Insomnia; and Other Disorders of Sleep

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e life. Though its onset may be for a time delayed by an effort of the will, the need of rest at length overcomes all opposition, and the most untoward circumstances cannot then prevent the access of unconsciousness. The story of the sailor-boy, sleeping on "the high and giddy mast," is familiar to every one. An officer in the United States Navy has assured me of more than one instance in which men had fallen asleep under his own eyes, oppressed by exhaustion, dur

titude of repose is assumed without effort if the body be permitted to follow the natural inclination of its different members. The eyes close, the other senses become inactive, though the sense of hearing is the most persistent. Released in considerable measure from the control of the brain, the reflex energy of the spinal cord is at first somewhat exalted. Witness the fibrillary twitching of the muscles, and the convulsive state, which may often be observed during the stage of somnolence after severe fatigue. The uneasy sleeper may even be roused to complete wakefulness by such involuntary movements. But, as sleep becomes more profound, the reflex functions of the cord are also weakened.[1] As the sensory organs retire from action, the intellectual faculties lose their equilibrium. First, the power of volition ceases. Then the logical association of ideas comes to an end. The reasoning faculty disappears, and judgment is suspended. We become, therefore, no longer capable of surprise or astonishment at the vagaries of memory and of imagination, the only faculties that remain in action. To their more or less unfettered activity we owe the presentation in consciousness of those dis

activity. While it is true that in sleep the expenditure of force is greatly reduced, the more exact researches of modern physiologists indicate a universal reduction in the rate of all the vital processes. The final result, however, is a

has been recorded by other observers.[4] Mosso has also noted the fact[5] that there is a change in the type of respiration, the movements during sleep become less diaphragmatic and more largely costal. He furthermore observed that during the waking period the act of inspiration consumed 8-12 of the complete respiratory phase, but during sleep it was prolonged till it occupied 10-12 of the same cycle. The interval between the end of expiration and the com

pulsations when awake and asleep. According to Trousseau[7] the average number of pulsations observed in a group of thirty children, varying in age from fifteen days to six months, was 140 when awake and 121 when asleep. In another group of twenty-nine children, between the ages of six months and twenty-one months, the av

legrammes when asleep. Scharling also observed that the quantities of carbon successively oxidized by the same man when asleep and awake bore to each other the ratio of 1:1.237. The observations of Demme[10] indicate that increase of bodily temperature during the hours of sleep must be considered as the result of pathological processes in the tissues. The observations of

ts of Horvath[11] are more convincing. This observer found that the marmots upon which he experimented were accustomed to sleep during the winter for about four days continuously, and would then remain awake for an equal length of time. "During the sleeping period they can be cooled down to such a degree that a thermometer introduced into the rectum to the depth of an inch and a half indicated only 3°F. above the

[12] remarks the diminution of pathological secretion in nasal catarrh during the hours of sleep. The mouth in like manner ceases to receive its full quota of saliva, and its cavity quickly dries if the lips remain open. The secretions of the gastro-intestinal glands vary with the contents of the alimentary canal; but in general they are considerably diminished, and diges

win, clearly indicate the fact that during sleep less oxygen is absorbed, and less carbonic acid gas is discharged, by the tissues. Voit found that while, during the daytime, 435 grammes of oxygen were taken in by a working man, only 326 grammes were needed by the same individual during the nocturnal half of the day. Artificial sleep occasioned by chloral hydrate produced a similar reduction in the consumption of oxygen and in the formation of carbonic acid

eripheral irritations. Hence the importance of quiet and darkness when we seek to induce that state of the body in which molecular processes should reach their minimum. Since every act of perception is attended by an outburst of refuse matter from

the various forms of somnambulism. The special senses are usually overcome by sleep before the muscular apparatus yields, and the cerebro-spinal nervous centres are the last of all to succumb. The eyes, for example, cease to see clearly before the eyelids droop, or the muscles of the neck give way in the act of nodding. The senses of touch and of taste fail next in order, as in the case of the infant gourmand, who may be seen falling asleep at supper,-his mouth yet filled with untasted sweets from the table before him. The sense of smell is more persistent, and its exerc

sed by the noise, to remain in a condition of repose which seems to be sustained and cheered by the regular rhythm of its own music. As a general rule, however, it is noteworthy that, when not wholl

f circulation continue to contract, though at a diminished rate. The vermicular movements of the intestinal coats persist, and in certain conditions of ill-health their exaggerated contractions may become a cause of imperfect repose. Reflex movements may always be excited during natural sleep. Tickling the sole of the foot will cause retraction of the limb; and befor

ociation of ideas slumber before the bonds of connection between the will and the muscular organs have been completely relaxed. Such an example affords a valuable illustration of the division of the brain into separate mechanisms which, though most intimately related, are nevertheless partially independent of each other. Sleep may operate like an invasive disease, falling with unequal incidence upon the different structures that make up the mass of the brain, paralyzing one portion, while simply benumbing another, and even arousing to excessive activity a third. Consequently the intellectual functions may be very unequally disturbed, and the order of their subsidence may be considerably varied; but, as a general rule,

consciousness contains after deep sleep no trace of such mental activity, it is claimed that the act of dreaming of which we are aware at the moment of waking is proof of intellectual function during the moments which preceded that incident, and that we are merely forgetful of all similar processes that occurred during undisturbed sleep. The unconsciousness of sleep, according to this theory, is not real-it is only apparent through failure of the memory. If this be true, memory is the only intellectual faculty of whose inaction we can be sure. The period of deep sleep might then be, for all we know to the contrary, a period of the most intense and exalted menta

is subject to fluctuations in the course of its phenomenal manifestation. When a physical force ceases to exhibit itself in an active state, and passes into a potential modification, we are not compelled to regard it as extinguished. It is merely latent or inhibited, but always ready to take its place again among the kinetic forces of nature. In like manner there seems to be no g

way the different degrees of intensity of the awakening noise could be calculated, and the corresponding depth of sleep could be estimated. It was thus concluded that the depth of sleep increases rapidly during the first hour, at the end of which time it has reached its maximum. During the next half hour it diminishes as rapidly as it had increased in the first half hour. During the next hour it still further diminishes, almost as much as it increased du

unterfeits of sleep which result from diseased conditions of the body. It is comparatively easy to frame hypotheses in explanation of such interruptions of our conscious life

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ditary need of a period of rest, nearly coincident with the duration of the shorter nights of the tropical year. Had the birth-place of primeval man been situated within the Arctic circle, it is probable that his hours of sleep might have differed considerably from the number now needed by the average individu

. II, Part 2, p. 295. A young man had been reduced by disease to such a condition of general an?sthesia that the right eye and the left ear were the only remaining paths of sensation between his brain and the external world. Whenever the sound eye and ear were bandaged so as to cut off all communication with the brain, the patient invariably fell asleep in the course of two or three minutes after the interruption of sensation. In like manner, some people, even in perfect health, are able to sleep at any time by simply lying down and closing the eyes. Such persons, however, are not

t if the whole body participate in any violent action, every part will manifest a consequent disposition to rest. Witness the effects of the venereal act. Every muscle is relaxed; the brain, which has officiated as the supreme source of energy, experiences exhaustion, and sleep frequently terminates the voluptuous paroxysm. In like manner, sensations of severe pain, if sufficiently prolonged, become a cause of sleep. Prisoners upon the rack have sle

s after exertion, corresponding with the development of acids in the muscular tissues during contraction, suggested the probability that an excessive presence of lactic acid and its sodic compounds might be the real cause of cerebral torpor and sleep. Could this hypothesis be proved, ordinary sleep would take its place along with the states of unconsciousness induced by an?sthetics and hypnotics, and t

t, as in hemorrhage, producing cerebral an?mia, or in impregnation of the red blood corpuscles with carbonic oxide or chloroform, or other substances capable of excluding oxygen from the hemoglobin of the corpuscle, the cerebral tissues are imperfectly renovated. The explosive constituents of the cortical protoplasm are then inadequately renewed after mental activity, and the sensitive portions of the brain are no longer fitted to manifest the highest forms of intelligent activity. But, when nothing interferes with he

ivity. The same thing is also indicated by the unconscious sleep of the rudimentary f?tal brain, and by the brevity of the intervals of wakefulness which mark the life of the new born babe. That this capacity is dependent upon a special mobility of the atoms of the brain, is shown by the speedy cessation o

onscious activity. But, still adhering to the hypothesis of Pflüger, we shall obtain a clearer explanation of the facts by considering the phenomena connected with the succession of impressions upon the organs of sense. It has been ascertained[21] that such impressions must persist for a certain measurable length of time in order to excite conscious perception. A sound must be prolonged for at least fourteen-hundredths of a second, a ray of light must agitate the retina for about eighteen to twenty-hundredths of a second, an ordinary contact with the surface of the skin must continue from thirteen to eighteen-hundredths of a second, in order to awaken any knowledge of sound and light and tactile sensation. For the simplest act of perception from two to four-hundredths of a second are necessary. It is, therefore, perfectly reasonable to suppose that when the "explosive material" of the brain has been sufficiently "dampened" by the accumulation of acid refuse which accompanies prolonged cerebral effort, the impressions of sense may no longer suffice to excite in the cortical protoplasm vibrations of sufficient length, or following each other in sufficiently rapid succession, to sustain consciousness. The cortex of the brain may then be likened to a body of water into which bubbles of partially soluble gas are introduced from below. When the bubbles are large, and when they follow each other rapidly, a continual effervescence is maintained upon the surface of the water. But if the size of the bubbles be reduced, or if the solvent capacity of the liquid be increased, the surface will become alm

the circulating apparatus. Wherever an organ is aroused to activity, so delicate are the adjustments by which it is connected with the brain and with the heart that it is at once irrigated by an increased flow of blood. When its functional activity subsides, the same mechanism provides for a corresponding reduction in the supply of blood to its tissues. The brain itself forms no exception to this law. This has been admirably shown by the observations of Professor Mosso, of Turin.[22] The learned professor enjoyed the rare opportunity of observing three individuals who had suffered the loss of a considerable portion of the bony walls of the cranium, exposing the surface of the cerebrum, and affording a view of the pulsation of the vessels of the brain. With the aid of the cardiograph, the sphygmograph, the hydrosphygmograph, and the plethosphygmograph, it became possible to register the circulation of the blood in the brain, and to compare that portion of its course with the coincident circulation in other parts of the body. It was thus shown that every increase of emotional or intellectual activity was attended by an increase in the activity of the

and an attack of convulsions was aroused. In no other part of the body can a corresponding disturbance of function be so quickly produced by similar means. A limb may be rendered bloodless for nearly half an hour, by the application of an elastic

ods of inactivity. Every impression upon the sensory structures of the brain occasions a corresponding liberation of motion in those structures. The movement thus initiated arouses the vaso-dilator nerves of the cerebral vessels and excites the vaso-constrictor nerves of all other portions of the vascular apparatus. Hence the superior vascularity of the brain so long as the organs of sense are fresh and receptive. Hence the diminishing and varying vascularity of the different departments of the brain as sleep becomes more or less profound. These modifications of the br

waste-products of intra-molecular oxidation during functional activity-products which hinder the further passage of oxygen into stable combination with the oxidizable elements of protoplasm. Sleep thus produced differs from the artificial sleep induced by narcotic drugs, in the fact that its cause is self-generated by the instrument of thought, while narcotic stupor is caused by the intrusion of substances derived from without-substances which, li

mal condition. They are either excessively fat, red-faced, and soaked with beer, or they are pale, an?mic, and pulpy, with flabby muscles and a feeble circulation. They fall asleep whenever l

ipally remarked. The onset of the malady is gradual, commencing with a slight frontal headache. After a few days a disposition to sleep after meals is noted. This becomes increasingly urgent, and the intervals of sleep are prolonged until at length the patient becomes continually soperose. The waking periods are marked by a sluggish state of the intellectual faculties. The pulse is not accelerated, and it remains full and soft. The veins of the sclerotic are turgid, and the eyeball seems unusually prominent. The temperature does not increase, but rather tends to diminish its figure. The skin is dry and moderately cool. The tongue continues moist, and is covered with a white fur. The bowels and the bladder are regularly emptied, and the appetite persists with considerable vigor. Finally, the patient becomes completely comatose, and dies quietly. Sometimes, however, the evolution of the disease is less tranquil. Epileptiform convulsions, followed by progressively deepening periods of coma, interrupt its course, and a continuous muscular agi

in,-in short, every morbid change of which the liquids and the solids within the cranium are capable-may become the cause of coma. Tox?mic conditions of the circulating fluids of the body may benumb the brain with comatose sleep. Few diseases, therefore, exist without the possibility of coma as one of their consequences-a coma which, however, must not be confounded with the genuine sleep which sometimes occupies the larger part of convalescence from acute illness. During such convalescence there is a reversion to

n of bodily movement is almost absolute. In the milder forms of this disorder the patient may be partially roused, so as to attempt an answer when addressed, appearing like a person in very deep sleep; but in the majority of cases he remains insensible, unconscious, and utterl

twenty-four years of age, who, in consequence of violent emotional excitement, became unconscious, and presented no signs of life, though tested by placing a mirror before the mouth, and by dropping melted sealing-wax upon the skin. On raising her eyelids, the pupils gave no reaction to light; the limbs remained perfectly flaccid, and the radial arteries were pulseless. Careful auscultation, however, detected a very feeble and intermittent sound in the cardiac region. The walls of the chest exhibited no movement, but the lateral surfaces of th

an the faintest sound can be distinguished in the region of the heart. It, therefore, becomes important to have within reach a crucial test of the persistence of general vitality. Such evidence, according to Rosenthal, is furnished by the faradaic current. Within two or three hours after actual death, the muscles cease to respond to t

tion does not cease. The senses of sight and hearing remain, and are, perhaps, intensified by inhibition of the power of voluntary movement. The sufferer see

e was also attended by several of the most eminent physicians in the city. After a long and exhausting illness she appeared to be dying. In the presence of her physician, and surrounded by her relatives, she ceased to breathe. The pulse stopped, life seemed to have gone out. Bottles of hot water were applied to the limbs, and various restoratives were employed. After a considerable time she began again to breathe, and a gradual recovery followed. During the whole time of apparent death, consciousness had been preserved. She seemed to be looking down from a point above her bed; she could see the doctor feeling for her pulse,

t fact for present consideration is the persistence of conscious life, despite the appearance of death. In this preservation of consciousness, notwithstanding the temporary suspension of certain kinds of