Sleep and Violence ? Forensic Implications

• Author: Julian Gojer
• Pages: 339-352

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CHAP TER 17

Sleep and Violence —

Forensic Implications

Julian Gojer

I. INTRODUCTION

“[S]leep is a dynamic behavior. Not simply the absence of waking, sleep is a special activity of the brain

controlled by elaborate and precise mechanisms” (Hobson, 1989). While historically sleep was con-

sidered to be a passive state, “the intermediate state between wakefulness and death” (MacNish, 1834),

it has become clear that in fact it is a complex state within which activity, including violent activity, is

entirely possible.

e use of sleep electroencephalographic studies (polysomnography) has indentied two distinct

sleep states (Carskadon, 2000; Dement, 2000). e states are distinguished by the presence or absence of

rapid eye movements and are known as the non-rapid eye movement (NREM) and rapid eye movement

(REM) states. e REM state is of shorter duration and is generally associated with muscle atonia and

dreaming. e NREM state progresses though four stages. Stage one being light sleep stage and each

progressive stage of sleep becoming deeper. During these four stages of NREM sleep brain electrical ac-

tivity slows, muscle tone, respiratory, and cardiac rates decrease. REM sleep usually appears aer about

ninety minutes from sleep onset and alternates with NREM sleep. e duration of REM sleep increases

in the later part of sleep. Both phases are of relevance when attempting to understand potential causes for

behaviours arising out of sleep (the physiology of sleep is well described by Carskadon, 2000).

Sleep disorders are an area of interest across a number of medical disciplines that include cardiac

and respiratory medicine, psychiatry, and as a discipline in itself: sleep medicine. e International Clas-

sication of Sleep Disorders (American Academy of Sleep Medicine et al., 1990) has four main categories,

the dyssomnias, the parasomnias, sleep disorders associated with medical/psychiatric disorders, and

proposed sleep disorders. From a psychiatric perspective, the DSM (APA, 2000) denes the parasomnias

as abnormal behaviours or physiological events associated with sleep. Dyssomnias on the other hand

deal with the sleep, wake, and timing mechanisms.

II. VIOLENCE AND SLEEP

e association between sleep and violence is complex, can occur in a broad spectrum of sleep states,

and oen manifests in individuals with other disorders. Complex and unusual behaviours arising out of

sleep, also known as parasomnias, can occur during dierent sleep states. Bornemann and colleagues

(2006) have grouped these sleep-related violent behaviours into the following categories:

• Disorders of arousal

• REM sleep behaviour disorder

• Nocturnal seizures

• Psychogenic dissociative disorders

• Malingering

• Munchausen sy ndrome by proxy