Insomnia

Chapter I. the Nature and Cause of Sleep.

Definition of sleep--The invasion of sleep--The hypnagogic state--Depth and duration of sleep--Diagrammatic illustration of the phases of sleep--Modifications of physiological functions produced by sleep--Effect of sleep upon the processes of respiration, circulation, calorification, secretion, and nutrition--Consequences of the progressive invasion of the nervous system by sleep-- Effect upon the organs of special sense--Effects observed in the muscular apparatus of the body--Condition of intellectual functions during the invasion of sleep--Does the mind ever sleep?--Arguments adduced by Sir William Hamilton and others to prove the continued activity of the mind during the sleep of the brain--Reasons for supposing that the mind may sleep--Variability of the depth of sleep--Experiments of Kohlshüter to estimate the degree of variation--Alternation of day and night considered as a cause of sleep--Diminution of sensation a cause of sleep-- Illustrative observation by Strümpell--Fatigue a cause of sleep--Hypothesis of Obersteiner regarding the cause of sleep--Hypothesis of Pflüger--Production of artificial sleep by impregnation of the brain with narcotic substances--Analogous production of natural sleep by accumulation of cerebral waste-products--Observations regarding the duration of sensory impressions requisite for the excitement of conscious perception--Difference between syncope and sleep--Observations of Mosso regarding the state of the cerebral circulation during sleep--Cause of the change in the cerebral circulation during sleep-- Molecular conditions necessary for the production of sleep--Somnolence--Sleeping Dropsy, or Maladie du Sommeil-- Coma--Lethargy--Apparent death--Lucid lethargy. 1

Chapter Ii. Insomnia, or Wakefulness.

Causes of insomnia--Affections of the organs of special sense--Effects of light--Effect of sound--Impressions upon the organs of smell and taste--Disturbances caused by a high temperature--Atmospheric and electrical disturbances-- Effects produced by cold--Hibernation of animals-- Disturbances of sleep occasioned by painful sensations-- Disorders of the sympathetic nerves--Morbid states of the central nervous organs--Disorders of circulation and nutrition--Hyperæmia of the brain--Anæmia and starvation of the brain--Effects of tea and coffee--Effect of alcohol-- Inflammations, degenerations, and tumors affecting the brain--Excitement of the brain by diseased conditions of the blood. 38

Chapter Iii. Remedies for Insomnia.

Serious consequences of insomnia--Its relation to cerebral diseases--Treatment of insomnia by moderation and control of the cerebral circulation--Remedial agents--Nervous stimulants and nervous sedatives--Heat--Baths--Massage-- Electricity--Counter-irritants--Food--Digitalis--Camphor-- Musk--Valerian--Cannabis indica--Belladonna--Hyoscyamus-- Stramonium--Phosphorus--Acids--Opium--Cold--Alcohol-- Paraldehyde--Ether--Chloroform--Chloral--Butylchloral hydrate--Amyl nitrite--Opium and opiates--Bromides--Hops-- Gelsemium--Conium. 56

Chapter Iv. Treatment of Insomnia in Particular Diseases.

Insomnia in acute affections of the brain--In insanity--In chronic alcoholism and delirium tremens--In diseases of the heart and blood-vessels--In angina pectoris--In diseases of the respiratory organs--In asthma--In renal diseases--In diseases of the liver--In gastro-intestinal diseases--In febrile conditions--In rheumatism and gout--In lithæmia--In syphilis--In disorders of nutrition--During pregnancy and after parturition--In spasmodic diseases--In childhood--In old age. 92

Chapter V. Dreams.

Physiology of perception and of dreaming--Definition of the act of dreaming--Revery--Production of illusions and hallucinations by drugs and by disease--Effects of hasheesh--Effects of acute disease--Association of ideas--Memory of past sensations--Dreams produced by excitement of the different organs of sense--Persistence of dream-impressions after waking--Experience of M. Baillarger--Of Professor Jessen--Belief of savages in the reality of dreams--Sensory dreams--Intellectual dreams-- Repetition of dreams--Incoherence of dreams--Cause of the superior vividness of certain dreams--Duration of dreams-- Dreams excited by morbid states of the body--Prophetic dreams--Their causes--Clairvoyant dreams--Hallucinatory dreams--Sir Edmund Hornby’s experience--Hallucinations-- Case related by Dr. E. H. Clarke--Revelation through dreams--Revival of memory in dreams. 116

Chapter Vi. Somnambulism.

Causes of somnambulism--Physiology of somnambulism-- Varieties of the disorder--Maury’s classification-- Classification of Ball and Chambard--Diagrammatic representation of their classification--Somnambulic lethargy--Illustrative cases--Somnambulic dreams--Night terrors--Somnolentia or sleep-drunkenness--Sleep-walking-- Illustrative cases--Condition of the special senses in somnambulism--Relation of memory to the somnambulic paroxysm--Illustrative cases--Occasional recollection of incidents connected with the somnambulic dream-- Resemblances between the somnambulic state and the condition of post-epileptic mania--Somnambulic visions--J. P. Frank’s case--Mesnet’s case--Somnambulic life--Its likeness with the double-consciousness of certain forms of epilepsy--Illustrative cases--General theory of somnambulism. 166

Chapter Vii. Artificial Somnambulism or Hypnotism.

Antiquity of the phenomena of hypnotism--Modern observations--Physical conditions favorable to the phenomena--Methods of inducing the hypnotic state--Duration of hypnotic sleep--Rudimentary states of hypnotism-- Investigations of the Society for Psychical Research-- Mind-reading--Physiological explanation of the process-- Charcot’s observations on artificial somnambulism-- Cataleptic variety of the hypnotic state--Lethargic variety--Somnambulic variety--Hypnotic clairvoyance-- Exalted sensibility of the brain in hypnotic states-- Susceptibility to suggestions from without--Phenomena of so-called spiritualism--Table-rapping--Planchette-- Therapeutical employment of hypnotism--Metaphysical healing. 212

CHAPTER I.. The Nature and Cause of Sleep.

THE NATURE AND CAUSE OF SLEEP.

Worn out, friend, is every theory, But green the golden tree of life. --GOETHE.

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. The subjoined diagram, borrowed from the Dictionaire Encyclopédique des Sciences Médicales, will facilitate the apprehension of these successive phases in the course of sleep:

+============================================================+ | Organic Life. | | | Conscious Life. | | | | Imaginative Faculties. | | | | | Coördinative Faculties. | | | | | | Special Sensation and Voluntary Motion.| |----+----+----+----+----+-----------------------------------| |XXXXXXXXXXXXXXXXXXXXXX | Normal life. | |------------------------------------------------------------| |XXXXXXXXXXXXXXXXX |First stage of sleep--Hypnagogic | | | hallucinations. | |------------------------------------------------------------| |XXXXXXXXXXXX |Second stage of sleep--Dreaming. | |------------------------------------------------------------| |XXXXXXX |Third stage of sleep. | |------------------------------------------------------------| |XX |Profound sleep. | |------------------------------------------------------------| |XXXXXXX |First stage of waking. | |------------------------------------------------------------| |XXXXXXXXXXXX |Second stage of waking--Dreams. | |------------------------------------------------------------| |XXXXXXXXXXXXXXXXX |Third stage of waking--Hypnagogic | | | hallucinations. | |------------------------------------------------------------| |XXXXXXXXXXXXXXXXXXXXXX |Complete awakening. | +------------------------------------------------------------+

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