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A 39-year-old executive presents with a chief complaint of insomnia. He is given a prescription for pentobarbital, and uses it as prescribed to induce sleep in the evening. When he runs out of the medication he has a great deal of difficulty falling asleep. When he finally does fall asleep, he experiences a multitude of intense, colorful dreams. This is an example of
A. hypnopompic hallucinations
B. night terrors
C. REM rebound
D. sensitization
E. tolerance
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The correct answer is C. Barbiturates, alcohol, phenothiazines, and MAO inhibitors decrease the amount of REM sleep while the patient is taking them. Withdrawal of the agent then allows the body to compensate for "missed" REM sleep, and REM rebound develops. This phenomenon is characterized by an increase in the number and intensity of dreams for several days after discontinuation of the drug in question.
Hypnopompic hallucinations (choice A) occur as the patient is awakening, not while in a deep sleep.
Night terrors (pavor nocturnus; choice B) generally occur in children, and are not characterized by vivid, colorful nightmares, as they occur in stage 4 rather than in REM sleep.
Sensitization (choice D) is a process in which prior exposure to an agent leads to an increased effect upon readministration of that agent. This effect is generally associated with psychostimulant drugs.
Tolerance (choice E) refers to a progressive decrement in the effectiveness of a particular dose of a drug.
