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REM while ‘awake’

Vol. 6, No. 2 / February 2007

I read with great interest Dr. Henry Nasrallah’s editorial, “Pathways of pleasure and pain,” and his postscript describing dopamine’s role in regulating the sleep-wake cycle (Current Psychiatry, November 2006). I am a psychiatrist and regularly observe my father who suffers from Parkinson’s disease caused by stroke, not progressive idiopathic Parkinson’s.

My father has episodes of what I call “REM awake.” He is awake and appears alert but responds to dream content as if it is real. When this happens he has rhythmic eye blinking and his gait is improved but not normal. He no longer gets “stuck” when trying to stand and walk, possibly because he does not remember that he cannot do this easily. He does not recall the episode when he is awake.

My father can rapidly transition out of “REM awake” when I have him close his eyes, relax, then stretch. His vital signs do not change, and EEG does not show a seizure.

When he “wakes” he cannot get up from his chair without great difficulty but is aware of his surroundings. This is his baseline. I therefore believe the process Dr. Nasrallah described in mice is present and observable in humans.

Kathleen Stack, MD
Hampton, VA

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