You go to sleep. You wake up, perhaps remembering a dream. Rising from the bed, your real “conscious” life begins.

         Is it really like that?

         No. The recent Sleep Meetings, held in Minneapolis, did not quite cast a sleepy pall over that comfortably ordered city.  Instead, they woke some up to the real differences between sleep and wake. 

         The keynote speech was given by University of Minnesota professor Mark  Mahowald. Mahowald is one of the  world’s experts on confusional arousals,  weird things people do in their sleep. Yet  many of us do weird, sleepy things while  we’re awake.

         Mahowald demonstrated some of the  strange clinical syndromes he’s defined  with Professor Carlos Schenck over the  last 25 years: people who walk to the  refrigerator and drink a quart of sour  cream, people who believe their bed  partners are trying to kill them and counter-attack, people who drive hundreds of  miles – all while asleep.  However, many of us engage in sleep  behaviors while awake. Eyes wide open,  train conductors undergoing “microsleeps”  fail to see stop signals. Narcoleptics  hear a joke, fall to the ground, and “hallucinate”  they’re flying, as REM sleep  interrupts their wakefulness. Soldiers in  the middle of the night attack a vicious  enemy, only to find they’ve shot their  comrades.  Mahowald talked of what can be learned  from anesthesia about the nature of consciousness.  Scientists still have only a  vague idea of how  anesthetics work,  as during anesthesia,  people are  neither asleep nor  awake. Their state  of unawareness is  probably related  to the commonly  remembered  intermediate  states of consciousness experienced with  drug intoxication. 

Systems Biology and Sleep

         What appears to be happening is that  sleep medicine, like other fields, is inching  toward acknowledging systems theory.  What we call sleep and wake are  manifestations of different parts of the  brain cooperating, negotiating, or opposing  each other as they create arousal,  alertness, torpor and slumber. When our  reticular activating system is fully engaged  and our cortex observing, we are aroused  and alert and call ourselves conscious.  When different systems from midbrain,  preoptic, and hypothalamic areas predominate,  we feel ourselves deeply and  profoundly asleep.

         Yet there’s lot of stuff going on between wake and sleep.

         It’s better to think of the brain as  consisting of many different subsystems working in concert. Different sections  modulate states from wakefulness to full  arousal to torpor to sleep, with plenty  happening in-between. Symphonic  movements between very different brain  regions are necessary to all such actions.

         Doctors often watch consciousness  change in front of them. Recently I  received a call that a patient of mine in  hospital was acting “crazy” following cancer  surgery. As he carried the diagnosis of  manic depression, he was clearly “nuts”.

         I met a man I always knew as sharp,  funny and cynical. Ashen, he told me he  would die within six hours. He thought  there were tumors in every part of his  body. Tobacco did not cause tumors, but  “glasses were carcinogenic.”

         I told him that was worrying, as I’d  been wearing eyeglasses since I was 13. 

         Was he crazy? No, he was suffering  organic delirium, brought on by surgery,  drugs and medications. He did not know  the date or where he was.

         This very bright man could not do  simple arithmetic. His consciousness was shifting  quickly. This classic fluctuating  mental status occurs commonly after  anesthesia. It’s rather like watching a  sputtering car engine, sometimes working  on two, sometimes one, sometimes  six cylinders.

         When brain subsystems are working  well, consciousness is full, people are  alert, sleep and wake feel very separate.  One project of Circadian Medicine is to  get people to live in ways where wakefulness  is fully vital and alive and sleep deep and restful, the states our body clocks are  meant to produce. 

         However, the lifestyles of 21st century  Americans often fight this natural ability  to greatly separate wakefulness and sleep.  We need sleep like we need food, but we don’t get enough. Sleep loss doesn’t just  help make us fat, cranky and depressed.  We became far less alert.

         Several years ago, Tom Wehr and colleagues reproduced “caveman sleep” at  the National Institutes of Health. People in artificial environments went to bed at  dusk and woke at dawn.

         When the experiment finished, many did not want it to end. Some had had mystical experiences, feeling oddly whole  and complete in the middle of the night.  Others said the experiment made clear  to them they never really knew full alertness. 

         To coordinate the different systems of  the brain we have to live according to  our blueprint. We need to integrate food,  activity, and rest, to let our bodies and  brainwork and restore, be active and  alert in the day, asleep and dreaming at  night. 

         Though they may use the same parts  of the brain, sleep and wake are meant  to be functionally separate. It’s good to  feel fully alert, even when reading about  sleep.   

Dr. Matthew Edlund, M.D., M.O.H., director of The Center for Circadian Medicine, is an expert on applied public health, sleep medicine and psychiatry. A former professor at Brown and University of Texas medical schools, he can be reached via email to DocME@DoctorEdlund.com. And CLICK HERE to subscribe to our new Fitcast, via the iTunes Store.