On the night, several years ago, that I tackled my nightstand, I should have known better. Jolted awake in the dark, my wife Alice peered over the covers to where I lay spread-eagled on the floor. I had lunged with open arms from our bed while still asleep, truly, I later mused, the consequence of an overactive imagination, all the more because my days playing football were long over. Alice joked that we should dust off the kids’ bed rails.
Since that night, we have been forced to take my wildest dreams more seriously. In a re-occurrence months later, I “blocked” Alice in bed, envisioning instead a defensive lineman (fortunately, despite her diminutive size, she was not hurt); and, more recently, I punched the headboard with my fist, thinking instead that I was protecting my parents from an assailant. What makes these incidents all the more bizarre is that three years ago, having written on the history of sleep, including its disorders, I began to collaborate with Dr. John Shneerson, the director of the largest sleep center in the United Kingdom, at Papworth Hospital. Our project: a series of papers devoted to sleep violence.
Despite the anguish caused by insomnia, it is far from the most frightening sleep abnormality. Nor, in contrast to the terror of nightmares, are the consequences of sleep violence confined to the unconscious. In extreme cases, sleepers have been known to inflict violence, even death, upon family members as well as physical injury or worse upon themselves. Some subjects, in doing so, never quit their beds, while others leave not only their beds but also their bedrooms, not unlike individuals prone to the related disorder of sleepwalking.
The term “sleep violence” encompasses several possible conditions, although some of these occasionally overlap with others. One of the most common disorders, especially among children, are night terrors, occasioned by momentary, frightening hallucinations, resulting in panic and confusion. Only in late adolescence and early adulthood, however, are subjects apt to commit violence, particularly if restrained. More sensational is R.E.M. Sleep Behavior Disorder (R.B.D.), which was formally identified in 1985 by sleep specialists at the University of Minnesota and Stanford. Insofar as we dream during the phase known as R.E.M. or rapid eye movement sleep, R.B.D., in contrast to other forms of sleep violence, is characterized by vivid dreams, distinguished by their narrative quality, which portray threatening persons or objects. Mild instances result in restlessness and abnormal twitching in bed; more serious are occasions when subjects, in acting out their dreams, attempt to fight back against their imaginary foe, thereby raising the risk of serious injury.
In recent years, sleep violence has figured in a number of high-profile criminal cases. Just this past November, a retired Welsh steelworker, Brian Thomas, admitted strangling his wife in their camper while dreaming of fighting off an intruder. Not only did Thomas have a history of sleepwalking but a polysomnography test, which monitors brain-waves and eye movements among other functions, was compelling enough for prosecutors to withdraw all charges. Better known, perhaps, on this side of the Atlantic was the case of Kenneth Parks, an unemployed Canadian whose murder of his mother-in-law in 1987 inspired a television movie, “The Sleepwalker Killing” (1997), in which Hilary Swank starred as his wife. Having no motive for the crime and a history of sleepwalking, Parks was acquitted by an Ontario jury.
Despite the potential for abuse by over-zealous defense attorneys, make no mistake. Sleep violence, whatever the variety, is a genuine malady not wanting for medical attention here or abroad. Although our understanding has improved dramatically in recent decades, it has been a source of consternation for centuries, particularly for legal scholars forced to grapple with the culpability of criminal suspects. As early as the 14th century, the Council of Vienne in southern France reported murders committed by persons in their sleep, a finding echoed the following century in a Spanish treatise that spoke of “murderous sleepwalkers” — “as is well-known has happened in England.” A notorious incident in London occurred years later when Colonel Cheyney Culpepper was convicted in 1678 at the Old Bailey for firing his blunderbuss at an officer of the guard. Although the soldier died, Culpepper was pardoned by James II.
By not holding defendants responsible for their unconscious behavior, authorities could be surprisingly enlightened, particularly if a prior pattern existed of troubled sleep. On the other hand, courts were less lenient in the event of ill will between a defendant and his victim. Then, too, if previous episodes on the part of the defendant had resulted in violence, he had a duty to take proper precautions. Least deserving of sympathy, noted the German legal authority Adrianus Beier in 1672, was “a sleepwalker,” who despite “knowing his condition, … sleeps with an enemy, after a quarrel, in the same house or bedroom and does not put away any weapons.”
By the 19th century, medical evidence in trials played an integral role, with lawyers drawing upon psychiatric testimony in an effort to exonerate their clients. A Kentucky defendant, convicted in 1879 of shooting a hotel porter three times, was later freed on the grounds that he had not been permitted to “prove by medical experts that persons asleep sometimes act as if awake.” Medical remedies, however, remained scant, limited to forcing adults to sleep by themselves, occasionally behind locked doors. Children, on going to bed, were typically monitored by anxious parents sleeping in the same room with one eye open.
Who today is most prone to sleep violence? That depends upon the nature of the disorder. If night terrors, for example, are especially common among children, most patients with R.B.D. are males over 50 years of age. Their advanced age, it seems, is owing to the development of lesions on a small portion of the brain stem that ordinarily inhibits physical movement in persons during R.E.M. sleep. Equally important is that, depending on the disorder, certain risk-factors are thought to increase the likelihood of episodes, including sleep deprivation, stress, and the consumption of alcohol.
The good news is that medication and, in some cases, therapy normally work wonders in combating sleep violence. Among other benzodiazepines, clonazepam, the same medication occasionally prescribed for restless-leg-syndrome, has proven very effective. Although most episodes of sleep violence do not result in physical injury, the potential for harm always exists, no matter how minor an incident might at first seem. Why run the risk?
As for myself, I currently take medication at the direction of my physician, and my wildest dreams are limited to more pedestrian concerns — a far more appealing alternative to sleeping apart from my wife or being forced to wear matching shoulder pads over our pajamas.
A. Roger Ekirch is a professor of history at Virginia Tech. He is the author of four books, including “At Day’s Close: Night in Times Past” (2005), which has been translated into eight languages. His new book, “Birthright: The True Story that Inspired ‘Kidnapped’ ” has nothing to do with sleep other than preventing him from getting enough.
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Full article: http://opinionator.blogs.nytimes.com/2010/03/23/violence-in-the-land-of-sleep/
