James F. Pagel

Definitions of Dream: A Paradigm for Comparing Field Descriptive Specific Studies of Dream

A single definition for dreaming is most likely impossible given the wide spectrum of fields engaged in the study of dreaming, and the diversity in currently applied definitions. Many studies do not specify a definition, yet results are likely to be comparable only when comparable definitions of the topic are used. The alternative is to develop a classification system organizing the multiplicity of definitions for dream. A dream should not be exclusively defined as a non-conscious electrophysiologic state. Dreaming is, at least in part, a mental experience that can be described during waking consciousness. Definitions for dreaming should be utilized in research and discussion which address the various axes which define dreaming: Wake/sleep, Recall, and Content.

Sleep Complaints Affecting School Performance at Different Educational Levels

The clear association between reports of sleep disturbance and poor school performance has been documented for sleepy adolescents. This study extends that research to students outside the adolescent age grouping in an associated school setting (98 middle school students, 67 high school students, and 64 college students). Reported restless legs and periodic limb movements are significantly associated with lower GPAs in junior high students. Consistent with previous studies, daytime sleepiness was the sleep variable most likely to negatively affects high school students. Sleep onset and maintenance insomnia were the reported sleep variables significantly correlated with poorer school performance in college students. This study indicates that different sleep disorder variables negatively affect performance at different age and educational levels.

The Effects of Altitude Associated Central Apnea on the Diagnosis and Treatment of Obstructive Sleep Apnea: Comparative Data from Three Different Altitude Locations in the Mountain West

STUDY OBJECTIVES This study documents both the incidence and effects of central apnea on diagnosis and treatment of OSA at different altitudes in the Mountain West and substantiates the clinical impression that individuals living at altitude with moderate to severe OSA are significantly more difficult to treat with PAP. METHODS Split-night polysomnography was compared between sites for patients with a diagnostic AHI > 15 living at 1421 meters (Site 1; N = 150), at 1808 m (Site 2; N = 150) and at 2165 m (Site 3; N = 142). The quality of PAP titration obtained was rated, based on AASM clinical guidelines, from 1 = optimal to 4 = unacceptable. Patients developing central apneas during PAP therapy (CAI > 5.0) were titrated with an alternative O(2) > CPAP/Bilevel PAP protocol. RESULTS The mean number of central apneas in the diagnostic portion of studies was significantly higher (p < 0.01) at Sites 2 (19.26) and 3 (12.36) than at Site 1 (3.11). Mean numbers of central apneas/h developing on treatment with PAP varied from 4.8/h at Site 1, to 9.79/h at Site 2, to 19.25/h at Site 3 (p < 0.001). At Site 1, 10.6% had a central apnea index (CAI) > 5.0, while 22% met this criterion at Site 2 and 38.7% at Site 3 (Site 3 vs Site 1, p = 0.01; Site 2 vs Site 1, p = 0.02). Rated titration quality varied significantly between sites. At Site 1, mean titration quality was 1.437 (SD 0.821); for Site 2, 1.569 (SD 0.96), and for Site 3, 1.772 (SD 1.025). Titration quality at Site 3 was significantly worse than at Site 1 (t = 3.22, p < 0.01) and at Site 2 (t = 2.55, p < 0.02). Repeat titration requirement differed significantly (p = 0.025). Analysis of covariance comparing titration across 3 altitude levels, controlling for age, was significant for the effect of altitude (p = 0.017). Utilizing the alternative O(2) > C-PAP/Bi-PAP protocol in patients with CAI > 5.0 developing on PAP treatment, an overall optimal or good titration (AASM criteria) was attained in 75/79 (95%) of titrated patients. CONCLUSIONS This study demonstrates that central apnea becomes significantly more common at increasing altitude in both diagnostic and treatment portions of split-night polysomnography in patients with significant OSA. An apparent exponential increase in the percentage of OSA patients with a CAI > 5.0 occurs with increasing altitude. Altitude associated central apnea has a significant negative effect on the quality of OSA treatment obtained during PAP titration for patients living at the altitudes addressed in this study.

Dream Use in Film Making

The correlation between film and dream has an extensive theoretical basis in both cognitive science and cinematic literature. Biographical and autobiographical reports from film makers document antidotal descriptions of the use of dream in creative aspects of screen writing, acting and directing film. However, no systematic or analytic approach has been used in the attempt to document dream utilization in film making. Film makers attending the Sundance Film Institute Screenwriter and Director Labs from 1995-7 were asked to complete a previously validated questionnaire regarding dream recall and incorporation into a spectrum of awake behaviors. Compared to a previous general population study, all responses to questions assessing reported dream effects on awake behaviors and recall were significantly higher for the film makers. An in-group study of film makers found that reported dream recall and effects on waking behavior for the Creative group (Directors, Screen writers, Actors) were significantly higher than for the Working group (Crew). Responses from the Professional Group (Producers, Editors and Cinematographers) were intermediate. Within the Creative Group, reported specific dream effects on behavior varied significantly with creative role.

Sleep Disorders in Primary Care

Each of us spend one-third of our lives asleep. Dysfunctions in this basic state lead to declines in quality of life, diminished waking performance, more frequent illness, and increases in both morbidity and mortality. Recent epidemiological data have emphasized the significant contribution of obstructive sleep apnea (OSA), one of the most physiological disruptive and dangerous sleep-related diagnosis, to pulmonary, cardiac, endocrine, and cognitive diseases (1–4). Yet sleep medicine is not just a pulmonary subspecialty. The spectrum of sleep disorders mirrors the clinical population of patients in a broad-based practice of primary care (5) (Table 1). Almost all chronic diseases result in physical or mental discomfort for the patient and consistently induce disturbances in the state of sleep.

Filmed Dreams: Cinematographic and Story Line Characteristics of the Cinematic Dreamscapes of John Sayles

The authors characterize the filmed dreamscapes of John Sayles though a structured interview with the screenwriter/director and an analysis of cinematographic and story line techniques utilized in creating dreamscapes in two of his films. The filmmaker uses complex techniques to produce believable dreams in otherwise naturalistic films by isolating the dream sequence and altering sound, color, cinematography, story, time, visual perspective and physical properties of the perceived external reality of the dream. This perceptual and orienting framework required to produce a believable dream on film may reflect innate characteristics of the dream state.

Dreaming and Sleep Disorder

The field of sleep medicine has contributed the aspect of empirical validity to the study of dreaming, a field long dominated by speculative theories based on anecdotal case reports. One aspect of this attempt toward clarity has been the classification and development of consistent definitions for the topic as well as for the phenomenology on which those definitions are based. Much of the recent history of dream research has been an exploration into the electrophysiology, neurochemistry, and neuroanatomy of REM sleep. Yet today, except when addressing nightmares, it is unclear as to whether any special relationship exists between dreaming and REM sleep. Different forms of dreaming occur in all stages of sleep, with dream mentation associated with many of the parasomnias. A spectrum of complex, yet difficult to control variables affects studies of dream content; however, the variables affecting dream recall are well defined. Today, the most pressing issue concerning dreaming for the field of sleep medicine involves questions as to the role of nightmares in the pathophysiology and therapy of post-traumatic stress disorder.