Fragmented sleep - fragmented mind : the role of sleep in dissociative symptoms

Abstract

In psychopathology, dissociation typically refers to a disturbance in the normal integration of thoughts, feelings, and experiences into consciousness and memory.In this chapter, we review the literature on how sleep disturbances relate to dissociative symptoms and cognitive aberrations seen in dissociative disorders.We contend that this body of research offers a fresh perspective on the origins of dissociation.Specifically, we argue that dissociative symptoms are associated with a labile sleep-wake cycle in which dreamlike mentation invades the waking state, sleep loss produces memory failures, and fuels dissociative experiences.The research domain of sleep and dissociation does not contradict the dominant idea in the clinical literature that trauma is the distal cause of dissociation, and holds substantial promise to inspire new treatments for dissociative symptoms (e.g., interventions that focus on normalization of the sleep-wake cycle).We conclude with worthwhile paths for further investigations and suggest that the sleepdissociation approach may help reconcile competing interpretations of dissociative symptoms. SummaryIn laboratory studies, sleepiness has been found to increase dissociative symptoms.We aimed to explore the link between sleepiness and dissociation in a natural setting.We conducted a longitudinal study among volunteers at a pop festival via self-report scales on four successive test moments distributed over a 12 hour period (7 p.m., 11 p.m., 3 a.m., and 7 a.m.).Sleepiness was the only variable that could predict the increase in dissociative symptoms.This effect was not mediated by mood.Our data suggest that also outside a lab environment, sleepiness intensifies dissociative symptoms.Studies focusing on sleep normalization may provide new insights for the treatment of dissociative symptoms. SummaryDissociative disorders encompass a range of symptoms varying from severe absentmindedness and memory problems to confusion about one's own identity.Recent studies suggest that these symptoms may be the by-products of a labile sleep-wake cycle.In the current study, we explored this issue in patients suffering from insomnia (N = 46).We investigated whether these patients have raised levels of dissociative symptoms and whether this is related to objective sleep parameters.Patients stayed for at least one night in a specialized sleep clinic, while sleep EEG data were obtained.In addition, they completed self-report measures on dissociative symptoms, psychological problems, and sleep characteristics.Dissociative symptom levels were elevated in patients suffering from insomnia, and were correlated with unusual sleep experiences and poor sleep quality.Longer REM sleep periods and less time spent awake during the night was predictive of dissociation.This is the first study to show that insomnia patients have raised dissociative symptom levels and that their dissociative symptoms are related to objective EEG parameters.These findings are important because they may inspire sleep-related treatment methods for dissociative disorders.