(p. 177) "The danger of apnea stems not only from heart problems and high blood pressure, but also from the incredible sleep debt that apnea suffers carry around with them since they get almost no continuous sleep at night. People with severe apnea typically carry so much sleep debt that they fall asleep while driving, eating, or talking."

(p. 178) "Although daytime fatigue and tiredness -- or outright drowsiness -- are usually one of the most troublesome, easily detectable symptoms for apnea patients, they are not the only ones. A variety of other difficulties are common, including esophageal reflux, frequent nocturnal urination, heavy sweating at night, morning headaches, raspy throat, personality changes, and loss of hearing -- even male impotence and the reduction of sex drive in both men and women. And yet, when patients go to doctors with these apnea-induced symptoms, their physicians nearly always miss the true cause. Even the by-products of excessive daytime sleepiness -- diminished performance, diminished mental acuity, forgetfulness, poor concentration, disorientation -- frequently are ascribed to some other problem, like Alzheimer's disease. The fact that sleep apnea and marked obesity often go hand in hand means that many of the health problems caused by apnea are erroneously attributed to the patient's weight."

(p. 182) "The prevalence of apnea rises as humans get older, probably because all tissue, including tissue in the airway, becomes less firm as we age."

(p. 184) "We have seen many children in our clinic since our group published the first description of obstructive sleep apnea in children in 1976. Obstructive sleep apnea can occur in children of any age, from infants to teenagers.... In a research project we're conducting in Moscow, Idaho, we have found that 40 percent of the children have noisy breathing and 10 percent had outright sleep apnea. Usually cases like this are resolved by taking out the tonsils and adenoids...."

(p. 185) "It is not uncommon for previously nonapneic women to develop obstructive sleep apnea during pregnancy, or for mild apnea to become very severe."

(p. 194-195) Stories of alien abduction are similar in many ways to demonic possession reported in an earlier age. Both of these may be related to sleep onset hallucinations.

NARCOLEPSY: "Truly vivid hypnagogic [associated with sleep onset] hallucinations occur when someone falls immediately or very rapidly into REM sleep without going through the intervening non-REM sleep stages. When REM sleep occurs so quickly, the dream story often begins exactly where wakefulness ended and is a seamless stream of consciousness from the real world to the dream world. Occasionally this can happen to normal individuals if they are extremely sleep deprived, or after waking up later in the sleep cycle, when REM is favored. However, hypnagogic hallucinations are frequent and are a true torment in patients who have a sleep disorder called narcolepsy."

(p. 197) "For people with narcolepsy, the most important and debilitating effect of the disorder is that they are unbearably sleepy all the time. Their struggle to stay awake is relentless, and whenever they let down their guard, sleep immediately overcomes them. Even when they are on guard, they are often overtaken by sleep -- in the middle of a sentence, while eating, or even during sex. Such unintended sleep 'attacks' may last up to 10 or 20 minutes, and then victims wake up feeling somewhat refreshed. Soon afterward, they become sleepy again."

"The most dramatic component of the narcolepsy syndrome is 'cataplexy' -- attacks of muscle weakness or near-total paralysis that occur suddenly, last for a few seconds or minutes, and vanish."

"Before I discovered that muscle paralysis is normally associated with human REM sleep, it was impossible to explain cataplexy. Others had erroneously assumed the attacks to be epileptic seizures not related to the sufferer's pervasive sleepiness. Contributing to the strangeness of cataplexy is the fact that an attack typically is precipitated by strong emotion -- anger, laughter, or just getting excited."

(p. 199) "Despite being sleepy all day, people with narcolepsy don't sleep well at night. In fact, their sleep resembles that of people with little or no sleep debt, compared with that of normal sleepers."

(p. 200) "It is nearly impossible for people with narcolepsy to lead normal lives. Relationships are often damaged irreversibly when patients fall asleep during a conversation -- or even during sex. We always encourage patients' spouses to accompany them to the sleep clinic so that we can explain that it is the disease, not boredom, that causes their mate to fall asleep at these emotionally charged moments. But if private life is difficult, social situations are strewn with potential land mines. One of my patients suffered a severe cataplectic attack at a party. Overhearing a funny remark, she collapsed to the floor while the tray full of champagne glasses she was carrying smashed all around her. Even though she tended to have attacks very infrequently, after this single traumatically embarrassing moment she withdrew completely from an active social life."

"Narcolepsy can strike people at almost any age -- it has been identified in children as young as three and has first emerged as late as 50 in a few adults -- but the peak time of onset is during adolescence, suggesting that the sexual maturation of the brain may play a role."

(p. 201) "People who aren't knowledgeable about narcolepsy may shun someone with the disorder or decide not to marry them or have children. Although there is a genetic component to the disorder, narcoleptics are only slightly more likely than the general population to have children who also develop the disorder. Given our ability to treat narcolepsy very effectively, the very slim chance of passing it to another generation should not influence such decisions."

"Narcolepsy affects about .05 percent of the population, or 1 in 2,000 people. This figure is fairly constant worldwide. Although it has a lower prevalence than insomnia, sleep apnea, or restless legs syndrome, narcolepsy is still a relatively common disorder...."

(p. 202-205) Dement learned about a dog with symptoms that sounded like narcolepsy so he began studying such dogs as well as bulls and ponies and blood from the dogs he studied by inbreeding to bring out this trait have led to finding the gene for narcolepsy in dogs.

(p. 205) "There is currently no cure for narcolepsy. We treat the disorder by providing stimulants to counter patients' pervasive daytime sleepiness. Cataplexy, hypnagogic hallucinations, and sleep paralysis are pure manifestations of REM sleep and must be treated with different medications. Most often antidepressants are used because they block REM paralysis (the source of cataplectic paralysis)."

(p. 206) "...[N]arcolepsy is a disease in which the daily periods of internal clock-dependent alerting appear to be missing. The physician, then, is using drugs to replace this important internal function."

(p. 208) REM BEHAVIOR DISORDER: "In REM behavior disorder, muscles that should be paralyzed during REM sleep are not. REM paralysis fails, and the body acts out the brain's dream. Injuries to the dreamer and the dreamer's spouse are common."

"...[O]ver 90 percent of REM behavior disorder patients are male. The disorder usually strikes after the age of 50, although we have seen patients as young as 9 at Stanford."

"As we have learned, the dreaming brain functions very similarly to the waking brain, processing thoughts and sending out messages to move limbs. Normally the instructions to move the eyes get through, but messages to move muscles in the rest of the body are blocked before they can leave the spinal cord. In REM behavior disorder, the messages are not halted, due to the pathology in the brain stem. People may just move their arms and legs in bed or talk in their sleep, or they may actually get out of bed and run around, without ever waking up or realizing that they are dreaming. The brain is blocking sensations from the environment and at the same time is replacing them with internally generated sensations from the dream world. As in every dream, the brain is directing the action -- in effect, the body is just along for the ride."

(p. 210) "Fortunately, the Minnesota sleep specialists have developed a fairly effective treatment for REM behavior disorder -- clonazepam, a benzodiazapine that curtails or eliminates the disorder in about 9 out of 10 cases."

(p. 211) PARASOMNIAS: SLEEPWALKING AND NIGHT TERRORS: "Unlike REM behavior disorder...people are not dreaming when they sleepwalk and are not having nightmares during night terrors. In fact, neither sleepwalking nor night terrors occur during REM sleep. Sleepwalking often happens when people have become very sleep deprived, and both night terrors and sleepwalking are more likely to occur in the beginnings of the night, when sleep debt is still high. Brain-wave recordings suggest that both sleepwalkers and night terror victims are passing back and forth rapidly between sleep and wakefulness. They wake up enough to get the most primitive parts of the brain working -- the emotional brain and the basic motor centers -- without engaging the brain's more reflective and self-aware functions. The sleep debt won't release its grip on the brain, so the sleeper never rises out of the blunted perception and amnesia that we all experience the first few moments after waking up. In true sleepwalking, there will be some perception but not high-level cognition: Sleepwalkers are able to recognize a door but do not know how to get a door open."

(p. 212) "...[P]erception is so intimately tied to memory that it is difficult to separate them. How conscious can you really be if you immediately forget what you are experiencing? Neuroscientist Gerald Edelman has proposed that consciousness is really a 'remembered present,' that self-awareness is an immediate memory of how we are feeling and what we are thinking. It is possible that sleepwalkers are not fully asleep, but that the part of the brain responsible for this remembering is not functioning as it normally would."

"Most cases of sleepwalking and night terrors begin in early childhood, although they can continue into adulthood. Sleepwalking can begin as early as children are able to walk, but it is mostly occurs between the ages of four and eight, then disappears spontaneously after adolescence."

(p. 213) "I hope I can allay the anxiety and worry. A child in the middle of a night terror episode is in a sense still. Such children are not having a bad dream and will almost never remember the episode. In fact, they may not be experiencing fear at all; it is their body that is expressing fright rather than their mind. Somehow it is not the conscious self that is terrified but some automatic process of the sleeping brain."

"About 3 percent of children experience night terrors, although many cases are probably not tabulated. Night terrors occur most often in children between two and five years of age and usually disappear completely by age seven. The disorder also may appear late in life, probably due to a form of epilepsy or organic changes in the brain."

"Sleepwalking or night terrors are less prevalent in adults. The attacks can have similar causes. When adults have persistent night terrors or sleepwalk, they should be evaluated by a sleep specialist."

(p. 214) "Sleepwalking also can be caused by excessive medication or by interactions between medications."

(p. 215) "...[M]odern sleep specialists no longer believe that people who sleep walk or have night terrors tend to have some sort of very severe psychological problem -- anxiety, fear, or guilt. A great deal of research convincingly shows that people who have any of these parasomnias -- night terrors, sleepwalking, bruxism (tooth grinding), bedwetting, and the like -- are no more likely to have psychological disorders than anyone else."

(p. 216) "...I'm sure that in many...cases people have been convicted of perpetrating a crime while they were, in fact, asleep. I firmly believe any such conviction is unlawful. The sleeping self is like another person inside us, someone who is not subject to the same laws and norms as the waking world."

"I admit that this idea raises some difficult questions about responsibility and accountability under the law. But be cannot hold sleeping people responsible for their actions for the same reason that we cannot hold insane people responsible; in order to do wrong in the eyes of the law, the accused has to be conscious and aware of his or her actions and their effects."

RESPONSE: Of course a Science of Religion takes a different approach to this issue of responsibility since it does not focus on punishment but on prevention and shared responsibility with society. (Both are totally responsible, each in their sphere of control). Therefore, the individual must do their part and society must do what it should.

(p. 218) "We are now in the midst of a pandemic of fatigue resulting from a long line of cultural, economic, health, and technological influences that can be traced back to long before Thomas Edison and his electric light bulb. Nonetheless, societal pressures to work more and at odd hours -- evenings, weekends, the night shift, round-the-clock -- have reduced our sleep time over the past century by about 20 percent. In the three decades since 1969, working American have added 158 hours annually -- nearly a full month of work -- to their workday (including commute). Many of those extra hours are being carved out of sleep time, and more work has meant extending other responsibilities of daily life into nighttime."

(p. 219) "The result of all this hard work and hard play is that we treat our sleep like a neglected child. We are resentful when the demands of sleep are inconvenient or too frequent. When we finally go to bed, we are frustrated when sleep doesn't come quickly. We express a longing for sleep while putting everything else ahead of it, spurning its cries for attention until it turns destructive."

"What's the way out of this sleep-deprived time trap?"

"I believe that the only solution is a radical rethinking of our relationship to sleep."

"A huge proportion of assembly-line accidents also are attribute to the potent combination of sleepiness and monotonous tasks. Serious efforts to gauge the full impact of fatigue in critical industries such as aviation, medicine, trucking, and shipping, have made it clear (at least to those with a fundamental knowledge of sleep) that the problem is worse and more pervasive than anyone suspected."

(p. 220) "Now that airplanes fly faster and farther and farther, sleep deprivation and circadian rhythms play a major role in how pilots perform in the cockpit. Any international flight crew can talk about the scheduling problems they have experienced and the burden of feeling sleepy in the cockpit on overseas flights."

(p. 222) "Mark [Rosekind, long time director of NASA's Fatigue Countermeasures Program] and his colleagues boarded planes and wired up the pilots to portable EEGs. The pilots took skill and reaction tests on handheld computers at set intervals. After observing and testing pilots on commercial, transpacific flights between San Francisco, Japan, Hawaii, and Los Angeles, Mark came away with frightening results. The reaction times of pilots flying these routes during the night decreased by more than 25 percent, very similar to the blunted reactions found in people who have stayed up all night. Furthermore, the pilots frequently fell into brief episodes of sleep -- episodes of falling asleep for 5 to 10 seconds. Fifteen percent of the episodes lasted more than 15 seconds. During these microsleeps, pilots were effectively out of touch with the world, unable to react to emergencies."

(p. 223) "What's more disturbing to me directly is that the health care professionals in whose hands we literally place our lives -- surgeons, anesthesiologists, and emergency room doctors and nurses -- are themselves chronically and severely sleep deprived. It is not unusual for medical residents and interns -- the foot soldiers of hospital and emergency room care -- to work 100 hours during a week that includes two nights on call."

"The scene inside operating rooms is frightening to contemplate. Surgeons, anesthesiologists, and nurses are all on call multiple nights a week. Doctors may be called into emergency surgery at 2:00 A.M., operate for five hours, and go straight into a previously scheduled 7:00 A.M. surgery. Patients have no idea that the surgeons preparing to cut into them are working on two or three hours' sleep or fatigued by a long operation the night before."

(p. 224) "...[T]rials and investigations of accidents caused by fatigued drivers, doctors, and pilots usually focus on whether or not the person actually fell asleep rather than on their state of mind in the moments before the accident."

(p. 225) "Given the enormous prevalence of sleep deprivation, it is surprising how little research has been done on exactly how sleep deprivation and circadian rhythms affect people's driving ability. But we do know that 33 percent of traffic accidents are traceable to sleepiness. And we know that fatigue is the number-one cause of fatal crashes in young drivers, ages 18 to 25."

(p. 226) "In 1990, on the heels of their report about the Exxon Valdez, the National Transportation and Safety Board recognized that fatigue is the most frequent, direct cause of truck accidents in which the driver is killed. It doesn't take a rocket scientist to realize that long-haul truck drivers are almost by definition severely sleep deprived. However, as the National Commission on Sleep Disorder Research delved into all sorts of issues, I began to wonder how many long-haul truck drivers also suffered from the prevalent sleep disorder obstructive sleep apnea."

"We were able to question 602 drivers, 90 percent males, as well as conduct actual overnight sleep recordings on 200."

(p. 227) This group set up by the National Commission on Sleep Disorder Research was surprised by the huge number of drivers who had sleep apnea. "Well over 70 percent were diagnosed with sleep apnea, and 13 percent had a very severe condition. This is about three times the rate found in the general population. Given all the other information we have uncovered about the high rates of accidents among sleep apnea patients, this was alarming news."

(p. 229) "...[T]he combination of alcohol use (two or more drinks per day) with severe apnea was associated with a fivefold increase in sleep-related accidents compared to healthy drivers with minimal to moderate alcohol use."

"On an everyday level, sleepy people make math errors, drop things, and become emotionally distant from their families, friends, and colleagues."

"What's dangerously deceptive is how awake you can feel even when you're carrying a heavy sleep load. That's because sleep debt is counteracted by arousal -- both from the periodic alerting effects of the biological clock and from the alerting effects of excitement or stress. You can stave off the effects of large sleep loads in the short term by staying engaged in stimulating activities -- for most of us, it's the pressing demands of the day's tasks. But the weight of sleep deprivation can't be ignored indefinitely. Eventually it catches up with you, usually when you relax a little, or when the body's clock-dependent alerting is at its lowest points during the early morning and the early afternoon. When arousal temporarily subsides, your underlying sleep drive is unleashed like a dammed-up river, and you're in immediate danger of being swamped by sleep, no matter where you are or what you're doing."

(p. 231) "Sleep deprivation is the most common brain impairment."

"Dave [Dinges, a fatigue expert at University of Pennsylvania] and other researchers have demonstrated that chronic sleep loss degrades nearly every aspect of human performance: vigilance (ability to receive information), alertness (ability to act on information), and attention span. In simple terms, a large sleep debt 'makes you stupid.' People take longer to react to challenging situations, and their reactions are more variable and less effective than when they are well rested."

Alcohol intoxication and sleep deprivation are similar in their effects on body functioning. Seventeen hours awake compares to a blood alcohol level of 0.05 percent. Twenty-four hours awake, compares to a level of 0.1 percent (with legally drunk being 0.08 percent) in most states.

(p. 233-234) Sleep deprivation and circadian rhythm changes have significant effects on athletes, business decisions/negotiations, etc.

(p. 241) Why do we sleep? "It boils down to the question of whether sleep serves a 'vital purpose' -- is there some critical function that sleep performs, without which we would die?... There are theories, guesses, some very suggestive experiments, but nothing has yet pinned down the precise reason the body must lie still and the mind draw inward for a third of every day. To paraphrase University of Chicago sleep scientist Allan Rechtschaffen: 'If the many hours of sleep accomplish nothing, it is the greatest mistake nature ever made.' And remember, there are really two kinds of sleep, REM and non-REM. A true understanding of sleep requires an explanation of the purpose for each."

(p. 242-247) In January 1965 Dement had the opportunity to study Randy Gardner, a San Diego high school student who was attempting to break the Guinness Book of World Records for the longest time awake: 260 hours. "Randy intended to stay up 11 whole days, or 264 hours...."

(p. 244) "As Randy's ordeal neared its end, staying awake actually got a little easier for him because his record-breaking wakefulness marathon started attracting a tidal wave of worldwide media attention. This was obviously very stimulating for an 18-year-old high school student."

(p. 245) "I spent day 10 walking around town with Randy and was generally very impressed at how well he was doing. We went to a penny arcade, where we played innumerable games on a mechanical base-ball machine. He beat me every time. On the last night of the vigil, he easily bested me in several 3:00 A.M. games of basketball. At 5:00 A.M. that morning Randy held a press conference. Even though it was the crack of dawn, all local and national TV cameras that had joined the throng showed up.... At a lectern bristling with microphones, Randy seemed like the President of the United States. He conducted himself flawlessly, neither slurring nor stumbling over words."

"The experience with Randy greatly altered my ideas about the effects of long-term sleep deprivation and mental illness. During Randy's 264 hours of continuous wakefulness he did not become psychotic nor did he exhibit any notable signs of individual psychotic symptoms. Losing sleep did not make him crazy. We could readily attribute any brief lapse to the severe drowsiness itself."

(p. 246)"...I can say with absolute certainty that his staying awake for 264 hours did not cause any psychiatric problems whatsoever."

(p. 247) However, "Randy's analytical abilities, memory, perception, motivation, and motor control were all affected in varying degrees. Even in his most alert periods, he was not entirely unimpaired."

"It appears that all mammals sleep. However, as more and more species are studied, the total amount of sleep and the total time devoted to non-REM sleep and REM sleep are extremely variable from species to species and are not consistently related to some biological principle."

(p. 248) "Nearly all mammals...[indicate] the presence of REM sleep and its unique brain-wave patterns.... Every creature on Earth, and even every cell in every creature's body, seems to have a cycle of rest and activity. But not every creature can be said to sleep. Somewhere between the evolution of yeast and yak, full-fledged sleep developed. Understanding when sleep evolved may help give us ideas about why we do it."

"One of the most unusual of mammalian sleepers is the dolphin.... [It lets] only one-half of the brain go to sleep at a time. First the left side sleeps for two hours or so, and then the right side, and so on until the day's sleep requirement is fulfilled.... To me, the extreme measures that nature has taken to conserve sleep in the dolphin seems to support the idea that there is a vital need for sleep."

(p. 249)"Birds also sleep, but their pattern of sleep is different from mammals' and probably evolved independently. For instance, many birds show very short bursts of the kind of activity that is typical of REM sleep -- perhaps a sign of REM sleep when it was just evolving. It may be that birds would find it impossible to roost if they had full-fledged REM sleep and the muscle paralysis that accompanies it. The fact that bird species developed their own form of sleep and yet also sleep about eight hours a day may ultimately lead sleep researchers to a better understanding of the basic reason for sleep."

"In general, investigators agree that most reptiles have a pattern of brain activity and behavior that shows some aspects of sleep (although they definitely have no REM sleep). For most lower species, this quiet time cannot really be called sleep in the sense we know it. Insects, worms, and other invertebrates don't show the changes in neurological activity, metabolism, and sensitivity to stimulation that we usually define as the basic signs of sleep. Fish periodically have a quiet time in which they rest their fins lightly on top of a rock or wrap a fin around a piece of seaweed. Many fish species seem to be less reactive to stimulus during this time, which could be a primitive example of sleeplike activity."

(p. 250) "Horses sleep about 3 hours a day, cats about 15, and bats about 20."

(p. 251) It may be that obtaining food and conserving energy laid the basis for the evolution of sleeping. "In any case, regardless of whether calorie conservation was the original purpose of sleep, the brain has created additional uses for it."

"Nested within quiet slow-wave sleep is a completely different kind of sleep -- REM sleep, the generator of dreams. Whatever its purpose, the intense activity of the dreaming brain is so important to us that the brain actively paralyzes the body's muscles to accommodate it. To find REM sleep's purpose, one of the first places we have looked is in the budding brain of infants."

"...[I]nfants spend about 50 percent of their sleep time in REM sleep, vs. about 25 percent for young adults. But the percentage does not tell the whole story, since newborn infants sleep about sixteen hours a day. This means they can spend a full eight hours in REM sleep. Howie [Roffwarg] and I hypothesized that fetuses and infants have such a large proportion of REM sleep because REM activity is crucial to the developing brain. We already know that the young brain is shaped by the nerve signals generated by sights, sounds, smells, and other sensations. Even in the womb, fetuses will be exposed to sounds, pressure on the skin, and smells and flavors in the amniotic fluid. As these nerve pulses travel through the brain, they are routed through various pathways. The nerve pathways that most efficiently connect cells and are used most often become stronger, much as well-traveled highways are expanded into interstates. On the other hand, like back roads that fall into disrepair, the nerve networks that are not used often, or don't work well with other cells, are weakened or eliminated. Nerve cells that don't fit in are destroyed. After about four months of gestation, the human fetus has grown 200 billion nerve cells in the brain, twice as many as it needs. The excess is eliminated during the first year of life. The brain cells that are killed off are the ones that don't fit in during the early brain activity."

(p. 252) "When nerve systems don't get the proper stimulation during certain critical early development periods they never function properly, even if they get plenty of stimulation later. In those rare cases where infants have cataracts, for example, part of the visual field that is blocked by the cataracts will atrophy and never develop if the cataracts are not treated immediately."

"Remember that during REM sleep, an area at the base of the brain sends out pulses of nerve activity that filter up through the rest of the brain and stimulate higher centers as well as the cortex, the brain's thin outer layer where most cognition takes place. It may be that REM sleep provides the developing brain with a regular workout and produces much more nerve stimulation than the fetus or infant would get simply from sensory stimulation. This self-stimulation by the brain may lay the foundation for its own organization by creating proto-sensations that train the brain and prepare it for the real-world sensations to follow."

"That is our theory, at least. Howie and I first published this hypothesis in the prestigious journal Science in 1966, and so far it has been neither completely proven nor completely disproven, mostly because it is extremely difficult to test. However, the last decade of neurological research provides evidence that the fetal brain uses artificial stimulation to help its visual system develop. Since the womb is dark, the eyes can't send messages back to the visual areas of the brain and give them the workout they need to develop. And yet immediately after birth, the eyes and the visual areas of the brain work fine. This is possible because the eyes of fetuses create their own nerve signals, just as they would if activated by light. These signals then pass from the retina to the visual areas of the brain and give them the stimulation they need to form images later. This allows the visual system to organize itself so it can make meaningful images from the first patterns of light that hit the eyes after birth."

(p. 253) "The idea that REM sleep is important for brain development fits nicely with the evolutionary pattern of brain development we see in other animals."

(p. 254) "...[It is possible] that REM sleep still continues to help our brains develop. Studies in animals and humans suggest that sleep deprivation may impair the formation of some long-term memories."

"Perhaps the brain never truly stops developing, and we need REM sleep to integrate new brain cells and to shape the connections made by existing ones."

(p. 256) "Every once in a while, there is a newspaper story about someone who is said never to sleep. Is this possible? As I have stated, not all people have the same need for sleep, and very few people seem to need either a huge amount of sleep each day or very little. In 1977 London psychologist Ray Medis searched for individuals who claimed to sleep less than an hour each day. After advertising widely for very short sleepers, he located a young woman who appeared to sleep approximately 70 minutes a night and agreed to undergo a sleep recording. Medis also found two other adult individuals who averaged perhaps 30 minutes of sleep per day and appeared to be in excellent health, with no complaints about fatigue or concern about not sleeping.... If there really is some vital need for sleep, then extremely short sleepers must be fulfilling that need in a very short time."

"This effort to study short sleepers should be repeated with adequate resources and a set of experiments that everyone agrees would settle the issue of whether short sleepers really sleep extremely little over the long term."

(p. 258) "Sleep touches on nearly every aspect of our physiology and psychology, of our interaction with the world and with others. It may be that sleep's original purpose is no longer its most important one. Hundreds of biological processes go on during sleep, making it impossible to separate sleep from the process of living. Whether we theoretically need sleep or not, for the foreseeable future we will need to work within the boundaries build by our need to sleep. For our health and happiness, we need to learn as much as we can about what kind of sleep we need for physical and psychological health."

(p. 259) "...I think in the aggregate, the widely diverse findings favor vital functions that are yet to be discovered or hints that are yet to be absolutely proven."

(p. 260) "From the perspective of longevity, sleep may turn out to be more important than most people think. There is plenty of compelling evidence supporting the argument that sleep is the most important predictor of how long you will live, perhaps more important than whether you smoke, exercise, or have high blood pressure or cholesterol levels. In the 1950s the American Cancer Society did a massive study of such factors. Volunteers surveyed over 1 million Americans representing every county and parish in the United States about their exercise, nutrition, smoking, sleep, and other health related habits. Six years later, the volunteers repeated the survey clearly identifying all of the respondents who had died since the original survey. Out of all the factors in this gigantic study, stated habitual sleep time had the best correlation with mortality. However, the correlation was not linear. The highest mortality rates at all age levels occurred for those who said they slept 4 hours or less, and for those who said they slept nine to ten hours or more. The lowest mortality rates were seen for those who said their habitual nightly sleep time was around eight hours. Other investigators carried out a very similar study with a smaller sample and a nine-year follow-up, and the results were essentially the same."

(p. 262) Studies at the British Medical Research Council's Common Cold Unit indicate that: "Quality of sleep before infection is a statistically significant factor in determining whether someone gets a cold. As Sheldon Cohen of Carnegie Mellon University and William Doyle of the University of Pennsylvania found, sleep seems to affect how sick people get and how much mucus they produce."

(p. 268) Growth hormone, growth factors and immune regulators seem to work with each other to foster sleep, the best state for doing their jobs. As we fall asleep, our bodies turn to the task of energy and tissue conservation. Body temperature decreases, conserving energy, sugars are stored away, growth hormone fosters the repair of tissue, and the immune system is bolstered. As we wake up and work through the day, our bodies are outfitted for action, and the opposite biochemical profile is put in place. Stress hormones rise, mobilizing stored sugars to make energy available and raising our adrenaline levels and general excitability. Stress hormones also are known to work against interleukin-1 and other immune factors, further encouraging wakefulness. Growth hormone levels drop, possibly because cells switch from reproduction to other functions, such as processing food or muscular action."

"I don't want to offend those individuals who have done outstanding work on sleep and immunology. Nonetheless, I feel that there still is not an absolutely unambiguous answer to the question 'If we do not sleep, will we inevitably get sick?'"

(p. 269) "Sleep is tightly woven into healthy neurological and hormonal function, like the warp and woof of cloth, and I strongly believe that taking a holistic approach to good health means that I must work on sleeping well and enough. Of course, as with many other aspects of life, sleep quality is the product of genes and environment, nature and nurture."

(p. 271) "Healthy sleep prepares the brain for the next day and renews our mental balance. At onetime or another nearly everyone has experienced something like the following: After a good night's sleep you rise feeling fresh and renewed. Your senses soak up simple pleasures, such as the clean smell of the air, the singing of the birds, the texture of the morning paper. You are rested and relaxed but not bored or sleepy. You are interested and pleasantly aware of your surroundings but not overwhelmed. You are engaged with the world. Confident that you are ready to tackle the day ahead, frustrations seem minor, challenges exciting rather than foreboding. You can focus your mind like a laser on any problem, tackling it with exhilaration and confidence, and you can concentrate at the highest level while your body is at rest."

(p. 272) "Sleep is both medicine and sustenance. It's balm we would like to be able to bottle and pull out on demand, the kind of feeling we wish we could make last throughout the day, every day.... [Yet] We so crave stimulation that it can be difficult to put away our entertainments tonight for the sake of securing tomorrow's well-being."

"In study after study, sleep researchers have found that good sleep sets up the brain for positive feelings. When we don't have enough sleep, we have a sour view of circumstances: We are more easily frustrated, less happy, short tempered, less vital. In addition, sleep deprivation increases complaints about other bodily problems -- headache, stomachache, sore joints or muscles. The fact that extreme sleep deprivation makes people grumpier has long been apparent."

(p. 276) "Sleep-deprivation studies have shown consistently that sleep-deprived subjects are more irritable, more volatile, and more depressed than control subjects. Accordingly, we can hypothesize that some of the violence and depression in today's society is related to pervasive chronic sleep deprivation."

"Sleep releases the natural vitality that we have in us, but it doesn't directly create that good feeling. This is a subtle but very important point: Sleep debt is what makes us feel lousy."

(p. 277) "...[A]nything that gets rid of sleep debt or covers it up can lift one's mood. This is true whether sleep debt is paid off through sleep, or covered up via a cup of coffee or amphetamines [or exercise]."

(p. 278) "The neuroscience of emotion is still in a fairly early stage of development. For thousands of years, people have been thinking about what sorts of things make us feel happy or unhappy, elated or depressed. While it is not known exactly how sleep and sleep debt help the brain create good feelings and bad, we are learning how the brain puts itself in an 'up' mood and how addictive drugs create a 'high' by stimulating the brain's pleasure centers. We also have a simple model of how the brain becomes activated and fully conscious during waking and dreaming activity. What we have found is that the biochemistry of wakefulness and sleep is intimately tied in with the state of the emotional part of the brain. The waking brain naturally excites and primes itself for vital interaction with the external world, while the sleep-deprived brain suppresses that natural buoyancy by damping the brain's neurochemical activity."

(p. 279) "A brain circuit called the reticular activating system plays a major role in arousal. It is highly likely that the biological clock operates on that system to wake up the brain and keep it awake. The reticular activating system is a small collection of nerves that originates deep in the brain stem, the most ancient and primitive part of the brain. A relatively few cells in the brain stem reach out and touch nearly every cell in the brain. These cells carry neurotransmitters, that relay activating signals from the reticular activating system. These neurotransmitters are norepinephrine, dopamine, and acetycholine. Norepinephrine is one of the key neurotransmitters for arousal, acting as the brain's form of adrenaline. Dopamine is known to be involved in body movement and pleasure. Acetycholine also acts as a prime arousal chemical and is known to be important in carrying signals concerning muscle movements. Another neurotransmitter, serotonin, also has a strong effect on mood."

"These excitatory neurochemicals prepare the brain's 100 billion nerve cells to react more quickly. It is also no surprise that they interface closely with the limbic system, which is sometimes called the emotional brain. This is because we must be wired not only to react quickly to challenge in a purely mechanical way but also to be motivated emotionally to face challenges. The reticular activating system sets the emotional brain on edge, as when runners ready to start a race get down on their hands and the balls of their feet. The activating system doesn't so much create feeling as set an emotional tone for any stimulus that filters into our brain."

(p. 281) "One school of thought holds that the sleep drive actively stresses brain activity through this braking mechanism, thereby linking sleepiness and mood. The more time we are awake, the more the inhibitory circuits of the brain damp down the stimulation of the reticular activating system, as if the nerve excitatory and dampening systems are fighting for control of the brain. As various areas of the brain are slowed down by this braking action, the effects show up in how we act, think, and feel. The dampening of nerve activity of motor areas makes us less coordinated; the dampening of nerve activity in the cerebral cortex makes us slow in thought; and quenching nerve activity in the emotional brain makes us feel less vital, less motivated. To counteract this we can walk around, concentrate harder, and give ourselves a pep talk, but eventually the brain's sleep drive triumphs. At some point no mental trick will stimulate brain activity in the areas we need to stay awake.... We have to fall asleep."

"The energized feeling you get when the sleep-satiated brain is turned on by clock-dependent alerting in the morning can be so good that you want to bottle it, and every generation throughout civilized history has tried to do just that.... coffee, tea, chocolate, and soda.... cocaine and amphetamines [as well as nicotine are attempts to do this]...."

(p. 282) "More and more, it seems that all addictive drugs are addictive precisely because they cause dopamine release, either directly or indirectly."

(p. 286) "So far, all of the drugs I've mentioned merely postpone the inevitable demands of the sleep drive. You may be able to stay up later, but eventually you will have to sleep extra to pay off the debt you build up during that time. But what if sleep researchers came up with a new drug that would allow us to go without sleeping and not accumulate debt. What if you could take a pill at 10:00 P.M., stay up all night, and still feel completely normal the next day?"

"One Stanford Sleep Research Center team led by Dale Edgar is currently investigating the properties of a different kind of molecule that may stimulate the body's natural arousal processes or block its natural sleep processes, or both. It was developed in France in 1976. This drug is modafinil.... Neither our group here at Stanford nor any of the other groups involved in the FDA testing process has yet to find a major negative side effect or a potential for addiction."

(p. 287) "What really makes modafinil of great interest to us is that it seems to both suspend the need for sleep in the short term, as well as delay or diminish the need to pay back sleep debt.... This means that modafinil and similar drugs are not stimulants at all but a new class of drugs that we have called 'somnolytics' rather than stimulants."

"Dale believes, as do I, that modafinil or similar compounds eventually may offer us a tool to find how the brain keeps track of sleep debt, one of the most important and interesting questions in sleep science."

(p. 287) "...[M]odafinil may be prescribed for other reasons [in the U.S.], not just narcolepsy or hypersomnolence. Assuming that modafinil and similar compounds prevent sleep without engendering the euphoria that underlies the abuse of other stimulants, these drugs could certainly be useful for individuals dealing with all kinds of emergencies: soldiers in combat, surgeons during very long operations, and leaders during national and international crisis, even the President of the United States. The U.S. Air Force already has studied the use of modafinil, and Canadian troops used it successfully in operations during the Persian Gulf War."

(p. 289) "Artificial stimulants may be beneficial in the short term to level out the swings of the biological clock or to deal with emergencies. But until proven otherwise (which may never happen), healthy sleep is the best long-term strategy for spurring brain activity and lifting our spirits.

(p. 290-292) THE REAL LIFE OF DREAMS: "As far as our brains are concerned, what we dream really happens to us.... This possibility of really experiencing two alternatives or experiencing what may be the consequence of a very important choice not as a fantasy or illumination but as a real experience may someday be of enormous importance. I think it is quite possible that someday we will be able to enter the dream world more or less at will."

Many people consider dreams the most important part of sleep. The idea that dreams are, as Freud said, 'letters to ourselves,' supplying crucial information about hidden emotions, continues to have strong popular support. It was dreams that first attracted me to the science of sleep, and I launched my research career studying the connection between dreams and REM. Decades later I continue to be fascinated by the power and mystery of dreams."

"Not all my fellow sleep researchers feel this way. Some regard dreams as merely an epiphenomenon of the sleep process. Dreams, according to sleep researcher, psychologist, and colleague Bernie Webb, are 'just the foam on the beer' of sleep. Two prominent neuroscientist sleep researchers ignited controversy by marshaling evidence to support their hypothesis that dreams are nothing more than random nerve activity in the brain with no real purpose or meaning."

"But I continue to be drawn to dreams, because I think they can signify much more.... I believe the answer to the question 'Why do we dream what we dream?' holds profound implications not just about ourselves but also about the nature of consciousness and the deepest workings of the human brain."

(p. 295) "No matter what the dream is about, REM sleep will produce an erection in any man who is not impotent for physical reason.... Even newborn males have erections during REM sleep."

(p. 296) DREAMS IN ANIMALS: When cats and dogs sleep they have all the signs of dreaming. "I tend to believe that if all the signs of dreaming are present, dreaming is too. Still, whether animals experience dreams as humans do continues to intrigue people."

(p. 297) "I believe the major characteristic that distinguishes dream from reality is continuity. Our life and events in the real world are smoothly continuous. The dream world lacks this property. Each dream tends to be an isolated event -- at best, slightly related to the next. Events within dreams also jump from one setting to another."

(p. 298) "If we remembered every dream clearly, it might become difficult to sort out what really occurred and what was a dream."

"I truly believe that the wall of memory [i.e., being able to forget] is a blessed protection."

"The eyes offer a window into the brain during REM sleep. The unparalyzed eyes reveal that the brain is reacting to the dream scenes in essentially the same way it would if the dream were real."

(p. 299) "Years of experimentation strongly suggest that in REM, the brain is acting very much as it does in waking life, sending out signals to move muscles in response to the scenario that is being played out in the dream. Even though the eyes are not receiving real images from the outside world, the brain orders them to move, to scan a scene that actually exists only in the mind.... To certain parts of the brain, there is no difference between waking life and dreaming life."

"In a way, all perception is dreaming. The sole difference is that in dreams what we experience is limited only by the brain itself, and not organized and driven by sensory input from the outside World. This idea is summed up nicely by my colleague Stephen LaBarge: 'Dreaming is perception unconstrained by sensory input, and perception is dreaming constrained by sensory input.'"

RESPONSE: Sort of like the difference between science and folk religions.

"The idea that dreams are a personal message to the dreamer has a long history."

"Freud brought markedly renewed interest to interpreting dreams, perhaps because he was the first person in modern Western thought to make a systematic psychological study of the subject.... While the idea that dreams are the 'safety valve' preventing psychosis is no longer widely accepted by sleep researchers, belief in the significance of dreams has become increasingly common among the lay public."

(p. 301-302) "A few of today's most prominent sleep scientists have concluded that dreams are not letters to ourselves."

"In the early 1970s two prominent Harvard sleep researchers, J. Allan Hobson and Robert McCarley, found that during REM sleep a small area near the brain's base creates strong, regular bursts of nerve signals. These signals travel upward through the brain and spread throughout the cortex, where most of the brain's higher functions take place. The two scientists studied cats but postulated that similar bursts are occurring during REM sleep in all animals, including humans. The two psychiatrists, who are also eminent neurophysiologists and sleep researchers, propose that these bursts are the source of dreams. According to their 'activation-synthesis hypothesis,' the bursts originating in the area called the pons at the base of the brain 'activate' nerve cells throughout the brain, bring forth images, sensations, and feelings."

"Dreams result when the brain does what it does every day in waking life: makes sense of incoming nerve signals. The idea is that the brain takes what is essentially random, meaningless nerve activation and 'synthesizes' something that has some meaning and coherence, even if it has to resort to making up its own story. Accordingly, there is no hidden meaning in dreams.... The superficial content of dreams, they believe, is the whole content; there is no need for finding hidden meanings."

(p. 303) "Many people cannot accept these conclusions. Psychoanalysts, of course, find heretical the idea that dreams are merely a random collage of thoughts and images. But even as Freud and his theories have faded from center stage, there is still a widespread belief that dreams do have some profound messages for us. Many people regularly look to their dreams for insight about their lives, and I won't accuse them of sheer credulity."

"I believe that the struggle between neuroscience and psychoanalysis has yielded a false dichotomy. The question is not whether all dreams are pointless or all dreams profound. First of all, we do not know for certain if the same brain-stem process operates during REM sleep in humans. Another possibility is that once the brain stem gets the dream process going, it may, in effect, take on a life of its own within the infinitely more complicated human brain. Finally, some dreams may be without purpose or meaning while others may be quite the opposite."

(p. 308) "Dreams free us from the bonds of the real world. The dream world offers us adventure, entertainment, pleasure, and, all too frequently, terror. It is the realism of the dream world that gives our dream experiences such special value. Most often, in my experience, the value and meaning are better appreciated after we wake up."

"Since at least the beginning of recorded history, people have looked to dreams for insights about the world. Ultimately, the real importance of thoroughly understanding dreams may be insights into how the brain works, how we perceive, and why we think the way we do. We cannot help but create worlds in our minds, to make sense of whatever neurological signals are buzzing about the brain."

(p. 310) CREATIVITY, PRODUCTIVITY, AND LEARNING: "Thousands of consultants tell businesses how to become more efficient or productive, and hundreds of books advise people how to carry over the same concepts to their personal lives. But few convey the idea that healthy sleep and the timing of work are an essential part of achieving the creativity and productivity we crave. Instead, many of us feel we must give up sleep to be more productive, that it is not possible to get enough sleep and be successful.... This routine may yield results in the short term, but in the long run, shortchanging sleep depletes our mental acuity and undermines our potential for sustained achievement."

RESPONSE: But for a Science of Religion and a Religion of Wisdom based on it, understanding sleep (and dreams) as well as everything else that effects the quality of human living is essential.

(p. 312) "When we are sleep deprived, cognition is one of the first functions to go. Sleep is a basic biological drive, and strong, unfilled drives like hunger, thirst, sex, and sleep have a way of giving us a case of cognitive butterfingers. In both school and work environments, well-slept people are much more engaged, can keep more ideas in their head simultaneously, and can think through new ideas more clearly."

(p. 313) "Some researchers speculate that the learning process, moving memories into long-term storage, requires actual changes in the connections between neurons and that REM sleep facilitates this activity. Remember that neural growth factors rise during sleep, so REM sleep might be a time when the growth factors and brain activity act together to create the nerve connections needed to put memories in long-term storage."

"The first experiments on sleep and memory were animal studies. Rodents that learned how to navigate a maze or press a lever for a reward had more trouble remembering how to solve these puzzles the next day if they were deprived of REM sleep. In other animal studies conducted by... French researchers, a day spent learning a challenging maze or puzzle resulted in increased REM sleep that night, as if the animals were increasing that sleep to fix the newfound knowledge in their brains."

"Human studies of the relationship between sleep and memory have been more complicated and contradictory."

(p. 314) "Howard Gardner, a psychologist at the Harvard School of Education, has identified seven types of human intelligence that depend on seven distinct ways of storing and processing information: verbal, mathematical-logical, spatial, physical, musical, interpersonal (understanding relationships between people), and intrapersonal (understanding yourself). While Gardner's model is a helpful development in our understanding of neuroscience, I suspect that even his seven-path map of cognition is a highly simplified form of a much more intricate web."

(p. 315) "Years ago many people entertained the wonderful possibility that they could learn in their sleep by using audiotapes that pour information into their ears.... This possibility has been conclusively set to rest. Researchers used EEGs to ensure that the audio information was given only while subjects were actually asleep, and they found absolutely no evidence of learning the next morning. No amount of repetition made any difference. Any other result would have been very puzzling because we now know that the brain shuts itself off from outside stimuli during sleep."

(p. 317) "Psychologists have looked closely at the process creative thinkers use to arrive at their ideas and have found common elements. Besides having mastery of a domain of knowledge, you must possess an intrinsic motivation. And essential to sustaining this motivation is the ability to take pleasure in the creative act. Finally, you need to be able to hold paradoxical ideas in you mind and resolve their seeming contradictions. To make this extralogical leap you must be open to new ideas, question your own assumptions, and examine existing constraints."

RESPONSE: And of course this is essential for the development and mastery of a Science of Religion.

"A lifetime of sleep research has shown me that motivation is one of the first things to go when sleep is shortchanged."

(p. 318) "The creative act takes us beyond the limitations dictated to us by normative reality; we transcend the dross of daily living and discover a source of exhilaration and wonder. Sleep is a potent tonic for the creative process because it helps put us in a receptive state of mind where we feel motivated, are open to new ideas, are able to grasp complex and subtle relationships, and are capable of reaping pleasure from the creative process."

RESPONSE: And this is the state a Wise Person shoots for every day.

"Another aspect of sleep that can provide an important arena for creativity is dreaming. There are innumerable instances in literature, music, and the visual arts in which the artist was inspired by a dream or the solution to a problem appeared in a dream."

(p. 323) "In 1980 we were able to publish convincing objective evidence for the existence of lucid dreaming, and that it occurs during and only during, REM sleep."

"...[Stephen] LaBerge has developed a very successful system for teaching this skill. He outfits his students with a special visor that detects rapid eye movements during sleep and shines a blinking red light on the dreamers' eyelids. The light is bright enough to pass through the eyelid and eventually be noticed by the dreamers, but not so bright as to wake them up. LaBerge trains people to recognize the red light as a cue that they are dreaming. Once they become aware that they are dreaming, they can learn to direct and manipulate their dreams at will."

RESPONSE: For reasons that are not clear to me it appers as though no serious researachers are working to clarify the whole dreasm issue. I seems to me that it would be relatively simple to assemble adequate data to allow a basic understanding of this phenomena by studying a small group of people over an extended time.

Individuals might be studied for a week at a time 3 or 4 times a year for as long as circumstances allowed. To wake them up after every REM period and have them record as much of each dream as they could recall. Along with this to have each person log the events of their awake hours in order to attempt to correlate the two periods. If there are relationships (and I find it difficult to believe that there are not) this ought to become obvious as this data is analyzed.

(p. 327 - 3) THE PRINCIPLES OF HEALTHY SLEEP: "I've built these last chapters around principal areas for relaiming healthy sleep. They are all based on a respect for you individual biological clock and a commitment to put your sleep needs at the center, rather than the periphery, of your life. The areas are:

1. Taking stock of your personal sleep needs.
2. Getting help for your sleep problems.
3. Learning to manage sleep crises.
4. Taking age into account.
5. Adopting a sleep-smart lifestyle.

Finally, I've provided a program for putting these ideas into effect, as well as appendices with quick-reference resource guides, so you'll have more information at your fingertips for finding additional help with your sleep problems."

"Reclaiming healthy sleep isn't any easier than learning to eat right or stay in good physical condition. It takes discipline and self-knowledge. But my students at Stanford and the citizens of Walla Walla, Washington, have convinced me that healthy sleep is within the grasp of each of us, as long as we care enough to seize it."

RESPONSE: Dement's book presents much that is startling and immediately applicable to enhancing the quality of life for all. Although research is just beginning to expose the mysteries of sleep, we know enough now to help us lead a better life and Dennet presents a wealth of data in that regard. Obtain a copy of THE PROMISE OF SLEEP and study it carefully in order to integrate its wisdom into your own life and the lives of those you know and love.

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1. THE PROMISE OF SLEEP, William C. Dement, Delacorte Press, New York, 1999.

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