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Scott reviews several articles and case reports, and concludes: 'Sleepiness, sleep, and waking are a sequence in an activity based on instinct concerning which we can ask more questions than anyone can answer. Sleepiness, sleep and waking can all enter the psychoanalytic situation, and long periods of sleep may occur during "working through". Sleepiness can be a defense against any situation including sleep and waking. Sleep can be a defense against waking. If we ask for associations about waking up when sleepiness or sleep appears, we shall be less in the dark. If no associations are obtained, reality information should be given as to when and how the patient wishes to be awakened, as, for example, by the analyst asking the patient to wake five minutes before the end of the interview in order to have some time left to deal with the frustration of the waking situation. Blankness, described as Lewin has described the dream screen, is a common defense against sleepiness and sleep. The reality test of awakeness lies in the act of waking and in the memory that it happened more recently than going to sleep.'