts a sensation of paralysis in all her body, with incapacity for breathing, chest oppression and tactile hallucinations like something or someone was touching her entire body. Due to that, the patient awoke frightened, with high levels of anxiety, with heart palpitations, shortness of breath, trembling, choking feeling, sweating, nausea and fear of dying. When the patient arrived to the emergency department, she was suffering a panic attack, thinking that she could have some kind of neurological disease or she was suffering a heart attack. after treating the panic attack with 1 mg of lorazepam, all the symptoms subsided gradually.Discussionin this case report, we present a patient with a new-onset parasomnia, with hypnagogic hallucinations and a panic attack at the awakening. It is known that stress factors are closely associated with parasomnias, as we can see in this case because the patient was moving and she was sleeping in a new place.ConclusionsParasomnias are very frequently present in general population and they can trigger intense anxiety status that can lead to panic attacks.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The role of modified states of consciousness in drug use

Modified state of consciousness (MSC) is defined as a mental state that can be subjectively recognized by an individual or by an objective observer of the individual, as representing a difference in the psychological functioning of the “normal” state, alert and awake of the individual. Drugs are products with definitions and conceptual boundaries, historically defined. The use of psychoactive drugs is related to the increased plasticity of human subjectivity which is reflected in various technical means to change the perception, cognition, affect and mood. The authors propose to conduct a literature review on the types of MSC, the way to achieve them and their implications in drug consumption pattern.A MSC consists of dimensions such as self-oceanic limitlessness, agonizing self-dissolution and visionary restructuring.Normal MSC includes dreams, hypnagogic state and sleep. Others may be induced by hypnosis, meditation or psychoactive substances. Those achieved by drugs allow the subject to access feelings and sensations which go beyond the everyday reality or, on the other hand, leakage of reality.Anthropological studies show that in almost all civilizations, man sought ways to induce MSC.What characterizes the problematic or abusive use of certain substances is not necessarily the amount and frequency of drug use, but the disharmony in the socio-cultural, family and psychosocial contexts of the individual.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cultural explanations of sleep paralysis: The spiritual phenomena

IntroductionSleep paralysis (SP) is relatively frequent condition, occurring either at sleep onset or sleep offset. It occurs at least once in a lifetime in 40–50% of normal subjects. During SP, the patient experiences gross motor paralysis, while the sensory system is clear. Hypnogogic and hypnopompic hallucinations are common. This experience might be interpreted as a spiritual phenomenon in several cultures, each one with different interpretations and attributions.ObjectiveThe authors revisit the clinical presentation of sleep paralysis and how this sleep disorder is seen from a cultural perspective.AimsTo describe several cultural interpretations of SP.MethodsA literature review of the theme is shortly surveyed.ResultsIt is very common during an episode of SP sensing the presence of menacing intruders in one's bedroom. Supernatural accounts of this hallucinated intruder are common across cultures. It has been traditionally labeled “ghost oppression” among the Chinese. In the Abruzzo region (Italy), the supernatural interpretation of the phenomena is called the Pandafeche attack. One study found that nearly half (48%) of the participants from the general Egyptian population believed their SP to be caused by the Jinn, a spirit-like creature. In Southwest Nigeria, Ogun Oru is a traditional explanation for nocturnal neuropsychiatric disturbances. The characteristics of the ‘a dead body climbed on top of me’ phenomenon suggest that is identical to sleep paralysis and a frequent experience among Mexican adolescents.ConclusionsDepending on the etiological interpretations of SP, which is largely culturally determined, patients react to the event in specific ways.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Duality of sleep mechanisms – A background of present-day clinical and neurophysiological knowledge

Rapid Eye Movement (REM) sleep discovery initiated a new area of scientific as well as clinical research in sleep medicine. Non-REM (NREM) and REM sleep have been studied from the neurophysiological, neuroanatomical and neurotransmitter points of view. The development of improved imaging techniques including electroencephalography (EEG), polysomnography (PSG), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) along with the power of advanced computational techniques help to improve our knowledge. While NREM sleep is characterized by slow oscillations and connected with decreased global and regional cerebral blood flow, REM sleep is characterized by high frequency, low amplitude activity and correlates with increased cerebral blood flow. Recent research suggests NREM sleep correlation with synaptic plasticity in the brain (particularly in childhood). Sleep macro- and microstructure (cyclic alternating patterns, CAP) revealed new connections with clinical implications (epilepsy, parasomnia). Besides rapid eye movements, changes in circulation and respiration, muscle atonia is a fundamental characteristic of REM sleep. Lack of REM atonia causes REM behavior disorder – a clinical entity preceding many neurodegeneratice diseases. In contrast, narcolepsy is associated with excessive and unwanted REM atonia – cataplexy, hypnagogic hallucinations or sleep paralysis. Neurophysiological knowledge then helps us to understand the background of different sleep disorders.

How to Make the Ghosts in my Bedroom Disappear? Focused-Attention Meditation Combined with Muscle Relaxation (MR Therapy)-A Direct Treatment Intervention for Sleep Paralysis.

Sleep paralysis (SP) is a common state of involuntary immobility occurring at sleep onset or offset. It can include terrifying hypnogogic or hypnopompic hallucinations of menacing bedroom intruders. Unsurprisingly, the experience is associated with great fear and horror worldwide. To date, there exist no direct treatment intervention for SP. In this article, I propose for the first time a type of focused inward-attention meditation combined with muscle relaxation as a direct intervention to be applied during the attack, to ameliorate and possibly eliminate it (what could be called, meditation-relaxation or MR therapy for SP). The intervention includes four steps: (1) reappraisal of the meaning of the attack; (2) psychological and emotional distancing; (3) inward focused-attention meditation; (4) muscle relaxation. The intervention promotes attentional shift away from unpleasant external and internal stimuli (i.e., terrifying hallucinations and bodily paralysis sensations) unto an emotionally pleasant internal object (e.g., a positive memory). It may facilitate a relaxed meditative state characterized by a shift from sympathetic to parasympathetic dominance, associated with greater levels of alpha activity (which may lead to drowsiness and potentially sleep). The procedure may also reduce the initial panic and arousal that occur when realizing one is paralyzed. In addition, I present a novel Panic-Hallucination (PH) Model of Sleep Paralysis; describing how through escalating cycles of fear and panic-like autonomic arousal, a positive feedback loop is created that worsens the attack (e.g., leading to longer and more fearful episodes), drives content of hallucinations, and causes future episodes of SP. Case examples are presented to illustrate the feasibility of MR therapy for SP.

Précis of Waking, Dreaming, Being: Self and Consciousness in Neuroscience, Meditation, and Philosophy

Précis of Waking, Dreaming, Being: Self and Consciousness in Neuroscience, Meditation, and Philosophy Evan Thompson (bio) The central idea of Waking, Dreaming, Being is that the self is a process, not a thing or an entity.1 The self isn’t something outside experience, hidden either in the brain or in some immaterial realm. It is an experiential process that is subject to constant change. We enact a self in the process of awareness, and this self comes and goes depending on how we are aware. When we’re awake and occupied with some manual task, we enact a bodily self geared to our immediate environment. Yet this bodily self recedes from our experience if our task becomes an absorbing mental one. If our mind wanders, the mentally imagined self of the past or future overtakes the self of the present moment. As we start to fall asleep, the sense of self slackens. Images float by, and our awareness becomes progressively absorbed in them. The impression of being a bounded individual distinct from the world dissolves. In this hypnagogic state, the borders between self and not-self seem to fall away. The feeling of being a distinct self immersed in the world comes back in the dream state. We experience the dream from the perspective of the self within it, or the dream ego. Although the entire dream world exists only as a content of our awareness, we identify our self with only a portion of it—the dream ego that centers our experience of the dream world and presents itself as the locus of our awareness. At times, however, something else happens. We realize we’re dreaming, but instead of waking up we keep right on dreaming with the knowledge that we’re dreaming. We enter what is called a lucid dream. Here we experience a different kind of awareness, one that witnesses the dream state. No matter what dream contents come and go, including the forms the dream ego takes, we can tell they’re not the same as our awareness of being in the dream state. We no longer identify only with our dream ego—the “I” as dreamed—for our sense of self now includes our dreaming self: the “I” as dreamer. Similarly, while meditating in the waking state, we can simply witness being conscious and watch whatever sensory or mental events occur within the field of our awareness. We can also watch how we may identify with some of them as “Me” or appropriate some of them as “Mine.” According to the Indian yogic traditions, which broadly construed include Buddhism, we can distinguish three aspects of consciousness.2 The first aspect is awareness, the second is the contents of awareness, and the third is how we experience some of these contents of awareness as “I” or “Me” or “Mine.” From this perspective, to understand how we enact a self we need to understand three things—the nature [End Page 927] of awareness and its sensory and mental contents, the mind-body processes that produce these contents, and how some of these contents come to be experienced as “I” or “Me” or “Mine.” In Waking, Dreaming, Being, I take this threefold framework of awareness, contents of awareness, and self-experience—or what the Indian tradition calls “I-making” (ahaṃkāra)—and put it to work in cognitive science. Whereas the Indian thinkers mapped consciousness and I-making in philosophical and phenomenological terms, I show how their insights can also help to advance the neuroscience of consciousness by weaving together neuroscience and Indian philosophy in an exploration of wakefulness, falling asleep, dreaming, lucid dreaming, out-of-body experiences, deep and dreamless sleep, forms of meditative awareness, and the process of dying. The organizing principle for the book comes from the Indian tradition, specifically from the Upaniṣads, which arguably contain the world’s first recorded map of consciousness. The earliest texts—the Bṛhadāraṇyaka and Chāndogya Upaniṣads—delineate three principal states of the self—the waking state, the dream state, and the state of deep and dreamless sleep. The later text of the Māṇḍūkya Upaniṣad adds a fourth state...

Frequencies and Associations of Narcolepsy-Related Symptoms: A Cross-Sectional Study.

Narcolepsy is a disabling disease with a delayed diagnosis. At least 3 years before the disorder identification, several comorbidities can be observed in patients with narcolepsy. The early recognition of narcolepsy symptoms may improve long-term prognosis of the patients. Thus, we aimed to investigate the prevalence of the symptoms associated with narcolepsy and its social and psychological association in a sample of Sao Paulo city inhabitants. We performed a cross-sectional evaluation with 1,008 individuals from the Sao Paulo Epidemiologic Sleep Study (EPISONO). Excessive daytime sleepiness (EDS) was assessed by the Epworth Sleepiness Scale. Volunteers were also asked about the occurrence of cataplectic-like, hypnagogic or hypnopompic hallucinations, and sleep paralysis symptoms. The participants underwent a full-night polysomnography and completed questionnaires about psychological, demographic, and quality of life parameters. We observed a prevalence of 39.2% of EDS, 15.0% of cataplectic-like symptom, 9.2% of hypnagogic or hypnopompic hallucinations, and 14.9% of sleep paralysis in Sao Paulo city inhabitants. A frequency of 6.9% was observed when EDS and cataplectic-like symptoms were grouped. The other associations were EDS + hallucinations (4.7%) and EDS + sleep paralysis (7.5%). Symptomatic participants were predominantly women and younger compared with patients without any narcolepsy symptom (n = 451). Narcolepsy symptomatology was also associated with a poor quality of life and symptoms of depression, anxiety, and fatigue. Narcolepsy-related symptoms are associated with poor quality of life and worse psychological parameters.

Sleep-related experiences longitudinally predict elevation in psychopathological distress in young adult Israelis exposed to terrorism

Unusual sleep and dream experiences—such as elevated dream recall, nightmares, hypnagogic hallucinations, flying dreams, or waking dreams—constitute a trait of atypical nocturnal cognitions that has been associated with life stress and psychopathological distress, as well as terrorism-related stress. In the present study, this trait was explored as a predictor of psychopathological distress following Israel's 2012 “Operation Pillar of Defense” by employing a prospective-longitudinal design. Fifty-three participants, for whom baseline data on psychopathology, sleep, and dreaming were previously assessed, were contacted again in the week following the conclusion of the Operation. They filled out questionnaires regarding sleep experiences, psychopathological distress, the degree of exposure to terrorism, dissociative experiences, and sleep quality. An elevation in psychopathological symptoms, from pre- to post-Operation measurements, was predicted by degree of exposure to terrorism, but also by pre-Operation sleep experiences. This effect of unusual dreaming in prospectively predicting psychopathological reactions to terrorism-related stress was also replicated when reanalyzing existing longitudinal data from a previous study on exposure to terrorism. These novel findings point to the importance of individual differences in nocturnal cognition as clinical indicators of risk for stress reactivity and psychopathology in the face of traumatic stress.

The Doors of Perception and the Artist Within

This paper discusses the significance for the philosophy of perception and aesthetics of certain productions of the ‘offline brain’. These are experienced in hypnagogic and other trance states, and in disease- or drug-induced hallucination. They bear a similarity to other visual patterns in nature, and reappear in human artistry, especially of the craft type. The reasons behind these resonances are explored, along with the question why we are disposed to find geometrical complexity and ‘supercolouration’ beautiful. The paper concludes with a plea on behalf of neuroaesthetics, but with a caution or two.

Update on therapy for narcolepsy.

Narcolepsy is a severe, incurable, neurological disorder that is treated by pharmacological management of its symptoms. The main symptoms are excessive daytime sleepiness (EDS) and cataplexy, although addition symptoms that may require treatment include sleep paralysis, hypnagogic hallucinations, and disturbed nocturnal sleep. Sodium oxybate and modafinil/armodafinil are the first-line treatments for EDS, and sodium oxybate for cataplexy. Sodium oxybate treats all the symptoms of narcolepsy, whereas modafinil is effective for EDS only. Alternative medications for EDS include methylphenidate or amphetamines such as dextroamphetamine, lisdexamfetamine, methamphetamine, or combination amphetamine salts. Non-FDA approved medications for cataplexy include norepinephrine reuptake inhibitors such as venlafaxine or atomoxetine. Combination therapy can be more effective for sleepiness such as sodium oxybate and modafinil/armodafinil. Medication for narcolepsy is generally well tolerated and usually required life-long although does not eliminate all symptoms of narcolepsy.

G69(P) Narcolepsy – an important but rare paediatric diagnosis

Aim To present patients investigated for narcolepsy in order to increase awareness of its clinical features. Methods 5 patients referred with possible narcolepsy to the sleep clinic. Results 8 year old boy with excessive daytime sleepiness and cataplexy. HLA typing has shown HLA- DQB*06:02. MSLT showed short sleep latency. Awaiting lumbar puncture for CSF analysis of orexin level. Commenced on methylphenidate with good response. 6 year old boy with 4 year history of falling asleep quickly including very short distances in the car, at school, and before finishing meals. HLA typing is positive for DQB1*06–02. Commenced on methylphenidate. 13 year old boy with 5 year history of falling asleep several times a day often missing his bus stop and has recurrent naps in school. Commenced on methylphenidate. 13 year old girl who falls asleep in lessons however related to boredom rather than irresistable desire to fall asleep. Found to be anaemic. Commenced on iron supplementation. 8 year old girl initially presenting with excessive daytime sleepiness with hallucinations on sleeping and waking. She was HLA DQB*06–02 positive suggesting narcolepsy with hypnagogic and hypnopompic hallucinations. MSLT not diagnostic of narcolepsy but had epileptiform changes on EEG. Commenced on clonazepam with improvement in hallucinations. Conclusion Narcolepsy is an autoimmune neurological disorder characterised by excessive daytime sleepiness associated with cataplexy, hypnagogic/hypnopompic hallucinations and sleep paralysis. This frightening onset of symptoms often occurs in childhood or adolescence with a 10–14 year diagnostic delay. Often multiple misdiagnoses such as hypothyroidism, depression and epilepsy are made along the way. By presenting these patients, the features of narcolepsy are highlighted enabling Paediatricians to consider this as a diagnosis. Better recognition and earlier diagnosis can lead to earlier onset of therapeutic intervention thus leading to a lower impact on academic performance and social development.