Dear Dream Doctor,

I “suffer” from very disturbed sleep. It tends to go in phases which usually last a week, but can last longer. I rarely get more than one or two nights of undisturbed sleep in a row. The most annoying part is where I dream but I seem to be awake and looking at my surroundings.

Usually I’m dreaming that something has changed in my room. I see my pillows as boxes or can’t work out what objects in the room are. I quite frequently pick my clock up because I can’t work out what the numbers mean. I also pick up things nearby in the room and will occasionally get out of bed and move things around.

I can usually arouse myself from this by persuading myself that I know I’m asleep so what I think is happening can’t be. Often I think that there is someone else in my room, not threatening, but I don’t want them to be there. Again I have to persade myself that I’m asleep and reason with myself that, as I live alone, there can’t be anyone else in my room. It really does lead to some very disturbed nights.

As far as I can tell these events are totally unconnected with my general daytime mood. They don’t seem to be in any way connected to stress. Any suggestions why I have these episodes, or more importantly, what I can do to stop them?

—Cary, Age 38, Wakefield, UK

Hi Cary—

Have you ever watched a dog sleep and observed some of the nervous muscle twitches that often occur? The dog is dreaming, and in her dream, she is busy chasing a rabbit, going for a walk, or perhaps simply exploring new smells in her “dream neighborhood.” Like humans during human dreams, the dog believes she is awake. Also like humans, she is sending commands to her body to move in accordance with her perceived needs. The reason why we don’t see our four-legged friend arise and chase imaginary objects around the living room, however, or hear her bark, is because these commands for movement are intercepted at the base of the brainstem. During dreams, commands for movement generated by the brain are not passed on to the main motor neurons. But not all the commands for movement are suppressed. The leg and whisker twitches of the dog, cat, horse, cow, newborn, or any other warm-blooded creature (dreaming is a universal characteristic of mammalian sleep) reveal the dreaming mind within.

In humans, the area responsible for suppressing commands for movement during REM, or Dreaming sleep, is known as the reticular formation. If there is a failure of this area to block commands for movement, strange and curious “sleep” behaviors result. In mild cases of REM Behavior Disorder, dreamers occasionally sleep talk and jerk suddenly in response to their dream activity. In more severe cases, dreamers do actually arise from their beds and chase imaginary objects around the room. When this occurs, the dreamer often endangers him or her self, and bed-partner.

Mild cases of REM Behavior Disorder are not considered sufficiently disruptive of sleep to merit treatment with medication. Medicines are prescribed, however, for severe and chronic cases of RBD, where the dreamer actually poses a threat to himself or experiences chronic restless and un-restorative sleep as a result.