Insomnia and Other Sleep Disorders (Ebook)

The regularly recurring incidence of natural sleep forms one of the most important subjects for physiological investigation. Were it an event of rare occurrence, it would excite a degree of astonishment and alarm equal to the agitation now experienced by the spectator of an ordinary attack of syncope or of epileptic convulsion. But, so completely does the recurrence of sleep harmonize with all the other facts of life that we are as indifferent to its nature as we are to every other healthy function of the body.

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It is only when the mind has undertaken a critical observation of the bodily and mental changes which accompany and condition the phenomenon that we begin to comprehend its wonderful character. Ushered in by a waning activity of body and mind that no effort of the will can long resist, nothing could more forcibly suggest the idea of approaching dissolution if, from the very earliest period of unconscious infancy, we had not been accustomed to the dominion of this imperious necessity. The remarkable likeness between the fading of consciousness in sleep and its extinction in death has, in all ages and among all people, arrested the attention of poets and philosophers of every degree.

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Natural sleep is that condition of physiological repose in which the molecular movements of the brain are no longer fully and clearly projected upon the field of consciousness. This condition is universally observed in all healthy animals; and its recurrence is intimately associated with the diurnal revolution of the earth, and the succession of day and night. The disappearance of daylight is, for the majority of living creatures, the signal for cessation of active 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, during the roar of a long continued bombardment. Thus produced, the relation of cause and effect between weariness and sleep becomes very apparent. The refreshing influence of such repose points clearly to the restorative character of the physiological processes which persist during the suspension of consciousness. It also renders evident the final cause of that periodical interruption of activity which the brain experiences in common with every other living structure.

Sleep is usually preceded for some time by a feeling of sleepiness. This sensation, like the analogous sensations of hunger and thirst, represents in some measure the progressive diminution of energy throughout the entire body; but it is chiefly expressive of the failure of cerebral energy. It produces a sense of general heaviness and intellectual dullness; the special senses become less alert, the eyelids droop, numerous groups of muscles experience the spasmodic contraction of yawning, the head drops forward and is recovered with a jerk, the limbs relax, and the whole body tends to assume a position convenient for repose. Every school-boy who has been compelled to pass an evening hour at a dull lecture, under the eye of a martinet monitor, will testify to the suffering which attends any unusual prolongation of this period. But, if the natural course of events be not obstructed, the stage of mere sleepiness is soon passed, and the introductory stage of sleep is entered. This is a state in which the individual is neither awake nor fully asleep. It is known as the hypnagogic state. During this period the phenomena of simple sleepiness become exaggerated to such a degree that the attitude 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. 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 disorderly pictures which, occurring in this stage of imperfect sleep, have been termed hypnagogic hallucinations. During the early moments of this period an observant person may often retain a power of reasoning sufficient to remark the fact of dreaming, and this effort of attention may produce a partial awakening; but, usually, the subsidence of cerebral function is progressive and rapid. The fire of imagination fades, the field of consciousness becomes less and less vividly illuminated, the entire nervous apparatus yields to the advancing tide, and, finally, the dominion of sleep is fully confirmed. The sleeper knows nothing of the external world, and has lost all consciousness of his own existence. But the duration of profound repose is brief. From the end of the first hour the depth of sleep, at first, rapidly, then, more gradually, subsides. Dreams disturb its tranquility, mental activity increases, the power of volition revives, and, at the end of six or eight hours, the individual is once more awake.

It was formerly believed that during the time of sleep all the processes of assimilation and nutrition throughout the body are increased,-in short, that it is the season of repair for the waste of tissue incurred during the hours of wakeful 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 general renewal of energy, because the aggregate income of the tissues is greater than their outgo during the suspension of conscious activity. The following observations make very apparent the fact of a reduction of physiological activity:

Respiration.-The process of breathing is conducted with greater deliberation during the period of sleep. This reduction is one of the most notable of the circumstances that first attract the attention of the spectator who observes a sleeping person. The average number of respirations per minute, in an adult of twenty-five to thirty years of age, is sixteen. Quetelet remarked that during sleep this number was diminished by about one-fourth. The same fact has been recorded by other observers. Mosso has also noted the fact 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 commencement of inspiration was also obliterated by sleep. Notwithstanding this relative increase of inspiratory motion, the quantity of air that passes through the lungs is considerably reduced by reason of the diminished action of the diaphragm. A corresponding reduction of the gaseous exchanges between the blood and the external air has been determined by the experiments of Pettenkofer and Voit, Boussingault, Lewin, and other equally competent observers.

Circulation.-During sleep the heart beats less frequently than during the waking hours. Though a portion of this delay must be attributed to the recumbent position, sleep does still further retard the movement of the heart. My own observations upon children in bed exhibit a difference of twelve to sixteen beats between the pulsations when awake and asleep. According to Trousseau7 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 average was 128 when awake and 112 when asleep. The observations of Hohl and Allix8 indicate that among very young children the difference between the pulse of sleep and the pulse of wakefulness may equal forty beats. According to Guy (loc. cit.) the pulse is more variable in the morning than during the afternoon or evening.