Emotional experience during rapid-eye-movement sleep in narcolepsy

STUDY OBJECTIVES: To describe emotional experience during sleep-onset rapid-eye-movement (REM) SOREM] sleep and nighttime REM in narcoleptic patients and to relate any differences in REM emotion to the more general abnormalities of this disorder. DESIGN: Awakenings were performed from SOREM (REM at the onset of daytime naps and nighttime sleep) and nighttime emergent (ascending) REM in 15 patients with narcolepsy and from nighttime REM in 9 normal healthy participants. Subjects rated the occurrence and intensity of discrete emotion types for each line in their REM-mentation reports. Fragmentation of REM was measured and related to emoton. SETTING: Subjects were studied in their own homes over 2 consecutive days and nights (3 nights for normals) and were monitored by ambulatory polysomnography. PARTICIPANTS: Fifteen patients with narcolepsy, aged 17 to 70 years (mean = 45.3) and 9 normal healthy subjects, aged 31 to 60 years (mean = 43.0). Results: Emotions were found more often and were more intense in narcoleptic SOREM than in nighttime REM of either narcoleptic or normal subjects, with anxiety/fear exhibiting the strongest increase, followed by joy/elation. Comparing nighttime REM in narcoleptic and normal subjects, narcoleptics were found to have more intense feelings of anxiety/fear and of joy/elation but to have a less frequent experience of surprise and anger. Positive and negative emotions occurred in a balanced fashion in SOREM and nighttime REM in narcoleptic subjects. In the SOREM of narcoleptic patients, high levels of positive emotions, in particular of joy/elation, were associated with a less fragmented (more stable) REM sleep. CONCLUSION: The REM sleep of patients with narcolepsy affords a unique opportunity to study emotion and to analyze its psychophysiology. Narcolepsy intensifies REM-dream emotion, especially anxiety/fear and joy/elation, and this is most clearly seen during SOREM sleep. The changes in REM emotion of narcoleptic patients could reflect the effect of the fundamental pathology of this disorder upon neurobiologic systems that support cognitive-emotional functions.