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Monday, April 01, 2002  Shock Waves:   A Scientist Studies His Stroke  By: J. Allan HobsonM.D. [continued]

SLEEPLESS, DREAMLESS, AND HALLUCINATING 

In the first 10 days of my hospitalization, I had the predictable manifestations of Wallenberg’s syndrome, already described, which are readily found in any medical textbook and well known to doctors. But I also had other experiences, including total insomnia—a symptom not previously reported in the neurological literature.

I knew that my brain lesion was precisely localized, and realized that my own sleep suppression closely resembled the insomnia that I had observed in cats who, as part of my research on sleep and dreaming, had undergone experimental brain-stem changes. I became determined to describe the subjective effects I was experiencing that were outside the parameters of my “classic case.” On the sixth day, February 8, I dictated this note to Lia:

Time is exquisitely attenuated in the hospital because there is nothing to do except try to keep from drowning in my own saliva or falling off the bed due to vertigo. So I lay for hours in my bed, flat on my back with my eyes closed. The worst time is the night because I am alone, usually from 7 p.m. to 7 a.m., and because I cannot sleep a wink. The usual side position does not help; I’m just awake, my mind working actively in the dark all night long. Attempts to watch TV are frustrated by the banal programming and my double vision. Toward morning, at first around 3 o’clock and subsequently as late as 7, I suddenly feel irresistibly sleepy, but this is not normal sleep onset. Instead I am drawn into a hallucinatory visual world of great complexity, which only occasionally bears a faint semblance to real dreaming. 

If sleep is totally suppressed, as was mine for the first 10 days, there of course can be no dreaming. During this acute post-stroke period, however, I did have abnormal visual experiences.

During the whole 10-day period, I could visually perceive, immediately upon closing my eyes, a vault over my supine body, which resembled the bottom of a swimming pool, its surface aqua, white, or beige. Less often, it resembled engraved obsidian or a sort of gauze of ice or glass crystals.

The most fully realized human images that I “perceived” were of my wife, featuring her lower body, and (most amusingly) of a Peter Pan-like version of a colleague, Robert Stickgold, and two fairies enjoying a bedtime story. Stickgold is a senior collaborator in my lab who does have a pixielike playfulness. While visual disturbances are not uncommon in Wallenberg’s syndrome, they have only been reported as occurring while awake and with the eyes open.

Mine were behind closed eyes. 

The severe suppression of my sleep continued for about two weeks, although I obtained some relief through antihistamines, which I was given starting on the eighth day. On February 15, two weeks after the stroke, I wrote:

“Among the strange psychic phenomena is the continued sense that normal sleep and dreaming are impossible. Last night I had the image of the antihistamines working on anterior hypothalamic sleep mechanisms, but my lower brain-stem sleep system could not be definitively turned over.” 

During this period I also had hallucinatory experiences involving balance—vivid impressions of being launched through space. These never accompanied the visual hallucinations that I just described; they came with their own imagery, which could be brought on by moving when I was awake during the day or could occur spontaneously at night as I lay in bed trying to sleep. The first, and most violent, was on my first night in the hospital. Here is the journal account I made the next morning after vomiting my breakfast:

I suddenly felt as if the bed were rotated 90 degrees in a counterclockwise direction and catapulted downward toward the front of the hospital and into the sea. The illusion that I was actually moving at very high speed for at least 100 meters through space was so completely convincing —and so terrifying—that I said to myself, “So this is what death is like.” To my amazement, these sensations abated as rapidly as they had begun, but they made a very lasting impression on me.