Awake in a dream: Exploring the depths of the sleepwalking mind

Have you ever wondered what goes on inside the mind of a sleepwalker? What thoughts, if any, occupy the consciousness of those with parasomnia as they navigate the world in a state between sleep and wakefulness?

These are the complex questions that researchers at the Netherlands Institute for Neuroscience have begun to explore in a recent study.

Parasomnia and the waking dreamscape

Led by Francesca Siclari, head of the dreams lab, the research team dove into the experiences and brain activity patterns of patients with parasomnia, a type of abnormal sleeping behavior that can include sleepwalking.

While most of us may imagine sleepwalkers as individuals wandering around with closed eyes and outstretched arms, the reality is usually much more complex.

Sleepwalkers typically have their eyes open and can engage in elaborate interactions with their environment, from sitting up in bed and appearing confused to moving around or even screaming with a fearful expression.

Prevalence and impact of sleepwalking

Although parasomnias are more common among children, they still affect approximately 2-3% of adults on a regular basis.

These episodes can be distressing for both the sleeper and their bedpartner.

“Affected individuals can hurt themselves or others during episodes and may later feel deeply embarrassed for what they did,” Siclari explains.

Inside the sleepwalking brain during parasomnia

To better understand what occurs in the brain during parasomnias, Siclari and her team have conducted a study focusing on patients who experience these episodes during non-REM sleep.

“It was commonly believed that dreams only occur in one sleep stage: REM sleep. We now know that dreams can happen in other phases too,” Siclari notes.

“Those who experience parasomnias during non-REM sleep sometimes report having dream-like experiences and sometimes appear completely unconscious (i.e., on automatic pilot),” she continued.

Measuring brain activity during a parasomnia episode is no easy task, as it requires the patient to fall asleep, experience an episode, and have their brain activity recorded while moving around.

However, with the use of multiple electrodes and specific analysis techniques, Siclari’s team has managed to obtain clean signals even when patients are in motion.

Triggering parasomnias in the lab

To study parasomnia episodes, Siclari’s team employs a two-night recording process. On the first night, the patient sleeps normally.

The second night, the patient is kept awake and only allowed to sleep the following morning. During this recording, a loud sound is played when the patient enters the deep-sleep stage, which can sometimes trigger a parasomnia episode.

After the episode, the patient is asked about their mental state during the event.

Dreamscapes and blank slates

The study revealed that in 56% of the episodes, patients reported dreaming during the parasomnia.

“It was often about an impending misfortune or danger. Some reported that they thought the ceiling was going to come down,” Siclari explains.

“One patient thought they’d lost their baby and was searching through the bedsheets, and stood up in bed to try to save ladybugs from gliding down the wall and dying,” she noted

In contrast, 19% of the patients reported no experience at all, seemingly acting in a trance-like state. A small portion of patients mentioned having an experience but being unable to recall the details.

Brain activity patterns and their implications

By comparing the measured brain activities across these three categories, Siclari’s group found clear parallels.

Patients who reported dreaming during the episode showed activations similar to those previously associated with dreaming, both immediately before and during the episode, when compared to patients who did not experience anything.

Siclari suggests that the patient’s state at the moment of brain activation determines whether they will be completely unconscious or experience a dream.

“If we activate the brain while they’re likely already dreaming, they appear to be able to ‘make something’ of the activation, while when their brain is largely ‘inactivated’, simple behaviors seem to occur without experience,” she explains.

Interestingly, patients rarely mention the sound that triggered the parasomnia episode, instead focusing on some other form of impending danger.

Home and away: The future of parasomnia research

While this study represents a significant first step, there is still much to be explored in the field of parasomnia research.

Siclari and her team hope to set up a system that allows more people to record their sleep at home, where they may experience more complex and frequent episodes.

They also plan to conduct similar studies on individuals who experience parasomnias during REM sleep.

By measuring brain activity, the researchers aim to better understand the neural systems involved in different types of parasomnias.

This knowledge could eventually lead to more specific drug interventions, as current treatments often involve unspecific sleeping drugs that can have negative side effects.

Understanding parasomnias and sleepwalking

Siclari’s work not only provides valuable insights into the complex world of parasomnias but also offers relief to those who experience these episodes.

“These experiences are very real to the patients and most already felt relieved to be sharing them with us,” she notes. “Similar to previous studies, our research clarifies what they are experiencing, which is educationally valuable.”

As research in this field continues, we can look forward to a deeper understanding of the mysterious realm that lies between sleep and wakefulness, and the potential for more effective treatments for those who find themselves navigating this liminal space.

The full study was published in the journal Nature Communications.

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