December 21, 2010

Most forms of DIMS fall into one or another of the categories I’ve just described; occasionally, however, I will run across cases that fit none of them. There is no doubt that the patients suffer from insomnia – they sleep less than they feel is right for them.
But when I examine them I am unable to discern any physical or psychological abnormality. Even the results of a sleep lab study may demonstrate no objective findings, by any of the usual clinical measurements, to indicate that sleep was disturbed, yet the patients insist that sleep was somehow unsatisfactory. Such patients are known as “short sleepers,” meaning that their sleep lasts less than 75 percent of the time considered average for their age group. Any symptoms they experience as a result of their sleep patterns are not directly related to their perceived insomnia. Rather, problems arise from their basic concern that they are somehow “abnormal,” that they should be sleeping differently from how they are. Sometimes these patients express the belief that there is a certain amount of sleep they “should” be getting—what I call the eight-hour myth. They may also feel lonely because they are awake during the early hours of the morning, or because there is relatively little support from our culture for people who do not fit the normal pattern of rest and waking. One short-sleeper acquaintance told me she would wake up hours before she had to be at work and do nothing except worry about her job. By the time she got there she was a nervous wreck. However, her life and her work improved tremendously when she began an early-morning hobby: writing. She is now writing a sequel to her first, unpublished spy novel.
Often a patient’s description of a sleep problem may initially suggest a disorder in initiating or maintaining sleep. As I’ve mentioned, however, careful attention to the patient’s sleep patterns, drug use, and medical history may help further differentiate the true nature of the disorder. Sometimes reassessment is mandated when the initial approach to therapy is insufficient or completely unsuccessful.
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May 8, 2009

The discovery of erection during REM sleep has helped progress in the treatment of impotence. There are two main types of impotence. The first type arises for psychological reasons. It is well known that some men can have sex with their wives but are unable to with their mistresses, or vice versa. A variety of psychological reasons are involved, such as anxiety over the fear of being discovered and a sense of guilt, fear of catching venereal disease, etc. This psychological impotence is best treated by psychological means. The second type results from physical illness; after a bad accident or a major operation in the pelvic area, a man may not be able to have an erection at any time. A penis implant has now been developed that can help those who are impotent because of physical illness. To sort out who is eligible for this implant, the impotent candidate has to spend a few nights in the sleep laboratory.

With the impotent candidate in the sleep laboratory, a gadget can be placed around the penis to record any erection occurring during REM sleep. This recording is called nocturnal penile tumescence or NPT, and a positive reading is a reliable indicator of psychological causes of impotence. In Melbourne, at the Cabrini Hospital, two strain gauges are placed around the penis and recordings are made on a scroll of graph paper running throughout the night Patients who have positive NPT readings are having erections and are suffering from psychological impotence. Sometimes they can be woken up during an episode of REM sleep while they are having a dream erection. The mere demonstration of their ability to have an erection can give them tremendous confidence, and their condition can sometimes be cured spontaneously as they now know that they are in fact potent.

Before the discovery of dream erections and the ability to measure NPT, most experts believed that 90 per cent of impotence resulted from psychological causes, and most impotent patients were sent to see the psychiatrist. However, since the discovery of dream erections, there has been a complete change of attitude. The experts now believe that only about 50 per cent of cases of impotence arise from psychological causes, with the other 50 per cent being the result of physical illness.

Patients who are impotent because of physical illness do not have positive NPT readings, and an implant may be able to reverse their status. There are now a variety of implants that can be surgically placed in the flaccid penis. One ingenious technique from the USA is to implant a long inflatable double sausage made of polyurethane into the penis. This is connected by thin tubes to a small bag acting as a reservoir of fluid and situated in the abdominal muscles. It is also connected by similar tubes to a small pump, rather like a third testicle, in the scrotum. When the patient wants to have sex, he can give his third testicle a squeeze, and the fluid is transferred from the reservoir to the inflatable implant in the penis to achieve

a good erection. He can maintain this erection as long as his partner desires. When they have finished, all he has to do is give the third testicle another squeeze and a special valve allows the fluid to be transferred out of the penis. Nowadays these operations are performed all over the world.

What about women? The clitoris, the most sensitive part of the female genitalia, is the equivalent of the male penis. Developmentally, parts of the body undergo involution if they serve no purpose. An example is breasts in men, as they are not required to feed babies. During REM sleep, the clitoris goes into engorgement and hardening, similar to the penis in men. So for the lady reader, do not think that dream erections refer only to men. Next time you wake up from a dream, feel your clitoris.

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April 29, 2009

When we go to sleep, we usually lie on our side or curl up comfortably. People often tell me that they have been practising relaxation like this. These are good positions for sleep, but we are aiming for deep mental relaxation which is different from sleep. Whether we lie down, or sit, or squat, our mental relaxation is more effective if we retain a symmetrical posture with our arms and legs in similar positions on each side of our body.

The Lying Posture-This is the basic posture and the easiest position for our exercises. We simply lie on our back with our arms by our side. Young people do not need a pillow. Adults can use a low pillow, but the lower the better, as lying quite flat enhances the feeling of abandonment—the letting go—which is such an important part of mental relaxation.

At the start a couch is quite suitable; but as soon as a real feeling of relaxation is attained it is wise to transfer to the harder surface of the floor. This is not quite so comfortable, and the relaxation achieved comes more from the mind and less from the body.

Lying on the sand on the beach is good; and the absence of clothes aids the feeling of abandonment. However, when we combine our exercises with sun-bathing, we want to

distinguish between the two things. The mental exercises require controlled activity of the mind, but in sun-bathing we just let ourselves doze off, relaxed and uncontrolled.

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