Disturbances of Childhood (Chapter Eight)

That great cathedral space which was childhood.
— Virginia Woolf, 1882-1941

Do you remember your childhood? I do: bike riding with friends, making sandcastles at the beach, climbing trees, launching into the air on the playground swing, playing hide and seek, tag, birthday parties, sleepovers, sneaking into an R-rated movie, picking wild fruits, reading, riding roller coasters and eating cotton candy, hot chocolate, fending off dad’ ticklish beard, Saturday morning cartoons, dodgeball, kickball, sneaking candy from the cupboard, summer vacations, swimming, lying in bed at night, waiting for the door to squeak open and mom to come in and say goodnight…

But was there more to it than just that?

If you allow your mind to wander freely within the “great cathedral space” of childhood, as Virginia Woolf described it, are you able to grasp another storyline, one that is less idyllic but not less pure of heart? Apart from happiness, or perhaps more aptly put, moments of happiness, are you able to capture an epic tale of resilience, a long struggle against the cold cruelties inflicted by fate and fortune? Can you recollect the rare and unwelcome terrors that were beyond words? And of the feelings born in the wake of these terrors - feelings of complete discontinuity, frightening insecurity, and profound emptiness. Can you remember being at a loss for words and having no way to convey what transpired because the events were beyond your ability to process, much less explain them? Can you see yourself once again as that small, helpless child overwhelmed by experiences beyond your control, lacking the narrative tools to communicate a tidal wave of feelings of panic, despair, horror, and confusion?

It’s easy to forget

Until now.


Do you fall asleep in class?

It is hard not to fall asleep in computer science class. The room is hot, and the sound of everyone typing has the same effect on you as rain. The professor lectures in a monotone voice, and your head nods as if you are being hypnotized. You succumb and fall into a guilty sleep.

A loud, gut emptying megaphone, liquid fart erupts into the lecture hall. The ripples of the fart against the plastic seat startle you awake. The deadly aroma permeates the room like thunder following lightning. The entire class stares at your with a stunned expression as you freeze, pretending not to notice. The ridicule is relentless.

As you walk home from school, you wonder how often you have farted and not woken up. Mom says to stop reading before bedtime, eliminate screen time at night, and increase your sleep to nine hours, but you are still sleepy.

Why?

The fateful childhood decision to breathe through your mouth has deflated and disfigured your face. While these changes permit breathing by day, the same changes suffocate at night. It is suffocation, the struggle to procure air that has broken your nights and left your days in a haze.

Are you inattentive?

Bedtime is boring. Some time between putting on your pajamas and brushing your teeth, your mind slips, and you start playing video games. Twisting and turning and squealing and with glee, the hours pass like minutes. Before you know it, mom opens the door to your room. She is about to yell at you to wake up for school but sees you with the laptop and is pleasantly surprised you are already awake.

“Wow, honey, I can’t believe you got up on your own!”

“Yeah, I had to study for my test.”

In your head, you wonder if it is even possible to go to school without sleeping. Somehow you manage, but you are exhausted. The eyes are bloodshot, and the head bobs as you struggle to keep yourself from asleep in class. Closing one eye and trying to sleep with half a brain like a dolphin just makes your head dive into the desk.

Do you wet the bed?

Your best friend invites you to a sleepover replete with mayhem and merriment: laughing, dancing, jumping, and playing until happily falling asleep together in bed. Sometime in the middle of the night, you awaken, put your hands in your underwear, and freeze. The underwear is wet! You pull your hands out and feel your pajama bottoms, and they are wet! You feel the sheets, and to your shock and dismay, both you and your friend are lying on a ginormous pee puddle. Crap! Crap! Crap! What can you possibly think of doing now?

"Yelp."

You grab the family's dog, who was sleeping on the ground next to you and nestle him between you and your best friend, and yell, "Oh my God! This is disgusting! What happened?"

Your best friend awakens to the commotion lying in a cesspool of pee and freaks out as you lie paralyzed in silence, praying Rover bails you out.

Growing up with a constant fear of someone, sometimes your friend, discovering you wet the bed is crippling. In its way, your body is crying for help.

Two hormones control pee. The anti-diuretic hormone makes you not want to pee. The atrial-natriuretic hormone makes you want to pee. When your face is deflated and overstuffed, and the breathing resistance is high, your body secretes too little anti-diuretic hormone and too much atrial-natriuretic hormone. The result is an overfilled bladder that overflows like a clogged toilet during deep sleep in childhood.

Do you have confusional arousals?

Snuggling with mom as she reads fairy tales of distant lands and dragons is the most precious part of the night. But an incredible imagination is matched by an equally striking fear of darkness. Protesting with conviction when she turns off the light, you eventually settle down as she gently holds your hand between hers deliberately long enough until you drift into a serene sleep.

Tick-tock. Tick-tock.

A rustling in your room breaks the stillness of the night. Mom awakens and cracks open the door to peek inside. You sit bolt upright in bed.

“What are you giggling at, Sweetie?”

It was then you strangely looked up and spoke, “The crow on the ceiling.”

The most frightening part of your sleep is something that arises in the deepest part of your mind. It’s something you’re unaware of and others can’t see. At times the only clue to its existence is when something harrowing emerges.

It’s an arousal.

An arousal is a mini-awakening of the brain below the level of consciousness. Just as every fire starts with a spark, every awakening begins with an arousal. You can’t feel it. Others can’t see it. But it’s there. From an arousal may emerge not only an awakening but also episodes of confusion, aimless wandering, and terror. Despite all the terrible things that may stem from an arousal, it’s what keeps you alive. An arousal awakens the airway muscles to overcome the suffocating effects of mouth breathing

Are you sleepwalking?

The sodden mud soils your clothes as you sink to the knees at the gravestone of your father. The salty tears mingle with the rain, and the gasping wails reverberate through the cemetery. As you lay flowers down, the sacred ground above him…rumbles.

“Help.”

It’s a cry, a faint, smothered, recognizable cry for help coming from the ground below. Your father is alive. Frantically thrusting your bare hands deep into the mud, you fling the cold and gritty earth that smells of life and death to the side. The strangled cries crescendo until a hand bursting from the ground grabs your face. Closing your eyes, you scream louder but burrow deeper until you feel your father’s head and pull with all your might.

“Stop!”

A shrill cry echoes through the house and fades away. You awaken, dazed and confused, in your parents’ bedroom, panting in pitch blackness, your body drenched in sweat and your hands tightly clasped around the neck of your petrified dad.

Sleepwalking, and for that matter, sleep running, sleep eating, sleep driving, sleep sex, et cetera, like a confusional arousal, may emerge from an arousal. Opening your mouth alters your face in a manner that immensely increases your nasal resistance to breathing. As the muscles relax during sleep, your mouth opens, and your lower jaw falls back, further restricting your airway. At some level of resistance to breathing, your body’s remedy to protect itself, to get enough air, is to try and awaken with an arousal. And to hell with whatever zombie-like, possessed creature you incarnate into afterward.

Do you have night terrors?

Mom sings a lullaby as she does every night. It calms your spirits and helps you fall asleep.

Tick-tock. Tick-tock.

Blood-curdling screams pierce the silence of the night. Mom rushes to your room but can’t open the door. Panicked, confused, she yells your name and bangs on the door, crashing through to find you sitting up and staring. She called your name, but there was no response. You just sat there drenched in sweat, trembling until she inadvertently aroused you.

“STOP! PLEASE! IT HURTS! WHY ARE THEY HURTING ME, MOMMY?”

“Who? Who is hurting you?”

“THEY SAID THEY WILL NEVER STOP!”

“Who said?”

“THE SPIRITS. THEY’RE UNDER MY SKIN,” you shout, savagely clawing your face and neck. Mom grabs your hands with one arm and puts her other arm around you to hug you. She starts to sing the lullaby that calms you down. She looked into your eyes, but they were blank. Blood was oozing from the scratches on your face and neck, but you were smirking. Your head turns to one side as you groan, “No longer yours.” Mom screams, letting you go as you fall back into bed and sleep.

Confusional arousals, sleepwalking, and sleep terrors are the trinity of hell, a phenomenon that may occur following arousals from a deep sleep. Confusional arousals start with confusion in bed. It transforms into sleepwalking once leaving he bed. Sleep terrors begin with a bone-chilling scream and intense fear. Though you may not recollect them, terrors of sleep, like confusional arousals and sleepwalking, leave an indelible image in the mind of a parent.

Are you having nightmares?

On a brilliant fall day, with leaves skittering about, you walk hand in hand with your parents, merrily watching the animals at the zoo.

KA-BOOM!

Thunderstorms roll in, and the world becomes pitch black.

You can’t move. You can’t talk. You can’t scream. Your neck is frozen, and you can’t move your head. You can only stare down the road. In the distance is a silhouette of a creature. Lightning bolts light up the sky but fail to illuminate the approaching beast.

Willing yourself to spin around, you begin frantically peddling a tricycle that is too mall for you as you see your parents drive away. The animal gets closer as you pedal like a maniac. You dread the swipe of the paw that will dig its razor-sharp claws into you and tear a big chunk of flesh from your back. Feeling the lion closing in, you scream and awaken…with your smug cat sleeping next to you.

Sleep alternates between non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep is divisible into three stages: N1, N2, and N3, with each stage successively deeper. REM sleep gets its name from the dramatic loss of muscle strength, darting eye movements, and dreaming.

The body’s need to breathe renders all parts of sleep vulnerable to dysfunction. Nightmares emerge from disturbed REM sleep; whereas, confusional arousals, sleepwalking, and sleep terrors arise from interrupted deep NREM sleep.

The doctor assures you all’s well, that the nightmares will pass. What if the good doctor is wrong? What if your dreams tell a different story? What if your nightmares are a cry in the darkness for help?

Do you have sleep paralysis with hallucinations?

The lights are off except for a projector running scratched film at the front of the classroom. The floor is dusty, and the floorboards are rotting. A crowd gathers around a gravely ill man lying on an exam table. Nudging closer, you see a shadowy figure with a long face and abysslike eyes, dirty-little-stained teeth crammed into the gums, and black phlegm dripping from the corners of the mouth. He is hissing and spitting and cursing and contorts himself in half as the professor beckons you to examine him. You commence the interview, feeling faint with heart-pounding in the ears and sweat dripping from the chin.

“Where did you come from?”

“Osaka…Osaka…Osaka” (whispering)

“What is your name?”

“Osaka…Osaka…Osaka” (whispering)

“Who killed you?”

“YOU,” he shrieks, bending his head back behind his shoulders and leering with a scowl stretched across his fiendish face. You turn to run but can’t lift legs mired in quicksand. Inhaling the scent of death approaching, the certainty of dying throbbing in every artery, you freeze…and awaken paralyzed, unable to move, with the specter fluidly crossing the shadowy realm of dreams to the palpable realm of reality. For moments that seem like an eternity, you lie motionless, at the complete mercy of the ghastly beast standing in the doorway of your bedroom.

Nightmares are terrifying, especially when remnants of REM sleep, that is, remnants of the paralysis and dreams, persist into wakefulness.

Chapter Eight Conclusion

Anil Rama, MD

Anil Rama, MD serves as Adjunct Clinical Faculty at the Stanford Center for Sleep Sciences and Medicine. He is the former Medical Director of Kaiser Permanente's tertiary sleep medicine laboratory. Dr. Rama is also an editorial board member of the Sleep Science and Practice Journal and has authored several book chapters and seminal peer-reviewed journal articles in sleep medicine. Dr. Rama is a guest lecturer for the Dental Sleep Medicine Mini-Residency at the University of Pacific, Arthur A. Dugoni School of Dentistry. Furthermore, Dr. Rama has been an investigator in clinical trials for drugs or devices designed to improve sleep. Several national newspapers, local news stations, and health newsletters have consulted with him.

https://www.sleepandbrain.com
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Cranial Dystrophy (Chapter Seven)

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Disturbances of Sleep (Chapter Nine)